Emerging zoonoses, antimicrobial resistance, and climate-linked health threats demand countermeasures that transcend geopolitical boundaries. India's unique ecological and administrative structure makes One Health operationalization both urgent and structurally complex. However, translating One Health from concept to practice has proven difficult, largely due to fragmented governance and weak intersectoral co-ordination. The Government of India’s governance framework model - Strengthening One Health Governance in States and Union Territories under the National One Health Mission, needs broader scientific dissemination, which will be essential to generate field evidence, catalyse peer learning across States and Union Territories, and strengthen its execution.

This study aimed to identify and characterise circulating DENV serotypes during the 2024 monsoon season in Belagavi, Karnataka and to analyze the clinical and demographic profiles of the hospitalized dengue cohort and correlate these patterns with the identified serotypes. A prospective, hospital-based observational study was conducted at a tertiary care centre in Belagavi, Karnataka, from June to September 2024. A total of 89 dengue-confirmed cases out of the 794 dengue-positive cases detected using NS1 antigen and IgM antibody by ELISA technique were subjected to serotyping by RT-PCR targeting the CprM gene. A subset of positive RT-PCR specimens was subjected to sequencing and phylogenetic analysis. The clinical details were analysed for demographic features, clinical manifestations, and diagnostic test results to establish correlations with serotype distribution. Of the 89 positive dengue patients, 28 (31.46%) were confirmed positive for dengue virus NS1 antigen by ELISA, while 87 (97.75%) patients tested positive for anti-dengue IgM antibodies. Dengue serotyping of the 28 NS1-positive samples was carried out, of which 23 (82.1%) were positive. DENV-2 (91.3%) was the predominant serotype, followed by DENV-1 and DENV-3, each identified in one case (4.3%, respectively). Genetic analysis of DENV-2 isolates revealed close phylogenetic relationships with the strains from Bhopal, indicating possible regional transmission dynamics. Fever and myalgia were the predominant symptoms across all serotypes, while chills, headache, and retro-orbital pain were associated with DENV-2. The present study is the first comprehensive molecular surveillance report from the northern part of Karnataka demonstrating the predominance of DENV-2 serotype, with distinct clinical and demographic patterns. The high proportion of late-phase diagnoses of dengue underscores the need for improved early detection strategies and timely interventions to manage dengue outbreaks, especially during high-risk transmission periods. These results underline the importance of continuous molecular surveillance to track viral evolution and monitor serotype shift and genetic variations.

BackgroundThe global rise of antimicrobial resistance (AMR) among priority bacterial pathogens represents a critical threat to public health, necessitating the development of alternative therapeutic strategies. Terminalia chebula Retz. (Terminalia chebula), a traditionally used medicinal plant rich in hydrolysable tannins, flavonoids, and polyphenolic metabolites, has emerged as a promising candidate due to its broad-spectrum antimicrobial and pharmacological properties.MethodsThis systematic review critically evaluates the in-vitro antimicrobial activity and resistance-modifying potential of T. chebula fruit extracts against ESKAPE pathogens, including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli as a representative of the Enterobacteriaceae (now Enterobacterales) family. A comprehensive literature search was conducted across PubMed, Scopus, ScienceDirect, and Google Scholar databases in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251024476). Based on predefined criteria, 24 studies were included for qualitative analysis.ResultsThe findings demonstrate that T. chebula extracts exhibit in vitro antimicrobial activity, with ethanolic and methanolic extracts showing enhanced higher efficacy, particularly against multidrug-resistant strains of S. aureus, and P. aeruginosa, and E. coli. Notably, few studies reported synergistic interactions between phytochemicals and conventional antibiotics, suggesting antibiotic resistance-modifying roles. Mechanistic insights suggest that metabolites such as chebulagic acid, chebulinic acid, and gallic acid contribute to antimicrobial activity by disrupting the bacterial cell membranes, inhibiting biofilm formation, and interfering with resistance pathways. However, substantial variations in extraction methods and experimental designs limit cross-study comparability, highlighting the need for standardized protocols.ConclusionOverall, the evidence supports the potential of T. chebula act as a resistance-modifying and an antibiotic adjuvant. Future studies should prioritize bioassay-guided isolation, mechanistic validation, and preclinical evaluation to facilitate translational application in combating AMR.

[This corrects the article DOI: 10.1371/journal.pntd.0013883.].

Rationale: The Government of India has established a network of Virus Research and Diagnostic Laboratories (VRDLs) to strengthen disease surveillance and response to outbreaks. However, comprehensive laboratory-based evidence on the epidemiology of multiple pathogens remains limited. This study reports the co-circulation of infectious pathogens to understand the local epidemiological trends. Methods: We conducted a retrospective cross-sectional analysis on 939 suspected patients presented with a varied spectrum of clinical signs using the syndromic approach in Belagavi, Karnataka (July 2024 - June 2025). We screened the samples for >25 pathogens, subjecting to 3213 diagnostic tests of Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase Chain Reaction (PCR) targeting diagnostic marker genes. Results: Out of 3213 diagnostic tests performed, 399 were positive, yielding a total positivity rate of 12.4% (399/3213). Dengue (19%, 165/867 positivity) was the most frequently detected pathogen, followed by leptospirosis (12.9%, 86/666 positivity) and scrub typhus (5.8%, 31/536). Adults aged 21–40 years were the most affected (51.3%). Other predominant co-circulating infections are leptospirosis and scrub typhus. Notably, 18 cases of dengue–chikungunya coinfection were identified exclusively among patients presenting with fever and rash syndrome. The highest burden of infection was observed in the 21–40-year age group. Conclusions: The integration of viral (dengue, chikungunya, hepatitis viruses, influenza, etc.), rickettsial (scrub typhus), and bacterial (leptospirosis) diagnostics within a single surveillance framework is more comprehensive. Demonstrates the limitations of single-pathogen testing approaches and provides evidence for expanding “Essential Panel” recommendations for Karnataka to enable timely and accurate diagnosis and improve public health response.

PURPOSE:Dengue virus (DENV) and Chikungunya virus (CHIKV) are significant arboviruses transmitted by Aedes mosquitoes. The concurrent circulation of these viruses complicates syndromic diagnosis and subsequently, the clinical management in endemic settings like India. OBJECTIVE:The present study evaluated the prevalence and clinical features of dengue immunoglobulin M (IgM) and dual IgM seropositive patients (dengue and chikungunya) among a subset of patients presenting with clinical suspicion of dengue fever admitted in tertiary care settings in Belagavi, Northwestern Karnataka, India. METHODS:A retrospective observational study was conducted using serum samples received from tertiary care hospitals in Belagavi, Karnataka between January 2024 to October 2025. Of 151 clinically suspected dengue cases, 94 patients with complete clinical records and available serum samples were included. Dengue virus (DENV) and chikungunya virus (CHIKV) IgM antibodies were detected using Indian Council of Medical Research - National Institute of Virology (ICMR-NIV) Immunoglobulin M Antibody Capture (MAC) Enzyme Linked Immunosorbent Assay (ELISA) kits. The reported sensitivity and specificity were 98.53% and 98.84% for DENV IgM ELISA and 95% and 98% for CHIKV IgM ELISA, respectively. RESULTS:Dual IgM seropositivity to dengue and chikungunya was observed in 19 patients (20.2%); whereas 73 (77.7%) were positive only for dengue IgM and 2 (2.1%) were negative for both assays. No isolated CHIKV IgM positivity was detected. Dual-IgM positive patients exhibited predominantly dengue-like illness, characterized by myalgia (57.9%), thrombocytopenia (median platelet count, 70,000 cells/mm3) and elevated aspartate transaminase (AST) levels (median AST, 67 U/L). CONCLUSIONS:Dual IgM seropositivity for dengue and chikungunya was observed in 20.2% of suspected dengue cases. While IgM serology cannot confirm concurrent infection, these findings suggest co-circulation of both arboviruses and highlight the need for integrated arboviral surveillance in endemic regions.

Background:The growing issue of antimicrobial resistance (AMR) in bacteria, particularly among the ESKAPE pathogens, has prompted the need to explore additional treatment options. Euphorbia hirta L. (E. hirta) is a botanical drug plant with antimicrobial activities attributed to its biologically active metabolites, namely flavonoids, terpenoids, and phenolic acids. Methods:This systematic review followed PRISMA guidelines to assess the antimicrobial effects of E. hirta against critical bacterial pathogens. A systematic search and collection of data from 27 peer- reviewed articles on the antimicrobial potential of E. hirta against different bacteria were conducted. Extraction solvents such as ethanol, methanol, petroleum ether, ethyl acetate, chloroform, and water were considered in this systematic review. The antimicrobial potential of E. hirta was assessed using methods such as MIC, MBC, and diffusion assays (disk and well diffusion). Results:Petroleum ether extract of E. coli, S. aureus, and P. aeruginosa showed the lowest MICs (0.4, 0.125, and 0.4 mg/mL, respectively), while ethanol extracts exhibited potent activity against S. aureus (14.53 mg/mL), K. pneumoniae (19.73 mg/mL), P. aeruginosa (20.06 mg/ mL), and E. faecalis (29 mg/mL). Chloroform extracts showed a relatively constant moderate level of activity against most of the organisms tested. It ranged from 1.45 mg/mL for E. coli and P. aeruginosa. In general, non-polar solvents such as petroleum ether and chloroform provided better results than their polar counterparts, like methanol (up to 100 mg/mL). Conclusion:The reported in vitro interactions between E. hirta fractions and conventional antibiotics, such as the observed reduction in MICs for cefepime and ciprofloxacin, suggest a potential resistance-modifying effect. However, these findings remain preliminary and unsubstantiated for clinical translation. Future research should prioritize bioassay-guided isolation, mechanistic studies and the development of standardized formulations for its integration into clinical practice for addressing antimicrobial resistance. Systematic Review:website, identifier CRD420251025371.

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.

Objectives: The aim of this study was to evaluate the role of Serum Ferritin (SF) and PRISM-III (Paediatric Risk of Mortality) in predicting mortality in critically ill children aged six months to 15 years diagnosed with Acute Encephalitis Syndrome (AES) admitted to the Paediatric Intensive Care Unit (PICU). Methods: This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Results: Etiology could be established in 85.5% (n=219) of the 256 children enrolled. Scrub Typhus accounted for nearly two-thirds of the cases (60.5%), while Dengue and Japanese Encephalitis were the next common diagnoses. The median [IQR] SF at admission was significantly higher among the non-survivors than survivors, 514 [260, 1857] and 318 [189, 699] mu g/L, respectively (p=0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with Area Under Receiver Operating Characteristic curve (AUROC) (95% CI) of 0.61 (0.51, 0.72) and 0.67 (0.56, 0.77), respectively. Conclusions: Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.

The global burden of respiratory viral infections is notable, which is attributed to their higher transmissibility compared to other viral diseases. Respiratory viruses are seen to have evolved resistance to available treatment options. Although vaccines and antiviral drugs control some respiratory viruses, this control is limited due to unexpected events, such as mutations and the development of antiviral resistance. The technology of proteolysis-targeting chimeras (PROTACs) has been emerging as a novel technology in viral therapeutics. These are small molecules that can selectively degrade target proteins via the ubiquitin–proteasome pathway. PROTACs as a therapy were initially developed against cancer, but they have recently shown promising results in their antiviral mechanisms by targeting viral and/or host proteins involved in the pathogenesis of viral infections. In this review, we elaborate on the antiviral potential of PROTACs as therapeutic agents and their potential as vaccine components against important respiratory viral pathogens, including influenza viruses, coronaviruses (SARS-CoV-2), and respiratory syncytial virus. Advanced applications of PROTAC antiviral strategies, such as hemagglutinin and neuraminidase degraders for influenza and spike proteins of SARS-CoV-2, are detailed in this review. Additionally, the role of PROTACs in targeting cellular mechanisms within the host, thereby preventing viral pathogenesis and eliciting an antiviral effect, is discussed. The potential of PROTACs as vaccines, utilizing proteasome-based virus attenuation to achieve a robust protective immune response, while ensuring safety and enhancing efficient production, is also presented. With the promises exhibited by PROTACs, this technology faces significant challenges, including the emergence of novel viral strains, tissue-specific expression of E3 ligases, and pharmacokinetic constraints. With advanced computational design in molecular platforms, PROTAC-based antiviral development offers an alternative, transformative path in tackling respiratory viruses.

Scrub typhus (ST) is an emerging public health concern in India. Despite being treatable, 20-30 % of acute febrile illnesses (AFI) progress to encephalitis in endemic regions. This study aimed to identify early markers for encephalitis development in children hospitalized with AFI and positive Orientia tsutsugamushi (Ots) serology. This prospective cohort study was conducted during January-December 2018, involved AFI patients (age <= 16 years) tested positive for IgM antibodies against Ots. These patients were followed up prospectively to monitor the development of encephalitis. The clinical and biochemical data from ST-AFI cases developed encephalitis were compared with ST-AFI cases did not develop encephalitis. Univariate and multivariate logistic regression analysis were used to determine predictors of encephalitis. Total 41 out of 190 (21.6 %) ST-AFI patients progressed to encephalitis. The multivariate regression analysis identified initiation of antibiotic therapy after more than 5 days from illness onset (OR 4; 95 % CI [1.4-11.6]), vomiting (>3 episodes) (OR: 10.9; 95 % CI [2.3-51.4]), Glasgow Coma Scale (9-12) (OR 6; 95 %CI [1.9-19]), calcium level (<= 8 mg/dL) (OR 6.1 95 % CI [1.1-32.6]), serum creatinine (>1 mg/dL) (OR 16.8, 95 % CI [1.5-191.9]), and oxygen support requirement (OR 19.5, 95 % CI[6.4-59.3]) at admission as predictor of encephalitis in ST-AFI cases. The sensitivity and specificity of model was 67.50 % and 93.96 % respectively, Hosmer-Lemeshow test (chi 2 = 8.82, P = 0.3584), and an area under the ROC curve of 0.9514. Study found initiation of antibiotic more than 5 days after illness onset, multiple vomiting episodes, low GCS, hypocalcaemia, high creatinine, and oxygen need as predictors of encephalitis in ST-AFI patients.

Background:Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India. Methods:We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG. Findings:Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%-83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%-71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%-24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%-24.3%) in UPHCs to 69.2% (95% CI: 48.2%-85.7%) in medical college hospitals. Interpretation:Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030. Funding:Indian Council of Medical Research.

Purpose: Q-fever is an underestimated zoonotic infection caused by Coxiella burnetii (CB). Humans are accidental host, and CB infection along with febrile illness also does neurological disorder. In India pediatric acute encephalitis syndrome (pAES) is reported very often from eastern Uttar Pradesh (E-UP), where, in 20-25 % of the cases, etiology remains unidentified. Therefore, we aim to investigate the seroprevalence for acute Q fever (AQF) among the hospitalized pAES patients, truly negative for other reported etiologies of the region by ELISA. Pricipal results: Total 282 pAES cases were recruited in this study. Each case presented with fever, and vomiting. Further, a combination of one or more symptoms including headache, abnormal body movement, frothing from mouth, up-rolling eyeballs, and unconsciousness was observed in infected patients. In this study we have found 2.1 % (6/282) seroprevalence of P2 Coxiella burnetii IgM in studied cases. Conclusion: The finding would assist clinicians in appropriate diagnosis of AES cases in India. Moreover, this study suggests further surveillance for CB infection among cases with neurological disorder.

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

Mosquitoes are a dominant fraction of dipteran fauna, occupying a variety of niches. The most common method deployed for their control is the use of insecticides. Throughout their life cycle they are exposed to a wide range of predators in different habitats, thus biological control of mosquitoes by using aquatic predators has been suggested. Therefore, the present study was carried out to explore the type of natural predators coexisting with the mosquito larvae in still water bodies and to determine their efficacy as predators for mosquito larvae. A coexistence of different predators with mosquito larvae was observed in 27 standing water bodies of Chandigarh, India. The predation efficiency of tadpoles of frog was comparable to Gambusia fish, as 97% of the mosquito larvae of all instars of the medically important mosquito genera Anopheles, Aedes, Culex and Armigeres were preyed. The toad tadpoles were found to be least effective and their predation rate was found to be negligible. Further studies on larval source management by frog tadpoles in combination with insecticides or stand-alone would be worthwhile.