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Japanese encephalitis virus belongs to the genus Flavivirus. Case fatality averages 30% and almost 50% of the survivors are left with permanent neuropsychiatric sequelae. Japanese encephalitis occurs in nearly all Asian countries including India. Patterns of JE transmission vary within individual countries and from year to year. In endemic areas, sporadic cases occur throughout the year. Japanese encephalitis or AES has been reported from 231 districts of 23 states. The best way to control JE in humans is through vaccination. Currently available vaccines in India are live attenuated, cell culture-derived SA 14-14-2, inactivated SA 14-14-2 vaccine (IC51; IXIARO® by Intercell and JEEV® by Biological Evans India Ltd.) and inactivated Vero cell culture-derived Kolar strain, 821564XY, JE vaccine (JENVAC® by Bharat Biotech). As 2006 position paper of WHO stated that mouse brain derived vaccines should be withdrawn and replaced by newer vaccines due to safety profile and as it is not available in our country now, this vaccine will not be discussed henceforth.

COVID-19 infection and its various signs and symptoms are still causing significant studies across the world. Although relatively less in prevalence and disease severity, children none the less are also affected by this infection. Most of the research in this regard has been focused on the adults, whereas there is a definite lacuna in the published data in the pediatric COVID-19 cases and its prognosis. India being a large country with significant number of population, which has experienced lot of such cases. The present study aims to explore data from 46 patients

Justification In view of new developments in vaccinology and the availability of new vaccines, there is a need to revise/review the existing immunization recommendations. Process Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP) had a physical meeting in March, 2020 followed by online meetings (September-October, 2020), to discuss the updates and new recommendations. Opinion of each member was sought on the various recommendations and updates, following which an evidence-based consensus was reached. Objectives To review and revise the IAP recommendations for 2020–21 and issue recommendations on existing and new vaccines. Recommendations The major changes include recommendation of a booster dose of injectable polio vaccine (IPV) at 4–6 years for children who have received the initial IPV doses as per the ACVIP/IAP schedule, re-emphasis on the importance of IPV in the primary immunization schedule, preferred timing of second dose of varicella vaccine at 3–6 months after the first dose, and uniform dosing recommendation of 0.5 mL (15 µg HA) for inactivated influenza vaccines.

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.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.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.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.

Justification In India, till recently, breastfeeding women have been excluded from the coronavirus disease (COVID-19) vaccination program, rendering a significant population of the country, including frontline workers, ineligible to derive the benefits of the COVID-19 vaccine rollout. Objective The objective of this recommendation is production of an evidence-based document to guide the pediatricians to give advice to breastfeeding mothers regarding the safety of COVID-19 vaccines in lactating women. Process Formulation of key question was done under the chairmanship of president of the IAP. It was followed by review of literature regarding efficacy and safety of COVID-19 vaccines in breastfeeding women. The recommendations of other international and national professional bodies were also deliberated in detail. The available data was discussed in the ACVIP focused WhatsApp group. Opinion of all members was taken and the final document was prepared after achieving consensus. Recommendations The IAP/ACVIP recommends the administration of COVID-19 vaccines to all breastfeeding women. The IAP/ACVIP endorses the recent recommendation of the Government of India, to consider all breastfeeding women as eligible for COVID-19 vaccination.

Background: Low birth weight (LBW) is prevalent in low-income countries. Level II neonatal intensive care at SCNUs is cost intensive. Rational use of SCNU services by targeting its utilization for the VLBW neonates and maintenance of community based newborn care is required. Even though the economic evaluation of interventions to reduce this burden is essential to guide health care policy making for low resource setting, data on low cost outcome study associated with LBW in Indian setup are scarce. Methods: This study aims to estimate the costs to the health system in the management of LBW in rural setting where affordability of parents for healthcare facility comparatively less. The cost of management was cut off by minimum investigations, more supervision by working health care personnel’s. A prospective observational study was conducted to see outcome of estimate the costs to the health system in the management of LBW or VLBW babies. Results: The mortality and survival rate among the evaluated LBW under this low cost health care setting was 6.66% and 86.6% respectively. Conclusions: Results of this unique cost and effectiveness evaluation of LBW healthcare management in a low resource setting are very relevant in Indian context where healthcare facility is almost out of reach and affordability in majority rural populations. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care in rural settings. Further larger research is required on cost effectiveness of level II neonatal intensive care.

Background: Febrile convulsion (FC) is the most common seizure disorder in childhood. White blood cell (WBC) and C reactive protein (CRP) are commonly measured in FC. Add a paragraph on Aims and Objectives of the study.Aims and Objectives: To compare WBC and CRP in febrile children, aged 6 months to five years, with and without FC, in order to determine whether leukocytosis and elevated CRP can be used as diagnostic tool for febrile seizure.Materials and Methods: In this cross sectional study 214 children (112 with FC), aged 6 months to 5 years, admitted to in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over a 12 months period. Age, sex, temperature; WBC, CRP and hemoglobin were recorded in all children. There was a significant increase of WBC (P

Background: Preterm birth is one of the major clinical problems in neonatology as it is commonly associated with perinatal mortality, serious neonatal morbidity and in some cases, it leads to childhood disability. The objective of this study was to find out the outcomes of VLBW and ELBW babies in the form of mortality and morbidity in neonatal period.Methods: A cross sectional study was conducted in SNCU, MKCG Medical College, Berhampur, Odisha between 2011 to 2013. All babies with birth weight less than 1500gm, admitted between days 1 to day 7 of life were enrolled in the study. Babies were broadly divided in to two groups i.e.VLBW group (weight 1000-1499gm) and ELBW group (weight

Background: India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes.Methods: The present study was undertaken to assess the sensitivity and specificity of tuberculin test (Mantoux) and BCG test in diagnosis of childhood tuberculosis and to compare above tests as a diagnostic tool and to assess the impact of factors affecting the test. Mantoux test was done with 1 TU contained in 0.1 ml of PPD R23 with tween 80 solution. BCG test was done using a heat stable freeze-dried vaccine, after fresh reconstitution and injected intradermally in left deltoid region with a tuberculin syringe and 27 G hypodermic needle.Results: Tuberculous cases were more common in malnourished subjects more so with severe malnutrition. While maximum positivity 89% was obtained with BCG test, it was only 63% with Mantoux test, done with 5TU of PPD-RT-23. BCG was always positive whenever PPD was positive in any group of children. Sensitivity of Mantoux test was around 63% whereas that of BCG test was 89%. BCG test was more significantly associated with disease than tuberculin test (p

Background: The first few years of life are the most crucial period as this age is known for accelerated growth and development and any adverse influences during this period may result in severe limitations in their development which warrants regular monitoring. Methods: The present study had been conducted to find out the total growth profile in relation to skeletal age, nutritional status and the disease pattern so as to give a clear idea of total growth profile in the age group of 3 months to 5 years. The cases were evaluated after proper history taking, clinical examination and conventional anthropometric measurements. The patients were divided in three different age groups as 3 months to 1 year, ≥1 to 3 years, and ≥3 to 5 years. Bone age was determined in all 52 cases by taking proper radiographs of both wrists and hands. Results: It was observed that 16 (30.77%) were normal, 11 (21.15%) were in both grade I and II, 10 (19.23%), 4 (7.7) were grade III and IV respectively among 52 children. The mean weight was 7.06±1.65, 9.33±1.92 and 11.18±2.90 in the age groups of 3 months to 1 year, 1-3 years and 3-5 years respectively. The length/heights were 68.55±5.54, 79.44±7.54 and 91.97±10.15 in the age group of 3 months to 1 year, 1-3 years and 3-5 years respectively. Conclusions: This study gave a true reflection of total growth of a child which comprised of anthropometrical measurement and skeletal development as the distribution of sex and racial distribution were not a factor. There was a statistical significant result in different three groups in regard to weight, length/height, head and chest circumference.

Background: Neonatal sepsis (NS) has significant morbidity and mortality rates and it is still difficult to diagnose on presentation. Early diagnosis and treatment decreases the mortality and morbidity of neonatal sepsis (NS). The study’s aim was to detect the levels of IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and establish its association with the pathogenesis of the disease.Methods: The case control study consists of 70 neonates of whom 36 were clinically suspected case of sepsis admitted in NICU of paediatric department and were taken as cases and 34 were normal healthy neonates taken as control subjects. The cases as well as controls were within 28 days of age. Preterm and term neonates (

Background: The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. Obstetric ultrasound provides a cornerstone to other modalities used for assessing hypertensive disorders of pregnancy. Placental architecture is modified in PE and eclampsia. This study was designed to detect the placental changes in hypertensive disorders of pregnancy and correlation with ultrasonic and histopathological changes.Methods: The study group comprised of 42 patients with pregnancy complicated with hypertension with period of gestation above 20 weeks and B.P. more than 140/90 mm of Hg measured on two occasions 6 hours or more apart. The control group consists of 42 normotensive patients matched with age and parity. One ultrasonic examination was performed between 28 weeks and 34 weeks and another after 34 weeks till term. Apart from routine parameters i.e. BPD, AC, FL, Amniotic fluid index, EBW and gestational age routine placental grading were performed according to the classification proposed by Grannum and associates. To evaluate perinatal outcome following measurement were studied birth weight immediately after delivery, mode of delivery, perinatal morbidity and mortality, APGAR score, presence of fetal distress.Results: In 97.62% cases (41 out of 42) of control group showed Grade–II changes as opposed to 57.14% of cases (24 out of 42) in study group before 34 weeks. All 21 cases in study group showing Grade ‘III’ changes before 34 weeks had infarction, calcification, increased syncytial knots, fibrinoid necrosis from 95.23 to 100% of these cases showed all these changes. Only 2 cases (9.52%) showed perivascular hemorrhage having Grade ‘III’ before 34 weeks.Conclusions: Accelerated maturation of placenta in pregnancy complicated with hypertension are more common in the hypertensive group. Increased histopathological degenerative changes e.g. calcification, fibrinoid necrosis etc., are more marked even before 34 weeks of gestation in hypertensive group.

Background: Respiratory infections are increasing globally with parallel increase in world population, pollution, urbanization, overcrowding, global warming and poverty. Multi drug resistant virulent bacteria are growing very rapidly. The objective of this study was to know the prescribing pattern of antibiotics in hospitalized patients suffering from different common respiratory disorders.Methods: This was a retrospective and observational study. Data was captured from 1st January 2016 to 31st December 2016 at ICARE Institute of Medical Sciences and Research and Dr. B.C.Roy Hospital. Total 200 patients were taken for the study of age range from 10 to 50 years.Results: COPD, bronchial asthma, pneumonia and ARIs were the most frequent respiratory illnesses among patients attended Medicine OPD. Most common antibiotics prescribed were co-amoxyclav, ceftriaxone, moxifloxacin, clarithromycin, azithromycin and aminoglycosides.Conclusions: Injudicious use of antibiotics in trivial viral respiratory infections may give rise to antibiotic resistant strains in the community.

Background: Respiratory illnesses in children form a substantial disease burden in emergency care, outpatients and hospitalised patients. Studies exploring the pattern of emergency room visits and hospitalization for individuals with respiratory complaints could inform decisions regarding the effective organisation and planning of health services. Methods: The present prospective observational study was conducted in children between one month to 18 years of age admitted with acute respiratory illness at Institute of Child Health, Kolkata from1st of February 2015 - 28 th of February 2015. Results: Preliminary data shows that most of them were diagnosed provisionally as pneumonia (30%) followed by wheeze associated lower respiratory infection (WALRI) (29%). Approximately 10% of admitted patients required PICU support. Antibiotics and bronchodilators were the most commonly used medications. Conclusions: CRP is significantly elevated in bacterial respiratory tract illnesses but a normal or low CRP does not exclude bacterial infection. Best practice may be to avoid antibiotics where possible unless clinically indicated and hospital courses determine so.

Background: Tubercular meningitis (TBM) is an endemic disease in developing countries. Adenosine deaminase activity (ADA) has been of great importance for many years in TBM diagnosis. The objective of this study was to determine the CSF-ADA levels in different CNS disorders, to compare the CSF-ADA activity in different types of meningitis, to find out the sensitivity and specificity of CSF-ADA in the diagnosis of TBM and to establish the prognostic value of CSF-ADA in TBM in comparison to Control group.Methods: For control group CSF was collected from the patients of simple febrile convulsions and idiopathic epilepsy.Results: The present study was carried out in the 112 cases of different CNS disorders, age ranging from 4 months to 12 years with a mean age of 4.12 years and 38 cases (27+11) of control group (simple febrile convulsion and idiopathic epilepsy). In the present study CSF-ADA level was statistically significantly increased in all types of meningitis (p

Background: Congenital coronary anomalies may be isolated, or they may accompany other congenital heart defects, such as Fallot's tetralogy, transposition of the great arteries or pulmonary atresia. The most common cause of acquired abnormalities of the coronary vessels in children is kawasaki disease (KD). The aim of this study was to find the best model to obtain valid and normally distributed Z-scores for coronary artery (CA) diameters in a large, heterogeneous population of healthy children. Methods: Echocardiography was performed on 300 healthy children. Linear regression models were tested with height, weight, body surface area, and aortic valve diameter. The computed Z scores were tested for normal distribution and stability. Results: CA diameter was best predicted using regression with the body surface area and age in month. The weighted least squares method yielded normally distributed and very stable Z-score estimates for 3 principal CAs. Conclusions: This study showed valid methods to estimate Z scores for CA size in children of all ages. Such Z scores are important for risk stratification in patients with Kawasaki disease.