Disease surveillance during a large religious mass gathering in India: The Prayagraj Kumbh 2019 experience.

BACKGROUND: Mass gathering (MG) events are associated with public health risks. During the period January 14 to March 4, 2019, Kumbh Mela in Prayagraj, India was attended by an estimated 120 million visitors. An onsite disease surveillance was established to identify and respond to disease outbreaks. METHODS: A health coordination committee was established for planning. Disease surveillance was prioritized and risk assessment was done to identify diseases/conditions based on epidemic potential, severity of illness, and reporting requirement under the International Health Regulations (IHR) of 2005. A daily indicator and event-based disease surveillance was planned. The indicator-based surveillance (IBS) manually and electronically recorded data from patient hospital visits and collected MG area water testing data to assess trends. The event-based surveillance (EBS) helped identify outbreak signals based on pre-identified event triggers from the media, private health facilities, and the food safety department. Epidemic intelligence was used to analyse the data and events to detect signals, verify alerts, and initiate the response. RESULTS: At Kumbh Mela, disease surveillance was established for 22 acute diseases/syndromes. Sixty-five health facilities reported 156 154 illnesses (21% of a total 738 526 hospital encounters). Among the reported illnesses, 95% (n = 148 834) were communicable diseases such as acute respiratory illness (n = 52 504, 5%), acute fever (n = 41 957, 28%), and skin infections (n = 27 094, 18%). The remaining 5% (n = 7300) were non-communicable diseases (injuries n = 6601, 90%; hypothermia n = 224, 3%; burns n = 210, 3%). Water samples tested inadequate for residual chlorine in 20% of samples (102/521). The incident command centre generated 12 early warning signals from IBS and EBS: acute diarrheal disease (n = 8, 66%), vector-borne disease (n = 2, 16%), vaccine-preventable disease (n = 1, 8%), and thermal event (n = 1, 8%). There were two outbreaks (acute gastroenteritis and chickenpox) that were investigated and controlled. CONCLUSIONS: This onsite disease surveillance imparted a public health legacy by successfully implementing an epidemic intelligence enabled system for early disease detection and response to monitor public health risks. Acute respiratory illnesses emerged as a leading cause of morbidity among visitors. Future MG events should include disease surveillance as part of planning and augment capacity for acute respiratory illness diagnosis and management.

A Comprehensive Voice Analysis in Benign Vocal Fold Lesions Treated by Cold Knife Endolaryngeal Surgery Using Subjective, Objective and Video-Stroboscopic Parameters.

In the era of globalisation, numerous technical methods have emerged in the management of benign laryngeal lesions. Still cold knife endolaryngeal surgery holds the basic and effective position in providing excellent voice outcome. The aim of this study is to assess the cold knife as a tool for excision of benign laryngeal lesions by protocol of voice assessment. Fifty-five patients with benign vocal fold lesions were included (26 women and 29 men), with age ranging from 22 to 56 years. Each patient was subjected to endoscopic microlaryngeal surgery with cold instruments. Voice assessment was done preoperatively and 3 weeks postoperatively and 3 month post-operatively. The patients were assessed subjectively by Voice Problem Self-Assessment Scale and objectively by laryngoscopy, stroboscopy, and acoustic analysis. Outcome was measured by comparing preoperative and postoperative groups. Significant improvement (< 0.05) was observed in the voice handicap index, acoustic parameters and video stroboscopy parameters between the preoperative and the postoperative groups. The cold knife endo-laryngoscopic surgery still stands out to be a simple, cost effective yet efficient way in treating majority of benign vocal fold lesions causing hoarseness of voice.