Incidence of Japanese Encephalitis and Acute Encephalitis Syndrome Hospitalizations in the Medium-Endemic Region in Central India.

BACKGROUND: We estimated the incidence of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) following routine immunization with the live-attenuated SA 14-14-2 JE vaccine. METHODS: We implemented enhanced surveillance of AES and JE hospitalizations in endemic districts in Maharashtra and Telangana States during 2015-2016 and 2018-2020. We estimated incidence and compared differences in the incidence of JE and AES between two states, and vaccinated and unvaccinated districts during two study periods. We also considered secondary data from public health services to understand long-term trends from 2007 to 2020. RESULTS: The annual AES incidence rate of 2.25 cases per 100,000 children in Maharashtra during 2018-2020 was significantly lower than 3.36 cases per 100,000 children during 2015-2016. The six JE-vaccinated districts in Maharashtra had significantly lower incidence rates during 2018-2020 (2.03, 95% CI 1.73-2.37) than in 2015-16 (3.26, 2.86-3.70). In addition, the incidence of both JE and AES in two unvaccinated districts was higher than in the vaccinated districts in Maharashtra. Telangana had a lower incidence of both JE and AES than Maharashtra. The AES incidence rate of 0.95 (0.77-1.17) during 2018-2020 in Telangana was significantly lower than 1.67 (1.41-1.97) during 2015-2016. CONCLUSIONS: The annual incidence rate of Japanese encephalitis was < 1 case per 100,000 children. It indicated accelerated control of Japanese encephalitis after routine immunization. However, the annual incidence of acute encephalitis syndrome was still > 1 case per 100,000 children. It highlights the need for improving surveillance and evaluating the impacts of vaccination.

Effectiveness of Japanese encephalitis vaccination among children in central India.

Japanese encephalitis (JE) disease among children continues in central India despite vaccination implemented in the routine immunization program. Therefore, we planned to estimate the JE vaccination effectiveness among children by undertaking a 1:2 individually-matched population-based case-control study from August 2018 to October 2020. The laboratory-confirmed JE cases aged 1-15 years were enrolled along with neighborhood controls without fever and encephalitis matched on the residence area, age and sex. The JE vaccination history was enquired from parents and verified independently from the vaccination cards available at home and records at health facilities. We enrolled 35 JE cases and 70 matched controls. The vaccination effectiveness of 86.7% (95% confidence interval [CI]: 30.8-94.7) was estimated on the per-protocol analysis of 31 case-control sets. The screening method provided an effectiveness of 89.5% (CI: 78.9-94.7) on using the population vaccination coverage of 90% reported earlier in the same area. In conclusion, JE vaccination offered a moderate level of protection among children in JE medium-endemic central India, similar to reports from high-endemic areas in India. The operational aspects of vaccination program implementation need to be evaluated to assess the impact of vaccination on the disease burden of JE in medium-endemic regions of India.

An assessment of admission pattern and treatment outcomes of neonates admitted in centers under facility-based newborn care program in Maharashtra, India.

Background: Newborn period is the most vulnerable period of life. As the rate of decline in neonatal mortality was slow compared to infant mortality rate, improved neonatal health-care services were started in existing facilities under facility-based newborn care program. Materials and Methods: A total of six special newborn care units at the district hospitals and 12 newborn stabilization units at the subdistrict/rural hospitals were included in the study. The outcome parameters were analyzed in the admitted babies using statistical tests. RESULTS: The mortality pattern was higher among low-birth-weight and preterm babies. The lower health-care centers had less neonatal deaths, as the neonates were referred. The common causes of admission were neonatal jaundice, respiratory distress syndrome, birth asphyxia, and so on. Conclusion: The focus on the high-risk babies needs to be strengthened, as these babies are at a high risk for neonatal mortality.

Coverage of Japanese encephalitis routine vaccination among children in Central India.

BACKGROUND: We aimed to estimate the coverage of Japanese encephalitis (JE) vaccination in central India to help explain the continued occurrence of JE disease despite routine vaccination. METHODS: We implemented a 30-cluster survey for estimating the coverage of JE vaccination in the medium-endemic areas implemented with JE vaccination in central India. The parents were enquired about the uptake of the JE vaccine by their children aged 2 to 6 years, followed by verification of the immunization cards at home along with reasons for non-vaccination. Vaccination coverage was reported as a percentage with 95% confidence intervals. RESULTS: We estimated high coverage of live-attenuated SA 14-14-2 JE vaccination in Maharashtra (94.8%, 95% CI 92.7-96.3) and Telangana (92.8%, 90.0-94.9). The vaccination card retention was 90.3% in Maharashtra and 70.4% in Telangana state. There were no gender differences in coverage in both states. A similar level of JE vaccination coverage was observed during the year 2013 to 2021 in both states. In Maharashtra, the maximum age-wise coverage was 96.6% in the >60 months age category, whereas in Telangana it was in the <24 months age category (97.2%). The timeliness of JE vaccination was appropriate and similar in both states. We found very good agreement between JE and Measles-Rubella vaccinations administered simultaneously. The reasons for non-vaccination were the shortage of vaccines and the parental migration for work. CONCLUSIONS: The coverage of Japanese encephalitis vaccination was high in medium-endemic regions in central India. Vaccination effectiveness studies may help further explain the continued incidence of Japanese encephalitis. This article is protected by copyright. All rights reserved.

A study of certain correlates of job satisfaction among judicial personnel, in a district of Western Maharashtra.

BACKGROUND: In present scenario, the legal profession has gained utmost importance, which makes the job of a lawyer the most challenging, with lots of mental and physical strain. The rewards can be great, but so are the pressures. High job demands lead to imbalance between what is expected and what is received (job dissatisfaction) which, in turn, leads to job strains. So, the present study focused on the impact of certain variables on job satisfaction of the judiciaries. OBJECTIVES: To study the level of job satisfaction among judicial personnel; to identify the impact of job level (hierarchy) in the experience of job satisfaction; to find the gender difference (if any) for the level of job satisfaction; and to examine the pattern of relationship of certain variables with job satisfaction. MATERIALS AND METHODS: A cross-sectional study was conducted in 1 year duration, in total 965 judicial personnel of different courts in the district of Sangli, which involved data collection using predesigned proforma. A scale, having 15 different independent predictors was used as a validated screening tool, to calculate their job satisfaction score. The most contributing variable and its correlation with job satisfaction was found by stepwise multiple regression and correlation analysis using SPSS Version-16. RESULTS AND CONCLUSION: Out of the total, Class I judiciaries were 692 (71.7%). A majority (71.4%) of the study subjects were male. Overall mean job satisfaction score was 5.38 ± 2.7. Twenty-three percent females, compared with only 9% males, had low job satisfaction (P < 0.5). The best predictor of job satisfaction in males and females was emotional exhaustion (ß = 0.191) and conflicts between values and practice (ß = 0.252), respectively. Higher is the job satisfaction score, lesser the level of job satisfaction. The findings of the study revealed that job satisfaction was found to be significantly (P < 0.0005) and positively correlated with all the variables in the study.