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One of the main sources of dangerous chemicals that are dumped untreated into land and water bodies and have a negative influence on the ecosystem are industrial effluents. Seaweeds are currently used for treating industrial effluent effectively. The technology is at a maturing stage. This paper reviews the characterization and cultivation of seaweeds for wastewater treatment. In this present study, different extracts of four seaweeds such as Gracilaria edulis, Sargassum wightii, Turbinaria ornata, and Kappaphycus alvarezii, from the Mandapam coastal regions were analyzed. The seaweeds are used to treat the leather industry effluents collected from EKM leather processing company, Erode, Tamil Nadu, India. Among all, extracts of Gracilaria edulis survived at different concentrations of TDS: 15,000, 25000, and 35000 mg/l. Out of these different ranges, TDS of about 25000 mg/l seaweed named Gracilaria edulis reduced more amounts of chemicals present in the effluent like TDS (93.90%), phosphates (72.71%), nitrate (75.08%), nitrite (76.92%), and turbidity (99.01%) content. Additionally, we produce the quality and strength of agar gel from the cultivation of Gracilaria edulis by the Nikansui method. Finally, we got the extraction procedure to obtain a higher yield of about 10.26% and a maximum gel strength of 92.06 g·cm−2 while maintaining the melting point at 78°C. [ABSTRACT FROM AUTHOR]

To design and implement a locally relevant competency- based MPH programme. The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention. A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research. This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries. [ABSTRACT FROM AUTHOR]

Objectives Somatic mutations of the PIK3 CA, CASP8, and NOTCH1 have been frequently detected in various human cancers. Our study aimed to analyze the mutational status of these genes in South Indian oral cancers. Subjects and methods We performed mutational analysis of the PIK3 CA (exons 9 and 20), CASP8 (exon 9), and NOTCH1 (exons 5, 6, 7, 8, and 9) genes in 96, 48, and 44 oral cancer samples, respectively. All the specified exons were PCR (polymerase chain reaction)-amplified and directly sequenced by Sanger sequencing. Results PIK3 CA gene mutations were not found; however, a synonymous single nucleotide polymorphism ( SNP) [rs17849079] was observed frequently [35/96 (36.4%)] in oral cancer samples. Further, no mutations were detected in the CASP8 gene, but observed a frequent [32/48 (66.6%)] SNP [rs1045487] in the oral cancer samples. We did not detect any mutation in the NOTCH1 gene (exons 5, 6, 7, 8, and 9) in all the [0/44] analyzed oral cancer samples. Conclusions This is the first study that reports the status of the PIK3 CA, CASP8, and NOTCH1 mutations in South Indian oral cancer samples. Our study suggests that either mutations in these genes are uncommon in South Indian oral cancer samples or likely other genes in this pathway might be mutated. [ABSTRACT FROM AUTHOR]

Background Health science students (HSS) are at increased risk of contracting and transmitting viral diseases such as measles, mumps, rubella, and varicella (chickenpox). This study was undertaken to determine the prevalence of susceptibility of HSS to these infections. Methods Using a cross-sectional design, 790 HSS of Manipal University, Manipal, India, answered a questionnaire and provided a blood sample which was tested for specific IgG antibodies to measles, mumps, rubella and varicella by ELISA (Enzygnost®). Results The study group was comprised of medical (53.9%), nursing (16.6%), and allied health (29.5%) students. Among the overall group (n = 790), the prevalence of serological susceptibility to measles, mumps, rubella, and varicella were 9.5%, 32.0%, 16.6%, and 25.8%, respectively. Among the subgroup of vaccinated subjects, susceptibility to measles, mumps, rubella, and varicella were 7.9%, 34.7%, 10.7%, and 35.2%, respectively. Conclusion HSS susceptible to measles, mumps, rubella, and/or varicella are at risk of acquiring these diseases during their training period. In addition, they may be a potential source for nosocomial transmission posing a risk to immunocompromised patients. Hence, in the Indian setting, HSS should be immunized against measles, mumps, rubella, and varicella at the time of joining the medical school. Am. J. Ind. Med. 56:58-64, 2013. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Various statistics indicate that many of the parts of India, especially rural and island areas have either partial or no access to electricity. The main reason for this scenario is the immense expanse of which the power producing stations and the distribution hubs are located from these rural and distant areas. This emphasizes the significance of subsidiarity of power generation by means of renewable energy resources. Although in current energy production scenario electricity supply is principally by AC current, a large variety of the everyday utility devices like cell phone chargers, computers, laptop chargers etc. all work internally with DC power. The count of intermediate energy transfer steps are significantly abridged by providing DC power to mentioned devices. The paper also states other works that prove the increase in overall system efficiency and thereby cost reduction. With an abundance of solar power at disposal and major modification in the area of power electronic conversion devices, this article suggests a DC grid that can be used for a household in a distant or rural area to power the aforementioned, utilizing Solar PV. A system was designed for a household which is not connected to the main grid and was successfully simulated for several loads totaling to 250 W with the help of an isolated flyback converter at the front end and suitable power electronic conversion devices at each load points. Maximum abstraction of operational energy from renewable sources at a residential and commercial level is intended with the suggested direct current systems. [ABSTRACT FROM AUTHOR]

The spotted fever group (SFG) of Rickettsia are zoonotic disease-causing pathogens, commonly transmitted by hard ticks to a wide range of hosts, including humans. Rickettsia conorii is the common SFG recognised in India, whereas most of the infections due to other group species go undifferentiated at the species level. Hence, this study was conducted to screen host-seeking ticks in the Western Ghats region, India, for the DNA of SFG Rickettsia. The ticks were collected from Kerala, Goa, and Maharashtra states of India during a survey conducted between November 2017 and January 2018. In total, 288 tick pools were screened for Rickettsia spp. DNA using pan-Rickettsia real-time PCR, and conventional PCR targeting the gltA, OmpA and 17-kDa protein-coding genes. Nucleotide sequences were subjected to phylogenetic analysis using the NCBI BLAST tool to identify submitted sequences with higher homology. Neighbour-joining trees were constructed using the reference sequences of the GenBank database. Overall, Rickettsia spp. DNA was detected in 27.2% (62/228 pools) of host-seeking ticks across the Western Ghats region, with an estimated minimum infection rate of 0.057. Upon phylogenetic analysis, it was identified that the detected sequences were highly similar (> 99% sequence homology) to R. africae, Candidatus R. laoensis and an un-categorised Rickettsia species, and they were widely carried by Haemaphysalis ticks. The current study is the first report of R. africae and Candidatus R. laoensis in ticks in India. Although the pathogenicity of these species is not well documented, they may pose a potential threat to both animal and the human population in this geographical region., (© 2023. The Author(s).)

Background: Kyasanur Forest disease (KFD) was first reported in 1957 and became an emerging tick-borne viral disease of public health importance in India. However, very little is known about the host-virus interaction and pathogenesis of KFD in humans. This study described the presence, duration, and kinetics of KFDV RNA in body fluids in infected human cases., Methodology: We enrolled 76 laboratory-confirmed KFD individuals and followed them up in the study. We obtained serial samples of blood, throat swabs in viral transport medium (VTM), urine, stool, and semen during the acute and convalescent phase of KFD illness. In addition, specimens were inactivated, and nucleic acid was extracted and tested for KFDV real-time reverse transcriptase -PCR. Clinical data was also obtained from the subjects., Result: The study provides evidence of KFD virus RNA in different biological body fluids of humans. The percentage positivity of KFDV RNA in blood was 100% during the first four days of illness. PCR became negative in most cases by 7-8 days; a subset of cases (14%) had prolonged viremia for up to 15 days post-onset of illness. Relatively low copies of KFDV RNA were also detected in throat swabs and urine in the first week of illness. In addition, we detected KFDV RNA in stool samples of cases of those who had diarrhea at an early stage of infection., Conclusion: The study provides evidence of KFDV RNA in different biological body fluids, which will help understand the pathogenesis, transmission pattern and develop diagnostic algorithms of KFDV in humans. In Kyasanur Forest disease infection, the blood has more RNA copies/ml than other body fluids, and viremia may last up to two weeks post-infection., Competing Interests: Declaration of Competing Interest Both the authors report no conflicts of interest. Both the authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the manuscript's content have been disclosed., (Copyright © 2022 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

EV-D68 is an emerging enterovirus infection associated with severe acute respiratory illness (SARI), acute flaccid myelitis (AFM) and acute flaccid paralysis (AFP). While EV-D68 outbreaks and sporadic cases are reported globally, a single case has been reported from India. The present study aims to investigate the molecular epidemiology and clinical characteristics of EV-D68-associated SARI cases from South India. We screened influenza-negative archived throat swab specimens from Influenza-Like Illness (ILI) and SARI cases (n=959; 2016 to 2018 period) for enteroviruses by pan-enterovirus real-time RT-PCR. Thirteen samples positive for enteroviruses were typed by PCR and sequencing based on VPI, VP2 and/or 5'NCR regions. One EV-D68 RNA sample was subjected to next-generation sequencing for whole genome characterisation. Among 13 enterovirus cases, four were ECHO-11, three EV-D68, two CV-A16 and one each EV-71, CV-B1, CV-B2 and CV-A9. All three cases of EV-D68 infection were reported in children below 2 years of age from Kerala state of South India during June and July 2017. The patients developed pneumonia without any neurological complications. Sequencing based on VPI and 5'NCR regions showed that EV-D68 strains belong to the novel subclade B3. The EV-D68 complete genome identified with two unique amino acid substitutions in VP1 (T-246-I) and 3D (K-344-R) regions. This study reiterates the EV-D68 novel subclade B3 circulation in India and indicates the urgent need for structured EV-D68 surveillance in the country to describe the epidemiology.

Kyasanur Forest disease (KFD) is a tick-borne, acute, febrile viral illness endemic in southern India. No major studies have been done to understand the adaptive immune response during KFDV infection in humans. In this study, KFDV-positive patients were prospectively enrolled, and repeated peripheral blood collections were performed. Clinical and virologic characterization of these samples is reported along with phenotypic analysis of cellular immunity and quantitation of humoral immunity. We noted robust T and B cell responses, particularly of CD8 T cells, during KFDV infection in most of the patients. Virus clearance from the blood coincided with peak CD8 T cell activation and the appearance of KFDV-specific IgG. Increased frequency of plasmablasts and very few activated B cells were observed in the acute phase of KFD infection. Notably, only humoral immunity and activated B cell frequency in the acute phase correlated with prior KFDV vaccination, and only with 2 or more doses. This novel work has implications in KFD vaccine research as well as in understanding the pathogenesis.

Background: An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department (ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described., Methods: The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed., Results: The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing., Conclusion: The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Kyasanur Forest disease virus (KFDV) and Alkhurma hemorrhagic fever virus (AHFV) are enveloped, positive-stranded RNA viruses of clinical importance with complex enzootic life cycles involving hematophagous ticks which feed on small and large mammals. Humans and monkeys are dead-end hosts for these viruses. Recent trends in epidemiological data suggest both virus incidences are steadily increasing and their geographical distribution expanding out of previously known circulation regions. For the detection and discrimination of these two closely related flaviviruses, we have developed quantitative real-time RT-PCR assays with 100 % sensitivity and 100 % specificity for KFDV, 100 % sensitivity and 99.4 % specificity for AHFV as determined using 550 clinical samples collected between 2015-2018 from Western Ghats region of India. This rapid and sensitive assay will enable researchers to accurately diagnose the presence of the virus during viremia in human and animal blood samples, and also from tick specimens. Incorporation of these new tests into a routine diagnosis will help in the diagnosis of KFDV as well as AHFV in the endemic areas and also would provide an early warning of the spread of this virus to newer regions with similar epidemiology., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes. The disease is characterized by fever, headache, rash, severe joint, and muscle pain. To evaluate the disease burden in the population and the effectiveness of public health measures, periodic seroprevalence surveys are essential. Chikungunya outbreaks were reported from many Asian countries since 2005, after more than three decades of disappearance. The study aimed to estimate the seroprevalence of the chikungunya virus in southern parts of Karnataka state, through demonstrating chikungunya virus-specific neutralizing antibodies. A cross-sectional study was carried out using 509 archived blood samples from a hospital-based acute febrile illness surveillance project, representative of the period between June 2014 and 2018. The study reported a 3.7% seroprevalence of chikungunya virus-neutralizing antibodies in Thirthahalli and Hosanagara taluks of South Karnataka. The low prevalence of chikungunya-neutralizing antibodies indicates that a major population is unexposed and prone to future outbreaks., (© 2019 Wiley Periodicals, Inc.)

Women with persistent human papillomavirus (HPV) infections have a high risk of developing cervical cancer (CaCx). HPV-16 alone accounts for more than 60% of CaCx worldwide. Most of the HPV infections are transient and only a subset of women develop persistent HPV-16 infection. Many studies have shown associations of different human leukocyte antigen (HLA) alleles with HPV-mediated CaCx, but there are only a few studies globally that relate to persistent HPV-16 infection. Furthermore, such studies from India are sparse. Hence, we investigated the association of HLA-A, B, DRB, and DQB alleles with persistent HPV-16 infection and HPV-16-positive CaCx in south India (Tamil Nadu). HPV-16 persistent infection was observed in 7% of normal women. A total of 50 women with HPV-16-positive CaCx, 21 women with HPV-16 persistent infection, and 74 HPV-16-negative normal women were recruited for this study. Low-resolution typing of HLA-A, B, DRB, and DQB alleles was performed. HLA-B*44 and DRB1*07 showed a significant association with persistent HPV-16 infection (odds ratio, p -value = 26.3, 0.03 and 4.7, 0.01, respectively). HLA-B*27 and DRB1*12 were significantly associated with both HPV-16 + CaCx and persistent HPV-16 infection (23.8, 0.03; 52.9, 0.01; 9.8, 0.0009; and 13.8, 0.009; respectively). HLA-B*15 showed a negative association with HPV-16-positive CaCx (0.1, 0.01), whereas DRB1*04 exhibited protection to both HPV-16-positive CaCx and persistent HPV-16 infection (0.3, 0.0001 and 0.1, 0.0002, respectively). Thus, we show HLA allelic association with HPV-16 infection in Tamil Nadu. Larger studies on high-resolution HLA typing coupled with HPV-16 genome diversity will offer further insights into host/pathogen genome coevolution.

Background: The Brokpas are an isolated tribal population of the Dah-Hanu villages of the Leh district of India. They speak Dardic, a sub-branch of the Indo-European language family, and are putatively identified as "pure Aryan," a hegemonic impression perpetuated by foreign tourism. Aim: To determine if the above is true by looking for an appreciable frequency of NRY-HG-R1a1(M17) signatures which are common to Indo-European language speakers of mainland India and elsewhere. Subjects and methods: We studied 75 random Brokpa males from the Dah-Hanu region, on the northern bank of the Indus river. Results: Interestingly, the Brokpa males possessed a high proportion of NRY-HG-L1a2(M357) (62.7%) that are found sporadically in India and her neighbourhood. A global analysis of this clade (present study, 214 of 3327 men from 63 populations; from the literature 56 of 873) suggested that they originated from southern India. Conclusion: The Y chromosomal studies suggest the Brokpa to be pre-Vedic settlers of the Himalayas, 9000 ybp, with an isolated evolution. The mtDNA profile shows a predominance of mtDNA HG A4 that must have arrived from outside the Indian subcontinent.

Background: Nipah virus (NiV) is 1 of 10 potential causes of imminent public health emergencies of international concern. We investigated the NiV outbreak that occurred in May 2018 in Kerala, India. Here we describe the longitudinal characteristics of cell-mediated and humoral immune responses to NiV infection during the acute and convalescent phases in 2 human survivors., Methods: Serial blood samples were obtained from the only 2 survivors of the NiV outbreak in Kerala. We used flow cytometry to determine the absolute T-lymphocyte and B-lymphocyte counts and the phenotypes of both T and B cells. We also detected and quantitated the humoral immune response to NiV by virus-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) enzyme-linked immunosorbent assay., Results: Absolute numbers of T lymphocytes remained within normal limits throughout the period of illness studied in both survivors. However, a marked elevation of activated CD8 T cells was observed in both cases. More than 30% of total CD8 T cells expressed Ki67, indicating active proliferation. Proliferating (Ki-67+) CD8 T cells expressed high levels of granzyme B and PD-1, consistent with the profile of acute effector cells. Total B-lymphocyte, activated B-cell, and plasmablast counts were also elevated in NiV survivors. These individuals developed detectable NiV-specific IgM and IgG antibodies within a week of disease onset. Clearance of NiV RNA from blood preceded the appearance of virus-specific IgG and coincided with the peak of activated CD8 T cells., Conclusions: We describe for the first time longitudinal kinetic data on the activation status of human B- and T-cell populations during acute NiV infection. While marked CD8 T-cell activation was observed with effector characteristics, activated CD4 T cells were less prominent., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Purpose: Hepatitis E virus (HEV) is an emerging pathogen causing acute viral hepatitis worldwide. Clinical manifestations often occur in young adults with an increased mortality rate among pregnant women. HEV genotypes 1 and 4 are mainly reported among humans and swines, respectively., Aims: The aim was to study the currently circulating genotypes of HEV in India., Materials and Methods: A retrospective cross-sectional study was carried out at Manipal Institute of Virology to know the circulating genotypes of hepatitis E, spanning over 5 years from August 2014 to September 2018. The serum samples screened serologically positive and confirmed positive for active infection by real-time reverse transcriptase-polymerase chain reaction (PCR) (Real Star ® HEV RT-PCR Kit 2.0, Altona Diagnostics, GmbH, Hamburg, Germany) were further subjected to nested conventional PCR targeting the RdRp gene of non-structural ORF1 region. The purified PCR product was sequenced in BigDye Terminator v3.1 Cycle Sequencing Kit (Life Technologies, Thermo Fisher Scientific, USA). The chromatograms obtained by sequencing were analysed using Sequencher 5.4.6, and HEV FASTA sequences were compared with reference sequences for HEV in GenBank Nucleotide Blast., Results: During the study period, there were 317 cases of laboratory-confirmed cases of acute viral hepatitis comprising 202, 70, 43 and 2 cases of hepatitis A, E, B and C, respectively. Serum samples of 70 acute hepatitis cases were positive for anti-hepatitis E IgM. According to the clinical case classification, there were 66 cases of acute viral hepatitis and four cases of fulminant hepatic liver failure. The mean age of the patients was 30.3 years (standard deviation = 12.5). The samples from various parts of India were genotyped as 1a., Conclusion: The HEV genotypes 1a was observed to be the currently circulating strain in the regions studied., Competing Interests: None

Molecular surveillance of influenza viruses is essential for early detection of novel variants. The aim of the present study was to analyze the hemagglutinin gene of influenza A(H1N1)pdm09 and A(H3N2) viruses circulating during the 2017 season. To investigate the genetic diversity of hemagglutinin gene of influenza A(H1N1)pdm09 and A(H3N2) viruses from 2017 season, ten samples from each subtype were sequenced and analyzed. The season was predominated by influenza A(H1N1)pdm09 viruses. Ten samples were sequenced from each subtype and all sequenced influenza A(H1N1)pdm09 and A(H3N2) viruses belonged to clades 6B.1 and 3C.2a, respectively. Sequence analysis of H1 gene in comparison to 2010-2016 vaccine strain showed mutations K166Q and S188T (K180Q and S202T here) that most likely resulted in antigenic drift and emergence of variant viruses. H3 gene substitutions N137K, N187K, I422V, and G500E that define clade 3C.2a1 were detected during analysis of sequences in comparison to 2017-2018 vaccine strain of northern hemisphere. These substitutions contributed to the change of WHO's recommendation of the 2018-2019 vaccine strain for northern hemisphere. The results of this study provide insights about the continuous genetic variability of the HA gene.

Background: WHO has recommended Visual Inspection with Acetic acid (VIA) or Human Papillomavirus (HPV) DNA testing if feasible, for cervical cancer screening in low income countries. However, the number of women undergoing screening is very low as a result of limited information, inadequate infrastructure and invasive nature of sampling. Methods: A cross sectional study was carried out comparing HPV DNA detection by Polymerase Chain Reaction (PCR) in paired cervical and urine samples procured from histologically confirmed cervical cancer cases. Results: Amongst the samples collected from 114 cervical cancer cases, HPV DNA was tested positive in cervical samples of 89 (78.1%) and urine samples of 55 (48.2%) patients. The agreement between the two sampling methods was 66.7% and the kappa value was 0.35 indicating a fair agreement. The sensitivity of HPV detection using urine samples was 59.6% (95% confidence interval 49.16%-69.15%) and the specificity was 92% (95% confidence interval 75.0%-97.8%). Conclusion: Even though not acceptable as an HPV DNA screening tool due to low sensitivity, the urine sampling method is inexpensive and more socially acceptable for large epidemiological surveys in developing countries to estimate the burden.

Background & Objectives: Dengue is a major public health problem in northeast India where the majority of the cases go unreported and undiagnosed. Even though all four dengue serotypes are reported, there is a dearth of information on genetic diversity. The present cross-sectional study was undertaken during 2016-17 to determine the genetic variance of dengue virus serotype 2 (DENV-2) based on the envelope (E) glycoprotein gene., Methods: The serum samples collected from the northeast parts of India, as a part of hospital-based acute febrile illness surveillance, were serotyped. Viral RNA was extracted from DENV-2 serum samples using QIAquick® RNA Extraction Kit. The E gene was amplified by conventional reverse-transcriptase polymerase chain reaction (RT-PCR) and the PCR products were sequenced., Results: The E glycoprotein gene of nine serum samples with high viral RNA concentration (Ct <25) was sequenced. The E gene sequences of eight DENV-2 strains from Assam and Meghalaya aligned with genotype IV (Cosmopolitan) and one strain from Tripura segregated with Asian-I genotype., Interpretation & Conclusion: Ongoing laboratory-based surveillance is mandatory to understand the transmission dynamics of dengue in endemic countries. This study concluded that in northeast India, presently two distinct genotypes of DENV-2, namely genotype IVb (Cosmopolitan) and Asian-I genotype are in circulation., Competing Interests: None

Background & Objectives: Influenza virological surveillance is an essential tool for the early detection of novel genetic variants of epidemiologic and clinical significance. This study was aimed to genetically characterize A(H1N1)pdm09 virus circulating in 2017 and to compare it with the global data., Methods: The regional/State Viral Research and Diagnostic Laboratories (VRDLs) provided influenza diagnosis for referred clinical samples and shared influenza A(H1N1)pdm09 positives with the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune, India, for hemagglutinin (HA) gene phylogenetic analysis. Sites at Manipal, Jaipur and Dibrugarh performed the sequencing and shared the sequence data for analysis. The antiviral susceptibility of influenza viruses was assessed for known molecular marker H275Y at the ICMR-NIV, Pune., Results: All the eight VRDLs had well-established influenza diagnostic facilities and showed increased activity of influenza A(H1N1)pdm09 during 2017. Phylogenetic analysis showed that the viruses from the different regions of the country were similar to A/Michigan/45/2015 strain which was the 2017-2018 recommended vaccine strain and were clustered with the globally circulating clade 6B.1 with signature mutations S84N, S162N and I216T. The clade 6B.1 showed further subgrouping with additional mutations S74R, S164T and I295V; however, there was no significant association between the presence of these mutations and severity of disease due to influenza. All the study viruses were sensitive to oseltamivir., Interpretation & Conclusions: During the study period, all the study sites reported globally circulating A/Michigan/45/2015 vaccine strain of influenza A(H1N1)pdm09 viruses and remained sensitive to oseltamivir. Further genetic and antigenic characterization of influenza viruses is recommended to address public health concerns., Competing Interests: None

Influenza viruses are major respiratory pathogens that cause seasonal epidemics and occasional pandemics. Immune response to influenza viruses is majorly targeted against the hemagglutinin antigen. A laboratory-based retrospective cross-sectional study was conducted on 50 acute and 50 follow-up samples to assess the immune response to influenza A(H1N1)pdm09 virus after natural infection and detect the presence of pre-existing antibodies against influenza A(H3N2) and influenza B viruses. Two-fourfold rise in hemagglutination-inhibition (HAI) titer was observed in 100% of the follow-up samples for influenza A(H1N1)pdm09 virus. No change in HAI titers for influenza A(H3N2) and influenza B viruses was observed.

Background: Nipah Virus (NiV) is a highly fatal emerging zoonotic virus and a potential threat to global health security. Here we describe the characteristics of the NiV outbreak that occurred in Kerala, India, during May-June 2018., Methods: We used real-time reverse transcription polymerase chain reaction analysis of throat swab, blood, urine, and cerebrospinal fluid specimens to detect NiV. Further, the viral genome was sequenced and subjected to phylogenetic analysis. We conducted an epidemiologic investigation to describe the outbreak and elucidate the dynamics of NiV transmission., Results: During 2-29 May 2018, 23 cases were identified, including the index case; 18 were laboratory confirmed. The lineage of the NiV responsible for this outbreak was closer to the Bangladesh lineage. The median age of cases was 45 years; the sex of 15 (65%) was male. The median incubation period was 9.5 days (range, 6-14 days). Of the 23 cases, 20 (87%) had respiratory symptoms. The case-fatality rate was 91%; 2 cases survived. Risk factors for infection included close proximity (ie, touching, feeding, or nursing a NiV-infected person), enabling exposure to droplet infection. The public health response included isolation of cases, contact tracing, and enforcement of hospital infection control practices., Conclusion: This is the first recorded NiV outbreak in South India. Early laboratory confirmation and an immediate public health response contained the outbreak., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background & Objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India., Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases., Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups., Interpretation & Conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme., Competing Interests: None

Purpose: The major cause of chronic hepatitis is infections with hepatitis B virus and hepatitis C virus (HCV) globally. However, there exists sparse epidemiological data regarding the prevalence of HCV infection from India., Methodology: We carried out a cross-sectional study to estimate the prevalence of anti-HCV antibody among acute febrile illness cases aged between 1 and 65 years in Idar Taluk, Sabarkantha district, Gujarat state located in West India. A total of 702 serum samples collected from the study area during the year 2017, were screened for anti-hepatitis C IgG by enzyme-linked immunosorbent assay. The serum samples screened positive were then subjected to molecular testing for confirmation., Results: Among the 702 study participants screened, 16 cases were reported to be anti-HCV IgG positive with an estimated seroprevalence rate of 2.3% (95% confidence interval: 1.4%-3.7%). Out of the 16 cases, two samples were confirmed positive by molecular testing indicating active infection. When analysed phylogenetically, one strain was genotyped as HCV1b genotype, and the other one was clustered along with HCV3a genotype. Both the patients with hepatitis C infection were observed to be having a probable 1-year survival rate of 100% and a 2-year survival rate of 85% when the Child-Turcotte-Pugh classification was applied., Conclusion: The estimated seroprevalence of hepatitis C in Idar Taluk, Sabarkantha district, west India was 2.3%. HCV genotypes 1b and 3a were observed to be circulating in the study area., Competing Interests: None

Kyasanur Forest Disease (KFD) is a viral haemorrhagic fever, transmitted to humans and other hosts by a tick vector of genus Haemaphysalis. It affects 400-500 people annually in the Western Ghats region of India through spring to summer season. To understand the species composition, distribution, and abundance of Haemaphysalis ticks in endemic taluks (sub-districts) of India, a surveillance for ticks was conducted between October 2017 and January 2018. In total 105 sites were selected based on grid sampling from five taluks representing five KFD endemic states in south India. A sum of 8373 ticks were collected by using standard flagging method. The study showed a wide distribution of host seeking tick species among the selected taluks, wherein Haemaphysalis spinigera was predominant in 3/5 taluks, Haemaphysalis bispinosa in 1/5 taluks, and both the species in 1/5 taluks. Further, the H. spinigera abundance was categorised and compared with the incidence of human cases during the same season. The grids with very high and high H. spinigera abundance had 70% of the 205 human cases reported. This method of tick surveillance could be efficiently used as a standard model for KFD transmission risk assessment and prediction of impending outbreaks.

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

Background: The WHO dengue classification 1997 was revised in 2009 and the revised classification system has now been in use for the past decade. This study was carried out to compare the 1997 and revised classifications in assessing the severity of dengue infection among all age groups during a dengue outbreak in southwest India., Methodology: This retrospective cross-sectional study was carried out including serologically confirmed dengue cases. A total of 1033 dengue cases were classified on the basis of the 1997 WHO classification and 2009 revised classification. The statistical analysis was carried out using SPSS 15.0 for Windows (SPSSTM Inc, Chicago, IL, USA)., Results: Both the 1997 and revised WHO classifications were applied to 1033 confirmed dengue cases, including 692 males (67%) and 341 females (33%). The median age of the study participants was 23 years (IQR 10-33), including 112 (10.8%) children at and below the age of 5 years. The level of agreement between the two systems of classification was poor (kappa=0.143, 0.055-0.198, p-value <0.001)., Conclusion: A greater sensitivity and specificity of the revised classification was observed in comparison with the 1997 WHO classification. In the context of changing dengue epidemiology and geographical expansion, the revised classification is helpful in the identification of severe cases, facilitating timely management.

Sexually transmitted infections (STI) have a major impact on the reproductive health of women. Among the different etiological agents of STIs, Chlamydia trachomatis and Neisseria gonorrhoeae are the main bacterial pathogens that cause sexually transmitted infections in women. The aim of the study was to estimate the prevalence of genital chlamydial and gonococcal infection among women in the age group of 18-65 years from a community-based setting. A community-based cross-sectional study was performed using the archived urine samples (n=811) of women in the age group of 18-65 years for C. trachomatis and N. gonorrhoeae using a multiplex conventional Polymerase Chain Reaction (PCR). Out of 811 samples tested in the present study, 2 (0.24%) were tested positive for C. trachomatis and none were positive for N. gonorrhoeae. The study demonstrates the very low prevalence of C. trachomatis and N. gonorrhoeae infection in a rural community. For large population-based screening, urine samples were observed to be more socially acceptable and cost-effective., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Deep vein thrombosis (DVT) is a life-threatening disease. Warfarin and acenocoumarol are anticoagulants used to treat DVT and vary among individuals in terms of treatment response/toxicity. Single nucleotide polymorphisms (SNPs) in CYP2C9 and VKORC1 play a role in the pharmacokinetics and dynamics of warfarin and acenocoumarol and they determine the efficacy of treatment by controlling drug clearance in treated individuals. The aim of the current study was to genotype the critical SNPs of CYP2C9 and VKORC1 genes in a south Indian population in order to understand the metabolizer phenotype of patients with DVT. CYP2C9 (rs1799853, rs1057910, rs1057909, rs28371686) and VKORC1 (rs9923231) SNPs were genotyped in 124 cases of DVT. Genomic regions of these SNPs from genomic DNA were amplified with PCR and directly sequenced using Sanger sequencing except for the SNP rs1799853, which was detected using Sau96I restriction endonuclease-based digestion of variant alleles. Among south Indian patients with DVT, 6.5% (8/124) had the rs1799853 SNP of CYP2C9 and 11% (14/124) had the rs1057910 SNP while 16% (20/124) had the rs9923231 SNP of VKORC1 which were associated with the response to warfarin treatment. None of the patients tested positive for poor drug metabolizing genotypes of the CYP2C9 gene and only 1.6% of the south Indian population was sensitive to warfarin treatment. Genotyping results suggest that a relatively greater amount of the therapeutic drug is required to achieve/maintain the international normalized ratio (INR) in south Indian patients with DVT.

Squamous cell carcinoma (SCC) of the uterine cervix and oral cavity are most common cancers in India. Telomerase reverse transcriptase (TERT) overexpression is one of the hallmarks for cancer, and activation through promoter mutation C228T and C250T has been reported in variety of tumors and often shown to be associated with aggressive tumors. In the present study, we analyzed these two hot spot mutations in 181 primary tumors of the uterine cervix and oral cavity by direct DNA sequencing and correlated with patient's clinicopathological characteristics. We found relatively high frequency of TERT hot spot mutations in both cervical [21.4 % (30/140)] and oral [31.7 % (13/41)] squamous cell carcinomas. In cervical cancer, TERT promoter mutations were more prevalent (25 %) in human papilloma virus (HPV)-negative cases compared to HPV-positive cases (20.6 %), and both TERT promoter mutation and HPV infection were more commonly observed in advanced stage tumors (77 %). Similarly, the poor and moderately differentiated tumors of the uterine cervix had both the TERT hot spot mutations and HPV (16 and 18) at higher frequency (95.7 %). Interestingly, we observed eight homozygous mutations (six 228TT and two 250TT) only in cervical tumors, and all of them were found to be positive for high-risk HPV. To the best of our knowledge, this is the first study from India reporting high prevalence of TERT promoter mutations in primary tumors of the uterine cervix and oral cavity. Our results suggest that TERT reactivation through promoter mutation either alone or in association with the HPV oncogenes (E6 and E7) could play an important role in the carcinogenesis of cervical and oral cancers.

Acute viral respiratory infections (AVRI) are a leading cause of morbidity and mortality among all age groups globally. Except for Influenza virus and Respiratory Syncytial virus, mostly viral aetiology of AVRI remains undiagnosed. Lately, human coronaviruses (HCoVs) have emerged as an important aetiology of AVRI. A laboratory based retrospective cross sectional study was conducted in which respiratory samples (throat swabs) of patients (n = 864), with Influenza negative SARI, of all age groups between Jan 2011-Dec 2012 were tested for HCoVs including MERS-CoV using Conventional and real time PCR assays. The prevalence of HCoV among SARI cases was 1.04% (9/864) [95% CI: 0.36-1.72]. Of these four (44.44%) were identified as HCoV OC43, three (33.33%) as HCoV NL63 and two (22.22%) as HCoV 229E. No HCoV HKU1 was detected. The samples were also negative for SARS-CoV and MERS-CoV. The results of this study documents low prevalence of human coronaviruses in SARI cases in south western India and the absence of highly pathogenic human coronaviruses. As the study included only SARI cases the prevalence reported could be an under estimate when it is extrapolated to community., (© 2015 Wiley Periodicals, Inc.)

Multiple questions relating to contributions of cultural and demographical factors in the process of human geographical dispersal remain largely unanswered. India, a land of early human settlement and the resulting diversity is a good place to look for some of the answers. In this study, we explored the genetic structure of India using a diverse panel of 78 males genotyped using the GenoChip. Their genome-wide single-nucleotide polymorphism (SNP) diversity was examined in the context of various covariates that influence Indian gene pool. Admixture analysis of genome-wide SNP data showed high proportion of the Southwest Asian component in all of the Indian samples. Hierarchical clustering based on admixture proportions revealed seven distinct clusters correlating to geographical and linguistic affiliations. Convex hull overlay of Y-chromosomal haplogroups on the genome-wide SNP principal component analysis brought out distinct non-overlapping polygons of F*-M89, H*-M69, L1-M27, O2a-M95 and O3a3c1-M117, suggesting a male-mediated migration and expansion of the Indian gene pool. Lack of similar correlation with mitochondrial DNA clades indicated a shared genetic ancestry of females. We suggest that ancient male-mediated migratory events and settlement in various regional niches led to the present day scenario and peopling of India.

Background: Cervical cancer is one of the commonest cancers among women all over the world. The association of cervical cancer with human papilloma virus (HPV) is well established. Knowledge about the causal relationship between HPV and cervical cancer is important to make appropriate, evidence-based health care choices. In this context we conducted a community based study among women about the knowledge, attitude and practice about HPV infections and their health effects., Materials and Methods: A cross sectional interview based house to house survey was conducted with a validated data collection tool covering sociodemographic factors, knowledge, attitude and practice about HPV and its health effects, among 1020 women from a rural village, Perdoor, in Udupi district, Karnataka, India in 2013-14., Results: The mean age of participants was 38.9 years (SD=12.6). Study participants showed a high literacy rate (85.7%). Only 2.4% of sexually exposed women had undergone Pap smear testing. Partners of 4.4%women had undergone circumcision and they belonged to the Muslim community. Male condom usage was reported by 26 women (2.6%). However, none of the participants had heard of HPV and its health effects., Conclusions: This community based study found complete ignorance about HPV among rural South Indian women in spite of a high literacy level.

Background: The UAB-ITREOH program has initiated a skill-based MPH program at Manipal University (MU), India, in 2009, to address the critical need for trained public health professionals and build institutional public health training capacity in the country., Methods: Funds from Fogarty have supported the curriculum development and specialized training of MU faculty to teach in the MPH program., Results: The program has been successfully launched and is gaining momentum. The lessons learned from our experiences as well as several challenges faced from the initialization to execution of the program are described in the article., Conclusions: Government support is crucial for raising the profile of this program by accreditation, creating job opportunities and by recognizing these professionals as leaders in the public health sector., (Copyright © 2012 Wiley Periodicals, Inc.)

Previous studies that pooled Indian populations from a wide variety of geographical locations, have obtained contradictory conclusions about the processes of the establishment of the Varna caste system and its genetic impact on the origins and demographic histories of Indian populations. To further investigate these questions we took advantage that both Y chromosome and caste designation are paternally inherited, and genotyped 1,680 Y chromosomes representing 12 tribal and 19 non-tribal (caste) endogamous populations from the predominantly Dravidian-speaking Tamil Nadu state in the southernmost part of India. Tribes and castes were both characterized by an overwhelming proportion of putatively Indian autochthonous Y-chromosomal haplogroups (H-M69, F-M89, R1a1-M17, L1-M27, R2-M124, and C5-M356; 81% combined) with a shared genetic heritage dating back to the late Pleistocene (10-30 Kya), suggesting that more recent Holocene migrations from western Eurasia contributed <20% of the male lineages. We found strong evidence for genetic structure, associated primarily with the current mode of subsistence. Coalescence analysis suggested that the social stratification was established 4-6 Kya and there was little admixture during the last 3 Kya, implying a minimal genetic impact of the Varna (caste) system from the historically-documented Brahmin migrations into the area. In contrast, the overall Y-chromosomal patterns, the time depth of population diversifications and the period of differentiation were best explained by the emergence of agricultural technology in South Asia. These results highlight the utility of detailed local genetic studies within India, without prior assumptions about the importance of Varna rank status for population grouping, to obtain new insights into the relative influences of past demographic events for the population structure of the whole of modern India.