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Can Non-Polio Enteroviruses Be Tamed with a Vaccine to Minimize Paralysis Caused by Them?

World Journal of Vaccines 2015年第1期5卷 54-59页

作者： omesh kumar bharti Corporation Health Officer Municipal Corporation Shimla India

Background: While we are inching towards global eradication of polio, the paralysis due to non-polio viruses (NPEV) poses greater challenge. Factors responsible for causing Acute Flaccid Paralysis (AFP) were studied in 3596 AFP patients in 64 districts of Uttar-Pradesh, India, to observe indirect relationship of AFP with wild polio as well as NPEV. A recent study suggests the need to investigate polio virus negative but NPEV positive AFP cases. Methods: The lab results of the stool samples of these children were line listed and analysed to observe the association of various factors with respect to presence of paralysis on 60 follow-up days. Taking zero OPV dose AFP cases as a biological base, we studied the relationship of presence of paralysis at 60 follow-up days to that of presence of NPEV in stool samples while polio virus was present or absent. Results: 70 of the 86 AFP cases (81%) with zero OPV dose and having only NPEV isolated in stool samples were having paralysis at 60 follow-up days. There were 4.54% (162) AFP cases, which did not carry any polio virus but were having NPEV isolated in the stool samples and paralysis at 60 follow-up days. 79% (75/95) of zero OPV dose children, who were having residual weakness at 60 follow-up days, were carrying both polio virus as well as NPEV in their stool samples. Total AFP cases, having residual weakness at 60 follow-up days and having NPEV in stool samples, decreased with increase in OPV doses;a behavior similar to what wild polio viruses (WPV) have to OPV. Conclusions: Maybe polio like NPEV is active for causing severe paralysis in children and is responding to the OPV. As is evident in the studies by M. Margalith, B. Fattal et al. [1] that there is an antibody response to the enteroviruses, we can think of coming out with a vaccine against the enteroviruses. Therefore, enterovirus vaccine can be produced on similar lines to that of OPV, as now we have enough isolates of NPEV. Effective NPEV surveillance system also

关键词： Polio Non-Polio Paralysis Enteroviruses Vaccine

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Immunizing Vulnerable Populations Like Rag Pickers, Garbage Collectors, Municipality Workers and Newspaper Hawkers against Rabies in Shimla Municipality, HP, India

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World Journal of Vaccines 2015年第1期5卷 19-24页

作者： omesh kumar bharti Corporation Health Officer Municipal Corporation Shimla India

Background: Rabies is a zoonotic disease and many vulnerable sections like rag pickers and municipality workers neglect animal bites due to ignorance of their potential deadly outcomes. Stray dogs abound in garbage pits and this population is exposed to their attacks. It should be a mandate for municipalities to help protect their sanitary workforce, especially rag pickers, from deadly infectious diseases such as Rabies, Hepatitis-B, HIV, Tetanus etc. Objectives: Objective of this study was to study methods to provide pre-exposure Rabies vaccination for such highly exposed populations by engaging them and understanding their perception of this disease through a constant dialogue with them. Methods: We started by engaging with the rag pickers to know how best to entice them to get themselves immunized. We then attempted to search literature for the most practical methods likely to succeed in reducing risk of rabies deaths in this population. Results: WHO approved 3 injections of 0.1 ml tissue culture vaccine on days 0, 7 and 21 were tried but were shown to result in many dropouts among rag pickers for repeat injections. We then followed a method where 0.1 ml of rabies vaccine was injected at 4 different anatomical sited in one setting. This proved acceptable and relatively inexpensive. A small number of subjects were studied by determination of neutralizing antibody by RFFIT, which proved immunogenic having anamnestic response on boosters given single IM or at 4 sites ID subsequently, implying that short schedule rabies pre-exposure vaccination can be done in high risk groups and may save lives if applied to the poorest that are highly exposed.

关键词： Pre-Exposure Rabies Vaccination Intradermal Antirabies Vaccination (IDRV) Rag Pickers

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Exploring the Feasibility of a New Low Cost Intra-Dermal Pre &Post Exposure Rabies Prophylaxis Protocol in Domestic Bovine in Jawali Veterinary Hospital, District Kangra, Himachal Pradesh, India

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World Journal of Vaccines 2018年第1期8卷 8-20页

作者： omesh kumar bharti Uppinder kumar Sharma Adarsh kumar Archana Phull Intra-Dermal Antirabies Clinic and Research Centre DDU Hospital Shimla Himachal Pradesh India Sub Divisional Hospital Jawali Kangra Himachal Pradesh India Department of Surgery and Radiology College of Veterinary and Animal Sciences CSK Agricultural University Palampur Himachal Pradesh India Department of Journalism Himachal Pradesh India

Cattle are the backbone of household economy in rural areas of India and many of them die after bites by potentially rabid dogs, despite being given currently recommended five shots of intramuscular (IM) rabies vaccination as Post Exposure Prophylaxis (PEP). In 2016, seven of 21 bovine bitten by rabid dogs given IM rabies vaccination died due to rabies in Shimla Municipality. This scenario prompted the authors to look for a suitable protocol, based on human studies, to save animals. We tested various schedules of IDRV in bovine and found that a schedule of 0.2 ml given in middle 1/3rd of neck on day 0, 3, 7, 14 and 28 along with local wound infiltration of eRIG is sufficiently immunogenic and life saving in all of them, even if bitten by lab confirmed rabid dogs/mongoose as tested by CRI. Rabivac Vet, a Cell Culture Rabies Vaccine, available as 1 ml per vial was used off level for IDRV. While injecting the vaccine, a raised papule of ≥1 cm will appear slowly causing a peau d’orange appearance. All 60 bovine serum samples tested by RFFIT after IDRV, had titers more than 0.5 IU/ml on day 14. Thereafter, a total of 150 animals were given five doses of IDRV as PEP, with or without RIG, after their exposure to clinically or lab confirmed rabid dogs/mongoose and all survived for more than a year. Serum samples from 15 animals bitten by lab confirmed rabid dogs/mongoose were collected on day 14 and tested for RVNA by RFFIT from NIMHANS Bangalore and all had desired antibody titers above 0.5 IU/ml, without any immunosuppression. The RFFIT titers in 55% bovine in all groups were more than adequate after one year and 100% of them had anamnestic response to a single 0.2 ml booster given at one year. Few of the bovine and even one equine (Horse. Figure 4) brought for PEP at some of nearby vet hospitals were given IM rabies vaccine with local eRIG infiltration also survived. Local eRIG infiltration appeared to have covered the lacuna of longer window period required for indigeno

关键词： Rabies Local Wound Infiltration of Rabies Immunoglobulin Intra-Dermal Rabies Vaccination

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Spontaneous Rabies in a Stray Bitch after Parturition Induced Immunosuppression —Investigating an Impending Outbreak of Rabies with One Health Approach

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World Journal of Vaccines 2016年第1期6卷 1-8页

作者： omesh kumar bharti Hamender Sharma Uppinder Sharma Archana Phull State Intradermal Antirabies Clinic and Research Centre DDU Hospital Shimla Shimla India Dog Sterilization Centre Animal Birth Control Programme MC Shimla Shimla India Veterinary Hospital Kangra India Daily Post Shimla India

Background: Rabies is endemic in India and every half an hour a person dies of this dreaded disease. Stray roaming dogs, mostly unvaccinated, are most dangerous host in spread of rabies in India and in our state of Himachal Pradesh. Timely prophylaxis is the only method to save animal bite victims, including that of rabid dog bite patients. Objectives: Objective of this study was to investigate an impending outbreak of rabies in Shimla town in the absence of life saving rabies immunoglobulins (RIGs) in the market, and to know the source of infection by using one health approach and using epidemiological tools. Methods: On April 7, 2015, there was a sudden surge in cases of suspected rabid dog bites. Impending rabies outbreak was suspected as there were no RIGs available in the market. A rapid Response Team (RRT) consisting of the author, veterinary doctor, dog squad of Municipal Corporation (MC) Shimla along with the vehicles to impound rabid dogs was constituted to investigate the terror spread by two rabid dogs on biting spree in the Shimla Municipality. Results: A total of 18 people were bitten by suspected rabid dogs within three days period. A black bitch and a brown dog, on the identity of affected people, were captured by the dog squad of Municipality next day on April 8, 2015 and taken to Dog Sterilization Centre, Animal Birth Control (ABC) programme, MC Shimla for observation. The most furious Black bitch died of clinically confirmed symptoms of furious rabies after three days. The second rabid dog, brown in color, died after a month of observation due to paralytic dumb rabies. The brain of the brown dog was extracted for Fluorescent Antibody Testing (FAT) at central research Institute (CRI) Kasauli and was found to be positive for FAT. Follow up of patients was 100% by house to house visit and over telephone and no casualty was reported. Conclusion: While we were working on hypothesis of rabid dogs getting the infection from nearby forest about 8 - 10 KM a

关键词： Human Rabies Dog Rabies Rabies Outbreak Local Rabies Immunoglobulins Anti Rabies Vaccination Immunosuppression FAT Testing ONE Health

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Pup Vaccination Practices in India Leave People to the Risk of Rabies — Lessons from Investigation of Rabies Deaths Due to Scratch/Bite by Pups in Remote Hilly Villages of Himachal Pradesh, India

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World Journal of Vaccines 2014年第1期4卷 7-10页

作者： omesh kumar bharti Vidya Ramachandran Sood Rajesh kumar Archana Phull Daily Post Shimla India Epidemiologist Kangra at Dharamshala India Municipal Corporation Shimla India National Institute of Epidemiology Chennai India

Rabies, a zoonotic disease, kills 55,000 persons every year globally and 20,000 persons in India. Two years back, we learnt of two deaths due to Rabies in remote village Shiv Shankar Garh of Arki block of District Solan and decided to investigate the deaths. Method: A rapid response team was constituted to investigate the deaths. We interviewed the villagers & family to conduct verbal autopsy. A line list of entire population of village and household contacts of the patients, who died, were made along with the line list of dogs and cattle. Results & Discussion: A-month-old stray pup brought home by the family and had caused an abrasion with its toes on the hands of both the deceased on June 2, 2011 while playing. The lady developed paralysis of the arm on July 3, 2011 and 3 days later developed symptoms of hydrophobia. She died on July 9, 2011. Her son had developed hydrophobia 10 days after that and died on July 19, 2011. Assumption that bite or abrasion by a small pup of one month cannot be fatal proved otherwise. Lack of awareness regarding the fatality of even a scratch and lack of knowledge regarding local treatment of the wound & vaccination of both human and pups, were the main reasons for the deaths. While such incidents keep on happening, and the veterinarians in India are refusing to vaccinate pups before three months of age, as pups may not develop immunity before that age, leaving unsuspecting people to the risk of rabies. Conclusions: Humans can be exposed to rabies even by pups below 3 months of age. Recommendation: Pup vaccination schedule in rabies endemic countries like India need revision. Veterinarians and public health experts need to strongly consider vaccinating pups at first contact with humans even if they are less than 3 months of age. A booster to the pup can be given at three months of age with subsequent yearly boosters.

关键词： Rabies Pup Scratch Pup Vaccination

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High Immunization Coverage but Delayed Immunization Reflects Gaps in Health Management Information System (HMIS) in District Kangra, Himachal Pradesh, India—An Immunization Evaluation

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World Journal of Vaccines 2015年第2期5卷 69-78页

作者： Rajesh kumar Sood Anjali Sood omesh kumar bharti Vidya Ramachandran Archana Phull District Epidemiologist Kangra Himachal Pradesh India College of Home Science CSKHPKV Palampur India State Institute of Health & Family Welfare Parimahal India National Institute of Epidemiology Chennai India Daily Post Shimla India

Background: Complete and timely childhood immunization is one of the most cost-effective interventions in improving child survival in developing countries. Computerized HMIS has been recently introduced to collect aggregated data on service beneficiaries in Himachal Pradesh. HMIS provides coverage estimates for immunization while information on timeliness is currently not available. Hence we conducted a study to validate coverage and assess the timeliness of immunization in Kangra District of Himachal Pradesh. We surveyed mothers (224) of children aged 12 - 23 months (as on January 2008) and selected 32 clusters in the district between January and March 2008. Design/Methods: We conducted a cross sectional survey and selected 32 clusters by probability proportional to size method whereas seven eligible children per cluster were randomly selected. We interviewed mothers using a structured interview schedule, examined immunization card & looked for Bacillus Calmette Guierre (BCG) Scar. Vaccination after 30 days from national schedule was considered “delayed”. We computed proportions of children completely immunized, immunization delayed, frequency of reasons for delay and 95% Confidence Interval (CI) for significance of associated factors. We conducted a case control analysis of factors associated with timely immunization by taking timely immunized children as cases and delayed immunized ones as controls. Results/Outcome: Reported coverage was universal (100%). Validated full immunization coverage was 94.2% by card/record & 99% by history. Only 29.5% (CI = 20.6% - 37.4%) of children were fully immunized as per schedule (delay less than 30 days). Median delay was 21 days for BCG, 28 days for Diptheria Pertussis Tetanus (DPT 3) and 25 days for measles. Among those with delayed vaccinations, reasons were forgetfulness (36%), lack of correct knowledge (27%) & mother gone to parents’ home (27%) & insufficient children in a camp to open full dose BCG vial (22%). Our case con

关键词： Immunization Coverage Delay Gaps Information Technology Health Information Systems

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Success Story of a Low Cost Intra-Dermal Rabies Vaccination (IDRV) Clinic-Lessons Learnt over Five Years of 12,000 Patient Vaccinations “Without Failure” at DDU Hospital Shimla, Himachal Pradesh, India <br/>—“Saving a Drop of Rabies Vaccine and Immunoglobulins” 12 Innovations to Make Himachal Pradesh Rabies Free State by 2020

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World Journal of Vaccines 2015年第3期5卷 129-139页

作者： omesh kumar bharti Shampur Narayan Madhusudana Ashok Kale Pyare Lal Gaunta Laxman Singh Chaudhry Jitender kumar Nirmal Gupta Dropda Shyam Faculty Epidemiologist State Institute of Health & Family Welfare Parimahal Shimla India Professor of Neurovirology Head WHO Collaborating Centre for Reference and Research on Rabies Department of Neurovirology NIMHANS Bangalore India Professor Department of Community Medicine Dr. Ulhas Patil Medical College & Hospital Jalgaon India Rtd. Sr. Medical Superintendent DDU Hospital Shimla India Associate Professor Department of Pediatrics Indira Gandhi Medical College Shimla India Staff Nurse Anti-Rabies Clinic and Research Centre (ARC&RC) DDU Hospital Shimla India Multi Purpose Health Worker (MPW) previously at Anti-Rabies Clinic and Research Centre DDU Hospital Shimla India

Background: Rabies is a dreaded disease and an estimated 55,000 people die of rabies every year. Himachal Pradesh is in the North bordering China and is predominantly rural and hilly. Villages are near forests, where wild reservoirs of rabies exist. Since health facilities are not accessible easily, we need to innovate on existing schedules of rabies vaccination keeping in view the compliance of the patients and affordability so as to give them the best possible option of treatment. In the year 2006 and 2007, we, at DDU Hospital Shimla, experienced a severe shortage of rabies vaccine and patients were running from pillar to post to fetch rabies vaccine. At the same time, we learnt that some of the patients died because either they were not able to purchase the vaccine, mostly because of its high cost, $35, or they ignored the animal bites and did not seek the treatment. Since last year, we have been experiencing non-availability of rabies immunoglobulins (RIGs) in the market and have to innovate new schedules and techniques to save lives of the patients. Methods: During shortage of rabies vaccine in 2008, we contemplated to start a low cost intra-dermal (ID) clinic so as to make rabies vaccine affordable as intramuscular (IM) vaccination cost five times more than ID vaccination. But, there were three main hurdles. One hurdle was the non-availability of rabies vaccine vials having written on them “For IM/ID use” and another hurdle was only fewer animal bite patients attending the DDU Hospital, sometimes only one or two per day, which was insufficient to open a vaccine vial and distribute among them. The third problem being faced was reluctance of the hospital doctors to prescribe ID vaccine as this was not the practice at higher teaching institutions, including medical colleges. We contacted a vaccine company and few vials labeled as “For IM/ID use” were sourced from Mumbai (1200 km away from here). We asked the Chief Medical Officer, Shimla district to write a lette

关键词： Intradermal Rabies Vaccination Local RIGs Infiltration Local Innovations Rabid Animals RIGs Scarcity One Health Zoonosis

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Breaking the Barriers to Access a Low Cost Intra-Dermal Rabies Vaccine through Innovative “Pooling Strategy”

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World Journal of Vaccines（疫苗） 2012年第3期

作者： omesh kumar bharti Wim Van Damme Kristof Decoster Petros Isaakidis An Appelmans Vidya Ramachandran Archana Phull Government of Himachal Pradesh Institute of Tropical Medicine National Institute of Epidemiology Bureau Chief Daily Post

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Molecules against COVID-19:An in Silico Approach for Drug Development

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Journal of Electronic Science and Technology 2021年第1期19卷 14-24页

作者： Rhythm bharti Sandeep kumar Shukla the Sri Venkateswara College University of DelhiNew Delhi 110021. The Institute of Nuclear Medicine and Allied Sciences Defence Research and Development OrganizationDelhi 110054

A large number of deaths have been caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)worldwide,turning it into a serious and momentous threat to public *** study tends to contribute to the development of effective treatment strategies through a computational approach,investigating the mechanisms in relation to the binding and subsequent inhibition of SARS-CoV-2 ribonucleic acid(RNA)-dependent RNA polymerase(RdRp).Molecular docking was performed to screen six naturally occurring molecules with antineoplastic properties(Ellipticine,Ecteinascidin,Homoharringtonine,Dolastatin 10,Halichondrin,and Plicamycin).Absorption,distribution,metabolism,and excretion(ADME)investigation was also conducted to analyze the druglike properties of these *** docked results have clearly shown binding of ligands to the SARS-CoV-2 RdRp ***,all ligands were found to obey Lipinski’s rule of *** results provide a basis for repurposing and using molecules,derived from plants and animals,as a potential treatment for the coronavirus disease 2019(COVID-19)infection as they could be effective therapeutics for the same.

关键词： Coronavirus disease 2019(COVID-19) drug repurposing,molecular docking natural therapeutics RNA-dependent RNA polymerase(RdRp) severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).

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Interval-Valued Programming Problem with Infinite Constraints

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Journal of the Operations Research Society of China 2018年第4期6卷 611-626页

作者： Promila kumar bharti Sharma Jyoti Dagar Department of Mathematics Gargi CollegeUniversity of DelhiNew DelhiIndia University of Delhi New DelhiIndia

In this paper,we explore a class of interval-valued programming problem where constraints are interval-valued and *** optimality conditions are *** of generalized(Φ,ρ)−invexity is utilized to establish sufficient op... 详细信息

关键词： LU-optimal solution Interval valued Semi-infinite Generalized invexity Duality

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