Assessing the Burden of COVID-19 among Children Aged 6-14 Years in Karnataka, India: A Cross-sectional Survey.

Background: India experienced three coronavirus disease (COVID-19) waves, with the third attributed to the highly contagious Omicron variant. Before the national vaccination rollout for children above 6, understanding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) positivity in the pediatric population was essential. This study aims to assess the burden of Covid-19 infection and to estimate the seroprevalence in children aged 6 to 14 years in the state of Karnataka. Material and Methods: We surveyed 5,358 children aged 6-14 across Karnataka using 232 health facilities, from June 6 to 14, 2022. We determined the sample size using the PPS (Population Proportional to Size) technique and employed cluster sampling. We tested all participants for SARS-CoV-2 IgG with an enzyme-linked immunosorbent assay (ELISA) kit and SARS-CoV-2 RNA with reverse transcription-polymerase chain reaction (RT-PCR). We sequenced samples with a cycle threshold (CT) value below 25 using whole genomic sequencing (WGS). Result: We found an adjusted seroprevalence of IgG at 75.38% statewide, and we found 0.04% of children RT-PCR positive for COVID-19. We determined a case-to-infection ratio of 1:37 and identified the SARS-CoV-2 strains as Omicron, BA.5, and BA.2.10. Conclusion: The study showed a high seroprevalence of IgG among children with low active infection. Omicron, BA. 5, and BA. 2.10 variants were detected through WGS.

Investigating the synergistic role of heavy metals in Arsenic-induced skin lesions in West Bengal, India.

BACKGROUND: Arsenic toxicity is one of the major health issues throughout the world. Approximately 108 countries that account for more than 230 million people worldwide are at high risk of arsenic poisoning mainly through drinking water and diet. Chronic exposure to arsenic causes several pathophysiological end-points including skin lesions, peripheral neuropathy, cancer, etc. In India, the population living in the lower Gangetic basin possesses a great risk of arsenicosis and other diseases. Scientists are trying to understand the gene-environmental interactions behind arsenic toxicity revealing the potential role of genetic variants of individuals. Few pieces of the literature showed that the population is not exposed to a mixture of metals. Hence, in this study, an attempt has been made to explore whether some other metals play a synergistic role in As-induced toxicity. METHODS: For this, an assessment of the level of heavy metals using ED-XRF in soil, vegetables from As-exposed areas along with quantification of the heavy metal concentration in human blood and hair of the As-exposed population were conducted. RESULTS: Results show the concentration of urinary arsenic is very high signifying the magnitude of the exposure. In addition to this, the levels of iron (Fe), copper (Cu), chromium (Cr) were found to be very high in soil and Fe, manganese (Mn), lead (Pb) in vegetables were exceeding the WHO/FAO recommended permissible limit. However, Fe and zinc (Zn) were predominantly high in whole blood and hair of the arsenic-exposed population when compared with the control population. CONCLUSION: It can be confirmed that the population from Murshidabad is exposed to As and other heavy metals through drinking water as well as food. Particularly for this population, Fe, Zn and rubidium (Rb) may play a synergistic role in arsenic-induced toxicity. However, further studies on the large population-based investigation are required to establish the chemistry of the metal toxicity.

Chemical analysis of low carbon content coals and their applications as dye adsorbent.

Coal is primarily a fuel material but lately it has been utilized as an adsorbent for removing toxic metal ions. However, its usage for removing organic pollutants is not well studied. We report here a systematic study on the use of coal samples of varying carbon contents as adsorbents for removing Basic Blue 41 as a model cationic dye. The coal samples were collected from coal mines and were thoroughly characterized. The concentrations of carbon, hydrogen, oxygen, nitrogen and sulphur contents were measured by CHNS analyzer. The concentrations of aluminum, silicon, sulphur, titanium and iron were determined by EDXRF, which corresponded to silicon dioxide (quartz) and aluminium silicate (kaolinite) as the major mineral inclusions, corroborated by XRD results and micrographs showing elemental maps determined from SEM-EDAX. The coal samples with low carbon content revealed higher adsorption capacity (qe âˆ¼ 8.0-9.3 mg/g) of Basic Blue dye at optimized adsorbent dose (2 mg/mL), pH 9 and contact time (120 min). The adsorption kinetic studies satisfied pseudo second order model and the intra-particle diffusion of the dye was evident. The dye adsorption followed Langmuir adsorption isotherm, and the qmax values ranged between 17 and 30 mg/g for low carbon content coal. The FT-IR, Brunauer-Emmett-Teller (BET) surface area and zeta potential results of the coal samples could explain the adsorption phenomenon of cationic dye. The kinetic and thermodynamic studies revealed that the adsorption of Basic Blue 41 dye was based on chemisorptions mechanism.

Silicon nanoparticle-pulsing mitigates fluoride stress in rice by fine-tuning the ionomic and metabolomic balance and refining agronomic traits.

The present manuscript investigates the roles of silicon nanoparticles (SiNPs) in ameliorating fluoride toxicity in the susceptible rice cultivar, IR-64. Fluoride toxicity reduced overall growth and yield by suppressing grain development. Fluoride stress alarmingly increased the accumulation of cobalt, which together with fluoride triggered electrolyte leakage, malondialdehyde, methylglyoxal and hydrogen peroxide accumulation and NADPH oxidase activity. The overall photosynthesis was compromised due to chlorosis and inhibited Hill activity. Nano-Si-priming efficiently ameliorated molecular injuries and restored yield by reducing fluoride bioaccumulation particularly in the grains. The level of non-enzymatic antioxidants like anthocyanins, flavonoids, phenolics and glutathione was stimulated upon SiNP-priming. Nano-Si-pulsing removed fluoride-mediated inhibition of glutathione synthesis by activating glutathione reductase. Glutathione was utilized to activate glyoxalases and associated enzymes like glutathione-S-transferase and glutathione peroxidase. Uptake of nutrients like silicon, potassium, zinc, copper, iron, nickel, manganese, selenium and vanadium improved seedling health even during prolonged fluoride stress. Nano-Si-pulsing produced a nanozymatic effect, since high level of crucial co-factors like copper, zinc and iron stimulated the activity of superoxide dismutase, catalase, ascorbate peroxidase and guaiacol peroxidase, which synergistically with other enzymatic and non-enzymatic antioxidants scavenged reactive oxygen species and promoted fluoride tolerance. Overall, the study supported by statistical modelling using principal component analysis, t-distributed stochastic neighbour embedding and multidimensional scaling, established the potential of SiNP to promote safe rice cultivation and precision farming even in fluoride-infested environments.

The impact of human waste hair reprocessing occupation on environmental degradation-A case study from rural West Bengal, India.

Human hair is considered as a potential biowaste worldwide, and improper disposal of hair can create multiple environmental problems. Due to unique characteristic features, human waste hair can be efficiently utilized for versatile applications, from agricultural industries to fashion industries. There is a huge business of human hair in many multinational countries and also in some rural areas of India. The continuous demand of such keratinous waste for human need in turn is producing residual waste at an alarming rate that causes environmental degradation. Therefore, our study aims to investigate the possible impacts of waste hair reprocessing activity on environmental health in rural India, citing examples from Radhapur village. Physico-chemical parameters of pond water and soil from the dumpsite were assessed. Along with this, elemental profile of waste hair, pond water and soil was estimated. To assess the deterioration of water quality, zooplankton diversity was also measured. Water quality index showed that the studied ponds are unsuitable for drinking purpose and aquaculture. The Shannon index further indicated comparatively lower diversity of zooplankton community in the studied ponds. Due to the presence of total organic carbon and available N-P-K, the soil can sustain the growth and survival of plants; however, the risk of toxic metal accumulation may be persisted. Hence, to enhance the utilization of waste hair in a large scale, a policy framework is extremely required that will incorporate environmental and social well-being and provide necessary support towards sustainable development. Future study needs to be carried out to eliminate the toxic elements from the water and soil using some phytoremediation strategies.

Elemental geochemistry in acid sulphate soils - A case study from reclaimed islands of Indian Sundarban.

Sundarban along with its networks of rivers, creeks and magnificent mangroves form a unique ecosystem. Acid sulphate soils have developed in this ecosystem under anoxic reducing conditions. In the present study, we have investigated the distribution of acid sulphate soils along with its elemental characterization and possible sources in four reclaimed islands of Indian Sundarban like Maushuni (I1), Canning (I2), Bally (I3) and Kumirmari (I4). Elements show moderate to strong correlation with each other (P < 0.01; P < 0.05). Except Si, Ca and Pb, a higher enrichment factor was observed for K, Cr, Mn, Fe, Ni, Cu and Zn. Geo-accumulation index values of all sampling locations reveal that Cr, Fe, Cu and Zn are in Igeo class 1. The pollution load index value of the reclaimed islands of Indian Sundarban varies between 1.31 and 1.48. The observation of this study could help to strategize policies to mitigate and manage acid sulphate soils in Indian Sundarban.

Sediment quality, elemental bioaccumulation and antimicrobial properties of mangroves of Indian Sundarban.

Mangroves have wide applications in traditional medicines due to their several therapeutic properties. Potentially toxic elements (PTEs), in mangrove habitats, need serious concern because of their toxicity, bioaccumulation capacity and ecotoxicological risks. In the current study, we aimed to examine sediment quality and bioaccumulation of PTEs in a mangrove-dominated habitat of Sundarban, India, and their relation with antimicrobial property of ten mangrove species of the region. Antimicrobial activity of different solvent fractions of mangrove leaves was assessed against seven microorganisms. The highest antimicrobial activity was detected in ethyl acetate and acetone-extracted fractions of Avicennia alba. Various sediment quality indices revealed progressively deteriorating nature of surface sediment having moderate contamination, however, low ecotoxicological risk. The accumulation factors (AF) for different PTEs indicate a gradual metal bioaccumulation in leaf tissue. Antimicrobial activities indicated both positive and negative correlations with manganese (Mn), copper (Cu), iron (Fe) and zinc (Zn) concentrations of mangrove species. Concentration of Mn showed a significant correlation with almost all the fractions, whereas Cu had correlation with ethyl acetate, acetone and methanol fractions (P < 0.05). The AF of Mn and Cu exhibited correlation with antimicrobial activities of acetone and methanol fractions, whereas Fe and Zn had correlation with hexane and ethyl acetate fractions. Overall, Mn, Fe, Cu and Zn concentrations of Acanthus ilicifolius and Avicennia alba leaves and in the surface sediments demonstrated the strongest association (P < 0.05) with their antimicrobial activity as also depicted in correlation and cluster analysis studies. Thus, this study will help to establish a link between the PTEs in mangrove ecosystem with their bioactivity.

Assessment of trace metal contamination of wetland sediments from eastern and western coastal region of India dominated with mangrove forest.

Ecosystem and biodiversity of India's coastal areas dominated with mangrove forest have been threatened by growing anthropogenic activities. The present work aims to investigate the contamination of wetland sediments with trace elements and assess the sediment quality at different sampling locations in eastern and western costal region dominated with mangrove forest. The longitudinal profile of trace elements in sediments from different sampling locations analyzed by employing Energy Dispersive X-ray Fluorescence (EDXRF) spectrometer shows variations in distribution of elements like Al, Si, K, Ca, V, Cr, Mn, Fe, Ni, Cu, Zn and Pb. The enrichment factor (EF) and Geo-accumulation index (Igeo) values suggested depletion of clay minerals and enrichment of heavy metals like Cr, Cu Fe and Mn. Depending on the variations in Igeo values, the elements are put into Igeo Class 0 to 3 levels of contamination. Contamination factor (Cf) and pollution load index (PLI) suggested deterioration of sediments analyzed in the present study. Assessment of ecological risk potential of elements suggests that few elements (Cr and Cu) are moderately contaminated and may cause environmental stress on the exposed flora and fauna.

Micro-spatial variation of elemental distribution in estuarine sediment and their accumulation in mangroves of Indian Sundarban.

This work describes the micro-spatial variation of elemental distribution in estuarine sediment and bioaccumulation of those elements in different mangrove species of the Indian Sundarbans. The potential ecological risk due to such elemental load on this mangrove-dominated habitat is also discussed. The concentrations of elements in mangrove leaves and sediments were determined using energy-dispersive X-ray fluorescence spectroscopy. Sediment quality and potential ecological risks were assessed from the calculated indices. Our data reflects higher concentration of elements, e.g., Al, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, and Pb, in the sediment, as compared to that reported by earlier workers. Biological concentration factors for K, Ca, Mn, Fe, Cu, and Zn in different mangroves indicated gradual elemental bioaccumulation in leaf tissues (0.002-1.442). Significant variation was observed for elements, e.g., Ni, Mn, and Ca, in the sediments of all the sites, whereas in the plants, significant variation was found for P, S, Cl, K, Ca, Mn, Fe, Cu, and Zn. This was mostly due to the differences in uptake and accumulation potential of the plants. Various sediment quality indices suggested the surface sediments to be moderately contaminated and suffering from progressive deterioration. Cu, Cr, Zn, Mn, and Ni showed higher enrichment factors (0.658-1.469), contamination factors (1.02-2.7), and geo-accumulation index (0.043-0.846) values. The potential ecological risk index values considering Cu, Cr, Pb, and Zn were found to be within "low ecological risk" category (20.04-24.01). However, Cr and Ni in the Sundarban mangroves exceeded the effect range low and probable effect level limits. Strong correlation of Zn with Fe and K was observed, reflecting their similar transportation and accumulation process in both sediment and plant systems. The plant-sediment elemental correlation was found to be highly non-linear, suggesting role of some physiological and edaphic factors in the accumulation process. Overall, the study of micro-spatial distribution of elements can act as a useful tool for determining health of estuarine ecosystem.

Status of Vitamin B12 and Folate among the Urban Adult Population in South India.

BACKGROUND: Deficiency of vitamin B12 (B12) and folate (FA) leads to a wide spectrum of disorders that affect all age groups. However, reports on B12 and FA status in healthy adults in India are limited. Hence, we determined the plasma levels and dietary intake of B12 and FA in the adult population. METHODS: We conducted a community-based cross-sectional study in an urban setup among 630 apparently healthy adults distributed into 3 age groups: 21-40, 41-60 and >60 years. Plasma concentrations of B12 and FA were analyzed by radio immunoassay and dietary intake by 24-hour recall method. RESULTS: The overall prevalence of FA deficiency was 12%, but there was no significant difference in plasma FA concentrations among the groups. While the overall prevalence of B12 deficiency was 35%, it was significantly higher in the 21-40 (44%) and 41-60 age groups (40%) when compared with the >60 group (30%). B12 deficiency was higher in vegetarians (54%) compared to those consuming mixed diet (31%), and the reverse was the case with FA. However, the dietary intakes of FA and B12 were not significantly different among the groups. CONCLUSIONS: These results indicate a higher prevalence of B12 deficiency in apparently healthy adults in an urban setup.

The outcomes of the elderly in acute care general surgery.

INTRODUCTION: Elderly patients form a growing subset of the acute care surgery (ACS) population. Older age may be associated with poorer outcomes for some elective procedures, but there are few studies focusing on outcomes for the elderly ACS population. Our objective is to characterize differences in mortality and morbidity for acute care surgery patients >80 years old. METHODS: A retrospective review of all ACS admissions at a large teaching hospital over 1 year was conducted. Patients were classified into non-elderly (<80 years old) and elderly (≥80 years old). In addition to demographic differences, outcomes including care efficiency, mortality, postoperative complications, and length of stay were studied. Data analysis was completed with the Student's t test for continuous variables and Fisher's exact test for categorical variables using STATA 12 (College Station, TX, USA). RESULTS: We identified 467 non-elderly and 60 elderly patients with a mean age-adjusted Charlson score of 3.2 and 7.2, respectively (p < 0.001) and a mortality risk of 1.9 and 11.7 %, respectively (p < 0.001). The elderly were at risk of longer duration (>4 days) hospital stay (p = 0.05), increased postoperative complications (p = 0.002), admission to the ICU (p = 0.002), and were more likely to receive a non-operative procedure (p = 0.003). No difference was found (p = NS) for patient flow factors such as time to consult general surgery, time to see consult by general surgery, and time to operative management and disposition. CONCLUSIONS: Compared to younger patients admitted to an acute care surgery service, patients over 80 years old have a higher risk of complications, are more likely to require ICU admission, and stay longer in the hospital.

Metal stoichiometry of isolated and arsenic substituted metallothionein: PIXE and ESI-MS study.

The stoichiometric analysis of the metal induced Metallothionein (MT) is pertinent for understanding the metal-MT interactions. Despite innumerable publications on MT, the literature addressing these aspects is limited. To bridge this gap, PIXE and ESI-MS analysis of the commercial rabbit liver MT1 (an isoform of MT), zinc induced isolated rat liver MT1, apo and Arsenic substituted rabbit liver MT1 have been carried out. These techniques in combination provide information about number and the signature of all the metal ions bound to MT. By using ESI-MS in the rabbit MT1, ions of Zn n MT1 (n = 0, 1, 4, 5, 6, 7) whereas, in rat MT1, the Zn1MT1 and Zn5MT1 ions are observed. PIXE analysis shows that some copper along with zinc is also present in the rabbit as well as rat MT1 which could not be assessed with ESI-MS. During As metallation reaction with rabbit MT1, with increase in arsenic concentration, the amount of arsenic bound to MT1 also increases, though not proportionally. The presence of both Zn and Cu in MT1 on Zn supplementation can be related to the role of MT in Zn and Cu homeostasis. Further, the presence of partially metallated MT1 suggests that MT1 may donate fractional amount of metal from it's fully metallated form to other proteins where Zn acts as a cofactor.

Physiological and chemical response of the lichen, Flavoparmelia caperata (L.) Hale, to the urban environment of Kolkata, India.

The present study was focused on the effect of increasing urbanization including industrial and traffic activity on the accumulation of heavy metals and possible damage of selected physiological parameters (composition of assimilation pigments, membrane lipid peroxidation, and membrane integrity) of an epiphytic foliose lichen, Flavoparmelia caperata (L.) Hale. The lichen samples were collected from three different localities in and around Kolkata, India, two sites being from the urban area and one from the relatively non-polluted sub-urban area. The results showed that thalli from the urban sites have significantly higher concentrations of Fe, Cr, Cu, Zn, and Pb compared to those collected from the sub-urban site. Physiological parameters of damage also exhibited stress symptoms in thalli from the urban sites--decreased chlorophyll a indicating less photosynthetic efficiency, and increase in lipid peroxidation and electrolyte conductivity indicating cell membrane injuries. Correlation studies among metals pinpointed vehicular traffic as the main source of pollution in this area.

What is the optimal management of dysphagia in metastatic esophageal cancer?

BACKGROUND: The palliation of dysphagia in metastatic esophageal cancer remains a challenge, and the optimal approach for this difficult clinical scenario is not clear. We therefore sought to define and determine the efficacy of various treatment options used at our institution for this condition. METHODS: We reviewed a prospective database for all patients managed in an esophageal cancer referral centre over a 5-year period. All patients receiving palliation of malignant dysphagia were reviewed for demographics, palliative treatment modalities, complications, and dysphagia scores (0 = none to 4 = complete). The Wilcoxon signed rank test was used to determine significance (p < 0.05). RESULTS: During 2004-2009, 63 patients with inoperable esophageal cancer were treated for palliation of dysphagia. The primary treatment was radiotherapy in 79% (brachytherapy in 18 of 50; external-beam in 10 of 50; both types in 22 of 50), and stenting in 21%. Mean wait time from diagnosis to treatment was 22 days in the stent group and 54 days in the radiotherapy group (p = 0.003). Mean duration of treatment was 1 day in the stent group and 40 days in the radiotherapy group (p = 0.001). In patients treated initially by stenting, dysphagia improved within 2 weeks of treatment in 85% of patients (dysphagia score of 0 or 1). However, 20% of patients presented with recurrence of dysphagia at 10 weeks of treatment. In the radiotherapy group, the onset of palliation was slower, with only 50% of patients palliated at 2 weeks (dysphagia score of 0 or 1). However, long-term palliation was more satisfactory, with 90% of patients remaining palliated after 10 weeks of treatment. CONCLUSIONS: In inoperable esophageal cancer at our centre, radiation treatment provided durable long-term relief, but came at a high price of a long wait time for initiation of treatment and a long lag time between initiation of treatment and relief of symptoms. On the other hand, endoluminal stenting provided more rapid and effective early relief from symptoms, but was affected by recurrence of dysphagia in the long-term. It is now time for a prospective randomized trial to assess the safety and efficacy of combined-modality treatment with both endoluminal stenting and radiation therapy compared with either treatment alone.

SEMEDS: an important tool for air pollution bio-monitoring.

Plant canopies act as absorbers of air-borne dust particles. Characterization of the dusts present over the leaf surfaces can indicate the nature of contaminant present in the surrounding area and possible sources as well. Dust particulates get adsorbed on both the surfaces of leaves, however more dust particulates get deposited on the upper surface. These dusts contain many inorganic elements, which were analyzed in the present study. For the present investigation, SEMEDS technique used to characterize the dusts adsorbed over the leaf surfaces. Using SEMEDS the samples were analyzed by two types of methods i.e. point analysis and elemental mapping. Both the methods showed the presence of elements like Si, Al, Fe, Mg, and Ca in the dusts adsorbed over the leaf surfaces. Thus, SEMEDS can be used for in situ air pollution monitoring using tree leaves from the area concerned.

Is the skin sensitivity test required for administering equine rabies immunoglobulin?

BACKGROUND: Rabies immunoglobulins are life-saving in patients with severe exposure to rabies. Despite the high degree of purification of equine rabies immunoglobulin (ERIG), the product inserts still recommend a skin sensitivity test before administration of this heterologous serum. A recent WHO recommendation states that there are no scientific grounds for performing a skin test before administering ERIG because testing does not predict reactions and it should be given irrespective of the result of the test. In this conflicting situation, we assessed the use of the skin sensitivity test in predicting adverse events to ERIG. METHODS: The data analysed were from the Antirabies Clinic of the Kempegowda Institute of Medical Sciences Hospital, Bengaluru, India. The period of study was 26 months (June 2008-July 2010). The skin sensitivity test was validated by evaluating its sensitivity, specificity, predictability, falsepositive and false-negative results. RESULTS: A total of 51 (2.6%) adverse events were reported in 31 (1.5%) subjects. Most of these were mild to moderate in nature and subsided without medication. There was no serious adverse event. The sensitivity and specificity of the skin sensitivity test to predict an adverse event was 41.9% and 73.9%, respectively. CONCLUSION: Our experience with the skin sensitivity test suggests that it may not be required before administering ERIGs, as recommended by WHO.

A survey of hospitals managing human rabies cases in India.

A survey of 23 infectious diseases (ID) hospitals/ID wards of general hospitals was done during 2008-09 to assess the facilities for and management of rabies patients. All were Government hospitals and 0.5% of total beds was earmarked for rabies cases. The hospitals were mostly run by medical colleges (47.8%) and ID hospitals (30.4%) and located outside city limits (52.2%). The patients were admitted to 'rooms (39.1%)' and 'wards (43.5%)'. The general conditions of rabies sections i.e. sanitation and linen (65%), space and toilet (52% and 56%) and bed (47.8%) require improvements. There is a need to improve staff availability, use of personal protective wears, preventive vaccination of care providers and medicinal supplies. It is recommended to encourage hospitalization of human rabies cases to ensure a 'painless and dignified death' and this must be considered as a 'human rights' issue.

An immunogenicity, safety and post-marketing surveillance of a novel adsorbed human diploid cell rabies vaccine (Rabivax) in Indian subjects.

In 1999, Serum Institute of India indigenously developed an adsorbed human diploid cell rabies vaccine (Rabivax). During 2000-04, this new vaccine was subjected to a series of immunogenecity and safety studies. Initially, an experimental batch of Rabivax (adsorbed) was assessed on ten healthy adult volunteers and its response was comparable with that of Merieux inactivated rabies vaccine (MIRV, lyophilized) which was used as a control. Subsequently, Rabivax (adsorbed) was assessed on forty-five suspect rabid dog bite cases with MIRV as control. The vaccine was found to be equally safe and immunogenic as MIRV and showed better rabies virus neutralizing antibody (RVNA) response on day 90 than MIRV. A post-licensing study conducted on 150 cases of suspect rabid animal bites showed it to be safe and immunogenic. To assess its long-term sero-efficacy some of these subjects tested after one year of follow up showed that 84% of them had adequate RVNA titers. In addition, a routine post-marketing surveillance done on 1608 animal bite cases demonstrated that Rabivax (adsorbed) was safe and efficacious. The adverse events to Rabivax (adsorbed) included pain at injection site (3.4%), swelling with induration (2.8%), fever and headache (1.4%). No serious adverse event was reported from the studies. In conclusion, Rabivax (adsorbed) is an immunogenic, safe and efficacious vaccine for rabies prophylaxis in humans.