Eco-epidemiological risk factors for Japanese encephalitis in the endemic region of North East India: a hospital-based case-control study.

Purpose: Japanese encephalitis (JE) has emerged as a major public health concern in North East India due to its complex eco-epidemiological risk factors. The objective of this study was to understand the various risk factors associated with JE infection in the endemic study location. Methods: A hospital-based case-control study was conducted at Jorhat Medical College and Hospital from August 2017 to September 2018. The study participants included 49 confirmed JE cases with two control arms, one consisting of non-JE acute encephalitis syndrome (AES) patients (n = 91) and the other of non-JE non-AES patients (n = 140), admitted at the same time in the pediatric and medicine wards. A predesigned, pretested, structured questionnaire was used for data collection. Results: Univariate analysis revealed the following to be risk factors: age at onset, sex, religion, immunization status, proximity to pigs, proximity to paddy fields (<100 m), use of a mosquito net, impregnated mosquito net, mosquito repellent, and outdoor activities. Multiple logistic regression analysis identified age at onset (adjusted odds ratio [AOR], 20.900; 95% confidence interval [CI], 2.210-31.815) and proximity to pigs (AOR, 4.190; 95% CI, 1.592-11.040) as risk factors for the first control arm and proximity to paddy fields (<100 m) (AOR, 8.470; 95% CI, 2.0251-35.438) was the only risk factor found for second control arm, whereas impregnated mosquito nets (AOR, 0.082; 95% CI, 0.009-0.725) and mosquito repellent (AOR, 0.173; 95% CI, 0.052-0.575) were found to be associated with the second control arm. Conclusion: Age at onset, proximity to pigs, proximity to paddy fields (<100 m), impregnated mosquito nets, and mosquito repellent were the most significant risk factors for JE in the NE region to warrant public health actions.

Profiles of institutional ethics committees and status of standard operating procedures in North East India.

Limited data are available regarding institutional ethics committees (IECs) and their standard operating procedures (SOPs) in North East (NE) India. An attempt was made to study the profiles of IECs and the status of their SOPs in health research institutes of NE India. Fourteen biomedical and health research institutes of NE India were reviewed. Only 12 of these 14 institutes had constituted their IECs. The IECs were multidisciplinary and multisectoral in nature; of the 12 institutes, 8 had adequate representation by age and seven committees had adequate representation by gender. In 11 out of 12 IECs, chairpersons were non-affiliated, and chairperson qualifications in 10 of 12 IECs were found to be in keeping with the National Ethical Guidelines for Biomedical and Health Research involving Human Participants, 2017, of the Indian Council of Medical Research (ICMR). There were no lay persons in 6 out of 12 IECs. Nine out of 12 institutes had framed their SOPs. Three out of nine IECs adopted all three types of reviews namely exemption from review, expedited review and full committee review. Six out of nine SOPs had adopted the provision of quarterly review meetings. Declarations of conflict of interest (CoI) were specified in seven out of nine SOPs. Five out of nine SOPs mentioned no voting power for members who declared CoI. Seven out of nine SOPs specified the designated office space, staff, and budget of the committee. Only 2 out of the 12 IECs were registered. Our findings concluded that the characteristics and composition of IECs of health research institutes in NE India are suboptimal. Most of the SOPs were not framed as per recommendations of the ICMR National Ethical Guidelines for Biomedical and Health Research Involving Human Participants, 2017, and were unregistered.

Clinico-epidemiological characteristics of hospitalized acute encephalitis syndrome children and their correlation with case fatality rate.

BACKGROUND: Acute Encephalitis Syndrome (AES) in children contributes considerable morbidity and mortality in endemic region. A study was conducted to see the clinico-epidemiological characteristics of hospitalized AES children and to find out if there is any correlation of clinico-epidemiological factors with case fatality rate (CFR). METHODS: This hospital-based observational prospective study was conducted in a tertiary care teaching hospital of Assam, India from 16th May, 2019 to 15th May, 2020. We enrolled clinically diagnosed 140 hospitalized AES children consecutively as per WHO case definition. Cerebrospinal fluid and serum samples were tested for JEV-specific IgM antibodies. RESULTS: Out of 140 AES children 84 (60%) were male and 5-12 years age group had the highest 79 (56.4%) number of cases. Primarily cases were from rural areas 132 (94.3%). In addition to fever, major clinical manifestations were seizures 114 (81.4%), altered sensorium 128 (91.4%), meningeal signs 62 (44.3%), and <8 GCS 42 (30%). CFR was 27.7%. Significantly high CFR was seen among AES children with GCS <8 (P-value 0.0001) and presence of meningeal signs (P-value 0.0007). A higher proportion of non-survivors 55.6% were non JE AES. Monthly incidence of AES/Death showed a peak in the month of July. CONCLUSION: AES in children is a significant public health problem in the study area with high CFR. Presence of GCS <8 and meningeal irritation are the important predictors of mortality in AES children. Preponderance of non-JE AES case fatality in children warrant further exploration and appropriate public health interventions.

Clinical profile and outcome of Japanese encephalitis in children admitted with acute encephalitis syndrome.

Japanese encephalitis (JE) is an arthropod borne viral disease. Children are most commonly affected in Southeast Asian region showing symptoms of central nervous system with several complications and death. The clinical characteristics and outcomes in pediatric JE patients hospitalized with acute encephalitis syndrome (AES) are still poorly understood. A prospective study was conducted in pediatric ward of Assam Medical College Hospital to evaluate the clinical profile and outcome of JE in children. A total of 223 hospitalized AES cases were enrolled during March to December 2012. Serum and cerebro spinal fluids were tested for presence of JE specific IgM antibody. 67 (30%) were found to be JE positive. The most common presenting symptoms in JE patients were fever (100%), altered sensorium (83.58%), seizure (82.08%), headache (41.79%), and vomiting (29.85%). Signs of meningeal irritation were present in 55.22% of cases. Around 40.29%, JE patients had GCS ≤ 8. Among the JE patients, 14.7% died before discharge. The complete recoveries were observed in 63.9% of cases, while 21.3% had some sort of disability at the time of discharge. JE is still a major cause of AES in children in this part of India. These significant findings thus seek attentions of the global community to combat JE in children.