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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.

Background: Odisha was endemic for B. malayi along with W. bancrofti for Lymphatic Filariasis, but since 2004, there was no evidence of B. malayi in Elimination of Lymphatic Filariasis (ELF) program. We conducted the present study to reconfirm the presence of B malayi in Baleswar and Bhadrak districts of Odisha. Methods: We conducted a night blood survey in 12 villages of Baleswar and 11 villages of Bhadrak district of Odisha in June 2017. Villages were selected purposively based on highest morbidity of reported lymphatic filariasis. A total of 6230 and 5606 blood slides were collected in Baleswar and Bhadrak districts respectively. Data was analyzed by using Microsoft Excel, 2007. Results were presented in the form of rates & ratios appropriately. Chi square, students‘t’ test & SEP was used as test of significance and p≤0.05 was considered statistically significant. Results: In Baleswar and Bhadrak district 0.99% and 0.43% of the slides were positive for microfilariasis (Mf). In Baleswar district Mf was detected in 83.3% of villages and in 5 villages the Mf infection rate was more than 1 percent. In Bhadrak district Mf was detected in 72.7% of villages and in 2 villages the Mf infection rate was more than 1 percent. In Baleshwar and Bhadrak district 98.4% and 33.3% of positive slides were due to B malayi infection and the difference was statistically significant (p

Kala-azar (KA) and Lymphatic Filariasis (LF), two out of the six vector borne diseases slated for elimination from the country by Government of India. Kala-azar or Visceral Leishmaniasisis prevalent in the eastern part of Uttar Pradesh mainly in the districts bordering to Bihar, the state known for high endemicity of the disease. This disease has been targeted for elimination not only from thestate butfrom the country by 2020 by bringing down the Kala-azar prevalenceto

Uttar Pradesh is the largest state of India and is comprised of 75 revenue districts. 51 districts of eastern Uttar Pradesh are endemic for LF and are under Elimination of Lymphatic Filariasis (ELF). In order to ensure elimination of the disease from the people, the Mass Drug Administration (MDA) was observed in these 51 districts since 2004 by ensuring administration of drug DEC alone once in a year according to the age excluding children >2years, pregnant women & seriously ill persons. Thereafter, 400 mg albendazole to >2 years age group was added with DEC since 2008. 24 districts of Western Uttar Pradesh are non endemic for filariasis. The state in coordination with WHO has conducted filaria antigenemia tests in these 24 non filaria endemic districts with the help of Filaria Test Strips (FTS) and the drive is termed as Mini-transmission assessment survey (Mini-TAS). 300 persons were examined with Filaria Test Strip (FTS) from each of the 04 sentinel sites of each district. On the basis of test reports, all 24 non endemic districts reported >2 % filaria antigenemia and the state claimed to declare the districts as filaria endemic districts/ areas. The possibilities of the claim to establish non filaria endemic districts to filaria endemic districts have been explored & discussed in detail in this paper. The critical examination of the data does not support to assign any non endemic area to endemic area. On the basis of conducting direct filaria antigenemia tests alone and the term used as mini-transmission assessment survey (‘Mini-TAS’) will be a misnomer, consequently misleading to the ELF programme in the country. How to cite this article:Chandra R, Singh SM, Kumar A, Kamal S, Mittra KK, Roy N. Use of Filaria Test Strips (FTS) in Identification of Filaria Endemicity in Non Filaria Endemic Districts of Uttar Pradesh, India. J Commun Dis 2020; 52(4): 70-76. DOI: https://doi.org/10.24321/0019.5138.202043

Uttar Pradesh is the largest state of India and is comprised of 75 revenue districts. 51 districts of eastern Uttar Pradesh are endemic for LF and are under Elimination of Lymphatic Filariasis (ELF). In order to ensure elimination of the disease from the people, the mass drug administration (MDA) is being observed in these 51 districts since 2004 by ensuring administration of drug Di-ethyl Carbamazine Citrate (DEC) alone once in a year according to the age excluding children 2 years age group was added with DEC since 2008. When both the drugs are administered together, the effect is on the adult worm too and therefore the parasite will be destroyed preventing the infected person from developing clinical manifestation. NVBDCP guidelines envisages that administration of drug to the 65% of the total population or 85% of the targeted population for five consecutive years will bring down the microfilarimia to 1% and during 2019, the antigenemia was found >2% in 13 districts. The possible gaps, issues and challenges at various levels of the programme implementation have been discussed in the present paper, the rectification of which may lead the state for achieving the goal of elimination of the disease. How to cite this article:Kamal S, Chandra R, Singh SM, Kumar A, Mittra KK, Roy N. Mass Drug Administration (MDA) for Lymphatic Filariasis Elimination in Uttar Pradesh, India: Issues, Gaps & Challenges. J Commun Dis 2020; 52(3): 62-73. DOI: https://doi.org/10.24321/0019.5138.202033

There are 670 million people at risk of contracting lymphatic filariasis (LF) in India, which bears 40% of the global burden of the disease. The National Program to Eliminate LF was launched in 2004 first with a single-drug therapy—diethylcarbamazine (DEC), followed by a two-drug therapy—DEC + albendazole (DA). In 2017, following successful drug trials, World Health Organization endorsed a new triple-drug therapy to fight LF using ivermectin with DEC and albendazole (IDA).1 In June 2018, India made new commitments to accelerate their program to eliminate LF and initiated the new IDA protocol in five districts in the country. This article looks at the experience of India in the roll out of the new drug protocol and shares their preparations, successes, challenges, and lessons learned.

Background In 2005, Bangladesh, India and Nepal agreed to eliminate visceral leishmaniasis (VL) as a public health problem. The approach to this was through improved case detection and treatment, and controlling transmission by the sand fly vector Phlebotomus argentipes, with indoor residual spraying (IRS) of insecticide. Initially, India applied DDT with stirrup pumps for IRS, however, this did not reduce transmission. After 2015 onwards, the pyrethroid alpha-cypermethrin was applied with compression pumps, and entomological surveillance was initiated in 2016. Methods Eight sentinel sites were established in the Indian states of Bihar, Jharkhand and West Bengal. IRS coverage was monitored by household survey, quality of insecticide application was measured by HPLC, presence and abundance of the VL vector was monitored by CDC light traps, insecticide resistance was measured with WHO diagnostic assays and case incidence was determined from the VL case register KAMIS. Results Complete treatment of houses with IRS increased across all sites from 57% in 2016 to 70% of houses in 2019, rising to >80% if partial house IRS coverage is included (except West Bengal). The quality of insecticide application has improved compared to previous studies, average doses of insecticide on filters papers ranged from 1.52 times the target dose of 25mg/m2 alpha-cypermethrin in 2019 to 1.67 times in 2018. Resistance to DDT has continued to increase, but the vector was not resistant to carbamates, organophosphates or pyrethroids. The annual and seasonal abundance of P. argentipes declined between 2016 to 2019 with an overall infection rate of 0.03%. This was associated with a decline in VL incidence for the blocks represented by the sentinel sites from 1.16 per 10,000 population in 2016 to 0.51 per 10,000 in 2019. Conclusion Through effective case detection and management reducing the infection reservoirs for P. argentipes in the human population combined with IRS keeping P. argentipes abundance and infectivity low has reduced VL transmission. This combination of effective case management and vector control has now brought India within reach of the VL elimination targets., Author summary Visceral Leishmaniasis (VL), also known as kala-azar, is a major parasitic disease in South Asia (Indian subcontinent), with 85% of the disease incidence in India. Historically VL had been controlled and almost eliminated with Indoor Residual Spraying (IRS) using dichlorodiphenyltrichloroethane (DDT). However, reinitiating this approach in 2015 failed due to high insecticide resistance in the sand fly vector and poor IRS quality, meaning that VL elimination targets were not met. To improve this the National Vector Borne Disease Control Programme changed to an effective insecticide, alpha-cypermethrin and altered the mode of application to compression pumps. Sentinel sites were established to monitor the entomological indicators, these showed the positive impact of these changes from 2016 to 2019. During this period the overall incidence of disease has decreased, and India is now on track to reach it’s target incidence for VL of less than 1/1000 people at the sub-district (block) level.

BackgroundIndia has made major progress in improving control of visceral leishmaniasis (VL) in recent years, in part through shortening the time infectious patients remain untreated. Active case detection decreases the time from VL onset to diagnosis and treatment, but requires substantial human resources. Targeting approaches are therefore essential to feasibility.MethodsWe analyzed data from the Kala-azar Management Information System (KAMIS), using village-level VL cases over specific time intervals to predict risk in subsequent years. We also graphed the time between cases in villages and examined how these patterns track with village-level risk of additional cases across the range of cumulative village case-loads. Finally, we assessed the trade-off between ACD effort and yield.ResultsIn 2013, only 9.3% of all villages reported VL cases; this proportion shrank to 3.9% in 2019. Newly affected villages as a percentage of all affected villages decreased from 54.3% in 2014 to 23.5% in 2019, as more surveillance data accumulated and overall VL incidence declined. The risk of additional cases in a village increased with increasing cumulative incidence, reaching approximately 90% in villages with 12 cases and 100% in villages with 45 cases, but the vast majority of villages had small cumulative case numbers. The time-to-next-case decreased with increasing case-load. Using a 3-year window (2016–2018), a threshold of seven VL cases at the village level selects 329 villages and yields 23% of cases reported in 2019, while a threshold of three cases selects 1,241 villages and yields 46% of cases reported in 2019. Using a 6-year window increases both effort and yield.ConclusionDecisions on targeting must consider the trade-off between number of villages targeted and yield and will depend upon the operational efficiencies of existing programs and the feasibility of specific ACD approaches. The maintenance of a sensitive, comprehensive VL surveillance system will be crucial to preventing future VL resurgence.

As India moves toward the elimination of visceral leishmaniasis (VL) as a public health problem, comprehensive timely case detection has become increasingly important, in order to reduce the period of infectivity and control outbreaks. During the 2000s, localized research studies suggested that a large percentage of VL cases were never reported in government data. However, assessments conducted from 2013 to 2015 indicated that 85% or more of confirmed cases were eventually captured and reported in surveillance data, albeit with significant delays before diagnosis. Based on methods developed during these assessments, the CARE India team evolved new strategies for active case detection (ACD), applicable at large scale while being sufficiently effective in reducing time to diagnosis. Active case searches are triggered by the report of a confirmed VL case, and comprise two major search mechanisms: 1) case identification based on the index case’s knowledge of other known VL cases and searches in nearby houses (snowballing); and 2) sustained contact over time with a range of private providers, both formal and informal. Simultaneously, house-to-house searches were conducted in 142 villages of 47 blocks during this period. We analyzed data from 5030 VL patients reported in Bihar from January 2018 through July 2019. Of these 3033 were detected passively and 1997 via ACD (15 (0.8%) via house-to-house and 1982 (99.2%) by light touch ACD methods). We constructed multinomial logistic regression models comparing time intervals to diagnosis (30-59, 60-89 and ≥90 days with =90 days compared to the referent of

A catechol-type siderophore was produced extracellularly by Rhizobium sp. strain BICC 651 isolated from Cicer arietinum during growth in iron-deficient medium. Production of the siderophore was fully repressed in the presence of 50 μM Fe3+. The siderophore was purified and characterized as containing 2,3-dihydroxybenzoic acid (DHBA) as the core compound and threonine as its conjugate. The siderophore was able to reverse growth inhibition of the strain induced by ethylenediamine-di(o-hydroxyphenyl-acetic acid) (EDDA). A high-affinity iron-transport system capable of transporting 59Fe-siderophore complex was also induced in Rhizobium BICC 651 grown under iron deficiency. Two protein bands of molecular masses 76 and 82 kDa were also inductively synthesized in the outer membrane of the cells. A partially purified ferrireductase enzyme of Rhizobium BICC 651 catalysed reductive release of iron from the ferric chelate of DHBA. The enzyme had a K m of 0.3 mM for ferri-DHBA, was constitutive in nature, and was present in the cytosolic fraction during growth under both iron-deficient and iron-sufficient conditions. The enzyme occurred as two isoenzymes with R F values of 0.48 and 0.51, respectively, in a nondenaturing polyacrylamide gel.

Effect of cyanate on nitrate reduction by Rhizobium meliloti SU47 was studied. In the presence of cyanate assimilatory nitrate reduction activity appeared in the culture after a long lag and a conspicuously low level of nitrite was accumulated. Dissimilatory nitrate reduction activity was low in the intact cells precultured in KCNO of KNO3 as compared to that in the control. Dissimilatory nitrate reductase activity in the extracts of cells precultured in KCNO was also compared to be low. In the extracts, dissimilatory nitrate reductase activity assayed with increasing concentrations of KCNO confirmed that KCNO acts as an inhibitor of the enzyme.

Introduction This study contributes to our understanding of acculturation and obesity by examining the association between several measures of acculturation, including a bidimensional scale of acculturation, body mass index (BMI), and waist-to-hip ratio (WHR). Methods Exploratory analyses were performed using baseline data from 357 Mexican women recruited into a Spanish-language randomized community trial. The women were randomly sampled by telephone and interviewed in their homes. Women’s height, weight, waist, and hip were measured to obtain estimates of their BMI and WHR. A face-to-face interview collected data on dietary intake, physical activity, acculturation, and other demographic and psychosocial variables. Results Less than a quarter of the women were normal weight (39% overweight and 41% obese). Univariate analyses revealed that more years living in the United States and less integration into the Anglo culture were associated with a larger BMI and WHR. However, in the multivariate analyses, significant correlates of a larger BMI were less moderate physical activity and unemployment. There were trends linking a larger BMI with older age, no vigorous physical activity, more energy intake, and less integration into the Anglo culture. These same variables plus less household income were associated with a higher WHR. Exploratory analyses on acculturation revealed that bicultural Mexican-American women were more educated, more likely to be employed, reported a higher household income, and perceived fewer barriers to a healthy diet compared with traditional Mexican women. Conclusions Intervention designed to prevent overweight/obesity should consider promoting maintenance of Mexican cultural practices, as well as teach women how to effectively integrate into the Anglo culture.