1
|
Jeyashree K, Shanmugasundaram P, Shanmugasundaram D, Priya G SL, Thangaraj JWV, Ts S, Pandey S, Ramasamy S, Sharma R, Arunachalam S, Shah V, Janagaraj V, Sundari S S, Chadwick J, Shewade HD, Chowdhury A, Iyer S, Rao R, Mattoo SK, Murhekar MV. Direct benefit transfer for nutritional support of patients with TB in India-analysis of national TB program data of 3.7 million patients, 2018-2022. BMC Public Health 2024; 24:299. [PMID: 38273246 PMCID: PMC10811802 DOI: 10.1186/s12889-024-17777-7] [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: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Patients with TB have additional nutritional requirements and thus additional costs to the household. Ni-kshay Poshan Yojana(NPY) is a Direct Benefit Transfer (DBT) scheme under the National Tuberculosis Elimination Programme(NTEP) in India which offers INR 500 monthly to all notified patients with TB for nutritional support during the period of anti-TB treatment. Five years after its implementation, we conducted the first nationwide evaluation of NPY. METHODS In our retrospective cohort study using programmatic data of patients notified with TB in nine randomly selected Indian states between 2018 and 2022, we estimated the proportion of patients who received at least one NPY instalment and the median time to receive the first instalment. We determined the factors associated (i) with non-receipt of NPY using a generalised linear model with Poisson family and log link and (ii) with time taken to receive first NPY benefit in 2022 using quantile regression at 50th percentile. RESULTS Overall, 3,712,551 patients were notified between 2018 and 2022. During this period, the proportion who received at least one NPY instalment had increased from 56.9% to 76.1%. Non-receipt was significantly higher among patients notified by private sector (aRR 2.10;2.08,2.12), reactive for HIV (aRR 1.69;1.64,1.74) and with missing/undetermined diabetic status (aRR 2.02;1.98,2.05). The median(IQR) time to receive the first instalment had reduced from 200(109,331) days in 2018 to 91(51,149) days in 2022. Patients from private sector(106.9;106.3,107.4days), those with HIV-reactive (103.7;101.8,105.7days), DRTB(104.6;102.6,106.7days) and missing/undetermined diabetic status (115.3;114,116.6days) experienced longer delays. CONCLUSIONS The coverage of NPY among patients with TB had increased and the time to receipt of benefit had halved in the past five years. Three-fourths of the patients received at least one NPY instalment, more than half of whom had waited over three months to receive the first instalment. NTEP has to focus on timely transfer of benefits to enable patients to meet their additional nutritional demands, experience treatment success and avoid catastrophic expenditure.
Collapse
Affiliation(s)
- Kathiresan Jeyashree
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India.
| | - Prema Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Devika Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sri Lakshmi Priya G
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Jeromie W V Thangaraj
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumitha Ts
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumit Pandey
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sabarinathan Ramasamy
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Rahul Sharma
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Vaibhav Shah
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Sivakami Sundari S
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Joshua Chadwick
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Hemant Deepak Shewade
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Aniket Chowdhury
- TB support network, WHO Country Office for India, New Delhi, India
| | - Swati Iyer
- TB support network, WHO Country Office for India, New Delhi, India
| | | | | | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| |
Collapse
|
2
|
Mathew A, Panwar J, Shanmugasundaram D, Thomas BP. Will preoperative combined MRI and high-resolution ultrasonography redefine brachial plexus imaging? A comparative study of preoperative MRI versus combined MRI and high-resolution ultrasonography in assessing usable C5, C6 root-stumps for intra-plexal nerve grafting. Clin Radiol 2023; 78:e1023-e1031. [PMID: 37777386 DOI: 10.1016/j.crad.2023.08.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 10/02/2023]
Abstract
AIM To compare the intraoperative findings with the preoperative imaging in detecting usable root stumps using magnetic resonance imaging (MRI) alone versus MRI combined with high-resolution ultrasonography (HRUS) in adults undergoing post-traumatic brachial plexus (BP) surgery. Further, when root stumps were present, the reliability of their measurements using both imaging methods was compared to their intraoperative length. MATERIALS AND METHODS A consecutive group of adults who were planned for post-traumatic BP surgery between July 2015 and April 2016 were evaluated prospectively. They underwent preoperative MRI and HRUS and the agreement (kappa value) between these imaging methods and their intraoperative findings in categorising roots were then compared. When stumps were present, the reliability of the extraforaminal measurements by each method were compared to their corresponding intraoperative stump length using intraclass correlation coefficients (ICC), and Bland-Altman plots. RESULTS Of the initial 60 patients, 48 patients with 82 roots were included in the study. Greater agreement was observed between HRUS and intraoperative findings in categorising BP root stumps (kappa value 0.70, SE 0.07) versus MRI and intraoperative findings (kappa value 0.42, SE 0.07). Similarly, there was a higher correlation between HRUS and intraoperative findings (ICC: 0.94, p<0.001) than that of MRI and intraoperative findings (ICC: 0.53, p<0.001) regarding stump length measurements. CONCLUSION Combining HRUS with MRI in the preoperative imaging of the adult BP injury can better predict the presence of usable nerve root stumps for intra-plexal nerve grafting. HRUS also gave reliable preoperative stump length measurements, and it was determined that a stump should be at least 1.3 cm to be deemed usable for nerve grafting.
Collapse
Affiliation(s)
- A Mathew
- Paul Brand Center for Hand Surgery, Christian Medical College, Vellore 632004, India
| | - J Panwar
- Department of Radiology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | - D Shanmugasundaram
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Epidemiology, Chennai, India
| | - B P Thomas
- Paul Brand Center for Hand Surgery, Christian Medical College, Vellore 632004, India
| |
Collapse
|
3
|
Campbell SJ, Shanmugasundaram D, Ganguly S, Sehgal R, Karmakar S, Sanga P, Stephen HN, Kaur H, Kihara J, Minnery M, Nath S, Sen S, Bundy DA, Mishra N, Batra G, Shah H, Balasubramaniam S, Dutta S, Khera A, Murhekar M. Low Prevalence of Soil-Transmitted Helminth Infections among Children in the States of Chhattisgarh and Himachal Pradesh, India, 2018. Am J Trop Med Hyg 2023; 109:820-829. [PMID: 37604473 PMCID: PMC10551095 DOI: 10.4269/ajtmh.23-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/17/2023] [Indexed: 08/23/2023] Open
Abstract
Large-scale impact assessments of soil-transmitted helminth (STH) programs are essential for determining the frequency of mass drug administration (MDA). In baseline surveys, the prevalence of STHs in the Indian States of Chhattisgarh and Himachal Pradesh was 80.2% in 2015 and 29.0% in 2016, respectively. In 2018, we estimated the prevalence and intensity of STHs after six rounds of biannual MDA in Chhattisgarh and annual MDA in Himachal Pradesh. We conducted multistage cluster sampling surveys in preschool-age children (PSAC), school-age children (SAC), and adolescent cohorts. Stool samples from 3,033 respondents (PSAC, n = 625; SAC, n = 1,363; adolescents, n = 1,045) in Chhattisgarh and 942 respondents (PSAC, n = 192; SAC, n = 388; adolescents, n = 362) in Himachal Pradesh were examined for presence of STH infection using the Kato-Katz method. The overall cluster-adjusted prevalence in Chhattisgarh was 11.6% among all age groups (95% CI, 5.6-22.4)-an 85.5% reduction in the prevalence since 2015. Prevalence was not significantly different across cohorts (PSAC, 11.0% [95% CI, 5.0-22.6]; SAC, 10.9% [95% CI, 5.2-21.6]; adolescents, 12.8% [95% CI, 6.2-24.5]). Ascaris lumbricoides was the most common helminth, with most infections of light intensity. In Himachal Pradesh, only three STH infections were detected in 2018, resulting in a cluster-adjusted prevalence of 0.3% (95% CI, 0.1-1.7)-a 99.0% reduction in prevalence since 2016. All infections were of light intensity. Both states showed substantial improvements in socioeconomic and water, sanitation, and hygiene (WASH) indicators since the baseline surveys. Extensive reductions in prevalence and intensity are linked to sustained, high deworming coverage, as well as socioeconomic WASH indicators.
Collapse
Affiliation(s)
- Suzy J. Campbell
- Deworm the World Initiative, Evidence Action, Brisbane, Australia
| | | | - Sandipan Ganguly
- Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Rakesh Sehgal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumallya Karmakar
- Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Prerna Sanga
- Model Resource Services Private Limited, Kolkata, India
| | | | - Hargobinder Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimmy Kihara
- Kenya Medical Research Institute, Kenya, South Africa
| | - Mark Minnery
- Deworm the World Initiative, Evidence Action, Brisbane, Australia
| | - Srabani Nath
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Shrabanti Sen
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Donald A. Bundy
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Neeraj Mishra
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Gunjan Batra
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Hemang Shah
- Children’s Investment Fund Foundation, New Delhi, India
| | | | - Shanta Dutta
- Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manoj Murhekar
- Indian Council of Medical Research–National Institute of Epidemiology, Chennai, India
| |
Collapse
|
4
|
Gunasekaran PK, Shanmugasundaram D, Santhanam S, Verma S, Singh K, Dwibedi B, Awasthi S, Singh H, Sangappa M, Mondal N, Sreenivasan P, Saradakutty G, Malik S, Jain M, Viswanathan R, Sapkal G, Tripathi S, Patel B, Jain MK, Naganur SH, Baranwal A, Rohit MK, Deora S, Sharma A, Anantharaj A, Pillai LS, Kumar A, Ramasamy S, Rajendran PP, Singh MP, Ratho RK, Nag V, Gadepalli R, Mishra B, Som TK, Jain A, Devara SM, Vannavada SR, Munivenkatappa A, Abraham AM, Dhodapkar R, Ali S, Biswas D, Pratkeye D, Bavdekar A, Prakash J, Ray J, Murhekar M. Profile of cardiac lesions among laboratory confirmed congenital rubella syndrome (CRS) infants: a nationwide sentinel surveillance, India, 2016-22. Lancet Reg Health Southeast Asia 2023; 16:100268. [PMID: 37662056 PMCID: PMC10474486 DOI: 10.1016/j.lansea.2023.100268] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
Background The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016-22. Methods Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness. Suspected CRS cases underwent detailed systemic examination, including echocardiography and serological investigation for rubella. Cardiac defects were categorized as 'Simple' or 'Complex' as per the National Heart, Lung, and Blood Institute classification. We compared the distribution of cardiac defects among laboratory confirmed CRS cases and seronegative discarded cases. Findings Of the 4578 suspected CRS cases enrolled by 14 sites, 558 (12.2%) were laboratory confirmed. 419 (75.1%) laboratory confirmed cases had structural heart defects (simple defects: n = 273, 65.2%, complex defects: n = 144, 34.4%), with ventricular septal defect (42.7%), atrial septal defect (39.4%), patent ductus arteriosus (36.5%), and tetralogy of Fallot as the commonest defects (4.5%). Laboratory confirmed CRS cases had higher odds of left to right shunt lesions (OR = 1.58, 95% CI: 1.15-2.17). This was mainly on account of a significant association of PDA with CRS (OR = 1.77, 95% CI: 1.42-2.21). Mortality was higher among CRS patients with complex heart defects (HR = 2.04, 95% CI: 1.26-3.30). Interpretation Three-fourths of the laboratory confirmed CRS cases had structural heart defects. CRS patients with complex cardiac defects had higher mortality. Detecting CRS infection early and providing timely intervention for cardiovascular defects is critical for the management of CRS patients. Funding Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance.
Collapse
Affiliation(s)
| | | | | | - Sanjay Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuldeep Singh
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | | | | | - Nivedita Mondal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | | | - Shikha Malik
- All India Institute of Medical Sciences, Bhopal, India
| | - Manish Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | | | | | | | | | | | | | - Arun Baranwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj K Rohit
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Akhil Sharma
- King George's Medical University, Lucknow, India
| | - Avinash Anantharaj
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | | | - Amber Kumar
- All India Institute of Medical Sciences, Bhopal, India
| | | | | | - Mini P. Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Kanta Ratho
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | - Amita Jain
- King George's Medical University, Lucknow, India
| | | | | | | | | | - Rahul Dhodapkar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Syed Ali
- Government Medical College, Trivandrum, India
| | | | | | | | - Jayant Prakash
- Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Jaydeb Ray
- Institute of Child Health, Kolkata, India
| | - Manoj Murhekar
- ICMR – National Institute of Epidemiology, Chennai, India
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Rajkumar P, Chethrapilly Purushothaman GK, Ponnaiah M, Shanmugasundaram D, Padma J, Meena RL, Vadivoo S, Mehendale SM. Low risk of relapse and deformity among leprosy patients who completed multi-drug therapy regimen from 2005 to 2010: A cohort study from four districts in South India. PLoS Negl Trop Dis 2021; 15:e0009950. [PMID: 34813598 PMCID: PMC8610257 DOI: 10.1371/journal.pntd.0009950] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Relapse of leprosy among patients released from treatment (RFT) is an indicator of the success of anti-leprosy treatment. Due to inadequate follow-up, relapse in leprosy patients after RFT is not systematically documented in India. Relapsed leprosy patients pose a risk in the transmission of leprosy bacilli. We determined the incidence of relapse and deformity among the patients RFT from the leprosy control programme in four districts in South India. Methods We conducted two follow-up surveys in 2012 and 2014 among the leprosy patients RFT between 2005 and 2010. We assessed them for any symptoms or signs of relapse, persistence and deformity. We collected slit skin samples (SSS) for smear examination. We calculated overall incidence of relapse and deformity per 1000 person-years (PY) with 95% confidence intervals (CI) and cumulative risk of relapse. Results Overall, we identified 69 relapse events, 58 and 11, during the first and second follow-up surveys, respectively. The incidence of relapse was 5.42 per 1000 PY, which declined over the years after RFT. The cumulative risk of relapse was 2.24%. The rate of deformity among the relapsed patients was 30.9%. The overall incidence of deformity was 1.65 per 1000 person years. The duration of M. leprae detection in smears ranged between 2.38 and 7.67 years. Conclusions Low relapse and deformity rates in leprosy RFT patients are indicative of treatment effectiveness. However, a higher proportion of detection of deformity among relapsed cases is a cause for concern. Periodic follow-up of RFT patients for up to 3 years to detect relapses early and ensure appropriate treatment will minimize the development of deformity among relapsed patients. India achieved leprosy elimination (<1 case/10000 population) in 2005. However, it remains a country with a high burden of leprosy (120,334 cases in 2017–18), with an annual detection of more than 10000 new cases, including children, indicating widespread active transmission. In addition to the untreated leprosy cases, even patients who relapse after release from leprosy treatment play a significant role in disease transmission. Early detection and management of leprosy relapse cases will minimize the disease transmission and might prevent leprosy-associated deformity. Leprosy management services are primarily provided by the government healthcare system in India and supported by several major non-governmental charitable organizations. The burden of leprosy relapse in India cannot be measured since there is no provision to follow-up the patients who complete multi-drug treatment (MDT) in the national leprosy program. We report the incidence of leprosy relapse among the patients who completed leprosy treatment from the national leprosy control program in four districts in South India. The report also highlights the effectiveness of MDT in program settings, the lower risk of developing deformity after treatment completion, and the need to incorporate an appropriately designed follow-up strategy.
Collapse
Affiliation(s)
- Prabu Rajkumar
- Division of Health Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
- * E-mail:
| | | | - Manickam Ponnaiah
- Division of Online Courses, ICMR-National Institute of Epidemiology, Chennai, India
| | - Devika Shanmugasundaram
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, India
| | - Jayasree Padma
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, India
| | - Rang Lal Meena
- Laboratory Division, ICMR-National Institute of Epidemiology, Chennai, India
| | - Selvaraj Vadivoo
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, India
| | - Sanjay M. Mehendale
- Division of Epidemiology and Biostatistics, ICMR-National Institute of Epidemiology, Chennai, India
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Gupta PC, Kumar-M P, Ram J, Verma S, Sachdeva RK, Singh K, Bavdekar A, Shah S, Sangappa M, Murthy KR, Santhanam S, John D, Shanmugasundaram D, Sabrinathan R, Murhekar M. Prediction of probability of rubella based on eye outcomes (PORBEO Nomogram)-a cross-sectional sentinel surveillance of 1134 infants. Graefes Arch Clin Exp Ophthalmol 2020; 259:1333-1342. [PMID: 33119803 DOI: 10.1007/s00417-020-04973-5] [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] [Received: 05/12/2020] [Revised: 09/09/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Rubella is an important infectious, vaccine-preventable etiology of congenital defects. The aim of the study was to develop a prediction nomogram to assess the probability of an infant being at risk for congenital rubella based on demographics and ophthalmological findings. METHODS This was a cross-sectional sentinel surveillance study conducted at 5 centers spanning pan-India and involved 1134 infants. The diagnosis of rubella was made using standard guidelines. For the construction of the prediction model, laboratory-confirmed cases were grouped as "at-risk" (AR) infants and the discarded cases into "not at risk" (NAR) infants. Univariate analysis (p value cut-off < 0.05) followed by multivariate binary logistic regression model development was performed. RESULTS The average (median) age of the suspected CRS infants was 3 (IQR 1-6) months, and the average (mean) age of their mothers was 25.8 ± 4.1 years. Out of the total infants, 81 (7.3%) died, 975 (88%) were alive, and 55 (5.0%) were lost to follow-up. The final model showed that the odds of cataract, retinopathy, glaucoma, microcornea, and age of the infant at presentation were 3.1 (2.2-4.3), 4.9(2.3-10.4), 2.7(1.1-5.9), 2.3(1.1-4.7), and 1.1 (1-1.1), respectively, for the AR infant as compared to NAR infant. AUC of final model was 0.68 (95% CI Delong, 0.64-0.72). Bootstrapping for calibration of the model showed satisfactory results. Nomogram, along with a web version, was developed. CONCLUSION The developed nomogram would have a wide community-based utilization and will help in prioritizing attention to high-risk children, thereby avoiding loss to follow-up.
Collapse
Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Sanjay Verma
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ravinder Kaur Sachdeva
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Science (AIIMS), Jodhpur, Rajasthan, India
| | - Ashish Bavdekar
- Department of Pediatrics, KEM Hospital, Pune, Maharashtra, India
| | - Sanjay Shah
- Department of Ophthalmology, KEM Hospital, Pune, Maharashtra, India
| | - Mahantesh Sangappa
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Krishna R Murthy
- Department of Ophthalmology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Deepa John
- Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - R Sabrinathan
- National Institute of Epidemiology, ICMR, Chennai, Tamil Nadu, India
| | - Manoj Murhekar
- National Institute of Epidemiology, ICMR, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
Jeyashree K, Shanmugasundaram D, Rade K, Gangakhedkar RR, Murhekar MV. Impact and operational feasibility of TrueNat ™ MTB/Rif under India's RNTCP. Public Health Action 2020; 10:87-91. [PMID: 33134121 PMCID: PMC7577004 DOI: 10.5588/pha.20.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Revised National Tuberculosis Control Programme (RNTCP) in Andhra Pradesh, India, introduced TrueNat™ MTB/Rif, a rapid molecular test for detecting Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance at 193 TB units (TUs) in October 2018. We evaluated its impact on TB diagnosis and assessed the operational feasibility of its deployment at point-of-care (POC) settings. METHODS We compared the number of presumptive TB cases tested and the number (proportion) of microbiologically positive before (January-August 2018) and after (January-August 2019) the deployment of TrueNat. We interviewed laboratory technicians and Senior TB Laboratory Supervisor from 25 randomly selected TUs to assess operational feasibility. RESULTS In 2018, 10.5% (range 8.9-13.1) of 245,989 presumptive cases tested were positive. In 2019, of the 185,435 presumptive cases tested, 13.7% (range 9.6-18.9) were positive. The proportion of presumptive TB cases in whom MTB was detected using TrueNat was 14.4% (range 10.0-21.2). TrueNat significantly increased case detection (incidence rate ratio [IRR] 1.30; 95%CI 1.15-1.46), yielding an additional 18 TB cases per 100 000 population. Laboratory technicians became comfortable in performing TrueNat after a median of 10 tests (interquartile range 5-17.5). Invalid reports declined from 6.8% to 3.6%. CONCLUSION The deployment of TrueNat as POC diagnostic test improved case detection and was operationally feasible under RNTCP.
Collapse
Affiliation(s)
- K Jeyashree
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D Shanmugasundaram
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - K Rade
- World Health Organization India Country Office, New Delhi, India
| | | | - M V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| |
Collapse
|
10
|
De S, Shanmugasundaram D, Singh S, Banerjee N, Soni KK, Galgalekar R. Chronic respiratory morbidity in the Bhopal gas disaster cohorts: a time-trend analysis of cross-sectional data (1986-2016). Public Health 2020; 186:20-27. [PMID: 32750505 DOI: 10.1016/j.puhe.2020.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In 1984, nearly 500,000 inhabitants of Bhopal city, India, were exposed to toxic gases that leaked from a nearby pesticide manufacturing plant. In 1985, four cohorts were established to assess the long-term health impact of exposure, namely, mild, moderate, severely exposed and unexposed groups. The self-reported morbidity data of these cohorts were collected by follow-up cross-sectional surveys at regular intervals over the last 35 years. The present study aimed to analyse the long-term trend of chronic (duration of symptoms >3 months) respiratory morbidity in the four cohorts, stratified by age groups. STUDY DESIGN The design of this study is a longitudinal analysis of cross-sectional respiratory morbidity data. METHODS Chronic respiratory morbidity data within the cohorts were analysed at 5-year intervals (first recorded data from 1986). Based on age at the time of exposure, subjects were stratified into four age groups: children (aged <10 years), teenagers (aged ≥10 to <20 years), younger adults (aged ≥20 to <40 years) and older adults (aged ≥40 years). RESULTS During the first decade, after exposure to the toxic gases, chronic respiratory morbidity in children and teenagers was high (up to 9.1%), which declined thereafter. Progressively increasing chronic respiratory morbidity was observed in both the younger and older adult age groups within all cohorts during the initial 5-10 years after exposure. Respiratory morbidity in both the younger and older adult age groups remained high for 15-20 years and thereafter recorded a declining trend. The highest respiratory morbidity observed during this study in the younger and older adult age groups was 38.6% and 59.5%, respectively; these values were both recorded in the severely exposed cohort. CONCLUSIONS Exposure to toxic gases released during the Bhopal gas disaster has resulted in chronic respiratory morbidity of the exposed population; this morbidity has continued over decades. The age of the individuals at the time of exposure and exposure severity were crucial determinants of the long-term trend of respiratory morbidity.
Collapse
Affiliation(s)
- S De
- Department of Pulmonary Medicine, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India.
| | - D Shanmugasundaram
- Department of Epidemiology, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - S Singh
- Department of Epidemiology, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - N Banerjee
- Department of Epidemiology, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - K K Soni
- Department of Epidemiology, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - R Galgalekar
- Department of Epidemiology, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| |
Collapse
|
11
|
De S, Kushwah GDS, Dharwey D, Shanmugasundaram D. Respiratory Morbidity of Roadside Shopkeepers Exposed to Traffic-related Air Pollution in Bhopal, India. J Health Pollut 2019; 9:190305. [PMID: 30931165 PMCID: PMC6421956 DOI: 10.5696/2156-9614-9.21.190305] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/25/2019] [Indexed: 04/18/2023]
Abstract
BACKGROUND Traffic-related air pollution (TRAP) is a major source of ambient air pollution in urban areas. Shopkeepers of heavily trafficked roadside shops are persistently exposed to high levels of TRAP. OBJECTIVES To estimate the prevalence of respiratory morbidity in shopkeepers of shops in heavily trafficked roadside areas in Bhopal city (India) and to determine any association with long term exposure to TRAP. METHODS This cross-sectional study was conducted among 251 shopkeepers working in roadside shops of three major traffic corridors in Bhopal city. The demographic profile and prevalence of respiratory morbidity were collected by administering a validated questionnaire. The total exposure period (TEP) to TRAP was calculated for each individual by multiplying their work duration (in years) and average working hours per day. Odds ratios were calculated to estimate the association of TEP with respiratory morbidity. RESULTS The age of the study population was 44.8±13.5 years old and 95% were male. Nearly 55% of the shopkeepers reported at least one respiratory symptom. The prevalence of bronchial asthma, chronic bronchitis, breathlessness, and cough was 3.6% (95% confidence interval (CI): 1.9-6.7), 13.9% (95% CI: 10.2-18.8), 41.8% (95% CI: 35.9-48.0), and 18.3% (95% CI: 14.0-23.6), respectively. The adjusted risk ratios of bronchial asthma 2.17 (95% CI: 0.35-13.41), chronic bronchitis 1.42 (95% CI: 0.58-3.48), breathlessness 1.71 (95% CI: 0.94-3.11), and cough 0.97 (95% CI: 0.47-2.03) for those with a TEP over 100. CONCLUSIONS Shopkeepers working in heavily trafficked roadside shops suffer from respiratory morbidity and the risk increases with higher TEP. Total exposure period is a valuable indicator to estimate the effects of long-term TRAP exposure. INFORMED CONSENT Obtained. ETHICS APPROVAL The study was approved by the Institutional Ethics Committee of the National Institute for Research in Environmental Health (Bhopal, India). COMPETING INTERESTS The authors declare no competing financial interests.
Collapse
Affiliation(s)
- Sajal De
- Department of Pulmonary Medicine, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - Gagan Deep Singh Kushwah
- Department of Pulmonary Medicine, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - Dharmendra Dharwey
- Department of Pulmonary Medicine, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| | - Devika Shanmugasundaram
- Department of Epidemiology, National Institute for Research in Environmental Health, Kamla Nehru Hospital Building, Gandhi Medical College Campus, Bhopal, India
| |
Collapse
|
12
|
Jayaraman R, Varghese R, Kumar JL, Neeravi A, Shanmugasundaram D, Ralph R, Thomas K, Veeraraghavan B. Invasive pneumococcal disease in Indian adults: 11 years' experience. J Microbiol Immunol Infect 2018; 52:736-742. [PMID: 29884448 DOI: 10.1016/j.jmii.2018.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the epidemiology of invasive pneumococcal disease (IPD), prevalent serotypes, and pattern of antimicrobial resistance (AMR) in Indian adults. METHODS Prospective laboratory based surveillance of IPD was carried out in >18 years age group between January 2007 and July 2017, from a tertiary care hospital in South India. All Streptococcus pneumoniae culture positives from blood, CSF and sterile body fluids were characterized to identify the serotypes and AMR. RESULTS A total of 408 IPD cases were characterized in this study. The overall case fatality rate in this study was 17.8% (95% confidence interval (CI): 14.1, 22.4). Pneumonia (39%), meningitis (24.3%), and septicaemia (18.4%) were the most common clinical conditions associated with IPD. Serotypes 1, 3, 5, 19F, 8, 14, 23F, 4, 19A and 6B were the predominant serotypes in this study. Penicillin non-susceptibility was low with 6.4% CONCLUSION: Serotype data from this study helped in accurate estimation of pneumococcal conjugate vaccine-13 and pneumococcal polysaccharide vaccine-23 protective coverage against serotypes causing IPD in India as 58.7% (95% CI: 53.8, 63.4) and 67.4% (95% CI: 62.7, 71.8) respectively. Penicillin non-susceptibility in meningeal IPD cases is 27.4%. Empirical therapy for meningeal IPD must be cephalosporin in combination with vancomycin since cefotaxime non-susceptibility in meningeal IPD is 9.9.
Collapse
Affiliation(s)
- Ranjith Jayaraman
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Rosemol Varghese
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Jones Lionel Kumar
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Ayyanraj Neeravi
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| | - Devika Shanmugasundaram
- Department of Biostatistics, National Institute for Research in Environmental Health (ICMR), Bhopal 462001, India.
| | - Ravikar Ralph
- Department of General Medicine, Christian Medical College and Hospital, Vellore 632004, India.
| | - Kurien Thomas
- Department of General Medicine, Christian Medical College and Hospital, Vellore 632004, India.
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India.
| |
Collapse
|
13
|
Gulwani H, Shukla P, Kaur S, Shanmugasundaram D. Reappraisal of morphological and immunohistochemical spectrum of intracranial and spinal solitary fibrous tumors/hemangiopericytomas with impact on long-term follow-up. Indian J Cancer 2018; 55:214-221. [DOI: 10.4103/ijc.ijc_631_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Barman A, Shanmugasundaram D, Bhide R, Viswanathan A, Magimairaj HP, Nagarajan G, Arumugam E, Tharion G, Thomas R. Survival in Persons With Traumatic Spinal Cord Injury Receiving Structured Follow-Up in South India. Arch Phys Med Rehabil 2014; 95:642-8. [DOI: 10.1016/j.apmr.2013.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 11/09/2013] [Accepted: 11/11/2013] [Indexed: 11/28/2022]
|
15
|
Ramakrishna K, Sampath S, Chacko J, Chacko B, Narahari DL, Veerendra HH, Moorthy M, Krishna B, Chekuri V, Raju RK, Shanmugasundaram D, Pichamuthu K, Abraham AM, Abraham O, Thomas K, Mathews P, Varghese GM, Rupali P, Peter JV. Clinical Profile and Predictors of Mortality of Severe Pandemic (H1N1) 2009 Virus Infection Needing Intensive Care: A Multi-Centre Prospective Study from South India. J Glob Infect Dis 2012; 4:145-52. [PMID: 23055645 PMCID: PMC3459431 DOI: 10.4103/0974-777x.100569] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This multi-center study from India details the profile and outcomes of patients admitted to the intensive care unit (ICU) with pandemic Influenza A (H1N1) 2009 virus [P(H1N1)2009v] infection. MATERIALS AND METHODS Over 4 months, adult patients diagnosed to have P(H1N1)2009v infection by real-time RT-PCR of respiratory specimens and requiring ICU admission were followed up until death or hospital discharge. Sequential organ failure assessment (SOFA) scores were calculated daily. RESULTS Of the 1902 patients screened, 464 (24.4%) tested positive for P(H1N1)2009v; 106 (22.8%) patients aged 35±11.9 (mean±SD) years required ICU admission 5.8±2.7 days after onset of illness. Common symptoms were fever (96.2%), cough (88.7%), and breathlessness (85.9%). The admission APACHE-II and SOFA scores were 14.4±6.5 and 5.5±3.1, respectively. Ninety-six (90.6%) patients required ventilation for 10.1±7.5 days. Of these, 34/96 (35.4%) were non-invasively ventilated; 16/34 were weaned successfully whilst 18/34 required intubation. Sixteen patients (15.1%) needed dialysis. The duration of hospitalization was 14.0±8.0 days. Hospital mortality was 49%. Mortality in pregnant/puerperal women was 52.6% (10/19). Patients requiring invasive ventilation at admission had a higher mortality than those managed with non-invasive ventilation and those not requiring ventilation (44/62 vs. 8/44, P<0.001). Need for dialysis was independently associated with mortality (P=0.019). Although admission APACHE-II and SOFA scores were significantly (P<0.02) higher in non-survivors compared with survivors on univariate analysis, individually, neither were predictive on multivariate analysis. CONCLUSIONS In our setting, a high mortality was observed in patients admitted to ICU with severe P(H1N1)2009v infection. The need for invasive ventilation and dialysis were associated with a poor outcome.
Collapse
Affiliation(s)
- Kartik Ramakrishna
- Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
|