Episode of coexisting infections with multiple dengue virus serotypes in central Karnataka, India

Summary: Background: The co-circulation of multiple dengue virus serotypes has been reported in many parts of the world, including India; however, concurrent infection with more than one serotype of dengue virus in the same individual is rarely documented. Method: An outbreak of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) occurred in and around Davangere, Karnataka, from June 2011–March 2012. This is the first report from India with a high percentage of concurrent infections with different dengue virus serotypes circulating during one outbreak. Acute phase sera from patients were tested for the presence of dengue virus RNA by RT-PCR. Results: Of the 72 samples tested for dengue virus RNA, 42 (58.3%) were positive. All four dengue virus serotypes were found to be co-circulating in this outbreak, and DENV-2 was the predominant serotype. In addition, concurrent infection with more than one dengue virus serotype was identified in 18 (42.9%) dengue virus-positive samples. Conclusion: Our study showed that serotype DEN-2 was dominant in the positive dengue virus-infected samples; the other serotype present was DEN-3. This is the first report of concurrent infections with different dengue virus serotypes in this part of the world. Keywords: Dengue fever, Concurrent infection, RT-PC

Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study

Objective: To explore potential reasons for differences in preterm neonatal mortality in neonatal intensive care units (NICUs) in India and Pakistan.Design: A prospective observational study, the Project to Understand and Research Stillbirth and Preterms in Southeast Asia (PURPOSe) was conducted July 2018 to February 2020.Setting: Three hospitals in Davangere, India, and a large public hospital in Karachi, Pakistan.Population: Of a total of 3,202 preterm infants enrolled, 1,512 were admitted to a study NICU.Methods: We collected data for neonates, including length of stay, diagnoses, and diagnostic tests.Main outcome measures: Neonatal mortality, tests performed, diagnoses ascertained.Results: For infants of equivalent weights and gestational ages, neonatal mortality in Pakistan was twice that in the Indian NICU. The mean newborn length of stay in Pakistan was 2 days compared with 10 days for India. Fewer diagnostics and other investigations were used to determine neonatal condition or guide treatment in the Pakistani NICU. Because of limited information from testing in Pakistan concerning clinical respiratory distress, respiratory distress syndrome appeared to be over-diagnosed, whereas other conditions including pneumonia, sepsis, necrotising entercolitis and intraventricular haemorrhage were rarely diagnosed.Conclusion: In the Pakistani site, the limited resources available to the NICU appeared related to a shorter length of stay and decreased diagnostic testing, likely explaining the higher mortality. With improved care, reduction in mortality among preterm neonates should be achievable