Trends in the Epidemiology of Hepatitis B Virus and Hepatitis C Virus Infections at a Tertiary Care Hospital in East Delhi: A 7-Year Retrospective Analysis

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are major global health problems. In 2009, the national Integrated Disease Surveillance Programme (IDSP) began conducting surveillance across all Indian states for epidemic-prone diseases including viral hepatitis. Hence this retrospective study was conducted to identify trend changes in HBV and HCV epidemiology over a period of 7 years at a tertiary care hospital in Delhi. Enzyme-linked immunoassay result entries for Hepatitis B surface antigen (HBsAg) and Hepatitis C antigen and/or anti-HCV antibody were analyzed. The 7-year seroprevalence of HBV and HCV was found to be 3.084% and 5.381% respectively. The seroprevalence of HBsAg was maximum in 2010. Since then the seroprevalence has shown a small decrease. Government of India has included HBV vaccine in the National Universal Immunization Program in the entire country in 2011-12. We consider the reduction in HBsAg seroprevalence to represent a true fall in HBV transmission due to vaccination and/or public consciousness. In the present study, HCV infection appeared to be more common than HBV infection. During last few years, seroprevalence of HCV also increased, which is possibly attributable to an increase in the population of Delhi and a heavy load of the migrant population. These figures may be important for estimation of the disease burden in this region. The study provides a fine reference for future studies, because of the large number of cases investigated over a long period of 7 years and draws attention to the lacunae in ongoing immunization programs

Co-Infection of HSV in Gonococcal Urethritis Patients

Co-infection with two different pathogens may alter the classical clinical course that manifests infection as single pathogen. In STIs, such co-infection may trigger the reactivation of a latent infection, and syndromic approach may not be insufficient to free the host of the entire gamut of infectivity agents. Present study analyzed appropriate samples for Neisseria gonorrheae and HSV from 200 patients presented to STI clinic. Gonorrhea was detected in 4% and HSV in 5% of patients. 25% of gonorrhea patients had HSV-2 co-infection with an overall 4.5% yield of subclinical HSV cases which would have been missed leading to inappropriate treatment, risk of recurrence and transmission to contacts. Awareness regarding encounter with multiple infections is necessary for effective management

Needle Stick Injury among Health Care Workers and Its Aftermath in a Tertiary Care Hospital in East Delhi, India

Needle stick injuries (NSI) present serious occupational threat to healthcare workers (HCW).Due to lack of epidemiological data on NSI in this geographical region, the present study was conducted to estimate incidence rate of NSI, identify factors associated, assess awareness of HCWs and evaluate post-injury sero-reactivity rates. This cross-sectional observational study involved 524 HCWs (151 medical and 373 paramedical staff). A validated questionnaire was filled by investigator using interviewing technique. Blood sample was collected from study subjects who reported NSI within last 28 days, at the time of NSI and subsequently after 1, 3 and 6 months. Screening for HBsAg, anti-HCV and anti-HIV 1/2 antibodies was done using commercially available Enzyme-Linked Immunosorbent Assay Kit. Sixty-three HCWs, comprising mainly of medical staff, gave history of NSI in preceding 28 days. The most frequent procedure leading to NSI included recapping needles and suturing in 28.57%, while commonest root cause was haste in 61.91%. Majority (61.91%, 39/63) suffered from NSI during latter part of their duty hours. None became HBsAg, anti-HCV or HIV seropositive. The proportion of NSI among HCWs who had received training on prevention and management of NSI was significantly lower than those who were untrained. Hence training programs emphasizing on safe techniques must be conducted regularly and HCWs putting in long working hours must be allowed to take breaks. Needle stick injury among health care workers and its aftermath in a tertiary care hospital in East Delhi, India

Hepatitis B & C virus infection in HIV seropositive individuals & their association with risk factors: A hospital-based study

Background & objectives: Hepatitis B and hepatitis C virus (HBV and HCV) cause acute and chronic hepatitis, and infections with HBV and HCV are common in HIV-infected patients. The present study was conducted to determine the co-infection of hepatitis B and C virus in stored serum samples of HIV-positive/negative individuals attending an Integrated Counselling and Testing Centre (ICTC) in north India and their association with certain risk factors. Methods: This study included a total of 840 serum samples, of which 440 were from HIV seropositive individuals and 400 were from control individuals seeking voluntary check-up of HIV status at ICTC. Serum samples were used for the detection of HBV and HCV infection. Results: HBV infection (11%) was found to be less in contrast to HCV (13%) amongst the HIV seropositive. In controls, HBV and HCV infection was two and three per cent, respectively. Co-infection of HBV and HCV was found in 15 of 109, and in controls, it was 2 of 15. Age group between 21 and 40 was significantly associated with HBV and HCV infection. Heterosexual contact was the leading mode of acquiring HBV and HCV infection. Interpretation & conclusions: HBV and HCV co-infection was found to be significantly higher in HIV-positive individuals in comparison to normal population. Hepatitis virus infection leads to rapid progression of liver cirrhosis in HIV-infected patients. Routine check-up of HIV seropositive patients for hepatitis virus may be required to monitor clinical outcome

Empirical model for estimating dengue incidence using temperature, rainfall, and relative humidity: a 19-year retrospective analysis in East Delhi

OBJECTIVES Aedes mosquitoes are responsible for transmitting the dengue virus. The mosquito lifecycle is known to be influenced by temperature, rainfall, and relative humidity. This retrospective study was planned to investigate whether climatic factors could be used to predict the occurrence of dengue in East Delhi. METHODS The number of monthly dengue cases reported over 19 years was obtained from the laboratory records of our institution. Monthly data of rainfall, temperature, and humidity collected from a local weather station were correlated with the number of monthly reported dengue cases. One-way analysis of variance was used to analyse whether the climatic parameters differed significantly among seasons. Four models were developed using negative binomial generalized linear model analysis. Monthly rainfall, temperature, humidity, were used as independent variables, and the number of dengue cases reported monthly was used as the dependent variable. The first model considered data from the same month, while the other three models involved incorporating data with a lag phase of 1, 2, and 3 months, respectively. RESULTS The greatest number of cases was reported during the post-monsoon period each year. Temperature, rainfall, and humidity varied significantly across the pre-monsoon, monsoon, and post-monsoon periods. The best correlation between these three climatic factors and dengue occurrence was at a time lag of 2 months. CONCLUSIONS This study found that temperature, rainfall, and relative humidity significantly affected dengue occurrence in East Delhi. This weather-based dengue empirical model can forecast potential outbreaks 2-month in advance, providing an early warning system for intensifying dengue control measures