RESUMO
Justification: Mumps, despite being a widely prevalent disease in the country, is considered as an insignificant public health problem mainly because of poor documentation of clinical cases and lack of published studies. In the absence of adequate published data on disease burden, Government of India has recently decided to introduce measles-rubella (MR) vaccine in its National Immunization Program and neglected mumps component. Process: Following an IAP ACVIP meeting on December 6 and 7, 2014, a detailed review of burden of mumps in India along with vaccination strategies to control the disease was prepared. The draft was circulated amongst the members of the committee for review and approval. Revised final draft was later approved by IAP executive board in January 2015. Objectives: To provide a review of community burden of mumps in India; and to discuss the vaccination strategies to impress upon policymakers to include mumps vaccination in National immunization program. Recommendations : A total of 14 studies and two media reports on mumps outbreak were retrieved. The outbreaks were reported from all the regions of the country. Mumps meningoencephalitis was responsible for 2.3% to 14.6% of all investigated hospitalized acute encephalitis syndrome or viral encephalitis cases in different studies. Data from Infectious Disease Surveillance (ID Surv) portal of IAP and Integrated Disease Surveillance Program (IDSP) of Government of India (GoI) were also reviewed. While a total of 1052 cases were reported by the IDSurv, IDSP had investigated 72 outbreaks with 1564 cases in 14 states during different time periods. Genotypes G (subtype G2) and C were found to be main genotypes of the mumps virus circulating in the country. Three studies studied serological status of young children and adolescents against mumps, and found susceptibility rates ranging from 32% to 80% in different age groups. Conclusions: Mumps poses a significant disease burden in India. This calls for inclusion of mumps vaccine in the National immunization program.
RESUMO
BACKGROUND: Use of trancatheter device closure for membranous ventricular septal defect is still in evolving phase. We report the early and mid-term results of our experience with the new asymmetric Amplatzer membranous ventricular septal defect occluder. METHODS AND RESULTS: We attempted, transcatheter closure of perimembranous ventricular septal defect using asymmetric Amplatzer occluder in 26 patients. The patients were selected on the basis of transthoracic and transesophageal echocardiographic assessment of the ventricular septal defect. The procedure was successful in 21 (81%) patients. The age ranged from 3 to 23 years, weight from 10 to 59 kg and defect size ranged from 3 to 9 mm (mean: 5 +/- 1.8 mm). One patient had situs inversus with dextrocardia: 11 had aneurysmal tissue partly occluding the defect and the device was deployed either across (n=6) or within the aneurysmal sac (n=5). Three patients developed high degree atrioventricular block on attempts to cross the defect with the sheath and the procedure was discontinued. In two patients it was not possible to place the sheath in left ventricle despite repeated attempts. There was a residual flow in 4 (19%) patients at 24 hours. Two patients developed bundle branch block and none had complete heart block. At follow-up (1-9 months, n=20), residual flow was seen in two patients. None developed late conduction defect, aortic regurgitation, infective endocarditis or hemolysis. CONCLUSIONS: Transcatheter closure of perimembranous ventricular septal defect can be performed safely and effectively with the new asymmetric Amplatzer occluder device in selected patients with good short- and midterm results. These devices can be deployed safely in and across and the aneurysmal sacs. In selected cases, this procedure is a satisfactory alternative to surgery.