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While vaccines have markedly reduced the incidence of pertussis, a resurgence has occurred in many countries. Until recently, pertussis has not been recognized as an important public health challenge in India due to its successful infant immunization program. However, India still accounts for a large proportion of the world's cases, and increasing reports of pertussis in other countries and in neonates have regenerated interest in pertussis among Indian authorities. The Global Pertussis Initiative (GPI) Annual Meeting was held virtually in October 2020, in part, to gain a better understanding of the epidemiology and disease burden of pertussis and to explore opportunities to improve its prevention in India. There was a consensus that pertussis cases are being underestimated in India due to multiple factors, such as a reliance on passive surveillance and diagnostic challenges. India offers both whole-cell pertussis and acellular pertussis vaccines, but vaccine coverage is inconsistent across regions due to differences in vaccine availability, access to health care, and regional administrative challenges. This report summarizes the outcomes and considers the key clinical implications of this meeting. The GPI agreed that active surveillance of pertussis in India would be optimal and recommended several studies, including serosurveillance among women of reproductive age to assess the prevalence of recent pertussis infection and to enable policy changes that will enhance the rational use of acellular and whole-cell vaccines. It also recommended engagement with nongovernmental organizations in order to encourage pregnancy immunization in the public sector. To achieve effective control of pertussis in the future, the GPI recognizes there are opportunities to characterize the burden of pertussis in India appropriately and increase vaccination coverage in multiple age groups.

Introduction: Varicella is a highly contagious infection that can lead to serious complications, particularly in high-risk groups; however, it is vaccine preventable. Disease awareness and understanding of the disease burden can strongly influence vaccine coverage. This review provides insight into the current epidemiology and the importance of varicella from both public health and economic perspectives across the Asia-Pacific (APAC) region. Areas covered: A systematic literature review was conducted to identify studies on the incidence, seroprevalence, fatality rate and complication rate of varicella. Economic burden studies were also captured. Altogether, 125 studies were identified across the region; these were supplemented by government reports (gray data). Reported vaccine coverage varied from 2.8% to 97%; a key influencing factor was inclusion of the varicella vaccine in national immunization programs. In general, varicella incidence in the unvaccinated population was highest in children ≤5 years old and seroprevalence increased with age. Economic analyses highlighted the cost-saving potential of vaccination programs, especially from a societal perspective. Expert opinion: Varicella-related data varied greatly across the APAC region, highlighting the need to better understand the burden of varicella in this area, and particularly identified the need for better surveillance and reporting.

Introduction: Antibiotic resistance is an increasing global problem which hampers appropriate treatment of Urinary Tract Infection (UTI) in paediatric population, rendering the developing kidneys vulnerable for scarring and long-term complications. The present study stressed upon the most severely affected patients who required hospitalisation for treatment of UTI. Authors conducted this study observing the higher degree of drug resistance in patients admitted to general paediatric ward lately, suffering from UTI. Aim: To observe different clinical presentations of paediatric patients hospitalised with UTI. Authors also intended to identify locally prevalent community acquired bacterial uropathogens of clinical importance and note the sensitivity and resistance patterns of the isolated organisms against different antibiotics. Materials and Methods: This prospective observational pilot study was conducted at the Institute of Child Health, Kolkata, a tertiary care paediatric referral hospital. A total of 950 urine samples (single sample per patient) were collected from hospitalised children (from neonatal age group, upto 12 years) with suspected UTI/sepsis, between October 2014 to April 2016. Of 132 culture positive samples, 35 were excluded as per exclusion criteria, and 97 isolates had antimicrobial sensitivity performed on them. Clinical presentation was documented. Statistical analysis was done using the Chi-Square test. Results: The most common clinical presentations were fever, pain abdomen and anorexia. The most common isolates were Escherichia coli 59/97 (60.82%), followed by Enterococcus spp. 19/97 (19.59%) and Klebsiella pneumoniae 9/97 (9.28%). The majority of E. coli (n=59) isolates showed resistance against all Cephalosporins: 49-52 (83.1-88.1%), meropenem: 39 (66.1%), cotrimoxazole: 42 (71.1%), amoxycillin-clavulanic acid: 55 (93.2%) and quinolones: 50-51 (84.8-86.4%). Most Enterococcus spp. (n=19) isolates were resistant to amikacin: 17 (89.5%). Overall, a large proportion, 79/97 (81.4%) of uropathogens isolated showed Multidrug-Resistance (MDR). Conclusion: The alarming rates of resistance of uropathogens to commonly used antibiotics calls for review of empiric treatment guidelines and emphasises the need for preventing antibiotic misuse in day-to-day practice.

Regulatory bodies in The Philippines, Sri Lanka, and India require post-marketing surveillance to provide additional safety data on Rotarix™ in real-life settings. In such studies conducted in The Philippines (November 2006 to July 2012; NCT00353366), Sri Lanka (November 2008 to August 2009; NCT00779779), and India (August 2009 to April 2010; NCT00938327), 2 doses of Rotarix™ were administered according to the local prescribing information (PI). The occurrence of at least Grade "2"/"3" solicited adverse event (AE) (fever, vomiting, or diarrhea), within 15 days in The Philippines or 8 days in Sri Lanka and India; unsolicited AEs within 31 days and serious adverse events (SAEs) throughout the study were recorded. Of the 1494, 522, and 332 infants enrolled in The Philippines, Sri Lanka, and India, 14.7% 14.9% and 12.7% infants, respectively recorded at least Grade "2"/"3" solicited AEs. The most commonly reported solicited AEs were irritability in The Philippines (32.2% post-Dose-1; 23.5% post-Dose-2) and India (23.0% post-Dose-1; 13.2% post-Dose-2), and fever (18.0% post-Dose-1; 20.2% post-Dose-2) in Sri Lanka. Unsolicited AEs were recorded in 24.5% (The Philippines), 4.8% (Sri Lanka), and 6.9% (India) of infants. Forty-one SAEs were recorded in the Philippines of which 6 (decreased oral intake with increased sleeping time and constipation; pneumonia, urinary tract infection, and intussusception) were considered by the investigators as causally related to vaccination. One vaccine-unrelated SAE occurred in a Sri Lankan infant. All SAEs resolved and the infants recovered. Two doses of Rotarix™, administered to healthy infants according to local PI, were well tolerated in The Philippines, Sri Lanka, and India.

The epidemiology of dengue fever in the Indian subcontinent has been very complex. It is no longer restricted to urban centres, with outbreaks now occurring in rural India also. The mosquito vectors, Aedes aegypti and Aedes albopictus prefers to breed in artificial water. They are day biters and are most active just after sunrise and just before sunset. As per the new guidelines dengue is now classified into three categories, dengue, dengue with warning signs and severe dengue whereas the clinical course of the disease is divided in three phases – febrile, critical, and recovery. The diagnostic tests are NS1 antigen, which can be done by ELISA or rapid test, and serological tests by detection of viral antibodies IgG and IgM. Depending on the severity, treatment may be as outpatient, inpatient or emergency treatment. Shock and hemorrhage are the two most dreaded complications which require monitoring and intensive care management.

Sodium valproate is an effective antiepileptic drug used as monotherapy or adjuvant/alternative with other antiepileptic drugs. Haematological toxicity of this drug, though rare, is now an established fact and comprises mainly of neutropenia, thrombocytopenia and aplastic anemia. Very few cases of Pure Red Cell Aplasia (PRCA) following valproate therapy were reported in last 35 years but none presented as acute emergency. We report a case of a 7-year-old child suffering from absence seizure who developed features of acute heart failure due to anemia after 2 months of sodium valproate monotherapy. No underlying haematological or cardiological cause was found. Bone marrow study showed evidence of PRCA. After discontinuation of the drug patient improved gradually and never relapsed again. This case highlights the importance of haematological evaluation both clinically and by laboratory investigation during follow up visits after starting sodium valproate therapy