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BACKGROUND & OBJECTIVE: Leptospirosis outbreaks occur frequently in North and South Andaman Islands but not in Middle Andaman. In 2002, an outbreak appeared in Middle Andaman for the first time. Although a study on risk factors was conducted in North Andaman, it used seropositivity to define leptospirosis. Since seropositivity might not indicate current leptospiral infection and as no study on risk factors was conducted in Middle Andaman, we carried out this study to identify the risk factors during the outbreak. METHODS: A suspected outbreak of leptospirosis occurred in Rangat of Middle Andaman during October - November 2002. Suspected cases were screened for leptospirosis using microscopic agglutination test (MAT). Fifty two patients confirmed to have leptospirosis based on rising titres in MAT on paired sera, and 104 age, sex and neighbourhood seronegative matched controls, were included in the study. A conditional multiple regression by backward elimination process was carried out with acute leptospirosis as the dependent factor and various environmental, occupational and behavioural factors as independent factors. A stratified analysis was also carried out. RESULTS: The presence of cattle in the house, drinking stream water, contact with garbage, walking barefoot and standing in water while working were identified as significant factors associated with leptospirosis. Stratified analysis showed a dose response relationship between number of cattle in the house and the risk of leptospiral infection suugesting that cattle could be a source of infection. INTERPRETATION & CONCLUSION: Identification of the potential risk factors would help understand the transmission dynamics of the disease and formulate public health interventions.

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ELISA based on the recombinant OmpL1 and LipL41 antigens of Leptospira interrogans serovar autumnalis strain N2 have been developed, for the serodiagnosis of the severe pulmonary form of leptospirosis on the endemic Andaman Islands. The recombinant OmpL1 and LipL41 were produced using Escherichia coli expression systems and then purified before each was evaluated in an IgM-ELISA. The sera tested came from 224 patients who had the severe form of leptospirosis and pulmonary pneumonitis as major symptoms, 148 patients who, although clinically suspected to have severe leptospirosis, had been found seronegative for leptospirosis, 528 patients with diseases other than lepstospirosis, and 704 apparently healthy individuals, all from the Andaman Islands. Among the patients with the severe pulmonary form of leptospirosis, the ELISA based on the recombinant OmpL1 achieved a sensitivity of 91.1%, a specificity of 86.5%, a positive predictive value of 91.1%, and a negative predictive value of 86.5%. The corresponding values for the assay based on the recombinant LipL41 were 89.3%, 89.2%, 92.6%, and 84.6%, respectively. The good performance of both ELISA indicates that either may be routinely used for the diagnosis of severe pulmonary leptospirosis which, at least on the Andaman Islands, occurs soon after the patient has become leptospiraemic. The evaluated ELISA may also be useful for early case detection and for monitoring the effects of treatment.

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BACKGROUND & OBJECTIVE: In India diurnally subperiodic filariasis is prevalent only in the Nicobar district of Andaman and Nicobar Islands, with significant health problem. Sample surveys indicated that this form of filariasis is restricted to a small region of Nancowry group of islands with Ochlerotatus niveus as the vector. We therefore carried out a comprehensive study to assess the transmission dynamics of LF in Teressa island in Nicobar district in view of its control and evaluation of interventions. METHODS: Entomological studies were carried out for a period of twelve months covering all the seasons in the year, by means of man landing catches in Teressa Island, an endemic island for this form of filariasis. Parameters viz., the annual biting rate (ABR), annual infective biting rate (AIBR), annual transmission index (ATI), risk of infection index (RII) and annual transmission potential (ATP), which reflect the dynamics and intensity of transmission of filariasis, were estimated. Host efficiency of Oc. niveus was also assessed. RESULTS: The number of vectors biting a person in a year was estimated to be 21851, of which 107 were harbouring infective parasite. Risk of infection intensity was 0.02332. Every person in this study area was at the risk of receiving an estimated number of 22 infective stage larvae per year. The host efficiency index of Oc. niveus indicated that over 40 per cent of the microfilariae ingested were able to develop into infective stages. The ATP was 169 with evidence of year round transmission. The pattern of monthly transmission potential suggested that the intensity of transmission was high during summer months. INTERPRETATION & CONCLUSION: Perennial transmission of subperiodic Wuchereria bancrofti in the typical forest ecosystem was evident in Teressa Island with transmission parameters suggesting that summer is a high risk season for transmission. Personal protection measure is the method of choice to protect from the risk of infection, because of day biting, exophilic and exophagic behaviour of the vector and larvae are not amenable to larvicidal measures. An alternative method to control the transmission would be to use selective or periodic mass chemotherapy to reduce the parasite load in this community.

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Leptospirosis is an emerging zoonosis. In the Andaman Islands during the early twentieth century, it occurred in the penal settlements of the British India Administration, mostly as Weil's disease, an acute febrile illness with hepato-renal complications. It was caused by leptospires belonging to groups Akiamy A and Andamans A. After the 1930s nothing further is known regarding the disease until the late 1980s, when Andaman haemorrhagic fever (AHF), a mysterious illness with the majority of cases presenting pulmonary involvement, appeared. AHF was later identified as leptospirosis and severe pulmonary haemorrhage was shown for the first time as a complication of leptospirosis from India. Leptospirosis continues to occur in the Islands annually. It generally presents as two separate clinical syndromes: the hepato-renal form, and the pulmonary form, which is associated with high case fatality rates ranging from 10 to 15%. Infections are due to a variety of serovars, Valbuzzi being the commonest. Leptospira interrogans sensu stricto has been the predominant infecting species. Doxycycline has been shown to confer a beneficial effect in reducing the clinical illness and mortality during outbreaks. The history of leptospirosis in the Islands, its epidemiology, clinical spectrum, characteristics of the isolates and control are reviewed and discussed in this article.

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The Jarawas, a classical hunter-gatherer tribe of Andaman and Nicobar Islands, India, were living in isolation for several centuries. They came into contact with the civilized world recently. Serological studies carried out among them revealed that hepatitis B virus (HBV) infection is hyper-endemic. The present study was carried out to investigate the possible origin of HBV infection in Jarawas. Genotyping, RFLP analysis, sequencing, and sequence analysis revealed the prevalence of HBV genotype C, similar to genotype C detected in Thailand, Vietnam, and Myanmar. In contrast, genotype D was prevalent among other non-Jarawa tribes of the island. These data suggest that HBV infection was transmitted from Indo-China to the Andaman Islands during migration of the Jarawas many centuries ago.

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OBJECTIVES: A study was conducted among the Onge tribe of the Andaman and Nicobar Islands with the objectives of identifying demographic factors responsible for the decline in their population and assessing their nutritional status, which is an important determinant of child survival. STUDY DESIGN AND SUBJECTS: The study included estimation of indices of fertility and child mortality, and assessment of nutritional status. All individuals of the Onge community settled on Little Andaman Island were included. RESULTS: The mean total marital fertility rate was estimated to be 5.15 live births per woman and the general fertility rate was 200 live births per 1000 married-woman-years. Although the gross reproduction rate was estimated to be 2.2 female children per married woman, the net reproduction rate was only 0.9 surviving female child per married woman. The mean infant mortality rate during the past 30 years was 192.7 per 1000 live births, and the child survival rate was found to be only 53.2%. A mild to moderate degree of malnutrition was found in 85% of children of pre-school age and severe malnutrition in 10%. The Onges had low intakes of iron, vitamin A and vitamin C. All the screened Onges were found to be infested with one or more intestinal parasites. CONCLUSIONS: High childhood mortality appears to be the predominant demographic factor responsible for the decline in the Onge population. The high prevalence of undernutrition and micronutrient deficiency disorders could be important factors contributing to the high childhood mortality.

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BACKGROUND: Pools of salt water and puddles created by giant waves from the sea due to the tsunami that occurred on 26th December 2004 would facilitate increased breeding of brackish water malaria vector, Anopheles sundaicus. Land uplifts in North Andaman and subsidence in South Andaman have been reported and subsidence may lead to environmental disturbances and vector proliferation. This warrants a situation analysis and vector surveillance in the tsunami hit areas endemic for malaria transmitted by brackish water mosquito, An. sundaicus to predict the risk of outbreak. METHODS: An extensive survey was carried out in the tsunami-affected areas in Andaman district of the Andaman and Nicobar Islands, India to assess the extent of breeding of malaria vectors in the habitats created by seawater flooding. Types of habitats in relation to source of seawater inundation and frequency were identified. The salinity of the water samples and the mosquito species present in the larval samples collected from these habitats were recorded. The malaria situation in the area was also analysed. RESULTS: South Andaman, covering Port Blair and Ferrargunj sub districts, is still under the recurring phenomenon of seawater intrusion either directly from the sea or through a network of creeks. Both daily cycles of high tides and periodical spring tides continue to cause flooding. Low-lying paddy fields and fallow land, with a salinity ranging from 3,000 to 42,505 ppm, were found to support profuse breeding of An. sundaicus, the local malaria vector, and Anopheles subpictus, a vector implicated elsewhere. This area is endemic for both vivax and falciparum malaria. Malaria slide positivity rate has started increasing during post-tsunami period, which can be considered as an indication of risk of malaria outbreak. CONCLUSION: Paddy fields and fallow land with freshwater, hitherto not considered as potential sites for An. sundaicus, are now major breeding sites due to saline water. Consequently, there is a risk of vector abundance with enhanced malaria transmission potential, due to the vastness of these tsunami-created breeding grounds and likelihood of them becoming permanent due to continued flooding in view of land subsidence. The close proximity of the houses and paucity of cattle may lead to a higher degree of man/vector contact causing a threat of malaria outbreak in this densely populated area. Measures to prevent the possible outbreak of malaria in this tsunami-affected area are discussed.

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AIMS: Andaman and Nicobar Islands in India has a century long history of human leptospirosis. Several isolates have been recovered over the years from different locations. The present study was undertaken to understand the clonal relationship between all these pathogenic leptospires recovered from these islands. METHODS AND RESULTS: Arbitrarily primed polymerase chain reaction (AP-PCR) was employed to genetically characterize 40 isolates recovered during 1995--2001 and their fingerprints were compared with those of 26 reference strains of known genetic and serological affinities. Sequences of PCR-amplified products from representative isolates were compared with those of different strains belonging to seven genospecies. AP-PCR fingerprints revealed that 32 of the 40 isolates were clonal in nature and fingerprints of all the isolates matched with known reference strains of pathogenic Leptospira interrogans sensu stricto. Comparison of sequence data of PCR amplified products of reference strains and isolates also corroborated these findings. CONCLUSIONS: The study revealed that 80% of the isolates recovered from these islands were clonal in nature and all the isolates taken in the study belonged to Leptospira interrogans sensu stricto. SIGNIFICANCE AND IMPACT OF THE STUDY: An extension of the study in animal population would help in understanding the transmission dynamics of this commonly circulating clone in these islands, which in turn might help in effective control of this public health problem.

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A survey to assess injection related practices carried out among the Nicobarese, a mongoloid tribe of Andaman and Nicobar Islands, India. The survey was carried out using the rapid assessment and response guide of Safe Injection Global Network of the World Health Organization and included review of randomly selected prescriptions of patients attending outpatient clinic of district hospital, interview and observation of injection providers in the district hospital and sub-centres and interview of the general population. The findings of the survey showed that 18.8% of prescriptions included at least one injection. The per capita injection rate was 3 per year. Majority of injections were administered with disposable syringe and needle and in hospital setting. All the injection providers were aware about possibility of HIV transmission through unsafe injections. However, the awareness among the general population was low. More than half of the individuals had preference to injections. It is suggested that remedial measures, such as education of prescribers to reduce the number of injections to a bare minimum, maintaining regular supply of disposable injection equipment, provision of adequate sharps containers with safe disposal facilities and community education be undertaken to avoid future spread of blood-borne pathogens.

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Hepatitis B virus infection is highly endemic among the tribes of Andaman and Nicobar Islands, India. We screened 223 hepatitis B surface antigen-positive members of these tribes for hepatitis delta virus infection (HDV). The infection was observed only among the Nicobarese. Considering the serious consequences of HDV infection, we suggest that the tribes of these islands should be monitored for HDV infection.

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BACKGROUND & OBJECTIVE: Early diagnosis is the key to the treatment of leptospirosis. For development of rapid diagnostic kits, a thorough knowledge about the nature of the proteins expressed by the pathogen during infection is necessary. The present study was undertaken to understand the nature of immunoreactive proteins from commonly circulating serogroups of Leptospira in the endemic Andaman and Nicobar Islands, India. METHODS: Proteins were extracted from six strains of Leptospira representing five different serogroups following four different preparation methods, viz., whole cell lysis by sonication, detergent solubilization, outer and inner membrane isolations, and were subsequently characterized on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Immunoblots were made from the sonicated proteins using hyperimmune rabbit antisera, homologous and heterologous patient sera separately. RESULTS: The 67, 65, 45, 43, 35, 32 and 18 kDa major proteins in the whole cell lysate were common among all the five serogroups of Leptospira. The 67, 41, 35, 32, 28 and 22 kDa were the major outer membrane proteins, while 94, 32, 25 and 18 kDa protein were in inner membrane. Immunoblots with hyperimmune rabbit antisera detected 67, 65, 60, 45, 43, 41 and 32 kDa common proteins from the whole cell lysates of all strains while homologous and heterologous patient sera detected 32 kDa as the major immunoreactive protein in all pathogenic serogroups. This protein reacted against specific LipL32 antisera indicating that this protein was LipL32. INTERPRETATION & CONCLUSION: The circulating serogroups of Leptospira have common nature of expression of proteins during human infection. Among several immunoreactive proteins, three (67, 45 and 32 kDa) were recognized as major antigens by both rabbit hyperimmune sera and patients sera while the 32 kDa protein was recognized as the major immunoreactive protein by homologous and heterologous patient sera. These conserved immunoreactive proteins could be utilized in developing indigenous diagnostic tests for leptospirosis.

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Leptospirosis is an emerging zoonotic disease with widespread distribution. The disease, caused by a large number of pathogenic serovars of leptospires, varies in severity from mild flu like illness to severe and fatal forms. It has often been observed that the strains of the same serovar are associated with different clinical syndromes. In this study the isolates recovered from patients with mild and severe form of leptospirosis and those isolated from rodents trapped in the same areas were analyzed by using random amplified polymorphic DNA (RAPD) fingerprinting method using the primers PB1, M16, B11 and B12. RAPD fingerprinting patterns of these strains consistently showed five different genetic clusters. Strains belonging to serovar Ratnapura that caused hepato-renal involvement in patients in South India were genetically dissimilar to strains of the same serovar isolated from patients in Andamans who had pulmonary complications. Strains of other serovars causing mild and sever illness could also be discriminated. However, isolates obtained from human patients and rodents in the same geographical areas showed identical fingerprint patterns indicating that strains circulating in different geographical regions, though belonging to same serovar, are unique to each region.

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BACKGROUND & OBJECTIVES: The leptospiral antigens that are conserved among the diverse pathogenic leptospires have potential importance in the development of new serodiagnostic and immunoprotective strategies. The present study was therefore carried out to find out the phenotypic conservation of the leptospiral proteins OmpL1 and LipL41, and the genetic conservation of ompL1 and lipL41 genes among the leptospiral isolates of Andaman Islands and among the reference strains. METHODS: In one dimensional SDS-PAGE the leptospiral samples prepared from strains of various leptospiral serovars were run and transferred on to nitrocellulose paper and probed with pooled convalescent phase human sera to find out the phenotypic conservation of the protein fragments at 31 and 41 kDa. Further, the proteins were indirectly confirmed as OmpL1 and LipL41 by using specific rabbit hyperimmune sera. Specific primers were utilized to amplify the fragments to study the genetic conservation of ompL1 and lipL41. Further, these two fragments were sequenced and BLAST analysis was done with the whole genome of Leptospira interrogans serovar Lai for comparison. RESULTS: Analysis of individual immunoblots using patient sera showed that the OmpL1 and LipL41 were conserved among all the isolates used in the study. Further, these two proteins were probed with specific rabbit hyperimmune sera of OmpL1 and LipL41 for confirming the fragments and it was found to be conserved among all the isolates. The PCR based amplification further showed that the genes ompL1 and lipL41 were conserved among the leptospiral isolates studied. Sequencing followed by BLAST analysis of these showed 97 per cent similarity with the whole genome sequence and low score values in comparison with other bacterial species. INTERPRETATION & CONCLUSION: The antigenic and genetic conservation of the two proteins, OmpL1 and LipL41, indicated that these could be potential candidates for development of diagnostic test systems for leptospirosis.

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We have examined the patterns of DNA sequence variation in and around the genes coding for ICAM1 and TNF, which play functional and correlated roles in inflammatory processes and immune cell responses, in 12 diverse ethnic groups of India. We aimed to (a) quantify the nature and extent of the variation, and (b) analyse the observed patterns of variation in relation to population history and ethnic background. At the ICAM1 and TNF loci, respectively, the total numbers of SNPs that were detected were 28 and 12. Many of these SNPs are not shared across ethnic groups and are unreported in the dbSNP or TSC databases, including two fairly common non-synonymous SNPs at positions 13487 and 13542 in the ICAM1 gene. Conversely, the TNF-376A SNP that is reported to be associated with susceptibility to malaria was not found in our study populations, even though some of the populations inhabit malaria endemic areas. Wide between-population variation in the frequencies of shared SNPs and coefficients of linkage disequilibrium have been observed. These findings have profound implications in case-control association studies.

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A screw-capped glass tube containing a Leptospira culture accidentally broke and the laboratory worker who was handling the tube sustained a cut on his hand. The wound was flooded with the culture. The culture was that of strain MG 347 belonging to serovar Australis recovered from a patient, and it had undergone 52 passages in Ellinghausen McCullough Johnson Harris medium. The laboratory worker developed a headache 21 days after the accident and became febrile the next day. He was hospitalized for 5 days and was treated initially with doxycycline and later with ciprofloxacin. A blood sample collected on the second day of illness, after starting doxycycline therapy, yielded leptospires and the isolate, HZ 651, was identified as serovar Australis. Monoclonal antibody patterns and randomly amplified polymorphic DNA fingerprinting patterns of the isolate and strain MG 347 were identical, thus indicating that HZ 651 and MG 347 were clonal.

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