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The Central Multidisciplinary team visited various treating facilities in Rourkela to assess the handling of Acute Diarrheal Disease (ADD) cases, including community perceptions and interventions. Data from October to December 2023 was analysed by our team to confirm the outbreak and standards followed during the emergency situation. Laboratory investigations were conducted at different facilities for testing stool and water samples. Samples were found to contain Vibrio cholera. Water and food quality tests were also performed to identify potential sources of contamination. The team recommended additional testing to understand antibiotic resistance patterns. Overall, the outbreak was linked to V. cholerae, and efforts were made to better understand and manage the situation through in-depth analysis and monitoring. Public health measures controlled the outbreak, with cases decreasing by late December.

Recommendations included continued surveillance, improved sample transport, regular water quality monitoring, and analysis of communicable disease data for public health action.

Meeting With Commissioner of RMC By Central Team

Visit at WATCO by Central Team

Lab Visit By Central Team

Outbreak Investigation 2021 - 22

The Nationwide COVID-19 Serosurvey - Round 4 was carried out in June 2021. ICMR-NICED, with active cooperation from the State and respective District Health Authorities, successfully conducted this survey in eight districts / health districts in West Bengal - namely, South 24-Parganas, Diamond Harbour HD, Bankura, Bishnupur HD, Jhargram, Alipurduar, Purba Medinipur, Nandigram HD. In each district, 10 clusters (villages / municipal wards) were selected and from each cluster a minimum of 40 individuals aged 6 years or more were included in this survey from the general population. Thus, the minimum sample size per district for the general population was 400; in addition,

100 health care workers were also included from 1 or 2 selected health care facilities. In this survey, the study teams visited the selected households and after obtaining informed consent, captured relevant information on an Open Data Kit (ODK) application on mobile phones. Trained phlebotomists in each survey team collected about 3 ml of venous blood from each participant. The serum was separated after centrifugation in a local health facility and later transported to the ICMR-NIE laboratory in Chennai. All serum samples were tested for presence of IgG antibodies against SARSCoV-2. Overall about 60% of the general population and 80% of the health care workers found to have antibodies against SARS-CoV-2.

In view of rapid surge in cases and deaths because of COVID 19, deployment of Central Multi-disciplinary team was done to 10 identified states including West Bengal. The team conducted their activities for a period of five days from 27/12/2021- 30/12/2021 Assist the state of West Bengal in management of COVID-19 pandemic and worked in several districts of West Bengal to understand the situation of SARS-CoV-2 infection. To assist the state in controlling COVID-19 outbreak we visited municipal areas and blocks to access the COVID- 19 situation in Kolkata, North 42 Parganas, South 24 Parganas, Hooghly and Howrah district of West Bengal. We also visited COVID 19 hospitals, district hospitals, PHCs and diagnostic centres at Kolkata, North 42 Parganas, South 24 Parganas, Medinipur and Howrah to provide necessary support to the state. Airport preparedness was access by the team at NSC Bose Airport, Kolkata.

Areas focussed during field visit was

• Testing : RAT/RTPCR

• Contact tracing, including surveillance, containment operations

• Samples for Genome sequencing to INSACOG network

• COVID appropriate behaviour and its enforcement

• Hospital logistics: Number of beds, ambulances, Medical O2 etc.

• COVID-19 Vaccination progress

This visit was important to provide necessary suggestion for better implementation of containment plans and micro

plans including better hospital management.

Information collection during COVID-19 serosurvey (round 4)

Specimen collection during COVID-19 serosurvey (round 4)

Specimen collection during COVID-19 serosurvey (round 4)

Specimen processing during COVID-19 serosurvey (round 4)

Outbreak Investigation 2020 - 21

Under the leadership of Dr. Shanta Dutta, this institute was involved in various emergency activities in connection with the Covid 19 pandemic situation. Since the inception, ICMR-NICED was designated as the regional center for testing clinical samples by RTPCR for COVID 19 diagnosis in West Bengal and other Eastern states of India. NICED-VRDL (Viral Research Diagnostic Lab) became operational for 24x7 hrs since 1st week of February 2020 and has completed testing of >387870 samples by 8 Jul 2022 by RT PCR and uploaded the data on ICMR portal in timely manner. During earlier days, it also provided diagnostic support to north-eastern states, Jharkhand, Odisha, Sikkim and was involved in capacity building for RTPCR test for SARS-CoV2, to the lab personnel of both Govt. (Medical colleges and hospitals) and non-Govt. Labs in West Bengal. It also acted as quality checking (quality control and quality assurance) center for all the testing labs in West Bengal and provided periodic feedback to ICMR. To further increase the capacity of testing per day, one high throughput machine (COBAS 8800) was launched at NICED by the Honorable PM, GOI on 27 Jul 2020. It acted as one of the ICMR's validation labs for validating COVID-19 RT-PCR kits and RNA Isolation kits before those kits were commercially available. It has been shouldering the responsibility of both Central Depot and the Regional depot for receiving, storage and distribution of diagnostic kits, viral RNA isolation kits and Viral transport media to the labs in eastern and north-eastern regions. The states covered under NICED Central/Regional Depot were West Bengal, Bihar, Odisha, Jharkhand, all North-Eastern States, including Assam, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura and Sikkim. On the directives of EMR Division, Ministry of Health, Govt. of India, Dr. Dutta has provided all support to the central team visiting this state and entrusted one NICED Scientist to become the member of Central Rapid Response Team for supervising the Implementation of Cluster Containment Plan, micro-plan and hospital preparedness for COVID-19 during 18April to 1May, 2020.Epidemiology division of NICED conducted three rounds of repeat cross sectional National COVID-19 sero-survey in selected six districts of West Bengal. The blood samples, collected during the sero-survey, were tested for determining COVID-19 IgG antibody titer and the trend of exposure in the population. ICMR-NICED was involved in Whole Genome Sequencing (WGS) of the SARS CoV-2 virus,present in the clinical samples,was jointly performed with NIBMG, Kalyani and IISC, Bangalore, the data has been published and uploaded in the public domain. NICED was involved in a number of multi centric vaccine trials

to determine safety,efficacy and immunogenicitythe vaccines against SARS-CoV 2 infection like Recombinant BCG (rBCG) vaccine trial and phase III trial of the indigenous vaccine (COVAXIN). ICMR-NICED has been selected as one of the ten centres for national COVID-19 biorepositories for collection, storage and maintenance of clinical samples from COVID-19 cases for steering research in developing new diagnostics, therapeutics, vaccines against COVID-19 infection. Online systems were developed for regular communication, reporting and data generation. To support National policy and generate national level evidence, various collaborative research activities were undertaken by NICED scientists. NICED also supported basic research on Covid 19, by becoming collaborating partner with IITs and other research organizations.

COVID-19 Pandemic was the greatest challenge of the century because of its high infectivity and little knowledge. ICMR-NICED has been involved in COVID 19 related activities since the beginning of the nationwide lockdown period. With limited human resources, mobility restrictions, the staff of this institute took a humongous task in receiving, testing enormous number of clinical specimens on daily basis round the clock and providing feedback to all concerned agencies.

Outbreak Investigation 2019 - 20

Post-flood visit at Patna, Bihar: In response to the concerns raised by the severe flood in Patna, visit was conducted as part of the central team during October 3-10, 2019 under the guidance of the Director RMRIMS. He briefed about the current situation of flood affected areas and about the work to be done by each member of the team. The team also met Hon'ble Minister of State for Health and Family Welfare, Govt. of India, who expressed his views and expectations from the team. The team visited several areas in Patna, many of which were still submerged under water. In many places Aedes vector breeding was noted and brought to the notice of concerned municipal health authorities and suggested appropriate measures. Water and food safety were also checked in the visited areas and recommendations were made as per needs.

Public Health Support After Extremely Severe Cyclone "Fani" In Odisha: An extremely severe cyclonic storm, Fani, struck coastal Odisha around Puri district on 3rd May, 2019. Following this, several scientists of ICMR-NICED took turn to be deployed in various affected areas of the State as part of the Central Public Health Team formed by the Directorate General of Health Services, Emergency Medical Relief Division, Ministry of Health & Family Welfare, Govt. of India to assist the State Health Department. Dr. S. Kanungo (Epidemiologist) visited Bhubaneswar during May 3-6, Dr. R. K. Nandy (Microbiologist) was deployed in Puri district during May 8-21 2019, Dr. A. K. Mukhopadhyay (Microbiologist) was posted to Khordha District during May 8-22, while Dr. A. K. Chakraborty (Microbiologist) was stationed in Puri District during May 23-June 06, 2019. The teams visited the affected areas and did a rapid situation analysis, assessed the preparedness and needs of the local health facilities especially in terms of water and vector-borne diseases, trained several peripheral health staff and made recommendations as appropriate.

EMR team members and State Health Officials meeting at Puri

Filed testing for chlorination of drinking water source

Testing for Malaria parasites at the household level by EMR team using Rapid Testing Kit

Outbreak Investigation 2018 - 19

Kerala Post Flood Outbreak Investigation: Following a devastating flood that affected several districts of Kerala in the last week of August 2018, five scientists of ICMR-NICED (Drs. A.K. Deb, H. Koley, S, Basu, A. Chakrabarti and A. Sinha) were deployed in two phases (September 1-14 and Sep 15-30, 2019) by the EMR Division, DGHS, Govt. of India to assess public health situation including potential of any epidemic and prevention and control measures to be implemented in the flood-affected areas. The scientists formed part of three-member teams, consisting of a public health specialist, a microbiologist and an entomologist, that were deployed in the flood-hit districts, and were posted in Thrissur, Kasargod, Kannur, Idukki and Thriruvananthapuram districts of Kerala. Upon arrival at Thiruvananthapuram, all team members were briefed about the overall scenario and expectations from each team by officials from the Regional Directorate of Health Services. Thereafter, each team proceeded to the allocated district, where the members first held discussions with the District Medical Officer (DMO), District Programme Manager (DPM) and other health officials and laid down a detailed plan of action regarding scrutinizing IDSP daily data, detecting potential of any outbreak, looking for mosquito breeding activities, checking for stockpiling of essential drugs and chemicals as well as water safety and sanitation, especially for the most affected parts of respective districts. Many local people were also shifted to temporary shelters that were set up in local schools, community halls and religious places; the teams also visited some of these camps and assessed their health and other requirements. The teams also made daily reporting to the DMO and DPM at the end of each day and revised their further action plan whenever necessary. For example, in Thrissur district, an outbreak of leptospirosis was detected but was quickly brought under control through distribution of appropriate chemoprophylaxis to all people at risk by the local health authority. Further, on several occasions, the teams detected inadequate chlorination of drinking water that was available to local residents in some areas; this was promptly brought to the notice of the health authorities and appropriate measures were taken. Thus, the scientists played an important role to alleviate flood-related public health problems in several districts of Kerala.

Avian Influenza outbreak Investigation at Village Fajilkhutahari, Godda District, Jharkhand: A Central Public Health Team was deployed by Directorate General of Health Services, Emergency Medical Relief Division, Ministry of Health and Family Welfare, Govt. of India regarding Avian influenza outbreak control and containment at Village Fajilkhutahari, Godda District, Jharkhand during February 9-18, 2019. Dr. A. Chakrabarti took part in the team as a Microbiologist. During the investigation the team in association with State, District, Block and Field level health officials. Initially the team members were briefed by the State Headquarters and then moved to the affected areas as per the direction. They visited the affected areas, trained health personnels and conducted seminar on influenza. No human cases were detected and the situation was under control. Surveillance activity was scrutinized and a proper surveillance was suggested. Test laboratories were also visited and proper guidance was provided.

Outbreak Investigation ...

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