A spectrum of viral diseases in Odisha state, eastern India: An evidence-based analysis from 2010-2017.

Introduction: Emerging and re-emerging viral diseases are a major threat to public health. Odisha, being one of the coastal states in the country, reports many viral illnesses due to its typical geographical location. This study focuses on the prevalence of different viral diseases in the state of Odisha, India, from 2010-2017. Material and Methods: A total of 43,397 patients with clinical suspicion of viral diseases were screened for different viral etiologies during 2010-2017. The laboratory diagnosis was conducted by serology (ELISA) and RT-PCR for 24 different viruses, i.e., dengue, chikungunya, Japanese encephalitis, hepatitis A virus, hepatitis E virus, hepatitis B virus, hepatitis C virus, rotavirus, herpes simplex virus-1 and herpes simplex virus-2, Epstein-Barr virus, cytomegalovirus, and respiratory viruses. Patients were enrolled from sporadic hospital admissions and outbreaks under different categories as per clinical diagnoses like fever with rash, diarrhoea, encephalitis, jaundice, respiratory illness, and fever of unknown etiology. Results: The majority of patients belonged to exanthematous group, i.e., fever with rash (32.24%). The number of males was more in all categories except fever with rash, where females (53.34%) were more. Children <16 years of age were found to be the predominant age group for suspected viral diarrhoea (85.26%), encephalitis (76.96%), fever of unknown origin (40.16%), and respiratory infections (27.23%). Conclusion: Not only vector-borne diseases pose a threat to the Odisha state, but other viral illnesses have also emerged. This detailed report of different viral diseases in the state of Odisha will support public health management.

Epidemiology of viral disease outbreaks in Odisha, India (2010-2019).

Despite consistent public health efforts, the burden of viral disease in India remains high. The present study was undertaken to understand the aetiology, frequency and distribution of viral disease outbreaks in the state of Odisha between 2010 and 2019. This was a prospective study conducted at the Virology Research and Diagnostic Laboratory located at ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, wherein all the outbreaks of viral aetiologies were investigated and analysed to provide a comprehensive picture of the state of viral disease outbreaks in the region. A total of 191 suspected viral outbreaks were investigated by the team from VRDL during September 2010 and September 2019 reported from all the 30 districts of Odisha. Annual number of suspected cases ranged from 185 to 1002. The most commonly suspected outbreaks were of viral hepatitis (55 outbreaks; 1223 cases) followed by dengue (45 outbreaks; 1185 cases), chickenpox (30 outbreaks; 421 cases), viral encephalitis (27 outbreaks; 930 cases), measles (23 outbreaks; 464 cases), chikungunya (10 outbreaks; 593 cases) and rubella (1 outbreak; 60). The outbreaks peaked in frequency and intensity during the months of July and September. The epidemiology of viral disease outbreaks in the region is presented in the study. Health system preparedness based on evidence is essential for early detection and adequate response to such viral outbreaks.

Molecular and phylogenetic analysis of the dengue strains circulating in Odisha, India.

Dengue has emerged as a major public health challenge in terms of both changing clinical pattern and epidemiological features. The state of Odisha reported first dengue epidemic in the year 2010 and this continued each year in epidemic form during post monsoon period gradually becoming an endemic phenomenon. Present study depicts the changing epidemiological and clinical pattern of dengue with reference to its serotypes and genotypes. The study included 5320 suspected dengue cases from different health facilities of the state during 2010-2017. Dengue NS1 antigen and IgM antibody was done through ELISA. Serotyping was done through RTPCR by amplifying a part of core-pre-membrane gene (CprM) followed by sequencing and phylogenetic analysis. Dengue IgM antibody in 17.7% cases and NS1 antigen in 53.20% cases was detected. Dengue serotype 2 (DEN-2) was the only serotype detected in 2010 and 2011 where as all four serotypes 1, 2, 3, 4 were detected in 2012-2017, DEN-2 being dominant but in 2017 DEN-3 was found to be dominant. Phylogenetic analysis revealed genotype IV of DEN-2 and genotype III of DEN-1 and DEN-3 circulating in this region. In 6 cases involvement of DEN-2 in clinically evident encephalitis cases is an important observation in this region and needs public health attention. High prevalence of dengue was observed without any previous reported outbreaks in the state with increased number of cases from 2010 to 2012 affecting both urban and rural areas. High incidence in 2012 was due to co-circulation of more than one serotype which continued in the following years. Severity in some cases was associated with mixed infection but in most cases it was mild indicating the endemic nature of the virus in most parts of Odisha.

Epidemiological and clinical profile of Influenza A(H1N1) pdm09 in Odisha, eastern India.

Epidemic of flu is highly contagious and it spreads through air. In 2009 H1N1 influenza virus emerged after reassortment of North American TRIG and Eurasia Avian like virus of swine and started epidemic in Mexico. The first cases were reported from Hyderabad city on 16th May 2009 in India that spread rapidly within a short span of time. During this period large population of Odisha situated at the eastern side of India was also affected and incidences of H1N1 cases were recorded through state Government surveillance system. In this study real time RT-PCR based diagnosis was conducted for the throat swabs collected from suspected H1N1 cases in Odisha during 2009-2017. A total of 2872 throat swabs were received from 23 different Government and private hospitals and 21.1% positivity was confirmed. The disease affected mostly 46-60 years age group, males (50.6%) being more affected. The clinical features had shown that fever with cough (89.6%) was the most common symptom followed by shortness of breath (72.7%). Post monsoon was the peak season in which most of the cases were reported. Neurological signs, pregnancy, diabetes and hypertension were found to be risk factors for H1N1. The case fatality rate (CFR) was 15%.

Real-time estimation of the hospitalization fatality risk of influenza A(H1N1)pdm09 in Hong Kong.

During the early stage of an epidemic, timely and reliable estimation of the severity of infections are important for predicting the impact that the influenza viruses will have in the population. We obtained age-specific deaths and hospitalizations for patients with laboratory-confirmed H1N1pdm09 infections from June 2009 to December 2009 in Hong Kong. We retrospectively obtained the real-time estimates of the hospitalization fatality risk (HFR), using crude estimation or allowing for right-censoring for final status in some patients. Models accounting for right-censoring performed better than models without adjustments. The risk of deaths in hospitalized patients with confirmed H1N1pdm09 increased with age. Reliable estimates of the HFR could be obtained before the peak of the first wave of H1N1pdm09 in young and middle-aged adults but after the peak in the elderly. In the next influenza pandemic, timely estimation of the HFR will contribute to risk assessment and disease control.

The effects of hyperuricaemia on flow-mediated and nitroglycerin-mediated dilatation in high-risk patients.

BACKGROUND AND AIMS: Uric acid is emerging as one of the newer risk markers to consider in the cardiovascular risk assessment because it is demonstrated to be associated with adverse cardiovascular outcomes, particularly in high cardiovascular risk patients. One of the proposed mechanisms involving hyperuricaemia is the development of vascular damage. The aim of this study is to examine the role of hyperuricaemia on vascular function in patients with high cardiovascular risk. METHODS AND RESULTS: We examined the clinical significance of hyperuricaemia in relation to vasomotor response of the brachial artery by using high-resolution ultrasound in 304 subjects with coronary artery disease and/or diabetes. Nitroglycerin-mediated dilatation (NMD) was significantly lower in the hyperuricaemic group compared with the normouricaemic group (12.8 ± 6.9% vs. 16.2 ± 7.7%, p < 0.001), but no significant difference was observed in flow-mediated dilatation (FMD) between the two groups [3.78 (95% CR: 1.5-9.9) vs. 3.88 (95% CR: -2.6 to 9.9), p = 0.78]. Multivariate analysis demonstrated that smoking was the strongest predictor of FMD (b = -0.81, p = 0.02); and that smoking (b = -2.62, p = 0.003), SBP (b = -0.11, p = 0.001), hyperuricaemia (b = -2.11, p = 0.02) and use of nitrates (b = -3.30, p = 0.001) were independent predictors of NMD. CONCLUSION: High cardiovascular risk patients with hyperuricaemia had a lower NMD than those with normouricaemia. Importantly, hyperuricaemia was independently associated with NMD after multivariable adjustments. To further understand the pathophysiological mechanisms involving hyperuricaemia, particularly in the context of impaired NMD, further experimental and clinical studies are needed.

Statistical algorithms for early detection of the annual influenza peak season in Hong Kong using sentinel surveillance data.

In Hong Kong, influenza sentinel surveillance systems have been recently established. Methods that compare current data to data from recent weeks may be appropriate to indicate the start of peak influenza activity. These methods can produce reliable and timely alerts at the start of the annual influenza peak season.

Are the 2006 World Health Organization standards for infant growth applicable to Hong Kong Chinese? Universalistic standards or epidemiological transition stage-specific norms.

1. Parental socio-economic status was positively associated with length and body mass index of Hong Kong Chinese infants at 9 months. 2. Maternal smoking in pregnancy was negatively associated with infant length at 9 months. 3. Some of the World Health Organization (WHO) criteria for an optimal nurturing environment contributed positively to growth. At 36 months, Hong Kong Chinese infants were generally shorter and fatter than the WHO growth references.

Transmission of Japanese encephalitis virus in Hong Kong.

1. Pigs are likely to be the main amplifying host for Japanese encephalitis virus. 2. The success of a swine vaccination programme depends on the timing of the loss of maternal antibody protection and seasonal dynamics of the vector population. 3. Vaccination may be ineffective in the face of strong natural infection because of the variability in timing of the loss of maternal antibody protection.4. Evidence in support of swine vaccination as a human health intervention was not found.

The effect of alcohol drinking on erectile dysfunction in Chinese men.

Erectile dysfunction (ED), smoking, and alcohol drinking are common in middle-aged men. Although smoking has been shown to be a risk factor of ED in Chinese and other populations, the relationship between drinking alcohol and ED is not clear. The Family Planning Association of Hong Kong conducted the Men Health Survey in 2004. In all, 1506 men aged 20-70 years were recruited by stratified random sampling of the male population. Face-to-face interviews were used to collect information on drinking and smoking and other life style factors, morbidities, and sociodemographic status during household visits. The more sensitive information on sexual activity and ED was obtained by a self-completed questionnaire at the end of the interview. A total of 816 subjects aged 31-60 years currently active in sexual activity were included in the present analysis. Compared with never drinkers, alcohol drinkers who consumed three or more standard drinks (one standard drink equals 12 g of alcohol) a week were more likely to report EDs as defined by having both sexual dissatisfaction and erectile difficulty (odds ratio (OR)=2.27, 95% confidence interval (CI)=1.28-4.03) after adjusting for age and cigarette smoking. When analyzed separately by smoking habit, the risks were higher in current smokers (OR=2.27, 95% CI=1.01-5.11) than never smokers (OR=1.91, 95% CI=0.68-5.35). Our results suggest that alcohol drinking of three or more standard drinks per week might reduce sexual satisfaction and impair erectile function in current smokers and might have less effect in never smokers.

Infant growth during the first year of life and subsequent hospitalization to 8 years of age.

BACKGROUND: There is accumulating evidence that rapid infant growth is associated with subsequent metabolic risk, but less investigation of potential benefits. We tested the life history trade-off hypothesis that rapid infant growth is associated with lower risk of serious childhood morbidity (in particular, infection) proxied by hospital admission. METHODS: We studied term births (n = 7833, 94% follow-up) from a Chinese birth cohort, "Children of 1997," comprising 88% of births in Hong Kong in April and May 1997. We used multivariable negative binomial regression to examine the association of growth trajectory (5 categories) from birth to 12 months with subsequent hospital admissions until the child's 8th birthday. Potential confounders included sex, gestational age, parental education, type of birth hospital, infant feeding, and the presence of congenital disease. RESULTS: Infants with the slowest growth trajectory (smallest birth weight and slowest weight gain) were more likely to be hospitalized between 1 and 8 years of age-particularly for noninfectious illnesses. Infants in the 4 faster growth trajectories differed little in their risk of hospitalization. Adjusted incident rate ratios of hospitalization for infectious diseases were 0.93 (95% confidence interval = 0.81-1.06), 0.97 (0.85-1.12), 0.91 (0.78-1.06), and 0.92 (0.79-1.08) for the 4 faster growth trajectories compared with the slowest. Results were similar when growth was assessed as change in weight-for-age z-score. CONCLUSION: Fast infant growth does not protect against serious infectious morbidity, but low birth weight infants born with slow growth are more vulnerable to serious morbidity, either as a consequence of poor growth or as a parallel marker of underlying health state. Whether maximum growth rates are ideal should be considered, as should the effects of infant over-nutrition.

Short- and medium-term outcomes of accelerated infant growth in a Hong Kong Chinese birth cohort.

1. In a large, population representative,Chinese birth cohort, higher birth weight and rapid growth, particularly at 0-3 months, were associated with higher body mass index (BMI) at 7 years. 2. Boys born heavy who had grown fast had the highest BMI, but rapid growth had the largest impact in lighter-born boys. 3. Rapid growth at 0-3 months or 3-12 months was not associated with a compensatory lower risk of serious infectious morbidity. 4. The ability to grow fast may be an embodiment of good health status, rather than fast growth being causally protective.

Epidemiology of SARS in the 2003 Hong Kong epidemic.

1. The temporal and spatial evolution of the SARS epidemic in Hong Kong is described. 2. Estimates of key epidemiological distributions and their stability over the course of the epidemic are derived. 3. The characteristics of those who contracted the disease are determined including factors associated with the likelihood of mortality as a result of SARS coronavirus infection.

Prevalence of SARS-CoV antibody in all Hong Kong patient contacts.

The near absence of transmission (seroprevalence=0.19%) resulting in asymptomatic infection in this representative high-risk group of close contacts indicates that the prevailing SARS-CoV strains in Hong Kong almost always led to clinically apparent disease.

Community psycho-behavioural surveillance and related impact on outbreak control in Hong Kong and Singapore during the SARS epidemic.

1. The promotion of personal protective health practices must take into account background perceptions of risk and psychological responses in the community-at-large. 2. Population psycho-behavioural factors in Hong Kong and Singapore are shown to be an important potential vector for the transmission of an infectious agent. 3. Comparative psycho-behavioural surveillance and analysis can yield important insights into generic versus population-specific issues that could be used to inform, design and benchmark public health infection control measures.

Early life second-hand smoke exposure and serious infectious morbidity during the first 8 years: evidence from Hong Kong's "Children of 1997" birth cohort.

BACKGROUND: Second-hand smoke (SHS) exposure is a modifiable cause of ill health. Despite the smoking ban in public places introduced in Hong Kong in 2007, infants and children continue to be exposed within the home. AIMS: To determine the critical windows of SHS exposure and the duration of its impact on serious infectious morbidity in the first 8 years of life. METHODS: The Hong Kong "Children of 1997" birth cohort is a prospective, population-based study of 8327 children comprising 88% of all births in April and May 1997, of whom 7402 (89%) were followed up until their eighth birthday in 2005. We used multivariable Cox regression to assess the relation between postnatal SHS exposure and risk of first admission to public hospitals (together accounting for >95% total bed-days overall) for respiratory, other and all infections from birth to 8 years of age, for all individuals and for vulnerable subgroups. RESULTS: Overall, household SHS exposure within 3 metres in early life was associated with a higher risk of admission for infectious illness up until 8 years of age (hazard ratio 1.14, 95% CI 1.00 to 1.31), after adjustment for sex, birthweight, gestational age, feeding method, maternal age, highest parental education and proxies of preferred service sector. The association was strongest in the first 6 months of life (HR 1.45, 95% CI 1.15 to 1.83). In vulnerable subgroups such as premature babies, the association held through to 8 years of age (HR 2.00, 95% CI 1.08 to 3.72). Infants exposed to SHS in the first 3 months of life were most vulnerable to infectious causes of hospitalisation. CONCLUSION: Household SHS exposure in early infancy increases severe infectious morbidity requiring hospital admission. Reducing SHS exposure in infants and particularly in more vulnerable infants will lower the bed-days burden due to infectious causes.

Effectiveness of control measures during the SARS epidemic in Beijing: a comparison of the Rt curve and the epidemic curve.

One of the areas most affected by SARS was Beijing with 2521 reported cases. We estimate the effective reproductive number Rt for the Beijing SARS epidemic, which represents the average number of secondary cases per primary case on each day of the epidemic and is therefore a measure of the underlying transmission dynamics. Our results provide a quantitative assessment of the effectiveness of public health control measures. More generally, our results illustrate how changes in Rt will reflect changes in the epidemic curve.