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Candasamy S, Ayyanar E, Devaraju P, Kumar A, Zaman K, Bhaskar Mishra B, Srinivasan L, Purushothaman J. Evidence on the prevalence of emerging and re-emerging tick- and flea-borne rickettsial agents in acute encephalitis syndrome endemic areas of northeast Uttar Pradesh, India. Med Vet Entomol 2024; 38:23-37. [PMID: 37736686 DOI: 10.1111/mve.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
Outbreaks of acute encephalitis syndrome (AES) with unknown aetiology are reported every year in Gorakhpur district, Uttar Pradesh, India, and Orientia tsutsugamushi, the rickettsial pathogen, responsible for scrub typhus has been attributed as the primary cause of AES problem. However, information on the prevalence of other rickettsial infections is lacking. Hence, this study was carried out to assess any occurrence of tick- and flea-borne rickettsial agents in villages reporting AES cases in this district. In total, 825 peridomestic small mammals were trapped, by setting 9254 Sherman traps in four villages with a trap success rate of 8.9%. The Asian house shrew, Suncus murinus, constituted the predominant animal species (56.2%) and contributed to the maximum number (87.37%) of ectoparasites. In total, 1552 ectoparasites comprising two species of ticks and one species each of flea and louse were retrieved from the trapped rodents/shrews. Rhipicephalus sanguineus, the brown dog tick, was the predominant species retrieved from the trapped rodents/shrews, and the overall infestation rate was 1.75 per animal. In total, 4428 ectoparasites comprising five tick species, three louse species and one flea species were collected from 1798 domestic animals screened. Rhipicephalus microplus was the predominant tick species collected from the domestic animals. The cat flea, Ctenocephalides felis, constituted 1.5% of the total ectoparasites. Of all the ectoparasite samples (5980) from domestic animals and rodents, tested as 1211 pools through real-time PCR assays, 64 pools were positive for 23S rRNA gene of rickettsial agents. The PCR-positive samples were subjected to multi-locus sequence typing (MLST). In BLAST and phylogenetic analysis, the ectoparasites were found to harbour Rickettsia asembonensis (n = 9), Rickettsia conorii (n = 3), Rickettsia massiliae (n = 29) and Candidatus Rickettsia senegalensis (n = 1). A total of 22 pools were detected to have multiple rickettsial agents. The prevalence of fleas and high abundance of tick vectors with natural infections of rickettsial agents indicates the risk of transmission of tick- and flea-borne rickettsial diseases in rural villages of Gorakhpur. Further epidemiological studies are required to confirm the transmission of these agents to humans.
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Affiliation(s)
| | - Elango Ayyanar
- ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry, India
| | - Panneer Devaraju
- ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry, India
| | - Ashwani Kumar
- ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry, India
| | - Kamran Zaman
- ICMR-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, India
- ICMR-National Institute of Traditional Medicine Belagavi (ICMR-NITM Belagavi), Belagavi, India
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Tandale BV, Deshmukh PS, Tomar SJ, Narang R, Qazi MS, Goteti Venkata P, Jain M, Jain D, Guduru VK, Jain J, Gosavi RV, Valupadas CS, Deshmukh PR, Raut AV, Narlawar UW, Jha PK, Bondre VP, Sapkal GN, Damle RG, Khude PM, Niswade AK, Talapalliwar M, Rathod P, Balla PS, Muttineni PK, Kalepally Janakiram KK, Rajderkar SS. Incidence of Japanese Encephalitis and Acute Encephalitis Syndrome Hospitalizations in the Medium-Endemic Region in Central India. J Epidemiol Glob Health 2023; 13:173-179. [PMID: 37162636 PMCID: PMC10271976 DOI: 10.1007/s44197-023-00110-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND We estimated the incidence of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) following routine immunization with the live-attenuated SA 14-14-2 JE vaccine. METHODS We implemented enhanced surveillance of AES and JE hospitalizations in endemic districts in Maharashtra and Telangana States during 2015-2016 and 2018-2020. We estimated incidence and compared differences in the incidence of JE and AES between two states, and vaccinated and unvaccinated districts during two study periods. We also considered secondary data from public health services to understand long-term trends from 2007 to 2020. RESULTS The annual AES incidence rate of 2.25 cases per 100,000 children in Maharashtra during 2018-2020 was significantly lower than 3.36 cases per 100,000 children during 2015-2016. The six JE-vaccinated districts in Maharashtra had significantly lower incidence rates during 2018-2020 (2.03, 95% CI 1.73-2.37) than in 2015-16 (3.26, 2.86-3.70). In addition, the incidence of both JE and AES in two unvaccinated districts was higher than in the vaccinated districts in Maharashtra. Telangana had a lower incidence of both JE and AES than Maharashtra. The AES incidence rate of 0.95 (0.77-1.17) during 2018-2020 in Telangana was significantly lower than 1.67 (1.41-1.97) during 2015-2016. CONCLUSIONS The annual incidence rate of Japanese encephalitis was < 1 case per 100,000 children. It indicated accelerated control of Japanese encephalitis after routine immunization. However, the annual incidence of acute encephalitis syndrome was still > 1 case per 100,000 children. It highlights the need for improving surveillance and evaluating the impacts of vaccination.
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Affiliation(s)
- Babasaheb V Tandale
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India.
| | - Pravin S Deshmukh
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India
| | - Shilpa J Tomar
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India
| | - Rahul Narang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
- All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | | | | | - Manish Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| | - Dipty Jain
- Government Medical College, Nagpur, Maharashtra, India
| | | | - Jyoti Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| | | | | | - Pradeep R Deshmukh
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
- All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Abhishek V Raut
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| | | | | | - Vijay P Bondre
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India
| | - Gajanan N Sapkal
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India
| | - Rekha G Damle
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India
| | - Poornima M Khude
- Epidemiology Group, ICMR-National Institute of Virology, 130/1, Sus Road, Pashan, Pune, Maharashtra, 411021, India
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Moore SM. The current burden of Japanese encephalitis and the estimated impacts of vaccination: Combining estimates of the spatial distribution and transmission intensity of a zoonotic pathogen. PLoS Negl Trop Dis 2021; 15:e0009385. [PMID: 34644296 PMCID: PMC8544850 DOI: 10.1371/journal.pntd.0009385] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/25/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Japanese encephalitis virus (JEV) is a major cause of neurological disability in Asia and causes thousands of severe encephalitis cases and deaths each year. Although Japanese encephalitis (JE) is a WHO reportable disease, cases and deaths are significantly underreported and the true burden of the disease is not well understood in most endemic countries. Here, we first conducted a spatial analysis of the risk factors associated with JE to identify the areas suitable for sustained JEV transmission and the size of the population living in at-risk areas. We then estimated the force of infection (FOI) for JE-endemic countries from age-specific incidence data. Estimates of the susceptible population size and the current FOI were then used to estimate the JE burden from 2010 to 2019, as well as the impact of vaccination. Overall, 1,543.1 million (range: 1,292.6-2,019.9 million) people were estimated to live in areas suitable for endemic JEV transmission, which represents only 37.7% (range: 31.6-53.5%) of the over four billion people living in countries with endemic JEV transmission. Based on the baseline number of people at risk of infection, there were an estimated 56,847 (95% CI: 18,003-184,525) JE cases and 20,642 (95% CI: 2,252-77,204) deaths in 2019. Estimated incidence declined from 81,258 (95% CI: 25,437-273,640) cases and 29,520 (95% CI: 3,334-112,498) deaths in 2010, largely due to increases in vaccination coverage which have prevented an estimated 314,793 (95% CI: 94,566-1,049,645) cases and 114,946 (95% CI: 11,421-431,224) deaths over the past decade. India had the largest estimated JE burden in 2019, followed by Bangladesh and China. From 2010-2019, we estimate that vaccination had the largest absolute impact in China, with 204,734 (95% CI: 74,419-664,871) cases and 74,893 (95% CI: 8,989-286,239) deaths prevented, while Taiwan (91.2%) and Malaysia (80.1%) had the largest percent reductions in JE burden due to vaccination. Our estimates of the size of at-risk populations and current JE incidence highlight countries where increasing vaccination coverage could have the largest impact on reducing their JE burden. Japanese encephalitis is a vector-transmitted, zoonotic disease that is endemic throughout a large portion of Asia. Vaccination has significantly reduced the JE burden in several formerly high-burden countries, but vaccination coverage remains limited in several other countries with high JE burdens. A better understanding of both the spatial distribution and the magnitude of the burden in endemic countries is critical for future disease prevention efforts. To estimate the number of people living in areas within Asia suitable for JEV transmission we conducted a spatial analysis of the risk factors associated with JE. We estimate that over one billion people live in areas suitable for local JEV transmission. We then combined these population-at-risk estimates with estimates of the force of infection (FOI) to model the national-level burden of JE (annual cases and deaths) over the past decade. Increases in vaccination coverage have reduced JE incidence from over 80,000 cases in 2010 to fewer than 57,000 cases in 2019. We estimate that vaccination has prevented almost 315,000 cases and 115,000 deaths in the past decade. Our results also call attention to the countries, and high-risk areas within countries, where increases in vaccination coverage are most needed.
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Affiliation(s)
- Sean M. Moore
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
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Sadanandane C, Elango A, Panneer D, Mary KA, Kumar NP, P Paily K, Mishra BB, Sankari T, Jambulingam P. Seasonal abundance of Leptotrombidium deliense, the vector of scrub typhus, in areas reporting acute encephalitis syndrome in Gorakhpur district, Uttar Pradesh, India. Exp Appl Acarol 2021; 84:795-808. [PMID: 34328572 DOI: 10.1007/s10493-021-00650-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
The rickettsial pathogen Orientia tsutsugamushi, causing scrub typhus, has been implicated as a major cause of acute encephalitis syndrome (AES) in many places in India including Gorakhpur district of Uttar Pradesh. Seasonal abundance of the principal vector mite of the pathogen, Leptotrombidium deliense, its animal hosts, and prevalence of infection on them are important attributes in the assessment of outbreaks of the disease. Hence, these aspects were investigated, seasonally, in rural villages of Gorakhpur district, where peak incidence of AES cases were reported. A total of 903 animals (rodents/shrews) was collected using 6484 Sherman traps in eight study villages (14% overall trap rate). A sum of 5526 trombiculid mites comprising 12 species was collected from 676 live rodents/shrews screened. Suncus murinus, the Asian house shrew was the predominant species (67%). Among trombiculids, the principal vector mite, L. deliense, was predominant (64.7%) and its infestation index (i.e., average number of chiggers per host animal) was 5.3. The L. deliense infestation index was higher during July to November with a peak in October. Out of 401 animal sera samples screened, 68% were positive for antibodies against O. tsutsugamushi. Of 465 blood samples tested by nested PCR, seven were positive for the 56 kDa gene of O. tsutsugamushi. In conventional PCR, 41 out of 265 samples were positive for the 60 kDa groEL gene of O. tsutsugamushi. Among the 5526 mite samples, tested as 352 pools through nested PCR, four pools were positive for 56 kDa gene. Phylogenetic analysis of 56 and 60 kDa genes confirmed circulation of Karp and TA678 (rodents) and TA678 (mite) serotypes of O. tsutsugamushi in Gorakhpur. Peak incidence of AES in Gorakhpur district occurs during the rainy season (July-October), coinciding with the peak abundance of L. deliense. These results indicate involvement of L. deliense as the vector mite transmitting the scrub typhus pathogen O. tsutsugamushi to humans in the rural areas of Gorakhpur district, India.
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Affiliation(s)
- Candasamy Sadanandane
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Ayyanar Elango
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India.
| | - Devaraju Panneer
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | | | - Narendran Pradeep Kumar
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Kummankottil P Paily
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Bhuwan Bhaskar Mishra
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Thirumal Sankari
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
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Behera SP, Kumar N, Singh R, Deval H, Zaman K, Misra B, Pandey A, Kant R, Kavathekar A, Kumar S, Nuthakki MR, Bondre VP. Molecular Detection and Genetic Characterization of Orientia tsutsugamushi from Hospitalized Acute Encephalitis Syndrome Cases During Two Consecutive Outbreaks in Eastern Uttar Pradesh, India. Vector Borne Zoonotic Dis 2021; 21:747-752. [PMID: 34191633 DOI: 10.1089/vbz.2021.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Seasonal outbreaks of acute encephalitis syndrome (AES) have been reported especially in the pediatric population with a high case fatality rate in Eastern Uttar Pradesh, India. Orientia tsutsugamushi (OT) is a causative agent of scrub typhus that has been recently identified as a major cause of AES. However, the specific genotypes of OT responsible for AES cases of this region are not known. Therefore, the present study was undertaken to understand the molecular epidemiology of OT prevailing in the AES endemic Eastern Uttar Pradesh region of India. Methods: The study was conducted on 2529 hospitalized AES cases from August 2016 to December 2017. The presence of antibodies against OT from cerebrospinal fluid (CSF) and serum samples were tested using OT IgM enzyme-linked immunosorbent assay (ELISA), whereas OT DNA was tested from whole blood and CSF specimens targeting the partial gene of 56 kDa using nested PCR. Phylogenetic analysis was conducted with sequences (n = 241) generated in this study. Findings: Among the studied AES cases, 50% were found positive for antibodies against OT, whereas 37% of cases were positive for OT DNA. The genetic analysis study revealed that Gilliam (93.8%) is the prevailing genotype of OT followed by Karp (6.16%) genotype in AES cases. Furthermore, the Gilliam strains of this study showed they were >99% identical to earlier reported Gilliam strains from AES cases. Conclusion: We observed the presence of two main OT genotypes in AES cases, among which the majority of OT genotypes fall under the Gilliam clade. The understanding of predominant genotype will be beneficial for its future implications in vaccine development strategies and the development of rapid diagnostic tests.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Madhava Rao Nuthakki
- ICMR-RMRC, Gorakhpur, India.,National Institute of Virology, Field Unit, Rajiv Gandhi Institute of Chest Disease Premises, Bangalore, India
| | - Vijay P Bondre
- ICMR-RMRC, Gorakhpur, India.,National Institute of Virology, Field Unit, Rajiv Gandhi Institute of Chest Disease Premises, Bangalore, India
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Sahoo KC, Negi S, Dash GC, Sahoo RK, Kshatri JS, Panda S, Pattanaik M, Badaik G, Pati S, Bhattacharya D. Health system preparedness & community participation in Japanese encephalitis/acute encephalitis syndrome (JE/AES) prevention in a tribal district of Odisha, India. Indian J Med Res 2021; 153:388-393. [PMID: 33907003 PMCID: PMC8204823 DOI: 10.4103/ijmr.ijmr_645_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & Objectives Japanese encephalitis/acute encephalitis syndrome (JE/AES) is one of the major zoonotic arbodiseases that has a significant effect on human and animal health. Though many studies have been published on the epidemiology and transmission mechanisms of JE/AES, but there is little evidence on health system preparedness, including community-based engagement. This study was undertaken to explore a multi-stakeholder perspective on health system preparedness for the prevention of JE/AES in a tribal district of Odisha, India. Methods This study was conducted at Malkangiri district of Odisha. A total of nine focus group discussions (FGDs) among women having under-five children, community volunteers, and community health workers (CHWs), and 20 in-depth-interviews (IDIs) among community leaders, healthcare providers, and programme managers were conducted. The FGDs and IDIs were digitally recorded, transcribed, translated and analysed using content analysis approach. Results Health system preparedness for the prevention of JE/AES was improved, including effective vector management, implementation of the surveillance system, and vaccination programme. The JE vaccine was introduced under Universal Immunization Programme in Odisha in 2016. Behavioural Change Communication activities were provided with the support of community volunteers on Village Health Nutrition and Sanitation Day (VHNSD) under Gaon Kalyan Samiti (GKS) platforms. The CHWs were actively involved in vector management and raising sanitation and hygiene awareness. Interpretation & conclusions Community participation and coordination between different stakeholders have a significant impact on the successful implementation of the programme. It was suggested that there was a need for a sustainability approach to active participation, orientation and capacity building training among CHWs and community volunteers to successfully implement the programme.
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Affiliation(s)
| | - Sapna Negi
- Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Girish Chandra Dash
- HTA Regional Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Rakesh Kumar Sahoo
- HTA Regional Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jaya Singh Kshatri
- Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sheetal Panda
- Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Matrujyoti Pattanaik
- Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Goldi Badaik
- Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- HTA Regional Hub; Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Debdutta Bhattacharya
- Department of Microbiology and One Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Murhekar MV, Vivian Thangaraj JW, Sadanandane C, Mittal M, Gupta N, Rose W, Sahay S, Kant R, Gupte MD. Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India: A One Health case study. Indian J Med Res 2021; 153:375-381. [PMID: 33907001 PMCID: PMC8204837 DOI: 10.4103/ijmr.ijmr_625_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/05/2022] Open
Abstract
Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of AES. With the introduction of JE vaccination and other control strategies, the incidence of JE in the region declined, however, outbreaks of acute febrile illness with neurological manifestations continued to occur. Subsequent investigations identified Orientia tsutsugamushi, as the major aetiology of AES outbreaks in the region. This review details clinical, epidemiological, animal and entomological investigations conducted for AES due to O. tsutsugamushi during 2015 and 2017 in Gorakhpur region. Surveillance of acute febrile illness among children attending peripheral health facilities identified scrub typhus as an important aetiology of febrile illness during monsoon and post-monsoon months. Population-based serosurveys indicated high endemicity of scrub typhus. Entomological studies demonstrated natural infection of O. tsutsugamushi in small animal hosts and vector mites. Children acquired this infection through recent exposure to outdoor environment, while playing, or visiting fields or defecating in open fields. A few of the children with scrub typhus progress to develop CNS manifestations. Hence, early administration of appropriate antibiotics is crucial in preventing progression of AFI due to scrub typhus to AES. The investigations conducted by the multi-disciplinary team helped understand the transmission dynamics of scrub typhus in Gorakhpur division and recommend strategies for its control.
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Affiliation(s)
| | | | | | - Mahima Mittal
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | - Winsley Rose
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Seema Sahay
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - Rajni Kant
- ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Mohan D. Gupte
- ICMR-National Institute of Epidemiology, Chennai, India
- Division of Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
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Singh H, Singh N, Mall RK. Japanese Encephalitis and Associated Environmental Risk Factors in Eastern Uttar Pradesh: A time series analysis from 2001 to 2016. Acta Trop 2020; 212:105701. [PMID: 32956640 DOI: 10.1016/j.actatropica.2020.105701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 01/19/2023]
Abstract
India and other Southeast Asian countries are severely affected by Japanese encephalitis (JE), one of the deadliest vector-borne disease threat to human health. Several epidemiological observations suggest climate variables play a role in providing a favorable environment for mosquito development and virus transmission. In this study, generalized additive models were used to determine the association of JE admissions and mortality with climate variables in Gorakhpur district, India, from 2001-2016. The model predicted that every 1 unit increase in mean (Tmean;°C), and minimum (Tmin;°C) temperature, rainfall (RF; mm) and relative humidity (RH; %) would on average increase the JE admissions by 22.23 %, 17.83 %, 0.66 %, and 5.22 % respectively and JE mortality by 13.27 %, 11.77 %, 0.94 %, and 3.27 % respectively Conversely, every unit decrease in solar radiation (Srad; MJ/m2/day) and wind speed (WS; Kmph) caused an increase in JE admission by 17% and 11.42% and in JE mortality by 9.37% and 4.88% respectively suggesting a protective effect at higher levels. The seasonal analysis shows that temperature was significantly associated with JE in pre-monsoon and post-monsoon while RF, RH, Srad, and WS are associated with the monsoon. Effect modification due to age and gender showed an equal risk for both genders and increased risk for adults above 15 years of age, however, males and age groups under 15 years outnumbered females and adults. Sensitivity analysis results to explore lag effects in climate variables showed that climate variables show the strongest association at lag 1 to 1.5 months with significant lag effect up tp lag 0-60 days. The exposure-response curve for climate variables showed a more or less linear relationship, with an increase in JE admissions and mortality after a certain threshold and decrease were reported at extreme levels of exposure. The study concludes that climate variables could influence the JE vector development and multiplication and parasite maturation and transmission in the Gorakhpur region whose indirect impact was noted for JE admission and mortality. In response to the changing climate, public health interventions, public awareness, and early warning systems would play an unprecedented role to compensate for future risk.
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Singh AK, Kharya P, Agarwal V, Singh S, Singh NP, Jain PK, Kumar S, Bajpai PK, Dixit AM, Singh RK, Agarwal T. Japanese encephalitis in Uttar Pradesh, India: A situational analysis. J Family Med Prim Care 2020; 9:3716-3721. [PMID: 33102356 PMCID: PMC7567188 DOI: 10.4103/jfmpc.jfmpc_449_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Disease Control Programme uses the term Acute Encephalitis Syndrome (AES). In this study, an attempt has been made to ascertain the status and trends of AES and JE in Uttar Pradesh, India. Methodology: This is a record-based retrospective study. The data were obtained from the Directorate of Medical and Health Services of Uttar Pradesh and analyzed using software SPSS version 24.0. Results: In Uttar Pradesh, there were 47,509 reported cases of AES from 2005 to 2018,. With yearly fluctuations, the average Case Fatality Rate of AES was 17.49% with highest in 2005 (24.76%) and lowest in 2018 (8%). Among the patients with AES, 9.98% were found positive for JE. The most commonly affected age group is 1-5 years for both AES and JE, closely followed by the age group of 5-10 years. Peak occurrence of both AES and JE was recorded in month of September. Among the AES-affected patients 53.8% were males and 46.2% were females. Conclusion: The most commonly affected age group was 1-5 years with peak occurrence in the month of September. Though there was a downward trend in CFR, awareness activities like “Dastak” campaign and intersectoral preventive activities, needs to be strengthened.
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Affiliation(s)
- Anil K Singh
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
| | - Pradip Kharya
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | | | - Soni Singh
- Department of Medical and Health, Uttar Pradesh, India
| | - Naresh P Singh
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
| | - Pankaj K Jain
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
| | - Sandip Kumar
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
| | - Prashant K Bajpai
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
| | - Anand M Dixit
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - Ramit K Singh
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
| | - Tanya Agarwal
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah
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Thangaraj JWV, Zaman K, Shete V, Pandey AK, Velusamy S, Deoshatwar A, Mittal M, Gupta N, Murhekar M. Effectiveness of Presumptive Treatment of Acute Febrile Illness With Doxycycline or Azithromycin in Preventing Acute Encephalitis Syndrome in Gorakhpur, India: A Cohort Study. Indian Pediatr 2020; 57:619-24. [DOI: 10.1007/s13312-020-1889-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Arankalle VA, Srivastava N, Kushwaha KP, Sen A, Ramdasi AY, Patel PA, Kuthe S, Haldipur B, Sakpal GN, Lole KS, Ingle NB. Detection of human parvovirus 4 DNA in the patients with acute encephalitis syndrome during seasonal outbreaks of the disease in Gorakhpur, India. Emerg Microbes Infect 2019; 8:130-138. [PMID: 30866767 PMCID: PMC6455185 DOI: 10.1080/22221751.2018.1563455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Seasonal outbreaks of acute encephalitis syndrome (AES) at Gorakhpur, India have been recognized since 2006. So far, the causative agent has not been identified. Use of next generation sequencing identified human parvovirus 4 (HPARV4) sequences in a CSF/plasma pool. These sequences showed highest identity with sequences earlier identified in similar patients from south India. Real-time PCR detected HPARV4 DNA in 20/78 (25.6%) CSF and 6/31 (19.3%) plasma of AES patients. Phylogenetic analysis classified three almost complete genomes and 24 partial NS1 sequences as genotype 2A. The observed association of HPARV4 with AES needs further evaluation. ELISAs for the detection of IgM and IgG antibodies against scrub typhus (Orientia tsutsugamushi, OT) showed ∼70% IgM/IgG positivity suggestive of etiologic association. Prospective, comprehensive studies are needed to confirm association of these agents, singly or in combination with AES in Gorakhpur region.
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Affiliation(s)
- Vidya A Arankalle
- a National Institute of Virology, Microbial Containment Complex , Pune , India.,b Interactive Research School for Health Affairs , Pune , India
| | - Navin Srivastava
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | | | - Agnibha Sen
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | - Ashwini Y Ramdasi
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | - Priyanka A Patel
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | - Sumeet Kuthe
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | - Bangari Haldipur
- a National Institute of Virology, Microbial Containment Complex , Pune , India.,b Interactive Research School for Health Affairs , Pune , India
| | - Gajanan N Sakpal
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | - Kavita S Lole
- a National Institute of Virology, Microbial Containment Complex , Pune , India
| | - Nilesh B Ingle
- a National Institute of Virology, Microbial Containment Complex , Pune , India
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Mittal M, Bondre V, Murhekar M, Deval H, Rose W, Verghese VP, Mittal M, Patil G, Sabarinathan R, Vivian Thangaraj JW, Kanagasabai K, Prakash JAJ, Gupta N, Gupte MM, Gupte MD. Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings. Pediatr Infect Dis J 2018; 37:1101-1106. [PMID: 29746378 DOI: 10.1097/inf.0000000000002099] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seasonal outbreaks of acute encephalitis syndrome (AES) with high fatality have been occurring in Gorakhpur, Uttar Pradesh, India, for several years. We conducted investigations during the 2016 outbreak to identify the etiology. METHODS We included 407 hospitalized AES patients with cerebrospinal fluid pleocytosis (>5 cells/mm) in our study. These patients were clinically examined; their blood and cerebrospinal fluid samples were collected and investigated for scrub typhus (ST), Japanese encephalitis virus (JEV), dengue virus and spotted fever group of Rickettsia by serology and/or polymerase chain reaction. RESULTS Of the 407 AES patients, 266 (65.4%), 42 (10.3%) and 29 (7.1%) were diagnosed to have ST, JEV and dengue infection, respectively. Four patients were diagnosed to have spotted fever group of Rickettsia infection. A significantly higher proportion of ST patients with AES had hepatomegaly, splenomegaly and facial edema. The common hematologic and biochemical abnormalities among ST-positive patients include thrombocytopenia, raised liver enzymes and bilirubin levels. The case fatality ratio was significantly higher among ST-negative AES patients (36.2% vs. 15.2%; P < 0.05). CONCLUSIONS ST accounted for approximately two third of the AES case-patients. Efforts are required to identify the etiology of AES case-patients who are negative for ST, JEV and dengue fever.
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Affiliation(s)
| | - Vijay Bondre
- ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India
| | - Manoj Murhekar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Hirawati Deval
- ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India
| | - Winsley Rose
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | | | - Gajanan Patil
- ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India
| | | | | | | | | | | | | | - Mohan D Gupte
- Indian Council of Medical Research, New Delhi, India
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Sadanandane C, Jambulingam P, Paily KP, Kumar NP, Elango A, Mary KA, Agatheswaran S, Sankari T, Mishra BB. Occurrence of Orientia tsutsugamushi, the Etiological Agent of Scrub Typhus in Animal Hosts and Mite Vectors in Areas Reporting Human Cases of Acute Encephalitis Syndrome in the Gorakhpur Region of Uttar Pradesh, India. Vector Borne Zoonotic Dis 2018; 18:539-547. [PMID: 30016222 DOI: 10.1089/vbz.2017.2246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Outbreaks of acute encephalitis syndrome (AES) with high fatality and disability, are reported every year in the Gorakhpur region of Uttar Pradesh, India, with the etiology of >60% of the cases being attributed to scrub typhus. In the present study, the prevalence of Orientia tsutsugamushi, the etiological agent of scrub typhus, was investigated among animal hosts and their ectoparasitic trombiculid mites prevalent in AES-reported areas of Gorakhpur. A total of 154 rodents/shrews were collected using 777 Sherman traps set in 12 study villages, and the overall trap rate was 19.8%. In total, 2726 trombiculid mites belonging to 12 species were collected from 154 rodents/shrews trapped. The shrew mouse Suncus murinus was the predominant animal species (78.6%) collected. The principal vector mite Leptotrombidium deliense was the predominant species (82.7%), and its index was 14.6 per animal. Of 114 rodent/shrew sera samples screened through the Weil-Felix test, 57% were positive for antibodies against O. tsutsugamushi. Of 128 blood samples tested by polymerase chain reaction (PCR), one rodent sample was positive for the gene encoding 56 kDa protein and 25 for 60 kDa. Among 2726 mite samples tested as 315 pools through nested PCR, seven pools were positive for 56 kDa gene. Phylogenetic analysis confirmed circulation of Gilliam, Karp, and TA678 serotypes of O. tsutsugamushi in Gorakhpur. The study clearly demonstrated natural infection of O. tsutsugamushi in both small-animal hosts and vector mites in the AES-reporting villages of Gorakhpur, which confirms transmission of the scrub typhus pathogen in this region. The high infestation rate of L. deliense with O. tsutsugamushi infection indicates that the people living in the rural villages of Gorakhpur are at risk of infection with scrub typhus, which might lead to AES.
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Affiliation(s)
- Candasamy Sadanandane
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Purushothaman Jambulingam
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Kummankottil P Paily
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Narendran Pradeep Kumar
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Ayanar Elango
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Kulandaisamy Athisaya Mary
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Sundararajan Agatheswaran
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Thirumal Sankari
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
| | - Bhuwan Bhaskar Mishra
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India , Puducherry, India
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Murhekar M, Vivian Thangaraj JW, Mittal M, Gupta N. Acute Encephalitis Syndrome in Eastern Uttar Pradesh, India: Changing Etiological Understanding. J Med Entomol 2018; 55:523-526. [PMID: 29635529 DOI: 10.1093/jme/tjy042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 06/08/2023]
Abstract
Seasonal outbreaks of acute encephalitis syndrome (AES) with high case fatality have been occurring in Gorakhpur division in Eastern Uttar Pradesh, India, for more than three decades. Japanese encephalitis virus (JEV) accounted for <10% of AES cases, while the etiology of the remaining cases remained largely unknown. Investigations conducted during the 2014 and 2015 outbreaks indicated Orientia tsutsugamushi (Haruo Hayashi 1920) (Norio Ogata 1929) Tamura et al. 1995 (Rickettsiales: Rickettsiaceae) as the etiology in about 60% of AES cases. Hospital-based surveillance studies indicated that about one-fifth of the patients with acute febrile illness were due to scrub typhus. Further studies are required to identify the etiology of about a third of AES cases that test negative for scrub typhus, JEV, or dengue.
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Affiliation(s)
- Manoj Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
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Mittal M, Thangaraj JWV, Rose W, Verghese VP, Kumar CPG, Mittal M, Sabarinathan R, Bondre V, Gupta N, Murhekar MV. Scrub Typhus as a Cause of Acute Encephalitis Syndrome, Gorakhpur, Uttar Pradesh, India. Emerg Infect Dis 2018; 23:1414-1416. [PMID: 28726617 PMCID: PMC5547812 DOI: 10.3201/eid2308.170025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks of acute encephalitis syndrome (AES) have been occurring in Gorakhpur Division, Uttar Pradesh, India, for several years. In 2016, we conducted a case-control study. Our findings revealed a high proportion of AES cases with Orientia tsutsugamushi IgM and IgG, indicating that scrub typhus is a cause of AES.
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Murhekar MV, Oak C, Ranjan P, Kanagasabai K, Shinde S, Pandey AK, Mittal M, Gore M, Mehendale SM. Coverage & missed opportunity for Japanese encephalitis vaccine, Gorakhpur division, Uttar Pradesh, India, 2015: Implications for Japanese encephalitis control. Indian J Med Res 2018; 145:63-69. [PMID: 28574016 PMCID: PMC5460575 DOI: 10.4103/ijmr.ijmr_712_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background & objectives: Japanese encephalitis (JE) is an important aetiology of acute encephalitis syndrome in Gorakhpur division, Uttar Pradesh, India. Two doses of JE vaccine (first during 9-12 months and second during 16-24 months of age) are administered under the Universal Immunization Programme. We conducted surveys to estimate the coverage of JE vaccine and magnitude of missed opportunity for vaccination (MoV) for JE in Gorakhpur division. Methods: To estimate the JE vaccine coverage, cluster surveys were conducted in four districts of Gorakhpur division by selecting 30 clusters by probability proportional to size method in each district, seven children aged 25-36 months were selected from each cluster and their mothers were interviewed about JE vaccination. To estimate the magnitude of MoV, exit surveys were conducted in vaccination clinics in selected health facilities, mothers were interviewed about the vaccination status of their children and vaccines administered to the child on the day of interview. Results: A total of 840 children were surveyed, 210 from each district. The coverages of one and two doses of JE vaccine in Gorakhpur division were 75 per cent [95% confidence interval (CI): 71.0-78.9] and 42.3 per cent (95% CI: 37.8-46.8), respectively. Facility-based exit survey indicated that 32.7 per cent of the eligible children missed JE vaccine. Interpretation & conclusions: The survey results showed that three of the four children aged 25-36 months in Gorakhpur division had received at least one dose of JE vaccine. The coverage of second dose of JE vaccine, however, was low. Failure to administer vaccination simultaneously was the most common reason for MoV for JE vaccine. Training vaccinators about correct vaccination schedule and removing their misconception about administering vaccines simultaneously would substantially improve JE vaccine coverage in Gorakhpur.
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Affiliation(s)
| | - Chinmay Oak
- ICMR-National Institute of Epidemiology, Chennai, India
| | - Prashant Ranjan
- Department of Health & Family Welfare, Government of Uttar Pradesh, Gorakhpur, India
| | - K Kanagasabai
- ICMR-National Institute of Epidemiology, Chennai, India
| | - Satish Shinde
- ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Mahima Mittal
- Department of Paediatrics, BRD Medical College, Gorakhpur, India
| | - Milind Gore
- ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, India
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Vivian Thangaraj JW, Mittal M, Verghese VP, Kumar CPG, Rose W, Sabarinathan R, Pandey AK, Gupta N, Murhekar M. Scrub Typhus as an Etiology of Acute Febrile Illness in Gorakhpur, Uttar Pradesh, India, 2016. Am J Trop Med Hyg 2017; 97:1313-1315. [PMID: 28820712 DOI: 10.4269/ajtmh.17-0135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Seasonal outbreaks of acute encephalitis syndrome (AES) with high mortality occur every year in Gorakhpur region of Uttar Pradesh, India. Earlier studies indicated the role of scrub typhus as the important etiology of AES in the region. AES cases were hospitalized late in the course of their illness. We established surveillance for acute febrile illness (AFI) (fever ≥ 4 days duration) in peripheral health facilities in Gorakhpur district to understand the relative contribution of scrub typhus. Of the 224 patients enrolled during the 3-month period corresponding to the peak of AES cases in the region, about one-fifth had immunoglobulin M (IgM) antibodies against Orientia tsutsugamushi. Dengue and leptospira accounted for 8% and 3% of febrile illness cases. Treating patients with AFI attending the peripheral health facilities with doxycycline could prevent development of AES and thereby reduce deaths due to AES in Gorakhpur region.
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Affiliation(s)
| | - Mahima Mittal
- Department of Pediatrics, BRD Medical College, Gorakhpur, India
| | | | | | - Winsley Rose
- Pediatric Infectious Diseases, Christian Medical College, Vellore, India
| | | | | | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Delhi, India
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18
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Hegde NR, Gore MM. Japanese encephalitis vaccines: Immunogenicity, protective efficacy, effectiveness, and impact on the burden of disease. Hum Vaccin Immunother 2017; 13:1-18. [PMID: 28301270 DOI: 10.1080/21645515.2017.1285472] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Japanese encephalitis (JE) is a serious public health concern in most of Asia. The disease is caused by JE virus (JEV), a flavivirus transmitted by Culex mosquitoes. Several vaccines have been developed to control JE in endemic areas as well as to protect travelers and military personnel who visit or are commissioned from non-endemic to endemic areas. The vaccines include inactivated vaccines produced in mouse brain or cell cultures, live attenuated vaccines, and a chimeric vaccine based on the live attenuated yellow fever virus 17D vaccine strain. All the marketed vaccines belong to the JEV genotype III, but have been shown to be efficacious against other genotypes and strains, with varying degrees of cross-neutralization, albeit at levels deemed to be protective. The protective responses have been shown to last three or more years, depending on the type of vaccine and the number of doses. This review presents a brief account of the different JE vaccines, their immunogenicity and protective ability, and the impact of JE vaccines in reducing the burden of disease in endemic countries.
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Affiliation(s)
- Nagendra R Hegde
- a Ella Foundation, Genome Valley , Turkapally, Shameerpet Mandal , Hyderabad , India
| | - Milind M Gore
- b National Institute of Virology, Indian Council of Medical Research , Pune , India
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19
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Kakkar M, Dhole TN, Rogawski ET, Chaturvedi S. Public Health Laboratory Surveillance and Diagnosis of Japanese Encephalitis: Time to Revisit. Indian Pediatr 2016; 53:33-5. [PMID: 26840668 DOI: 10.1007/s13312-016-0785-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We assessed detection of recent Japanese encephalitis virus infection using recommended strategy. METHODS Cross-sectional community-based study conducted in 12 villages in Kushinagar, Uttar-Pradesh, India in 2012-13. Recent infection with Japanese encephalitis virus in 239 healthy children aged 1-15 year was detected using a combination of serology and molecular methods. RESULTS 24 (10%) children showed recent infection; 2 by serology and 22 by molecular method. Symptomatic cases were estimated as 626 in Kushinagar against reported 139 in all age groups across the state. CONCLUSIONS Lower positivity using recommended serology suggests major gap in existing surveillance and diagnostic protocols and estimation of burden of Japanese encephalitis.
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Murhekar MV, Mittal M, Prakash JAJ, Pillai VM, Mittal M, Girish Kumar CP, Shinde S, Ranjan P, Oak C, Gupta N, Mehendale S, Arora R, Gupte M. Acute encephalitis syndrome in Gorakhpur, Uttar Pradesh, India - Role of scrub typhus. J Infect 2016; 73:623-626. [PMID: 27592263 DOI: 10.1016/j.jinf.2016.08.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Manoj V Murhekar
- Dept of Epidemiology, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India.
| | - Mahima Mittal
- Dept of Pediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | | | - Vivekanandan M Pillai
- Dept of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Mahim Mittal
- Dept of Medicine, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | - C P Girish Kumar
- Dept of Epidemiology, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Satish Shinde
- Dept of Epidemiology, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Prashant Ranjan
- Dept of Epidemiology, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Chinmay Oak
- Dept of Epidemiology, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Nivedita Gupta
- Dept of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sanjay Mehendale
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Rashmi Arora
- Dept of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Mohan Gupte
- Dept of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Singh A, Mitra M, Sampath G, Venugopal P, Rao JV, Krishnamurthy B, Gupta MK, Sri Krishna S, Sudhakar B, Rao NB, Kaushik Y, Gopinathan K, Hegde NR, Gore MM, Krishna Mohan V, Ella KM. A Japanese Encephalitis Vaccine From India Induces Durable and Cross-protective Immunity Against Temporally and Spatially Wide-ranging Global Field Strains. J Infect Dis 2015; 212:715-25. [PMID: 25601942 DOI: 10.1093/infdis/jiv023] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a vaccine-preventable acute disease. We report the results of a phase 2/3 trial of JENVAC, a Vero cell-derived vaccine developed using an Indian strain of JE virus (JEV). METHODS JENVAC was administered in 2 doses 28 days apart, and immunogenicity was compared to that from a single dose of SA-14-14-2, the only approved JE vaccine and regimen at the time in India. RESULTS After both the doses, seroconversion and seroprotection were >90% for JENVAC. For SA-14-14-2, seroconversion and seroprotection were 57.69% and 77.56%, respectively, on day 28 and 39.74% and 60.26%, respectively, on day 56. The geometric mean titers at day 28 and day 56 were 145.04 and 460.53, respectively, for JENVAC and 38.56 and 25.29, respectively, for SA-14-14-2. With a single dose of JENVAC, seroprotection titers lasted at least 12 months in >80% of the subjects. Following receipt of 2 doses, 61.17% of subjects retained seroprotection titers at 24 months, and immunogenicity criteria were higher than that for SA-14-14-2 at 12, 18, and 24 months each. Sera from JENVAC subjects neutralized JEV genotypes I, II, III, and IV equally well. Adverse events were not significantly different between the 2 vaccines. CONCLUSIONS JENVAC elicits long-lasting, broadly protective immunity. CLINICAL TRIALS REGISTRATION CTRI/2011/07/001855.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Milind M Gore
- Gorakhpur Unit, National Institute of Virology, India
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Murhekar MV, Ranjan P, Selvaraju S, Pandey A, Gore MM, Mehendale SM. Low coverage and acceptable effectiveness of single dose of Japanese encephalitis vaccine, Gorakhpur division, Uttar Pradesh, India, 2013. J Infect 2014; 69:517-20. [DOI: 10.1016/j.jinf.2014.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
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Murhekar M, Ranjan P, Mehendale S. Hypothesis generation based on available evidence is not wishful thinking! J Infect 2014; 69:521-3. [PMID: 25194473 DOI: 10.1016/j.jinf.2014.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 08/19/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Manoj Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India.
| | - Prashant Ranjan
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Sanjay Mehendale
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
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