An explosive outbreak of poliomyelitis in an orphanage in Delhi: risk factors for the unusually high attack rates.
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Child↗
Biomedical subjects
R S Sharma
Publications and source records attributed to R S Sharma.
V. cholerae 01 outbreak in remote villages of Shimla district, Himachal Pradesh, 1994.
An outbreak of V. cholerae 01 occurred in remote villages of Rohru tehsil, district Shimla, Himachal Pradesh, during June-July 1994. Seven villages were affected. Overall attack rate was 16.4 per cent in surveyed villages. Attack rate in children < 5 was significantly high. Suspected source was spring water contaminated from open air defaecation. V. cholerae was resistant to co-trimoxazole and streptomycin.
Adult↗
Status of Plasmodium falciparum resistance to chloroquine in Orissa.
Orissa is known for its contribution of 15-20% of malaria cases to the national total. Deaths due to malaria in the state are also not uncommon. Proportion of P. falciparum cases have reached to 85%. In the recent years over 0.3 million confirmed malaria cases have been reported each year. Annual consumption of chloroquine in the state is over 170 lakh tablets. A 17 year study on monitoring of choloroquine resistance in P. falciparum in Orissa revealed that out of a total of 1165 tests conducted in vivo, in 12% of the cases RI level of resistance was detected. And 4.4% cases were of RII and 1.9% RIII level. 51% of the sample tested in vitro showed P. falciparum resistance to chloroquine. P. falciparum resistance to chloroquine appears to have been developed by the parasite over the length and breadth of the state. Strengthening of the monitoring of drug resistance in P. falciparum in the state is indicated.
Antimalarials↗
Vibrio cholerae O1 and O139 in less than five years old children hospitalised for watery diarrhoea in Delhi, 1993.
In Delhi, patients with cholera-like illness are admitted to the Infectious Diseases Hospital. In 1993, rectal swabs from 836 such patients aged less than five years were examined for the presence of Vibrio cholerae O1 and O139. Of them, 232 (28%), 180 (22%), and 424 (51%) were found suffering from O1 cholera, O139 cholera, and non-cholera watery diarrhoea respectively. Twelve children (1.4%) excreted both V. cholerae O1 and O139. Both types of cholera were similarly distributed by age, with 19% of the cases occurring in infants. The findings indicate that cholera should be suspected in children aged less than two years and in infants with acute watery diarrhoea. For both serotypes, males were more represented than females; the differences were, however, not significant. Clinical features of patients with V. cholerae O139 and O1 were indistinguishable, except that a significantly higher percentage of the former had fever. Potential risk factors for cholera were almost equally prevalent in the families of children aged less than 5 years having either O1 or O139 cholera. The results suggest a similar mode of transmission of the two serotypes in children. By inference, the preventive and control measures are also likely to be similar.
Antigens, Bacterial↗
Malaria outbreak in Mewat region Gurgaon district of Haryana State.
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Disease Outbreaks↗
Epidemiological considerations on age distribution of paralytic poliomyelitis.
Despite a declining trend of poliomyelitis due to high coverage of OPV, the age distribution of poliomyelitis cases have not shown any change over the years in India. More than 90 percent of the cases have continued to occur in children below 5 years of age; the median age of cases remained below 2 years of age. The authors examined the issue and suggest that any major shift in age at paralysis may not occur in India, in spite of high vaccine coverage with OPV unless there is concomitant improvement in sanitation and hygiene.
Age Distribution↗
Unnatural deaths in Delhi during 1991.
An analysis was undertaken of 3623 post-mortems conducted in the Civil Hospital, Delhi, during 1991, covering 75 per cent of civil police stations and all three railway police stations. The study showed that the death rate was highest in the age group of 30-39 years (29.6%), road traffic accidents being the most common cause (33.9%). In general four times more deaths occurred in males than in females. However, in deaths by burning it was three times higher in females. The attention of all concerned should be drawn to this huge, untimely and tragic loss of lives.
Accidents↗
Evaluation of immunization coverage by lot quality assurance sampling compared with 30-cluster sampling in a primary health centre in India.
The immunization coverage of infants, children and women residing in a primary health centre (PHC) area in Rajasthan was evaluated both by lot quality assurance sampling (LQAS) and by the 30-cluster sampling method recommended by WHO's Expanded Programme on Immunization (EPI). The LQAS survey was used to classify 27 mutually exclusive subunits of the population, defined as residents in health subcentre areas, on the basis of acceptable or unacceptable levels of immunization coverage among infants and their mothers. The LQAS results from the 27 subcentres were also combined to obtain an overall estimate of coverage for the entire population of the primary health centre, and these results were compared with the EPI cluster survey results. The LQAS survey did not identify any subcentre with a level of immunization among infants high enough to be classified as acceptable; only three subcentres were classified as having acceptable levels of tetanus toxoid (TT) coverage among women. The estimated overall coverage in the PHC population from the combined LQAS results showed that a quarter of the infants were immunized appropriately for their ages and that 46% of their mothers had been adequately immunized with TT. Although the age groups and the periods of time during which the children were immunized differed for the LQAS and EPI survey populations, the characteristics of the mothers were largely similar. About 57% (95% CI, 46-67) of them were found to be fully immunized with TT by 30-cluster sampling, compared with 46% (95% CI, 41-51) by stratified random sampling. The difference was not statistically significant. The field work to collect LQAS data took about three times longer, and cost 60% more than the EPI survey. The apparently homogeneous and low level of immunization coverage in the 27 subcentres makes this an impractical situation in which to apply LQAS, and the results obtained were therefore not particularly useful. However, if LQAS had been applied by local staff in an area with overall high coverage and population subunits with heterogeneous coverage, the method would have been less costly and should have produced useful results.
Adult↗
Visceral leishmaniasis control in India through primary health care system--a successful experiment of district level planning.
A model district action plan for control of Visceral Leishmaniasis a serious public health problem in north-east Bihar was developed in late 1989 and implemented in 1992 in district Vaishali. A two years implementation resulted in decline in cases and deaths due to Visceral Leishmaniasis to the extent of 65.32% and 46.51% respectively in 1993 as compared to 1992 and 41.13% and 44.93% respectively in 1994 as compared to 1993 with an overall decrease of 79.58% in case and 70.54% in deaths in 1994 as compared to 1992. The implementation of action plan not only established declining trends in morbidity and mortality due to Visceral Leishmaniasis in the district but also successfully contained the cases unresponsive to first line treatment with Sodium Stibogluconate by reducing the prevalence of such cases from 12.42% in 1992 to 8.59% in 1994. Various components of the action plan, implementation strategy and consequent impact on disease situation are presented in this paper.
Cause of Death↗
Epidemiology and transmission of V. cholerae O1 and V. cholerae O139 infections in Delhi in 1993.
In 1993, rectal swabs from clinically suspected cases of cholera admitted to the Infectious Diseases Hospital (IDH), Delhi were examined for Vibrio cholerae O1 and O139. Epidemiological data of 396 cholera cases were collected before the patients' discharge from IDH. Of the 1528 laboratory-confirmed cholera cases, 46% and 54% were caused by serotype O1 and O139 respectively. Both serotypes appeared and disappeared simultaneously, and peaked during the same time of the year. However, the two serotypes affected persons of different age groups; about 65% of the O1 cases occurred in children aged less than 10 years, whereas this age group accounted for 40% of the cases due to V. cholerae O139. Although there were some focal outbreaks due to serotype O139, both serotypes had almost similar geographical distributions. Important risk factors for transmission of cholera were almost equally prevalent in the majority of both types of cholera cases. Since the seasonality, geographical distribution, and risk factors for transmission were similar for both serotypes, the study indicates that the preventive and control measures are also likely to be similar. The study also shows that the emergence of V. cholerae O139 in 1993 did not affect the incidence, seasonality, and epidemiology of endemic V. cholerae O1 E1 Tor strains in Delhi.
Adolescent↗
Ecological observations on the anopheline mosquitoes of Jalpaiguri Duars, West Bengal.
A nine month entomological study was conducted from August 1989 to April 1990 in Jalpaiguri duars of West Bengal where malaria has been persistent problem. Amongst the anopheline fauna three vector species were recorded; An. minimus was the principal vector supported by A. dirus during the rainy months and An. fluviatilis in dry months. All the three vectors were found in close association with human orbit and An. minimums was found to be primarily a domestic vector. The primary role of An. minimus in the transmission of malaria in the region has been highlighted. Observations on seasonal variation, biting preferences, and biting time and vector infection rates were recorded.
Animals↗
Methods for estimating prevalence and incidence of senile cataract blindness in a district.
The problem of senile cataract blindness (SCB) is very acute in India, contributing to 80 per cent of total blindness. The national objective of reducing the prevalence of blindness from 1.49 per cent, during 1986-89 to 0.3 per cent by AD 2000 has necessitated the surgical correction of SCB to be the major activity. With the introduction of District Blindness Control Society (DBCS), there has been a substantial increase in the number of operations of SCB in those districts. However, in the absence of standard, feasible, simple and cost effective methods to estimate the prevalence and incidence of SCB, the DBCS may find it difficult to plan and execute its major activity in a realistic way. The paper suggests two such methods for the use by DBCS. Only five seemingly rational assumptions have been adopted for the purpose. The authors feel that proper field testing is required to be sure about the reliability and validity of these methods.
Adult↗
Further observations on comparison of immunization coverage by lot quality assurance sampling and 30 cluster sampling.
Lot Quality Assurance Sampling (LQAS) and standard EPI methodology (30 cluster sampling) were used to evaluate immunization coverage in a Primary Health Center (PHC) where coverage levels were reported to be more than 85%. Of 27 sub-centers (lots) evaluated by LQAS, only 2 were accepted for child coverage, whereas none was accepted for tetanus toxoid (TT) coverage in mothers. LQAS data were combined to obtain an estimate of coverage in the entire population; 41% (95% CI 36-46) infants were immunized appropriately for their ages, while 42% (95% CI 37-47) of their mothers had received a second/ booster dose of TT. TT coverage in 149 contemporary mothers sampled in EPI survey was also 42% (95% CI 31-52). Although results by the two sampling methods were consistent with each other, a big gap was evident between reported coverage (in children as well as mothers) and survey results. LQAS was found to be operationally feasible, but it cost 40% more and required 2.5 times more time than the EPI survey. LQAS therefore, is not a good substitute for current EPI methodology to evaluate immunization coverage in a large administrative area. However, LQAS has potential as method to monitor health programs on a routine basis in small population sub-units, especially in areas with high and heterogeneously distributed immunization coverage.
Cluster Analysis↗
Epidemiology of cholera in Delhi--1992.
Cholera is endemic in Delhi and is a highly seasonal disease. Suspected cholera cases are referred to Infectious Diseases Hospital, Delhi. Rectal swabs from 2783 cases were bacteriologically examined during 1992, out of which 1075 were found to be positive for Vibrio cholerae O1 biotype El Tor. First isolation was made on 3 April and the last on 14 December. About 87 per cent isolations were made between May and September, which are summer and monsoon months in Delhi. Detailed epidemiological information was collected for about 198 cases of diarrhoea out of which 103 were confirmed cases of cholera. Half of these cases occurred in children below 10 years of age. The other major group affected was adult females, especially housewives. All the cholera cases occurred in those who were illiterate or educated up to primary level. Important risk factors were: contact with person having similar illness, storage of water in wide-mouthed containers, use of glass or mug to draw water from containers, absence of sanitary latrines and habit of washing hands with water alone after defecation, before cooking and eating food. About 30 percent cases had access to piped water supply which was found safe in Delhi during 1992. The findings suggest that the hygienic practices were more important than contaminated water sources for transmission of cholera in Delhi during the year 1992.
Adolescent↗
Concurrent evaluation of immunization programme by Lot Quality Assurance Sampling.
The current EPI methodology for identifying immunization coverage is simple and easy to carry out under field conditions and gives a good idea about immunization coverage. However, it is not useful for local managers. It does not identify small health units with poor performance. Information on performance at the local level is vital to enhance overall immunization coverage. Estimation of coverage on a small area basis can be made by Lot Quality Assurance Sampling (LQAS). LQAS was used in nine sub-centres of district Saharanpur. The methodology was found to be feasible and identified seven sub-centres with poor current performance. Although LQAS may not be a good substitute for current EPI methodology to evaluate immunization coverage in a large administrative area, it is suggested that LQAS is a useful additional method for routine monitoring and evaluation of health programmes on a small area basis, especially as the overall coverage increases.
Communicable Disease Control↗
An outbreak of viral hepatitis A in Ibrahimpatnam town of Andhra Pradesh.
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Adolescent↗
Need of an efficient surveillance to combat malaria.
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Disease Outbreaks↗
An outbreak of viral hepatitis E: role of community practices.
A small localised outbreak of viral hepatitis due to HEV occurred in an educated and well placed community. The overall attack rate was found to be 1.9%; the children and adults were equally affected. No fatality was observed. Five blood samples collected from the cases of jaundice were found negative for Anti HAV IgM, HBsAg and Anti HBc IgM, but positive for Anti HEV. The infection spread by contamination of piped water by sewage system resulting from scarcity of water, intermittent water supply and installation of on-line private booster pumps by the residents. Community action, especially the boiling of drinking water till the quality of piped water improved, restricted jaundice cases to only one incubation period. The outbreak highlights the importance of community behaviour in first precipitating the crisis and then limitating the damage.
Adolescent↗