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1.  Tracking the Implementation to Identify Gaps in Integrated Disease Surveillance Program in a Block of District Jhajjar (Haryana) 
To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The responsibility for effective implementation of IDSP at the sub-center level lies with the health workers.
The aim of the following study was to assess the knowledge and practice of health workers regarding IDSP and to assess the quality of IDSP reports at the sub-center level.
Settings and Design:
It was cross-sectional study carried out in the area under Community Health Center Dighal which is the rural field practice area attached to Post Graduate Institute of Medical Sciences, Rohtak in the State of Haryana, India. Subjects and Methods: All the 24 sub-centers in the area were visited and 46 health workers (22 male; 24 female) who met the inclusion criteria i.e. who had completed 1 year of their service or had been trained for IDSP, were included in the study. Data were collected on a self-designed, semi-structured and pre-tested schedule by interviewing the study subjects and observation of the records/reports.
Statistical Analysis Used:
Percentages and proportions.
Only 14/46 (~30%) of the workers could expand the abbreviation “IDSP” correctly. Only 4/46 (~9%) workers could narrate any of the trigger events and none could tell all the trigger events. Only at 12 such sub-centers, diagnoses were being written in their out-patient registers according to the defined syndromes. 43/46 (~93%) workers were not aware of the zero reporting.
The surveillance system is much less alert and intense than the desired level and needs to be strengthened.
PMCID: PMC4209674  PMID: 25374856
Disease; gaps; integrated disease surveillance program; surveillance; track
2.  Malaria vaccine can prevent millions of deaths in the world 
Human Vaccines & Immunotherapeutics  2013;9(6):1268-1271.
Malaria is a major public health problem, afflicting ~36% of the world’s population. The World Health Organization (WHO) has estimated that there were 216 million cases of malaria in 2010, and ~655,000 people died from the disease (~2000 per day), many under age five. Yet the disease, a killer for centuries, remains endemic in many poor nations, particularly in Africa, where it is blamed for retarding economic growth. India contributes ~70% of the 2.5 million reported cases in Southeast Asia. Malaria is also an important threat to travelers to the tropics, causing thousands of cases of illness and occasional deaths. The 5 Plasmodium species known to cause malaria are P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. Most cases of malaria are uncomplicated, but some can quickly turn into severe, often fatal, episodes in vulnerable individuals if not promptly diagnosed and effectively treated. Malaria vaccines have been an area of intensive research, but there is no effective vaccine. Vaccines are among the most cost-effective tools for public health; they have historically contributed to a reduction in the spread and burden of infectious diseases. Many antigens present throughout the parasite life cycle that could be vaccine targets. More than 30 of these are being researched by teams worldwide in the hope of identifying a combination that can elicit protective immunity. Most vaccine research has focused on the P. falciparum strain due to its high mortality and the ease of conducting in vitro and in vivo studies. DNA-based vaccines are a new technology that may hold hope for an effective malaria vaccine.
PMCID: PMC3901816  PMID: 23403452
malaria; parasites; immunity; research; vaccines
3.  Whole-cell inactivated Leptospirosis vaccine 
Leptospirosis is an infectious disease of worldwide distribution that is caused by pathogenic spirochete bacteria of the genus Leptospira. It is transmitted by the urine of an infected animal and contagious in a moist environment. Epidemiological studies indicate that infection is commonly associated with certain occupational workers such as farmers, sewage workers, veterinarians, and animal handlers. The annual incidence is estimated at 0.1–1 per 100,000 in temperate climates to 10–100 per 100,000 in the humid tropics. A disease incidence of more than 100 per 100,000 is encountered during outbreaks and in high-exposure risk groups. The 11 countries in South-East Asia (SEA) together have a population of more than 1.7 billion and a work force of about 770 million with more than 450 million people engaged in agriculture. Because of the large number of serovars and infection sources and the wide differences in conditions of transmission, the control of leptospirosis is complicated and will depend on local conditions. The available leptospirosis vaccines are mono- or polyvalent cellular suspensions. These cells are inactivated by chemical agents like formaldehyde and phenol, or by physical agents like heat. The vaccine confers protection for not longer than about one year, while there are cases that need revaccination six months later during epidemic periods.
PMCID: PMC3903893  PMID: 23295984
bacteria; incidence; outbreak; prevention; vaccine
4.  Development of Toxoplasma gondii vaccine 
Toxoplasmosis is caused by the protozoan parasite T. gondii. Humans and other warm-blooded animals are its hosts. The infection has a worldwide distribution; one-third of the world’s population has been exposed to this parasite. There are three primary ways of transmission: ingesting uncooked meat containing tissue cysts, ingesting food and water contaminated with oocysts from infected cat feces and congenitally. Those particularly at risk of developing clinical illness include pregnant women, given that the parasite can pose a serious threat to the unborn child if the mother becomes infected while pregnant, and immunosuppressed individuals such as tissue transplant subjects, AIDS subjects, those with certain types of cancer and those undergoing certain forms of cancer therapy. Maternal infections early in pregnancy are less likely to be transmitted to the fetus than infections later in pregnancy, but early fetal infections are more likely to be severe than later infections. In the absence of an effective human vaccine, prevention of zoonotic transmission might be the best way to approach the problem of toxoplasmosis and must be done by limiting exposure to oocysts or tissue cysts. Vaccine development to prevent feline oocyst shedding is ongoing, mostly with live vaccines. The S48 strain Toxovax is a live vaccine originally developed for use in sheep, but when used in cats inhibits sexual development of T. gondii. This vaccine is used in sheep to reduce tissue cyst development. The T-263 strain of T. gondii is a live mutant strain designed to reduce or prevent oocyst shedding by cats by developing only partial infection in the feline intestinal tract.
PMCID: PMC3859749  PMID: 23111123
parasite; oocyst; pregnancy; congenital anomalies; vaccine
6.  Human papilloma virus vaccines 
Human papilloma viruses (HPVs) infect the skin and mucosal epithelium of both men and women. There are about 100 types of HPVs, which are differentiated by the genetic sequence of the outer capsid protein L1. More than 30 types of HPVs are sexually transmitted. Most cases of carcinoma of the cervix are caused by HPV. Cervical cancer is one of the most common forms of cancer in women is the second biggest cause of female cancer mortality worldwide. The worldwide incidence of cervical carcinoma is 529,000 per year, and mortality is 275,000, of which an estimated 88% of deaths occur in developing countries. At least 20 million people worldwide are already chronically infected. Over 80% of cases of cervical carcinoma occurs in developing countries, with 25% estimated to occur in India. At least 50% of sexually active men and women encounter genital HPV at some time in their lives. Cervical cancer is ranked as the most frequent cancer in women in India. India has a population of approximately 366 million women above 15 y of age, who are at risk of developing cervical cancer. The current estimates indicate approximately 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting for nearly one-third of the global cervical cancer deaths. HPV can be prevented by vaccination. Two types of HPV vaccines are available, as Gardasil and Cervarix, both of which are highly effective at preventing HPV infection. HPV vaccine is administered in a three-dose series administered by intramuscular injection, either in the deltoid muscle or in the antero-lateral thigh. The second and third doses should be administered 2 and 6 mo after the first dose respectively. The minimum interval between the first and second doses should be 4 weeks, between the second and third dose should be 12 weeks.
PMCID: PMC3667952  PMID: 23108360
HPV; cervical carcinoma; wart; death; vaccines
7.  Meningococcal vaccine 
Human Vaccines & Immunotherapeutics  2012;8(12):1904-1906.
Meningococcal meningitis is caused by Neisseria meningitidis, a gram-negative, aerobic, encapsulated diplococcus. Meningococci are divided into numerous serogroups based on the composition of their capsular polysaccharide (Ps) antigens. At least 13 serogroups have been described: A, B, C, D, 29E, H, I, K, L, W-135, X, Y and Z. Out of these 13, six (A, B, C, W135, X and Y) can cause epidemics. The incubation period averages 3–4 d (range 1–10 d), which is the period of communicability. Bacteria can be found for 2–4 d in the nose and pharynx, and for up to 24 h after starting antibiotics. N. meningitidis is a leading cause of meningitis worldwide and a significant public health problem and dreaded disease in most countries. Morbidity and mortality rates from the disease remain high. Apart from epidemics, at least 1.2 million cases of bacterial meningitis are estimated to occur every year, 135,000 of which are fatal – of these, ~500,000 and ~50,000 respectively are caused by meningococci. Many outbreaks of meningococcal meningitis have been documented, with major outbreaks mainly seen in large cities of northern, western and eastern India like New Delhi, Mumbai, Kolkata and northeastern states. In 2011, 245 people died in India, the vast majority (179) in West Bengal, while 467 and 341 people in 2009 and 2010 respectively died of this disease. The meningococcal conjugate vaccines (MCV) are preferred for reasons of immunogenicity and persistence of immunity but are unavailable in India. Only the quadrivalent and bivalent meningococcal Ps vaccines (MPV) are available in India. The quadrivalent MPV is preferred for Haj pilgrims, international travelers and students in that it provides protection against emerging W-135 and Y disease in these areas. A single-dose 0.5mL injection is recommended.
PMCID: PMC3656083  PMID: 22906940
meningitis; disease; morbidity; mortality; vaccines
8.  India towards diabetes control: Key issues 
The Australasian Medical Journal  2013;6(10):524-531.
The problem of mass diabetes is steadily increasing everyday. This editorial introduces key issues that need to be addressed to support the effective control of diabetes in India as well as globally. Issues like awareness generation for risk reduction, frequency of monitoring for selected parameters, standards for monitoring chronic complications in patients with diabetes, and current recommended targets of various parameters, amongst others, are presented along with extensions to the vaccinations recommended for diabetic patients.
PMCID: PMC3821052  PMID: 24223071
Diabetes; challenges; control; India; key issues; vaccinations; awareness
9.  Tetanus toxoid vaccine: Elimination of neonatal tetanus in selected states of India 
Human Vaccines & Immunotherapeutics  2012;8(10):1439-1442.
Tetanus is caused by a neurotoxin produced by Clostridium tetani (C. tetani), a spore-forming bacterium. Infection begins when tetanus spores are introduced into damaged tissue. Tetanus is characterized by muscle rigidity and painful muscle spasms caused by tetanus toxin’s blockade of inhibitory neurons that normally oppose and modulate the action of excitatory motor neurons. Maternal and neonatal tetanus (MNT) are caused by unhygienic methods of delivery, abortion, or umbilical-cord care. Maternal and neonatal tetanus are both forms of generalized tetanus and have similar clinical courses. About 90% of neonates with tetanus develop symptoms in the first 3–14 d of life, mostly on days 6–8, distinguishing neonatal tetanus from other causes of neonatal mortality which typically occur during the first two days of life. Overall case fatality rates for patients admitted to the hospital with neonatal tetanus in developing countries are 8–50%, while the fatality rate can be as high as 100% without hospital care. Tetanus toxoid (TT) vaccination of pregnant women to prevent neonatal tetanus was included in WHO’s Expanded Program on Immunization (EPI) a few years after its inception in 1974. In 2000, WHO, UNICEF, and UNFPA formed a partnership to relaunch efforts toward this goal, adding the elimination of maternal tetanus as a program objective, and setting a new target date of 2005. By February 2007, 40 countries had implemented tetanus vaccination campaigns in high-risk areas, targeting more than 94 million women, and protecting more than 70 million subjects with at least two doses of TT. In 2011, 653 NT cases were reported in India compared with 9313 in 1990. As of February 2012, 25 countries and 15 States and Union Territories of India, all of Ethiopia except Somaliland, and almost 29 of 34 provinces in Indonesia have been validated to have eliminated MNT.
PMCID: PMC3660763  PMID: 22894950
elimination; maternal; neonatal; tetanus; vaccine
10.  Assessment of self-awareness among rural adolescents: A cross-sectional study 
Adolescence is a period of biological, cognitive and social transition of such magnitude and rapidity that it is no surprise to find that it is associated with the onset or exacerbation of a number of health-related problems. It is the level of self-awareness among adolescents, which enables them to see where their thoughts and emotions take them.
The aim of this study was to assess the extent of awareness regarding adolescent changes/problems among school going adolescents.
Settings and Design:
It was a cross-sectional study and was carried out in Block Beri, District, Jhajjar (Haryana).
Materials and Methods:
A sample of 320 adolescent students of 9th-12th classes (80 from each school) were selected from four randomly chosen large Government senior secondary schools with strength of more than 250 students (two girls and two boys/co-ed senior secondary schools). Data were collected on predesigned, pre-tested and semi-structured schedules by conducting in-depth interviews of selected study adolescents by the investigator.
Statistical Analysis Used:
Percentages, proportions, Chi-square test, Chi-square test with Yate's correction and t-test.
Out of 320, 212 (66.3%) study adolescents were aware of at least one adolescent change(s) whereas, when probed and further asked to enumerate the changes taking place in them, 272/320 (85%) adolescents could narrate at least one such change. Out of those 272, 24 (8.82%) (95% CI 6.0-12.79) adolescents either did not consider these changes as normal or they did not know whether the changes were normal or abnormal.
Adolescents greatly lack correct information related to their bodies’ physiological, psychological and sexual changes. There is an urgent need for regular adolescent friendly information, education and communication activities covering different aspects of adolescent knowledge needs/problems.
PMCID: PMC3830363  PMID: 24251217
Adolescents; awareness; changes; knowledge; school; self
12.  Pentavalent vaccine 
Human Vaccines & Immunotherapeutics  2012;8(9):1314-1316.
Immunization is one of the most important public health interventions and a cost effective strategy to control the infectious diseases especially in children. Complete immunization coverage in India has increased from below 20% in the 1980s to nearly 61% at present, but still more than 1/3rd children remain un-immunized. Advent of combination vaccines has facilitated incorporation of additional vaccines into immunization schedule. Pentavalent vaccine, against five killer diseases–diphtheria, pertussis, tetanus, hepatitis B and Hemophilus influenza type B (Hib), has been introduced in almost all GAVI eligible countries by 2011. Government of India introduced the vaccine in two states in pilot phase and has given green signal to six more states. The use of pentavalent vaccine automatically raises the coverage level of hepatitis B and Hib vaccines. If the vaccines are provided individually, the coverage of hepatitis B and Hib vaccines usually lags behind DPT coverage. This gap can be filled by using pentavalent vaccine in routine immunization programmes.
PMCID: PMC3579914  PMID: 22894968
Haemophilus influenza type b; DPT; cost-effectiveness; hepatitis B; immunization; immunogenicity; pentavalent vaccine
13.  Pneumococcal conjugate vaccine: A newer vaccine available in India 
Human Vaccines & Immunotherapeutics  2012;8(9):1317-1320.
Streptococcus pneumoniae, or “pneumococcus,” causes pneumonia and infections of the brain and blood that are responsible for significant mortality in children under five years as well as in the elderly. Pneumococcal diseases are a major public health problem worldwide. S. pneumoniae is responsible for 15–50% of all episodes of community-acquired pneumonia, 30–50% of all cases of acute otitis media, and a significant proportion of bacterial meningitis and bacteremia. S. pneumoniae kills at least one million children under the age of five every year, which is more than malaria, AIDS and measles combined. More than 70% of the deaths are in developing countries. In 2007, pneumococcal pneumonia was the leading infectious killer of children worldwide. Perhaps more importantly, pneumonia remains the leading killer of children in India. A recent UNICEF publication estimated that 410,000 children under age 5 y die of pneumonia each year in India, and recent data shows that an estimated 25% of all child deaths in India are due to pneumonia. The fact that this high burden of pneumonia has remained undiminished in India in spite of economic growth and decline in child mortality due to other diseases is a reminder of the importance of tackling pneumonia head-on with dedicated resources. The burden of pneumococcal meningitis, which constitutes about half of all childhood meningitis cases in most settings and a greater proportion of meningitis deaths, makes it difficult to avoid the conclusion that the pneumococcus is responsible for 1 million child deaths each year. Global Alliance for Vaccine and Immunization (GAVI) has offered to supply PCV at a cost of 0.15–0.30 USD/dose to India for inclusion in the national immunization schedule and commits to extending this support until the year 2015. Pneumococcal vaccination in not recommended in children aged 5 and above.
PMCID: PMC3579915  PMID: 22894967
Streptococcus pneumonia; mortality; otitis media; pneumonia; vaccines
14.  India is on the way forward to maternal and neonatal tetanus elimination! 
Human Vaccines & Immunotherapeutics  2012;8(8):1129-1131.
Tetanus is an acute, potentially fatal disease, caused by a bacterium, Clostridium tetani. The disease usually occurs in newborns through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. NT contributes to 5–7% of neonatal mortality worldwide. Several thousand mothers are also estimated to die annually of maternal tetanus. MNT elimination relies on promotion of maternal tetanus immunization along with safe delivery and avoidance of unsafe abortion and umbilical cord care practices. The Government of India (1983) introduced at least two doses of tetanus toxoid vaccine (TT) to all pregnant women during each pregnancy as a part of its nationwide immunization policy. To date, a total of 15 States including union territories of the India have achieved NT elimination. The remaining Indian States need to strengthen TT coverage to save the lives of neonates as well as mothers from tetanus.
PMCID: PMC3551886  PMID: 22854674
Tetanus toxoid; coverage; elimination; validation; MNT; LQA-CS
15.  Hepatitis A vaccine should receive priority in National Immunization Schedule in India 
Human Vaccines & Immunotherapeutics  2012;8(8):1132-1134.
Hepatitis A is an acute, usually self-limiting infection of the liver caused by a virus known as hepatitis A virus (HAV). Humans are the only reservoir of the virus; transmission occurs primarily through the fecal-oral route and is closely associated with poor sanitary conditions. The virus has a worldwide distribution and causes about 1.5 million cases of clinical hepatitis each year. The risk of developing symptomatic illness following HAV infection is directly correlated with age. As many 85% of children below 2 y and 50% of those between 2–5 y infected with HAV are anicteric, and among older children and adults, infection usually causes clinical disease, with jaundice occurring in more than 70% of cases. The infection is usually self-limiting with occasional fulminant hepatic failure and mortality. In most developing countries in Asia and Africa, hepatitis A is highly endemic such that a large proportion of the population acquires immunity through asymptomatic infection early in life. HAV is endemic in India; most of the population is infected asymptomatically in early childhood with life-long immunity. Several outbreaks of hepatitis A in various parts of India have been recorded in the past decade such that anti-HAV positivity varied from 26 to 85%. Almost 50% of children of ages 1–5 y were found to be susceptible to HAV. Any one of the licensed vaccines may be used since all have nearly similar efficacy and safety profiles (except for post-exposure prophylaxis / immunocompromised patients, where only inactivated vaccines may be used). Two doses 6 mo apart are recommended for all vaccines. All Hepatitis A vaccines are licensed for use in children aged 1 y or older. However in the Indian scenario, it is preferable to administer the vaccines at age 18 mo or more when maternal antibodies have completely declined. Vaccination at this age is preferable to later since it is easier to integrate with the existing schedule, protects those who have no antibodies, and protects children by the time they attend day care. In India the vaccine against hepatitis A is available for the people who can afford it, but the government of India should give this vaccine as a priority in the national immunization schedule.
PMCID: PMC3551887  PMID: 22854671
hepatitis A virus; immunity; jaundice; outbreak; vaccines
19.  Crimean-Congo haemorrhagic fever: An outbreak in India 
The Australasian Medical Journal  2011;4(11):589-591.
PMCID: PMC3562913  PMID: 23386871
20.  Why Say No to Tobacco: Indian Perspective 
The Australasian Medical Journal  2011;4(3):139-142.
PMCID: PMC3562961  PMID: 23390462
21.  Local skin reaction following an accidental injection from a BCG vaccine in a healthcare worker 
Exposure to blood‐borne pathogens from sharp injuries continue to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under‐reporting of events. Healthcare professionals are at risk of sustaining such injuries from hollow‐bore needles. Sharps injuries are associated with risk of infection with blood‐borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) hepatitis C virus (HCV) and other live organisms. Here we are reporting a case of an adverse reaction in a HCW due to an accidental sharps injury by a needle used to administer the Bacillus Calmittee Gurien (BCG) vaccine.
PMCID: PMC3562930  PMID: 23386886
BCG vaccine; adverse reaction; healthcare worker; medical error
23.  Understanding survival analysis: Kaplan-Meier estimate 
Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate. This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects.
PMCID: PMC3059453  PMID: 21455458
Survival analysis; Kaplan-Meier estimate
Indian Journal of Psychiatry  2002;44(4):348-352.
A sample of 4,691 subjects aged 14 years and above were interviewed on a schedule based on WHO Questionnaire to collect information about prevalence & pattern of alcohol and substance abuse The study revealed a prevalence rate of 19 78%. 42.41% of users were in the age group of 25-34 years while 44.1 % were literate (up to matric). 45.04% among labourers were alcohol users. In terms of age of onset, 94.83% respondents had their first drink between the ages of 15-25 years. Most common type of alcohol consumed was country liquor by 69.07%. Majority (63.44%) of alcohol users said that they usually drink with some companion, only in the evening and night. 50.03% had arguments with family or friends after taking alcohol while 13.57% alcohol abusers confessed that they had neglected their family and work due to alcohol. In family history of 23.16% alcohol users, father was abusing alcohol. 26.61% alcohol users cited to be sociable as reason for their drinking. 16.81% users were smokers also while 6.89% had the habit of taking Pan Masala/Zarda. 2.04% of alcohol users were taking soolfa also along with alcohol while the frequency of opium and cannabis abuse was 1.51 and 1.18% respectively.
PMCID: PMC2955305  PMID: 21206598
Substance abuse; Prevalence; Pattern

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