Manoj V. Murhekar

Prevalence of Posttraumatic Stress Disorder in a Coastal Fishing Village in Tamil Nadu, India, After the December 2004 Tsunami

Two months after the December 2004 tsunami in Tamil Nadu, India, we surveyed adults aged 18 years or older in a severely affected coastal village using structured interviews and the Harvard Trauma Questionnaire. The prevalence of posttraumatic stress disorder was 12.7% (95% confidence interval [CI]=9.4%, 17.1%), and odds of posttraumatic stress disorder were higher among individuals with no household incomes, women, and those injured during the tsunami. In addition to promoting feelings of safety, interventions aimed toward populations affected by the December 2004 tsunami need to focus on income-generating activities. Also, there is a need to target initiatives toward women and those individuals injured during the tsunami, given that these groups are more likely to experience posttraumatic stress disorder.

A typhoid fever outbreak in a slum of South Dumdum municipality, West Bengal, India, 2007: Evidence for foodborne and waterborne transmission

BackgroundIn April 2007, a slum of South Dumdum municipality, West Bengal reported an increase in fever cases. We investigated to identify the agent, the source and to propose recommendations.MethodsWe defined a suspected case of typhoid fever as occurrence of fever for ≥ one week among residents of ward 1 of South Dumdum during February – May 2007. We searched for suspected cases in health care facilities and collected blood specimens. We described the outbreak by time, place and person. We compared probable cases (Widal positive >= 1:80) with neighbourhood-matched controls. We assessed the environment and collected water specimens.ResultsWe identified 103 suspected cases (Attack rate: 74/10,000, highest among 5–14 years old group, no deaths). Salmonella (enterica) Typhi was isolated from one of four blood specimens and 65 of 103 sera were >= 1:80 Widal positive. The outbreak started on 13 February, peaked twice during the last week of March and second week of April and lasted till 27 April. Suspected cases clustered around three public taps. Among 65 probable cases and 65 controls, eating milk products from a sweet shop (Matched odds ratio [MOR]: 6.2, 95% confidence interval [CI]: 2.4–16, population attributable fraction [PAF]: 53%) and drinking piped water (MOR: 7.3, 95% CI: 2.5–21, PAF-52%) were associated with illness. The sweet shop food handler suffered from typhoid in January. The pipelines of intermittent non-chlorinated water supply ran next to an open drain connected with sewerage system and water specimens showed faecal contamination.ConclusionThe investigation suggested that an initial foodborne outbreak of typhoid led to the contamination of the water supply resulting in a secondary, waterborne wave. We educated the food handler, repaired the pipelines and ensured chlorination of the water.

Tuberculosis situation among tribal population of Car Nicobar, India, 15 years after intensive tuberculosis control project and implementation of a national tuberculosis programme

OBJECTIVE To assess the tuberculosis (TB) situation in the tribal community of Car Nicobar island 15 years after the national TB programme was implemented in this area after an intensive phase of TB control in 1986. METHODS The entire population of Car Nicobar was enumerated through a house-to-house survey. Children aged <14 years were tuberculin tested and read for reaction sizes. Individuals aged >15 years were asked about the presence of chest symptoms (cough, chest pain, and unexplained fever for two weeks or longer and haemoptysis), and sputum samples were collected from patients with chest symptoms. Sputum samples were examined for presence of acid-fast bacilli. FINDINGS Among the 4,543 children enumerated, 4,351 (95.8%) were tuberculin tested and read. Of the 981 children without bacille Calmette-Guerin scars, 161 (16.4%) were infected with TB. A total of 77 cases who were smear-positive for TB were detected from among 10,570 people aged >15 years; the observed smear-positive case prevalence was 728.5 per 100,000. The standardized prevalence of TB infection, annual risk of TB infection, and prevalence of cases smear-positive for TB were 17.0%, 2.5%, and 735.3 per 100,000, respectively. CONCLUSION The prevalence of TB infection and smear-positive cases of TB increased significantly between 1986 and 2002. Such escalation took place despite the implementation of the national TB programme on this island, which was preceded by a set of special anti-TB measures that resulted in sputum conversion in a substantially large proportion of the smear-positive cases prevalent in the community. The most likely reason for the increase seems to be the absence of a district TB programme with enough efficiency to sustain the gains made from the one-time initial phase of special anti-TB measures. High risk of transmission of TB infection currently observed on this island calls for a drastic and sustained improvement in TB control measures.

Estimating the burden of disease and the economic cost attributable to chikungunya, Andhra Pradesh, India, 2005-2006.

To estimate the burden and cost of chikungunya in India, we searched for cases of fever and joint pain in the village of Mallela, Andhra Pradesh, and collected information on the demography, signs, symptoms, healthcare utilization and expenditure associated with the disease. We estimated the burden of the disease using disability-adjusted life years (DALYs). We estimated direct and indirect costs and made projections for the district and state using surveillance data corrected for under-reporting. On average, from December 2005 to April 2006, each of the 242 cases in the village led to a burden of 0.0272 DALYs (95% CI 0.0224-0.0319) and a cost of US

Persistence of Diphtheria, Hyderabad, India, 2003–2006

37.50 (95% CI 30.6-44.3). Overall, chikungunya in Mallela led to 6.57 DALYs and a loss of US

Epidemiology of hepatitis B infection among the Nicobarese - a mongoloid tribe of the Andaman and Nicobar Islands, India

9100. Out-of-pocket direct medical costs accounted for 68% of the total. From January to December 2006 the burden for Kadapa district was 160 DALYs (cost: US

Coverage and Effectiveness of Kyasanur Forest Disease (KFD) Vaccine in Karnataka, South India, 2005–10

290 000). Over the same period the burden for Andhra Pradesh was 6600 DALYs (cost: US

Kyasanur Forest disease, India, 2011-2012.

12 400 000). While the burden was moderate, costs were high and mostly out of pocket.

Malnutrition and high childhood mortality among the Onge tribe of the Andaman and Nicobar Islands.

During 2003–2006, diphtheria rates in Hyderabad, India, were higher among persons 5–19 years of age, women, and Muslims than among other groups. Vaccine was efficacious among those who received >4 doses. The proportion of the population receiving boosters was low, especially among Muslims. We recommend increasing booster dose coverage.

Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004-2005

Andaman and Nicobar Islands, Union Territory of India, is home to six primitive tribes. Preliminary serological studies carried out earlier among the four accessible tribes revealed that hepatitis B virus (HBV) infection is hyper-endemic among them. The present study was carried out to understand important modes of transmission and to identify possible risk factors associated with HBV infection among the Nicobarese tribe. The epidemiology of HBV infection in these islands appears to be distinct with a high prevalence of the chronic carrier state (22.2%) associated with a comparable proportion of the population being anti-HBs positive (26.3%). More than half of the HBsAg and anti-HBs negative individuals have anti-HBc antibodies. Age, past history of hospital admission, intramuscular injections and number of carriers in the tuhet were found to be significantly associated with exposure to hepatitis B virus. Horizontal transmission through close contact with carriers and perinatal route appears to be an important mode of transmission of HBV in this community. Besides this, use of unsafe injections represents an independent risk factor for acquiring HBV infection in this population. Introducing HBV vaccine in the infant immunization programme and improving injection safety would help to control the infection in the tribal community of these islands.