Atypical presentation of Hand foot mouth disease (HFMD) caused by enterovirus serotype Coxsackievirus A6, in India

A 27-year-old male presented in the OPD of Naval Hospital in Port Blair, Andaman Islands, India, in 2011 with a history of low-grade fever associated with malaise and a pruritic skin rash. Case 2 – A 17-year-old male student reported to the OPD at Naval Hospital, Kochi Kerala, India, in August 2015. He presented with eruptions on both the palm and soles with a history of high-grade fever for the past 3–4 days. Clinically, both the cases were diagnosed as hand, foot, and mouth disease (HFMD). Both samples were tested against measles virus and varicella-zoster IgM antibodies by enzyme immunoassay and found negative. Stool sample (case 1) and lesion swab (case 2) were processed by enterovirus reverse transcription polymerase chain reaction and phylogenetic analysis, and both were positive for enterovirus human coxsackievirus A6 (CVA6) (untranslated region [UTR]). Phylogenetic analysis also confirmed that both the CVA6 etiology belonged to the genotype F. HFMD in adults often asymptomatic and very few patients get atypical symptoms. Clinical diagnosis is often troublesome to identify HFMD in such cases. An epidemiological surveillance/vigilance is essential to document these atypical cases in near future in developing countries like India

Experiences of sharing results of community based serosurvey with participants in a district of Maharashtra, India.

A growing number of organisations, including medical associations, recommend that research subjects should be given the option of being informed about the general outcome and results of the study. We recently completed a study involving nine serosurveys from 2018 to 2020 in five districts of India among three age groups (children 9 months to < 5 years; 5 to < 15 years of age, and women 15 to < 50 years of age before and after the measles and rubella (MR) vaccination campaigns). In Palghar district of Maharashtra all individuals in 30 selected clusters were enumerated, and 13 individuals per age group were randomly sampled. We established the procedures to return the results to the respondents for each stage of the survey. Of the 1,166 individuals selected for the measles and rubella serosurvey, 971 (83%) agreed to participate and were enrolled. Participants were informed that they will only be contacted if they test seronegative for measles and/or rubella antibodies. Overall, 140 individuals enrolled in the survey tested seronegative for IgG antibodies to measles and/or rubella viruses; were provided the reports and informed to seek medical advice. Upon follow up by phone, 10% (14) of the 140 participants reported to have been vaccinated. In this paper we discuss the procedures, experiences and considerations in returning results to participants in a community-based measles and rubella serosurvey. Although the lessons learned are specific to post measles-rubella vaccine campaign serosurvey in India, they might be helpful to those contemplating sharing results to participants of large scale survey settings

National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: A study protocol.

BackgroundSnakebite envenoming (SBE) is an acute, life-threatening emergency in tropical and subtropical countries. It is an occupational hazard and a major socioeconomic determinant. Limited awareness, superstitions, lack of trained health providers, poor utilization of anti-venom results in high mortality and morbidity. India is the snakebite capital of the world. Yet, information on awareness, knowledge, and perceptions about snakebite is limited. Data on capacity building of health systems and its potential impact is lacking. Recommended by the National Task Force on snakebite research in India, this protocol describes the National Snakebite Project aiming for capacity building of health systems on prevention and management of snakebite envenomation in Maharashtra and Odisha states.MethodsA cross-sectional, multi-centric study will be carried out in Shahapur, Aheri blocks of Maharashtra, and Khordha, Kasipur blocks of Odisha. The study has five phases: Phase I involves the collection of retrospective baseline data of snakebites, facility surveys, and community focus group discussions (FGDs). Phase II involves developing and implementing educational intervention programs for the community. Phase III will assess the knowledge and practices of the healthcare providers on snakebite management followed by their training in Phase IV. Phase V will evaluate the impact of the interventions on the community and healthcare system through FGDs and comparison of prospective and baseline data.DiscussionThe National Snakebite Project will use a multi-sectoral approach to reduce the burden of SBE. It intends to contribute to community empowerment and capacity building of the public healthcare system on the prevention and management of SBE. The results could be useful for upscaling to other Indian states, South Asia and other tropical countries. The findings of the study will provide critical regional inputs for the revision of the National Snakebite Treatment protocol.Trial registrationRegistered under the Clinical Trials Registry India no. CTRI/2021/11/038137