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ObjectiveTo evaluate pertussis antibody status of pregnant women and their newborns, and the impact of antenatal immunisation.DesignObservational study.SettingHospitals in urban western India.ParticipantsPregnant women and their newborns.MethodsPertussis antibody titres in mothers and their newborns were determined. Vaccinated and unvaccinated mothers and their newborns were compared for baseline characteristics, geometric mean titres (GMTs) and placental transfer ratio of antibodies. Multivariate logistic regression was performed to understand the influence of different factors on protective antibody titres.ResultsOf 284 mother–infant pairs, 75 mothers and 73 of their newborns were seropositive for anti-pertussis toxin (PT) IgG antibodies. 94 women were vaccinated in pregnancy; 51 (54.3%) of these mothers and newborns were PT IgG positive, compared with 24 (12.3%) of the women (and 22 newborns) not vaccinated in pregnancy. Women vaccinated in pregnancy and their newborns had higher GMT (30.88 and 32.54 IU/mL), compared with women who were not vaccinated (12.63%, 2.24 IU/mL) and their newborns (11.58%, 2.53 IU/mL). Placental transfer ratios in newborns of mothers vaccinated in pregnancy and those who had childhood immunisation or natural immunity were similar (1.05 and 1.12, respectively). Protective titres of antibodies at birth (>20 IU/mL) were observed in 72.3% vs 21% of newborns of vaccinated and unvaccinated pregnant women, respectively; influenced by mother’s vaccination status and seropositivity.ConclusionProtection against pertussis is low in newborns of mothers who are only immunised during childhood. Vaccination early in pregnancy boosts maternal and neonatal immunity.

Alappuzha coastal district was worst affected by floods due to the heavy rainfall in August 2018. Aedes albopictus survey carried out in the post flood/ disaster areas covering 1,140 households revealed maximum larval positivity in plastic/leather followed by metal and earthen containers. The House index ranged from 1.75 to 12.28 per cent whereas the container index ranged from 1.73 to 20.51 per cent. Breteau index ranged from 3.5 to14.3. As dengue is endemic in the district, there exists a potential outbreak of the vector borne disease.

In rural India, since 2014, the Swachh Bharat Abhiyan (Clean India Mission) has ensured construction of more than 100 million toilets and is now focusing on reinforcement of sanitation behaviors. We report a cholera outbreak in a remote village in western India where open defecation was implicated in causation. A water pipeline was damaged in the vicinity of a stream flowing from a site of open defecation. Despite the availability of a toilet facility in the majority of households (75%), open defecation was widely practiced (62.8%). Many reported not washing hands with soap and water before eating (78.5%) and after defecation (61.1%). The study emphasizes the need for focused health behavior studies and evidence-based interventions to reduce the occurrence of cholera outbreaks. This could be the last lap in the path toward achieving the United Nations Sustainable Development Goal 6, which aims to “ensure availability and sustainable management of water and sanitation for all.”

Background India has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to, Author summary Rubella infection during the first trimester of pregnancy can affect fetus, resulting in spontaneous abortion, stillbirth or birth of a baby with a combination of birth defects known as congenital rubella syndrome (CRS). Vaccination with rubella containing vaccine (RCV) is recommended as one of the strategies for eliminating rubella/CRS. The Southeast Asia region has set a target to eliminate rubella/CRS by 2023. Towards this goal, India completed nationwide immunization campaigns using measles-rubella vaccine during 2017–19, targeting children aged 9 months to

Rubella or German measles is an infection caused by rubella virus (RV). Infection of children and adults is usually characterized by a mild exanthematous febrile illness. However, RV is a major cause of birth defects and fetal death following infection in pregnant women. RV is a teratogen and is a major cause of public health concern as there are more than 100,000 cases of congenital rubella syndrome (CRS) estimated to occur every year. Several lines of evidence in the field of molecular biology of RV have provided deeper insights into the teratogenesis process. The damage to the growing fetus in infected mothers is multifactorial, arising from a combination of cellular damage, as well as its effect on the dividing cells. This review focuses on the findings in the molecular biology of RV, with special emphasis on the mitochondrial, cytoskeleton and the gene expression changes. Further, the review addresses in detail, the role of apoptosis in the teratogenesis process.

Background Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of mental retardation, developmental delay and sensorineural deafness. Nonprimary infection plays a major role in transmission of this infection in countries with high maternal seroprevalence. Noninvasive sampling and testing is a useful alternative to traditional methods of laboratory detection of congenital CMV infection. The present study was conducted to understand birth prevalence of cCMV infection using molecular techniques, in an urban setting of a developing country with evidence of high maternal seroprevalence. Methods Universal newborn screening for cCMV was performed for 750 infants born at a tertiary care center in Western India. Real-time polymerase chain reaction was directly carried out on saliva samples. Follow-up laboratory testing of saliva, urine and blood was performed for neonates identified as positive. Sequential clinical follow-up was offered to the affected infants. Results A birth prevalence of 0.4% (95% CI: 0.13-1.2) was observed with 3 of 750 babies confirmed to be positive for cCMV infection. All 3 babies were born to seropositive mothers (anti-CMV immunoglobulin G positive). One of the babies detected was symptomatic with sepsis like features. All of them survived and did not develop any sequelae up to 1 year of age. Conclusion The use of direct real-time polymerase chain reaction of saliva samples can be considered as a feasible option for newborn screening of congenital CMV infection in developing countries. Relatively low birth prevalence of cCMV infection was observed in our study, which needs to be corroborated through further studies.

In the aftermath of a natural disaster, multispecialty rapid response teams are deployed to support health-related relief work. Microbiologists are often part of such teams, along with public health specialists, clinicians and entomologists, and can contribute to the response in multiple ways. The role of a microbiologist is critical not only for laboratory diagnosis of infectious diseases, but also for situational analysis and evaluation, planning, prevention and control. The task begins with risk assessment, specifically for identification of diseases epidemic and endemic to the area. Evaluation of existing laboratory setups and establishment of services where none exist is a priority, including facilitation of a tiered laboratory system. Training of laboratory staff at short notice in field settings, biosafety and biomedical waste management are niche areas where microbiologists can contribute. Emerging focus areas include establishment of modular laboratories, infection prevention and control in community evacuation centres and considerations for reopening of healthcare facilities closed due to extensive natural damage. A trained and efficient microbiologist will prove a valuable asset to provide timely and useful support for infectious disease diagnosis, prevention, control and management in the wake of natural disasters.

Background Government of India is committed to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020. In 2016, CRS surveillance was established in five sentinel sites. We analyzed surveillance data to describe the epidemiology of CRS in India. Methodology/Principal findings We used case definitions adapted from the WHO-recommended standards for CRS surveillance. Suspected patients underwent complete clinical examination including cardiovascular system, ophthalmic examination and assessment for hearing impairment. Sera were tested for presence of IgM and IgG antibodies against rubella. Of the 645 suspected CRS patients enrolled during two years, 137 (21.2%) were classified as laboratory confirmed CRS and 8 (1.2%) as congenital rubella infection. The median age of laboratory confirmed CRS infants was 3 months. Common clinical features among laboratory confirmed CRS patients included structural heart defects in 108 (78.8%), one or more eye signs (cataract, glaucoma, pigmentary retinopathy) in 82 (59.9%) and hearing impairment in 51. (38.6%) Thirty-three (24.1%) laboratory confirmed CRS patients died over a period of 2 years. Surveillance met the quality indicators in terms of adequacy of investigation, adequacy of sample collection for serological diagnosis as well as virological confirmation. Conclusions/Significance About one fifth suspected CRS patients were laboratory confirmed, indicating significance of rubella as a persistent public health problem in India. Continued surveillance will generate data to monitor the progress made by the rubella control program in the country., Author summary Rubella infection during the first trimester of pregnancy can affect the fetus, resulting in spontaneous abortion, stillbirth or an infant born with a combination of birth defects known as congenital rubella syndrome (CRS). Government of India is committed to eliminate measles and control rubella/CRS and has completed nationwide immunization campaigns using measles-rubella vaccine targeting children aged 9 months to 14 years. A case-based surveillance for CRS is one of the strategies for achieving elimination. The Indian Council of Medical Research and the Ministry of Health and Family Welfare initiated surveillance for CRS in five sentinel sites to estimate the disease burden. During 2016–18, the surveillance sites enrolled 645 suspected CRS patients, 137 (21.2%) were classified as laboratory confirmed CRS and 8 (1.2%) as congenital rubella infection. Common clinical features among laboratory confirmed CRS patients included structural heart defects (78.8%), one or more eye signs (cataract, glaucoma, pigmentary retinopathy (59.9%)) and hearing impairment (38.6%). Thirty-three (24.1%) laboratory confirmed CRS patients died over a period of 2 years. The surveillance data indicated significance of rubella as persistent public health problem in India.

• After WHO declaration of Zika threat, a surveillance program was conducted under the initiative of Department of Health research/ Indian council of Medical Research, Ministry of Health, India using Virology Research and Diagnostic Laboratories (VRDL) network.

Background & objectives: Differential diagnosis of Crimean-Congo haemorrhagic fever (CCHF) from other acute febrile illnesses with haemorrhagic manifestation is challenging in India. Nosocomial infection is a significant mode of transmission due to exposure of healthcare workers to blood and body fluids of infected patients. Being a risk group 4 virus, laboratory confirmation of infection is not widely available. In such a situation, early identification of potential CCHF patients would be useful in limiting the spread of the disease. The objective of this study was to retrospectively analyse clinical and laboratory findings of CCHF patients that might be useful in early detection of a CCHF case in limited resource settings. Methods: Retrospective analysis of clinical and laboratory data of patients suspected to have CCHF referred for diagnosis from Gujarat and Rajasthan States of India (2014-2015) was done. Samples were tested using CCHF-specific real time reverse transcription (RT)-PCR and IgM ELISA. Results: Among the 69 patients referred, 21 were laboratory confirmed CCHF cases of whom nine had a history of occupational exposure. No clustering of cases was noted. Platelet count cut-off for detection of positive cases by receiver operating characteristic curve was 21.5×10[9]/l with sensitivity 82.4 per cent and specificity 82.1 per cent. Melaena was a significant clinical presentation in confirmed positive CCHF patients. Interpretation & conclusions: The study findings suggest that in endemic areas thrombocytopenia and melaena may be early indicators of CCHF. Further studies are needed to confirm these findings.

Enzyme linked immunosorbent assay (ELISA) for antibody identification, is important for laboratory confirmation of rubella infection in different settings. The Enzygnost rubella ELISA, widely used in the World Health Organization (WHO) Global Measles and Rubella Laboratory Network, is expensive and often unavailable. Qualitative and quantitative performance of the Euroimmun ELISA was compared with the Enzygnost ELISA, for detection of rubella specific IgM, using 283 sera collected from suspected congenital rubella syndrome (CRS) patients and IgG antibodies using 435 sera from a serosurvey among pregnant women. Good qualitative agreement was observed for detection of both rubella specific IgM (94.7% agreement and κ of 0.86) and IgG (96.3% agreement and κ of 0.84). Bland-Altman analysis for IgG yielded a mean difference of 0.781 IU/ml with 97.1% values within ±2 SD of the mean difference. Our study findings suggest that Euroimmun ELISA may be considered for detection of rubella specific IgM in suspected CRS cases and rubella specific IgG in surveillance studies.

Background & objectives: Kyasanur forest disease (KFD) is an infectious disease discovered in Karnataka State of India in 1957; since then, the State has been known to be enzootic for KFD. In the last few years, its presence was observed in the adjoining five States of the Western Ghats of India. The present study was conducted to understand the kinetics of viral RNA, immunoglobulin M (IgM) and IgG antibody in KFD-infected humans for developing a diagnostic algorithm for KFD. Methods: A prospective follow up study was performed among KFD patients in Sindhudurg district of Maharashtra State, India. A total of 1046 suspected patients were tested, and 72 KFD patients were enrolled and followed for 17 months (January 2016 to May 2017). Serum samples of KFD patients were screened for viral RNA, and IgM and IgG antibodies. Results: KFD viral positivity was observed from 1st to 18th post-onset day (POD). Positivity of anti-KFD virus (KFDV) IgM antibodies was detected from 4th till 122nd POD and anti-KFDV IgG antibodies detected from 5th till 474th POD. A prediction probability was determined from statistical analysis using the generalized additive model in R-software to support the laboratory findings regarding viral kinetics. Interpretation & conclusions: This study demonstrated the presence of KFD viral RNA till 18th POD, IgM antibodies till 122nd POD and IgG till the last sample collected. Based on our study an algorithm was recommended for accurate laboratory diagnosis of KFDV infection. A sample collected between 1 and 3 POD can be tested using KFDV real-time reverse transcriptase polymerase chain reaction (RT-PCR); between 4 and 24 POD, the combination of real-time RT-PCR and anti-KFDV IgM enzyme-linked immunosorbent assay (ELISA) tests can be used; between POD 25 and 132, anti-KFDV IgM and IgG ELISA are recommended.

Non-fermenting gram-negative bacilli (NFGNB) are an emerging problem in neonatal sepsis. A major concern is multi-drug resistance which severely limits treatment options.A retrospective observational study was conducted to analyse the role of non-fermenters in neonatal sepsis over a 4-year period, the factors leading to this trend and the pattern of antibiotic resistance.Demographic and clinical data were collected for all neonates with blood culture-positive sepsis during the study period, January 2007 to December 2010.Blood cultures were positive in 186 (13%) of 1402 neonates, in 44 (32.1%) of whom the cause was NFGNB. Acinetobacter spp was the most common organism (n = 30). Infection by NFGNB showed a steady increase (P0.0001), and was fairly evenly distributed between early- and late-onset sepsis. The infection rate was significantly higher in inborn neonates (P = 0.04) and those delivered vaginally (P = 0.002). Multi-drug resistance (MDR) occurred in 50% and carbapenem resistance in 30% of Acinetobacter spp isolates. In five cases there was panresistance of Acinetobacter spp to all antibiotics tested.The trend of increasing numbers of cases of NFGNB in neonatal sepsis compounded by MDR is of great concern. It is necessary to administer antibiotics judiciously, strengthen surveillance and laboratory services in neonatal intensive care units, and re-evaluate treatment guidelines for management of infection by these organisms.

Sepsis is an important cause of morbidity and mortality among neonates. Enteric Gram-negative bacteria and Staphylococcus aureus are common causes of neonatal sepsis in the developing world. We report a case of neonatal sepsis caused by Brevundimonas vesicularis. To the best of our knowledge, this is the first case report of invasive B. vescularis infection in a newborn in the English literature.

To investigate the trend of tigecycline susceptibility and mechanisms behind tigecycline non-susceptibility in Klebsiella pneumoniae and Escherichia coli isolates causing neonatal septicaemia (2007-10).MICs of tigecycline for the isolates were determined. The isolates were evaluated for β-lactamases and carbapenemases. Molecular typing of the tigecycline-resistant isolates was performed. Expression of efflux pump genes (acrA, acrB and tolC) and regulators (soxS and ramA) was examined by real-time RT-PCR and western blotting. Sequencing of the ramA and ramR genes was carried out to identify mutations within these genes.Tigecycline susceptibility was evaluated in all K. pneumoniae (n = 57) and E. coli (n = 19) blood isolates. The prevalence of extended-spectrum β-lactamase (ESBL)-producing organisms was high, but tigecycline non-susceptibility remained low in these isolates. Though MIC values of tigecycline remained in the susceptible range, there was a 2-fold increase in the value of MIC90 from 2007 to 2010. Over the 4 year period K. pneumoniae showed higher MIC values of tigecycline in comparison with E. coli. Tigecycline non-susceptibility was not observed among carbapenem-resistant isolates. Only two ESBL-producing clonally distinct K. pneumoniae isolates showed tigecycline resistance with overexpression of ramA and the AcrAB-TolC pump. No mutations were present within the ramA and ramR genes that might enhance the expression of the pump.The study showed for the first time the trend of tigecycline susceptibility in E. coli and K. pneumoniae causing neonatal septicaemia. Tigecycline still has potent antimicrobial effects against most ESBL- or carbapenemase-producing K. pneumoniae and E. coli, but the increasing MIC values make it essential to be vigilant.

Objective To study the organisms causing early and late onset neonatal sepsis, with special reference to multi-drug resistant gram negative bacilli, at two neonatal units (one urban, one rural) in India. Methods Prospective surveillance study. Results There were 159 episodes of sepsis (81 urban and 77 rural) affecting 158 babies. Gram negative bacilli caused 117 infections (68%) and predominated at both centres in both early and late sepsis. Klebsiella pneumoniae was the commonest organism, causing 61 infections (38.3%). In early sepsis (0–2 days), non-fermenting gram negative bacilli caused 42.1% of infections at the urban centre; there were no cases of early Group B Streptococcus sepsis. Late onset sepsis was mainly caused by gram negative bacilli at both centres. Multi-drug resistance of over 80% of early-onset gram negative organisms to ampicillin, third generation cephalosporins and gentamicin indicates that these multi-resistant organisms are almost certainly circulating widely in the community. The overall mortality from early sepsis was 27.3% (9 of 33) and from late sepsis was 26.2% (33 of 126). Gram negative bacilli caused all deaths from early sepsis and 87.5% of deaths from late sepsis. Conclusion This study shows that multi-drug resistant gram negative bacilli are a major cause of early and late neonatal sepsis in India and are almost certainly widespread in the community.

Stenotrophomonas maltophilia, a multi drug resistant non fermenting Gram negative bacillus is an increasingly common nosocomial pathogen, especially in intensive care units. Comparatively few cases of infection have been reported in neonatal population. We present two cases of early onset neonatal sepsis due to S.maltophilia and a brief review of documented isolation in neonates.

Neonatal sepsis due to carbapenem-resistant bacteria is difficult to treat due to limited therapeutic options. The detection of the new carbapenemase New Delhi metallo-β-lactamase-1 (NDM-1) from neonates has further complicated the situation (Roy et al., 2011a). The potent metallo-β-lactamase NDM-1 efficiently hydrolyses all classes of β-lactam antibiotics (penicillins, cephalosporins and carbapenems) and is also associated with multiple determinants that enable the bacteria to become resistant to other antibiotic classes (Nordmann et al., 2011). In the presence of NDM-1 other β-lactamases may go unobserved because of the spectrum of activity of NDM-1 against all β-lactam antibiotics. Thus, under the canopy of the NDM-1 these β-lactamases also get the opportunity to spread. This communication reports association of two novel β-lactamases, SHV-type β-lactamase (SHV-167) and AmpC-type β-lactamase (ACT-16), in two NDM-1-carrying Enterobacteriaceae isolated from the blood of two septicaemic neonates admitted to a neonatal intensive care unit.

To review aetiological agents of neonatal sepsis and their antibiotic resistance pattern over the past 3 years, at a 20 bedded Level III neonatal intensive care unit (NICU) in eastern India. Blood culture reports of culture positive sepsis were reviewed for the period 2007–2009. Demographic data of the babies was collected. Blood culture was done for 997 neonates with suspected clinical sepsis. The incidence of culture proven neonatal sepsis among inborn babies was 14.8/1,000 live births. The proportion of culture positive sepsis for outborn babies admitted in neonatal intensive care unit was 8.3%. Gram negative aetiology was predominant (71.6%), with Klebsiella pneumoniae being the most common isolate. Non fermenting Gram negative bacilli like Acinetobacter sp emerged as an important cause of infection. The aetiology of early onset and late onset sepsis was similar. The proportion of resistance to common first and second line antibiotics like ampicillin (98.5%), gentamicin (84.4%), amikacin (65.6%) and cefotaxime (81.3%) was high. The present study is the first in recent years from eastern India on aetiology and antimicrobial resistance in neonatal sepsis. Two areas of concern were the emergence of non fermenting Gram negative bacilli as causative organisms and the alarming degree of antibiotic resistance observed for commonly used antibiotics

Infections caused by Acinetobacter baumannii are a threat to neonates because of its resistance to antimicrobials, including carbapenems. In 2007, A. baumannii emerged as an important aerobic Gram-negative bacillus (12.5%, 4/32) that caused sepsis in our unit. A. baumannii from the gut of the neonates was analyzed, as this could be indicative of the antibiotic resistance of the organisms. The study attempts to understand the gut colonization with multidrug-resistant A. baumannii among hospitalized neonates with special reference to carbapenem resistance. A. baumannii was found in the gut of 11% of babies. Interestingly, 60.7% (17/28) and 21.4% (6/28) of the isolates from the gut were multidrug-resistant and carbapenem-resistant, respectively. The number of multidrug-resistant and carbapenem-resistant isolates from blood cultures were 3/4 and 1/4, respectively. The study reports for the first time OXA-23 and OXA-58 carbapenemases in A. baumannii from India. Pulsed field gel electrophoresis (PFGE) patterns indicated that the strains were diverse and no epidemic clone existed. Though A. baumannii gut colonization could not be implicated as a risk factor for subsequent sepsis, the high rate of isolation of multidrug-resistant and carbapenem-resistant isolates indicates that these therapeutic options might be drastically reduced among neonates in the future.

The various thermal properties, viz., specific heat, thermal conductivity and thermal diffusivity were determined for both the grains and flours of foxtail millet (Sestaria italia), little millet (Panicum miliare), poroso millet (Panicum miliaceum), kodo millet (Paspalum sorobiculatum), finger millet (Eleusine coracana) and barnyard millet (Echinochola colona) in the moisture content range of 10–30%. Specific heat was determined using the method of mixtures and the transient heat flow method, and a thermal diffusivity probe was used for the determination of thermal conductivity and thermal diffusivity of the millets and their flours. An increase in specific heat was observed in the range of 1·33– 2·40 kJ kg −1 K −1 for both grains and flours, with an increase in moisture content. The thermal conductivity of the millet grains increased from 0·119– 0·223 W m −1 K −1 and the flours increased from 0·026– 0·128 W m −1 K −1 in the moisture range of 10–30%. The thermal conductivity of flour was considerably less than that of grains. As the moisture content increased from 10 to 30% (wb), thermal diffusivity of millet grains decreased from 0·731×10−3 to 0·55×10 −3 m 2 h −1 and that of their flours ranged from 0·820×10−3 to 0·592×10 −3 m 2 h −1 . Notation A constant D thermal diffusivity, m 2 h −1 H c heat capacity of the calorimeter, kJ K −1 H ca heat capacity of the capsule, kJ K −1 Q heat input, W R inner radius of the cylinder, m S specific heat of sample, kJ kg −1 K −1 S w specific heat of water, kJ kg −1 K −1 T 1 temperature at time θ 1 , K T 2 temperature at time θ 2 , K T cp temperature at the centre of the thermal diffusivity probe, K T e equilibrium temperature of the mixture in the calorimeter, K T s temperature of the sample, K T sp temperature at the outer surface of the thermal diffusivity probe, K T w initial temperature of water in the calorimeter, K W s mass of sample, kg W w mass of water in the calorimeter, kg θ 0 time correction factor, s θ 1 time corresponding to temperature T 1 , s θ 2 time corresponding to temperature T 2 , s

Although sepsis is a major cause of morbidity and mortality among newborns in resource-poor countries, little data are available from rural areas on culture-proven sepsis. The aim of the present study was to provide information in this regard. The study reports results on the incidence and aetiology of neonatal sepsis cases admitted to a facility in a rural area in eastern India. Blood culture was done for all babies, with suspected clinical sepsis, who were admitted to the sick newborn care unit at Suri where the study was conducted during March 2009–August 2010. A standard form was used for collecting clinical and demographic data. In total, 216 neonatal blood culture samples were processed, of which 100 (46.3%) grew potential pathogens. Gram-negative infection was predominant (58/100 cases) mainly caused by enteric Gram-negative bacteria. Klebsiella pneumoniae was the most common Gram-negative isolate. The emergence of fungal infection was observed, with 40% of the infection caused by yeast. Gram-negative organisms exhibited 100% resistance to ampicillin, cefotaxime, and gentamicin. Amikacin and co-trimoxazole showed 95% (n=57) resistance, and ciprofloxacin showed 83.3% (n=50) resistance among the Gram-negative bacteria. Carbapenem showed emerging resistance (n=4; 6.6%). Results of analysis of risk factors showed an extremely significant association between gestation and sepsis and gender and sepsis. Gastrointestinal symptoms were highly specific for fungal infections. One-third of babies (n=29), who developed culture-positive sepsis, died. Blood culture is an investigation which is frequently unavailable in rural India. As a result, empirical antibiotic therapy is commonly used. The present study attempted to provide data for evidence-based antibiotic therapy given to sick newborns in such rural units. The results suggest that there is a high rate of antibiotic resistance in rural India. Urgent steps need to be taken to combat this resistance.

This study reports a cluster of septicaemic newborns with imipenem-resistant Escherichia coli in the blood and delineates the possible mechanisms of transmission of imipenem resistance with respect to the New Delhi metallo-β-lactamase (NDM-1) gene.During a point prevalence survey, attempts were made to isolate Gram-negative bacilli (GNB) from the environment of a sick newborn care unit (SNCU) and body sites of neonates. Subsequently, four fresh neonates admitted to the SNCU developed sepsis with E. coli. E. coli isolates from body sites and blood of the newborns were analysed in terms of clonality, carbapenemases, integrons, virulence factors, porins and transmissibility.During the survey, both imipenem-resistant and imipenem-susceptible E. coli were isolated from the body sites of neonates, but none from the environment. None of these neonates developed sepsis. The freshly admitted septicaemic neonates had imipenem-resistant E. coli in their blood, which were similar to the imipenem-susceptible E. coli obtained from the body sites (during the survey) in terms of clonality, phylogroup, virulence and other resistance genes, except possession of bla(NDM-1). Imipenem-resistant E. coli from blood and body sites were not clonal, though both had bla(NDM-1). Besides E. coli, other GNB isolated from the environment and body sites also harboured bla(NDM-1). Imipenem-resistant and imipenem-susceptible E. coli from the blood and body sites respectively, possessed a novel AmpC β-lactamase, bla(CMY-59). The plasmid carrying bla(NDM-1) was transferable.The time frame of isolation and clonal identity indicated a possible transfer of bla(NDM-1) from imipenem-resistant GNB to the imipenem-susceptible E. coli, which subsequently caused septicaemia. This establishes the promiscuous nature of bla(NDM-1) and emphasizes the need for the early recognition of similar isolates.

A pilot study was undertaken to develop a feasible neonatal screening strategy for hemoglobinopathies. Isoelectric focusing using dried blood spots samples as a primary screening technique was standardized for the first time in India. The screened positives were confirmed by high performance liquid chromatography followed by parental screening, confirmation, and education.

SUMMARYNewborns often present with skin conditions ranging from transient benign to severe. An occasional cause of neonatal exanthemic rash is infection due to Gram-positive bacteria, but Gram-negative infection is uncommon. We describe an outbreak of sepsis in 10 neonates over a 2-week period, caused by Klebsiella pneumoniae in a level III neonatal intensive care unit (NICU). Seven babies developed an exanthematous maculopapular rash. Molecular analysis by pulsed-field gel electrophoresis showed that all the babies with rash were infected by a single strain of K. pneumoniae which was distinct from the strain recovered from babies without rash.

Occurrence of sugarcane yellow leaf syndrome (SCYLV) has been reported from four states (U.P., Haryana, Maharashtra, Tamil Nadu) of India. The association of SCYLV was confirmed by DAC-ELISA test using polyclonal antiserum. This is the first report of the occurrence of sugarcane yellow leaf virus in India.

Rubella infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). The 11 countries in the World Health Organization (WHO) South-East Asia Region are committed to the elimination of measles and control of rubella and CRS by 2020. Until 2016, when the Government of India's Ministry of Health and Family Welfare and the Indian Council of Medical Research initiated surveillance for CRS in five sentinel sites, India did not conduct systematic surveillance for CRS. During the first 8 months of surveillance, 207 patients with suspected CRS were identified. Based on clinical details and serologic investigations, 72 (34.8%) cases were classified as laboratory-confirmed CRS, four (1.9%) as congenital rubella infection, 11 (5.3%) as clinically compatible cases, and 120 (58.0%) were excluded as noncases. The experience gained during the first phase of surveillance will be useful in expanding the surveillance network, and data from the surveillance network will be used to help monitor progress toward control of rubella and CRS in India.