BackgroundMonitoring and evaluation guidelines of the programme to eliminate lymphatic filariasis require impact assessments in at least one sentinel and one spot-check site in each implementation unit (IU). Transmission assessment surveys (TAS) that assess antigenaemia (Ag) in children in IUs that have completed at least five rounds of mass drug administration (MDA) each with >65% coverage and with microfilaria (Mf) levels <1% in the monitored sites form the basis for stopping the MDA. Despite its rigour, this multi-step process is likely to miss sites with transmission potential (‘hotspots’) and its statistical assumptions for sampling and threshold levels for decision-making have not been validated. We addressed these issues in a large-scale epidemiological study in two primary health centres in Thanjavur district, India, endemic for bancroftian filariasis that had undergone eight rounds of MDA.Methodology/Principal FindingsThe prevalence and intensity of Mf (per 60 µl blood) were 0.2% and 0.004 respectively in the survey that covered >70% of 50,363 population. The corresponding values for Ag were 2.3% and 17.3 Ag-units respectively. Ag-prevalence ranged from 0.7 to 0.9%, in children (2–10 years) and 2.7 to 3.0% in adults. Although the Mf-levels in the survey and the sentinel/spot check sites were <1% and Ag-level was <2% in children, we identified 7 “residual” (Mf-prevalence ≥1%, irrespective of Ag-status in children) and 17 “transmission” (at least one Ag-positive child born during the MDA period) hotspots. Antigenaemic persons were clustered both at household and site levels. We identified an Ag-prevalence of ∼1% in children (equivalent to 0.4% community Mf-prevalence) as a possible threshold value for stopping MDA.Conclusions/SignificanceExistence of ‘hotspots’ and spatial clustering of infections in the study area indicate the need for developing good surveillance strategies for detecting ‘hotspots’, adopting evidence-based sampling strategies and evaluation unit size for TAS.

We investigated chikungunya outbreaks in South India and observed a high attack rate, particularly among adults and women. Transmission was facilitated by Aedes aegypti mosquitoes in peridomestic water containers, as indicated by a high Breteau index. We recommended vector control measures and health education to promote safe water storage practices.

Treatment of patients with patent Wuchereria bancrofti infection results in an acute clinical reaction and peripheral eosinophilia. To investigate the dynamics of the eosinophil response, changes in eosinophil activation and degranulation and plasma levels of eosinophil-active chemokines and cytokines were studied in 15 microfilaremic individuals in south India by sequential blood sampling before and after administration of 300 mg of diethylcarbamazine (DEC). Clinical symptoms occurred within 24 h. Plasma interleukin-5 (IL-5) and RANTES levels peaked 1 to 2 days posttreatment, preceding a peak peripheral eosinophil count at day 4. Major basic protein secretion from eosinophils paralleled IL-5 secretion, while levels of eosinophil-derived neurotoxin peaked at day 13 after treatment. Expression of the activation markers HLA-DR and CD25 on eosinophils rose markedly immediately after treatment, while expression of VLA-4 and ␣4␤7 showed an early peak within 24 h and a second peak at day 13. Thus, the posttreatment reactions seen in filarial infections can be divided into an early phase with killing of microfilariae, clinical symptomatology, increases in plasma IL-5 and RANTES levels, and eosinophil activation and degranulation and a later phase with expression of surface integrins on eosinophils, recruitment of eosinophils from the bone marrow to tissues, and clearance of parasite antigen.

Japanese encephalitis (JE) is the leading cause of viral encephalitis through large parts of Asia with temperate and subtropical or tropical climate. In the present communication environmental determinants that influence the occurrence of JE have been enlisted, and based on which a conceptual frame for JE transmission was developed. The concept of endemic and epidemic has been defined using cluster analysis on JE occurrences in 175 districts over a period of 53 years in India. The average number (±standard deviation) of occurrences in endemic (7.4±3.5) and epidemic districts (3.4±2.9) was statistically significant ('t'=8.3; P=0.000). In the epidemic areas, JE immunization of target population in the risk area may be an effective preventive measure. In the endemic areas regular monitoring of vector population and viral activity, and implementing appropriate integrated methods of vector control are likely to reduce the transmission, besides the selective immunization of children.

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BackgroundAnemia continues to be a major public health problem in India despite multiple initiatives to address it among various vulnerable groups including adolescents. AimThis study was conducted to assess the prevalence of anemia among rural adolescent girls who had attained menarche. MethodsThe community-based cross-sectional study was conducted in 28 villages of Ballabgarh Block of district Faridabad, Haryana. From the computerized Health Management Information System data (HMIS), a random list of 363 adolescent girls was generated. Adolescent girls who had attained menarche were included in the study. Hemoglobin level was measured for all the consented or assented participants using a digital hemoglobinometer (HemoCue201+ photometer, HemoCue AB, Angelholm, Sweden). ResultsA total of 272 participants were enrolled in the study. Mean (SD) age at menarche was 13.2 (1.2) years. Prevalence of anemia among adolescent girls who had attained menarche was observed to be 71.7% (95% CI: 66.3 -77.1) as per the WHO classification. Among the 195 anemic adolescent girls, severe, moderate, and mild anemia was observed in 4.8%, 41.2%, and 25.7%, respectively. In multivariable analysis, after adjusting for the age, the mother's education was significantly associated with anemia (Adjusted Odds Ratio = 0.46, 95% CI: 0.22 -0.96, p-value = 0.04). ConclusionThe prevalence of anemia among rural adolescent girls who had attained menarche was high. Mother's education status had a protective effect on anemia among adolescent girls.

Introduction: The foetus exhibits a wide array of structural and functional adaptations in response to intrauterine conditions, towards protection of vital organs and maintaining the supply of essential nutrients. When oxygen is limited, foetal adaptations prioritise brain growth, irrespective of whether other essential nutrients are limited or not. The hypothesis for this study was that fatty acid synthesis occurs in foetal liver therefore if adaptive changes occur in the hepatic and umbilical flow it will affect fat deposition which will manifest as neonatal adiposity. Aim: Correlation of maternal Basal Metabolic Index (BMI) with Foetal liver blood flow and neonatal adiposity in normal pregnancies and pregnancies complicated by Gestational Diabetes Mellitus (GDM) and Foetal Growth Restriction (FGR) .Materials and Methods: An observational pilot study was carried out in a tertiary care referral hospital of Northern India. Antenatal women were recruited in three groups of singleton uncomplicated pregnancies (40), Women with GDM (31) and women with FGR (29). Maternal characteristics including pre-pregnancy BMI and obstetric ultrasound doppler study were recorded at 35 weeks gestation. The time-averaged maximum velocity (TAMX) was calculated for Umbilical Vein (UV) and Ductus Venosus (DV) as (Vmax) UV and (Vmax) DV. Blood flow (Q) was calculated as Q=h×(D/2)2×p×TAMX. The neonatal biometry and Skin Fold Thickness (SFT) was measured. Statistical techniques used were t-tests for analyses of dichotomous outcomes, Pearson’s correlation (r) and multivariate regression. Results: In mothers with higher DV shunting neonatal adiposity was significantly lower in the FGR group. In the uncomplicated group about 46% of variation in adiposity was explained by all the study variables and overall regression equation was statistically significant (p=0.004). Conclusion: Mothers with low BMI and normal umbilical and middle cerebral doppler flow had higher foetal hepatic flow to improve substrate deposition. DV shunting was significantly higher in hypoxic foetuses with reduced hepatic flow.

Evaluate the impact of third trimester ultrasound in identifying ,small for gestational age (SGA) growth restricted (FGR) and appropriately grown fetuses (AGA).Analyse their outcomes ,ascertain the main causes of perinatal death and lastly compare ultrasound intervention to standard antenatal care . Design Prospective observational study Setting Secondary care, government hospital Population Antenatal women Methods Based on estimated fetal weight by scan , patients were categorized into FGR < 3, SGA >3 and <10 and AGA >10 centile. Perinatal outcomes and deaths were analysed by category. Health Ministry data was extracted for standard care outcomes and compared to study group. Main Outcomes Perinatal deaths and causes,composite neonatal morbidity ,severe adverse outcomes Results Number of births in study and standard care was 1817 and 15,427 respectively. Detection rate by ultrasound for FGR/SGA fetuses was 28.5%.This contained 44.8% (13/29) of all perinatal deaths. Neonatal deaths, composite neonatal morbidity, serious adverse perinatal outcomes were significantly more in FGR compared to AGA. Standard care group had twice as many stillbirths RR 2.32(1.3-4.1)and early neonatal deaths (RR2.5 (1.18-5.34) . Majority of perinatal deaths (17/29; 58.6%) in study group were the direct result of failure to recognize antepartum/ intrapartum risk factors, leading to delayed delivery. In addition (3/12 ; 25%), women reported late after decreased fetal movements and ( 3/12 25%)were post dated. Ill-equipped nursery contributed to neonatal mortality in (10/17 ; 58.8%) cases. Conclusion Perinatal outcomes will not improve by ultrasound identification of small fetuses unless concomitantly, obstetric protocols and patient awareness programmes are not improved.