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.

Herbal medicines causing kidney failure, bladder cancer in India

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These types of news are common in the media and mislead the public that Ayurveda is bad for the country. Most of the herbs that contain aristolochic acid (AA) are Chinese herbs and only one Ayurvedic drug contains AA. However drugs can be adulterated with AA containing herbs. Unless authenticated and proved, these types of researches by UK journals are nothing but a direct attack on Ayurveda.

Aristolochic acid (AA) nephropathy is an interstitial nephritis first described in 1991. A high incidence of cellular atypia and transitional cell cancer of the renal pelvis, ureter, and bladder is associated with this disease.

AA in combination with the vasoconstrictive appetite suppressants, fenfluramine and diethylpropion, diuretics, and other potential nephrotoxins may underlie AA nephropathy. Stimulation of the intrarenal renin-angiotensin system likely contributes to the lesion.

Risk factors include women, toxin dose and a genetically determined predisposition. Patients present with kidney insufficiency and normal or only mildly elevated blood pressure.

In the disease, urinary protein excretion is moderately increased and the sediment reveals only a few red and white cells. Corticosteroids may slow the rate of loss of renal function. Renal transplantation is an effective modality.

It is not clear if AA has been part of the herbal preparations used by all patients in most studies. AA (0.15 mg/tablet) has been used as an immunomodulatory drug for 20 years in Germany by thousands of patients, sometimes in doses comparable to that found in AA-containing slimming regimens; despite this exposure, there is no report relating chronic tubulointerstitial nephritis to AA in Germany.

Fast-developing chronic tubulointerstitial renal disease is caused by combined exposure to both a potent nephrotoxic substance, AA, and to renal vasoconstrictors, fenfluramine/diethylpropion.

Chinese herbs with AA: Aristolochia species of the family Aristolochiaceae are often found in traditional Chinese medicines, e.g. Aristolochia debilis, A. contorta, A. manshuriensis, and A. fangchi. The medicinal parts of each plant (stem, root, fruit) have distinct Chinese names like fangchi (Root) Guang Fang Ji; Aristolochia manshuriensis (Stem) Guan Mu Tong; Aristolochia contorta (Fruit) Ma Dou Ling; Aristolochia debilis (Fruit) Ma Dou Ling; Aristolochia contorta (Herb) Tian Xian Teng; Aristolochia debilis (Herb) Tian Xian Teng and Aristolochia debilis (Root) Qing Mu Xiang.

In Ayurveda, the herb is ARISTOLOCHIA BRACTEOLATA from family ARISTOLOCHIACEAE, SANSKRIT name Keetmari, Dhumrapatra, Kitamari, Visanika and HINDI names: Kiramar, Kitamar, Aulosa, Hukka-bel, Kalipaad.

In April 2001, the FDA identified botanicals known of suspected to contain aristolochic acid, and others as potentially adulterated with species containing aristolochic acid. This potential adulteration can occur when an aristolochic acid containing herb is mistakenly identified as an herb that does not contain aristolochic acid.

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