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Influenza in India
Context:
Reports on March 7-8 mentioned a surge in influenza cases in the Delhi-NCR region, attributed to a “54% spike,” based on a LocalCircle survey of over 13,000 people. This estimate, however, wasn’t grounded in clinical testing.
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- National Centre for Disease Control (NCDC) data showed 516 influenza cases and six deaths in January 2025. For the entirety of 2024, India reported 20,414 influenza cases and 347 deaths.
- Historically, influenza peaks during monsoons and winters in India. Between 2016 and 2018, surveillance indicated 15.4% of acute respiratory infection (ARI) cases and 12.7% of severe ARI cases were caused by influenza.
Challenges in Influenza Mortality Estimation
- Influenza deaths are underestimated due to limited routine testing and its rare certification as a cause of death.
- A study (2010–2013) estimated 1,27,092 annual influenza-associated deaths in India, with the highest impact on adults over 65 years and children under five.
Vaccination Guidelines and Challenges
- India’s Health Ministry recommends influenza vaccines for healthcare workers, pregnant women, and people with chronic conditions.
- For adults above 65 and children under five, vaccination is only “desirable” despite high mortality in these age groups.
- Influenza vaccines are not part of India’s Universal Immunisation Programme.
Vaccine Uptake and Production
- Vaccine uptake in India remains low, at less than 5%. A 2022 study revealed only 1.5% of adults aged 45+ were ever vaccinated for influenza.
- In 2025, India’s flu vaccine market grew 21% compared to 2024. Serum Institute manufactures 3,00,000-4,00,000 doses annually, scalable to over one million as demand rises. Sanofi offers egg-based and recombinant vaccines.
Global and WHO Initiatives
- WHO recommends influenza strains for vaccines months in advance to align with circulating strains in the next flu season.
- For the 2024-25 season, 57 million adults and 47% of children received flu vaccines in the U.S., showcasing higher adoption than in India.
Production and Effectiveness
- Most vaccines are egg-based, requiring months for production. The Serum Institute uses this method, while Sanofi also offers recombinant options.
- While mismatches between vaccine strains and circulating viruses can reduce effectiveness, current circulating strains in North India match WHO’s 2025-26 recommendations.
