Implementation of National Leprosy Eradication Programme during COVID-19 era: A qualitative research.

Introduction The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis.

Looking back to move forward: A travel rule underlined by the current pandemic.

Learning from the past - is easier said than done. In this narrative, "travel" refers to the forward movement of the society at large on the path of health and development. It is suggested that looking back and learning from the lived experiences of the past outbreaks could help generating public health insights and incorporating them in planning for a better future. In the process, a country may choose to revisit what took place in the recent past during the COVID-19 pandemic within its boundary and beyond. However, unfolding of events in the past, which is not as immediate as COVID neither too far as the flu pandemic of 1918, also has lessons to offer. Recognizably, a few alarms, that rang in the recent past and cried for mass attention towards beefed up public health preparedness, were missed. It is therefore necessary now to critically examine the past-efforts to eradicate, eliminate or control diseases such as small pox, polio, HIV, tuberculosis, leprosy, measles or malaria. Results of such evaluation could inform the future courses of actions around disease elimination science and health (DESH) and help develop better nations.

Tuberculosis vaccine BCG: the magical effect of the old vaccine in the fight against the COVID-19 pandemic.

Bacillus Calmette-Guérin (BCG) is a live attenuated M. bovis vaccine that was developed about 100 years ago by Albert Calmette and Camille Guérin. Many countries have been using the vaccine for decades against tuberculosis (TB). The World Health Organization (WHO) recommends a single dose of BCG for infants in TB endemic as well as leprosy high risk countries, and globally almost 130 million infants are vaccinated yearly. The role of BCG is well known in reducing neonatal and childhood death rates. Epidemiological and retrospective cross-sectional studies demonstrated that the BCG vaccination protects the children against respiratory tract infections and lowers the risk of malaria in children. In addition, BCG enhances IFN-γ and IL-10 levels, thus providing immunity against respiratory tract infection even in elderly people. The BCG is also known to provide nonspecific innate immunity against viruses and parasites, through an innate immune mechanism termed 'trained immunity' and is defined as the immunological recall of the innate immune system by epigenetic reprogramming. Based on these studies it is suggested that the BCG has the potential to act as a protective agent against COVID-19. Further proven safety records of BCG in humans, its adjuvant activity and low-cost manufacturing make it an attractive option to stop the pandemic and reduce the COVID-19 related mortality. In this review we discuss the heterologous effects of BCG, induction of trained immunity and its implication in development of a potential vaccine against COVID-19 pandemic.

An assessment of the reported impact of the COVID-19 pandemic on leprosy services using an online survey of practitioners in leprosy referral centres.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to governments implementing a variety of public health measures to control transmission and has affected health services. Leprosy is a communicable neglected tropical disease caused by Mycobacterium leprae and is an important health problem in low- and middle-income countries. The natural history of leprosy means that affected individuals need long-term follow-up. The measures recommended to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can create barriers to health services. We evaluated the impact of the COVID-19 epidemic response on leprosy services and disease management. METHODS: We conducted a cross-sectional online survey with healthcare professionals in leprosy referral centres. RESULTS: Eighty percent of leprosy diagnostic services were reduced. All respondents reported that multidrug therapy (MDT) was available but two reported a reduced stock. Clinicians used alternative strategies such as telephone consultations to maintain contact with patients. However, patients were not able to travel to the referral centres. DISCUSSION: This study highlights the effects of the initial phase of the SARS-CoV-2 pandemic on leprosy services in a range of leprosy-endemic countries. Many services remained open, providing leprosy diagnosis, MDT and leprosy reaction medications. Centres developed innovative measures to counter the negative impacts of the COVID-19 pandemic.

Bacillus Calmette-Guérin (BCG) vaccine generates immunoregulatory cells in the cervical lymph nodes in guinea pigs injected intra dermally.

This work demonstrates the presence of immune regulatory cells in the cervical lymph nodes draining Bacillus Calmette-Guérin (BCG) vaccinated site on the dorsum of the ear in guinea pigs. It is shown that whole cervical lymph node cells did not proliferate in vitro in the presence of soluble mycobacterial antigens (PPD or leprosin) despite being responsive to whole mycobacteria. Besides, T cells from these lymph nodes separated as a non-adherent fraction on a nylon wool column, proliferated to PPD in the presence of autologous antigen presenting cells. Interestingly, addition of as low as 20% nylon wool adherent cells to these, sharply decreased the proliferation by 83%. Looking into what cells in the adherent fraction suppressed the proliferation, it was found that neither the T cell nor the macrophage enriched cell fractions of this population individually showed suppressive effect, indicating that their co-presence was necessary for the suppression. Since BCG induced granulomas resolve much faster than granulomas induced by other mycobacteria such as Mycobacterium leprae the present experimental findings add to the existing evidence that intradermal BCG vaccination influences subsequent immune responses in the host and may further stress upon its beneficial role seen in Covid-19 patients.

Avaliação situacional de influenza pós pandemia de 2009 - uma breve revisão / Situational assessment of influenza post 2009 Pandemic - a brief review

Os vírus influenza são responsáveis por epidemias anuais com gravidade da doença variável. Causam infecção respiratória aguda com elevada transmissibilidade devido sua alta variabilidade genética, capacidade de adaptação e rápida disseminação. Os vírus influenza apresentam genoma fragmentado,o que ocasiona variações antigênicas frequentes, e consequentemente pode induzir o aparecimento de subtipos mais virulentos, como ocorreu em 2009,quando foi registrada pandemia por um novo vírus Influenza A H1N1. A Organização Mundial de Saúde(OMS) estima que a gripe acometa 5 a 15% da população,ocasionando 3 a 5 milhões de casos graves e 250.000 a 500.000 mortes anualmente. As epidemias anuais de gripe e o risco de novas pandemias tornamo monitoramento epidemiológico do vírus influenza fundamental e, para isto, a OMS coordena a Rede Mundial de Vigilância da Influenza com a finalidade de fornecer informações necessárias para a escolha das variantes virais que farão parte da composição anual da vacina, visto que a vacinação é uma das medidas mais efetivas para prevenção da gripe e suas complicações. Além disso, a rede constitui uma vigilância rápida para identificações de vírus influenza emergentes com potencial epidêmico ou pandêmico.Esta vigilância é viabilizada pelos resultados dos testes laboratoriais que são ferramentas importantes para a Saúde Pública, sendo fundamentais para a contenção e prevenção dos vírus circulantes. O objetivo deste estudo foi apresentar informações relacionadas ao vírus influenza e a doença, como são realizados o diagnóstico e monitoramento pelas redes de vigilâncias mundiais pós-pandemia e, ainda, quais os novos desafios que se apresentam.

Influenza viruses are responsible for annual epidemics with patients presenting variable degrees of diseases everity. These virus can cause acute respiratory infection with a high transmissibility due to its high genetic variability, adaptability and rapid spread. Influenza viruses have fragmented genome which causes frequent antigenic variation, which can result in more virulent subtypes emergence, as occurred in 2009 when it was described a new pandemic influenza virus H1N1. WHO estimates that flu affects 5-15% of the population and it causes 3 to 5 million of severe cases and 250.000 to 500.000 deaths annually. The annual influenza epidemics and the new pandemics risk high lights the importance of Influenza virus epidemiological monitoring. Based in this concern WHO created and coordinates the Global Influenza Surveillance and Response System in order to provide necessary information for viral variants selection that will be part of vaccine annual composition, since that, vaccination is one of the most effective measures for influenza prevention and its complications. In addition, the network is a rapid surveillance of emerging influenza virus identifications with potential to cause epidemic or pandemic situations. The surveillance isenable due to laboratory tests results which are important tools for public health, with essential role for circulating viruses containment and prevention. The aim of this study was to present information related to influenza virus and flu disease, how the diagnosis and monitoring are performed by global surveillance networks at post pandemic time and, also,the new challenges facing.