The document discusses pneumococcal disease and the latest data on pneumococcal strains in India. It provides an introduction to pneumococcal disease and outlines the significant disease burden in India, particularly from pneumonia. It summarizes several studies on pneumococcal serotypes prevalent in India, finding that serotypes 1, 5, and 7 are major causes of invasive pneumococcal disease. The document also discusses Non-Typable Haemophilus influenzae (NTHi) as a pathogen in otitis media. It provides details on a recent dual pathogen vaccine for S. pneumoniae and NTHi that could help address the combined disease burden from these pathogens.
The document discusses pneumococcal disease burden in India and recommendations for pneumococcal conjugate vaccines (PCVs). It provides the following key points:
1. Pneumonia is a leading cause of death among Indian children under 5. Streptococcus pneumoniae is estimated to cause 30-40% of severe pneumonia cases and around 123,000-164,000 pneumonia deaths annually in this age group.
2. Available Indian studies show S. pneumoniae serotypes 1, 5, 6A, 14 and 19A are commonly isolated from pediatric IPD cases. PCV13 provides coverage against these prevalent serotypes while PCV10 does not cover serotype 3 or 19A.
3. Non
Emerging concepts in pneumococcal disease prevention in India sept 2011Gaurav Gupta
Latest information about Pneumococcal disease and its prevention from Indian perspective - as of sept 2011.
Covers latest Pneumonet data, and review from other studies like IBIS, ANSORP etc.
The document discusses pneumococcal disease burden in India and compares the coverage of different pneumococcal conjugate vaccines (PCVs). Pneumonia is a leading cause of death among children under 5 in India, with an estimated 123,000-164,000 deaths annually from pneumococcal pneumonia. Studies on invasive pneumococcal disease in India found the top serotypes to be 6A, 5, and 1. PCV7 covers less than 5% of serotypes causing disease in Asia and Africa, while PCV10 covers 70-85% and PCV13 covers 75-90% or more. PCV13 therefore provides the highest coverage for pneumococcal disease in India and other developing countries.
Efficacy differences between PCV10 and PCV13 - Slideset by Professors Esposit...WAidid
This slideset edited by Professors Esposito, Palmu, De Wals and Sanders for the Second WAidid Congress present some studies that compare in different countries (including Finland, Sweden, Quebec and the Netherlands) efficacy differences between PCV10 and PCV13.
To learn more please visit www.waidid.org
Choosing a pneumococcal vaccine - wisely.. Prevenar in Indian contextGaurav Gupta
Choosing a pneumococcal vaccine - wisely.. Prevenar in Indian context latest studies as of July 2018,
Which vaccine is the best in India as of 2018, latest studies and scientific data
Rotavirus vaccines in India - Whats new in 2021 Gaurav Gupta
This document provides information on Rotavirus gastroenteritis (RVGE) and rotavirus vaccines in India, with a focus on vaccine 116E. It discusses how RVGE is a major cause of childhood diarrhea and mortality in India. It summarizes clinical trial results showing the 116E vaccine is effective at preventing severe RVGE, has a good safety profile with no increased risk of intussusception compared to other vaccines, and provides broad protection against circulating rotavirus strains in India. Phase 3 and 4 trials demonstrated 116E is well-tolerated and effective in preventing severe RVGE in Indian children when administered in a 3-dose schedule.
Emerging concept sin pneumococcal disease prevention Gaurav Mathur
Pneumonet provided data on pneumococcal disease in India from a one-year surveillance study across three hospitals. The study found that pneumonia was the most common presentation of invasive pneumococcal disease. Serotypes 6A and 5 were most common, with over 50% coverage by PCV10 and 100% by PCV13. Antibiotic resistance was observed in several serotypes. Serotype 19A is emerging globally and in India, often associated with the multidrug resistant ST320 clone. This highlights the need for effective pneumococcal vaccination in India.
Meningococcal vaccination needed in india may 2017 chd revisedGaurav Gupta
Menactra, Sanofi Pasteur, latest data from India regarding Meningococcal disease, with information regarding need for vaccination in Indian situation for Pediatricians.
Presented in Chandigarh in May 2017
The document discusses pneumococcal disease burden in India and recommendations for pneumococcal conjugate vaccines (PCVs). It provides the following key points:
1. Pneumonia is a leading cause of death among Indian children under 5. Streptococcus pneumoniae is estimated to cause 30-40% of severe pneumonia cases and around 123,000-164,000 pneumonia deaths annually in this age group.
2. Available Indian studies show S. pneumoniae serotypes 1, 5, 6A, 14 and 19A are commonly isolated from pediatric IPD cases. PCV13 provides coverage against these prevalent serotypes while PCV10 does not cover serotype 3 or 19A.
3. Non
Emerging concepts in pneumococcal disease prevention in India sept 2011Gaurav Gupta
Latest information about Pneumococcal disease and its prevention from Indian perspective - as of sept 2011.
Covers latest Pneumonet data, and review from other studies like IBIS, ANSORP etc.
The document discusses pneumococcal disease burden in India and compares the coverage of different pneumococcal conjugate vaccines (PCVs). Pneumonia is a leading cause of death among children under 5 in India, with an estimated 123,000-164,000 deaths annually from pneumococcal pneumonia. Studies on invasive pneumococcal disease in India found the top serotypes to be 6A, 5, and 1. PCV7 covers less than 5% of serotypes causing disease in Asia and Africa, while PCV10 covers 70-85% and PCV13 covers 75-90% or more. PCV13 therefore provides the highest coverage for pneumococcal disease in India and other developing countries.
Efficacy differences between PCV10 and PCV13 - Slideset by Professors Esposit...WAidid
This slideset edited by Professors Esposito, Palmu, De Wals and Sanders for the Second WAidid Congress present some studies that compare in different countries (including Finland, Sweden, Quebec and the Netherlands) efficacy differences between PCV10 and PCV13.
To learn more please visit www.waidid.org
Choosing a pneumococcal vaccine - wisely.. Prevenar in Indian contextGaurav Gupta
Choosing a pneumococcal vaccine - wisely.. Prevenar in Indian context latest studies as of July 2018,
Which vaccine is the best in India as of 2018, latest studies and scientific data
Rotavirus vaccines in India - Whats new in 2021 Gaurav Gupta
This document provides information on Rotavirus gastroenteritis (RVGE) and rotavirus vaccines in India, with a focus on vaccine 116E. It discusses how RVGE is a major cause of childhood diarrhea and mortality in India. It summarizes clinical trial results showing the 116E vaccine is effective at preventing severe RVGE, has a good safety profile with no increased risk of intussusception compared to other vaccines, and provides broad protection against circulating rotavirus strains in India. Phase 3 and 4 trials demonstrated 116E is well-tolerated and effective in preventing severe RVGE in Indian children when administered in a 3-dose schedule.
Emerging concept sin pneumococcal disease prevention Gaurav Mathur
Pneumonet provided data on pneumococcal disease in India from a one-year surveillance study across three hospitals. The study found that pneumonia was the most common presentation of invasive pneumococcal disease. Serotypes 6A and 5 were most common, with over 50% coverage by PCV10 and 100% by PCV13. Antibiotic resistance was observed in several serotypes. Serotype 19A is emerging globally and in India, often associated with the multidrug resistant ST320 clone. This highlights the need for effective pneumococcal vaccination in India.
Meningococcal vaccination needed in india may 2017 chd revisedGaurav Gupta
Menactra, Sanofi Pasteur, latest data from India regarding Meningococcal disease, with information regarding need for vaccination in Indian situation for Pediatricians.
Presented in Chandigarh in May 2017
Meningococcal vaccination needed in india july 2016Gaurav Gupta
Menactra Meningococcal Conjugate Vaccine in India, is it really needed?
July 2016 Sanofi Pasteur Talk for Pediatricians, Child Specialist Doctors related to Vaccination, Immunization etc.
Hep a Live & Inactivated vaccines in IndiaGaurav Gupta
dIAP presentation for GSK - Havrix and comparison of Live and inactivated Hepatitis A vaccines in Dec 2020.. Online discussion about the various Hep A vaccines available and their pros and cons
Top 10 practical questions about Flu Vaccine in India!Gaurav Gupta
What does a practising paediatrician want to to know about the Flu vaccination? Talk for Abbott Vaccines (Influvac Tetra) in Oct 2020 about common queries that doctors have about the flu vaccine in India, including how it may help in COVID-19?
Prevenar e cme june 2020 & FAQs & COVID Clinic QuestionsGaurav Gupta
Lockdown E-CME & Webinars - this one is on Pfizer vaccine - Prevenar,
We have also discussed the common questions on Pneumonia & how to run clinical practice during COVID shutdown
Timing of Influenza vaccination in indiaGaurav Gupta
This document discusses influenza vaccination in India, including who should receive the vaccine, when they should receive it, and how it should be administered. It recommends routine influenza vaccination for all people aged 6 months and older. Children aged 3-9 years have the best protection against influenza-like illness when vaccinated. The best time to receive the vaccine in India is before the peak influenza season, which typically runs from June to August in the north and October to December in the south. The vaccine is administered as either a 0.25 ml dose for children 6-35 months or a 0.5 ml dose for older children and adults.
At the four front of flu vaccination - Quadrivalent Flu Vaccination in India ...Gaurav Gupta
Is flu vaccination needed in India? Is there any benefits of Quadrivalent Flu vaccination over Trivalent Flu vaccination? Any safety & efficacy data about Vaxiflu 4 by Zydus Vaccines. All discussed in a Presentation in Panchkula, in September 2019
- The document discusses whether people should get the H1N1 vaccine. It provides historical context on influenza pandemics and vaccines. It addresses common myths about flu vaccines and H1N1 specifically, noting that vaccines are safe, effective, and have an excellent safety record. The costs of vaccination are far lower than the societal costs of influenza epidemics.
WEBINAR - Zyvac tcv master class september 2018Gaurav Gupta
WEBINAR - Zyvac tcv master class september 2018. All indian webinar on the new Indian typhoid conjugate vaccination,
Broadcast throughout India with more than 500 pediatricians from across the country registering for viewing and asking questions
ROTAVIRUS VACCINES IN INDIA .WHICH ONE WILL YOU CHOOSE AND WHY?DR SHAILESH MEHTA
Many brands of Rotavirus vaccine are available in India. However we need to have full evidence based decision making before we choose one rotavirus vaccine over another. This slideshow focuses on the need to have Indian studies which are not there with some of the international brands. Regionwise variability of rotavirus vaccines have prompted ICMR and various other scientific bodies in India to have our own data on efficacy of rotaviral vaccines in Indian scenario. Diarrhoea is a major cause of under 5 mortality in children. After the use of rotavirus vaccines there is a huge reduction of financial burden on our healthcare sytems.
Childhood diarrhoea incidence and severity have decreased ever since rotavirus vaccine was made a part of national immunization schedule.
Hepatitis A is an under rated infectious disease in children , with high morbidity and a major cause of fulminant hepatitis in children.There has been a longstanding debate between the LIVE VACCINE FOR HEPATITIS A AND THE KILLED INACTIVATED VACCINE FOR HEPATITIS A. Recent CDC guidelines and INDIAN ACADEMY OF PEDIATRICS GUIDELINES and recent references were studied before making these slides. Hope you find these useful.
Zyvac tcv the Indian typhoid conjugate vaccination - Yamunanagar aug 2018Gaurav Gupta
Zyvac TCV by Zydus Vaccines is the Indian Typhoid Conjugate vaccination with Indian Carrier TT protein.
Recent data from Lancet regarding TCV efficacy is featured in this presentation
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
FOGSI POSITION STATEMENT COVID VACCINATION FOR PREGNANT & BREASTFEEDING WOMENNARENDRA C MALHOTRA
This document discusses recommendations and guidelines regarding COVID-19 vaccination for pregnant and breastfeeding women. It provides information on the current COVID-19 situation globally and in India, the different types of COVID vaccines available in India, benefits of vaccination for the general population and pregnant women, safety of the vaccines for pregnant women, and international recommendations that vaccination should be offered to pregnant women similar to non-pregnant individuals based on risk-benefit analysis. The document concludes by stating current recommendations in India do not support vaccination of pregnant or breastfeeding women due to lack of safety data, but international organizations support vaccination for pregnant women.
This document discusses estimates of the global burden of meningitis from several modelling initiatives, including the Global Burden of Disease study and the Meningitis Clinical and Epidemiologic Estimates (MCEE) model. It finds that estimates of meningitis deaths in children under 5 vary between models, especially in the neonatal period. Many meningitis deaths occur in countries with poor quality death registration. The document also describes the Meningitis Progress Tracker, which monitors progress toward reducing meningitis burden through prevention, diagnosis/treatment, surveillance, support/aftercare, and advocacy.
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CAR...Earthjournal Publisher
This study analyzed 99 suspected diphtheria cases admitted to a hospital in Assam, India over 3 years. Throat swabs were collected and tested. Corynebacterium diphtheriae was isolated in 26 cases (26.26%). The highest culture positivity was in patients aged 5-9 years (53.84%) and 10-14 years (30.76%). Culture positivity was highest in non-immunized patients (62.5%) and surprisingly high in fully immunized patients too (31.58%). The study findings suggest a re-emergence of diphtheria in Assam, calling for intensive monitoring and review of immunization programs and vaccine quality/handling in the state
Flu Vaccination Dr Sharda Jain
Contents
What is Influenza
Influenza outbreaks and pandemics
Impact of Influenza
Influenza vaccine: Rationale
Influenza vaccine safety & effectiveness
When, whom & how to vaccinate?
The document discusses epidemiology of Hepatitis B and Hib diseases in India. It states that India has intermediate endemicity of Hepatitis B with an estimated 4 crore chronic carriers. Most chronic Hepatitis B infections are due to infections during infancy and childhood. It recommends infant immunization with Hepatitis B vaccine to reduce chronic infections and reservoir. Regarding Hib, it estimates over 72,000 deaths annually in India due to Hib diseases like pneumonia and meningitis. Sentinel surveillance is being proposed to establish the disease burden and monitor impact of vaccines.
This document discusses antimicrobial resistance (AMR) surveillance efforts in India, including the IndiaCLEN Invasive Bacterial Infections Surveillance (IBIS) project and Community AMR (CAMR) study. IBIS monitored AMR patterns of Streptococcus pneumoniae and Haemophilus influenzae from invasive disease cases and nasopharyngeal swabs. CAMR studied colonizing strains from healthy children. Both found high resistance to co-trimoxazole. Nasopharyngeal samples showed potential for alternative AMR surveillance. The document calls for policies to address emerging penicillin resistance and continue long-term AMR monitoring to guide treatment and evaluate interventions.
Meningococcal vaccination needed in india july 2016Gaurav Gupta
Menactra Meningococcal Conjugate Vaccine in India, is it really needed?
July 2016 Sanofi Pasteur Talk for Pediatricians, Child Specialist Doctors related to Vaccination, Immunization etc.
Hep a Live & Inactivated vaccines in IndiaGaurav Gupta
dIAP presentation for GSK - Havrix and comparison of Live and inactivated Hepatitis A vaccines in Dec 2020.. Online discussion about the various Hep A vaccines available and their pros and cons
Top 10 practical questions about Flu Vaccine in India!Gaurav Gupta
What does a practising paediatrician want to to know about the Flu vaccination? Talk for Abbott Vaccines (Influvac Tetra) in Oct 2020 about common queries that doctors have about the flu vaccine in India, including how it may help in COVID-19?
Prevenar e cme june 2020 & FAQs & COVID Clinic QuestionsGaurav Gupta
Lockdown E-CME & Webinars - this one is on Pfizer vaccine - Prevenar,
We have also discussed the common questions on Pneumonia & how to run clinical practice during COVID shutdown
Timing of Influenza vaccination in indiaGaurav Gupta
This document discusses influenza vaccination in India, including who should receive the vaccine, when they should receive it, and how it should be administered. It recommends routine influenza vaccination for all people aged 6 months and older. Children aged 3-9 years have the best protection against influenza-like illness when vaccinated. The best time to receive the vaccine in India is before the peak influenza season, which typically runs from June to August in the north and October to December in the south. The vaccine is administered as either a 0.25 ml dose for children 6-35 months or a 0.5 ml dose for older children and adults.
At the four front of flu vaccination - Quadrivalent Flu Vaccination in India ...Gaurav Gupta
Is flu vaccination needed in India? Is there any benefits of Quadrivalent Flu vaccination over Trivalent Flu vaccination? Any safety & efficacy data about Vaxiflu 4 by Zydus Vaccines. All discussed in a Presentation in Panchkula, in September 2019
- The document discusses whether people should get the H1N1 vaccine. It provides historical context on influenza pandemics and vaccines. It addresses common myths about flu vaccines and H1N1 specifically, noting that vaccines are safe, effective, and have an excellent safety record. The costs of vaccination are far lower than the societal costs of influenza epidemics.
WEBINAR - Zyvac tcv master class september 2018Gaurav Gupta
WEBINAR - Zyvac tcv master class september 2018. All indian webinar on the new Indian typhoid conjugate vaccination,
Broadcast throughout India with more than 500 pediatricians from across the country registering for viewing and asking questions
ROTAVIRUS VACCINES IN INDIA .WHICH ONE WILL YOU CHOOSE AND WHY?DR SHAILESH MEHTA
Many brands of Rotavirus vaccine are available in India. However we need to have full evidence based decision making before we choose one rotavirus vaccine over another. This slideshow focuses on the need to have Indian studies which are not there with some of the international brands. Regionwise variability of rotavirus vaccines have prompted ICMR and various other scientific bodies in India to have our own data on efficacy of rotaviral vaccines in Indian scenario. Diarrhoea is a major cause of under 5 mortality in children. After the use of rotavirus vaccines there is a huge reduction of financial burden on our healthcare sytems.
Childhood diarrhoea incidence and severity have decreased ever since rotavirus vaccine was made a part of national immunization schedule.
Hepatitis A is an under rated infectious disease in children , with high morbidity and a major cause of fulminant hepatitis in children.There has been a longstanding debate between the LIVE VACCINE FOR HEPATITIS A AND THE KILLED INACTIVATED VACCINE FOR HEPATITIS A. Recent CDC guidelines and INDIAN ACADEMY OF PEDIATRICS GUIDELINES and recent references were studied before making these slides. Hope you find these useful.
Zyvac tcv the Indian typhoid conjugate vaccination - Yamunanagar aug 2018Gaurav Gupta
Zyvac TCV by Zydus Vaccines is the Indian Typhoid Conjugate vaccination with Indian Carrier TT protein.
Recent data from Lancet regarding TCV efficacy is featured in this presentation
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
FOGSI POSITION STATEMENT COVID VACCINATION FOR PREGNANT & BREASTFEEDING WOMENNARENDRA C MALHOTRA
This document discusses recommendations and guidelines regarding COVID-19 vaccination for pregnant and breastfeeding women. It provides information on the current COVID-19 situation globally and in India, the different types of COVID vaccines available in India, benefits of vaccination for the general population and pregnant women, safety of the vaccines for pregnant women, and international recommendations that vaccination should be offered to pregnant women similar to non-pregnant individuals based on risk-benefit analysis. The document concludes by stating current recommendations in India do not support vaccination of pregnant or breastfeeding women due to lack of safety data, but international organizations support vaccination for pregnant women.
This document discusses estimates of the global burden of meningitis from several modelling initiatives, including the Global Burden of Disease study and the Meningitis Clinical and Epidemiologic Estimates (MCEE) model. It finds that estimates of meningitis deaths in children under 5 vary between models, especially in the neonatal period. Many meningitis deaths occur in countries with poor quality death registration. The document also describes the Meningitis Progress Tracker, which monitors progress toward reducing meningitis burden through prevention, diagnosis/treatment, surveillance, support/aftercare, and advocacy.
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CAR...Earthjournal Publisher
This study analyzed 99 suspected diphtheria cases admitted to a hospital in Assam, India over 3 years. Throat swabs were collected and tested. Corynebacterium diphtheriae was isolated in 26 cases (26.26%). The highest culture positivity was in patients aged 5-9 years (53.84%) and 10-14 years (30.76%). Culture positivity was highest in non-immunized patients (62.5%) and surprisingly high in fully immunized patients too (31.58%). The study findings suggest a re-emergence of diphtheria in Assam, calling for intensive monitoring and review of immunization programs and vaccine quality/handling in the state
Flu Vaccination Dr Sharda Jain
Contents
What is Influenza
Influenza outbreaks and pandemics
Impact of Influenza
Influenza vaccine: Rationale
Influenza vaccine safety & effectiveness
When, whom & how to vaccinate?
The document discusses epidemiology of Hepatitis B and Hib diseases in India. It states that India has intermediate endemicity of Hepatitis B with an estimated 4 crore chronic carriers. Most chronic Hepatitis B infections are due to infections during infancy and childhood. It recommends infant immunization with Hepatitis B vaccine to reduce chronic infections and reservoir. Regarding Hib, it estimates over 72,000 deaths annually in India due to Hib diseases like pneumonia and meningitis. Sentinel surveillance is being proposed to establish the disease burden and monitor impact of vaccines.
This document discusses antimicrobial resistance (AMR) surveillance efforts in India, including the IndiaCLEN Invasive Bacterial Infections Surveillance (IBIS) project and Community AMR (CAMR) study. IBIS monitored AMR patterns of Streptococcus pneumoniae and Haemophilus influenzae from invasive disease cases and nasopharyngeal swabs. CAMR studied colonizing strains from healthy children. Both found high resistance to co-trimoxazole. Nasopharyngeal samples showed potential for alternative AMR surveillance. The document calls for policies to address emerging penicillin resistance and continue long-term AMR monitoring to guide treatment and evaluate interventions.
Dr vijay pneumococcal disease prevention in older adults 2020vkatbcd
The document provides details about Dr. Vijay K. Agrawal including his credentials and positions held. It also includes two disclosure statements indicating that Dr. Agrawal does not have any financial interests or arrangements that could be perceived as a conflict of interest. The rest of the document appears to be a slide presentation on pneumococcal disease.
Among 427 cases of invasive pneumococcal disease (IPD) in children under 5 years old in the US in 2007:
- 64% (274 cases) were caused by serotypes contained in the 13-valent pneumococcal conjugate vaccine (PCV13).
- 95% (260 cases) of those were caused by 3 additional serotypes not included in PCV7.
- 42% (180 cases) overall were caused by serotype 19A alone.
- An estimated 4,600 total cases of IPD occurred in this age group in 2007, including approximately 2,900 cases that could potentially be prevented by PCV13.
Corticosteroids for acute bacterial meningitis DR RML DELHI
This Cochrane review analyzed 25 studies with over 4,000 participants to evaluate the effects of corticosteroids for acute bacterial meningitis. The review found that corticosteroids significantly reduced hearing loss and neurological sequelae but did not reduce overall mortality. Corticosteroids were shown to be beneficial in high-income countries by reducing hearing loss, neurological sequelae, and mortality from S. pneumoniae meningitis, but no benefit was seen in low-income countries.
Ocular inflammatory disease and ocular tuberculosis in a cohort of patients c...Dr.Samsuddin Khan
Abstract
BACKGROUND:
The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART).
METHODS:
Lilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation ofHIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations.
RESULTS:
Between February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158-361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of sevenpatients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). 'These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%).Patients with extrapulmonary TB and patients<39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively].
CONCLUSIONS:
Ocular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai,India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.
The document summarizes key information about measles, including:
- Measles is highly infectious and complications can include blindness, encephalitis, pneumonia and death.
- Vaccination with two doses of the live attenuated vaccine can provide long-lasting immunity and control of the disease.
- India's surveillance data shows measles transmission in all states, with higher mortality in states that conducted catch-up vaccination campaigns. Most cases are in unvaccinated children under 10 years old.
- Proper implementation of two-dose vaccination strategies through routine immunization and supplemental immunization activities is needed nationwide to work towards measles elimination.
2.3 overview of emerging infectious disease issues in the asia pacific region...sandraduhrkopp
This document discusses antimicrobial resistance (AMR) issues in the Asia Pacific region. It notes that AMR is a global crisis and Asia is an epicenter with high resistance rates. Surveillance programs have been established in some countries but more coordination is needed regionally. Awareness campaigns and promoting appropriate antibiotic use are important strategies. National and international policies and regulations are urgently required to control AMR through surveillance, stewardship, infection prevention and vaccination efforts. Regional collaboration through groups like APEC is important to combat the growing threat of AMR.
A PROPOSED NEURO-FUZZY MODEL FOR ADULT ASTHMA DISEASE DIAGNOSIScscpconf
The task of medical diagnosis with the help different intelligent system techniques is always crucial because it require high level of accuracy and less time consumption in decision making.
Among all other AI techniques Artificial Neural Networks (ANN) as a tool for medical diagnosis has become the most popular in last few decades due to its flexibility and accuracy. ANN was
developed after getting the inspiration from biological neurons. There are various diseases that are still needed to be diagnosed. Among many other critical diseases like cancer, thyroid disorder, diabetes, heart diseases, neuro diseases, asthma disease was also tried to bediagnosed
effectively with various ANN mechanisms by different researchers. Due to various uncertainties about symptoms the study of Neuro-Fuzzy technique in this context became very popular in last few years. Neuro-Fuzzy now-a-days is one of the most advanced technique that is mainly concatenation of two model-neural networks and the fuzzy logic. In this model various
parameters are used that are much crucial if ill-chosen and may led to failure of the whole system. Recent trend in analysis is following this model for advanced expert work. In this study
an enhanced Neuro-fuzzy model has been proposed for the proper diagnosis of adult Asthma disease and to foster the proper aid or medication to the patients and make physicians alert forthe upcoming disease pattern otherwise they may lack in the process of providing improper medication at right time. In the first phase data collected from various hospitals are used to
train by three different types of learning of ANN like ANN with Self Organizing Maps (SOM),ANN with Learning Vector Quantization (LVQ) and ANN with Backpropagation Algorithm
(BPA) through NF tool for much accurate result. In the second phase fuzzy rule base is appliedto the classified data for the diagnosis of the disease.
Facilitor's guide for cv training draft1Abhijit Dey
This document provides training materials for community volunteers on tuberculosis (TB) including:
1. Basic information about TB such as what it is, how it spreads, and its magnitude in India with over 28 lakh new cases annually and 1.2 lakh deaths daily.
2. Classification of TB into pulmonary TB affecting the lungs and extra-pulmonary TB affecting other parts of the body.
3. Signs and symptoms of TB and how it is diagnosed using sputum smear microscopy, chest X-ray, and Cartridge Based Nucleic Acid Amplification Test (CBNAAT).
4. Details on India's Revised National Tuberculosis Control Programme (RNTCP)
Ipv – need of the hour dr gaurav guptaGaurav Gupta
The document discusses the history of polio and polio vaccines such as the inactivated polio vaccine (IPV) and oral polio vaccine (OPV). It notes that while OPV has helped reduce polio cases globally, ongoing issues with OPV include vaccine-derived polio viruses and vaccine-associated paralysis. The document advocates for the increased use of IPV to address these issues and aid in the final push to eradicate polio globally.
Acute respiratory infections (ARIs) are the leading cause of death among children under 5 years old in India. ARIs account for a large proportion of childhood morbidity and mortality. Major factors contributing to the high incidence of ARIs include the emergence of new pathogens, reemergence of previously controlled diseases, widespread antibiotic resistance, and suboptimal immunization coverage. Low-cost interventions like hand washing, breastfeeding, improved diagnostics, and introduction of vaccines such as the pentavalent vaccine have potential to significantly reduce the burden of ARIs but require further implementation efforts.
The cost of antibiotics is always an area of concern in treating RTI. The present study was carried out to study the contribution of costs of antibiotics on the overall prescription costs in paediatric patients.
Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide, responsible for over 1 million deaths annually. It is the leading cause of bacterial pneumonia. Certain populations are at higher risk of pneumococcal disease, including the elderly, young children, smokers, and those with chronic medical conditions. Pneumococcal infections have seasonal peaks in the winter. Multidrug resistant strains are increasing globally. Guidelines from organizations like the WHO and ACIP recommend pneumococcal vaccination for high risk groups like all adults over 65 and those with chronic lung, heart or liver disease.
DIAGNOSTICS - Diagnosis of TB - A Nanodiagnostic Approach.pdfsudeepbhattacharyya
The document discusses diagnosis of tuberculosis and highlights opportunities for nanotechnology-based diagnostic approaches. It summarizes several existing methods for TB diagnosis including microscopy, culture-based techniques, immunological methods, and molecular tests. However, current diagnostics have limitations such as low sensitivity, long turnaround time, and requirements for specialized equipment and facilities. The document proposes that nanodiagnostics utilizing nanoparticles, antigens, and antibodies may enable the development of improved point-of-care tests for more rapid, affordable and accurate TB detection.
Standards for TB care in India, RNTCP challenges: India, Maharashtra & Mumbai...Amol Patil
This document summarizes information from various reports on tuberculosis (TB) standards of care and organizational structure for TB treatment in India and Mumbai. It finds that while TB rates are declining globally and in some countries and regions, India still accounts for a large proportion of global TB cases. It outlines the Revised National Tuberculosis Control Programme (RNTCP) phases and 12th five year plan in India, and notes ongoing challenges around engaging private providers, ensuring consistent drug supplies, and reducing high mortality rates. The document also provides statistics on TB cases and deaths specifically in Mumbai.
This document discusses Cryptococcal infections and Pneumocystis jirovecii pneumonia. It covers the epidemiology, life cycles, pathogenesis, clinical presentations, diagnostic modalities, and management of these fungal infections. Specifically, it notes that cryptococcosis has a worldwide distribution and causes life-threatening infections in HIV/AIDS patients. It affects the lungs and central nervous system. Pneumocystis jirovecii commonly causes pneumonia in immunosuppressed individuals, especially those with HIV/AIDS, and has clinical manifestations of fever, cough and dyspnea. Both infections are diagnosed using stains of respiratory samples and treated with antifungal medications like amphotericin and fluconazole.
Evaluation factors contributing to the treatment default by tuberculosis pati...PUBLISHERJOURNAL
Tuberculosis (TB) is one of the biggest public health problem and now ranks alongside Human Immunodeficiency Virus (HIV) as the world’s leading infectious cause of death. Globally, patient compliance with anti-TB therapy estimated as low as 40% in developing countries, remains the principle cause of treatment failure. The aim of this study was to establish the factors contributing to treatment default by Tuberculosis patients at ART clinic in Ishaka Adventist Hospital, Bushenyi District. A cross-sectional and descriptive study which employed both qualitative and quantitative approach of data collection were used. The study was conducted in ART clinic at Ishaka Adventist Hospital, Bushenyi District and it took a period of four weeks. A purposive sampling technique was used to select the study participants. Results showed that out of 38 study participants, majority 26 (68%) were of age 30 years and above. A large proportion 24 (63%) of the participants were unemployed compared to the least 14 (37%) who were employed. Majority 21 (55%) travel at a distance of 10km and above to get TB treatment. Out of 38 participants, majority 26 (68%) did not informed the family or friends when they were on TB treatment. Of 26 participants 16 (61.5%) had fear of being isolated and 2 (7.7%) were other reason of no support. A large proportion of participants rated the attitude of staff who attended to them at the health facility to be unfriendly with 21 (55%) while very few 6 (16%) were rude. The ministry should ensure availability of and access to resources for strengthening systems for delivery of quality tuberculosis treatment, prevention and control.
Keywords: treatment, default, tuberculosis, ART, Uganda
Evaluation factors contributing to the treatment default by tuberculosis pati...PUBLISHERJOURNAL
This document summarizes a study that evaluated factors contributing to treatment default among tuberculosis patients at an ART clinic in Uganda. The study found that the majority of participants were over 30 years old, unemployed, and had to travel over 10km to receive treatment. Most participants were not diagnosed with TB more than a year ago. The majority felt that TB treatment is curative but takes longer than 6 months to complete. Fear of isolation was the most common reason patients did not inform family/friends of their TB status. The study concludes that strengthening TB treatment, prevention, and control systems is needed.
Similar to Synflorix what’s new in preventing pneumococcal disease (feb 2012) (20)
Impact of Social Media on Mental Health.pptxGaurav Gupta
## Social Media: The Ups and Downs for Young Minds
**Uncover the impact of social media on children's mental health.**
This presentation explores the complex relationship between social media and the developing minds of children. We'll delve into:
* **The positive connections:** How social media fosters friendships, self-expression, and access to information.
* **The potential pitfalls:** Increased anxiety, depression, body image issues, and cyberbullying.
* **Strategies for healthy use:** Explore practical tips for parents and educators to promote safe and balanced social media habits in children.
**Equip yourself with the knowledge to guide young people in navigating the social media landscape.**
Good evening everyone, and thank you for joining me today. Today we’ll be exploring the impact of social media on the mental health of children and adolescents. Social media is an undeniable part of our lives, and pediatricians are in a unique position to guide parents and children in navigating this digital landscape.
How AI will transform Pediatric Practice - Feb 2024Gaurav Gupta
Creating a concise and compelling summary for a SlideShare presentation on "How AI Will Transform Pediatric Practice" involves highlighting key points that emphasize AI's potential benefits, challenges, and future implications in pediatric healthcare. Here's a structured summary that could be effectively used in your SlideShare:
---
**Title: Transforming Pediatric Practice: The Role of AI**
**Introduction:**
- Briefly introduce the current state of pediatric practice, emphasizing the importance of accurate diagnosis, personalized treatment, and efficient healthcare delivery.
- Introduce Artificial Intelligence (AI) as a transformative tool in medicine, with a focus on pediatrics.
**AI's Impact on Diagnostics:**
- Highlight how AI algorithms enhance diagnostic accuracy in pediatric care, enabling early detection of diseases through pattern recognition in imaging, genomics, and clinical data.
- Discuss case studies where AI has successfully identified pediatric conditions earlier and more accurately than traditional methods.
**Personalized Treatment Plans:**
- Explain how AI contributes to the development of personalized medicine in pediatrics, considering the unique genetic, environmental, and lifestyle factors of each child.
- Provide examples of AI systems recommending customized treatment protocols and monitoring disease progression in real-time.
**Operational Efficiency and Patient Care:**
- Illustrate AI's role in streamlining administrative tasks, scheduling, and patient flow, allowing healthcare professionals to focus more on patient care.
- Discuss AI-powered virtual health assistants and chatbots that provide 24/7 support and guidance to caregivers, answering questions and offering advice based on medical guidelines.
**Challenges and Ethical Considerations:**
- Address the challenges of integrating AI into pediatric practice, including data privacy, ethical considerations, and the need for robust training data.
- Discuss the importance of balancing AI tools with human oversight to ensure compassionate and empathetic patient care.
**The Future of AI in Pediatrics:**
- Envision a future where AI not only supports clinical decision-making but also predicts health outcomes, identifies potential public health crises, and contributes to global pediatric health research.
- Highlight the importance of interdisciplinary collaboration in developing AI tools that are ethical, equitable, and truly beneficial for child health.
**Conclusion:**
- Summarize the transformative potential of AI in pediatric practice, emphasizing its role in enhancing healthcare delivery, improving patient outcomes, and paving the way for innovative treatment approaches.
- Call to action for healthcare professionals, researchers, and technologists to collaborate in harnessing the power of AI for the betterment of pediatric healthcare.
Latest GINA guidelines for Asthma & COVIDGaurav Gupta
What are the changes from 2019 onwards till 2022, in the GINA guidelines for developing countries like India.
Includes COVID guidelines and also a FUN QUIZ !
Talk about why these guidelines have changed - use of ICS - formoterol combination for treating even intermittent asthma
Dr Naveen Kini, Pediatrician from Bengaluru talks about WHAT is podcasting, HOW we can listen to podcasts, WHY doctors should create podcasts and much more. Co-hosted with Dr Gaurav Gupta. In arrangement with dIAP and CMIC. This is PART 1 - we discuss how to create a simple free & easy podcast in part 2 - check the presentation on slideshare under my account
Podcast creation for doctors (Pediatricians)Gaurav Gupta
To create a doctor podcast, one must first develop a clear concept focused on a specific medical area of interest. Then, choose an attention-grabbing name related to the topic and register the podcast on major platforms like Apple Podcasts and Spotify to reach a wide audience. Basic recording equipment like a computer and quality microphone are sufficient to produce clear audio. Promoting the podcast through one's website, social media, and practice's blog is key to growing the listener base.
Prevention of influenza in relation to COVID 19 - the TWINDEMICGaurav Gupta
What is the concern about the TWINDEMIC of COVID 19 & Influenza?
My talk on the digital IAP platform in Dec 2020 for the pediatricians across the country
Helping doctors avoid COVID in their Office PracticeGaurav Gupta
Tips for doctors and their patients to avoid Coronavirus during OPD practice in India. From a Pediatrician's perspective. How can we take supplements prophylactic medicines like Vit D, Vit C, Zinc, etc. and medicines like HCQ or Ivermectin to prevent COVID during seeing patients in our practice.
Digital eye strain - Computer vision syndrome for students during Online clas...Gaurav Gupta
Dr. Poonam Gupta, Eye Specialist from Charak Clinics, Mohali, talks with Aakash Institute about Computer vision syndrome, Digital Vision Syndrome, Eye fatigue in students doing online classes during the lockdown. How to prevent it and treat with with simple steps including the 20-20-20 rule etc.
Digital waste management pedicon 2020 Indore, preconference workshopGaurav Gupta
What is important and relevant about Digital waste management pedicon 2020 Indore, preconference workshop. How to dispose of your printers, computers, mobile phones, relevant to India
How to Advertise yourself with simple office tools PEDICON 2020 Indore workshop 8 jan, 2020. How to use whatsapp, blogs, youtube facebook to advertise yourself online
Zyvac TCV - The Indian Typhoid Conjugate VaccineGaurav Gupta
The document discusses a new typhoid conjugate vaccine called Zyvac-TCV developed by Zydus Vaccines. It provides details of a phase II/III clinical trial conducted to evaluate the immunogenicity and safety of Zyvac-TCV compared to another licensed typhoid conjugate vaccine. The results showed that Zyvac-TCV was non-inferior in inducing seroconversion and had a comparable safety profile. No serious adverse events were reported for either vaccine. The document concludes that Zyvac-TCV met the immunogenicity and safety endpoints for efficacy.
Dr. Gaurav Gupta - Should you be buying an E-bike this Diwali?
Dr RP Bansal- Feeding difficulties in the newborn
Dr Nivedita- Tips on how to Continue Breast Feeding
Dr Ridhi- Teething tips
Dr Arushi - First afebrile seizure
Dr Amit - Mesentric lymphadenopathy
Dr Gunjan - Acute events following immunization plus update on BCG adenitis
Dr Sandip Jain- Tips for examining children
Dr Diljot - Mefenemic acid as an antipyretic
Dr Jaskaran- colicky infant : knowledge , attitude and practices
Dr Shailesh - School se chutti kitne din karayein ?
Dr Gaurav- Is it oral Herpes? Visual Quiz
Meningococcal disease sep 2019 National Epidemiology & Indian recommendationsGaurav Gupta
This document discusses meningococcal disease in India, including past outbreaks, current epidemiology and surveillance data, and recommendations for vaccination. It notes that while India has a poor surveillance system and diagnostic challenges, meningococcal disease is present and the country has seen outbreaks every 6-8 years. Surveillance data from 2012-2016 shows several states regularly report over 100 cases annually. Current recommendations from the Indian Academy of Pediatrics advise vaccination for high-risk groups, international travelers, and Hajj/African meningitis belt pilgrims. While antibiotics can treat the disease, vaccination is an effective prevention strategy given unknowns around antibiotic resistance and underdiagnosis.
Japanese encephalitis - Sep 2019 India epidemiology - Is vaccination needed?Gaurav Gupta
1) Japanese encephalitis (JE) is a viral disease spread by mosquitoes that is endemic in many parts of Asia and the Pacific. India reports the highest number of JE cases annually, with an estimated actual number between 15,000-20,000 cases per year.
2) JE vaccination is the most important preventive measure according to WHO and IAP guidelines. The national vaccination program in India recommends routine vaccination with two doses of JE vaccine for children up to 15 years of age in endemic areas.
3) While mosquito and pig control efforts have not proven reliable at controlling JE, vaccination is currently the single most effective public health approach for prevention in India given the disease burden.
Research in pediatrician office - my story! NORC Aug 2019 New DelhiGaurav Gupta
Presented in NORC - Aug 2019 - National Original Research convention, discussion of Flu like illnesses and the Flu vaccination and drug utilization reviews and prescription audits and various other original research presented and published by Dr. Gaurav Gupta in his years of clinical practice, including yellow fever, Complementary medicines, drug costs and prescriptions analysis
What nelson forgot 4 - Super CME for Common Pediatric OPD questionsGaurav Gupta
What nelson forgot 4 - Super CME for Common Pediatric OPD questions, 12th July 2019
Common Office practice questions, answered in just 5-10 minutes per topic ...
The document discusses various topics related to pediatric practice including treatment of capillary hemangioma, seborrheic dermatitis in infants, drugs for nocturnal enuresis, anthropometry in children under 2 years, geographic tongue, acute limp in children, adenoids, role of intranasal steroids in children, role of Tamiflu in pediatric OPD practice, and categories and dosing of Tamiflu for influenza.
Rotavirus vaccine - Rotateq- Does Valency Matter North Zone Pedicon oct 2018Gaurav Gupta
Rotavirus vaccine - Rotateq- Does Valency Matter North Zone Pedicon oct 2018 - talk taken in the holy city of amritsar as a part of the First NZ pedicon for IAP. Discussed the differences and benefits of Rotavirus vaccines that are available in India including Rotateq, Rotarix, Rotavac Rotasure and Rotasiil
Dr. Bhavesh Shah, Pediatrician and member CMIC, IAP, from Vadodara talks about best app for pediatricians at IAP Chandigarh Meeting.- discusses free & paid apps and also best apps as per budget of the doctor
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
pathology MCQS introduction to pathology general pathology
Synflorix what’s new in preventing pneumococcal disease (feb 2012)
1. Dr Gaurav Gupta,
Pediatrician,
Member AAP, IAP,
Charak Clinics, Mohali
Feb 2012
2. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
3. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
4. Pneumococcal Disease
S. pneumoniae first isolated by
Pasteur in 1881
90 known serotypes
First U.S. vaccine in 1977 (14 valent
PPV)
PCV 7 launched in 2000
Type-specific antibody is protective
5. DISEASES CAUSED BY STREPTOCOCCUS
PNEUMONIAE
PNEUMOCOCCAL INFECTION
Non-invasive disease Invasive disease
• Sinusitis • Bacteraemia (blood)
• Otitis media
• Pneumonia
• Meningitis (CNS)
• Endocarditis (heart)
• Peritonitis (body cavity)
• Septic arthritis (bones and joints)
• Others (appendicitis, salpingitis,
soft-tissue infections)
Musher, in Principles and Practice of Infectious
Diseases, 1995
6. Strep Pneumoniae in developing countries
1000 X
AOM
100 X
Non Invasive
pneumoneia
10 X
Bacteremia
Meningitis
7. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
8. Each Dot = 5,000 child deaths
Child DEATHS
We are No. 1 Black RE. The Lancet 2003; 361: 2226-2234
9. Pneumococcal Disease Burden
in India
Meningitis and Sepsis –
Among Top 10 causes of mortality
in India
Meningitis
causing 1.53 lakh deaths in
children under 5 yrs
Sepsis
Pneumonia –
No. 1 Killer of children in India
Causing 4 lakh deaths in children Pneumonia
under 5yrs
Acute Otitis Media (AOM) – Non-invasive diseases
Most frequent disease of (Otitis media)
Non-invasive diseases
childhood (Otitis media)
Leading cause of physician visits
and antibiotic therapy
Black RE et al. Lancet 2010; 375: 1969-1987
Pneumonia: The Forgotten killer; WHO September 2008
Rudan et al. Bull World Health org 2008; 86: 408
Gehrard grevers, IJPO Vol 74 Issue 6, June 2010, Pages 572-
577
10. PNEUMOCOCCAL DISEASE BURDEN
Countries with the greatest number of pneumococcal
deaths among children under 5 years
TOP TEN
O,Brien K, et al. Lancet. 2009;374:893-902.
11. PNEUMONIA AND INDIA
Pneumonia remains the leading killer of children1
410,000 children < 5 die of pneumonia every year1,2
25% of all child deaths are due to pneumonia3
Meta-analysis of 4 CTs suggest 30-40% of all severe
pneumonia in children is pneumococcal.
In Indian context, around 123,000 to 164,000 children <5
years die annually from pneumococcal pneumonia1
1. Levine OS et al Indian Pediatrics 2007; 44:491-496
2. Pneumonia – The forgotten killer of children, WHO, UNICEF, 2006
3. Thacker N. IPD burden - An Indian Perspective. Pediatrics Today 2006; 9(4): 208-213
12. We are missing the target
(Millennium Development Goal 4)
Under-five mortality ratio (U5MR) projections
60 priority countries
U5MR in 2015
85
at current
AAR
38 MDG Target
U5MR in 2015
AAR =average annual rate of reduction
MDG=millennium development goal
Source: UN Population Division World Population Prospects, 2004.
12
13. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
14. A limited number of serotypes
cause IPD in young Children
~ 10 Serotypes causes
75% of IPD in children
under 5 years of age
Johnson et al PLOS Medicine 2010
15. PCV 7 - Coverage
References: 1. Johnson et al. Plos Medicine 2010
18. Pneumococcal Polysaccharide and Non- Typable Haemophilus influenza
(NTHi)
Protein D conjugate vaccine, adsorbed
Europe Asia
North America
Africa
Latin America
oceania
References: 1. Johnson et al. Plos Medicine 2010
2.Nitin k. shah et al. summary of invasive pneumococcal disease burden among
children in Asia-Pacific region. Vaccine 28(2010) 7589-7605
19. Epidemiology of Pneumococcal Serotypes in India in Children under 5
yrs :
An overview of available data
1999 : IBIS study (Invasive Bacterial Infection
Surveillance)
2006-07 :SAPNA network (South Asia
Pneumococcal Alliance)
2008 : Asian Network for Surveillance Of Resistant
Pathogens ( ANSORP 2008 )
1992-07 : S. Pneumoniae Surveillance for Serotype
distribution in Bangladesh:
2008 : KIMS Study (PneumoNET)
2009 :Pneumo ADIP (Pneumococcal vaccine
Accelerated Development and Introduction Plan )
2011 : Alliance for Surveillance of Invasive
Pneumococci (ASIP) : (Jan – Nov )
19
20. PNEUMONET KIMS study… (1 year data)
•Study done at 3 hospitals in
Table 3: Serotype Distribution
Bangalore South Zone
(Kempegowda Institute of Medical Serotype N
Sciences Hospital, Vanivilas 6A 5
Hospital, and Indira Gandhi 5 3
Institute of Child Health) 1 2
3 2
•Limited no. of serotype and only
from part of a city of a region 14 2
hence can not represent a Sub 9V 1
continent like India 19F 1
18C 1
• No indication of high prevalence
of serotype 19 A 19A 1
a – In 1 subject 2 different serotypes were obtained from blood and CSF (6A in CSF and 3 in blood)
20
21. Pressing Need For Robust
Indian Data ……
Very limited data available from India regarding
Pneumococcal disease causing
Serotypes
Prevalence
Distribution
Robust data from PAN India will help in
Suitability and choice of PCV in India
ASIP : ALLIANCE FOR SURVEILLANCE OF
INVASIVE PNEUMOCOCCI IN INDIA can really
help in understanding the prevalence of S.
Pneumonie and serotype
22. CMC CNBC Inclusion
Study Centres Criteria
Ludhian Delhi
a • PAN India
• Age:
Safdar <5 years Network
•
JungClinically suspected case of pneumonia, meningitis
Delhior bacteremia (as per modified WHO case Institutes
• 12
definition)
KEM • Without previous antibiotic therapy
Mumba KEM • After informed consent by parent • 48 Sentinel
i Pune • Microbiology protocol as per modified WHO/CDC
Pediatricians
surveillance manual
BVP SRMC
Pune Chenn • 7 Sentinel
MGIM ai local labs
S Pushpag
Wardh iri
a Tiruvalla
LTMM
C
Mumba Central
i Monitoring
Lab CMC,
St. AIMS
Vellore
Johns Kochi
Bengalu
19
23. ASIP: Distribution of Serogroup/type
Preliminary Results (n=35), 2011
Serogroup / No. of
Serotype isolates
1 01
4 01 19 A % : 1/35 ( 2.85 %)
19F % : 3/35 ( 8.57%)
5 02
------------------------------------
10 04 19 % : 4/35 (11.4%)
7F -
• In line with previous studies and
9V - PneumoADIP- Asia: 2009
14 (F) 01
18C - • Others: includes serogroups with 1 isolates
19F 03
23F 02 No case of ST 3 in India,
3 - results in line with
6 03 Previous large
multicentric trials
19A 01
Others 17 23
24. Summary : Prevalence of
Pneumococcal Serotypes in
India
Available data since 1999 to 2011 suggest that in
children < 5 yrs of age
Serotype 1,5 and 7 are major cause of IPD in India
across all studies
In pan India serotype surveillance studies there was no
evidence of ST 3 prevalence in India
No rise / uptrend seen in serotype 19 A prevalence
in India or no data is available to assume the same
25. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
26. Spectrum of disease caused by 2
bacteria
H. influenzae S. pneumoniae
Meningitis
Sepsis
Incidence of invasive H. influenzae
disease drastically reduced—but
not eliminated--where Hib
vaccination introduced
Pneumonia
Non-invasive diseases
+ NTHi (Otitis media)
(non-invasive &
invasive diseases)
26
26
27. NTHi is one of the leading pathogen in Otitis Media
40.0%
36.7%
35.0%
31.7%
30.0%
25.0%
20.0% 18.7%
15.0%
10.0%
5.0%
0.0%
S. NTHi M.
Pneumoniae Catarrhalis
The 3 predominant pathogens in otitis media: S. pneumoniae, NTHi and M. catarrhalis (from 8 different studies involving
tympanocentesis and culture of middle ear fluid from 1990–2007).9–16
Murphy et al The Pediatric Infectious Disease Journal • Volume 28, Number 10, October 2009
28. Indian data on NP carriage of NTHi in
children under 2yrs of age
29. Review of contribution of NTHi (non typable Haemophilus influenzae) and
S pneumonia in children Acute otitis media
Study Journa Year Place Sampl Age group S. pneumoniae Non typable
l e H. influenzae
Alexandr BMC 2011 Colombi 99 3-60 months 30/99 (30%) 31/99 (31%)
a Sierra infect. a
et al. Dis
Parra M Vaccin 2011 Mexico 121 3-59 months 35/121 (29%) 41/121 (34%)
Bacterial e
et al.
Shiping AJ of 2011 Taiwan 225 1-94months --------------- 189/225 (84%)
He. et al med.
Res.
Barkai G. Ped. 2009 Israel 8145 < 60months 4339/8145(53% 4928/8145
et al Infect. ) (60%)
Dis J
Ref: Alexandra Sierra et al.,BMC infectious diesease,2011
Parra M Bacterial et al., Vaccine. 2011 (29) 5544– 5549
Shiping He. African Journal of Microbiology Research Vol. 5(17), pp. 2407-2412
Barkai G. Pediatr Infect Dis J.2009 Jun;28(6):466-71
30. Conclusion:
NTHi (Non Typable Haemophilus influenzae) and S.
pneumonia and are the major causative organism for
AOM among under 5 children worldwide.
NTHi and S. pneumoniae mixed episodes are more
likely to occur in AOM, & interaction between these two
pathogens contribute to chronicity and complexity of AOM.
31. Pneumococcal Otitis Efficacy Trial (POET)
Vaccine Efficacy Vaccine Efficacy
Acute Otitis Media Endpoint (95% CI) (95% CI)
POET [11Pn-PD] FinOM [PCV-7]
Any (confirmed by presence of middle-ear % 33.6 %6
fluid) (20.8 to 44.3) (-4 to16)
Vaccine pneumococcal serotypes % 57 % 57
(41.4 to 69.3) (44 to 67)
Non-vaccine pneumococcal serotype %8 % -33
(-64.2 to 49) (-80 to 1)
Haemophilus influenzae % 35.6* (-%11)
(3.8 - 57.0) (-34 to 8)
Recurrent AOM % 55 % 16
(-1.9 to 80.7) (-6 to 35)
*Non-Typeable Haemophilus influenzae % 35.3 (1.8 to 57.4)
Synflorix Only new generation PCV offer dual
Note: Results cannot be quantitatively compared due to differences in study population,
Pathogen Protection against S. Pneumoniae and
epidemiology of AOM, case-ascertainment , etc.
NTHi in AOM
1.Eskola J, et al. N Engl J Med 2001; 344:403-409; FinOM: Finnish Otitis Media; 2. Prymula R, et al. Lancet 2006; 367:740–748 31
32. Summary : Importance of NTHi
and dual pathogen protection
NTHi along with S. Pneumoniae causes non
invasive disease like AOM
NTHi is one of the leading pathogen in OM
Managing OM is difficult and challenging and
every children by 3 years of age will have an
episode of AOM
In POET trial 11 v PNPD vaccine offered dual
pathogen protection against S. Pneumoniae and
NTHi All cause AOM was reduced by 33.6 %
33. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
34. Description of PCV vaccines
Prevenar 4, 6B, 9V, 14, 18C, 19F, 23F
CRM197 Diphtheria carrier protein
Synflorix 4, 6B, 9V, 14, 23F, 18C, 19F 1, 5, 7F
NTHi protein D
Prevenar13 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F 3, 6A, 19A
CRM197 Diphtheria carrier protein
34
35. Design of Synflorix
Why use a carrier protein derived from H. influenzae?
Synflorix designed to potentially:
• protect against most prevelent 10 pneumococcal serotypes
• minimize risk of interference with co-administered vaccines
• provide protection against NTHi disease
S.pneumoniae Non-Typeable
H. influenzae
protein D
[carrier protein]
Polysaccharides
(10 serotypes*)
* 2 polysaccharides conjugated on tetanus and diphtheria toxoid respectively 35
36. Summary : What about Serotype 3, 6A and 19A?
Is there any difference between these 2 Vaccines
? Serotype 3 (not a common pediatric serotype)
is an atypical serotype and non boostable
In large muticentric clinical studies, Serotype 3 has not been isolated in
children < 5 years of age in India ( IBIS 1999 TO ASIP 2011)
Serotype 6A (globally accepted 6B-6A cross-protection)
PCV 7 which included only ST 6B, reduced 90% of serotype 6A IPD cases
as per CDC surveillance data
Serotype 19A (not rising in India)
Data from pan India studies confirms that, there is no rise / upward trend
observed in serotype 19 A IPD cases
Both the vaccine in India will offer > 70% IPD coverage
37. Clinical Otitis Media and
Pneumonia Study (COMPAS)
• Multicentre, double-
Panama:
blind, randomised, 7 centres
controlled trial N= 7.000
subjects
• Sample Size = 24,000 Colombia:
3 centres
• Synflorix™ vs. control
N= 3.000
(Randomised 1:1) subjects
• 3 Latin American
countries Argentina:
17 centres
• Urban Setting
N=14.000
• Good access to health subjects
care system
38. Synflorix : Only new generation PCV with
Proven Efficacy Against Clinical
Pneumonia
Synflorix™ C-CAP
Alveolar consolidation on
Vaccine efficacy (%) Chest X-ray analyzed acc to
,[95% CIs] , p-value WHO definition
Per-protocol (ATP) 25.7 [8.4;39.6]
Intent-to-treat (TVC) 23.4 [8.8;35.7]
^ p-value significant if lower than 0.0175
*first episodes of pneumonia by Data Lock Point 31Aug2010
Per-protocol : Vaccine Efficacy for time to first occurrence of CAP anytime from 2 weeks after the administration of dose III and part of the ATP cohort.
Intent-to-treat: Vaccine Efficacy for time to first occurrence of likely bacterial CAP (B-CAP) anytime from the administration of dose I
1.Tregnaghi et al., XIV SLIPE, Punta Cana, May 2011; 2.Tregnaghi et al., 29th ESPID, The Hague, June 2011
3.10PN-PD-DIT-028; NCT00466947
39. Synflorix IPD Effectiveness II:
Pneumococcal Meningitis in Brazil, in <2 yr olds
1998-2011
Cumulative number of Pneumococcal meningitis cases in children <2 years of age by month of occurrence, Brazil,
2007-10
Synflorix™ introduction March-June 2010. 2009
UMV, 3+1 schedule
2010
~48% reduction
any Pn.
meningitis
2011 Jun11 vs Jun10
Brazil National Pneumococcal menigitis reporting. MoH - SAUDE :
http://portal.saude.gov.br/portal/saude/profissional/visualizar_texto.cfm?idtxt=37811 accessed 21Nov2011
40. Synflorix in Various Countries NIPs
National Immunization Programs Regional High Risk
Imm. Population
Programs s
Finland Brazil New Zealand Sweden Bosnia &
(5 regions) Herzegovina
Iceland Chile Kenya Poland
Netherlands Peru Ethiopia Croatia
Czech Rep Ecuador Saudi Arabia
Slovakia Mexico Oman
Bulgaria Colombia
Austria Caribbean: Aruba, Jamaica,
Bermuda, Gran Cayman,
Cyprus, Albania Trinidad & Tobago, Barbados
41. Brief intro about Pneumococcal Disease
India – Scope of IPD – morbidity &
mortality
Latest data (including ASIP) regarding
Pneumococcal strains prevalent in Asia/
India
What about NTHi ?
Information about the latest dual pathogen
vaccine against S. Pneumoniae and NTHi
Common Questions regarding using PCV
10
42. Q 1. Why should I use Synflorix when prophylactic use
of Paracetamol is not recommended as the immune
response may be lowered?
43.
44. Q 2. Synflorix co-administration with IPV caused a
reduced immune response to IPV 2. Can I still use
Synflorix with IPV?
Answer: Synflorix can safely be co-administered
with IPV and will not cause a reduced antibody
response to the poliovirus antigens
45. Summary
Pneumococcal disease is the #1 vaccine-preventable cause
of death worldwide in children aged <5 years1
Data from India clearly points to vaccine preventable
serotypes being common cause of Pneumococcal Disease !
Convenient transition from PCV 7 to newer vaccines at any
point in the vaccination schedule4
PCV 10 offers protection against AOM too – unique.
For high risk cases PCV/ PPSV can be given up to 18 years
1. WHO. http://www.who.int/immunization_monitoring/data/GlobalImmunizationData.pdf. Accessed September 3, 2009.
2. Dinleyici E, et al. Expert Rev Vaccines. 2009;8:977-986.
3. GAVI Pneumococcal AMC TPP, Nov 2008. http://www.vaccineamc.org/files/TPP_codebook.pdf. Accessed September 3, 2009.
4. Prevenar 13. Summary of Product Characteristics. Wyeth Pharmaceuticals.
5. Data on file. Pfizer Inc, New York, NY. 45
Editor's Notes
Key PointsAs per the O’Brien report in Lancet 2009, India tops the countries with the greatest number of pneumococcal deaths in children under 5 years, ahead of China which has a higher population.
Key PointsThe Millennium Development Goal 4 aims to reduce mortality in children younger than 5 years by two-thirds between 1990 and 2015. However looking at this graph for 60 priority countries (including India), it seems we are still far away from that goal.
Although 91 serotypes have been isolated only a few of these serotypes are responsible for invasive pneumococcal disease. According to Johnson et al published in 2010, only 10 serotypes cause 75% of IPD in children under 5 years of age.
Key PointsOverall, positive culture growth was obtained in 432 (8.2%) of the 5,249 enrolled subjects. Percentages of total growth were as follows: Salmonella sp. 60 (13.9%); Streptococcus pneumonia 27 (6.3%); Staphylococcbus hominis 41(9.5%); Micrococcus sp. 32 (7.4%); Staphylococcus epidermidis 24 (5.6%); Staphylococcus aureus 19 (4.4%).SP was detected and serotype information obtained in 17 subjects (n=18 serotypes). In 1 subject isolates grown from CSF and blood were of 2 different serotypes (CSF=6A and blood=3).Distribution of the serotypes isolated is shown in Table 3; 6A and 5 were seen most frequently.The serotype coverage offered by PCV7, PCV10, and PCV13 was 27.77%, 55.55%, and 100%, respectively.Four of the 18 isolates were resistant to trimethoprim/sulfamethoxazole, 3 to erythromycin, and 1 to ceftriaxone. Antibiotic resistance was observed for serotypes 6A, 14, 1, 3, and 19A.
Based on a compilation paper written by Murphy et al in 2009, NTHi is one of the leading othopathogens and is responsible more than 30% AOM cases in children under 5 years of age.
Speakers notesBecause of the broad impact and the management difficulties of AOM, prevention of otitis media by vaccination is an appealing prospect. Over the past decade, evidence has emerged that this is indeed a viable option. AOM can be a vaccine preventable disease.First evidence were obtained with the PCV-7 vaccine. In studies conducted in Finland and the USA, efficacy was demonstrated against AOM following infant vaccination. This slide reports the results observed in the Finnish study. The vaccine efficacy against all-cause AOM was shown to be limited (~6%) in the FinOM study, even though efficacy against pneumococcal vaccine serotypes was 57%.This interesting but modest results may be explained by evidence of significant replacement with non-vaccine serotypes (-33% = an increase in episodes due to non-vaccine serotypes) and otopathogen replacement with H.influenzae (-11%).PCV-7 shows no evidence of efficacy against Hi AOM, which together with Strep pneumoniae is the second biggest cause of bacterial AOM
To summarize on these 3 serotypes – Serotype 3 is not commonly isolated in children under 5 yrs of age. It is an atypical serotype and there is inconsistent immune boosting by any of the pneumococcal vaccines. Even the FDA has questioned the effectiveness of ST 3 in Prevenar 13.Serotype 6B-6A cross-protection is now a globally accepted fact and the WHO/GAVI organizations accept that any PCV with ST 6B will provide cross-protection to 6A.Serotype 19A as shown in the earlier slides is not a rising problem across the globe. And 19F-19A cross-reactivity is possible.To conclude – both vaccines have only a marginal difference in their coverage and for India, based on Dr. Nitin Shah’s article, both vaccines offer >70% IPD coverage.
BIO-SYN-0023-11Primary objective is met. Efficacy for other CAP endpoints was shown with LL>0 irrespective of type of analysis*High consitency between per protocol (ATP) and Intent-to-treat (ITT or TVC -total vaccinated cohort)