Introduction:

Scrub typhus is an acute febrile illness caused by the bacteria Orientia tsutsugamushi. Owing to the increase in the number of cases and a suspected death due to scrub typhus, the director of health services, Kerala state, requested a death audit and an outbreak investigation in the Nedumangad and Palode areas of Thiruvananthapuram district and the Department of Community Medicine, Medical College, Thiruvananthapuram was called in for technical expertise and this outbreak investigation was undertaken.

Methods:
The methodology involved a death audit for a suspected death due to scrub typhus, fever surveillance for detection of scrub typhus cases among admitted patients in two local hospitals, training need assessment using a rapid assessment questionnaire and house visit of three confirmed cases of scrub typhus in the recent past.

Results:
The death audited was likely due to Scrub typhus. Scrub typhus could have caused an acute kidney injury aided by rhabdomyolysis, or it could have precipitated an acute exacerbation of an already existing kidney disease resulting from the patients’ long-standing untreated diabetes mellitus. The presence of rats and shrubs in the area, the history of active involvement of the patient in the sanitation works of the area, the history and clinical finding of eschar in the patient along with two positive IgM Scrub typhus lab reports done in an interval of fifteen days, are strongly suggestive. Two out of the ten blood samples collected for the fever surveillance tested positive for scrub typhus IgM. Training need assessment revealed good knowledge among health care workers, but minimal experience of dealing with actual cases. The household visits identified potential environmental risk factors like abundance of shrub vegetation, rat infestations, involvement in activities like clearing of shrubs, and contact with pets.

Conclusion:
A strong suspicion is necessary for an early diagnosis of scrub typhus and scrub typhus co-infections. Delay in the initiation of treatment could be a potential reason for death due to scrub typhus. The absence of eschar should not be taken as a criterion for ruling out scrub typhus. The community should be empowered for early treatment seeking. Surveillance should be strengthened. Capacity building of health professionals may facilitate early case detection, treatment and prevention of deaths.

Adenovirus outbreaks have been reported to be associated with recreational water over the past decades. An outbreak of respiratory tract infection in a primary school in central Taiwan occurred in September 2011. The laboratory tests showed that it was an outbreak of adenovirus infection. Epidemiological investigations revealed that the outbreak was associated with a swimming facility outside the school. Our report emphasized the potential threat of adenovirus infection associated with swimming facilities, especially in a community adenovirus epidemic setting.

Respiratory Syncytial Virus (RSV) infection is of public health concern worldwide. Globally, it is a common cause of bronchiolitis and pneumonia in childhood, outbreaks occurs every year depending on the locale. Worldwide, it is estimated that 30 million Lower Respiratory Tract Infections (LRI), 3 million hospitalization and 160,000 deaths occur annually. It also causes morbidity/mortality in the elderly/at risk adults. In spite of concentrated efforts of many over more than five decades, vaccine or therapy for this virus has remained elusive. Many conventional and newer vaccine strategies have been evaluated but none have been licensed to date. We are exploring mammalian cell-derived Virus-like Particles (VLPs) composed of the two surface glycoproteins G and prefusion F (RSV fVLPs) and M as vaccine. In prefusion F there is a neutralizing epitope at site zero that induces significantly higher Neutralizing Antibody (NtAb) titers. In preliminary studies, we have shown by Electron Microscopy (EM) that our fVLPs are functional and immunoreactive. We have done western blot with two conformation dependent antibodies AM14, and D25, and Motavizumab which is conformation independent. We have shown also that MPLA-adjuvanted fVLPs induced 8.2Log2±1.13 NtAb titers. With regular F (instead of prefusion F) lower NtAb titers are seen in cotton rats and in mice. On challenge lung virus titers in the homogenate was almost clear.

Climate change is a global issue and its immediate and long-term health effects are significant and severe. According to the World Health Organization (WHO, 2016), “Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhea and heat stress”.

Aedes aegypti, a main vector of dengue fever, is very high density in some areas of Vietnam. These mosquitoes in some cities such as Hanoi (HN), Nhatrang (NT), Dongnai (DN), Kiengiang (KG), Daklak (DL), and Hochiminh (HCM) cities have been found high resistance to Pyrethroid group and DDT. Mosquito populations have been sensitive to malathion insecticide.

Identifying insecticide resistant characteristics by esterase enzyme electrophoresis showed that the first esterase appeared in pyrethroid insecticide resistant mosquito population and not recorded in Bora Bora strain.

Analysis of mutations in by multiplex PCR 1011 and 1016 codons encoding VAL and ISO in 20 and 21 exons showed that mutation in 1016 codons with two types VAL/1016/ISO and VAL/1016/GLY were found in the domain II of the sodium channel gene with 94 Aedes aegypti adult female mosquitoes after susceptibility test to alphacypermethrin. The results showed that no mutation in 1011 codon encoding ISO was observed. 14 samples collected from four provinces containing mutations in 1016 codons with two VAL/1016/ISO and VAL/1016/GLY types have been detected.