Circulation of a community healthcare-associated multiply-resistant meticillin-resistant Staphylococcus aureus lineage in South Yorkshire identified by whole genome sequencing

BACKGROUND

A cluster of seven cases of skin and wound infections caused by a multiply resistant meticillin-resistant Staphylococcus aureus (MRSA) were detected in a small-town community in South Yorkshire. Initial microbiological investigations showed that all isolates belonged to a spa type observed rarely in England (t1476).

AIM

To describe the epidemiology of t1476 MRSA in South Yorkshire.

METHODS

Retrospective and prospective case ascertainment was promoted through communication with local microbiology laboratories. Public health investigation included a detailed review of clinical notes for a subset of nine cases. Genomic and phylogenetic analysis was undertaken on t1476 MRSA.

FINDINGS

Thirty-two cases of t1476 MRSA infection or colonization were identified between December 2014 and February 2018. Cases were older adults (aged 50-98 years). Healthcare exposures for a subset of nine cases indicated frequent contact with a team of district nurses, with all but one case receiving treatment on the same day as another case prior to their own diagnosis. No cases were admitted to hospital at the time of specimen collection. Despite detailed investigations, no carriers were detected among district nursing staff. A long-term carrier/super-shedder was not found. Phylogenetic analysis indicated that t1476 MRSA cases from South Yorkshire were monophyletic and distant from both MRSA of the same lineage from elsewhere in the UK (N = 15) and from publicly available sequences from Tanzania.

CONCLUSION

Genomic and epidemiological analyses indicate community-based transmission of a multiply resistant MRSA clone within South Yorkshire introduced around 2012-2013, prior to the detection of a spatial-temporal cluster associated with a distinct risk group. Surveillance data indicate continued circulation.

Emergence of dengue in the tribal pockets of Nilgiris district, Tamil Nadu

As original tribal ways of living have morphed from a forest dweller existence, dengue is no longer an urban infection but is now also found in rural hilly areas. The spread of dengue is enhanced by the frequent movement of people to endemic areas where there is a vector mosquito presence. The impact of the virus is known to be great in the immunologically naive population. Our study reports on the threat of the dengue virus in these hilly areas.

An Outbreak of Human Listeriosis in England between 2010 and 2012 Associated with the Consumption of Pork Pies

An outbreak of listeriosis in England affecting 14 people between 2010 and 2012 and linked to the consumption of pork pies was investigated. All 14 individuals were older than 55 years, 12 were men, and 10 reported the presence of an underlying condition. All were resident in or had visited either of two English regions and were infected with the same strain of Listeria monocytogenes. In interviews with 12 patients, 9 reported eating pork pies, and individuals that consumed pork pies were significantly more likely to be infected with an outbreak strain than were individuals with sporadic cases of listeriosis infections in England from 2010 to 2012. Pork pies were purchased from seven retailers in South Yorkshire or the East Midlands, and the outbreak strain was recovered from pork pies supplied by only the producer in South Yorkshire. The outbreak strain was also recovered from samples of finished product and from environmental samples collected from the manufacturer. The likely source of contamination was environmental sites within the manufacturing environment, and the contamination was associated with the process of adding gelatin to the pies after cooking. Inadequate temperature control and poor hygienic practices at one of the retailers were also identified as possible contributory factors allowing growth of the pathogen. Following improvements in manufacturing practices and implementation of additional control measures at the retailers' premises, L. monocytogenes was not recovered from subsequent food and environmental samples, and the outbreak strain was not detected in further individuals with listeriosis in England.

Detection of Wolbachia endobacteria in Culex quinquefasciatus by Gimenez staining and confirmation by PCR

BACKGROUND & OBJECTIVES

Wolbachia are common intracellular bacteria that are found in arthropods and nematodes. These endosymbionts are transmitted vertically through host eggs and alter host biology in diverse ways, including the induction of reproductive manipulations, such as feminization, parthenogenesis, male killing and sperm-egg incompatibility. Since they can also move horizontally across species boundaries, Wolbachia is gaining importance in recent days as it could be used as a biological control agent to control vector mosquitoes or for paratransgenic approaches. However, the study of Wolbachia requires sophisticated techniques such as PCR and cell culture facilities which cannot be affordable for many laboratories where the diseases transmitted by arthropod vectors are common. Hence, it would be beneficial to develop a simple method to detect the presence of Wolbachia in arthropods.

METHOD

In this study, we described a method of staining Wolbachia endobacteria, present in the reproductive tissues of mosquitoes. The reliability of this method was compared with Gram staining and PCR based detection.

RESULTS

The microscopic observation of the Gimenez stained smear prepared from the teased ovary of wild caught and Wolbachia (+) Cx. quinquefasciatus revealed the presence of pink coloured pleomorphic cells of Wolbachia ranging from cocci, comma shaped cells to bacillus and chain forms. The ovaries of Wolbachia (-) cured mosquito did not show any cell. Although Gram's staining is a reliable differential staining for the other bacteria, the bacterial cells in the smears from the ovaries of wild caught mosquitoes did not take the stain properly and the cells were not clearly visible. The PCR amplified product from the pooled remains of wild caught and Wolbachia (+) Cx. quinquefasciatus showed clear banding, whereas, no banding was observed for the negative control (distilled water) and Wolbachia (-) Cx. quinquefasciatus.

INTERPRETATION & CONCLUSION

The Gimenez staining technique applied, could be used to detect the members of the endobacteria Wolbachia easily, even in a simple laboratory without any special facilities or even in the field condition and for handling large number of samples in a shorter duration.

Studies on community knowledge and behavior following a dengue epidemic in Chennai city, Tamil Nadu, India

In 2001, a major dengue outbreak was recorded in Chennai city, with 737 cases (90%) out of a total of 861 cases recorded from Tamil Nadu state. A KAP survey was carried out to assess the community knowledge, attitude and practice on dengue fever (DF), following the major dengue outbreak in 2001. A pre- tested, structured questionnaire was used for data collection. The multistage cluster sampling method was employed and 640 households (HHs) were surveyed. Among the total HHs surveyed, 34.5% of HHs were aware of dengue and only 3.3% of HHs knew that virus is the causative agent for DF. Majority of the HHs (86.5%) practiced water storage and only 3% of them stored water more than 5 days. No control measures were followed to avoid mosquito breeding in the water holding containers by majority of HHs (65%). Sixty percent of HHs did not know the biting behaviour of dengue vector mosquitoes. The survey results indicate that the community knowledge was very poor on dengue, its transmission, vector breeding sources, biting behavior and preventive measures. The lack of basic knowledge of the community on dengue epidemiology and vector bionomics would be also a major cause of increasing trend of dengue in this highly populated urban environment. There is an inevitable need to organize health education programmes about dengue disease to increase community knowledge and also to sensitize the community to participate in integrated vector control programme to resolve the dengue problem.

Prevalence of Ascogregarina spp. in the container breeding Aedes albopictus from Chikungunya fever affected areas of Kerala State, India

The prevalence of protozoan, Ascogregarina sp. had been determined in the container breeding mosquitoes, Aedes albopictus. Since, the cyst of Ascogregarina might play role in the maintenance of the Chik virus during silent period, the presence of Ascogregarina has gained importance in recent days. The prevalence was found to be 71.62.

The effects of climatic factors on the distribution and abundance of Japanese encephalitis vectors in Kurnool district of Andhra Pradesh, India

BACKGROUND & OBJECTIVES

Climatic attributes have been associated with relative mosquito abundance and transmission of mosquito borne infections in many parts of the world, especially in warm and tropical climatic regions. The main objectives of this study were to assess the change in seasonal pattern of Japanese encephalitis (JE) vectors, their density, to elucidate whether the lagged climate variables (precipitation, temperature and humidity) are associated with JE vector density, and to determine if temperature and precipitation are similarly important for the rise in the number of potential mosquito vectors for JE virus in the temperate climate of Andhra Pradesh, India.

METHODS

Mosquito samples were collected from Kurnool district of Andhra Pradesh using hand catch and light-trap methods during 2002 to 2006. The type and abundance of recovered species were compared to ecological correlates. In each geographic area, temperature and precipitation are the two possible proxy variables for mosquito density, in conjunction with other seasonal factors for JE epidemics.

RESULTS

Out of the various mosquito species collected, Culex gelidus and Cx. tritaeniorhynchus were noticed in high numbers. There was considerably high prevalence of Cx. gelidus (68.05%) in urban area than in rural areas whereas, Cx. tritaeniorhynchus (57.51%) was found to be more in rural areas than in the urban area. It is noticed that the factors such as rainfall and temperature were found to be correlated with the per man hour (PMH) density, whereas the humidity was inversely correlated with the PMH.

INTERPRETATION & CONCLUSION

The environmental and eco-climatic factors are assisting in enhancing the breeding of these mosquitoes in Kurnool district of Andhra Pradesh, India. Both Cx. tritaeniorhyncus and Cx. gelidus are quite adaptable to these environmental conditions and this necessitates immediate control measures in both rural and urban areas of Kurnool district.

Longitudinal studies of Japanese encephalitis virus infection in vector mosquitoes in Kurnool district, Andhra Pradesh, South India

A 4-yr (2002-2006) entomological study was carried out in Kurnool district, Andhra Pradesh state, south India, to identify the mosquito vectors of Japanese encephalitis virus (family Flaviviridae, genus Flavivirus, JEV). In total, 37,139 female mosquitoes belonging five genera and 18 species resting on vegetation were collected in villages and periurban areas at dusk. Mosquito species composition and pattern of JEV infection in mosquitoes varied in periurban and rural areas. In periurban area, Culex gelidus Theobald was abundant, making up 49.7% of total catch followed by Culex tritaeniorhynchus Giles (44.5%). In rural area, Cx. tritaeniorhynchus was predominant, making up 78.9% of total catch followed by Culex quinquefasciatus Say (10.8%), Anopheles subpictus Grassi (7.1%), and Cx. gelidus (1.1%). In light trap collections, Cx. gelidus and Cx. tritaeniorhynchus predominated in periurban and rural areas, respectively. Of 50,145 mosquitoes screened JEV isolations were made only from Cx. gelidus and Cx. tritaeniorhynchus. Based on high abundance and frequent JEV isolation, Cx. tritaeniorhynchus was found to be the principal vector in both areas, whereas Cx. gelidus plays a secondary vector role in periurban areas only.

A study on chikungunya outbreak during 2007 in Kerala, south India

BACKGROUND & OBJECTIVE

The first chikungunya outbreak occurred in Kerala during 2006 affecting 14 districts, followed by another during May 2007 affecting almost whole of the State. Four of the worst affected districts viz, Pathanamthitta, Idukki, Kottayam and Thrissur were surveyed during 2007 to understand the magnitude of the problem of chikungunya fever, particularly clinical signs and symptoms.

METHODS

A total of 1265 persons from 310 houses were surveyed door-to-door in 20 different localities representing four affected districts. The history and examination findings from 354 clinically diagnosed chikungunya cases were recorded. The symptoms recorded were fever, headache, myalgia, arthralgia, itch/rash, oedema, eye congestion, eye pain, oral ulcers, distaste, nausea, vomiting and haemorrhage.

RESULTS

The major symptoms were fever (100%), headache (97.5%), arthralgia (99.4%) and myalgia (99.4%). A significant difference was observed in oedema, distaste, nausea and headache among different age groups and these symptoms were reported to be lower (12.2-89.8%) in younger age group than in older age group (90.4-100%). No genderwise difference was observed for any of the symptoms. In clinically diagnosed chikungunya cases higher age group (>35 years) found with higher rate of severity with symptoms of oedema, distaste, nausea and headache when compared with lower age group (1-35 yr).

INTERPRETATION & CONCLUSION

Chikungunya invaded Kerala State for the first time in 2006 and continues to be a major vector borne disease in the State. The clinical symptoms in affected cases highlighted high fever, sever myalgia and prolonged arthralgia, with occasional history of skin itch/rash (petechiae).

Host feeding pattern of Japanese encephalitis virus vector mosquitoes (Diptera: Culicidae) from Kuttanadu, Kerala, India

Identification of blood meals of vector mosquitoes is an important tool in the epidemiological investigations of vector-borne diseases. The blood meals of three mosquito species involved in the transmission of Japanese encephalitis virus (JEV) from the Kuttanadu area, Kerala, were determined using the agarose gel diffusion technique. A total of 4959 blood smears belonging to Culex (Culex) tritaeniorhynchus Giles (3273), Cx. (Culex) gelidus Theobald (64), Mansonia (Mnd.) indiana Edwards (735) ,and Ma. (Mnd.) uniformis (Theobald) (887) were tested. Cx. tritaeniorhynchus had predominantly fed on bovids (46.4%), and a good proportion (29%) had fed on more than one host. Cx. tritaeniorhynchus was highly zoophagic, and human feeding accounted for only 1.5% of those individuals successfully tested. Cx. gelidus showed bovid feeding at 36% and pig feeding at 12.5%. The test results showed 42.3% Ma. indiana and 12.2% Ma. uniformis had fed on humans. Multiple feeding was observed in Ma. indiana and Ma. uniformis, and most of the double feedings were from bovids and ovids (7.9 and 20.1%, respectively). Pig feeding accounted for 4.8% of the feedings by Cx. tritaeniorhynchus, 5.3% of Ma. indiana, and 6.4% of Ma. uniformis. This study is significant because of the role played by these mosquitoes in the transmission of JEV in the Kuttanadu area of Kerala, India.

Natural vertical transmission of dengue viruses by Aedes aegypti in Chennai, Tamil Nadu, India

BACKGROUND & OBJECTIVE

Dengue viruses are spread and maintained in an Aedes aegypti-human- Ae. aegypti cycle in urban areas of the tropics. Dengue viruses are also maintained in nature by vertical transmission by Ae. aegypti. A study was undertaken in Chennai, a known endemic city in south India, to comprehend the natural vertical transmission dynamics in Ae. aegypti and to assess its epidemiological importance.

METHODS

Ae. aegypti males collected in resting and landing collections were tested for dengue virus infection by antigen-capture enzyme-linked immunosorbent assay (ELISA) and further examined by insect bioassay, Toxorhynchites splendens inoculation-indirect immunofluorescence technique (Toxo-IFA) using serotype-specific monoclonal antibodies (Mabs), if found positive by ELISA.

RESULTS

Of the 509 pools of Ae. aegypti males (n=5408) screened, 15 pools, collected in April, June- July, November-December in 2003 and March, May in 2004, were found positive for dengue virus infection and the minimum infection rate (MIR) among adult males was high in June 2003 (28.0/ 1000). Three positive pools could be serotyped as dengue-2 (2 pools) and dengue-3 (1 pool).

INTERPRETATION & CONCLUSION

Dengue virus isolations from wild caught males of Ae. aegypti indicate the occurrence of transovarial transmission. Vertical transmission was mainly observed in summer months when dengue infections in humans were low suggesting that dengue viruses adopt a novel strategy of surviving adverse climatic conditions.

Desiccated vector mosquitoes used for the surveillance of Japanese encephalitis virus activity in endemic southern India

To monitor Japanese encephalitis virus (JEV) activity in endemic areas of Tamil Nadu, southern India, desiccated vector mosquitoes were screened for JEV antigen using ELISA, from 1996. A total of 133 233 specimens from eight index villages comprising 2816 pools (mainly Culex vishnui subgroup) were tested. Of these, 59 pools (2.1%) were positive for JEV antigen. Control measures were undertaken in positive villages accordingly. The average annual minimum infection rate was 0.8 at the beginning of the study and remained lower for nearly 8 years. A declining trend in JE cases was recorded.

Clear cell "sugar" tumour of the lung: a case report

We report a case of clear cell "sugar" tumour of the lung (CCTL) occurring in a 26-year-old lady. The patient was asymptomatic and the lesion was picked up in the course of a pre-employment medical examination. A well-defined 5 cm nodule in the right lower lobe was detected on routine chest X-Ray. Microscopical examination of the coin lesion showed clear cells containing abundant diastase-sensitive intracytoplasmic glycogen, as demohstrated with periodic acid-Schiff stains. Tumour immunoreactivity for HMB-45 and non-reactivity for cytokeratin support the histological diagnosis. To our knowledge, this is the first reported case of CCTL in Malaysia.

Community-based study to assess the efficacy of DEC plus ALB against DEC alone on bancroftian filarial infection in endemic areas in Tamil Nadu, south India

As part of the Global Programme for Elimination of Lymphatic Filariasis (GPELF), India is implementing mass drug administration (MDA) with annual single dose of diethylcarbamazine (DEC) with and without albendazole (ALB). The impact of MDAs on filarial infections and soil-transmitted helminth (STH) infections was assessed during a 3-year period in two communities, one with DEC + ALB and the other with DEC alone. Prior to each MDA (during 2001, 2002 and 2003), filarial indices (microfilaraemia and antigenaemia) were assessed from blood samples of 450-650 persons aged 2-25 years and STH infections in stool samples (Kato-Katz method) from 325 to 500 children aged 9-10 years. Mosquitoes resting indoors were collected to determine the filarial infection status. The microfilaraemia prevalence decreased significantly (P < 0.05) in both arms, with the highest decline in the DEC + ALB arm (72%vs. 51%). Decline in micrefilaria intensity was also higher in the DEC + ALB arm (81.4%vs. 48.5%). In this arm alone, the antigenaemia prevalence was reduced significantly (62%; P < 0.001). The reduction in STH prevalence was lower in the DEC alone arm (6.5%; NS) than in the DEC + ALB arm (70.9%; P < 0.001). Also, the egg reduction in DEC alone arm was only half that of DEC + ALB arm (49%vs. 97%). Our community-based follow-up study showed higher and sustained benefits with regard to filarial and STH infections for the two-drug arm over the DEC alone arm. The trends suggest that at least 10 MDAs may be necessary to achieve the goal of elimination.

Efficacy of thermal fog application of deltacide, a synergized mixture of pyrethroids, against Aedes aegypti, the vector of dengue

We evaluated the efficacy of indoor and peridomestic thermal fog applications of deltacide, a synergized mixture of pyrethroids (S-bioallethrin 0.7% w/v, deltamethrin 0.5% w/v and piperonyl butoxide 8.9% w/v) against adult populations of Aedes aegypti in Chennai, Tamil Nadu, India. We bioassayed adult caged mosquitoes, counted indoor resting and human landing adult mosquitoes and assessed the percentage of potential breeding sites with Aedes larvae. The bioassay mortalities indicated that the knockdown and killing effect was greater when fogging was applied inside houses rather than around them. Peridomestic thermal fogging reduced the resting and biting populations by 76% and 40%, respectively for the 3 days after treatment, whereas indoor fogging suppressed adult populations for 5 days.

Short report: observations on the multiple feeding behavior of Culex tritaeniorhynchus (Diptera: culicidae), the vector of Japanese encephalitis in Kerala in southern India

A study was undertaken in villages endemic for Japanese encephalitis (JE) in Kerala in southern India during the period 1998-2001 to determine the host-feeding pattern of Culex tritaeniorhynchus, the major vector of JE in southeast Asia. A total of 3,067 blood-engorged Cx. tritaeniorhynchus were tested and 2,553 (82.2%) of the samples could be identified. Culex tritaeniorhynchus had fed mainly (56.6%) on cattle. Pig feeding accounted 6.3% of the total samples. Some samples (n = 980, 38.3%) were of serologic mixed origin. Of 980 mixed blood-fed mosquitoes, 975 (99.5%) had imbibed blood from two distinct hosts and 5 (0.5%) imbibed blood from three distinct hosts. Mixed blood meals were mostly (96.7%) from cattle and goats. The epidemiologic implications of multiple feeding of Cx. tritaeniorhynchus on dampening (dead-end) hosts such as cattle and goats in the transmission of JE virus is discussed.

Japanese encephalitis virus (JEV) is an important cause of encephalitis among children in Cuddalore district, Tamil Nadu, India

BACKGROUND

Japanese encephalitis (JE) is endemic in Cuddalore district, Tamil Nadu (TN), Southern India. The reports of JE cases from the local hospitals did not reflect the actual disease burden. It is likely that these cases were attending the nearby referral hospitals, for want of better treatment facilities.

OBJECTIVES

Between July 2002 and February 2003, a pilot study was undertaken to examine whether JE was a component of paediatric acute encephalitis syndrome (AES) reported to two major referral hospitals adjacent to Cuddalore, and to map the distribution of the JE cases.

STUDY DESIGN

A total of 58 hospitalized children [0-15 years] with AES were investigated. Other than the routine laboratory investigations, either CSF or sera or both [depending on the availability] collected from these children were analyzed at Center for Research in Medical Entomology, Madurai (TN) for JEV-antigen, antibody detection, virus isolation and virus genome detection by indirect immunofluorescence, MAC enzyme linked immunosorbent assay (ELISA), insect bioassay and by reverse transcriptase polymerase chain reaction (RT-PCR), respectively.

RESULTS

JE was established in 17 (29%) of 58 AES cases; half of the AES cases [31/58, 53%] and 59% [10/17] of JE cases were confined to JE-endemic areas in Cuddalore district. The JE confirmation scored by different assays varied according to the clinical phase of the illness. The attack rate was high among the children aged 3-8 years. The monthly distribution of acute encephalitic syndrome cases followed the distribution of JE cases [coinciding with the rainy season in this region] suggesting encephalitis of JE origin.

CONCLUSION

In JE-endemic areas, the actual JE burden can be estimated by the collection of JE case reports from the local hospitals and from the referral hospitals. Building of diagnostic facilities in hospitals for JE is necessary to achieve this goal.

Effectiveness of two annual, single-dose mass drug administrations of diethylcarbamazine alone or in combination with albendazole on soil-transmitted helminthiasis in filariasis elimination programme

A longitudinal community-trial on the control of soil-transmitted helminths (STHs), as part of a lymphatic filariasis elimination campaign, was taken up in two revenue blocks of southern India in the years 2001 and 2002 to assess the impact of two annual single-dose mass drug administration (MDA) of diethylcarbamazine (DEC) + albendazole (ALB) with that of DEC alone. The prevalences and intensities of STHs were studied among cross-sectional samples of school children aged 9-10 years by using the Kato-Katz technique at baseline and 11 months after each MDA. The combined drug mass treatment produced a higher reduction in the prevalence (RIP) (51-77%) and the egg reduction rate (ERR) (92-98%) compared with 12-15% RIP and 58-62% ERR of DEC alone mass treatment. The effect of two-drug therapy after two annual treatments was relatively long lasting as shown by RIP and ERR indicating that the reinfection rates were relatively lower in this approach than single-drug therapy. This study demonstrates that mass drug co-administration of DEC + ALB in Global Programme for Elimination of Lymphatic Filariasis (GPELF) targeted at the community had a synergistic and sustainable effect against soil-transmitted helminthiasis and provided considerable 'beyond filariasis' benefits. The additional advantages accrued to the community underscore the importance of scaling-up GPELF to cover the entire population at risk.

Japanese encephalitis in India: an overview

Japanese encephalitis (JE)-epidemics have been reported in many parts of the country. The incidence has been reported to be high among pediatric group with high mortality. The incidence of JE in recent times is showing an increasing trend. It appears that JE may become one of the major public health problems in India, considering the quantum of the vulnerable pediatric population, the proportion of JEV infections among the encephalitic children and wide scattering of JE-prone areas. JE burden can be estimated satisfactorily to some extend by strengthening diagnostic facilities for JE confirmation in hospitals and by maintenance of contact with the nearby referral hospitals to collect the particulars on JE cases. Vaccination proves to be the best to protect the individual against any disease. In the case of JE, it is essential to immunize the pigs (amplifying host) also to interrupt the transmission of the disease.

Japanese encephalitis in Kerala, south India: can Mansonia (Diptera: Culicidae) play a supplemental role in transmission?

A 2-yr entomological study was carried out in Kerala, south India, to identify the mosquito vectors of Japanese encephalitis (JE) virus and to determine their seasonal abundance and infection. In total, 150,454 mosquitoes belonging to five genera and 18 species were collected from vegetation surrounding cattle sheds and pigsties in villages at dusk. Culex tritaeniorhynchus Giles (66.7%) was the most abundant species, with increases in numbers associated with rice cultivation. JE virus isolations were made from Cx. tritaeniorhynchus and Mansonia indiana Edwards. Based on high abundance and frequent JE virus infection, Cx. tritaeniorhynchus seems to be the most important vector, whereas Ma. indiana is probably a secondary vector.

Host-feeding pattern of Culex quinquefasciatus Say and Mansonia annulifera (Theobald) (Diptera: Culicidae), the major vectors of filariasis in a rural area of south India

Culex quinquefasciatus and Mansonia annulifera are abundant in the rural areas of Kuttanadu, Kerala, India. Bloodmeal identification for individuals of these species collected in this region was determined by the agar-gel precipitin test. A total of 2,328 blood smears from Cx. quinquefasciatus (1,148) and Ma. annulifera (1,180) was tested. Results showed that Cx. quinquefasciatus and Ma. annulifera were highly anthropophilic and that human feeding accounted for 74 and 66% of the total bloodmeals tested. Feeding on cattle accounted for only 1.5 and 2.1% of Cx. quinquefasciatus and Ma. annulifera bloodmeals, respectively. This study showed the high anthropophilic feeding rates of Cx. quinquefasciatus and Ma. annulifera collected from an endemic belt of Malayan filariasis, where epidemiological studies revealed the coexistence of Bancroftian and Malayan filariasis.

Impact of two annual single-dose mass drug administrations with diethylcarbamazine alone or in combination with albendazole on Wuchereria bancrofti microfilaraemia and antigenaemia in South India

A two-arm community-based lymphatic filariasis elimination trial is being carried out in Tamil Nadu state, India to assess the effect of 2 annual single-dose mass drug administrations of diethylcarbamazine + albendazole (DEC + ALB) on microfilaraemia and antigenaemia in one arm, and diethylcarbamazine(DEC) alone in the other arm. In a cross-sectional survey at each time-point, 450-650 subjects in childhood (2-9 years old) and young adulthood (10-25 years old) were screened from each treatment arm. After 2 annual mass drug administrations, microfilaraemia prevalence in the 2-drug arm was reduced by 54% and 62% in the 2-9 year old and 10-25 year old groups respectively; and corresponding figures for the single-drug arm were 26% and 37%. Though higher reductions were recorded for geometric mean intensity of microfilaraemia in the 2-9 year old groups for both treatment arms, reduction was more pronounced in the 2-drug arm than the single drug arm (74% vs. 24%) in the 10-25 year old group. The reduction in the antigenaemia prevalence in the 2-9 year old group was evident in both treatment arms, but in the 10-25 year old group the reduction was only 16.8% in the 2-drug arm. Our results suggest that the annual, single-dose combination (DEC + ALB) mass treatment regimen has an enhanced effect against bancroftian filariasis compared to single-drug therapy.

Studies on dengue in rural areas of Kurnool District, Andhra Pradesh, India

A dengue case was reported for the 1st time in a rural area of Kurnool District, Andhra Pradesh, India. Entomological and serological investigations were carried out to determine the prevalence of dengue vectors and dengue virus. Aedes aegypti was recorded for the 1st time in rural areas of Andhra Pradesh. Breeding of Ae. aegypti was observed only in containers with nonpotable water. Cement cisterns and tanks, stone tubs, and clay pots were the major breeding habitats of Ae. aegypti. Larval indices for Ae. aegypti ranged as follows: house index 28-40%, container index 13-37%, and Breteau index 32-60. A serological survey indicated that humans in Kurnool District have been exposed to dengue virus infections. The potential threat of an outbreak of dengue fever in rural areas because of the prevalence of the vector (Ae. aegypti) and dengue virus is discussed.

Dengue disease spectrum among infants in the 2001 dengue epidemic in Chennai, Tamil Nadu, India

An investigation in a referral pediatric hospital has indicated that during a recent dengue outbreak in Chennai, Tamil Nadu, India, dengue in infancy constituted 20% of total dengue virus infections with low mortality rates in this hospital. In developing countries, strengthening of dengue management capabilities at hospitals can prevent dengue-related deaths in infants.

Seasonal prevalence of Culex vishnui subgroup, the major vectors of Japanese encephalitis virus in an endemic district of Andhra Pradesh, India

Seasonal prevalence of members of the Culex vishnui subgroup, the major vectors of Japanese encephalitis virus (JE) in an endemic district of Andhra Pradesh, was investigated. Approximately 15,500 mosquitoes belonging to 2 genera and 5 species were collected by indoor-resting collections. The predominant species were found to be from the Cx. vishnui subgroup, which comprised 42.6% of the total collection, followed by Anopheles subpictus (40.4%), An. hyrcanus (12.8%), Cx. gelidus (3.5%), and An. barbirostris (0.8%). Mosquitoes of the Cx. vishnui subgroup were collected throughout the year, and densities of females ranged from 2.3/man-hour in January 1999 to 26.0/man-hour in December 1999. Ninety-three cases of Japanese encephalitis (27 confirmed serologically) were reported, mainly during the monsoon months of November and December. A significant positive correlation between densities of mosquitoes of the Cx. vishnui subgroup and occurrence of Japanese encephalitis cases (r = 0.765, P < 0.01) was observed. The factors responsible for transmission of JE in the endemic district are discussed.

Efficacy of diethylcarbamazine-medicated salt for microfilaraemia of Brugia malayi

BACKGROUND

Pilot studies in India and abroad have demonstrated the benefit of cooking salt fortified with diethylcarbamazine citrate (DEC) for the control of lymphatic filariasis. In India, DEC-medicated salt has been introduced on a commercial basis in the Cherthala region of Kerala, which is endemic for Brugia malayi (B. malayi). We studied the efficacy of DEC-medicated salt in the clearance of microfilaraemia of B. malayi.

METHODS

Eighteen cases of microfilaraemia (11 men; 7 women) were selected; 14 in the experimental group (i.e. treated with 0.2% w/w DEC-medicated salt) and the rest as the control group who were given a placebo. The consumption of salt and the status of parasitaemia were monitored till all the microfilaria carriers became negative.

RESULTS

There was a significant reduction in the density of microfilariae (intensity) among the treated individuals over a period of time. The duration required for the clearance of microfilariae ranged from 9 to 30 [mean (SD) 19.4 (1.7)] weeks. All microfilaraemics except one reported side-effects which were mild-to-moderate and persisted for a maximum period of one month.

CONCLUSION

DEC-medicated salt effectively clears microfilariae within 30 weeks in parasitaemic individuals. No 'endemic normals' reported any side-effects, though these were common among the microfilaria carriers.

Virus isolation from wild-caught mosquitoes during a Japanese encephalitis outbreak in Kerala in 1996

Out of 5357 wild-caught mosquitoes in 163 pools tested for virus using antigen capture ELISA and an insect-bioassay (inoculation into Toxorhynchites splendens larvae and identification by IFA using JE virus-specific monoclonal antibody), 16 flavivirus isolations were made of which 12 (75%) were identified as JE virus. Of the 12 JE virus isolations, 7 were from Culex tritaeniorhynchus, 3 from Mansonia uniformis and 1 each from Ma. indiana and Anopheles subpictus. Four isolations from Mansonia species for the first time reported here are noteworthy.

Mattancherry urban agglomeration, a diminishing focus of lymphatic filariasis in Kerala

Parasitological survey conducted recently in Mattancherry, Kerala showed a low prevalence of microfilariae (mf), with a mf rate of 1.81%, compared to that of 1956 when the mf rate was 14.7%. No brugian infection was encountered in the present investigation, though both bancroftian and brugian infections were reported earlier. Culex quinquefasciatus, the vector of bancroftian filariasis was the most predominant (93.3%) mosquito species, and its infection and infectivity rates were 0.76% and 0.54% respectively. Mansonioides spp., the vectors of brugian filariasis constituted only 0.2% of the total mosquitoes and with no infection. The overall reduction in the prevalence of mf cases and vector infection rates over the years is attributed to the continued activities of the National Filaria Control Programme. The disappearance of brugian filariasis could mainly be due to the drastic reduction in the Mansonioides breeding habitats, as a result of rapid urbanization coupled with improved socio economic conditions.

Brackish water mosquito problem of Vypeen Island, Cochin, Kerala

A preliminary study has shown that the marshy terrain and brackish water bodies associated with mangrove forests contributed profuse breeding of mosquitos in Vypeen island, causing a severe menace to the island population. A total of 14 species belonging to four genera viz, Aedes, Anopheles, Armigeres and Culex was recorded from different habitats. Culex sitiens was found to be the predominant mosquito in all the perennial breeding habitats. The extent of different habitats in the production of mosquitos, and its possible abatement, using environmental and/or biocontrol methods are discussed.

Observations on population density of Culex quinquefasciatus and transmission indices of Bancroftian filariasis during and after Integrated Vector Management strategy

An Integrated Vector Management strategy, implemented as an alternative to the conventional control operations that include mainly chemical control in Pondicherry, South India, reduced very substantially the population density of Culex quinquefasciatus. This resulted in drastic decrease in the intensity of transmission of bancroftian filariasis transmitted by Culex quinquefasciatus and consequently the incidence of new infections in children of 0-5 age group was minimized. When the IVM strategy was withdrawn after five years of implementation and conventional control measures were re-adopted, resilience of Culex quinquefasciatus population was observed and human exposure to the risk of infection increased. The results suggest that maintenance of vector density at reduced levels for prolonged periods, is necessary to control infectious diseases like filariasis, which is difficult in the present day urban situations in developing countries. Hence the emphasis should be on chemotherapy to achieve control of lymphatic filariasis.

Infectivity of a mermithid nematode Romanomermis iyengari (Welch) in different conductivity levels under laboratory and field conditions

Infectivity of R. iyengari was examined by exposing mosquito (Culex quinquefasciatus) larvae to the preparasite at different conductivity levels. The preparasite infected 63.5, 30, 11, 1.5 and 0.5% of the mosquito larvae respectively at 2000, 2500, 3000, 3300 and 3600 mu ho/cm. Although, 62-69% of the preparasite survived at 4000-5400 mu ho/cm, it did not infect. Application of preparasite to tree-holes resulted in 53-63% infection of Aedes albopictus larvae initially. On 6th day the infection level was 40% which decreased further to 7% by 15th day. The infection reappeared on 38th day indicating that R. iyengari has not only infected mosquito larvae as soon as they were applied to tree-holes in which the conductivity was 600-2800 mu ho/cm but also got established there.