Background Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. A... more Background Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. Although Japanese encephalitis virus (JEV) accounts for around 15% of reported cases, the aetiology of most cases remains unknown. We aimed to establish an enhanced surveillance network and to use a standardised diagnostic algorithm to conduct a systematic evaluation of acute encephalitis syndrome in India. Methods In this large-scale, systematic surveillance study in India, patients presenting with acute encephalitis syndrome (ie, acute onset of fever with altered mental status, seizure, or both) to any of the 18 participating hospitals across Uttar Pradesh, West Bengal, and Assam were evaluated for JEV (serum and cerebrospinal fluid [CSF] IgM ELISA) per standard of care. In enhanced surveillance, JEV IgM-negative specimens were additionally evaluated for scrub typhus, dengue virus, and West Nile virus by serum IgM ELISA, and for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, dengue virus, herpes simplex virus, and enterovirus by CSF PCR across five referral laboratories. In 2017, chikungunya and Leptospira serum IgM by ELISA and Zika virus serum and CSF by PCR were also tested. Findings Of 10 107 patients with acute encephalitis syndrome enrolled in enhanced surveillance between Jan 1, 2014, and Dec 31, 2017, 5734 (57•8%) of 9917 participants with available data were male and 6179 (62•7%) of 9856 were children aged 15 years and younger. Among patients who provided a sample of either CSF or serum in enhanced surveillance, an aetiology was identified in 1921 (33•2%) of 5786 patients enrolled between 2014 and 2016 and in 1484 (34•3%) of 4321 patients enrolled in 2017. The most commonly identified aetiologies were JEV (1023 [17•7%] of 5786 patients), scrub typhus (645 [18•5%] of 3489), and dengue virus (161 [5•2%] of 3124). Among participants who provided both CSF and serum specimens, an aetiology was identified in 1446 (38•3%) of 3774 patients enrolled between 2014 and 2016 and in 936 (40•3%) of 2324 enrolled in 2017, representing a 3•1-times increase in the number of patients with acute encephalitis syndrome with an identified aetiology compared with standard care alone (299 [12•9%]; p<0•0001). Interpretation Implementation of a systematic diagnostic algorithm in an enhanced surveillance platform resulted in a 3•1-times increase in identification of the aetiology of acute encephalitis syndrome, besides JEV alone, and highlighted the importance of scrub typhus and dengue virus as important infectious aetiologies in India. These findings have prompted revision of the national testing guidelines for this syndrome across India.
Female health workers in India face an increasing workload that affects their performance. We did... more Female health workers in India face an increasing workload that affects their performance. We did a study in 2 districts of West Bengal, India, to quantify their workload and identify determinants of good performance. We randomly sampled female health workers from the health department's list. First, we quantified the time allocated to tasks through observations of work sessions. Second, we estimated the prevalence ratio (PR) of above-average performance for three indicators (DPT-booster coverage, antenatal check-up coverage and family planning performance) according to selected potential determinants. Female health workers spent 26% of their time in documentation. We recruited 42 female health workers (average population covered: 6495). Larger floor space (PR 2.5; 95% CI 1.2-5.3), use of simplified documentation procedures (PR 2.5; 95% CI 1.2-5.2) and monthly supervision (PR 3.0; 95% CI 1.1-8.5) were associated with above-average DPT-booster coverage. Availability of a private ...
Despite emerging consensus that the One Health concept involves multiple stakeholders, the human ... more Despite emerging consensus that the One Health concept involves multiple stakeholders, the human health sector has continued to view it from a predominantly human health security perspective. It has often ignored the concerns of other sectors, e.g. concerns that relate to trade, commerce, livelihoods and sustainable development, all of which are important contributors to societal well-being. In the absence of a culture of collaboration, clear One Health goals, conceptual clarity and operating frameworks, this disconnect between human health and One Health efforts has often impeded the translation of One Health from concept to reality, other than during emergency situations. If there are to be effective and sustainable One Health partnerships we must identify clear operating principles that allow flexible approaches to intersectoral collaborations. To convince technical experts and political leaders in the human health sector of the importance of intersectoral cooperation, and to make the necessary structural adjustments, we need examples of best practice models and trans-sectoral methods for measuring the risks, burden and costs across sectors. Informal collaborations between researchers and technical experts will play a decisive role in developing these methods and models and instilling societal wellbeing into the human health sector's view of One Health.
Anthrax is a potentially life-threatening bacterial disease that can spread between wild and live... more Anthrax is a potentially life-threatening bacterial disease that can spread between wild and livestock animals and humans. Transmission typically occurs indirectly via environmental exposure, with devastating consequences for human and animal health, as well as pastoralist economies. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modelled the geographical suitability of anthrax across India and its associated environmental features using a biogeographic application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence. The elephant–livestock interface was the dominant feature in delineating anthrax suitability. In addition, water–soil balance, soil chemistry and historical forest loss were also influential. These findings suggest that the elephant–livestock interface plays an important role in the cycling of anthrax in India. L...
Anthrax is a potentially life-threatening bacterial disease that can spread between wild and live... more Anthrax is a potentially life-threatening bacterial disease that can spread between wild and livestock animals and humans. Transmission typically occurs indirectly via environmental exposure, with devastating consequences for human and animal health, as well as pastoralist economies. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modelled the geographical suitability of anthrax across India and its associated environmental features using a biogeographic application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence. The elephant–livestock interface was the dominant feature in delineating anthrax suitability. In addition, water–soil balance, soil chemistry and historical forest loss were also influential. These findings suggest that the elephant–livestock interface plays an important role in the cycling of anthrax in India. L...
Background Anthropogenic pressure in biodiversity hotspots is increasingly recognised as a major ... more Background Anthropogenic pressure in biodiversity hotspots is increasingly recognised as a major driver of the spillover and expansion of zoonotic disease. In the Western Ghats region of India, a devastating tick-borne zoonosis, Kyasanur Forest disease (KFD), has been expanding rapidly beyond its endemic range in recent decades. While it has been suggested that anthropogenic pressure in the form of land use changes that lead to the loss of native forest may be directly contributing to the expanding range of KFD, clear evidence has not yet established the association between forest loss and KFD risk. Methods The current study sought to investigate the relationship between KFD landscape suitability and both forest loss and mammalian species richness to inform its epidemiology and infection ecology. Forty-seven outbreaks of KFD between 1 January, 2012 and 30 June, 2019 were modelled as an inhomogeneous Poisson process. Results Both forest loss (relative risk (RR) = 1.83; 95% C.I. 1.33 ...
The rainforests of the Western Ghats exhibit some of the highest biodiversity on the planet, and ... more The rainforests of the Western Ghats exhibit some of the highest biodiversity on the planet, and yet are undergoing rapid land use change due to the expansion of agriculture and other industries. As the landscape of the region is transformed, more people are coming into conflict with wildlife and becoming exposed to pathogens that previously circulated beyond the boundaries of human incursion. Despite an ecological knowledge imperative, this emerging landscape is ill-defined with respect to the ecology of zoonotic viruses and their mammalian wildlife hosts. Without a better understanding of the underlying infection ecology, the epidemiology of viral spillover will remain elusive and unsuited to the task of predicting and preventing outbreaks. The current investigation explored the association between mammalian zoonotic virus richness and species-level landscape, life-history, and dietary traits to describe an initial ecological profile of zoonotic virus hosts in the Western Ghats. Social group composition and dietary forage were both non-linearly associated with greater zoonotic viral richness among these species, whereby species active in smaller social groups, albeit in higher population densities, and exhibiting a tendency toward a generalist diet hosted more zoonotic viruses. While these findings provide no definitive ecological demarcation of zoonotic virus hosts or their contribution to viral maintenance or amplification, it is expected that this preliminary profile can help to develop targeted wildlife pathogen surveillance programs and to expand the current approach to epidemiological modelling of emerging zoonoses in the region, which typically do not account for the macroecological parameters of infection transmission.
Background and Objective: Amongst all the states and union territories in India, New Delhi shares... more Background and Objective: Amongst all the states and union territories in India, New Delhi shares the highest burden of the disease. Dengue infection is influenced by several socioeconomic factors, which involve roles, and responsibilities of various stakeholders of the society. In this study, we attempt to explore the awareness, knowledge and perception about dengue amongst relevant stakeholders. Methodology: A sample of 30 stakeholders having different roles in management of dengue was taken all over from Delhi. In-depth, face-to-face, qualitative interviews were taken using an interview tool customized as per roles and responsibilities of the stakeholders. Result: The study identified four key themes in management of dengue in Delhi. These themes were studied in depth and various challenges in dengue management were explored.
Background Anthropogenic pressure in biodiversity hotspots is increasingly recognized as a major ... more Background Anthropogenic pressure in biodiversity hotspots is increasingly recognized as a major driver of the spillover and expansion of zoonotic disease. In the Western Ghats region of India, a devastating tick-borne zoonosis, Kyasanur Forest disease (KFD), has been expanding rapidly beyond its endemic range in recent decades. It has been suggested that anthropogenic pressure in the form of land use changes that lead to the loss of native forest may be directly contributing to the expanding range of KFD, but clear evidence has not yet established the association between forest loss and KFD risk. Methods The current study sought to investigate the relationship between KFD landscape suitability and both forest loss and mammalian species richness, to inform its epidemiology and infection ecology. A total of 47 outbreaks of KFD between 1 January 2012 and 30 June 2019 were modelled as an inhomogeneous Poisson process. Results Both forest loss [relative risk (RR) = 1.83; 95% confidence ...
Background: In the context of newly emerging diseases, global health security has gained importan... more Background: In the context of newly emerging diseases, global health security has gained importance in recent years. The pandemic COVID-19 has reemphasized the significance. Despite increased attention to enhance health security, the existing capacities were not optimally prepared to respond to public health threats posed by emerging infectious diseases. Objective: The objective of the study was to develop a simple tool that can help monitor and build up the critical capacity to prevent, detect, respond and help identify the gaps in the preparedness of the health system. Methods: The cross-sectional study was conducted from January 2018 – December 2018 amongst the district level health functionaries like the disease surveillance, laboratory, and the animal health focal points in the selected districts across the three South Indian states. Results: The responses received from the participants of the study were scored and categorized by domains into a biosecurity index, which was easi...
Highly pathogenic avian influenza (HPAI), subtype H5N1, constitutes one of the world’s most impor... more Highly pathogenic avian influenza (HPAI), subtype H5N1, constitutes one of the world’s most important health and economic concerns given the catastrophic impact of epizootics on the poultry industry, the high mortality attending spillover in humans, and its potential as a source subtype for a future pandemic. Nevertheless, we still lack an adequate understanding of HPAI H5N1 epidemiology and infection ecology. The nature of the wild waterfowl-poultry interface, and the sharing of diverse wetland habitat among these birds, currently underscore important knowledge gaps. India has emerged as a global hotspot for HPAI H5N1, while also providing critical wintering habitat for many species of migratory waterfowl and year-round habitat for several resident waterfowl species. The current study sought to examine the extent to which the wild waterfowl-poultry interface, varied wetland habitat, and climate influence HPAI H5N1 epizootics in poultry in India. Using World Organisation for Animal ...
Kyasanur Forest disease (KFD) is one of India’s severe arboviruses capable of causing prolonged d... more Kyasanur Forest disease (KFD) is one of India’s severe arboviruses capable of causing prolonged debilitating disease. It has been expanding beyond its historical endemic locus at an alarming rate over the last two decades. The natural nidus of this zoonosis is located in the monsoon rainforest of the Western Ghats, India, which is one of the world’s most important biodiversity hotspots. Definitive reservoir hosts for KFD virus (KFDV) have yet to be delineated, and thus much of the infection ecology of this virus, and its consequent transmission dynamics, remains uncertain. Given its unique biogeographical context, identifying ecological parameters of KFDV relevant to the virus’ epidemiology has been complex and challenging. The challenge has been exacerbated by diminished research efforts in wildlife surveillance over the last two decades, coinciding with the expansion of the range of KFD across the region. The current investigation sought to define a preliminary ecological profile ...
Anthrax is a potentially life-threatening bacterial disease that can circulate in wild and domest... more Anthrax is a potentially life-threatening bacterial disease that can circulate in wild and domestic animals and subsequently spillover to human contacts with devastating consequences for human and animal health, as well as livestock economies and ecosystem conservation. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modeled the geographic suitability of anthrax across India and its associated environmental features using a biogeographical application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence and the wildlife-livestock interface, using elephants as a wildlife sentinel species, was the dominant feature in delineating anthrax suitability. In addition, water-soil balance, soil chemistry, and historical forest loss were also influential. These findings suggest that the wildlife-livestock interface plays an important role...
Proceedings of the Royal Society B: Biological Sciences
Anthrax is a potentially life-threatening bacterial disease that can spread between wild and live... more Anthrax is a potentially life-threatening bacterial disease that can spread between wild and livestock animals and humans. Transmission typically occurs indirectly via environmental exposure, with devastating consequences for human and animal health, as well as pastoralist economies. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modelled the geographical suitability of anthrax across India and its associated environmental features using a biogeographic application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence. The elephant–livestock interface was the dominant feature in delineating anthrax suitability. In addition, water–soil balance, soil chemistry and historical forest loss were also influential. These findings suggest that the elephant–livestock interface plays an important role in the cycling of anthrax in India. L...
Acute Encephalitis Syndrome (AES) poses a major public health problem in India affecting thousand... more Acute Encephalitis Syndrome (AES) poses a major public health problem in India affecting thousands of people every year during the post monsoon season (July-November) Japanese encephalitis virus (JEV) accounts for 5-35% of the AES seen in India; however no systematic efforts have been made to determine the precise etiology of all AES cases
Antibiotic resistance, a global concern, is particularly pressing in developing nations, includin... more Antibiotic resistance, a global concern, is particularly pressing in developing nations, including India, where the burden of infectious disease is high and healthcare spending is low. The Global Antibiotic Resistance Partnership (GARP) was established to develop actionable policy recommendations specifically relevant to low- and middle-income countries where suboptimal access to antibiotics - not a major concern in high-income countries - is possibly as severe a problem as is the spread of resistant organisms. This report summarizes the situation as it is known regarding antibiotic use and growing resistance in India and recommends short and long term actions. Recommendations aim at (i) reducing the need for antibiotics; (ii) lowering resistance-enhancing drug pressure through improved antibiotic targeting, and (iii) eliminating antibiotic use for growth promotion in agriculture. The highest priority needs to be given to (i) national surveillance of antibiotic resistance and antibi...
Objective. Effective early management at home level and health seeking behavior in case of appear... more Objective. Effective early management at home level and health seeking behavior in case of appearance of danger signs are key strategies in Acute respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) where majority of episodes are selflimiting and viral in origin. Integrated Management of Childhood illnesses (IMNCI) also envisages that family and community health practices especially health care seeking behaviors are to be improved to reduce childhood morbidity, mortality and cost of admissions to hospitals. Thus, a study was undertaken at an urban slum area-'Gokul Puri' in Delhi, among under-5 children with the aim to assess the magnitudes of ARI and ADD. Methods. A Cross-sectional survey was conducted in this urban slum of Trans-Yamuna, covering 1307 under-5 children for five days starting from 9 th of August, 2004. Survey team consisted of 14 FETP Participants (WHO Fellows) from India, Nepal, Myanmar, Bhutan and Sri Lanka. A pre-tested, household tally marking form was used to interview the caretakers/mothers. History of episodes of ARI and/or ADD in the last two weeks was asked. Health care practices including use of ORS & home available fluids in diarrhea, continued feeding during diarrhea, awareness of danger signs of ARI & ADD and medical advice sought were asked of those mothers whose children had such an episode. Results. 191 (14.6 %) of 1307 children surveyed, had an attack of ARI in the preceding two wk. The common symptoms of ARI cases were mild running nose (78%), cough (76.4%) and/or fever (45.5%). Only 8 (4%) had fast breathing. One or more danger signs were known to 80% (152/191) of mothers and an equal number (80%) of mothers had sought treatment. ARIs are mostly mild or self limiting but only 16% of caretakers perceived so and doctors also prescribed medicines. The attack rate of Acute Diarrheal Diseases was 7.73% in the study and ADD's annual adjusted morbidity rate was 1.69 episodes per child per year. Though nearly three-fourth of mothers (71.3%) had reported to be seeking medical advice (which is not needed in mild episodes of diarrhea) the ORS use was 38.6%, use of Home available fluids (HAF) was 42% and continued feeding was 50% during the ADD episode and awareness of at least two danger signs was present in 34%. Conclusion. Though aware of danger signs of ARI, care takers were still seeking medical advice for mild cases of ARI and doctors were prescribing drugs. Correct home based management e.g. use of ORS, continued feeding etc. was deficient in the community. Knowledge of danger symptoms was low and medical advice was being sought and drugs were being prescribed for ADD, too.
Background Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. A... more Background Annual outbreaks of acute encephalitis syndrome pose a major health burden in India. Although Japanese encephalitis virus (JEV) accounts for around 15% of reported cases, the aetiology of most cases remains unknown. We aimed to establish an enhanced surveillance network and to use a standardised diagnostic algorithm to conduct a systematic evaluation of acute encephalitis syndrome in India. Methods In this large-scale, systematic surveillance study in India, patients presenting with acute encephalitis syndrome (ie, acute onset of fever with altered mental status, seizure, or both) to any of the 18 participating hospitals across Uttar Pradesh, West Bengal, and Assam were evaluated for JEV (serum and cerebrospinal fluid [CSF] IgM ELISA) per standard of care. In enhanced surveillance, JEV IgM-negative specimens were additionally evaluated for scrub typhus, dengue virus, and West Nile virus by serum IgM ELISA, and for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, dengue virus, herpes simplex virus, and enterovirus by CSF PCR across five referral laboratories. In 2017, chikungunya and Leptospira serum IgM by ELISA and Zika virus serum and CSF by PCR were also tested. Findings Of 10 107 patients with acute encephalitis syndrome enrolled in enhanced surveillance between Jan 1, 2014, and Dec 31, 2017, 5734 (57•8%) of 9917 participants with available data were male and 6179 (62•7%) of 9856 were children aged 15 years and younger. Among patients who provided a sample of either CSF or serum in enhanced surveillance, an aetiology was identified in 1921 (33•2%) of 5786 patients enrolled between 2014 and 2016 and in 1484 (34•3%) of 4321 patients enrolled in 2017. The most commonly identified aetiologies were JEV (1023 [17•7%] of 5786 patients), scrub typhus (645 [18•5%] of 3489), and dengue virus (161 [5•2%] of 3124). Among participants who provided both CSF and serum specimens, an aetiology was identified in 1446 (38•3%) of 3774 patients enrolled between 2014 and 2016 and in 936 (40•3%) of 2324 enrolled in 2017, representing a 3•1-times increase in the number of patients with acute encephalitis syndrome with an identified aetiology compared with standard care alone (299 [12•9%]; p<0•0001). Interpretation Implementation of a systematic diagnostic algorithm in an enhanced surveillance platform resulted in a 3•1-times increase in identification of the aetiology of acute encephalitis syndrome, besides JEV alone, and highlighted the importance of scrub typhus and dengue virus as important infectious aetiologies in India. These findings have prompted revision of the national testing guidelines for this syndrome across India.
Female health workers in India face an increasing workload that affects their performance. We did... more Female health workers in India face an increasing workload that affects their performance. We did a study in 2 districts of West Bengal, India, to quantify their workload and identify determinants of good performance. We randomly sampled female health workers from the health department's list. First, we quantified the time allocated to tasks through observations of work sessions. Second, we estimated the prevalence ratio (PR) of above-average performance for three indicators (DPT-booster coverage, antenatal check-up coverage and family planning performance) according to selected potential determinants. Female health workers spent 26% of their time in documentation. We recruited 42 female health workers (average population covered: 6495). Larger floor space (PR 2.5; 95% CI 1.2-5.3), use of simplified documentation procedures (PR 2.5; 95% CI 1.2-5.2) and monthly supervision (PR 3.0; 95% CI 1.1-8.5) were associated with above-average DPT-booster coverage. Availability of a private ...
Despite emerging consensus that the One Health concept involves multiple stakeholders, the human ... more Despite emerging consensus that the One Health concept involves multiple stakeholders, the human health sector has continued to view it from a predominantly human health security perspective. It has often ignored the concerns of other sectors, e.g. concerns that relate to trade, commerce, livelihoods and sustainable development, all of which are important contributors to societal well-being. In the absence of a culture of collaboration, clear One Health goals, conceptual clarity and operating frameworks, this disconnect between human health and One Health efforts has often impeded the translation of One Health from concept to reality, other than during emergency situations. If there are to be effective and sustainable One Health partnerships we must identify clear operating principles that allow flexible approaches to intersectoral collaborations. To convince technical experts and political leaders in the human health sector of the importance of intersectoral cooperation, and to make the necessary structural adjustments, we need examples of best practice models and trans-sectoral methods for measuring the risks, burden and costs across sectors. Informal collaborations between researchers and technical experts will play a decisive role in developing these methods and models and instilling societal wellbeing into the human health sector's view of One Health.
Anthrax is a potentially life-threatening bacterial disease that can spread between wild and live... more Anthrax is a potentially life-threatening bacterial disease that can spread between wild and livestock animals and humans. Transmission typically occurs indirectly via environmental exposure, with devastating consequences for human and animal health, as well as pastoralist economies. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modelled the geographical suitability of anthrax across India and its associated environmental features using a biogeographic application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence. The elephant–livestock interface was the dominant feature in delineating anthrax suitability. In addition, water–soil balance, soil chemistry and historical forest loss were also influential. These findings suggest that the elephant–livestock interface plays an important role in the cycling of anthrax in India. L...
Anthrax is a potentially life-threatening bacterial disease that can spread between wild and live... more Anthrax is a potentially life-threatening bacterial disease that can spread between wild and livestock animals and humans. Transmission typically occurs indirectly via environmental exposure, with devastating consequences for human and animal health, as well as pastoralist economies. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modelled the geographical suitability of anthrax across India and its associated environmental features using a biogeographic application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence. The elephant–livestock interface was the dominant feature in delineating anthrax suitability. In addition, water–soil balance, soil chemistry and historical forest loss were also influential. These findings suggest that the elephant–livestock interface plays an important role in the cycling of anthrax in India. L...
Background Anthropogenic pressure in biodiversity hotspots is increasingly recognised as a major ... more Background Anthropogenic pressure in biodiversity hotspots is increasingly recognised as a major driver of the spillover and expansion of zoonotic disease. In the Western Ghats region of India, a devastating tick-borne zoonosis, Kyasanur Forest disease (KFD), has been expanding rapidly beyond its endemic range in recent decades. While it has been suggested that anthropogenic pressure in the form of land use changes that lead to the loss of native forest may be directly contributing to the expanding range of KFD, clear evidence has not yet established the association between forest loss and KFD risk. Methods The current study sought to investigate the relationship between KFD landscape suitability and both forest loss and mammalian species richness to inform its epidemiology and infection ecology. Forty-seven outbreaks of KFD between 1 January, 2012 and 30 June, 2019 were modelled as an inhomogeneous Poisson process. Results Both forest loss (relative risk (RR) = 1.83; 95% C.I. 1.33 ...
The rainforests of the Western Ghats exhibit some of the highest biodiversity on the planet, and ... more The rainforests of the Western Ghats exhibit some of the highest biodiversity on the planet, and yet are undergoing rapid land use change due to the expansion of agriculture and other industries. As the landscape of the region is transformed, more people are coming into conflict with wildlife and becoming exposed to pathogens that previously circulated beyond the boundaries of human incursion. Despite an ecological knowledge imperative, this emerging landscape is ill-defined with respect to the ecology of zoonotic viruses and their mammalian wildlife hosts. Without a better understanding of the underlying infection ecology, the epidemiology of viral spillover will remain elusive and unsuited to the task of predicting and preventing outbreaks. The current investigation explored the association between mammalian zoonotic virus richness and species-level landscape, life-history, and dietary traits to describe an initial ecological profile of zoonotic virus hosts in the Western Ghats. Social group composition and dietary forage were both non-linearly associated with greater zoonotic viral richness among these species, whereby species active in smaller social groups, albeit in higher population densities, and exhibiting a tendency toward a generalist diet hosted more zoonotic viruses. While these findings provide no definitive ecological demarcation of zoonotic virus hosts or their contribution to viral maintenance or amplification, it is expected that this preliminary profile can help to develop targeted wildlife pathogen surveillance programs and to expand the current approach to epidemiological modelling of emerging zoonoses in the region, which typically do not account for the macroecological parameters of infection transmission.
Background and Objective: Amongst all the states and union territories in India, New Delhi shares... more Background and Objective: Amongst all the states and union territories in India, New Delhi shares the highest burden of the disease. Dengue infection is influenced by several socioeconomic factors, which involve roles, and responsibilities of various stakeholders of the society. In this study, we attempt to explore the awareness, knowledge and perception about dengue amongst relevant stakeholders. Methodology: A sample of 30 stakeholders having different roles in management of dengue was taken all over from Delhi. In-depth, face-to-face, qualitative interviews were taken using an interview tool customized as per roles and responsibilities of the stakeholders. Result: The study identified four key themes in management of dengue in Delhi. These themes were studied in depth and various challenges in dengue management were explored.
Background Anthropogenic pressure in biodiversity hotspots is increasingly recognized as a major ... more Background Anthropogenic pressure in biodiversity hotspots is increasingly recognized as a major driver of the spillover and expansion of zoonotic disease. In the Western Ghats region of India, a devastating tick-borne zoonosis, Kyasanur Forest disease (KFD), has been expanding rapidly beyond its endemic range in recent decades. It has been suggested that anthropogenic pressure in the form of land use changes that lead to the loss of native forest may be directly contributing to the expanding range of KFD, but clear evidence has not yet established the association between forest loss and KFD risk. Methods The current study sought to investigate the relationship between KFD landscape suitability and both forest loss and mammalian species richness, to inform its epidemiology and infection ecology. A total of 47 outbreaks of KFD between 1 January 2012 and 30 June 2019 were modelled as an inhomogeneous Poisson process. Results Both forest loss [relative risk (RR) = 1.83; 95% confidence ...
Background: In the context of newly emerging diseases, global health security has gained importan... more Background: In the context of newly emerging diseases, global health security has gained importance in recent years. The pandemic COVID-19 has reemphasized the significance. Despite increased attention to enhance health security, the existing capacities were not optimally prepared to respond to public health threats posed by emerging infectious diseases. Objective: The objective of the study was to develop a simple tool that can help monitor and build up the critical capacity to prevent, detect, respond and help identify the gaps in the preparedness of the health system. Methods: The cross-sectional study was conducted from January 2018 – December 2018 amongst the district level health functionaries like the disease surveillance, laboratory, and the animal health focal points in the selected districts across the three South Indian states. Results: The responses received from the participants of the study were scored and categorized by domains into a biosecurity index, which was easi...
Highly pathogenic avian influenza (HPAI), subtype H5N1, constitutes one of the world’s most impor... more Highly pathogenic avian influenza (HPAI), subtype H5N1, constitutes one of the world’s most important health and economic concerns given the catastrophic impact of epizootics on the poultry industry, the high mortality attending spillover in humans, and its potential as a source subtype for a future pandemic. Nevertheless, we still lack an adequate understanding of HPAI H5N1 epidemiology and infection ecology. The nature of the wild waterfowl-poultry interface, and the sharing of diverse wetland habitat among these birds, currently underscore important knowledge gaps. India has emerged as a global hotspot for HPAI H5N1, while also providing critical wintering habitat for many species of migratory waterfowl and year-round habitat for several resident waterfowl species. The current study sought to examine the extent to which the wild waterfowl-poultry interface, varied wetland habitat, and climate influence HPAI H5N1 epizootics in poultry in India. Using World Organisation for Animal ...
Kyasanur Forest disease (KFD) is one of India’s severe arboviruses capable of causing prolonged d... more Kyasanur Forest disease (KFD) is one of India’s severe arboviruses capable of causing prolonged debilitating disease. It has been expanding beyond its historical endemic locus at an alarming rate over the last two decades. The natural nidus of this zoonosis is located in the monsoon rainforest of the Western Ghats, India, which is one of the world’s most important biodiversity hotspots. Definitive reservoir hosts for KFD virus (KFDV) have yet to be delineated, and thus much of the infection ecology of this virus, and its consequent transmission dynamics, remains uncertain. Given its unique biogeographical context, identifying ecological parameters of KFDV relevant to the virus’ epidemiology has been complex and challenging. The challenge has been exacerbated by diminished research efforts in wildlife surveillance over the last two decades, coinciding with the expansion of the range of KFD across the region. The current investigation sought to define a preliminary ecological profile ...
Anthrax is a potentially life-threatening bacterial disease that can circulate in wild and domest... more Anthrax is a potentially life-threatening bacterial disease that can circulate in wild and domestic animals and subsequently spillover to human contacts with devastating consequences for human and animal health, as well as livestock economies and ecosystem conservation. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modeled the geographic suitability of anthrax across India and its associated environmental features using a biogeographical application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence and the wildlife-livestock interface, using elephants as a wildlife sentinel species, was the dominant feature in delineating anthrax suitability. In addition, water-soil balance, soil chemistry, and historical forest loss were also influential. These findings suggest that the wildlife-livestock interface plays an important role...
Proceedings of the Royal Society B: Biological Sciences
Anthrax is a potentially life-threatening bacterial disease that can spread between wild and live... more Anthrax is a potentially life-threatening bacterial disease that can spread between wild and livestock animals and humans. Transmission typically occurs indirectly via environmental exposure, with devastating consequences for human and animal health, as well as pastoralist economies. India has a high annual occurrence of anthrax in some regions, but a country-wide delineation of risk has not yet been undertaken. The current study modelled the geographical suitability of anthrax across India and its associated environmental features using a biogeographic application of machine learning. Both biotic and abiotic features contributed to risk across multiple scales of influence. The elephant–livestock interface was the dominant feature in delineating anthrax suitability. In addition, water–soil balance, soil chemistry and historical forest loss were also influential. These findings suggest that the elephant–livestock interface plays an important role in the cycling of anthrax in India. L...
Acute Encephalitis Syndrome (AES) poses a major public health problem in India affecting thousand... more Acute Encephalitis Syndrome (AES) poses a major public health problem in India affecting thousands of people every year during the post monsoon season (July-November) Japanese encephalitis virus (JEV) accounts for 5-35% of the AES seen in India; however no systematic efforts have been made to determine the precise etiology of all AES cases
Antibiotic resistance, a global concern, is particularly pressing in developing nations, includin... more Antibiotic resistance, a global concern, is particularly pressing in developing nations, including India, where the burden of infectious disease is high and healthcare spending is low. The Global Antibiotic Resistance Partnership (GARP) was established to develop actionable policy recommendations specifically relevant to low- and middle-income countries where suboptimal access to antibiotics - not a major concern in high-income countries - is possibly as severe a problem as is the spread of resistant organisms. This report summarizes the situation as it is known regarding antibiotic use and growing resistance in India and recommends short and long term actions. Recommendations aim at (i) reducing the need for antibiotics; (ii) lowering resistance-enhancing drug pressure through improved antibiotic targeting, and (iii) eliminating antibiotic use for growth promotion in agriculture. The highest priority needs to be given to (i) national surveillance of antibiotic resistance and antibi...
Objective. Effective early management at home level and health seeking behavior in case of appear... more Objective. Effective early management at home level and health seeking behavior in case of appearance of danger signs are key strategies in Acute respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) where majority of episodes are selflimiting and viral in origin. Integrated Management of Childhood illnesses (IMNCI) also envisages that family and community health practices especially health care seeking behaviors are to be improved to reduce childhood morbidity, mortality and cost of admissions to hospitals. Thus, a study was undertaken at an urban slum area-'Gokul Puri' in Delhi, among under-5 children with the aim to assess the magnitudes of ARI and ADD. Methods. A Cross-sectional survey was conducted in this urban slum of Trans-Yamuna, covering 1307 under-5 children for five days starting from 9 th of August, 2004. Survey team consisted of 14 FETP Participants (WHO Fellows) from India, Nepal, Myanmar, Bhutan and Sri Lanka. A pre-tested, household tally marking form was used to interview the caretakers/mothers. History of episodes of ARI and/or ADD in the last two weeks was asked. Health care practices including use of ORS & home available fluids in diarrhea, continued feeding during diarrhea, awareness of danger signs of ARI & ADD and medical advice sought were asked of those mothers whose children had such an episode. Results. 191 (14.6 %) of 1307 children surveyed, had an attack of ARI in the preceding two wk. The common symptoms of ARI cases were mild running nose (78%), cough (76.4%) and/or fever (45.5%). Only 8 (4%) had fast breathing. One or more danger signs were known to 80% (152/191) of mothers and an equal number (80%) of mothers had sought treatment. ARIs are mostly mild or self limiting but only 16% of caretakers perceived so and doctors also prescribed medicines. The attack rate of Acute Diarrheal Diseases was 7.73% in the study and ADD's annual adjusted morbidity rate was 1.69 episodes per child per year. Though nearly three-fourth of mothers (71.3%) had reported to be seeking medical advice (which is not needed in mild episodes of diarrhea) the ORS use was 38.6%, use of Home available fluids (HAF) was 42% and continued feeding was 50% during the ADD episode and awareness of at least two danger signs was present in 34%. Conclusion. Though aware of danger signs of ARI, care takers were still seeking medical advice for mild cases of ARI and doctors were prescribing drugs. Correct home based management e.g. use of ORS, continued feeding etc. was deficient in the community. Knowledge of danger symptoms was low and medical advice was being sought and drugs were being prescribed for ADD, too.
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