Trends in Urban Immunization Coverage in India: A Meta-Analysis and Meta-Regression

Objectives To assess the gaps and trends in child immunization coverage among urban and rural areas in India, and compare the success of immunisation program in each. Methods PubMed, Scopus, and Crossref, and Google Scholar electronic databases were searched on October 9, 2019, and March 21, 2020, for studies that measured and reported immunization coverage indicators in India. Random-efects metaanalyses and meta-regressions were conducted. Results The authors' search identifed 545 studies, and 2 were obtained by expert suggestion. Among these 68 studies and 6 surveys were included. They found that full immunization coverage has grown yearly at 2.65% and 0.82% in rural and urban areas, respectively whereas partial immunization coverage declined by ?2.44% and ?0.69%, respectively. Percentage of nonimmunized children did not show a statistically signifcant trend in either. Conclusion While rural immunization coverage has seen a large increase over the past two decades, the progress in urban areas is weak and negligible. This was largely attributable to a focus on minimizing dropouts in rural areas. However, a lack of signifcant reduction in unimmunized children may indicate left-out children or pockets in both rural and urban areas. The poor performance of immunization programs in urban areas, coupled with a larger impact of COVID-19, warrants that India urgently adopts urban-sensitive and urban-focused policies and programs.

Diagnostic Efficacy Of Gene X-Pert/ MTB-RIF Assay And Its Implication For The Treatment Of MDR TB In Rural Medical College.

Aims and objectives: To diagnose and treat the MDR Tuberculosis by XPERT MTB/RIF assay as early as possible so that transmission of infection can be minimized and To find out prevalence of MDR TB in our rural district of Maharashtra. Methods: This is a observational ,prospective study conducted over a period of 14 months ( Jan 15 to April 16 ) in the Dept. of Pulmonary Medicine, Shri Vasantrao Naik Gov.t Medical College, Yavatmal, Maharashtra. We have subjected 613 patients who fulfill the clinical criteria for RNTCP - MDRTB suspect 1.Treatment failure. 2. Retreatment case sputum positive at the end of 4 months, 3.Contact of known MDRTB case, 4.Sputum positive at diagnosis, retreatment case, 5. Any follow up sputum positive, 6.Other category (sputum negative retreatment cases), and 7. HIV-TB Cases. We have excluded all new cases (sputum positive, sputum negative and extrapulmonary cases ). With all precautions two sputum samples collected in the designated microscopy centre. One sample was subjected for routine ZN staining and other one for GENE X-PERT MTB/RIF assay. Result. Out of 613 MDR suspect subjects, 314 (51.23%) were found in the age group 30 to 50 which is economically productive age group. There were 428 (69.82%) male and 185 (30.18%) female. Out of total study patient 44 (7.18 %) were detected Rifampicin resistance by X-PERT MTB/RIF assay. Amongst MDR suspect criteria highest no (4.07 %) of Rifampicin resistant were found in Retreatment cases ( group 4 ) followed by 1.47 % in any follow up sputum positive ( group 5 ) , 0.65 % in sputum negative retreatment cases ( group 6), 0.32 % in treatment failure ( group 1 ) , 0.49 % in HIV TB cases (group7 and0.16 % in contacts of known MDR ( group 3) .There were 144 ( 23 .5 ) were co infected with HIV.TB. Conclusion: We conclude that GENE XPERT MTB /RIF assay has significant role in detecting Rifampicin resistance, patient can be started on treatment at the earliest thereby reducing morbidity, progression to XDR, mortality and transmission of MDR/XDR TB in the community can be minimized. However it has some shortcomings that it cannot detect resistance of other anti- tubercular drugs and atypical mycobacteria.[B.B.Bhadke NJIRM 2016; 7(5):33-39]

Methicillin-resistant staphylococcus aureus : prevalence and risk factors among healthcare workers :.

Background & Objectives: Awareness of Methicillin-resistant Staphylococcus aureus (MRSA) is still lacking in various regions of developing countries. The present study was carried out to assess the prevalence and to establish significant risk factors for colonization with MRSA in health care workers. Methods: A cross sectional study was carried out. Ninety one health care workers and were screened for MRSA by nasal swabbing. MRSA strains were detected by disc diffusion and chromogenic agar. The D test was also carried out to detect inducible clindamycin resistance. Hand hygiene practices were surveyed. Results:Twenty MRSA carriers were identified among the 91 health care workers (21.98%; CI95:13.97-31.88 %). A high prevalence was found in emergency ward (62.5 %; CI95: 24.49 -91.48 %) (p <0.05) .The surgical and orthopedic departments also showed high prevalence (54.55% and 75% respectively) (p< 0.001). Inducible clindamycin resistance was found in 20.45% samples. Chromogenic agar was found to have high sensitivity and results were similar to those of disc diffusion (p<0.001). Interpretation & Conclusion: The presence of significant risk factors aids in identification of high risk groups among hospital staff. Selective surveillance and effective lab techniques implemented in these groups will reduce the burden of MRSA in hospitals.

Fatal rabies despite post-exposure prophylaxis.

Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

A comparison of treatment outcome in re-treatment versus new smear positive cases of tuberculosis under RNTCP.

A study was conducted to compare and quantify the treatment outcome in re-treatment cases as compared to the new smear positive cases of Tuberculosis under Revised National Tuberculosis Control Program in District Tuberculosis Center, Yavatmal district, Maharastra in 2003. The cure rates were 68% and 84% in the new smear positive and the re-treatment group respectively. Favorable outcomes were significantly less in the re-treatment group (66.47%) as compared to the new smear positive cases (84.28%). Unfavorable outcome of default and failure was also more among different subgroups of re-treatment category.

Kerosene poisoning--varied systemic manifestations.

We report here unusual clinical manifestations in a case of kerosene poisoning. The patient presented with encephalopathy and in the course of stay in the hospital developed renal tubular acidosis, delayed first-degree burns and myocarditis. With supportivetherapy the patient recovered completely and was discharged without any sequelae.