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Albert V, Ramamurthy T, Das S, G Dolma K, Majumdar T, Baruah PJ, Chaliha Hazarika S, Apum B, Das M. Comprehending the risk of foodborne and waterborne disease outbreaks: Current situation and control measures with Special reference to the Indian Scenario. Heliyon 2024; 10:e36344. [PMID: 39253199 PMCID: PMC11382067 DOI: 10.1016/j.heliyon.2024.e36344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 09/11/2024] Open
Abstract
Background Foodborne and waterborne diseases and outbreaks are a neglected public health issue worldwide. In developing countries, diarrheal disease caused by foodborne and waterborne infections is a major cause of ill health. There is a lack of information on foodborne pathogens, their transmission routes, outbreaks, and related mortalities, due to the absence of a robust disease surveillance system and adequately equipped laboratories. Although hygiene practices are much better in Western countries, the widespread use of preserved and raw food items is a cause of concern. Consequently, the occurrence of foodborne diseases is not rare in these countries either. WHO has recently released the 'Global Strategy for Food Safety 2022-2030', addressing the emerging challenges, new technologies, and innovative approaches to strengthen food safety systems and enhance laboratory capacity for foodborne disease surveillance. Foodborne outbreaks are a huge challenge in India. Malnutrition, anemia, hookworm and enteric infections, are the predominant cryptic health conditions among children in rural and tribal areas, leading to severe consequences, including death, and posing a substantial threat to public health. Combating such events with adequate food safety and hygiene practices is achievable. Systematic collection of data can help to develop food safety policies that could reduce the burden of foodborne diseases. Objective This review aims to examine the current situation of foodborne and waterborne diseases, identification of the factors contributing to their occurrence and outbreaks, and defining the gaps in control measures, challenges, and potential solutions in improving the public health system. Methods Strengths, weaknesses, opportunities, and threats (SWOT) analysis was made based on the literature review of foodborne and waterborne infections to assess the current situation and to identify knowledge gaps. Finding SWOT analysis showed the strength and gaps in the different national initiatives analogous to the global programs. Though, Integrated Disease Surveillance Programme (IDSP), Food Safety and Standards Authority of India (FSSAI), the core Government missions, independently generate substantial information, sporadic and outbreak cases of diarrhea still prevail in the country due to the absence of a systematic national surveillance system. Recently, many government initiatives have been made through Sustainable Development Goals (SDGs), G20 goals, etc. However, potential threats such as risk of zoonotic disease transmission to humans, emerging infections and antimicrobial resistance (AMR), and unauthorized activities in the food sector pose a big challenge in safeguarding the public health. Conclusion Maintenance of global food safety requires a systematic analysis of present situations, identification of existing shortcomings, and targeted efforts toward prevention of infections. The ongoing G20 mission and the SDGs for 2030 represent significant strides in this direction. To have pathogen-free animals and supply of contamination-free raw foods is impractical, but, mitigating the prevalence of zoonotic diseases can be accomplished by rigorously enforcing hygiene standards throughout the food production chain. A crucial requirement at present is the implementation of integrated laboratory surveillance for foodborne and waterborne infections, as this will provide policymakers and stakeholders all the evidence based scientific information. This system will facilitate efforts in minimizing the risks associated with foodborne and waterborne infections.
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Affiliation(s)
- Venencia Albert
- Indian Council of Medical Research, Ansari Nagar East, New Delhi-110029, India
| | - Thandavarayan Ramamurthy
- ICMR-National Institute for Research in Bacterial Infections (NIRBI), Kolkata, West Bengal 700010, India
| | - Samaresh Das
- Center for Development of Advanced Computing (CDAC), Kolkata, 700 091, West Bengal, India
| | - Karma G Dolma
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences (SMIMS), Sikkim Manipal University, Gangtok, Sikkim 737102, India
| | - Tapan Majumdar
- Department of Microbiology, Agartala Government Medical College, Agartala, Tripura 799006, India
| | | | | | - Basumoti Apum
- Department of Microbiology, Bankin Pertin General Hospital & Research Institute, Pasighat, Arunachal Pradesh 791102, India
| | - Madhuchhanda Das
- Division of Development Research, Indian Council of Medical Research, Department of Health Research (Ministry of Health & Family Welfare), P.O. Box No. 4911, Ansari Nagar East, New Delhi-110029 India
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Jeong J, Kim M, Choi J. Investigating the spatio-temporal variation of hepatitis A in Korea using a Bayesian model. Front Public Health 2023; 10:1085077. [PMID: 36743156 PMCID: PMC9895396 DOI: 10.3389/fpubh.2022.1085077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 01/22/2023] Open
Abstract
Hepatitis A is a water-borne infectious disease that frequently occurs in unsanitary environments. However, paradoxically, those who have spent their infancy in a sanitary environment are more susceptible to hepatitis A because they do not have the opportunity to acquire natural immunity. In Korea, hepatitis A is prevalent because of the distribution of uncooked seafood, especially during hot and humid summers. In general, the transmission of hepatitis A is known to be dynamically affected by socioeconomic, environmental, and weather-related factors and is heterogeneous in time and space. In this study, we aimed to investigate the spatio-temporal variation of hepatitis A and the effects of socioeconomic and weather-related factors in Korea using a flexible spatio-temporal model. We propose a Bayesian Poisson regression model coupled with spatio-temporal variability to estimate the effects of risk factors. We used weekly hepatitis A incidence data across 250 districts in Korea from 2016 to 2019. We found spatial and temporal autocorrelations of hepatitis A indicating that the spatial distribution of hepatitis A varied dynamically over time. From the estimation results, we noticed that the districts with large proportions of males and foreigners correspond to higher incidences. The average temperature was positively correlated with the incidence, which is in agreement with other studies showing that the incidences in Korea are noticeable in spring and summer due to the increased outdoor activity and intake of stale seafood. To the best of our knowledge, this study is the first to suggest a spatio-temporal model for hepatitis A across the entirety of Korean. The proposed model could be useful for predicting, preventing, and controlling the spread of hepatitis A.
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Affiliation(s)
- Jaehong Jeong
- Department of Mathematics, Hanyang University, Seoul, Republic of Korea,Research Institute for Natural Sciences, Hanyang University, Seoul, Republic of Korea
| | - Mijeong Kim
- Department of Statistics, Ewha Womans University, Seoul, Republic of Korea,*Correspondence: Mijeong Kim ✉
| | - Jungsoon Choi
- Department of Mathematics, Hanyang University, Seoul, Republic of Korea,Research Institute for Natural Sciences, Hanyang University, Seoul, Republic of Korea,Jungsoon Choi ✉
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Murlidharan S, Sangle AL, Engade M, Kale AB. The Clinical Profile of Children With Hepatitis A Infection: An Observational Hospital-Based Study. Cureus 2022; 14:e28290. [PMID: 36168369 PMCID: PMC9506446 DOI: 10.7759/cureus.28290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Hepatitis A is a frequent form of hepatitis, especially in children. The changing epidemiology of the disease signifies the need for descriptive data concerning the clinical presentation and outcome of hepatitis A in children. The present study describes the clinical and biochemical profile of children with hepatitis A infection from a tertiary care center in the Aurangabad district of Maharashtra in Western India. Methods: One hundred patients between one and 18 years of age, presenting with symptoms/signs such as nausea, anorexia, vomiting, jaundice, abdominal pain, tender hepatomegaly, bleeding manifestations, or encephalopathy, were enrolled for the study. Serologically confirmed cases by detecting immunoglobulin M (IgM) antibodies against hepatitis A virus (HAV) were enrolled in the study. A detailed case proforma noted the clinical features and details such as age, gender, area, water supply, socioeconomic status, season, and biochemical parameters. Results: Most patients (45%) were among the age group of one to five years. Fever was reported in 96 (96%) patients, abdominal pain in 78 (78%) patients, dark-colored urine in 65 (65%) patients, vomiting in 47 (47%) patients, and anorexia in 63 (63%) patients. Icterus was found in 80 (80%) patients and hepatomegaly in 74 (74%) patients. In 61 (61%) patients, serum total bilirubin level on the first day was 1-4 mg/dL. Sixty-five (65%) patients were using tap water as the water source, and the maximum number of patients (43%) came in August. Most patients belonged to the class IV group (61%) as per the modified Kuppuswamy classification. Conclusions: Most patients were 10 years or below, presenting predominantly with fever, abdominal pain, dark-colored urine, vomiting, and anorexia. Icterus and hepatomegaly were found in three-fourths or more of the patients. Around monsoon (June to September), there was the highest frequency of cases, and the socioeconomic status of most of the patients was within lower or upper-lower categories.
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Surendranath M, Wankhedkar R, Lele J, Cintra O, Kolhapure S, Agrawal A, Dewda P. A Modern Perspective on Vaccinating Healthcare Service Providers in India: A Narrative Review. Infect Dis Ther 2022; 11:81-99. [PMID: 34773563 PMCID: PMC8590119 DOI: 10.1007/s40121-021-00558-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 10/28/2022] Open
Abstract
Healthcare providers (HCPs) are at increased risk of acquisition and transmission of infectious disease. Vaccinating HCPs is an essential preventive measure to protect them and their patients against communicable diseases, while positively and directly impacting the functioning of the healthcare system. In India, healthcare represents one of the largest employment sectors with 3.8 million HCPs; however, there is limited awareness of national immunisation guidelines for the Indian HCP population. Data from communicable disease outbreaks across India suggest inadequate vaccination rates amongst HCPs; studies have reported influenza and varicella vaccination rates as low as 4.4% and 16%, respectively. In this review, we discuss data highlighting the impact of insufficient vaccination coverage, barriers to vaccination, and the lack of immunisation guidelines amongst HCPs in India. COVID-19 vaccination programmes for HCPs have been critical in slowing the pandemic in India. This provides an opportunity to raise awareness about the importance of vaccines amongst HCPs in India.
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Affiliation(s)
| | - Ravi Wankhedkar
- World Medical Association and Sitaram Hospital, Dhule, India
| | - Jayesh Lele
- National Hospital Board of India, Mumbai, India
| | | | | | | | - Pavitra Dewda
- Medical Affairs, GSK, Mumbai, India.
- Vaccines Medical, No 252, Dr Annie Besant Rd, Worli Shivaji Nagar, Worli, Mumbai, 400018, Maharashtra, India.
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Thuluva S, Matur R, Tsa K, Gv SR. A single blind randomized phase 3 study to evaluate safety and immunogenicity of inactivated hepatitis A vaccine (HAPIBEV TM) in 1-15 years-old healthy hepatitis A vaccine-naïve children. Vaccine 2021; 39:7166-7174. [PMID: 34763950 DOI: 10.1016/j.vaccine.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022]
Abstract
The Biological E inactivated hepatitis A (HAPIBEV™) vaccine was developed by importing the Healive® vaccine bulk from China and fill-finish it in India. Healive® vaccine is approved in China for both children and adults. This study assessed the safety and immunogenicity of HAPIBEV™ vaccine as compared to the Havrix 720® vaccine of GlaxoSmithKline (GSK) pharmaceuticals when administered intramuscularly (IM) 6 months apart in 1-15 years old hepatitis A virus (HAV) vaccine naive children in India. This Phase 3, single blind, parallel, randomized, active-controlled, two-arm study was conducted at 8 centers in India in healthy HAV vaccine-naive children. Subjects were stratified into 2 age subsets (1-7 and 8-15 years) and randomly assigned to either BE-HAPIBEV™ or GSK's Havrix® vaccine and administered 2 IM injections 6 months apart. The immunogenicity evaluations included: (1) proportion of subjects who achieved the following at Day 210 from baseline: (a) seroconversion (≥20 mIU/mL) with anti-HAV immunoglobulin G (IgG) antibodies, (b) ≥4-fold increase in anti-HAV IgG antibodies, and (c) ≥2-fold increase in anti-HAV IgG antibodies concentration who were already seroconverted at baseline and (2) geometric mean concentrations (GMC) of anti-HAV IgG antibodies at baseline and Day 210. Safety was evaluated throughout the study. A total of 467 (89.8%) subjects completed the study. The non-inferiority criterion was met by HAPIBEV™ vaccine as seroconversion rates in both vaccine groups were 100%. Overall, other immunogenicity evaluations were either similar in both vaccine groups or higher in the HAPIBEV™ group compared with the Havrix® group. The safety profile was also comparable between HAPIBEV™ and Havrix® groups. The most common adverse event (AE) was injection site pain, and the majority of AEs were mild in severity. The HAPIBEV™ vaccine demonstrated an immunological and safety profile on par with Havrix® in 1-15 years old healthy HAV vaccine-naive Indian children. This study is registered with clinical trial registry of India bearing no: CTRI/2019/04/018384 on 02 Apr 2019.
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Affiliation(s)
- Subhash Thuluva
- Biological E Limited, 18/1&3, Azamabad, Hyderabad 500 020, Telangana, India.
| | - Ramesh Matur
- Biological E Limited, 18/1&3, Azamabad, Hyderabad 500 020, Telangana, India
| | - Kishore Tsa
- Biological E Limited, 18/1&3, Azamabad, Hyderabad 500 020, Telangana, India
| | - Subba Reddy Gv
- Biological E Limited, 18/1&3, Azamabad, Hyderabad 500 020, Telangana, India
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Franklyne JS, Gopinath PM, Mukherjee A, Chandrasekaran N. Nanoemulsions: The rising star of antiviral therapeutics and nanodelivery system-current status and prospects. Curr Opin Colloid Interface Sci 2021; 54:101458. [PMID: 33814954 PMCID: PMC8007535 DOI: 10.1016/j.cocis.2021.101458] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nanoemulsions (NEs) of essential oil (EO) have significant potential to target microorganisms, especially viruses. They act as a vehicle for delivering antiviral drugs and vaccines. Narrowing of drug discovery pipeline and the emergence of new viral diseases, especially, coronavirus disease, have created a niche to use NEs for augmenting currently available therapeutic options. Published literature demonstrated that EOs have an inherent broad spectrum of activity across bacterial, fungal, and viral pathogens. The emulsification process significantly improved the efficacy of the active ingredients in the EOs. This article highlights the research findings and patent developments in the last 2 years especially, in EO antiviral activity, antiviral drug delivery, vaccine delivery, viral resistance development, and repurposing EO compounds against SARS-CoV-2.
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Affiliation(s)
| | | | - Amitava Mukherjee
- Centre for Nanobiotechnology, VIT University, Vellore, 32014, Tamil Nadu, India
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Shenoy B, Andani A, Kolhapure S, Agrawal A, Mazumdar J. Endemicity change of hepatitis A infection necessitates vaccination in food handlers: An Indian perspective. Hum Vaccin Immunother 2021; 18:1868820. [PMID: 33595412 PMCID: PMC8920195 DOI: 10.1080/21645515.2020.1868820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In the last two decades, outbreaks due to the foodborne hepatitis A virus (HAV) have been frequently reported in India, with adolescents and adults primarily affected. In India, most food handlers are adolescents and young adults who might be exposed to unsatisfactory environmental conditions and poor water quality. This increases the risk of HAV infection and consequently compounds the risk of HAV transmission from food handlers to susceptible populations. Given the shift in hepatitis A endemicity from high to intermediate levels in India, implementing the vaccination of food handlers has become important as it can also contribute to the elimination of hepatitis A in India. This narrative review makes a case for hepatitis A immunization of food handlers in India considering the growing food industry, evolving food culture, and the substantial burden caused by hepatitis A outbreaks.
What is the context?
Hepatitis A disease is a common form of viral hepatitis and is transmitted through contaminated food and water or through close contact with an infected person. The virus with stands high temperature and can survive on surfaces for long periods of time. In India, the burden of hepatitis A has shifted from children to adolescents and adults who are more culnerable to infection. They present a high risk of complications, often requiring hopitalization. The prevention of the disease has often bee neglected, inadequate safety measures for the preparation of food (via food handlers) is a known risk factor for the transmission of hepatitis A.
What is new?
Our review highlights the relationship between food handling and hepatitis A infection among adolescents and adults in Inida. The lack of knowledge of food safety regulations and hygiene measures among food handlers and the organizations that guide them may contribute to the spread of hepatitis A.
What is the impact?
Sanitation efforts, awareness and educational programs for food are needed to help reduce the transmission of hepatitis A virus and disease, yet these measures alone may not be sufficient. Vaccination among high-risk populations such as food handlers can prevent hepatitis A infection and its complications as well as transmission.
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Affiliation(s)
- Bhaskar Shenoy
- Department of Paediatrics, Division of Pediatric Infectious Diseases, Manipal Hospital, Bangalore, India
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Srinivasan M, Sindhu KN, Kumar SJ, Abraham P, Anandan S, Balaji V, Mohan VR, Kang G, John J. Hepatitis A Outbreak with the Concurrence of Salmonella Typhi and Salmonella Poona Infection in Children of Urban Vellore, South India. Am J Trop Med Hyg 2020; 102:1249-1252. [PMID: 32228778 DOI: 10.4269/ajtmh.19-0742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated an outbreak of hepatitis A infection among children in an urban settlement of Vellore, South India. A total of 58 cases of jaundice were reported between April and August 2019. Sera from children who presented with jaundice were tested for hepatitis A virus (HAV) IgM. HAV IgM was positive in 18 (94.7%) of the 19 cases tested. These children also received a blood culture at the same time, as a part of the ongoing Surveillance for Enteric Fever in India (SEFI). Blood cultures from three children with confirmed hepatitis A infection grew Salmonella sp.: two with Salmonella Typhi and one with Salmonella Poona. Salmonella Poona is being reported for the first time from India. The overall hospitalization rate during the outbreak was 21%. Outbreaks of hepatitis A continue to occur with substantial morbidity in children from endemic settings, with notable emergence of other concurrent enteric infections, thereby warranting continued surveillance.
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Affiliation(s)
- Manikandan Srinivasan
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | | | - Senthil J Kumar
- Department of Community Health, Christian Medical College, Vellore, India
| | - Priya Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, India
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Sinha A, Dutta S. Waterborne & foodborne viral hepatitis: A public health perspective. Indian J Med Res 2020; 150:432-435. [PMID: 31939386 PMCID: PMC6977369 DOI: 10.4103/ijmr.ijmr_1430_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Abhik Sinha
- Department of Clinical Medicine, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700 055, West Bengal, India
| | - Shanta Dutta
- Department of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700 055, West Bengal, India
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Suspected spread of hepatitis A virus from a restaurant among adults in rural area of the Kerala state, India. Epidemiol Infect 2020; 147:e210. [PMID: 31364560 PMCID: PMC6624875 DOI: 10.1017/s0950268819000967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
India is experiencing a substantial decrease in early childhood exposure to hepatitis A virus (HAV). Kerala has experienced several hepatitis A outbreaks in young adults/adults in the recent past. The current hepatitis outbreak occurred in Nellikuzhi, Kerala state, India in December 2016. Investigation was carried by preparing a line list of suspected hepatitis cases. The blood and stool samples collected from patients were tested for anti-HAV/anti-Hepatitis E virus (HEV) immunoglobulin (IgM) antibodies and RNA respectively. A total of 562 suspected hepatitis cases were reported during the outbreak. Along with the first case (35 years, male), 86.1% (484/562) of the cases gave history of consuming food/water/cold drinks from one restaurant. Anti-HAV IgM positivity was 74.5% (73/98) in tested samples and amongst the positives, 81% were adults/young adults and adolescents. None of the samples tested positive for anti-HEV IgM. There were three HAV associated deaths without any co-morbidity. Sequence analysis of HAV RNA positive stool samples showed the presence of genotype IIIA HAV. The suspected source of the infection was a private well situated in the premise of a restaurant. Considering increasing HAV naive population in Kerala, there is a need to introduce hepatitis A vaccine in high-risk age groups.
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Reddy DCS. Elimination of viral hepatitis: Evolution and India's response. Indian J Public Health 2020; 63:275-276. [PMID: 32189643 DOI: 10.4103/ijph.ijph_581_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dandu Chandra Sekhar Reddy
- Member, Advisory Board, Indian Journal of Public Health; Former Professor, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh; Former National Professional Officer, WHO, New Delhi, India; Chair, Technical Resource Group on Surveillance of Viral Hepatitis, 77, Type IV, SGPGI (Old Campus), Raebareli Road, Lucknow - 226 014, UP, India
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Kurup KK, Manickam P, Gurav Y. Infected food handlers led to an outbreak of hepatitis A in Ernakulam district, Kerala, Southern India, 2016. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Agrawal A, Singh S, Kolhapure S, Hoet B, Arankalle V, Mitra M. Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent. Infect Dis Ther 2019; 8:483-497. [PMID: 31679118 PMCID: PMC6856242 DOI: 10.1007/s40121-019-00270-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis A, an acute inflammatory liver disease caused by hepatitis A virus (HAV) infection from close contact with infected people, is highly endemic in the Indian subcontinent. Due to poor sanitary conditions, most of the population is exposed to the virus in childhood. At this age, the disease is asymptomatic and provides life-long protection against the disease. Due to rapid socioeconomic development in some areas, however, pockets of the population are reaching adolescence/adulthood without prior exposure to the virus and are thus susceptible to infection. At these ages, infection carries a higher risk of symptomatic disease and complications including mortality. This review of epidemiology and burden of disease studies in the Indian subcontinent, published since 2005, shows increasing evidence of a shift from high to intermediate endemicity in high-income-typically urban-populations. The prevalence of anti-HAV antibodies (previously reported at > 90%) is lower now in adolescents and young adults (e.g., around 80% in Bangladesh and 55% in 5-15 years in India). As a result, HAV is responsible for more acute viral hepatitis predominantly in this age group (e.g., > 15 years: 3.4% in 1999 to 12.3% in 2003 or high socioeconomic status 13-20 years: 27% in 1999 to 62% in 2003), with a greater clinical and economic burden. Numerous outbreaks due to HAV have been reported [e.g., Sri Lanka (2009-2010): > 13,000 affected; Kashmir (2015-2017): 12 outbreaks; Kerala (2012-2016): 84 outbreaks] from water or food contamination. Due to current shifts in endemicity, a growing proportion of the population is no longer exposed in childhood. As the disease remains highly endemic, it also provides a source for more severe disease in susceptible people at an older age and for outbreaks. Well-tolerated and effective vaccines are available and help prevent disease burden and provide long-term protection. These should now be used more widely to protect more patients from the growing disease burden of hepatitis A. FUNDING: GlaxoSmithKline Biologicals SA. Plain language summary available for this article-please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.9963044.Fig. 1Plain Language Summary. Highlights the context of the article, the endemicity shift and the burden of hepatitis A in adolescents and adults and steps to be taken to address the impact of this disease.
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Sood V, Lal BB, Gupta E, Khanna R, Siloliya MK, Alam S. Hepatitis A Virus-related Pediatric Liver Disease Burden and its Significance in the Indian Subcontinent. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1640-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Methods for generating hypotheses in human enteric illness outbreak investigations: a scoping review of the evidence. Epidemiol Infect 2019; 147:e280. [PMID: 31558173 PMCID: PMC6805753 DOI: 10.1017/s0950268819001699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Enteric illness outbreaks are complex events, therefore, outbreak investigators use many different hypothesis generation methods depending on the situation. This scoping review was conducted to describe methods used to generate a hypothesis during enteric illness outbreak investigations. The search included five databases and grey literature for articles published between 1 January 2000 and 2 May 2015. Relevance screening and article characterisation were conducted by two independent reviewers using pretested forms. There were 903 outbreaks that described hypothesis generation methods and 33 papers which focused on the evaluation of hypothesis generation methods. Common hypothesis generation methods described are analytic studies (64.8%), descriptive epidemiology (33.7%), food or environmental sampling (32.8%) and facility inspections (27.9%). The least common methods included the use of a single interviewer (0.4%) and investigation of outliers (0.4%). Most studies reported using two or more methods to generate hypotheses (81.2%), with 29.2% of studies reporting using four or more. The use of multiple different hypothesis generation methods both within and between outbreaks highlights the complexity of enteric illness outbreak investigations. Future research should examine the effectiveness of each method and the contexts for which each is most effective in efficiently leading to source identification.
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Gupta R, Sanjeev RK, Agarwal A, Tomar RPS, Kumar N, Dutt V, Gupta S. A study of hepatitis A virus seropositivity among children aged between 1 and 5 years of age: Implications for universal immunization. Med J Armed Forces India 2019; 75:335-338. [PMID: 31388240 DOI: 10.1016/j.mjafi.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background Hepatitis A virus (HAV) causes an enterically transmitted viral disease mainly affecting children and endemic in many developing countries, including India. There is an epidemiological shift with an increased incidence of symptomatic cases among children. This study was conducted to assess the seroprevalence of HAV among young children aged below 5 years and the need for universal immunization. Method This cross-sectional study was conducted at two tertiary care hospitals in Northern India, from Apr 2014 to Jul 2015, among healthy children aged between 1 and 5 years. The sample size was calculated based on the prevalence of HAV seropositivity of 40% among children aged <10 years [16-60%] and alpha error of 5%. Analysis of serum IgG against HAV was performed by enzyme-linked immunosorbent assay method, and results were analyzed. Results A total of 1084 children aged between 12 and 60 months were enrolled, with male-to-female ratio of 1.86:1. A total of 471 children (43.5%) were found to be positive for IgG against HAV. The seroprevalence of HAV was lower among younger children aged 12-23 months (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.52-0.87, p = 0.03), which was statistically significant. Seropositivity of HAV was lower among boys and families consuming safe drinking water and having improved sanitation facilities. Conclusion The study observed lower seropositivity against HAV among younger children, making them susceptible of contracting the disease. Possible underlying risk factors were younger age, unsafe drinking water, poor sanitation, and low education status of parents. Therefore, vaccination may be recommended as optional vaccine at one year of age, along with improved public health efforts for safe drinking water, hygiene practices, and food safety.
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Affiliation(s)
- Rakesh Gupta
- Director, Government Institute of Medical Sciences, Greater Noida, Gautam Buddha Nagar 201310, India
| | - R K Sanjeev
- Assistant Professor (Pediatrics), Pravara Institute of Medical Sciences, Loni, Ahmadnagar, India
| | - A Agarwal
- Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - R P S Tomar
- Senior Advisor (Pediatrics), Military Hospital Secundrabad, India
| | - N Kumar
- Professor & Head (Pathology), TS Mishra Medical College, Lucknow, India
| | | | - Shishir Gupta
- Ex Medical Officer, INHS Kalyani, Visakhapatnam, India
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Thakur R, Singh BB, Jindal P, Aulakh RS, Gill JPS. The Clean India Mission: Public and animal health benefits. Acta Trop 2018; 186:5-15. [PMID: 29949730 DOI: 10.1016/j.actatropica.2018.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 12/20/2022]
Abstract
The Clean India Mission is a national campaign that aims for complete elimination of open defecation from the country. In India, 564 million people do not have access to toilets and defecate in the open environment. The 'Millennium development goals' have given increased weightage to elimination of open defecation for improving health, nutrition and productivity of developing country populations. The Indian economy bears an estimated annual total loss (in terms of health, education, access time and tourism) of US$ 54 billion due to lack of toilets, poor hygiene and over US$ 38.5 billion in treatment costs for diseases occurring due to poor hygiene. Out of 1415 human pathogens, at least more than 10% of pathogens are transmitted through the faecal-oral route. The practice of open defecation helps pathogens persist in the environment and cause diseases. This review focuses on the current status and harms of open defecation, as well as the public and animal health benefits of implementing 'The Clean India Mission' in India.
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Affiliation(s)
- Rashmi Thakur
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
| | - Balbir Bagicha Singh
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India.
| | - Prateek Jindal
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
| | - Rabinder Singh Aulakh
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
| | - Jatinder Paul Singh Gill
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
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18
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Rakesh PS, Retheesh R, Chandran R, Sadiq A, Ranjitha S. Out-of-pocket expenditure due to hepatitis A disease: A study from Kollam district, Kerala, India. Indian J Med Res 2018; 146:426-429. [PMID: 29355152 PMCID: PMC5793480 DOI: 10.4103/ijmr.ijmr_275_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- P S Rakesh
- Centre for Public Health Protection, Kollam, Kerala, India
| | - Rahul Retheesh
- Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
| | - Rangeen Chandran
- Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
| | - A Sadiq
- Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
| | - S Ranjitha
- Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
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19
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Karna R, Ruttala R, Kar P. Do medical college students living in hostel in India need hepatitis A vaccine? Indian J Med Res 2018; 148:235-237. [PMID: 30381548 PMCID: PMC6206773 DOI: 10.4103/ijmr.ijmr_636_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rahul Karna
- Department of Medicine, Maulana Azad Medical College, New Delhi 110 002, India
| | - Rajesh Ruttala
- Department of Medicine, Maulana Azad Medical College, New Delhi 110 002, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, New Delhi 110 002, India,For correspondence:
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20
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Nagraj VP, Randhawa N, Campbell F, Crellen T, Sudre B, Jombart T. epicontacts: Handling, visualisation and analysis of epidemiological contacts. F1000Res 2018; 7:566. [PMID: 31240097 PMCID: PMC6572866 DOI: 10.12688/f1000research.14492.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 10/15/2023] Open
Abstract
Epidemiological outbreak data is often captured in line list and contact format to facilitate contact tracing for outbreak control. epicontacts is an R package that provides a unique data structure for combining these data into a single object in order to facilitate more efficient visualisation and analysis. The package incorporates interactive visualisation functionality as well as network analysis techniques. Originally developed as part of the Hackout3 event, it is now developed, maintained and featured as part of the R Epidemics Consortium (RECON). The package is available for download from the Comprehensive R Archive Network (CRAN) and GitHub.
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Affiliation(s)
- VP Nagraj
- Research Computing, University of Virginia School of Medicine, Charlottesville, VA, 22903, USA
| | - Nistara Randhawa
- One Health Institute, University of California, Davis, Davis, CA, 95616, USA
| | - Finlay Campbell
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Thomas Crellen
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok , 10400, Thailand
| | - Bertrand Sudre
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Thibaut Jombart
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, W2 1PG, UK
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21
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Nagraj VP, Randhawa N, Campbell F, Crellen T, Sudre B, Jombart T. epicontacts: Handling, visualisation and analysis of epidemiological contacts. F1000Res 2018; 7:566. [PMID: 31240097 PMCID: PMC6572866 DOI: 10.12688/f1000research.14492.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/20/2022] Open
Abstract
Epidemiological outbreak data is often captured in line list and contact format to facilitate contact tracing for outbreak control.
epicontacts is an R package that provides a unique data structure for combining these data into a single object in order to facilitate more efficient visualisation and analysis. The package incorporates interactive visualisation functionality as well as network analysis techniques. Originally developed as part of the Hackout3 event, it is now developed, maintained and featured as part of the R Epidemics Consortium (RECON). The package is available for download from the
Comprehensive R Archive Network (CRAN) and
GitHub.
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Affiliation(s)
- V P Nagraj
- Research Computing, University of Virginia School of Medicine, Charlottesville, VA, 22903, USA
| | - Nistara Randhawa
- One Health Institute, University of California, Davis, Davis, CA, 95616, USA
| | - Finlay Campbell
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Thomas Crellen
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok , 10400, Thailand
| | - Bertrand Sudre
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Thibaut Jombart
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, W2 1PG, UK
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Rakesh PS, Mainu TTCR, Raj A, Babu D, Rajiv M, Mohandas KS, Das A, Balasubramanian A. Investigating a community wide outbreak of hepatitis A in Kerala, India. J Family Med Prim Care 2018; 7:1537-1541. [PMID: 30613555 PMCID: PMC6293930 DOI: 10.4103/jfmpc.jfmpc_127_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: There was an outbreak of acute hepatitis in Nellikuzhy panchayat of Kothamangalam taluk, Ernakulam district, Kerala, during November and early December 2016. Objective of this study is to describe the epidemiological features of the outbreak and to identify the probable source. Materials and Methods: The outbreak was defined in terms of time, place, and person. A hypothesis was generated and tested using a case–control study. Cases were selected by simple random sampling from the line list and controls were age-matched neighborhood individuals without any history of jaundice. Chi-square test, univariate analysis, and multi-variate logistic regression analyses were done to identify the probable risk factors. Results: Around 223 hepatitis A cases were identified. Attack rate was found to be highest among the age group of 16-30 years at 1.44% and was eight times higher among males. Epidemic curve suggested a point source outbreak possibly from exposure to food or water from a newly opened hotel in the area. The case–control study confirmed the hypothesis with a statistically significant association between cases and history of exposure to food from the hotel [OR 120; 95% CI 14.6–996.2; P value < 0.001]. Conclusion: Observations and results of the case–control study revealed that the probable source of the Hepatitis A outbreak at Nellikuzhy panchayat was a hotel. The study findings also add evidences to the changing epidemiological pattern of hepatitis A in Kerala, and warrant the necessity to enforce food safety rules in the State.
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Affiliation(s)
- P S Rakesh
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - T T Carmel Regeela Mainu
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Arun Raj
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Devika Babu
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Midhun Rajiv
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - K Sreelakshmi Mohandas
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Amrita Das
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Arjun Balasubramanian
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Hakim MS, Wang W, Bramer WM, Geng J, Huang F, de Man RA, Peppelenbosch MP, Pan Q. The global burden of hepatitis E outbreaks: a systematic review. Liver Int 2017; 37:19-31. [PMID: 27542764 DOI: 10.1111/liv.13237] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/15/2016] [Indexed: 12/12/2022]
Abstract
Hepatitis E virus (HEV) is responsible for repeated water-borne outbreaks since the past century, representing an emerging issue in public health. However, the global burden of HEV outbreak has not been comprehensively described. We performed a systematic review of confirmed HEV outbreaks based on published literatures. HEV outbreaks have mainly been reported from Asian and African countries, and only a few from European and American countries. India represents a country with the highest number of reported HEV outbreaks. HEV genotypes 1 and 2 were responsible for most of the large outbreaks in developing countries. During the outbreaks in developing countries, a significantly higher case fatality rate was observed in pregnant women. In fact, outbreaks have occurred both in open and closed populations. The control measures mainly depend upon improvement of sanitation and hygiene. This study highlights that HEV outbreak is not new, yet it is a continuous global health problem.
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Affiliation(s)
- Mohamad S Hakim
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Microbiology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Wenshi Wang
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jiawei Geng
- Department of Infectious Diseases, The First People's Hospital of Yunnan Province, Kunming, China
| | - Fen Huang
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
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24
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Viral hepatitis: Indian scenario. Med J Armed Forces India 2016; 72:204-10. [PMID: 27546957 DOI: 10.1016/j.mjafi.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023] Open
Abstract
Viral hepatitis is a cause for major health care burden in India and is now equated as a threat comparable to the "big three" communicable diseases - HIV/AIDS, malaria and tuberculosis. Hepatitis A virus and Hepatitis E virus are predominantly enterically transmitted pathogens and are responsible to cause both sporadic infections and epidemics of acute viral hepatitis. Hepatitis B virus and Hepatitis C virus are predominantly spread via parenteral route and are notorious to cause chronic hepatitis which can lead to grave complications including cirrhosis of liver and hepatocellular carcinoma. Around 400 million people all over the world suffer from chronic hepatitis and the Asia-Pacific region constitutes the epicentre of this epidemic. The present article would aim to cover the basic virologic aspects of these viruses and highlight the present scenario of viral hepatitis in India.
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Raveendran S, Rakesh PS, Dev S, Vijayakumar N, Prasannakumar P. Investigation of an Outbreak of Hepatitis A in a Coastal Area, Kerala, Southern India. J Prim Care Community Health 2016; 7:288-90. [PMID: 27257046 DOI: 10.1177/2150131916647007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An outbreak investigation was initiated following an unusual occurrence of hepatitis A reported among people residing in the coastal belt of Vadi to Vedikunnu area, Kollam district, Kerala, southern India. The time frame of disease occurrence, pattern of its distribution, and the incubation period of hepatitis A infection indicated the probability of occurrence of the outbreak as a result of pipe line water contamination due to mixing of sewage from a canal. The results add evidence to the epidemiology of hepatitis A in the state and warrant the establishment of an efficient water quality surveillance system.
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Affiliation(s)
- Sandhya Raveendran
- District Medical Office, District Surveillance Unit, Kollam, Kerala, India
| | - P S Rakesh
- Centre for Public Health Protection, Kollam, Kerala, India
| | - Soumya Dev
- District Medical Office, District Surveillance Unit, Kollam, Kerala, India
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26
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Rakesh PS, Narayanan V, Pillai SS, Retheesh R, Dev S. Investigation of an Outbreak of Acute Gastroenteritis in Kollam, Kerala, India. J Prim Care Community Health 2016; 7:204-6. [PMID: 27053229 DOI: 10.1177/2150131916641286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An outbreak investigation was initiated following a report of unusual occurrence of acute gastroenteritis in Ashramam area, Kollam district, Kerala, India. House to house survey was conducted to identify cases. Person, place, and time analysis was done. Hypothesis was generated based on findings from cross sectional study, anecdotal evidences, laboratory investigation, and environmental observations. Univariate analysis was done generating odds ratios and confidence intervals to identify factors associated with the disease. A total of 57 cases were reported. Attack rate was highest among children younger than 14 years (22%). Among them, 91.2% (52/57) of the cases and 45.8% (169/369) of the people who had not developed the disease were dependent on pipe water (OR 12.31; 95% CI 4.81-31.52) for drinking purpose. The time frame of the disease occurrence, environmental observations, anecdotal evidences, and the results of analytical study indicated the possibility of the acute gastroenteritis outbreak as a result of pipeline contamination. The study warrants establishment of a good water quality surveillance system.
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Affiliation(s)
- P S Rakesh
- Centre for Public Health Protection, Kollam, Kerala, India
| | | | | | | | - Soumya Dev
- Integrated Disease Surveillance Project, Kollam, Kerala, India
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Chandrakumar A, Xavier A, Xavier A, Manakkadiyil A, Reghu A, Thomas L. Implications of traditional medicine in the treatment of Hepatitis A in Kerala. J Tradit Complement Med 2016; 6:316-20. [PMID: 27419100 PMCID: PMC4936754 DOI: 10.1016/j.jtcme.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction The recent outbreaks of Hepatitis A in Kerala are suggestive of decrease in endemicity as most adults were not exposed during the childhood. In allopathic system of medicine, there is no established treatment for Hepatitis A and hence most people tend to rely on the alternate systems of medicine. The study was aimed at identifying the burden of Hepatitis A in the locality and to uncover the degree of dependence of the people on traditional systems of medicine. Methods The study spanned over 7 months and was conducted in Malappuram district of Kerala. A simple questionnaire having closed-ended questions was prepared and circulated among the physicians in the area. Demographic and other relevant details were obtained from the patients and the medicine system relied on was scrutinized. Results Of the 348 patients enrolled, majority of the patients were between the age of 10–30 years. The study revealed that females were more affected than males. Similarly people in rural areas were greater than those from urban areas. Most patients (73.28%) relied on Ayurvedic treatment after one week of onset of symptoms. Discussion and conclusion The preparations such as triphala which has great efficacy in treatment has to be further studied to establish the pathways and mechanism through which it acts. A collaborative effort between government, modern medicine and alternate medicine system can be highly effective in reducing the outbreaks of such epidemics through proper preventive and therapeutic strategies.
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Affiliation(s)
- Abin Chandrakumar
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Poonthavanam, Kizhattur P.O, Perinthalmanna 679325, Kerala, India
| | - Abin Xavier
- Mannam Ayurveda Co-operative Medical College, Pathanamthitta, Pandalam 689501, Kerala, India
| | - Augustine Xavier
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Poonthavanam, Kizhattur P.O, Perinthalmanna 679325, Kerala, India
| | - Anas Manakkadiyil
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Poonthavanam, Kizhattur P.O, Perinthalmanna 679325, Kerala, India
| | - Anupama Reghu
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Poonthavanam, Kizhattur P.O, Perinthalmanna 679325, Kerala, India
| | - Levin Thomas
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Poonthavanam, Kizhattur P.O, Perinthalmanna 679325, Kerala, India
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Abstract
PURPOSE OF REVIEW Transmission of hepatitis A virus (HAV) infection is primarily fecal-oral. Symptomatic hepatitis, severe disease, and death are more likely to occur when infection occurs at an older age. Improvements in socioeconomic and hygienic conditions have led to a change in its epidemiology worldwide. RECENT FINDINGS In the last two decades, improved hygiene in several resource-poor countries has led to reduced transmission of HAV, an increase in average age at infection, and, consequently, a paradoxical increase in morbidity and mortality because of hepatitis A. In Argentina, introduction of one dose (instead of the conventional two doses, to reduce costs) of inactivated HAV vaccine at 12-month age in a universal childhood immunization program during such 'epidemiologic transition' has markedly reduced the incidence of symptomatic hepatitis A, and of fulminant hepatitis and liver transplantation caused by HAV infection. The monetary value of medical and nonmedical benefits of this strategy outweighed the expenditure on vaccination. These excellent results were possibly contingent upon a high vaccination coverage. SUMMARY Resource-poor countries should closely monitor the epidemiology of HAV infection and periodically undertake cost-effectiveness analyses of HAV immunization strategies. This should allow timely identification of epidemiologic transition and introduction of preventive strategies before HAV infection becomes a public health problem.
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Banerjee A. Comments on investigating a community wide outbreak of hepatitis a in India. J Glob Infect Dis 2015; 7:45-6. [PMID: 25722624 PMCID: PMC4338454 DOI: 10.4103/0974-777x.146379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amitav Banerjee
- Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
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Affiliation(s)
- Ekta Gupta
- Department of Clinical Virology, Institute of Liver & Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Neha Ballani
- Department of Clinical Virology, Institute of Liver & Biliary Sciences, Vasant Kunj, New Delhi, India
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