The chikungunya virus (CHIKV) infection epidemic has emerged as a significant public health concern in the last 10-15 years, especially in Asian and south American countries. However, with ever-expanding tourism and migration, cases have now been reported in north America and Europe. CHIKV infection predominantly causes musculoskeletal symptoms with a chronic polyarthritis which may resemble autoimmune inflammatory arthritis. CHIKV infection should always be suspected in a returning traveller presenting with fever, skin rash and arthralgia. Though first reported in the last century, a series of epidemics since 2004 have substantially improved our knowledge. There has also been a significant increase in our understanding of the immunopathogenesis of chikungunya infection. This knowledge is being used in the development of new treatment strategies and preventive measures. In this narrative review, we discuss some of the recent advances in the epidemiology, immunopathogenesis, and management of CHIKV arthritis.
Hepatitis B is a major problem in many parts of the world. The WHO has recommended the inclusion of hepatitis B vaccines in routine immunization schedules. We wanted to compare two recombinant hepatitis B vaccines in an infant population for immunogenicity and reactogenicity when given at 6, 10, and 14 weeks of age. One hundred seventy-three infants meeting eligibility criteria were given either GeneVac-B (Serum Institute of India Ltd.) or Engerix-B (GlaxoSmithKline Beecham) in a random fashion. Three 0.5-ml (10-g) doses of the vaccines were given at 6, 10, and 14 weeks of age along with diphtheria-pertussis (whole cell)-tetanus (DTPw) vaccine. Blood samples were collected at baseline and 1 month after administration of the third dose of the vaccines to measure anti-HBs antibody levels. Seroconversion was defined as a titer of more than 1 ؋ 10 ؊3 IU/ml, while seroprotection was defined as a titer of more than 10 ؋ 10 ؊3 IU/ml. Of the GeneVac-B recipients, 98% seroconverted versus 99% of the Engerix-B group. The anti-HBs geometric mean titer was slightly greater for GeneVac-B (229 ؋ 10 ؊3 IU/ml) than for Engerix-B (167 ؋ 10 ؊3 IU/ml), but the difference was not significant. The seroprotection rates were similar for both vaccines (96% and 95%, respectively). The most common systemic reaction events were mild to moderate fever, excessive crying, local swelling, rash, and irritability, and the local reactions were redness, induration, and edema, which most probably were caused by the simultaneously administered DTPw vaccine. All events were transient and resolved without sequelae. Reactogenicity was similar for the two vaccines. The present study shows that GeneVac-B is as immunogenic and as well tolerated as Engerix-B when administered with DTPw vaccine at 6, 10, and 14 weeks of age.Hepatitis B is one of the world's major health problems (9). By recent estimates, more than 2 billion people are infected with hepatitis B virus (HBV) globally. This includes 350 million chronic carriers of the virus. The infection is supposed to be causally related to 1 to 2 million deaths per year worldwide (11).In India, too, hepatitis B is a major public health problem. India comes under the intermediate zone (2 to 7%) of HBV prevalence, the carrier rate being approximately 5%. The HBV carrier load is around 38 to 43 million (12).The WHO Assembly endorsed the recommendation of its Global Advisory Group that all countries should implement a hepatitis B immunization program (15). According to the WHO report of March 1994, 72 countries have adopted hepatitis B vaccine in their universal program of immunization (12). However, HBV vaccine has not been included in the national immunization program in India, and cost is one of the limiting factors. The page may be turning, however, because recombinant HBV vaccines are now manufactured locally and the price of the vaccine is much less than that of imported vaccine(s).A recombinant hepatitis B vaccine (GeneVac-B) is manufactured by the Serum Institute of India Ltd., Pune, India. The vaccine ...
Rabies is a fatal disease in humans and till date survivors of the disease after the clinical onset of the illness are rare. The approach to management of rabies is usually palliative. In rare cases of paralytic rabies a trial for cure has been tried. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon alpha, ketamine etc. the only reported cases in literature were with rare success of the Milwaukee protocol. This is the case report of a 45 year old male who presented with clinical rabies and was started on the trial. Has the treatment had any benefit is to be debated and further options discussed.
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