An outbreak of acute hemorrhagic conjunctivitis due to Coxsackievirus A24 in a residential school, Naharlagun, Arunachal Pradesh: July 2023.

PURPOSE: An acute conjunctivitis outbreak was investigated at a residential school in Naharlagun, Arunachal Pradesh, Northeast India, in July 2023. We aimed to identify the etiological agent and assess any complications in follow-up cases. METHODS: We used a structured questionnaire to record clinical findings and followed up with cases one-month post-conjunctivitis. Sixty-one cases were examined and eight conjunctival and oropharyngeal swab samples were collected after obtaining informed consent from guardians/school authorities. We screened for 33 viral and bacterial pathogens using an IVD-approved Real-time PCR assay. Further, the samples were subjected to nucleic acid sequencing. RESULTS: Among 465 screened students and staff, 80 individuals (approximately 17.2%) showed acute hemorrhagic conjunctivitis symptoms among which 61 cases were available for clinical examination. We identified the Enterovirus responsible by targeted sequencing using next-generation sequencing. The etiological agent was found to be Coxsackievirus A24, a member of Enterovirus C, in seven out of eight samples subjected to sequencing. Common symptoms included conjunctival hyperemia and foreign body sensation (100%), bilateral eye involvement (73.8%), eye pain (70%), watery discharge (49.2%), and eyelid swelling (38%). Only 6.5% had purulent discharge. Most cases resolved within 5-6 days, with only 9.8% reporting abdominal symptoms post-conjunctivitis. No serious complications occurred within one month. Throat swabs aided in diagnosing enterovirus infections alongside eye swabs. CONCLUSIONS: The outbreak of acute conjunctivitis was caused by Coxsackievirus A24, a member of Enterovirus C. Cases resolved spontaneously within 6-7 days, with no severe complications. Collecting oropharyngeal swabs alongside conjunctival swabs could improve enteroviral conjunctivitis diagnosis.

Stakeholder Analysis for Hypertension Management in the Context of the Indian Public Health System.

BACKGROUND: Hypertension (HTN) portends a significant public health burden in India and calls for multi-stakeholder action. OBJECTIVES: We aimed to analyze the role of key stakeholder constituencies implicated in managing HTN across different levels of care within the public health system in India, alongside the enablers and barriers for effective program implementation. METHODS: We reviewed 45 articles and policy documents, and 17 consenting stakeholder representatives scored the stakeholder constituencies for "power," "position" and "interest." They ranked enablers and barriers to noncommunicable disease programs in each of the six building blocks of the WHO Health System Strengthening Framework. Data were analyzed on Jamovi 2.2.2. RESULTS: Policymakers/program managers emerged as the most critical stakeholder in influencing policy implementation (score for power: 23.3 ± 8.5, position: 25.4 ± 6.9, and interest: 22.1 ± 8.3). Beneficiaries ranked lowest (power: 10 ± 5.1, position: 12.3 ± 4.5, and interest: 19.4 ± 4.2). Effective "on-ground" implementation ("service delivery") was the most important enabler (17.9 ± 3.3) as well as a barrier (17.6 ± 9.2). The health workforce (19.2 ± 4.8) emerged as a top barrier. CONCLUSION: To bring around impactful efficiency in the health system, provider-side interventions, especially those at the point of delivery, emerged as the need of the hour. Policymakers and program managers could lead using a top-down leadership and Governance Approach, focusing on deploying an adequately trained and motivated health workforce to deliver HTN services. For ensuring better performance of the health system for HTN care, the health workforce/seemed to be the "obligatory pivot." Health-care providers could serve as the "point of convergence" of efforts made by all the stakeholder constituencies.

Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital.

BACKGROUND: Sputum microscopy is still used for diagnosis of drug-sensitive pulmonary tuberculosis (TB). Revised National Tuberculosis Control Program (TB programs) aims to rapidly diagnose and treat all cases of TB. The aim of this study is to find the proportion of loss to follow up during diagnosis of pulmonary TB after the patient reached hospital (was handed over sputum cups for sputum collection) from DOTS center after referral from respective outpatient department (OPD) at a tertiary care hospital. METHODOLOGY: Record-based data from designated microscopic center at a tertiary care hospital were collected regarding the number of patients who had been given sputum cup container for sputum collection for diagnosis of pulmonary TB referred from different OPDs from January to December 2015. RESULTS: A total of 1518 presumptive patient for pulmonary TB had visited DOTS center after referral from different OPDs in the hospital for sputum examination during the above period. The loss to follow-up during diagnosis among presumptive pulmonary TB patient was 461 (30.04%), which was higher among those below 15 years of age. At this rate of loss to follow up of presumptive TB patient to submit sputum for diagnosis, it was estimated to be about 46 smear-positive pulmonary TB cases per year which will be missed out for diagnosis during the above period (considering sputum positivity rate is 10% in the hospital). The mean gap between sputum referral to submission of two sputum samples was 2.73 days (95% confidence interval 2.52-2.84) among those of submitted sputum for diagnosis. CONCLUSION: Approximately one-third of presumptive patient for pulmonary TB had loss to follow-up for diagnosis of TB even after consulting a doctor at a tertiary care hospital. There is a need to address this gap in diagnosis of pulmonary TB in this region.