Browsing by Author "John, T Jacob"
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Item 2009 Pandemic Influenza in India.(2010-01) John, T Jacob; Moorthy, MaheshPandemic-09-H1N1 virus caused the pandemic starting in the second quarter of 2009. The world was prepared to face the pandemic since it was anticipated for over one decade. Most countries, including India, had made detailed pandemic preparedness plans well ahead of its actual occurrence. The infection rapidly spread to the whole country within 2-3 months. The national tactics were to slow down its importation through international air travelers and to slow down its spread in cities and major towns. More than 75% of all infected persons were urban dwellers, suggesting that efforts were concentrated in urban communities. In general the illness of pandemic influenza has been similar to endemic/seasonal influenza; however, there is insufficient epidemiological and clinical data on the latter. We hope that the unprecedented experience of managing the pandemic will encourage the Government of India to plan to confront endemic/seasonal influenza more systematically. The pandemic seems to have reached a peak in September/October and has been on the decline since then.Item Accelerating measles control in India: Opportunity and obligation to act now.(2009-11) John, T Jacob; Choudhury, PannaItem Antibody response to pulse polio immunization in Aligarh.(2005-01-08) John, T JacobItem Atypical Features of Severe Dengue: Probable Pathogenesis.(2015-04) John, T Jacob; Eapen, C EItem Authors’ response.(2010-03) John, T Jacob; Muliyil, JayaprakashItem Avian influenza: expect the best but prepare for the worst.(2004-02-02) John, T JacobItem A bedside dipstick method to detect Plasmodium falciparum.(2005-04-07) John, T Jacob; John, Sushil MathewItem Cassia occidentalis poisoning as the probable cause of hepatomyoencephalopathy in children in western Uttar Pradesh.(2007-06-21) Vashishtha, V M; Kumar, Amod; John, T Jacob; Nayak, N CBACKGROUND & OBJECTIVE: Recurrent annual outbreaks of acute encephalopathy illness affecting young children have been reported for several years in many districts of western Uttar Pradesh (UP). Our earlier investigations over three consecutive years (2002-2005) proved that these outbreaks were due to a fatal multi-system disease (hepatomyoencephalopathy syndrome) probably caused by some phytotoxin and not due to viral encephalitis as believed so far. We conducted a case-control study to investigate the risk, if any, from various environmental factors and also to identify the putative toxic plant responsible for development of this syndrome. METHODS: Eighteen cases with acute hepatomyoencephalopathy syndrome admitted in 2005 in a secondary care paediatric hospital of Bijnor district of western UP were included in the study. Three age-matched controls were selected for each case. A semi-structured questionnaire was developed and applied to all 18 cases and 54 controls. All interviews were conducted within one week of discharge or death of each case. Quantitative data were analyzed using the relevant established statistical tests. RESULTS: Parents of 8 (44.4%) cases gave a definite history of their children eating beans of Cassia occidentalis weed before falling ill, compared with 3 (5.6% controls), the odds ratio being 12.9 (95% CI 2.6-88.8, P<0.001). History of pica was the other associated factor with the disease, odds ratio 5.20 (95% CI 1.4-19.5, P<0.01). No other factor was found significantly associated with the disease. INTERPRETATION & CONCLUSION: Consumption of C. occidentalis beans probably caused these outbreaks, described earlier as hepatomyoencephalopathy syndrome. Public education has the potential to prevent future outbreaks.Item Cassia occidentalis poisoning causes fatal coma in children in western Uttar Pradesh.(2007-07-09) Vashishtha, Vipin M; Kumar, Amod; John, T Jacob; Nayak, N CWe investigated cases of the annual seasonal outbreaks of acute hepato-myo-encephalopathy in young children in western Uttar Pradesh for causal association with Cassia occidentalis poisoning, by a prospective survey in 2006. During September-October homes of 10 consecutive cases were visited and history of eating Cassia beans was obtained in all. Nine children died within 4-5 days. There appears to be an etiological association between consumption of Cassia occidentalis beans and acute hepato-myo-encephalopathy.Item Chandipura virus – what we know & do not know.(2010-08) John, T JacobItem Clinical manifestations of HIV-1 infection.(2002-01-24) Verghese, Valsan Philip; Cherian, Thomas; Cherian, Anil J; Babu, P George; John, T Jacob; Kirubakaran, Chellam; Raghupathy, PItem Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India.(2004-08-07) John, T Jacob; Rajappan, K; Arjunan, K KBACKGROUND & OBJECTIVES: A disease surveillance model developed in the North Arcot district, Tamil Nadu, was found to be practical, efficient, inexpensive and useful for public health action to monitor the success of ongoing interventions and to detect and intercept outbreaks. It was centred in the private (voluntary) sector with full co-operation and participation by the government sector. As Kerala state wanted to replicate this model in all districts, one district was chosen to pilot test it centred within the existing district public health system, soliciting participation from the private sector. A two-year (1999-2001) performance of this model is presented. METHODS: After elaborate preparations including the selection of 14 diseases to be reported and training of doctors in the private sector health care institutions and doctors and paramedical staff in all government health centres and hospitals, printed post cards were widely distributed. The business reply system was used so as to avoid handling postage stamps. Cards were received by the nodal officer in the district public health office and checked on a daily basis to detect disease prevalence and evidence of clustering in time and space. Swift action was taken on detecting case clustering. A monthly bulletin containing disease summaries and other useful information was freely distributed to all reporting centres. RESULTS: On an average, just over 100 disease reports were received every month. The most frequently reported diseases were, in the descending order, leptospirosis, acute dysentery, typhoid fever and acute hepatitis. Among vaccine-preventable childhood diseases, only measles was reported, but no diphtheria, tetanus or whooping cough. Several outbreaks were detected early and interventions applied to intercept them. The most striking example was that of cholera, the occurrence of which was detected swiftly for instituting highly successful control measures. INTERPRETATION & CONCLUSION: The district level disease surveillance system centred in the government public health system has been highly successful. Disease surveillance was responsible for the government to obtain information on the prevalence of leptospirosis in the district. The reports enabled the public health officers to detect disease-clustering as the early signals of outbreaks and to take quick remedial measures.Item Control of Tuberculosis in India: President’s Vision and Bold Initiative.(2015-08) John, T JacobItem Death of children after measles vaccination.(2008-06-05) John, T JacobItem Detecting mycobacteraemia for diagnosing tuberculosis.(2004-06-10) David, S Thambu; Mukundan, Umadevi; Brahmadathan, K N; John, T JacobBACKGROUND & OBJECTIVES: In human immunodeficiency virus (HIV) infected persons with pulmonary tuberculosis (TB), sputum may not always show acid fast bacilli (AFB). Moreover, in most cases of suspected extrapulmonary TB (irrespective of HIV status) mycobacteria-containing material is not readily available for investigation. This study evaluated whether blood culture for Mycobacterium tuberculosis bacteraemia (mycobacteraemia) help in diagnosing TB in such cases. METHODS: A total of 93 consecutive subjects with a clinical diagnosis of tuberculosis with or without laboratory confirmation, 42 with and 38 without coexisting HIV infection, and 13 patients with HIV infection without clinical evidence of TB were enrolled. Mycobacterial blood cultures were done using lysis centrifugation technique followed by subculturing onto the modified Lowenstein-Jenson medium (LJ-1) and Selective Kirchner's medium followed by subculturing onto the modified Lowenstein-Jenson medium (LJ-2, LJ-3). RESULTS: Of the 15 (16.2%) subjects with evidence of mycobacteremia in 4 (26.7%) blood was the first/ only source of diagnosing TB. Among 80 patients with clinical diagnosis of TB whether supported by laboratory tests or not, 14 (17.5%) had mycobacteraemia. Among the 21 HIV infected patients with laboratory proven TB, 9 (43%) had mycobacteraemia. INTERPRETATION & CONCLUSION: Blood culture appears to be a useful additional test to diagnose TB in persons with HIV infection. In patients without HIV infection, but with clinical picture compatible with TB, blood culture for mycobacteraemia may occasionally help in the diagnosis. We recommend the use of the lysis centrifugation technique followed by direct smear of the sediment along with inoculation of the sediment into both modified Lowenstein-Jenson medium and the Selective Kirchner's medium with subsequent subculturing onto the modified Lowenstein-Jenson medium for mycobacterial blood culture for detecting mycobacteraemia.Item Efficacy and Safety of Azithromycin for Typhoid Fever.(2011-10) John, T JacobItem Encephalopathy Clusters Conflated with Encephalitis Outbreaks.(2014-11) John, T JacobItem Encephalopathy without rash, caused by measles virus? More evidence is needed.(2003-06-26) John, T JacobItem Eradicating poliomyelitis: India's journey from hyperendemic to polio-free status.(2013-05) John, T Jacob; Vashishtha, Vipin MIndia's success in eliminating wild polioviruses (WPVs) has been acclaimed globally. Since the last case on January 13, 2011 success has been sustained for two years. By early 2014 India could be certified free of WPV transmission, if no indigenous transmission occurs, the chances of which is considered zero. Until early 1990s India was hyperendemic for polio, with an average of 500 to 1000 children getting paralysed daily. In spite of introducing trivalent oral poliovirus vaccine (tOPV) in the Expanded Programme on Immunization (EPI) in 1979, the burden of polio did not fall below that of the pre-EPI era for a decade. One of the main reasons was the low vaccine efficacy (VE) of tOPV against WPV types 1 and 3. The VE of tOPV was highest for type 2 and WPV type 2 was eliminated in 1999 itself as the average per-capita vaccine coverage reached 6. The VE against types 1 and 3 was the lowest in Uttar Pradesh and Bihar, where the force of transmission of WPVs was maximum on account of the highest infant-population density. Transmission was finally interrupted with sustained and extraordinary efforts. During the years since 2004 annual pulse polio vaccination campaigns were conducted 10 times each year, virtually every child was tracked and vaccinated - including in all transit points and transport vehicles, monovalent OPV types 1 and 3 were licensed and applied in titrated campaigns according to WPV epidemiology and bivalent OPV (bOPV, with both types 1 and 3) was developed and judiciously deployed. Elimination of WPVs with OPV is only phase 1 of polio eradication. India is poised to progress to phase 2, with introduction of inactivated poliovirus vaccine (IPV), switch from tOPV to bOPV and final elimination of all vaccine-related and vaccine-derived polioviruses. True polio eradication demands zero incidence of poliovirus infection, wild and vaccine.Item Eradication of vaccine polioviruses: why, when & how.(2009-11) John, T Jacob; Vashishtha, Vipin M