District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure.

Background: In 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children were appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks? Methods: We analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months. Results: Among this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres. Conclusions: Age-inappropriate vaccination impacts adversely on the effectiveness of India’s measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed.

/pdf/age-appropriate-vaccination-against-measles-and-dpt-3-in-e9xir2tz57.pdf

Age-appropriate vaccination against measles and DPT-3 in India – closing the gaps

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

/pdf/hospital-preparedness-in-community-measles-outbreaks-17t0yv6pii.pdf

Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

In search of novel chemical nucleases the synthesis of dehydroacetic acid based tridentate hydrazone Schiff base and its colored complexes with Co(II), Ni(II), Cu(II), Mn(II), and Zn(II) has been achieved. All synthesized compounds were screened for their DNA cleavage potential using the plasmid DNA. The hydrazone Schiff base was synthesized via a condensation reaction between acetic acid hydrazide and dehydroacetic acid. Further, this novel ligand was allowed to react with different transition metal salts in 1:1 and 1:2 ratios, respectively to synthesize metal complexes with a different ligand to metal stoichiometry. All the compounds were characterized on the basis of various spectroscopic techniques. 1H NMR data of complexes showed the coordination of enolic oxygen atom with subsequent lose of proton and IR data shows that the participation of carbonyl oxygen atom of ligand in coordination with metal ion. UV–Visible data reveals the square planner and octahedral geometry of the synthesized metal complexes. Mass spectrum confirms the formation of both 1:1 and 1:2 metals to ligand stoichiometry. Metal complexes were found to exhibit good level of DNA cleaving activities at concentration of 10 μg μl−1.

Synthesis, characterization, and DNA cleavage study of dehydroacetic acid based tridentate Schiff’s base and its metal complexes of first transition series

Background: Two outbreaks of measles were reported from an urban and a village area of Bhavnagar District, Gujarat, India in January and March 2011 respectively. Aim: The present study was conducted to investigate and to assess various epidemiological features which were associated with the measles outbreak. Settings and Design: The present study was designed as a cross sectional study, which was conducted in an urban and a rural area of the Talaja block of the Bhavnagar district of Gujarat, India from December 2010 to April 2011. Methods and Material: The suspected cases were detected through an active case finding in the community. We defined a case clinically by the WHO criteria as the occurrence of a febrile rash with or without cough, coryza and conjunctivitis in a resident of the Talaja-urban and the Gorkhi village of the Talaja block, in the period from 1 st December 2010 to 30 th April 2011. Blood samples from 10 case patients were collected for the IgM antibody detection. A community based, retrospective, cohort design was carried out to find the vaccine efficacy in the Gorkhi village. Statistical Analysis: We entered and analyzed the data by using an MS-Excel sheet. Results: This study identified 27 confirmed cases of measles in the urban area of Talaja and 78 cases in Gorkhi village. All the 105 case patients belonged to the age group of 3 months-15 years. According to their mothers’ statements, out of the 105 measles cases in the two areas, 40 (38%) case patients were immunized. Ten sera from five case-patients each from both the areas were tested; all were found to be positive for the IgM/IgG antibodies by ELISA. Conclusions: The outbreaks occurred due to a poor community participation and the poor vaccine coverage levels.

Double outbreak of measles in the talaja block of bhavnagar district, gujarat, India 2011: a need for improving the vaccine coverage and the community participation.

Background: Globally, measles is the fifth killer disease among children under five years of age. Despite high immunization coverage in Himachal, outbreaks are occurring. Upon two outbreaks in a hilly district in North India, a case control study was conducted to identify factors contributing to outbreaks and to recommend remedial measures to prevent further outbreaks. Materials and Methods: Factors were reviewed under three heads: program related, health care providers, and beneficiaries related. Cold chain maintenance was determined and responses were compared between workers from study Shahpur and control Nagrota Bagwan blocks. All 69 mothers of age and sex matched children with measles were enrolled. A pre-designed pre-tested data collection instrument was used. For statistical analysis, the odds ratio (OR) and adjusted odds ratio with 95% confidence interval (C.I.) among women of children exposed and unexposed to selected characteristics were calculated. Results: Poor cold chain maintenance and gaps in knowledge of health workers supplemented with beneficiary-related issues precipitated outbreaks in case area. Univariate analysis yielded strong statistical significance to 17 variables. Important statistically significant variables are educational status; OR 27.63 (C.I. 9.46-85.16); occupation; OR 0.35 (C.I. 0.16-0.75); income; OR 5.49 (C.I. 2.36-13.00); mode of transport to health care facility; OR 8.74 (C.I. 2.90-28.23); spread of illness from one person to another; OR 5.60 (95% C.I. 1.40-25.97); first help for sick child OR 2.12 (C.I. 1.00-4.50), and place of visit after recovery; OR 3.92 (C.I. 1.80-8.63). Multiple logistic regression yielded significant association with educational status, drinking water sources, and time taken to reach the nearest health facility. Conclusion: Measles outbreaks were confirmed in high immunization coverage areas. We recommend 2nd dose opportunity for measles (MR) between 5 and 17 years; refresher trainings to workers; mobile access to health care facility, and Information Education Communication activities for social behavioral change in affected areas.

http://www.nie.gov.in/images/publication/Gupta._Factors_precipitating_outbreaks_of_measles_in_ditrict_kangra_2011_341.pdf

Factors precipitating outbreaks of measles in district Kangra of North India: A case-control study.

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Factors precipitating outbreaks of measles in district Kangra of North India: A case-control study.