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Joy S, Rahi M. Empowering lymphatic filariasis affected individuals in India: acknowledging disability status and ensuring justice. Lancet Reg Health Southeast Asia 2024; 25:100400. [PMID: 38601259 PMCID: PMC11004378 DOI: 10.1016/j.lansea.2024.100400] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Sam Joy
- Indian Council of Medical Research, New Delhi, India
| | - Manju Rahi
- Indian Council of Medical Research, New Delhi, India
- ICMR-Vector Control Research Centre, Puducherry, India
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Nema S, Srivastava B, Ahmad N, Sharma S, Anvikar AR, Rahi M, Sharma A, Bharti PK, Nitika N. Malaria Slide Bank to Strengthen and Improve the Quality of Malaria Diagnosis: A National Slide Repository in India. Am J Trop Med Hyg 2024; 110:921-924. [PMID: 38579702 PMCID: PMC11066356 DOI: 10.4269/ajtmh.23-0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/01/2023] [Indexed: 04/07/2024] Open
Abstract
Malaria elimination is one of the top health care priorities in India, necessitating accessible and accurate diagnosis for effective treatment. A malaria slide bank in India is a collection of quality-controlled malaria-positive and -negative slides and is considered a vital asset for quality diagnosis. The collection of blood samples, preparation of blood smears, staining, quality control, molecular characterizations, and slide validation were carried out according to standard operating procedures in accordance with the WHO reference laboratory. The true count and parasite density per microliter were computed in accordance with WHO guidelines. Over 27 months, 48 batches (8,196 slides) were prepared. Overall, the majority of slide batches were Plasmodium vivax (45.9%; 22/48), followed by Plasmodium falciparum (25%; 12/48), malaria-negative infections (25%; 12/48), and mixed infections (4.1%; 2/48). All 48 batches passed internal validation by WHO-certified level-1 microscopists. For a batch, the true count was the median of the validators' counts (range, 111-280,795 parasites/µL). Except for mixed infections, the PCR results agreed with the verified microscopy results. Malaria slide bank slides would be a valuable tool for quality control, assurance, and microscopist training.
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Affiliation(s)
- Shrikant Nema
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Bina Srivastava
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Naseem Ahmad
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Supriya Sharma
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Anup R. Anvikar
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Praveen Kumar Bharti
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Nitika Nitika
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
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Nain M, Dhorda M, Flegg JA, Gupta A, Harrison LE, Singh-Phulgenda S, Otienoburu SD, Harriss E, Bharti PK, Behera B, Rahi M, Guerin PJ, Sharma A. Systematic Review and Geospatial Modeling of Molecular Markers of Resistance to Artemisinins and Sulfadoxine-Pyrimethamine in Plasmodium falciparum in India. Am J Trop Med Hyg 2024; 110:910-920. [PMID: 38574550 PMCID: PMC11066343 DOI: 10.4269/ajtmh.23-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/17/2023] [Indexed: 04/06/2024] Open
Abstract
Surveillance for genetic markers of resistance can provide valuable information on the likely efficacy of antimalarials but needs to be targeted to ensure optimal use of resources. We conducted a systematic search and review of publications in seven databases to compile resistance marker data from studies in India. The sample collection from the studies identified from this search was conducted between 1994 and 2020, and these studies were published between 1994 and 2022. In all, Plasmodium falciparum Kelch13 (PfK13), P. falciparum dihydropteroate synthase, and P. falciparum dihydrofolate reductase (PfDHPS) genotype data from 2,953, 4,148, and 4,222 blood samples from patients with laboratory-confirmed malaria, respectively, were extracted from these publications and uploaded onto the WorldWide Antimalarial Resistance Network molecular surveyors. These data were fed into hierarchical geostatistical models to produce maps with a predicted prevalence of the PfK13 and PfDHPS markers, and of the associated uncertainty. Zones with a predicted PfDHPS 540E prevalence of >15% were identified in central, eastern, and northeastern India. The predicted prevalence of PfK13 mutants was nonzero at only a few locations, but were within or adjacent to the zones with >15% prevalence of PfDHPS 540E. There may be a greater probability of artesunate-sulfadoxine-pyrimethamine failures in these regions, but these predictions need confirmation. This work can be applied in India and elsewhere to help identify the treatments most likely to be effective for malaria elimination.
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Affiliation(s)
- Minu Nain
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Mehul Dhorda
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jennifer A. Flegg
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Apoorv Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Lucinda E. Harrison
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sabina D. Otienoburu
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- College of STEM, Johnson C. Smith University, Charlotte, North Carolina
| | - Eli Harriss
- The Knowledge Centre, Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | | | - Beauty Behera
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh
| | - Philippe J. Guerin
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Infectious Diseases Data Observatory, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Kumar G, Gupta S, Kaur J, Pasi S, Baharia R, Mohanty AK, Goel P, Sharma A, Rahi M. Mapping malaria vectors and insecticide resistance in a high-endemic district of Haryana, India: implications for vector control strategies. Malar J 2024; 23:107. [PMID: 38632650 PMCID: PMC11022408 DOI: 10.1186/s12936-023-04797-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/20/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Achieving effective control and elimination of malaria in endemic regions necessitates a comprehensive understanding of local mosquito species responsible for malaria transmission and their susceptibility to insecticides. METHODS The study was conducted in the highly malaria prone Ujina Primary Health Center of Nuh (Mewat) district of Haryana state of India. Monthly entomological surveys were carried out for adult mosquito collections via indoor resting collections, light trap collections, and pyrethrum spray collections. Larvae were also collected from different breeding sites prevalent in the region. Insecticide resistance bioassay, vector incrimination, blood meal analysis was done with the collected vector mosquitoes. RESULTS A total of 34,974 adult Anopheles mosquitoes were caught during the survey period, out of which Anopheles subpictus was predominant (54.7%). Among vectors, Anopheles stephensi was predominant (15.5%) followed by Anopheles culicifacies (10.1%). The Human Blood Index (HBI) in the case of An. culicifacies and An. stephensi was 6.66 and 9.09, respectively. Vector incrimination results revealed Plasmodium vivax positivity rate of 1.6% for An. culicifacies. Both the vector species were found resistant to DDT, malathion and deltamethrin. CONCLUSION The emergence of insecticide resistance in both vector species, compromises the effectiveness of commonly used public health insecticides. Consequently, the implementation of robust insecticide resistance management strategies becomes imperative. To effectively tackle the malaria transmission, a significant shift in vector control strategies is warranted, with careful consideration and adaptation to address specific challenges encountered in malaria elimination efforts.
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Affiliation(s)
- Gaurav Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sanjeev Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Jaspreet Kaur
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Shweta Pasi
- ICMR-National Institute of Malaria Research, New Delhi, India
- ICMR-National Institute of Occupational Health, Ahmedabad, India
| | - Rajendra Baharia
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | | | - Pawan Goel
- Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
- International Centre of Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India.
- Academy of Scientific and Innovative Research, Ghaziabad, India.
- Indian Council of Medical Research (ICMR), New Delhi, India.
- ICMR-Vector Control Research Center, Puducherry, India.
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Singh-Phulgenda S, Kumar R, Dahal P, Munir A, Rashan S, Chhajed R, Naylor C, Maguire BJ, Siddiqui NA, Harriss E, Rahi M, Alves F, Sundar S, Stepniewska K, Musa A, Guerin PJ, Pandey K. Post-kala-azar dermal leishmaniasis (PKDL) drug efficacy study landscape: A systematic scoping review of clinical trials and observational studies to assess the feasibility of establishing an individual participant-level data (IPD) platform. PLoS Negl Trop Dis 2024; 18:e0011635. [PMID: 38626228 PMCID: PMC11051605 DOI: 10.1371/journal.pntd.0011635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/26/2024] [Accepted: 03/27/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis which can occur after successful treatment of visceral leishmaniasis (VL) and is a public health problem in VL endemic areas. We conducted a systematic scoping review to assess the characteristics of published PKDL clinical studies, understand the scope of research and explore the feasibility and value of developing a PKDL individual patient data (IPD) platform. METHODS A systematic review of published literature was conducted to identify PKDL clinical studies by searching the following databases: PubMed, Scopus, Ovid Embase, Web of Science Core Collection, WHO Global Index Medicus, PASCAL, Clinicaltrials.gov, Ovid Global Health, Cochrane Database and CENTRAL, and the WHO International Clinical Trials Registry Platform. Only prospective studies in humans with PKDL diagnosis, treatment, and follow-up measurements between January 1973 and March 2023 were included. Extracted data includes variables on patient characteristics, treatment regimens, diagnostic methods, geographical locations, efficacy endpoints, adverse events and statistical methodology. RESULTS A total of 3,418 records were screened, of which 56 unique studies (n = 2,486 patients) were included in this review. Out of the 56 studies, 36 (64.3%) were from India (1983-2022), 12 (21.4%) from Sudan (1992-2021), 6 (10.7%) were from Bangladesh (1991-2019), and 2 (3.6%) from Nepal (2001-2007). Five (8.9%) studies were published between 1981-1990 (n = 193 patients), 10 (17.9%) between 1991-2000 (n = 230 patients), 10 (17.9%) between 2001-2010 (n = 198 patients), and 31 (55.4%) from 2011 onwards (n = 1,865 patients). Eight (14.3%) were randomised clinical trials, and 48 (85.7%) were non-randomised studies. The median post-treatment follow-up duration was 365 days (range: 90-540 days) in 8 RCTs and 360 days (range: 28-2,373 days) in 48 non-randomised studies. Disease diagnosis was based on clinical criterion in 3 (5.4%) studies, a mixture of clinical and parasitological methods in 47 (83.9%) and was unclear in 6 (10.7%) studies. Major drugs used for treatment were miltefosine (n = 636 patients), liposomal amphotericin B (L-AmB) (n = 508 patients), and antinomy regimens (n = 454 patients). Ten other drug regimens were tested in 270 patients with less than 60 patients per regimen. CONCLUSIONS Our review identified studies with very limited sample size for the three major drugs (miltefosine, L-AmB, and pentavalent antimony), while the number of patients combined across studies suggest that the IPD platform would be valuable. With the support of relevant stakeholders, the global PKDL community and sufficient financing, a PKDL IPD platform can be realised. This will allow for exploration of different aspects of treatment safety and efficacy, which can potentially guide future healthcare decisions and clinical practices.
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Affiliation(s)
- Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rishikesh Kumar
- ICMR—Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India
| | - Prabin Dahal
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Abdalla Munir
- Department of Clinical Pathology and Immunology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Sumayyah Rashan
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rutuja Chhajed
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Caitlin Naylor
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Brittany J. Maguire
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Niyamat Ali Siddiqui
- ICMR—Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India
| | - Eli Harriss
- The Knowledge Centre, Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Manju Rahi
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kasia Stepniewska
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ahmed Musa
- Department of Clinical Pathology and Immunology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Philippe J. Guerin
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Krishna Pandey
- ICMR—Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India
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Rahi M, Nazmeen A, Yadav CP, Sirohi PR, Gupta S, Bhati G, Baharia R, Goel P, Sharma A. Prevalence and Correlates of Malnutrition in Nuh District, Haryana State, India. Am J Trop Med Hyg 2024; 110:588-595. [PMID: 38350138 PMCID: PMC10919177 DOI: 10.4269/ajtmh.23-0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/11/2023] [Indexed: 02/15/2024] Open
Abstract
India has a substantial burden of undernutrition coupled with overweight and obesity at the other end of the spectrum of malnutrition. Nuh district, in the Haryana State in northern India, is an impoverished district in India. With an aim to investigate the problem of malnutrition in the community, a cross-sectional study was conducted in four villages of the Nuh district. Height/length, weight, and age data of children under 5 years were used to calculate three indices: weight-for-age, height-for-age, and weight-for-height. The body mass index was calculated for individuals older than 6 years. Associations between malnutrition and other factors were assessed using simple and multiple logistic regression to get adjusted coefficients. The total surveyed population comprised 11,496 individuals. Over 51% were female, and 13.2% of the surveyed population were children under 5 years. Almost half of the population was illiterate and unemployed. The prevalences of underweight, stunting, and wasting in children under 5 years were 37%, 53%, and 21%, respectively. The prevalences of underweight and stunting in the 6- to 19-year-old age group were 29% and 38%, respectively. The prevalence of overweight was 36% in the 20- to 40-year-old and > 60-year-old age groups, and 44% in the 41- to 60-year-old age group. Our findings reveal a considerable burden of undernutrition among children under 5 years and a dual burden of undernutrition and overnutrition in adults, highlighting the need to map these areas and sharpen our responses to mitigate the overwhelming and long-term consequences of malnutrition in the Nuh district.
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Affiliation(s)
- Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- ICMR-Vector Control Research Centre, Puducherry, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Aarifa Nazmeen
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
- National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | | | - Sanjeev Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Gaurav Bhati
- Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India
| | | | - Pawan Goel
- Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India
| | - Amit Sharma
- International Centre of Genetic Engineering and Biotechnology, New Delhi, India
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Ahmad SS, Verma R, Commons RJ, Nitika, Singh-Phulgenda S, Chhajed R, Bharti PK, Behera B, Naser SM, Pal SK, Ranjit PH, Baharia RK, Solanki B, Upadhyay KJ, Guerin PJ, Sharma A, Price RN, Rahi M, Thriemer K. A randomised controlled trial to compare the efficacy, safety, and tolerability of low dose, short course primaquine in adults with uncomplicated P. vivax malaria in two hospitals in India. Trials 2024; 25:154. [PMID: 38424577 PMCID: PMC10905854 DOI: 10.1186/s13063-024-07987-0] [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: 11/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Plasmodium vivax remains a major challenge for malaria control and elimination due to its ability to cause relapsing illness. To prevent relapses the Indian National Center for Vector Borne Diseases Control (NCVBDC) recommends treatment with primaquine at a dose of 0.25 mg/kg/day provided over 14 days. Shorter treatment courses may improve adherence and treatment effectiveness. METHODS This is a hospital-based, randomised, controlled, open-label trial in two centres in India. Patients above the age of 16 years, with uncomplicated vivax malaria, G6PD activity of ≥ 30% of the adjusted male median (AMM) and haemoglobin levels ≥ 8 g/dL will be recruited into the study and randomised in a 1:1 ratio to receive standard schizonticidal treatment plus 7-day primaquine at 0.50 mg/kg/day or standard care with schizonticidal treatment plus 14-day primaquine at 0.25 mg/kg/day. Patients will be followed up for 6 months. The primary endpoint is the incidence risk of any P. vivax parasitaemia at 6 months. Safety outcomes include the incidence risk of severe anaemia (haemoglobin < 8 g/dL), the risk of blood transfusion, a > 25% fall in haemoglobin and an acute drop in haemoglobin of > 5 g/dL during primaquine treatment. DISCUSSION This study will evaluate the efficacy and safety of a 7-day primaquine regimen compared to the standard 14-day regimen in India. Results from this trial are likely to directly inform national treatment guidelines. TRIAL REGISTRATION Trial is registered on CTRI portal, Registration No: CTRI/2022/12/048283.
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Affiliation(s)
| | - Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Robert J Commons
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- General and Subspecialty Medicine, Grampians Health, Ballarat, Australia
| | - Nitika
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Rutuja Chhajed
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | | | - Beauty Behera
- Delhi Skill and Entrepreneurship University, New Delhi, India
| | | | - Salil Kumar Pal
- Calcutta National Medical College, Kolkata, West Bengal, India
| | | | - Rajendra Kumar Baharia
- NIMR Field Unit, Academy of Scientific and Innovative Research, Ghaziabad, Gujarat, India
| | - Bhavin Solanki
- Ahmedabad Municipal Corporation, Ahmedabad, Gujarat, India
| | | | - Philippe J Guerin
- Infectious Diseases Data Observatory - IDDO, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Asia-Pacific Regional Hub, Melbourne, Australia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Manju Rahi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
- Indian Council of Medical Research, New Delhi, India.
| | - Kamala Thriemer
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
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Rahi M, Nazmeen A, Kumar S, Yadav CP, Kumar G, Mittal P, Joy S, Sharma S, Baharia RK, Bhati G, Goel P, Sharma A. Enhancing healthcare access and malaria management via mobile clinics and phone call services in Nuh district of Haryana, India. J Vector Borne Dis 2024:01196045-990000000-00044. [PMID: 38381048 DOI: 10.4103/jvbd.jvbd_163_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/15/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND OBJECTIVES Malaria remains a complex challenge in India due to its diverse epidemiology, multi-ethnic population, and multiplicity of malaria vectors. While progress has been made in reducing malaria nationally, persistent pockets hinder elimination efforts. These challenges include hidden reservoirs, inadequate healthcare, suboptimal surveillance, non-compliance, and subclinical infections. Shortage of grassroot level and primary care health staff, transportation issues and general inaccessibility and unavailability of healthcare services are additional challenges. METHODS Mobile healthcare vans have been tried and found useful in enhancing healthcare availability in several health conditions in different settings. Nuh (Mewat) district in Haryana is a malaria endemic region; it is indeed one of the districts included by NITI Aayog in the Aspirational Districts Programme (ADP) a government initiative that focuses on rapidly transforming and developing the most underdeveloped districts in India. With an aim to improve the health care seeking behavior of malaria endemic community of selected villages of Nuh district, we carried out a study to using interventions in two villages of Nuh district like mobile malaria clinics and toll-free telephone services in enhancing healthcare access. RESULTS We found that the Sangel village had higher literacy rates (60.6%) as compared to 39.4% in Naushera. Similarly, the unemployment rate was higher for Naushera. The mobile malaria clinic was deployed from December 2019 to July 2020 and a total of 269 phone calls were received from both the villages. A similar number of rapid tests and microscopy smears were examined and all were negative for malaria. The febrile patients were referred to the nearest healthcare facility. INTERPRETATION CONCLUSION The study shows that the community is open to using these healthcare interventions and these initiatives of mobile malaria clinics and toll-free telephone services can bridge healthcare gaps, especially in malaria-endemic regions, aligning with India's malaria elimination and equitable healthcare access goals.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research (ICMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Aarifa Nazmeen
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sanjeev Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Chander Prakash Yadav
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- ICMR-National Institute of Malaria Research, New Delhi, India
- National Institute of Cancer Prevention and Research, Noida, U.P, India
| | - Gaurav Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Peeyush Mittal
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Sam Joy
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Sachin Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Rajendra Kumar Baharia
- Indian Council of Medical Research (ICMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Gaurav Bhati
- Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India
| | - Pawan Goel
- Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Subramanian S, Maheswari RU, Prabavathy G, Khan MA, Brindha B, Srividya A, Kumar A, Rahi M, Nightingale ES, Medley GF, Cameron MM, Roy N, Jambulingam P. Modelling spatiotemporal patterns of visceral leishmaniasis incidence in two endemic states in India using environment, bioclimatic and demographic data, 2013-2022. PLoS Negl Trop Dis 2024; 18:e0011946. [PMID: 38315725 PMCID: PMC10868833 DOI: 10.1371/journal.pntd.0011946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/15/2024] [Accepted: 01/26/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND As of 2021, the National Kala-azar Elimination Programme (NKAEP) in India has achieved visceral leishmaniasis (VL) elimination (<1 case / 10,000 population/year per block) in 625 of the 633 endemic blocks (subdistricts) in four states. The programme needs to sustain this achievement and target interventions in the remaining blocks to achieve the WHO 2030 target of VL elimination as a public health problem. An effective tool to analyse programme data and predict/ forecast the spatial and temporal trends of VL incidence, elimination threshold, and risk of resurgence will be of use to the programme management at this juncture. METHODOLOGY/PRINCIPAL FINDINGS We employed spatiotemporal models incorporating environment, climatic and demographic factors as covariates to describe monthly VL cases for 8-years (2013-2020) in 491 and 27 endemic and non-endemic blocks of Bihar and Jharkhand states. We fitted 37 models of spatial, temporal, and spatiotemporal interaction random effects with covariates to monthly VL cases for 6-years (2013-2018, training data) using Bayesian inference via Integrated Nested Laplace Approximation (INLA) approach. The best-fitting model was selected based on deviance information criterion (DIC) and Watanabe-Akaike Information Criterion (WAIC) and was validated with monthly cases for 2019-2020 (test data). The model could describe observed spatial and temporal patterns of VL incidence in the two states having widely differing incidence trajectories, with >93% and 99% coverage probability (proportion of observations falling inside 95% Bayesian credible interval for the predicted number of VL cases per month) during the training and testing periods. PIT (probability integral transform) histograms confirmed consistency between prediction and observation for the test period. Forecasting for 2021-2023 showed that the annual VL incidence is likely to exceed elimination threshold in 16-18 blocks in 4 districts of Jharkhand and 33-38 blocks in 10 districts of Bihar. The risk of VL in non-endemic neighbouring blocks of both Bihar and Jharkhand are less than 0.5 during the training and test periods, and for 2021-2023, the probability that the risk greater than 1 is negligible (P<0.1). Fitted model showed that VL occurrence was positively associated with mean temperature, minimum temperature, enhanced vegetation index, precipitation, and isothermality, and negatively with maximum temperature, land surface temperature, soil moisture and population density. CONCLUSIONS/SIGNIFICANCE The spatiotemporal model incorporating environmental, bioclimatic, and demographic factors demonstrated that the KAMIS database of the national programmme can be used for block level predictions of long-term spatial and temporal trends in VL incidence and risk of outbreak / resurgence in endemic and non-endemic settings. The database integrated with the modelling framework and a dashboard facility can facilitate such analysis and predictions. This could aid the programme to monitor progress of VL elimination at least one-year ahead, assess risk of resurgence or outbreak in post-elimination settings, and implement timely and targeted interventions or preventive measures so that the NKAEP meet the target of achieving elimination by 2030.
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Affiliation(s)
| | | | | | | | - Balan Brindha
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry, India
| | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry, India
| | - Manju Rahi
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry, India
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Emily S Nightingale
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mary M Cameron
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nupur Roy
- National Centre for Vector-Borne Diseases Control, Ministry of Health and Family Welfare, Government of India, New Delhi
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10
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Kumar A, Singh PP, Tyagi S, Hari Kishan Raju K, Sahu SS, Rahi M. Vivax malaria: a possible stumbling block for malaria elimination in India. Front Public Health 2024; 11:1228217. [PMID: 38259757 PMCID: PMC10801037 DOI: 10.3389/fpubh.2023.1228217] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Plasmodium vivax is geographically the most widely dispersed human malaria parasite species. It has shown resilience and a great deal of adaptability. Genomic studies suggest that P. vivax originated from Asia or Africa and moved to the rest of the world. Although P. vivax is evolutionarily an older species than Plasmodium falciparum, its biology, transmission, pathology, and control still require better elucidation. P. vivax poses problems for malaria elimination because of the ability of a single primary infection to produce multiple relapses over months and years. P. vivax malaria elimination program needs early diagnosis, and prompt and complete radical treatment, which is challenging, to simultaneously exterminate the circulating parasites and dormant hypnozoites lodged in the hepatocytes of the host liver. As prompt surveillance and effective treatments are rolled out, preventing primaquine toxicity in the patients having glucose-6-phosphate dehydrogenase (G6PD) deficiency should be a priority for the vivax elimination program. This review sheds light on the burden of P. vivax, changing epidemiological patterns, the hurdles in elimination efforts, and the essential tools needed not just in India but globally. These tools encompass innovative treatments for eliminating dormant parasites, coping with evolving drug resistance, and the development of potential vaccines against the parasite.
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Affiliation(s)
- Ashwani Kumar
- ICMR - Vector Control Research Centre, Puducherry, India
| | | | - Suchi Tyagi
- ICMR - Vector Control Research Centre, Puducherry, India
| | | | | | - Manju Rahi
- ICMR - Vector Control Research Centre, Puducherry, India
- Indian Council of Medical Research, Hqrs New Delhi, India
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11
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Freitas LT, Khan MA, Uddin A, Halder JB, Singh-Phulgenda S, Raja JD, Balakrishnan V, Harriss E, Rahi M, Brack M, Guérin PJ, Basáñez MG, Kumar A, Walker M, Srividya A. The lymphatic filariasis treatment study landscape: A systematic review of study characteristics and the case for an individual participant data platform. PLoS Negl Trop Dis 2024; 18:e0011882. [PMID: 38227595 PMCID: PMC10817204 DOI: 10.1371/journal.pntd.0011882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/26/2024] [Accepted: 12/22/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a neglected tropical disease (NTD) targeted by the World Health Organization for elimination as a public health problem (EPHP). Since 2000, more than 9 billion treatments of antifilarial medicines have been distributed through mass drug administration (MDA) programmes in 72 endemic countries and 17 countries have reached EPHP. Yet in 2021, nearly 900 million people still required MDA with combinations of albendazole, diethylcarbamazine and/or ivermectin. Despite the reliance on these drugs, there remain gaps in understanding of variation in responses to treatment. As demonstrated for other infectious diseases, some urgent questions could be addressed by conducting individual participant data (IPD) meta-analyses. Here, we present the results of a systematic literature review to estimate the abundance of IPD on pre- and post-intervention indicators of infection and/or morbidity and assess the feasibility of building a global data repository. METHODOLOGY We searched literature published between 1st January 2000 and 5th May 2023 in 15 databases to identify prospective studies assessing LF treatment and/or morbidity management and disease prevention (MMDP) approaches. We considered only studies where individual participants were diagnosed with LF infection or disease and were followed up on at least one occasion after receiving an intervention/treatment. PRINCIPAL FINDINGS We identified 138 eligible studies from 23 countries, having followed up an estimated 29,842 participants after intervention. We estimate 14,800 (49.6%) IPD on pre- and post-intervention infection indicators including microfilaraemia, circulating filarial antigen and/or ultrasound indicators measured before and after intervention using 8 drugs administered in various combinations. We identified 33 studies on MMDP, estimating 6,102 (20.4%) IPD on pre- and post-intervention clinical morbidity indicators only. A further 8,940 IPD cover a mixture of infection and morbidity outcomes measured with other diagnostics, from participants followed for adverse event outcomes only or recruited after initial intervention. CONCLUSIONS The LF treatment study landscape is heterogeneous, but the abundance of studies and related IPD suggest that establishing a global data repository to facilitate IPD meta-analyses would be feasible and useful to address unresolved questions on variation in treatment outcomes across geographies, demographics and in underrepresented groups. New studies using more standardized approaches should be initiated to address the scarcity and inconsistency of data on morbidity management.
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Affiliation(s)
- Luzia T. Freitas
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
| | | | - Azhar Uddin
- ICMR-Vector Control Research Centre, Puducherry, India
| | - Julia B. Halder
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Eli Harriss
- The Knowledge Centre, Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Manju Rahi
- ICMR-Vector Control Research Centre, Puducherry, India
| | - Matthew Brack
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Philippe J. Guérin
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Maria-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
| | - Ashwani Kumar
- Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Infectious Diseases Data Observatory, University of Oxford, Oxford, United Kingdom
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
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12
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Verma R, Commons RJ, Gupta A, Rahi M, Nitika, Bharti PK, Thriemer K, Rajasekhar M, Singh-Phulgenda S, Adhikari B, Alam MS, Ghimire P, Khan WA, Kumar R, Leslie T, Ley B, Llanos-Cuentas A, Pukrittayakamee S, Rijal KR, Rowland M, Saravu K, Simpson JA, Guerin PJ, Price RN, Sharma A. Safety and efficacy of primaquine in patients with Plasmodium vivax malaria from South Asia: a systematic review and individual patient data meta-analysis. BMJ Glob Health 2023; 8:e012675. [PMID: 38123228 DOI: 10.1136/bmjgh-2023-012675] [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: 04/25/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The optimal dosing of primaquine to prevent relapsing Plasmodium vivax malaria in South Asia remains unclear. We investigated the efficacy and safety of different primaquine regimens to prevent P. vivax relapse. METHODS A systematic review identified P. vivax efficacy studies from South Asia published between 1 January 2000 and 23 August 2021. In a one-stage meta-analysis of available individual patient data, the cumulative risks of P. vivax recurrence at day 42 and 180 were assessed by primaquine total mg/kg dose and duration. The risk of recurrence by day 180 was also determined in a two-stage meta-analysis. Patients with a >25% drop in haemoglobin to <70 g/L, or an absolute drop of >50 g/L between days 1 and 14 were categorised by daily mg/kg primaquine dose. RESULTS In 791 patients from 7 studies in the one-stage meta-analysis, the day 180 cumulative risk of recurrence was 61.1% (95% CI 42.2% to 80.4%; 201 patients; 25 recurrences) after treatment without primaquine, 28.8% (95% CI 8.2% to 74.1%; 398 patients; 4 recurrences) following low total (2 to <5 mg/kg) and 0% (96 patients; 0 recurrences) following high total dose primaquine (≥5 mg/kg). In the subsequent two-stage meta-analysis of nine studies (3529 patients), the pooled proportions of P. vivax recurrences by day 180 were 12.1% (95% CI 7.7% to 17.2%), 2.3% (95% CI 0.3% to 5.4%) and 0.7% (95% CI 0% to 6.1%), respectively. No patients had a >25% drop in haemoglobin to <70 g/L. CONCLUSIONS Primaquine treatment led to a marked decrease in P. vivax recurrences following low (~3.5 mg/kg) and high (~7 mg/kg) total doses, with no reported severe haemolytic events. PROSPERO REGISTRATION NUMBER CRD42022313730.
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Affiliation(s)
- Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Robert J Commons
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
- WorldWide Antimalarial Resistance Network, Asia Pacific Regional Hub - Australia, Melbourne, Victoria, Australia
- General and Subspecialty Medicine, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Apoorv Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Nitika
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Megha Rajasekhar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sauman Singh-Phulgenda
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mohammad Shafiul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rishikesh Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Toby Leslie
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- HealthNet TPO, Kabul, Afghanistan
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Alejandro Llanos-Cuentas
- Unit of Leishmaniasis and Malaria, Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mark Rowland
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Julie A Simpson
- WorldWide Antimalarial Resistance Network, Asia Pacific Regional Hub - Australia, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ric N Price
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
- WorldWide Antimalarial Resistance Network, Asia Pacific Regional Hub - Australia, Melbourne, Victoria, Australia
| | - Amit Sharma
- International Centre For Genetic Engineering and Biotechnology, New Delhi, India
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Munir A, Dahal P, Kumar R, Singh-Phulgenda S, Siddiqui NA, Naylor C, Wilson J, Buck G, Rahi M, Alves F, Malaviya P, Sundar S, Ritmeijer K, Stepniewska K, Pandey K, Guérin PJ, Musa A. Haematological dynamics following treatment of visceral leishmaniasis: a protocol for systematic review and individual participant data (IPD) meta-analysis. BMJ Open 2023; 13:e074841. [PMID: 38101841 PMCID: PMC10729213 DOI: 10.1136/bmjopen-2023-074841] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Visceral leishmaniasis (VL) is a parasitic disease with an estimated 30 000 new cases occurring annually. Despite anaemia being a common haematological manifestation of VL, the evolution of different haematological characteristics following treatment remains poorly understood. An individual participant data meta-analysis (IPD-MA) is planned to characterise the haematological dynamics in patients with VL. METHODS AND ANALYSIS The Infectious Diseases Data Observatory (IDDO) VL data platform is a global repository of IPD from therapeutic studies identified through a systematic search of published literature (PROSPERO registration: CRD42021284622). The platform currently holds datasets from clinical trials standardised to a common data format. Corresponding authors and principal investigators of the studies indexed in the IDDO VL data platform meeting the eligibility criteria for inclusion were invited to be part of the collaborative IPD-MA. Mixed-effects multivariable regression models will be constructed to identify determinants of haematological parameters by taking clustering within study sites into account. ETHICS AND DISSEMINATION This IPD-MA meets the criteria for waiver of ethical review as defined by the Oxford Tropical Research Ethics Committee (OxTREC) granted to IDDO, as the research consists of secondary analysis of existing anonymised data (exempt granted on 29 March 2023, OxTREC REF: IDDO). Ethics approval was granted by the ICMR-Rajendra Memorial Research Institute of Medical Sciences ethics committee (letter no.: RMRI/EC/30/2022) on 4 July 2022. The results of this analysis will be disseminated at conferences, the IDDO website and peer-reviewed publications in open-access journals. The findings of this research will be critically important for control programmes at regional and global levels, policymakers and groups developing new VL treatments. PROSPERO REGISTRATION NUMBER CRD42021284622.
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Affiliation(s)
- Abdalla Munir
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Prabin Dahal
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rishikesh Kumar
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Caitlin Naylor
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James Wilson
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gemma Buck
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Manju Rahi
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Fabiana Alves
- Drugs for Neglected Disease Initiative, Geneva, Switzerland
| | - Paritosh Malaviya
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Kasia Stepniewska
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Philippe J Guérin
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ahmed Musa
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
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14
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Panda BB, Krishnamoorthy K, Das A, Jain HK, Dixit S, Rahi M, Somalkar N, Mohanty S, Pati S, Ranjit M, Bal M. Mini-TAS as a confirmatory mapping tool for remapping areas with uncertain filarial endemicity to exclude/ include for mass drug administration: A report from field validation in India. PLoS One 2023; 18:e0293641. [PMID: 37922274 PMCID: PMC10624291 DOI: 10.1371/journal.pone.0293641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
India has targeted elimination of lymphatic filariasis (LF) through mass drug administration (MDA) by 2027. Mapping of LF endemic areas is a priority for implementation of MDA. Current national LF remapping tool for unsurveyed/uncertain districts, have many limitations. The WHO has recommended a sensitive and rapid remapping protocol (Mini-TAS), that needs validation in Indian setting. Hence, in the present study a comparative assessment of these two protocols (national protocol vs Mini-TAS) was undertaken in two non-MDA districts of Odisha, with unknown filarial endemicity but reporting chronic cases. Purposive sampling was done in five top sites based on filarial case count as per the national protocol. Random 30 cluster survey was done by conducting school based Mini-TAS, Microfilariae (Mf) survey among adults (>10 years) in villages/wards with schools and Molecular Xenomonitoring (MX) of infection in vectors. Costing by activity and items of the surveys was acomplished using itemized cost menu. In Kalahandi, one of the five purposive sampling sites showed Mf prevalence above threshold (> 1%). But except Mini-TAS neither MX nor house-hold Mf survey among adults could detect the infection above the threshold. While in Balangir, Mf prevalence in all purposive sampling sites,Mini-TAS, Mf prevalence among adult and MX were above the respective thresholds confirming endemicity of LF in the district. The per sample cost of purposive sampling for Mf was the lowest INR 41, followed by adult Mf sampling INR 93. Mini-TAS and MX were expensive with INR 659 and 812 respectively. The study demonstrates that though all the sampling methods could detect filarial infection above the threshold in high-risk areas, Mini-TAS could only detect infection in low-risk areas. Therefore, in the national programme Mini-TAS can be used as a decision-making tool to determine whether to exclude/ include a district having uncertain endemicity for MDA.
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Affiliation(s)
| | | | - Arundhuti Das
- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Sujata Dixit
- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Manju Rahi
- Indian Council of Medical Research, New Delhi, India
| | - Nilam Somalkar
- Regional Office for Health & Family Welfare, Bhubaneswar, Odisha, India
| | | | | | | | - Madhusmita Bal
- Regional Medical Research Centre, Bhubaneswar, Odisha, India
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15
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Kumar R, Dahal P, Singh-Phulgenda S, Siddiqui NA, Munir A, Naylor C, Wilson J, Buck G, Rahi M, Malaviya P, Alves F, Sundar S, Ritmeijer K, Stepniewska K, Guérin PJ, Pandey K. Host, parasite and drug determinants of clinical outcomes following treatment of visceral leishmaniasis: a protocol for individual participant data meta-analysis. BMJ Open 2023; 13:e074679. [PMID: 37898487 PMCID: PMC10618999 DOI: 10.1136/bmjopen-2023-074679] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION Visceral leishmaniasis (VL) is a parasitic disease with an estimated 30 000 new cases occurring annually. There is an observed variation in the efficacy of the current first-line therapies across different regions. Such heterogeneity could be a function of host, parasite and drug factors. An individual participant data meta-analysis (IPD-MA) is planned to explore the determinants of treatment outcomes. METHODS AND ANALYSIS The Infectious Diseases Data Observatory (IDDO) VL living systematic review (IDDO VL LSR) library is an open-access resource of all published therapeutic studies in VL since 1980. For this current review, the search includes all clinical trials published between 1 January 1980 and 2 May 2021. Studies indexed in the IDDO VL LSR library were screened for eligibility for inclusion in this IPD-MA. Corresponding authors and principal investigators of the studies meeting the eligibility criteria for inclusion were invited to be part of the collaborative IPD-MA. Authors agreeing to participate in this collaborative research were requested to share the IPD using the IDDO VL data platform. The IDDO VL data platform currently holds data sets from clinical trials standardised to a common data format and provides a unique opportunity to identify host, parasite and drug determinants of treatment outcomes. Multivariable regression models will be constructed to identify determinants of therapeutic outcomes using generalised linear mixed-effects models accounting for within-study site clustering. ETHICS AND DISSEMINATION This IPD-MA meets the criteria for waiver of ethical review as defined by the Oxford Tropical Research Ethics Committee (OxTREC) granted to IDDO, as the research consists of secondary analysis of existing anonymised data (Exempt granted on 29 March 2023, OxTREC REF: IDDO) Ethics approval was granted by the ICMR-Rajendra Memorial Research Institute of Medical Sciences ethics committee (Letter no: RMRI/EC/30/2022) on 04-07-2022. The results of this IPD-MA will be disseminated at conferences, IDDO website and any peer-reviewed publications. All publications will be open source. Findings of this research will be critically important for the control programmes at regional/global levels, policy makers and groups developing new VL treatments. PROSPERO REGISTRATION CRD42021284622.
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Affiliation(s)
- Rishikesh Kumar
- Indian Council of Medical Research (ICMR)-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Prabin Dahal
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Niyamat Ali Siddiqui
- Indian Council of Medical Research (ICMR)-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
| | - Abdalla Munir
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Caitlin Naylor
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James Wilson
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gemma Buck
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Manju Rahi
- Epidemiology and Communicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, Delhi, India
| | - Paritosh Malaviya
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Fabiana Alves
- Drugs for Neglected Disease Initiative, Geneva, Switzerland
| | - Shyam Sundar
- Infectious Disease Research Laboratory, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Kasia Stepniewska
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Philippe J Guérin
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Krishna Pandey
- Indian Council of Medical Research (ICMR)-Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, India
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Yadav CP, Hussain SSA, Mullick R, Rahi M, Sharma A. Climate zones are a key component of the heterogeneous presentation of malaria and should be added as a malariometric for the planning of malaria elimination. PLOS Glob Public Health 2023; 3:e0001878. [PMID: 37379340 DOI: 10.1371/journal.pgph.0001878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Abstract
Malaria is a climate-sensitive disease and different climatic conditions affect the propagation of malaria vectors thereby influencing malaria incidence. The present study was undertaken to delineate malaria distribution across different climate types and sub-types in India and assess its significance as a malariometric in the ongoing elimination activities. All Indian districts were classified into three major climatic zones (Tropical, Temperate, and others (Arid, Cold, and Polar) based on the Köppen-Geiger climate classification system. The Annual Parasite Incidence (API) of malaria was analyzed in these climatic zones using the Kruskal Wallis test, and a post hoc comparison was done using the rank-sum test with an adjusted p-value for the level of significance. Further logistic regression was used to investigate the association of these climatic zones with high malaria incidence (i.e., API>1). The majority of Indian districts fall in Temperate (N = 270/692 (39.0%)) and Tropical (N = 260/692 (37.6%)) regions, followed by Arid (N = 140/692 (20.2%)), Polar (N = 13/692 (1.9%)) and Cold (N = 9/692 (1.3%)) regions. Three climate zones: Arid, Polar, and Cold were similar in terms of malaria incidence over the years and thus were grouped into one. It was found that the tropical and temperate zones display a significantly higher burden of malaria as compared to others for the studied years (2016-2021). Future projections of climate suggest a significant expansion of tropical monsoon climate towards central and northern India, along with a growing footprint of tropical wet savannah climate in the northeast of India by 2100, which could increase the risk of malaria transmission in these regions. The heterogeneous climatic zones of India play an important role in malaria transmission and can be used as a malariometric for the stratification of districts destined for malaria elimination.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Cancer Prevention & Research (NICPR), Noida, UP, India
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rajit Mullick
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Rahi M, Sirohi PR, Sharma A. Supervised administration of primaquine may enhance adherence to radical cure for P. vivax malaria in India. Lancet Reg Health Southeast Asia 2023; 13:100199. [PMID: 37383547 PMCID: PMC10305963 DOI: 10.1016/j.lansea.2023.100199] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/21/2023] [Accepted: 03/31/2023] [Indexed: 06/30/2023]
Abstract
The Plasmodium vivax lifecycle encompasses a dormant liver-stage known as 'hypnozoite' which serves as silent reservoirs of malaria, reactivation of which results in recurring episodes of relapse with varying periodicity. This contributes to continuous transmission of malaria unamenable to control methods. The prevention of relapse requires a "radical cure" by a hypnozoitcidal drug. Primaquine (PQ) has been the recommended radical cure for this malaria. However, adherence to 14 days PQ treatment remains poor. India accounts for majority of P. vivax burden globally. However, PQ administration is not supervised in the current national programme. Supervised administration of drugs ensures compliance and improves drug regime success rate. Trials across different countries have established the effectiveness of directly observed therapy (DOT) for prevention of relapses. As India aims to eliminate malaria by 2030, it is prudent to consider DOT to ensure complete treatment of the malaria affected populations. Therefore, we recommend that the Indian malaria control programme may consider DOT of primaquine for treatment of vivax malaria. The supervised administration would entail additional direct and indirect costs but will ensure complete treatment and hence minimize the probability of relapses. This will help the country in achieving the goal of malaria elimination.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | | | - Amit Sharma
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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18
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Rahi M, Joy S, Sharma A. Public Health Challenges in the Context of the Global Spread of Mpox Infections. Am J Trop Med Hyg 2023; 108:641-645. [PMID: 36868216 PMCID: PMC10076996 DOI: 10.4269/ajtmh.22-0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/09/2022] [Indexed: 03/05/2023] Open
Abstract
The declaration of the ongoing mpox (formerly monkeypox) outbreak by the WHO as a public health emergency of international concern has put global attention on mpox disease. As of December 4, 2022, a total of 80,221 mpox cases had been confirmed from 110 countries, with a major proportion of cases being reported from previously non-endemic countries. The current global emergence and spread of the disease has highlighted the challenges and the need for efficient public health preparedness and response. There are several challenges posed in the current mpox outbreak, ranging from epidemiological factors to diagnostic and socio-ethnic issues. These challenges may be circumvented with proper intervention measures such as strengthening surveillance, robust diagnostics, clinical management plans, intersectoral collaboration, firm prevention plans, capacity building, addressing stigma and discrimination against vulnerable groups, and ensuring equitable access to treatments and vaccines. To address the above challenges in the wake of the current outbreak, it is essential to understand the gaps and plug them with effective countermeasures.
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Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
- National Institute of Malaria Research, New Delhi, India
| | - Sam Joy
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- Academy of Scientific and Innovative Research, Ghaziabad, India
- National Institute of Malaria Research, New Delhi, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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19
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Baharia RK, Kaur J, Sindhania A, Sharma G, Srivastava HC, Pant CS, Rahi M, Raghavendra K, Singh OP. Bionomics of Anopheles culicifacies Sensu Lato in two Malaria Endemic Districts of Central Gujarat, India. J Arthropod Borne Dis 2023; 16:108-123. [PMID: 37038509 PMCID: PMC10082408 DOI: 10.18502/jad.v16i2.11802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Gujarat State has been witnessing large scale urbanization, in last two decades, resulting changes in local environment and microclimate may have also influenced the resting, feeding habits and development of Anopheles culicifacies sensu 1ato. Therefore, a systematic longitudinal study was undertaken to know the bionomics of An. culicifacies s.l. in present study.
Methods: The study was conducted in four sentinel villages in Kheda and Panchmahal Districts. The mosquitoes resting indoors and outdoors were collected in early morning hours, using mouth aspirator, pyrethrum space spray and light traps. Mosquito landing collections on human volunteers was carried out from dusk to dawn. Species composition, abundance, seasonal prevalence, resting behavior (Endophily and Exophily), sibling species composition, vector potential and insecticide susceptibility status of malaria vectors was studied.
Results: Six Anopheles species were collected, An. subpictus s.l. was the predominant species followed by An. culicifacies s.l., a known malaria vector was resting indoor and zoophagic behaviour. Anopheles culicifacies, sibling species B (89%) was found. The sporozoite rate (%) and entomological inoculation rate in Kheda was 2.33%, 3.09 per bite/ person/annum and they were 1.05% and 0.475 bite/person/annum in Panchmahal, respectively. Anopheles culicifacies s.l. was found possible resistance to alpha-cypermethrin.
Conclusion: Anopheles culicifacies s.l. showed endophillic, zoophagic behaviour and found possible resistance to alpha-cypermethrin. Early biting behaviour of An. culicifacies s.l. in this area is a cause of concern. Therefore, there is need for frequent monitoring and evaluation of vector control measures in order to achieve the elimination target of malaria in this area.
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Affiliation(s)
- Rajendra K Baharia
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Field unit, Civil Hospital Nadiad, Gujarat, India
- Corresponding author: Dr Rajendra Kumar Baharia, E-mail:
| | - Jaspreet Kaur
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Dwarka Secctor-8, New Delhi, India
| | - Ankita Sindhania
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Dwarka Secctor-8, New Delhi, India
| | - Gunjan Sharma
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Dwarka Secctor-8, New Delhi, India
| | - Harish C Srivastava
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Field unit, Civil Hospital Nadiad, Gujarat, India
| | - Chandra S Pant
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Field unit, Civil Hospital Nadiad, Gujarat, India
| | - Manju Rahi
- Indian Council of Medical Research (ICMR), Division of Epidemiology and Communicable Diseases, Ansari Nagar, New Delhi, India
| | - Kamaraju Raghavendra
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Dwarka Secctor-8, New Delhi, India
| | - Om P Singh
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, Dwarka Secctor-8, New Delhi, India
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Mbuba E, Odufuwa OG, Moore J, Mmbaga S, Tchicaya E, Edi C, Chalageri V, Uragayala S, Sharma A, Rahi M, Raghavendra K, Eapen A, Koenker H, Ross A, Moore SJ. Multi-country evaluation of the durability of pyrethroid plus piperonyl-butoxide insecticide-treated nets: study protocol. Malar J 2023; 22:30. [PMID: 36707886 PMCID: PMC9881340 DOI: 10.1186/s12936-023-04465-x] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/20/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Mass distributions of long-lasting insecticidal nets (LLINs) have contributed to large reductions in the malaria burden. However, this success is in jeopardy due in part to the increasing pyrethroid-resistant mosquito population as well as low LLINs coverage in various areas because the lifespan of LLINs is often shorter than the interval between replenishment campaigns. New insecticide-treated nets (ITNs) containing pyrethroid and piperonyl-butoxide (PBO) have shown a greater reduction in the incidence of malaria than pyrethroid LLINs in areas with pyrethroid-resistant mosquitoes. However, the durability (attrition, bio-efficacy, physical integrity and chemical retainment) of pyrethroid-PBO ITNs under operational settings has not been fully characterized. This study will measure the durability of pyrethroid-PBO ITNs to assess whether they meet the World Health Organization (WHO) three years of operational performance criteria required to be categorized as "long-lasting". METHODS A prospective household randomized controlled trial will be conducted simultaneously in Tanzania, India and Côte d'Ivoire to estimate the field durability of three pyrethroid-PBO ITNs (Veeralin®, Tsara® Boost, and Olyset® Plus) compared to a pyrethroid LLIN: MAGNet®. Durability monitoring will be conducted up to 36 months post-distribution and median survival in months will be calculated. The proportion of ITNs: (1) lost (attrition), (2) physical integrity, (3) resistance to damage score, (4) meeting WHO bio-efficacy (≥ 95% knockdown after 1 h or ≥ 80% mortality after 24 h for WHO cone bioassay, or ≥ 90% blood-feeding inhibition or ≥ 80% mortality after 24 h for WHO Tunnel tests) criteria against laboratory-reared resistant and susceptible mosquitoes, and insecticidal persistence over time will be estimated. The non-inferiority of Veeralin® and Tsara® Boost to the first-in-class, Olyset® Plus will additionally be assessed for mortality, and the equivalence of 20 times washed ITNs compared to field aged ITNs will be assessed for mortality and blood-feeding inhibition endpoints in the Ifakara Ambient Chamber Test, Tanzania. CONCLUSION This will be the first large-scale prospective household randomized controlled trial of pyrethroid-PBO ITNs in three different countries in East Africa, West Africa and South Asia, simultaneously. The study will generate information on the replenishment intervals for PBO nets.
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Affiliation(s)
- Emmanuel Mbuba
- grid.414543.30000 0000 9144 642XVector Control Product Testing Unit, Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania ,grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, St. Petersplatz 1, 4002 Basel, Switzerland
| | - Olukayode G. Odufuwa
- grid.414543.30000 0000 9144 642XVector Control Product Testing Unit, Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania ,grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, St. Petersplatz 1, 4002 Basel, Switzerland ,grid.8991.90000 0004 0425 469XEpidemiology and Population Health Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jason Moore
- grid.414543.30000 0000 9144 642XVector Control Product Testing Unit, Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania ,grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland
| | - Selemani Mmbaga
- grid.414543.30000 0000 9144 642XVector Control Product Testing Unit, Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
| | - Emile Tchicaya
- grid.462846.a0000 0001 0697 1172Swiss Centre for Scientific Research in Côte d’Ivoire, 1303 Abidjan, Côte d’Ivoire ,Vegro Aps, Copenhagen, Denmark Refshalevej 213A,
| | - Constant Edi
- grid.462846.a0000 0001 0697 1172Swiss Centre for Scientific Research in Côte d’Ivoire, 1303 Abidjan, Côte d’Ivoire
| | - Vani Chalageri
- grid.419641.f0000 0000 9285 6594Field Unit, ICMR-National Institute of Malaria Research, Bangalore, Karnataka India
| | - Sreehari Uragayala
- grid.419641.f0000 0000 9285 6594Field Unit, ICMR-National Institute of Malaria Research, Bangalore, Karnataka India
| | - Amit Sharma
- grid.419641.f0000 0000 9285 6594ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, 110077 India
| | - Manju Rahi
- grid.19096.370000 0004 1767 225XICMR-Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Kamaraju Raghavendra
- grid.419641.f0000 0000 9285 6594ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, 110077 India
| | - Alex Eapen
- grid.19096.370000 0004 1767 225XField Unit, ICMR-Indian Council of Medical Research, Chennai, India
| | | | - Amanda Ross
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, St. Petersplatz 1, 4002 Basel, Switzerland
| | - Sarah J. Moore
- grid.414543.30000 0000 9144 642XVector Control Product Testing Unit, Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania ,grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, St. Petersplatz 1, 4002 Basel, Switzerland
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Yadav CP, Hussain SSA, Pasi S, Sharma S, Bharti PK, Rahi M, Sharma A. Linkages between malaria and malnutrition in co-endemic regions of India. BMJ Glob Health 2023; 8:bmjgh-2022-010781. [PMID: 36653068 PMCID: PMC9853155 DOI: 10.1136/bmjgh-2022-010781] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Malaria and malnutrition are key public health challenges in India. However, the relationship between them is poorly understood. Here, we aimed to elucidate the potential interactions between the two health conditions by identifying the areas of their spatial overlap. METHODS We have analysed the district-wise undernutrition and malaria data of 638 districts of India across 28 states and 8 union territories. Data on malnutrition parameters viz. stunting, wasting, underweight and anaemia, sourced from the fourth National Family Health Survey (2015-2016), and malaria Annual Parasite Index (API) data of the same year (i.e, 2015), sourced from National Center of Vector Borne Diseases Control were analysed using local Moran's I Index and logistic regression. RESULTS Among all the malnutrition parameters, we found underweight in children and anaemia in men to co-occur with malaria in the districts of Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha. Further, districts with more than 36% underweight children (OR (95% CI): 2.31 (1.53 to 3.48)) and/or more than 23.6% male population with anaemia (OR (95% CI): 2.06 (1.37 to 3.11)) had higher odds of being malaria endemic districts (ie, Annual Parasite Index >1). CONCLUSION Malaria and malnutrition co-occur in the malaria-endemic parts of India. The high prevalence of undernutrition in children and anaemia among men may contribute to malaria endemicity in a particular region. Therefore, future research should be prioritised to generate data on the individual level. Further, malaria control interventions could be tailored to integrate nutrition programmes to disrupt indigenous malaria transmission in endemic districts.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Epidemiology and Biostatistics, ICMR-National Institute of Cancer Prevention & Reserch, Noida, Uttar Pradesh, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Pasi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Praveen K Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India .,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India.,Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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22
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Rahi M, Yadav CP, Ahmad SS, Das P, Sharma S, Baharia RK, Bhattacharya D, Deshmukh P, Dhatrak A, Dogra S, Eapen A, Goel P, Faizi N, Khan SA, Kochar SK, Kochar A, Kumar A, Mundra A, Narang R, Narain K, Pandey K, Pati S, Raghav P, Ranjha R, Shah S, Singh K, Singh PK, Singh RK, Kuttiatt VS, Soni R, Sreehari U, Malhotra S, Sharma A. Vaccination coverage and breakthrough infections of COVID-19 during the second wave among staff of selected medical institutions in India. PLOS Glob Public Health 2023; 3:e0000946. [PMID: 37027349 PMCID: PMC10081792 DOI: 10.1371/journal.pgph.0000946] [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] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
India experienced the second wave of SARS-CoV-2 infection from April 3 to June 10, 2021. During the second wave, Delta variant B.1617.2 emerged as the predominant strain, spiking cases from 12.5 million to 29.3 million (cumulative) by the end of the surge in India. Vaccines against COVID-19 are a potent tool to control and end the pandemic in addition to other control measures. India rolled out its vaccination programme on January 16, 2021, initially with two vaccines that were given emergency authorization-Covaxin (BBV152) and Covishield (ChAdOx1 nCoV- 19). Vaccination was initially started for the elderly (60+) and front-line workers and then gradually opened to different age groups. The second wave hit when vaccination was picking up pace in India. There were instances of vaccinated people (fully and partially) getting infected, and reinfections were also reported. We undertook a survey of staff (front line health care workers and supporting) of 15 medical colleges and research institutes across India to assess the vaccination coverage, incidence of breakthrough infections, and reinfections among them from June 2 to July 10, 2021. A total of 1876 staff participated, and 1484 forms were selected for analysis after removing duplicates and erroneous entries (n = 392). We found that among the respondents at the time of response, 17.6% were unvaccinated, 19.8% were partially vaccinated (received the first dose), and 62.5% were fully vaccinated (received both doses). Incidence of breakthrough infections was 8.7% among the 801 individuals (70/801) tested at least 14 days after the 2nd dose of vaccine. Eight participants reported reinfection in the overall infected group and reinfection incidence rate was 5.1%. Out of (N = 349) infected individuals 243 (69.6%) were unvaccinated and 106 (30.3%) were vaccinated. Our findings reveal the protective effect of vaccination and its role as an essential tool in the struggle against this pandemic.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Chander Prakash Yadav
- ICMR- National Institute of Cancer Prevention & Research, Noida, Uttar Pradesh, India
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Sundus Shafat Ahmad
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Payal Das
- Indian Council of Medical Research, New Delhi, India
| | - Shweta Sharma
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Rajendra Kumar Baharia
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | | | - Pradeep Deshmukh
- All India Institute of Medical Sciences, Nagpur, Maharshtra, India
| | - Amey Dhatrak
- Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sandeep Dogra
- Government Medical College, Jammu, Jammu and Kashmir, India
| | - Alex Eapen
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Pawan Goel
- Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana, India
| | - Nafis Faizi
- Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Siraj A Khan
- Regional Medical Research Centre, Dibrugarh, Assam, India
| | | | - Aditya Kochar
- Sardar Patel Medical College, Bikaner, Rajasthan, India
| | | | - Anuj Mundra
- Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Rahul Narang
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Kanwar Narain
- Regional Medical Research Centre, Dibrugarh, Assam, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | | | - Pankaja Raghav
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ritesh Ranjha
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Salman Shah
- Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Kuldeep Singh
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Piyoosh Kumar Singh
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Raj Kumar Singh
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | | | | | - Uragayala Sreehari
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
| | - Sumit Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - Amit Sharma
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- New Delhi and its Field Units (FUs), ICMR- National Institute of Malaria Research, New Delhi, India
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Yadav CP, Hussain SSA, Gupta S, Bharti PK, Rahi M, Sharma A. Tracking district-level performance in the context of achieving zero indigenous case status by 2027. PLOS Glob Public Health 2023; 3:e0001292. [PMID: 36962890 PMCID: PMC10021673 DOI: 10.1371/journal.pgph.0001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/25/2022] [Indexed: 01/09/2023]
Abstract
India has committed to zero indigenous malaria cases by 2027 and elimination by 2030. Of 28 states and 8 union territories of India, eleven states were targeted to reach the elimination phase by 2020. However, state-level epidemiology indicates that several states of India may not be on the optimum track, and few goals set in National Framework for Malaria Elimination (NFME) for 2020 remain to be addressed. Therefore, tracking the current progress of malaria elimination in India at the district level, and identifying districts that are off track is important in understanding possible shortfalls to malaria elimination. Annual malaria case data from 2017-20 of 686 districts of India were obtained from the National Center for Vector-Borne Diseases Control (NCVBDC) and analysed to evaluate the performance of districts to achieve zero case status by 2027. A district's performance was evaluated by calculating the annual percentage change in the total number of malaria cases for the years 2018, 2019 and 2020 considering the previous year as a base year. The mean, median and maximum of these annual changes were then used to project the number of malaria cases in 2027. Based on these, districts were classified into four groups: 1) districts that are expected to reach zero case status by 2027, 2) districts that would achieve zero case status between 2028 and 2030, 3) districts that would arrive at zero case status after 2030, and 4) districts where malaria cases are on the rise. Analysis suggest, a cohort of fifteen districts require urgent modification or improvement in their malaria control strategies by identifying foci of infection and customizing interventions. They may also require new interventional tools that are being developed recently so that malaria case reduction over the years may be increased.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
- ICMR-National Institute of Cancer Prevention and Research, Noida, UP, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
| | - Sanjeev Gupta
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Praveen K Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, UP, India
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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24
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Raghavendra K, Rahi M, Verma V, Velamuri PS, Kamaraju D, Baruah K, Chhibber-Goel J, Sharma A. Insecticide resistance status of malaria vectors in the malaria endemic states of India: implications and way forward for malaria elimination. Heliyon 2022; 8:e11902. [PMID: 36506377 PMCID: PMC9732330 DOI: 10.1016/j.heliyon.2022.e11902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/20/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background In 2012, the World Health Organization (WHO) released the Global Plan for Insecticide Resistance Management in malaria vectors to stress the need to address insecticide resistance. In a prospective multi-centric study commissioned by the Indian Council of Medical Research (ICMR), we assessed the insecticide susceptibility status of the primary malaria vectors in India from 2017 through 2019. Methods The insecticide susceptibility status of the prevalent primary malaria vectors - An. culicifacies, An. fluviatilis, An. stephensi, An. minimus and An. baimaii and secondary malaria vectors - An. aconitus, An. annularis and An. philippinensis/nivepes from 328 villages in 79 districts of 15 states of India were assessed following the WHO method mainly to insecticides used in vector control, organochlorine (DDT), organophosphate (malathion), and other pyrethroids (alpha-cypermethrin, cyfluthrin, lambda-cyhalothrin and permethrin). The study sites were selected as suggested by the National Vector Borne Disease Control Programme. Results The primary malaria vector An. culicifacies showed resistance to DDT (50/50 districts including two districts of Northeastern India), malathion (27/44 districts), and deltamethrin (17/44 districts). This species was resistant to DDT alone in 19 districts, double resistant to DDT-malathion in 16 districts, double resistant to DDT-deltamethrin in 6 districts, and triple resistant to DDT-malathion-deltamethrin in 9 districts. An. minimus and An. baimaii were susceptible in Northeastern India while An. fluviatilis and the secondary malaria vector An. annularis was resistant to DDT in Jharkhand. Conclusion In this study we report that among the primary vectors An. culicifacies is predominantly resistant to multiple insecticides. Our data suggest that periodic monitoring of insecticide susceptibility is vital. The national malaria program can take proactive steps for insecticide resistance management to continue its push toward malaria elimination in India.
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Affiliation(s)
- Kamaraju Raghavendra
- ICMR-National Institute of Malaria Research (NIMR), Sector 8, Dwarka, Delhi, India
| | - Manju Rahi
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, New Delhi, India,Corresponding author.
| | - Vaishali Verma
- ICMR-National Institute of Malaria Research (NIMR), Sector 8, Dwarka, Delhi, India
| | | | - Divya Kamaraju
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, New Delhi, India
| | - Kalpana Baruah
- National Vector Borne Disease Control Programme, Shastri Park, New Delhi, India
| | - Jyoti Chhibber-Goel
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research (NIMR), Sector 8, Dwarka, Delhi, India,Molecular Medicine, International Centre for Genetic Engineering and Biotechnology (ICGEB), Aruna Asaf Ali Marg, New Delhi, India,Corresponding author.
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25
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Kumar G, Gupta SK, Rahi M, Sharma A. Challenges in Understanding the Bionomics of Indian Malaria Vectors. Am J Trop Med Hyg 2022; 107:1005-1014. [PMID: 36096410 PMCID: PMC9709009 DOI: 10.4269/ajtmh.22-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/07/2022] Open
Abstract
Many factors influence the success or failure of malaria vector control program such as political will, leadership, sustained funding, robustness of healthcare system and others. In addition, updated knowledge and information about the triad of host, parasite, and vector is of paramount importance. Vector bionomics studies that determine mosquito behavior in terms of feeding, resting, biting, mating, breeding, longevity, vectorial capacity, and response to different insecticides are a step towards enhancing our understanding. In the present work, we have compiled studies conducted in India over the past two decades (2000-2020) to identify gaps in our knowledge of malaria vector bionomics and the research that needs to be done in the future. We retrieved district-level data of India's six primary malaria vector species. According to our findings, vector bionomics studies have been undertaken in ∼50% and ∼15% of the country's high (annual parasite index > 1) and low (annual parasite index < 1) malaria-endemic districts respectively. Most of the research studies focused on mosquito density, insecticide susceptibility status, and parasite detection, whereas other vital bionomics parameters were neglected. Surveys conducted were incomplete, and vector bionomics data were not captured sufficiently. The absence of vector bionomics data can be a blind spot and the lack or inadequate understanding of vector bionomics can lead to use of inappropriate vector control tools. Thus, there is an urgent need to initiate comprehensive bionomics studies on India's primary and secondary malaria vectors.
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Affiliation(s)
- Gaurav Kumar
- National Institute of Malaria Research, New Delhi, India
| | | | - Manju Rahi
- National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- National Institute of Malaria Research, New Delhi, India
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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26
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Yadav CP, Gupta S, Bharti PK, Rahi M, Faizi N, Sharma A. India may need an additional metric to assess the endemicity of malaria in low surveillance districts. PLOS Glob Public Health 2022; 2:e0000326. [PMID: 36962502 PMCID: PMC10021988 DOI: 10.1371/journal.pgph.0000326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 10/19/2022] [Indexed: 06/18/2023]
Abstract
India's National Framework for malaria elimination is essentially dependent on Annual Parasite Incidence (API). API is the primary criterion for classifying states and districts into different categories: intensified control, pre-elimination, elimination, prevention and re-establishment of malaria. However, API's validity is critically dependent on multiple factors, one such important factor is Annual Blood Examination Rate (ABER) and is often considered as indicator of operational efficiency. Therefore, the present study aimed to determine whether the API is a sufficiently good malaria index to assess malaria endemicity in India. An in-depth analysis of malaria data (2017-19) was done to determine the appropriateness of API as a sole indicator of malaria endemicity. We stratified the Indian districts into three strata based on Annual Blood Examination Rate (ABER): <5, 5.0-5.0, >15, further APIs was compared with Slide Positivity Rates (SPRs) using sign rank test, independently in each stratum. API and SPR were found comparable (p-value 0.323) in stratum 2 only. However, in the case of lower ABER (<5%, strata 1), the API was significantly lower than the SPR, and higher ABER (>15%), the API was found substantially higher than the SPR. Thus, ABER tunes the validity of API and should avoid to use as a single indicator of malaria endemicity. API is an appropriate measure of malaria endemicity in high and moderate transmission areas where surveillance is good (ABER≥5%). However, it is vitally dependent upon surveillance rate and other factors such as population size, the selection of individuals for malaria testing. Therefore, where surveillance is poor (<5%), we propose that API should be complemented with SPR and the number of cases. It will significantly aid the design and deployment of interventions in India.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Sanjeev Gupta
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Praveen K. Bharti
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Manju Rahi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - Nafis Faizi
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Jawaharlal Nehru Medical College, AMU, Aligarh, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
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Chakrabarti R, Chery-Karschney L, White J, Mascarenhas A, Skillman KM, Kanjee U, Babar PH, Patrapuvich R, Mohapatra PK, Patankar S, Smith JD, Anvikar A, Valecha N, Rahi M, Duraisingh MT, Rathod PK. Diverse Malaria Presentations across National Institutes of Health South Asia International Center for Excellence in Malaria Research Sites in India. Am J Trop Med Hyg 2022; 107:107-117. [PMID: 36228910 PMCID: PMC9662227 DOI: 10.4269/ajtmh.21-1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/14/2022] [Indexed: 11/07/2022] Open
Abstract
The Malaria Evolution in South Asia (MESA) International Center for Excellence in Malaria Research (ICEMR) was established by the US National Institutes of Health (US NIH) as one of 10 malaria research centers in endemic countries. In 10 years of hospital-based and field-based work in India, the MESA-ICEMR has documented the changing epidemiology and transmission of malaria in four different parts of India. Malaria Evolution in South Asia-ICEMR activities, in collaboration with Indian partners, are carried out in the broad thematic areas of malaria case surveillance, vector biology and transmission, antimalarial resistance, pathogenesis, and host response. The program integrates insights from surveillance and field studies with novel basic science studies. This is a two-pronged approach determining the biology behind the disease patterns seen in the field, and generating new relevant biological questions about malaria to be tested in the field. Malaria Evolution in South Asia-ICEMR activities inform local and international stakeholders on the current status of malaria transmission in select parts of South Asia including updates on regional vectors of transmission of local parasites. The community surveys and new laboratory tools help monitor ongoing efforts to control and eliminate malaria in key regions of South Asia including the state of evolving antimalarial resistance in different parts of India, new host biomarkers of recent infection, and molecular markers of pathogenesis from uncomplicated and severe malaria.
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Affiliation(s)
- Rimi Chakrabarti
- Department of Chemistry, University of Washington, Seattle, Washington
- Department of Medicine, Goa Medical College and Hospital, Bambolim, Goa, India
| | | | - John White
- Department of Chemistry, University of Washington, Seattle, Washington
| | - Anjali Mascarenhas
- Department of Chemistry, University of Washington, Seattle, Washington
- Department of Medicine, Goa Medical College and Hospital, Bambolim, Goa, India
| | - Kristen M. Skillman
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Usheer Kanjee
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Prasad H. Babar
- Department of Chemistry, University of Washington, Seattle, Washington
- Department of Medicine, Goa Medical College and Hospital, Bambolim, Goa, India
| | - Rapatbhorn Patrapuvich
- Drug Research Unit for Malaria (DRUM), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Swati Patankar
- Department of Biosciences and Bioengineering, IIT Bombay, Powai, Mumbai, India
| | | | - Anup Anvikar
- National Institute of Biologicals, Noida, UP, India
| | - Neena Valecha
- National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - Manoj T. Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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28
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Kumar S, Patel A, Lai L, Chakravarthy C, Valanparambil R, Reddy ES, Gottimukkala K, Davis-Gardner ME, Edara VV, Linderman S, Nayak K, Dixit K, Sharma P, Bajpai P, Singh V, Frank F, Cheedarla N, Verkerke HP, Neish AS, Roback JD, Mantus G, Goel PK, Rahi M, Davis CW, Wrammert J, Godbole S, Henry AR, Douek DC, Suthar MS, Ahmed R, Ortlund E, Sharma A, Murali-Krishna K, Chandele A. Structural insights for neutralization of Omicron variants BA.1, BA.2, BA.4, and BA.5 by a broadly neutralizing SARS-CoV-2 antibody. Sci Adv 2022; 8:eadd2032. [PMID: 36197988 PMCID: PMC9534492 DOI: 10.1126/sciadv.add2032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In this study, by characterizing several human monoclonal antibodies (mAbs) isolated from single B cells of the COVID-19–recovered individuals in India who experienced ancestral Wuhan strain (WA.1) of SARS-CoV-2 during early stages of the pandemic, we found a receptor binding domain (RBD)–specific mAb 002-S21F2 that has rare gene usage and potently neutralized live viral isolates of SARS-CoV-2 variants including Alpha, Beta, Gamma, Delta, and Omicron sublineages (BA.1, BA.2, BA.2.12.1, BA.4, and BA.5) with IC
50
ranging from 0.02 to 0.13 μg/ml. Structural studies of 002-S21F2 in complex with spike trimers of Omicron and WA.1 showed that it targets a conformationally conserved epitope on the outer face of RBD (class 3 surface) outside the ACE2-binding motif, thereby providing a mechanistic insights for its broad neutralization activity. The discovery of 002-S21F2 and the broadly neutralizing epitope it targets have timely implications for developing a broad range of therapeutic and vaccine interventions against SARS-CoV-2 variants including Omicron sublineages.
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Affiliation(s)
- Sanjeev Kumar
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Anamika Patel
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Lilin Lai
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Chennareddy Chakravarthy
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Rajesh Valanparambil
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Elluri Seetharami Reddy
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
- Kusuma School of Biological Sciences, Indian Institute of Technology, New Delhi-110 016, India
| | - Kamalvishnu Gottimukkala
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Meredith E. Davis-Gardner
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
| | - Venkata Viswanadh Edara
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
| | - Susanne Linderman
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Kaustuv Nayak
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Kritika Dixit
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Pragati Sharma
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Prashant Bajpai
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Vanshika Singh
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Filipp Frank
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Narayanaiah Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hans P. Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02215, USA
| | - Andrew S. Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - John D. Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Grace Mantus
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Pawan Kumar Goel
- Shaheed Hasan Khan Mewat Government Medical College, Haryana, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi-110 029, India
| | - Carl W. Davis
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Jens Wrammert
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Sucheta Godbole
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amy R. Henry
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel C. Douek
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mehul S. Suthar
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Eric Ortlund
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, Dwarka, New Delhi-110 077, India
- Structural Parasitology Group, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
| | - Kaja Murali-Krishna
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
- Department of Pediatrics, Emory University School of Medicine, Emory University Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
| | - Anmol Chandele
- ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology, New Delhi-110 067, India
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Abstract
Public-private partnerships (PPP) have been beneficial in different sectors like infrastructure development and service sector across the world, including in India. Such partnerships in the healthcare sector have also been successful in providing access to affordable medical attention to all sections of society. These partnerships between public and private entities have proven to be beneficial in controlling malaria in high burden districts of India and taking these areas to the brink of elimination, thus setting examples to follow. The two successful ones are the Comprehensive Case Management Project (CCMP) in Odisha which is now adopted by the state, and the Malaria Elimination Demonstration Project (MEDP) which has nearly eliminated malaria from the highly endemic district of Mandla in Madhya Pradesh. Here we propose that non-government and semi-government actors may be given vital roles in the malaria elimination efforts till 2030 and beyond. These partners will add value to the national programme and may have the potential to develop and test different models of malaria elimination in real-life settings that the government programme can absorb sustainably.
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Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Amit Sharma
- Academy of Scientific and Innovative Research, Ghaziabad, India
- ICMR-National Institute of Malaria Research, New Delhi, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Nema S, Rahi M, Sharma A, Bharti PK. Strengthening malaria microscopy using artificial intelligence-based approaches in India. Lancet Reg Health Southeast Asia 2022; 5:100054. [PMID: 37383665 PMCID: PMC10305910 DOI: 10.1016/j.lansea.2022.100054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Shrikant Nema
- ICMR-National Institute of Malaria Research, Sector 8, Dwarka, 110077 New Delhi, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, Sector 8, Dwarka, 110077 New Delhi, India
| | - Praveen Kumar Bharti
- ICMR-National Institute of Malaria Research, Sector 8, Dwarka, 110077 New Delhi, India
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Rahi M, Joy S, Bhargava B. Towards dog-free hospital campuses in India. Indian J Med Res 2022; 156:573-578. [PMID: 36510886 DOI: 10.4103/ijmr.ijmr_1748_22] [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] [Indexed: 12/14/2022] Open
Affiliation(s)
- Manju Rahi
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sam Joy
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Narang R, Deshmukh P, Jain J, Jain M, Raut A, Deotale V, Pote K, Rahi M. Scrub typhus in urban areas of Wardha district in central India. Indian J Med Res 2022; 156:435-441. [PMID: 36588363 PMCID: PMC10101365 DOI: 10.4103/ijmr.ijmr_707_19] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background & objectives Scrub typhus caused by Orientia tsutsugamushi presents as acute undifferentiated fever and can be confused with other infectious causes of fever. We studied scrub typhus as part of a study on hospital-based surveillance of zoonotic and vector-borne zoonotic diseases at a tertiary care hospital located in the Wardha district, Maharashtra, India. We report here descriptive epidemiology and climatic factors affecting scrub typhus. Methods Patients of any age and sex with fever of ≥5 days were enrolled for this study. Data on sociodemographic variables were collected by personal interviews. Blood samples were tested by IgM ELISA to diagnose scrub typhus. Confirmation of scrub typhus was done by indirect immunofluorescence assay for IgM (IgM IFA). The climatic determinants were determined using time-series Poisson regression analysis. Results It was found that 15.9 per cent of the study participants were positive for scrub typhus by IgM ELISA and IgM IFA, both. Positivity was maximum (23.0%) in 41-60 yr of age and more females were affected than males (16.6 vs. 15.5%). Farmworkers were affected more (23.6%) than non-farm workers (12.9%). The disease positivity was found to be high in monsoon and post-monsoon seasons (22.9 and 19.4%) than in summer and winter. Interpretation & conclusions There were three hot spots of scrub typhus in urban areas of Wardha district. Rainfall and relative humidity in the previous month were the significant determinants of the disease.
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Affiliation(s)
- Rahul Narang
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Pradeep Deshmukh
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Jyoti Jain
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Manish Jain
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Abhishek Raut
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Vijayshri Deotale
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Kiran Pote
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Manju Rahi
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Sadanandane C, Gunasekaran K, Panneer D, Subbarao SK, Rahi M, Vijayakumar B, Athithan V, Sakthivel A, Dinesh S, Jambulingam P. Studies on the fitness characteristics of wMel- and wAlbB-introgressed Aedes aegypti (Pud) lines in comparison with wMel- and wAlbB-transinfected Aedes aegypti (Aus) and wild-type Aedes aegypti (Pud) lines. Front Microbiol 2022; 13:947857. [PMID: 35992676 PMCID: PMC9389317 DOI: 10.3389/fmicb.2022.947857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Wolbachia, an intracellular maternally transmitted endosymbiont, has been shown to interfere with the replication of dengue virus in Aedes aegypti mosquitoes. The Wolbachia-transinfected Ae. aegypti has been currently released in many countries to test its effectiveness in preventing the transmission of dengue virus. ICMR-Vector Control Research Centre in collaboration with World Mosquito Program Monash University, Australia, has generated two new Wolbachia-introgressed Ae. aegypti Puducherry (Pud) lines via backcrossing Ae. aegypti females of Australian (Aus) strains, infected with wMel and wAlbB Wolbachia with wild-type Ae. aegypti Puducherry (Pud) males. Wolbachia infections are known to induce a fitness cost and confer benefit on the host mosquito populations that will influence spread of the Wolbachia into native wild mosquito populations during the field release. Hence, the induced fitness cost or benefit/advantage in the two newly generated Ae. aegypti (Pud) lines was assessed in the laboratory in comparison with the wild-type Ae. aegypti (Pud) strain. In addition, maternal transmission (MT) efficiency, induced cytoplasmic incompatibility (CI), and insecticide resistance status of the two (Pud) lines were determined to assess the likely frequency of wMel and wAlbB infections in the native wild population after field invasion. The study shows that wMel and wAlbB infections did not induce any fitness cost on the two newly generated (Pud) lines. Rather, in terms of wing length, fecundity, egg hatch rate, and adult survival, the Wolbachia introgression conferred fitness benefits on the (Pud) lines compared to uninfected Wolbachia free wild Ae. aegypti population. wMel and wAlbB exhibited a high maternal transmission (99–100%) and induced nearly complete (98–100%) cytoplasmic incompatibility. Both the (Pud) lines were resistant to deltamethrin, malathion, DDT, and temephos, and the level of resistance was almost the same between the two lines as in the wild type. Overall, the stable association of wMel and wAlbB established with Ae. aegypti and the reproductive advantages of the (Pud) lines encourage a pilot release in the field for population replacement potential.
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Affiliation(s)
- Candasamy Sadanandane
- ICMR-Vector Control Research Centre, Medical Complex, Puducherry, India
- *Correspondence: Candasamy Sadanandane,
| | | | - Devaraju Panneer
- ICMR-Vector Control Research Centre, Medical Complex, Puducherry, India
| | - Sarala K. Subbarao
- Indian Council of Medical Research, Ramalingaswami Bhawan, New Delhi, India
| | - Manju Rahi
- Indian Council of Medical Research, Ramalingaswami Bhawan, New Delhi, India
- Manju Rahi,
| | | | - Velan Athithan
- ICMR-Vector Control Research Centre, Medical Complex, Puducherry, India
| | | | - Sundaram Dinesh
- ICMR-Vector Control Research Centre, Medical Complex, Puducherry, India
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Das MK, Rahi M, Kumar G, Raghavendra K. A note on the insecticide susceptibility status of secondary malaria vector An. annularis in Jharkhand state of India. J Vector Borne Dis 2022; 59:253-258. [PMID: 36511042 DOI: 10.4103/0972-9062.345179] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND & OBJECTIVES An. annularis van der Wulp (1884) is the secondary malaria vector of importance in India. In Jharkhand state it is present in almost all the districts abundantly and transmits malaria. The development of resistance to Dichlorodipheny ltrichloroethane (DDT) in An. annularis was reported from various parts of India. The main objective of this study was to generate information on insecticide susceptibility status of An. annularis to DDT, malathion, deltamethrin and permethrin in different districts of Jharkhand state. Methods; Adult An. annularis female mosquitoes were collected form villages of six tribal districts Simdega (Kurdeg and Simdega CHC), Khunti (Murhu and Khunti CHCs), Gumla (Bharno and Gumla CHCs), West Singhbhum (Chaibasa and Bada Jamda CHCs), Godda (Poraiyahat and Sunderpahari (CHCs) and Sahibganj (Borio and Rajmahal CHCs). Insecticide susceptibility status was determined by using WHO tube test method against prescribed discriminatory dosages of insecticides, DDT - 4.0%, malathion - 5.0%, deltamethrin - 0.05% and permethrin - 0.75%. RESULTS An. annularis was reported resistant to DDT in six districts, possible resistant to malathion in districts Gumla, Khuntiand Sahibganj and susceptible to deltamehrin (98% to100% mortality) and permethrin (100% mortality). INTERPRETATION & CONCLUSION An. annularis, the secondary vector species is associated with the transmission of malaria reported resistant to DDT and susceptible to pyrerthroids deltamethrin and permethrin. In view of large-scale distribution of long-lasting insecticidal nets (LLINs) in all the districts, the response to synthetic pyrethroid needs to be periodically monitored to assess the effectiveness.
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Affiliation(s)
- M K Das
- ICMR-National Institute of Malaria Research, Field Unit, Ranchi, Jharkhand, India
| | - Manju Rahi
- Indian Council of Medical Research, Ramligaswami Bhawan, New Delhi, India
| | - Gaurav Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - K Raghavendra
- ICMR-National Institute of Malaria Research, New Delhi, India
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Rahi M, Sharma A. Malaria control initiatives that have the potential to be gamechangers in India's quest for malaria elimination. Lancet Reg Health Southeast Asia 2022; 2:100009. [PMID: 37383297 PMCID: PMC10306036 DOI: 10.1016/j.lansea.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Malaria continues to have devastating effect on people's lives especially in developing countries. India is slated for malaria elimination by 2030. Though India has sustained a decline in malaria burden at the national level the epidemiological picture remains heterogenous. India's road to malaria elimination plan is riddled with many roadblocks. Major challenges include insufficient surveillance, slow and aggregated data reporting especially in exigent situations like cross-border areas and vulnerable high-risk groups. More than half of total malaria cases were due to Plasmodium vivax (P. vivax) in India as reported by national malaria control programme in 2019. This translates into substantial burden of P. vivax malaria in absolute numbers. P. vivax malaria, which is difficult to resolve as compared to other species, poses a threat to India's elimination plans by virtue of its tendency to develop hypnozoites, due to poor compliance to primaquine (PQ), due to host factors like G 6 PD deficiency and other genes that affect PQ metabolism. Also, India's malaria endemic areas largely coincide geographically with tribal regions which are poor in healthcare infrastructure. The tribal population disproportionately bears a huge burden of malaria. They also harbour more G6PD deficient individuals than non-tribal regions. Therefore, in addition to inadequate diagnostic facilities (for both malaria and G6PD testing) these remote rural and tribal communities suffer from lack of timely treatment, incomplete radical treatment due to poor compliance and thus repeated episodes of P. vivax due to relapses and/or reinfections. Another challenge is that the the current diagnostic tools in the national programme in India and other countries are mostly available only via the programme and are able to detect patent infections on the whole. These therefore miss low-density infections which are another major limitation for their use in malaria endemic countries. Drug and insecticide resistance need to be constantly monitored as they have direct impact on the efficacy of the current tools. Need for better vector control products for the diverse entomological requirements is also felt. India is the second most populous country in the world with majority of its population at risk of malaria. Despite many agencies (government and non-government) working in the field of malaria, there needs to be more synergy at the local or central level for malaria control. Here, we have proposed solutions for specific facets of the malaria programme. Surveillance, data visualization and analysis can all be supported through over the counter availability of rapid diagnostics, adoption of molecular tools like PCR (requiring additional infrastructure and expertise), mobile applications for data capture and use of malaria data dashboard. Management could be augmented by inclusion of tafenoquine for treatment of P. vivax malaria with a companion point-of care diagnostic which has been developed to assess G6PD enzyme activity. A switchover to artemether-lumefantrine for the entire country can also be considered. Vector control can be strengthened by commercial availability of insecticidal bednets and exploration of novel vector control tools like ivermectin. Lastly, enhancing synergy amongst various stakeholders would also catalyze the malaria elimination plans. Funding The authors have received no funding for this paper.
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Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Amit Sharma
- Academy of Scientific and Innovative Research, Ghaziabad, India
- ICMR-National Institute of Malaria Research, New Delhi, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Gunasekaran K, Sadanandane C, Panneer D, Kumar A, Rahi M, Dinesh S, Vijayakumar B, Krishnaraja M, Subbarao SK, Jambulingam P. Sensitivity of wMel and wAlbB Wolbachia infections in Aedes aegypti Puducherry (Indian) strains to heat stress during larval development. Parasit Vectors 2022; 15:221. [PMID: 35729601 PMCID: PMC9215077 DOI: 10.1186/s13071-022-05345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/21/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background ICMR-Vector Control Research Centre, Puducherry, India, developed two colonies of Aedes aegypti infected with wMel and wAlbB Wolbacia strains called Ae. aegypti (Pud) lines for dengue control. The sensitivity of wMel and wAlbB strains in Ae. aegypti (Pud) lines to heat stress was studied. Methods wMel and wAlbB infected and uninfected Ae. aegypti larvae (first to fourth instars) were reared in the laboratory to adults at 26 °C, 30 °C, 36 °C and 40 °C constant temperatures and also 26–30 °C, 26–36 °C and 26–40 °C diurnal cyclic temperatures. The adults were tested for Wolbachia infection. Experiments were also carried out rearing the larvae under simulated field conditions in summer (April and June) under sunlight using fully open and half open bowls and also under sunlight and natural shade. Results At 36 °C and 40 °C constant temperatures, complete larval mortality was observed. At 30 °C and 26 °C, no larval mortality occurred, but Wolbachia density was relatively low in wMel infected males compared to control (maintained at 26 ± 1 °C). At diurnal cyclic temperature of 26–40 °C, Wolbachia density was reduced in males of both the (Pud) lines, but not in females. At 26–36 °C, reduction in Wolbachia density was observed in wMel males but not in wAlbB males. At 26–30 °C, no significant reduction in Wolbachia density was observed with wMel and wAlbB strains. In simulated field conditions (April), under sunlight, the daytime water temperature reached a maximum of 35.7 °C in both full and half open bowls. No larval mortality occurred. Wolbachia frequency and density was reduced in wMel-infected Ae. aegypti (Pud) males from both type of bowls and in females from full open bowls, and in wAlbB males from half open bowls. In June, rearing of larvae under sunlight, the first-instar larvae experienced a maximum daytime water temperature of > 38 °C that caused complete mortality. No larval mortality was observed in bowls kept under shade (< 32 °C). Conclusions Exposure of larvae to higher rearing temperatures in the laboratory and simulated-field conditions reduced the densities of wMel and wAlbB strains particularly in males, but the impact was more pronounced for wMel strain. The actual effect of heat stress on the stability of these two Wolbachia strains needs to be tested under natural field conditions. Graphical Abstract ![]()
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Affiliation(s)
- Kasinathan Gunasekaran
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
| | - Candasamy Sadanandane
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India.
| | - Devaraju Panneer
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
| | - Ashwani Kumar
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
| | - Manju Rahi
- Indian Council of Medical Research, Ramalingaswami Bhawan, Ansari Nagar, New Delhi, 110029, India
| | - Sundaram Dinesh
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
| | - Balakrishnan Vijayakumar
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
| | - Muthuraman Krishnaraja
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
| | - Sarala K Subbarao
- Indian Council of Medical Research, Ramalingaswami Bhawan, Ansari Nagar, New Delhi, 110029, India
| | - Purushothaman Jambulingam
- Medical Complex, Indian Council of Medical Research-Vector Control Research Centre (ICMR-VCRC), Indira Nagar, Puducherry, 605006, India
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Sharma S, Verma R, Yadav B, Kumar A, Rahi M, Sharma A. What India can learn from globally successful malaria elimination programmes. BMJ Glob Health 2022; 7:bmjgh-2022-008431. [PMID: 35760440 PMCID: PMC9237895 DOI: 10.1136/bmjgh-2022-008431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/02/2022] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
India is targeting malaria elimination by 2030. Understanding and adopting the strategies employed by countries that have successfully eliminated malaria can serve as a crucial thrust in this direction for a geographically diverse country like India. This analysis is based on extensive literature search on malaria elimination policies, strategies and programmes adopted by nine countries (China, El Salvador, Algeria, Argentina, Uzbekistan, Paraguay, Sri Lanka, Maldives and Armenia) which have attained malaria-free status over the past decade. The key points which India can learn from their journey are mandatory time-bound response in the form of case reporting and management, rapid vector control response, continuous epidemiological and entomological surveillance, elevated community participation, more training and capacity building, private sector involvement, use of quality diagnostics, cross-border collaborations, inclusion of prevention of re-establishment programmes into the elimination plans, higher investment in research, and uninterrupted funds for successful implementation of malaria elimination programmes. These learnings would help India and other South Asian countries steer their programmes by devising tailor-made strategies for their own regions.
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Affiliation(s)
- Sachin Sharma
- ICMR-National Institute of Malaria Research, New Delhi, Delhi, India
| | - Reena Verma
- ICMR-National Institute of Malaria Research, New Delhi, Delhi, India
| | - Bhawna Yadav
- ICMR-National Institute of Malaria Research, New Delhi, Delhi, India
| | - Amit Kumar
- ICMR-National Institute of Malaria Research, New Delhi, Delhi, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Delhi, Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, Delhi, India .,International Centre for Genetic Engineering and Biotechnology, New Delhi, Delhi, India
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Khan SA, Saikia J, Bora T, Khamo V, Rahi M. Rickettsiae in fleas infesting domestic pets of eastern Himalayan terrains of India. Trans R Soc Trop Med Hyg 2022; 116:595-598. [DOI: 10.1093/trstmh/trab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Flea-borne rickettsioses have been limitedly explored in the Indian sub-Himalayan belt, including the North Eastern Region (NER) of India. This study investigates the presence of rickettsiae hosts and their probable pathogens in the disease-endemic hilly state of the NER of India.
Methods
Entomological surveys were carried out in disease-reporting localities in a hilly state in India. Fleas collected from domesticated animals were processed for detection of a Rickettsia-specific 17-kDa gene.
Results
Sequence analysis revealed Rickettsia felis in six flea pools (40%), Candidatus Rickettsia senegalensis in two pools (13.3%) and Rickettsia asembonensis in one pool (6.6%).
Conclusions
Our findings suggest Ctenocephalides felis, Ctenocephalides canis and Pulex irritans as potential carriers of R. felis and R. felis–like organisms in India.
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Affiliation(s)
- Siraj A Khan
- Department of Medical Entomology, Arbovirology and Rickettsial diseases, Indian Council of Medical Research-Regional Medical Research Centre , Northeast Region, Post Box 105, Dibrugarh 786010, Assam, India
| | - Jahnabi Saikia
- Department of Medical Entomology, Arbovirology and Rickettsial diseases, Indian Council of Medical Research-Regional Medical Research Centre , Northeast Region, Post Box 105, Dibrugarh 786010, Assam, India
| | - Trishna Bora
- Department of Medical Entomology, Arbovirology and Rickettsial diseases, Indian Council of Medical Research-Regional Medical Research Centre , Northeast Region, Post Box 105, Dibrugarh 786010, Assam, India
| | - Vinotsole Khamo
- Health Care and Research laboratory, Naga Hospital Authority , Kohima 797001, Nagaland, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research , Ansari Nagar New Delhi 110029, India
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Khan SA, Saikia J, Bora T, Khamo V, Rahi M. Molecular detection of Orientia tsutsugamushi strains circulating in Nagaland. Indian J Med Microbiol 2022; 40:443-445. [DOI: 10.1016/j.ijmmb.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/05/2022]
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Rahi M, Sharma R, Saroha P, Chaturvedi R, Bharti PK, Sharma A. Polymerase Chain Reaction-Based Malaria Diagnosis Can Be Increasingly Adopted during Current Phase of Malaria Elimination in India. Am J Trop Med Hyg 2022; 106:1005-1012. [PMID: 35130488 PMCID: PMC8991334 DOI: 10.4269/ajtmh.21-0966] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/09/2021] [Indexed: 11/07/2022] Open
Abstract
Despite commendable progress in control of malaria in India and other countries, there are hidden reservoirs of parasites in human hosts that continually feed malaria transmission. Submicroscopic infections are a significant proportion in low-endemic settings like India, and these infections possess transmission potential. Hence, these reservoirs of infection add to the existing roadblocks for malaria elimination. It is crucial that this submerged burden of malaria is detected and treated to curtail further transmission. The currently used diagnostic tools, including the so-called "gold standard" microscopy, are incapable of detecting these submicroscopic infections and thus are suboptimal. It is an opportune time to usher in more sensitive molecular tools like polymerase chain reaction (PCR) for routine diagnosis at all levels of healthcare as an additional diagnostic tool in routine settings. PCR assays have been developed into user-friendly formats for field diagnostics and are near-point-of-collection. Because of the COVID-19 pandemic in India, these are being used rampantly across the country. The facilities created for COVID-19 diagnosis can easily be co-opted and harnessed for malaria diagnosis to augment surveillance by the inclusion of molecular techniques like PCR in the routine national malaria control program.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
- AcSIR, New Delhi, India
| | - Rishu Sharma
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
- AcSIR, New Delhi, India
| | - Poonam Saroha
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Rini Chaturvedi
- International Center for Genetic Engineering and Biotechnology, New Delhi, India
| | - Praveen K. Bharti
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
| | - Amit Sharma
- Indian Council of Medical Research-National Institute of Malaria Research, New Delhi, India
- International Center for Genetic Engineering and Biotechnology, New Delhi, India
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Rahi M, Sharma A. Active Engagement of Private Healthcare Providers Is Needed to Propel Malaria Elimination in India. Am J Trop Med Hyg 2022; 106:tpmd220025. [PMID: 35378510 PMCID: PMC9209940 DOI: 10.4269/ajtmh.22-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 11/07/2022] Open
Abstract
Malaria is a major public health concern in India. Despite a remarkable decline in overall malaria cases and deaths over the past several years, the caseload is still substantial. India's commitment towards malaria elimination by 2030 requires several additional measures for its achievement. The country's malaria data are collated from the public health sector only by the aggregated paper-based surveillance system, which is considered weak because it captures only a minuscule percentage (8% as per the World Malaria Report 2017). The absence of private-sector data is a serious caveat in India's malaria epidemiological scenario. The private healthcare sector (trained and untrained) is a major provider to communities in malaria-endemic areas. It is increasingly recognized that the involvement of the private healthcare sector is crucial for understanding the complete epidemiological picture and targeting elimination strategies accordingly as is being done for tuberculosis in India. Active involvement and alignment of the private sector to the government program of the private sector can be fostered by assessing the presence of the private healthcare sector via landscaping exercise, establishing linkages between the two sectors, incentivization, and encouraging reporting via user-friendly online and offline systems. There are challenges and barriers to the successful adoption of the private healthcare providers in the fold of the national malaria control program; at the same time, it is a critical step that will propel malaria elimination plans of India.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research (ICMR), V. Ramalingaswami Bhawan, P.O. Box No. 4911, Ansari Nagar, New Delhi, 110 029, India
- Academic Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Amit Sharma
- Academic Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- ICMR National Institute of Malaria Research, Sector 8, Dwarka, New Delhi 110 077, India
- Group Leader, Structural Parasitology, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi- 110 067, India
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Rahi M, Chaturvedi R, Goswami R, Sharma A. India Needs to Consider Planning a Change to Artemether-Lumefantrine to Treat Plasmodium falciparum Malaria. Am J Trop Med Hyg 2022; 106:tpmd211095. [PMID: 35292598 PMCID: PMC9128701 DOI: 10.4269/ajtmh.21-1095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 11/07/2022] Open
Abstract
As the malaria elimination target draws closer for India, it must be ensured that the country's policies, strategies, and tools remain effective. Artemisinin-based combination therapies are the mainstay of Plasmodium falciparum malaria management. India has a differential standard therapy for uncomplicated falciparum malaria in the form of artemether-lumefantrine in its northeastern states and artesunate + sulfadoxine-pyrimethamine in the rest of the country. The clinical failure of artesunate + sulfadoxine-pyrimethamine in the northeast regions were attributed primarily to parasite resistance resulting from mutations in the enzymes dihydropteroate synthase and dihydrofolate reductase. Artemether-lumefantrine was therefore substituted for artesunate + sulfadoxine-pyrimethamine in the region. The change has been a success, as evidenced by the therapeutic efficacy studies conducted at regular intervals in India. However, studies suggest that resistance may be emerging toward sulfadoxine-pyrimethamine in multiple parts of the nation. Hence, there is a possibility that the artesunate + sulfadoxine-pyrimethamine combination may be acting in part as a monotherapy, and this makes the longevity of the artesunate + sulfadoxine-pyrimethamine drug combination therapy uncertain. The increasing presence of drug-resistant mutants in P. falciparum dhps and dhfr genes suggests the need for a policy switch for uncomplicated P. falciparum malaria from artesunate + sulfadoxine-pyrimethamine to artemether-lumefantrine.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
| | - Rini Chaturvedi
- Molecular Medicine Group, International Center for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ritu Goswami
- National Institute of Medical Research, New Delhi, India
| | - Amit Sharma
- Molecular Medicine Group, International Center for Genetic Engineering and Biotechnology, New Delhi, India
- National Institute of Medical Research, New Delhi, India
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Ahmad SS, Rahi M, Saroha P, Sharma A. Ivermectin as an endectocide may boost control of malaria vectors in India and contribute to elimination. Parasit Vectors 2022; 15:20. [PMID: 35012612 PMCID: PMC8744265 DOI: 10.1186/s13071-021-05124-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/13/2021] [Accepted: 12/12/2021] [Indexed: 11/10/2022] Open
Abstract
Malaria constitutes one of the largest public health burdens faced by humanity. Malaria control has to be an efficient balance between diagnosis, treatment and vector control strategies. The World Health Organization currently recommends indoor residual spraying and impregnated bed nets as two malaria vector control methods that have shown robust and persistent results against endophilic and anthropophilic mosquito species. The Indian government launched the National Framework for Malaria Elimination in 2016 with the aim to achieve the elimination of malaria in a phased and strategic manner and to sustain a nation-wide malaria-free status by 2030. India is currently in a crucial phase of malaria elimination and novel vector control strategies maybe helpful in dealing with various challenges, such as vector behavioural adaptations and increasing insecticide resistance among the Anopheles populations of India. Ivermectin can be one such new tool as it is the first endectocide to be approved in both animals and humans. Trials of ivermectin have been conducted in endemic areas of Africa with promising results. In this review, we assess available data on ivermectin as an endectocide and propose that this endectocide should be explored as a vector control tool for malaria in India.
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Affiliation(s)
- Sundus Shafat Ahmad
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, New Delhi, India
| | - Manju Rahi
- Indian Council of Medical Research, New Delhi, India.,Academy of Scientific and Innovative Research (AcSir), Ghaziabad, India
| | - Poonam Saroha
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, New Delhi, India.,Academy of Scientific and Innovative Research (AcSir), Ghaziabad, India
| | - Amit Sharma
- Indian Council of Medical Research (ICMR)-National Institute of Malaria Research, New Delhi, India. .,International Centre for Genetic Engineering and Biotechnology, New Delhi, India. .,Academy of Scientific and Innovative Research (AcSir), Ghaziabad, India.
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Rahi M, Sharma A. Should India be considering deployment of the first malaria vaccine RTS,S/AS01? BMJ Glob Health 2022; 7:bmjgh-2021-007870. [PMID: 34983788 PMCID: PMC8728450 DOI: 10.1136/bmjgh-2021-007870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 01/25/2023] Open
Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Amit Sharma
- National Institute of Malaria Research, New Delhi, Delhi, India.,Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, Delhi, India
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Dhiman R, Hussian SA, Ojha V, Jeena M, Rahi M, Anvikar A, Sharma A. Validation of micro-chip based PCR assays for diagnosis of both Plasmodium falciparum and Plasmodium vivax. J Vector Borne Dis 2022; 59:57-62. [DOI: 10.4103/0972-9062.328978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Sabesan S, Krishnamoorthy K, Hoti S, Subramanian S, Srividya A, Roy N, Jain T, Kumar A, Rahi M. Diethylcarbamazine citrate-fortified salt for lymphatic filariasis elimination in India. Indian J Med Res 2022; 155:347-355. [PMID: 36124509 PMCID: PMC9707683 DOI: 10.4103/ijmr.ijmr_171_22] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Lymphatic filariasis (LF) is a vector-borne neglected tropical disease, causing permanent disability. The disease is debilitating and widespread, leading to tremendous productivity and economic loss. The Government of India (GOI) prioritized the elimination of LF through the annual mass drug administration (MDA) programme in 2004 and continued with a single dose of diethylcarbamazine citrate (DEC), 6 mg/kg of body weight, plus albendazole annually over a period of 5-6 years. The GOI had set the target to achieve LF elimination by 2015 and now by 2030. The progress so far has been suboptimal. Much remains to be done as about 84 per cent of the total 328 endemic districts are still under MDA. The major challenge in implementing MDA is poor compliance. It is necessary to have a feasible alternative strategy addressing the above challenge to achieve the desired goal of LF elimination. At this juncture, a well-researched approach, i.e. the use of DEC-fortified salt, also advocated by the World Health Organization, as a unique form of MDA, is proposed. As per this strategy, a low dose of DEC (0.2% w/w) is added to the cooking salt at the manufacturing facility of iodized salt and consumed by the LF-endemic communities for about two years. Many examples of successful use of this strategy for LF elimination in small- and large-scale trials have been documented in India and several other endemic countries in the world. Implementing DEC-iodine-fortified salt is a safe, less expensive, more efficient and prompt approach for achieving the elimination of LF in India. Adverse effects are none or minor and self-limiting. The DEC-fortified salt strategy can easily piggyback on the existing countrywide deployment of iodized salt under the National Iodine Deficiency Disorders Control Programme (NIDDCP), which has achieved a great success in reducing iodine-deficiency disorders such as hypothyroidism. This existing robust programme can be leveraged to launch DEC-fortified salt for the community. If implemented appropriately, this strategy will ensure the complete cessation of LF transmission within two years from its introduction. If the said strategy is implemented in 2022, it is expected that India will be able to achieve the LF elimination by 2024, much before the global target of 2030.
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Affiliation(s)
- S. Sabesan
- Vector Control Research Centre, Puducherry, India
| | | | - S.L. Hoti
- Vector Control Research Centre, Puducherry, India
| | | | - A. Srividya
- Vector Control Research Centre, Puducherry, India
| | - Nupur Roy
- National Centre for Vector-Borne Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, India
| | - Tanu Jain
- National Centre for Vector-Borne Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, India
| | | | - Manju Rahi
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India,For correspondence: Dr Manju Rahi, Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India e-mail:
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Ahmad SS, Rahi M, Ranjan V, Sharma A. Mefloquine as a prophylaxis for malaria needs to be revisited. Int J Parasitol Drugs Drug Resist 2021; 17:23-26. [PMID: 34339933 PMCID: PMC8342532 DOI: 10.1016/j.ijpddr.2021.06.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 10/26/2022]
Abstract
According to WHO, 2019 witnessed 229 million cases of malaria globally, of which Africa accounted for 94% of cases. Early diagnosis and treatment are the basis of malaria management, and the need for good chemoprophylaxis especially for people travelling to endemic areas is vital. There are a number of drug options available for the prophylaxis of malaria, mefloquine being one of the drugs used. Mefloquine has been around from the 1970s, and was developed in the United States keeping in mind the soldiers that were being deployed to areas where chloroquine resistant strains of Plasmodium were discovered. Mefloquine was preferred for its once a week dosage. Within a decade of its introduction, reports of the side effects associated with its long-term use surfaced. Mefloquine is now reported to cause a myriad of neuropsychiatric side effects including anxiety, sleep disturbance, depression, dizziness and frank psychosis, especially in patients with pre-existing psychiatric disorders. Many countries like the United States and the United Kingdom have updated their drug boxes to include the warning of these potential neuropsychiatric effects. This paper reviews the side effects of mefloquine and why there is a need to revisit its use in Indian drug policy.
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Affiliation(s)
| | - Manju Rahi
- Indian Council of Medical Research, New Delhi, India
| | - Vikash Ranjan
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India; International Centre of Genetic Engineering and Biotechnology, New Delhi, India.
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Rahi M, Sharma S, Das P, Anvikar A, Pandey M, Sharma A. Connecting the dots to strengthen malaria elimination strategies in India: A Malaria Elimination Research Alliance - India initiative. Indian J Med Res 2021; 154:19-23. [PMID: 34782526 PMCID: PMC8715696 DOI: 10.4103/ijmr.ijmr_4370_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Sachin Sharma
- MERA-India Office, National Institute of Malaria Research, Dwarka, New Delhi 110 077, India
| | - Payal Das
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Anup Anvikar
- MERA-India Office, National Institute of Malaria Research, Dwarka, New Delhi 110 077, India
| | - Monica Pandey
- MERA-India Office, National Institute of Malaria Research, Dwarka, New Delhi 110 077, India
| | - Amit Sharma
- MERA-India Office, National Institute of Malaria Research, Dwarka, New Delhi 110 077, India
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Pal Bhowmick I, Chutia D, Chouhan A, Nishant N, Raju PLN, Narain K, Kaur H, Pebam R, Debnath J, Tripura R, Gogoi K, Ch Nag S, Nath A, Tripathy D, Debbarma J, Das N, Sarkar U, Debbarma R, Roy R, Debnath B, Dasgupta D, Debbarma S, Joy Tripura K, Reang G, Sharma A, Rahi M, Chhibber-Goel J. Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study. JMIR Form Res 2021; 5:e28951. [PMID: 34757321 PMCID: PMC8663496 DOI: 10.2196/28951] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/25/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background A surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis. Objective In this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination. Methods FeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time. Results The use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4% (114/122; Plasmodium falciparum), 4.9% (6/122; P vivax), and 1.6% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing. Conclusions The use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems.
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Affiliation(s)
- Ipsita Pal Bhowmick
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | | | | | - Nilay Nishant
- North Eastern Space Applications Centre, Umaim, India
| | - P L N Raju
- North Eastern Space Applications Centre, Umaim, India
| | - Kanwar Narain
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | | | - Rocky Pebam
- North Eastern Space Applications Centre, Umaim, India
| | - Jayanta Debnath
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Rabindra Tripura
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Kongkona Gogoi
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Suman Ch Nag
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Aatreyee Nath
- North Eastern Space Applications Centre, Umaim, India
| | - Debabrata Tripathy
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Jotish Debbarma
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Nirapada Das
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Ujjwal Sarkar
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Rislyn Debbarma
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Rajashree Roy
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Bishal Debnath
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Dipanjan Dasgupta
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Suraj Debbarma
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Kamal Joy Tripura
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Guneram Reang
- Regional Medical Research Centre-Northeastern Region, Indian Council of Medical Research, Dibrugarh, India
| | - Amit Sharma
- National Institute of Malaria Research, Indian Council of Medical Research, Dwarka, Delhi, India.,International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Manju Rahi
- Indian Council of Medical Research, Delhi, India
| | - Jyoti Chhibber-Goel
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Rahi M, Ahmad SS, Sharma A. Coverage enhancement and community empowerment via commercial availability of the long-lasting nets for malaria in India. Public Health in Practice 2021; 2:100133. [PMID: 36101614 PMCID: PMC9461163 DOI: 10.1016/j.puhip.2021.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Achieving malaria elimination goal in India will require supplemental measures to plug in the gaps in implementation of malaria control programmes. Use of long-lasting insecticide nets is one of the two core interventions for vector control in malaria. The most common distribution channel is free delivery via national malaria control programme of various countries and in India, this is the only channel to provide nets to the masses. Understandably, there are gaps in the optimum coverage of at-risk population due to multiple reasons ranging from population growth to time lag in replacements, emergency conditions like floods and logistical impediments among others. At this juncture, it is crucial for India to explore complementary routes to expand access for nets by its people and one is making them available in private sector at an affordable price. The commercial availability of nets offers several advantages like filling in coverage gaps, overcoming additional requirements by families and financial resources being freed up for poor households. However, there are barriers to the successful operationalization of net commercialization like affordability issues, economic viability for manufacturers, regulatory issues etc. All the so-called barriers can be addressed in a concerted and pragmatic way to make access and availability of nets in private market a reality as that is a need of the hour, if India wants to achieve malaria elimination goal by 2030.
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