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Background Quantitative molecular assays are increasingly used for detection of enteric viruses. Methods We compared the clinical severity using the modified Vesikari score (mVS) of enteric viruses detected by conventional assays (enzyme immunoassays [EIAs] for rotavirus and adenovirus 40/41 and conventional polymerase chain reaction for astrovirus, sapovirus, and norovirus) and a quantitative molecular assay (TaqMan Array Card [TAC]) among children aged 0–59 months in the Global Enteric Multicenter Study. For rotavirus and adenovirus 40/41, we compared severity between EIA-positive and TAC-positive cases assigned etiologies using different cycle threshold (Ct) cutoffs. Results Using conventional assays, the median mVS (interquartile range) was 10 (8–11) for rotavirus, 9 (7–11) for adenovirus 40/41, 8 (6–10) for astrovirus, sapovirus, and norovirus GII, and 7 (6–9) for norovirus GI. Compared with rotavirus EIA-positive cases, the median mVS was 2 and 3 points lower for EIA-negative/TAC-positive cases with Ct <32.6 or Ct ≥32.6 and <35, respectively (P <.001). Adenovirus 40/41 EIA-positive and EIA-negative/TAC-positive cases were similar, regardless of Ct cutoff. Conclusions Quantitative molecular assays compared with conventional assays, such as EIA, may influence the severity of identified cases, especially for rotavirus. Cutoffs to assign etiology for quantitative assays should be considered in the design and interpretation of enteric virus studies. [ABSTRACT FROM AUTHOR]

Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0–11 months of age and ST-ETEC infections among children 12–23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12–59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children's feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities. [ABSTRACT FROM AUTHOR]

Abstract Background There is not much information on the differences in clinical, epidemiological and spatial characteristics of diarrhea due to V. cholerae and V. parahaemolyticus from non-coastal areas. We investigated the differences in clinical, epidemiological and spatial characteristics of the two Vibrio species in the urban slums of Kolkata, India. Methods The data of a cluster randomized cholera vaccine trial were used. We restricted the analysis to clusters assigned to placebo. Survival analysis of the time to the first episode was used to analyze risk factors for V. parahaemolyticus diarrhea or cholera. A spatial scan test was used to identify high risk areas for cholera and for V. parahaemolyticus diarrhea. Results In total, 54,519 people from the placebo clusters were assembled. The incidence of cholera (1.30/1000/year) was significantly higher than that of V. parahaemolyticus diarrhea (0.63/1000/year). Cholera incidence was inversely related to age, whereas the risk of V. parahaemolyticus diarrhea was age-independent. The seasonality of diarrhea due to the two Vibrio species was similar. Cholera was distinguished by a higher frequency of severe dehydration, and V. parahaemolyticus diarrhea was by abdominal pain. Hindus and those who live in household not using boiled or treated water were more likely to have V. parahaemolyticus diarrhea. Young age, low socioeconomic status, and living closer to a project healthcare facility were associated with an increased risk for cholera. The high risk area for cholera differed from the high risk area for V. parahaemolyticus diarrhea. Conclusion We report coexistence of the two vibrios in the slums of Kolkata. The two etiologies of diarrhea had a similar seasonality but had distinguishing clinical features. The risk factors and the high risk areas for the two diseases differ from one another suggesting different modes of transmission of these two pathogens.

We believe a lack of transparency undermines both the credibility of, and interest in, stated choice studies among policy makers. Unlike articles reporting the results of contingent valuation studies, papers in the stated choice literature rarely present simple tabulations of raw response data (that is, a table or graph showing the percentage of respondents agreeing to purchase a good or service, or vote for a proposed management plan as a function of price). We describe an approach for adding "policy" tasks to a standard orthogonal-in-attribute-levels research design that allows the researcher to plot raw responses as a function of changes in only one characteristic of the offered good or service. We demonstrate this approach using data from a stated choice study of private demand for cholera and typhoid vaccines in Kolkata, India, carried out in the summer of 2004.

Objective To define mortality patterns in an urban slum in Kolkata, India, in the context of a cholera and typhoid fever project. Methods In a well-defined population that was under surveillance for 18 months, we followed a dynamic cohort of 63 788 residents whose households were visited monthly by community health workers to identify deaths. Trained physicians performed verbal autopsies and experienced senior physicians assigned the primary cause of death according to the International classification of diseases, 10th edition. We tabulated causes of death in accordance with Global Burden of Disease 2000 categories and assessed overall and cause-specific mortality rates per age group and gender. Findings During 87 921 person-years of follow-up, we recorded 544 deaths. This gave an overall mortality rate of 6.2 per 1000 person-years. We assigned a cause to 89% (482/544) of the deaths. The leading causes of death, in descending order, were cardiovascular diseases (especially among adults aged over 40 years), cancer, respiratory ailments and digestive disorders. Most deaths in children under 5 years of age were caused by tuberculosis, respiratory infections and diarrhoeal diseases. Conclusion Although the most common causes of death in children were infectious, non-communicable diseases were predominant among adults. There is a need for continuing interventions against infectious diseases in addition to new and innovative strategies to combat non-infectious conditions. Objectif Definir des modeles de mortalite dans un quartier urbain pauvre de Kolkata en Inde, dans le contexte d'un projet cholera et fievre typhoide. Methodes Au sein d'une population bien definie, surveillee pendant 18 mois, nous avons suivi une cohorte dynamique de 63788 residents dont les foyers ont ete visites chaque mois par des professionnels communautaires de la sante pour identifier les deces. Des medecins competents ont realise des autopsies verbales et des professeurs experts ont reference la cause primaire du deces a partir de la Classification internationale des maladies, 10e edition. Nous avons mis en tableau les causes de deces conformement aux categories du <> et nous avons evalue les taux de mortalite generaux et pour cause specifique par tranche d'age et par sexe. Resultats Au cours des 87921 personnes-annees de suivi, nous avons enregistre 544 deces. Cela donne un taux de mortalite total de 6,2 par 1 000 personnes-annees. Nous avons attribue une cause a 89% (482/544) des deces. Les principales causes de deces, par ordre decroissant, etaient des maladies cardio-vasculaires (surtout parmi les adultes ages de 40 ans et plus), des cancers, des maladies respiratoires et des troubles digestifs. La plupart des deces chez les enfants de moins de 5 ans ont ete causes par la tuberculose, des infections respiratoires et des maladies diarrheiques. Conclusion Alors que les causes de deces les plus communes chez les enfants etaient d'origine infectieuse, les maladies non transmissibles ont ete predominantes chez les adultes. Des interventions en continu sont necessaires contre les maladies infectieuses, conjointement a ales strategies nouvelles et innovatrices pour combattre les conditions non infectieuses. Objetivos Definir los patrones de mortalidad en un barrio urbano pobre de Kolkata, India, dentro dei contexto de un proyecto contra el colera y la fiebre tifoidea. Metodos En una poblacion bien definida y sometida a vigilancia durante 18 meses se realizo el seguimiento de un conjunto de 63 788 residentes, cuyos hogares recibieron visitas mensuales, dei personai sanitario comunitario para identificar las defunciones. Las entrevistas con los familiares y allegados de las personas fallecidas fueron realizadas por medicos expertos, y los directores medicos atribuyeron la causa principal de la muerte siguiendo la Clasificacion Intemacional de Enfermedades, 10.a edicion. Las causas de la muerte se clasificaron segun las categorias de la Carga Mundial de Morbilidad dei 2000 y se evaluaron las tasas de mortalidad general y especifica de cada caso en funcion dei grupo de edad y dei sexo. Resultados Se registraron 544 muertes durante el seguimiento de 87921 anos-persona. Estos datos generaron una tasa de mortalidad de 6,2 por 1000 anos-persona. En el 89% de las muertes (482/544) se asigno una causa. Las principales causas de defuncion, en orden descendente, fueron: las enfermedades cardiovasculares (fundamentalmente, entre los adultos mayores de 40 anos), el cancer, las enfermedades respiratorias y los trastornos digestivos. La mayoria de las muertes acaecidas en ninos menores de cinco anos se debieron a la tuberculosis, las infecciones respiratorias y las enfermedades diarreicas. Conclusion Aunque las causas mas frecuentes de muerte infantil fueron las infecciosas, en los adultos predominaron las enfermedades infecciosas no contagiosas. Es necesario continuar con las intervenciones contra las enfermedades infecciosas, asi como iniciar estrategias nuevas e innovadoras para luchar contra las enfermedades no infecciosas., Introduction Mortality data are important indicators of population health and are crucial for setting priorities for health interventions and research. However, in areas with scanty resources little reliable information is [...]

A study was conducted to ascertain the efficacy of the Vi polysaccharide typhoid vaccine when administered to children less than 5 years of age. Results revealed that the vaccine was effective in young children as well as protected the unvaccinated neighbors of vaccinees and should be used in areas where typhoid is endemic.

Objective. To assess the impact of zinc supplementation on diarrheal morbidity and growth pattern of low birth weight (LBW) infants. Methodology. In a randomized, double-blind, placebo-controlled, community-based study conducted in the Tiljala slum of eastern Kolkata, India, between 1999 and 2001, a birth cohort of 100 LBW infants was randomly allocated into either an intervention group receiving 1 mL daily dose of 5 mg of elemental zinc as zinc sulfate in vitamin B complex-based syrup or a placebo group receiving an identical placebo of 1 mL of vitamin-based syrup from birth up to 1 completed year of age. Active weekly surveillance was conducted for detection of diarrhea. Anthropometric measurements of each child were recorded once every month as close to the child&apos;s birth date as possible. Data were analyzed by using statistical software packages SPSSPC+ 4.0 (SPSS, Inc, Chicago, IL) and Epi Info 6.0 (Centers for Disease Control and Prevention, Atlanta, GA). Results. Among the zinc-supplemented group, diarrheal incidence of 1.36 episodes per child per year were observed, whereas it was 1.93 episodes per child per year among the placebo group, giving a relative risk of 1.4 (95% confidence interval: 1.02-2.00). Linear growth and weight for age showed significant differences between the supplemented and placebo groups only at the end of 1 year. Interestingly, the impact of zinc supplementation was masked to a large extent by the protective action of breastfeeding. Conclusions. The study showed that zinc supplementation had a beneficial impact on the incidence of diarrhea and also weight gain among LBW infants. Pediatrics 2003;112:1327-1332; low birth weight, zinc supplementation, diarrhea, nutrition, breastfeeding., The role of zinc in human nutrition is being increasingly highlighted after recent advances in biomedical research. Zinc as a micronutrient contributes greatly to healthy growth and development, especially of [...]