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Yadav RM, Gomare M, Gaikwad A, Waghmare U, Betodkar U, Vashi MD, Kamal VK, Thangaraj JWV, Bangar S, Bhatnagar T, Murhekar M. Interplay of missed opportunity for vaccination and poor response to the vaccine led to measles outbreak in a slum area of Eastern Mumbai, India. Epidemiol Infect 2024; 152:e56. [PMID: 38497493 PMCID: PMC11022250 DOI: 10.1017/s0950268824000426] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
In the third week of September 2022, an outbreak of measles was reported from a slum in Eastern Mumbai, India. We sought to investigate whether failure to vaccinate or vaccine failure was the cause. We constructed an epidemic curve, drew a spot map, and calculated the attack rate and case-fatality ratio. We calculated vaccine effectiveness (VE) for one and two doses of measles vaccine in an unmatched case-control study and did stratified analysis by sex, availability of vaccination card, and migrant status. We identified 358 cases and four deaths with a 11.3% attack rate and 1.1% case fatality, both being highest among 0-24-month-old boys. The epidemic curve suggested a propagated mode of spread. The VE for two doses was 64% (95% confidence interval (CI): 23-73%) among under-5-year-old children and 70% (95% CI: 28-88%) among 5-15-year-old children. Failure to vaccinate, consequent to the COVID-19 pandemic, and vaccine hesitancy might have led to the accumulation of susceptible children in the community. Additionally, the occurrence of case-patients among vaccinated suggests reduced VE, which needs further investigation into humoral and cell-mediated immunity as well as contributory factors including nutritional status. Outbreak response immunization to complete immunization of missed and dropout children was carried out to control the outbreak.
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Affiliation(s)
- Reetika Malik Yadav
- ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, India
- Department of Pediatric Immunology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Mangala Gomare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Arun Gaikwad
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Upalimitra Waghmare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Utkarsh Betodkar
- ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Vineet Kumar Kamal
- ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Sampada Bangar
- Division of Epidemiology and Statistics, ICMR-National AIDS Research Institute, Pune, India
| | - Tarun Bhatnagar
- ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, India
| | - Manoj Murhekar
- ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, India
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Daniels B, Shah D, Kwan AT, Das R, Das V, Puri V, Tipre P, Waghmare U, Gomare M, Keskar P, Das J, Pai M. Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India. BMJ Glob Health 2022; 7:bmjgh-2022-009657. [PMID: 36261230 PMCID: PMC9582305 DOI: 10.1136/bmjgh-2022-009657] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3). CONCLUSIONS While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.
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Affiliation(s)
- Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Daksha Shah
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Ada T Kwan
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Varsha Puri
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Pranita Tipre
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Upalimitra Waghmare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Mangala Gomare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Padmaja Keskar
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Québec, Canada
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Wang J, Scholl A, Zheng H, Ogale SB, Viehland D, Schlom DG, Spaldin NA, Rabe KM, Wuttig M, Mohaddes L, Neaton J, Waghmare U, Zhao T, Ramesh R. Response to Comment on "Epitaxial BiFeO
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Multiferroic Thin Film Heterostructures". Science 2005. [DOI: 10.1126/science.1103959] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- J. Wang
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742, USA
| | - A. Scholl
- Advanced Light Source, Lawrence Berkeley Laboratory, Berkeley CA, 94720, USA
| | - H. Zheng
- Department of Materials Science and Engineering, University of Maryland, College Park
| | - S. B. Ogale
- Department of Physics, University of Maryland, College Park
| | - D. Viehland
- Department of Materials Science and Engineering, Virginia Polytechnic Institute, Blacksburg, VA 24061, USA
| | - D. G. Schlom
- Department of Materials Science and Engineering, Pennsylvania State University, University Park, PA 16802–5055, USA
| | - N. A. Spaldin
- Materials Department, University of California, Santa Barbara, CA 93106–5050, USA
| | - K. M. Rabe
- Department of Physics and Astronomy, Rutgers University, Piscataway, NJ 08854, USA
| | - M. Wuttig
- Department of Materials Science and Engineering, University of Maryland, College Park
| | - L. Mohaddes
- Department of Materials Science and Engineering and Department of Physics, University of California, Berkeley, CA 94720
| | - J. Neaton
- Department of Materials Science and Engineering and Department of Physics, University of California, Berkeley
| | | | - T. Zhao
- Department of Materials Science and Engineering and Department of Physics, University of California, Berkeley
| | - R. Ramesh
- Department of Materials Science and Engineering and Department of Physics, University of California, Berkeley
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