Retrospective study of chikungunya outbreak in urban areas of India.

BACKGROUND & OBJECTIVES: A retrospective study on chikungunya outbreak in India in five States viz. Delhi, Madhya Pradesh, Orissa, Maharashtra and Kerala was conducted in 2007-2008 to know the distribution and determinants of chikungunya fever outbreak in India. METHODS: On the basis of high and low incidence of chikungunya fever, two districts from each State and two wards from the selected district were taken for random selection of 1000 households from 10 districts and 5 States. Semi-structured questionnaires were administered to individuals, patients, qualified health professionals and to stakeholders for collecting information. RESULTS: The educational background and occupation of the respondents showed variations across the study States. Only in high incidence ward of Maharashtra, water storage period for 3-6 days and emptying, drying of water containers on weekly basis was noted. The study through knowledge, attitude, belief, practice (KABP) obtained individual's perception of chikungunya fever, its prevention and control. Patients' expenditure on treatment was mainly recorded less than Rs 500 across study States. Health facility survey obtained an overview of the capacity of local health facilities. Stakeholders' perception regarding chikungunya fever was also noted. INTERPRETATION & CONCLUSIONS: The study revealed differences in awareness of chikungunya, cause of the disease, vector responsible, mode of transmission, biting time and elimination of breeding of mosquitoes statistically significant among high and low incidence wards of all the States. Expenditure on treatment was independent of economically active status and loss of man-days across all the States. Education and occupation did not have any relation with emptying/drying of water containers in high incidence wards. Strengthening of surveillance, information, education and communication (IEC) activities along with case management facilities may be provided by the State health department for prevention of chikungunya outbreaks in future. Stakeholders should be more involved in outbreak management and future planning.

Fludarabine phosphate and melphalan: a reduced intensity conditioning regimen suitable for allogeneic transplantation that maintains the graft versus malignancy effect.

Reduced intensity conditioning (RIC) for allogeneic stem cell transplantation allows stable donor cell engraftment with the maintenance of a graft versus malignancy effect. Many different regimens exist employing various combinations of chemotherapy, radiotherapy and T-cell depletion. We examined the role of non-T-cell depleted RIC regimens in 56 patients with haematological malignancies. Patients received fludarabine phosphate for 5 days (30 mg/m2 in 35 patients, 25 mg/m2 in 21 patients) and melphalan for 1 day (140 mg/m2 in 36 patients, 100 mg/m2 in 20 patients). Immunosuppression was with CyA alone in 33 patients and CyA/MTX in 23 patients. Twenty-four of the 26 patients with chimerism data showed >95% donor chimerism at 3 months post transplant. aGVHD occurred in 18% of patients receiving CyA/MTX compared to 53% of patients receiving CyA. The 100-day mortality rate was 0.16 (95%CI 0.08-0.28) and 1-year nonrelapse mortality was 0.24 (95%CI 0.13-0.38). Thirty-three patients remained alive and in CR at a median of 19 months post transplant (range 3-38 months). We have shown that patients transplanted with fludarabine phosphate, melphalan 100 mg/m2 and with CyA/MTX as post transplant immunosuppression can achieve good disease control with an acceptable level of toxicity. Further studies are required to confirm these findings.

Ecological observations on the anopheline mosquitoes of Jalpaiguri Duars, West Bengal.

A nine month entomological study was conducted from August 1989 to April 1990 in Jalpaiguri duars of West Bengal where malaria has been persistent problem. Amongst the anopheline fauna three vector species were recorded; An. minimus was the principal vector supported by A. dirus during the rainy months and An. fluviatilis in dry months. All the three vectors were found in close association with human orbit and An. minimums was found to be primarily a domestic vector. The primary role of An. minimus in the transmission of malaria in the region has been highlighted. Observations on seasonal variation, biting preferences, and biting time and vector infection rates were recorded.

Blood meal identification by using Microdot ELISA in vector mosquitoes.

The blood meals of five mosquito species which are vectors for malaria, J.E. and Filaria were determined by using Microdot ELISA technique, which is a rapid and sensitive method. A total of 4354 freshly fed mosquitoes comprising of Anopheles culicifacies, An stephensi, Culex quinquefasciatus, Cx. vishnui gp. and Cx. tritaeniorhynchus were tested. Results of the study reveal that highest proportion of An. culicifacies between 76-100% fed on bovine host followed by 0.3 to 24.2% on human. Cx. vishnui showed 1.9% feeding on human, 49-87.7% on bovine and 7.4-12.3% on the pigs. It has been observed that malaria vectors namely An. culicifacies and An. stephensi are still zoophilic in nature. Similarly, the vector of J.E. namely Culex vishnui gp. and Cx. tritaeniorhynchus also fed on cattle but some samples have indicated feeding of blood meal from pigs.

Status of chloroquine resistance in Plasmodium falciparum in Tripura.

In-vivo chloroquine resistance studies on P. falciparum were conducted in 1981 and 1988 in South district of Tripura. Resistance status to chloroquine has been gradually changing over the seven years period. A single case at RIII level was detected in 1988, and RI level of resistance had shown a increasing trend.

In vivo test for sensitivity of Plasmodium falciparum to chloroquine in Faridabad complex of Haryana (India).

A study was conducted to know the chloroquine sensitivity of Plasmodium falciparum in Faridabad complex of Haryana state where indigenous resistant cases of P. falciparum to chloroquine have been detected for the first time in the district. Out of 13 cases tested, 3 cases showed resistance at RIII level, 5 cases at RII level and 5 cases at RI level.