Modelling the Impact of a Smallpox Attack in India and Influence of Disease Control Measures
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History and Epidemiology of Global Smallpox Eradication Smallpox
History and Epidemiology of Global Smallpox Eradication Smallpox Three Egyptian Mummies 1570-1085 BC Ramses the Vth Died 1157 BC Early Written Description of Smallpox India 400 AD “Severe pain is felt in the large and small joints, with cough, shaking, listlessness and langour; the palate, lips, and tongue are dry with thirst and no appetite. The pustules are red, yellow, and white and they are accompanied by burning pain. The form soon ripens …the body has a blue color and seems studded with rice. The pustules become black and flat, are depressed in the centre, with much pain.” Smallpox and History • In the Elephant war in Mecca 568 AD, smallpox decimated the Ethiopian soldiers • Introduction of smallpox into the new world (Carribean 1507, Mexico 1520, Peru 1524, and Brazil 1555 ) facilitated Spanish conquest • Smallpox destroys Hottentots (1713) • In 1738, smallpox killed half the Cherokee Indian population • Smallpox disrupted colonial army in 1776 Smallpox Control Strategies • Smallpox hospitals (Japan 982 AD). • Variolation 10th Century. • Quarantine 1650s. • Home isolation of smallpox in Virginia 1667. • Inoculation and isolation (Haygarth 1793). • Jenner and widespread practice of vaccination throughout Europe and rest of the world. • Mass vaccination. • Surveillance containment. Variolation Inoculation with Smallpox Pus • Observations: – Pocked marked persons never affected with smallpox – Persons inoculated with smallpox pustular fluid or dried scabs usually had milder disease • Not ideal control strategy – Case fatality rate still 2% – Can transmit disease to others during illness The 1st Smallpox Vaccination Jenner 1796 Cowpox lesions on the hand of Sarah Nelmes (case XVI in Jenner’s Inquiry), from which material was taken for the vaccination of James Phipps below in 1796 History of Smallpox Vaccination 1805 Growth of virus on the flank of a calf in Italy. -
The 1947 Smallpox Vaccination Campaign in New York City, Revisited
LETTERS The 1947 Smallpox Two days later, epidemiologic contrast, the Army and Navy had investigation indicated that all given almost 800,000 doses, and the Vaccination patients with diagnosed cases were city’s public health laboratories had Campaign in New related and that, in all likelihood, the made the remaining 400,000. York City, Revisited outbreak had been successfully halted During the shortage, the Times through tracing the movements of the noted, “hundreds of eager men, To the Editor: In 1947, millions of various patients and vaccinating any- women, and children queued up at New Yorkers received smallpox vacci- one who had contact with them, so- Bellevue Hospital at dawn, although nations, an accomplishment still appro- called “ring” vaccination (4). Despite vaccinations were not scheduled to priately held up as an example of pub- this halt of the outbreak, the city begin until 10 a.m. At some stations, lic health planning and mobilization. pushed forward. The campaign to “Be the crowds did not take kindly to the Although now mythological, a review sure, be safe, get vaccinated!” had news that the doctors had run out of of the events of April 1947, from proven successful. By city estimate, vaccine and the police had a little dif- copies of The New York Times (1–9), >600,000 persons had received vac- ficulty dispersing a crowd of several tells of a more recognizably human cine in the first week. hundred” outside one vaccine station response: pushing, jawing, deceit, Vaccine side effects, which domi- (5). shortages, surpluses, and perhaps a nate coverage of today’s vaccination On April 17, the situation bright- unusual way of counting vaccinees. -
Determinants of Childhood Immunisation Coverage in Urban Poor Settlements of Delhi, India: a Cross-Sectional Study
Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-013015 on 26 August 2016. Downloaded from Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study Niveditha Devasenapathy,1 Suparna Ghosh Jerath,1 Saket Sharma,1 Elizabeth Allen,2 Anuraj H Shankar,3 Sanjay Zodpey1 To cite: Devasenapathy N, ABSTRACT Strengths and limitations of this study Ghosh Jerath S, Sharma S, Objectives: Aggregate data on childhood et al. Determinants of immunisation from urban settings may not reflect the ▪ childhood immunisation We report current estimates of childhood com- coverage among the urban poor. This study provides coverage in urban plete immunisation including hepatitis B vaccine poor settlements of Delhi, information on complete childhood immunisation coverage from representative urban poor com- India: a cross-sectional study. coverage among the urban poor, and explores its munities in the Southeast of Delhi. BMJ Open 2016;6:e013015. household and neighbourhood-level determinants. ▪ The sample size was large and therefore our doi:10.1136/bmjopen-2016- Setting: Urban poor community in the Southeast effect estimates for coverage and determinants 013015 district of Delhi, India. were precise. Participants: We randomly sampled 1849 children ▪ We quantify unknown neighbourhood effects on ▸ Prepublication history and aged 1–3.5 years from 13 451 households in 39 this outcome using median ORs which are more additional material is clusters (cluster defined as area covered by a intuitively understood. available. To view please visit community health worker) in 2 large urban poor ▪ Based on the data, representative of only one the journal (http://dx.doi.org/ settlements. -
Issues to Consider: Smallpox Response Plans
ISSUES TO CONSIDER: SMALLPOX RESPONSE PLANS Smallpox is one of history’s greatest scourges, and its eradication is one of medicine’s greatest triumphs. Because it is both highly contagious and highly lethal, smallpox presents a preeminent threat as a biological weapon. While all the countries represented in Atlantic Storm have smallpox response plans, which vary widely in their substance and length, all address roughly the same set of key issues: 1. Alert Levels • Most countries have developed a system of “alert levels” that direct their actions for preparedness and response. • Alert levels generally start at “zero,” which signifies no cases of smallpox anywhere in the world, and progress upward through levels determined according to the number and location of suspected and/or confirmed smallpox cases. • The most vigorous responses are triggered when smallpox cases appear within a given country’s boundaries. 2. Smallpox Vaccine and Vaccination Strategies • Countries have varying amounts of smallpox vaccine stockpiled for use in an emergency. Some countries have enough vaccine to cover every person in the nation, while others have minimal amounts that would cover less than 5% of their population. • Most countries, and the World Health Organization, consider “ring vaccination” to be the preferred strategy for controlling the spread of disease. Ring vaccination is typically characterized by an effort to identify and vaccinate all of the direct contacts of confirmed smallpox victims, including friends, family members, and co- workers. • Most countries indicate that if it appears that a smallpox epidemic cannot be controlled through ring vaccination, they would switch to mass vaccination, which is the vaccination of all individuals in an area (city, region, or entire country) regardless of exposure to the smallpox virus. -
Analysis of the Universal Immunization Programme and Introduction
Vaccine 32S (2014) A151–A161 Contents lists available at ScienceDirect Vaccine j ournal homepage: www.elsevier.com/locate/vaccine Analysis of the Universal Immunization Programme and introduction of a rotavirus vaccine in India with IndiaSim a a,b a c Itamar Megiddo , Abigail R. Colson , Arindam Nandi , Susmita Chatterjee , d e a,b,c,∗ Shankar Prinja , Ajay Khera , Ramanan Laxminarayan a Center for Disease Dynamics, Economics & Policy, Washington, DC, USA b Princeton Environmental Institute, Princeton University, Princeton, NJ, USA c Public Health Foundation of India, New Delhi, India d School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India e Ministry of Health and Family Welfare, Government of India, New Delhi, India a b s t r a c t Background and objectives: India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India’s Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India’s population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. Methods: We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. -
Why Is the Vaccination Rate Low in India?
medRxiv preprint doi: https://doi.org/10.1101/2021.01.21.21250216; this version posted February 18, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Why is the Vaccination Rate Low in India? First Version: 21st January 2021 This Version: 15th February 2021 Pramod Kumar Sur Asian Growth Research Institute (AGI) and Osaka University [email protected] Abstract India has had an established universal immunization program since 1985 and immunization services are available for free in healthcare facilities. Despite this, India has one of the lowest vaccination rates globally and contributes to the largest pool of under-vaccinated children in the world. Why is the vaccination rate low in India? This paper explores the importance of historical events in shaping India’s current vaccination practices. We examine India’s aggressive family planning program implemented during the period of emergency rule in the 1970s, under which millions of individuals were forcibly sterilized. We find that greater exposure to the forced sterilization policy has had negative effects on the current vaccination rate. We also find that institutional delivery and antenatal care are currently low in states where policy exposure is high. Together, the evidence suggests that the forced sterilization policy has had a persistent effect on current health-seeking behavior in India. Keywords: Vaccination, family planning, sterilization, institutional delivery, antenatal care, persistence JEL Classification: N35, I15, I18, O53, Z1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. -
A Brief History of Vaccines & Vaccination in India
[Downloaded free from http://www.ijmr.org.in on Wednesday, August 26, 2020, IP: 14.139.60.52] Review Article Indian J Med Res 139, April 2014, pp 491-511 A brief history of vaccines & vaccination in India Chandrakant Lahariya Formerly Department of Community Medicine, G.R. Medical College, Gwalior, India Received December 31, 2012 The challenges faced in delivering lifesaving vaccines to the targeted beneficiaries need to be addressed from the existing knowledge and learning from the past. This review documents the history of vaccines and vaccination in India with an objective to derive lessons for policy direction to expand the benefits of vaccination in the country. A brief historical perspective on smallpox disease and preventive efforts since antiquity is followed by an overview of 19th century efforts to replace variolation by vaccination, setting up of a few vaccine institutes, cholera vaccine trial and the discovery of plague vaccine. The early twentieth century witnessed the challenges in expansion of smallpox vaccination, typhoid vaccine trial in Indian army personnel, and setting up of vaccine institutes in almost each of the then Indian States. In the post-independence period, the BCG vaccine laboratory and other national institutes were established; a number of private vaccine manufacturers came up, besides the continuation of smallpox eradication effort till the country became smallpox free in 1977. The Expanded Programme of Immunization (EPI) (1978) and then Universal Immunization Programme (UIP) (1985) were launched in India. The intervening events since UIP till India being declared non-endemic for poliomyelitis in 2012 have been described. Though the preventive efforts from diseases were practiced in India, the reluctance, opposition and a slow acceptance of vaccination have been the characteristic of vaccination history in the country. -
Smallpox: Should Everyone Be Vaccinated?
10/25/2019 WebMD/Lycos - Article - Smallpox: Should Everyone Be Vaccinated? Lycos Home | Site Map | My Lycos SEARCH HEALTH FOR: Search Health Home Smallpox: Should Everyone Be Health News Vaccinated? Conditions A-Z Drugs & Herbs Study Says 'Yes' -- If Biological Terrorist Attack Has Occurred Wellness Topics By Jeanie Davis Medical Library Resource Center Health Calculators July 10, 2002 -- America is gearing up for the worst-case scenario - Find a Physician - a deadly smallpox attack. The best defense is mass inoculation, Chat & Events with all U.S. residents rolling up their sleeves as soon as there's Message Boards evidence of exposure, says one Yale epidemiologist. Member Columns The Yale report comes on the heels of a new federal announcement -- one calling for vaccination of emergency personnel and Sign In healthcare workers, some 500,000 people. Each state would Post a message, designate teams to receive the shots, teams that will consist of chat... doctors, disease trackers, nurses, lab workers, and law enforcement Join officers -- the first to respond in case of bioterrorism attack, Free newsletters according to the Department of Health and Human Services. and more Volunteers at four sites around the country are already being Event Highlight inoculated with diluted doses of two vaccines to test their effectiveness. A vaccine known as Dryvax was made 20 years ago; Monday, August 15 million doses of it are available. Another vaccine by Aventis 26, 2002 9:00 Pasteur, Inc., was donated to the government; the company has a.m. stockpiled it for decades. Virtual Vacation: Lake Austin Spa "I think it makes sense to vaccinate emergency responders pre- Resort attack, precisely so that there will be a pool of persons who can protect the rest of us," says Edward H. -
Ring Vaccination and Smallpox Control Mirjam Kretzschmar,* Susan Van Den Hof,* Jacco Wallinga,* and Jan Van Wijngaarden†
RESEARCH Ring Vaccination and Smallpox Control Mirjam Kretzschmar,* Susan van den Hof,* Jacco Wallinga,* and Jan van Wijngaarden† We present a stochastic model for the spread of small- We investigated which conditions are the best for effec- pox after a small number of index cases are introduced into tive use of ring vaccination, a strategy in which direct con- a susceptible population. The model describes a branching tacts of diagnosed cases are identified and vaccinated. We process for the spread of the infection and the effects of also investigated whether monitoring contacts contributes intervention measures. We discuss scenarios in which ring to the success of ring vaccination. We used a stochastic vaccination of direct contacts of infected persons is suffi- cient to contain an epidemic. Ring vaccination can be suc- model that distinguished between close and casual con- cessful if infectious cases are rapidly diagnosed. However, tacts to explore the variability in the number of infected because of the inherent stochastic nature of epidemic out- persons during an outbreak, and the time until the outbreak breaks, both the size and duration of contained outbreaks is over. We derived expressions for the basic reproduction are highly variable. Intervention requirements depend on number (R0) and the effective reproduction number (Rυ). the basic reproduction number (R0), for which different esti- We investigated how effectiveness of ring vaccination mates exist. When faced with the decision of whether to rely depends on the time until diagnosis of a symptomatic case, on ring vaccination, the public health community should be the time to identify and vaccinate contacts in the close con- aware that an epidemic might take time to subside even for tact and casual contact ring, and the vaccination coverage an eventually successful intervention strategy. -
IJPP Hemotology 9-2-08
2009; 11(1) : 1 INDIAN JOURNAL OF IJPP PRACTICAL PEDIATRICS • • IJPP is a quarterly subscription journal of the Indian Academy of Pediatrics committed to presenting practical pediatric issues and management updates in a simple and clear manner • • Indexed in Excerpta Medica, CABI Publishing. Vol.11 No.1 JAN.-MAR.2009 Dr. K.Nedunchelian Dr. S. Thangavelu Editor-in-Chief Executive Editor CONTENTS FROM THE EDITOR'S DESK 3 TOPIC OF INTEREST - TOXICOLOGY Organophosphate, carbamate and rodenticide poisoning 6 - Rajendiran C, Ravi G, Thirumalaikolundu Subramanian P Hydrocarbon and related compounds poisoning 15 - Utpal Kant Singh, Prasad R, Gaurav A Common drug poisoning 22 - Suresh Gupta Corrosive poisoning 37 - Jayanthi Ramesh House hold material poisoning 41 - Shuba S, Betty Chacko Cardiotoxins 53 - Rashmi Kapoor Narcotic poisoning 64 - Kala Ebinazer Journal Office and address for communications: Dr. K.Nedunchelian, Editor-in-Chief, Indian Journal of Practical Pediatrics, 1A, Block II, Krsna Apartments, 50, Halls Road, Egmore, Chennai - 600 008. Tamil Nadu, India. Tel.No. : 044-28190032 E.mail : [email protected] 1 Indian Journal of Practical Pediatrics 2009; 11(1) : 2 GENERAL ARTICLES Intrauterine growth retardation : Journey from conception to late adulthood 68 - Neelam Kler, Naveen Gupta Child adoption 82 - Ganesh R, Suresh N, Eswara Raja T, Lalitha Janakiraman, Vasanthi T DERMATOLOGY Ichthyosis - An approach 86 - Anandan V PICTURE QUIZ 91 RADIOLOGIST TALKS TO YOU Disorders of ventral induction and similar conditions - I 92 - Vijayalakshmi G, Elavarasu E, Vijayalakshmi M, Venkatesan MD CASE STUDY Unusual complication of nasogastric tube insertion in a child 95 - Poovazhagi V, Shanthi S, Vijayaraghavan A, Kulandai Kasturi R Congenital miliary tuberculosis 97 - Vijayakumari, Suresh DV CLIPPINGS 14,21,52,63,81,94 NEWS AND NOTES 85,90 FOR YOUR KIND ATTENTION * The views expressed by the authors do not necessarily reflect those of the sponsor or publisher. -
Strategy for COVID-19 Vaccination in India: the Country with the Second Highest Population and Number of Cases ✉ Velayudhan Mohan Kumar 1, Seithikurippu R
www.nature.com/npjvaccines PERSPECTIVE OPEN Strategy for COVID-19 vaccination in India: the country with the second highest population and number of cases ✉ Velayudhan Mohan Kumar 1, Seithikurippu R. Pandi-Perumal 2 , Ilya Trakht3 and Sadras Panchatcharam Thyagarajan 4 Free vaccination against COVID-19 commenced in India on January 16, 2021, and the government is urging all of its citizens to be immunized, in what is expected to be the largest vaccination program in the world. Out of the eight COVID-19 vaccines that are currently under various stages of clinical trials in India, four were developed in the country. India’s drug regulator has approved restricted emergency use of Covishield (the name employed in India for the Oxford-AstraZeneca vaccine) and Covaxin, the home- grown vaccine produced by Bharat Biotech. Indian manufacturers have stated that they have the capacity to meet the country’s future needs for COVID-19 vaccines. The manpower and cold-chain infrastructure established before the pandemic are sufficient for the initial vaccination of 30 million healthcare workers. The Indian government has taken urgent measures to expand the country’s vaccine manufacturing capacity and has also developed an efficient digital system to address and monitor all the aspects of vaccine administration. npj Vaccines (2021) 6:60 ; https://doi.org/10.1038/s41541-021-00327-2 1234567890():,; INTRODUCTION eight vaccine candidates, currently undergoing clinical trials in A year has passed since the first case of novel coronavirus India, is shown in Table 1 and their technical details are given in 13 infections was detected in China’s Wuhan province. -
JANUARY 2014 S. No Principal Investigator Department Title Fund
LIST OF STUDIES WITH RESPECTIVE FUNDING AGENCY JANUARY 2006 – JANUARY 2014 Principal S. No Department Title Funding Agency Investigator A randomized, double-blind, placebo-controlled, parallel group study to determine whether, in patients with type 2 diabetes at AACT – Academic 1 Dr. Nihal Thomas Endocrinology high risk for cardiovascular and renal events, aliskiren, on top of Alliance for Clinical conventional treatment, reduces cardiovascular and renal Trials morbidity and mortality. This prospective, open label, multi –center, observational, single- 2 Dr. Sunil Chandy Cardiology arm registry is designed to XIENCE VEECSS continued safety and Abbott Vascular effectiveness during commercial use in real world settings. Prospective, randomized, placebo-controlled, double-blind, Dr. Debashish Clinical Immunology multicenter, parallel group study to assess the efficacy, safety and 3 Actelion Danda & Rheumatology tolerability of macitentan in patients with ischemic digital ulcers associated with systemic sclerosis. Targeted Second- Generation Resequencing for the Molecular 4 Dr. Nihal Thomas Endocrinology Genetic Diagnosis of Maturity Onset Diabetes of the Young Actelion (MODY). A randomized, active therapy controlled phase 2 study to assess Advaxis Inc, North 5 Dr. Subhashini John Radiation Therapy the safety and efficacy of ADXS11-001 with or without Cisplatin Brunswick as 2nd line therapy for the treatment of recurrent cervix cancer. A multicentre, open label, parallel group, randomized, phase IIB Adventrux Dr. Raju Titus clinical trial to evaluate the safety and efficacy of CofactorTM and 6 Medical Oncology Pharmaceuticals, Chacko 5-FU versus Leucovorin and 5-FU in subjects with Metastatic USA colorectal carcinoma. FORTIS-M: A phase 3, randomized, double-blind, placebo- controlled study of oral talactoferrin in addition to best 7 Dr.