key: cord-009362-4ewemyny authors: Chugh, Tulsi title: Snippets date: 2016-02-06 journal: nan DOI: 10.1016/j.cmrp.2016.01.006 sha: doc_id: 9362 cord_uid: 4ewemyny nan With concerted efforts of World Health Organisation (WHO) since 1988, poliomyelitis is on the threshold of global eradication. Wild poliovirus type 2 (WPV 2 ) was eradicated in 1999 and WPV 3 in 2012, and WPV 1 is still present but only in Pakistan and Afghanistan. Live attenuated oral polio vaccine (OPV) has been the mainstay. It provides durable humoral and intestinal immunity, is easy to administer and has a low cost. 1 However, OPV has two major risks due to genetic instability. First, it may very rarely cause sporadic case of vaccineassociated paralytic poliomyelitis (VAPP) when the given vaccine dose may revert to neurovirulence and cause paralysis in the vaccine recipient or a non-immune contact, who are otherwise immunologically competent. VAPP may also occur in persons who have primary immunodeficiency of antibody production. The second risk is the emergence of genetically divergent neurovirulent vaccine-derived polioviruses (VDPVs). These resemble WPV and can cause outbreaks in areas with low OPV coverage. Whereas VAPP is an adverse event following a dose of OPV, VDPVs are polioviruses whose genetic properties show a prolonged replication or transmission. Three different types of VDPVs are reported: (1) circulating VDPVs (cVDPVs) from outbreaks in low OPV coverage settings, All cVDPVs seen worldwide are identified and registered with WHO in Geneva. Among the 686 cVDPV cases reported since 2006, more than 97% were associated with cVDPV 2 . An update on vaccine-derived polioviruses worldwide, January 2014-March 2015, has been published recently. 2 Four aVDPV 2 s were isolated from AFP patients from four different states in India during this period. In addition, two VDPV isolates that escaped detection by screening assay by The Global Polio Laboratory Network have been reported from Mumbai, India. The first was seen in a 1.2-year-old girl with AFP in January 2008. It was identified as Sabin Type 3. The second was Type 2 VDPV found in an immunocompetent girl, 3.5 years old, in March 2014. A new confirmed case of VDPV in a 2.5-year-old child has been reported in Delhi in November 2015. This has been identified as P 2 . Replacement of trivalent OPV with bivalent OPV will greatly eliminate the risk for circulating VDPV 2 cases and iVDPV infections. Maintenance of high levels of immunity through comprehensive IPV coverage will be necessary to protect against iVDPV spread. Detection of chronic iVDPV exeretors with suitable antiviral therapy is also important. Infections with P. vivax and P. falciparum occur at approximately equal frequencies in 8 states of India where malaria is endemic. 1 The other three species, P. malariae, P. ovale and P. knowlesi, are reported less often. Mixed infections are reported in Peru, Brazil, Ethiopia and Papua New Guinea. Malaria diagnosis in India is based primarily on microscopy of peripheral blood smears and rapid diagnostic tests, which cannot differentiate monoinfections from mixed infections. A total of 1521 blood samples positive only for P. falciparum by microscopy were subjected to species-specific nested PCR (targeted 185 rRNA gene) and 265 (17.4%) of these were positive for mixed infections. Mixed infection of P. vivax and P. falciparum was seen in 239 (16%), P. falciparum and malaria in 19 (1%), P. falciparum and P. ovale in 6 (0.4%) and P. falciparum, P. malariae and P. ovale in 1 (0.1%) samples. These mixed infections were seen in all 8 states where malaria is endemic. Misidentification of malarial parasites may prolong parasite clearance time and lead to resistance to antimalarial drugs and more severe anaemia. P. vivax and P. ovale both cause relapses and P. malariae can sustain at low rates in the community for decades, and complicate malaria epidemiology and subsequent control. There is thus a need for improved quality of microscopy and rapid diagnostic tests in India. Invasive salmonella infections are a huge global burden. Worldwide annual estimates are: typhoid fever 22 million, paratyphoid fever 5.4 million and invasive non-typhoid salmonella disease (iNTS) 3.4 million. Morbidity and mortality are high, especially in resource-limited settings and in compromised hosts. Invasive non-typhoid salmonella diseases are principally Salmonella typhimurium and Salmonella enteritidis. The routine and prospective surveillance for antimicrobial resistance is not readily available. 1 Currently resistance to chloramphenicol, ampicillin and cotrimoxazole (MDR) has declined. However, if used, there is a need for multiple dosing, longer course of therapy (2-3 weeks), risk of chloramphenicol myelotoxicity and higher relapse rates. Fluorquinolone resistance is very common and hence unreliable for therapy. Third generation cephalosporins, oral and parenteral, are currently the mainstay, safe and effective. However, MIC creep and rarely full resistance have been reported. Azithromycin is a good alternative: oral, single daily dose, excellent tissue penetration, high intracellular concentration and almost negligible relapse rate. But resistance is already being reported. Combination therapy with third generation cephalosporins is under discussion. 2 Management of iNTS disease is as yet not fully determined, due to lack of adequate laboratory and clinical data. Third generation cephalosporins for at least 2 weeks is the conventional therapy. 3 Improved public health hygiene, wider use of WHO approved typhoid vaccines and designs of new vaccines which target the other serovars (S. paratyphi A, S. typhimurium, S. enteritidis, S. choleraesuis) are an urgent need to reduce the burden. New approaches to develop live attenuated multivalent salmonella vaccines are also in progress. 4 There is a high prevalence of severe disease in children under two years of age. The presently available vaccines cannot be used in these children. There is a need for conjugate vaccines which can be administered to infants and children. Ciprofloxacin-resistant Shigella sonnei associated with travel to India Shigella spp. is a major pathogen in food borne diseases. Shigella dysenteriae serotype 1 causes severe disease, outbreaks or even epidemics. Occasional outbreaks by antibiotic-resistant S. sonnei have been reported in industrialised world, especially among children. Such outbreaks are also now being reported from developing countries. In India, severe outbreaks of dysentery with high mortality were caused by multidrug-resistant S. dysenteriae type 1 during 1984-1985. Later, it re-emerged with fluoroquinolone resistance and caused several dysentery outbreaks. More recently, food-borne outbreaks due to S. sonnei have been reported in India. 1 The emergence of ciprofloxacinresistant S. sonnei causing such outbreaks and spread among international travellers is a cause of serious concern. Antimicrobial drug resistance is a serious worldwide issue more so in countries with poor sanitation and excessive use of antibiotics in humans and animals. Several studies show the emergence of ciprofloxacin-resistant S. sonnei in India. In view of this, ciprofloxacin can no longer be recommended for empiric therapy of S. sonnei infections. 2 Foodborne-associated Shigella sonnei Ciprofloxacin-resistant Shigella sonnei associated with travel to India The author has none to declare.