Intensified Mission Indradhanush: boats, vans at work in 191 districts

MediBulletin Bureau
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Intensified Mission Indradhanush: boats, vans at work in 191 districts

For three days now, vaccinators in vans, on foot and in some areas even in boats have been fanning out in 190 districts of the country to ensure that children and pregnant women left out of the routine immunisation exercise are covered. The weeklong third phase of Intensified Mission Indradhanush (IMI)  started on December 7 and will go on till 13.

Pulse_Polio_Day

Prime minister Narendra Modi in October this year, IMI is targetted at every child under two years of age. The special drive focuses on improving immunization coverage in select districts and cities to ensure full immunization to more than 90% by December 2018. The achievement of full immunisation under Mission Indradhanush to at least 90% coverage was to be achieved by 2020 earlier. With the launch of IMI, achievement of the target has now been advanced. Mission Indradhanush recently came in for rich praise in a global pneumonia/diarrhoea report card drawn up by Johns Hopkins Bloomberg School of Public Health and other partners.

Four phases of Mission Indradhanush have reached to more than 2.53 crore children and 68 lakh pregnant women. Vaccination is accepted the world over as one of the most effective preventive measures and one of the best ways to prevent under five child mortality. Yet only 62% of children are fully immunised says data from the National Family Health Survey 4. There are wide variations between states – the coverage is 38.2% in Arunachal Pradesh and 82% in Kerala.

The vaccines covered in the universal immunisation programme include BCG, hepatitis B, polio, diphtheria, pertussis and tetanus, measles-rubella, Japanese Encephalitis (in endemic areas), pneumonia and rotavirus. “It is for the states to devise strategies best suited to reach the target population in chosen districts – for example in riverine districts like Dhubri in Assam boats may be pressed into service. There is one mobile vaccination unit – commonly known as vaccine vans – in Srawasti district of Uttar Pradesh. In North 24 Parganas of West Bengal where there is a substantial Muslim population, clerics have been roped in to take the message across,” said a senior health ministry official.

For IMI the Union ministry of health is leaving no stone unturned with daily monitoring happening through officers whatsapp groups and additional resources been given to states to reach the target. Items like vaccine vans or refrigerators to store vaccines states have been given for IMI will henceforth become a part of the routine immunisation programme – that in fact is one of the key differences from Mission Indradhanush as it was since its launch on December 25, 2014. IMI will also award states and districts reaching more than 90% coverage. Targets have been set at 90% rather than 100 because it is a fact accepted in public health globally that the last 10% is usually the hardest to achieve and also requires far higher resource commitment.

Time Is Running Out For Your Flu Shot

MediBulletin Bureau
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Time Is Running Out For Your Flu Shot

Delhi for now is gasping for breath. While pollution is hogging headlines and mindspace, time may be running out for that flu shot in preparation for Delhi’s harsh winter. India introduced Haemophilus Influenzae Type B (Hib) vaccine into the routine immunisation programme earlier this year but adults in the country largely remain unvaccinated. The result: lost mandays and illness.

What is influenza?

Influenza commonly known as Flu is a disease associated with symptoms of low grade fever, running nose, dry cough, headache, malaise and bodyache. Fever is sometimes high grade going upto 104 degrees F with chills and sweating. It is not uncommon for young children to have higher temperature than adults. Flu usually lasts for about a week but you may continue to feel tired for several days after the symptoms have subsided.

Is there really a “flu” season?

There is, actually. The disease usually picks up in the winter months starting October and lasts upto March of every year. It is a contagious disease which means affected individuals can pass on the infection to people who come in contact with them. It can sometimes lead to more serious complications like sinus and ear infections, pneumonias, life threatening sepsis etc. Young children below 5 years of age, senior citizens, pregnant women, people with preexisting chronic diseases (like Diabetes, Tuberculosis,COPD, asthma etc) and smokers are particularly at risk of serious infection due to weakened immune system. High levels of household and ambient air pollution are also associated with increased complication rates.

Who can take a flu shot?

The best way to prevent the illness and its spread is by receiving a shot of Flu Vaccine which is recommended for everyone above the age of 6months of age. The Flu vaccine is produced from the influenza virus that has been weakened or inactivated. Since there are variations, known as “strains,” in the flu virus from year to year, and place to place, vaccines protect against the three or four strains that research shows will be most common during the upcoming season. These are known as trivalent (three-sided) or quadrivalent (four-sided) vaccines. It is usually administered in the form of injection. It takes about two weeks for the antibodies against flu to develop.

Are there any complications of the vaccine?

You may sometimes develop mild Flu like symptoms post immunisation. The flu shot may cause soreness, redness, tenderness or swelling at the injection site, as well as a low-grade fever, which should only last for a day or two and improves with oral paracetamol or ibuprofen. Aspirin should be avoided in children because of risk of a very rare but fatal condition called Reye’s Syndrome. Serious allergic reactions to the vaccine is rare and it usually develops within few minutes to hours and should be reported to the doctor immediately.

Which vaccine does one take?

In India the commonly used vaccine contains Influenza Vaccine (A&B)& H1N1 Vaccine (Swine Flu) strains. Individuals in highly populated, low to medium income countries like India are at increased risk of infections and it is recommended by most doctors to get your Flu shot before the advent of winter.

An infographic explaining flue shot

Sirenomelia: 14 cases of “mermaid” disease in India

Dr O P Choudhury
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Sirenomelia: 14 cases of “mermaid” disease in India

The death of the “mermaid baby” in Kolkata was only the second known case of Sironomelia in India

Opera di John Collier
Work by John Collier

In all the years when you fantasised over The Little Mermaid in your favourite fairy tale book, you may never have imagined her as a little girl who was unwell. She may have been, though.

The death of the “mermaid baby” in Kolkata two days ago was, if doctors there are to be believed, only the second known case of Sironomelia in India. However there are published articles in medical journals, that claim that there have been no less than 14 documented cases in India. Globally the number touches 300.

Sironomelia is a rare disorder where the baby is born with the two legs joined together – what gives the appearance of the mermaid’s tail. It is a fetal development disorder caused by a lower spine anomaly, triggered by a genetic defect and may be accompanied by other deficiencies such as genitourinary abnormalities, gastrointestinal abnormalities, anomalies of the lumbarsacral spine and pelvis and absence or underdevelopment (agenesis) of one or both kidneys. That is why survival is an issue with these children though there have been exceptions. Tiffany Yorks is a 13-year-old girl with fused legs.

According to the National Organisation for Rare Disorders, US: “Sirenomelia affects males more often than females by a ratio of 2.7-1. The exact incidence is unknown, but sirenomelia is estimated to occur in approximately 1 in 60,000 to 100,000 births. Sirenomelia occurs with greater frequency in one twin of identical (monozygotic) twins than it does in fraternal (dizygotic) twins or individuals.”

In a 2015 article in the Journal of Natural Science, Biology and Medicine researchers from the Mahatma Gandhi Medical College and Research Institute Puducherry wrote: “Sirenomelia is usually fatal within a day or two of birth because of complications associated with abnormal kidney and urinary bladder development and function. In literature approximately 300 cases are reported worldwide of which 14 are from India. In most of the cases the diagnosis was performed after birth.”

They concluded that if the genetic defect is detected before birth within the medically and legally permissible limits of abortion that is the best option.

Loneliness, unemployment can cause heart disease

MediBulletin Bureau
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Loneliness, unemployment can cause heart disease

Loneliness can affect your heart. So can unemployment

Researchers at the University College London have found. A UCL study, published in PLOS Medicine, analysed cohort data from three eastern European countries and found that heart disease incidence is more likely among people who rarely see their friends and relatives, are single, unemployed, less wealthy, and have depression-like symptoms. The researchers focused on eastern European countries because heart disease rates are higher there than anywhere else in the world.

Researchers found: “During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives.” The risk factors were independent of one another.

“Previously the impact of these factors have been studied in isolation, so it has been unclear whether one of these factors is the most important root cause. For example, the potential effects of factors such as unemployment and social isolation were thought to be the link between poverty and heart disease,” explained Dr Taavi Tillmann (UCL Institute of Epidemiology and Public Health), the first author of the study.

Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India. According to an article published last year in the journal Circulation: “A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for >80% of CVD deaths. The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population. Some aspects of the CVD epidemic in India are particular causes of concern, including its accelerated buildup, the early age of disease onset in the population, and the high case fatality rate.” India has been going through rapid social changes with the advent of nuclear families, migration and rising consumerism.

Co-principal investigator in the UCL study, Professor Pajak, Jagiellonian University in Poland, said: “These findings show that in addition to classical risk factors such as smoking, blood pressure and cholesterol, psychological factors related to stress also have an important influence on the risk of heart disease. We should now look to include these factors in our prevention and primary care programmes, especially in the eastern European region where the rates of heart disease are among the highest in the world.”

Now, Haryana moves to cancel Fortis licence

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Now, Haryana moves to cancel Fortis licence

State govt. is seeking to cancel the land lease of Fortis that got land on concession in return for keeping 20% beds free

One day after Delhi government cancelled the licence of Max Hospital Shalimar Bagh, Haryana has started a similar process for Fortis Hospital. State health minister Anil Vij has written to the urban development authority seeking to cancel the land lease of Fortis that got land on concession in return for keeping 20% beds free.

Fortis which was accused of making profit out of drugs and consumables in handing out a bill of more than Rs 15 lakh to the family of a 7-year-old girl who died of dengue has also been found guilty of some other misdemeanours by a committee formed by the Haryana government. On Friday Delhi government cancelled the licence of Max for declaring a living baby dead. The baby subsequently died.

Vij had, earlier described the death of Aadya Singh, the seven year old dengue patient as a murder and the government of Haryana has already announced that an FIR will be lodged against the hospital. He had accused the hospital of having made a hefty profit on medicines given, which works out to 108 per cent and for some consumables it was as high as 1,737 per cent.

Just before Aadya Singh, who had suffered more than 70% brain damage was taken off the ventilator after two weeks of hospitalisation, her father was billed Rs 1559322, including the price of 611 syringes – the figure would mean Aadya was given 43 injections every day – and 1546 pair of gloves. The massive accumulation of fluid in her body meant that Aadya would not fit into the clothes that she had come to the hospital in. Also included in the bill is Rs 900 as the cost of the hospital gown the little girl wore when she was taken out of Fortis to a different hospital where they would issue her a death certificate. The probe found the hospital guilty of not adhering to the leave against medical advice (LAMA) protocol that requires a hospital to provide transportation with life support for a patient who needs artificial help to survive.

Fortis had earlier said that all medical protocol had been followed in the case and all consumables are transparently reflected in records and charged as per actuals.

Genexpert Ultra could revolutionise investigation modalities for Tubercular Meningitis, other Extrapulmonary TB

Dr O P Choudhury
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Genexpert Ultra could revolutionise investigation modalities for Tubercular Meningitis, other Extrapulmonary TB

By Dr O P Choudhury

The advent of Xpert MTB / RIF, also called GeneXpert assay in 2004 and subsequent recommendation from WHO in 2010 to include it in the diagnosis of Mycobacterium  tuberculosis (MTB) infection has dramatically improved the diagnosis especially in smear negative (AFB negative) and multidrug resistant TB. GeneXpert combines early diagnosis of TB (within 2 hours)  with direct detection of Rifampicin resistance.

However the limitation of the assay was low sensitivity and high rate of false positivity particularly in smear negative and HIV associated TB (paucibacillary TB).

The makers of GeneXpert assay, Cepheid, Sunnyvale, CA, USA, have developed the new Xpert Ultra MTB/RIF to improve the sensitivity of the test. This was achieved by adding additional primers (two new multi-copy amplification targets (IS6110 and IS1081) and a larger DNA amplification reaction chamber and is run on the same device as Xpert. As published in a recent edition of Lancet Infectious Diseases, Susan Dorman and colleagues reported the results of a comparison between Xpert Ultra with Xpert assay on sputum samples from 1753 patients tested at ten reference laboratories in high endemic countries.

Xpert Ultra had a high overall sensitivity (88%) versus Xpert (83%) which resulted in higher positive cases but resulted in a drop of 2% in specificity (96%) compared to Xpert (98%). The difference in sensitivity was more pronounced in smear negative cases (63%) versus (46%) and in HIV coinfected cases (90%) versus (77%).

Another study by Bahr and colleagues compared Xpert Ultra with Xpert for detection of Mycobacterium tuberculosis in cerebrospinal fluid, showing that the sensitivity was superior even when compared to culture. Culture is considered the gold standard in diagnosis of Tubercular infection as it grows only viable bacilli.The only drawback was excess false positive cases as detection of DNA from small number of non viable / dead bacilli as it was previously observed in Xpert assay particularly with recent history of TB . That included patients treated for TB in the past two years.

WHO after a meeting of its technical expert consultation in January 2017 declared the Ultra assay as non inferior to the current Xpert MTB/RIF assay for the detection of MTB and the detection of rifampicin resistance and can be procured as an alternative to the latter in all settings.The current WHO recommendation for the use of Xpert MTB/ RIF also apply to the use of Ultra as the initial diagnostic test for all adults and children with signs and symptoms of TB and in the testing of selected extrapulmonary specimens (cerebrospinal fluid, lymph nodes, and tissue specimens ).

An update of the current guidelines is expected in 2018 for the use of Xpert MTB /RIF , when more information on the use of Ultra assay will be available.

Surgeries don’t just save lives; they pollute, like refrigerators do

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Surgeries don’t just save lives; they pollute, like refrigerators do

For all the years that pollution has been in the news, surgeries have rarely been associated with it. However as it turns out, not just refrigerators, even surgeries can be a source of greenhouse gases.

The first analysis of the carbon footprint of surgical suites at three hospitals in the UK, Canada and the USA highlights that the choice of anaesthetic gases used in surgery can be a major contributor to greenhouse gas emissions from operating theatres. The study was published in The Lancet Planetary Health.

The study measured the carbon footprint of three surgical suites in Canada (Vancouver General Hospital), the USA (University of Minnesota Medical Centre) and the UK (John Radcliffe Hospital, Oxford). The annual carbon footprint of surgical suites ranged from approximately 3218 tonnes of CO2 equivalents to 5187 tonnes of CO2e. While there were differences in the size and case load among all three surgical suites, there was also wide differences in the major contributors to greenhouse emissions. For instance, at Vancouver and Minnesota, anaesthetic gases were responsible for 63% and 51% of the total surgical emissions, compared to only 4% at Oxford.

The authors say this is largely the result of a higher usage of desflurane in the two North American hospitals. Desflurane has a high global warming potential (GWP), approximately 5 to 18 times higher than other anaesthetic gases, such as isoflurane and sevoflurane.

Dr Andrea MacNeill, Vancouver General Hospital, BC, Canada, and lead author of the study says: “Not only is desflurane a primary contributor to global anaesthetic gas emissions, it is also one of the most expensive anaesthetic gases. One of the greatest barriers to widespread implementation of low-carbon practices is the lack of awareness regarding the environmental impacts of anaesthetic choices. The climate impacts of surgery are generally accepted as necessary for the provision of quality care, but our study shows that it’s possible to reduce the carbon footprint of surgery, which also reduce costs, without compromising patient care.”

The health sector is one of the largest service industries, with a considerable carbon footprint. In the USA, the health care system generates 8-10% of all greenhouse gas emissions. In the UK, the National Health Service is responsible for 25% of public sector emissions.

Rapeseed (canola) oil can affect brain, hasten Alzheimer’s Disease

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Rapeseed (canola) oil can affect brain, hasten Alzheimer’s Disease

Rapeseed oil, commonly used as a cooking medium in India can hasten memory impairments associated with Alzheimer’s Disease (AD), a study has found.

Researchers at the Temple University administered canola oil (also known as rapeseed oil)  to mouse and studied its effects on a variety of neurological aspects including Alzheimer’s Disease pathogenesis (process by which a disease happens). “In conclusion, our investigation demonstrates for the first time to the best of our knowledge a negative effect of the chronic consumption of canola oil on memory, synaptic integrity and Aβ 42/40 ratios in a mouse model of AD (Alzheimer’s Disease). The translational value of our findings lies in the observation that this type of oil supplementation can influence some of the most important features of the AD pathological phenotype,” they concluded in the study that was published in Scientific Reports. In short they found that the neurological incidents leading to AD are hastened by rapeseed oil.

Rapeseed or canola oil is the third largest vegetable oil by volume after palm and soybean oil worldwide. Alzheimer’s is the most common form of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer’s disease (AD) accounts for 60 to 80 percent of dementia cases. An estimated 4.1 million people are supposed to be living in India with dementia. According to a paper published in Neurology India which was trying to analyse the population incidence rates of AD, “Alzheimer’s disease (AD) and other forms of dementia are a growing public health problem among the elderly in developing countries, whose aging population is increasing rapidly. It is estimated that by the year 2020, approximately 70% of the world’s population aged 60 and above will be living in developing countries, with 14.2% in India.” For India the problem is compounded by the fact that AD which is more common in older people can often go undiagnosed because of a variety of reasons including lack of awareness and lack of qualified health professionals. It is mostly disregarded as age related forgetfulness and the patient just keeps deteriorating.

The Temple University researchers concluded: “Overall our findings do not provide support to some of the current ideas suggesting healthy benefits deriving from the regular consumption of canola oil. Although we recognize that more studies are needed to investigate the biological effects of this oil, our data would not justify the increasing tendency of replacing olive oil with canola oil as part of a good and healthy dietary alternative in non-Mediterranean countries.”

India is free of trachoma, leading cause of infective blindness

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India is free of trachoma, leading cause of infective blindness

This infection of the eyes was the most important cause of blindness in India

India has eliminated trachoma, a chronic infective disease of the eye and is the leading cause of infective blindness globally. The National Trachoma Prevalence Surveys and the Trachoma Rapid Assessment Surveys conducted by experts from the All India Institute of Medical Sciences found an overall prevalence of 0.7%. The WHO limit for elimination is 5%.

Trachoma is a disease of poor environmental and personal hygiene and inadequate access to water and sanitation. It affects the conjunctiva under the eyelids. Repeated infections cause scarring leading to in-turning of the eyelashes and eyelids. This further causes damage to the cornea and blindness. It affects the population in certain pockets of the States of North India like Gujarat, Rajasthan, Punjab, Haryana, Uttar Pradesh and Nicobar Islands. Trachoma infection of the eyes was the most important cause of blindness in India in 1950s and over 50% population was affected in Gujarat, Rajasthan, Punjab, and Uttar Pradesh. It was the most important cause of corneal blindness in India, affecting young children.

Health minister J P Nadda said that the survey results show that active trachoma is no longer a public health problem in India.

Describing it as a “momentous achievement”, health minister J P Nadda said that the survey results show that active trachoma is no longer a public health problem in India. “We have met the goal of trachoma elimination as specified by the WHO under its GET2020 program, he said. This has been possible due to decades of inter-sectoral interventions and efforts that included provision of antibiotic eye drops, personal hygiene, availability of safe water, improved environmental sanitation, availability of surgical facilities for chronic trachoma, and a general improvement in the socio economic status in the country,” he said.

The surveys were conducted in 27 high-risk districts across 23 states and union territories. Trachoma Prevalence Surveys were done in 10 districts selected from the previously hyper-endemic states. Under the survey, 19662 children in 1-9 year age group were examined by trained ophthalmologists. As many as 44135 persons were examined among the 15yr+ age group. The Trachoma Rapid Assessment Surveys (TRA) was done in 17 other districts from other parts of the country in places where trachoma cases have been reported, which were not previously hyper-endemic.

Experts call for universal flu vaccine

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Experts call for universal flu vaccine

It is always better to get vaccinated than not to get vaccinated

It is flu season once more and as numbers in the USA cause panic – in India winter is yet to kick in and the influenza virus is not having a field day just yet – experts have called for a universal flu vaccine. The flu vaccine which is really the cornerstone of influenza prevention has to be updated every year as per World Health Organisation updates in February on the circulating strain.

In an authored article in the New England Journal of Medicine, infectious disease experts from the National Institutes of health argued: “However imperfect, though, current influenza vaccines remain a valuable public health tool, and it is always better to get vaccinated than not to get vaccinated. In this regard, the CDC estimates that influenza vaccination averted 40,000 deaths in the United States between the 2005–2006 and 2013–2014 seasons. Yet we can do better. Although targeted research to improve current vaccine antigens, platforms, and manufacturing strategies may in the short term lead to enhanced effectiveness of seasonal influenza vaccines, to achieve the ultimate objective of a universal influenza vaccine, a broad range of expertise and substantial resources will be required to fill gaps in our knowledge and develop a transformative approach to influenza-vaccine design.”

The perspective article in the prestigious journal estimated that seasonal influenza epidemics cause 3 million to 5 million severe cases and 300,000 to 500,000 deaths globally each year, according to the World Health Organization (WHO). The United States alone sees 140,000 to 710,000 influenza-related hospitalizations and 12,000 to 56,000 deaths each year, with the highest burden of disease affecting the very young, the very old, and people with coexisting medical conditions. In India one child is said to die every minute of either pneumonia or diarrhoea. This prompted the government to introduce an influenza vaccine in the universal immunisation programme earlier this year. The commonly used vaccine contains Influenza Vaccine (A&B)&  H1N1 Vaccine (Swine Flu) strains.

Whether the vaccine being used in a particular year is matched to the circulating strain has a direct bearing on the pneumonia burden in that year. The NEJM authors noted:”For example, during the 2014–2015 influenza season in the United States, more than 80% of the circulating influenza A (H3N2) viruses that were characterized differed from the vaccine virus, and vaccine effectiveness was only 13% against influenza A (H3N2).2 This mismatch most likely contributed to the severity of the 2014–2015 influenza season and the substantial related morbidity and mortality among people over 65 years of age.”

Here are some facts about flu vaccine from CDC website

fluFLU VACCINE

Protects You And Your Family

Flu Can Be Serious

The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness and, at times, can lead to death.

Flu Vaccine Is The Best Protection

Everyone 6 months and older should get a flu vaccine each year. Flu vaccines…

  • Can keep you from getting sick with flu
  • Can reduce the risk of flu-associated hospitalizations including among children and older adults
  • Are very important for people with chronic health conditions like diabetes and heart and lung disease
  • Help protect both pregnant women and their babies for several months after birth from the flu
  • May make your illness milder if you do get sick Each year, CDC reports the number of flu illnesses, medical visits, and hospitalizations prevented by flu vaccination.

CDC recommends that people get a flu vaccine by the end of October, if possible. However, getting vaccinated later can still be beneficial. Ongoing flu vaccination is recommended as long as flu viruses are circulating, even into January or later. Every flu season is different, and the flu can affect people differently. Every flu season millions of people get the flu, hundreds of thousands of people are hospitalized and thousands or tens of thousands of people die from flu-related causes.

 

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