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Justification: Data generated after the first wave has revealed that some children with Coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected COVID-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2–18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval. Objective: To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use. Process: Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of COVID-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on COVID-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized. Recommendations: The IAP supports the Government of India's decision to extend the COVID-19 vaccination program to children between 2–18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out. [ABSTRACT FROM AUTHOR]

It is widely known that India holds a high burden of pneumococcal disease and studies related to the genetic variation in the penicillin-binding proteins (PBP), the principal target of beta-lactam drugs are sparse. Further, serotype 19F of Streptococcus pneumoniae was the predominant serotype among Indian children. The present study identifies the genetic variations and AMR patterns of PBP genes 1a, 2b, and 2x of S. pneumoniae 19F serotype in Indian children (≤5 years). A total of 97 S.pneumoniae serotype 19F clinical isolates collected across India from 2009-2018, were subjected to WGS on the Illumina platform. Multiple Sequence Alignment on MEGA-X-V10.0.3 was performed for extracted PBP sequence data, and the AMR pattern was determined. Of the 97, 19F serotype isolates, 62 belonged to the pediatric age. A total of 29 different substitution mutations in PBP 1a, 2b, and 2x genes were observed. In the conserved motifs of PBP genes, the following substitutions were observed: PBP1a-85.5% (P432T), 75.8% (T371A); PBP1b-85.5% (T446A), 83.9% (Q438E), 46.8% (A619G); PBP2x- 78.3% (T338A and L546V), respectively. Whereas in the protein, active sites 100% substitutions were detected in E388D (PBP1a), and S517A (PBP2b) regions. The genetic variations were correlated phenotypically and it was interesting to note that 53 of the 62 isolates conferred resistance to penicillin (MIC = 0.5 µg/ml to 4 µg/ml). About 9 isolates displayed sensitivity to penicillin (MIC = 0.03 µg/ml) without any mutations. There was a higher degree of genetic diversity detected in PBPs substitutions among the isolates, a few of which were on par with previously reported data, while the major substitution mutations observed in the study resulted in high-level resistance to beta-lactams. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa is an opportunistic pathogen and is associated with serious infections, and treatment can be challenging. Rates of antimicrobial resistance (AMR), multidrug-resistant (MDR) infections are increasing. Our objective was to characterize the epidemiology and AMR mechanisms of this pathogen circulating in India using whole genome sequencing. 312 P.aeruginosa isolates recovered from 21 hospital sites in India between 2017–2022 were seqeunced. Isolates were subjected to antimicrobial susceptibility testing by Vitek-2 automated system, and their genomes were assembled from Illumina sequencing data. MLST type, virulence genes, AMR determinants, and relatedness between isolates were derived; and determined concordance between phenotypic and genotypic resistance. β-lactam resistance was high (99.6%), with 99.6%to Cephalosporins, 98.3%to Aminoglycosides, 96.4%to Phenicols, 54.8% to Fluroquinolones, 36% to carbapenem and 17.6% to Macrolides. Carbapenem resistance was associated mainly with acquisition of the MBLs- blaOXA genes and blaNDM1 gene. Loss of function of the OprD-porin was observed in 4 isolates. KPC-2 was detected in 5 isolates and blaVIM gene was not detected. Concordance between phenotypic and genotypic resistance was 99.5% overall. Virulence genes, toxA (94.8%), plcH (98.3%), lasA/B/I (99.6%), exoS (51.6%), exoT (97.1%), exoU (48%), exoX (90%) were detected. Genotyping by MLST revealed 80 different sequence types. The population of P.aeruginosa was diverse, with MLSTs ST357, ST308, ST235, ST244 and ST654 predominant. About 13.7%of STs were of novel types and were found to emerge from the high-risk clones, having 100% resistance to Beta lactams and Cephalosporins, 90% resistance to Aminoglycosides and harbouring diverse virulence genes. Most of the ST357 and Novel ST genomes formed a distinct lineage from global genomes, thus raising the possibility that they may be unique to the India. The survey bridges the gap in genomic data from India. The association of resistance determinants with phylogenetic background displays the utility of WGS-monitoring AMR in P.aeruginosa. The presence of resistance and virulence determinants throughout phylogenetic tree shows that knowledge of local epidemiology is crucial for guiding potential treatment of MDR P. aeruginosa infections. [ABSTRACT FROM AUTHOR]

K.pneumoniae is an urgent health concern due to the emergence of multidrug-resistant strains for which vaccination offers potential remedy. Vaccines based on surface polysaccharides are highly promising but need to address high diversity of surface-exposed polysaccharides. For the success of K/O-antigenbased vaccine strategies, knowledge of serotype distribution and diversity among clinical isolates are mandatory. The study aimed to elucidate the genetic diveristy of K.pneumoniae capsular types in India. 1072 K.pneumoniae isolates collected during 2013-2022 from 38 hospitals were sequenced. The assembled data was uploaded to pathogen watch for analysis, using kleborate for typing K.pneumoniae The study defines the genetic diversity of O-and K-loci bearing isolates in India. 71 different K-loci were identified in the study. KL64 (25.5%), KL51 (23.2%) and K2 (8.2%) were predominant and 18 isolates had novel cps loci. Prevalence of internationally known KL-types K1 and K2 was 1.3% and 8.2% respectively. 37.2% of KL-64 strains and 85.1% of KL-51 strains belong to clonal lineage ST147 and ST231 respectively. Strikingly, virulence and antibiotic resistance genes were present in high proportion (70.3% virulence, 90.8% resistance) among KL51 strains where as their presence was 31.4% and 90.9% in KL64 strains. Serotypes-O1/O2v1 and-O1/O2v2 were most prevalent accounting for 43.9% and 32.9% respectively. 67% of O1/O2v2 strains harboured KL51 loci and were associated with ST231 clonal lineage, which is a predominant lineage in India. The distribution of virulence and resistance genes was 22.7% and 79.8% among O1/O2v1 strains where as their presence was 58.6% and 69.6% in O1/O2v2 strains The study reveals the existence of diverse population pool of Kantigens among the Indian circulating strains of K.pneumoniae which is different from other parts of the world. The study isolates in addition, displayed a high diverse STs, virulome and resistome. On the contrary, O-antigens were less diverse. The diversity of circulating population has to be considered while developing vaccines. [ABSTRACT FROM AUTHOR]

In the city of Mumbai (formerly Bombay), chloroquine (CQ) continues to be recommended as the drug of first choice for the treatment of Plasmodium vivax and P. falciparum infections, even though > 50% of local isolates of P. falciparum are resistant to it. Primaquine, an 8-aminoquinoline is also given to patients with falciparum malaria, in a single, 45-mg dose, to kill the gametocytes and so reduce transmission. The gametocytocidal activity of supervised primaquine (45 mg given on day 8) was investigated in 90 patients who had been treated with CQ. Of these, 15 were found to be CQ-sensitive patients, 61 were resistant (49, eight and four considered RI, RII and RIII, respectively) and 14 were lost before completion of the follow-up. The mean (S.D.) baseline gametocytaemias in the CQ-sensitive and RI-resistant cases were 665.1 (411.3) and 1537.4 (1045.5)/mul, respectively. Despite supervised primaquine treatment, four of the 15 CQ-sensitive patients and 32 of the 49 patients found to be RI-resistant had gametocytes on day 29. There therefore appears to be a need to review the current, gametocytocidal, primaquine-dosage schedule and to re-treat patients who remain gametocytaemic with higher doses of primaquine, as an important, transmission-blocking strategy. [ABSTRACT FROM AUTHOR]

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, immunization practices of all age groups, especially routine childhood vaccines, have been interrupted. Immunization is considered an essential health activity, which needs to be resumed as early as possible. This pandemic has created several unique issues related to routine immunization of individual children at clinics, which needs to be addressed. In this communication, the Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics addresses the common questions and issues related to SARS-CoV-2 and routine immunization services. This also includes the recommendations for routine immunization of SARS-CoV-2 suspect and positive children, and for the logistics to be followed for immunization services.

The increasing prevalence of unethical practices such as unnecessary investigations, overcharging, and violation of patients' rights, especially in private hospitals, have drawn attention to the unregulated and overwhelmingly commercialised nature of the private healthcare sector in India.

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India, the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semistructured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra and from a witness seminar on the topic of transformation in Maharashtra's healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities and the perceived benefits of work in larger providers. We describe a 'reprofessionalisation' of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying 'restratification' within this part of the profession affords prestige and influence to 'star doctors' while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals' bodies can, and should, play in contemporary transformation of private healthcare and the implications of these trends for health systems more broadly., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Diagnosis of extra pulmonary tuberculosis (EPTB) is challenging due to its atypical clinical presentation and frequently results in a delay or deprivation of treatment. Apart from rapid case detection, early determination of MDR status is imperative in such situations. The commercially available Geno Type MTBDRplus assay version 2.0 (Hain Lifescience, Nehren, Germany) detects both the presence of Mycobacterium tuberculosis (MTB) complex as well as the presence of INH and Rifampcin resistance. We aim to evaluate the role of this test in diagnosis and detection of resistance by comparing its performance against gold standard i.e. culture and against the composite reference standards (CRS) in the diagnosis of EPTB., Material and Methods: The data of 130 EPTB samples processed form January 2014 till May 2017 at Poona Hospital and Research centre were selected for the study. All the samples were processed for Ziehl-Neelsen stain, Geno Type MTBDRplus assay (LPA) and liquid automated culture (BacT/Alert) simultaneously. Geno Type MTBDRplus assay (LPA) was performed directly on the samples. The 24 samples giving positive results on LPA and grown M. tuberculosis on culture were subjected to anti mycobacterial susceptibility testing for 1st line anti-tubercular drugs by BACTEC MGIT 320 system., Results: Out of 130 samples, 7 samples grew atypical mycobacterium and all the 7 samples turned negative on Line Probe Assay. Direct LPA on processed samples yielded 48/130 (36.9%) positivity. Geno Type MTBDRplus assay was positive for M. tuberculosis in (72.09%) 31/43 culture positive cases and (21%) 17/80 of culture negative cases. Geno Type MTBDRplus assay sensitivity and specificity results were assessed in comparison to CRS made up of culture results and clinical, radiological and histological findings. The overall sensitivity of Geno Type MTBDRplus assay was 45.19% (47/104) and specificity was 94.73 (18/19). Out of 24 samples which were compared for results between LPA and culture, Geno Type MTBDRplus assay accurately identified 3 of 3 of Rifampcin resistant strains and 20 of 21 Rifampcin sensitive strains. Geno Type MTBDRplus assay identified 4 of 4 INH resistant strains and 19 of 20 INH sensitive strains and MDR was obtained for 3 of 3 strains., Conclusions: Geno Type MTBDRplus assay can give early diagnosis and sensitivity for both INH and Rifampcin in extra pulmonary samples. More number of studies is further required to establish Geno Type MTBDRplus assay as an important tool for obtaining diagnosis and resistance to first line drugs in extra pulmonary samples., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)