Mohan D. Gupte

Multicenter, Hospital-Based Surveillance of Rotavirus Disease and Strains among Indian Children Aged <5 Years

BACKGROUND Current, nationally representative data on rotavirus disease burden and rotavirus strains in India are needed to understand the potential health benefits of rotavirus vaccination. METHODS The Indian Rotavirus Strain Surveillance Network was established with 4 laboratories and 10 hospitals in 7 different regions of India. At each hospital, children aged <5 years who presented with acute gastroenteritis and required hospitalization with rehydration for at least 6 h were enrolled. A fecal specimen was obtained and was tested for rotavirus with use of a commercial enzyme immunoassay, and strains were characterized using reverse-transcription polymerase chain reaction. RESULTS From December 2005 through November 2007, rotavirus was found in approximately 39% of 4243 enrolled patients. Rotavirus was markedly seasonal in northern temperate locations but was less seasonal in southern locations with a tropical climate. Rotavirus detection rates were greatest among children aged 6-23 months, and 13.3% of rotavirus infections involved children aged <6 months. The most common types of strains were G2P[4] (25.7% of strains), G1P[8] (22.1%), and G9P[8] (8.5%); G12 strains were seen in combination with types P[4], P[6], and P[8] and together comprised 6.5% of strains. CONCLUSIONS These data highlight the need for development and implementation of effective prophylactic measures, such as vaccines, to prevent the large burden of rotavirus disease among Indian children.

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.

Diversity of circulating rotavirus strains in children hospitalized with diarrhea in India, 2005-2009.

BACKGROUND India accounts for 22% of the 453,000 global rotavirus deaths among children <5 years annually. The Indian Rotavirus Strain Surveillance Network provides clinicians and public health partners with valuable rotavirus disease surveillance data. Our analysis offers policy-makers an update on rotavirus disease burden with emphasis on regional shifts in rotavirus strain epidemiology in India. METHODS Children <5 years requiring hospitalization for acute gastroenteritis were selected from 10 representative hospitals in 7 cities throughout India between November 2005 through June 2009. We used a modified World Health Organization protocol for rotavirus surveillance; stool specimens were collected and tested for rotavirus using enzyme immunoassay and reverse-transcription polymerase chain reaction. RESULTS A total of 7285 stool specimens collected were tested for rotavirus, among which 2899 (40%) were positive for rotavirus. Among the 2899 rotavirus detections, a G-type could not be determined for 662 (23%) and more than one G type was detected in 240 (8%). Of 1997 (69%) patients with only one G-type, the common types were G1 (25%), G2 (21%), G9 (13%), and G12 (10%). The proportion of rotavirus infections attributed to G12 infections rose from 8% to 39% in the Northern region and from 8% to 24% in the Western region. CONCLUSIONS This study highlights the large, ongoing burden of rotavirus disease in India, as well as interesting regional shifts in rotavirus strain epidemiology, including an increasing detection of G12 rotavirus strains in some regions. While broad heterotypic protection from rotavirus vaccination is expected based on pre- and post-licensure data from other settings, effectiveness assessments and rotavirus strain monitoring after vaccine introduction will be important.

Psycho-social impact and quality of life of people living with HIV/AIDS in South India.

Abstract This study examines psycho-social impact of HIV and quality of life of 646 HIV-infected persons from a major government sexually transmitted disease (STD) clinic in South India. In this cross-sectional study, data was collected using interview schedule and scales. Nearly 70% had problems in parenting their children after acquiring the infection. Most (88%) of the respondents reported of seeking help from their family members, relatives or close friends at the time of their illness. Among the four categories of stigma, most of them (96%) reported perceived stigma whereas actual stigma was mentioned by only 33%. All four categories of stigma were experienced on a higher proportion by females than males (p<0.05). Each type of stigma was significantly associated with each domain of quality of life of the respondents (p<0.005). Respondents who reported of actual stigma (33%) had significantly good quality of life in their physical domain (49%), psychological domain (48%) and environmental domain (44%). Multivariate analysis showed that gender and marital status had significant association with quality of life. The findings of the study underscore the need for enabling environment through “human force” to uplift their social status and to have a better quality of life.

Scrub typhus in Darjeeling, India: opportunities for simple, practical prevention measures

To identify risk factors for scrub typhus in Darjeeling, India, we compared 62 scrub typhus cases (acute fever with eschar and specific IgM) with 62 neighbourhood controls. Cases were more likely to live close to bushes [matched odds ratio (MOR) 10; 95% CI 2.3-63] and wood piles (MOR 3.5; 95% CI 1.5-9.5), to work on farms (MOR 10; 95% CI 2.7-63), to observe rodents at home (MOR 3.6; 95% CI 1.4-11) and at work (MOR 9; 95% CI 2.4-57), and to rear domestic animals (MOR 2.4; 95% CI 1.1-5.7). Cases were less likely to wash after work (MOR 0.4; 95% CI 0.1-0.9) and change clothes to sleep (MOR 0.2; 95% CI 0.1-0.5). A cleaner, rodent-controlled environment may prevent exposure to scrub typhus. Personal protection measures and better hygiene could further reduce individual risk.

Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India, 2006

Outbreaks of cholera are common in West Bengal. In April 2006, Garulia municipality reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of ≥3 loose/watery stools a day among the residents of Garulia since April 2006. We searched for cases of diarrhea in health care facilities and health camp. We conducted a gender- and age-matched case-control study to identify risk factors. We inspected the sanitation and water supply system. We collected rectal swabs from diarrhea patients and water specimens from the affected areas for laboratory investigation. Two hundred and ninety-eight cases of diarrhea were reported to various health care facilities (attack rate: 3.5/1000, no deaths). The attack rate was highest among children (6.4/1000). Vibrio cholerae El Tor O1 Inaba was isolated from two of 7 rectal swabs. The outbreak started on 10 April 2006, peaked on 26 April and lasted till 6 May. Cases clustered in an area distal to leaking water pipelines. Drinking municipal water exclusively was significantly associated with the illness (OR 13, 95% CI=6.5-27). Eight of the 12 water specimens from the affected area had fecal contamination and poor chlorine content. This outbreak was due to a contaminated municipal piped water supply and V. cholera 01 Inaba was possibly the causative organism.

Visceral leishmaniasis is preventable in a highly endemic village in West Bengal, India

In 2004, following a cluster of kala-azar cases in Chatrakhali, West Bengal, India, we screened and treated this endemic village for leishmaniasis infection. In 2005, following new reports of kala-azar, we screened the village again and conducted a retrospective cohort study (exposure period: August 2004 to July 2005). We defined an incident case of leishmaniasis as a new seropositive sample (>or=1:1600 dilution in a direct agglutination test) in a person seronegative in 2004. We obtained information about potential risk factors and calculated the relative risk (RR) of infection for exposure to these factors. One hundred and fifty (20%) of the 751 residents acquired leishmaniasis in 1 year. Factors associated with infection included residing in homes with mud walls (RR 4.3), dampness in the home (RR 2.5), proximity to bodies of water (RR 2.5) and livestock ownership (RR 2.4). Sleeping dressed (RR 0.4), or under a bed net (RR 0.5) or in a cot (RR 0.6) were associated with a lower risk. High rates of infection indicated that transmission persisted in this community. Poor housing conditions were associated with a higher risk, while personal protection measures against vectors were effective. Major housing improvement and personal protection efforts are needed to protect this vulnerable population from leishmaniasis.

International open trial of uniform multi-drug therapy regimen for 6 months for all types of leprosy patients: rationale, design and preliminary results

Objective  To describe the rationale, design and preliminary results of an open trial of 6 months uniform multi‐drug therapy (U‐MDT) for all types of leprosy patients assuming a cumulative relapse rate not exceeding 5% over 5 years of follow‐up.

Persistence of Diphtheria, Hyderabad, India, 2003–2006

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

BackgroundOn 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control.MethodsWe received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate.ResultsWe identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu.ConclusionMeasles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies.