Eradicating successfully yaws from India: The strategy & global lessons.

Yaws, a non-venereal treponematosis, affecting primarily the tribal populations, has been considered historically as one of the most neglected tropical diseases in the world. In 1996, India piloted an initiative to eradicate yaws based on a strategy consisting of active case finding through house-to-house search and treatment of cases and their contacts with long acting penicillin. Thereafter, the campaign implemented in all 51 endemic districts in 10 states of the country led to the achievement of a yaws-free status in 2004. In the post-elimination phase, surveillance activities accompanied by serological surveys were continued in the erstwhile endemic districts. These surveys carried out among children between the age of 1-5 yr, further confirmed the absence of community transmission in the country. The experience of India demonstrates that yaws can be eradicated in all endemic countries of Africa and Asia, provided that political commitment can be mobilized and community level activities sustained until the goal is achieved.

Lymphatic Filariasis in East District, Sikkim.

East district of Sikkim has been considered as non-endemic for lymphatic filariasis (LF). However, a LF survey conducted during 2008 revealed microfilaria rate (mf rate) of 1.2%. The LF survey was carried out in 15 randomly selected villages and urban localities of East Sikkim. Out of 3,428 night blood smears collected and examined, 42 were found positive for Wuchereria bancrofti. Microfilaria (mf) carriers were detected from 5 surveyed villages and 5 urban localities of Singtam and Rangpoo with mf rate ranging from 0.5% to 4.2%. The mean mf density was 5.4 per 20cmm3 blood. All mf carriers were residents of east district, Sikkim except two persons who were from Bihar. The detection of microfilaria in young children who had never moved from the area indicates probable indigenous transmission. Out of 15 surveyed areas LF disease was found in 11 areas with prevalence ranging from 0.4% to 7.0%.(Disease rate was 1.6%) (1.7% for Males & 1.4% for females). One local individual was found with lymphoedema and also mf positive. Vector density ranged from 70 to 435 per ten-man-hours, sufficient for transmission of LF. 712 female Cx. quinquefasciatus were dissected to detect the filarial infection and none was found positive. The present survey findings indicate endemicity of filariasis in East district of Sikkim.

Effect of Cold Hexane Extract of Karanja (Pongamia Glabra Vent) Seed Kernel on the Development of Mosquito Larvae.

Cold Hexane extract of karanja, Pongamia glabra Vent (Fabaceae) seed kernel (HKSK) ranging at the concentrations of 4 ppm to 28 ppm was evaluated against the freshly emerged larvae of Aedes aegypti and Culex quinquefasciatus. Treatment of HKSK imparted the mortality that was correlated with the level of dosage. Before pupation,100% fatality occurred in Ae. aegypti at a concentration of 20 ppm whereas in Cx. quinquefasciatus the same degree of mortality occurred at the extract concentration of 12 ppm in the first instar larvae only. At low doses, the emerging adults of Cx. quinquefasciatus had deformed legs, wings and truncated abdomen but the adults of Ae. aegypti showed no deformities. The developmental period was prolonged significantly in a dose-dependent manner for both the species treated. In Cx. quinquefasciatus this effect was more pronounced because of increased intermoult period showing an IGR effect of the extract. The calculated growth index also decreased in dose-dependent manner significantly more in Cx. quinquefasciatus. Indeed, Ae. aegypti appeared more susceptible to HKSK than Cx. quinquefasciatus.

Study on The Eco-epidemiology of Chikungunya in U T of Lakshadweep.

An unusual increase in the incidence of viral fever was noticed in Androth and Kalpeni Island, U.T of Lakshadweep during November 2006. The Ecoepidemiology of the disease was studied in detail. The study indicated that Aedes albopictus is the predominant species (98.74%) and it exhibited a wide spectrum of breeding preferences with a clear-cut predilection for rat-damaged coconuts (RDCs). All the entomological indices were very high in both the Islands with a marked increase in Kalpeni Island. The clinical presentation of the cases was typical of chikungunya and the laboratory study confirmed this. Based on the investigation, control and preventive measures were planned, advised and implemented. The details regarding the bio-ecology of vectors, clinical presentation, laboratory investigations and effectiveness of control measures are discussed.

Status of Lymphatic Filariasis in Lucknow District, Uttar Pradesh.

Lucknow district was endemic for lymphatic filariasis (LF). During March 2008, LF survey was carried out in 14 randomly selected villages (six Primary Health Centres) and 4 Mohallas of Lucknow city. Out of 3,654 night blood smears (NBS) collected and examined, 209 were found positive for Wuchereria bancrofti (micrifilaria rate: 5.7%). Microfilaria (mf) carriers were detected from all surveyed villages and Mohallas. The age of these positive persons ranged from 6-70 years. In all areas, prevalence of microfilaraemia generally increased with age up to 21- 30 years. Males (6.7%) were more affected than females (3.9%). All mf carriers were residents of Lucknow district. Overall disease rate was 4.7%. In all, 175 individuals had disease manifestations of LF. Out of 108 males, 81 had hydrocele(75%). Disease rate was similar in males (4.7%) and females (4.8%). The mean mf density was 9.5 per 20 cmm blood, but no significant difference between males (9.4) and females (9.9). Vector density ranged from 150 to 810 per ten-man-hours. Infectivity and infection rates were 0.14%. The present survey indicates that filariasis is one of the major public health problems in surveyed areas.

Lymphatic filariasis in rural areas of Patna District, Bihar. A challenge ahead.

Patna district was endemic for lymphatic filariasis (LF). During November 2004, a lymphatic filariasis survey was carried out in seven randomly selected villages from four PHCs of Patna district. Of 1878 night blood smears (NBS) examined, 117 were found positive for W. bancrofti infection (mf rate 6.2%). Microfilaria carriers were detected from all surveyed villages. In all areas prevalence of microfilaria generally increased with age to maximum 15-34 years and then decline within most age-groups. More males (6.4%) were affected than the females (5.8%). All microfilaria (mf) carriers were residents of Patna district. Over all disease rate was 9.1%. Out of 171 diseased individuals, 121 persons were having hydrocele (6.4%). Disease rate was higher in males (12.0%) than females (4.1%). The mean mf density was 11.7. There was no significant difference of mean mf density in males and females. Vector density ranged from 205 to 780 per ten man hours. The survey indicates that the filariasis situation remained unchanged since last fifty years and still is one of the major public health problem in surveyed areas.

Entomological indices of Aedes aegypti at some international airports and seaports of southern India--a report.

Entomological surveys were undertaken at some of the international airports/seaports (Bangalore, Calicut, Chennai, Cochin, Thiruvanathapuram and Vishakapatnam) to find out the breeding prevalence of dengue vector mosquito in diverse breeding containers from 1998 to 2004. Three vector indices (House index, Container index and Breateu index) were used to assess the breeding potential at each airport/seaport. International Health Regulations urged national governments to keep all the international airports/seaports and peripheral areas up to 400 meters free from Aedes aegypti mosquitoes. However, surveys revealed high vector indices at all the airports and seaports. Health authorities of airports/seaports need to take cognizance of these facts and develop action plan for appropriate control measures with emphasis on vector surveillance.

Lymphatic filariasis in Bilaspur district, Chhattisgarh.

As per earlier reports only Ratanpur PHC of the district Bilaspur of Chattisgarh was endemic for filariasis. During the present survey microfilaria infection and disease manifestations were detected in two more PHCs namely Bilha and Bilaspur. 3426 Night blood smears were collected from 24 randomly selected localities (13 rural and 11 urban) covering 25% known endemic areas and 75% reportedly non-endemic areas. Sample size was calculated taking 12% prevalence rate using standard statistical formula. Sixty-two indigenous residents (mf rate 1.80%) were found positive for W. bancrofti infection. Males (2.17%) were more affected than females (1.19%). The mf carriers were 2.05% in rural and 1.45% in urban communities, which indicates that lymphatic filariasis is prevalent in rural areas also. The mean mf density was 5.06. No infective or infected mosquitoes could be detected in Culex quinquefasciatus (544 nos.), M. annulifera (13 nos.) and M. uniformis (2 nos.). Comparing the earlier studies, in Bilaspur district the infection has been showing a declining trend and Brugia malayi infection has disappeared.

Status of soil transmitted helminthiasis in UT of Lakshadweep.

Soil Transmitted Helminthes (STH) survey in UT of Lakshadweep was conducted during February-March 2004. The survey was undertaken using WHO sampling methodology and Kato-Katz technique for stool sample examination. A total of 387 stool samples were examined of whom 322 samples (83.2%) were found positive for one or more STH. Maximum prevalence (100%) was found in Kavaratti Junior Basic School. Thirty children (7.8%) had high intensity of infection. In Kadmat Junior Basic School high intensity TT infection was 8.9%, For AL highest intensity of infection was found among Kavaratti Senior Basic School (7.0%). Mass anthelminthic chemotherapy of all school children was advocated.

Yaws and its eradication in India--a brief review.

Until 1996-97, when Yaws Eradication Programme (YEP) in India was launched, there were three initiatives to assess/control the yaws disease in the country. YEP was initially started as pilot study in Koraput district, Orissa and later on extended to ten states covering 49 districts. The first goal has been to get the disease eliminated from the country with ultimate goal being its eradication. Strategies for YEP are active case detection and treatment including contacts and targeted IEC. The number of reported cases reduced from 735 in 1997 to "Zero Case" in 2004 from entire country. The recent Third Independent Appraisal of YEP could not confirm any new yaws case. However, before declaring the elimination (meaning no new early infectious case), there is need to make a thorough search in the affected areas. Future activities under the programme includes sero- surveillance among under-five children to demonstrate cessation of yaws transmission.

Status of Soil Transmitted Helminth infections in an urban locality of Assam; as observed from survey by WHO sampling methodology for school children and community survey by random sampling.

In this study, an attempt was made to compare and correlate findings of a Soil Transmitted Helminths (STH) survey carried out using WHO sampling methodology for school children and community survey by random sampling. The prevalence and intensity of STH in the age-group of 9-10 yrs reportedly represent community status. The results showed that the STH prevalence and intensity in the age-group of 9-10 years do represent community burden. However, more such surveys will have to be carried out to substantiate this statement.

Bancroftian filariasis in Bagdogra town, district Darjeeling (West Bengal).

Filaria endemicity is probably gradually increasing over the years in Bagdogra town, district Darjeeling (West Bengal). Of 1511 night blood smears examined, 35 were found positive for Wuchereria bancrofti (mf rate 2.32%). The microfilaria (mf) rates for males and females were 2.84% and 1.79 % respectively. The age of these positives ranged from 5-45 years. The mf rate was highest (4.46%) in the age group of 20-29 years. All mf carriers were local residents of Bagdogra and Wuchereria bancrofti was only the infection encountered. Mean microfilaria density was 7.71 per 20 cmm. of blood, whereas Median microfilaria density (MFD50) was 21 per 20 cmm. of blood. Disease and filarial endemicity rates were 0.33% and 2.65% respectively. Ten man hour vector mosquito density ranged from 30 to 65. Out of 49 female Culex quinquefasciatus mosquitoes dissected for the presence of filaria infection, none was found positive for the infection. During 1976 survey in the same town, mf rate was 1.6% and disease rate was nil.

Status of soil transmitted helminthic infections in India--observations on sample surveys using Kato-Katz technique.

Results of surveys conducted in eight different ecologically homogenous zones in the country, using WHO sampling design methodologies and Kato-Katz technique are presented in this communication. Hilly and coastal areas had high STH prevalence ranging from 34%-36% with total epg ranging from 53,952-4,67,976. Apart from this, Chitradurga urban area had STH prevalence of 39.6% with epg of 81,792. However, except in few cases, in all these surveyed areas, intensity of STH infection was found to be light. A national programme for control of soil transmitted helminthic infections is advocated.

A study of filarial transmission in a non-endemic area of Pathankot (Punjab).

A filariasis survey was conducted in July 1998 in Pathankot town of Punjab covering a population of 28, 041. A total of 2136 blood smears were collected from migratory and local inhabitants. Microfilaria (Mf) rate and mean Mf density was 1.19 and 15.05 respectively. Disease rate was nil. All the 20 microfilaria carriers detected were known to hall from filaria endemic areas of different states. Mf rate was highest in 20-49 years age-group, whereas Mf density was high in younger age group. Wuchereria bancrofti was the only infection encountered. 10 Men Hour Density of Culex quinquefasciatus ranged between 343 in the North Command unit to 400 in an engineering unit. A total of 339 female Culex quinquefasciatus were dissected. None was found positive for human microfilaria parasite, thus negating any indigenous filariasis transmission in this town. These findings were compared to earlier surveys in the same area and other non-endemic areas. Non-endemic areas continue to be non-endemic for filariasis despite considerable increase in MF rate among migratory population and vector density.