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Background: Limited information is available about the risk factors associated with death among patients of influenza A (H1N1) in India. Aims: To describe the epidemiology of laboratory-confirmed influenza A (H1N1) patients and identify risk factors associated with death. Settings and Design: We reviewed the surveillance data of laboratory-confirmed patients in Tamil Nadu, India, for the year 2010. We conducted a case-control study by comparing 70 laboratory-confirmed A (H1N1) patients who died (cases) with 210 A (H1N1) patients who recovered (controls) to identify the risk factors for deaths. Materials and Methods: We interviewed the controls and immediate care-takers of the influenza patients who died to collect information about socio-demographic details and co-morbid conditions. We used an abstraction form to collect the information about the clinical details from the case records of the hospitals where the cases and controls received treatment. Statistical Analysis: We analysed the surveillance data by time, place and person. We conducted univariate and multivariate logistic regression analysis for identifying factors associated death. Results: During 2010, 1302 laboratory-confirmed cases were reported to the Tamil Nadu surveillance unit. Of these, 72 patients died (case fatality=5.5%). About 2/3 of the cases and 40% of the deaths were from three districts. On multivariate analysis, past history of diabetes, treatment in private hospitals, treatment with corticosteroids during illness, visit to >1 healthcare facility before laboratory confirmation and delay of >48 h in starting antivirals were found to be independently associated with the deaths. Conclusions: Influenza patients with previous history of diabetes, who had treatment with corticosteroids during illness, and started with antivirals after 48 h of onset of symptoms, were at higher risk of adverse outcome. In order to reduce the risk of death during future waves of influenza in Tamil Nadu, the physicians need to be sensitised regarding (1) higher risk of adverse outcomes among A (H1N1) patients with diabetes; (2) adherence to the national protocol for categorisation of cases; (3) prompt initiation of antivirals for severe cases; and (4) avoidance of systemic corticosteroids during management. [ABSTRACT FROM AUTHOR]

Objective To identify risk factors for typhoid and propose prevention measures. Methods Case–control study; we compared hospital-based typhoid cases defined as fever>38°C for ≥3 days with four-fold rise in ‘O’ antibodies on paired sera (Widal) with community, age and neighbourhood matched controls. We obtained information on drinking water, fruits, vegetables, milk products and sanitation; and calculated matched odds ratios (MOR) and attributable fractions in the population (AFP) for the risk factors or failure to use prevention measures. Results The 123 typhoid cases (median age: 25 years, 47% female) and 123 controls did not differ with respect to baseline characteristics. Cases were less likely to store drinking water in narrow-mouthed containers (MOR: 0.4, 95% CI: 0.2–0.7, AFP 29%), tip containers to draw water (MOR: 0.4, 95% CI: 0.2–0.7, AFP 33%) and have home latrines (MOR: 0.5, 95% CI: 0.3–0.8, AFP 23%). Cases were more likely to consume butter (OR: 2.3, 95% CI: 1.3–4.1, AFP 28%), yoghurt (OR: 2.3, 95% CI: 1.4–3.7, AFP 34%) and raw fruits and vegetables, including onions (MOR: 2.1, 95% CI: 1.2–3.9, AFP 34%), cabbages (OR: 2.8, 95% CI: 1.7–4.8, AFP 44%) and unwashed guavas (OR: 1.9, 95% CI: 1.2–3, AFP 25%). Conclusion Typhoid was associated with unsafe water and sanitation practices as well as with consumption of milk products, fruits and vegetables. We propose to chlorinate drinking water at the point of use, wash/cook raw fruits and vegetables and ensure safer preparation/storage of local milk products. [ABSTRACT FROM AUTHOR]