Seroprevalence of brucellosis among animal handlers in West Bengal, India: an occupational health study.

Brucellosis is a highly contagious zoonotic disease and a major human health problem worldwide. Due to its ways of transmission, direct or indirect contact with infected animals or their contaminated biological products, the disease exhibits strong occupational association with animal handlers comprising a significant population at risk. This study was undertaken to estimate the seroprevalence of brucellosis in animal handlers and to understand the epidemiological and serological aspects of the same. The animal handlers from the state of West Bengal, India were included in this study. It was a prospective and observational cohort study from November 2021 to March 2022. A total of 669 sera samples were collected from animal handlers and tested using various serological tests for Brucella antibodies. All serum samples were tested using the Rose Bengal plate test (RBPT), standard tube agglutination test (STAT), and enzyme-linked immunosorbent assay (ELISA). 106 (15.8%) patients were diagnosed with brucellosis among the total number of patients tested. Most of the patients affected with brucellosis belonged to the age group 51-60 years (23.5%). The seropositivity rate in male animal handlers was higher than female animal handlers in this study. More studies are needed to understand the occupational association of this disease. Awareness programs, safe livestock practices, and prevention of the disease by timely diagnosis must be implemented in order to control human brucellosis.

Human anthrax in India in recent times: A systematic review & risk mapping.

The disease anthrax occurs generally in herbivores and the causative organism (Bacillus anthracis) infects humans who come in contact with infected animals or their products. The persistence of anthrax spores for decades and its lethality contribute to its biowarfare potential. We conducted this systematic review along with risk mapping to investigate the spatio-temporal distribution, clinico-epidemiological, socio-behavioural and programmatic issues pertaining to anthrax in India over the last two decades. Peer reviewed quantitative and qualitative studies and grey literature comprising weekly reports of the 'Integrated Disease Surveillance Program' (IDSP), were accessed for extracting data. IDSP data were used for geo-referencing of the villages of anthrax cases; Pseudo-absence was generated to fit a Bayesian Additive Regression Trees (BART) model to develop anthrax risk map. The case fatality rate of cutaneous anthrax ranged from 2% to 38%, while the gastrointestinal and inhalational types were 100% fatal. Our synthesis revealed that human anthrax outbreaks in India were clustered around the eastern coastal regions. The states of Odisha, West Bengal, Andhra Pradesh and Jharkhand reported maximum number of outbreaks. Odisha reported a maximum number of 439 human anthrax cases since 2009, of which Koraput district contributed to 200 cases (46%). While handling or consumption of infected animal product were proximal drivers of these events, poverty, lack of awareness, traditional beliefs and local practices served as facilitatory factors. Other structural determinants were wild life-livestock interface, historical forest loss, soil pH, soil-water balance, organic carbon content, temperature, rainfall and humidity. The programmatic issues identified through this review were lack of active surveillance, non-availability of diagnostic facility at the periphery, delayed reporting, absence of routine livestock vaccination and lack of adequate veterinary services. Interventions based on One-health approach in the country merit immediate policy and program attention; high risk zones for anthrax identified during present investigation, should be prioritized.

Comparative Evaluation of Intradermal vis-à-vis Intramuscular Pre-Exposure Prophylactic Vaccination against Rabies in Cattle.

Rabies is a progressively fatal viral disease affecting a wide variety of warm-blooded animals and human beings. With cattle being major part of Indian livestock population, rabies can result in significant financial losses. Immunization of livestock vulnerable to exposure is the best way to control rabies. The present study was undertaken to investigate the efficacy of a rabies pre-exposure prophylactic vaccine administered through different routes and to sequentially monitor the levels of rabies virus-neutralizing antibody (RVNA) titers in cattle. Thirty cattle were divided into five groups of six animals each. Group I and III animals were immunized with 1 mL and 0.2 mL of rabies vaccine through intramuscular (IM) and intradermal (ID) routes, respectively, on day 0, with a booster dose on day 21; Group II and IV animals were immunized with 1 mL and 0.2 mL of rabies vaccine, respectively, without the booster dose; unvaccinated animals served as a control (Group V). Serum samples were collected on days 0, 14, 28, and 90 to estimate RVNA titers using the rapid fluorescent focus inhibition test (RFFIT). The titers were above an adequate level (≥0.5 IU/mL) on day 14 and maintained up to 90 days in all animals administered the rabies vaccine through the IM and ID route with or without a booster dose. The study indicated that both routes of vaccination are safe and effective in providing protection against rabies. Hence, both routes can be considered for pre-exposure prophylaxis. However, the ID route proved to be more economical due to its dose-sparing effect.

Evaluation of Scrub Typhus Surveillance, Alwar District, Rajasthan, India, July-August 2020.

Introduction: Scrub typhus is one of the most underreported and fatal illnesses accounting for 23% of all febrile illness. Rajasthan reported cases during 2018-2019 in state reporting system but did not report any case to central Integrated Disease Surveillance Programme (IDSP) unit. We evaluated the Scrub typhus surveillance system in Alwar district, Rajasthan, with the objective of describing and evaluating the system and providing evidence-based recommendations to identify gaps. Material and Methods: In cross-sectional study, we reviewed records and conducted key informant interviews at district- and block-level health facilities. Using US Centers for Disease Control guidelines, we evaluated the system by framing indicators for selected attributes for a defined reference period. Overall performance was ranked as outstanding (90-100%), excellent (80-89%), very good (70-79%), good (60-69%), and poor (<60%). Results: Line list of confirmed cases was sent from district to block level for additional active case search (ACS) to implement control measures. We conducted 26 key informant interviews and reviewed records and calculated simplicity as 79%, flexibility 100%, data quality 46%, acceptability 92%, representativeness 48%, timeliness 43%, and stability 79%. Conclusions: Epidemiological surveillance (active and passive) is a core intervention under scrub typhus surveillance system. Lab reports were incompletely uploaded on IDSP portal. Surveillance reports should be updated after each ACS. Reporting format under IDSP should be uploaded timely, and lab reports from state should be sent within 48 hours of diagnosis so that case investigation is not delayed.

Multisectoral prioritization of zoonotic diseases in Haryana (India) using one health approach.

Zoonotic diseases have huge livestock and public health burden worldwide, including India. Prioritizing zoonotic diseases is one of the important tasks under 'One Health' as it facilitates effective policy making, proper allocation of resources and promotion of multisectoral collaboration. Although some efforts have been made to prioritizing zoonotic diseases at national level in India, it is important to identify priority diseases in regional settings due to wide variation in climate and demography of different states. Therefore, the present study aims to prioritize zoonotic diseases for the state of Haryana (India). One Health Zoonotic Disease Prioritization (OHZDP) tool was used in this study to prioritize zoonotic diseases. Based on literature review of the past 23 years (2000-2022) on prevalence, morbidity, and mortality of zoonotic diseases, twenty-three high-scoring zoonotic diseases in Haryana and neighboring states of India were initially shortlisted for prioritization. A three-day participatory workshop was conducted involving 17 experts representing the Health, Animal Husbandry and Wildlife departments of Haryana. The Analytical Hierarchy Process (AHP) was used to rank the criteria, which were used to score the selected diseases using the decision tree analysis. The participants selected the following 7 criteria along with their relative weights to score the diseases: (1) Severity of disease in humans, (2) Severity of disease in animals, (3) Presence of disease in the region, (4) Transmission and outbreak potential, (5) Socio-economic impact, (6) Availability of interventions, and (7) Existing inter-sectoral collaboration for surveillance and reporting. The top scoring eight diseases selected as priority zoonotic diseases for Haryana were rabies, Japanese encephalitis, bovine tuberculosis, leptospirosis, avian influenza (H5N1), brucellosis, glanders and Influenza A (H1N1). Sensitivity analysis did not reveal any significant variation in prioritization results by varying criteria weights. This is the first systemic attempt to prioritize zoonotic diseases in the state and this will help in formulating effective monitoring, prevention, and control strategies for zoonotic diseases in the regional settings.

Intravitam Diagnosis of Rabies in Patients with Acute Encephalitis: A Study of Two Cases.

Rabies is one of the oldest known zoonotic diseases. Rhabdovirus, an RNA virus belonging to the genus Lyssavirus and family Rhabdoviridae, causes rabies. Rabies diagnosis is challenging as the rabies virus remains confined to neurons after the initial animal bite. It largely remains immune-evasive until the infection reaches the central nervous system. The bottleneck in rabies diagnosis remains the non-availability of technical expertise and failure to collect an appropriate sample. The laboratory confirmation of rabies in both antemortem and postmortem samples is important. The samples were tested for anti-rabies antibodies using quantitative ELISA. In this report, two case studies are presented to demonstrate the suitability of ELISA for the intra vitam diagnosis of rabies using cerebrospinal fluid (CSF) as a diagnostic sample. The interpretation of serology results for both vaccinated and unvaccinated individuals has been discussed in detail, which has helped to confirm the antemortem diagnosis of rabies. In this report, we observed that ELISA can be a viable alternative for anti-rabies antibody detection in CSF and can be used as a viable alternative to more technically challenging tests, such as Rapid Fluorescent Focus Inhibition Test (RFFFIT) and Immunofluorescence Assays (IFA).

Rabies Outbreak in the Urban Area of Delhi: An Investigation Report and One Health Perspective for Outbreak Management.

Rabies is a global problem and is endemic in India. Rabies cases occur throughout the year, and the majority of cases are associated with dog bites. We report a rabies outbreak investigation in an urban area of Delhi conducted by our multidisciplinary team, and its role in proactively controlling a rabies outbreak by concerted efforts and timely advice to various stakeholders using a "One Health Approach." A veterinary care NGO from Delhi picked up a suspected rabid stray dog and submitted a brain sample for diagnosis of rabies, as they had received information from a resident of the locality about an unprovoked animal bite incident involving a girl (category III bite) and close contact of two more stray dogs living in the vicinity of the suspected rabid dog. The laboratory diagnosis of rabies in the suspected dog brain sample was confirmed by using Fluorescence Antibody Test (FAT). A multi-expert investigation team with expertise in medicine, microbiology, veterinary sciences, laboratory diagnosis, and public health was constituted to investigate the outbreak. The timely, adequate, and appropriate anti-rabies management initiated for the animal bite victims in this incident could prevent rabies. Proactive involvement of multiple stakeholders and knowledge attributes and practice of local residents could prevent human rabies. As there were no further reports of dog bites from the area, the chain of rabies transmission in that area could be controlled. The presented work is a classical case scenario where concerted efforts of all stakeholders achieved effective control and prevention of rabies by adopting the "One Health approach".

Rabies can be a disease of puppyhood.

This brief report documents an interesting and a rare case of 10 week old male puppy who suddenly showed a change in his behavior (irritable, agitated, anorexic, and refusing feeds), bitten six humans, and was laboratory-confirmed as died due to rabies (Rapid antigen test and reverse transcriptase polymerase chain reaction positive for rabies at the National Rabies Reference Laboratory, WHO collaborating Centre for Rabies Epidemiology, Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, Delhi). All animal bite victims were timely provided postexposure prophylaxis for rabies who had shown sufficient seroconversion by IgG antirabies antibody using enzyme linked immunoassay (ELISA) and have been reported healthy. This case report reinforces the role of veterinarians/primary care physicians for strong suspicion of rabies encephalitis in puppies with behavioral or neurologic abnormalities and timely/appropriate rabies immunization of the animal bite victims. Shreds of evidence also focus that rabies in puppies younger than 3 months of age is grave and the risk of human beings contracting rabies from young puppies is of public health importance because of fatal consequences. Continuing medical education for primary care physicians and veterinarians, and outreach community public awareness campaigns should be regularly done to promote knowledge of pre-exposure/post-exposure prophylaxis, preventive measures, and animal bite management.

Relationship between sputum smear grading and smear conversion rate and treatment outcome in the patients of pulmonary tuberculosis undergoing dots--a prospective cohort study.

BACKGROUND: The Smear Conversion Rate (SCR) is an operational indicator for the Directly Observed Treatment Short-course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India. The present study was undertaken to determine the relationship between sputum smear grading and smear conversion rate among the Category I smear positive pulmonary tuberculosis patients undergoing DOTS. METHODS: A prospective cohort study was conducted among the Category I smear positive pulmonary tuberculosis patients registered under DOTS at GTB, Karawal Nagar and Shahdara Chest Clinics of Delhi. Sample size for the present study was calculated on the basis of a similar study of a retrospective design conducted at LRS Institute of Tuberculosis and Respiratory diseases New Delhi, India using statistical software Epi Info version 6. Accordingly, a total of 338 sputum smear positive patients with 169 each in the High Positive Cohort (pre-treatment sputum grading 3+) and Low Positive Cohort (pre-treatment sputum grading 2+, 1+ and Scanty) were followed periodically at two months (end of Intensive Phase), at three months (after one month extension of Intensive Phase), at two months of Continuation Phase and then at the end of the treatment to record the sputum AFB result and treatment outcome as per the RNTCP guidelines. Data was analyzed using SPSS Version -15. RESULTS: After two months (end of the intensive phase), SCR was 57.9% (98 of 169) among the High Positive and 71.6% (121 of 169) in the Low positive cohort ( p -0.008). After three months (one month's extension of intensive phase), cumulative SCR was 85.2%( 144 of 169)) in the High Positive and 92.3% (156 of 169) in the Low Positive cohort (p-0.03). Cure rate was 82.8% (140 of 169) in the High Positive and 84.6% (143 of 169) in the Low Positive cohort. Default rate was 3% (five of 169) in the High Positive and 5.3% (nine of 169) in the Low Positive cohort. Failure rate was 11.2% (19 of 169) in the High positive and 6.5% in the Low positive Cohort (11 of 169). Only one patient (0.6%) in each High and Low Positive cohort died during course of treatment (p -0.631). Treatment outcome was further compared among the patients according to their sputum status achieved at two and three months of the treatment after ignoring their initial sputum status. The cure rates for the patients who converted at two months was 90.9% (199 of 219) and for those who did not convert at two months, was 74.3% (84 Of 113) (p -0.000). Similarly, the cure rate for the patients who converted at three months was 84% (68 of 81) and for those who did not convert at three months was 55.2% (16 of 29) (p-0.01). INTERPRETATION: Patients with higher grades of sputum positivity at the beginning of the treatment have significantly lower SCR at the end of intensive phase and even after extending the intensive phase for one month. Hence, they are likely to remain infectious for a longer duration and continue to transmit infection in the community. Therefore, these patients demand to have more stringent self-precautionary measures to break the chain of infection in the community. The SCR at two months and three months as an operational indicator should be given more importance rather than being practised only as a documentation and academic exercise. The patient should be investigated for the possible co-morbid conditions and drug resistance which could be a cause for the persistent sputum smear positivity at two and three months and hence poor treatment outcome.