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In India diurnally subperiodic filariasis (DspWB) is prevalent only in the Nicobar district of Andaman and Nicobar Islands. Studies undertaken at different points of time indicate that this form of filariasis is restricted to a small region in Nancowry group of islands where it is transmitted by mosquito Downsiomyia nivea, a day biting mosquito. Studies on prevalence, distribution, and assessment of endemicity status, vector incrimination, bioecology, host seeking behaviour, population dynamics of the vector, transmission dynamics and clinical epidemiology indicate the prevalence and persistence of this infection in the Nancowry group of islands with perennial transmission. There was no control programme in these islands, until the National programme to eliminate filariasis was launched in 2004. Eight rounds of annual mass drug administration (MDA) with diethyl carbamazine (DEC) + albendazole have been completed. Despite this, microfilaria prevalence remains at above one per cent, the level identified for initiating transmission assessment survey to decide on continuation of MDA further. This necessitates adjunct measures to the ongoing MDA programme in these islands. The vector control options could be an adjunct measure, but the vector is a forest dweller with a unique bio-ecology, therefore, not a technically feasible option. Use of DEC fortified salt for six months to one year could hasten the process of elimination. Although administration of DEC-fortified salt is simple, rapid, safe, and cost-effective, challenges are to be tackled for evolving operationally realistic strategy. Such a strategy requires commitment of all sections of the society, a distribution mechanism that ensures the use of DEC-fortified salt in the Nancowry islands. Here we discuss the plan of action to serve the indigenous communities and operationalizing DEC fortified salt strategy through an inter-sectoral approach involving multiple stakeholders. [ABSTRACT FROM AUTHOR]

In India diurnally subperiodic filariasis (DspWB) is prevalent only in the Nicobar district of Andaman and Nicobar Islands. Studies undertaken at different points of time indicate that this form of filariasis is restricted to a small region in Nancowry group of islands where it is transmitted by mosquito Downsiomyia nivea, a day biting mosquito. Studies on prevalence, distribution, and assessment of endemicity status, vector incrimination, bioecology, host seeking behaviour, population dynamics of the vector, transmission dynamics and clinical epidemiology indicate the prevalence and persistence of this infection in the Nancowry group of islands with perennial transmission. There was no control programme in these islands, until the National programme to eliminate filariasis was launched in 2004. Eight rounds of annual mass drug administration (MDA) with diethyl carbamazine (DEC) + albendazole have been completed. Despite this, microfilaria prevalence remains at above one per cent, the level identified for initiating transmission assessment survey to decide on continuation of MDA further. This necessitates adjunct measures to the ongoing MDA programme in these islands. The vector control options could be an adjunct measure, but the vector is a forest dweller with a unique bio-ecology, therefore, not a technically feasible option. Use of DEC fortified salt for six months to one year could hasten the process of elimination. Although administration of DEC-fortified salt is simple, rapid, safe, and cost-effective, challenges are to be tackled for evolving operationally realistic strategy. Such a strategy requires commitment of all sections of the society, a distribution mechanism that ensures the use of DEC-fortified salt in the Nancowry islands. Here we discuss the plan of action to serve the indigenous communities and operationalizing DEC fortified salt strategy through an inter-sectoral approach involving multiple stakeholders.

Background & Objectives: Tuberculosis is a major health problem in India, and the emergence of multidrug resistant (MDR) and extensively drug resistant (XDR) strains of Mycobacterium tuberculosis (Mtb) has further complicated the situation. Though several studies characterizing drug sensitive and drug resistant strains are available in literature, almost all studies are done on unrelated strains. Therefore, the objective of this study was to compare the proteomic data of four sequential isolates of Mtb from a single patient who developed MDR-TB during the course of anti-tuberculosis therapy (ATT)., Methods: In this study, using two-dimensional (2D) gel electrophoresis and MALDI-TOF mass spectrometry, we compared and analyzed the cell lysate proteins of Mtb sequential clinical isolates from a patient undergoing anti-TB treatment. The mRNA expression levels of selected identified proteins were determined by quantitative real-time polymerase chain reaction (qRT-PCR)., Results: The genotypes of all four isolates remained homologous, indicating no re-infection. The initial isolate (before treatment) was sensitive to all first-line drugs, but the consecutive isolates were found to be resistant to isoniazid (INH) and rifampicin (RIF) and developed mutations in the katG, inhA and rpoB. the intensities of 27 protein spots were found to be consistently overexpressed in INH and RIF resistant isolates. The most prominent and overexpressed proteins found during the development of drug resistance were GarA (Rv1827), wag31 (Rv2145c), Rv1437 and Rv2970c., Interpretation & Conclusions: This preliminary proteomic study provides an insight about the proteins that are upregulated during drug resistance development. These upregulated proteins, identified here, could prove useful as immunodiagnostic and possibly drug resistant markers in future. However, more studies are required to confirm these findings.

Background & Objectives: Haemophilus influenzae type b (Hib) is one of the leading bacterial causes of invasive disease in populations without access to Hib conjugate vaccines (Hib-CV). India has recently decided to introduce Hib-CV into the routine immunization programme in selected States. Longitudinal data quantifying the burden of bacterial meningitis and the proportion of disease caused by various bacteria are needed to track the impact of Hib-CV once introduced. A hospital-based sentinel surveillance network was established at four places in the country and this study reports the results of this ongoing surveillance., Methods: Children aged 1 to 23 months with suspected bacterial meningitis were enrolled in Chennai, Lucknow, New Delhi, and Vellore between July 2008 and June 2010. All cerebrospinal fluid (CSF) samples were tested using cytological, biochemical, and culture methods. Samples with abnormal CSF (≥10 WBC per μl) were tested by latex agglutination test for common paediatric bacterial meningitis pathogens., Results: A total of 708 patients with abnormal CSF were identified, 89 of whom had a bacterial pathogen confirmed. Hib accounted for the majority of bacteriologically confirmed cases, 62 (70%), while Streptococcus pneumoniae and group B Streptococcus were identified in 12 (13%) and seven (8%) cases, respectively. The other eight cases were a mix of other bacteria. The proportion of abnormal CSF and probable bacterial meningitis that was caused by Hib was 74 and 58 per cent lower at Christian Medical College (CMC), Vellore, which had a 41 per cent coverage of Hib-CV among all suspected meningitis cases, compared to the combined average proportion at the other three centres where a coverage between 1 and 8 per cent was seen (P<0.001 and P= 0.05, respectively)., Interpretation & Conclusions: Hib was found to be the predominant cause of bacterial meningitis in young children in diverse geographic locations in India. Possible indications of herd immunity was seen at CMC compared to sites with low immunization coverage with Hib-CV. As Hib is the most common pathogen in bacterial meningitis, Hib-CV would have a large impact on bacterial meningitis in Indian children.

Background & Objective: In India diurnally subperiodic filariasis is prevalent only in the Nicobar district of Andaman and Nicobar Islands, with significant health problem. Sample surveys indicated that this form of filariasis is restricted to a small region of Nancowry group of islands with Ochlerotatus niveus as the vector. We therefore carried out a comprehensive study to assess the transmission dynamics of LF in Teressa island in Nicobar district in view of its control and evaluation of interventions., Methods: Entomological studies were carried out for a period of twelve months covering all the seasons in the year, by means of man landing catches in Teressa Island, an endemic island for this form of filariasis. Parameters viz., the annual biting rate (ABR), annual infective biting rate (AIBR), annual transmission index (ATI), risk of infection index (RII) and annual transmission potential (ATP), which reflect the dynamics and intensity of transmission of filariasis, were estimated. Host efficiency of Oc. niveus was also assessed., Results: The number of vectors biting a person in a year was estimated to be 21851, of which 107 were harbouring infective parasite. Risk of infection intensity was 0.02332. Every person in this study area was at the risk of receiving an estimated number of 22 infective stage larvae per year. The host efficiency index of Oc. niveus indicated that over 40 per cent of the microfilariae ingested were able to develop into infective stages. The ATP was 169 with evidence of year round transmission. The pattern of monthly transmission potential suggested that the intensity of transmission was high during summer months., Interpretation & Conclusion: Perennial transmission of subperiodic Wuchereria bancrofti in the typical forest ecosystem was evident in Teressa Island with transmission parameters suggesting that summer is a high risk season for transmission. Personal protection measure is the method of choice to protect from the risk of infection, because of day biting, exophilic and exophagic behaviour of the vector and larvae are not amenable to larvicidal measures. An alternative method to control the transmission would be to use selective or periodic mass chemotherapy to reduce the parasite load in this community.

Economic analysis of the revised strategy to control lymphatic filariasis with mass annual single dose diethylcarbamazine (DEC) at 6 mg/kg body weight launched in one of the districts of Tamil Nadu in 1996 was carried out. This exploratory study, proposed for five years in 13 districts under 7 states on a pilot scale through the Department of Public Health is an additional input of the existing National Filaria Control Programme in India. A retrospective costing exercise was undertaken systematically from the provider's perspective following the completion of the first round of drug distribution. The major activities and cost components were identified and itemized cost menu was prepared to estimate the direct (financial) and indirect (opportunity) cost related to the implementation of the Programme. The total financial cost of this Programme to cover 22.7 lakh population in the district was Rs. 22.05 lakhs. The opportunity cost of labour and capital investment was calculated to be Rs. 7.98 lakhs. The total per capita cost was Rs. 1.32, with Rs. 0.97 and Rs. 0.35 as financial and opportunity cost respectively. Based on these estimates, the implementation cost of the Programme at Primary Health Centre (PHC) level was calculated and projected for five years. The additional financial cost for the existing health care system is estimated to be Rs. 27,800 per PHC every year. DEC tablets (50 mg) was the major cost component and sensitivity analysis showed that the cost of the Programme could be minimized by 20 per cent by switching over to 100 mg tablets. The analysis indicates that this Programme is a low-cost option and the results are discussed in view of its operational feasibility and epidemiological impact.

The cost benefit analysis of fish culture as a means for vector control towards the containment of Brugian filariasis in Shertallai, a highly endemic tract for this disease in Kerala was carried out. While the financial gain accrued to the community was to the tune of Rs. 1,82,052 in ponds (under monoculture) with Chinese grass carp from 763 ponds, it was Rs. 1,83,740 from 1000 ponds under polyculture with Catla catla, Cyprinus carpio, Labeo rohita, Labeo fimbriatus, Cirrhina mrigala and Ctenopharyngodon idella (Chinese grass carp). Monoculture with Giant gourami (Osphronemous goramy) fetched an income of Rs. 7,654 to the community from 128 ponds. A marked reduction in weed reinfestation/vector breeding was observed in ponds under fish culture than other without fishes. The study clearly indicates that fish culture is an ideal strategy for Mansonioides control as it can bring perceptible benefits to the community.

Three species of Mansonia (Mansonioides) mosquitoes, viz., Mansonia annulifera, M. uniformis and M. indiana were recorded in the Shertallai region of Kerala state. M. annulifera and M. uniformis were recorded throughout the year while M. indiana was seasonal and in small numbers. Their indoor resting density was 3.29, 0.25 and 0.10 per man per h and the man biting density was 24.67, 12.74 and 0.47 per man per night respectively. Vector density fluctuated through seasons and reached a peak during the monsoon/post-monsoon period when there was an increase in the breeding surface area and a relatively higher survival of the adults. The biting tendency of M. annulifera and M. indiana was relatively more indoors (endophagic) whereas it was outdoors (exophagic) for M. uniformis. All these mosquitoes showed a predilection towards cattle, with varying degrees of zoophily. The relative abundance, man biting behaviour and a higher transmission potential indicate that M. annulifera is a more potent vector of Brugia malayi, than M. uniformis in this region.

The patent period of infection which reflects the fecundic life span of the adult female worm was estimated for periodic B. malayi in south India by using immigration death model. Longitudinal data on natural loss of infection or that due to different degrees of DEC pressure in a cohort population of microfilaria carriers after a three years period, were used for the estimations. The patent period of infection was estimated to be 3.45 yr under natural conditions (without DEC therapy), which was reduced to 1.67 yr following one full course of selective therapy (6 mg/kg body wt/day for 12 days). When selective therapy was supplemented with four rounds of biannual single-dose mass DEC therapy (6 mg/kg body wt) the patent period was further reduced to 1.34 yr. The proportion loss of infection was relatively higher in microfilaria carriers who discontinued DEC selective therapy, when compared to natural loss. The percentage reduction in the mean microfilaria count was observed to decrease with increasing DEC pressure. Neither sex nor the age of the host was found to influence the fecundic life span or the survival of female adult worm.

Treatment following rapid case detection in population, particularly the target age classes, which record high prevalence, is necessary for effective control of lymphatic filariasis. Conventional door-to-door surveys resulted in delay in detection of parasite carriers and patients with clinical filariasis, particularly in rural areas. An integration with other approaches like school surveys, health camps, filariasis clinics and microfilaria detection camps (MDC) was found effective in covering a much larger population in brugian filariasis case detection in an endemic area in south India. The MDCs organized through Integrated Child Development Scheme (ICDS MDC) yielded a good coverage of pre-school children. School surveys were ideal in covering children en masse. Community MDCs and health camps arranged with active community participation were useful in covering adolescents and young adults in large numbers. The filariasis clinic was effective in screening older adults above 30 yr. The relative efficiency of these approaches in terms of time and manpower utilization has been discussed.

In a door-to-door survey in Shertallai area of Kerala state in southern India, 7,766 persons were examined for clinical manifestations of filariasis. The prevalence of disease was 9.85 per cent and chronic persistent oedema (grade-II) was the predominant clinical presentation in both sexes. There was no significant difference in the age prevalence of disease between the sexes. Incidence of episodic filarial fever was higher (4.73/1000) compared to other manifestations (2.49/1000) in children aged 5-15 yr and hence this may be an useful indicator of the degree of occurrence of fresh cases of clinical filariasis. Classification of patients with lymphoedema into three grades showed that 1.65 per cent of those examined had developed lymphoedema within 6 months. Persistence of oedema (grade II) for prolonged period (13.64 +/- 1.17 yr) without skin changes indicated that the development of elephantiasis is a slow process. The clinical picture of malayan filariasis is similar to that reported elsewhere in the world except for the rarity of abscess formation is inguinal area.

The detachment and reattachment of the immatures of M. annulifera with their host plants (hydrophytes) is a regular phenomenon. This occurs frequently with the same plant, or with a different one, throughout the larval span. The duration between detachment and reattachment varied from 30 sec to one hour and majority of them get reattached within a minute. This behaviour is instinctive and not found to be influenced by food availability. In the absence of hydrophyte, early immature stages survive relatively longer (192 h), when compared to the late ones.