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Cholera remains a major contributor of diarrheal diseases and leads to substantial morbidity and mortality, particularly in low socioeconomic settings. Nonavailability of a national cholera control plan in India, compounded by underreporting of cholera cases and deficient accurate cholera hotspot estimates, has made cholera control a challenge. Obstacles in the programmatic introduction of oral cholera vaccine (OCV) lie within the infrastructure—stockpile, costing, distribution system, cold-chain mechanism, vaccine logistics, and lack of strengthened surveillance systems for adverse events following immunization. Sustained political commitment along with collaboration of people working in the media will also determine the policy outcome of OCV introduction in India.

Background Despite established benefits, exclusive breastfeeding (EBF) rate remains poor in India. This study measured the rate of early initiation of breastfeeding and EBF up to 42 days postpartum period and the reasons associated with early interruption of it. Methods In this study we followed a cohort 319 mother-newborn dyads, on a scheduled day of each week for six postpartum weeks (42 postpartum days), during May 2017 – March 2019. We used standard maternal 24 h recall method to collect data on newborn feeding practices. Additionally, using content the analysis method, we analysed the data captured through open ended question on current breastfeeding practice and reasons to identify the sociocultural facilitators/barriers of exclusive breastfeeding . Results Of the retained 306 newborns, early initiation of breastfeeding rate was 60% (184/306), whereas, EBF rate was 47% (143/306). Mothers’ educational level did not emerge as a risk for unsuccessful breastfeeding practices, whereas, father being not the major earner of the family (Relative risk [RR] 2.4; 95% Confidence interval [CI] 1.7,3.3), mothers who did not believe that effect of breastfeeding is longstanding (RR 1.8; 95% CI 1.3, 2.1) emerged as a risk for unsuccessful EBF practices. Lack of self-conviction about EBF among mothers; significant family members’ influence; cultural beliefs; emerged as major socio-environmental barriers of early interruption of exclusive breastfeeding. Repeated counselling by the healthcare provider particularly focusing on exclusive breastfeeding, supportive family environment in terms of the elders being aware of the positive health outcomes of it, and prior positive experience emerged as the socio-environmental facilitators for successful EBF until 42 postpartum days. Conclusions We conclude that the socio-environmental causes need to be addressed through the present healthcare delivery system for ensuring better infant feeding outcome.

About 30–40 percent of all cancers can be prevented by adopting a proper lifestyle and dietary measures. Obesity, sugars and refined flour products that contribute to impaired glucose metabolism (which leads to diabetes), low fiber intake, consumption of red meat, and imbalance of omega 3 and omega 6 fats all contribute to excess cancer risk. However, intake of flaxseed, especially its lignan fraction, and abundant portions of fruits and vegetables will lower cancer risk. Garlic, which contains Allium, cruciferous vegetables, and broccoli sprouts being the richest source of sulforophane, are especially beneficial, for cancer prevention. Protective elements in a cancer prevention diet include all the micronutrients, such as, selenium, folic acid, vitamin B-12, vitamin D, chlorophyll, and antioxidants such as the carotenoids (α-carotene, β-carotene, lycopene, lutein, cryptoxanthin). Further, Ascorbic acid has limited benefits orally, but could be very beneficial intravenously. Supplementary use of oral digesti e enzymes and probiotics also has merit as anticancer dietary products. When a diet is compiled according to the proper guidelines, there would be at least a 60–70 percent decrease in breast cancers, colorectal cancers, and prostate cancers, and even a 40–50 percent decrease in lung cancer, along with similar reductions in cancers at other sites. Such a diet would be conducive in preventing cancer and would favor recovery from cancer as well.

The most progressive neurodegenerative disease so far we know are Alzheimer’s disease (AD) and Parkinson’s disease (PD). They manifest cognitive and motor disorders, respectively. No cures are found yet for both the diseases, except some palliatives. At this stage, some alternative measures can be adopted that may slowdown the further progression and may bring comfort to the affected people. Epidemiological data supports a direct relationship between the physical activity (PA) and the risk of developing those two diseases. Aerobic physical exercise (PE) induces the release of neurotrophic factors, promotes angiogenesis, neurogenesis and synaptogenesis, and improves memory and cognitive functions. Further, PE activates the superoxide scavengers, like superoxide dismutase, endothelial nitric oxide synthase, and thereby protects the hippocampus, which is involved particularly in memory function. AD and PD not only deteriorate the quality of life but also may cause death. Therefore, any positive impact of non-pharmacological interventions, such as physical activity and exercise, would improve public health.

Despite high morbidity and mortality of ongoing coronavirus disease 2019 (COVID-19) pandemic, no specific therapy has been established till date. Though in vitro studies identified various molecules as possible therapies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), these findings call for substantiation by human studies. We conducted this review aiming at reporting evidences on therapies used so far globally for management of COVID-19 in clinical settings. We searched electronic databases as PubMed, Google Scholar, EMBASE and extracted 612 possible studies as on May 31, 2020. We included original studies of any epidemiological design done on human COVID-19 patients and measured clinical outcomes. Finally, following removal of duplicates and studies meeting exclusion criteria, we derived 22 studies, of which eight were clinical trials, seven were case reports and case series, and seven were observational studies. The most reported therapies were hydroxychloroquine (HCQ) (eight studies) and lopinavir/ritonavir (four studies). We conclude from the evidence generated so far that interferon combined with antivirals, remdesivir, umifenovir and favipiravir were mostly associated with better clinical outcomes. The therapeutic effect of HCQ was established initially by two clinical trials; one of them showing a reinforcing effect by azithromycin but subsequent studies did not elicit any effectiveness rather increased rate of adverse events was reported. Lopinavir/ritonavir was found beneficial when administered with interferon and ribavirin, but one clinical trial on its sole use proved contrary. As many clinical trials are in process, we expect to get concrete evidences on repurposing of existing drugs based on less biased, high powered studies.

Background Despite relatively simple prevention and treatment, syphilis remains a major social and public health concern worldwide, particularly in developing nations. Objective To estimate the prevalence and to determine the sociodemographic factors associated with syphilis infection among antenatal-care (ANC) attendees in Meghalaya, India. Materials and Method A facility-based cross-sectional study was conducted utilizing National HIV Sentinel Surveillance of Meghalaya, January–March 2017. Pregnant women aged 15–49 years ( n = 3015) were recruited consecutively, interviewed, and tested for syphilis by Venereal Disease Research Laboratory test in eight selected ANC sites representing all districts of Meghalaya. Results Prevalence of syphilis was found to be 1.03 % (95% CI = 0.67–1.39) (31/3015). Prevalence was maximum among illiterates with gradual lowering of adjusted odds ratio (AOR) with improvement of education. Women whose husbands had no income were associated with higher risk (AOR = 4.97, 95% CI = 1.11–22.20) of syphilis. Significant risk (OR = 2.42, 95% CI = 1.02–5.74) was also observed with Jaintia Hills residents as compared to Garo Hills. Conclusions As high prevalence of gestational syphilis was identified in Meghalaya along with important sociodemographic predictors, evidence to policy translation is required at state and national level to scale up prevention, screening, and management of syphilis

Background: Evaluation of prescription patterns would determine the drug utilization with main emphasis on rational use of medicine. The problem of irrational use of drugs is rampant particularly in developing nations. The present study was undertaken for evaluating the prevailed prescription patterns in tertiary hospitals with diarrhoea and/or Acute Respiratory Infection (ARI) to address specific areas of deficiencies and deviation from the available guidelines. Method: We conducted this observational cross-sectional study from August 2019 to December 2020 in Medicine & Paediatrics outpatient departments and Urban Health Training Centre in two Government teaching hospitals in West Bengal, India. We included 630 prescriptions (511 – ARI, 119- diarrhoea) and evaluated in terms of disease and medicine prescribed including antibiotic related indicators. We compared prescription patterns across different age groups, different strata of prescribers and compared against WHO standards. A Rational Use of Medicine Consensus (RUMC) committee was formed and the prescriptions were assessed for appropriateness independently by a pharmacologist and clinician. Deviations, if any, were ascertained from the available guidelines and the acceptability of the deviations were determined by consensusResult: Age and sex were mentioned in all prescriptions however signs & symptoms, provisional diagnosis and follow up visit were mentioned in 90.3%, 4.9% and 67.9% prescriptions respectively. Body weight was mentioned in 88.5% of prescription of children (< 18 years). Higher rates of Fixed Dose Combination (51%), lower proportion of generic drug (23.3%) and adherence to hospital formulatory (36.5%) were some the major concerns identified. Antibiotics prescription rate (APR) and multiple antibiotic prescription rate (MPR) were respectively 57% and 10%; both found significantly higher for diarrhoea than ARI. Deviations from Standard Treatment Guidelines were found in 98.9% prescriptions and 90.4% of which were unacceptable. Agreement between clinician and pharmacologist was observed in 90% prescriptions (Kappa -0.114). Deviations were most commonly observed with prescriptions by interns and house-staff (99.6%), whereas acceptable deviations were more frequent among the residents (15%).Conclusion: We conclude that in light of identified irrational prescription patterns, development of level specific treatment protocol coupled with periodic training of physician including junior doctors is required to ensure rational medicine practice.

Serodiscordant couples serve as potential sources of human immunodeficiency virus (HIV) transmission. Understanding the demographic dynamics of serodiscordant couples plays an important role in tailoring interventions to eliminate HIV infection. We conducted this cross-sectional analysis among 314 integrated counseling and testing centers in West Bengal, India, from April 2016 to March 2020. General individuals who were detected as HIV-reactive and whose spouses were also tested for HIV comprised the study population, in which a total of 8,740 couples were included. Sociodemographic variables were compared across concordant and discordant arms, as well as between male positive (M+ F-) and female positive (F+ M-) subgroups of serodiscordant couples. Among the couples studied, 35.2% (95% CI: 34.2-36.2%) were serodiscordant. Among serodiscordant couples, the proportion of M+ F- (86.1%) was significantly higher than that of F+ M- (13.9%). We observed that higher mean ages of couples, higher education, business and service occupations, and urban residence were significantly associated with the serodiscordance relationship (P0.05). A high mean age of couples and a low proportion of housewives were associated with the F+ M- subgroup. As approximately 35% of serodiscordant couples carry the risk of transmission to negative spouses, particularly in older age and urban residence, reorientation of HIV programs may be required to avert transmission in the future.

Carcinogenesis, in a recent years, is highly known to be linked with nutrition, particularly the micronutrients which play an important role as an antioxidant as well as an immunity-potentiating agent. Epidemiological studies with human cancer subjects, however, were very limited in India though people in India are exposed to different kind of carcinogens quite often. In this review, we analyzed and showed that Vitamin C, Vitamin E and Zinc have significant effect in lowering cancer risk.The vegetables and fruits that are rich in Vit C are broccoli, Brussels sprouts, cauliflower, green and red peppers, spinach, cabbage, turnip greens, and other leafy greens, capsicyum, Lemon, oranges, etc. Food rich in Vitamin E are nuts, seeds, avocado, vegetable oils and wheat germ. Zinc, an important trace elements for growth can be found in meat, shellfish, legumes like chickpeas, lentils and beans, seeds, nuts, dairy, eggs and whole GrainsOur mission, as an educators and researchers, is to translate the scientific discovery of any health issue like cancer to a health-literate generation in college, family, and community. Coordinated collaboration between professionals in education and public health can better prepare our young people to be health literate and cancer-free.

Emergence of the 2019 novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and its spread, with life-threatening outcomes, have caused a pandemic burden worldwide. Studies of emerging diseases under outbreak conditions have focused on the complete spectrum of pathogens, transmissibility, shedding kinetics in relation to infectivity, epidemiological causes, and interventions to control emergence. During the initial stages of an outbreak, laboratory response capacity focuses on expansion of efficient diagnostic tools for rapid case detection, contact tracing, putting epidemiological findings into sources, mode of transmission, and identification of susceptible groups and reservoirs. It is important for public health diagnostic laboratories to have a fundamental knowledge of viral shedding, antibody response kinetics, assay validation, interpretation, and uncertainties of test results. This study reviewed currently published data from available literature on SARS-CoV-2 infection and compared this with data on viral shedding and antibody response kinetics of other human coronaviruses. Also described are current challenges and comments on some biases and significant data gaps that have limited laboratory preparedness to SARS-CoV-2. Consistent documentation of progress and data gaps from standardized reporting of methods utilized, sampling date, details of test results by specimen type, risk assessments, and symptoms can all be used strategically and provide incentives to governments and their partners to prioritize the development, detection, and response to outbreaks.

Human immunodeficiency virus (HIV) infection in pregnancy may result in adverse obstetric outcomes, such as stillbirth. The present study aimed to compare the stillbirth rate (SBR) in HIV-infected pregnant women with that in the general population, observing the year-wise trends of HIV infection-associated SBR and identifying possible associated exposures. A retrospective cohort study was conducted through the analysis of secondary data from 314 integrated counseling and testing centers across the state of West Bengal, India, from 2012 to 2020. A total of 3,478 HIV-infected pregnant women were followed up, and year-wise SBR trends were compared with that among all pregnancies of the state as per the latest available Sample Registration System report in India. A linear regression analysis of the year-wise trend in SBR was performed. T-test of two means and the relative risk (RR with 95% confidence interval) was conducted to identify the associations between different exposures and stillbirth. The SBR was significantly higher (26.7/1,000) in HIV-infected pregnancies than in all pregnancies (5/1,000) and was significantly reduced after the initiation of antiretroviral treatment (RR = 0.09: 0.05-0.16). Spouse testing for HIV (surrogate marker for familial involvement) (RR = 0.35: 0.20- 0.61) and maternal literacy (RR = 0.62: 0.40-0.97) were also found to be significantly effective in preventing stillbirth.

Background: Repeated cross-sectional serosurveys in the same geographic area establish the trend of the evolving pandemic. We present the findings of the third round of a national serosurvey to estimate the seroprevalence of SARS-CoV-2 infection among the general population and health care workers of India. Methods: We conducted the third population-based serosurvey between Dec 18, 2020 and Jan 6, 2021 in the same 700 villages or wards from 70 districts in 21 states across India, which were selected for the first and second serosurveys. We enrolled from each district, at least 400 individuals aged ≥ 10 years from general population and 100 HCWs from sub-district level public health facilities. Serum samples from general population were tested for the presence of IgG antibodies against nucleocapsid (N) and spike protein (S1-RBD) of SARS-CoV-2 using the Abbott and Siemens assays respectively, whereas sera from HCWs were tested for anti-S1-RBD. For general population, sera positive for either of the antibodies were considered positive, while sera positive for anti-S1-RBD were considered as positive for HCW. Weighted seroprevalence estimates were adjusted for sensitivity and specificity of respective assays. Findings: Of the 28,598 sera from general population, 4585 (16%) had IgG antibodies against N, 6647 (23.2%) against S1-RBD and 7436 (26%) against either. The weighted and assay characteristic adjusted seroprevalence against either of the antibodies was 24.1 (95%CI: 23.0% to 25.3%). Seroprevalence was lower in rural areas (21.4%, 95% CI: 20.3% to 22.6%) compared to urban non-slum (29.4%, 95% CI: 26.9% - 32.1%) and slum areas (34.6%, 95% CI: 31.0% to 38.3%). Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI: 23.5% to 27.8%). Interpretation: Nearly one in four individuals aged 10 years or older from general population as well as HCWs were exposed to SARS-CoV-2 by December 2020 amounting to 271 million infections in India. Funding Statement: Indian Council of Medical Research Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no competing interests Ethics Approval Statement: The project was approved by Institutional Human Ethics Committee at ICMR-National Institute of Epidemiology.

Background: India witnessed a severe second wave of COVID-19 during March and June 2021. We did the fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged >=6 years and health care workers (HCWs). Methods: We did a cross-sectional study between 14 June and 6 July 2021 in 700 clusters in the same 70 districts across 21 states/Union Territory. From each district, a minimum of 400 individuals aged >=6 years from general population and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test adjusted seroprevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein along with 95% CI. Findings: Of the 28,975 sera tested, the weighted and test adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged >=6 years was 67.6% (95% CI: 66.4 – 68.7). The seroprevalence increased with age and was not different in rural and urban areas. Compared to unvaccinated adults (62.3%, 95% CI: 60.9 – 63.7), seroprevalence was significantly higher among individuals who received one (81.0%, 95% CI: 79.6 - 82.3) and two doses (89.8%, 95% CI: 88.4 - 91.1). The seroprevalence of IgG antibodies among 7,252 health care workers was 85.2% (95% CI: 83.5 - 86.7). Interpretation: Nearly one third of the population is still seronegative. It is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions. Funding: Indian Council of Medical Research. Declaration of Interest: None to declare. Ethical Approval: The Institutional Human Ethics Committee of the ICMR National Institute of Epidemiology, Chennai approved the study protocol.

Background & objectives: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. Methods: From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity. Results: Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths. Interpretation & conclusions: Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.

Background: Ewing sarcoma is a malignant tumour found mainly in childhood and adolescence. The present study aims at analyzing the data on Ewing sarcoma cases of bone from the National Cancer Registry Programme, India to provide incidence, patterns, and trends in the Indian population. Materials and Methods: The data of five Population Based Cancer Registries (PBCR) of Bangalore, Mumbai, Chennai, Bhopal and Delhi over 30 years period (1982– 2011) were used to calculate the Age Specific and Age Standardized Incidence Rates (ASpR and ASIR), and trends in incidence was analyzed by linear and Joinpoint Regression. Results: Ewing sarcoma comprised around 15 % of all bone malignancies. Sixty-eight percent were 0–19 years, with 1.6 times risk of tumour in bones of limbs as compared to other bones. The highest incidence rate (per million) was in the 10–14 years age group (male −4.4, female −2.9) with significantly increasing trend in ASpR observed in both sexes. Pooled ASIR per million for all ages was higher in male (1.6) than female (1.0) with an increasing rate ratio of ASIR with increase in age. Trend of pooled ASIR for all ages was significantly increased in both sexes. Twelve percent cases were reported in ≥30 years of age. Conclusion: This paper has described population based measurements on burden and trends in incidence of skeletal Ewing in India. These may steer further research questions on the clinical and molecular epidemiology to explain factors associated with the increasing incidence of Ewing sarcoma bone observed in India. Keywords: Ewing sarcoma, Bone, Incidence, Cancer Registry, India

Background: West Bengal is a low-prevalent state with high vulnerability for HIV. The state bears around 6% of HIV burden of India. With consistent effort on preventive, diagnostic, and curative services under National AIDS Control Program, HIV prevalence is gradually coming down. Our study objective is to determine the trend of HIV positivity among different groups/population attending Integrated Counseling and Testing Centres (ICTCs) over a period of 8 years and identify the group of population needing special attention. Methods: The study was conducted with available program data year-wise from 2008–2009 to 2014–2015 among different groups of population who attended ICTCs for HIV testing. Year-wise positivity was calculated and trend analysis was performed by linear regression method keeping year as regressor. Similar methodology was applied for different typologies among the high-risk groups (HRGs) and trend analysis was done using linear regression for the study period from 2012–2013 to 2014–2015. Results: HIV positivity among general male and non-pregnant individuals, HRG population, transgender (TG) population, and pregnant women showed a significant declining trend over the past 8 financial years, but the discordance rate remained almost the same. Regarding HIV positivity trend among different typologies of HRGs, trucker group showed a significant increase in HIV positivity over the past 3 years, whereas HIV positivity among other groups like female sex workers, men having sex with men, injecting drug users, and migrant labors did not undergo significant changes over the past 3 years. Conclusion: HIV-preventive services among truckers need to be emphasized. HIV screening services among the TG population should be further scaled up through more number of targeted interventions.

Background: Long-distance truckers (LDTs) belong to a special sentinel group with potentially high risk of acquisition of HIV owing to their high mobility, sociodemographic vulnerability, and high-risk behaviors. Objective: The objective is to estimate the prevalence of HIV and identifies its sociodemographic correlates among a representative population of LDTs in West Bengal, India. Methods: Between May and July 2017, HIV Sentinel Surveillance (HSS) was conducted in West Bengal by the National AIDS Control Organization. A total of 749 LDTs were recruited for the study, were interviewed, and tested for HIV. Descriptive and logistic regression analysis of socio-demographics, sexual risk behavior, and HIV serostatus were performed using SAS 9.3.2. Results: The prevalence of HIV among LDT was 1.2% (95% confidence interval [CI] = 0.4–2.0). Mean age was 32.8 years (standard deviation 8.5), 77.1% were currently married, 89.9% were literate, 85.7% visited HSS site for collecting condoms or seeking medical care and treatment, 53.1% were rural residents, 86.7% had sex at least once with a female partner other than wife in the past 6 months, 2.7% had sex with a male partner and 1.7% injected drugs for recreational purpose. Higher age (odds ratio [OR] = 1.1 [95% CI = 1.0–1.1]), literate (OR = 0.3 [95% CI = 0.1–0.9]), visiting HSS sites for collecting condoms or seeking medical care and treatment (adjusted OR [AOR] = 0.2 [95% CI = 0.1–0.6]), rural residence (OR = 0.2 [95% CI = 0.1–0.3]) and duration of stay in home (AOR = 1.3 [95% CI = 1.1–1.5]) were found to be significant predictors of having sex with a female partner other than wife.Conclusion: High HIV burden calls for urgency in the implementation of targeted intervention to minimize HIV risk among LDTs in West Bengal to fight against HIV/AIDS.

Background: : In Prevention of Parent to Child Transmission (PPTCT) program in India, single dose Nevirapine was used for prevention of intrapartum transmission of HIV, but the protective efficacy of this regimen in Indian population is not beyond question. Objective: To analyze the protective efficacy of single dose Nevirapine prophylaxis in preventing mother to child transmission of HIV and comparing the effect of Nevirapine prophylaxis in different types of infant feeding practices and modes of delivery. Methods: A retrospective cohort study was carried out through analysis of secondary data during October 2010 to September 2011 from 16 Integrated Counseling and Testing Centers (ICTCs) having DNAPCR (Polymerase Chain Reaction) collection facility in West Bengal among 224 babies born of HIV infected mothers, 168 unexposed (covered with intrapartum Nevirapine) and 56 exposed (not covered with intrapartum Nevirapine) to risk of transmission. HIV reactivity in babies was confirmed by DNA PCR of Dry Blood spot from 6 weeks age onwards. Data was entered and analyzed using Epi Info version 3.5.1 and Statistical Package for Social Sciences software version (SPSS 16.0). Results: About 10.12% of those received Nevirapine were found HIV reactive compared to 26.79% of those who did not. Overall Relative Risk of non coverage of Nevirapine for vertical transmission of HIV was 2.65 (95% CI : 1.42 ‐ 4.95). Overall Attributable Risk was 62.22%. Conclusion: Since in 62.2% cases vertical transmission of HIV was prevented, additional regimen may be thought of for rest 37.8% cases.

Background: An unusual outbreak of acute encephalitis syndrome (AES) with high case fatality was reported from Kaliachak- I, II and III Blocks of Malda District of West Bengal in the month of June 2014 affecting 72 children with 34 deaths. The purpose of this study was to investigate the outbreak in the light of epidemiological as well as etiological determinants. Methods: The investigating team collected clinical and epidemiological data from the cases admitted at Malda Medical College and at the Kaliachak BPHC. Different clinical samples, (serum, CSF etc) collected from cases as well as control population were screened for different pathological, biochemical and microbiological parameters. Additionally, the CSF specimens were also processed for the isolation of viruses by inoculating in the chorio-allantoic membrane (CAM) of embryonated chick eggs and intracerebral inoculation of suckling mice. Statistical methods included calculation of proportions (percentages), different test of significance (t-test, chi square etc). Results: All children were from age group of 9 months to 10 years (median=3, mean=3.73, SD=1.98) and belonged to low socioeconomic background of litchi growing belt of Malda. Most of the cases were male (65% approx). Case Fatality Rate was 47.2%. The main presenting features were sudden onset of convulsions (100%) in the early hours of dawn followed by rapid progression to unconsciousness (100%) and decerebrate rigidity (47%). Fever was present in around one third of cases. Hypoglycaemia and leucocytosis were two predominant features. Clinical samples subjected to molecular and serological testing, were all found negative for known viruses causing acute encephalitis. 3 out of 4 CSF samples produced demonstrable pocks in Chorio allantoic membrane of the embryonated eggs although the pock count varied from 4- 22 per CAM. Significantly low blood glucose level was found in the controls from litchi belt areas as compared to the controls of non-litchi belt areas of Malda. Conclusion: The evidence gathered so far pointed towards a viral etiology although the causative virus remained unidentified. Hypoglycaemia probably induced by litchi fruit might have aggravated the encephalitis rather than actually causing it.