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Background & objectives: Severe anaemia in Plasmodium falciparum (Pf) associated malaria is a leading cause of death despite low levels of parasitaemia. In an effort to understand the pathogenesis of anaemia we studied expression level of RBC complement regulatory proteins, CR1 (CD35), CD55 and CD59 with haemoglobin status in a group of malaria cases from Assam, Goa and Chennai, and in healthy controls. Methods: Flowcytometry was used to study expression of CRI, CD55 and CD59 in 50 Pf cases and 30 normal healthy volunteers. Giemsa stained thick and thin blood films were used for microscopic detection and identification of malarial parasites and parasite count. Results: No correlation was found between degree of expression of RBC surface receptors CR1, CD55 and CD59 with haemoglobin level. However, expression of CD55 was less in malaria cases than in healthy controls. Interpretation & conclusions: The present findings indicate that malaria infection changes the expression profile of complement regulatory protein CD55 irrespective of severity status of anaemia. Further studies are needed to explore the pathophysiology of anaemia in malaria cases in Assam where expression of RBC complement receptors appears to be low even in normal healthy population. [ABSTRACT FROM AUTHOR]

Background & objectives: Injection drug users (IDUs) are generally a mobile group who engage in risky behaviour not only in their locale but also outside areas. The IDUs of the northeast region of India form the major victims of HIV/AIDS infections. Hence an attempt was made to explore their mobility pattern of networking and risky behaviour. Methods: A large cross-sectional Integrated Behavioural and Biological Assessment survey (IBBA) was conducted among 1699 IDUs in four districts (Bishnupur and Churachandpur of Manipur; Phek and Wokha of Nagaland) in the northeast region of India by India AIDS initiative, the Avahan during January and May 2006. The mobility patterns of the IDUs were viewed as two different types, mobility of networking and frequent mobility. The networking mobility has been portrayed using exploratory spatial analysis. The frequently mobile IDUs profile, risky behaviour, HIV and other infections are discussed based on the RDSAT estimates. The volume of mobility and their average movement were also studied. Results: More than 48 per cent of the IDUs had networked far and wide outside their places of residence. One fourth or more of the mobile IDUs were young, more than 35 per cent were literate, more than one fourth were unemployed and nearly 31 per cent or more were living alone. The frequently mobile IDUs risky behaviour was two times higher compared to the non-mobile IDUs (except in Phek district). The average movements of IDUs who had at least one movement inside and outside the district were higher in Wokha district. Interpretation & conclusions: The pattern of networking and the mobile IDUs risky behaviour showed an alarming signal. Mobility being a general phenomenon, the attention towards their surrogate risky factors had to be focussed to control the spatial epidemic wave. [ABSTRACT FROM AUTHOR]

Background & objectives: Integrated Behavioral and Biological Assessment (IBBA) study is the first cross-sectional survey to study large number of covariates of HIV/STI (sexually transmitted infection) in India. Generally, districts are identified as of HIV high or low based on its prevalence. Instead, it would be optimal to label the districts based on several high-risk related covariates in the concurrent set up. The objectives of the present study were to obtain an index for each district, to discover 'natural' clusters and a map with Kriged estimates. Methods: The study population consisted of 10461 female sex workers (FSWs) from 29 sites spread over 24 districts from five HIV high prevalent States. Covariates based on demographic characteristics, sexual practices, knowledge of HIV/STI and biological variables were studied. The analyses were done on weighted estimates based on principal component analysis, cluster analysis and Kriging technique. Five factors were extracted and improved using varimax rotation and standardized factor scores obtained. Natural clusters in a multivariate setting were identified. Each district was expressed as geographic coordinates and using the standardized scores the Kriged estimates were obtained. Results: The proxy determinants were 'never used a condom', 'wanted to use a condom but did not use', 'experience of condom breakage' and 'current STI that needs a doctor'. Dimapur district stood first rank demanding the greatest attention. The cluster analysis branded Dimapur, Warangal, Prakasam, and Chittoor districts as a cluster, which required greatest attention and kriged estimates showed the high-risk concentrated regions as Andhra Pradesh, Maharashtra and northeast region. Interpretation & conclusions: The results of this study may help the programme officials and policy managers to concentrate on the key factors, and districts/regions, which need greater attention in the order of priority. [ABSTRACT FROM AUTHOR]

Background & objectives: Prevalence of injection drug users (IDUs) is high in the northeastern region of India. This coupled with unsafe injecting practices as well as practice of tattooing in remote tribal areas call for baseline data on the prevalence of parentally transmitted viral diseases. In the present study we aimed to measure the risk behaviours and seroprevalence of hepatitis C virus (HCV) antibodies amongst IDUs of Mizoram, a State of the northeast India. Methods: A cross-sectional study was conducted in 2004-2005 amongst IDUs (including female sex workers) who had injected in the past six months and were unaware of their HCV/HIV status. They were recruited from various drop-in centers from Aizawl, Mizoram, and screened for anti-HCV antibodies using 3rd generation HCV EIA and recombinant immunoblot assay (RIBA). Results: The prevalence of HCV antibodies was 71.2 per cent among the active IDUs. On univariate analysis increasing duration of injection, syringe sharing and heroin (diacetylmorphine) injectors were at a significantly higher risk of acquiring HCV antibodies (P<0.001). On multivariate analysis, HCV antibody prevalence showed a strong association with the type of drugs injected (P=0.001), frequency of injecting (P=0.013), multiplicity of drugs abused (P=0.004), and needle syringe sharing (P=0.003). Interpretation & conclusions: Unsafe injecting practices were found to be associated with a higher risk of acquiring hepatitis C infection. Our findings showed that syringe and needle exchange programme alone was not sufficient as a preventive strategy for control of hepatitis C infection among IDUs of Aizawl. [ABSTRACT FROM AUTHOR]

Background & objectives: The National Vector Borne Disease Control Programme (NVBDCP), India has been promoting and scaling up the use of insecticide-treated nets (ITNs) in the tribal dominated malarious areas of north-east India. But, information on sleeping habits, bed pet ownership and use practices, and feedback of communities in ITN - targeted areas is needed for formulating a strategic framework for upscaling the coverage of ITNs. We carried out a community-based cross-sectional survey in select areas of Nagaland and Mizoram (where ITNs were introduced) along with Assam (where ITNs were not introduced) to know the response of community. Methods: Following large scale introduction of ITNs during 2001-2002 in the north-eastern States or Nagaland and Mizoram by NVBDCP, India, a cross-sectional community-based survey was undertaken in April-May, 2003 covering 435 households of Nagaland and 464 households in Mizoram, using a structured questionnaire, to assess the demographic variables relevant to bed net use, bed net washing practices and acceptability of ITNs etc., for upscaling the coverage of ITNs in the surveyed communities. A total of 448 households in 8 villages in a non-ITN PHC area of Assam were served as the control area. Results: The average bet net usage per family (2.01 to 2.65). Bed net use was mostly, seasonal in Nagaland where a majority (65.1-78.7%) used bed nets only during summers and monsoon a compared to the year round use in Mizoram (83.5%) and Assam (78.9%). Frequent washing of nets was most common in Assamese communities with 77 per cent households washing their nets at least once in a month. More than two third users favoured use of ITNs river the conventional indoor residual spray of DDT for malaria control. Interpretation & conclusion: ITNs are widely acceptable in the user communities and a demand for ITNs is evident in the non-user communities of north-east India. Approach of treating community owned nets through an efficient service delivery mechanism will be a viable option for upscaling the ITN coverage. [ABSTRACT FROM AUTHOR]

Background & objectives: During a malaria epidemiological study in Arunachal Pradesh, Plasmodium malariae like human malaria parasites were seen in blood smears from fever rases. The study was undertaken to detect the presence of P. malariae and to confirm its identity through DNA based polymerase chain reaction approach. Methods: Fever survey was carried out in 22 villages in Indo-Myanmar bordering district of Lohit, Arunachal Pradesh in 2005. Morphologically suspected P malariae cases were confirmed using nested PCR based on 18S small subunit ribosomal DNA gene sequence. Results: Screening of 1,995 fever cases resulted in 9 probable cases of P. malariae based on morphological identification in Chakma tribe people residing in 2 villages. Nested PCR confirmed the identity of all probable cases of P. malariae by producing diagnostic band of 144 bp. PCR method was able to detect mixed infection of P. malariae with P. vivax and with P. falciparum. Interpretation & conclusion: P. malariae may have been present in Arunachal Pradesh but most probably is being misdiagnosed due to its close resemblance with P. vivax, especially in ring forms. Estimation of actual case load of P. malariae in north-east India is, therefore, important with accurate species identification using molecular methods. [ABSTRACT FROM AUTHOR]

A letter to the editor about Penicillium marneffei infection in patients with human immunodeficiency virus (HIV) in Nagaland, India is presented.

A letter to the editor about a survey on the re-emergence and outbreak of kala-azar in Assam, India in 2008 is presented.

Background and Objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India., Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions., Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria., Interpretation & Conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes.

Background & Objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India., Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated., Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills., Interpretation & Conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Background & Objectives: Northeast (NE) India is one of the high endemic regions for malaria with a preponderance of Plasmodium falciparum, resulting in high morbidity and mortality. The P. falciparum parasite of this region showed high polymorphism in drug-resistant molecular biomarkers. However, there is a paucity of information related to merozoite surface protein 1 (msp-1) and glutamate-rich protein (glurp) which have been extensively studied in various parts of the world. The present study was, therefore, aimed at investigating the genetic diversity of P. falciparum based on msp-1 and glurp in Arunachal Pradesh, a State in NE India., Methods: Two hundred and forty nine patients with fever were screened for malaria, of whom 75 were positive for P. falciparum. Blood samples were collected from each microscopically confirmed patient. The DNA was extracted; nested polymerase chain reaction and sequencing were performed to study the genetic diversity of msp-1 (block 2) and glurp., Results: The block 2 of msp-1 gene was found to be highly polymorphic, and overall allelic distribution showed that RO33 was the dominant allele (63%), followed by MAD20 (29%) and K1 (8%) alleles. However, an extensive diversity (9 alleles and 4 genotypes) and 6-10 repeat regions exclusively of R2 type were observed in glurp., Interpretation & Conclusions: The P. falciparum population of NE India was diverse which might be responsible for higher plasticity leading to the survival of the parasite and in turn to the higher endemicity of falciparum malaria of this region.

Background & Objectives: The interactions between HIV and malaria co-infection have been shown to influence each other in their clinical outcomes in Sub-Saharan Africa. This study was carried out in the two States of north east India endemic for both HIV and malaria infections, to study the interactions between the two diseases in the HIV-infected population., Methods: In this prospective study, a total of 333 HIV-infected individuals were followed up for a period of 6-18 months in Mizoram and Manipur during 2010-2011. The study assessed the changes in viral load and also the therapeutic efficacy of artesunate plus sulphadoxine-pyrimethamine (AS+SP) combination therapy in HIV-infected and HIV-uninfected individuals with Plasmodium falciparum malaria., Results: Viral load in HIV-infected malaria patients on day zero (D0) ranged from 1110 to 147,000 copies/ml. The log transformation of the geometric means of HIV viral loads revealed no significant difference on different days of follow up. There was 100 per cent adequate clinical and parasitological response (ACPR) after treating with artemisinin based combination therapy (ACT) both in HIV-infected and HIV-uninfected P. falciparum-positive individuals. Similarly, chloroquine showed 100 per cent ACPR in P. vivax HIV-infected individuals., Interpretation & Conclusion: The study showed no significant increase in HIV viral load in malaria cases. All HIV-infected and HIV-uninfected P. falciparum malaria-positive cases responded to the treatment with 100 per cent ACPR.

Background & Objectives: Japanese encephalitis (JE) caused by mosquito-borne Flavivirus is one of the leading causes of viral encephalitis in Asia. Control strategies include vector control and human vaccination. Due to lack of immunization programmes in endemic regions, there are still high mortality and morbidity. A live-attenuated SA 14-14-2 JE vaccine (LAJEV) has been licensed and used in Asian countries, including India. We report the assessment of immunogenicity and safety of the vaccine in adults during the first mass adult vaccination campaign carried out in Assam, India., Methods: One thousand and seventy five adults (aged ≥15 yr) who received LAJEV were monitored for adverse events following immunization for one year. The safety assessment of vaccinated population was evaluated till 28 days and at 6 and 12 months. Blood samples collected from the enrolled participants were tested by plaque reduction neutralization test (PRNT 50 ) to assess the neutralizing antibody titres (NATs) before vaccination and 28 days, six and 12 months post-vaccination (PV)., Results: Among the 1075 vaccinated individuals, four reported minor adverse effects from 30 min to 28 days PV. Based on the pre-vaccination NAT, the study participants were categorized as seronegative, moderately seropositive and strongly seropositive. Nearly 85.5 per cent of JE seronegative participants seroconverted by 28 days PV. The geometric mean titre (GMT) in all the three groups increased by 28 days and decreased by six and 12 months PV. Nearly 60 per cent of the moderately positive individuals exhibited four-fold rise in GMT, 28 days PV. Almost 95.5 per cent of the participants in the study population remained seroprotected at the end of 12 months PV., Interpretation & Conclusions: This study on immunogenicity and safety of LAJEV in adults showed that a single dose of the live-attenuated vaccine was safe and induced protective immunity to both JE seronegative and naturally seropositive adults. Further study is required to find out long term protective efficacy of this vaccine.

Background & Objectives: It is well documented that the Northeast state of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection., Methods: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection., Results: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection., Interpretation & Conclusions: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.

Background & Objectives: Elevated blood pressure (BP) in the young predicts serious cardiovascular events in the adults. High prevalence of adult hypertension reported from Assam, North East (NE) India may be linked with elevated blood pressure in the childhood. The present study was an attempt to describe the distribution of BP and correlates of hypertension in children aged 5-14 yr., Methods: A total of 10,003 school children from 99 schools of Dibrugarh district, Assam, NE India, were surveyed by stratified random cluster method. Blood pressure, demographic and anthropometric information were recorded. Blood pressure was categorized in to normal, prehypertension, stage I and stage II hypertension., Results: Girls had significantly higher (104.2 ± 12.0 vs. 103.2 ± 11.6 mm Hg, p0 <0.001) mean systolic blood pressure (SBP) than boys. Both SBP and diastolic blood pressure (DBP) revealed significant correlation with age, height, weight and BMI in overall and in gender specific analysis. Hypertension was found in 7.6 per cent school children (Boys: 7.3%, Girls: 7.8%). In multivariable analysis older age (OR 3.3, 95% CI: 2.82-3.91), children from tea garden community (OR 1.3, 95% CI: 1.08-1.55) and other community (OR 1.4, 95% CI: 1.18-1.73) and overweight (OR 1.5, 95% CI: 1.1-2.1) were independently associated with hypertension., Interpretation & Conclusions: Mean blood pressure in the young school children of 5-14 yr was high. A programme comprising screening, early detection and health promotion through school health programmes may help prevent future complications of hypertension.

Background & Objectives: In India, human pulmonary paragonimiasis is an important public health problem in the northeastern (NE) region. In 2005 we reported a hyperendemic focus of paragonimiasis in a remote tribal village in the hills of Changlang district in Arunachal Pradesh. The community was made aware of the disease and all active cases were treated. This study was aimed to assess the decline in the prevelance of paragonimiasis in the same area after a re-survey done in 2011 after a gap of six years., Methods: Re-surveys were carried to determine the reduction in the prevalence of paragonimiasis. Community education was given to the villagers to raise their awareness about paragonimiasis. A total of 624 individuals including 301 children (age 15 yr) were included in the study. Sputum and stool samples were examined for eggs of lung flukes. Serum samples were screened for IgG antibodies against lung fluke antigen by ELISA., Results: A significant (P<0.001) decline in the prevalence of paragonimiasis was found. There was decline in both ELISA positivity and egg positivity. Antibody positivity against excretory-secretary (ES) antigen in children (age 15 yr) fell down from earlier 51.7 to 15.9 per cent and in individuals 16 - 30 yr of age the serological prevalence fell down from 22.4 to 8.2 per cent and in individuals aged th > 31 yr, the decline in prevalence was from 15.3 to 3.7 per cent. Gender-wise analysis revealed that the decline in ELISA positivity was similar in both genders and fell down from 33.9 to 11.5 per cent in males and from 29.8 to 10.7 per cent in females. Similarly, there was a significant decline rate in egg positivity also., Interpretation & Conclusions: The strategy of hotspot targeted active paragonimiasis case detection and treatment of infected cases together with community education appears to be feasible methods to achieve control of paragonimiasis in this region.

Background & Objectives: Chikungunya (CHIK) fever is a mosquito-borne disease caused by chikungunya virus (CHIKV). Chikungunya infection was first reported from India in 1963 from Kolkata. We report the serological and molecular evidence of an outbreak of chikungunya in northeast India that occurred in Tura, a hilly and forested terrain in Garo Hills district of Meghalaya., Methods: Blood samples (3 ml) collected from hospitalized patients during the outbreak were tested for IgM antibodies against CHIKV and followed up four months later. A repeat survey was carried out in the same area after four months from where cases had been reported. Blood samples were also collected from people with history of fever and body ache in the last four months. Persons showing IgM positivity against CHIKV in the repeat survey were followed up one and a half years later. All samples were also processed by RT-PCR assay for CHIK Envelope (E) 1 gene. Immature mosquitoes were collected, link reared and identified with standard keys. Virus incrimination studies were done on Aedes aegypti and Ae. albopictus mosquitoes collected during the survey., Results: Fever, headache and joint pain were the primary clinical presentations. Twenty three (35.93 %) of 64 samples reported during the outbreak were IgM positive for CHIK. Three samples showed PCR amplification. All these were IgM positive. The sequenced E1 gene revealed that the strains belonged to East Central South African (ECSA) genotype., Interpretation & Conclusions: Field survey done after four months revealed that some individuals still had joint pain associated with episodes of headache and fever. It could be inferred that these persons might have contracted infection during the CHIK outbreak four months ago or during the intervening period which caused persistence of sequelae. ECSA genotype was found to be involved in the outbreak. Aedes albopictus was the predominant mosquito species collected during the outbreak.

Background & Objectives: Endothelial nitric oxide is a potent vasodilator and impairment of its generation brought about by gene polymorphism is considered a major predictor for several diseases. A single nucleotide polymorphism G894T within exon 7 of endothelial nitric oxide synthase (eNOS-7) gene, resulting in a replacement of glutamic acid by aspartic acid, has been studied as a putative candidate gene for cardiovascular diseases. The pattern of eNOS-7 Glu298Asp variant in the Indian population is poorly known. The present study was planned to determine the prevalence of the variant of this gene among tea garden community in Assam, North-East India with high prevalence of hypertension., Methods: Study participants of both sex aged ≥18 yr were recruited randomly from temporary field clinics established in tea gardens of Dibrugarh, Assam. Genomic DNA was extracted from 409 subjects by the conventional phenol-chloroform method. The prevalence of the eNOS exon 7 Glu298Asp variant was determined by polymerase chain reaction and restriction fragment length polymorphism analysis., Results: The study population was in Hardy-Weinberg Equilibrium. The frequency of the eNOS GG, GT and TT genotypes was found to be 75, 22 and 3 per cent respectively and did not show any significant difference in gender wise analysis., Interpretation & Conclusions: Our results showed that the prevalence of the homozygous GG genotype was high (75%) and the rare mutant genotype (homozygous, TT) was 3 per cent in a population at risk with cardiovascular disease. Such population-based data on various polymorphisms can ultimately be exploited in pharmacogenomics.

Background & Objective: There is a paucity of information on distribution of hepatitis B genotypes from northeastern part of India. Arunachal Pradesh, one of the northeastern State of India bordering Bhutan, China and Myanmar, reported abnormally high numbers of hepatitis B surface antigen (HBsAg) positive cases in one of its districts during January-June 2005. We conducted this study in the subsequent months (August-December 2005) to know the prevalent genotypes by a rapid and specific method based on type-specific primers in Upper Dibang valley of Arunachal Pradesh., Methods: A total of 438 randomly selected individual were screened for HBsAg positivity. Of the 93 HBsAg positive individuals, 36 HBsAg and HBV DNA positive samples were processed for HBV genotyping using type-specific primer based nested PCR (TSP-PCR). Representative samples were retested with RFLP-PCR based genotyping and nucleotide sequencing., Results: Of the 36 samples, 29 (80.1%) could be genotyped by the TSP-PCR based method used. The predominant genotype was genotype A (41.6%) followed by genotypes C (27.8%) and D (11.1%). Seven isolates (19.9%) could not be genotyped by this method., Interpretation & Conclusion: The presence of genotype C in this part of the country needs attention as genotype C takes a more aggressive disease course. Also, detection of genotype C in this isolated community bordering Tibet suggests viral gene flow from Tibet or other South-east Asian countries where genotype C of HBV is predominant.

Background & Objective: Although human paragonimiasis is known to occur in Manipur and Arunachal Pradesh, there is no indigenous immunodiagnostic test available in India. Sputum examination for detection of eggs is less sensitive method for diagnosis of paragonimiasis and unfortunately, the eggs are not always present in the sputum of infected individuals. Due to overlapping clinical manifestations and similarities between X-ray picture in pulmonary paragonimiasis and pulmonary tuberculosis, chances of diagnostic confusion can increase. Therefore, the objective of this study was to develop an ELISA test indigenously for diagnosis of paragonimiasis., Methods: Somatic (S) and excretory-secretory (ES) antigens of adult trematodes belonging to genus Paragonimus were prepared. Serum samples were collected from 22 confirmed patients of paragonimiasis and from five groups of negative controls. The cut-off points for both types of antigens were calculated using receiver operating characteristic (ROC) curve analysis. The sensitivity, specificity, predictive values and efficiency of the ELISA tests were also calculated., Results: IgG-ELISA test using either S or ES antigens were 100 per cent sensitive yet the utility of S antigen for diagnosis of paragonimiasis seemed to be less reliable because of low specificity (91.3%). On the other hand, ES antigen was more reliable with 100 per cent specificity as no false positive cases were recorded., Interpretation & Conclusion: ES antigen can be effectively used for screening large populations for paragonimiasis. In areas where both paragonimiasis and tuberculosis are endemic, suspected subjects should be screened for both the diseases because of chance of mistaken diagnosis. Correct diagnosis will avoid unnecessary costly treatment.

Background & Objectives: Malaria is one of the major public health problems in the north eastern region of India. Antimalarial drug resistance is widespread and one of the important causes of recent resurgence of falciparum malaria in this region. Antimalarial drugs are seen to be used sequentially one after another in many areas of the region, when therapeutic failure is observed with a drug. In view of this, the present study was undertaken to assess the therapeutic efficacy of common antimalarial drugs viz., chloroquine, sulfadoxine+pyrimethamine (S-P) and quinine, administered sequentially to the patients with Plasmodium falciparum infection in a Myanmar bordering area of Arunachal Pradesh., Methods: A hospital based in vivo study was carried out with 53 patients with uncomplicated falciparum malaria. All patients were first treated with chloroquine and therapeutic efficacy assessed. In case of therapeutic failure of chloroquine combination drug (S-P) was given and those showing failure with S-P combination, oral quinine was administered and followed up for 28 days to assess both clinical and parasitological responses., Results: Therapeutic failure was observed with chloroquine in 83.1 per cent (44 of 53) and to both chloroquine and S-P combination drug in 44.1 per cent (19/43) patients. Further, 15.8 per cent patients (3 of 19) failed to respond even to quinine. Overall, 5.7 per cent patients (3 of 53) showed unresponsiveness to all the three drugs i.e., chloroquine, S-P combination and quinine. Asexual parasite clearance and also fever clearance was slowest with chloroquine and fastest with quinine., Interpretation & Conclusion: The findings of this study show the presence of multi drug failure P. falciparum in Jairampur-Nampong, a western Myanmar bordering area of Arunachal Pradesh. Anti malarial drug resistance is increasing in Indo-Myanmar border areas and systematic studies need to be done to review the situation.

Background & Objectives: Stunting, anaemia, and the poor level of mental development are known to be associated with Trichuris trichiura infections. However, no information is available on the socio-environmental predictors relevant to Trichuris infection in rural communities. Whilst geohelminthic infections per se is an inevitable consequence of poor personal hygiene and household sanitation, the importance of specific factors in the epidemiology of Trichuris infection have not been formally investigated. The objective of this study was to explore, quantify and study different socio-environmental risk factors and find out their possible interaction vis-a-vis T. trichiura infection., Methods: The study population consisted of 244 children (aged 15 yr and below) and 336 adults selected from 144 randomly selected households belonging to three villages of upper Assam. The prevalence rate ratio (PRR; = relative risk) and 95 per cent confidence interval (CI) were calculated. Univariate, multivariate analysis using Cox's proportional hazards regression assuming constant risk period and a tree-based risk factor analysis, were used., Results: In the overall multivariate model, open field defaecation, large family size, and three or more children in the household were found independently associated with Trichuris infection. Gender specific analysis revealed that in females the age was also independently associated with increased risk of infection whereas in males, earth flooring was the most significant risk factor independently associated with the risk of Trichuris infection. Tree-based risk factor analysis indicated interaction between defaecating habits of people and the source of drinking water., Interpretation & Conclusions: Installation of pit latrines (if not sanitary latrines) together with provision for safe drinking water and the construction of cement floors would probably reduce community prevalence of T. trichiura effectively.

An investigation was undertaken of a malaria outbreak in the Primary Health Centre Titabor, district Jorhat, Assam during May/June 1999. The fever rate in the community since March 1999, was 44.4 per cent with an average case load of 2.5 per family. The fever cases peaked in the third week of May. Slide positive and slide falciparum rates in mass blood survey, in the study village were 16.1 and 14.5 per cent respectively with 90 per cent infection of Plasmodium falciparum. Males (SPR 17.5%) suffered relatively more than females (SPR 14.7%). Malaria prevalence was significantly less in individuals above 15 yr of age (SPR 11.0%) as compared to those below 15 yr (SPR 22.9%). Prevalence of malaria as well as mosquito densities in different clusters of the village were inversely related to the distance from the forested Naga hills. Anopheles minimus and A. dirus were collected in good numbers with comparatively higher densities of the former. Several factors like unusual climatic conditions, inadequate surveillance, unsatisfactory laboratory services and inadequate indoor residual insecticide spray were instrumental for the outbreak.

Presence of antibodies in human sera reacting with chloroquine (CQ) was demonstrated from a malaria endemic belt. The study groups consisted of 53 healthy volunteers, receiving regular chloroquine prophylaxis [2 tablets of CQ (150 mg)/wk, single dose], 105 individuals with a history of frequent CQ intake for any febrile attack and 95 individuals from a non-endemic area who had neither a history of malaria nor of previous consumption of CQ. Sixty six per cent individuals taking regular prophylactic chloroquine and about ten per cent of those with a history of taking frequent chloroquine due to febrile illness in the malaria endemic area showed antibodies reacting to chloroquine. However, antichloroquine antibodies were either insignificant or nondetectable in serum samples collected from persons without any history of chloroquine intake. The results indicate a possible interaction of CQ in vivo.

Follow up of microfilaraemic individuals infected with Wuchereria bancrofti at five years after treatment was carried out in a tea workers population. Diethylcarbamazine citrate in the dose schedule of 72 mg/kg body weight given in equal daily doses over a period of 21 days cleared 51.6 per cent microfilaraemic individuals five year post-treatment. Eighty five subjects were successfully followed and among these, 10 (11.8%) showed increase in mf counts, 31 (36.4%) showed reduction but remained microfilaraemic and 44 (51.8%) became amicrofilaraemic. The age and sex of the host had no significant effect on the clearance of mf. Persistence of a relatively stable low number of mf in treated individuals is more likely due to survival of one or more female worms after the therapy or due to reinfection which could not be ruled out in the present study. Overall, findings indicated that diethylcarbamazine citrate appeared to give a long-term benefit to treated individuals.

Thirty patients of uncomplicated Plasmodium falciparum malaria completed a clinical trial of arteether alpha/beta conducted in a malaria endemic tea garden of district Dibrugarh, Assam. Arteether was given intramuscularly in once a day dose of 150 mg for three consecutive days. The cure rate was 100 per cent with mean fever and parasite clearance time of 42.4 +/- 17.5 and 37.6 +/- 13.6 h respectively. Recrudescence/reinfection rate was 6.7 per cent. Palpable spleens of twenty out of twenty one cases on day 0 became non palpable within 28 days. Following the treatment, percentage of hemoglobin improved marginally with no remarkable change in total and differential leucocyte count. Arteether alpha/beta, besides being a potent and fast acting schizontocidal drug, also exhibited gametocytocidal action on P. falciparum.

Preliminary random and mass blood surveys undertaken between 2000-0100 h in a tea garden of Upper Assam revealed more than 8 per cent positivity for microfilaria (mf) of Wuchereria bancrofti. The mf carriers were considerably high among males (73) as compared to females (48). Culex quinquefasciatus was incriminated as a vector with man hour density of 68.5 in human dwellings (indoors). The detection of mf in children who had never moved from the area and filaria larvae in vector mosquitoes collected from human dwellings indicate that indigenous transmission is going on in the garden and that filariasis has become a local health problem.