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Thangaraj JWV, Prosperi C, Kumar MS, Hasan AZ, Kumar VS, Winter AK, Bansal AK, Chauhan SL, Grover GS, Jain AK, Kulkarni RN, Sharma SK, Soman B, Chaaithanya IK, Kharwal S, Mishra SK, Salvi NR, Sarmah NP, Sharma S, Varghese A, Sabarinathan R, Duraiswamy A, Rani DS, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Chonker SK, Sangal L, Mehendale SM, Sapkal GN, Gupta N, Hayford K, Moss WJ, Murherkar MV. Post-campaign coverage evaluation of a measles and rubella supplementary immunization activity in five districts in India, 2019-2020. PLoS One 2024; 19:e0297385. [PMID: 38551928 PMCID: PMC10980234 DOI: 10.1371/journal.pone.0297385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 01/04/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose. METHODS AND FINDINGS Community-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district. CONCLUSION Awareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children.
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Affiliation(s)
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Muthusamy Santhosh Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Alvira Z. Hasan
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - V. Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Amy K. Winter
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Avi Kumar Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Sanjay L. Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Ragini N. Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Achutha Menon Centre for Health Science Studies, Trivandrum, Kerala, India
| | - Itta K. Chaaithanya
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Sanchit Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Sunil K. Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Neha R. Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Nilanju P. Sarmah
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - Sandeep Sharma
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Adarsh Varghese
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Achutha Menon Centre for Health Science Studies, Trivandrum, Kerala, India
| | - R. Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Augustine Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - D. Sudha Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - K. Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Abhishek Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Poonam Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Mitali Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Saurabh Kumar Chonker
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - Lucky Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | | | | | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Kyla Hayford
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - William J. Moss
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Manoj V. Murherkar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
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Shewade HD, Frederick A, Kalyanasundaram M, Chadwick J, Kiruthika G, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Shivakumar SVBY, Jeyashree K, Bhavani PK, Aarthi S, Suma KV, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj KD, Kaleeswari M, Durai VP, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash AR, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan KP, Tharageshwari N, Chokkalingam D, Anandrajkumar SM, Selvavinayagam TS, Padmapriyadarsini C, Ramachandran R, Murhekar MV. --Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India. Glob Health Action 2023; 16:2161231. [PMID: 36621943 PMCID: PMC9833404 DOI: 10.1080/16549716.2022.2161231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.
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Affiliation(s)
- Hemant Deepak Shewade
- ICMR – National Institute of Epidemiology, Chennai, India,CONTACT Hemant Deepak Shewade ; Department of Health Research, Government of India, ICMR-National Institute of Epidemiology, R-127, Second Main Road, TNHB, Ayapakkam, Chennai600077, India
| | | | | | | | - G. Kiruthika
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | - K. Gayathri
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | | | | | | | - P. K. Bhavani
- ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K. V. Suma
- The WHO Country Office for India, New Delhi, India
| | | | | | | | | | | | | | - S. Lokesh
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | - K. Krishnamoorthy
- Department of Respiratory Medicine, Tirunelveli Medical College Hospital, Tirunelveli, India
| | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | | | | | - T. S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
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Shanmugasundaram D, Verma S, Singh K, Dwibedi B, Awasthi S, Mahantesh S, Singh H, Santhanam S, Mondal N, S G, Sreenivasan P, Malik S, Jain M, Viswanathan R, Tripathi S, Patel B, Sapkal G, Sabarinathan R, Singh MP, Ratho R, Nag V, Gadepalli R, Som TK, Mishra B, Jain A, Ashok M, Madhuri DS, Rani VS, Abraham AM, John D, Dhodapkar R, Syed Ali A, Biswas D, Pratyeke D, Bavdekar A, Prakash J, Singh V, Prasad N, Ray J, Majumdar A, Dutta S, Gupta N, Murhekar M, Sharma A, Ghosh A, Alexander A, Baranwal A, Anantharaj A, Bethou A, Shekhawat DS, Kiruthika G, Ram J, Gupta M, Gowda M, Rohit MK, Dash N, Sankhyan N, Kaushal N, Shivanna NH, Kasturi N, Kumar PP, Gupta PC, Gunasekaran PK, Singh P, Kumar P, Munjal SK, Agarwal S, Manasa S, Shukla S, Nehra U, Verghese VP, Vyas V, Gupta V. Congenital rubella syndrome surveillance in India, 2016-21: Analysis of five years surveillance data. Heliyon 2023; 9:e15965. [PMID: 37251844 PMCID: PMC10209330 DOI: 10.1016/j.heliyon.2023.e15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Background In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016-2021 from 14 sentinel sites to describe the epidemiology of CRS. Method We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. Results During 2016-21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6-16.2), cataract (OR = 7.8, 95% CI: 5.4-11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3-13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2-12.2) and glaucoma (OR = 3.1, 95% CI: 1.2-8.1). Nomogram, along with a web version, was developed. Conclusions Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.
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Affiliation(s)
| | - Sanjay Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuldeep Singh
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | - S. Mahantesh
- Indira Gandhi Institute of Child Health, Bengaluru, India
| | | | | | - Nivedita Mondal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Geetha S
- Government Medical College, Trivandrum, India
| | | | - Shikha Malik
- All India Institute of Medical Sciences, Bhopal, India
| | - Manish Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | | | | | | | | | | | - Mini P. Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R.K. Ratho
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | - Amita Jain
- King George's Medical University, Lucknow, India
| | - M. Ashok
- ICMR-National Institute of Virology, Pune, India
| | | | | | | | - Deepa John
- Christian Medical College, Vellore, India
| | - Rahul Dhodapkar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - A. Syed Ali
- Government Medical College, Trivandrum, India
| | | | | | | | - Jayant Prakash
- Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Varsha Singh
- Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Nidhi Prasad
- Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Jaydeb Ray
- Institute of Child Health, Kolkata, India
| | - Agniva Majumdar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | | | - Akhil Sharma
- King George's Medical University, Lucknow, India
| | | | - Arun Alexander
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Arun Baranwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avinash Anantharaj
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Adhisivam Bethou
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - G. Kiruthika
- ICMR–National Institute of Epidemiology, Chennai, India
| | - Jagat Ram
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mamatha Gowda
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Manoj K Rohit
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nabaneeta Dash
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Kaushal
- All India Institute of Medical Sciences, Jodhpur, India
| | | | - Nirupama Kasturi
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - P. Prem Kumar
- Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Parul Chawla Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Praveen Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Suhani Manasa
- Indira Gandhi Institute of Child Health, Bengaluru, India
| | | | - Urvashi Nehra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Varuna Vyas
- All India Institute of Medical Sciences, Jodhpur, India
| | - Vikas Gupta
- All India Institute of Medical Sciences, Bhopal, India
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4
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Shewade HD, Frederick A, Kiruthika G, Kalyanasundaram M, Chadwick J, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Kathiresan J, Bhavani P, Aarthi S, Suma K, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj K, Kaleeswari M, Durai V, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash A, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan K, Tharageshwari N, Chokkalingam D, Anandrajkumar S, Selvavinayagam T, Padmapriyadarshini C, Ramachandran R, Murhekar MV. The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade. Glob Health Sci Pract 2023; 11:e2200505. [PMID: 37116929 PMCID: PMC10141439 DOI: 10.9745/ghsp-d-22-00505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there are few examples of implementing this type of strategy in routine program settings. Beginning in April 2022, the Indian state of Tamil Nadu implemented a differentiated care strategy called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET) for all adults aged 15 years and older with drug-susceptible TB notified by public facilities. Before evaluating the impact on TB deaths, we sought to understand the retention and delays in the care cascade as well as predictors of losses. During April-June 2022, 14,961 TB patients were notified and 11,599 (78%) were triaged. Of those triaged, 1,509 (13%) were at high risk of severe illness; of these, 1,128 (75%) were comprehensively assessed at a nodal inpatient care facility. Of 993 confirmed as severely ill, 909 (92%) were admitted, with 8% unfavorable admission outcomes (4% deaths). Median admission duration was 4 days. From diagnosis, the median delay in triaging and admission of severely ill patients was 1 day each. Likelihood of triaging decreased for people with extrapulmonary TB, those diagnosed in high-notification districts or teaching hospitals, and those transferred out of district. Predictors of not being comprehensively assessed included: aged 25-34 years, able to stand without support, and diagnosis at a primary or secondary-level facility. Inability to stand without support was a predictor of unfavorable admission outcomes. To conclude, the first quarter of implementation suggests that TN-KET was feasible to implement but could be improved by addressing predictors of losses in the care cascade and increasing admission duration.
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Affiliation(s)
- Hemant Deepak Shewade
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - G. Kiruthika
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - Joshua Chadwick
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - T. Daniel Rajasekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - K. Gayathri
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Vijayaprabha
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Sabarinathan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - Jeyashree Kathiresan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - P.K. Bhavani
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K.V. Suma
- World Health Organization Country Office for India, New Delhi, India
| | | | | | | | - Jerome G. Thampi
- World Health Organization Country Office for India, New Delhi, India
| | | | - Tarun Bhatnagar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - S. Lokesh
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | | | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V.P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A.R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - D. Chokkalingam
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - T.S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
| | - C. Padmapriyadarshini
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | | | - Manoj V. Murhekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
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5
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Prosperi C, Thangaraj J, Hasan A, Kumar M, Truelove S, Kumar V, Winter A, Bansal A, Chauhan S, Grover G, Jain A, Kulkarni R, Sharma S, Soman B, Chaaithanya I, Kharwal S, Mishra S, Salvi N, Sharma N, Sharma S, Varghese A, Sabarinathan R, Duraiswamy A, Rani D, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Chonker S, Cutts F, Sangal L, Mehendale S, Sapkal G, Gupta N, Hayford K, Moss W, Murhekar M. Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20. Vaccine 2023; 41:486-495. [PMID: 36481106 PMCID: PMC9831119 DOI: 10.1016/j.vaccine.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.
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Affiliation(s)
- C. Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J.W.V. Thangaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A.Z. Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M.S. Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - S. Truelove
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V.S. Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A.K. Winter
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A.K. Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - S.L. Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - G.S. Grover
- Directorate of Health Services, Government of Punjab, Chandigarh, India
| | - A.K. Jain
- ICMR-National Institute of Pathology, New Delhi, India
| | - R.N. Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - S.K. Sharma
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
| | - B. Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - I.K. Chaaithanya
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - S. Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - S.K. Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - N.R. Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - N.P. Sharma
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - S. Sharma
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - A. Varghese
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - R. Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A. Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D.S. Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - K. Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A. Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - P. Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - M. Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - S.K. Chonker
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - F.T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - L. Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | - S.M. Mehendale
- PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - G.N. Sapkal
- ICMR-National Institute of Virology, Pune, India
| | - N. Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - K. Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W.J. Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author at: International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - M.V. Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
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Murhekar MV, Gupta N, Hasan AZ, Kumar MS, Kumar VS, Prosperi C, Sapkal GN, Thangaraj JWV, Kaduskar O, Bhatt V, Deshpande GR, Thankappan UP, Bansal AK, Chauhan SL, Grover GS, Jain AK, Kulkarni RN, Sharma SK, Chaaithanya IK, Kharwal S, Mishra SK, Salvi NR, Sharma S, Sarmah NP, Sabarinathan R, Duraiswamy A, Rani DS, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Shrivastava AK, Chonker SK, Tilekar B, Tandale BV, Ahmad M, Sangal L, Winter A, Mehendale SM, Moss WJ, Hayford K. Evaluating the effect of measles and rubella mass vaccination campaigns on seroprevalence in India: a before-and-after cross-sectional household serosurvey in four districts, 2018-2020. Lancet Glob Health 2022; 10:e1655-e1664. [PMID: 36240831 PMCID: PMC9579355 DOI: 10.1016/s2214-109x(22)00379-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/14/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
Background India did phased measles–rubella supplementary immunisation activities (MR-SIAs; ie, mass-immunisation campaigns) targeting children aged 9 months to less than 15 years. We estimated measles–rubella seroprevalence before and after the MR-SIAs to quantify the effect on population immunity and identify remaining immunity gaps. Methods Between March 9, 2018 and March 19, 2020 we did community-based, cross-sectional serosurveys in four districts in India before and after MR-SIAs. 30 villages or wards were selected within each district, and one census enumeration block from each was selected as the survey cluster. Households were enumerated and 13 children in the younger age group (9 months to <5 years) and 13 children in the older ager group (5 to <15 years) were randomly selected by use of computer-generated random numbers. Serum samples were tested for IgG antibodies to measles and rubella viruses by enzyme immunoassay. Findings Specimens were collected from 2570 children before the MR-SIA and from 2619 children afterwards. The weighted MR-SIA coverage ranged from 73·7% to 90·5% in younger children and from 73·6% to 93·6% in older children. Before the MR-SIA, district-level measles seroprevalence was between 80·7% and 88·5% among younger children in all districts, and between 63·4% and 84·5% among older children. After the MR-SIA, measles seroprevalence among younger children increased to more than 90% (range 91·5 to 96·0) in all districts except Kanpur Nagar, in which it remained unchanged 80·4%. Among older children, measles seroprevalence increased to more than 90·0% (range 93·7% to 96·5%) in all districts except Hoshiarpur (88·7%). A significant increase in rubella seroprevalence was observed in all districts in both age groups, with the largest effect in Dibrugarh, where rubella seroprevalence increased from 10·6% to 96·5% among younger children. Interpretation Measles–rubella seroprevalence increased substantially after the MR-SIAs but the serosurvey also identified remaining gaps in population immunity. Funding The Bill & Melinda Gates Foundation and Indian Council of Medical Research.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India,Correspondence to: Dr Manoj V Murhekar, ICMR-National Institute of Epidemiology, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 070, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Alvira Z Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - V Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Christine Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | - Avi Kumar Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Sanjay L Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Ragini N Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | - Itta K Chaaithanya
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India,Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Sanchit Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Sunil K Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Neha R Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Sandeep Sharma
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Nilanju P Sarmah
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Augustine Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D Sudha Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - K Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Abhishek Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Poonam Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Mitali Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | | | - Saurabh Kumar Chonker
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | | | | | | | - Lucky Sangal
- WHO, Southeast Asia Region Office, New Delhi, India
| | - Amy Winter
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology and Statistics, University of Georgia, Athens, GA, USA
| | | | - William J Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Laxmaiah A, Rao NM, Arlappa N, Babu J, Kumar PU, Singh P, Sharma D, Anumalla VM, Kumar TS, Sabarinathan R, Kumar MS, Ananthan R, Basha DA, Blessy P, Kumar DC, Devaraj P, Devendra S, Kumar MM, Meshram II, Kumar BN, Sharma P, Raghavendra P, Raghu P, Rao KR, Ravindranadh P, Kumar BS, Sarika G, Rao JS, Surekha M, Sylvia F, Kumar D, Rao GS, Tallapaka KB, Sowpati DT, Srivastava S, Murhekar VM, Hemalatha R, Mishra RK. SARS-CoV-2 seroprevalence in the city of Hyderabad, India in early 2021. IJID Regions 2022; 2:1-7. [PMID: 35721436 PMCID: PMC8603330 DOI: 10.1016/j.ijregi.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
Background COVID-19 emerged as a global pandemic in 2020, spreading rapidly to most parts of the world. The proportion of infected individuals in a population can be reliably estimated via serosurveillance, making it a valuable tool for planning control measures. Our serosurvey study aimed to investigate SARS-CoV-2 seroprevalence in the urban population of Hyderabad at the end of the first wave of infections. Methods This cross-sectional survey, conducted in January 2021 and including males and females aged 10 years and above, used multi-stage random sampling. 9363 samples were collected from 30 wards distributed over six zones of Hyderabad, and tested for antibodies against SARS-CoV-2 nucleocapsid antigen. Results Overall seropositivity was 54.2%, ranging from 50% to 60% in most wards. Highest exposure appeared to be among those aged 30–39 and 50–59 years, with women showing greater seropositivity. Seropositivity increased with family size, with only marginal differences among people with varying levels of education. Seroprevalence was significantly lower among smokers. Only 11% of the survey subjects reported any COVID-19 symptoms, while 17% had appeared for COVID-19 testing. Conclusion Over half the city's population was infected within a year of onset of the pandemic. However, ∼ 46% of people remained susceptible, contributing to subsequent waves of infection.
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Murhekar M, Raju M, Vivian Thangaraj J, Selvavinayagam TS, Somasundaram A, Parthipan K, Sivadoss R, Sabarinathan R, Subramaniam S, A. Rozario A, Rani S, Suganya E. Clinical profile of patients infected with suspected SARS-CoV-2 Omicron variant of concern, Tamil Nadu, India, December 2021-January 2022. Indian J Med Res 2022; 155:165-170. [PMID: 35417991 PMCID: PMC9552397 DOI: 10.4103/ijmr.ijmr_312_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives: Methods: Results: Interpretation & conclusions:
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9
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Murhekar MV, Bhatnagar T, Thangaraj JWV, Saravanakumar V, Santhosh Kumar M, Selvaraju S, Rade K, Kumar CPG, Sabarinathan R, Asthana S, Balachandar R, Bangar SD, Bansal AK, Bhat J, Chakraborty D, Chopra V, Das D, Devi KR, Dwivedi GR, Jain A, Khan SMS, Kumar MS, Laxmaiah A, Madhukar M, Mahapatra A, Ramesh T, Rangaraju C, Turuk J, Yadav S, Bhargava B. Seroprevalence of IgG antibodies against SARS-CoV-2 among the general population and healthcare workers in India, June-July 2021: A population-based cross-sectional study. PLoS Med 2021; 18:e1003877. [PMID: 34890407 PMCID: PMC8726494 DOI: 10.1371/journal.pmed.1003877] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/04/2022] [Accepted: 11/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March-June 2021. We conducted a fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged ≥6 years and healthcare workers (HCWs). METHODS AND FINDINGS We did a cross-sectional study between 14 June and 6 July 2021 in the same 70 districts across 20 states and 1 union territory where 3 previous rounds of serosurveys were conducted. From each district, 10 clusters (villages in rural areas and wards in urban areas) were selected by the probability proportional to population size method. From each district, a minimum of 400 individuals aged ≥6 years from the general population (40 individuals from each cluster) and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test-adjusted seroprevalence of IgG antibodies against SARS-CoV-2, along with 95% CIs, based on the presence of antibodies to S1-RBD and/or nucleocapsid protein. Of the 28,975 individuals who participated in the survey, 2,892 (10%) were aged 6-9 years, 5,798 (20%) were aged 10-17 years, and 20,285 (70%) were aged ≥18 years; 15,160 (52.3%) participants were female, and 21,794 (75.2%) resided in rural areas. The weighted and test-adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged ≥6 years was 67.6% (95% CI 66.4% to 68.7%). Seroprevalence increased with age (p < 0.001) and was not different in rural and urban areas (p = 0.822). Compared to unvaccinated adults (62.3%, 95% CI 60.9% to 63.7%), seroprevalence was significantly higher among individuals who had received 1 vaccine dose (81.0%, 95% CI 79.6% to 82.3%, p < 0.001) and 2 vaccine doses (89.8%, 95% CI 88.4% to 91.1%, p < 0.001). The seroprevalence of IgG antibodies among 7,252 HCWs was 85.2% (95% CI 83.5% to 86.7%). Important limitations of the study include the survey design, which was aimed to estimate seroprevalence at the national level and not at a sub-national level, and the non-participation of 19% of eligible individuals in the survey. CONCLUSIONS Nearly two-thirds of individuals aged ≥6 years from the general population and 85% of HCWs had antibodies against SARS-CoV-2 by June-July 2021 in India. As one-third of the population is still seronegative, it is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions.
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Affiliation(s)
| | | | | | | | | | - Sriram Selvaraju
- ICMR–National Institute for Research in Tuberculosis, Chennai, India
| | - Kiran Rade
- WHO Country Office for India, New Delhi, India
| | | | | | - Smita Asthana
- ICMR–National Institute of Cancer Prevention and Research, Noida, India
| | | | | | - Avi Kumar Bansal
- ICMR–National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Jyothi Bhat
- ICMR–National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Vishal Chopra
- State TB Training and Demonstration Centre, Patiala, India
| | - Dasarathi Das
- ICMR–Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, India
| | | | | | | | | | - M. Sunil Kumar
- State TB Training and Demonstration Centre, Thiruvananthapuram, India
| | | | - Major Madhukar
- ICMR–Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | | | | | - Jyotirmayee Turuk
- ICMR–Regional Medical Research Centre, Bhubaneswar, Bhubaneswar, India
| | - Suresh Yadav
- ICMR–National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India
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Rajamanickam A, Kumar NP, Pandiarajan AN, Selvaraj N, Munisankar S, Renji RM, Venkatramani V, Murhekar M, Thangaraj JWV, Kumar MS, Kumar CPG, Bhatnagar T, Ponnaiah M, Sabarinathan R, Saravanakumar V, Babu S. Dynamic alterations in monocyte numbers, subset frequencies and activation markers in acute and convalescent COVID-19 individuals. Sci Rep 2021; 11:20254. [PMID: 34642411 PMCID: PMC8511073 DOI: 10.1038/s41598-021-99705-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/13/2021] [Indexed: 02/06/2023] Open
Abstract
Monocytes are thought to play an important role in host defence and pathogenesis of COVID-19. However, a comprehensive examination of monocyte numbers and function has not been performed longitudinally in acute and convalescent COVID-19. We examined the absolute counts of monocytes, the frequency of monocyte subsets, the plasma levels of monocyte activation markers using flowcytometry and ELISA in seven groups of COVID-19 individuals, classified based on days since RT-PCR confirmation of SARS-CoV2 infection. Our data shows that the absolute counts of total monocytes and the frequencies of intermediate and non-classical monocytes increases from Days 15-30 to Days 61-90 and plateau thereafter. In contrast, the frequency of classical monocytes decreases from Days 15-30 till Days 121-150. The plasma levels of sCD14, CRP, sCD163 and sTissue Factor (sTF)-all decrease from Days 15-30 till Days 151-180. COVID-19 patients with severe disease exhibit higher levels of monocyte counts and higher frequencies of classical monocytes and lower frequencies of intermediate and non-classical monocytes and elevated plasma levels of sCD14, CRP, sCD163 and sTF in comparison with mild disease. Thus, our study provides evidence of dynamic alterations in monocyte counts, subset frequencies and activation status in acute and convalescent COVID-19 individuals.
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Affiliation(s)
- Anuradha Rajamanickam
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India.
| | - Nathella Pavan Kumar
- Immunology-ICMR-National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Arul Nancy Pandiarajan
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Nandhini Selvaraj
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Saravanan Munisankar
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Rachel Mariam Renji
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Vijayalakshmi Venkatramani
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Manoj Murhekar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | | | | | - C P Girish Kumar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | | | - R Sabarinathan
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | - V Saravanakumar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | - Subash Babu
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
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Hasan AZ, Kumar MS, Prosperi C, Thangaraj JWV, Sabarinathan R, Saravanakumar V, Duraiswamy A, Kaduskar O, Bhatt V, Deshpande GR, Ullas PT, Sapkal GN, Sangal L, Mehendale SM, Gupta N, Moss WJ, Hayford K, Murhekar MV. Implementing Serosurveys in India: Experiences, Lessons Learned, and Recommendations. Am J Trop Med Hyg 2021; 105:1608-1617. [PMID: 34607310 PMCID: PMC8641364 DOI: 10.4269/ajtmh.21-0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022] Open
Abstract
Serological surveillance for vaccine-preventable diseases, such as measles and rubella, can provide direct measures of population immunity across age groups, identify gaps in immunity, and document changes in immunity over time. Rigorously conducted, representative household serosurveys provide high-quality estimates with minimal bias. However, they can be logistically challenging, expensive, and have higher refusal rates than vaccine coverage surveys. This article shares lessons learned through implementing nine measles and rubella household serosurveys in five districts in India—the challenges faced, the potential impact on results, and recommendations to facilitate the conduct of serosurveys. Specific lessons learned arose from challenges related to community mobilization owing to lack of cooperation in certain settings and populations, limitations of outdated census information, nonresponse due to refusal or unavailability during survey enumeration and enrollment, data collection issues, and specimen collection and handling issues. Although some experiences are specific to serosurveys in India, these lessons are generalizable to other household surveys, particularly vaccination coverage and serosurveys conducted in low- and middle-income settings.
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Affiliation(s)
- Alvira Z. Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Christine Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Ojas Kaduskar
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | - Vaishali Bhatt
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | - Gururaj Rao Deshpande
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | | | - Gajanan N. Sapkal
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | - Lucky Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | - Sanjay M. Mehendale
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - William J. Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manoj V. Murhekar
- ICMR-National Institute of Epidemiology, Chennai, India
- Address correspondence to Manoj V. Murhekar, National Institute of Epidemiology, Indian Council of Medical Research, R-127, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 070, India. E-mail: † Cosenior authors. The order was mutually agreed on accounting for equal roles in multiple manuscripts and final editorial responsibilities. ‡ These authors contributed equally to this work. The order was mutually agreed on accounting for equal roles in multiple manuscripts and final editorial responsibilities
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Rajamanickam A, Kumar NP, Nancy P A, Selvaraj N, Munisankar S, Renji RM, V V, Murhekar M, Thangaraj JWV, Kumar MS, Kumar CPG, Bhatnagar T, Ponnaiah M, Sabarinathan R, Kumar VS, Babu S. Recovery of Memory B-cell Subsets and Persistence of Antibodies in Convalescent COVID-19 Patients. Am J Trop Med Hyg 2021; 105:1255-1260. [PMID: 34583334 PMCID: PMC8592221 DOI: 10.4269/ajtmh.21-0883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022] Open
Abstract
It is essential to examine the longevity of the defensive immune response engendered by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We examined the SARS-CoV-2-specific antibody responses and ex vivo memory B-cell subsets in seven groups of individuals with COVID-19 classified based on days since reverse-transcription polymerase chain reaction confirmation of SARS-CoV-2 infection. Our data showed that the levels of IgG and neutralizing antibodies started increasing from days 15 to 30 to days 61 to 90, and plateaued thereafter. The frequencies of naive B cells and atypical memory B cells decreased from days 15 to 30 to days 61 to 90, and plateaued thereafter. In contrast, the frequencies of immature B cells, classical memory B cells, activated memory B cells, and plasma cells increased from days 15 to 30 to days 61 to 90, and plateaued thereafter. Patients with severe COVID-19 exhibited increased frequencies of naive cells, atypical memory B cells, and activated memory B cells, and lower frequencies of immature B cells, central memory B cells, and plasma cells when compared with patients with mild COVID-19. Therefore, our data suggest modifications in memory B-cell subset frequencies and persistence of humoral immunity in convalescent individuals with COVID-19.
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Affiliation(s)
- Anuradha Rajamanickam
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
| | - Nathella Pavan Kumar
- Immunology-ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Arul Nancy P
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
| | - Nandhini Selvaraj
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
| | - Saravanan Munisankar
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
| | - Rachel Mariam Renji
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
| | - Vijayalakshmi V
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
| | - Manoj Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | | | - C P Girish Kumar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - R Sabarinathan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - V Saravana Kumar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Subash Babu
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, Tamil Nadu, India
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Vivian Thangaraj JW, Kumar MS, Velusamy S, Girish Kumar CP, Selvaraju S, Sabarinathan R, Jagadeesan M, Hemalatha MS, Bhatnagar T, Murhekar MV. Age- & sex-specific infection fatality ratios for COVID-19 estimated from two serially conducted community-based serosurveys, Chennai, India, 2020. Indian J Med Res 2021; 153:546-549. [PMID: 34528527 PMCID: PMC8555611 DOI: 10.4103/ijmr.ijmr_365_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background & objectives Infection fatality ratio (IFR) is considered a more robust and reliable indicator than case fatality ratio for severity of SARS-CoV-2 infection. Age- and sex-stratified IFRs are crucial to guide public health response. Infections estimated through representative community-based serosurveys would gauge more accurate IFRs than through modelling studies. We describe age- and sex-stratified IFR for COVID-19 estimated through serosurveys conducted in Chennai, India. Methods Two community-based serosurveys were conducted among individuals aged ≥10 yr during July and October 2020 in 51 of the 200 wards spread across 15 zones of Chennai. Total number of SARS-CoV-2 infections were estimated by multiplying the total population of the city aged ≥10 yr with the weighted seroprevalence and IFR was calculated by dividing the number of deaths with the estimated number of infections. Results IFR was 17.3 [95% confidence interval (CI): 14.1-21.6] and 16.6 (95% CI: 13.8-20.2) deaths/10,000 infections during July and October 2020, respectively. Individuals aged 10-19 years had the lowest IFR [first serosurvey (R1): 0.2/10,000, 95% CI: 0.2-0.3 and second serosurvey (R2): 0.2/10,000, 95% CI: 0.1-0.2], and it increased with age and was highest among individuals aged above 60 yr (R1: 140.0/10,000, 95% CI: 107.0-183.8 and R2: 111.2/10,000, 95% CI: 89.2-142.0). Interpretation & conclusions Our findings suggested that the IFR increased with age and was high among the elderly. Therefore, elderly population need to be prioritized for public health interventions including vaccination, frequent testing in long-term care facilities and old age homes, close clinical monitoring of the infected and promoting strict adherence to non-pharmaceutical interventions.
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Affiliation(s)
| | - Muthusamy Santhosh Kumar
- ICMR-School of Public Health, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Saravanakumar Velusamy
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - C P Girish Kumar
- Laboratory Division, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Sriram Selvaraju
- Division of Epidemiology, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - R Sabarinathan
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - M Jagadeesan
- Department of Health, Greater Chennai Corporation, Chennai, Tamil Nadu, India
| | - M S Hemalatha
- Department of Health, Greater Chennai Corporation, Chennai, Tamil Nadu, India
| | - Tarun Bhatnagar
- ICMR-School of Public Health, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Manoj Vasant Murhekar
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Santhosh Kumar M, Kamaraj P, Khan SA, Allam RR, Barde PV, Dwibedi B, Kanungo S, Mohan U, Sundar Mohanty S, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Kumar CPG, Sabarinathan R, Kumar VS, Karunakaran T, Jose A, Sadhukhan P, Toteja GS, Dutta S, Murhekar M. Seroprevalence of Dengue Infection Using IgG Capture ELISA in India, 2017-2018. Am J Trop Med Hyg 2021; 105:1277-1280. [PMID: 34370710 DOI: 10.4269/ajtmh.21-0386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
We conducted a nationally representative population-based survey in 60 districts from 15 Indian states covering all five geographic regions during 2017-2018 to estimate the age specific seroprevalence of dengue. Of the 12,300 sera collected, 4,955 were positive for IgG antibodies against dengue virus using IgG Indirect ELISA indicating past dengue infection. We tested 4,948 sera (seven had inadequate volume) positive for IgG antibodies on indirect ELISA using anti-dengue IgG capture ELISA to estimate the proportion of dengue infections with high antibody titers, suggestive of acute or recent secondary infection. Of the 4,948 sera tested, 529 (10.7%; 95% CI: 9.4-12.1) were seropositive on IgG capture ELISA. The proportions of dengue infections with high titers were 1.1% in the northeastern, 1.5% in the eastern, 6.2% in the western, 12.2% in the southern, and 16.7% in the northern region. The distribution of dengue infections varied across geographic regions, with a higher proportion of infections with high antibody titer in the northern and southern regions of India. The study findings could be useful for planning facilities for clinical management of dengue infections.
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Affiliation(s)
| | - P Kamaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Siraj Ahmed Khan
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip V Barde
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | - Suman Sundar Mohanty
- ICMR, National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India
| | - Subarna Roy
- ICMR-National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - C P Girish Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - V Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Karunakaran
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Annamma Jose
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Provash Sadhukhan
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR, National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Manoj Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
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Thangaraj JWV, Yadav P, Kumar CG, Shete A, Nyayanit DA, Rani DS, Kumar A, Kumar MS, Sabarinathan R, Saravana Kumar V, Jagadeesan M, Murhekar M. Predominance of delta variant among the COVID-19 vaccinated and unvaccinated individuals, India, May 2021. J Infect 2021; 84:94-118. [PMID: 34364949 PMCID: PMC8343391 DOI: 10.1016/j.jinf.2021.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 01/17/2023]
Affiliation(s)
| | - Pragya Yadav
- ICMR National Institute of Virology, Pune, Maharashtra
| | - Cp Girish Kumar
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu
| | - Anita Shete
- ICMR National Institute of Virology, Pune, Maharashtra
| | | | - D Sudha Rani
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu
| | | | | | - R Sabarinathan
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu
| | | | | | - Manoj Murhekar
- National Institute of Epidemiology, R127, TNHB, Ayapakkam, Ambattur, Chennai 600077, India.
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Shanmugasundaram D, Awasthi S, Dwibedi B, Geetha S, Jain M, Malik S, Patel B, Singh H, Tripathi S, Viswanathan R, Agarwal A, Bonu R, Jain S, Jena SK, Priyasree J, Pushpalatha K, Ali S, Biswas D, Jain A, Narang R, Madhuri S, George S, Kaduskar O, Kiruthika G, Sabarinathan R, Sapakal G, Gupta N, Murhekar MV. Burden of congenital rubella syndrome (CRS) in India based on data from cross-sectional serosurveys, 2017 and 2019-20. PLoS Negl Trop Dis 2021; 15:e0009608. [PMID: 34297716 PMCID: PMC8376255 DOI: 10.1371/journal.pntd.0009608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/19/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background India has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to <15 years and established a hospital-based sentinel surveillance for CRS. Reliable data about incidence of CRS is necessary to monitor progress towards the elimination goal. Methods We conducted serosurveys in 2019–20 among pregnant women attending antenatal clinics of 6 hospitals, which were also sentinel sites for CRS surveillance, to estimate the prevalence of IgG antibodies against rubella. We systematically sampled 1800 women attending antenatal clinics and tested their sera for IgG antibodies against rubella. We used rubella seroprevalence data from the current survey and the survey conducted in 2017 among antenatal women from another 6 CRS surveillance sites to construct a catalytic models to estimate the incidence and burden of CRS. Result The seroprevalence of rubella antibodies was 82.3% (95% CI: 80.4–84.0). Rubella seropositivity did not differ by age group and educational status. Based on the constant and age-dependent force of infection models, we estimated that the annual incidence of CRS in India was 225.58 per 100,000 live births (95% CI: 217.49–232.41) and 65.47 per 100,000 live births (95% CI: 41.60–104.16) respectively. This translated to an estimated 14,520 (95% CI: 9,225–23,100) and 50,028 (95% CI: 48,234–51,543) infants with CRS every year based on age-dependent and constant force of infection models respectively. Conclusions Our findings indicated that about one fifth of women in the reproductive age group in India were susceptible for rubella. The estimates of CRS incidence will serve as a baseline to monitor the impact of MRCV SIAs, as well progress towards the elimination goal of rubella/CRS. Rubella infection during the first trimester of pregnancy can affect fetus, resulting in spontaneous abortion, stillbirth or birth of a baby with a combination of birth defects known as congenital rubella syndrome (CRS). Vaccination with rubella containing vaccine (RCV) is recommended as one of the strategies for eliminating rubella/CRS. The Southeast Asia region has set a target to eliminate rubella/CRS by 2023. Towards this goal, India completed nationwide immunization campaigns using measles-rubella vaccine during 2017–19, targeting children aged 9 months to <15 years. A case-based surveillance for CRS was initiated in five sentinel hospitals (Phase-1) in 2016 and later expanded to additional 6 sites (Phase-2) in 2019, to estimate burden of CRS and monitor its trend. As an adjunct to CRS surveillance, periodic serologic surveys were also planned to monitor the rubella seroprevalence among the pregnant women. A serosurvey conducted in 2017 indicated that 83.4% pregnant women attending antenatal clinics of Phase-1 sentinel hospitals had IgG antibodies against rubella. The second serosurvey conducted during 2019–20 in 6 Phase-2 sites indicated a comparable seroprevalence of 82.3%. Using seroprevalence data from these two serosurveys, we estimated that the annual incidence of CRS in India was 225.58 per 100,000 live births with constant force of infection and 65.47 per 100,000 live births with age-dependent force of infection models. This incidence rates translated to an estimated 14,520 to 50,028 infants with CRS every year. The estimates of CRS incidence will serve as a baseline to monitor the progress towards the elimination goal of rubella/CRS in India.
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Affiliation(s)
| | - Shally Awasthi
- King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - S Geetha
- Govt Medical College, Thiruvananthapuram, Kerala, India
| | - Manish Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | - Shikha Malik
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bhupeshwari Patel
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | | | | | - Anjoo Agarwal
- King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Shuchi Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | | | - J Priyasree
- Govt Medical College, Thiruvananthapuram, Kerala, India
| | - K Pushpalatha
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Syed Ali
- Govt Medical College, Thiruvananthapuram, Kerala, India
| | - Debasis Biswas
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Amita Jain
- King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Narang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.,All India Institute of Medical Sciences, Bibinagar, Telangana
| | | | - Suji George
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Ojas Kaduskar
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - G Kiruthika
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - R Sabarinathan
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Gajanan Sapakal
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | | | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Murhekar MV, Bhatnagar T, Thangaraj JWV, Saravanakumar V, Kumar MS, Selvaraju S, Rade K, Kumar CPG, Sabarinathan R, Turuk A, Asthana S, Balachandar R, Bangar SD, Bansal AK, Chopra V, Das D, Deb AK, Devi KR, Dhikav V, Dwivedi GR, Khan SMS, Kumar MS, Laxmaiah A, Madhukar M, Mahapatra A, Rangaraju C, Turuk J, Yadav R, Andhalkar R, Arunraj K, Bharadwaj DK, Bharti P, Bhattacharya D, Bhat J, Chahal AS, Chakraborty D, Chaudhury A, Deval H, Dhatrak S, Dayal R, Elantamilan D, Giridharan P, Haq I, Hudda RK, Jagjeevan B, Kalliath A, Kanungo S, Krishnan NN, Kshatri JS, Kumar A, Kumar N, Kumar VGV, Lakshmi GGJN, Mehta G, Mishra NK, Mitra A, Nagbhushanam K, Nimmathota A, Nirmala AR, Pandey AK, Prasad GV, Qurieshi MA, Reddy SD, Robinson A, Sahay S, Saxena R, Sekar K, Shukla VK, Singh HB, Singh PK, Singh P, Singh R, Srinivasan N, Varma DS, Viramgami A, Wilson VC, Yadav S, Yadav S, Zaman K, Chakrabarti A, Das A, Dhaliwal RS, Dutta S, Kant R, Khan AM, Narain K, Narasimhaiah S, Padmapriyadarshini C, Pandey K, Pati S, Patil S, Rajkumar H, Ramarao T, Sharma YK, Singh S, Panda S, Reddy DCS, Bhargava B. SARS-CoV-2 seroprevalence among the general population and healthcare workers in India, December 2020-January 2021. Int J Infect Dis 2021; 108:145-155. [PMID: 34022338 PMCID: PMC8132496 DOI: 10.1016/j.ijid.2021.05.040] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Earlier serosurveys in India revealed seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of 0.73% in May-June 2020 and 7.1% in August-September 2020. A third serosurvey was conducted between December 2020 and January 2021 to estimate the seroprevalence of SARS-CoV-2 infection among the general population and healthcare workers (HCWs) in India. METHODS The third serosurvey was conducted in the same 70 districts as the first and second serosurveys. For each district, at least 400 individuals aged ≥10 years from the general population and 100 HCWs from subdistrict-level health facilities were enrolled. Serum samples from the general population were tested for the presence of immunoglobulin G (IgG) antibodies against the nucleocapsid (N) and spike (S1-RBD) proteins of SARS-CoV-2, whereas serum samples from HCWs were tested for anti-S1-RBD. Weighted seroprevalence adjusted for assay characteristics was estimated. RESULTS Of the 28,598 serum samples from the general population, 4585 (16%) had IgG antibodies against the N protein, 6647 (23.2%) had IgG antibodies against the S1-RBD protein, and 7436 (26%) had IgG antibodies against either the N protein or the S1-RBD protein. Weighted and assay-characteristic-adjusted seroprevalence against either of the antibodies was 24.1% [95% confidence interval (CI) 23.0-25.3%]. Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI 23.5-27.8%). CONCLUSIONS Nearly one in four individuals aged ≥10 years from the general population as well as HCWs in India had been exposed to SARS-CoV-2 by December 2020.
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Affiliation(s)
- Manoj V Murhekar
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu, India.
| | - Tarun Bhatnagar
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - V Saravanakumar
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Sriram Selvaraju
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Kiran Rade
- WHO Country Office for India, New Delhi, India
| | - C P Girish Kumar
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - R Sabarinathan
- ICMR National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Alka Turuk
- Indian Council of Medical Research, New Delhi, India
| | - Smita Asthana
- ICMR National Institute of Cancer Prevention and Research, NOIDA, Uttar Pradesh, India
| | - Rakesh Balachandar
- ICMR National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | | | - Avi Kumar Bansal
- ICMR National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Vishal Chopra
- State TB Training and Demonstration Centre, Patiala, Punjab, India
| | - Dasarathi Das
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Alok Kumar Deb
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Kangjam Rekha Devi
- ICMR Regional Medical Research Centre, N.E. Region, Dibrugarh, Assam, India
| | - Vikas Dhikav
- ICMR National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | | | | | - M Sunil Kumar
- State TB Training and Demonstration Centre, Thiruvananthapuram, Kerala, India
| | - Avula Laxmaiah
- ICMR National Institute of Nutrition, Hyderabad, Telangana, India
| | - Major Madhukar
- ICMR Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | | | - Chethana Rangaraju
- National Tuberculosis Institute, Bangalore and Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | | | - Rajiv Yadav
- ICMR National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Rushikesh Andhalkar
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - K Arunraj
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Pravin Bharti
- ICMR National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | | | - Jyothi Bhat
- ICMR National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | | | - Debjit Chakraborty
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Anshuman Chaudhury
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Hirawati Deval
- ICMR Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Sarang Dhatrak
- ICMR National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Rakesh Dayal
- State TB Training and Demonstration Centre, Ranchi, Jharkhand, India
| | - D Elantamilan
- ICMR National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | | | - Inaamul Haq
- Government Medical College Srinagar, Srinagar, Jammu, India
| | - Ramesh Kumar Hudda
- ICMR National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Babu Jagjeevan
- ICMR National Institute of Nutrition, Hyderabad, Telangana, India
| | - Arshad Kalliath
- State TB Training and Demonstration Centre, Thiruvananthapuram, Kerala, India
| | - Srikanta Kanungo
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | | | - Alok Kumar
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Niraj Kumar
- ICMR Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - V G Vinoth Kumar
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Ganesh Mehta
- ICMR National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Nandan Kumar Mishra
- ICMR National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Anindya Mitra
- State TB Training and Demonstration Centre, Ranchi, Jharkhand, India
| | - K Nagbhushanam
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - A R Nirmala
- National Tuberculosis Institute, Bangalore and Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | | | | | | | | | - Aby Robinson
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Seema Sahay
- ICMR National AIDS Research Institute, Pune, Maharashtra, India
| | - Rochak Saxena
- State TB Training and Demonstration Centre, Raipur, Chhattisgarh, India
| | - Krithikaa Sekar
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Hari Bhan Singh
- ICMR National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Prashant Kumar Singh
- ICMR National Institute of Cancer Prevention and Research, NOIDA, Uttar Pradesh, India
| | - Pushpendra Singh
- ICMR National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Rajeev Singh
- ICMR Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Nivetha Srinivasan
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Ankit Viramgami
- ICMR National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | | | - Surabhi Yadav
- ICMR National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Suresh Yadav
- ICMR National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Kamran Zaman
- ICMR Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Amit Chakrabarti
- ICMR National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Aparup Das
- ICMR National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - R S Dhaliwal
- ICMR National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Shanta Dutta
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Rajni Kant
- ICMR Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - A M Khan
- Indian Council of Medical Research, New Delhi, India
| | - Kanwar Narain
- ICMR Regional Medical Research Centre, N.E. Region, Dibrugarh, Assam, India
| | - Somashekar Narasimhaiah
- National Tuberculosis Institute, Bangalore and Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | | | - Krishna Pandey
- ICMR Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Shripad Patil
- ICMR National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | | | | | - Y K Sharma
- State TB Training and Demonstration Centre, Raipur, Chhattisgarh, India
| | - Shalini Singh
- ICMR National Institute of Cancer Prevention and Research, NOIDA, Uttar Pradesh, India
| | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
| | - D C S Reddy
- Independent Consultant, Lucknow, Uttar Pradesh, India
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18
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Thangaraj JWV, Kumar MS, Kumar CG, Kumar VS, Kumar NP, Bhatnagar T, Ponnaiah M, Sabarinathan R, Sudharani D, Nancy A, Jagadeesan M, Babu S, Murhekar M. Persistence of humoral immune response to SARS-CoV-2 up to 7 months post-infection: Cross-sectional study, South India, 2020-21. J Infect 2021; 83:381-412. [PMID: 34058261 PMCID: PMC8160281 DOI: 10.1016/j.jinf.2021.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - D Sudharani
- ICMR National Institute of Epidemiology, Chennai, India
| | - Arul Nancy
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, India
| | | | - Subash Babu
- ICER-ICMR-NIRT-International Center for Excellence in Research, Chennai, India
| | - Manoj Murhekar
- ICMR National Institute of Epidemiology, Chennai, India.
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19
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Kumar MS, Thangaraj JWV, Saravanakumar V, Selvaraju S, Kumar CPG, Sabarinathan R, Jagadeesan M, Hemalatha MS, Rani DS, Jeyakumar A, Sonekar HB, Rubeshkumar P, Prathiksha G, Bhatnagar T, Murhekar MV. OUP accepted manuscript. Trans R Soc Trop Med Hyg 2021. [PMCID: PMC8511806 DOI: 10.1093/trstmh/trab136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The first serosurvey conducted in Chennai, India in July 2020 reported sudden
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence of
18.4%. The aim of this study was to estimate the seroprevalence in
the month of October 2020. Methods We conducted a survey in 153 streets covering 51 wards and all 15 zones of
the city and enrolled from each street 40 individuals ≥10 y of
age. We collected 3–5 ml of venous blood and tested for
anti-nucleocapsid (N) immunoglobulin (IgG) antibodies using a SARS-CoV-2 IgG
assay. We estimated the weighted seroprevalence of SARS-CoV-2 infection and
adjusted for test characteristics. Results Of the 6366 sera tested, 2052 were positive for anti-N IgG antibodies. The
weighted seroprevalence after adjusting for test characteristics was
30.1% (95% confidence interval [CI] 24.7 to
36.1). There was wide variation in the seroprevalence between wards, ranging
from 11.0% (95% CI 5.6 to 16.4) to 48.1% (95% CI
39.5 to 56.7). Conclusions The seroprevalence of SARS-CoV-2 infection in Chennai nearly doubled between
July and October 2020.
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Affiliation(s)
| | | | - V Saravanakumar
- ICMR-National Institute of Epidemiology,
Chennai, Tamil Nadu, India
| | - Sriram Selvaraju
- ICMR-National Institute for Research in
Tuberculosis, Chennai, Tamil Nadu, India
| | - C P Girish Kumar
- ICMR-National Institute of Epidemiology,
Chennai, Tamil Nadu, India
| | - R Sabarinathan
- ICMR-National Institute of Epidemiology,
Chennai, Tamil Nadu, India
| | | | | | - D Sudha Rani
- ICMR-National Institute of Epidemiology,
Chennai, Tamil Nadu, India
| | | | | | | | - G Prathiksha
- ICMR-National Institute for Research in
Tuberculosis, Chennai, Tamil Nadu, India
| | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology,
Chennai, Tamil Nadu, India
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20
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Murhekar MV, Bhatnagar T, Selvaraju S, Rade K, Saravanakumar V, Vivian Thangaraj JW, Kumar MS, Shah N, Sabarinathan R, Turuk A, Anand PK, Asthana S, Balachandar R, Bangar SD, Bansal AK, Bhat J, Chakraborty D, Rangaraju C, Chopra V, Das D, Deb AK, Devi KR, Dwivedi GR, Salim Khan SM, Haq I, Kumar MS, Laxmaiah A, (Major) Madhukar, Mahapatra A, Mitra A, Nirmala A, Pagdhune A, Qurieshi MA, Ramarao T, Sahay S, Sharma Y, Shrinivasa MB, Shukla VK, Singh PK, Viramgami A, Wilson VC, Yadav R, Girish Kumar C, Luke HE, Ranganathan UD, Babu S, Sekar K, Yadav PD, Sapkal GN, Das A, Das P, Dutta S, Hemalatha R, Kumar A, Narain K, Narasimhaiah S, Panda S, Pati S, Patil S, Sarkar K, Singh S, Kant R, Tripathy S, Toteja G, Babu GR, Kant S, Muliyil J, Pandey RM, Sarkar S, Singh SK, Zodpey S, Gangakhedkar RR, Reddy D, Bhargava B. Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020. Indian J Med Res 2020; 152:48-60. [PMID: 32952144 PMCID: PMC7853249 DOI: 10.4103/ijmr.ijmr_3290_20] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND & OBJECTIVES Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. METHODS From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity. RESULTS Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths. INTERPRETATION & CONCLUSIONS Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.
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Affiliation(s)
| | - Tarun Bhatnagar
- ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | | | - Kiran Rade
- WHO Country Office for India, New Delhi, India
| | - V. Saravanakumar
- Division of Epidemiology & Bio-Statistics, Chennai, Tamil Nadu, India
| | | | | | | | - R. Sabarinathan
- Division of Epidemiology & Bio-Statistics, Chennai, Tamil Nadu, India
| | - Alka Turuk
- Division of Epidemiology & Communicable Diseases, All India Institute of Medical Sciences, New Delhi, India
| | | | - Smita Asthana
- Division of Epidemiology & Biostatistics, Noida, India
| | | | | | | | - Jyothi Bhat
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Debjit Chakraborty
- Division of Epidemiology, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Chethana Rangaraju
- Division of Advocacy, Communication & Social Mobilisation, Bengaluru, Karnataka, India
| | - Vishal Chopra
- State TB Training & Demonstration Centre, Patiala, Punjab, India
| | - Dasarathi Das
- ICMRRegional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Alok Kumar Deb
- Division of Epidemiology, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Kangjam Rekha Devi
- Division of Enteric Diseases, ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam, India
| | | | - S. Muhammad Salim Khan
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Inaamul Haq
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - M. Sunil Kumar
- State TB Training & Demonstration Centre Thiruvananthapuram, Kerala, India
| | - Avula Laxmaiah
- Division of Public Health Nutrition, ICMRNational Institute of Nutrition, Hyderabad, Telangana, India
| | - (Major) Madhukar
- Division of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | | | - Anindya Mitra
- State TB Training & Demonstration Centre Ranchi, Jharkhand, India
| | - A.R. Nirmala
- Lady Willingdon State TB Centre, Government of Karnataka, Bengaluru, Karnataka, India
| | | | - Mariya Amin Qurieshi
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
| | | | - Seema Sahay
- Social and Behavioural Research Sciences, Pune, Maharashtra, India
| | - Y.K. Sharma
- Directorate Health Services, Raipur, Chhattisgarh, India
| | | | | | - Prashant Kumar Singh
- Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Ankit Viramgami
- Division of Clinical Epidemiology, Ahmedabad, Gujarat, India
| | | | - Rajiv Yadav
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - C.P. Girish Kumar
- Laboratory Division, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Uma Devi Ranganathan
- Immunology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Subash Babu
- NIH-ICER (International Centers for Excellence in Research) Program, Chennai, India
| | | | | | - Gajanan N. Sapkal
- Diagnostic Virology Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Aparup Das
- ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Pradeep Das
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Puducherry, India
| | - Kanwar Narain
- ICMR-Vector Control Research Centre, Puducherry, India
| | | | - Samiran Panda
- ICMR-National AIDS Research Institute, Jabalpur, Madhya Pradesh, India
| | - Sanghamitra Pati
- ICMRRegional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Shripad Patil
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam, India
| | - Kamalesh Sarkar
- ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
| | - Shalini Singh
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Rajni Kant
- ICMR-Regional Medical Research Centre, Gorakhpur, India
| | - Srikanth Tripathy
- ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - G.S. Toteja
- ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | | | - Shashi Kant
- Centre for Community Medicine, New Delhi, India
| | - J.P. Muliyil
- Independent Consultant, Vellore, Tamil Nadu, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Swarup Sarkar
- Division of Epidemiology & Communicable Diseases, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Raman R. Gangakhedkar
- Division of Epidemiology & Communicable Diseases, All India Institute of Medical Sciences, New Delhi, India
| | - D.C.S. Reddy
- Independent Consultant, Lucknow, Uttar Pradesh, India
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21
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Murhekar MV, Santhosh Kumar M, Kamaraj P, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Girish Kumar CP, Sabarinathan R, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Hepatitis-B virus infection in India: Findings from a nationally representative serosurvey, 2017-18. Int J Infect Dis 2020; 100:455-460. [PMID: 32896662 DOI: 10.1016/j.ijid.2020.08.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION India introduced a hepatitis-B (HB) vaccine in the Universal Immunization Program in 2002-2003 on a pilot basis, expanded to ten states in 2007-2008 (phase-1), and the entire country in 2011-2012 (phase-2). We tested sera from a nationally representative serosurvey conducted duing 2017, to estimate the seroprevalence of different markers of HB infection among children aged 5-17 years in India and to assess the impact of vaccination. METHODS We tested sera from 8273 children for different markers of HB infection and estimated weighted age-group specific seroprevalence of children who were chronically infected (HBsAg and anti-HBc positive), and immune due to past infection (anti-HBc positive and HBsAg negative), and having serological evidence of HB vaccination (only anti-HBs positive). We compared the prevalence of serological markers among children born before (aged 11-17 years) and after (aged 5-10 years) introduction of HB-vaccine from phase-1 states. RESULTS Among children aged 5-8 years, 1.1% were chronic carriers, 5.3% immune due to past infection, and 23.2% vaccinated. The corresponding proportions among children aged 9-17 years were 1.1%, 8.0%, and 12.0%, respectively. In phase-1 states, children aged 5-10 years had a significantly lower prevalence of anti-HBc (4.9% vs. 7.6%, p<0.001) and higher prevalence of anti-HBs (37.7% vs. 14.7%, p<0.001) compared to children aged 11-17 years. HBsAg positivity, however, was not different in the two age groups. CONCLUSIONS Children born after the introduction of HB vaccination had a lower prevalence of past HBV infection and a higher prevalence of anti-HBs. The findings of our study could be considered as an interim assessment of the impact of the hepatitis B vaccine introduction in India.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India.
| | | | - P Kamaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Siraj Ahmed Khan
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip Barde
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR-National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - C P Girish Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Sailaja Bitragunta
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - S K Singh
- King George's Medical University, Lucknow, India
| | | | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR-Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
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22
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Joshua V, Kanagasabai K, Sabarinathan R, Ravi M, Kirubakaran BK, Ramachandran V, Shete V, Gowri AK, Murhekar MV. Space time analysis of dengue fever diagnosed through a network of laboratories in India from 2014-2017. J Vector Borne Dis 2020; 57:221-225. [PMID: 34472505 DOI: 10.4103/0972-9062.311774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES The Department of Health Research and the Indian Council of Medical Research, Government of India, have established Virus Research and Diagnostic Laboratory Network (VRDLN) to strengthen the laboratory capacity in the country for providing timely diagnosis of disease outbreaks. Fifty-one VRDLs were functional as on December 2017 and had reported about dengue fever across Indian states. The objectives of the study were to detect space time clusters and purely temporal clusters of dengue using Kulldorff's SaTScan statistics using patient level information; and to identify regions at greater risk of developing the disease using Kriging technique aggregating at district level. METHODS A total of 211,432 patients from 51 VRDLs were investigated for IgM antibodies or NS1 antigen against dengue virus during the period from 1 January 2014 to 31 December 2017 and among them 60,096 (28.4%) were found to be positive. Kulldorff's space time analysis was used to identify significant clusters over space and time. Kriging technique was used to interpolate dengue data for areas not physically sampled using the relationship in the spatial arrangement of the data set. Maps obtained using both the methods were overlaid to identify the regions at greater risk of developing the disease. RESULTS Kulldorff Space time Scan Statistics using the Bernoulli model with monthly precision revealed eight statistically significant clusters (P <0.001) for the time period, 1 January 2014 to 31 December 2017. Eight significant clusters identified were districts of Nagpur, Jhunjhunu, Gadag, Dakshin Kannada, Kancheepuram, Sivaganga, Ernakulam and Malda. The purely temporal clusters occurred during the last quarter of 2015 and 2016. The Kriging technique identified north eastern part of the country (Arunachal Pradesh, Nagaland and Manipur) and Gujarat. INTERPRETATION & CONCLUSION Dengue fever has spread in all directions in the country. Hence, it is need of the hour to perform an in-depth investigation.
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Affiliation(s)
- Vasna Joshua
- ICMR-National Institute of Epidemiology, Chennai, India
| | - K Kanagasabai
- ICMR-National Institute of Epidemiology, Chennai, India
| | | | - M Ravi
- ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | - Vishal Shete
- ICMR-National Institute of Epidemiology, Chennai, India
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23
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Murhekar MV, Ashok M, Kanagasabai K, Joshua V, Ravi M, Sabarinathan R, Kirubakaran BK, Ramachandran V, Shete V, Gupta N, Mehendale SM. Epidemiology of Hepatitis A and Hepatitis E Based on Laboratory Surveillance Data-India, 2014-2017. Am J Trop Med Hyg 2019; 99:1058-1061. [PMID: 30182922 DOI: 10.4269/ajtmh.18-0232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hepatitis A and hepatitis E viruses (HAV and HEV) are the most common etiologies of viral hepatitis in India. To better understand the epidemiology of these infections, laboratory surveillance data generated during 2014-2017, by a network of 51 virology laboratories, were analyzed. Among 24,000 patients tested for both HAV and HEV, 3,017 (12.6%) tested positive for HAV, 3,865 (16.1%) for HEV, and 320 (1.3%) for both HAV and HEV. Most (74.6%) HAV patients were aged ≤ 19 years, whereas 76.9% of HEV patients were aged ≥ 20 years. These laboratories diagnosed 12 HAV and 31 HEV clusters, highlighting the need for provision of safe drinking water and improvements in sanitation. Further expansion of the laboratory network and continued surveillance will provide data necessary for informed decision-making regarding introduction of hepatitis-A vaccine into the immunization program.
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Affiliation(s)
- Manoj V Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - M Ashok
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - K Kanagasabai
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Vasna Joshua
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - M Ravi
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - R Sabarinathan
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - B K Kirubakaran
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - V Ramachandran
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Vishal Shete
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sanjay M Mehendale
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Murhekar M, Joshua V, Kanagasabai K, Shete V, Ravi M, Ramachandran R, Sabarinathan R, Kirubakaran B, Gupta N, Mehendale S. Epidemiology of dengue fever in India, based on laboratory surveillance data, 2014–2017. Int J Infect Dis 2019; 84S:S10-S14. [DOI: 10.1016/j.ijid.2019.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 11/17/2022] Open
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Murhekar MV, Kamaraj P, Kumar MS, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Sapkal G, Kumar CPG, Sabarinathan R, Kumar VS, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Bhagat A, Srivastava R, Dinesh ER, Karunakaran T, Govindhasamy C, Rajasekar TD, Jeyakumar A, Suresh A, Augustine D, Kumar PA, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Burden of dengue infection in India, 2017: a cross-sectional population based serosurvey. Lancet Glob Health 2019; 7:e1065-e1073. [PMID: 31201130 DOI: 10.1016/s2214-109x(19)30250-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/03/2019] [Accepted: 05/01/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India. METHODS We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 districts of 15 Indian states from five geographical regions. We enumerated each cluster, randomly selected (with an Andriod application developed specifically for the survey) 25 individuals from age groups of 5-8 years, 9-17 years, and 18-45 years, and sampled a minimum of 11 individuals from each age group (all the 25 randomly selected individuals in each age group were visited in their houses and individuals who consented for the survey were included in the study). Age was the only inclusion criterion; for the purpose of enumeration, individuals residing in the household for more than 6 months were included. Sera were tested centrally by a laboratory team of scientific and technical staff for IgG antibodies against the DENV with the use of indirect ELISA. We calculated age group specific seroprevalence and constructed catalytic models to estimate force of infection. FINDINGS From June 19, 2017, to April 12, 2018, we randomly selected 17 930 individuals from three age groups. Of these, blood samples were collected and tested for 12 300 individuals (5-8 years, n=4059; 9-17 years, n=4265; 18-45 years, n=3976). The overall seroprevalence of DENV infection in India was 48·7% (95% CI 43·5-54·0), increasing from 28·3% (21·5-36·2) among children aged 5-8 years to 41·0% (32·4-50·1) among children aged 9-17 years and 56·2% (49·0-63·1) among individuals aged between 18-45 years. The seroprevalence was high in the southern (76·9% [69·1-83·2]), western (62·3% [55·3-68·8]), and northern (60·3% [49·3-70·5]) regions. The estimated number of primary DENV infections with the constant force of infection model was 12 991 357 (12 825 128-13 130 258) and for the age-dependent force of infection model was 8 655 425 (7 243 630-9 545 052) among individuals aged 5-45 years from 30 Indian states in 2017. INTERPRETATION The burden of dengue infection in India was heterogeneous, with evidence of high transmission in northern, western, and southern regions. The survey findings will be useful in making informed decisions about introduction of upcoming dengue vaccines in India. FUNDING Indian Council of Medical Research.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India.
| | - P Kamaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | - Siraj Ahmed Khan
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip Barde
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR-National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | - C P Girish Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Velusamy Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - S K Singh
- King George's Medical University, Lucknow, India
| | | | - Asha Bhagat
- ICMR-National Institute of Virology, Pune, India
| | | | - E Ramya Dinesh
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Karunakaran
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - C Govindhasamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Daniel Rajasekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A Jeyakumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A Suresh
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D Augustine
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - P Ashok Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR-Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
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Murhekar M, Kanagasabai K, Shete V, Joshua V, Ravi M, Kirubakaran BK, Ramachandran R, Sabarinathan R, Gupta N. Epidemiology of chikungunya based on laboratory surveillance data—India, 2016–2018. Trans R Soc Trop Med Hyg 2019; 113:259-262. [DOI: 10.1093/trstmh/try141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/14/2018] [Accepted: 12/14/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manoj Murhekar
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - K Kanagasabai
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - Vishal Shete
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - Vasna Joshua
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - M Ravi
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - B K Kirubakaran
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - R Ramachandran
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
| | - R Sabarinathan
- Indian Council of Medical Research–National Institute of Epidemiology, R127, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu, India
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Muliyil DE, Singh P, Jois SK, Otiv S, Suri V, Varma V, Abraham AM, Raut C, Gupta M, Singh MP, Viswanathan R, Naik S, Nag V, Benakappa A, Bavdekar A, Sapkal G, Singh K, Gupta N, Verma S, Santhanam S, Mishra S, Bhatnagar A, Prasad GRV, Kolekar J, Raj N, Sabarinathan R, Sachdeva RK, George S, Chaudhary S, Verghese VP, Jagtap V, Bharadwaj M, Murhekar M. Sero-prevalence of rubella among pregnant women in India, 2017. Vaccine 2018; 36:7909-7912. [PMID: 30448333 DOI: 10.1016/j.vaccine.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND We conducted a sero-survey among pregnant women attending antenatal clinics of six hospitals which also function as sentinel sites for CRS surveillance, to estimate the prevalence of IgG antibodies against rubella. METHODS We systematically sampled 1800 pregnant women attending antenatal clinics and tested their sera for IgG antibodies against rubella. We classified sera as seropositive (titre ≥10 IU/ml), sero-negative (titre <8 IU/ml) or indeterminate (titre 8-9.9 IU/ml) per manufacturer's instructions. In a sub-sample, we estimated the titers of IgG antibodies against rubella. IgG titer of ≥10 IU/mL was considered protective. RESULTS Of 1800 sera tested, 1502 (83.4%) were seropositive and 24 (1.3%) were indeterminate and 274 (15.2%) were sero-negative. Rubella sero-positivity did not differ by age group, educational status or place of residence. Three hundred and eighty three (87.8%) of the 436 sera had IgG concentrations ≥10 IU/mL. CONCLUSION The results of the serosurvey indicate high levels of rubella sero-positivity in pregnant women. High sero-prevalence in the absence of routine childhood immunization indicates continued transmission of rubella virus in cities where sentinel sites are located.
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Affiliation(s)
| | | | - Srinivas Krishna Jois
- Bangalore Medical College and Research Institute, Vanivilas Women and Children's Hospital, Bengaluru, Karnataka, India
| | | | - Vanita Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Chandrakant Raut
- National Institute of Virology, Bengaluru Unit, Bengaluru, India
| | | | - Mini P Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Asha Benakappa
- Indira Gandhi Institute of Child Health, Bengaluru, India
| | | | | | - Kuldeep Singh
- All India Institute of Medical Sciences, Jodhpur, India
| | | | - Sanjay Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - G R V Prasad
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naga Raj
- National Institute of Epidemiology, Chennai, India
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Murhekar M, Bavdekar A, Benakappa A, Santhanam S, Singh K, Verma S, Sapkal GN, Gupta N, Verghese VP, Viswanathan R, Abraham AM, Choudhary S, Deshpande GN, George S, Goyal G, Gupta PC, Jhamb I, John D, Philip S, Kadam S, Sachdeva RK, Kumar P, Lepcha A, Mahantesh S, Manasa S, Nehra U, Munjal SK, Nag VL, Naik S, Raj N, Ram J, Ratho R, Raut C, Rohit MK, Sabarinathan R, Shah S, Singh P, Singh MP, Tiwari A, Vaid N. Sentinel Surveillance for Congenital Rubella Syndrome - India, 2016-2017. MMWR Morb Mortal Wkly Rep 2018; 67:1012-1016. [PMID: 30212443 PMCID: PMC6146948 DOI: 10.15585/mmwr.mm6736a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mittal M, Thangaraj JWV, Rose W, Verghese VP, Kumar CPG, Mittal M, Sabarinathan R, Bondre V, Gupta N, Murhekar MV. Scrub Typhus as a Cause of Acute Encephalitis Syndrome, Gorakhpur, Uttar Pradesh, India. Emerg Infect Dis 2018; 23:1414-1416. [PMID: 28726617 PMCID: PMC5547812 DOI: 10.3201/eid2308.170025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks of acute encephalitis syndrome (AES) have been occurring in Gorakhpur Division, Uttar Pradesh, India, for several years. In 2016, we conducted a case-control study. Our findings revealed a high proportion of AES cases with Orientia tsutsugamushi IgM and IgG, indicating that scrub typhus is a cause of AES.
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Joshua V, Murhekar MV, Ashok M, Kanagasabai K, Ravi M, Sabarinathan R, Kirubakaran BK, Ramachandran V, Gupta N, Mehendale S. Mapping dengue cases through a national network of laboratories, 2014-2015. Indian J Med Res 2018; 144:938-941. [PMID: 28474634 PMCID: PMC5433290 DOI: 10.4103/ijmr.ijmr_673_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vasna Joshua
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | | | - M Ashok
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | - K Kanagasabai
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | - M Ravi
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | - R Sabarinathan
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | - B K Kirubakaran
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | - V Ramachandran
- ICMR-National Institute of Epidemiology, Chennai 600 077, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110 29, India
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Kanagasabai K, Joshua V, Ravi M, Sabarinathan R, Kirubakaran BK, Ramachandran V, Murhekar MV. Epidemiology of Japanese Encephalitis in India: Analysis of laboratory surveillance data, 2014-2017. J Infect 2017; 76:317-320. [PMID: 28970044 DOI: 10.1016/j.jinf.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Vasna Joshua
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Muthusamy Ravi
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - R Sabarinathan
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - B K Kirubakaran
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - V Ramachandran
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Manoj V Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India.
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Vivian Thangaraj JW, Mittal M, Verghese VP, Kumar CPG, Rose W, Sabarinathan R, Pandey AK, Gupta N, Murhekar M. Scrub Typhus as an Etiology of Acute Febrile Illness in Gorakhpur, Uttar Pradesh, India, 2016. Am J Trop Med Hyg 2017; 97:1313-1315. [PMID: 28820712 DOI: 10.4269/ajtmh.17-0135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Seasonal outbreaks of acute encephalitis syndrome (AES) with high mortality occur every year in Gorakhpur region of Uttar Pradesh, India. Earlier studies indicated the role of scrub typhus as the important etiology of AES in the region. AES cases were hospitalized late in the course of their illness. We established surveillance for acute febrile illness (AFI) (fever ≥ 4 days duration) in peripheral health facilities in Gorakhpur district to understand the relative contribution of scrub typhus. Of the 224 patients enrolled during the 3-month period corresponding to the peak of AES cases in the region, about one-fifth had immunoglobulin M (IgM) antibodies against Orientia tsutsugamushi. Dengue and leptospira accounted for 8% and 3% of febrile illness cases. Treating patients with AFI attending the peripheral health facilities with doxycycline could prevent development of AES and thereby reduce deaths due to AES in Gorakhpur region.
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Affiliation(s)
| | - Mahima Mittal
- Department of Pediatrics, BRD Medical College, Gorakhpur, India
| | | | | | - Winsley Rose
- Pediatric Infectious Diseases, Christian Medical College, Vellore, India
| | | | | | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Delhi, India
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Nagarajan R, Siva Balan S, Sabarinathan R, Kirti Vaishnavi M, Sekar K. Fragment Finder 2.0: a computing server to identify structurally similar fragments. J Appl Crystallogr 2012. [DOI: 10.1107/s0021889812001501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Fragment Finder 2.0is a web-based interactive computing server which can be used to retrieve structurally similar protein fragments from 25 and 90% nonredundant data sets. The computing server identifies structurally similar fragments using the protein backbone Cα angles. In addition, the identified fragments can be superimposed using either of the two structural superposition programs,STAMPandPROFIT, provided in the server. The freely available Java plug-inJmolhas been interfaced with the server for the visualization of the query and superposed fragments. The server is the updated version of a previously developed search engine and employs an in-house-developed fast pattern matching algorithm. This server can be accessed freely over the World Wide Web through the URL http://cluster.physics.iisc.ernet.in/ff/.
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Abstract
It is well known that water molecules play an indispensable role in the structure and function of biological macromolecules. The water-mediated ionic interactions between the charged residues provide stability and plasticity and in turn address the function of the protein structures. Thus, this study specifically addresses the number of possible water-mediated ionic interactions, their occurrence, distribution and nature found in 90% non-redundant protein chains. Further, it provides a statistical report of different charged residue pairs that are mediated by surface or buried water molecules to form the interactions. Also, it discusses its contributions in stabilizing various secondary structural elements of the protein. Thus, the present study shows the ubiquitous nature of the interactions that imparts plasticity and flexibility to a protein molecule.
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Affiliation(s)
- R Sabarinathan
- Bioinformatics Centre, Centre of Excellence in Structural Biology and Bio-computing, Indian Institute of Science, Bangalore 560012, India
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Salini PS, Thomas AP, Sabarinathan R, Ramakrishnan S, Sreedevi KCG, Reddy MLP, Srinivasan A. Calix[2]-m-benzo[4]phyrin with Aggregation-Induced Enhanced-Emission Characteristics: Application as a HgII Chemosensor. Chemistry 2011; 17:6598-601. [DOI: 10.1002/chem.201100046] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Indexed: 11/07/2022]
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Sabarinathan R, Banerjee N, Balakrishnan N, Sekar K. An algorithm to find distant repeats in a pair of protein sequences. Pattern Recognit Lett 2010. [DOI: 10.1016/j.patrec.2010.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sabarinathan R, Basu R, Sekar K. ProSTRIP: A method to find similar structural repeats in three-dimensional protein structures. Comput Biol Chem 2010; 34:126-30. [PMID: 20430700 DOI: 10.1016/j.compbiolchem.2010.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 12/09/2009] [Accepted: 03/26/2010] [Indexed: 11/15/2022]
Abstract
The occurrence of similar structural repeats in a protein structure has evolved through gene duplication. These repeats act as a structural building block and form more than one compact structural and functional unit called a repeat domain. The protein families comprising similar structural repeats are mainly involved in protein-protein interactions as well as binding to other ligand molecules. The identification of internal sequence repeats in the primary structure is not sufficient for the analysis of structural repeats. Thus, a new method called ProSTRIP has been developed using dynamic programming to find the similar structural repeats in a three-dimensional protein structure. The detection of these repeats is made by calculating the protein backbone Calpha angles. An internet computing server is also created by implementing this method and enables graphical visualization of the results. It can be freely accessed at http://cluster.physics.iisc.ernet.in/prostrip/.
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Affiliation(s)
- R Sabarinathan
- Bioinformatics Centre (Centre of Excellence in Structural Biology and Bio-computing), Indian Institute of Science, Bangalore 560 012, India
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Chandrashekar TK, Prabhuraja V, Gokulnath S, Sabarinathan R, Srinivasan A. Fused core-modified meso-aryl expanded porphyrins. Chem Commun (Camb) 2010; 46:5915-7. [DOI: 10.1039/c000387e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
MLDB (macromolecule ligand database) is a knowledgebase containing ligands co-crystallized with the three-dimensional structures available in the Protein Data Bank. The proposed knowledgebase serves as an open resource for the analysis and visualization of all ligands and their interactions with macromolecular structures. MLDB can be used to search ligands, and their interactions can be visualized both in text and graphical formats. MLDB will be updated at regular intervals (weekly) with automated Perl scripts. The knowledgebase is intended to serve the scientific community working in the areas of molecular and structural biology. It is available free to users around the clock and can be accessed at http://dicsoft2.physics.iisc.ernet.in/mldb/.
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