India is nearing formal validation for elimination of kala-azar as a public health problem, contingent upon sustaining the elimination threshold for three consecutive years. As incidence declines, the post-elimination phase demands sustained vigilance beyond case counts alone. Residual transmission and preventable mortality may remain undetected, particularly in settings affected by poverty, poor housing and population mobility. Housing support under the Pradhan Mantri Awas Yojana offers a valuable opportunity to reduce structural risk factors by limiting indoor sandfly breeding and human-vector contact in endemic blocks. Continued incentives for frontline health workers and the integration of verbal autopsy into routine surveillance can strengthen mortality monitoring, identify programme gaps, and ensure that elimination gains are sustained and equitable.
BACKGROUND OBJECTIVES:Dengue fever is the world's most rapidly expanding vector-borne viral disease. India bears an estimated one-third of the global burden-a modelling-derived estimate. The epidemiological picture remains fragmented across surveillance streams with well-documented under-reporting of both cases and deaths. To characterise temporal trends in reported dengue cases and deaths in India from 2010 to 2023; to compare case fatality ratios from two independent official government data streams; to assess state-level distribution and serotypic patterns; and to synthesise published seroprevalence estimates from distinct peer-reviewed sources. METHODS:Pre-specified secondary data analysis following STROBE guidelines for observational epidemiology. No primary data collection. Data derived from National Centre for Vector Borne Diseases Control (NCVBDC) national passive surveillance records, Registrar General of India (RGI) Medical Certification of Cause of Death 2023, GBD Study 2021 outputs, and peer-reviewed Indian epidemiological studies (2018-2024). Annual reported cases, deaths, and case fatality ratios (NCVBDC vs. RGI); state-level dengue burden; dengue virus (DENV) serotype distribution; pooled seroprevalence; and synthesised autoregressive integrated moving average (ARIMA)-based case projections through 2026. RESULTS:Reported cases rose ten-fold from 28,292 in 2010 to 289,235 in 2023. NCVBDC recorded 485 deaths (CFR 0.17%) versus 3,254 RGI-certified deaths-a 571% discrepancy. INTERPRETATION CONCLUSION:GBD-based age-standardised incidence rose at an average annual percent change (AAPC) of 1.39% (95% CI: 1.34-1.44) and mortality at 1.65% (95% CI: 1.23-2.08) over 1990-2021. Pooled seroprevalence was 56.9% nationally (Ganeshkumar et al . [5]) and 81% in an urban Pune cohort (Mishra et al . [18]). DENV-2 was dominant nationally (45% in western UP). Synthesised ARIMA models project 309,836 cases (95% CI: 240,337-379,334) by 2026.
Background & objectives: Scrub typhus and Leptospirosis are emerging zoonotic bacterial infections prevalent in the Himalayan region, including Himachal Pradesh in India. Scrub typhus and leptospirosis are key drivers of acute febrile illness, particularly in tropical and subtropical regions. Both diseases share overlapping clinical symptoms and making differential diagnosis challenging in endemic region. The aim of present study was to investigate the seroprevalence of scrub typhus and leptospirosis and their co-infection in patients with acute febrile illness (AFI) in the hilly area of Himachal Pradesh, focusing on demographic and seasonal trends. Methods: This retrospective hospital-based study was conducted for a period of one year, from January 2023 to December 2023 at Viral Research and Diagnostic Laboratory (VRDL), in the Department of Microbiology at Dr. Rajendra Prasad Government Medical College Tanda, Himachal Pradesh, a tertiary care hospital in northern India. Blood samples were collected from both in and out patients presenting with acute febrile illness. Total 1538 samples were tested for Scrub typhus and 860 samples were tested for Leptospirosis by Enzyme Linked Immunosorbent assay (ELISA). Results: During the study period, the seroprevalence of scrub typhus was 12.40%, while leptospirosis had a slightly higher prevalence of 14.65%. The co-infection rate of scrub typhus and leptospirosis was 2.4% in patients with acute febrile illness. Seroprevalence of scrub typhus was more in female population whereas leptospirosis showed a male predominance. Age-wise distribution revealed that both diseases were most prevalent among individuals age group of 21-40 years, followed by the 41-60 age group. Co-infection of both scrub typhus and leptospirosis was observed in 37 patients, with 14 were males and 23 were females, indicating a higher occurrence of co-infection in the latter. A seasonal variation highlights that the majority of scrub typhus cases occur during the month of August, September and October while leptospirosis cases peaks in the month of September and October. Interpretation & conclusion: The findings of this study highlighted the critical importance of strengthening awareness, improving early diagnostic efforts, and ensuring prompt interventions-particularly during the seasonal peaks. Special attention should be given to cases involving co-infection, as they pose greater challenges in clinical management.
Background & objectives: Antimalarial induced dystonia (AID) is a paediatric emergency. It is a rare adverse reaction to antimalarial therapy. Available, information on AID is almost entirely from case reports, thus necessitating this report. To study managed cases of AID at a Paediatric Emergency unit (PEU), with the view of identify causative factors and recommending evidence-based preventive strategies. Methods: Information was extracted from case notes of children with AID over a 10year period at the PEU of Wesley Guild Hospital, (WGH). Data obtained was analyzed. Results: The 23 AID admissions (12 boys and 11girls) aged between 4 and 13 years constituted 0.8% of the total 2830 PEU malaria admissions. Admission duration ranged 1 - 3 days for AID. No case of malaria managed at WGH developed dystonia. The malaria medications (MM) associated with AID were Artesunate /Amodiaquine (AA) combination, Amodiaquine(AM), Chloroquine (CH), Artesunate/Piperiquine Phosphate, and Artesunate/Lumefantrine combination in 12, 7, 2,1 and 1 cases respectively. Malaria management before development of AID was presumptive. These MM were mostly prescribed by chemists and parents. Over-dosages of AA, AM and CH were recorded in 10, 2 and 1 case respectively. Compared with other antimalarials, significantly more, aged based fixed dose combinations of AA were associated with dystonia (P<0.05). Generalized dystonia had significantly longer admission duration than focal (P<0.05). Interpretation & conclusion: The AA combination is the most common antimalarial associated with AID. Presumptive malaria treatment and non-pharmaceutical dispensations should be discouraged. Recommended doses of AA should be weight based in order to prevent over-dosage and AID.
Background & objectives: Scrub typhus is a re-emerging vector-borne zoonotic disease in India, with increasing case incidences and outbreaks reported across several states. The bacteria, Orientia tsutsugamushi , shows substantial genetic diversity, with reported evidence of more than 70 different strains globally. However, there are limited molecular studies on exploring the circulating genotypes of this bacterium in disease endemic regions. Therefore, the objective of the study was to identify the antigenic diversity of Orientia tsutsugamushi strains circulating in the delta district of Thiruvarur, using nested PCR, targeting the partial 56 kDa type-specific antigen and GroEL genes. Methods: This descriptive cross-sectional study, conducted from January to December 2024, screened 235 clinically suspected scrub typhus cases serologically. IgM positive samples were subjected to nested PCR targeting the partial 56 kDa and GroEL genes, followed by sequencing and phylogenetic analysis. Results: Fourteen of 235 clinically suspected cases (6.0%) were positive for IgM antibodies by both serological assays. Of these, seven samples (50.0%) yielded PCR amplicons, and five produced high-quality sequences suitable for phylogenetic analysis (GroEL, n = 4; 56 kDa, n = 1). Phylogenetic analysis of the study revealed that the sequences clustered closely with Karp and Kato-related genotypes, suggesting the circulation of these genotypes in the region. The sequences were deposited in GenBank under accession numbers PX781774, PX804529, PX804530, PX804531, and PX804532. Interpretation & conclusion: This study provides preliminary evidence that the strains of Orientia tsutsugamushi circulating in the Thiruvarur district are closely related to Karp and Kato related genotypes. Although sequenceable amplicons were obtained from only a limited number of samples, the findings add to the emerging molecular epidemiological data on scrub typhus in Tamil Nadu. Larger studies integrating molecular findings with clinical and epidemiological data are needed to better define strain diversity in endemic settings.
