Background: Gujarat experienced an outbreak of acute encephalitis syndrome in 2024 with Chandipura virus accounting for 23.45% of the laboratory confirmed cases. Among samples collected during the outbreak 69% of human samples and 8.76% of the animal samples showed detectable levels of neutralizing antibodies against CHPV, although no virus was recovered from sandflies. A follow up study was undertaken to compare the seroprevalence of CHPV among the paediatric (≤15 years) and livestock animal population between the CHPV frequently affected and never affected districts of Gujarat. Methods: We conducted a cross sectional serosurvey across the FADs; Panchmahal and Kheda and NADs i.e. Amreli and Bhavnagar in the months of January and Feb 2025 enrolling 816 children and 474 domesticated animals; complemented by an entomological survey. Human and animal seropositivity was tested using the virus neutralization test. Findings: Paediatric seropositivity was 33·45% (95% CI [0·3, 0·37]), significantly higher in FADs (40·14%) than in NADs (26·33%) (p = 0·000029). Overall animal seropositivity was 10·97% (95% CI [0·085, 0·14]). No sandfly or mosquito pools were positive for CHPV. However, the average man-hour density was significantly higher in the FADs (7.01 vs 1.19) (p=0·0002634). Multiple linear regression showed that both spatial relative animal seropositivity and MHD predicted spatial relative human seropositivity (Adj. r2-0·43, p=0·001). Interpretation: The findings suggest that CHPV endemicity across Gujarat, with widespread, likely asymptomatic transmission occurring even in outbreak-naive districts. The lower seropositivity in children under five and in NAD points to an "immunity gap" highlighting the need for targeted vaccination efforts. The role of domesticated animals in CHPV dynamics is significant but requires warrants investigation, as do vector competency studies among sandflies to clarify their role in the transmission and/or maintenance of the disease.

Background: Acute encephalitis syndrome (AES) is a significant public health issue in India, attributed to various etiologies. In eastern Uttar Pradesh, Japanese encephalitis (JE) was the leading cause of AES (10-14% of total AES) until scrub typhus (ST), caused by Orientia tsutsugamushi, was identified in cerebrospinal fluid and blood samples of AES patients contributing more than 60% of AES cases. This study investigates the prevalence of JE-ST coinfection and compares clinical outcomes among JE mono-infection, ST mono-infection, and JE-ST coinfection. Materials and Methods: AES cases admitted to BRD Medical College, Gorakhpur, Uttar Pradesh, India, from January 1, 2017, to December 31, 2017, were included. JE and ST diagnosis was confirmed by serological (IgM) and molecular (PCR) tests. Statistical analysis was done to correlate clinical outcomes and infection group. Results: Total 1180 cases were tested positive for JE and/or ST. The prevalence of JE-ST coinfection was 8.9% among AES cases. JE mono-infection showed a mortality rate of 34.5%, ST mono-infection 13.4%, and JE-ST coinfection 9.5%. JE-ST co-infected cases experienced less severe clinical outcomes compared to mono-infected cases. Conclusion: JE-ST coinfection in AES cases is relatively common, with better clinical outcomes and lower mortality rates compared to JE or ST mono-infections.

Objective: Acute hemorrhagic conjunctivitis (AHC), commonly called pink eye, saw an alarming increase in incidence from July to September 2023 in different parts of India. Pink eye occurrences had reportedly increased three to four times more than in prior years, raising concerns among the community and healthcare professionals. This study aimed to identify the aetiological agent associated with AHC in 2023, genetically characterize the agent and describe the clinical presentation. Methods: From July to September 2023, 300 ocular and throat swab samples were collected from patients with AHC across various regions of India, including Maharashtra, Daman & Diu, Delhi, Lucknow, and Hyderabad. These samples represented a diverse geographic spread of the condition. The swabs were examined for qRT-PCR analyses, to detect adenovirus and enterovirus. Following this, conserved regions within the enteroviral 5 '-UTR and VP2/3 C gene were further investigated for serotype identification. Results: Enterovirus was found in 52.6 % (158 out of 300) of the patients. Among the enterovirus-positive samples, coxsackievirus-A24 was present in every positive sample. Conclusion: The rise in AHC cases in India in 2023 was attributed to the Coxsackievirus-A24 strain GIV C5. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: In December 2020, over 500 residents of Eluru City were hospitalised with seizures and sudden loss of consciousness (LOC) resembling the neurotoxic effects of organochlorine poisoning after a flooding event during the last week of November 2020. We described the epidemiological investigation of outbreak and identified risk factors. Methods: We performed descriptive analysis followed by 1:1 unmatched case-control study. Cases were identified through house-to-house search and review of medical records at district hospital. A case defined as sudden onset LOC or new-onset seizures in an Eluru resident aged >= 1 year, December 1-15, 2020 and a control as absence of neurological symptoms in a person aged >= 1 year selected randomly from same administrative division of the case. We compared cases and controls for possible risk factors and calculated adjusted odds ratio (aOR) with 95% confidence interval (CI). Biological and environmental samples were tested for contaminants. Results: We identified 545 cases (56% males), including one death. Seizures were reported in 491 (90%) cases. Median age was 27 years (interquartile range: 17-37 years) and 480 (88%) cases resided in urban area. Cases were clustered in administrative divisions supplied by municipal water reservoirs. Cases were more likely than controls to use municipal water as primary source of drinking water (aOR = 4.6, 95% CI = 1.6-13.0). High levels (average: 14.6 mg/l) of organochlorine compounds were detected in all municipal water samples (acceptable limit: <0.001 mg/l). Conclusion: This investigation highlights water ingestion as an exposure pathway for environmental contami-nants (organochlorines) in the community after largescale flooding. We recommended strengthening safe water surveillance in natural disaster response contingency plans in Eluru.

Objective To determine the Japanese encephalitis (JE)-associated long-term functional and neurological outcomes, the extent of reduced social participation and predictors of poor outcomes among paediatric JE survivors.Design A retrospective cohort study.Setting Laboratory-confirmed JE-positive paediatric cases (<16 years of age) hospitalised at the paediatric ward of Baba Raghav Das Medical College, Gorakhpur, India, between 1 January 2017 and 31 December 2017, were followed up after 6–12 months of hospital discharge.Participants 126 patients were included in the study; median age was 7.5 years (range: 1.5–15 years), and 74 (58.73%) were male.Outcome measures Functional outcome defined by Liverpool Outcome Score (LOS) dichotomised into poor (LOS=1–2) and good (LOS=3–5) outcome groups compared for demographic, clinical and biochemical parameters for prognostic factors of poor outcomes. Social participation of patients scaled on Child and Adolescent Scale of Participation score 2–5.Results About 94 of 126 (74.6%) children developed neurological sequelae at different levels of severity. Age-expected social participation was compromised in 90 out of 118 children. In multivariate logistic regression analysis, a combination of parameters, JE unvaccinated status (OR: 61.03, 95% CI (14.10 to 264); p<0.001), low Glasgow Coma Score (GCS) at admission (≤8) (OR: 8.6, 95% CI (1.3 to 57.1); p=0.026), malnutrition (OR: 13.56, 95% CI (2.77 to 66.46); p=0.001) and requirement of endotracheal intubation (OR: 5.43, 95% CI (1.20 to 24.44); p=0.027) statistically significantly predicted the poor outcome with 77.8% sensitivity and 94.6% specificity. The goodness-of-fit test showed that the model fit well (Hosmer-Lemeshow goodness-of-fit test) (χ2=3.13, p=0.988), and area under the receiver operating characteristic curve was 0.950.Conclusion This study estimates the burden of JE-presenting post-discharge deaths (15.4%) and disability (63.08%). Those who did not receive JE vaccine, were suffering from malnutrition, had GCS ≤8 at admission and required endotracheal intubation had poorer outcomes.

Sir, Given the possibility of asymptomatic or pre-symptomatic transmission of SARS-CoV-2, especially given the emergence of newer variants, frontline workers (FLWs) are at a higher risk of contracting the infection as well as transmitting it to others. A survey conducted in the containment zones in Pune city, India, by the Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), during the last week of May and the first week of June 2020, showed the seroprevalence of SARS-CoV-2 infection to be 15-30 per cent in containment zones (ICMR-NIV unpublished data). In this preliminary study, we present SARS-CoV-2 seroprevalence among non-medical FLWs in urban western India during August 2020-January 2021. For the ICMR study in containment zones in Pune city conducted in May-June 2020, five containment zones were selected randomly out of total 69 zones at that time. FLWs rendering services in and around these zones were included in the present study. FLWs, i.e. (i) grocery store operators and medical store operators, (ii) police, (iii) Pune municipal corporation (PMC) employees, and (iv) vegetable/fruit vendors and swachh workers (domestic waste collectors employed by PMC), were considered for inclusion. Sample size was calculated according to the primary objective of understanding seropositivity among FLWs. Assuming a seroprevalence of 30 per cent, average seroprevalence in the city1, with a five per cent margin of error and a design effect of two, the total sample size was calculated to be 646 (Epi Info v7.2, CDC, Atlanta, USA). The design effect of two was considered because of the possible heterogeneity among different sections of FLWs. It was planned to enrol equal number of participants each from four groups mentioned, though the targeted number of PMC workers did not show willingness to participate in the study. For the organized sector workers, the officials were approached with requests for approvals. Willing workers were enrolled in the study. For the unorganized sectors, small organizations in the selected areas were approached. Participants willing to offer blood samples were included in the study; giving nasal swab and throat swab (NS/TS) samples was optional. The study was approved by the Institutional Ethics Committee (NIV/IEC/June/2020/D-12), ICMR-NIV, Pune. After obtaining written informed consent from the participants, 2-5 ml of blood was collected once from each participant. NS and TS samples were collected in viral transport medium vials. All the samples were transported to ICMR-NIV laboratories in cold chain. A questionnaire addressing possible risk factors was administered to the participants. Information regarding frequency of hand sanitization, social distancing (working within six feet of customer or more) and proper use of mask was collected. Those residing within approximately 100 m of a known confirmed case were considered to be in ‘Zone-1’, between 100-200 m were in ‘Zone-2’ and >200 m were in ‘Zone-3’. Being from lower socio-economic status (SES), vegetable/fruit vendors and swachh workers were combined in a single category for analysis. IgG ELISA was performed on the serum samples (COVID Kawach ELISA, J. Mitra & Co. Pvt. Ltd., India) as per the manufacturer’s instructions. NS and TS samples were tested by multiplex one-tube real-time reverse transcriptase polymerase chain reaction (RT-PCR) at the National Influenza Center (NIC) at ICMR-NIV2. Simple proportional analyses were performed with the help of Epi Info V7.2 (CDC, Atlanta, USA) and SPSS V.20 (IBM Corp., Armonk, NY, USA). A total of 635 FLWs participated in the study. Overall, 223 FLWs were seropositive for SARS-CoV-2 [35.12 %; 95% confidence interval (CI)=31.50-38.91]. Among the 635 NS/TS swabs, six tested positive (0.95%; 95% CI=0.45-1.71). Among different categories, FLWs from lower SES (vegetable vendors and swachh workers) had higher seropositivity than other higher SES categories put together. Several studies have reported seroprevalence of SARS-CoV-2 in India, and in the world, in different populations3-7. There are reports on medical FLWs at different points in time8-10. Surveys conducted in high and low SES populations in Pune city during May-June 2020 reported seroprevalence to be between 15 and 45 per cent in different populations1. Mask usage was well accepted among FLWs; 97.63 per cent reported strict use of masks at work places. A total of 316 participants reported ‘always working within six feet’ of their customers/clients or colleagues; they had higher seropositivity (41.14%) than those who did not (29.97%); the difference was significant (odds ratio=1.63; 95% CI=1.17-2.27). Regarding frequency of soap hand wash/sanitization, 30.55 per cent reported sanitization after every interaction with client/customer, 22.83 per cent reported every hour, 33.07 per cent every two hours, 11.65 per cent at beginning and end of working hours and 0.2 per cent rarely. Those who sanitized their hands after every interaction had lower seropositivity compared to all other categories put together (Table).Table: Seropositivity for SARS-CoV-2 among non-healthcare frontline workers in Pune city, India (August 2020-January 2021)When compared based on type of housing (as a proxy for SES), 49 of those residing in hutments or temporary housing had higher seropositivity (57.14%; 95% CI=42.21-71.18) than 586 of those residing in permanent houses (40.00%; 95% CI=33.47-46.80). Those residing in Zone-1 (n=143; confirmed case within 100 m from home) had higher seropositivity (48.61%; 95% CI=25.18-37.78) than those from Zone-3 [n=492; confirmed case beyond 200 m from home (31.22%; 95% CI=25.18-37.78)]. It was observed that the seropositivity among the Pune FLWs was comparable with the general population in the Pune city but lower than that in other parts of the country135. The seropositivity was lower than that reported in slums or among lower SES general population in Pune city or other cities in India based on surveys conducted before and during the study period1 Almost all the FLWs (97.67%) followed strict use of masks at work places. Those who sanitized their hands after every interaction with their customer had lower seropositivity than those who sanitized hands less frequently. It was evident that seropositivity was associated with strict hand-washing, observing social distancing at all times and also the SES of the FLWs. Recently reported COVID-19 transmission modelling efforts imply that individual COVID-19 appropriate behaviour can be a major factor in deciding the quantum of spread of the virus in future4 and our findings were in agreement. Studies conducted in Pune city, other parts of India and other countries have shown higher seroprevalence among low SES populations compared with higher SES populations111315. It needs to be reiterated that this study was conducted before the FLWs were vaccinated against SARS-CoV-2. It was observed that six of the 635 NS/TS samples tested positive for the presence of SARS-CoV-2 RNA by RT-PCR. All the RT-PCR-positive individuals were found to be IgG antibody negative. The overall seroprevalence among FLWs was higher than that reported in the general population in other parts of the country during the same period1. The systems need to be sensitive to these higher risks to the FLWs including the psychological impact similar to that on the frontline healthcare workers16. Unavailability of a well-characterized sampling frame was a limitation of the study. Only willing individuals were included; whether their willingness to participate had any confounding factor with their sero-status could not be commented upon. Although it was presumed that the FLWs answered the questions correctly, yet a recall bias regarding some parameters might have occurred. In conclusion, the FLWs had similar seropositivity as general population in the Pune city. Frequent hand sanitization, maintaining social distancing and strict use of masks were effective in prevention of SARS-CoV-2 infection. Financial support & sponsorship: This study was supported by the Intramural funds of the ICMR-NIV, Pune. Conflicts of Interest: None.

In rural India, since 2014, the Swachh Bharat Abhiyan (Clean India Mission) has ensured construction of more than 100 million toilets and is now focusing on reinforcement of sanitation behaviors. We report a cholera outbreak in a remote village in western India where open defecation was implicated in causation. A water pipeline was damaged in the vicinity of a stream flowing from a site of open defecation. Despite the availability of a toilet facility in the majority of households (75%), open defecation was widely practiced (62.8%). Many reported not washing hands with soap and water before eating (78.5%) and after defecation (61.1%). The study emphasizes the need for focused health behavior studies and evidence-based interventions to reduce the occurrence of cholera outbreaks. This could be the last lap in the path toward achieving the United Nations Sustainable Development Goal 6, which aims to "ensure availability and sustainable management of water and sanitation for all."

To estimate effectiveness of presumptive doxycycline or azithromycin treatment in preventing progression of Acute Febrile Illness to Acute Encephalitis Syndrome in Gorakhpur. Prospective cohort study. Primary healthcare centers and Community healthcare centers of Gorakhpur district, Uttar Pradesh. Children aged 1 year to less than 15 years with fever of 3 days to less than 15 days duration attending three selected peripheral health facilities in Gorakhpur during August to October, 2018. 35 medical officers in three selected Primary Healthcare Centers/Community Healthcare centers were sensitized on the treatment strategy. After sensitization, study participants were enrolled and information about prescription of doxycycline or azithromycin was collected. Participants were telephonically followed-up to know their progression status from AFI to AES. Incidence of acute encephalitis syndrome among acute failure illness patients who received presumptive doxycycline or azithromycin treatment and those who did not receive this treatment. Of the enrolled 930 AFI patients, 801 (86%) were prescribed doxycycline or azithromycin and 725 (78%) could be telephonically followed-up. Progression to acute encephalitis syndrome was seen in 6 of the 621 patients who received presumptive treatment, and 5 of the 104 who did not receive the treatment. The relative risk of developing acute encephalitis syndrome among acute febrile illness patients who were prescribed presumptive treatment with doxycycline or azithromycin was 0.20 (95% Cl: 0.06–0.65). The effectiveness of presumptive treatment with doxycycline or azithromycin strategy was 79.9% (95% CI: 35.4–94). PDA treatment to children presenting with fever in peripheral health facilities of the study blocks in Gorakhpur during August-November, 2018 had good effectiveness in preventing progression of acute febrile illness to acute encephalitis syndrome.

Reduction in seroprevalence of Hepatitis A virus (HAV) is known to be associated with improvements in socioeconomic conditions of the community. National Institute of Virology, Pune has been studying seroprevalence of hepatitis viruses in Pune region over the past four decades. In total, 1438 samples were collected from urban general (UGEN), urban lower socioeconomic stratum (ULSES) and rural (RURAL) populations of the Pune district. Based on estimates in previous studies, subjects were enrolled from age groups '6-10', '15-25' and '40 + ' years. HAV seroprevalence in younger population showed a significant decline. A significant decline in HAV seroprevalence in '15-25' years age group in UGEN (from 85.9% to 73.9%; OR = 0.46, 95% CI: 0.25-0.86) and RURAL (from 98.6% to 91.4%; OR = 0.15, 95% CI: 0.05-0.45) populations suggested that the trend probably started more than a decade ago. Seroprevalence of HAV among ULSES '6-10' children was found to be significantly higher (70.4%) than that among the RURAL children (44.2%; OR = 3.0, 95%CI: 1.7-5.2) and UGEN children (40.4%; OR = 3.5, 95%CI: 1.8-6.7). In view of increasing rates of urbanisation in India, ULSES population needs special consideration while designing future studies and viral hepatitis vaccination/elimination strategies. Our findings call for robust population-based studies that consider heterogeneity within populations and dynamics of socio-economic parameters in various regions of a country.

Dengue infections have become a huge threat to public health systems in developing countries. Data on seroprevalence and incidence of dengue infections are lacking from rural regions of India. The objective of present study was to investigate the seroprevalence and incidence of dengue infection utilizing repeated serosurveys from a rural region of Maharashtra, Western India.

BACKGROUND:Hepatitis E, caused by hepatitis E virus (HEV), accounts for 50% of acute hepatitis cases in India. We report an outbreak of hepatitis E in Shimla, India, in 2015-2016.METHODS:ICMR-National Institute of Virology (NIV), Pune, received two batches of water samples from Shimla in January 2016 to test for the presence of enterically transmitted hepatitis viruses. Subsequently, 57 icterus patients were tested for various markers of hepatotropic viruses, i.e. anti-HEV IgM/IgG, anti-hepatitis A virus (anti-HAV) IgM/IgG antibodies and HEV RNA. Water samples were screened for HEV and HAV RNA followed by phylogenetic analysis.RESULTS:Overall, 48/57 patients availing municipal water had evidence of HEV infection, detected by serology and RT-PCR. All the water samples tested positive for HEV and HAV RNA, while the patients were negative for anti-HAV IgM antibody, indicating no recent HAV infection. Phylogenetic analysis confirmed the aetiological agent of the current outbreak to be HEV genotype 1.CONCLUSIONS:Serology and RT-PCR confirmed HEV as the aetiology of the outbreak. The absence of new cases of hepatitis A, despite the presence of HAV in the water supply, could be due to previously acquired immunity. Sewage contamination of water leading to faecal-oral transmission of HEV still remains a concern, thus emphasising the need for a vaccination/control strategy.

Influenza-like illness (ILI) and acute respiratory infection (ARI) are common presentations during winter, and indiscriminate antibiotic use contributes significantly to the emerging post-antibiotic era. Although viral agents causing ILI are predominant, they are indistinguishable from the bacterial agents based on the clinical features alone. The present study was aimed at determining the bacterial agents associated with ILI and their susceptibility pattern during a study done in a community setting in Pune during a surveillance of ILI between March 2013 to November 2016. Throat swabs from 512 suspected ILI cases were processed, and organisms were identified by the standard conventional method. An antimicrobial susceptibility testing was done as per the Clinical Laboratory Standard Institute (CLSI) guidelines. The patients comprised 238 males and 274 females with the majority (38.7%) in the age group of <= 10 years. Bacteria could be isolated from 9.8 % of the patients. The predominant bacteria included beta-hemolytic Streptococcus (42%) followed by group G Streptococcus (30%) and group A Streptococcus (20%). All organisms were sensitive to Penicillin except two isolates of Staphylococcus aureus (50%). Tetracycline (98.8%) and ciprofloxacin (87%) were the next most effective drugs. Overall resistance was observed for erythromycin (37%) and co-trimoxazole (32%).

Scrub typhus is associated with outbreaks of acute encephalitis syndrome in Uttar Pradesh, India. A case-control study indicated that children residing, playing, or visiting fields; living with firewood stored indoors; handling cattle fodder; and practicing open defecation were at increased risk for scrub typhus. Communication messages should focus on changing these behaviors.

Chickenpox and measles, both vaccine preventable febrile rash illnesses, present in a comparatively severe form among young adults/adults than among children. Immunity levels against chickenpox are not known in India and those against measles have been found variable across the country. Places where students or adults/young adults from various parts of the country come together pose a peculiar challenge in preventive policy making regarding these diseases. In this article, we present findings from parallel outbreaks of the two diseases in a graduate/postgraduate institute in the city of Pune. A team from National Institute of Virology [Pune] investigated outbreak of febrile rash illness in a premier graduate institute and found that it was a case of two parallel outbreaks of chickenpox and measles. In this outbreak chickenpox cases did not present with greater severity but measles cases were severe. The concerned institute hosts more than 800 students and 300 staff including faculty. These outbreaks were contained because of the alert physician in the institute; but it also highlights a need for uniform policies across such educational institutions in the country.

SUMMARYAn outbreak of influenza A(H1N1)pdm09 was detected during the ongoing community-based surveillance of influenza-like illness (ILI). Among reported 119 influenza A(H1N1)pdm09 cases (59 cases in the year 2012 and 60 cases in 2015) in summer months, common clinical features were fever (100%), cough (90·7%), sore throat (85·7%), nasal discharge (48·7%), headache (55·5%), fatigue (18·5%), breathlessness (3·4%), and ear discharge (1·7%). Rise in ILI cases were negatively correlated with the seasonal factors such as relative humidity (Karl Pearson's correlation coefficient, i.e. r = −0·71 in the year 2012 and r = −0·44 in the year 2015), while rise in ILI cases were positively correlated with the temperature difference (r = 0·44 in the year 2012 and r = 0·77 in the year 2015). The effective reproduction number R, was estimated to be 1·30 in 2012 and 1·64 in 2015. The study highlights the rise in unusual influenza activity in summer month with high attack rate of ILI among children aged ⩽9 years. Children in this age group may need special attention for influenza vaccination. Influenza A(H1N1)pdm09 outbreak was confirmed in inter-seasonal months during the surveillance of ILI in Pune, India, 2012–2015.

BACKGROUND & OBJECTIVES:Dengue is highly prevalent in tropical and subtropical regions. The prevalence of dengue is influenced by number of factors, i.e. host, vector, virus and environmental conditions including urbanization and population density. A cross sectional study was undertaken to determine the seroprevalence of dengue in two selected villages that differed in the level of their urbanization and population density. METHODS:Two villages with demographically well-defined populations close to Pune, a metropolitan city of western India, were selected for the study. Age stratified serosurvey was carried out during February to May 2011 in the two villages-a rural village A, located 6 km from the national highway with a population density of 159/km2 ; and an urbanized village B, located along the highway with a population density of 779/km2 . Assuming a low seroposi- tivity of 10%, 702 serum samples were collected from village A. Sample size for village B was calculated on the basis of seropositivity obtained in village A, and 153 samples were collected. Serum samples were tested for the presence of dengue virus (DENV)-specific IgG. Simple proportional analyses were used to calculate and compare the seroprevalence. RESULTS:Of the 702 samples collected from village A, 42.8% were found positive for anti-DENV IgG. A significantly higher seropositivity for DENV (58.8%) was found in village B. In village A, there was an age dependent increase in seroprevalence; whereas, in village B, there was a steep increase from 17% positivity in 0-10 yr age group to 72% in the 11-20 yr age group. The seroprevalence was almost similar in the older age groups. INTERPRETATION & CONCLUSION:The observations suggested that prevalence of dengue is probably associated with urbanization and host population density. Areas that are in the process of urbanization needs to be monitored for prevalence of dengue and its vector, and appropriate vector control measures may be implemented.

Objective: To investigate the Chikungunya outbreak in rural Talegaon Dhamdhere Town of Pune City in Western Maharashtra in October-November 2012.Methods: Samples were collected from people who experienced fever and joint pains since a month ago.Clinical information was collected and entomological investigations were carried out in affected areas.Blood samples collected from hospital and clinics during the outbreak were tested for CHIKV using IgM ELISA (NIV kit), nested RT-PCR and real time RT-PCR.Age specific attack rates were calculated for the epidemic. Results:The overall attack rate for this outbreak was 4.64/1 000 population.The Breteau Index of the area was 12.0 and Adult House Index was 6.2%.A total of 63.6% samples were positive for CHIKV by either ELISA or PCR.Sequence analysis of the partial E1 gene in 4 representative samples found an alanine residue at position 226 of the E1 protein, showing that the CHIKV strain belonged to the ECSA genotype. Conclusions:The epidemic with low transmission intensity was experienced by this area from the western region of the state.This indicates probability of such outbreaks in areas that have witnessed larger Chikungunya outbreaks in the past.Sero-prevalence studies and surveillance for Chikungunya in wide areas of such regions will help formulate well directed policies.

Immunoglobulin A (IgA)-based tests have been evaluated in different studies for their utility in diagnosing dengue infections. In most of the studies, the results were inconclusive because of a small sample size. Hence, a meta-analysis involving nine studies with 2096 samples was performed to assess the diagnostic accuracy of IgA-based tests in diagnosing dengue infections. The analysis was conducted using Meta-Disc software. The results revealed that IgA-based tests had an overall sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios of 73.9%, 95.2%, 66.7, 22.0 and 0.25, respectively. Significant heterogeneity was observed between the studies. The type of test, infection status and day of sample collection influenced the diagnostic accuracy. The IgA-based diagnostic tests showed a greater accuracy when the samples were collected 4 days after onset of symptoms and for secondary infections. The results suggested that IgA-based tests had a moderate level of accuracy and are diagnostic of the disease. However, negative results cannot be used alone for dengue diagnosis. More prospective studies comparing the diagnostic accuracy of combinations of antigen-based tests with either IgA or IgM are needed and might be useful for suggesting the best strategy for dengue diagnosis.