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Background: There are between 1 and 2 million annual deaths in children due to severe acute malnutrition. It's one of the leading preventable causes of death among kids every year. Severe acute malnutrition is a global problem that has been overlooked by child survival programs despite its criticality. Methods: The research was a descriptive study conducted in a hospital setting. During Department of Paediatric, Dhanalakshmi Srinivasan Medical College, Siruvachur, Perambalur, Tamil Nadu, India, research was carried out at the December 2021 to November, 2022. All hospitalized kids diagnosed with SAM per WHO criteria. Results: 100 children with Severe Acute Malnutrition were hospitalized. Age at onset was, on average, 17.75 months in most cases, infants were seen at 15 months of age. Sixty of the youngsters were younger than two years old. Seven girls and 93 boys made up the total of 100 SAM youngsters hospitalized. Conclusion: Children with SAM who are hospitalized often suffer from multiple co-occurring diseases, the most common of which are acute gastroenteritis and acute respiratory infections. Significant risk factors for mortality were the presence of underlying organic illness, as well as sepsis and retroviral infections. [ABSTRACT FROM AUTHOR]

Background: Rotavirus is the leading cause of severe dehydrating gastroenteritis among children younger than 5 years in low-income and middle-income countries. Two vaccines-Rotavac and Rotasiil-are used in routine immunisation in India. The safety and immunogenicity of these vaccines administered in a mixed regimen is not documented. We therefore aimed to compare the safety and seroresponse of recipients of a mixed regimen versus a single regimen.Methods: We did a multicentre, open-label, randomised, controlled, phase 4, non-inferiority trial at two sites in India. We recruited healthy infants aged 6-8 weeks. Infants with systemic disorders, weight-for-height Z scores of less than minus three SDs, or a history of persistent diarrhoea were excluded. Eligible infants were randomly allocated to six groups in equal numbers to receive either the single vaccine regimen (ie, Rotavac-Rotavac-Rotavac [group 1] or Rotasiil-Rotasiil-Rotasiil [group 2]) or the mixed vaccine regimen (ie, Rotavac-Rotasiil-Rotavac [group 3], Rotasiil-Rotavac-Rotasiil [group 4], Rotavac-Rotasiil-Rotasiil [group 5], or Rotasiil-Rotavac-Rotavac [group 6]). Randomisation was done using an online software by site in blocks of at least 12. The primary outcome was seroresponse to rotavirus vaccine, measured using rotavirus-specific serum IgA antibodies 4 weeks after the third dose. The seroresponse rates were compared between recipients of the four mixed vaccine regimens (consisting of various combinations of Rotavac and Rotasiil) with recipients of the single vaccine regimens (consisting of Rotavac or Rotasiil only for all three doses). The non-inferiority margin was set at 10%. Safety follow-ups were done for the duration of study participation. This trial was registered with the Clinical Trials Registry India, number CTRI/2018/08/015317.Findings: Between March 25, 2019, and Jan 15, 2020, a total of 1979 eligible infants were randomly assigned to receive a single vaccine regimen (n=659; 329 in group 1 and 330 in group 2) or a mixed vaccine regimen (n=1320; 329 each in groups 3 and 4, and 331 each in groups 5 and 6). All eligible participants received the first dose, 1925 (97·3%) of 1979 received the second dose, and 1894 (95·7%) received all three doses of vaccine. 1852 (93·6%) of 1979 participants completed the follow-up. The immunogenicity analysis consisted of 1839 infants (1238 [67·3%] in the mixed vaccine regimen and 601 [32·7%] in the single vaccine regimen; 13 samples were insufficient in quantity) who completed vaccination and provided post-vaccination sera. The seroresponse rate in the mixed vaccine regimen group (33·5% [95% CI 30·9-36·2]) was non-inferior compared with the single vaccine regimen group (29·6% [26·1-33·4]); the seroresponse rate difference was 3·9% (95% CI -0·7 to 8·3). The proportion of participants with any type of solicited adverse events was 90·9% (95% CI 88·4-93·0) in the single vaccine regimen group and 91·1% (89·5-92·6) in the mixed vaccine regimen group. No vaccine-related serious adverse events or intussusception were reported during the study.Interpretation: Rotavac and Rotasiil can be safely used in an interchangeable manner for routine immunisation since the seroresponse was non-inferior in the mixed vaccine regimen compared with the single vaccine regimen. These results allow for flexibility in administering the vaccines, helping to overcome vaccine shortages and supply chain issues, and targeting migrant populations easily.Funding: Ministry of Health and Family Welfare, Government of India.Translation: For the Hindi translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

An epidemiological study was conducted along with pathological, immunohistochemistry (IHC) of capsid antigen and molecular detection of jaagsiekte sheep retrovirus (JSRV) causing ovine pulmonary adenocarcinoma (OPA) in sheep and goats population from three states of India viz. Delhi, Gannavaram (Andhra Pradesh), and Bareilly (Uttar Pradesh). A total of 1350 lungs samples were screened and out of which 31 (2.29%) animals were found to be positive [sheep (3.49%) and goats (0.00%)] for JSRV. The prevalence of infection was recorded Gannavarum (20.00%) followed by Delhi (2.10%) and no any positive cases found in Bareilly area. Age wise higher prevalence was recorded >3 year age groups followed by 1–3 years and 1 < year, respectively. Significantly, higher infection was observed in female sheep compared to male sex of sheep. Seasonally, the prevalence of JSRV infection was higher in monsoon (6.00%) followed winter season (3.34%) and summer season. The observations of the present study would provide basis for further an effective explorative surveillance and epidemiological studies to know real impact of JSRV infection circulating in sheep and goats population of India. [ABSTRACT FROM AUTHOR]

Background. Thyroid dysfunction in patients with human retroviral infection has been reported but the prevalence of thyroid function abnormalities in patients on highly active antiretroviral therapy (HAART) has not been studied. We aimed to assess the prevalence of thyroid dysfunction and autoimmunity (antithyroid peroxidase auto-antibodies [TPO-Ab]) in patients on first-line HAART, identify risk factors for thyroid dysfunction and determine any association of thyroid dysfunction with HAART. Methods. We screened and enrolled consecutive patients from the outpatient department if they were (i) diagnosed with HIV infection (enzyme-linked immunosorbent assay); (ii) aged more than 18 years; (iii) on HAART for 1 year or more; and (iv) clinically stable with no evidence of any acute illness in the past 2 months. We excluded patients who were on drugs that affect thyroid function. Thyroid function tests and CD4 counts were done. Results. A total of 159 patients on firstline HAART were included in the study. Their mean (SD) age was 43.3 (10) years and duration of HAART was 44.4 (33.54) months. The mean CD4 count was 502.8 (274.45). Forty-seven patients (29.6%) had thyroid dysfunction. TPO-Ab positivity was noted in 6 patients. No association was seen between thyroid dysfunction and any type of regimen or drug. There was a significant negative correlation between CD4 counts and thyroid-stimulating harmone (TSH) suggesting that thyroid dysfunction may be more prevalent when immunity is low. Conclusions. There is a high prevalence of thyroid dysfunction, predominantly subclinical hypothyroidism, in patients on HAART. Thyroid autoimmunity is low in this subset of patients. Lower immunity is associated with higher TSH levels. Larger longitudinal studies are required to determine the course of hypothyroidism in patients on HAART. [ABSTRACT FROM AUTHOR]

Background: Observational studies in socioeconomically distinct populations have yielded conflicting conclusions about the strength of naturally acquired immunity against rotavirus gastroenteritis (RVGE), mirroring vaccine underperformance in low-income countries. We revisited birth cohort studies to understand naturally acquired protection against rotavirus infection and RVGE.Methods: We reanalyzed data from 200 Mexican and 373 Indian children followed from birth to 2 and 3 years of age, respectively. We reassessed protection against RVGE, decomposing the incidence rate into the rate of rotavirus infection and the risk of RVGE given infection, and tested for serum antibody correlates of protection using regression models.Results: Risk for primary, secondary, and subsequent infections to cause RVGE decreased per log-month of age by 28% (95% confidence interval [CI], 12%-41%), 69% (95% CI, 30%-86%), and 64% (95% CI, -186% to 95%), respectively, in Mexico City, and by 10% (95% CI, -1% to 19%), 51% (95% CI, 41%-59%) and 67% (95% CI, 57%-75%), respectively, in Vellore. Elevated serum immunoglobulin A and immunoglobulin G titers were associated with partial protection against rotavirus infection. Associations between older age and reduced risk for RVGE or moderate-to-severe RVGE given infection persisted after controlling for antibody levels.Conclusions: Dissimilar estimates of protection against RVGE may be due in part to age-related, antibody-independent risk for rotavirus infections to cause RVGE. [ABSTRACT FROM AUTHOR]

Objective: To study the case series for intussusception associated with the vaccination of rotavirus vaccine in children.Methods: The study of spontaneous adverse event monitoring such as intussusception due to rotavirus vaccine was carried out from the year 2011 through 2015. The individual case safety reports (ICSRs) of this event were collated, assessed and recorded as per the requirement of Suspected Adverse Drug Reactions Reporting form of Pharmacovigilance Programme of India (PvPI).Results: In the present study, 10 ICSRs of intussussception due to rotavirus vaccine were reported to PvPI. Of which 3 ICSRs were found to be causal relationship with rotavirus vaccine, as evidenced by the adequate information provided in ICSRs.Conclusions: Since intussusception, the emerging safety as one of the important safety concern, healthcare professionals are advised to monitor and report to the concerned authority for appropriate action. [ABSTRACT FROM AUTHOR]

Objective: To enumerate the cases of intussusception in Chennai during 2012-2013, describe the clinical profile, outcomes of case management and highlight the importance of systematically collecting this data in lieu of rotavirus vaccine introduction in India.Methods: Medical records of pediatric intussusception cases admitted in eight large hospitals in Chennai from July 2012 through June 2013 were retrospectively reviewed. Demographic and clinical data including diagnostic and treatment practices were obtained. Cases were categorized based on the diagnostic certainty criteria stipulated by the Brighton collaboration on intussusception.Results: During the one year of study period, 205 cases of intussusception were diagnosed in 8 hospitals in Chennai city of India. The median age at presentation was 9 mo (Inter Quartile Range, IQR 6-14) with a male to female ratio of 1.8:1. The commonest site of intussusception was ileocolic (80.4 %). Most of the cases (59.8 %) were managed non-surgically. Direct surgical intervention was carried out in 26.5 % cases whereas in 11.8% of cases, surgery was required after failure of non-surgical measures. Median duration of hospital stay was 3 d (IQR 1-5).Conclusions: This study documents the case burden of intussusception among children in Chennai in a calendar year. Data on receipt of rotavirus vaccine was not available. The authors recommend collection of rotavirus vaccine data among all cases of intussusception in the country, and do retrospective analysis in other parts of the country and prospective surveillance in pediatric / immunization clinics to assess impact of rotavirus vaccine on intussusception rates in the post rotavirus vaccine introduction scenario. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the disparities in the effectiveness of vaccines when used in lower-income countries like Bangladesh and Nicaragua compared to developed countries like the U.S. and Finland, as well as the efforts to resolve the issue as of February 2016. Also cited are the study by pediatrician T. Jacob John on the effectiveness of the polio vaccine in India in the mid-1900s, and the efforts to boost the effectiveness of the rotavirus vaccine in Bangladesh.

Abstract: Objective: To assess early mortality and identify its predictors among the ART naive HIV–infected patients initiating anti retroviral therapy (ART) available free of cost at the ART Centres. Methods: A retrospective cohort analysis of routinely collected programme data was done for assessing mortality of all ART naive adult patients who received first-line ART at a government tertiary care hospital in eastern India during 1st March 2009 and 28th February 2010. Bivariate and multiple regression analyses of the baseline demographic, clinical and laboratory records using SPSS 15.0 were done to identify independent predictors of mortality. Results: The mortality rate at one year was estimated to be 7.66 (95%CI 5.84-9.83) deaths/100 patient-years and more than 50% of the deaths occurred during first three months of ART initiation with a median time interval of 73 days. Tuberculosis was the major cause of death. ART naive patients with baseline serum albumin <3.5 mg/dL were eight (OR 7.9; 95%CI: 3.8-16.5) at risk of death than those with higher serum albumin levels and patients with CD4 count <100 cells/μ L were two times (OR 2.2; 95%CI1.1–4.4) at risk of death compared to higher CD4 counts. Conclusions: Risk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme. [Copyright &y& Elsevier]

Rotavirus is the leading cause of childhood diarrhea worldwide, causing an estimated 600,000 deaths each year. To assess the potential benefits of a national rotavirus immunization program in India, we analyzed 40 published studies of rotavirus that were conducted between 1976 and 1997 and included a total of approximately 13,000 Indian pediatric inpatients. Pediatric studies featuring 100 or more patients and lasting at least 12 months in duration and all neonatal studies were analyzed. Rotavirus was detected in a median of 18% of pediatric patients and 28% of neonates surveyed. Fifty percent of all children hospitalized with rotavirus by age 5 were hospitalized by the age of 6 months, 75% by the age of 9 months, and almost 100% by the age of 2 years. Rotavirus was most prevalent (31%) in children between 7 and 12 months of age, followed by children between 1 and 2 years of age (20%), and children < 7 months of age (13%). VP7 genotypes G1 and G2 were most commonly isolated although significant heterogeneity of serotypes was observed. P[11], G9 strains were most frequently isolated among neonates. In 1998; approximately 98,000 childhood deaths were caused by rotavirus. These data underscore the urgent need for safe and effective interventions against rotavirus such as vaccines. The significant diversity of rotavirus strains and young age of hospitalization pose unique challenges to the formulation of a rotavirus immunization program in India, but raise the possibility of utilizing a neonatal vaccine to provide effective coverage. [ABSTRACT FROM AUTHOR]

In this article the authors discuss the economic and social benefits of childhood vaccinations in Brazil, the Russian Federation, India, China and South Africa (BRICS). They are supportive of having BRICS countries, especially China and India, introduce or scale up childhood vaccination in an effort to save lives and money.

Objective: To study the occurrence of nosocomial diarrhea in pediatric wards and the role of infections in its causation.Methods: 75 cases conforming to the CDC definition of nosocomial diarrhea were selected for the study. Stool samples were subjected to direct microscopic examination, bacteriological culture and direct antigen detection for Clostridium difficile (C. difficile) and Rota virus.Results: All the cases were sporadic in origin. Rota virus was detected in 16.67% cases and Enteropathogenic Escherichia coli (E.P.E.C.) was detected in 12% cases. Cases in which no pathogen was detected (82.7%) outnumbered those in which a pathogen was identified (17.3%).Conclusion: Rota virus and E.P.E.C were the most common etiological agents. C. difficile was detected in one case only. Most of the sporadic cases of nosocomial diarrhea in pediatric patients can be managed on fluids and electrolytes. [ABSTRACT FROM AUTHOR]