CONTENTS

1.   Introduction           Organisation Chart           NICD Faculty/Administration/Staff           Budget at a Glance (1997)

2.   Objectives and Functions of the Institute

3.   National Health Programmes           National Surveillance Programme for Communicable Diseases (NSPCD)           Guinea Worm Eradication Programme (GWEP)           Yaws Eradication Programme (YEP)

4.   Scientific and Research Activities        Headquarters           Division of AIDS & HIV           Division fo Biochemistry/Biotechnology           Division of Epidemiology           Division of Helminthology           Division of Microbiology           Division of Medical Entomology/Vector Control           Division of Training & Malariology           Division of Zoonosis        Branches           Alwar           Bangalore           Calicut           Coonoor           Jagdalpur           Patna           Rajamundry           Varanasi

5.   Manpower Development/Training Courses, Workshops, Seminars

6.   Outbreak Investigations

7.   Participation in Conferences, Workshops, Seminars and Symposia

8.   WHO/Other International Fellowships

9.   Membership of Expert Committes/Advisory Panel/Honours

10. Important Visitors during the Year

11. Publications/Presentations

Annexures           Central Library           Central Animal Facility

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6. Outbreak Investigations

January 1997

Viral hepatitis B outbreak in rural Mehsana (Gujrat), Sirsa (Haryana) and Sri Ganganagar district

Outbreaks of viral hepatitis B were observed in rural areas of Mehasana (Gujarat), Sirsa (Haryana) and Sri Ganganagar (Rajasthan) districts in the early months of 1997. The outbreaks were epidemiologically linked to the use of inadequately sterilised needles and syringes by unqualified private practitioners. All these outbreaks were marked by high case fatality rates. But for the high mortality, the outbreaks would have gone unnoticed and reinforced the impression that hepatitis B outbreaks do not occur in this country. Many cases have already occurred by the time the health authorities came to know about the first outbreak associated cases/deaths in the affected areas. In fact, while carrying out the investigations, the investigators came across some clustering of hepatitis B cases which were ye to be recogised and reported through the routine surveillance system. These outbreaks are summarised below:

Summary of viral hepatitis B outbreaks in India, 1997

* Cases in 8 villages, single or a few cases in other affected village

Positivity of viral hepatitis markers in cases of jaundice associated with outbreaks, 1997

* 2 patients died    ** n = 15

          Figures in parentheses show percentages

February 1997

Cholera outbreak in Lakshadweep islands

An outbreak of diarrhoeal diseases has occurred in Kalpeni island of Lakshadweep from Feb.’97 to May’97. Total number of case are as follows:

Out of 911 diarrhoeal cases, 5 deaths ae reported. The details of death are as follows:

Microbiological examinations of stool samples by Calicut Medical College and Ernakulam hospitals confirmed the presence of Vibrio cholerae 01 EI Tor Ogawa which is resistant to Ampicillin, Furoxone, Gentamicin and moderately susceptible to Tetracycline and Ciprofloxacin.

The first cases was a labourer named Abubaker, 35 yrs., M C/o K. Koya from the Mainland. The first case was reported on 10.02.97.

The last case was also a labourer named Napolean, 22 yrs., M, C/o M. Muthu Koya, who came from the mainland to Kalpani island.

All control measures including distribution of ORS packets, chlorination of water, management of patients, health education etc. were intensified. After 15^th May, 1997 no case of diarrhoea was repoted from Kalpani island.

May 1997

Acute Gastroenteritis outbreak in Arthala village, Ghaziabad (UP).

Following newspaper reports regarding deaths due to cholera in Arthala village in Ghaziabad, visits were made to the affected area on 1.5.97 and 5.5.97, which is an urbanized village with a population of about 1,00,000. On investigation six deaths were reported due to acute gastroenteritis in children below the age of eight years. Of the four water samples collected, there were found to be unsatisfactory. However, none of the rectal swab samples from cases currently having diarrhoea showed growth of enteropathogen. Sanitary conditions of the area were grossly unsatisfactory. Residents had inadequate knowledge regarding preventive measures for diarrhoea. Appropriate measures to prevent further morbidity and mortality were suggested to the concerned authorities.

Leptospirosis outbreak at Mysore

An oubtreak of leptospirosis, a widely prevalent zoonotic disease was reported from Mysore Medical College campus during May, 1997. 78 clinically suspected cases of leptospirosis from PG Hostel, Mysore Medical College were admitted in college hospital between May 13 to May 26, 1997. The disease were characterised by high temperature associated with headache, body pain and gastro-intestinal manifestations and other protean manifestations. 94 samples collected from 78 medicos and 16 OPD patients were examined and 63 samples were found to be positive (-ve) by DGM at MMC, Mysore. Blood samples collected from 76 medicos and 27 OPD patients were transported to NICD, Plague Surveillance Unit, Bangalore and tested to detect the evidence of leptospira antibodies by PHA test. Out of 76 samples tested 12 were found to be +ve. Seropositivity percentage in the blood samples collected upto 2nd week of infection was found to be 3.03% whereas it was 50% in blood sera samples collected between 3-5 week of infection. From these observations it was clear that there was a significant seroconversion among the patients. The outbreak occurred due to short term fluctuations in rodent density due to migration of B.bengalensis from the abondoned market place to the kitchen site of PG Hostel. Contamination of sump water with urine and faeces of infected Bandicoots, which was used directly for bathing before chlorination by hostel inmates was the probable cause of infection.

All the symptomatic cases were treated with crystalline penicillin (15L,6 hourly x 7 days) and those were sensitive to penicillin were treated with doxycycline.

Effective disposal of garbage were made to reduce the short term fluctuations of migratory Bandicoots in the area and to prevent environment contamination (Water, flood etc.) by animal excreta.

An outbreak of Viral hepatitis E in Berhampur town of Orissa was investigated

An outbreak of Viral hepatitis E in Berhampur town of Orissa was investigated by Dr. S.K.Patanaik, Joint Director from 12^th to 14^th May 1997. A total of 252 Viral hepatitis cases had received treatment in the two major hospitals of the town and most of the patients availaed treatment from a traditional healer in a nearby village. Without a community survey, the actual incidence could not be ascertained. There were 10 deaths in the hospitals due to viral hepatitis and 60% of these were females. Three deceased were pregnant and one was in puerpereum.

Our of 16 sera samples collected, 14 were positive for anti HEV on testing at NICD, Delhi indicating HEV as the cause of outbreak. On a test checking it was found that the water lpipe lines had breached at a number of places in old Berhampur town area where majority of cases occurred. Some pipe lines ran through the drains in silt with sewage overflowing them. Two water samples on analysis at State Public Health Laboratory, Bhubaneshwar were found bacteriological unsatisfactory showing MPN of coliform organisms 1800 + per 100ml suggesting sewage contamination and both the samples did not contain any residual chlorine. For chlorination of the large bodies of water, bleaching powder, on unstable compound was being used and not chlorine gas. It was concluded from epidemiological and laboratory investigations that HEV was the cause of viral hepatitis outbreak in the town due to contamination of drinking water supply system with sewage.

Cholera outbreak in Alleppey district

During May 1997 (from 1.5.97 to 26.5.97) 228 cases of diarrhoeal diseases were admitted in Alleppey Medical College Hospital and other hospitals of Alleppey district. Out of 228 cases 76 were children below the age of 12 years. About 1/3 of the cases were reported from Alleppey town.

Out of 70 stool samples examined at the Department of Microbiology, Alleppey Medical College 12 are found positive for Vibrio Cholera 01 E1 Tor Ogawa which was found susceptible for Doxicycline and Tetracycline.

Out of 228 diarrhoeal disease cases 3 deaths were reported and out of 3 deaths 2 were confirmed as cholera.

Water testing conducted during March 1997 indicates that the coliform count in tap water and well water was 350/100 ml and 1800/100 ml respectively in some parts of Alleppey town. Preventive measures such as ORS distribution, Health education, chlorination of well water etc. were undertaken.

Alleppey district is reporting cholera cases almost every year from 1991 onwards. Details of confirmed case are given below:

July 1997

Deaths in Hatin block, Faridabad district, Haryana on July 22, 1997

Investigations revealed that 85.7% of serum samples were positive for measles antibodies, 33.5% of the blood smears were positive for Malarial parasite and 45.5% of the serum samples were positive for Dengue IgM antibodies.

Outbreak of Leptospirosis in Surat and Valsad districts – Gujarat, 1997

Valsad has been reporting cases of leptospirosis for many years. In 1997, the disease spread towards north into the Surat district. Early cases started occurring in the middle of July. As of 11 September, 281 cases and 34 deaths (case fatality ratio 12%) had been reported in district Valsad, whereas 132 cases and 14 deaths (CFR 11%) occurred in district Surat. More than 40% of the clinically suspected cases of leptospirosis were found seropositive for IgM antibodies in Medical College, Surat. Almost 60% of cases were found positive for IgG antibodies in the laboratories of NICD. A high seropositivity in persons denying any illness in the last 3 months or who had only mild fever (even in villages considered to be unaffected during the present outbreak) indicated that the infection was much more extensive and wide spread. Virtually all the cases were adults and from rural areas; about 80% of them being males. Almost all the families and most of the affected villages reported only single cases. Valsad, Chikhali and Gandevi taluks in district Valsad and Vyara and Mahuva taluks in district Surat were the worst affected areas.

Most of the cases were involved in agricultural and dairy activities. The disease pattern co-related well with the rainfall. The extensive outbreak in 1997 was probably due to very high precipitation’s during August and September, May’97.

Outbreak of Dengue/ Dengue Haemorrhagic Fever / Japanese Encephalitis

Outbreak of suspected Dengue/DHF were reported from various areas of Delhi, Haryana, Gujarat, Karnataka, and Rajasthan mainly during July to Nov., 1997. A total of 1263 blood samples are processed for antibodies to Dengue Virus IgM antibodies. Of these 352 were found to be Positive for IgM antibodies. 223 samples were also processed for the presence of IgG antibodies. Out of which 172 were found to be Positive.

Cases of Encephalitis suspected to be Japanese Encephalitis were also reported mainly from various parts of Haryana and Uttar Pradesh. Samples collected from human and 9 Pigs from these outbreaks were processed for the presence of J.E. antibodies, few sera reacted to Flavi Virus antigens, all the Pig sera were found to be Negative. Seventy four samples of human sera and CSF were also received from Nepal through W.H.O. from a suspected outbreak. Of these 34 samples showed the presence of J.E. Antibodies, 4 of these were in a diagnostic titre.

Outbreak investigations of Dengue/DHF

Haryana

Panipat: Consequent upon the receipt of report regarding the occurrence of fever cases in Panipat city during September, 1997, an Aedes larval survey was carried out in and around the houses reporting fever cases in Sethi Chowk, Ward No. 8 and Jain Mohalla. The details of entomological surveillance are summarised below:

S. No.           Entomological Localities

          parameters   

The entomological investigations carried out revealed significantly higher house and container index in all the three localities surveyed for Aedes aegypti mosquito breeding. During the survey water container showing Aedes breeding were got emptied and the Civil Surgeon and District Malaria Officer were advised to get all the water containers having Aedes breeding empties. Need to intensify the entomological surveillance and immediate vector control measures to bring down the mosquito density at a low level was recommended.

Faridabad: In view of the reported fever cases and few deaths in Khiluka village, Block-Hatin in Faridabad District, an Aedes survey was carried out during July, 1997 in the village wherein a total of 45 houses and 138 containers were searched, however, no Aedes breeding was detected in any of the house containers.

Studies carried out revealed the total absence of Aedes mosquito and extremely low prevalence of malaria vectors viz. Anopheles stephensi and An. culicifacies indicating thereby that the present episode was not due to vector-borne diseases.

Sonipat: Consequent upon the admission of suspected dengue/J.E. cases from Sonipat district in Haryana in Barah Hindu Rao Hospital, Delhi, mosquito surveys were undertaken in Sonipat town and around the houses of admitted patients. The results of mosquito surveys undertaken revealed the presence of Aedes aegypti, vector of dengue; An. culicifacies and An. stephensi, vectors of malaria and Cx. quinquefasciatus, vector of filariasis. The Aedes aegypti density was found to be 12.0 per man hour, much higher than the critical density. Moreover, House index and Container index were also found to be appreciably high viz. 31.4% and 13.0?% respectively. It appears that the present episode was due to dengue. The prevalence of extremely low density of vector Anopheles species rules out the possibility of malaria.

Delhi

Aedes survey was carried out in and around the suspected dengue/DHF patients house in Trinagar area in Delhi. Out of a total of 36 houses searched for Aedes breeding and 10 houses were found to be positive giving a House Index as 27.7%. Similarly out of a total of 65 containers searched, 13 were found to be positive for Aedes breeding thereby giving the Container index as 20.0%. The larval index was found to be much higher than the critical level reported for Dengue/DHF outbreak.

Uttar Pradesh

Ghaziabad (U.P.): Consequent upon the report of two suspected Dengue cases from Ghaziabad (U.P.), an entomological survey of Aedes mosquitoes was undertaken in localities reporting suspected cases. A total of 50 houses and 72 containers were searched, however, none of them was found to be positive for Aedes breeding.

Entomological investigation of an outbreak of mysterious disease in District Meerut (Uttar Pradesh)

Consequent upon the outbreak of a mysterious disease in district Meerut (U.P.), wherein 12 deaths in Village Khiwani and 7 deaths in Village Nirpura were reported, entomological investigations were undertaken in these villages w.e.f. 16-18th October 1997 to study the prevalence, distribution, density and breeding habitats of various species of mosquitoes. Adult mosquito survey were undertaken both in indoor and outdoor situations, human dwellings, cattlesheds and mixed dwellings by suction tube and total catch by pyrethrum spray. Larval collections were made in and around the villages from ponds, stagnant wate collections.

Results of the survey carried out in the affected and non-affected villages revealed the presence of An. culicifacies and An. annularis with a very low density of 1.0 & 4.0 in affected villages and 5.0 & 12.0 per man hour in non-affected villages. Villagewise adult and larval density are given in Table 9 and 10. Both the villages showed the absence of adult or larval stages of Aedes mosquito which may be because of the absence of water storage practices in the two villages.

Per man hour density of adult mosquitoes recorded in different villages of District Meerut

Gastroenteritis outbreak investigation in the Sanganer tehsil of Jaipur

On the receipt of the telegraphic information from the Director, NICD, Delhi on the dated 11.7.1997 regarding investigation of the said outbreak & as per the Times of India News, Dated 19.6.1997, a team of FPU, NICD reached to Jaipur on 15.7.1997. The team constituted by Dr. R.S. Gupta, Dy. Director, Dr. V.R. Meena, Medical Officer, Mr. R.K. Mishra, Research Assistant & Mr. R.K. Jain, Technician.

Area affected

In this episode labourer & factory workers in the Sitapura Industrial area i.e. of the Dhanseri Tea Company & Swadeshi Polyfills Limited were mainly affected. However cases were also occurred is nearby villages i.e. Shivdaspura, Jalupura, Goner Mod, Butaria, Pachuda, Shri Ram Pura Ki Nangal, Chandlai & Bas Beelwa in the area of Mini PHC Beelwa of the Block PHC Vatiks, Tehsil Sanganer, District Jaipur.

Discussion with the State & District Health Authorities

On reaching at the Jaipur, discussion were held with the Director Medical & Health Services (Public Health), Addl. Director (Rural Health) & Deputy Director. They were in opinion that this was simply an episode of food poisoning in the area of Goner, Chowkhi Dhani & Adjacent Industrial area of the block PHC Beelwa, Tehsil Sanganer, Distt. Jaipur. A total 49 patients were admitted in a private Kedawat Hospital & temporarily established Govt. treatment camp near the Beelwa PHC. This episode was started on 16.6.1997 & lasted upto 18.6.1997. The similar opinion was also given by the CM&HO of the Distt. Two rectal swabs & one water sample were taken by the District Health Authorities during this episode. On laboratory testing the water sample was found unsatisfactory. However the report of rectal swabs was not available.

Survey in the affected area

A total 64 cases of Gastroenteritis occurred during this episode. Majority of the patients were labourer working at Dhanseri Tea Copany construction site & Industrial workers of Swadeshi Polyfills Ltd.

A total 57 labourer were engaged at the Dhanseri Tea Company construction site from West Bengal, living in three groups of 32, 15 & 10 & a total 26 (40.63%) cases were occurred i.e. 21, 2 & 3 cases respectively in these groups. The group of 32 workers reached at Dhanseri Tea Company construction site on 11.6.1997 from the West Bengal & one of these worker cook meals for them. However the cook was not affected during this episode.

A total 11 cases were reported from Swadeshi Polyfills Ltd., this include 7 workers, two worker’s wife & two of their children.

The distribution of village cases reveals that a total 27 cases occurred in the seven villages. However it is noted that the severity of the village cases were very mild.

Age & Sex wise distribution of the cases shows that 83.38% of the cases were males & the maximum number of these cases i.e. 60.94% were in the age group of 15-44 years, as labourer & factory workers were mainly affected who were males in their age group of 15-44 years.

The first case reported from the Dhanseri tea company on 15.6.1997 night, thereafter maximum number of the cases occurred on 17.7.1997 & no case was repoted on 19.6.1997.

Cent per cent of the cases were giving the history of loose motions about 4-25 in numbers, watery, painless, without blood & no history of fever. However about 68.75% (44) cases were also giving the history or vomiting.

Case control study in the affected Sitapura Industrial area

For the case control study, 37 cases were taken from labourer of the Dhanseri Tea Company construction site & Swadeshi Polyfills Ltd. & 37 workers of the same age group & sex were taken as control from the nearby factory i.e. Autopal India Ltd. None of the control were suffered from Gastroenteritis. During detail study it was found found that the Autopal factory worker are bringing their meal from their home or taking meal in the factory canteen & the factory workers are being provided safe drinking water by a water cooler. However at Dhanseri Tea Company construction site & Swadeshi Polyfills Ltd. the source of drinking water is RIICO water supply system. It is noted that both the affected factory workers cook their meal at factory site under unhygenic conditions. They also store the cooking and drinking water in cement tank and earthenpots. The cement tank was found uncovered at the investigation time, however earthen pots were covered but these people were taking water by glass from the pots and they are living in an over crowded room. While in Autopal factory, the residential facility do not exists. The hand washing practice after defecation and before taking meal is there in the affected factory workers but using soap occasionally, sand oftenly and some time with only water also, while in Autopal India Ltd. provides soap in their canteen and toilet which the workers use regularly.

Water supply system in the area

A details study of the water supply system was conducted in the Sitapura Industrial area. They have deep tube wells, overhead tanks & RIICO water supply distribution system. In the Industrial area people also monitoring water quality at source. However at distribution point, water quality monitoring is not being carried out routinely.The chances of contamination of the water at source in overhead tanks distribution system is being excluded as the cases were occurred only in two factories. During field investigation it was observed that unhygenic storage of drinking water and their habit of taking drinking water may be responsible for the occurrence of the outbreaks. No sewage disposal & drainage system was available in the affected villages. However the proper drainage & sewage disposal system is present at RIICO, Sitapura Industrial area.

Laboratory Investigation

During the field survey in the industrial area, 16 rectal swabs were taken, 15 from cases and one from cook of the Dhanseri tea company from where the maximum number of cases were occurred. Two water samples were also taken. On the laboratory analysis of the 16 stool samples & 2 water samples all were found negative for cholera. Dhensari tea company workers may be suffered from cholera s they were belonging to known endemic area for cholera. The water storage habit, prevailing unhygenic conditions, overcrowded living conditions and typical symptomatology goes in favours of probably the occurrence of cholera in the labourer. However the aetiology of occurrence of gastro-enteritis cases in Swadeshi Polyfills Ltd. & in the rural areas could not be established.

August 1997

Outbreak of Leptospirosis

A severe outbreak of Leptospirosis hit Valsad District of Gujarat in the month of August/ September, 1997 resulting into great morbidity and significant mortality. The victims included poor Agricultural Labours/Farmers. The outbreak was investigated by the Division. Out of 332 sera samples received 87 were found to be Positive for Leptospira Antibodies.

September 1997

An outbreak of poliomyelitis in Lucknow, Barabanki and Gonda districts of Uttar Pradesh

National Institute of Communicable Diseases received a large of stools specimens from Lucknow, Barabanki and Gonda districts of Uttar Pradesh during end of August, 1997, of which more than 80% were found positive for wild polio virus Type-1. As well as news items in National newspaper appeared about sharp increase in polio cases in the above districts. Following this the Director NICD deputed Dr. Uma Chawla, Joing Diretor (Epidemiology) to investigate the episode in Gonda, Barabanki and Lucknow districts of Uttar Pradesh during September 8-12, 1997.

As per the State EPI reports, a total of 181 polio cases with no death have been reported from 20 districts (total-77) of the state from Jan.’97 to 12 Sept.’97. The districts primarily affected are Gonda (53), Lucknow (31), Behriach (25), Barabanki (20) and Baraille (15).

          Districtwise distribution of polio cases admitted in two NGO hospitals and cases

          reported by the Directorate of Family Welfare, U.P. Govt. during 95-97

          * No. of deaths

          ** As per the Dte. of FW records, polio cases reported from the above districts were maintained according to the fiscal years i.e. from April to march and not by Calendar year. Therefore, it is, difficulty to give exact figures for the year 1995.    

          The salient observations in respect to cold chain maintenance