The Double Burden of COVID-19 and Dengue in Nepal: The challenges ahead.

Coronavirus disease 2019 (COVID-19) pandemic has caused significant impact on the health care system. As a consequence, diagnosis and treatment of vector borne diseases including dengue has been equally affected. Nepal is no exception to this, where COVID-19 cases is exponentially increased and all resources are concentrated on its prevention, control and management. Dengue, one of the major vector-borne diseases in Nepal, is apparently overlooked despite approaching the peak season of the disease. The aim of this paper is to describe the double burden of COVID-19 and dengue in Nepal, particularly highlighting the co-circulation and possible coinfections. This has posed higher risk of increased severity, more severe cases and deaths in Nepal. Moreover, potential misdiagnosis of these viral diseases may lead to delayed or, inappropriate treatment and poor allocation of resources.

Comparative study of microscopy and polymerase chain reaction for the diagnosis of suspected visceral leishmaniasis patients in Nepal.

BACKGROUND: Visceral leishmaniasis is potentially fatal protozoan diseases caused by Leishmania donovani. Nepal is an endemic region in which visceral leishmaniasis causes a major public health problem in the lowland areas that border the endemic areas of Bihar state in India. Accurate diagnosis to inform treatment is a first step in achieving the goal of visceral leishmaniasis elimination from South East Asian regions by 2020. OBJECTIVE: The objective of the present study was to compare between the Microcopy and polymerase chain reaction for diagnosis of visceral leishmaniasis. METHODS: In the present study, 236 bone marrow aspirations were collected from suspected visceral leishmaniasis patients in Janakpur Zonal Hospital, Dhanusa district, Terai region of Nepal in between 2003-2007. We evaluated bone marrow samples by microscopic examination with subsequent testing of the same sample by polymerase chain reaction and sequence analysis. RESULTS: Giemsa's solution stained bone marrow slides stored for over five years were used for polymerase chain reaction amplification. The result showed that 71% were polymerase chain reaction positive and 56% were microscopic positive. Out of 104 microscopic negative bone marrow samples, 15% of samples were positive by polymerase chain reaction. CONCLUSION: Polymerase chain reaction could make a very good option for diagnosis by using less or non-invasive material from visceral leishmaniasis patients in endemic areas of Nepal.

Trends of rotavirus in Nepal.

BACKGROUND: Rotavirus gastroenteritis is the major cause of morbidity and mortality in infants and young children worldwide. Safe and effective rotavirus vaccine is needed to have significant impact on severe rotavirus gastroenteritis. Currently, two live oral rotavirus vaccines have been licensed in many countries. Knowledge on distribution of human rotavirus of G and P types are essential before rotavirus vaccines are introduced in the target populations. OBJECTIVE: To observe the trends of rotavirus strains in children below five years of age, during the years, 2003-2005 in Nepal. METHODS: Stool specimen collected from children with acute diarrhea who were referred to observation unit or hospitalized in Kanti Children Hospital between 2003 and 2005 were examined. Meteorological data was obtained from Ministry of Environment, Nepal to examine the possibility on the impact of weather on rotavirus infection. RESULTS: Of 1250 stool specimens, 271(22%) were positive for rotavirus by Rotaclone ELISA. G1 was the most common serotype in the first year of study, and G2 in the following year. G12 serotype emerged and remained predominant in two consecutive years. In addition, G9 and G3 emerged in the second year of the study. Children less than three years of age were commonly affected. The records reveal that rotavirus infection is related to the climate, and is commonly seen in the dry season, peaking in January. CONCLUSIONS: Continued surveillance of different regions is needed to monitor the trend of rotavirus strains and to establish rotavirus disease burden, which will help policy makers to make a decision in introducing rotavirus vaccine in Nepal.

Rotavirus infection: an unrecognised disease in Nepal.

Rotavirus is the most common cause of acute infectious gastroenteritis in young children and is associated with substantial morbidity and mortality worldwide, mostly in developing countries. The global rotavirus disease burden has prompted study on their basic research, molecular epidemiology and vaccine development. Little is known about rotavirus infection among health professionals in Nepal. This article summarises basic and clinical features, treatment and prevention, epidemiological pattern, challenges and recommendations of human rotavirus infections in Nepal.

Understanding the burden of disease in Nepal: a call for local evidence.

The burden of disease, most commonly expressed in terms of Disability-Adjusted Life Years, has become a crucial component in decision making processes within the health sector. In Nepal, however, burden of disease estimates are scarce and lack representativeness. To improve our understanding of the burden of disease in Nepal and thereby increase the efficiency of health policies, there is an urgent need to strengthen the local evidence base. All relevant stakeholders should therefore collaborate to generate new data, improve existing data generation mechanisms, make generated data available, and optimize the use of available data.

Human rotavirus associated diarrhea and strain diversity in Nepal.

Two new rotavirus vaccines were recently introduced to the market and have shown a tremendous impact in reducing severe diarrhea due to rotavirus in children. Diarrheal disease is a common cause of morbidity and mortality among Nepalese children. In anticipation of a rotavirus vaccine in Nepal, we systematically reviewed published articles on rotavirus infection in Nepal. Literatures were searched in health related national and international databases. Fifteen rotavirus related articles between 1978 and 2010 were identified. Of these, information from five articles were extracted and analyzed in the present study. Of 3671 participants, 864 were positive for rotavirus infection by ELISA. The prevalence ofrotavirus infection ranged from 12 to 39%. G1P[8] (25%) was the most frequent combined G and P genotype, followed by G12P[6] (23%) and G2P[4] (16%) between 2003 and 2007. Nearly 9% of analyzed rotavirus positive samples (G and P genotype) were non-typable. The data demonstrated that rotavirus is the most identifiable cause of severe diarrhea in children less than 5 years old in Nepal. The wide variety of rotavirus strains circulating in Nepal; underscore the need for continued surveillance. This will be the key to understanding the epidemiological characteristics of rotavirus disease and the impact of vaccination after introduction.

Relapse of kala-azar after use of multiple drugs: a case report and brief review of literature.

We present a case of kala-azar infection that recurred in a patient after completion of the standard treatment course of miltefosine, amphotericin B-deoxycholate (short course), and amphotericin B lipid formulations. The patient was cured after continuous amphotericin B-deoxycholate administration for 4 weeks. This is a unique case of relapse following the use of three important drugs. Although amphotericin B-deoxycholate is a second line drug in Nepal, it has shown a satisfactory clinical response with continuous treatment for 4 weeks. Therefore, an extended course of amphotericin B-deoxycholate may be beneficial in patients with resistance to the standard short course and other anti-leishmania drugs.

Dengue: an emerging disease in Nepal.

Dengue is an acute infectious disease caused by dengue viruses and transmitted by the Aedes species of mosquito. The rapid global spread of the dengue virus into new areas has begun to attract more research attention. A series of dengue fever outbreaks in several districts of Nepal has been recently observed. The evidence of all four serotypes (DEN - 1 - 4) could be a consequence of a sudden resurgence of a more severe dengue disease in Nepal. Health care providers need to become familiar with the disease to prevent or control the possibility of future outbreaks. The clinical features, diagnosis, treatment, epidemiological patterns and challenges of dengue virus infection in Nepal will be discussed here.