2. vaccines, diseases , programs

India TB elimination target year?

2025

• Mortality ↓ 90%

• Incidence ↓ 80%

• 0% catastrophic cost d/t TB

Strategy for tb elimination

Test → Treat → Prevent → Build

TTPB

Vision of national strategic plan for eliminating tb?

0 death

0 disease

0 poverty

What does “intensified case finding” mean for tb?

Screening tb in patients with HIV, diabetes, Covid!

Screening for tb / IOC to detect tb in a community

Sputum AFB (30mins)

Confirmatory test for tb

CBNAAT (2hrs)

(Gene expert- detects resistance to rifampicin only)

Gold standard test for tb

Liquid culture (6wks)

What is TRUNAT?

Made in India version of CBNAAT 2hrs

TURN AROUND TIME 1hr

drug resistance test for tb

Line probe assay (72hrs)

LPA- Detects Isoniazid(INH) + Rifampicin resistance

Tb pt. Comes to you what all investigations will u do?

Sputum AFB + CXR + CBNAAT

Universal Drug Susceptibility Testing (UDST)

Done by CBNAAT in ALL patients at baseline

To rule out TB and rifampicin resistance

How many population does 1 TB unit cover ?

1-2 lac population

1 TB unit = 2-4 DMCs

DMC (designated microscopy centers )

Tb diagnostic centers

Population covered ?

50k -hilly

1 lac - plain

WHO END TB STRATERGY

End TB globally by 2035

95(tb deaths)-90(tb incidence)-0(cost) = TB hero

TB end strategy by WHO and India

WHO- 2035 (95-90-0) (death- incidence - cost)

India- 2025 (90-80-0)

MCC of death in HIV

Tb

Cross referral screening

HIV + test for TB

TB + test for HIV

Needle prick injury . Post exposure prophylaxis of HIV?

LTD

(2h - 28days)

Can start upto 72 hrs

HIV + TB -

Tb preventive therapy is given:

3months x (INH + RIFAPENTINE) weekly

• pyridoxine (b6)

HIV + TB +

ATT» 2 weeks baad ART

To prevent IRIS( immune reconstitution syndrome)

MC opportunistic infection in PLHIV

India and worldwide

India - TB

World - pneumocystis jirovecii / pneumocysts carail pneumonia

Pneumocystis jiroveci prevention

DOC - double strength cotrimoxazole

Start - CD4 < 350

Stop - CD4 >350 (for >6months)

A case of presumptive pulmonary tb

What tests will you do

CBNAAT + CXR + Sputum AFB

Sputum and chest xray normal ?

Does the patient have tb?

No

Sputum and CBNAAT +

Give diagnosis

Microbiologically confirmed case of TB

Red ribbon club

College —- sec education for HIV prevention

Link worker scheme

community level HIV prevention

(Health workers included)

What all tests are done to ensure safe blood transfusion ?

HIV 1,2

Hep B,C

Malaria

Syphilis

UN aids global strategy

End AIDS by 2030

95:95:95 - know: treat: viral suppression

Annual parasite incidence(API) formula

(New cases in 1 yr / populatn under surveillance ) x 100

Shows burden of malaria

Elimination strategies are made based on api

Annual blood examination rate (ABER) formula

(No of slides examined / populatn under surveillance) x 100

Shows operational efficiency of the program

Speen rate

% of 2-10yr old with spleenomegaly (shows endemicity of malaria)

Slide positivity rate formula

(No of positive smears / no of smears examined ) x 100

Tells abt outbreak

Infant parasite rate

% of infants showing parasite incidence blood films

Shows recent transmission of malaria

What yields permanent results in vector borne disease control

Anti larval measures

LLIN (longlasting insecticidal nets)

Can be used upto?

No. Of holes

Diameter of holes

>3yrs

>150

<0.0475

Anti adult measures—- sprays

Which one to use if,

API <2 :

>2 :

API <2 : space spray

>2 : IRS (indoor residual spray)

Field test for

P FALCI

FALCI + vivax

HRP2 (histidine rich protein 2) - falci

LDH - pf and pv

Mc method used for epidemiological assessment of filariasis

Thick film (most sensitive )

Thick film test blood collection time

8:30pm to 12midnight

Night sample because Microfilaria show nocturnal periodicity

Special test for filariasis

DEC PROVOCATION TEST

If you want to see microfilaraemia during day time

DEC khila k 30-60min m MF can be seen

Most sensitive method for detecting low density microfilaraemia

Membrane filter conc method

Diagnosis of Kala Azar

rk39

Treatment of Kala Azar

LAMB (liposomal amphoterecin B) (10ml/kg)

Vector control in Kala Azar

IRS (indoor residual spray)

Pyrethroids » DDT

Types of lesgmaniasis

Visceral (Kala-azar)	L. donovani Phlebotomous Argentipes
Cutaneous (oriental sore)	L. tropica P.papatasii
Mucocutaneous	L. braziliensis P.sergentii

Leshmania bodies / amastigote form is seen in

Vertebrae/ man

In leshmaniasis , Flagellated promastigote seen in

Insect

Vector of yellow fever

Aedes aegypti

Aegypti = exotic in India

Yellow fever reservoir

Monkey

Vaccine yelllow fvr

17D live

Yellow vaccine immunity begins after how many days of vaccination?

7-10days

Quarantine and isolation are which level of prevention

Primary

Validation of 17D vaccine / yellow fvr vaccine

10 days to lifetime

Aedes aegypti index : house index

👉 % of houses with aides larvae

👉 Should be <1% around 400m of ports

Yellow fever

CD 4 <100 in male with HIV, most common opportunistic infection

MAC

BRETEAU INDEX

👉 (Containers with larvae / houses inspected) × 100

Yellow fever

If a traveller comes to India without vaccination certificate of 17D vaccine. How many days will the person be in quarantine ?

6days

JE vector

Culex (tritaeniorhynchus, vishnui)

JE cycle

👉 BIRD ↔ MOSQUITO ↔ BIRD

👉 PIG ↔ MOSQUITO ↔ PIG

What is the role of humans in JE?

Dead end host

No man to man transmission

JE reservoir

Ardeid Birds (pond herons, cattle egrets)

JE amplifier /maintain viremia

Pigs

Horses in JE role

Only animal without symptoms

Role of cattle and buffaloes in JE

Zooprophylaxis

(They divert mosquitos) hence protective

JE case fatality rate ?

30%

JE vaccine live and killed names and do they follow open vial policy ?

Live - SA-14-14-2 (does not follow)

Killed - JENVAC (follows) used in NIS

Hepatitis A spread route & incubation period

Feco oral , sexual

AE SHORT : 10-50 days

Hepatitis B spread route & incubation period

Sexual , prenatal, parenteral

Biggest incubation - 30-180 days

Hepatitis E spread route & incubation period

Feco oral

AR SHORT : 3-8 wks

Hepatitis C spread route & incubation period

Parenteral

Chaotic wide spread - 2wks - 6 months

Hepatitis D spread route & incubation period

Sexual, prenatal, parenteral

B like D (meDium): 30-90 days

Oldest known disease to mankind

Leprosy

current status of leprosy in India

ELIMINATED

Current prevalence of leprosy

0.45

Most imp epidemiological indicator of NLEP( national leprosy eradication program)

ANCDR - annual new case detection rate (<10 cases/ 1 lac)

Most imp health awareness / leprosy awareness indicator in NLEP (national leprosy eradication program)

Grade 2 disability indicator

Agar g2 kam mtlb leprosy awareness health operations thik chal rhe h

Most imp operational indicator in NLEP national leprosy eradication program)

Grade 2 disability indicator

Treatment of PauciBacillary leprosy

DRC X 6-9months

Dapsone rifampicin clofazimine

Treatment of Multibacilary leprosy

DRC- 12-18months

Dapsone rifampicin clofazimine

Welfare allowance for reconstructive surgery for leprosy

₹ 12,000

SPARSH INITIATIVE

used SAPNA as a mascot .

Village skl girl to spread awareness on leprosy

Prophylaxis for leprosy

Single dose rifampicin to house mates, social mates . Contact time >20hrs/wk

ASBULS

Asha based surveillance for leprosy

Leprosy mukt Bharat 2027 features

1 early detection

2 free of cost treatment

3 medical rehabilitation for existing cases

UJJAWLA SCHEME

Ujjawala = save women

Human trafficking + rescue + rehabilitation + reintegration of victims of trafficking of csw

UJJWALA YOJANA

👉 Free LPG connections worth 5crore to BPL till 2019 families

Gas = ghar ki Ujjwala

UJALA SCHEME

Unnat jeevan by Affordable LEDs and Appliances

Largest domestic lighting project in the world

Promotes use of energy efficient LED bulbs in every household

👉 “UJALA = light”

INSPIRE SCHEME

INSPIRE = stop violence”

Violence prevention (7 strategies)

Urban health equity assessment & response tool

URBAN HEART

Which measure of obesity is height independent

Corpulence index

H5N1 influenza vaccine route of administration

Intramuscular

Rickettsiae transmission

Louse

Tick

Mite

Flea

Never mosquito

Yellow fever incubation

3-6 days

Swine flu test

PCR

Viral culture

4 fold rise in H1N1 virus specific neutralizing antibodies

Chandler’s index is used in epidemiological studies of

Hookworms

Monica project

Sodium content of ReSoMal

45mmol/L

Which cholera vaccine is no longer produced

CVD103-HgR

Which vaccine is SECONDARY LEVEL of protection

BCG (intravesical instillation) used for bladder cancer treatment