Swine flu work in process

In the last three months,the institute,a designated WHO reference laboratory for influenza research in the South East Asia region,has tested over 1,200 samples for the H1N1 virus. The 25-odd scientists at NIV have been working round the clock,studying the H1N1 strain that has been in circulation,testing samples and training virologists in a “preparedness programme”.

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By noon on Tuesday,Deputy Director Mandeep Chadda’s team has already reported about 20 samples that had tested positive for the H1N1 virus. The guard walks in to Chadda’s office to say that one more box of ten samples has just arrived from Bangalore.

The drill begins. The swabs are first taken to the specimen handling room,where Rangole and his team conduct a check. “After ensuring the labels are marked on each sample and the cold chain has been maintained,the samples undergo a spinning and aliquoting (dividing into several samples) process for an hour,’’ says Rangole,peering hard at a test tube that has a bright pink swab solution.

At the end of this,the samples are sent to the ‘cleaner’ rooms for further tests. In one of these rooms,there is an emergency of another sort: a lab technicians has fallen sick and now the entire duty chart will have to be drawn up again. “Who can I accommodate here?” asks research scientist Dr Varsha Potdar. Her colleagues Dr Manohar Choudhary and administrative assistant Smita Karambelkar sit down to sort out the chart.

After that’s done,the scientists roll up their sleeves to tackle the virus. “How many plates today,’’ Potdar asks her colleague Ruhi Phaltane,who is arranging a tray of processed viral samples to be fed into the 7500 Real Time PCR machine. The innocuous-looking off-white machine holds the key to the rapidly rising H1N1 count in the country—this is the machine that detects the virus after a crucial realtime Polymerase Chain Reaction (PCR) test.

“From a few samples,we now talk in terms of the number of plates that have to be fed into the machine. Each plate can hold 20 samples,” explains Amit Salunke,a microbiologist. While Salunke is busy making a ‘master mix’ of enzymes,primers and probes,his colleague from the dengue department is working on extracting the RNA of the virus from the throat swabs. The virus is embedded in this master mix and the entire process takes an hour. By the time it is done,Priyanka Sinha,another lab technician,comes with a fresh batch of samples. All this has to be processed before it’s fed into the machine.

The machine has a life of its own,say scientists. It takes an hour to detect the virus in each sample and with the backlog piling up,NIV has bought another machine and asked for additional staff. “We have just got Applied Bio System Inc to deliver another Real Time PCR machine that cost around Rs 35 lakh,” says Dr A.C. Mishra,director of NIV.

Each sample goes through at least six hours of processing before the virus,if it exists,is extracted from the sample. The virus is then sent off for “isolation and characterisation”. Then there are the mundane tasks of writing reports,dashing off emails and making phone calls.

The last three months have been crazy,says Chadda,who heads the human influenza team at NIV. And on those rare days when there are fewer samples to handle,there are phone calls to tackle—from panic-stricken people and friends. Chadda recalls how she got a call from a worried doctor about her four-year-old daughter. “Please take her sample for swine flu testing,’’ she had pleaded. Chadda tried explaining she couldn’t be obliged because the samples had to be sent from government-notified centres. “But she just wouldn’t get it,” says Chadda.

Pune has handled panic situations before—when patients with Severe Acute Respiratory Syndrome (SARS) had to be quarantined at the government-run Naidu Hospital and later,when the avian influenza caused panic and confusion. But this time,with 600 cases of H1N1 in India,the fear is real. Worldwide,there have been 1.63 lakh cases of H1N1 and 1,154 deaths across 168 countries. But Reeda Shaikh’s death on August 4 has only complicated things for NIV. In the two days after the death,nearly 2,000 patients visited Naidu Hospital in the city,which sent over 100 samples to NIV.

Director Mishra admits,“The task has become even more crucial as this virus is going to linger around. For five days,five years,or even 15,who knows?” The virologist says the strain of the virus is mild and eventually,a person can develop immunity to it.

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The phone in the director’s office decides to join in the chaos and rings all day. Mishra’s day begins with these calls—from the Central ministry,the state government’s health officials,team members,administrators at NIV. And then,there are meetings to attend,besides “handling an overwhelming response from the public”.

His team has had no respite either. “We have made NIV our home. On busy days,we sleep at the guest house as the samples come in batches at 11 p.m. and 3 a.m.,” says Potdar. They have now reorganised the duty chart and start their day at 8 a.m. Nobody knows when they are going home,though. There is no time to answer phone calls from home,no time to exchange pleasantries or even share tiffins,says lab technician Minal Dakhave.

As team members take a 20-minute lunch break at the NIV canteen,it’s time to reflect and even get philosophical. “Though we work hard,we share a sense of satisfaction that all this will help us characterise this virus and understand it,” says Salunke. “If only people stayed at home and did not panic,the virus would be under control,” says Ruhi.

Do they panic too? And don’t they worry about goof-ups while entering data or the machine possibly acting up? “Oh yes,we handle all those situations,” says Dr Manohar Chaudhary,as he sends the last email of the day to officials of the Central and state health ministries.

Even as panic grips the country,the scientists at NIV hold fort and quietly do their job. The next step,they say,is to come up with a vaccine within six months.

Strains of influenza in India

The pandemic preparedness for the avian influenza (H5N1) has come in handy for detecting and containing the ‘novel’ H1N1 virus. This has also led to the launch of a study on the disease burden for influenza in the country. Two centres—KEM Hospital in Pune and AIIMS in Delhi—will participate in this study. Hospitalised patients who are suffering from acute respiratory infection will be studied in this ambitious effort.

Presently there are three strains of influenza circulating in the country—H1N1,H3N2 (both human influenzas of the mild variety) and Influenza B. A surveillance programme is underway at nine centres,including Delhi,Chennai,Kolkata,Nagpur,Vellore,Mumbai and Pune.