Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015-2020.

OBJECTIVES: We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India. DESIGN: A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data. SETTING: National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status. PARTICIPANTS: Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district. OUTCOME MEASURES: We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015. RESULTS: The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra. CONCLUSION: TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.

Effectiveness of ChAdOx1 nCoV-19 Corona Virus Vaccine (CovishieldTM) in preventing SARS-CoV2 infection, Chennai, Tamil Nadu, India, 2021

BackgroundIndia experienced the second wave of the COVID-19 pandemic in March 2021, driven by the delta variant. Apprehensions around the usefulness of vaccines against delta variant posed a risk to the vaccination program. Therefore, we estimated the effectiveness of two doses of the ChAdOx1 nCoV-19 (Covishield) vaccine against COVID-19 infection among individuals [≥]45 years in Chennai, India. MethodsA community-based cohort study was conducted from May to September 2021 in a selected geographic area in Chennai, Tamil Nadu. The estimated sample size was 10,232. We enumerated individuals from all eligible households and periodically updated vaccination and COVID-19 infection data. We computed vaccine effectiveness with its 95% confidence interval for two doses of the Covishield vaccine against any COVID-19 infection. ResultsWe enrolled 69,435 individuals, of which 21,793 were above 45 years. Two dose coverage of Covishield in the 18+ and 45+ age group was 18% and 31%, respectively. The overall incidence of COVID-19 infection was 1099 per 100,000 population. The vaccine effectiveness against COVID-19 disease in the [≥]45 age group was 61.3% (95% CI: 43.6 - 73.4) at least two weeks after receiving the second dose of Covishield. Genomic analysis of 74 (28 with two doses, 15 with one dose, and 31 with zero dose) out of the 90 aliquots collected from the 303 COVID-19 positive individuals in the 45+ age group showed delta variants and their sub-lineages. ConclusionWe demonstrated the effectiveness of two doses of the ChAdOx1 vaccine against the delta variant in the general population of Chennai. We recommend similar future studies considering emerging variants and newer vaccines. Two-dose vaccine coverage could be ensured to protect against COVID-19 infection.

Epidemiology of COVID-19 and effect of public health interventions, Chennai, India, March - October 2020

ObjectivesTo describe the public health strategies and their effect in controlling the COVID-19 pandemic from March to October 2020 in Chennai, India. SettingChennai, a densely populated metropolitan city in Southern India, was one of the five cities which contributed to more than half of the COVID-19 cases in India. ParticipantsWe collected the de-identified line list of all the 192,450 COVID-19 case-patients reported from 17 March to 31 October 2020 in Chennai and their contacts for the analysis. We defined a COVID-19 case-patient based on the RT-PCR positive test in one of the Government approved labs. Outcome measuresThe primary outcomes of interest were incidence of COVID-19 per million population, case fatality ratio, deaths per million and the effective reproduction number (Rt). We also analysed the indicators for surveillance, testing, contact tracing and isolation. ResultsOf the 192,450 RT-PCR confirmed COVID-19 case-patients reported in Chennai from 17 March-31 October 2020, 114,889 (60%) were males. The highest incidence was 41,064 per million population among the 61-80 years. The incidence peaked during June 2020 at 5239 per million and declined to 3,627 per million in October 2020. The city reported 3,543 deaths, with a case fatality ratio (CFR) of 1.8% and the crude death rate was 431 per million. When lockdown began, Rt was high (4.2) in March and fluctuated from April to June 2020. The Rt dropped below one by the first week of July and remained so until October 2020, even with the relaxation of restrictions ConclusionThe combination of public health strategies controlled the COVID-19 epidemic in a large, densely populated city in India. We recommend continuing the interventions to prevent resurgence, even as vaccination is being rolled out. StrengthsO_LIWe did a comprehensive analysis of COVID-19 strategies and outcome in a large, densely populated metropolitan city in India. C_LIO_LIWe documented that the community-centric public health strategies were feasible and effective in controlling the COVID-19 outbreak even in a large, thickly populated city C_LIO_LIThe lessons learnt are relevant to similar settings in low-and middle-income countries. Given the ongoing multiple waves of COVID-19 and the difficulty in controlling the transmission, our experience and lessons learnt will be valuable for policymakers and scientific advisors globally C_LI LimitationsO_LIWe analysed the data available from the GCC database and not from the hospitals where patients with moderate to severe illness were admitted. Hence, we could not report the severity of illness among admitted patients. C_LIO_LISecond, the COVID-19 incidence might have been underestimated while testing was low during the early phase of the epidemic C_LI

Now casting and Forecasting of COVID-19 outbreak in the National Capital Region of Delhi

ObjectivesThe study aimed to estimate the disease burden due to COVID-19 in the scenarios of unchecked spread and with various public health interventions in New Delhi. MethodsWe adopted Susceptible, Exposed, Infected and Recovered (SEIR) model to estimate the course of COVID-19 outbreak in Delhi population and effect of public health intervention on the pandemic. We first estimated the basic reproductive rate (R0) based on the evidence from Wuhan, then ran the model considering no intervention implemented, followed by case isolation, social distancing, and lockdown, each implemented in isolation and in combinations to estimate the number of cases. Markovs model was used to estimate the number of cases in various clinical scenarios of the disease. Sensitivity analysis conducted to estimate the effect of asymptomatic cases on case based interventions. ResultsEstimated R0 in Delhi population was 6.18 (range 4.15 - 12.2). Effective reproductive rate (Rt) was least for case isolation (3.5). Lockdown showed highest reduction (28%) in number of prevalent cases on peak day and 22% reduction in patients in need of intensive care unit (ICU). Case isolation and lockdown together resulted in 50% reduction in number of prevalent cases and 42% reduction in patients in need of ICU care. Sensitivity analysis showed that the effect of case isolation was inversely proportionate to the proportion of asymptomatic (hidden) cases. ConclusionsInterventions should be implemented in combinations of individual and community level interventions to gain better outcome. Identifying and isolation of all cases as early as possible is important to flatten the pandemic curve.

Coverage of and compliance to iron supplementation under the National Iron Plus Initiative among reproductive age-group women in urban Puducherry - a cross-sectional study.

BACKGROUND: Anaemia is a global health problem and an important cause of morbidity in all age groups, especially among women and children. Various programmes have been implemented to combat anaemia in India and National Iron Plus Initiative (NIPI) is the latest programme to be implemented. AIM: To ascertain the proportion of reproductive age women receiving iron supplementation under the NIPI and assess the compliance and factors hindering the implementation and compliance of the programme. MATERIALS AND METHODS: A cross-sectional study was conducted among women of reproductive age (15-49 years) during November 2017. The participants were interviewed at their household using a pre-tested semi-structured questionnaire to obtain information on socio-demographic details, whether they were receiving iron supplements and compliance to the programme. RESULTS: Out of 302 study participants, only 138 (45.7%) were found to be receiving the supplements under the NIPI. The major source of iron supplementation was various health facilities (69.4%). Of those not receiving the tablets, 96.3% were non-pregnant non-lactating women. The proportion of study participants receiving iron supplementation through house visits by auxiliary nurse mid-wives (ANMs) was only 1.45%. Of the 138 women receiving supplementation, 85 (61%) were compliant with their medication. Compliance also tended to be higher among pregnant and lactating women. The most important reasons for non-compliance were adverse effects and forgetfulness. The presence of regular house visits by ANMs had a significant association with reception of tablets [prevalence ratio (PR)-1.43]. Pregnant women had a significant association with both reception (PR-2.19) and compliance (PR-1.8) with iron supplementation. CONCLUSION: The current NIPI programme needs to be regularly evaluated to ensure its effective implementation. Importance should be given to non-pregnant non-lactating women to increase coverage among them.