Community-based study to describe the epidemiology of dengue infection in a large cantonment during one transmission season.

Background: Dengue is one of the most important vector-borne disease in India. It has been linked to monsoons when Aedes aegypti mosquitoes breed profusely in containers. No study exists in Armed Forces wherein a community-based sero-survey has described the epidemiology of dengue. The present study tries to fill this knowledge gap. Methods: A total of 422 participants were studied for one transmission season of July-December. Blood samples were collected for testing dengue IgG and IgM at the beginning and at end of the study period. The study participants were interviewed at least twice within this period of 6 months to assess clinical condition and follow-up. Point prevalence and incidence were measured. Distribution of presence or absence of symptoms was noted for positive as well as negative cases. Results: All participants were males. Average age was 31.75 years. Point prevalence at the beginning of transmission season was 11.6% (95% CI: 8.4%-14.6%) and 15.6% (95% CI: 12.1%-19.1%) towards the end. Incidence was found to be 147.4 per 1000 for 6 months. Forty percent of incident cases were asymptomatic. Conclusion: Healthcare planners and hospital commanders in stations across Armed Forces can use the prevalence and incidence figures obtained in this study as a general guide while planning for prevention and control of dengue. Also, this study points to the fact that dengue transmission in Delhi may have shifted earlier to months of April/May than the conventionally accepted season of July-December.

Outbreak control of hospital acquired varicella infection amongst health care workers in a tertiary care hospital.

Background: Adult and immunocompromised patients suffering from varicella (chicken pox) are potential source of infection to healthcare workers. An outbreak of varicella among healthcare workers in a tertiary care centre was investigated, and preventive measures were implemented. Methods: Cases of chicken pox between 05 Feb 2017 and 11 Feb 2017 in a tertiary healthcare establishment were investigated. An epidemiological investigation by developing case definitions, spot map and contact tracing was conducted. Eight cases were identified among healthcare workers. Suitable preventive measures including identification of susceptible contacts and vaccination of susceptible ones with two doses of varicella vaccine was undertaken. Results: Index case was a 21-year-old nurse who was exposed to a 34-year-old male patient transferred from a secondary care hospital on 24 Jan 2017 as a case of acute liver failure and coagulopathy. Primary case was later diagnosed as case of varicella based on serological and clinical evidence. Among a total of 8 cases identified in the outbreak, the cases occurred among healthcare workers of secondary care centre, healthcare workers managing the primary case in the intensive care unit and who conducted the autopsy. A total of 181 contacts were identified in the epidemiological investigation, and 54 were susceptible to chicken pox. Two-dose immunization with varicella vaccination of susceptible ones was found to be effective in preventing further cases. Conclusion: Two-dose vaccination of healthcare workers with varicella vaccine is an effective strategy to prevent nosocomial varicella among healthcare workers.

COVISHIELD (AZD1222) VaccINe effectiveness among healthcare and frontline Workers of INdian Armed Forces: Interim results of VIN-WIN cohort study.

BACKGROUND: On 16 Jan 2021, India launched its immunization program against COVID-19. Among the first recipients were 1.59 million Health Care Workers (HCWs) and Frontline Workers (FLWs) of the Indian Armed Forces, who were administered COVISHIELD (Astra Zeneca). We present an interim analysis of vaccine effectiveness (VE) estimates till 30 May 2021. METHODS: The VIN-WIN cohort study was carried out on anonymized data of HCWs and FLWs of Indian Armed Forces. The existing surveillance system, enhanced for COVID-19 monitoring, was sourced for data. The cohort transitioned from Unvaccinated (UV) to Partially Vaccinated (PV) to Fully Vaccinated (FV), serving as its own internal comparison. Outcomes studied in the three groups were breakthrough infections and COVID related deaths. Incidence Rate Ratio (IRR) was used to compare outcomes among the three groups to estimate VE. RESULTS: Data of 1,595,630 individuals (mean age 27.6 years; 99% male) over 135 days was analysed. Till 30 May 21, 95.4% and 82.2% were partially and fully vaccinated. The UV, PV and FV compartments comprised 106.6, 46.7 and 58.7 million person-days respectively. The number of breakthrough cases in the UV, PV and FV groups were 10061, 1159 and 2512; while the deaths were 37, 16 and 7 respectively. Corrected VE was 91.8-94.9% against infections. CONCLUSION: Interim results of the VIN-WIN cohort study of 1.59 million HCWs and FLWs of Indian Armed Forces showed a ∼93% reduction in COVID-19 breakthrough infections with COVISHIELD vaccination.

Seropositivity of severe acute respiratory syndrome coronavirus 2 infection among healthcare workers of the Armed Forces medical services, India: A multicentric study.

BACKGROUND: Serosurveys provide the prevalence of infection and over time will reveal the trends. The present study was conducted to estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) and to analyse various characteristics (risk factors) associated with SARS CoV-2 infection. METHODS: Eight government designated Corona virus disease -19 (COVID-19) hospitals were selected based on the hospital admission of patients with COVID-19 and the local epidemiological situation in the region. Multistage population proportion to size sampling was performed for the selection of HCWs. Serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Bivariate and multiple logistic regression was performed to find out the factor/factors associated with the positive antibody test. RESULTS: Out of 3255 HCWs that participated in the study, data of 3253 were analysed. The seroprevalence was 19.7% (95% confidence interval: 18.5-21.3%). Factors associated were location, category of HCWs, male sex, previously tested positive by the molecular test, training on infection prevention and control, personal protective measures, handwashing technique, close contact with a patient confirmed with COVID-19, use of personal protective equipment and symptoms in the last 30 days. However, in multiple logistic regression, only location, category, previously tested positive by the molecular test and symptoms in the last 30 days were statistically significant. CONCLUSION: HCWs are vulnerable to SARS-CoV-2 infection. One in five HCWs had detectable antibodies. The presence of antibodies among HCWs may help in their placement and triage. HCWs may be advised to report early in case of any symptoms of COVID-19. Preventive measures may be targeted based on the location, with particular emphasis on ancillary workers and nurses.

Qualitative research in medicine - An art to be nurtured.

To acquire complete knowledge on a subject both qualitative and quantitative research methods need to be perused by researchers. However, over the period of time qualitative research teaching among medical professionals has reduced. Wisdom amongst doctors seems getting muddled in 'data'. Operational research as well as health systems research have been the basis of 'key' policy changes in situations and programmes including polio immunization to achieve desired objectives. Both qualitative and quantitative methods complement each other and cannot replace one another. We need to protect the 'endangered art' of qualitative research before it becomes extinct from medical schools.

Antimicrobial resistance: A public health challenge.

Antimicrobial resistance has become a global concern. Though an evolutionary phenomenon, it is promulgated by faulty human behaviours. It is a growing concern ever since first reported in 1940s. Today, a plethora of newer generation antimicrobials have become ineffective against previously susceptible organisms. This is a huge challenge for health care managers all across the globe, compounded by the "discovery void" in the field of development of new antibiotics. If proper steps are not taken presently, the lurking fear of reaching a therapeutic dead end will become a reality. This paper aims at describing the pandemic of AMR from a public health perspective and suggesting strategies to deal with it in an effective and collaborative manner.

Alcohol and Tobacco Use Among Undergraduate and Postgraduate Medical Students in India: A Multicentric Cross-sectional Study.

BACKGROUND: Substance use among medical fraternity is a well-known phenomenon among both undergraduate (UG) and postgraduate (PG) medical students. Yet, there have been very few multi-centric studies to estimate the actual burden of this problem in this important population group in India. This study was conducted to estimate the prevalence of alcohol and tobacco use, assess the knowledge and attitudes towards this issue, and identify factors associated with substance use among UG and PG medical students in India. METHODS: A pre-tested, self-report, anonymous questionnaire was administered to medical undergraduates and post graduate medical residents of eight medical colleges across India. This study used a convenience sample of medical colleges with random selection of study participants within each college for each group, UG and PG. RESULTS: Prevalence of alcohol and tobacco use among UG students was 16.6%, 95% CI [14.5, 18.9] and 8.0%, 95% CI [6.4, 9.6], respectively, whereas prevalence was 31.5%, 95% CI [26.3, 37.0] and 14.5%, 95% CI [10.7, 18.9], respectively for PGs. For both substances, males had a higher prevalence of use compared to females in both groups (p < 0.001). Positive family history of substance use (p < 0.001 for both groups) and early age of initiation (p = 0.011 for tobacco; p > 0.05 for alcohol) were associated with a greater difficulty to quit the habit. Over 90% of study participants felt that substance use adversely affected their skills and reported not using substances prior to managing their patients. CONCLUSIONS: Since substance use is a relatively common phenomenon among UG and PG medical students in India, future prospective studies and interventions are required to better understand the pattern of substance use and reduce its prevalence.