Development of the India COVID-19 vaccine tracker

COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO’s emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ?18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India’s COVID-19 vaccination drive

Clinical profile of patients infected with suspected SARS-CoV-2 Omicron variant of concern, Tamil Nadu, India, December 2021-January 2022

Background & objectives: COVID-19 cases have been rising rapidly in countries where the SARS-CoV-2 variant of concern (VOC), Omicron (B.1.1.529) has been reported. We conducted a study to describe the epidemiological and clinical characteristics and outcomes of COVID-19 patients with ‘S’ gene target failure (SGTF, suspected Omicron). Furthermore, their clinical outcomes with COVID-19 patients with non-SGTF (non-Omicron) were also compared. Methods: This study was conducted in Tamil Nadu, India, between December 14, 2021 and January 7, 2022 among patients who underwent reverse transcription-PCR testing for SARS-CoV-2 in four laboratories with facilities for S gene screening. Consecutively selected COVID-19 patients with SGTF were telephonically contacted, seven and 14 days respectively after their date of positive result to collect information on the socio-demographic characteristics, previous history of COVID-19, vaccination status and clinical course of illness along with treatment details. To compare their outcomes with non-SGTF patients, one randomly suspected non-Omicron case for every two suspected Omicron cases from the line-list were selected, matching for the date of sample collection and the testing laboratory. Results: A total of 1175 SGTF COVID-19 patients were enrolled for this study. Almost 6 per cent (n=72) reported a history of previous infection. 141 (13.5%) suspected Omicron cases were non-vaccinated, while 148 (14.2%) and 703 (67.4%) had received valid one and two doses of COVID-19 vaccines, respectively. Predominant symptoms reported included fever (n=508, 43.2%), body pain (n=275, 23.4%), running nose (n=261, 22.2%) and cough (n=249, 21.2%). Five (0.4%) of the 1175 suspected Omicron cases required oxygen supplementation as compared to ten (1.6%) of the 634 suspected non-Omicron cases. No deaths were reported among omicron suspects, whereas there were four deaths among suspected non-Omicron cases. Interpretation & conclusions: Majority of the suspected Omicron cases had a mild course of illness. The overall severity of these cases was less compared to the suspected non-Omicron cases.

Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu.

Background. India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors. Methods. We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January– March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy. Results. Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR <60 mg/dl) and 67.4% had neuropathy. Among patients with comorbid conditions, 60%, 48%, 32%, and 3% were already diagnosed to have hypertension, neuropathy, retinopathy, and nephropathy, respectively. The risk factors for diabetic retinopathy were hypertension (AOR 3.2, 95% CI 1.7–6.3), duration of T2DM >5 years (AOR 6.5, 95% CI 3.6–11.7), poor glycaemic control (AOR 2.4,

Cholera Outbreak Linked with Lack of Safe Water Supply Following a Tropical Cyclone in Pondicherry, India, 2012.

In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ratio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8,367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered around two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% CI 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage following rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water.

Prevalence of Behavioral Risk Factors, Overweight and Hypertension in the Urban Slums of North 24 Parganas District, West Bengal, India, 2010.

Globally, 1 billion people live in slums. There are few reports of high prevalence of noncommunicable disease (NCD) risk factors among the urban poor. The prevalence of NCD risk factors in the slums in North 24 Parganas, West Bengal, India was estimated. Cross-sectional survey in 24 slums selected using cluster sampling method was conducted. Questionnaire for behavioral risk factors was used and anthropometric and blood pressure measurements were done. The study population included 1052 participants aged 25-64 years, 528 (50%) were males. Among males, 206 (39%) were current smokers and 154 (29%) were current alcohol users. Central obesity was prevalent among 32.8% males and 56.1% females and 115 (10.9%) had body mass index ≥27.5 kg/m2. Hypertension was prevalent among 35% males and 33% females. We observed high prevalence of NCD risk factors among urban slum dwellers that need to be addressed with health promotion programs and strengthening of primary health care system.

Monitoring smoke-free laws in restaurants and educational institutions in Chennai, India.

Background. Smoking tobacco affects the health of smokers as well as non-smokers who are exposed to secondhand smoke. The Government of India enacted the Cigarettes and Other Tobacco Products Act in 2003, which included a ban on smoking in public places and on sale of tobacco around educational institutions. We assessed the extent of compliance with these laws in restaurants and educational institutions in Chennai, Tamil Nadu, India. Methods. We conducted a cross-sectional survey using an observation checklist in restaurants and educational institutions in Chennai. We used cluster sampling for restaurants and random sampling for schools and colleges. We collected data regarding the signage displaying prohibition of smoking as per the law and sale of tobacco products around educational institutions. We estimated the proportions for various indicators. Results. Among the 400 restaurants surveyed, 371 (92.8%) did not have any signage displaying prohibition of smoking and of the 29 restaurants with signage, only 4 were as per the specifications. There were 62 (15.5%) smoking events in restaurants at the time of visit for survey. Among the 287 schools surveyed, only 8 (2.8%) had the signage displaying prohibition of smoking and 2 (0.7%) had the signage for ban on sale of tobacco products. Of the 54 colleges surveyed, 8 (14.8%) had the signage displaying prohibition of smoking and 7 (13%) had the signage for ban on sale of tobacco products. Conclusion. There was low compliance of smoke-free laws in restaurants and educational institutions in Chennai. We recommend a robust monitoring mechanism to ensure the enforcement of smoke-free laws in public places.

Descriptive Epidemiology of Novel Influenza A (H1N1), Andhra Pradesh 2009-2010.

Background: The fi rst case of pandemic Infl uenza A (H1N1) in India was reported from Hyderabad, Andhra Pradesh on 16th May 2009. Subsequently, all suspected cases seeking treatment from A (H1N1) treatment centers and their contacts were tested. Laboratory confi rmed cases were hospitalized and treated with antivirals according to national guidelines. We reviewed the surveillance data to assess the morbidity and mortality due to A (H1N1) in the state of Andhra Pradesh (population-76,210,007) during the period from May 2009 to December 2010. Materials and Methods: We obtained the line-list of suspected (infl uenza like illness as per World Health Organization case defi nition) and laboratory confi rmed cases of A (H1N1) from the state unit of integrated disease surveillance project. We analyzed the data to describe the distribution of case-patients by time, place and person. Results: During May 2009 to December 2010, a total of 6527 suspected (attack rate: 8.6/100,000) and 1480 (attack rate: 1.9/100,000) laboratory confi rmed cases were reported from the State. Nearly 90% of the suspected and 93% of the confi rmed cases was from nine districts of Telangana region, which includes Hyderabad. Nearly 65% of total confi rmed cases were reported from Hyderabad. The attack rate was maximum (2.6/100,000) in the age group of 25-49 years. The cases peaked during August-October. 109 case-patients died (Case fatality ratio: 7%) and most (80%) of these patients had comorbid conditions such as diabetes (24%), chronic obstructive pulmonary disease (20%), hypertension (11%) and pregnancy (11%). Case fatality was higher (16%) among patients who were older than 60 years of age compared with other age groups. Conclusions: In Andhra Pradesh, H1N1 transmission peaked during August-October months and predominately affected adults. Case fatality was higher in patients older than 60 years with comorbid conditions.

Incidence, management, and reporting of severe and fatal Plasmodium falciparum malaria in secondary and tertiary health facilities of Alipurduar, India in 2009.

Background & objectives: The proportion of malaria cases that are complicated and fatal are not well described in India. Alipurduar sub-division of Jalpaiguri district in West Bengal is highly endemic for malaria. We constructed a retrospective cohort of severe malaria patients admitted in the secondary and tertiary care facilities in Alipurduar to determine the incidence, assess the management, and evaluate the reporting of severe and fatal malaria. Methods: We reviewed routine surveillance data and the case records of all the malaria patients admitted in all secondary and tertiary care facilities, both public and private. We defined severe malaria cases as Plasmodium falciparum infection with clinical signs and symptoms of organ involvement in a resident of Alipurduar admitted during January to December 2009. We compared clinical and demographic characteristics of severe malaria cases that died with those who survived. We also reviewed human resources and laboratory facilities available for the treatment of severe malaria in these health facilities. Results: During 2009, 6191 cases of P. falciparum in Alipurduar were reported to the malaria surveillance system. We identified 336 (5.4%) cases of severe malaria among which 33 (9.8%) patients died. Four malaria deaths were also recorded from primary health centres. Only 17 of the 37 (46%) total deaths recorded were reported to the routine surveillance system. Most severe cases were males (65%), aged >15 years (72%), and nearly half were admitted to secondary care hospitals (48%). In multivariate analysis, the risk factors associated with death included increased delay fever onset and hospitalization, treatment in a secondary level hospital, younger age, and multi-organ involvement. The secondary level public hospital had too few physicians and nurses for supporting severe malaria patients as well as inadequate laboratory facilities for monitoring such patients. Conclusions: Severe and fatal malaria continue to burden Alipurduar and record keeping in health facilities was poor. Many malaria deaths were not routinely reported even in the public sector. Improved surveillance and increased human and laboratory resources are needed to reduce malaria mortality.

A Rapidly-progressing Outbreak of Cholera in a Shelter-home for Mentally-retarded Females, Amta-II Block, Howrah, West Bengal, India.

On 13 May 2010, a cluster of diarrhoeal disease cases was reported among the inmates of a shelter-home for mentally-retarded females in Parbaksi village of Howrah district in West Bengal, India. The outbreak was investigated to identify the aetiological agent and source of infection and to propose recommendations. A suspected case of cholera was defined as an acute onset of >3 loose watery stools in a female resident of the shelter-home since 1 May 2010. The demographic and clinical details were collected from the suspected case-patients, and the outbreak was described by time, place, and person. A retrospective cohort study was conducted to identify the risk factors associated with the illness. Of the 101 inmates, 91 (90%) developed diarrhoea, and three patients died (case fatality−3%). Four of the five stool specimens were positive for Vibrio cholerae O1 Ogawa. Drinking of water from the pond-connected tubewell (adjusted odds ratio=25.7, 95% confidence interval 2.7-236.4) was associated with the illness. Relocation of the pond-connected tubewell away from the groundwater tubewell, colour-coding of the tubewells meant for drinking purposes, and regular disinfection of the tubewells were recommended.

Five Pond-centred Outbreaks of Cholera in Villages of West Bengal, India: Evidence for Focused Interventions.

In rural West Bengal, outbreaks of cholera are often centred around ponds that is a feature of the environment. Five investigations of laboratory-confirmed, pond-centred outbreaks of cholera were reviewed. Case-control odds ratios were approximated with relative risks (RRs) as the incidence was low. The environment was investigated to understand how the pond(s) could have become contaminated and could have infected villagers. The five outbreaks of cholera in 2004-2008 led to 277 cases and three deaths (median attack rate: 51/1,000 people; case fatality: 1.1%; median age of case-patients: 22 years; median duration: 13 days, range: 6-15 days). Factors significantly (p<0.05) associated with cholera in the case-control (n=4) and cohort investigations (n=1) included washing utensils in ponds (4 outbreaks of cholera, RR range: 6-12), bathing (3 outbreaks of cholera, RR range: 3.5-9.3), and exposure to pond water, including drinking (2 outbreaks of cholera, RR range: 2.1-3.2), mouth washing (1 outbreak of cholera, RR: 4.8), and cooking (1 outbreak of cholera, RR: 3.0). Initial case-patients contaminated ponds through washing soiled clothes (n=4) or defaecation (n=1). Ubiquitous ponds used for many purposes transmit cholera in West Bengal. Focused health education, hygiene, and sanitation must protect villagers, particularly following the occurrence of an index case in a village that has ponds.

Factors associated with low utilization of x-ray facilities among the sputum negative chest symptomatics in Jalpaiguri District (West Bengal), 2009.

Summary: New sputum negative (NSN) tuberculosis case detection in Jalpaiguri district has been consistently low. Availability and accessibility of health facilities with chet x-rays is key for the diagnosis of NSN cases. To identify factors associated with utilisation of x-ray facilities in the district, we interviewed 4,875 chest symptom&tics who were sputum negative on two occasions with an antibiotics course in between. Chest radiography was available in only three public health facilities in the district. Low income, long distance from the public health facilities with chest radiography and high cost of x-rays at private hospitals were key factors associated with symptomatics not undergoing X-ray. It is necessary to increase facilities for radiological diagnosis and provide mobility support for the symptomatics in Jalpaiguri.

The 2010 Outbreak of Cholera among Workers of a Jute Mill in Kolkata, West Bengal, India.

On 10 March 2010, an outbreak of diarrhoeal disease was reported among workers of a jute mill in Kolkata, West Bengal, India. The cluster was investigated to identify the agent(s) and the source of infection and make recommendations. A suspected case of cholera was defined as having >3 loose watery stools in a 24-hour period and searched for case-patients in the workers’ colony. The outbreak was described by time, place, and person, and a case-control study was conducted to identify the source of infection. Rectal swabs were collected from the hospitalized case-patients, and the local water-supply system was assessed. In total, 197 case-patients were identified among 5,910 residents of the workers’ colony (attack rate 3.33%). Fifteen of 24 stool samples were positive for Vibrio cholerae O1. The outbreak started on 7 March, peaked on 11 March, and ended on 16 March 2010. Compared to 120 controls, 60 cases did not differ in terms of age and socioeconomic status. Drinking-water from the reservoir within the mill premises was associated with an increased risk of illness [odds ratio: 26.7, 95% confidence interval (CI) 11.4-62.6) and accounted for most cases (population attributable risk percentage=82%, 95% CI 70.8-92.9). An outbreak of cholera occurred among workers of the jute mill due to contamination of the drinking-water reservoir. It occurred within a few days of re-opening of the mill after the workers’ strike. Health authorities need to enforce disinfection of drinking-water and regularly test its bacteriological quality, particularly before re-opening of the mill after the strike.

Prevalence and pattern of substance use among the higher secondary school students of Imphal, Manipur, India.

Background. Substance use often begins in adolescence. We did a study to describe substance use and its associated factors among adolescent students in Imphal. Methods. We defined substance use as the use of licit and illicit substance other than when medically indicated. Using a WHO self-administered questionnaire, we collected information about substance use from 61 randomly selected students of 17 government/private higher secondary schools. We calculated the prevalence of substance use according to selected characteristics. Results. We surveyed 1020 students, 551 of whomreported prior substance use (prevalence of ever use: 54%, 95% confidence interval [CI] 42%–67%). Prevalence of recent and current user was 35% (95% CI 28%–43%) and 22% (95% CI 17%–28%), respectively. Among ever users, tobacco (46%) was used most commonly, followed by alcohol (29%), cannabis (14%) and opiates (12%). On multivariate analysis, substance use was significantly higher among boys (adjusted odds ratio [AOR] 2.6, 95% CI [2.0– 3.4]), whose father (AOR 2.0, 95% CI 1.6–2.7) or sibling (AOR 2.1, 95% CI 1.5–3.0) used substance. It was significantly lower among children of Hindu/Jain religion (AOR 0.5, 95% CI 0.4–0.7). Conclusion. Prevalence of tobacco and alcohol use was high among students. Familial use of substances was associated with the behaviour of adolescents. Friends were the key proximal determinant. We recommend introducing a substance use prevention policy in schools to educate students about various adverse effects and to impart refusal skills.