Epidemiology and Vaccines

2009: Influenza A (H1N1) vaccine approved

SMALL POX

· Case (confirmed) definition for notification under IHRs (2005) : [Mnemonic:FRALL]

o Fever (≥38.3º C/101º F) acute onset at any age, malaise, prostration, headache, backache occurring 2-4 days prior to onset of rash AND

o Rash maculo-papular starting from face & forearms, evolving to vesicles (48 hours) and pustules (umblicated/confluent) later AND

o Lesions at same stage of development at any part of body AND

o Absence of Alternative diagnosis to explain illness AND

o Laboratory confirmation.

MEASLES

Coverage of 1st dose of Measles vaccine in world: 82% [2007]

· Proportional mortality rate in children <5 years: 1% [2008]

INFLUENZA: PANDEMIC (H1N1) 2009 INFLUENZA

· WHO declaration of Influenza pandemic: 11 June 2009

· World is now post-pandemic EXCEPT: INDIA & NEW ZEALAND (locally intense transmission)

· Problem statement India: 37000 cases, 1833 deaths [May 2009- August 2010]

· Incubation period : 2-3 days

· Clinical features:

o Uncomplicated influenza: Influenza like illness (Fever, cough, sorethroat, rhinorrhoea, headache, muscle pain), GIT illness (diarrhoea WITHOUT dehydration)

o Complicated/severe influenza: Pneumonia, CNS involvement, Severe diarrhoea, Secondary complications, Exacerbation of chronic diseases.

o Progressive disease: Oxygen impairment/cardiopulmonary insufficiency, CNS complications, Invasive secondary bacterial infection, Severe dehydration.

· Risk factors of severe disease:

o Infants & children < 2 years

o Pregnant females

o COPD

o Chronic cardiac disease

o Metabolic disorders

o Chronic renal/hepatic/neurological/hemoglobinopathies/immunosuppression (INCLUDING HIV) disorders

o Children on aspirin therapy

o Persons aged ≥ 65 years

o Morbid obesity.

· Laboratory diagnosis:

o Most timely & sensitive detection: RT-PCR test

o Samples: Nasopharyngeal + throat swabs [Tracheal/bronchial aspirates in lower respiratory tract infection cases]

o Point-of-care/Rapid diagnostic tests: Not recommended.

· Duration of isolation: for 7 days after onset of illness OR 24 hours after resolution of fever/respiratory symptoms whichever is longer.

· H1N1 Inactivated vaccine: Single i/m injection

o Strain : A/California/7/2009 (H1N1) V like strain

o Storage temperature: +2º to +8 º C

o Contraindications: History of anaphylaxis/severe reaction/Guillian Barre Syndrome, Infants <6 months, Moderate-to-severe illness with fever.

o Protective immunity: Develops after 14 days (NOT 100%).

· H1N1 Live attenuated vaccine: Nasal spray

o Side effects: Rhinorrhoea, nasal congestion, cough, sore throat, fever, wheezing, vomiting

· Priority groups (in order) for Influenza vaccines:

o Pregnant women

o Age > 6 months with chronic medical conditions

o 15-49 years healthy young adults

o Healthy young children

o Healthy adults 49-65 years

o Healthy adults >65 years.

· Antiviral therapy:

o Severe/progressive clinical illness: Oseltamivir (if not available or resistance, use Zanamivir)

o High risk of severe/complicated illness: Oseltamivir OR Zanamivir

o Not high risk OR Uncomplicated confirmed/suspected illness: No need of treatment.

· Dosage:

o Oseltamivir 75 mg BD X 5 days

o Zanamivir 2 inhalations (2 X 5 mg) BD X 5 days

ARI/PNEUMONIA: KEY INDICATORS (INDIA)-

· % under-five deaths due to Pneumonia: 20%

· % under-weight children : 46% (moderate to severe); 18% (severe)

· % exclusive breast-fed infants <6 months:46%

· % 1-year old immunised against Measles: 67%

· % under-five taken to appropriate health care provider for Pneumonia: 69%

TUBERCULOSIS

Daily self-administered Non-DOTS regime: ONLY if there are adverse reactions to drugs or patients compliance is not possible.

Non-DOTS regime 1 (ND1)

o Pulmonary (SS+ve) seriously ill

2 (SHE) + 10 (HE)

o Extra-pulmonary seriously ill

Non-DOTS regime 2 (ND2)

o Pulmonary (SS-ve) not seriously ill

12 (HE)

o Extra-pulmonary not seriously ill

· DOTS-PLUS (Category IV DOTS MDR-TB treatment):

Cat IV* MDR- TB

IP

CP

Duration

6(KOCZEEt)*

12-18 (OCEEt)

18-24 months

(* IP extended by 3 months if culture +ve at end of 4 months treatment

Follow-up sputum smears: 4, 6, 12, 18, 24 months of treatment)

MALARIA

· Six primary Malaria vectors in India:

o Anopheles culicifacies: Rural and peri-urban areas [Species A-P, vivax & P, falciparum; Species B-P.falciparum]

o Anopheles stephensi : Urban and industrial areas

o Anopheles fluviatilis: Hilly, forest and forest fringe areas

o Anopheles minimus: Foot-hills of NE states

o Anopheles dirus : Forests of NE states

o Anopheles epiroticus: Andaman & Nicobar islands

· Diagnosis of Malaria in India:

o Microscopy: Thick smear (High sensitivity in searching for parasite, parasite load estimation) + Thin file (for species identification, stages)

o Serological testing: Malaria Fluorescent Antibody Test (MFAT) necomes +ve after 2 weeks of infection (not indicative of current infection)

o Rapid diagnostic test (RDT): Detect circulating parasite antigens.

· Active intervention measures for Malaria control:

o Micro-stratification of problem

o Vector control strategies

1) Anti-adult measures: Indoor residual spray (DDT/Malathion,Fenitrothion), Space

2) Anti-larval measures: Larvicides (temephos), Source reduction, Integrated control.

· Changes in WHO recommendations for Malaria control [2008] :

o New ACT recommended: Dihydroartemisin-piperaquine

o Artemisin derivatives should not be used as montherapies for uncomplicated malaria

o Single dose of Primaquine (anti-gametocyte) added to ACT treatment of P, falciparum.

HIV/AIDS: WHO RECOMMENDATIONS ON ART (2010):

· Start ART: CD4≤350 cells/mm3

· First line therapy: 1 NNRTI + 2 NRTIs (including Zidovudine/Tenofovir)

· Second line therapy: PI + 2NRTIs (including Zidovudine/Tenofovir)

· Treatment 2.0:

o Is a new approach ‘to simplify the way HIV treatment is currently provided, and to scale-up access to life-saving medicines.

o Could reduce newly HIV+ upto 1 million annually and avert additional 10 million deaths by 2025

o Requires progress across five areas: [Mnemonic: C2D3]

1) Reduce Costs

2) Mobilize Communities

3) Optimize Drug regimes: “Smarter,better pill”

4) Adopt Delivery systems

5) Provide access to point of care Diagnostics.

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Selection of test stastistic in Biostatistics (Frequently asked in AIIMS)

For Nominal Data-

In 1 Group-Mc Nemar test

2 Groups-Chi square test

3 Groups-Fisher test

For Ordinal Data

1 Group-Wilcoxon Rank singed Rank test

2 Group-Wilcoxon Rank Sum test

For Qualitative Data

For 2 Mean

a) Sample Size <100 – T test

b)Sample Size>100- Z test

For > or = 3 Mean

ANOVA or F-TEST (ANOVA used more commonly)

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PSM Q’S AIIMS MAY 2013

Q1]Amount of vitamin A given to mother postpartum (in IU )
…[AIIMS MAY 2013]

a) 50, 000
b) 1Lakh
c) 1.5 lakh
d) 2 Lakh

Ans = [d]
There was a previous recommendation by WHO on giving 2 lacs IU of Vitamin A to pregnant women immediately after delivery, which was withdrawn in 2011

Q2] Type of growth chart used by Anganwadi workers (ICDS) for growth monitoring –
[AIIMS MAY 2013]
a) NCHS
b) CDC
c) IAP
d) MGRS

Ans = [d]  WHO child growth standards, which is also called as MGRS standards
.

Q3] Meningococcal meningitis is called hyper-endemic when incidence is-
[AIIMS MAY 2013]
a) <2/100,000
b) 2-10/ 100,000
c) >10/100,000
d) >100/ 100,000
Ans: [c]

High endemicity (hyperendemic)->10 cases/100 000 population/year
Moderate endemicity-2?10 cases/100 000 population/year
Low endemicity- <2 cases/100 000 population.

Q4]Ridley Jopling classifiaction is based upon-
[AIIMS MAY 2013]

Ans = Clinical, bacteriological and immunological criteria.

Q5 If childhood blindness is assessed using blind school standards as compared to population survey standards, what will happen to prevalence of blindness?
a) Underestimated
b) Overestimated
c) Remain same
d) None of them is used for evaluation
Ans: c

According to NAB (National Association for Blind), India Legal blindness is defined as visual acuity of not greater than 20/200 in the better eye with best correction or a visual field of less than 20 degrees.
A person with normal visual acuity can see an object clearly, at 200 feet; a legally blind person must be 20 feet or closer to see the same object.
Note: 20/200 feet is same as 6/60 meters

According to NPCB, the criteria for blindness (Economic Blindness) is visual acuity of <6/60 in the better eye with best possible correction. This is  used for population surveys of blindness.

Thus, since both the criteria are same, the prevalence will remain same.

FOR OTHER Q FROM MAY AIIMS 2013

1 KLUVER BUCY SYNDROME http://pguploads.com/2013/03/16/amygdal/

2. EYE Q = NHL OF ORBIT / METS TO ORBIT http://pguploads.com/2013/05/14/nhl-of-orbit-mets-to-orbit-aiims-may-2013/

3 . psychiatry ..jean piaget http://pguploads.com/2013/05/15/out-of-sight-is-not-out-of-mind-or-object-permanence-in-jean-piagets-development-theory-aiims-may-2003/

4. sudecks dystrophy http://pguploads.com/2013/05/15/reflex-symphathetic-dystrophy-cprs-i-sudecks-dystrophy-aiims-2013/

5 . isochromosome http://pguploads.com/2013/05/14/q-how-is-isochromosome-formed-aiims-may-2013/

6 .seizure related qs in aiims 2013 http://pguploads.com/2013/05/14/seizure-related-qs-in-aiims-may-2013/

BIOMEDICAL WASTE MANAGEMENT ( IN ACCORDENCE WITH 2011 AMMENDMENTS)

SOURCE: THE GAZETE OF INDIA: EXTRAORDINARY

MINISTRY OF ENVIRONMENT AND FOREST NOTIFICATION

DATED 24TH AUGUST 2011 , ISSUED IN NEW DELHI

AMMENDMENTS IN BIOMEDICAL WASTE RULES(1998)

COMPILED /DESIGN BY : SUJEET KUMAR

1.SCHEDULE I : CATEGORIES OF BMW

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2.SCHEDULE 2: COLOUR CODING AND TYPE OF CONTAINER FOR BMW (NOTE THAT COLOUR USED FOR TABULATION OF SCHEDULE I  HAS BEEN DONE IN ACCOEDENCE WITH THE COLOUR OF CONTAINER TO BE USED)

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3. IMPORTANT NOTE POINTS

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