Natural contamination of human hands with enteric parasites in Indian Subcontinent

AIM: To investigate the prevalence of enteric parasite contamination on hands and the potential role naturally contaminated hands may have in their transmission. METHODS: Prior to initiating the survey, the protocol was reviewed and approved by respective Institutional Review Boards of each survey site(Dhaka, Bangladesh and Kolkata, India). Both stool and corresponding hand wash samples collected, were analyzed for the presence of enteric parasitic ova/(oo)cysts employing conventional microscopy coupled with permanent staining techniques. Additionally molecular approachessuch as polymerase chain reaction(PCR) of enteric parasites recovered from both stool and corresponding hand wash samples, were also used to further confirm their identity. RESULTS: A total of 972 stool samples were collected from both sites surveyed(300 volunteers from Kolkata, India and 672 from Dhaka, Bangladesh). Parasitic analysis revealed, 113(38%) from Kolkata, India and 267(40%) of stool samples from Dhaka, Bangladesh were positive for parasitic ova/(oo)cysts. When the corresponding hand wash samples were analyzed, 43(14%) stool-positive volunteers in Kolkata, India and 47(7%) in Dhaka, Bangladesh were positive for enteric parasitic ova/(oo)cysts. Ascaris lumbricoides(A. lumbricoides) ova and Giardia lamblia(G. lamblia) cysts predominated in hands wash samples from both sites surveyed(from India, A. lumbricoides ova, 53%; G. lamblia cysts 31% and from Bangladesh, A. lumbricoides ova, 47%; G. lamblia cysts 19%). Genotypic analysis of enteric parasitic ova/(oo)cysts obtained from both stool and corresponding hand wash samples taken from the same person were found to be identical. CONCLUSION: These results suggest a possible role of hands contaminated with enteric parasites' ova/(oo)cysts in the transmission of these parasites highlighting another role of hand hygiene/proper hand washing in reducing the disease burden in low socioeconomic communities.

Using focused pharmacovigilance for ensuring patient safety against antileishmanial drugs in Bangladesh’s National Kala-azar Elimination Programme

Background:Adverse effects of antileishmanial drugs can affect patients’quality of life and adherence to therapy for visceral leishmaniasis(VL)and post-kala-azar dermal leishmaniasis(PKDL).In Bangladesh,there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas(subdistricts)of 26 districts(these include VL,PKDL,treatment failure,and relapse VL and cutaneous leishmaniasis cases).This study aimed to investigate the feasibility of using focused pharmacovigilance for VL(VLPV)in Bangladesh’s National Kala-azar Elimination Programme for the early detection and prevention of expected and unexpected adverse drug reactions(ADRs).Methods:This activity has been going on since December 2014.Activity area includes secondary public hospital or Upazila health complex(UHC)in hundred sub districts and Surya Kanta Kala-azar Research Center(SKKRC)in Mymensingh District,a specialized center for management of complicated VL and PKDL cases.Communicable Disease Control(CDC)of the Directorate General of Health Services(DGHS)assigned twenty five of hundred UHCs and SKKRC(total 26)as treatment centers depending on their suitable geographical location.This was implemented for better management of VL cases with Liposomal Amphotericin B(AmBisome®)to ensure patient convenience and proper utilization of this expensive donated drug.A VLPV expert committee and a UHC VLPV team were established,an operational manual and pharmacovigilance report forms were developed,training and refresher training of health personnel took place at UHCs and at the central level,collected information such as patient data including demographics,treatment history and response,adverse events were analyzed.This report includes information for the period from December 2014 to December 2016.Results:From December 2014 to December 2016,1327 leishmaniasis patients were treated and 1066(80%)were available for VLPV.Out of these,57,33,9,and 1%were new VL,PKDL,VL relapse,and other cases,respectively.Liposomal amphotericin B was mostly used(82%)for case management,followed by miltefosine(20%)and paromomycin(3%).Out of the 1066 patients,26%experienced ADRs.The most frequent ADR was fever(17%,176/1066),followed by vomiting(5%,51/1066).Thirteen serious adverse events(SAEs)(eight deaths and five unexpected SAEs)were observed.The expert committee assessed that three of the deaths and all unexpected SAEs were possibly related to treatment.Out of the five unexpected SAEs,four were miltefosine-induced ophthalmic complications and the other was an AmBisome^(■)-induced avascular necrosis of the nasal alae.The Directorate General of the Drug Administration entered the ADRs into the World Health Organization Uppsala Monitoring Centre(WHO-UMC)VigiFlow database.Conclusions:This study found that VLPV through NKEP is feasible and should be continued as a routine activity into the public health system of Bangladesh to ensure patient safety against anti-leishmanial drugs.