NATIONAL INSTITUTE CUMMUNICABLE DISEASES, DELHI6.21. National Institute of Communicable Diseases
6.21.1. Objectives: The National Institute of Communicable Diseases (NICD) was established in July, 1963 by. expansion and re-organising the activities of the erstwhile Malaria Institute of India with the following objectives:(i)To undertake basic and applied research on various aspects of communicable diseases;(ii)To provide guidelines in the planning of epidemiological services, organising field investigations of communicable disease outbreaks and suggest control measures. (iii) To organise training programmes at National and International levels for raising trained man-power for programme management and augmentation of research.
6.21.2. Organisation: There are eight divisions: Bio-chemistry and Bio-technology, Helminthology, Epidemiology, Zoonosis, Medical Entomology and Vector Control, Microbiology, Training and Malariology and AIDS. The Institute also has eight field stations in Coonoor (Tamil Nadu), Jagdalpur (Madhya Pradesh), Patna (Bihar), Alwar (Rajasthan), Bangalore (Karnataka), Calicut (Kerala), Rajahmundry (Andhra Pradesh) and Varanasi (Uttar Pradesh). These field stations undertake specific epidemiological studies as well as assist in the training programmes.
6.21.3. Budget Allocation For 1998-99
(Rs. in Lakh)
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Name of Scheme Budget
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NICD(NON-PLAN) 724.00
NICD (PLAN) 460.00
YAWS Eradication Programme 75.00
Guineaworm Eradication 50.00
Programm
National Disease Surveillance 485.00
Programme
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6.21.4. International Collaborating/ Reference Centres: The institute has been recognised as: (i) WHO collaborative Centre for training in epidemiology for SEAR countries; (ii) WHO Colaborative Centre for Rabies epidemiology in SEAR countries; (iii) SEAR Regional Reference Lab for Poliomyelitis.
6.21.5. Research Projects: A number of research projects are currently being undertaken on epidemiological, biotech- nological, microbiological and entomological aspects of various communicable diseases.
6.21.6. Salient acctivities of varioul Division:
6.21.6.(i) Division Of Biochemistry & Biotechnology: The major activities of the division are as follows:
6.21.6.(i)(a) Sequencing of Polio virus for molecular epidemiology: Nucleotide sequence of Polio viruses are being carried out in the samples received from Poliovirus lab of NICD to study the molecular epidemiology and strain typing etc.
6.21.6.(i)(b) Molecular diagnosis and gene sequencing of Dengue viruses : Molecular diagnosis of Dengue/DHF is being carried out by selecting different target regions in the viral genome for strain typing and to dind out the changes in the gene to ascertain the cause of severity of the virus.
6.21.6.(i)(c) Screening of cDNA Library of P.vivax: the cDNA library of P.vivax constucted in lambda Zap-II vector are being screened to isolate and characterise unique genes which may be useful for identification of drug sesistant strains and for the development of newer drug formulations and vaccine etc.
6.21.6.(i)(d) Laboratory support for Epidemilogical surveys and, outbreaks: The blood, water and other biological samples collected during epidemiological surveys and outbreaks are being processed for suspected etiological agents by using molecular techniques (PCR/RT-PCR) etc. Blood samples collected during epidemiological dropsy outbreak (1998) in Delhi were analysed for the presence of toxic Sangurinine by reverse phase HPLC. The water samples received were processed for anions, cations and heavy metal contamination.
6.21.6.(i)(e) Laboratory support for management & monitoring of IDD: Being a National reference laboratory for IDD, training programme for programme officers and laboratory personnel of States/UTs.
6.21.7. Outbreaks Investigated
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Diagnosis of Area affected
outbreak
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1. Arthritis-cause Nursery of St.
probably Stephen's Hospital,
Coxsackie B4 Delhi
Virus
2. Mysterious Meerut, Uttar
diseases Pradesh
3. Cholera, Ghaziabad, Uttar
Typhoid fever, Pradesh
Hepatitis
4. Acute Renal Gurgaon district
Failure (Haryana) and
adjoining areas
5. Acute Diarrhoeal Tihar Jail, Delhi
disease
6. Acute Diarrhoeal Aizwal district,
Diseases Tripura
7. Cholera Sindhudurg district,
Maharasthra
8. Viral Hepatitis Engineering College,
Kota, Raiasthan
40 Tea gardens of
9. Cholera Assam (Golaghat,
Jorhat and other
districts)
Kalyan-Dombivali
10. Hepatitis Municipal
Coporation Area
11. Acute febrile Warangal, Kareem
encephalopathy Nagar & Adilabad of
Andhra Pradesh
12. Acute febrile Chota Udepur taluka
encephalopathy of Vadodara district,
Gujarat
13. Diarrhoeal Dwakra, Pappankala,
deaths Delhi
14. Epidemic dropsy Delhi and
neighbouring districts
15. Rapid health
assessment Surat district, Gujarat
following flood
16. Japanese Gorakhpur division,
Encephalitis Uttar Pradesh
17. Arbovirus Different parts of the
infections like country.
dengue and JE
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6.21.8. Epidemiology Division: The division is coordinating Yaws Eradication Programme and National Surveillance Programme for Communicable Diseases. The division conducted epidemiol- ogical investigations of outbreaks of various diseases (details given under outbreak investigations) and epidemiological surveillance of Cholera and Dengue fever.
6.21.9. Helminthology Division: The division coordinates the activities of guineaworm eradication programme for the country.
6.21.10. Filariasis: Under the programme, NICD undertook the following activities during 1998-99
6.21.10.(i) Filariasis Surveys: During the period 1998-99, filariasis surveys was conducted in Pathankot (Punjab). Apart from local residents, there were large number of primarily migratory Army and Air Force personals in the town. Similar survey was conducted during 1972. Though the Mf rate and Mf density increased from nil to 1.91 and 15.02, no local population was found to be infected. Average ten man hour density of Culex quinquefasciatus was 154. Filaria surveys in Faridabad (Haryana), Ghaziabad (U.P.) and in Delhi are continuing.
6.21.10.(ii) Cross-checking of slide examinationfor microfilaria: 246 blood smears were received from various NFCP units for cross checking. No discrepancy was observed in the report.
6.21.10.(iii) Filaria Clinics: Filaria clinics are conducted in all three Regional Filaria Training & Research Centres at Varanasi, Calicut and Rajahmundry. More than 5000 Mf positive cases (provisional) were treated during this period.
6.21.10.(iv) Filaria training: During the year filaria Inspectors and Technicians from filaria endemic states have been trained in filaria control activities at the Regional Fi- laria Training & Research Centres under NICD. Duration of the training course was 20 working days. These were conducted at RFT&RC, Varanasi from 13.04.98 to 08.05.98, at RFT&RC, Calicut from 03.08.98 to 28.08.98 and at RFT&RC, Rajahmundry from 26.10.98 to 20.11.98.
6.21.10.(v) Supply of teaching materials: 10 ml infected blood and 200 mf blood smears were supplied to different teaching institutes of Delhi
6.21.10.(vi) Miscellaneous: NICD branch, Rajahmundry conducted filariasis survey in Eluru, West Godavari district of Andhra Pradesh. 3,396 blood smears were collected and examined out of which 150 were found to be Mf positive (Mf rate 4.4 %). Disease rate was found to 1.6 % . Ten men hour density of Culex quinquefasciatus was 140 and infection rate was 6.4 %.
6.21.10.(vi)(a) NICD branch, Calicut conducted epidemiological study of filariasis in the ethnic hill tribal community of Trivandrum and Quilon districts of Kerala State. A total of 654 blood smears were and examined from eight settlements (villages). Mf rate varies from 0.69 to 20.69. Ten men hour vector density was found to vary between 2 to 46. Brugia malayi was the only filarial infection prevalent in the area.
6.21.11. Medical Entomology And Vector Control Division:
6.21.11.(i) Entomological aspects: Studies on vector of Dengue/DHF
6.21.11.(i)(a) Aedes Survey in Delhi:Sentinel Aedes survey carried out in a few selected localities in Delhi region revealed that the House index, Container index and adult man biting rate was recorded to be much above the critical level particularly during post-monsoon months in July, August and September, 1998.
6.21.11.(i)(b) Aedes survey at Airport/ Seaport: Aedes surveys carried out in and around Airport /Seaport areas during pre- monsoon period at Visakhapattanam , Chennai, Bangalore, Calicut, Cochin and Trivandrum revealed the breeding of Ae. aegypti, Ae.albopictus and Ae. vittatus mosquitoes. Ae. aegypti larval index was found to be much above the critical level at Calicut, Cochin, Chennai and Vishakapattanum port areas.
6.21.11.(ii) Studies on vectors of Malaria: Studies carried out in Vasant Kunj area in South Delhi reported large number of malaria cases over the last few years which revealed that the quarry pits and low lying areas are the major breeding site for malaria vector species, An.stephensi and A.culicifacies.
6.21.11.(iii) Studies on vectors of Japanese encephalitis: Entomological surveillance of J.E. vectors undertaken in and around Delhi areas revealed that Culex tritaeniorhynchus is the predominantly occurring species prevalent round the year.
6.21.11.(iv) Studies on vectors of Plague: An entomological survey for flea/rodents was undertaken at National Science Centre, Pragti Madian, New Delhi, consequent upon receiving the report about flea bites. A total of 17 fleas viz. Ctenocephalides felis felis, an ectoparasite of cats and dogs were collected. This flea species is not an efficient vector of Plague. Three rodents, Rattus rattus, trapped were found to be negative for flea infestation.
6.21.11.(v) Colonisation of Toxorhynchites splendens mosquito for the isolation of arboviruses. : During the year a colony of Toxorhynchites splendens, a tree hole breeding mosquito was established under laboratory conditions for the isolation of Dengue/JE viruses from blood sera or from pool of mosquitoes.
6.21.12. Vector Control aspects:
6.21.12.(i) Evaluation of insecticidal properties of indigenous plants: Laboratory studies undertaken to evaluate the insecticidal properties of essential oil of Cannabis sativa plant against mosquito larvae of C.tritaeniorhynchus, Cquinquefasciatus, An. stephensi and Ae. aegypti revealed that the oil induced 100.0% larval mortality at concentrations ranging from 0.06 to 0.2 ml/lit. of water.
6.21.12.(i)(a) Laboratory studies undertaken with Ipomea cairica, an indigenous plant commonly known as Railway creeper revealed that oil could induce 100% larval mortality in four species of mosquito at concentrations ranging from 0.1 to 0.15 ml/lit.of water.
6.21.12.(ii) Laboratory evaluation of Insecticide formulations: Insecticide formulations received from various agencies were evaluated as larvicides, adulticides, space spray, repellent etc. against the arthropods of medical importance and the results of bioassay tests were communicated to the concerning agencies.
6.21.12.(iii) Insecticide susceptibility status: Mosquitoes: Studies carried out on the insecticide susceptibility status of Cx. tritaeniorhynchus revealed that it is resistant to DDT & Dieldrin but susceptible to malathion and synthetic pyrethroid. Susceptibility tests carried out against the Aedes larvae revealed that they are susceptible to Temephos.
6.21.12.(iv) Biological control agents: Laboratory studies were undertaken to evaluate the mosquito larvae feeding potential of hemipteran ins" viz. Anisops, Ranatra, Diplonychus, Plea; Lakhccophilus (Coleptera); Aeshna (Odonata) and flatworm, Mesostorna sp.
6.21.13. Microbiology Division
6.21.13.(i) Polio and other enteroviruses: National Monitoring of cold chain system under this, the potency testing of field samples of oral polio vaccine (OPV) received from 5 States (U.P., Delhi, Rajasthan, Bihar and Madhya Pradesh) was carried out. A total of 3395 samples of OPV were tested, of which 91.0% of the samples were found to be having the satisfactory titres. This indicates that the cold chain conditions have improved as compared to previous year.
6.21.13.(i)(a) Laboratory based surveillance of Acute Flakhcid Paralysis (AFP) in Delhi and adjoining areas, was carried out; 680 cases of AFP were reported to the laboratory, and a total of 1290 stool samples were collected from these cases. However, satisfactory sample collection could be done in 80% of the cases.
6.21.13.(i)(b) Virus isolation was done on RD and HEp2 cell lines and subsequently the virus isolates were subjected to polio and enterovirus typing. 11% of cases showed the presence of non-polio enteroviruses. Polio were isolated in 203. Polio type 1 (123), Polio type 2 (15), Polio type 3 (36), Mixture of polio (15). All polio type I except 8 were wild, all polio type 2 except 2 are Sabin. All, polio type 3 were wild except 12 which were Sabin. Polio isolates from national polio laboratory at CRI, Kasauli were also received for intratypic differentiation.
6.21.13.(ii) Measles: One of the most important late sequalaes of measles infection is sub-acute panencephalitis (SSPE). Eleven clinically suspected cases of SSPE were reported to the laboratory. Three of these cases were confirmed by labroatory tests involving demonstration of high titre antibodies in serum and CSF samples. No case, so far, is reported following measles vaccination.
6.21.13.(iii) Viral Hepatitis: Laboratory support was provided to multicentric field study to ascertain aetiology of jaundice and determine carrier rate in community. Laboratory support was also provided to project on Hepatitis B immunization being conducted by Government of National Capital Territory of Delhi.
6.21.13(iii)(a) A total of 805 serum samples, referred from various hospitals in Delhi were tested for markers of viral hepatitis, viz. Anti-HAV-IgM, HBsAg, Anti-HEV, AntiHBeIgM, HBeAg, Anti-HBe, Anti HBc, Anti HBs, Anti-Delta, Anti-HCV and Anti HCV-IgM.
6.21.13.(iii)(b) HBsAg was found positive in 149 out of the 765 cases screened, while hepatitis-C prevalence, among the high risk individuals, was seen in 7 out of the 111 cases screened.
6.21.13.(iv) Terratogenic viruses (Rubella, CMV & HSV): These viral infections result in abortions and congenital malforma- tions in infants. A total of 412 serum samples from women having bad obstetric history and congenital malformed babies were tested for antibodies against rubella, CMV and HSV infections.
6.21.13.(v) Diarrhoeal Diseases:
6.21.13.(v)(a) Cholera: A total of 4,278 rectal swab specimens from cases of gastroenteritis in and around Delhi were processed for Vibrio Cholerae 01, V. cholera 0139 and other enteropathogen. About 38.92% of these were positive for Vcholerae 01 and 5.24% of these were positive for V.cholerae 0139.
6.21.13.(vi) Otherenteropathogens: Out of 3,907 rectal/stool specimens, 51 Salmonella specimens, 27 Shigella specimens viz. Shigella flexneri, S. sonnei, S. dysenteriae and S.boydii, and 216 E.coli & cultures were isolated.
6.21.13.(vii) Diphtheria and Tetanus: Diphtheria: A total of 165 throat swab samples from suspected cases of fauceal diphtheria were processed. Only 38 (23%) were found positive for C.diphtheriae.
6.21.13.(viii) Meningitis: Total of 6 CSF samples, received from different hospitals tested for the presence of antigen for Meningitis group A & C, pneumococci and H. influenzae--b. None of the samples were found positive.
6.21.13.(ix) Antimicrobial Resistance Monitoring: Antibiotic sensitivity of 2012 isolates (V. Cholerae, E. coli, Salmonella, Klebsiella.) were done during the period.
6.21.13.(x) Water bacteriology: Testing of drinking water samples for bacteriological standards: A total of 333 drinking water samples belonging to different drinking water sources (collected during outbreak investigations of water borne diseases, air-line caterers serving VVIP flights, referred sam- ples from schools, hospitals, etc.) were tested for bacteriological standards and safety. Over 57% of the samples tested were found satisfactory for bacteriologial standards.
6.21.13.(xi) Tuberculosis: A total of 895 clinical samples (mainly serum samples and a few other samples like CSF, pleural, other fluids) obtained from suspected cases of tu- berculosis were tested for anti-A60 and Anti-38kd mycobacterial antiboies by ELISA test, 200 samples were found to be positive.
6.21.13.(xi)(a) 515 clinical samples, majority of these being sputum samples obtained from different categories of tuberculosis were processed for Acid fast staining and mycobacterial culture, out of these 152 were positive for Mycobacteria, the majority of the isolates being Mycobacterium tuberculosis. 138 M.tuberculosis isolates were processed for in-vitro drug sensitivity testing by proportion method against INH, Streptomycin, Rifampicin, Ethambutol, Thiacetazone, Cy- closerine and ethionamide.
6.21.13.(xii) Training and Malariology Division: The division is fully equipped to undertake vector borne diseases out break investigations, especially malaria. The malaria clinic provides laboratory diagnosis for malaria to fever cases. During the year 256 blood smears were examined for malaria.
6.21.13.(xiii) Manpower development activities of the divison shown on Table next page.
6.21.14. Zoonosis Division: Currently the studies are being carried out on following zoonotic diseases Salmonellosis, Brucellosis, Hydatidosis, Plague, Rabies, Visceral Leishmaniasis, Toxoplasmosis, Arboviruses, Leptospirosis and Neurocysticercosis.
6.21.14.(i) Kala Azar: Diagnosis of Kala-azar in Delhi: Diagnostic services are provided to all Hospitals of Delhi. Diagnosis is made by bone-marrow smear examinations, promastigote culture and serological tests. During 1998 out of 204 bone marrow smears and 148 sera samples tested; 65 were found positive.
6.21.15. Toxoplasmosis: Toxoplasma gondii strain is being maintained in albino mice. Diagnostic facilities are provided to all the Hospitals. Indirect immunofluorescence test is used for detection of toxoplasma antibodies in patients serum. A total 1,423 sera samples were tested by IFA and 214 were found positive.
6.21.15.(i) Plague:
6.21.15.(i)(a) Serological surveillance: Rodent & dog serum samples from the States of Karnataka, Andhra Pradesh and Tamil Nadu and other parts of the country are tested by passive haemagglutination test for the presence of plague antibodies. During the year, 430 rodent and 293 dog sera were tested and none was found positive.
6.21.15.(i)(b) Bacteriological Surveillance: Wild rodents are being screened for the presence of Yersinia pestis infection. During the year 326 rodent organs were cultured for isolation of Y.pestis, none was found positive.
6.21.15.(ii) Rabies: Post-mortem diagnosis of Rabies in animals is provided by examination of brain specimens by Seller's straining, fluorescent antibody test and mouse inoculation. 37 animal brains were processed and 25 were found to be positive.
6.21.15.(ii)(a) Studies on suspected hydrophobia cases: Corneal smears, saliva and CSF from suspected hydrophobia cases are being tested by FAT and mouse inoculation test. Samples are obtained from I.D. Hospital, AIIMS and Safdarjung Hospital. 17 suspected hydrophobia cases were investigated.
6.21.15.(ii)(b) Assessment of antirabiesantibodies. Post immunization sera from humans and animals are being tested for the antirabies antibody titre by Counter immunoelectrophoresis. A total of 308 serum samples were tested during the year.
6.21.15.(iii) Arboviruses: Serodiagnosis. Serological diagnosis using haemagglutination Inhibition Test is performed on Serum & CSF samples. A total of 1,773 sera samples were tested using HI and ELISA tests.
6.21.15.(iv) Brucellosis: Serological investigations are being performed on sera samples received from different Hospitals (Medical and Veterinary). Out of 102 samples tested 19 were found to be positive for antibodies against Brucella.
6.21.15.(v) Food Borne infections:
6.21.15.(v)(a) Hydatidosis: Serological investigations are being carried out for the presence of antibodies against E. granulosus. Samples are being collected from these suspectecd cases of hydatid disease attending various Hospitals. During the year 21 sera samples were tested and 9 were found to be positive.
6.21.15.(v)(b) Salmonellosis: Serological surveillance is being carried out to find out the present status of the infection. Samples are collected from animals and humans from different plakhes in and around Delhi. Out of 48 samples tested 3 were found to be positive.
6.21.15.(vi) Rickettsial infections: Antibodies against Rickettsia are detected using WF test in patients with pyrexia of unknown origin. Out of 10 samples tested none was found positive.
6.21.15.(vii) Leptospirosis: ELISA test has been standardised for serology of Leptospirosis. Blood samples from patients with jaundice are tested for Leptospira antibodies using ELISA test and a total of 83 samples were tested and 7 were found to be positive.
6.21.15.(viii) Neurocysticercosis. Samples are being received from patients suspected of suffering from cysticercosis. Serological investigations are being carried out using ELISA test. A total of 477 samples were tested and 60 were found to be positive for antibodies against T.solium.