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Table of Contents
January-March 2022
Volume 66 | Issue 1
Page Nos. 1-87
Online since Tuesday, April 5, 2022
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EDITORIAL
The state of elderly in India: Life and challenges in the decade of healthy aging
p. 1
Ashish Goel, Amanjot Kaur
DOI
:10.4103/ijph.ijph_190_22
PMID
:35381705
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ORIGINAL ARTICLES
Prevalence of obesity and hypertension and its associated risk factors among chiru females of Manipur
p. 3
Hosea Thanglen, Lorho Mary Maheo
DOI
:10.4103/ijph.ijph_1481_21
PMID
:35381706
Background:
Obesity and hypertension are two well-known public health issues associated with a very high risk of cardiovascular diseases worldwide. It has become increasingly prevalent with the advancing chronological age and developing of noncommunicable diseases such as hypertension, diabetes, cancer, and respiratory diseases.
Objectives:
The paper aims to determine the prevalence of obesity and hypertension and their associated risk factors among the Chiru females of Manipur.
Methods:
A cross-sectional study was conducted among 207 Chiru females of Manipur, whose ages ranged from 20 to 79 years. Anthropometric and blood pressure were measured using standard procedures. Statistical methods such as Chi-square, Pearson correlation, and odds ratio (OR) were employed.
Results:
The nutritional status of the overweight and the obese are 33.3% and 11.6%. The overall prevalence of high blood pressure was 22.2%. This study observed a significant Pearson correlation between blood pressure and body mass index (BMI), age, physical activity, salt intake, smoking, and alcohol. The binary logistic regression, in terms of OR and coefficient of correlation, shows enough shreds of evidence that BMI and lifestyle factors are strongly associated and correlated with hypertension.
Conclusion:
The present study found a high prevalence of overweight and obesity among Chiru females, which might have contributed to the overall moderate prevalence of hypertension. Smoking, physical inactivity, and salt intake involve a significant risk of hypertension. Therefore, lifestyle has dramatically influenced the Chiru females of Manipur in terms of hypertension and obesity.
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Association of birth weight with risk factors of cardiovascular diseases: A birth cohort analysis from a rural area of Northern India
p. 9
Divya Valecha, P. V. M. Lakshmi, Naresh Sachdeva, Rajesh Kumar
DOI
:10.4103/ijph.IJPH_944_20
PMID
:35381707
Background:
Fetal origin of cardiovascular diseases (CVD) hypothesis has been explored mostly in retrospective studies.
Objectives:
A prospective study was conducted to find the association of birth weight with CVD risk factors.
Methods:
A cohort of 243 babies born in 1992–1993 in ten villages of Raipur Rani Block in India, were followed-up in 2016–2017. WHO STEPS methods were used to assess the risk factors of CVDs. A total of 213 (87.8%) participants were examined; blood samples were collected from 207. Multivariable regression analysis was done to adjust for the confounding variables.
Results:
Study participants were 22–24 year old, 27.7% were exposed to tobacco and 24.8% consumed alcohol, 3.3% were taking >5 servings of fruits and vegetables per day, 35.7% were physically inactive, 28.6% were overweight (body mass index [BMI] ≥23 kg/m
2
), 12.2% had hypertension, 16% had high cholesterol (≥200 mg/dl), 16.4% had insulin resistance (IR) (Homeostatic Model Assessment-IR >3), and 20.7% were born with low birth weight (<2.5 kg). Multivariable regression analysis revealed inverse relationship between birth weight and systolic blood pressure (regression coefficient ‒3.72 mmHg, 95% confidence interval ‒7.249; ‒0.183,
P
< 0.05).
Conclusion:
Birth weight has inverse relationship with blood pressure. Effect of birth weight on CVDs should also be studied in future follow-ups.
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A critical assessment of stillbirths at a tertiary care hospital
p. 15
Richa Aggarwal, Amita Suneja, Vandana Mohan, Kiran Guleria
DOI
:10.4103/ijph.IJPH_1364_20
PMID
:35381708
Background:
Globally in 2015, 2.6 million stillbirths occurred with estimated stillbirth rate (SBR) of 18.4/1000 births. India is the world capital of stillbirth accounting for 22.6% of world's stillbirths.
Objectives:
The objective of the study is to study the demographic profile of women experiencing stillbirth, to understand the risk factors for stillbirth in low resource settings, and to find the etiology of stillbirth so as to facilitate designing of a stillbirth prevention strategy.
Methods:
This was a cross-sectional observational study done at a tertiary care hospital of Delhi from June 2017 to December 2019. All babies delivered after 20 weeks of gestation showing no sign of life after birth were considered stillborn. Prestructured proforma was filled for each case and data were analyzed.
Results:
A total of 50,461 births took place during the study period, out of which 1824 were stillborn, making SBR of 36.15/1000 births of our institution. Most of the women belonged to age group 21–25 years and more than 50% of women were illiterate. Twenty-nine percent of women were completely unbooked, 48% were referred from other centers and 23% were registered at our hospital. Placental causes accounted for 22%, hypertension for 23%, and labor complications for 9% of cases while in 22% cases, cause could not be found.
Conclusion:
Stillbirth remains a neglected issue. A significant proportion of stillbirths are preventable by adequate antenatal care. Notification of stillbirths will give us the exact figures and realization of the seriousness of the problem which will help us work towards the solutions.
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Climate and Disease vulnerability analysis in blocks of Kalahandi District of Odisha, India
p. 20
Martand Mani Mishra, Netrananda Sahu
DOI
:10.4103/ijph.ijph_1298_21
PMID
:35381709
Background:
Diarrhea and typhoid, ancient water-borne diseases which are highly connected to rainfall are serious public health challenges in the blocks of Kalahandi district of Odisha, India.
Objectives:
Corroboration of rainfall and waterborne diseases are available in abundance; therefore, the objective of this article is to calculate the climate and disease vulnerability index (CDVI) value for each block of Kalahandi.
Methods:
We have applied the livelihood vulnerability index with some modifications and classify the three major categories, i.e., exposure, sensitivity, and adaptive capacity into six subcategories. These six subcategories are further divided into 26 vulnerability indicators based on a detailed literature review.
Results:
The result indicated that the Thuamul Rampur block, the southernmost part of the district is highly exposed to the annual and seasonal mean rainfall, and the Madanpur Rampur block lies in the northernmost part of the district is highly exposed to diarrhea and typhoid. Based on the calculation of the final CDVI value, nearly 50% of blocks of the Kalahandi district fall in the category of very high to high vulnerable zones. Furthermore, it has been observed that factors such as rainfall and disease distribution, vulnerable population and infrastructure, and education and health-care capacities had a notable influence on vulnerability.
Conclusion:
It is rare to find a health vulnerability-related study in India at this microlevel based on the suitable indicators selected for a tribal and backward region.
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A real-time investigation on public health consequences of chromium laden effluent from the leather industries
p. 27
Rinaldo John, Anand Prem Rajan
DOI
:10.4103/ijph.ijph_1511_21
PMID
:35381710
Background:
Extensive evidence of elevated chromium (Cr) in the surface and groundwater exists. However, the importance of exposure toward Cr-associated health risks in areas with tanneries is still often neglected. These situations prompted an independent research study to investigate the views of those close-knit communities who are being directly affected by this tannery village.
Objectives:
To establish an understanding of the local demographics and; exploratory data analysis (EDA) to discover patterns in the occurrence of diseases; measure the awareness of residents of the presence of Cr and its harmful health effects.
Methods:
The EDA technique was used to conduct survey studies on data to uncover patterns, identify anomalies, test hypotheses, and validate assumptions using summary statistics and graphical representations.
Results:
Out of 14 diseases directly linked to high Cr toxicity, the study reported high levels of diarrhea, epigastric pain, and moderate-to-severe cases of vertigo among those aged more than 22 years. With over 90 active tanneries and toxic Cr released to the environment in a town of <78 km
2
area (1.2 tannery/km), there are only 15 hospitals (0.2 hospitals/km) for the population currently accommodating more than a quarter-million people daily (3205 people/km).
Conclusion:
New mitigation strategies must be put forth to alleviate the negative impacts of the tanneries on the residents and nature most affected as well as the population as a whole.
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Spatiotemporal epidemiology of Japanese encephalitis cases of Dibrugarh district from 2014 to 2018: A hospital record-based descriptive study
p. 33
Monuj Kurmi, Jenita Baruah
DOI
:10.4103/ijph.ijph_1296_21
PMID
:35381711
Background:
Since 1976, several JE outbreaks have been reported from most of the districts of Assam.
Objectives:
The present study aims to conduct a descriptive and spatial analysis to understand the spatiotemporal distribution of JE cases of Dibrugarh district.
Methods:
Spatiotemporal distribution of JE cases from 2014 to 2018 at village level was described in maps using Geographical Information System. Spatial association between JE reporting places in the study area has been analyzed using spatial statistics analytical techniques. Temporal distribution of JE cases from 2014 to 2018 for different variable were described in tables.
Results:
During the period 2014–2018, incidence rate of JE cases ranged between 2.7/100,000 and 5.9/100,000 population and highest case fatality rate was 18.3% in 2014. Highest numbers of JE cases were reported in the age group 0–10 years. Most of the JE cases were from rural areas (84.2%). There was a seasonal pattern of JE which peaked in July. There were hotspots around Dibrugarh Municipality area, Duliajan oil town, Hatiali gaon, Naharkatiya chah bagicha, Nagaon Dhadumia gaon, and Nahortoli Tea Estate.
Conclusion:
On the basis of the study, JE hotspots can be identified that would help health authorities to further investigate and identify the factors responsible for its occurrence.
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Barriers to treatment adherence for female Tuberculosis (TB) patients during the COVID-19 pandemic: Qualitative evidence from front-line TB interventions in Bengaluru City, India
p. 38
Sobin George, Aditi Paranjpe, Prajwal Nagesh, Mohamed Saalim
DOI
:10.4103/ijph.ijph_1146_21
PMID
:35381712
Background:
Available evidence shows that India's ongoing COVID-19 pandemic response has adversely affected the national tuberculosis elimination program.
Objectives:
The study attempted to understand the barriers to successful treatment adherence for female tuberculosis (TB) patients due to disruptions caused by the pandemic.
Methods:
The study draws on qualitative in-depth interviews conducted with patients and TB health visitors from Bengaluru city before and during the pandemic period using a grounded theory approach.
Results:
While TB has the potential to push female patients who worked in informal arrangements to joblessness and poverty, the pandemic situation has exacerbated these vulnerabilities. The pandemic situation slowed down or suspended vital frontline interventions such as active case finding, distribution of medicine, follow-up of sputum examination, monitoring of medicine intake, and patient support measures.
Conclusion:
The pandemic-induced barriers to treatment adherence for the vulnerable TB patients can lead to adverse treatment outcomes including disease relapse and drug resistance. It is hence suggested that there is an urgent need for recasting the frontline TB interventions in India in the context of the pandemic in order to achieve the goal of TB elimination.
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Prevalence of novel Corona Virus (severe acute respiratory syndrome Coronavirus 2) and its uncertain future in the different regions of Punjab
p. 45
Shailpreet Kaur Sidhu, Kanwardeep Singh, Arpandeep Kaur Tuli, Samira Bigdelitabar, Mohan Jairath
DOI
:10.4103/ijph.ijph_1793_21
PMID
:35381713
Background:
Coronavirus disease-19 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health threat globally. Many countries have seen a two-wave pattern in there reported cases during the period of pandemic. Similarly, our country has reported the first peak between March and October 2020 followed by the second peak between April and June 2021.
Objectives:
The objective of this study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID-19 cases from November 2020 to May 2021 in the central (Majha) region of Punjab state of India which was considered as the epicenter of the infection.
Methods:
The multiplexed real-time reverse transcription–polymerase chain reaction (RT-PCR) method was used to detect SARS-CoV-2, with co-amplification of specific target genes using real-time PCR kits.
Results:
During the second wave, test positivity rate for COVID-19 in our laboratory (the central region of Punjab) was recorded as 4.8%. The study revealed that an increased sustained proportion of COVID-19 incidence is present in young adult age group (20–39 years) with 8.65% positive rate followed by the older age group and least in young ones. It was observed that during the second wave, more symptomatic individuals are positive (10.26%) alongside it was also observed that male population (5.61%) was more prone to infection in comparison to females (3.78%). Whole-genome sequencing carried out on 120 random samples selected from all the districts of Majha region of Punjab state showed two prominent strains, namely alpha variant (95 cases) and delta variant (19 cases).
Conclusion:
A higher positivity rate in the second wave demonstrates the rapid spread of the new emerging virus variants and warrants the implementation of strict vaccination regimes and quarantine in the affected region.
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BRIEF RESEARCH ARTICLES
Experiences and challenges during implementation of operational guidelines of Maternal Near Miss Review of the Government of India at tertiary hospitals in Maharashtra
p. 49
Ragini Nitin Kulkarni, Sanjay Chauhan, The Maternal Near Miss Working Group
DOI
:10.4103/ijph.ijph_1068_21
PMID
:35381714
The Government of India released operational guidelines for Maternal Near Miss-Review (MNM-R) in December 2014 for implementation at all the tertiary hospitals in India. An implementation research study was conducted at two selected tertiary hospitals in Maharashtra to assess the feasibility of implementation of the MNM-R guidelines at these hospitals and document the experiences and challenges during this process. The study findings suggest that for implementation of MNMR guidelines at these tertiary hospitals, there is need of dedicated staff; revision of MNM facility based form and critical review of the criteria for identification of MNM cases. MNM meetings could not be conducted with Maternal Death Review Committee meetings as mentioned in the guidelines. More efforts are needed for follow-up of the implementation of the corrective measures recommended by the MNM Committee. The study findings indicate that it is feasible to implement the MNM-R guidelines at the tertiary hospitals, if the above points are considered at these hospitals.
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Preventive measures and self-protective rights at workplace: A study on steel and power industry workers in Odisha, India
p. 53
Parthsarathi Dehury, K Anil Kumar
DOI
:10.4103/ijph.IJPH_35_21
PMID
:35381715
This study aims to assess the preventive measures and self-protective rights of employees at the workplace. A survey has been conducted in a steel and power industry of Angul district of Odisha (India) using a semi-structured interview schedule to assess the determinants of occupational hazards. Occupational health practices among 425 male workers were assessed from the steel and power industry using the population proportion to sample technique (PPS). Respondents from the higher educational background, skilled workers, Hindu religious group, general category, and employees with high-household income were significantly associated (
P
< 0.05) with self-protective rights at the workplace. Industrial workers are considered a vulnerable group with respect to the power of self-protective rights in the industry. The factors such as job insecurity, financial hardship, less education, and unskilled profession make them vulnerable, which forces them to settle with a lower level of rights at the workplace.
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Physical and mental health status of women whose spouses inject drugs – A cross-sectional, multisite study
p. 57
Ravindra Rao, Preethy Kathiresan, Kunal Kishore, Parveen Kumar, Charanjit Sharma, Jatinder Kumar Mishra
DOI
:10.4103/ijph.IJPH_1249_20
PMID
:35381716
Substance use disorder impacts the lives of significant others, more especially the wives of individuals using substances. However, the physical and mental health issues among wives of people who inject drugs (PWID) are less studied. The current cross-sectional, multisite study assessed the physical and mental health of wives of 433 PWID across six sites in Delhi. The mean age of the participants was 32.7 years (standard deviation: 9.7). More than 50% of the participants reported menstrual problems, most commonly dysmenorrhea. Around 55.9% had adverse pregnancy outcomes (abortion, miscarriage, or stillbirth). Around one out of four participants reported at least one specific sexually transmitted infection symptom. Around 11% were diagnosed with tuberculosis and 35% with a major medical illness in their lifetime. More than 90% of the participants had depressive and anxiety symptoms. The study showed that there is a huge burden of physical and mental health issues among the wives of PWID.
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Educational short film versus powerpoint based lecture in school tobacco awareness programs: Study from a tertiary cancer Center, Kerala, India
p. 61
Neethu Ambali Parambil, Phinse Mappalakayil Philip, Satheesan Balasubramanian, Maya Padmanabhan
DOI
:10.4103/ijph.ijph_1326_21
PMID
:35381717
Multimedia, being more attention-getting and attention-holding, is a powerful tool for mass awareness creation and is used for intervention among students in many studies. Our aim was to see the effectiveness of an educational short film in tobacco awareness generation and to compare it with the traditional lecture-based awareness. Selected schools were divided into two groups as per convenience. Short film was used as intervention in Group 1 and PowerPoint-based lecture in Group 2. The increase in awareness was assessed by a pre and posttest. On analysis, though both methods increased awareness as given by higher posttest score, it is found that the awareness levels showed a statistically significant difference between educational short film on hazards of tobacco and power point-based lecture using Mann–Whitney test. Our study proves that an educational short film carefully scripted and picturized can be used effectively in imparting awareness in school-based tobacco control programs.
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COVID-19 pandemic: Trend analysis with respect to District Anantnag, Jammu and Kashmir, Northern India
p. 64
Mehbooba Rasool, Mohsina Mukhtar, Iftikhar Hussain Munshi, Muneer Ahmad Masoodi, Mohammad Yousuf Zagoo, Imtiyaz Ahmad
DOI
:10.4103/ijph.IJPH_255_21
PMID
:35381718
With 1
st
case being reported in Wuhan city of China in December 2019, COVID-19 infection cases made their way to every corner of the world. Then, on January 07, 2020, laboratory results led to pneumonia being named as COVID-19. Scant data is available from Northern India, thus to reveal the trend of COVID-19 infection since last year of COVID-19 pandemic onset, this study took shape. The unit of analysis of our study was District Anantnag, Jammu and Kashmir. Till February 05, 2021, a total of 4625 cases of COVID-19 virus were reported in District Anantnag, Jammu and Kashmir. Negative history of close contact with COVID-19 patient (66.1%) constituted the most common exposure, majority (84.4%) were asymptomatic and comorbidities were present in 68 (1.5%). COVID-19 infection was more prevalent among younger age group, with higher male predominance, with comorbid being at higher risk, hence most stringent measures must be adopted.
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Evaluation of point of entry surveillance for COVID-19 at Mumbai international airport, India, July 2020
p. 67
Khyati Aroskar, Rajesh Sahu, Sushma Choudhary, Achhelal R Pasi, Pragati Gaikwad, Tanzin Dikid
DOI
:10.4103/ijph.ijph_1487_21
PMID
:35381719
India started Point of entry (PoE) surveillance at Mumbai International Airport, screening passengers returning from coronavirus disease (COVID-19)-affected countries using infrared thermometers. We evaluated in July 2020 for March 1–22 with the Centers for Disease Control and Prevention evaluation framework. We conducted key informant interviews, reviewed passenger self-reporting forms (SRFs) (randomly selected) and relevant Airport Health Organization and Integrated Disease Surveillance Programme (IDSP) records. Of screened 165,882 passengers, three suspects were detected and all were reverse transcription-polymerase chain reaction negative. Passengers under-quarantine line-listing not available in paper-based PoE system, eight written complaints: 6/8 SRF filling inconvenience, 3/8 no SRF filling inflight announcements, and standing in long queues for their submission. Outside staff deployed 128/150 (85.3%), and staff: passenger ratio was 1:300. IDSP reported 59 COVID-19 confirmed cases against zero detected at PoE. It was simple, timely, flexible, and useful in providing information to IDSP but missed cases at PoE and had poor stability. We recommended dedicated workforce and data integration with IDSP.
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COMMENTARIES
Measles elimination by 2020 – Current status and future challenges in India
p. 71
Manas V Pustake, Manasi Shekhar Padhyegurjar, Nitin S Mehkarkar, Shekhar Padhyegurjar
DOI
:10.4103/ijph.ijph_963_21
PMID
:35381720
India, as a member of the World Health Organization South-East Asia Region, had committed to measles elimination by 2020. Efforts to increase immunization coverage, special immunization activities, and case-based surveillance have been implemented rigorously over the last 7 years, but India has not been able to eliminate measles. Multiple factors led to this namely inadequate vaccination coverage and COVID pandemic and others. The pandemic added its contribution in disruption of vaccine delivery services under Intensified Mission Indradhanush preventing the achievement of the elimination target, in stipulated time. India may need to think beyond strengthening the routine immunization activities and increasing the geographical coverage under Intensified Mission Indradhanush. Promising the future in the measles vaccine delivery system in the form of Measles-Micro-Array-Patches is seen on the horizon may prove to be a game-changer for targeting measles elimination, in the current decade.
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COVID-19 Pandemic: An Indian radiologist' perspective
p. 74
Annapurna Srirambhatla, Abhishek J Arora
DOI
:10.4103/ijph.ijph_1448_21
PMID
:35381721
During the COVID-19 pandemic, differences in health-care system and policies among countries worldwide meant that each country had to come up with their own strategies for containment, diagnosis, and treatment of the disease − “no one size fits all.” India being the second populous country in the world with modern and traditional systems of health care has its own challenges to face during the pandemic. Among the increased cacophony of information regarding the COVID-19 disease and controversies surrounding the usage of various radiological modalities for its diagnosis, we are trying to present a sane perspective from an Indian radiologist viewpoint. Knowing the strengths and shortcomings of the Indian health-care system, we have suggested plausible solutions which may be the answers to the issues raised by the Indian media.
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Managing the next pandemic: Lessons for policy makers from COVID-19
p. 77
Rajeev Sadanandan
DOI
:10.4103/ijph.ijph_1699_21
PMID
:35381722
Managing a pandemic offers lessons for preparing for similar episodes in future. The importance of surveillance in One World–One Health mode and the need to share information expeditiously to mobilize national and international resources has been evident. Pandemics cause disruption to normal social and economic activity, which would be tolerated better if there is trust in authorities. Governments need to guard against over centralization in a health crisis as it discourages community involvement and willing compliance with pandemic-related restrictions. Health emergencies can be managed effectively if health systems have been strengthened during normal times. Financial flexibility needs to be built into the public financial management systems to fund the unanticipated expenditure. The pandemic has underscored the global interdependence and the need to have systems for a global response to health emergencies. Health systems have to be reengineered to better deal with future pandemics.
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CASE SERIES REPORT
SARS-CoV-2 cluster among security guards, Chennai, Tamil Nadu, India, June–July 2020
p. 80
Vidhya Viswanathan, Polani Rubeshkumar, Manikandanesan Sakthivel, Alby John
DOI
:10.4103/ijph.ijph_1813_21
PMID
:35381723
Congregate work settings are at increased risk for SARS-CoV-2 transmission and predispose to super spreader events. We investigated a COVID-19 outbreak among security guards to identify the risk factors and propose recommendations. We defined a COVID-19 case as a laboratory-confirmed reverse transcription polymerase chain reaction-positive case. We traced the contacts actively and described the cases by time, place, and person. We conducted a case–control study and collected data on potential exposures. We identified 20 (27%) COVID-19 cases among 75 security guards. Among the cases, 17 (85%) were male and 12 (60%) were symptomatic. We recruited all the 20 COVID-19-confirmed cases and 55 COVID-19-negative controls for the case–control study. SARS-CoV-2 infection was higher among those had high-risk exposure (60%, [12/20]) than who did not (16%, [9/55], adjusted odds ratio = 5.9, 95% confidence interval = 1.6-22.1). Having had high-risk exposure with COVID-19 cases led to COVID-19 outbreak among the security guards. We recommended avoiding the activities predisposed to high-risk exposure.
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Herpes zoster following vaccination with ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant)
p. 83
Anupa Mary Job, Bindurani Sudhamani, Manju Mohan, SN Mohanasundaram
DOI
:10.4103/ijph.ijph_2017_21
PMID
:35381724
Ever since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, science has unraveled much knowledge on SARS-CoV-2 which has led to extraordinary and unprecedented progress in developing COVID-19 vaccines. Several adverse cutaneous reactions, ranging from more common local injection site reaction, neutrophilic and pustular drug reactions to flare-up of preexisting dermatoses, have been reported with currently available vaccines. We report a case series of 7 patients who developed herpes zoster (HZ) following the first dose of ChAdOx1 nCoV-19 coronavirus vaccine (recombinant). HZ following vaccination is a rare entity. The occurrence of HZ in the patients presented in this series within the time window 1–21 days after vaccination defined for increased risk and postulated dysregulation of T-cell-mediated immunity, suggests that the ChAdOx1 nCoV-19 coronavirus vaccine (recombinant) could probably be a trigger for reactivation of varicella zoster virus to cause HZ in them.
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LETTER TO EDITOR
Immunization by MObilization and MOtivation strategy: Tackling COVID-19 vaccine hesitancy among the pregnant and lactating women in India
p. 86
Ananya Balaji, Amrit Mishra, Abhijit Vinodrao Boratne
DOI
:10.4103/ijph.ijph_1977_21
PMID
:35381725
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Online since 25
th
September, 2010