Epidemiology and genetic relatedness of measles virus infection in Uttar Pradesh,India, during 2009-2010

Measles surveillance and epidemiological investigation are beneficial tools for genetic analysis and documentation of the interruption of transmission of endemic measles. In this study, areas of Uttar Pradesh, India, associated with measles outbreaks were investigated. Random blood and urine samples were collected from clinically defined cases. The cases were investigated through extensive house-to house surveys. The cases were diagnosed clinically and serologically, and through genotyping of the virus. All of the cases were found to be serologically positive for measles. In the studied population, a 1.9% case fatality rate and an overall 16% attack rate of measles virus were found. Out of 10 outbreak areas, the measles virus D8 genotype was found in nine, and the D8 and A genotypes were found in the remaining area. This study calls for an improved surveillance system and intensive characterization of genotypes in circulation for the measles elimination program in India.     

Development and trial of a new system of active search for the intensive suppression of smallpox outbreaks in India

In carrying out emergency smallpox control campaign in Uttar Pradesh State of India in the spring of 1973 the authors developed and first tried in a large-scale field work a new system of smallpox control consisting in repeated weekly search of cases in the entire territory of the affected district followed by intensive suppression of the discovered foci of the disease by vaccination. This new strategy for smallpox eradication was officially adopted since October, 1973, in the smallpox eradication programme in India. The new system was widely used for smallpox control in the last smallpox-endemic countries of the Hindustan peninsula which significantly speeded up smallpox eradication.     

Interrupting wild poliovirus transmission using oral poliovirus vaccine: environmental surveillance in high-risks area of India

Global eradication of poliomyelitis has reached critical stage. Sabin Oral Poliovirus Vaccine (OPV) has been successful in three major regions of the world. In India eradication of poliomyelitis from states of Uttar Pradesh (UP) and Bihar has been difficult due to high population and low-socioeconomic standards of living. Acute flaccid paralysis (AFP) surveillance and intensive OPV rounds continues with the World Health Organization (WHO) operational strategies. Yet apparent lack of progress in reducing the number of wild cases has resulted in occasional impatience and frustration, even leading to questions about ultimate feasibility of global eradication using OPV. Lucknow in UP is in geographical area endemic for poliomyelitis and is surrounded by high-risk areas yet maintains a polio-free status since 2002. Environmental surveillance study was conducted (2004-2006) to authenticate the decline in the wild poliovirus (PV) cases in Lucknow. Sewage sample analyses were compared with stools of AFP patients and healthy children from same geographical area. Study reveals useful information on OPV circulation and proves important epidemiological tool to trust WHO's OPV immunization program. Genetic sequencing had detected silent wild PV-1 circulation of RCP1PGI (EU049849), RCP2PGI (EU049850), RCP3PGI (EU049851), and RCP4PGI (EU049852) in sewage waters. Properties of isolates from sewage reflected those of viruses excreted from human. This study provides valuable information and encouragement to AFP surveillance to maintain high levels of OPV immunization campaigns in the most difficult endemic region of India to interrupt the wild PV transmission.     

Fasciolopsiasis: is it a controllable food-borne disease?

Fasciolopsiasis, endemic to the Orient and Southeast Asia, is a snail-transmitted, intestinal, food-borne parasitic zoonosis caused by a trematode, Fasciolopsis buski, which also infects farm pigs. Fasciolopsiasis remains a public health problem despite changes in eating habits, alterations in social and agricultural practices, health education, industrialization, and environmental alterations. The disease occurs focally and is most prevalent in school-age children. In foci of parasite transmission, the prevalence of infection in children ranges from 57% in mainland China to 25% in Taiwan and from 50% in Bangladesh and 60% in India to 10% in Thailand. Control programs implemented for food-borne zoonoses are not fully successful for fasciolopsiasis because of century-old traditions of eating raw aquatic plants and using untreated water. Fasciolopsiasis is aggravated by social and economic factors such as poverty, malnutrition, an explosively growing free-food market, a lack of sufficient food inspection and sanitation, other helminthiases, and declining economic conditions. Received: 19 May 2000 / Accepted: 19 July 2000     

Morphological,histological, and molecular description of Myxobolus ompok n. sp. (Myxosporea: Myxobolidae), a kidney myxozoan from Pabdah catfish Ompok pabda (Hamilton, 1822) (Siluriformes: Siluridae) in India

Parasitology Research - In a parasitological survey of freshwater fishes near Meerut, Uttar Pradesh, India, myxozoan infections in Pabdah catfish Ompok pabda Ham. (Siluriformes: Siluridae) were...     

Insights into human immunodeficiency virus-hepatitis B virus co-infection in India

Shared routes of transmission lead to frequent human immunodeficiency virus(HIV)-hepatitis B virus(HBV) coinfection in a host which results in about 10% of HIV positive individuals to have chronic hepatitis B infection worldwide. In post-antiretroviral therapy era, liverdiseases have emerged as the leading cause of morbidity and mortality in HIV-infected individuals and HBV coinfection have become the major health issue among this population particularly from the regions with endemic HBV infection. In setting of HIV-HBV co-infection, HIV significantly impacts the natural history of HBV infection, its disease profile and the treatment outcome in negative manner. Moreover, the epidemiological pattern of HBV infection and the diversity in HBV genome(genotypic and phenotypic) are also varied in HIV co-infected subjects as compared to HBV mono-infected individuals. Several reports on the abovementioned issues are available from developed parts of the world as well as from sub-Saharan African countries. In contrast, most of these research areas remained unexplored in India despite having considerable burden of HIV and HBV infections. This review discusses present knowledge from the studies on HIV-HBV co-infection in India and relevant reports from different parts of the world. Issues needed for the future research relevant to HIV-HBV co-infection in India are also highlighted here, including a call for further investigations on this field of study.     

Prevalence of hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: A hospital based study

Context: Acute viral hepatitis (AVH) is a major public health problem and is an important cause of morbidity and mortality. Aim: The aim of the present study is to determine the prevalence of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV) as causes of AVH in a tertiary care hospital of North India. Settings and Design: Blood samples and clinical information was collected from cases of AVH referred to the Grade I viral diagnostic laboratory over a 1-year period. Subjects and Methods: Samples were tested for hepatitis B surface antigen, anti-HCV total antibodies, anti-HAV immunoglobulin M (IgM) and anti-HEV IgM by the enzyme-linked immunosorbent assay. PCR for nucleic acid detection of HBV and HCV was also carried out. Those positive for HBV infection were tested for anti-HDV antibodies. Statistical Analysis Used: Fisher’s exact test was used and a P < 0.05 was considered to be statistically significant. Results: Of the 267 viral hepatitis cases, 62 (23.22%) patients presented as acute hepatic failure. HAV (26.96%) was identified as the most common cause of acute hepatitis followed by HEV (17.97%), HBV (16.10%) and HCV (11.98%). Co-infections with more than one virus were present in 34 cases; HAV-HEV co-infection being the most common. HEV was the most important cause of acute hepatic failure followed by co-infection with HAV and HEV. An indication towards epidemiological shift of HAV infection from children to adults with a rise in HAV prevalence was seen. Conclusions: To the best of our knowledge, this is the first report indicating epidemiological shift of HAV in Uttar Pradesh.     

Fourteen-year experience with imported malaria

Geographical position, an increasing flow of immigrants and refugees coming from regions where malaria is endemic might further increase those cases of malaria imported to Calabria due to travel on military missions, visiting relatives, business and leisure. However, few reports have been published regarding malaria imported into the southern Italian region of Calabria. Based on data from our laboratory, official reports received from the Italian Ministry of Health and Regional Health Offices, an epidemiological analysis of malaria cases registered in Calabria from January 1988 to December 2001 is reported. The epidemiological and clinical features concerning the cases are discussed. A total of 34 slide-confirmed malaria cases were observed in Calabria during the period in question. Infections were mostly acquired in Africa (84.8%), while remaining infections came from Asia (9.1%) and South America and Europe (6.0%). Length of stay in the endemic area did not increase the infection risk. Etiological diagnosis indicated Plasmodium falciparum as the species most often involved (60.6%), followed by Plasmodium vivax (36.3%) and P. vivax/Plasmodium malariae mixed infection (3.0%). The mortality rate was about 3.0%. The number of cases during the second seven-year period of this study was almost double that of the first seven-year period. Correct chemoprophylaxis was performed by only 27.3% of our studied subjects. Delay of malaria diagnosis ranged between 4 days and 1 month. In conclusion, increases in malaria cases, mostly due to P. falciparum, delay in diagnosis and reporting to the Regional Health Office, as well as the increasing arrival of refugees from endemic areas, are epidemiological concerns in Calabria, the southernmost region of continental Italy.     

Molecular characterization,isolation, pathology and pathotyping of peafowl (Pavo cristatus) origin Newcastle disease virus isolates recovered from disease outbreaks in three states of India

Disease outbreak investigations were carried out in three states of Northern India namely Haryana (Rewari), Uttar Pradesh (Noida) and Delhi, where a total of 110 Indian peafowls (Pavo cristatus) showed sudden onset of nervous signs and died within a period of two weeks during June, 2012. The F (fusion) gene-based RT-PCR detection of Newcastle disease virus (NDV) in affected tissues confirmed the presence of the virus. Three NDV isolates were selected (one from each area under investigation) and further characterized. They were found to be of virulent pathotype (velogenic NDV) based on both pathogenicity assays (MDT, ICPI and IVPI) and partial F gene sequence analysis. Additionally, the phylogenetic analysis revealed that the isolates belonged to the genotype VIIi and XIII of class II avian Paramyxovirus serotype1 (APMV-1) and related closely to new emerging sub-genotypes. This is the first report regarding the presence of the fifth panzootic vNDV genotype VIIi from India. In this scenario, extensive epidemiological studies are suggested for surveillance of NDV genotypes in wild birds and poultry flocks of the country along with adopting suitable prevention and control measures.     

Prevalence of human immunodeficiency virus infection in and around Varanasi, Uttar Pradesh, India

Human Immunodeficiency Virus (HIV) infection is rising rapidly in the eastern Uttar Pradesh; however no data is available regarding its positivity rate. We have screened 1239 cases of various groups. HIV seropositivity rate of 0.28% was noted. These results suggest that HIV infection is spreading rapidly in this part of the country. M. tuberculosis was the commonest co-infection amongst them (29.5%). We recommend routine HIV screening of all patients of tuberculosis, especially if the persons frequent the cities, visit foreign countries where sex tourism is encouraged or stay away from their spouses for long periods as true history of sexual contact with commercial sex workers was difficult to obtain from them.     

安徽省血吸虫病综合防治策略实施效果与费用-效果分析

目的评价以传染源控制为主的综合防治措施预防血吸虫病的效果及其费用-效果。方法在安徽省7个县选择8个较严重的血吸虫病流行村实施传染源控制、综合治理和卫生血防项目等综合防治措施,通过2年措施的实施观察其预防血吸虫病效果及费用-效果情况。结果8个试点村人群感染率平均下降了91.8%,有螺环境感染螺密度及钉螺感染率分别平均下降了97.2%和89.9%;每百人感染率下降1%的费用平均为841元,每千平方米有螺环境感染螺密度下降1%的费用平均为106元,每千平方米有螺环境钉螺感染率下降1%的费用平均为115元。结论实施以传染源控制为主的综合防治策略具有很好的预防血吸虫病效果,并对其费用-效果进行了定量分析。     

Chikungunya fever: a re-emerging viral infection

Chikungunya (CHIK) fever is a re-emerging viral disease characterized by abrupt onset of fever with severe arthralgia followed by constitutional symptoms and rash lasting for 1-7 days. The disease is almost self-limiting and rarely fatal. Chikungunya virus (CHIKV) is a RNA virus belonging to family Togaviridae, genus Alphavirus. Molecular characterization has demonstrated two distinct lineages of strains which cause epidemics in Africa and Asia. These geographical genotypes exhibit differences in the transmission cycles. In contrast to Africa where sylvatic cycle is maintained between monkeys and wild mosquitoes, in Asia the cycle continues between humans and the Aedes aegypti mosquito. CHIKV is known to cause epidemics after a period of quiescence. The first recorded epidemic occurred in Tanzania in 1952-1953. In Asia, CHIK activity was documented since its isolation in Bangkok, Thailand in 1958. Virus transmission continued till 1964. After hiatus, the virus activity re-appeared in the mid-1970s and declined by 1976. In India, well-documented outbreaks occurred in 1963 and 1964 in Kolkata and southern India, respectively. Thereafter, a small outbreak of CHIK was reported from Sholapur district, Maharashtra in 1973. CHIKV emerged in the islands of South West Indian Ocean viz. French island of La Reunion, Mayotee, Mauritius and Seychelles which are reporting the outbreak since February, 2005. After quiescence of about three decades, CHIKV re-emerged in India in the states of Andhra Pradesh, Karnataka, Maharashtra, Madhya Pradesh and Tamil Nadu since December, 2005. Cases have also been reported from Rajasthan, Gujarat and Kerala. The outbreak is still continuing. National Institute of Communicable Diseases has conducted epidemiological, entomological and laboratory investigations for confirmation of the outbreak. These have been discussed in detail along with the major challenges that the country faced during the current outbreak.     

Meningococcal disease: history, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention

Meningoccocal disease has repeatedly caused outbreaks worldwide. There has been sudden surge of cases of meningococcemia and meningococcal meningitis in early 2005 in Delhi, India and neighboring states of Uttar Pradesh and Haryana. As of June 17, 2005, 429 probable cases of meningococcal disease have been reported in Delhi out of which 128 cases have revealed microbiological evidence of Neisseria meningitidis. It is possible that the number of cases was in excess of the numbers notified. During this episode drug susceptibility testing by MIC method (E-test) using break points recently recommended by NCCLS/CLSI, revealed that all isolates were sensitive to penicillin, ampicillin, rifampicin and ceftriaxone. As regards to ciprofloxacin, about two third of the isolates tested were found to be 'non-susceptible' (MIC =0.03microg/mL- 0.190microg/mL). All the isolates were found resistant to cotrimoxazole (MIC> 16microg/mL). Repeated outbreaks, decreased susceptibility to ciprofloxacin, which is commonly used for chemoprophylaxis of meningococcal disease, highlights the need for a constant surveillance system. Present review deals with various aspects of Neisseria meningitidis and meningococcal disease in view of recent episode.     

Fasciolopsiasis--a persisting problem in eastern U.P.--a case report

Fasciolopsiasis, or infection by the intestinal fluke, Fascilopsis buski, is endemic in the eastern states of our country. While it is by no means a rarity, especially in the rural set up, awareness regarding this common parasitic infestation is still a much-needed entity. The importance of a strong degree of suspicion and early diagnosis cannot be over emphasised, if a successful campaign is to be launched in its control. With this as our central theme, we proceed to report a case of and unsually heavy Fasciolopsis buski infection in our hospital, which had failed to be diagnosed in a semi urban setup in UP.     

Declining trend of resistance to first-line anti-tubercular drugs in clinical isolates of Mycobacterium tuberculosis in a tertiary care north Indian hospital after implementation of revised national Tuberculosis control programme

Trends showing drug-resistance pattern are needed to understand direction of tuberculosis (TB) control programme. The drug-resistance pattern in state of Uttar Pradesh, India, is not documented. Here we are reporting the prevalence of multi-drug-resistant (MDR) and drug-resistant TB in previously treated cases of pulmonary tuberculosis following launch of revised national TB control programme (RNTCP) in whole of Uttar Pradesh. Isolates of Mycobacterium tuberculosis, from patients of pulmonary tuberculosis, who were treated with antitubercular drugs for more than 4 weeks, were tested for resistance to first-line drugs; streptomycin (S), Ethambutol (E), Rifampicin (R) and isoniazid (H) over a period of 4 years, 2009-2012. Total 2496 isolates of M. tuberculosis were tested, of which 1139 isolates (45.6%) were pan-sensitive and 370 (14.8%) were pan-resistant. Total 695 isolates (27.8%) were MDR. Maximum resistance was with Isoniazid (n = 1069, 42.8%) followed by streptomycin (n = 840, 33.7%), rifampicin (n = 742, 29.7%), and ethambutol (n = 613, 24.6%). A decline in number of MDR strains and individual drug resistance was seen. Total MDR strains in the year 2009, 2010, 2011 and 2012 were 35.6%, 30.8%, 26.7% and 22.8% respectively. The drug resistance pattern reported from time to time may vary substantially. The decline in drug resistance visible over last four years, after implementation of DOTS, appears promising.     

A community outbreak of Legionnaires'' disease: evidence of a cooling tower as the source

A community outbreak of Legionella pneumonia in the district of Cerdanyola, Mataró (Catalonia, Spain) was investigated in an epidemiological, environmental and molecular study. Each patient was interviewed to ascertain personal risk-factors and the clinical and epidemiological data. Isolates of Legionella from patients and water samples were subtyped by pulsed-field gel electrophoresis. Between 7 August and 25 August 2002, 113 cases of Legionella pneumonia fulfilling the outbreak case definition criteria were reported, with 84 (74%) cases being located within a 500-m radius of the suspected cooling tower source. In this area, the relative risk of being infected was 54.6 (95% CI 25.3-118.1) compared with individuals living far from the cooling tower. Considering the population residing in the Cerdanyola district (28,256 inhabitants) as a reference population, the attack rate for the outbreak was 399.9 cases/100,000 inhabitants, and the case fatality rate was 1.8%. A single DNA subtype was observed among the ten clinical isolates, and one of the subtypes from the cooling tower matched exactly with the clinical subtype. Nine days after closing the cooling tower, new cases of pneumonia caused by Legionella ceased to appear. The epidemiological features of the outbreak, and the microbiological and molecular investigations, implicated the cooling tower as the source of infection.     

Genetic analysis of Asian measles virus strains--new endemic genotype in Nepal

In many parts of Asia measles virus (MV) continues to be endemic. However, little is known about the genetic characteristics of viruses circulating on this continent. This study reports the molecular epidemiological analysis based on the entire nucleocapsid (N) and hemagglutinin (H) genes of the first isolates from Nepal and Taiwan, as well as of recent MV strains from India, Indonesia, and China. Four isolates collected in various regions in Nepal during 1999 belonged to a new genotype, tentatively called D8. Another Nepalese isolate and one from India belonged to genotype D4. The diversity of the Nepalese strains indicated that measles continues to be endemic in this country. The isolate from Taiwan grouped with D3 viruses and one Chinese strain isolated in The Netherlands was assigned to the previously described clade H, known to be endemic in Mainland China. Molecular characterization emerges as an important tool for monitoring virus endemicity and vaccination efforts.     

2005-2007年重庆市万州区血吸虫病及相关因素监测结果分析

目的了解三峡库区万州段血吸虫病及其潜在流行因素,为制定库区血吸虫病预防控制措施提供科学依据。方法根据《全国血吸虫病疫情监测方案》要求,在2005-2007年间选择重庆市万州区全国血吸虫病监测点区域内,开展血吸虫病疫情监测及血吸虫病潜在流行因素钉螺与家畜感染输入情况的监测。结果本地居民无血吸虫病例报告,居民血吸虫病血清抗体阳性检出率为0.78%,外出疫区返乡人员血清抗体阳性检出率为2.10%,疫区来万州人员血清抗体阳性检出率为1.97%。在万州段港口码头、船坞、沟壑、洲滩以及水生动植物的饲养繁殖场所开展钉螺输入调查,调查结果发现库区存在钉螺输入因素,但暂未发现有钉螺输入。库区117份牛血清IHA检测结果均为阴性。结论重庆三峡库区万州段存在着潜在血吸虫病输入传染源和血吸虫病流行的相关因素,三峡成库后的生态环境变化及居民生产生活习惯为血吸虫病的传播提供了有利条件,提示应重点加强监测与防控。     

2007年江西余干县驾湖村血吸虫病疫情监测报告

目的了解江西省余干县驾湖村2007年血吸虫病疫情监测情况。方法人群以间接血凝试验（IHA）进行免疫学筛查,阳性者再以Kato-katz法进行病原学检查;家畜以顶管孵化法检测;4月上旬采用系统抽样和环境抽样法查螺,对查获的钉螺全部用压碎法检查是否阳性。结果共检查常住人口906人。阳性155人．阳性率17．11％;粪检阳性9人,阳性率5．92％,推算人群平均感染率为1．01％。耕牛粪检60头,阳性2头,阳性率为3．33％。共查螺238只,无阳性钉螺。结论江西省余干县驾湖村皿吸虫病疫情监测点人、牛感染率和螺情呈明显的下降趋势。