Trier Social Stress Test in Indian Adolescents.

Objective: To test the Trier Social Stress Test for children (TSSTC) in a cohort of Indian adolescents. Design: Cohort study Setting: Holdsworth Memorial Hospital, Mysore, India. Participants: Adolescent children (N=273, 134 males; mean age 13.6 yrs) selected from an ongoing birth cohort; 269 completed the test. Intervention: Performance of 5-minutes each of public- speaking and mental arithmetic tasks in front of two unfamiliar ‘evaluators’. Outcome measures: Salivary cortisol concentrations were measured at baseline and at regular intervals after the TSST-C. Continuous measurements of heart rate, finger blood pressure, stroke volume, cardiac output and systemic vascular resistance were carried out before, during and for 10 minutes after the TSSTC using a finger cuff. Results: Cortisol concentrations [mean increment (SD): 6.1 (6.9) ng/mL], heart rate [4.6 (10.1) bpm], systolic [24.2 (11.6) mmHg] and diastolic blood pressure [16.5 (7.3) mmHg], cardiac output [0.6 (0.7) L/min], stroke volume [4.0 (5.6) mL] and systemic vascular resistance [225 (282) dyn.s/cm5] increased significantly (P<0.001) from baseline after inducing stress. Conclusions: The TSST-C produces stress-responses in Indian adolescents of a sufficient magnitude to be a useful tool for examining stress physiology and its relationships to disease outcomes in this population.

Laboratory-based dengue fever surveillance in Tamil Nadu, India.

Dengue fever and dengue haemorrhagic fever (DF/DHF) have become a serious public health problem in many parts of India in recent years. Several vertical national programmes for communicable diseases, which include vector-borne diseases such as malaria and filariasis have been in operation for over five decades in India. The remarkable increase in dengue fever and DHF related deaths during the last decade has necessitated an effective surveillance system to detect the cases and adopt appropriate control measures against dengue vectors. Although the existence of all the four serotypes of dengue virus was proved as early as in 1960s, it was only after 1990, several outbreaks of DF/DHF were reported in Tamil Nadu. Further, dengue, once considered as urban problem has now penetrated into rural areas also, due to various changes in the environment. The geographic spread, increase in number of cases, reporting system, laboratory diagnosis, monitoring of vector density and investigation of outbreaks in Tamil Nadu during the last decade are comprehensively documented and discussed here to further strengthen the surveillance network to prevent possible major outbreaks of DF/DHF.

Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu.

BACKGROUND & OBJECTIVE: Although the re-emergence of spotted fevers and typhus was documented from southern India a few years ago, there was a paucity of community based data. Therefore a collaborative study was carried out in several districts of Tamil Nadu to understand the distribution of these infections. METHODS: Blood (3 ml) was collected from patients presenting to primary health centres (PHCs) with fever >10 days duration in 15 districts of Tamil Nadu during January 2004 to December 2005. Patients negative for malaria, were tested by Weil-Felix test. Clinical data were collected from patients visiting two hospitals. RESULTS: A total 306 samples were tested in 2004 and 115 (37.5%) had titres of >or=80 with OX K antigen, suggesting a diagnosis of scrub typhus. During 2005, 964 patients were tested and 89 (9.2%) were positive for scrub typhus. An additional 44 (4.6%) were positive for other rickettsial illnesses. In both years majority of scrub typhus occurred in individuals above 14 yr of age. Cases increased from August until the earlier part of next year. INTERPRETATION & CONCLUSION: This community based study from south India involving several districts in Tamil Nadu, showed that scrub typhus and rickettsial illnesses were widely distributed in the State. Measures to increase awareness and also to diagnose and treat this infection in the affected areas are essential.

Dengue fever outbreaks in two villages of Dharmapuri district in Tamil Nadu.

BACKGROUND & OBJECTIVES: Dengue fever is an important public health problem in India. In recent years this disease has extended to rural areas also due to rapid urbanization. In Tamil Nadu, fever outbreaks were reported in two villages of Dharmapuri district during May and September 2001 with clinical symptoms suggestive of dengue fever. Epidemiological, virological and entomological investigations were carried out in these two villages to ascertain the etiology of the outbreaks. METHODS: Paired serum samples were collected from febrile patients clinically suspected to have dengue and were tested for the presence of IgM antibodies to dengue virus by MAC ELISA. Samples were also tested by Dengue Duo IgM/IgG rapid strip. Surveys of larval and adult Aedes mosquitoes were carried out before and after anti-larval and anti-adult measures were implemented. Female Ae. aegypti mosquitoes collected in Mampatti village were tested individually for the presence of dengue-2 viral antigen by indirect immunofluorescence assay (IIFA). In addition, two pools of female Ae. aegypti mosquitoes were tested for the presence of dengue viral antigen by ELISA and then subjected to Toxo-IFA system for demonstration of dengue virus. RESULTS: A total of 124 and 267 fever cases with clinical symptoms and signs suggestive of dengue were reported in Kadumuchandiram and Mampatti villages of Dharmapuri district, respectively. Serodiagnosis revealed that 13 of 31 and 14 of 52 patients tested were positive for dengue-2 virus by MAC ELISA in Kadumuchandiram and Mampatti villages respectively. Dengue Duo rapid strip test also detected 14 (of 31 tested) patients positive for dengue virus specific IgM antibodies in Kadumuchandiram village and 8 (of 12 tested) in Mampatti village. Application of temephos and fogging with pyrethrum 2 per cent extract were found to be effective against immatures and adults respectively. Both the pools of Ae. aegypti tested for the presence of dengue viral antigen were positive by ELISA and one mosquito (tested individually) was positive by IIFA. Supernatants of two pools were found to be positive for dengue-2 virus by Toxo-IFA. INTERPRETATION & CONCLUSION: Virological and serological investigations confirmed that the outbreaks of fever were due to dengue virus infection. High breeding of Ae. aegypti in the study villages, detection of dengue-2 viral antigen and isolation of dengue-2 virus in Ae. aegypti mosquitoes confirmed the etiology.

First outbreak of Japanese encephalitis in two villages of Dharmapuri district in Tamil Nadu.

BACKGROUND & OBJECTIVES: Three cases of Japanese encephalitis (JE) were reported for the first time from two villages in Krishnagiri Health Unit district of Tamil Nadu during November 1999. Two children died and one developed neurological sequelae. A serological survey was conducted in these villages to find out the prevalence of JE antibodies among children below 15 yr of age in addition to the epidemiological investigations. METHODS: The prevalence of haemagglutination inhibiting (HI) antibodies to JE virus (JEV), West Nile virus (WNV) and dengue-2 virus (DEN-2) was detected by HI test and IgM antibody capture ELISA (MAC ELISA) was performed to determine recent infections with JE virus. Adult mosquitoes were collected in the study villages and females of Culex pseudovishnui, C. tritaeniorhynchus and C. vishnui were tested for the presence of JE viral antigen by ELISA. RESULTS: Out of 146 sera samples from children below 15 yr, the prevalence of HI antibodies to JEV, WNV and DEN-2 virus was found to be 8.9, 3.4 and 6.85 per cent respectively and three children had IgM antibodies to JEV. Of the 13 species of mosquitoes identified, C. tritaeniorhynchus (30.8%) was the most abundant species in the study villages. Two pools of female C. tritaeniorhynchus were found to be positive for JEV antigen. Fogging with 2 per cent pyrethrum and residual spray with 10 per cent cyfluthrin were effective in reducing vector density. INTERPRETATION & CONCLUSIONS: Serological investigations revealed that the JE virus was predominant in the study villages. In addition, DEN-2 and WN viruses were also prevalent. Detection of JE virus specific IgM antibodies in three specimens and the presence of JE viral antigen in 2 pools of C. tritaeniorhynchus emphasized the need for constant surveillance and monitoring so as to prevent future large outbreaks.

Randomised controlled field trial of two antenatal care packages in rural south India.

A randomised community intervention trial was undertaken in 12 subcentres in Karur health unit district, Tamil Nadu, to compare the efficacy of two antenatal care packages. A newly recommended 'high-risk' strategy package and a uniform package recommended by the Tamil Nadu Government were each implemented in 4 randomly selected subcentres by the study team, and the latter was also delivered by routine health services in the 4 remaining subcentres. Analyses were based on 294 pregnant women on the high-risk package (HR), 242 on the Tamil Nadu Government (TNG) package and 335 women in the control series. The HR package reduced the differences between the high-risk women and the others in mean haemoglobin and the percentages with preventable neonatal morbidity and low birth weight, and consequently the overall outcome was better in the HR series than in the TNG series. Finally, the results with the TNG package were better when it was implemented by the study team than by the routine health services, in terms of preventable maternal morbidity and preventable perinatal morbidity, but there was no impact on birth weight.