Genotyping of Orientia tsutsugamushi circulating in and around Vellore (South India) using TSA 56 gene

PURPOSE

The immunodominant TSA 56 gene of Orientia tsutsugamushi, (scrub typhus agent) has four variable regions (VD-I to VD-IV) making it useful for genotyping. This study was undertaken to determine Orientia tsutsugamushi genotypes circulating in and around Vellore using complete and partial TSA 56 gene.

METHODS

Of the 162 patients positive by 47 ​kDa qPCR, on 21 samples PCR to amplify the complete TSA 56 gene (≈1605 bp: Long protocol) and the partial gene sequence using the Horinouchi (≈650bp) and the Furuya (≈480 bp) protocol was performed. Sanger and Nanopore sequencing was performed to obtain sequence data for assigning genotype. For 13 amplicons partial and complete gene data was obtained.

RESULTS

Phylogenetic analysis of the complete gene (Long protocol) which includes VD-I to VD-IV region and partial gene (Horinouchi) which amplifies the VD-I to VD-III regions showed identical genotypes. Twelve belonged to TA763 genotype and one belongs to Karp genotype. The Furuya sequence (in silico) correctly identified the Karp genotype and 10 of the TA763 genotypes. Two TA763 genotypes (identified by complete and 650 bp partial gene analysis) were misidentified by Furuya sequence analysis as Karp genotype.

CONCLUSIONS

Analysis of the 13 complete 56 ​kDa gene sequences suggests that TA763 is the commonest genotype in Vellore. Sanger sequencing of the 650 bp fragment gives similar results. However, these results need to be validated by larger prospective multi-centric studies.

Spatio-temporal health benefits attributable to PM2.5 reduction in an Indian city

Fine particulate matter (PM_2.5) is linked with a wide spectrum of human health effects and has the highest contribution to total air pollution mortality. This study aims to quantify health benefits of reducing PM_2.5 concentration to World Health Organization standard (annual mean = 10 µg m^-3) for various health endpoints during 2011-2019 period using AirQ+ and BenMAP-CE software packages. Intraurban assessment in Vellore city, India was done by estimating health benefits at ward level. Both software packages estimated annual average all-cause, ischemic heart disease, stroke, and chronic obstructive pulmonary disease health benefits in the range of 919-945, 175-234, 70-152, and 99-175 cases at city level and 15-16, 3-4, 1-3, and 2-3 cases at ward level, respectively. Sensitivity analysis showed that relative risk had a large influence on health benefit estimates. Present study results will play a crucial role in the future air quality and public health policies of Vellore city.

Quality of life and associating factors in pulmonary tuberculosis patients

BACKGROUND

Quality of life is a significant issue among patients with tuberculosis and is used for evaluating treatment responses and therapeutic outcome. This study aimed to assess the quality of life in tuberculosis patients receiving anti-tuberculosis therapy for a short duration in the Vellore district of Tamil Nadu and its associated variables.

METHODS

A cross-sectional study was designed to evaluate pulmonary tuberculosis patients receiving treatment under category -1 registered in the NIKSHAY portal at Vellore. A total of 165 pulmonary tuberculosis patients were recruited from March 2021 to the third week of June 2021. On obtaining informed consent, the data were collected through the telephone interview by administering WHOQOL- BREF structured questionnaire. The data were examined with descriptive and analytical statistics. Multiple regression analysis for independent quality of life variables was done.

RESULTS

The lowest median scores, 31(25,38) & 38(25,44) was, related to psychological and environmental domains, respectively. In addition, the Man-Whitney & Kruskal Wallis showed a statistically significant variation in the mean quality of life for gender, employment status, duration of treatment, persistent symptoms, the location of residence of patients, and the stage of therapy. Age, gender, marital status, and persistent symptoms were the main associating factor.

CONCLUSION

Tuberculosis and its treatment influence psychological, physical functioning, and the environmental domain of patient quality of life. Attention is required in the follow-up and treatment of patients by monitoring their quality of life.

Vaccination coverage and the factors influencing routine childhood vaccination uptake among communities experiencing disadvantage in Vellore, southern India: a mixed-methods study

BACKGROUND

In 2015, the Vellore district in southern India was selected for intensified routine immunization, targeting children from communities experiencing disadvantage such as migrant, tribal, and other hard-to-reach groups. This mixed-methods study was conducted to assess routine immunization coverage and the factors influencing childhood vaccination uptake among these communities in Vellore.

METHODS

We conducted a cross-sectional household survey (n = 100) and six focus group discussions (n = 43) among parents of children aged 12-23 months from the known communities experiencing disadvantage in Vellore during 2017 and 2018. Multivariate logistic regression was conducted to examine associations between the parental characteristics and children's vaccination status in the household survey data; the qualitative discussions were analyzed by using the (previously published) "5As" taxonomy for the determinants of vaccine uptake.

RESULTS

In the household survey, the proportions of fully vaccinated children were 65% (95% CI: 53-76%) and 77% (95% CI: 58-88%) based on information from vaccination cards or parental recall and vaccination cards alone, respectively. Children whose mothers were wage earners [Adjusted prevalence odds ratio (aPOR): 0.21, 95% CI = 0.07-0.64], or salaried/small business owners [aPOR: 0.18, 95% CI = 0.04-0.73] were less likely to be fully vaccinated than children who had homemakers mothers. In the focus group discussions, parents identified difficulties in accessing routine immunization when travelling for work and showed knowledge gaps regarding the benefits and risks of vaccination, and fears surrounding certain vaccines due to negative news reports and common side-effects following childhood vaccination.

CONCLUSIONS

Vaccination coverage among children from the surveyed communities in Vellore was suboptimal. Our findings suggest the need to target children from Narikuravar families and conduct periodic community-based health education campaigns to improve parental awareness about and trust in childhood vaccines among the communities experiencing disadvantage in Vellore.

Superintendence of antimicrobial resistance observed in bacterial flora isolated from human faecal carriage in Vellore, India

A frequent cross-sectional study was conducted to determine the patterns of antimicrobial resistance in 296 bacterial strains isolated from in-patient faecal samples of Government Vellore Medical College and Hospital, Vellore. Isolation and identification of bacterial strains were done using enrichment media, selective media, and biochemical tests. Antimicrobial susceptibility testing by the disc diffusion method and minimal inhibitory concentration method was conducted and the strains were subjected to extended spectrum beta-lactamases screening. Antibiotic sensitivity pattern of Staphylococcus spp. showed oxacillin resistance. Almost all the strains were sensitive to linezolid, vancomycin, gentamycin and chloramphenicol. In gram negative isolates ciprofloxacin and tobramycin showed better sensitivity and ceftazidime showed a higher percentage of resistance by MIC. Out of 250 isolates, Enterobacteriaceae showed positive for 86/250, 82/250 and 94/250 isolates and 3/10, 4/10 and 4/10 non-Enterobacteriaceae isolates were found to be positive for CTX-M gene, TEM gene and SHV gene, respectively. This study helps to assess/analyse the relation between the spectrum of microorganisms present in various grades of faecal carriage and their susceptibility pattern in this part of the Vellore town.

Genotype distribution of Group A rotavirus from southern India, 2005-2016

Diarrheal disease due to Group A rotaviruses remain a leading cause of mortality and morbidity in the less developed parts of the world. India has started a phased roll out of rotavirus vaccine in the national immunization program. This analysis summarizes the rotavirus genotype strain distribution pre-vaccine introduction in Vellore, India from December 2005 to June 2016. Rotavirus was responsible for 32% of all diarrheal admission to the hospital. G2P[4] was the predominant strain in the initial years and was gradually replaced by G1P[8]. The emergence of G9P[4] replacing G9P[8], and the detection of G12 strains over several years were documented. There was no clear seasonality of disease. These data form the baseline to monitor genotype distribution post-vaccine introduction in Tamil Nadu.

Differential patterns, trends and hotspots of road traffic injuries on different road networks in Vellore district, southern India

OBJECTIVE

To describe spatial and temporal profiles of Road Traffic Injuries (RTIs) on different road networks in Vellore district of southern India.

METHODS

Using the information in the police maintained First Information Reports (FIRs), daily time series of RTI counts were created and temporal characteristics were analysed with respect to the vehicle, road types and time of the day for the period January 2005 to May 2007. Daily incidence and trend of RTIs were estimated using a Poisson regression analysis.

RESULTS

Of the reported 3262 RTIs, 52% had occurred on the National Highway (NH). The overall RTI rate on the NH was 8.8/100 000 vehicles per day with significantly higher pedestrian involvement. The mean numbers of RTIs were significantly higher on weekends. Thirteen percentage of all RTIs were associated with fatalities. Hotspots are major town junctions, and RTI rates differ over different stretches of the NH.

CONCLUSION

In India, FIRs form a valuable source of RTI information. Information on different vehicle profile, RTI patterns, and their spatial and temporal trends can be used by administrators to devise effective strategies for RTI prevention by concentrating on the high-risk areas, thereby optimising the use of available personnel and resources.