ABSTRACT
An isolated area with diarrhoea epidemic was explored at Pakhirala village of the Sundarbans, a coastal region of South 24 Parganas district of West Bengal, eastern India. The Pakhirala village was surrounded by other villages affected by a similar epidemic. The affected villages experienced this epidemic following the cyclone Aila, which had hit the coastal region of the Sundarbans in eastern India. In Pakhirala, the situation was the worst. Within a span of six weeks (5 June–20 July 2009), 3,529 (91.2%) of 3,871 residents were affected by watery diarrhoea. Of all the cases (n=3,529), 918 (26%) were affected by moderate to severe diarrhoea. In other villages, 28,550 (70%) of the 40,786 people were affected; of them, 3,997 (14%) had moderate to severe watery diarrhoea. The attack rate and the severity of the cases were significantly higher in Pakhirala village compared to other affected villages. The laboratory results revealed that Vibrio fluvialis was the predominant pathogen in Pakhirala village (5 of 6 laboratory-confirmed organisms) whereas Vibrio cholerae O1 Ogawa was the predominant pathogen in other villages of Gosaba block (7 of 9 bacteriologically- confirmed organisms). This result indicates that V. fluvialis behaves more aggressively than V. cholerae O1 in an epidemic situation with a higher attack rate and a different clinical picture. An in-depth study is required to explore its pathogenicity in detail, geographical distribution, and possible control measures, including development of specific vaccine preparation and determination of its efficacy.
ABSTRACT
A community-based cross-sectional study was conducted among injecting drug-users (IDUs) of the northeastern states of India to understand the host genetic factors that confer resistance to HIV infection. The study aimed at assessing the existence and magnitude of genetic mutations of chemokine receptors, such as CCR2-64I, CCR-5 D-32, and SDF-1-3`A, that are known to confer resistance to HIV infection and progression of disease in some set-ups. In total, 711 IDUs from Manipur, Mizoram, Nagaland, and Meghalaya were sampled for the study. The selected participants were interviewed to study their sociodemography, risk behaviours, and risk perceptions after obtaining their verbal informed consent. The interview was followed by collection of about 5 mL of blood samples by an unlinked anonymous method for studying genetic mutation and HIV infection. All the blood samples were transported to and processed at the clinical medicine laboratory of the National Institute of Cholera & Enteric Diseases, Kolkata, India. The genetic mutations were detected by polymerase chain reaction (PCR) and the restriction fragment length polymorphism (RFLP) assay techniques. The study revealed that 328 (46.1%) IDUs were aged 20-29 years, 305 (42.9%) were aged 30-39 years, and only two (0.3%) were aged above 49 years. The rate of HIV seropositivity varied widely among the IDUs living in different northeastern states that ranged from 4.5% to 61%. There was not a single IDU with CCR5 homozygous mutation. Mutated genes of CCR2-64I and SDF-1-3’A were detected in the frequencies of 49% and 23% respectively in them. The rate of HIV seropositivity in IDUs having CCR2 mutant gene was 27% (n=94) and without mutation was 27% (n=98). Similarly, HIV seropositivity in IDUs with and without SDF1 mutation was 28% (n=46) and 27% (n=146) respectively. Both the differences were not statistically significant. A CCR5 homozygous mutation is known to be the most prominent marker that confers resistance against HIV infection. The absence of CCR5 mutant gene in this population suggests that they do not have any additional protection against HIV infection. Analysis also revealed that, although mutation of CCR2 and SDF1 was present in this population, it did not confer any additional resistance against HIV. This indicates that the IDUs of northeastern India are not additionally protected against HIV infection through genetic mutation and are, therefore, vulnerable to acquire HIV infection due to high-risk behaviour and other related factors.