Manoj Jais

Serological immunity to diphtheria and tetanus in healthy adults in Delhi, India

Widespread childhood immunization with DPT (diphtheria, pertussis and tetanus) has largely eradicated diphtheria and tetanus from many countries. The reduction in the circulation of toxigenic strains has resulted in less natural boosting of adult immunity. As a result, the adult population in countries with high childhood immunization coverage have become susceptible to the disease. The duration of immunity after primary immunization to diphtheria and tetanus is limited and a reduction in immunity is common in adults. With this perspective, the present study was carried out on a random serum sample of 255 healthy individuals aged 20-50 years. The serum samples were tested for immunoglobulin G levels against diphtheria and tetanus by enzyme immuno assays. Fifty-three per cent of adults were unprotected; 22 % were seen to have only a basic protection against diphtheria; 25% were protected against both diseases; and 47% were susceptible to tetanus. The susceptibility was seen to increase with age. To avoid epidemics in the future, immunity must be improved. It is important to treat even the most trivial wound with care and tetanus toxoid immunization. Also, it is necessary to monitor the community for immunity to diphtheria using standard techniques in order to undertake epidemiological surveillances of, and prevention from, these dreadful diseases.

Correlation between Bacterial Pathogens Transfer in Healthcare Workersand Patients: A Study from Paediatric ICU and Nursery of a Tertiary CareHospital

Background: Cross transmission of microorganisms by the hands of healthcare workers is the main route of spread of health care associated infections (HCAI) as they provide essential services to the patients. HCAI has increased the morbidity and mortality of hospitalized patients especially the ones admitted in Paediatric ICU and nursery. Objectives: The present study was undertaken to isolate bacteria from hands of resident doctors and nursing staff from Paediatric ICU and nursery and to correlate them with the patients sample isolates from same Paediatric ICU and Nursery during the same time period. Material and Methods: Fingertips of subjects were directly stabbed on MacConkey agar and Blood agar plates. Antibiogram of isolated pathogens was also determined by standard methods. Observations: Hands of 60% healthcare workers were culture positive. Predominant isolate were Coagulase negative Staphylococcus spp. (73.3%), followed by Staphylococcus aureus (10%), Enterococcus and Acinetobacter spp. (each 6.6%). Methicillin resistant Staphylococcus aureus (50%) were also observed. Conclusion: Implementation and improving the compliance to hand hygiene may result in order to reduce cross infection from health care workers to patients.

Magnitude and pattern of hepatitis B infection in clinically suspected infectious hepatitis at a tertiary care hospital in urban India

Introduction: Hepatitis B virus (HBV) is a parenterally transmitted viral illness of significant public health importance. The prevalence of HBV related viral hepatitis still remains debatable. Objectives: The objective of the following study is to determine the magnitude and pattern of HBV infection in clinically suspected infectious hepatitis at a tertiary care hospital in urban India. Materials and Methods: This prospective study was conducted in the Department of Microbiology at Lady Hardinge Medical College, New Delhi, over a period of 1 year from January 2008 to December 2008. All the serum samples taken from subjects (600 study and 200 control) were tested for hepatitis B surface antigen (HBsAg) using commercially available enzyme linked immunosorbent assay kit. Serum samples testing positive for HBsAg were tested for hepatitis B e antigen, immunoglobulin M (IgM) capture anti hepatitis D virus (HDV), IgM anti hepatitis B surface and IgM anti hepatitis B core. Results: 24 (4%) serum samples tested positive for HBsAg in the study group while 5 (2.5%) tested positive in the control. Maximum seropositivity of HBsAg was in 20-30 years of age group in the study group (7.6%) followed by 11-20 years (4.5%), 0-10 years (2.8%) and >40 years (2.5%). The difference in seropositivity in study and control group was statistically insignificant in all the age groups (P > 0.05). Out of 24 cases positive for HBsAg, 4 cases (16.6%) were co infected with HDV in study group while there were none in control group. Conclusions: HBV is a common cause of parenterally transmitted viral hepatitis and hence, it is recommended that measures for public awareness regarding safe infection practices and safe sex practices should be undertaken to limit its spread.

Age-wise seroprevalence of hepatitis C virus infection in clinically suspected infectious hepatitis patients attending a tertiary care hospital in Delhi

Introduction: Hepatitis C is a major public health problem globally. There are limited studies on age and sex related prevalence of hepatitis C virus (HCV). As hepatitis C is a preventable disease, the burden of the disease could be reduced to a significant extent if its seroprevalence is better known in different age groups. Objective: The objective of this study is to determine age-wise seroprevalence of HCV in clinically suspected infectious hepatitis patients. Materials and Methods: This prospective study was conducted in the Department of Microbiology at Lady Hardinge Medical College, New Delhi over a period of one year from January 2008 to December 2008. All the serum samples taken from subjects (600 study and 200 control) were tested for immunoglobulin M (IgM) anti HCV using commercially available enzyme linked immunosorbent assay kit. Study group consisted of patients with clinically suspected acute infectious hepatitis while the control group had age and sex matched patients showing no clinical evidence of acute infectious hepatitis. Results: Overall 33 (5.5%) samples tested positive for IgM anti HCV in the study group while 3 (1.5%) samples tested positive in the control group. On analyzing age-wise seropositivity, it was found that maximum seropositivity of IgM anti HCV was in 11-20 years of age group in the study group (9%) followed by 21-30 years (6.1%), 0-10 years (5.1%) and >40 years (3.7%) of age. On the other hand in the control group, the maximum seropositivity of IgM anti HCV was seen in 0-10 years (2.8%) followed by 11-20 years (2.7%). Conclusions: HCV infection is predominantly a disease of young adults, which is due to cumulative risk of exposure with increasing age. However infection in children is explained by the mother to baby transmission. Most of the HCV infected patients are unaware of their clinical status and hence the disease may be under reported.

Entomo-epidemiological investigations of chikungunya outbreak in Delhi, India

Context: An outbreak of fever with severe joint pain started in the Palam area of Delhi in August 2010. An entomological and epidemiological investigation of this outbreak was conducted to ascertain the nature and cause of the outbreak. Aim: Aim of the study was to investigate the nature and cause of the outbreak and to contain its further spread. Settings and Design: It was a cross-sectional study conducted in the Palam area of south-west Delhi, situated at a distance of about 20 km from Medical College. It is one of the field practice areas for training of undergraduate and postgraduate students of Department of Community Medicine of Medical College of Delhi. Materials and Methods: All patients attending OPD of Primary Health Center (PHC) Palam, complaining of ever with incapacitating joint pain, were screened for chikungunya fever. Of the 750 suspected chikungunya patients, 130 blood samples were randomly drawn amongst these patients. Out of the 130 tested, 97 (70.8%) were positive for the IgM antibodies against chikungunya virus. House-to-house survey was conducted in the affected area for more cases and to find out the vector-breeding sites. Statistical Analysis: Frequency distributions were calculated for age and sex. Results: The main breeding sites of the mosquitoes were the desert coolers of houses, water stored in metal and plastic containers, and water collections at construction sites. Aedes mosquito was present in almost all the houses surveyed in the area. Conclusions: It was concluded that the routine campaigns need to be organized regularly within the community highlighting the potential breeding grounds of mosquitoes and the possible control methods. Source reduction strategies like cleaning of desert coolers on weekly basis, emptying of water containers, and close monitoring of construction sites for potential breeding of the vector needs to be done on a regular basis to avoid future outbreaks.