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Advancing age is accompanied by decreased immunity, poor health, and physiological changes, which render the elderly population highly susceptible to infectious diseases. We aim to identify the guidelines for pneumococcal vaccines in old-age facilities in India. We performed an extensive review of Indian literature (indexed and non-indexed publications) from 2010 to 2020 using search strings "Pneumococcal vaccine AND Recommendations AND India," "Pneumococcal vaccine AND Guidelines AND India," followed by a hand search to identify the most updated versions of recommendations. We reviewed immunization guidelines recommended by nine medical associations and societies in India-Association of Physicians of India (API), Geriatric Society of India (GSI), Indian Society of Nephrology (ISN), Mass Gathering Advisory Board Consensus Recommendation, Indian Medical Association (IMA), Indian Chest Society and National College of Chest Physicians (ICS-NCCP), Research Society for Study of Diabetes in India (RSSDI), Indian Association of Occupational Health Guidelines for Working Adults (IAOH), and API guidelines for immunization during COVID19 pandemic. All bodies recommend pneumococcal vaccines, sequence and preference of which depend on factors such as age, underlying conditions, and immune status. Integration of society recommendations and their implementation into public and private vaccination programs are required to promote adult immunization.
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Objective: Comorbidities and risk factors have a major implication on incidence, complications, mortality, and management of community-acquired pneumonia complications and treatment outcomes. This study attempts to identify the same in the Indian population through a systematic review and meta-analysis. Methods: We screened observational studies (between January 1990 and February 2021) that reported potential comorbidities and other factors associated with increased risk of community-acquired pneumonia in the Indian population (⩾12 years) using PubMed, Google Scholar, and manual search. The risk of bias was identified using the Joanna Briggs Institute checklist for prevalence studies. Meta-analysis was conducted by using the random intercept logistic regression model. Results: Twenty-three studies were included in this analysis. The most prevalent comorbidities were chronic obstructive pulmonary disease (24.2%; 95% confidence interval: 16.4%-34.2%), hypertension (23.7%; 95% confidence interval: 13.6%-38.1%), and diabetes mellitus (16%; 95% confidence interval: 9.9%-24.7%). The prevalence of community-acquired pneumonia was high in patients with a current or previous history of smoking (51.4%; 95% confidence interval: 42.3%-61%) and advanced age ⩾50 years: (55.8%; 95% confidence interval: 48.4%-62%). Conclusions: Comorbid conditions like chronic obstructive pulmonary disease, hypertension, and diabetes mellitus and factors like advanced age and smoking history were common risk factors for community-acquired pneumonia in the Indian population.
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OBJECTIVE: To perform systematic review and meta-analysis of meningococcal disease burden in India. METHODS: We searched publications on meningococcal disease in India between 1996 and 2020 using PubMed and Google Scholar. Prevalence (proportion) of Meningococcal meningitis and Case-fatality ratio (CFR) were pooled using random effects model. Other outcomes were pooled qualitatively. RESULTS: The prevalence of Meningococcal meningitis in epidemic and endemic conditions was 12.1% (95% CI: 5.2-21.4) and 0.76% (95% CI: 0.3-1.4), respectively, with a CFR of 12.8% (95% CI: 6.8-20.4) in epidemic settings; N. meningitis caused 3.2% (95% CI: 1.6-5.3) of Acute Bacterial Meningitis (ABM) cases in endemic settings. The disease appeared in infants, adolescents, and adults with Serogroup A prevalence. Treatment and prophylaxis were limited to antibiotics despite increased resistance. CONCLUSION: The study reveals epidemic and endemic presence of the disease in India with high fatality and serogroup A prevalence. Further monitoring and immunization are required to prevent outbreaks.
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INTRODUCTION: A high burden of vaccine-preventable diseases, increasing elderly population, immunosenescence, and emerging drug resistance emphasize the need for robust adult immunization in India. While immunization guidelines from various societies exist, there is inadequate implementation of the same. AIM: We undertook this narrative review of the adult vaccination ecosystem in India to (i) gain insights into existing adult vaccination practices, (ii) identify barriers to adult vaccination and possible solutions, and (iii) improve collaboration between various stakeholders to help establish adult vaccination centers in the country. RESULTS: Besides the high cost and lack of insurance coverage, the lack of adult vaccination centers contributes to the low coverage of adult immunization. DISCUSSION: These challenges can be addressed through multiple approaches including community awareness and immunization programs, setting up mobile vaccination vans, patient/consumer education, and adequate training of healthcare providers. Successful implementation of these strategies requires active collaboration between the government, hospitals, different stakeholders, and policymakers.
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AIM AND OBJECTIVE: This systematic review and meta-analysis was conducted to assess the prevalence, burden and epidemiology of methicillin-resistant S. aureus (MRSA). This systemic review was also aimed to highlight the challenges in the diagnosis and management of methicillin-resistant S. aureus (MRSA) in India (for all age groups). We also examined the published literature on the available treatment options and the role of prevention in the management of MRSA in India. By summarizing the currently available data, our objectives were to highlight the need for the prevention of MRSA infections and also emphasize the role of vaccination in the prevention of MRSA infections in India. METHODOLOGY: Electronic databases such as PubMed and databases of the National Institute of Science Communication and Information Resources and Indian Council of Medical Research Embase were searched for relevant literature published from 2005/01/01 to 2020/05/13 in English language, according to the predefined inclusion and exclusion criteria. A manual search was also conducted using the key term "MRSA 'or' Methicillin Resistant Staphylococcus aureus 'and' India." An independent reviewer extracted data from the studies using a structured Microsoft Excel spreadsheet, and a meta-analysis of proportion for MRSA prevalence with a corresponding 95% confidence interval (CI) for all included individual studies were performed. RESULT: A total of 34 studies involving 16 237 patients were included in the final meta-analysis. The pooled proportion of patients with MRSA infection was 26.8% (95% CI: 23.2%-30.7%). The MRSA infection was more prevalent among male patients (60.4%; 95% CI: 53.9%-66.5%) as compared to female patients (39.6%; 95% CI: 33.5%-46.1%), while the prevalence of MRSA was higher among adults (18 years and above; 32%; 95% CI: 5%-80%) in comparison to pediatric patients (0-18 years; 68%; 95% CI: 20%-94.8%). The degree of heterogeneity was found to be significant. CONCLUSION: The prevalence of MRSA in India was relatively high at 27% with a higher proportion observed among men aged >18 years. The high prevalence of MRSA infections in India necessitates the implementation of surveillance and preventive measures to combat the spread of MRSA in both hospital and community settings.
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INTRODUCTION: Statins (or HMG-CoA reductase inhibitors) have become drug of choice for raised Low-Density Lipoprotein Cholesterol (LDL-C) in treating. Of these, Atorvastatin, because of its prolonged 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase inhibition has been considered for alternate day therapy in primary prevention of (CHD). OBJECTIVES: To compare the efficacy and safety of daily versus alternate day 10 mg Atorvastatin on reduction of lipid levels in patients of dyslipidemia and to evaluate the number of patients reaching the target Low-Density Lipoprotein (LDL) goals in these groups. METHODOLOGY: In this comparative, randomized, parallel group, non-blinded study, 100 naïve dyslipidemic patients in low to moderate risk group as per NCEP ATP (III) Guidelines were divided in two groups. Group A (n=50) received Atorvastatin 10 mg every alternate day for three months and Group B (n=50) received Atorvastatin 10 mg daily for three months. Apart from general examination and baseline investigations, lipid profile was also done. Efficacy was assessed by the percentage reduction in LDL and attainment of LDL goals as per NCEP ATP III Guidelines at the end of the study. Safety of the medication was assessed. RESULTS: Atorvastatin 10 mg daily produced a significant reduction in Total Cholesterol (TC), LDL, Very Low Density Lipoprotein (VLDL) as compared to Atorvastatin 10 mg alternate day. The increase in the HDL level was also greater with a daily dose as compared to alternate day (but not statistically significant). In Low risk category 86.12 % patients (n=31) on daily dose reached their LDL-C goal vis-a-vis 66.67% (n=18) of patients on alternate day therapy. In the moderate risk category 100 % of daily Atorvastatin patients (n=10) achieved their LDL-C goal versus 33.33% patients (n=4) on alternate day therapy. Adverse events with alternate day therapy (n=4) were less as compared with daily treatment (n=10). CONCLUSION: Atorvastatin 10 mg daily was found to be safe and efficacious in patients with dyslipidemia compared to an alternate day therapy.
