Seroprotection against measles in previously vaccinated children with difficult-to-treat nephrotic syndrome.

BACKGROUND: Children with nephrotic syndrome (NS) are vulnerable to infections. Measles infection is an important cause of morbidity and mortality in immunosuppressed children. A suboptimal seroprotection against measles has been shown in immunocompromised children. There is limited published literature on measles immunity in children with difficult-to-treat nephrotic syndrome (DTNS). We compared the proportions of children with DTNS and healthy controls who were seroprotected against measles. METHODS: This was a cross-sectional study. Measles-specific IgG antibodies of 108 children with DTNS (3 to 10 years of age) and an equal number of age-matched healthy controls were measured. All children had received two doses of measles-containing vaccine at 9-12 and 16-24 months of age under routine immunisation programme. Serum measles IgG antibody titres were measured by indirect ELISA. The assay results were interpreted as (1) > 11 NTU (NovaTec Units), positive/seroprotective titres; (2) 9-11, equivocal; and (3) < 9 NTU, negative. Inter- and intra-group comparisons were made to identify the disease characteristics related to seroprotection status. RESULTS: The proportion of children with protective anti-measles antibodies (n = 70, 65%) was significantly lower in DTNS as compared to controls (n = 88, 81.48%) (p = 0.005). Their median [IQR] antibody titres were also significantly lower than those in controls (14.1 [14] NTU vs. 18.3 [15.2] NTU (p = 0.001). The age, gender, clinical subtype, duration of disease, and type of immunosuppressive therapy were not significantly different between seroprotected and non-seroprotected children with DTNS. CONCLUSION: A significantly lower percentage of fully vaccinated children with DTNS were seroprotected against measles compared to healthy controls. A higher resolution version of the Graphical abstract is available as Supplementary information.

Perplexity vs Clarity in choosing the right molecular diagnostic techniques for SARS-COV2 detection in Indian setup.

After the havoc created by Spanish flu a century ago, the world is witnessing exactly a similar pandemic situation since the beginning of the year 2020. The unexplained respiratory illness with high morbidity & mortality which started in Wuhan, China and spread across the world was finally termed as COVID-19 disease caused by SARS-CoV-2 and later announced as pandemic by WHO. This novel virus SARS-CoV-2 is a new variant of SARS corona virus with high infectivity and mysterious pathophysiology. The major step towards containment of this pandemic is to scale up the testing for SARS-CoV-2 and thereby isolating and managing the patients at the earliest. Molecular amplification based methods such a Real time Polymerase chain reaction (RT-PCR), CBNAAT and TrueNAT are the most commonly used techniques for detection of SARS-CoV2. To utilize these diagnostic facilities optimally in the management of the suspected COVID 19 patients, it is of utmost importance for the healthcare providers to understand the intricacies related to these technologies. Thus, the technical details along with the pros & cons of these three amplification-based technologies for proper understanding of these diagnostic modalities for SARS COV-2 diagnosis are discussed herewith.

Seasonal variation of diarrheal diseases and drinking water quality in resettlement colony in Delhi, India: A community-based cross-sectional study.

Seasonal variation plays an important role in the occurrence of diarrheal diseases and distinct seasonal occurrence of diarrheal diseases, with bacterial diarrhea occurring more during the warm seasons and viral diarrhea occurring during the drier cool months, has been observed due to seasonal variation. Time-series cross-sectional study was conducted from January to December 2018 among 553 under-five children to assess seasonal variation of diarrheal diseases and its association with the drinking water quality in a resettlement colony of Delhi. The prevalence of diarrhea was 40.7% and was highest during the rainy season (67.6%). Majority of the water samples were found to be unsatisfactory for human consumption during the rainy and summer seasons. Significant and moderate relationship was found between the seasonal variation and occurrence of diarrhea (r = 0.728, P < 0.05) and most probable number count (r = 0.50, P < 0.05), respectively. Understanding the environmental factors that influences the occurrence of diarrheal diseases is warranted.

Comparative evaluation of cost effective extraction free molecular technique for detection of SARS-CoV-2 with reference to standard VTM based RT-qPCR method.

BACKGROUND AND OBJECTIVES: The entire globe is undergoing an unprecedented challenge of COVID-19. Considering the need of rapid and accurate diagnostic tests for SARS-CoV-2, this study was planned to evaluate the cost effective extraction free RT-PCR technique in comparison to the standard VTM based RT-qPCR method. MATERIALS AND METHODS: Paired swabs from nasopharynx and oropharynx were collected for SARS-CoV-2 testing, from 211 adult patients (≥18 years) in VTM and plain sterile tubes (dry swabs). These samples were processed and RT-qPCR was carried out as per standard protocols. RESULTS: 54.5% of the patients were females and 45.5% were males with sex ratio 1:1.19 (M: F). 38.86% were symptomatic, of which fever (86.59%), cough (79.23%) and breathlessness (46.34%) were the most common symptoms. The positivity by VTM based method and index method was 31.27% and 13.27% respectively. Of the 27 inconclusive results from index method, 37.04% were positive, 48.15% were negative by VTM based method. However, in 40 inconclusive results by VTM based method, 90% were negative and rest remained inconclusive by index method. The sensitivity and specificity of the index method were 39.39% and 85.71% respectively. The overall agreement between VTM based method and index method was 49.59% with estimated Kappa value of 0.19. CONCLUSION: VTM based method showed higher sensitivity compared to the index method. The higher positivity by VTM based method, suggests that VTM based method could plausibly be a better detection method of SARS-CoV-2. Still, the index method might add value in a resource limited setups for detection of SARS-CoV-2.

The Syndromic Spectrum of COVID-19 and Correlates of Admission Parameters with Severity-outcome Gradients: A Retrospective Study.

BACKGROUND: Clinical and laboratory features of COVID-19 may have regional variations. This study aimed to discern their association with severity of illness and mortality in tertiary setup of Delhi, India. METHODS: Retrospective data of hospitalised COVID-19 patients over 3 months (end March to June 2020) were evaluated for symptom profile, blood investigations and chest radiograph data and classified according to COVID-19 severity and as survivors and non-survivors. RESULTS: Average age (n=182) was 46.1 years, male to female ratio 1.4:1. Fever (51.1%), cough (49.4%) and breathlessness (48.3%) were the commonest symptoms, and frequency of all the three increased with severity of COVID-19. Fever duration, leucocytosis, neutrophilia, elevated blood urea, transaminitis and higher Brixia score on chest X-ray were also more in severe COVID-19 compared to mild and moderate categories. Higher age, more comorbidities, fever, breathlessness and chest pain; longer duration of fever, leucocytosis, neutrophilia, lymphopenia, high neutrophil to lymphocyte ratio, elevated serum urea, creatinine, transaminases and hyperglycemia, and higher radiographic Brixia score were observed in non-survivors compared to survivors. CONCLUSION: Greater prevalence of symptoms (alone and in combination) and derangements in blood biochemistry are seen in severe COVID-19 compared to mild or moderate cases, and also in non-survivors compared to survivors.

Immune Response to Double Dose Hepatitis-B Vaccine using Four Dose Schedule in HIV Infected Children.

OBJECTIVE: To assess the immune response to hepatitis B vaccination in HIV infected children using 4 double dose schedule administered at 0-1-2-6 mo. METHODS: In a prospective observational study, 40 HIV infected children were vaccinated with hepatitis B virus (HBV) vaccine (20 mcg, 1 ml IM at anterolateral aspect of thigh of recombinant DNA vaccine) at 0-1-2-6 mo. Anti-HBsAb titre were assessed 4-8 wk after the last dose. Clinical severity was assessed according to WHO staging. Immune status of the patients was assessed using CD 4+ counts before the vaccination. RESULTS: Of the total 40 patients, 33 (28 boys, 5 girls) completed the study. Six patients were in pre-antiretroviral therapy (ART) care while 27 were receiving ART for a mean duration of 2.06 y. Ten patients belonged to WHO clinical stage 1, and 17, 2 and 4 patients to WHO clinical stage 2, 3 and 4 respectively. Median CD4+ cell count was 738/mm(3) and 28 patients had mild or no immunosuppression. Out of the total 33 patients who completed followup, only 2 patients (6 %) did not seroconvert (Anti HBsAb titre at end of study <10 IU/L), the rest (94 %) achieved different levels of Anti HBsAb titre at end of study. Twenty two (66 %) patients had anti HBsAb titre more than 1000 IU/L, 8 (24 %) had titre between 100 and 1000 IU/L and one (3 %) patient had level of 10-99.99 IU/L. CONCLUSIONS: In HIV-infected children who have no or mild immunosuppression, four dose, double dose schedule of HBV vaccine achieves very high seroconversion rates.

Magnitude and pattern of hepatitis B infection in clinically suspected infectious hepatitis at a tertiary care hospital in urban India.

INTRODUCTION: Hepatitis B virus (HBV) is a parenterally transmitted viral illness of significant public health importance. The prevalence of HBV related viral hepatitis still remains debatable. OBJECTIVES: The objective of the following study is to determine the magnitude and pattern of HBV infection in clinically suspected infectious hepatitis at a tertiary care hospital in urban India. MATERIALS AND METHODS: This prospective study was conducted in the Department of Microbiology at Lady Hardinge Medical College, New Delhi, over a period of 1 year from January 2008 to December 2008. All the serum samples taken from subjects (600 study and 200 control) were tested for hepatitis B surface antigen (HBsAg) using commercially available enzyme linked immunosorbent assay kit. Serum samples testing positive for HBsAg were tested for hepatitis B e antigen, immunoglobulin M (IgM) capture anti hepatitis D virus (HDV), IgM anti hepatitis B surface and IgM anti hepatitis B core. RESULTS: 24 (4%) serum samples tested positive for HBsAg in the study group while 5 (2.5%) tested positive in the control. Maximum seropositivity of HBsAg was in 20-30 years of age group in the study group (7.6%) followed by 11-20 years (4.5%), 0-10 years (2.8%) and >40 years (2.5%). The difference in seropositivity in study and control group was statistically insignificant in all the age groups (P > 0.05). Out of 24 cases positive for HBsAg, 4 cases (16.6%) were co infected with HDV in study group while there were none in control group. CONCLUSIONS: HBV is a common cause of parenterally transmitted viral hepatitis and hence, it is recommended that measures for public awareness regarding safe infection practices and safe sex practices should be undertaken to limit its spread.

Serological immunity to diphtheria and tetanus in healthy adults in Delhi, India.

Widespread childhood immunization with DPT (diphtheria, pertussis and tetanus) has largely eradicated diphtheria and tetanus from many countries. The reduction in the circulation of toxigenic strains has resulted in less natural boosting of adult immunity. As a result, the adult population in countries with high childhood immunization coverage have become susceptible to the disease. The duration of immunity after primary immunization to diphtheria and tetanus is limited and a reduction in immunity is common in adults. With this perspective, the present study was carried out on a random serum sample of 255 healthy individuals aged 20-50 years. The serum samples were tested for immunoglobulin G levels against diphtheria and tetanus by enzyme immuno assays. Fifty-three per cent of adults were unprotected; 22 % were seen to have only a basic protection against diphtheria; 25% were protected against both diseases; and 47% were susceptible to tetanus. The susceptibility was seen to increase with age. To avoid epidemics in the future, immunity must be improved. It is important to treat even the most trivial wound with care and tetanus toxoid immunization. Also, it is necessary to monitor the community for immunity to diphtheria using standard techniques in order to undertake epidemiological surveillances of, and prevention from, these dreadful diseases.

Seroprevalence of anti Helicobacter pylori IgG/IgA in asymptomatic population from Delhi.

Helicobacter pylori is recognised as the most important etiological agent for chronic antral gastritis in humans, the major predisposing factor in the pathogenesis of duodenal and gastric ulcers as well as probable cofactor in the development of gastric cancer. This study was undertaken to determine the seroprevalence of anti - H. pylori IgG/ IgA in asymptomatic population. Two hundred and fifty eight serum samples from various age groups (1-40 years) were collected from patients admitted to the wards for conditions other than gastrointestinal disorders and screened for anti H. pylori IgG/IgA antibodies. The prevalence of anti H. pylori IgG/IgA in the age group < 10 years, 10-19 years, 20-29 years, 30-39 years and anti 40 years were found to be 38.89%, 52.08%, 59.62%, 67.88% and 54.17% respectively. The prevalence of H. pylori increased markedly with age, being maximum in 30-39 year age group. Similar trend was observed in a study conducted in South India and Mumbai. Almost half the children acquire H. pylori infection early in life which increases slowly and steadily with a peak prevalence in the age group 30-39 years and then declines as the age advances. There was no significant difference in prevalence rate in males and females.