The burden of dengue and force of infection among children in Kerala, India; seroprevalence estimates from Government of Kerala-WHO Dengue study.

Background: Dengue shows high geographic heterogeneity within and across endemic countries. In the context of increasing burden and predicted outbreaks due to climate change, understanding the heterogeneity will enable us to develop region specific targeted interventions, including vaccination. World Health Organisation (WHO) suggests standard methodologies to study the burden and heterogeneity at national and subnational levels. Regional studies with robust and standard methodology to capture heterogeneity are scarce. We estimated the seroprevalence of dengue in children aged 9-12 years and the force of infection in Kerala, India, from where Zika cases also have been reported recently. Methods: We conducted a school-based cross-sectional survey in 38 clusters; selected by stratified random sampling, representing rural, urban, high burden and low-burden administrative units. Validation of Indirect IgG ELISA was done by Plaque Reduction Neutralization Test (PRNT90) using the local isolates of all four serotypes. Force of infection (FOI) was estimated using the WHO-FOI calculator. We conducted a follow-up survey among a subsample of seronegative children, to estimate the rate of sero-conversion. Results: Among 5236 children tested, 1521 were positive for anti-dengue IgG antibody. The overall seroprevalence in the state was 29% (95% CI 24.1-33.9). The validity corrected seroprevalence was 30.9% in the overall sample, 46.9% in Thiruvananthapuram, 26.9% in Kozhikkode and 24.9% in Kollam. Age-specific seroprevalence increased with age; 25.7% at 9 years, 29.5% at 10 years, 30.9% at 11 years and 33.9% at 12 years. Seroprevalence varied widely across clusters (16.1%-71.4%). The estimated force of infection was 3.3/100 person-years and the seroconversion rate was 4.8/100 person-years. 90% of children who tested positive were not aware of dengue infection. All the four serotypes were identified in PRNT and 40% of positive samples had antibodies against multiple serotypes. Interpretation: The study validates the WHO methodology for dengue serosurveys and confirms its feasibility in a community setting. The overall seroprevalence in the 9-12 year age group is low to moderate in Kerala; there are regional variations; high burden and low burden clusters co-exist in the same districts. The actual burden of dengue exceeds the reported numbers. Heterogeneity in prevalence, the high proportion of inapparent dengue and the hyperendemic situation suggest the need for region-specific and targeted interventions, including vaccination. Funding: World Health Organization.

Finishing the task of eliminating neglected tropical diseases (NTDs) in WHO South-East Asia Region: promises kept, challenges, and the way forward.

Globally 20 Neglected tropical diseases (NTDs) are prioritized by World Health Organization (WHO), of which 15 are present in the South-East Asia Region (SEAR) with all 11 countries being affected. As the region bears 54% of the global burden, "Finishing the task of eliminating neglected tropical diseases and other diseases on the verge of elimination" was identified as a regional flagship priority in 2014 with focus on lymphatic filariasis (LF), kala-azar, yaws, trachoma, and leprosy. Intensified efforts have been made to raise and sustain political commitment and momentum among partners innovate tools, interventions and strategies to accelerate elimination, and establish the process and support countries to accelerate and validate achievement of elimination targets. Seven countries have verified or validated for having eliminated at least one NTD since 2016, including yaws, LF and trachoma. Between 2010 and 2020, the number of people requiring interventions against NTDs in the South-East Asia Region reduced by 20%. The priorities in the next decade are to strengthen last-mile efforts to eliminate identified NTDs, sustain it and to use the lessons learnt to eliminate other NTDs. Funding: None.

Progress and impact of 20 years of a lymphatic filariasis elimination programme in South-East Asia.

BACKGROUND: The South-East Asia regional programme to eliminate lymphatic filariasis (LF) was launched in 2000. This study presents the progress and impact of the programme in the region. METHODS: Mass drug administration (MDA) and morbidity management data were accessed from the WHO preventive chemotherapy databank. The status of the programme in the nine South-East Asia countries was reviewed and progress was assessed. The impact of the programme on LF disease burden was estimated on the basis of the effectiveness of the MDA drugs against microfilaraemia and chronic disease. RESULTS: Under the MDA programme, 8.1 billion treatments were delivered in nine countries and 5.7 billion treatments were consumed by the target population during 2001-2018. Three of nine countries eliminated LF. Bangladesh is poised to reach its elimination goal by 2021. In the other five countries, 38-76% of intervention units completed intervention and surveillance is in progress. The MDA programme prevented or cured 74.9 million infections, equivalent to an 84.2% reduction. Close to 1 million lymphoedema patients and 0.5 million hydrocele patients were reported and are being provided with the minimum package of care. CONCLUSIONS: The South-East Asia region's LF elimination programme reduced the burden of LF appreciably and is moving towards achieving the elimination goal in the next 8-10 y.

Surveillance for non-communicable disease risk factors in Maldives: results from the first STEPS survey in Male.

OBJECTIVE: To identify the major risk factors for non-communicable diseases (NCDs) among the population of the capital city Male. METHODS: We undertook a cross-sectional survey among the 25-64-year-age group using a multi-stage sampling method with households as sampling unit. Information on behavioral, physiological, and biochemical risk factors was obtained through standardized methods as recommended by the STEPS survey guideline of the World Health Organization. Age-adjusted prevalence was calculated using the census figures for the year 2000. RESULTS: Among 2,028 individuals who participated in the survey, complete biochemical data were available for 1,506 subjects. The prevalence of NCD risk factors was high among both men and women in low education group: current smoking (39.9, 9.9%); overweight (BMI ≥ 23 kg/m(2)) (60.8, 65.5%); abdominal obesity (24.2, 54.1%); raised blood pressure (29.7, 32.9%); raised blood glucose (4.3, 4.7%); hypercholesterolemia (53.7, 54.9%). CONCLUSION: The significant burden posed by the NCD risk factors along with the gender and socioeconomic differentials point to the need for public health action. The Ministry of Health has already initiated a comprehensive response to this threat. The experience and lessons from this survey will be useful for developing a comprehensive and sustainable surveillance system in the country.

First report of chikungunya from the Maldives.

An outbreak, characterised by fever, arthralgia and myalgia, in Malé and other islands of the Maldives began in December 2006. The illness was suspected as being due to chikungunya virus based on clinical symptoms and the prevailing chikungunya epidemic in the Indian Ocean region. The Department of Public Health initiated an investigation and collected blood samples from 67 patients; 21% were IgM-positive for chikungunya and 96% were PCR-positive. Six percent were positive for dengue by enzyme immunosorbent assay and 4% had evidence of dual infection. This is the first time that chikungunya fever has been confirmed in the Maldives. A total of 11,879 suspected and confirmed cases affecting 61% of inhabited islands (attack rate ranging from 0% to 72% on individual islands) were reported by the end of the epidemic in April 2007.