Re-emergence of diphtheria in Kerala: the need for change in vaccination policy

Background Diphtheria cases continue to occur in India despite a national vaccination program targeting the disease. Outbreaks of diphtheria have been known to occur in areas of low immunization coverage. An age shift has been noted to older children and adults in recent outbreaks from the Indian states of Andhra Pradesh, Karnataka, Delhi and Assam. Kerala witnessed its largest outbreak of Diphtheria in recent times from 2015 to 2017.Methods: Surveillance data from the Regional PEID Cell during the outbreak period was analysed and epidemiological data generated.Results: A total of 734 cases of diphtheria were reported during this period with eight deaths (Case fatality rate=1.08%). The mean age of the cases was 17.4 years (±13.9). More than 72% of the cases occurred in children above 10 year of age and 68% of the cases were either unimmunized or partially immunized. 32% of the cases were immunized for age. Of these, immunized children, 88% were above 10 years of age, indicating waning immunity with age. The existence of a sizeable unimmunized cohort in the adolescent age group and waning immunity among immunized were two major factors contributing to the outbreak.Conclusions: An age shift has been observed in the occurrence of Diphtheria cases during the outbreak in Kerala. Booster doses with Td vaccine during adolescence in addition to maintaining a high immunization coverage in the routine immunization program, with special emphasis on pockets of low coverage is essential for preventing the reemergence of diphtheria.

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A short communication: Diphtheria outbreak, Tdap vaccination for adults

Indian Journal of Microbiology Research ◽

10.18231/j.ijmr.2021.052 ◽

2021 ◽

Vol 8 (3) ◽

pp. 256-259

Author(s):

Sabi Jeevan P J

Keyword(s):

Vaccination Coverage ◽

Tamil Nadu ◽

Andhra Pradesh ◽

Short Communication ◽

Disease Outbreaks ◽

Immunization Coverage ◽

Older Children ◽

Immunization Program ◽

Indian States ◽

Routine Immunization Program

Diphtheria cases continue to occur also in Madurai, Tamil Nadu despite a national vaccination program targeting the disease. Outbreaks of diphtheria are noted in areas of low immunization coverage. Last week our nephews came with swollen cheeks etc so forth and so on. Disease manifesting among older children and adults as in of the recent outbreaks from the Indian states of Andhra Pradesh, Karnataka, Delhi and Assam.Of these, immunized children, 88% were above 10 years of age.A booster second doses of Adacel is for person 8 years and above along with tetanus prophylaxia is given in addition to maintaining a high immunization coverage in the routine immunization program, with special emphasis on areas of low vaccination coverage is essential for preventing then emergence of diphtheria.

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Regression Analysis of COVID-19 Spread in India and its Different States

10.1101/2020.05.29.20117069 ◽

2020 ◽

Cited By ~ 3

Author(s):

Poonam Chauhan ◽

Ashok Kumar ◽

Pooja Jamdagni

Keyword(s):

Regression Analysis ◽

Regression Model ◽

Tamil Nadu ◽

Polynomial Regression ◽

Case Fatality ◽

Epidemiological Data ◽

Fatality Rate ◽

Indian States ◽

Number Of Patients ◽

Polynomial Regression Model

AbstractLinear and polynomial regression model has been used to investigate the COVID-19 outbreak in India and its different states using time series epidemiological data up to 26th May 2020. The data driven analysis shows that the case fatality rate (CFR) for India (3.14% with 95% confidence interval of 3.12% to 3.16%) is half of the global fatality rate, while higher than the CFR of the immediate neighbors i.e. Bangladesh, Pakistan and Sri Lanka. Among Indian states, CFR of West Bengal (8.70%, CI: 8.21–9.18%) and Gujrat (6.05%, CI: 4.90–7.19%) is estimated to be higher than national rate, whereas CFR of Bihar, Odisha and Tamil Nadu is less than 1%. The polynomial regression model for India and its different states is trained with data from 21st March 2020 to 19th May 2020 (60 days). The performance of the model is estimated using test data of 7 days from 20th May 2020 to 26th May 2020 by calculating RMSE and % error. The model is then used to predict number of patients in India and its different states up to 16th June 2020 (21 days). Based on the polynomial regression analysis, Maharashtra, Gujrat, Delhi and Tamil Nadu are continue to remain most affected states in India.

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Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018

Epidemiology and Infection ◽

10.1017/s0950268819001912 ◽

2019 ◽

Vol 147 ◽

Cited By ~ 6

Author(s):

F. Mboussou ◽

P. Ndumbi ◽

R. Ngom ◽

Z. Kassamali ◽

O. Ogundiran ◽

...

Keyword(s):

Infectious Disease ◽

Disease Onset ◽

Disease Outbreaks ◽

Case Fatality ◽

World Health ◽

African Region ◽

Regional Office ◽

Member States ◽

Infectious Disease Outbreaks ◽

The World

Abstract The WHO African region is characterised by the largest infectious disease burden in the world. We conducted a retrospective descriptive analysis using records of all infectious disease outbreaks formally reported to the WHO in 2018 by Member States of the African region. We analysed the spatio-temporal distribution, the notification delay as well as the morbidity and mortality associated with these outbreaks. In 2018, 96 new disease outbreaks were reported across 36 of the 47 Member States. The most commonly reported disease outbreak was cholera which accounted for 20.8% (n = 20) of all events, followed by measles (n = 11, 11.5%) and Yellow fever (n = 7, 7.3%). About a quarter of the outbreaks (n = 23) were reported following signals detected through media monitoring conducted at the WHO regional office for Africa. The median delay between the disease onset and WHO notification was 16 days (range: 0–184). A total of 107 167 people were directly affected including 1221 deaths (mean case fatality ratio (CFR): 1.14% (95% confidence interval (CI) 1.07%–1.20%)). The highest CFR was observed for diseases targeted for eradication or elimination: 3.45% (95% CI 0.89%–10.45%). The African region remains prone to outbreaks of infectious diseases. It is therefore critical that Member States improve their capacities to rapidly detect, report and respond to public health events.

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An epidemiological investigation of the 2019 suspected pertussis outbreak in northwestern Nigeria

SAGE Open Medicine ◽

10.1177/20503121211008344 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110083

Author(s):

Omoleke Semeeh ◽

Biniam Getachew ◽

Yusuf Taofik ◽

Lukman Surajudeen ◽

Assad Hassan ◽

...

Keyword(s):

Confidence Interval ◽

Disease Transmission ◽

Attack Rate ◽

Odds Ratio ◽

Case Fatality Rate ◽

Adjusted Odds Ratio ◽

Case Fatality ◽

Immunization Coverage ◽

Fatality Rate ◽

Vaccine Preventable Diseases

Introduction: In 2019, we investigated the profile of the cases and controls and the determinants of pertussis transmission in Kebbi State, Northwestern Nigeria, to inform better immunization and surveillance strategies. Methods: Community-based unmatched case–control study and review of the 2019 pertussis routine surveillance data in the affected settlements in the state were conducted. A total of 52 suspected cases of pertussis and 107 control from two local government areas in Kebbi State were recruited. Data were analyzed using descriptive and inferential statistics. Results: The highest attack rate was observed among between 1- and 4-year age group followed by children less than 1-year old, and the least attack rate was among those above 15 years. The overall attack rate and the case fatality rate were 2.10% and 0.10%, respectively. A higher attack rate was observed among women, whereas the case fatality rate was more among males. From the community survey, we observed that the cases were less likely to have pertussis vaccination history (adjusted odds ratio = 0.28, 95% confidence interval = 0.11–0.74) compared with the controls. Knowing pertussis prevention methods were found protective for pertussis transmission (adjusted odds ratio = 0.14, 95% confidence interval = 0.04–0.45). Conclusion: This study showed the vulnerability of children under 5 years, especially under 1 year, to vaccine-preventable diseases in rural populations, where “real” immunization coverage is sub-optimal, and the dominant socio-demographic factors are supportive of disease transmission. We found immunization and knowledge of the preventive measures to be protective against pertussis outbreaks. Therefore, routine immunization services must be intensified to improve coverage and prevent future pertussis outbreak(s).

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A stochastic metapopulation state-space approach to modeling and estimating COVID-19 spread

Mathematical Biosciences and Engineering ◽

10.3934/mbe.2021381 ◽

2021 ◽

Vol 18 (6) ◽

pp. 7685-7710

Author(s):

Yukun Tan ◽

◽

Durward Cator III ◽

Martial Ndeffo-Mbah ◽

Ulisses Braga-Neto ◽

...

Keyword(s):

State Space ◽

State Space Model ◽

Synthetic Data ◽

Public Health Intervention ◽

Disease Outbreaks ◽

Real Data ◽

Epidemiological Data ◽

Transmission Parameters ◽

Intervention Measures ◽

Spatio Temporal

<abstract><p>Mathematical models are widely recognized as an important tool for analyzing and understanding the dynamics of infectious disease outbreaks, predict their future trends, and evaluate public health intervention measures for disease control and elimination. We propose a novel stochastic metapopulation state-space model for COVID-19 transmission, which is based on a discrete-time spatio-temporal susceptible, exposed, infected, recovered, and deceased (SEIRD) model. The proposed framework allows the hidden SEIRD states and unknown transmission parameters to be estimated from noisy, incomplete time series of reported epidemiological data, by application of unscented Kalman filtering (UKF), maximum-likelihood adaptive filtering, and metaheuristic optimization. Experiments using both synthetic data and real data from the Fall 2020 COVID-19 wave in the state of Texas demonstrate the effectiveness of the proposed model.</p></abstract>

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COVID 19 Dawn from Wuhan: “The Number Game”

Indian Journal of Community Health ◽

10.47203/ijch.2020.v32i03.017 ◽

2020 ◽

Vol 32 (3) ◽

pp. 564-568

Author(s):

Sumit Chawla ◽

Harinder Singh ◽

Bharti Chawla

Keyword(s):

Case Fatality ◽

Epidemiological Data ◽

Unknown Etiology ◽

The Novel ◽

Time Data ◽

Public Health Response ◽

Expected Time ◽

Hospitalization Rates ◽

Health Response ◽

Novel Virus

On 31st December 2019, China informed local WHO office of "cases of pneumonia of unknown etiology detected in Wuhan. As of 6th May 2020, there are nearly 3.6 million cases of corona virus infection and approximately 0.25 million deaths worldwide. The real-time data regarding the actual number of cases, as it originates from the epicenter is the key to the estimation of the case fatality rate, hospitalization rates, expected timeline of arrival of contagion, and other epidemiological data. The novel virus has no available literature pertaining to its epidemiological parameters, on which experts can base their estimates and hence the challenge in planning for epidemic management. Bolstering this challenge are the reports alleging under-reporting by Chinese authorities. Alleged toned down numbers could have led to erroneously low estimates contributing to inadequate public health response globally. We conducted a simulation on epidemiological model of COVID-19 to find out expected time off arrival of infections and mortality in different countries and compared this to actual data.

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THE AGE INCIDENCE OF POLIOMYELITIS IN CLEVELAND

PEDIATRICS ◽

10.1542/peds.1.1.83 ◽

1948 ◽

Vol 1 (1) ◽

pp. 83-89

Author(s):

HELMUT M. DEHN

Keyword(s):

General Population ◽

Age Distribution ◽

Small Towns ◽

Acute Illness ◽

Distribution Data ◽

Older Children ◽

North Central ◽

Apparent Increase ◽

Age Shift ◽

Infantile Paralysis

An apparent increase in the number of older children and adults attacked by poliomyelitis has been reported by a number of observers who have compared age distribution data of more recent epidemics (after 1930) with those of the years before 1920. Such reports have come from the northeastern,midwestern, and north central states,1,2,3 from California,4 from Sweden and Australia5 and from Germany.6 Relatively fewer infants and pre-school children have been affected, while the percentile participation of older children and adults has increased. Of course, adults have still remained a minority of patients everywhere. Maxcy7 has questioned the reality of such an age shift for several reasons: (1) the shift may be merely an expression of the changing age distribution of the general population; (2) diagnosis may have become more accurate, especially for abortive forms; (3) selective under-reporting may obscure real conditions. That the epidemiologic pattern of poliomyelitis can be badly distorted by under-reporting was shown by Nelson and Aycock8 in a thorough analysis of the data for Massachusetts. In brief, they found that of 2300 patients who were registered between 1928 and 1941 with the Harvard Commission for Infantile Paralysis for the treatment of paralysis due to poliomyelitis,23.1% or almost 1 out of 4 were not reported to the authorities at the time of their acute illness, although most of these unreported patients were attended by a physician. The greatest percentages of unreported cases occurred in non-epidemic years, off season months, small towns, and among infants and adults. One-third

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CASE FATALITY IN INFANTS AND CHILDREN WITH PERTUSSIS, 1942-1946

PEDIATRICS ◽

10.1542/peds.5.5.840 ◽

1950 ◽

Vol 5 (5) ◽

pp. 840-852

Author(s):

JEROME L. KOHN ◽

ALFRED E. FISCHER ◽

HERBERT H. MARKS

Keyword(s):

United States ◽

Case Fatality Rate ◽

Communicable Disease ◽

Case Fatality ◽

The United States ◽

Fatality Rate ◽

Older Children ◽

Severity Of The Disease ◽

One Year ◽

In Infants And Children

Analysis of data on patients with pertussis during 1942-1946 obtained by means of a questionnaire from communicable disease hospitals and from health officers in a number of cities in the United States and Canada showed these results: Case fatality rates of patients admitted to hospitals for treatment have declined substantially in the period under review. This decline is general, both among infants under one year of age and among older children. In 1946, the case fatality rate of the infants hospitalized for the disease was 5.0% in those cities for which data for at least four years were available. This may be compared with the rate of 7.8% in 1942 and 11.1% in 1943. At ages one year and over, the rate was only 1.3% in 1946, as compared with 1.7% in 1942 and 3.7% in 1943. The rates in the hospitals with larger experiences were generally more favorable than in hospitals with smaller experiences. Despite the incomplete reporting of pertussis, which results in exaggerating the case fatality rate for the general population, the level of these rates in the community as a whole was lower than for hospitalized cases. This reflects the higher proportion of the severer cases in the hospitalized group. Indications are that in many places hospitalization is limited more and more to severe cases. Progress in the management of pertussis, especially of the severer cases admitted to hospitals, is believed to be the chief factor in the decline in case fatality of pertussis. A request contained in the questionnaire for an opinion on the severity of pertussis during the period studied elicited few replies, and these replies showed a division of opinion on the matter. It appears unlikely that there has been much of any change in the severity of the disease.

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Evidence-Based Considerations Exploring Relations between SARS-CoV-2 Pandemic and Air Pollution: Involvement of PM2.5-Mediated Up-Regulation of the Viral Receptor ACE-2

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155573 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5573 ◽

Cited By ~ 10

Author(s):

Marina Borro ◽

Paolo Di Girolamo ◽

Giovanna Gentile ◽

Ottavia De Luca ◽

Robert Preissner ◽

...

Keyword(s):

Air Pollution ◽

Mortality Rate ◽

Cellular Response ◽

Case Fatality ◽

Epidemiological Data ◽

Cell Receptor ◽

Bioinformatic Analysis ◽

Individual Variability ◽

Viral Receptor ◽

Consensus Motifs

The COVID-19/SARS-CoV-2 pandemic struck health, social and economic systems worldwide, and represents an open challenge for scientists —coping with the high inter-individual variability of COVID-19, and for policy makers —coping with the responsibility to understand environmental factors affecting its severity across different geographical areas. Air pollution has been warned of as a modifiable factor contributing to differential SARS-CoV-2 spread but the biological mechanisms underlying the phenomenon are still unknown. Air quality and COVID-19 epidemiological data from 110 Italian provinces were studied by correlation analysis, to evaluate the association between particulate matter (PM)2.5 concentrations and incidence, mortality rate and case fatality risk of COVID-19 in the period 20 February–31 March 2020. Bioinformatic analysis of the DNA sequence encoding the SARS-CoV-2 cell receptor angiotensin-converting enzyme 2 (ACE-2) was performed to identify consensus motifs for transcription factors mediating cellular response to pollutant insult. Positive correlations between PM2.5 levels and the incidence (r = 0.67, p < 0.0001), the mortality rate (r = 0.65, p < 0.0001) and the case fatality rate (r = 0.7, p < 0.0001) of COVID-19 were found. The bioinformatic analysis of the ACE-2 gene identified nine putative consensus motifs for the aryl hydrocarbon receptor (AHR). Our results confirm the supposed link between air pollution and the rate and outcome of SARS-CoV-2 infection and support the hypothesis that pollution-induced over-expression of ACE-2 on human airways may favor SARS-CoV-2 infectivity.

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Maternal and Infant Death and the rVSV-ZEBOV Vaccine Through Three Recent Ebola Virus Epidemics-West Africa, DRC Équateur and DRC Kivu: 4 Years of Excluding Pregnant and Lactating Women and Their Infants from Immunization

Current Tropical Medicine Reports ◽

10.1007/s40475-019-00195-w ◽

2019 ◽

Vol 6 (4) ◽

pp. 213-222 ◽

Cited By ~ 9

Author(s):

David A. Schwartz

Keyword(s):

At Risk ◽

Clinical Trials ◽

West Africa ◽

Pregnant Women ◽

Ebola Virus ◽

Disease Outbreaks ◽

Case Fatality ◽

Viral Disease ◽

Lactating Women ◽

Health Communities

Abstract Purpose of Review Ebola virus infection has one of the highest overall case fatality rates of any viral disease. It has historically had an especially high case mortality rate among pregnant women and infants—greater than 90% for pregnant women in some outbreaks and close to 100 % in fetuses and newborns. The Merck recombinant vaccine against Ebola virus, termed rVSV-ZEBOV, underwent clinical trials during the 2013–2015 West Africa Ebola epidemic where it was found to be 100% efficacious. It was subsequently used during the 2018 DRC Équateur outbreak and in the 2018 DRC Kivu Ebola which is still ongoing, where its efficacy is 97.5 %. Pregnant and lactating women and their infants have previously been excluded from the design, clinical trials, and administration of many vaccines and drugs. This article critically examines the development of the rVSV-ZEBOV vaccine and its accessibility to pregnant and lactating women and infants as a life-saving form of prevention through three recent African Ebola epidemics—West Africa, DRC Équateur, and DRC Kivu. Recent Findings Pregnant and lactating women and their infants were excluded from participation in the clinical trials of rVSV-ZEBOV conducted during the West Africa epidemic. This policy of exclusion was continued with the occurrence of the DRC Équateur outbreak in 2018, in spite of calls from the public health and global maternal health communities to vaccinate this population. Following the onset of the DRC Kivu epidemic, the exclusion persisted. Eventually, the policy was reversed to include vaccination of pregnant and lactating women. However, it was not implemented until June 2019, 10 months after the start of the epidemic, placing hundreds of women and infants at risk for this highly fatal infection. Summary The historical policy of excluding pregnant and lactating women and infants from vaccine design, clinical trials, and implementation places them at risk, especially in situations of infectious disease outbreaks. In the future, all pregnant women, regardless of trimester, breastfeeding mothers, and infants, should have access to the Ebola vaccine.

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