Background: A visceral leishmaniasis outbreak was reported from a village in a low-endemic district of Bihar, India. Methods: Outbreak investigation with house-to-house search and rapid test of kala-azar suspects and contacts was carried out. Sandfly collection and cone bio-assay was done as part of entomological study.Results: A spatially and temporally clustered kala-azar outbreak was found at Kosra village in Sheikhpura district with 70 cases reported till December 2018. Delay of more than a year was found between diagnosis and treatment of the index case. The southern hamlet with socio-economically disadvantaged migrant population was several times more affected than rest of the village (attack rate of 19.0% vs 0.5% respectively, OR MH = 39.2, 95% CI 18.2-84.4). The median durations between onset of fever to first contact with any health services, onset to kala-azar diagnosis, diagnosis to treatment were 10 days (IQR 4-18), 30 days (IQR 17-73) and 1 day (IQR 0.5 to 3), respectively, for 50 kala-azar cases assessed till June 2017. Three-fourths of these kala-azar cases had out-of-pocket medical expenditure for their condition. Known risk factors for kala-azar such as illiteracy, poverty, belonging to socially disadvantaged community, migration, residing in kutcha houses, sleeping in rooms with unplastered walls and nonuse of mosquito nets were present in majority of these cases. Only half the dwellings of the kala-azar cases were fully sprayed. Fully gravid female P. argentipes collected post indoor residual spraying (IRS) and low sandfly mortality on cone-bioassay indicated poor effectiveness of vector control. Conclusions:There is need to focus on low-endemic areas of kala-azar. The elimination programme should implement a routine framework for kala-azar outbreak response. Complete case-finding, use of quality-compliant insecticide and coverage of all sprayable surfaces in IRS could help interrupt transmission during outbreaks.

Dengue fever (DF) is increasingly recognized as one of the world’s major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.

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Background: A notification received from state of Chhattisgarh in July, 2018 that 10 cases in a family of 14 members at Salaunikhurd village, Bhatgaon Primary Health Center (PHC), Block Bhilaigarh of Balodabazar district diagnosed as leprosy cases. In response, an investigation team was constituted by Central Leprosy Division to carry out the epidemiological investigation. Aim: To find out reasons of high leprosy endemicity, detailed investigation of multicase family and assessment of health service delivery in village. Methods: House to house survey of the village was carried out to find out new cases along with clinicepidemiological assessment of all patients affected with leprosy. Detailed investigation of two MCFs and assessment of health service delivery from block to the village level was carried out. Results: 84% of the village population screened for leprosy, two new leprosy cases, three defaulter and two newly developed Grade 2 Deformity (G2D) cases were identified during survey. All the cases in the Multi-case Family (MCF) were MB leprosy cases. Atypical signs and symptoms of leprosy -infiltrations and nodules over skin, low socio-economic status, poor housing condition, high family density, poor sanitation, seasonal migration, poor health seeking behaviour, lack of awareness on the disease and health system ignorance are the major factors led to delay in detection. Conclusion: Analysis of case detection trend in the region across the years indicates a smouldering epidemic of Leprosy. Multiple factors are responsible for the occurrence of multiple cases of leprosy within a family. Limitations: 100% population could not survey due to time constraint, harvesting season and migration. Molecular epidemiology study needed to explore the genetic structure which contributed MCF.

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