Hepatitis B virus genotype D infection among antenatal patients attending a maternity hospital in Calcutta, India: assessment of infectivity status.

A seroepidemiological study was conducted to determine the hepatitis B virus carrier rate and infectivity status among antenatal patients in Calcutta. Fifteen of 400 antenatal mothers (3.74%) were carriers of HBV genotype D. Four (1.0%) of them were positive for HBeAg with a high risk of transmitting infection to their babies. The presence of precore mutant HBV, which has been associated with transmission events from HBeAg mothers to their babies, was not detected in any of the HBeAg negative mothers.

Age related seroprevalence of antibodies to varicella in India.

OBJECTIVE: To determine the age related prevalence of Varicella Zoster Virus (VZV) antibodies in India. SETTING: This was a cross sectional multicentric study performed in 4 major cities of India: Calcutta (outpatients), Mumbai (outpatients), Lucknow (walk-in patients to a diagnostic laboratory, orphanage and factory workers) and Bangalore (outpatients and walk-in patients to a diagnostic laboratory). METHODS: A total of 1609 volunteers from birth to 40 years of age were included into the study. IgG antibodies against VZV were determined using commercial kits (ELISA-Enzygnost). RESULTS: Overall seroprevalence of anti VZV antibodies was 68. 22percnt. The age related seroprevalence rate of anti VZV antibodies was 29percnt in the age group of 1-5 years, 51.1percnt in 5-10 years, 71.7percnt in 11-15 years, 79.8percnt in 16-20 years, 88.1percnt in 21-30 years and 91.1percnt in 31-40 years. CONCLUSION: A significant proportion of adolescents and adults are susceptible to varicella in India, as in other tropical countries

Tuberculosis and HIV illness.

The HIV infection leading to AIDS is considered to be one of the greatest biomedical challenges in the present century. Like all other communicable diseases AIDS is gradually penetrating the underprivileged sections of society in all countries. Nearly 5 million people in India are living with AIDS at present that makes India a single country with highest number of HIV infected people in the world. The hallmark of HIV disease is the reduction of CD4+ T-lymphocytes, the key cells of immunity. The initial phase of the disease may be termed as HIV seroconversion illness. The next phase is termed asymptomatic HIV infection. When the CD4 count falls below 400/microliter, the patient develops early opportunistic infections which may be termed as early symptomatic HIV infection or AIDS related complex (ARC). Mycobacterial infections are also common in these patients and have led to an alarming resurgence of tuberculosis (TB) in many countries. The available information suggests that TB may be the commonest HIV related disease in the world. The clinical presentation of TB in HIV infected individual is influenced by the degree of HIV related immunosuppression. The atypical features like extrapulmonary TB and absence of positive Mantoux test are generally noticed at a fairly advanced stage. The x-ray chest is also an important adjunct to diagnosis of TB in HIV infected individual. The studies on TB and AIDS in the early part of HIV epidemic in developed countries suggest that extrapulmonary TB is more common in co-infected people but when TB infection is considered in all HIV infected persons, extrapulmonary TB is less common than pulmonary TB. The result of treatment in co-infected pulmonary TB cases is almost similar with the cases suffering from TB alone. Treatment failure, however, has been noticed rarely at extrapulmonary sites.

Projection of HIV infection in Calcutta.

Starting with the base year of 1991, the HIV infection projection for 1992-99 for the total, as well as various high-risk sub-populations of Calcutta, the first of its kind is provided. These projections are based on statistical methodology developed in this paper. Our methodology for spread of HIV infection takes into account various social interactions and practices and also uses available data. Rates of these interactions and practices and estimates of demographic parameters used in making projections were obtained primarily from surveys and census data. Since one of these estimated rates, that of HIV transmission rate through heterosexual encounters between an infected and an uninfected had a large range, we have provided two sets of projections based on the largest of these rates (worst-case scenario) and another that is consistent with the available data. The total projection of the number of HIV infected cases in Calcutta for 1999 is between 49,000 and 1,26,000. Separate projections are also provided for high-risk sub-groups. Among these, the sex workers expectedly will continue to manifest the highest numbers of newly infected cases. The temporal rate of increase in prevalence is projected to be alarmingly higher in the general population than even among sex workers, although the actual prevalence will continue to be the lowest in the general population compared to all other sub-groups of the population.

An in vitro qualitative assay for the detection of antibodies to HIV type 1/2 contained in human saliva.

There is ample evidence that saliva contains secretory antibody against most infections. Therefore, saliva has been recommended as a non invasive, safe and effective alternative to serum, for HIV antibody testing. The present study attempted comparative evaluation of antibody detection by serum and saliva specimens in laboratory by ELISA and Western Blot for diagnosis of HIV infection in the Indian situation. From a study of 42 test sera it is concluded that test apart from its simplicity and reproducibility, is almost free from any false positive and false negative reactions.

Febrile episode among a floating population of C.R.P.F. Jawans stationed at Calcutta.

A virological investigation was carried out to establish the etiologic agent of a febrile outbreak amongst a floating population of C.R.P.F. Jawans, stationed at Calcutta during May-July, 1993. The illness was associated with fever, severe headache, bodyache and arthralgia which lasted for 2-4 days in most of the cases. Fifty cases were examined clinically and blood samples (both acute and convalescent) were subjected to virological study. One mouse-pathogenic agent could be isolated in suckling mice and identified as DEN-3. Sero-investigation of 50 single sera by HI & CF method revealed evidence of presumptive dengue infection in 33, while sero-conversion could be noted in 10 out of 25 available paired sera tested. Results of MAC ELISA revealed evidence of primary dengue infection in 6 out of 12 acute phase sera examined. Thus, the study shows that the episode is strongly suggestive of primary dengue infection.

Serosurvey of chikungunya antibody in Calcutta metropolis.

Since its first isolation in Calcutta, in 1963, there have been many reports about epidemis of chikungunya virus infection in different parts of India. Calcutta experienced a concurrent epidemic of dengue and chikungunya between 1963 and 1965. But after that there is no report about any chikungunya infection in Calcutta. During routine investigations it is found that chikungunya antibody is on the wane. The present survey for chikungunya antibody showed only 4.37% (n = 17) seropositivity out of 389 sera tested. The highest (12.5%) seropositivity was observed in the age group of 51-55 years and no chikungunya antibody was detected in young and young adults. The findings suggest that chikungunya virus is disappearing from the Calcutta population.

Community based survey of STD/HIV infection among commercial sex workers in Calcutta (India). Part-IV: Sexually transmitted diseases and related risk factors.

Community based survey on a sample of commercial sex workers in one red light area of Calcutta, was carried out to determine prevalence of sexually transmitted diseases (STD) including HIV infection and related risk factors. An alarmingly high prevalence of STDs (80.56 per cent) but low HIV-seropositivity (1.13 per cent) was observed. Candida albicans, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 23.24, 13.24 and 11.11 per cent of genital specimens respectively. BY TPHA test 62.97 per cent of the sera were reactive for Treponema pallidum. Duration in the profession of sex workers was found to have an association with seropositivity for syphilis. Prevalence of HIV infection might be low at present, but conditions were highly favourable for rapid spread of infection.

Community based survey of STD/HIV infection among commercial sex-workers in Calcutta (India). Part-III: Clinical findings of sexually transmitted diseases (STD).

On physical examination of 418 sex workers, 202 (48.32 per cent) were found to have vaginal discharge, which was found to be most common among younger age class. Endocervical pus, genital ulcer, and swelling of inguinal lymph glands were observed in 13.16, 6.22 and 1.91 per cent of the sex workers respectively. Clinically 16.51, 15.31, 11.96 and 4.78 per cent were found to suffer from candidiasis, trichomoniasis, cervicitis and syphilis respectively.

Community based survey of STD/HIV infection among commercial sex-workers in Calcutta (India). Part II. Sexual behaviour, knowledge and attitude towards STD.

A community based sample survey of STD/HIV infections was carried out among 450 commercial sex workers, (CSW) of one red light area in Calcutta. In this paper, sexual practices of sex workers, their knowledge about sexually transmitted diseases (STD) and practice of preventive and curative measures against STDs, is described. Vaginal intercourse was the usual sexual practice. But as many as 74.44 per cent also practised oral sex. About 82.67 per cent had the practice of washing external genitalia with antiseptic solution after sexual intercourse. About 69.11 per cent of sex workers were aware of sexually transmitted diseases and 30.67 per cent had knowledge about AIDS. About 70.22 per cent had symptoms related to genital tract during one year preceding the survey and 34 per cent of sex workers took medical treatment during last one month.

Community based survey of STD/HIV infection among commercial sexworkers in Calcutta (India). Part I. Some social features of commercial sexworkers.

A community based sample survey of sexually transmitted diseases and Human Immuno deficiency Virus infection was carried out among commercial sex workers of a red-light area in Calcutta. In this paper socio-demographic aspects of sex workers are discussed. For the survey, 450 sex workers were selected by random sampling method. Among the sex workers surveyed, 84.89 per cent were in the age group 15-29 years. Lowest age was 13 years and mean age was 23.12 years. Large number of sex workers were from Nepal (15.11 per cent) and Bangladesh (11.78 per cent). About 38 per cent were from three districts of West Bengal bordering Bangladesh. About 84.44 per cent of the sex workers were illiterate. Extreme poverty forced 49.10 per cent to choose this profession and family disturbances led 21.56 per cent to this profession. Almost all sex workers (448) had addiction, alcohol being taken regularly by 81.11 per cent. Number of clients of sex workers varied from 2 to 10, average being 3. About 67.33 per cent gave history of pregnancy, 46 per cent had abortion and 41.11 per cent had living children. About 27.11 per cent took precaution against pregnancy regularly. Use of oral pills was found to be the most common practice against pregnancy (13.65 per cent), followed by ligation (11.56 per cent). Only 1.11 per cent reported that their clients used condom regularly.

Dengue haemorrhagic fever (DHF) outbreak in Calcutta--1990.

An outbreak of Dengue Haemorrhagic Fever (DHF) occurred in Calcutta between September and December, 1990. Children and young adults were the major victims. Haemorrhagic manifestations and shocks were the main features in most of the hospitalised cases. Five mouse pathogenic agents were isolated from 105 acute cases and all were identified as DEN-3. HI and CF test with 55 paired sera revealed evidence of dengue infection in 33 (60 per cent) and flavivirus group reaction including dengue in 17 (30.9 per cent). It was for the first time, that DEN-3 was considered to be the etiologic agent for DHF in Calcutta.

Study of the outbreak of Japanese encephalitis in Lakhimpur district of Assam in 1989.

An outbreak of Japanese encephalitis was reported from Lakhimpur district of Assam in July-August, 1989. The outbreak affected 90 villages of the district, covering a population of approximately 36,000. There were 140 cases and 70 deaths due to the epidemic, giving a case fatality rate of 50%. There were no cases from Gogamukh area of the district, where a pilot Japanese encephalitis vaccination project was conducted in the population between July-August 1987, with Kasauli Japanese encephalitis vaccine. Serological examination of acute and convalescent cases showed Japanese encephalitis specific IgM indicating strong evidence of recent Japanese encephalitis infection.

Recurrent outbreaks of Japanese encephalitis in Nagaland (1985-1989)--a seroepidemiological study.

Recurrent epidemics of encephalitis in Nagaland, a North-Eastern State of India, following its first appearance in 1985, were investigated both epidemiologically and virologically. Although, no viral agent could be isolated from any of the clinical samples and mosquitoes, detection of JE specific IgM antibodies in many of the CSF and acute blood samples, together with presence of HI and CF antibodies to JE antigen in a number of acute and convalescent sera established the etiologic role of JE virus in this region. A total number of 83 clinically diagnosed cases could only be investigated virologically between 1985-89, where evidence of JE could be established in 34 (40.9 per cent) and flavivirus (including JE in majority) in 17 (21.5 per cent) cases. A limited serological survey among the close contacts of the victims in 1985 revealed JE antibody in 26.6 per cent of them. Analysis of the epidemiological and serological findings of different years revealed that while the outbreaks of 1985, 1987 and 1988 were due to JE infection, the episodes of 1986 and 1989, on the other hand, had chiefly features of high and prolonged fever with limited number of CNS involvement of undetermined origin, where the possibility of malarial infection has been a suspect apart from JE etiology.

Investigation of an outbreak of Japanese encephalitis in Rourkela City (Orissa) during 1989.

An outbreak of Japanese encephalitis (JE) was reported from Rourkela city for the first time in September-November 1989. 41 cases and 15 deaths occurred with a case fatality rate of 36.6 per cent. Most of the cases (66 per cent) were in the age group of 5-19 years. There was no case under 5 years. Female-male ratio of cases was 1:1.7. Serological examination of convalescent cases showed JE specific IgM indicating strong evidence of recent JE infection. Large number of pigs were seen in the affected areas.

Seroepidemiological study of Japanese encephalitis in Dimapur, Nagaland.

A seroepidemiological study of Japanese encephalitis (JE) in Dimapur, Nagaland was carried out following an outbreak of the disease between July, 1985 and February, 1986. Altogether 50 persons were affected with 30 (60 per cent) deaths. The attack and death rates per 1000 were more in Nagas viz. 0.55 and 0.34 than non-Nagas viz. 0.33 and 0.20 respectively. All ages and both sexes were affected. Of the nine mosquito species encountered Culex vishnui showed the highest density (44.5/MH). Culture of mosquito pool did not yield any viral agent. A total of 311 serum samples comprising 95 humans, 166 animals and 50 birds were tested for the presence of haemagglutination inhibition (HI) antibodies against Chikungunya and three flavirus antigens, viz. JE, WN and DEN-2. The overall flavivirus HI antibody in humans was positive in 26 (27.3 per cent) almost identical to JE antibody prevalence. The per cent positivity of HI antibodies to JE, WN and DEN-2 were 42.2 per cent, 22.2 per cent and 13.3 per cent in the affected and 14.2 per cent, 10 per cent and 6 per cent in the unaffected area. The activity of Alpha (Chikungunya) virus though very low was significantly higher (chi 2 = 5.57) in the affected area. The prevalence of JE antibody was 77.7 per cent in dogs, 52 per cent in cattle, 34 per cent in pigs and 21.1 per cent in goats. Of the five species of birds, flavivirus and JE antibodies were detected in 21.4 per cent pigeons and 22.2 per cent heron egrettes. Neutralisation test established the distinct role of JE virus over other related flavivirus antigens.