Medical Tourism in India continues to show steady growth

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Affordability, availability, and advanced technologies are some reasons for this growth

New Delhi, 25 July 2018: As per recent statistics, India currently contributes to about 18% of the global medical tourism market. Its medical value travel (MVT) was pegged at $3 billion in 2015 and is estimated to grow at a CAGR of 15%, according to a report by FICCI and IMS Health, a health industry information firm. It has been estimated that by 2020, India’s medical tourism industry could be worth $9 billion, and account for 20% of the global market share.

Medical tourism is the process of traveling outside the country of residence for receiving medical care. This originally referred to the travel of patients from less-developed countries to developed nations in pursuit of the treatments not available in their homeland. Another major reason for the rise in medical tourism in India is the availability of alternative treatment options such as Ayurveda and Naturopathy.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “India is the preferred destination for cardiology, orthopedics, transplants, and ophthalmology. The country also enjoys high credibility in wellness, preventive, and alternative medicine.Affordability, high quality healthcare, availability of specialist treatment and advanced technologies are just a few reasons that have made India a much sought-after destination. Furthermore, the diversity of its flora and fauna, its natural beauty including a rich and vibrant cultural heritage has already put India on the tourist map. Many facilities in India have become a destination for learning and healing together. One can opt for a complete body detox using Yoga techniques and learn them too.”

Bangladesh and Afghanistan continue to be the top countries from where the maximum number foreign tourist arrivals (for medical purpose) is seen. In 2017, about 2.21 lakh tourists from Bangladesh are estimated to have come to India for medical reasons.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said,“Understanding the need for holisticwellness, the Government of India has constituted a Medical and Wellness Tourism Board as adedicated institution to guide the promotion and positioning of India as a competent andcredible medical and wellness tourism destination.The Board hasrepresentatives from government departments, tourism and hospitality sectors,the Indian Medical Association and experts in various disciplines including Wellness and Yoga,apart from other stakeholders. Another significant development to be mentioned here is theformation of an integrated Ministry of Ayush, with a special Department of Yoga.”

IMA is a member of National Medical and Wellness Tourism Board. The following recommendations are likely to be implemented.

  • Government to facilitate e-Medical Visa.
  • Normally e-Visa given for 60 days but e-Medical Visa will be for 6 months.
  • e-Visa will have a permission for double entry, but e-Medical Visa will permit Triple entry.
  • e-Visa will be extendable to e-Medical Visa.
  • e-Medical Visa will be available at five major Indian Ports i.e. Mumbai, Cochin, Goa, Chennai and Mangalore.
  • e-Medical Visa will be available for 161 countries.
  • Presently, medical attendants are given Visa, but the Committee has recommended that medical attendants should also be given e-Medical Visa.
  • The Committee also recommended that all hospitals should have a common Greet and Meet Counter and it should be at major Airports / Ports.
  • Free SIM card at entry will be given to e-Medical Visa patient.
  • Committee have recommended a Translation App at Airports/ Ports.
  • All Medical Tourism Hospitals will have to be NABH or JCI Accredited. We are pushing for IMA accreditation also.
  • The Committee also recommended that fee for e-Visa and e-Medical Visa should be the same.

WHO confirms three Zika cases in India

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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.

India unveils rota virus vaccine

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Indian scientists unveiled an affordable vaccine (a dollar a vaccine) against a deadly diarrhea-causing virus, Rota virus that kills some 100,000 children in India every year. Rota virus is globally responsible for some 453,000 deaths annually. Rota virus is blamed for causing up to 884,000 hospitalizations a year in India, at a cost to the country of 3.4 billion rupees.

K Vijayaraghavan, Secretary of India’s Department of Biotechnology said it was a product of international cooperation. For the first time Indian scientists have taken a vaccine from the earliest discovery to every stage of development.

The vaccine named Rotavac will be manufactured by Hyderabad-based Bharat Biotech. Each vaccination consists of three doses.

Each dose of licenced vaccines from GlaxoSmithKline and Merck costs around 1,000 rupees.

Dr M K Bhan pioneered the project after local scientists discovered a localized rotavirus 23 years ago in a New Delhi hospital.

This vaccine would prevent 25 percent of all diarrheal admissions. More than 300,000 babies die within 24 hours of being born in India each year from infections and other preventable causes.

NIH has also congratulated the Program for Appropriate Technology in Health (PATH), Bharat Biotech International, Ltd., and the scientists, government and people of India on the important results from the ROTAVAC rotavirus vaccine study.
An oral vaccine, Rotavac will be administered to infants in three dose course at the age of 6, 10 and 14 weeks. It will be given along with routine immunizations recommended at these ages.

Why a Rota vaccine?

1. Rotavirus is the single most important viral cause of severe gastroenteritis in children.

2. Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the European Society for Paediatric Infectious Diseases, and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition, recommend universal immunization of infants against rotavirus disease.

3. The two currently available oral vaccines for the prevention of rotavirus disease are pentavalent human-bovine reassortant rotavirus vaccine (RV5, PRV, RotaTeq) and attenuated human rotavirus vaccine (RV1, HRV, Rotarix). These vaccines have different doses and schedules for administration.

4. Whenever possible, the rotavirus vaccine series should be completed with the same vaccine product, but vaccination should not be deferred if the product used for previous doses is not known. This problem will not come once the Indian vaccine is available.

5. Rotavirus vaccine is contraindicated in infants who are allergic to any of the ingredients of the vaccine, those who had an allergic reaction after a previous dose and those with a history of intussusception.

6. The vaccine should not be administered to infants with immunodeficiency.

7. RV1 is contraindicated in infants with a history of severe hypersensitivity reaction to latex, but RV5 may be administered to such infants.

Conditions that are precautions for administration of rotavirus vaccine include acute moderate or severe illness, preexisting chronic gastrointestinal disorder, and receipt of blood products.

What is the rotavirus?

1. When a virus infects the intestines and causes diarrhea and vomiting it is called “viral gastroenteritis.”
2. Rotavirus is a virus that can infect the intestines and cause diarrhea and vomiting.
3. In children, rotavirus is the most common cause of viral gastroenteritis.
4. Children can get a rotavirus infection if they touch an infected person or a surface with the virus on it, and then do not wash their hands or when they eat foods or drink liquids with the virus in them.
5. If people with a rotavirus infection don’t wash their hands, they can spread it to food or liquid they touch.
6. Adults can also be infected, but rotavirus infection is much more common in children.
7. A rotavirus infection commonly causes vomiting, diarrhea that is watery (but not bloody) and fever.
8. If the child has vomiting or diarrhea, his or her body can lose too much water leading to dehydration.
9. Symptoms of dehydration can include fewer wet diapers, or dark yellow or brown urine; no tears when a child cries; a dry mouth or cracked lips; eyes that look sunken in the face and a sunken fontanel (a fontanel is a gap between the bones in a baby’s skull).
10. When babies are dehydrated, the fontanel on the top of their head can look or feel caved in.
11. Call your child’s doctor or nurse if your child has any symptoms of dehydration; has diarrhea or vomiting that lasts longer than a few days; vomits up blood, has bloody diarrhea, or has severe belly pain; is passing urine much more than usual; hasn’t had anything to drink in a few hours, or can’t keep fluids down; hasn’t needed to urinate in the past 6 to 8 hours (in older children), or hasn’t had a wet diaper for 4 to 6 hours (in babies and young children)
12. Most children do not need any treatment, because their symptoms will get better on their own.
13. It is important to make the child drink enough fluids so that he or she does not get dehydrated. You will know that you are giving your child enough fluids when his or her urine looks pale yellow or clear, or when the baby has a normal amount of wet diapers.

To prevent dehydration

1. Give your baby or young child an “oral rehydration solution (ORS). You can buy this in a grocery store or pharmacy. If your child is vomiting, you can try to give him or her a few teaspoons of fluid every few minutes. Oral rehydration solution works better than juice, because juice sometimes makes diarrhea worse.
2. Continue to breastfeed your baby, if he or she is still breastfed.
3. Do not give your child medicines to stop diarrhea (anti-diarrhea medicines). These medicines can make the infection last longer.
4. If the child has a severe infection and gets dehydrated, he or she might need to be treated in the hospital.

Rotavirus infection be prevented

5. All babies are given a vaccine to prevent the rotavirus infection.
6. If your child has a rotavirus infection, you can prevent spreading the infection by: washing your hands with soap after you change your child’s diaper; not changing your child’s diaper near where you prepare food; putting diapers in a sealed bag before you throw them out and cleaning the diaper changing area with alcohol or with a bleach and water mixture.

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