scholarly journals Experiential learnings from the Nipah virus outbreaks in Kerala towards containment of infectious public health emergencies in India

2020 ◽  
Vol 148 ◽  
Author(s):  
Rima R. Sahay ◽  
Pragya D. Yadav ◽  
Nivedita Gupta ◽  
Anita M. Shete ◽  
Chandni Radhakrishnan ◽  
...  
Keyword(s):  
State Government ◽  
Single Case ◽  
Point Of Care ◽  
Nipah Virus ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Hospital Infection Control ◽  
Kerala State

Abstract Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.

scholarly journals Visual Exploratory Analysis of COVID-19 Pandemic: One Year After the Outbreak

2021 ◽  
Author(s):  
Amril Nazir ◽  
Suleyman Ulusoy ◽  
Lujaini Lotfi
Keyword(s):  
Case Fatality ◽  
International Travel ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Control School ◽  
One Year ◽  
Restrictive Measures ◽  
The Impact ◽  
Spearman Test

Background Since the beginning of the year 2020, governments across the globe have taken different measures to handle the Covid-19 outbreak. Many different policies and restrictive measures were implemented to prevent transmission outspread, to reduce the impacts of the outbreak (i.e., individual, social, and economic), and to provide effective control measures. Although it has been more than one year already after the outbreak, very little studies have been done to examine the long-term effects and impact of the pandemic, and to examine the government intervention variables that are most effective and least effective. Such analysis is critical to determine the best practices in support of policy decisions. Methods Visual exploratory data analysis (V-EDA) is highly recommended to evaluate the impact of the pandemic since it offers a user's friendly data visualization model that allows one to observe visual patterns on trends. The V-EDA was conducted on one-year data for the COVID-19 Pandemic- one year after the outbreak between 1st January and 31 December 2020. The data were analyzed using the student's t-test to verify if there was a statistical difference between two independent groups and the Spearman test was used to analyze the correlation coefficient between two quantitative data, as well as their positive or negative inclination. Findings We found that high-testing countries had more cases per million than low-testing countries. However, for low-testing countries, there was a positive correlation between the testing level and the number of cases per million. This suggests that countries that had tested more, did it in a preventive manner while countries with fewer tests may have a higher number of cases than confirmed. In the poorest developing countries, the reduced new cases coincide with the reduction in conducted tests, which was not observed in the high-testing countries. Among the restrictive measures analyzed, a higher population aged 70 or more and lower GDP per capita was related to a higher case fatality ratio. Restrictive measures reduce the number of new cases after four weeks, indicating the minimum time required for the measures to have a positive effect. Finally, public event cancellation, international travel control, school closing, contact tracing, and facial coverings were the most important measures to reduce the virus spread. As a result, it was observed that countries with the lowest number of cases had a higher stringency index.

scholarly journals 2452. Outbreak of Candidemia Associated With a Contaminated Intravenous (IV) Anesthetic in an Adult Intensive Care Unit (ICU) in San Luis Potosí, México.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S848-S848 ◽  
Author(s):  
Carlos Portales-Castillo ◽  
Javier Araujo-Meléndez ◽  
Pedro Torres-González ◽  
Mariana Mancilla-González
Keyword(s):  
Early Recognition ◽  
Case Fatality ◽  
Case Control ◽  
Fungal Species ◽  
Case Definition ◽  
Control Measures ◽  
Epidemiological Surveillance ◽  
Effective Control ◽  
Adult Intensive Care Unit ◽  
Outbreak Case

Abstract Background In June 2018, an unusual number of candidemia-associated sepsis cases were diagnosed in sedated patients hospitalized in the 12-bed adult ICU of a teaching hospital in Mexico. The pre-outbreak candidemia rate had been calculated at 0.66 cases/100 ICU admissions for the previous 3 years. Methods We performed a case–control and microbiological study designed to trace the source of the outbreak. Case definition included adult patients with systemic inflammatory response syndrome and Candida species isolated on BC (blood cultures). The rest of the patients in the ICU within the study period (6/12/2018–6/22/2018) were used as controls. Results A total of 5 cases and 19 controls were included in the study. Demographic and clinical characteristics were similar between groups, except for SOFA scores (Table 1). Differences in median SOFA scores between groups were statistically significant (7.5 in cases and 3 in controls (p = 0.02)). After review of common medications used between cases, propofol infusion use (5/5 in cases and 6/19 in controls) was calculated as the strongest risk factor for candidemia (OR 22.84 (p = 0.04)). In-use propofol infusions available at the time were stopped and sent for culture as were unopened vials stored in the pharmacy from the lot being used in the ICU. Intrinsical contamination with bacterial and fungal species related to the outbreak was identified (Table 3). Case fatality rate during the outbreak was 80% (4/5) Conclusion Lethal infections due to contaminated medications, including propofol, have been reported worldwide. Propofol is a potential source for infections given its lipophilic nature that promotes microbial growth. This likely remains an underecognized problem that deserves awareness for early recognition. Epidemiological surveillance in our hospital prompted our case–control study and the subsequent implementation of effective control measures including rapid notification to hospital and national authorities (COFEPRIS), elimination of the identified contaminated lot, and increased promotion of both hand hygiene and adequate IV medication handling techniques among staff. Disclosures All authors: No reported disclosures.

scholarly journals Epidemiology and transmission dynamics of COVID-19 in two Indian states

2020 ◽  
Author(s):  
Ramanan Laxminarayan ◽  
Brian Wahl ◽  
Shankar Reddy Dudala ◽  
K Gopal ◽  
Chandra Mohan ◽  
...  
Keyword(s):  
Tamil Nadu ◽  
Andhra Pradesh ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Primary Data ◽  
Indian States ◽  
Middle Income ◽  
Time To Death ◽  
Middle Income Countries

Although most COVID-19 cases have occurred in low-resource countries, there is scarce information on the epidemiology of the disease in such settings. Comprehensive SARS-CoV-2 testing and contact-tracing data from the Indian states of Tamil Nadu and Andhra Pradesh reveal stark contrasts from epidemics affecting high-income countries, with 92.1% of cases and 59.7% of deaths occurring among individuals <65 years old. The per-contact risk of infection is 9.0% (95% confidence interval: 7.5-10.5%) in the household and 2.6% (1.6-3.9%) in the community. Superspreading plays a prominent role in transmission, with 5.4% of cases accounting for 80% of infected contacts. The case-fatality ratio is 1.3% (1.0-1.6%), and median time-to-death is 5 days from testing. Primary data are urgently needed from low- and middle-income countries to guide locally-appropriate control measures.

scholarly journals Contact Tracing is Associated with Lower COVID-19 Case Fatality Rates: Evidence from 40 countries

2020 ◽  
Author(s):  
ABDULLAH YALAMAN ◽  
GOKCE BASBUG ◽  
CEYHUN ELGIN ◽  
ALISON P. GALVANI
Keyword(s):  
Panel Data ◽  
Early Detection ◽  
Medical Care ◽  
Regression Models ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Regression Analyses ◽  
Cross Sectional ◽  
Lower Case

Abstract The coronavirus disease (COVID-19) outbreak has killed over 725,000 people since its emergence in late 2019. As of early August 2020, there has been substantial variability in the policies and intensity of diagnostic efforts between countries. In this paper, we quantitatively evaluate the effectiveness of the national contact tracing policy in decreasing case fatality rates of COVID-19 in 40 countries. Our regression analyses indicate that countries that utilize comprehensive contact tracing have significantly lower case fatality rates. The association of contact tracing policy and case fatality rates is robust and observed in regression models using cross-sectional and panel data, even controlling for the number of tests conducted and non-pharmaceutical control measures adopted by governments. Our results suggest that comprehensive contact tracing is instrumental not only to curtailing transmission but also to reducing case fatality rates by early detection and isolation of secondary cases and ultimately diminishing the burden on the healthcare system and speeding the rate at which infected individuals receive the medical care they need to maximize their chance of recovery.

scholarly journals Contact tracing: a lesson from the Nipah virus in the time of COVID-19

2020 ◽  
Vol 50 (3) ◽  
pp. 174-175 ◽  
Author(s):  
Arun Wilson ◽  
Anup Warrier ◽  
Balram Rathish
Keyword(s):  
Single Case ◽  
Nipah Virus ◽  
Community Setting ◽  
Healthcare Setting ◽  
Daily Basis ◽  
World Health ◽  
Contact Tracing ◽  
The Public ◽  
Contact List ◽  
Health Organization

Without a vaccine or proven therapeutic options in COVID-19, the World Health Organization (WHO) recommends a combination of measures: rapid diagnosis and immediate isolation of cases; rigorous contact tracing; and precautionary self-isolation of close contacts to curb the spread of COVID-19. During a Nipah outbreak in Kerala, India in 2019, it was confined to a single case. The authors were involved in the in-hospital contact tracing. With a single patient producing a contact list of 98 in a healthcare setting, the implications in a community setting during a pandemic of the scale of COVID-19 are huge but it proves that early and rigorous tracing with quarantining is an effective strategy to limit clusters. We believe that if the public is encouraged to maintain their own contact list on a daily basis, it would help in significantly reducing the time and effort invested into contact tracing in the event of a person contracting COVID-19.

scholarly journals Clinical Manifestations of Nipah Virus–Infected Patients Who Presented to the Emergency Department During an Outbreak in Kerala State in India, May 2018

2019 ◽  
Vol 71 (1) ◽  
pp. 152-157 ◽  
Author(s):  
Radhakrishnan Chandni ◽  
T P Renjith ◽  
Arshad Fazal ◽  
Noufel Yoosef ◽  
C Ashhar ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Nipah Virus ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Molecular Testing ◽  
X Rays ◽  
Female Ratio ◽  
The Difference ◽  
The Government ◽  
Kerala State

Abstract Background An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department (ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described. Methods The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed. Results The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing. Conclusion The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained.

scholarly journals A Single Case Outbreak of Nipah Encephalitis From India in May–June 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s104-s104
Author(s):  
Anup Warrier ◽  
Arun Wilson
Keyword(s):  
Respiratory Symptoms ◽  
Throat Swab ◽  
Close Contact ◽  
Single Case ◽  
Nipah Virus ◽  
Family Members ◽  
Contact Tracing ◽  
Surveillance Period ◽  
Standard Precautions ◽  
Close Family

Background: Nipah encephalitis outbreaks mostly involve multiple patients. We report a case of Nipah virus encephalitis (NVE), which had no documented secondary cases in spite of many having prolonged and close contact with the patient. Methods: A 21-year-old male was admitted with NVE on May 30, 2019. Before the confirmatory report, there was close contact with multiple healthcare workers (HCWs), defined as exposure for >1 hour to the patient or his immediate environment and/or exposure to body fluids. We conducted extensive contact tracing of all HCWs who had come into close contact with the proven NVE case from the time of admission to the time of discharge. This contact tracing included those who had nursed him before the diagnosis with usual standard precautions and those who had nursed him after the diagnosis with full PPE. These HCWs were reviewed daily for fever and respiratory symptoms. All those who developed these symptoms within the 3 weeks of exposure where tested for NEV with a throat swab using RT-PCR. This testing was conducted twice over 3 days to confirm negative results. For the close family contacts that were asymptomatic, both throat swab and serum for Nipah IgM were tested. Results: In total, 169 HCW contacts were identified at our hospital. Of these, 94 were at high risk according the predetermined criteria and others were low-risk contacts. Moreover, 7 HCWs developed fever and respiratory symptoms within the defined surveillance period; 5 had symptoms before the diagnosis (using only standard precautions) and 2 were in contact with full PPE after the diagnosis. All of these symptomatic contacts were tested for NEV (throat swab and serology), and all were negative. The family members of the patient (his mother and aunt) who had cared for him throughout his illness period of 12 days before the diagnosis were also tested and were seronegative for NEV. Conclusions: This NEV case had very low transmission capability; even close family members who cared for him for 12 days without any precautions and had exposure to urine (which was positive for NEV) did not contract the disease. The absence of overt respiratory involvement and young age of the affected patient could have contributed to low transmissibility both prior to hospitalization and during the hospitalization.Funding: NoneDisclosures: None

scholarly journals Serial interval, basic reproduction number and prediction of COVID-19 epidemic size in Jodhpur, India

2020 ◽  
Author(s):  
Suman Saurabh ◽  
Mahendra Kumar Verma ◽  
Vaishali Gautam ◽  
Akhil Goel ◽  
Manoj Kumar Gupta ◽  
...  
Keyword(s):  
Basic Reproduction Number ◽  
Capacity Planning ◽  
Reproduction Number ◽  
Local Level ◽  
Substantial Reduction ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Epidemic Size ◽  
Serial Interval

ABSTRACTBackgroundUnderstanding the epidemiology of COVID-19 is important for design of effective control measures at local level. We aimed to estimate the serial interval and basic reproduction number for Jodhpur, India and to use it for prediction of epidemic size for next one month.MethodsContact tracing of SARS-CoV-2 infected individuals was done to obtain the serial intervals. Aggregate and instantaneous R0 values were derived and epidemic projection was done using R software v4.0.0.ResultsFrom among 79 infector-infectee pairs, the estimated median and 95 percentile values of serial interval were 5.98 days (95% CI 5.39 – 6.65) and 13.17 days (95% CI 11.27 – 15.57), respectively. The overall R0 value in the first 30 days of outbreak was 1.64 (95% CI 1.12 – 2.25) which subsequently decreased to 1.07 (95% CI 1.06 – 1.09). The instantaneous R0 value over 14 days window ranged from a peak of 3.71 (95% CI 1.85 -2.08) to 0.88 (95% CI 0.81 – 0.96) as on 24 June 2020. The projected COVID-19 case-load over next one month was 1881 individuals. Reduction of R0 from 1.17 to 1.085 could result in 23% reduction in projected epidemic size over the next one month.ConclusionAggressive testing, contact-tracing and isolation of infected individuals in Jodhpur district resulted in reduction of R0. Further strengthening of control measures could lead to substantial reduction of COVID-19 epidemic size. A data-driven strategy was found useful in surge capacity planning and guiding the public health strategy at local level.

scholarly journals Control of a Nosocomial Outbreak of COVID-19 in a University Hospital

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Sei Harada ◽  
Shunsuke Uno ◽  
Takayuki Ando ◽  
Miho Iida ◽  
Yaoko Takano ◽  
...  
Keyword(s):  
High Risk ◽  
Large Scale ◽  
Secondary Infection ◽  
Control Measures ◽  
University Hospital ◽  
Contact Tracing ◽  
Effective Control ◽  
Primary Case ◽  
Pcr Screening ◽  
Social Distancing

Abstract Background Nosocomial spread of coronavirus disease 2019 (COVID-19) causes clusters of infection among high-risk individuals. Controlling this spread is critical to reducing COVID-19 morbidity and mortality. We describe an outbreak of COVID-19 in Keio University Hospital, Japan, and its control and propose effective control measures. Methods When an outbreak was suspected, immediate isolation and thorough polymerase chain reaction (PCR) testing of patients and health care workers (HCWs) using an in-house system, together with extensive contact tracing and social distancing measures, were conducted. Nosocomial infections (NIs) were defined as having an onset or positive test after the fifth day of admission for patients and having high-risk contacts in our hospital for HCWs. We performed descriptive analyses for this outbreak. Results Between March 24 and April 24, 2020, 27 of 562 tested patients were confirmed positive, of whom 5 (18.5%) were suspected as NIs. For HCWs, 52 of 697 tested positive, and 40 (76.9%) were considered NIs. Among transmissions, 95.5% were suspected of having occurred during the asymptomatic period. Large-scale isolation and testing at the first sign of outbreak terminated NIs. The number of secondary cases directly generated by a single primary case found before March 31 was 1.74, compared with 0 after April 1. Only 4 of 28 primary cases generated definite secondary infection; these were all asymptomatic. Conclusions Viral shedding from asymptomatic cases played a major role in NIs. PCR screening of asymptomatic individuals helped clarify the pattern of spread. Immediate large-scale isolation, contact tracing, and social distancing measures were essential to containing outbreaks.

scholarly journals Suppression and Mitigation Strategies for Control of COVID-19 in New Zealand

2020 ◽  
Author(s):  
Alex James ◽  
Shaun C. Hendy ◽  
Michael J. Plank ◽  
Nicholas Steyn
Keyword(s):  
New Zealand ◽  
Herd Immunity ◽  
Healthcare Systems ◽  
Mitigation Strategies ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
List Type ◽  
Absolute Minimum ◽  
Executive Summary

AbstractA standard SEIR-type compartment model, parameterised for New Zealand, was used to simulate the spread of Covid19 in New Zealand and to test the effectiveness of various control strategies. Control aims can be broadly categorised as either suppression or mitigation. Suppression aims to keep cases to an absolute minimum for as long as possible. Mitigation aims to allow a controlled outbreak to occur, with the aim of preventing significant overloads on healthcare systems and gradually allowing the population to develop herd immunity.Both types of strategy are fraught with uncertainty. Suppression strategies can succeed in delaying an outbreak, but only for as long as such control measures can be sustained. Once controls are eased or restricted, an epidemic is likely to follow as no herd immunity has been acquired. The success or failure of mitigation strategies can depend sensitively on the timing and efficacy of control measures, and require the ability to bring rapidly growing outbreaks under immediate control when needed. This is as yet untested even for a combination of national interventions including case isolation, household quarantine, population-wide social distancing and closure of schools and universities.Although there are disadvantages to both types of approach, suppression has the advantage of buying time until a vaccine and/or treatment become available and allowing NZ to learn from rapidly unfolding events in other countries. A combination of successful suppression, strong border measures, and widespread contact tracing and testing resulting in containment could allow periods when control measures can be relaxed, but only if cases are reduced to a handful.Executive SummarySuppression strategies aim to keep the number of cases to an absolute minimum for as long as possible. This requires early and effective control interventions.Suppression can only delay an epidemic, not prevent it, but may buy enough time for a vaccine or treatment to become available.Mitigation strategies aim to control an epidemic so that herd immunity is acquired by the population without overwhelming healthcare systems.Mitigation strategies are likely to be very high risk: they are unproven internationally, potentially sensitive to uncertainty, and it may take years for herd immunity to be acquired.Strategy can be switched from suppression to mitigation. For example, once successful mitigation strategies have been tested in other countries. It is likely to be difficult or impossible to switch from a mitigation to a suppression strategy.A combination of successful suppression, strong border measures, and widespread contact tracing and testing resulting in containment could allow periods when control measures can be relaxed, but only if we can reduce cases to a handful.

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