Outbreak of chickenpox in a military center in northern Pakistan

Objective: To study the outbreak of chickenpox in a military training center in Northern Pakistan

Study Design: Cross sectional study

Place and Duration of Study: Combined Military Hospital [CMH] Attock from 1st Nov 2007 to 30th Jan 2008

Material and Methods: Patients with clinical suspicion of chickenpox during the outbreak were confirmed by laboratory tests including complement fixation test using commercial antigen of Virion/Serion of Germany and Immunoglobulin M for Varicella zoster virus by enzyme linked immunosorbent assay of Vircell, Spain. Moreover, direct immunofluorescence using BioRad kit was also done in patients with active lesions

Results: A total of 102 cases occurred in the present outbreak. The age of the patients ranged from 16 to 35 years with a mean of 21.16 + 4.47 years. From a total of 102 patients, 60 [58.8%] were positive for antibodies against Varicella zoster virus by complement fixation test, 30 [29.4%] were positive by ELISA and 12 [11.7%] were positive on Immunofluorescence testing. None of the admitted cases developed any complication and their hospital stay remained uneventful

Conclusion: This outbreak of chickenpox in a military training center affected a considerable number of military recruits, led to a number of hospital admissions and had an adverse effect on training activities. There is a need to formulate a policy to offer vaccination against Varicella zoster virus to all unimmunized individuals before induction in the military to avoid unnecessary interruption in training and academic activities

End of treatment response in patients treated for hepatitis c virus with standard interferon and ribavirin based on viral load

To determine the End-of-Treatment-Response [ETR] to standard interferon and ribavirin based regimen in patients of chronic hepatitis C and to compare the ETR response in low and high viral load groups. Descriptive study. Virology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from March 2012 to May 2013. Patients with chronic hepatitis C virus infection were included in the study. Pre-treatment viral load was determined by RoboGene Quantification kit. Based on viral load, the 400 patients were divided into two equal groups of low viral load [< 800,000 IU/ml] and high viral load [> 800,000 IU/ml]. The patients were treated with standard interferon alpha [3 million units subcutaneously thrice weekly] and ribavirin [10.6 mg/kg body weight] for 6 months. ETR was measured using Sacace Biotechnologies Qualitative kit. Chi-square test was used to compare the ETR in the two viral load groups. P-value < 0.05 was considered as significant. Out of 400 patients, 206 [51.5%] were males and 194 [48.5%] were females. Two hundred seventy [67.5%] patients achieved ETR and 130 [35.5%] failed to do so. In low viral load group, 145 [72.5%] patients achieved and 55 [27.5%] patients did not achieve ETR. In high viral load group, 123 [61.5%] patients achieved and 77 [38.5%] did not achieve ETR. The difference in ETR between low and high viral load groups was statistically significant [p=0.019]. End-of-treatment-response in patients treated for hepatitis C virus with standard interferon and ribavirin was greater in patients with low viral load as compared to patients with high viral load

Molecular and serological assessment of chronic HBV carriers and additional burden of applying updated guidelines in Pakistan

To assess the additional burden of the patients eligible for treatment, based on recommendations on viral load, in the light of 2009 version of AASLD guidelines, as compared to 2004 guidelines and to determine the frequency of HBeAg in chronic HBV carriers. Descriptive cross-sectional study. Virology Department, Armed Forces Institute of Pathology, Rawalpindi, from November 2010 to January 2012. Persons with chronic HBV infection, reporting for HBV DNA PCR test, were included in the study and blood samples were collected. HBV DNA load was determined by Real Time PCR. HBsAg and HBeAg were tested by ELISA. Out of the 801 subjects positive for HBsAg, 74 [9.24%] were positive for HBeAg. Out of them, 113 [14.1%] had HBV DNA load > 100,000 copies/ml and were eligible for treatment according to AASLD 2004 guidelines. Forty one [5.1%] had HBV load between 10,000 and 100,000 copies/ml, and were additionally eligible for treatment as per AASLD 2009 guidelines. The 5.1% of 4.5 million estimated HBV carries in Pakistan comes to 229500. There was a low HBeAg positivity and HBV DNA positivity in our chronic HBV infected persons. Moreover, there is an increase of 229500 potential candidates for HBV treatment in Pakistan based on viral load testing, according to the AASLD 2009 guidelines when compared with 2004 guidelines. The increase in the number of candidates for treatment may require an additional expenditure of tens of billions of rupees