WHO confirms three Zika cases in India

Health Care Comments Off

The first three cases of Zika virus infection were confirmed on Friday from Ahmedabad, Gujarat by the World Health Organization (WHO).

In its report dated May 26, 2017, the WHO said, “On 15 May 2017, the Ministry of Health and Family Welfare-Government of India (MoHFW) reported three laboratory-confirmed cases of Zika virus disease in Bapunagar area, Ahmedabad District, Gujarat, State, India. The routine laboratory surveillance detected a laboratory-confirmed case of Zika virus disease through RT-PCR test at B.J. Medical College, Ahmedabad, Gujarat. The etiology of this case has been further confirmed through a positive RT-PCR test and sequencing at the national reference laboratory, National Institute of Virology (NIV), Pune on 4 January 2017 (case 2, below). Two additional cases (case 1 and case 3), have then been identified through the Acute Febrile Illness (AFI) and the Antenatal clinic (ANC) surveillance.”

(Source: WHO, May 26, 2017)

Zika virus disease was declared as a Public Health Emergency of International Concern (PHEIC) by the WHO in February last year. And, in November 2016, the WHO declared an end to its global health emergency over the spread of the Zika virus.

Guidelines on the Zika virus disease were issued by the Ministry of Health and Family Welfare last year. NCDC, Delhi and National Institute of Virology (NIV), Pune were designated as the apex laboratories to support the outbreak investigation and for confirmation of laboratory diagnosis.

According to the WHO report, an Inter-Ministerial Task Force has been set up under the Chairmanship of Secretary (Health and Family Welfare) together with Secretary (Bio-Technology), and Secretary (Department of Health Research). The Joint Monitoring Group, a technical group tasked to monitor emerging and re-emerging diseases is regularly reviewing the global situation on Zika virus disease.

In addition to National Institute of Virology, Pune, and NCDC in Delhi, 25 laboratories have also been strengthened by Indian Council of Medical Research for laboratory diagnosis. In addition, 3 entomological laboratories are conducting Zika virus testing on mosquito samples.

The Indian Council of Medical Research (ICMR) has tested 34 233 human samples and 12 647 mosquito samples for the presence of Zika virus. Among those, close to 500 mosquitoes samples were collected from Bapunagar area, Ahmedabad District, in Gujarat, and were found negative for Zika.

However, this report has highlighted India’s vulnerability to vector-borne diseases due to its huge population, climate and people traveling into the country in large numbers. These cases provide evidence on the circulation of the virus in India suggesting low level transmission of Zika virus and chances of more cases occurring.

Dengue and Chikungunya are already endemic in the country. All these three diseases – Dengue, Chikungunya and Zika – are viral infections and share a common vector, the Aedes mosquitoes.

Dengue or Chikungunya-like symptoms with red eyes, fever with a rash or joint pain should not be ignored. Such cases could be Zika. Eliciting a travel history in such patients is very important.

There is no specific treatment. Patients should be advised to take paracetamol to relieve fever and pain, plenty of rest and plenty of liquids. Aspirin, products containing aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should be avoided.

In view of the detection of Zika in India, the need of the hour is enhanced surveillance: community-based and at international airports and ports to track cases of acute febrile illness. While awareness needs to be created about the disease, the public needs to be reassured that there is no cause for undue concern.

There is no vaccine for Zika virus infection. Protection against mosquito bites is very important to prevent Zika infection. People traveling to high risk areas, especially pregnant women, should take protections from mosquito bites.

• Stay inside when the Aedes are most active. They bite during the daytime, in the very early morning, and in the few hours before sunset.
• Buildings with screens and air conditioning are safest.
• Wear shoes, long-sleeved shirts, and long pants when you go outside.
• Ensure that rooms are fitted with screens to prevent mosquitoes from entering.
• Wear bug spray or cream that contains DEET or a chemical called picaridin.

Vedas and fertility

Health Care Comments Off

Infertility has been known from the Vedic era. Examples of fertility and assisted reproduction can be read in cases of King Dashrath, Ganesha, Kartikeya, Dhritarashtra, Vidur and Pandu etc.

The three Shahi Snans mentioned in our Vedic literature are undertaken in the month of Magh, Vaishakh & Kartik (Vikram calendar) months. Shahi snan denotes exposure to sunlight to get Vitamin D. The rituals also involve eating the calcium-rich sesame seeds in a fasting state. Increase in both vitamin D and calcium are necessary to increase fertility.

The main wedding season starts from Devuthan Ekadashi, Tulsi Vivah followed by Amala Navami. The seeds of Shyama Tulsi are known to increase the viscosity of semen and in women they help the release of eggs, a clomiphene-like action. Amla also increases sperm concentration.

Pooja means dharam karam i.e. whatever we offer to God, we should also offer to ourselves (God is in me, the basis of Advaita philosophy).

Indian doctors have been practicing Fallopian tube patency test or HSG (hysterosalpingography) for years. In this test, water or medicated oil dye is used to test and flush the fallopian tubes. It was noticed that post-HSG, the women showed improved fertility.

Now, with the advent of CT, MRI and hysteroscopy, use of HSG has reduced, while the need for IVF has increased. Can we consider the use of vedic era methods and HSG to get better fertility results?

Unfortunately, IUI, which was done by GPs, has gone in disrepute because of some unethical practices by so-called sadhus and saints and is now in the domain of IVF specialists only to the extent that it is now being covered under a separate Act.

Dr KK Aggarwal
National President IMA & HCFI

There is still confusion among doctors regarding the word “Generic”

Health Care Comments Off

Confusion still prevails among doctors as to what does the word “Generic” mean. I have tried to explain what is a generic drug as below.

There are two types of drugs – patented or generic.

The patented drugs are introduced in the market by the original company that researched the basic molecule. Let us take the example of Pfizer, which introduced two original molecules – Amlodipine and Sildenafil – and launched them in the international market as Amlogard (Amlodipine) and Viagra (Sildenafil). Being their research molecules, Pfizer had exclusive rights for 10 years based on their patent. These drugs are called patented drugs and the pharmaceutical company will have exclusive rights to them till the patent expires.

After 10 years as the patent period expires, other companies can also market these molecules under their own brand name or as generic molecules. These are called non-patented generic version of the drugs.

There is no difference by law in the quality of generic or patent versions of the drugs.

For example, amlodipine in India is still available as Amlogard (Pfizer) @ Rs. 8/-; however, Dr. Reddy’s Lab also markets it as Stamlo, at less than Re.1/-. Similarly, Viagra (Sildenafil) was introduced @ Rs 600/- during the term of the patent, but the generic version is now available at less than Rs. 25/-.

When we are asked to write generic name of the drug/s, this means that we should write the generic version of the drug/s and not the patented drug/s still marketed in India.

Prescribing Amlogard or Viagra, when the generic Indian versions are available, cannot be justified. The generic version will be available at fraction of a cost than the patented versions.

Let us take another example of the patented drug Clopidogrel, which is available as Plavix (original drug) and Deplatt, the Indian generic version. Plavix costs Rs.100/- and Deplatt Rs 5/-.

Why write imported patented versions, when Indian generic versions are available.

India is the largest exporter of generic versions of the drugs in the world as they can manufacture drugs at fraction of a cost compared to international brands.

The word ‘Brand’ has nothing to do with the words ‘generic’ or ‘patented’ drugs.

In India, generic versions of drugs can be sold in the name of molecule (generic-generic) or brand (generic-brand).

The only thing that the Indian Medical Association (IMA) wants is that all generic versions of drugs in India should be permitted to be sold only at one price by one company. At present, the generic versions are being sold at three different prices (generic-generic, trade-generic and branded-generic) by the same company.

Dr KK Aggarwal
National President IMA & HCFI

« Previous Entries