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   Table of Contents - Current issue
Coverpage
March 2021
Volume 153 | Issue 3
Page Nos. 241-400

Online since Friday, April 23, 2021

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EDITORIAL  

One World One Health: Widening horizons Highly accessed article p. 241
Samiran Panda, Balram Bhargava, Mohan D Gupte
DOI:10.4103/ijmr.ijmr_1056_21  PMID:33906983
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POLICY Top

Pandemics & One Health: India's evolving response p. 245
K Srinath Reddy, Manu Raj Mathur
DOI:10.4103/ijmr.IJMR_671_21  PMID:33906984
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Addressing challenge of zoonotic diseases through One Health approach p. 249
Rajesh Bhatia
DOI:10.4103/ijmr.IJMR_374_21  PMID:33906985
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International Conventions & One Health p. 253
Atanu Basu, Harpreet Sandhu
DOI:10.4103/ijmr.IJMR_644_21  PMID:33906986
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Biothreat & One Health: Current scenario & way forward p. 257
Atul Kotwal, Arun Yadav
DOI:10.4103/ijmr.IJMR_583_21  PMID:33906987
There is an increased connectedness among humans, animals, and the environment and the current pandemic has taught the interlinking of the health of humans, animals and the planet. This inter-connectedness and factors like population growth, migration, urbanization, and climate change contribute significantly to the enhanced probability of emergence of previously unknown wildlife source pathogens at any place, any time, and without warning. Lurking in the background is the massive potential for the deliberate use of biological agents as weapons by State or non-State entities. Biological weapons have been used in wars since antiquity, however, newer research and techniques have led to these being real threats with a vast potential of harm to humans, animals, and crops. Over a period, it has become increasingly difficult to differentiate between deliberate and natural biothreat incidents. The response to both types is alike to safeguard lives, livestock, crops and the environment and reduce the consequent socio-economic ramifications. Biothreat may be targeted towards humans, animals, or crops, or all these concurrently. Every country including India is at risk of biothreat. The concept of one health is thus essential for responding to emerging infectious diseases or biothreats. Comprehensive surveillance for early detection, reporting and early concerted action is needed for prevention and blunting the effect of biothreats, which require close coordination and collaboration among various stakeholders within each country as well as globally.
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One Health, “Disease X” & the challenge of “Unknown” Unknowns p. 264
Pranab Chatterjee, Parvati Nair, Matthew Chersich, Yitagele Terefe, Abhimanyu Singh Chauhan, Fabiola Quesada, Greg Simpson
DOI:10.4103/ijmr.IJMR_601_21  PMID:33906988
The emergence of SARS-CoV-2 and its rapid spread globally emphasizes the ever-present threat of emerging and re-emerging infectious diseases. In this review, the pathogen pyramid framework was utilized to identify the “unknown unknowns” associated with the emergence and rapid transmission of novel infectious disease agents. Given that the evolutionary origin of most of the emerging infectious disease agents can be traced to an animal source, we argue the need to integrate the “One Health” approach as a part of surveillance activities. The need for focusing on undertaking global and regional mapping activities to identify novel pathogens is discussed, given that there are an estimated 1.67 million unknown viruses, of which around 631,000 to 827,000 unknown viruses have the capacity to infect human beings. The emerging risks due to the ever-expanding interface between human, animals, both domestic and wildlife, and the environment are highlighted, these are largely driven by the need for safe habitation, growing food, developing infrastructure to support the increasing human population and desire for economic growth. The One Health approach provides a holistic way to address these cross-sectoral issues, by bridging institutional gaps, enumerating priority risk areas and pathogens, and highlighting putative risk factors for subsequent spillover events involving emerging and re-emerging infectious disease pathogens at the human-animal-environment interface.
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PROGRAMME Top

Enabling One Health solutions through genomics p. 273
Trinad Chakraborty, Sukhadeo B Barbuddhe
DOI:10.4103/ijmr.IJMR_576_21  PMID:33906989
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Adopting an intersectoral One Health approach in India: Time for One Health Committees p. 281
Rajib Dasgupta, Fiona Tomley, Robyn Alders, Sukhadeo B Barbuddhe, Anita Kotwani
DOI:10.4103/ijmr.IJMR_537_21  PMID:33906990
Following the several episodes of zoonotic disease outbreaks and the more recent COVID-19 pandemic, the Indian policy initiatives are committed to institutionalize One Health (OH) approaches and promote intersectoral, transdisciplinary collaboration and cooperation. The OH principle needs to be visualized beyond the scope of zoonoses. While conservation, ecological and veterinary professions are getting increasingly engaged with OH, most of the medical/clinical and social sciences professions are only peripherally aware of its nuances. The OH initiatives, by their essentially multidisciplinary nature, entail working across ministries and navigating tacit institutional hierarchies and allocating leadership roles. The logical operational step will be the constitution of One Health Committees (OHC) at the State and district levels. Here, we outline the key foundational principles of OHC and hope that the framework for implementation shall be deliberated through wider consultations and piloted and adopted in a phased manner.
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Emergency preparedness for public health threats, surveillance, modelling & forecasting p. 287
Jasbir Singh Bedi, Deepthi Vijay, Pankaj Dhaka, Jatinder Paul Singh Gill, Sukhadeo B Barbuddhe
DOI:10.4103/ijmr.IJMR_653_21  PMID:33906991
In the interconnected world, safeguarding global health security is vital for maintaining public health and economic upliftment of any nation. Emergency preparedness is considered as the key to control the emerging public health challenges at both national as well as international levels. Further, the predictive information systems based on routine surveillance, disease modelling and forecasting play a pivotal role in both policy building and community participation to detect, prevent and respond to potential health threats. Therefore, reliable and timely forecasts of these untoward events could mobilize swift and effective public health responses and mitigation efforts. The present review focuses on the various aspects of emergency preparedness with special emphasis on public health surveillance, epidemiological modelling and capacity building approaches. Global coordination and capacity building, funding and commitment at the national and international levels, under the One Health framework, are crucial in combating global public health threats in a holistic manner.
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Animal disease surveillance: Its importance & present status in India p. 299
HB Chethan Kumar, Jagadish Hiremath, R Yogisharadhya, V Balamurugan, Siju Susan Jacob, GB Manjunatha Reddy, KP Suresh, Rajeswari Shome, M Nagalingam, R Sridevi, SS Patil, Awadesh Prajapati, G Govindaraj, PP Sengupta, Divakar Hemadri, P Krishnamoorthy, Jyoti Misri, Ashok Kumar, BN Tripathi, Bibek Ranjan Shome
DOI:10.4103/ijmr.IJMR_740_21  PMID:33906992
Animal disease surveillance encompasses systematic collection of long-term data on disease events, risk factors and other relevant parameters followed by analyzing the same with reference to temporal and spatial characteristics to arrive at a conclusion so that necessary preventive measures can be taken. In India, the animal disease surveillance is done through National Animal Disease Reporting System, which is a web-based information technology system for disease reporting from States and Union Territories with the aim to record, monitor livestock disease situation and to initiate the preventive and curative action in a swift manner during disease emergencies. National Animal Disease Referral Expert System is a dynamic geographic information system and remote sensing-enabled expert system that captures an incidence of 13 economically important livestock diseases from all over the country and also provides livestock disease forecasting. The laboratories under State and Central governments, several research institutes under the Indian Council of Agricultural Research and veterinary colleges are involved in livestock disease diagnosis including zoonotic diseases. An integrated surveillance system is necessary for early detection of emerging/zoonotic diseases in humans. This review provides information on disease reporting and surveillance systems in animal health sector and the need for One Health approach to improve and strengthen the zoonotic disease surveillance system in India.
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One Health aspects & priority roadmap for fungal diseases : A mini-review p. 311
Sayantan Banerjee, David W Denning, Arunaloke Chakrabarti
DOI:10.4103/ijmr.IJMR_768_21  PMID:33906993
Fungal diseases have not been taken seriously in public health agendas as well as research priorities, despite of globally causing an estimated two million deaths every year, and the emergence of many troublesome fungal pathogens like Candida auris, azole resistant Aspergillus fumigatus, terbinafine and azole resistant dermatophytes, and zoonotic sporotrichosis in humans. Fungi are also responsible for huge losses of agricultural products and stored crops as well as recent massive and unexpected mortality in animals caused by white-nose syndrome in the bats and Chytridiomycosis in amphibians. This review aims to underscore the need for collaborative, multisectoral, and trans-disciplinary approach to include the One Health approach as an essential component of surveillance, prevention, and control of globally emerging fungal diseases. Rigorous evidence based surveillance of the environment as well as strengthening rapid and quality diagnosis of fungal diseases can save millions of lives and reduce significant morbidity.
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Journey towards National Institute of One Health in India p. 320
Sandeep P Chaudhari, Dewanand R Kalorey, Sudhakar P Awandkar, Nitin V Kurkure, Rahul Narang, Rajpal S Kashyap, Manju Rahi, Sukhadeo B Barbuddhe
DOI:10.4103/ijmr.IJMR_636_21  PMID:33906994
Background & objectives: Issues such as emerging and re-emerging infectious diseases, antimicrobial resistance, food security, biosafety and biosecurity are associated with changes in land use, population growth, urbanization, global travel and trade and climate change. As a result, a trans-disciplinary approach among human, animal and environmental health disciplines gained support. The Indian Council of Medical Research (ICMR) and Indian Council of Agricultural Research (ICAR) decided to establish a National Institute of One Health at Nagpur, Maharashtra, India. In this context, two collaborative research projects, funded by the ICAR and ICMR were initiated to conduct the epidemiological surveillance of selected zoonotic diseases in Central India. Methods: Disease surveillance and molecular detection employing standard techniques like enzyme linked immunosorbent assay (ELISA), immuno-fluroscent assay (IFA), standard tube agglutination test (STAT) , Rose Bengal plate test (RBPT) and polymerase chain reaction (PCR) were undertaken based on the disease to be screened. Results: In animals, the seropositivities for listeriosis (7.66%) and brucellosis (11.69%) were recorded. The occurrence of tuberculosis (3.8%) and leptospirosis (6.33%) was detected by PCR. Through cross-sectional studies from suspected human population with associated risk factors for zoonotic diseases, the seropositivity of brucellosis (1.83-11%), listeriosis (1.01-10.18 %), leptospirosis (8.14-12.67%) and scrub typhus (1.78-20.34%) was recorded. The investigations on scrub typhus indicated bimodal pattern during the months of pre-monsoon and post-monsoon season with a peak in post-monsoon in human cases. Ornithonyssus bacoti mites were identified from the rodents as a vector harbouring Orientia tsutsugamushi. The bovine tuberculosis was detected in 1.43 per cent human cases employing molecular assay. Interpretation & conclusions: The data indicated the occurrence of important zoonotic diseases adversely affecting the livestock health and human wellbeing. The scientific collaboration between veterinary and medical faculties has set an example for effective implementation of One Health (OH) programme for the establishment of National Institute of OH.
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PRACTICE Top

Tribal health & culture: Symbiotic model of One Health p. 327
RK Mutatkar
DOI:10.4103/ijmr.IJMR_593_21  PMID:33906995
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The concept of One Health: Cultural context, background & prospects in India p. 333
Mitchell G Weiss, Mohan Agashe, Mohan D Gupte
DOI:10.4103/ijmr.IJMR_732_21  PMID:33906996
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Experiences of Indian Council of Medical Research with tick-borne zoonotic infections: Kyasanur Forest disease & Crimean-Congo haemorrhagic fever in India with One Health focus p. 339
Devendra T Mourya, Pragya D Yadav, Deepak Y Patil, Rima R Sahay, Manju Rahi
DOI:10.4103/ijmr.IJMR_532_21  
Emergence and re-emergence of several pathogens have been witnessed by this century in the form of outbreaks, epidemics and pandemics. In India, the influencing factor that promotes dissemination of emerging and re-emerging viral infections is the biogeographical zones: a megadiverse country, characterized by varied geographical, climatic conditions and ever-changing socio-economical and geopolitical issues. These influence the movement of humans and animals and add layers of complexity for the identification and timely management of infectious diseases. This review focuses on two tick-borne infections: Crimean-Congo haemorrhagic fever (CCHF) and Kyasanur forest disease (KFD). In the last two decades, these viruses have emerged and caused outbreaks in different parts of India. KFD virus was initially identified in 1957 and was known to be endemic in Karnataka State while CCHF virus was first identified during 2010 in Gujarat State, India. These viruses have managed to emerge in new areas within the last decade. With changing epidemiology of these arboviruses, there is a probability of the emergence of these viruses from new areas in future. The investigations on these two diseases under the One Health focus involved early detection, quickly developing diagnostic tools, identifying stakeholders, capacity building by developing collaboration with major stakeholders to understand the epidemiology and geographical spread in domestic animal reservoirs and tick vectors in the affected areas, developing laboratory network, providing diagnostic reagents and biosafety and laboratory diagnosis training to the network laboratories to control these diseases.
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Food safety in fisheries: Application of One Health approach p. 348
Jess Vergis, Deepak B Rawool, Satya Veer Singh Malik, Sukhadeo B Barbuddhe
DOI:10.4103/ijmr.IJMR_573_21  PMID:33906998
Fisheries comprise the fastest growing sector meeting the global protein requirements. Being an affordable enterprise, it is considered a safe source of food and the muscles of healthy fishes are almost sterile. However, a multitude of hazards (biological, chemical, and environmental) can be introduced into aquaculture throughout the production and supply chain. Also, it can originate from unsuitable farming practices, environmental pollution, and socio-cultural habits prevailing in various regions. Hence, with an increasing global population and demands for aquacultural products, assessment and regulation of food safety concerns are becoming significantly evident. Ensuring safe, secure, affordable, and quality food for all in a global context is pragmatically difficult. In this context, it is quite imperative to understand the ecology and dynamics of these hazards throughout the entire production chain in a One Health approach. Here, we discuss the issues and challenges faced in the fisheries sector as a whole and the need for a One Health approach to overcome such hurdles.
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Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal – Current status & the way forward p. 358
Puran Kumar Sharma, Rina Tilak
DOI:10.4103/ijmr.IJMR_607_21  PMID:33906999
India is perilously poised on the threshold of an explosion of infectious diseases, some of which have witnessed re-emergence while others await apposite opportunity to do so. The State of West Bengal is uniquely positioned with its innate geographical vulnerabilities that favour outbreaks of a host of infectious diseases. The northern districts of this State are well known endemic areas for many outbreak prone communicable diseases like malaria, Japanese encephalitis, scrub typhus, dengue and kala-azar. An outbreak of Nipah virus in the recent past is a pointer towards the emerging and re-emerging threat in these regions and warrants urgent prioritization for surveillance and monitoring of these diseases. Identification of risk factors, challenges in delivery of primary healthcare, implementation of intervention strategies along with strengthening of healthcare setup are also the need of the hour. Multisectoral initiatives with emphasis on understanding the complex and rapidly evolving human-animal-vector dynamics as envisaged under the 'One Health' concept are indubitably important pillars in the effective management of these emerging public health challenges.
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Hitchhiking microbes: Declining biodiversity & emerging zoonoses p. 367
Gurudas Nulkar, Madhura Bedarkar, Ketaki Ghate, Sakshi Nulkar
DOI:10.4103/ijmr.IJMR_620_21  PMID:33907000
The connection between nature conservation and human wellbeing is well known, however, the role of declining biodiversity and emerging diseases is relatively less studied. The presence of a thriving biological diversity is known to have therapeutic effects on human health. On the other hand, human economic activities have contributed to a sharp decline in species, resulting in poor ecosystem health. Several studies have shown how microorganisms have switched from animals to humans, leading to novel diseases. This review describes studies on zoonotic diseases and biodiversity, with examples from India. It is argued that conservation of biodiversity and ecosystems and changes in economic activities must be made to ward off new diseases, and why cooperation between ministries is critical to restrict the decline of biological diversity in a megadiverse country like India.
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Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India: A One Health case study p. 375
Manoj V Murhekar, Jeromie Wesley Vivian Thangaraj, Candasamy Sadanandane, Mahima Mittal, Nivedita Gupta, Winsley Rose, Seema Sahay, Rajni Kant, Mohan D Gupte
DOI:10.4103/ijmr.IJMR_625_21  PMID:33907001
Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of AES. With the introduction of JE vaccination and other control strategies, the incidence of JE in the region declined, however, outbreaks of acute febrile illness with neurological manifestations continued to occur. Subsequent investigations identified Orientia tsutsugamushi, as the major aetiology of AES outbreaks in the region. This review details clinical, epidemiological, animal and entomological investigations conducted for AES due to O. tsutsugamushi during 2015 and 2017 in Gorakhpur region. Surveillance of acute febrile illness among children attending peripheral health facilities identified scrub typhus as an important aetiology of febrile illness during monsoon and post-monsoon months. Population-based serosurveys indicated high endemicity of scrub typhus. Entomological studies demonstrated natural infection of O. tsutsugamushi in small animal hosts and vector mites. Children acquired this infection through recent exposure to outdoor environment, while playing, or visiting fields or defecating in open fields. A few of the children with scrub typhus progress to develop CNS manifestations. Hence, early administration of appropriate antibiotics is crucial in preventing progression of AFI due to scrub typhus to AES. The investigations conducted by the multi-disciplinary team helped understand the transmission dynamics of scrub typhus in Gorakhpur division and recommend strategies for its control.
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Coastal ecosystem services & human wellbeing p. 382
Ahana Lakshmi
DOI:10.4103/ijmr.IJMR_695_21  PMID:33907002
Coastal areas are home to diverse ecosystems that provide essential goods and services for human wellbeing. Recognition, understanding and appreciation of the various goods and services provided by coastal ecosystems, especially the provisioning and cultural services are of utmost importance today. Systematic exploration of bioactive compounds from marine flora and fauna and deriving pharmaceuticals and nutraceuticals, as well as promotion of concepts such as the blue gym are essentially linked to human health and sustenance, necessitating measures towards preservation of these ecosystems. They also link Sustainable Development Goals, SDG 3: good health and wellbeing and, SDG-14: life below water.
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Health system preparedness & community participation in Japanese encephalitis/acute encephalitis syndrome (JE/AES) prevention in a tribal district of Odisha, India p. 388
Krushna Chandra Sahoo, Sapna Negi, Girish Chandra Dash, Rakesh Kumar Sahoo, Jaya Singh Kshatri, Sheetal Panda, Matrujyoti Pattanaik, Goldi Badaik, Sanghamitra Pati, Debdutta Bhattacharya
DOI:10.4103/ijmr.IJMR_645_21  PMID:33907003
Background & Objectives: Japanese encephalitis/acute encephalitis syndrome (JE/AES) is one of the major zoonotic arbodiseases that has a significant effect on human and animal health. Though many studies have been published on the epidemiology and transmission mechanisms of JE/AES, but there is little evidence on health system preparedness, including community-based engagement. This study was undertaken to explore a multi-stakeholder perspective on health system preparedness for the prevention of JE/AES in a tribal district of Odisha, India. Methods: This study was conducted at Malkangiri district of Odisha. A total of nine focus group discussions (FGDs) among women having under-five children, community volunteers, and community health workers (CHWs), and 20 in-depth-interviews (IDIs) among community leaders, healthcare providers, and programme managers were conducted. The FGDs and IDIs were digitally recorded, transcribed, translated and analysed using content analysis approach. Results: Health system preparedness for the prevention of JE/AES was improved, including effective vector management, implementation of the surveillance system, and vaccination programme. The JE vaccine was introduced under Universal Immunization Programme in Odisha in 2016. Behavioural Change Communication activities were provided with the support of community volunteers on Village Health Nutrition and Sanitation Day (VHNSD) under Gaon Kalyan Samiti (GKS) platforms. The CHWs were actively involved in vector management and raising sanitation and hygiene awareness. Interpretation & conclusions: Community participation and coordination between different stakeholders have a significant impact on the successful implementation of the programme. It was suggested that there was a need for a sustainability approach to active participation, orientation and capacity building training among CHWs and community volunteers to successfully implement the programme.
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A qualitative exploratory study using One Health approach for developing an intervention package for elimination of human anthrax in an endemic district of Odisha, India p. 394
Asit Mansingh, Hari Ram Choudhary, Jyoti Shandilya, Debdutta Bhattacharya, Jaya Singh Kshatri, Debaprasad Parai, Matrujyoti Pattanaik, Arun Kumar Padhi, Hitesh Kumar Jain, Prasantajyoti Mohanty, Srikanta Kanungo, Sanghamitra Pati
DOI:10.4103/ijmr.IJMR_646_21  PMID:33907004
Background & objectives: Anthrax is a zoonotic disease of public health concern in India. One of the key predisposing factors is linked to the behaviour of the community. This study was nested within a baseline survey to understand the risk perception, attitude, socio-cultural and behavioural practices among different communities in an anthrax endemic tribal district of Odisha, India. It was aimed to explore the systemic gaps from the officials of different departments while addressing the animal and human anthrax cases and the knowledge, attitude, and behavioural practices among the tribal communities with regards to both animal and human anthrax signs, symptoms, and transmission from animal to human. Methods: A qualitative exploratory study was carried out in the district of Koraput, Odisha. Insights from eight focus group discussions (FGDs) and 42 in-depth-interviews (IDIs) with the stakeholders from health, veterinary, forest, general administrative departments and community were collected and analyzed thematically. Results: Major themes that emerged were inter-departmental coordination, livestock vaccination, surveillance network, laboratory facilities, prevention and control strategies with regards to the animal and human anthrax cases. The study also emphasized setting up the surveillance system as per the standard guidelines, and strengthening the diagnostic facilities for timely detection of confirmed cases. It also highlighted the current needs and the gaps among inter-sectoral coordination, collaboration, and sensitization among Health, Veterinary, Forest, Education, Nutrition, and Tribal Welfare Departments at various levels to reduce the prevalence and control the outbreaks of anthrax in the district and State. Interpretation & conclusions: The coordination gaps, financial burden, insufficient relevant knowledge and information among the concerned stakeholders were the issues found in this study in addition to non-availability of proper diagnostic facility. The coordination among different departments adapting One Health approach may be one of the best possible ways for the elimination of anthrax cases in an endemic region.
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