Malaria situation in India with special reference to tribal areas.

Background & objectives: In India, malaria is a major public health problem in states having predominantly tribal population. The objective of this analysis was to find out the incidence of malaria in various states/districts having varied proportions of tribal population using National Vector Borne Disease Control Programme (NVBDCP) data. Methods: States and districts were classified into three categories based on proportions of Scheduled Tribes (ST) population as <10, 10-29.9 and 30 per cent + ST population. Five year average (2008-2012) of all important malaria indicators collected by NVBDCP was taken to normalize the effect of annual fluctuations in malaria incidence. Results: State level analysis revealed that ten states/UTs with 30 per cent or more tribal population comprising only three per cent of total population, contributed 14 per cent of total malaria, 21 per cent Plasmodium falciparum and 29 per cent of deaths due to malaria. Similarly, district level analysis showed that districts with 30 per cent or more tribal population comprising about eight per cent country’s population contributed to 46 per cent of total malaria cases, 70 per cent P. falciparum and 47 per cent malarial deaths in the country. Interpretation & conclusions: our analysis showed that the neglect of the ethnic communities in tribal areas would be detrimental to the overall reduction of morbidity and mortality due to malaria. The fight against the increasing burden of malaria in tribal belt requires adoption of multiple approaches and socio-economic development of the tribal communities.

Media Scanning as a Supplemntal tool to Disease Outbreak Reporting und)er IDSP-IndiaAn event based surveillance Project (IDSP).

Media scanning & verification cell (MSVC) was established on 24th July 2008 under IDSP at National Centre for Disease Control (NCDC), Delhi for providing supplemental information on early detection of outbreaks in India so that a timely and an appropriate action can be taken. Since then the system is working efficiently and has detected many outbreaks before the conventional system in their incipient stages and helped in their containments at early stages. Media scanning & verification cell is an “Early Warning System” (EWS) that gathers preliminary reports of public health significance on a real time basis and immediately disseminate the information to the users electronically for verification. This unique system monitors Global and National Media sources such as National and Regional print media, news on internet, websites, news channels and news shared by partners like Global Public Health Intelligence Network (GPHIN), Canada, WHO and other International and national agencies. Media scanning & verification cell is managed by trained Epidemiologists and Public Health Consultants working in Central Surveillance Unit of IDSP. The major part of work is manual with two rounds of screening by experts that fulfills issues regarding quality assurance.

Study on The Eco-epidemiology of Chikungunya in U T of Lakshadweep.

An unusual increase in the incidence of viral fever was noticed in Androth and Kalpeni Island, U.T of Lakshadweep during November 2006. The Ecoepidemiology of the disease was studied in detail. The study indicated that Aedes albopictus is the predominant species (98.74%) and it exhibited a wide spectrum of breeding preferences with a clear-cut predilection for rat-damaged coconuts (RDCs). All the entomological indices were very high in both the Islands with a marked increase in Kalpeni Island. The clinical presentation of the cases was typical of chikungunya and the laboratory study confirmed this. Based on the investigation, control and preventive measures were planned, advised and implemented. The details regarding the bio-ecology of vectors, clinical presentation, laboratory investigations and effectiveness of control measures are discussed.

Status of Lymphatic Filariasis in Lucknow District, Uttar Pradesh.

Lucknow district was endemic for lymphatic filariasis (LF). During March 2008, LF survey was carried out in 14 randomly selected villages (six Primary Health Centres) and 4 Mohallas of Lucknow city. Out of 3,654 night blood smears (NBS) collected and examined, 209 were found positive for Wuchereria bancrofti (micrifilaria rate: 5.7%). Microfilaria (mf) carriers were detected from all surveyed villages and Mohallas. The age of these positive persons ranged from 6-70 years. In all areas, prevalence of microfilaraemia generally increased with age up to 21- 30 years. Males (6.7%) were more affected than females (3.9%). All mf carriers were residents of Lucknow district. Overall disease rate was 4.7%. In all, 175 individuals had disease manifestations of LF. Out of 108 males, 81 had hydrocele(75%). Disease rate was similar in males (4.7%) and females (4.8%). The mean mf density was 9.5 per 20 cmm blood, but no significant difference between males (9.4) and females (9.9). Vector density ranged from 150 to 810 per ten-man-hours. Infectivity and infection rates were 0.14%. The present survey indicates that filariasis is one of the major public health problems in surveyed areas.

A rare case of trypanosomiasis in a two month old infant in Mumbai, India.

Human Trypanosomiasis is a rare occurrence in India. In the cases reported so far the disease causative species have been the species infective to animals viz., Trypanosoma lewisi and Trypanosoma evansi. These animal species usually non pathogenic in humans can acquire the desired virulence and emerge as human pathogens causing serious disease, in the right combination of environmental, host related and organism related factors. We report here a case of trypanosomiasis caused by the rodent parasite T. lewisi in a two months old infant in urban Mumbai. Under the fastly changing environmental scenario there is an urgent need to be prepared for the emerging zoonoses. Any unusual disease occurrence in a given geographical area acquires a special significance in this context and should be reported to assess its public health importance and be prepared to deal with the consequent challenges posed, if any.

Evaluation of Og4C3 antigen ELISA as a tool for detection of bancroftian filariasis under lymphatic filariasis elimination programme.

Diagnosis of Lymphatic Filariasis by microscopic examination of thick blood films (TBF) collected between 8.30 pm to 12 midnight, though highly specific is operationally problematic. We evaluated the TropBio Og4C3 serum ELISA as a tool for detection of W. bancrofti microfilaria carriers using Dried Blood Spots (DBS). The study was carried out in two parts (i) to test the sensitivity and specificity of the ELISA test for detection of circulating filarial antigen (CFA) in microfilaria (Mf) carriers vis-à-vis the conventional thick blood film (TBF) microscopy and its persistence in different categories of individuals during the course of disease viz., Endemic normals (n=51), microfilaria (Mf) carriers (n=27), acute cases (n=27), chronic cases (n=50) and a control group of non-endemic normals (n=48) using sera samples and ii) to study the utility of finger prick Dried Blood Spots (DBS) collected on filter paper for detection of Mf carriers and its comparison with another antigen detection assay, the Immunochromatographic test (ICT).Considering the non-endemic normals and microfilaria carriers, the ELISA test was found to have 100% sensitivity and 94.12% specificity for detection of Mf carriers in sera samples. The CFA was absent in majority of the subjects tested under other categories with a positivity of 7.8% among endemic normals, 11.12% among acute cases, 7.84% among chronic cases and 6.25% among nonendemic normals. Comparison of finger prick DBS and sera samples by ELISA vis-à-vis the ICT, carried out on Mf carriers (n=91) and endemic normals (n=97), showed a positivity of 88 (96.7%) in DBS as against 86 (94.5%) in sera samples and 88 (96.7%) by ICT, amongst Mf carriers, with a statistically significant correlation in antigen units between sera and DBS samples (r = 0.959, p = 0.000) amongst the microfilaria carriers. Out of 97 endemic normals, 19 (19.6%) sera and 17 (17.5%) DBS samples tested positive by ELISA while as 12(12.4%) tested positive by ICT, again with a statistically significant correlation between the antigen units in sera and DBS samples (r = 0.942, p = 0.000). DBS prepared from 25 microl of blood were found to be as sensitive as 50 microl for antigen detection. Antigen positivity detected from DBS collected during day and night from known microfilaria carriers (n=27) showed a statistically insignificant difference (p = 0.125) and a significant correlation in antigen units (r = 0.820 and p = 0.013).In view of the comparable results of ELISA, ICT and TBF microscopy, it is concluded that the TropBio Og4C3 ELISA using finger prick DBS can be used as an alternate to TBF microscopy for detection of bancroftian Filariasis under the LFE programme.

Study on the factors affecting the MDA programme in Kerala state.

The Mass Annual Single dose DEC administration (MDA) was initiated in India from 1997. In Kerala MDA was studied as a pilot project in Alappuzha and Kozhikode District from 2000-04 and the first round of MDA was launched in Kerala covering eleven endemic districts, in March 2005. On evaluation, the drug distribution coverage, compliance, etc. were found to be not satisfactory and a need to elicit the factors for poor performance of MDA is felt essential. The main reasons for poor performance of MDA in Kerala state were the lack of adequate prior information to the target population regarding the importance LF elimination programme and inadequate awareness. The fear of side reactions, antipropagonda, poor IEC activities repeated postponement of programme, insufficient time for mobilisation etc. were the other reasons for poor compliance. The purpose of the present study was to bring the observations to the notice of the authorities so that appropriate remedial measures are incorporated.

Mass drug administration against lymphatic filariasis: experiences from Kozhikode district of Kerala State.

The mass DEC drug administration to eliminate lymphatic filariasis in Kozhikode district was monitored from 2001 to 2003 to assess the drug distribution coverage, compliance, reasons for non-compliance, side reactions, mf prevalence and intensity, infection and infectivity rates in the vector. The drug distribution coverage and compliance were much below the required level. "No disease so not necessary" (42.5%) and "fear of side reactions" (25.2%) were the two major reasons for non-compliance. The adverse reactions were minimal. No appreciable changes were found in the mf prevalence and intensity. For the successful implementation of the MDA programme, proper planning, intense and timely efforts to motivate the community and innovative drug delivery strategies are required.

Lymphatic filariasis in rural areas of Patna District, Bihar. A challenge ahead.

Patna district was endemic for lymphatic filariasis (LF). During November 2004, a lymphatic filariasis survey was carried out in seven randomly selected villages from four PHCs of Patna district. Of 1878 night blood smears (NBS) examined, 117 were found positive for W. bancrofti infection (mf rate 6.2%). Microfilaria carriers were detected from all surveyed villages. In all areas prevalence of microfilaria generally increased with age to maximum 15-34 years and then decline within most age-groups. More males (6.4%) were affected than the females (5.8%). All microfilaria (mf) carriers were residents of Patna district. Over all disease rate was 9.1%. Out of 171 diseased individuals, 121 persons were having hydrocele (6.4%). Disease rate was higher in males (12.0%) than females (4.1%). The mean mf density was 11.7. There was no significant difference of mean mf density in males and females. Vector density ranged from 205 to 780 per ten man hours. The survey indicates that the filariasis situation remained unchanged since last fifty years and still is one of the major public health problem in surveyed areas.

Decline of brugian filariasis in Cherthala taluk, Alappuzha district, Kerala.

A total of 4492 persons from 5 panchayats and 1 town were investigated from the Brugia malayi most endemic taluk of Cherthala, Alappuzha district of Kerala state. The urban area in Cherthala taluk only revealed mf carriers; mf rate was 0.13%. Rural areas in Cherthala taluk were free from infection. Microfilaria rate had declined by 99.5% and disease rate by 90.7% in Cherthala compared to 1934 prevalence. Shedding of sheath by B. malayi microfilariae was recorded for the first time in India. The youngest person with microfilaria and disease manifestation was 4 1/2 and 9 years respectively. All the 3 major vectors, Mansonia annulifera, Ma.uniformis and Culex quinquefasciatus were prevalent throughout. Complete disappearance of brugian filariasis from this taluk is a distinct possibility. The reasons for the drastic decline are discussed.

Lymphatic filariasis in Bilaspur district, Chhattisgarh.

As per earlier reports only Ratanpur PHC of the district Bilaspur of Chattisgarh was endemic for filariasis. During the present survey microfilaria infection and disease manifestations were detected in two more PHCs namely Bilha and Bilaspur. 3426 Night blood smears were collected from 24 randomly selected localities (13 rural and 11 urban) covering 25% known endemic areas and 75% reportedly non-endemic areas. Sample size was calculated taking 12% prevalence rate using standard statistical formula. Sixty-two indigenous residents (mf rate 1.80%) were found positive for W. bancrofti infection. Males (2.17%) were more affected than females (1.19%). The mf carriers were 2.05% in rural and 1.45% in urban communities, which indicates that lymphatic filariasis is prevalent in rural areas also. The mean mf density was 5.06. No infective or infected mosquitoes could be detected in Culex quinquefasciatus (544 nos.), M. annulifera (13 nos.) and M. uniformis (2 nos.). Comparing the earlier studies, in Bilaspur district the infection has been showing a declining trend and Brugia malayi infection has disappeared.

Status of soil transmitted helminthiasis in UT of Lakshadweep.

Soil Transmitted Helminthes (STH) survey in UT of Lakshadweep was conducted during February-March 2004. The survey was undertaken using WHO sampling methodology and Kato-Katz technique for stool sample examination. A total of 387 stool samples were examined of whom 322 samples (83.2%) were found positive for one or more STH. Maximum prevalence (100%) was found in Kavaratti Junior Basic School. Thirty children (7.8%) had high intensity of infection. In Kadmat Junior Basic School high intensity TT infection was 8.9%, For AL highest intensity of infection was found among Kavaratti Senior Basic School (7.0%). Mass anthelminthic chemotherapy of all school children was advocated.

Yaws and its eradication in India--a brief review.

Until 1996-97, when Yaws Eradication Programme (YEP) in India was launched, there were three initiatives to assess/control the yaws disease in the country. YEP was initially started as pilot study in Koraput district, Orissa and later on extended to ten states covering 49 districts. The first goal has been to get the disease eliminated from the country with ultimate goal being its eradication. Strategies for YEP are active case detection and treatment including contacts and targeted IEC. The number of reported cases reduced from 735 in 1997 to "Zero Case" in 2004 from entire country. The recent Third Independent Appraisal of YEP could not confirm any new yaws case. However, before declaring the elimination (meaning no new early infectious case), there is need to make a thorough search in the affected areas. Future activities under the programme includes sero- surveillance among under-five children to demonstrate cessation of yaws transmission.

Status of Soil Transmitted Helminth infections in an urban locality of Assam; as observed from survey by WHO sampling methodology for school children and community survey by random sampling.

In this study, an attempt was made to compare and correlate findings of a Soil Transmitted Helminths (STH) survey carried out using WHO sampling methodology for school children and community survey by random sampling. The prevalence and intensity of STH in the age-group of 9-10 yrs reportedly represent community status. The results showed that the STH prevalence and intensity in the age-group of 9-10 years do represent community burden. However, more such surveys will have to be carried out to substantiate this statement.