Manoj Murhekar

• MBBS, MD
• Indian Council of Medical Research

Background & objectives Event-based surveillance (EBS) is a critical component of early warning systems for detecting and responding to infectious disease outbreaks. While EBS is widely used in public health settings, its integration into private healthcare facilities remains limited. This study undertook to pilot an EBS in private hospitals in Kas...

Background and Objective We evaluated the DR-TB component of the National Tuberculosis Elimination Program (NTEP) in a high-burden district in Kerala to identify the programmatic gaps, if any, in screening, diagnosis, treatment, and follow-up of notified DR-TB patients. Methods A mixed-methods design was used, and the evaluation was performed in t...

Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incur...

Residual blood specimens collected at health facilities may be a source of samples for serosurveys of adults, a population often neglected in community-based serosurveys. Anonymized residual blood specimens were collected from individuals 15 – 49 years of age attending two sub-district hospitals in Palghar District, Maharashtra, from November 2018...

Residual blood specimens provide a sample repository that could be analyzed to estimate and track changes in seroprevalence with fewer resources than household-based surveys. We conducted parallel facility and community-based cross-sectional serological surveys in two districts in India, Kanpur Nagar District, Uttar Pradesh, and Palghar District, M...

Background In 2022, India’s national tuberculosis (TB) elimination program (NTEP) commissioned a national level evaluation of active case finding (ACF) for TB to guide evidence-based strategic planning. As part of this evaluation, based on secondary data analysis we observed that the quality of ACF was suboptimal in 2021. Hence, this study aimed to...

Background Reliable and recent data of human rabies deaths and animal bites are not available in India, where a third of global cases occur. Since there is a global target of eliminating dog-mediated human rabies by 2030, understanding whether the country is on track is essential. We aimed to estimate the animal-bite burden and the number of human...

An outbreak of acute headache, weakness, breathing difficulty and gastrointestinal symptoms occurred among schoolchildren who went near the seashore of a coastal school in North Kerala, India. This article describes a field investigation conducted in response to this outbreak. The overall attack rate was 47% among schoolchildren on the seashore, wi...

In India, the incidence of mucormycosis reached high levels during 2021–2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. P...

Background Ni-kshay Poshan Yojana (NPY), a direct benefit transfer scheme under the National Tuberculosis Elimination Program (NTEP) in India, provides a monthly benefit of INR500 for nutritional support of persons with TB (PwTB). Objectives To determine the proportion of PwTB receiving atleast one NPY instalment and pattern of utilisation; to asc...

Key Findings n TB champions-individuals who have been affected by TB, have completed treatment, and subsequently been trained to provide support and counseling-provided baseline and additional counseling for more than 95% of severely ill people with TB and facilitated nutritional supplementation for 60% of those with severe undernutrition. n The un...

We conducted a systematic review of analytical epidemiological studies to assess the association between ChAdOx1-S vaccination and thromboembolic, thrombocytopenic, and hemorrhagic events. We searched Medline, Embase, Google Scholar, WHO-COVID-19 database, and medRxiv for studies evaluating the association between ChAdOx1-S and vascular events. Pri...

Background Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, r...

Objectives: Kasaragod district reports the highest drug-resistant tuberculosis (DR-TB) case notification rates in Kerala. We conducted a cross-sectional study in Kasaragod to describe the DR-TB cases notified from January 2017 to December 2021 and to identify the factors associated with unfavorable treatment outcomes in DR-TB patients. Materials...

Acute encephalitis syndrome (AES) outbreaks in children of Eastern Uttar Pradesh (E-UP) region of India have been a longstanding public health issue, with a significant case fatality rate of 20–25%. Since past decade, a rise in chikungunya (CHIK) cases has been occurring, which is a reported etiology of AES. However, the burden of chikungunya virus...

To reduce TB deaths, Tamil Nadu, a southern Indian state, implemented the first state-wide differentiated TB care strategy starting April 2022. Triage-positive severely ill patients are prioritised for comprehensive assessment and inpatient care. Routine program data during October–December 2022 revealed that documentation of total score after comp...

Background This research paper reports on the first statewide implementation of differentiated Tuberculosis (TB) care in routine health system settings in India and possibly globally. This pilot aimed to assess the feasibility in routine health system settings and to identify the predictors of triaging and the burden of triage positive. Methods/de...

Background Patients with TB have additional nutritional requirements and thus additional costs to the household. Ni-kshay Poshan Yojana(NPY) is a Direct Benefit Transfer (DBT) scheme under the National Tuberculosis Elimination Programme(NTEP) in India which offers INR 500 monthly to all notified patients with TB for nutritional support during the p...

attributes (data quality, acceptability, predictive value positive, representativeness , timeliness and stability) from surveillance data collected between April-June 2019. We calculated proportions to evaluate all attributes. Results We interviewed 26 health care workers including medical officers, assistant medical officers, non-medical superviso...

Background: India has been implementing active case-finding (ACF) for TB among marginalised and vulnerable (high-risk) populations since 2017. The effectiveness of ACF cycle(s) is dependent on the use of appropriate screening and diagnostic tools and meeting quality indicators. Objectives: To determine the number of ACF cycles implemented in 2021...

The potential for influenza viruses to cause public health emergencies is great. The World Health Organisation (WHO) in 2005 concluded that the world was unprepared to respond to an influenza pandemic. Available surveillance guidelines for pandemic influenza lack the specificity that would enable many countries to establish operational surveillance...

Background: In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. Methods: From 2017 through...

Monkeypox (MPX) is a zoonotic infection caused by the monkeypox virus (MPXV) and is primarily characterized by rash or pox marks and lymph node enlargement. The recent MPX has quickly spread across the globe and is now declared a global public health emergency. Being a contact illness, sexual encounters have been identified as the most common mode...

To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there...

Objectives The present study was planned to estimate the prevalence of dental fluorosis in 6–12 years of children and its association with various drinking water sources, water, and urine fluoride levels among the subset of children under the umbrella of a larger study to address iodine deficiency disorders and iron deficiency anemia in 17 villages...

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a...

Introduction Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children m...

A complete sampling frame (CSF) is needed for the development of probability sampling structures; utilisation of a spatial sampling frame (SSF) was the objective of the present study. We used two sampling methods, simple random sampling (SRS) and stratified random sampling (STRS), to compare the prevalence estimates delivered by a CSF to that by a...

Summary Background India did phased measles–rubella supplementary immunisation activities (MR-SIAs; ie, massimmunisation campaigns) targeting children aged 9 months to less than 15 years. We estimated measles–rubella seroprevalence before and after the MR-SIAs to quantify the effect on population immunity and identify remaining immunity gaps. Metho...

A growing number of organisations, including medical associations, recommend that research subjects should be given the option of being informed about the general outcome and results of the study. We recently completed a study involving nine serosurveys from 2018 to 2020 in five districts of India among three age groups (children 9 months to < 5 ye...

Objectives: India introduced BBV152/Covaxin and AZD1222/Covishield vaccines in January 2021. We estimated the effectiveness of these vaccines against severe COVID-19 among individuals aged ≥45 years. Methods: We did a multi-centric, hospital-based, case-control study between May and July 2021. Cases were severe COVID-19 patients, and controls were...

Background India introduced BBV152/Covaxin and AZD1222/Covishield vaccines from January 2021. We estimated effectiveness of these vaccines against severe Coronavirus disease 2019 (COVID-19) among individuals aged ≥45 years. Methods We did a multi-centric, hospital-based, case–control study between May and July 2021. Cases were severe COVID-19 patie...

Background: During July 2017 to August 2017, five cases of laboratory-confirmed dengue cases were reported from Jothinagar village, Tamil Nadu, India. The episode was investigated to confirm the existence of an outbreak and formulate appropriate recommendations for containment. Methods: The monthly occurrence of dengue cases from 2014 to 2017 was c...

Background Risk factors for the development of severe COVID-19 disease and death have been widely reported across several studies. Knowledge about the determinants of severe disease and mortality in the Indian context can guide early clinical management. Methods We conducted a hospital-based case control study across nine sites in India to identif...

Background India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March–June 2021. We conducted a fourth nationwide serosurv...

Introduction India experienced two waves of Coronavirus disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] and reported second highest caseload globally. Seroepidemiological studies were done to track the course of the pandemic. We systematically reviewed and synthesized seroprevalence of SARS-Co...

Objective To describe the characteristics of contacts of patients with COVID-19 case in terms of time, place and person, to calculate the secondary attack rate (SAR) and factors associated with COVID-19 infection among contacts. Design A retrospective cohort study Setting and participants Contacts of cases identified by the health department from...

Background India has set a goal to eliminate measles and rubella/Congenital Rubella Syndrome (CRS) by 2023. Towards this goal, India conducted nationwide supplementary immunization activity (SIA) with measles-rubella containing vaccine (MRCV) targeting children aged between 9 months to <15 years and established a hospital-based sentinel surveillanc...

Dried blood spot (DBS) collection offers various advantages over conventional methods of blood collection, especially when collecting and transporting samples for a serosurvey. Yet use of DBS requires additional processing steps in the laboratory that can add to variability in results.

Background Japanese encephalitis virus (JEV) remains the major etiology of encephalitis throughout Asia. In India, the state of Assam alone contributes more than one-third of the national burden of JE. Between 2011 and 2014, a single dose of JE vaccine SA 14-14-2 (LAJEV) was administered among adults aged 15–65 years residing in Sivasagar and Dibru...

Background: Earlier serosurveys in India revealed seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of 0.73% in May–June 2020 and 7.1% in August–September 2020. A third serosurvey was conducted between December 2020 and January 2021 to estimate the seroprevalence of SARS-CoV-2 infection among the general population and...

A cross-sectional survey was undertaken to estimate seroprevalence of immunoglobulin G antibodies against scrub typhus, spotted fever group rickettsiae, and typhus group rickettsiae in randomly selected 48 clusters in 12 districts of 3 Northeast states of India: Assam, Meghalaya, and Tripura. Individuals in 3 age groups (5-8, 9-17, and 18-45 years)...

Background Earlier serosurveys in India revealed SARS-CoV-2 seroprevalence of 0.73% during May-June and 7.1% during August-September 2020. We conducted the third serosurvey during Dec 2020 and Jan 2021, to estimate the seroprevalence of SARS-CoV-2 infection among general population and healthcare workers (HCWs) in India. Methods We conducted the s...

Background Early detection of symptoms of loss of smell and taste lately added for Coronavirus disease 2019 (COVID-19) has the potential for improving pandemic response. In the Indian context, we compared proportion experiencing new loss of smell or taste among COVID-19 positive and negative individuals in Chennai city, Southern India. Methods We...

Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of A...

Background The first national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in India, done in May–June, 2020, among adults aged 18 years or older from 21 states, found a SARS-CoV-2 IgG antibody seroprevalence of 0·73% (95% CI 0·34–1·13). We aimed to assess the more recent nationwide seroprevalence in the general population...

Background The first national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in India, done in May-June, 2020, among adults aged 18 years or older from 21 states, found a SARS-CoV-2 IgG antibody seroprevalence of 0·73% (95% CI 0·34-1·13). We aimed to assess the more recent nationwide seroprevalence in the general population...

Background Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5–17 years in India. Methods We used residual serum samples from a cross-sectional, population-based ser...

Background Since its re-emergence in 2005, chikungunya virus (CHIKV) transmission has been documented in most Indian states. Information is scarce regarding the seroprevalence of CHIKV in India. We aimed to estimate the age-specific seroprevalence, force of infection (FOI), and proportion of the population susceptible to CHIKV infection. Methods W...

Background: The first round of national serosurvey in India was conducted in May-June 2020 among adults from 21 States. The second serosurvey was conducted in AugustSeptember 2020 to estimate the nationwide seroprevalence for SARS-CoV-2 infection in the general population aged ten years and above. Methods: The household serosurvey was conducted...

We describe the process and experience of implementing a Community event-based Surveillance (CEBS) pilot project in one district in Tamil Nadu, India. The project was implemented by National Institute of Epidemiology (NIE) in collaboration with the Tamil Nadu State Public Health Department and US Centres for Disease Control and Prevention. The desi...

Background & objectives: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. Methods: From May 11 to June 4, 2020, a randomly sampled,...

Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection. We report the findings of the first round of a national serosurvey to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India.

Objective: To estimate the regional cutoff of optical density (OD) values for immunoglobulin M (IgM) antibodies against Orientia tsutsugamushi in serum and cerebrospinal fluid (CSF) for clinical diagnosis of scrub typhus and immunoglobulin G (IgG) antibodies in serum for sero-epidemiology in Gorakhpur, Uttar Pradesh, India. Methods: We used data...

Introduction: India introduced hepatitis-B (HB) vaccine in Universal immunization program in 2002-2003 on pilot basis, expanded to 10 states in 2007-2008 (phase-1) and entire country in 2011-2012 (phase-2). We tested sera from a nationally representative serosurvey, to estimate seroprevalence of different markers of HB infection among children age...

Seasonal outbreaks of acute encephalitis syndrome have been occurring in Gorakhpur division in the Indian state of Uttar Pradesh during monsoon and post-monsoon months. Orientia tsutsugamushi was identified as the major aetiology of these outbreaks. Orientia tsutsugamushi was also identified as one of the important aetiology of febrile illness amon...

We estimated the incidence of laboratory-confirmed dengue patients for Surat city, India, using surveillance data from 2011 to 2016 and described the related entomological indices and climatic factors. There was a rise in incidence from 1.5 to 17.6 per 100,000 population, as the numbers of notified cases have increased because of better surveillanc...

Zoonotic diseases affect resource-poor tropical communities disproportionately, and are linked to human use and modification of ecosystems. Disentangling the socio-ecological mechanisms by which ecosystem change precipitates impacts of pathogens is critical for predicting disease risk and designing effective intervention strategies. Despite the glo...

As of February 29, 2020, more than 85,000 cases of coronavirus disease 2019 (COVID-19) have been reported from China and 53 other countries with 2,924 deaths. On January 30, 2020, the first laboratory-confirmed case of COVID was reported from Kerala, India. In view of the earlier evidence about effectiveness of repurposed lopinavir/ritonavir agains...

With the rising number of dengue patients, the economic burden to patients also increases particularly in the case when hospitalized. Severity has its own implication on dengue costs. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, India. We used World Health Organization 2009 c...

Background & objectives: Dengue virus (DENV) transmission is known to be influenced by the environmental conditions. During 2017, the Viral Research and Diagnostic Laboratories (VRDLs) tested 78,744 suspected dengue fever (DF) patients, of whom, 21,260 were laboratory confirmed. The objectives of the study were to evaluate the hypothesis that spati...

Background: The Model Rural Health Research Unit at Kallur, Tirunelveli, established by the Department of Health Research, Government of India, is linked to Tirunelveli Medical College. It is mentored by the ICMR-National Institute of Epidemiology, Chennai. The key objective was to develop area-specific models to undertake field health research dep...

Background: Dengue is major public health problem in India, especially in urban areas. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, Gujarat, India. Methods: We reviewed the medical records of dengue patients hospitalized in five tertiary care facilities (private [n=2], sem...

Enzyme linked immunosorbent assay (ELISA) for antibody identification, is important for laboratory confirmation of rubella infection in different settings. The Enzygnost rubella ELISA, widely used in the World Health Organization (WHO) Global Measles and Rubella Laboratory Network, is expensive and often unavailable. Qualitative and quantitative pe...

Background: The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India. Methods: We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 districts of 15 Indian states fro...

We conducted a serosurvey of 155 healthcare workers and 124 household and community members who had close contact with 18 patients who had laboratory-confirmed Nipah virus infections in Kerala, India. We detected 3 sub-clinical infections; 2 persons had IgM and IgG and 1 only IgM against Nipah virus.

We conducted a serosurvey of 155 healthcare workers and 124 household and community members who had close contact with 18 patients who had laboratory-confirmed Nipah virus infections in Kerala, India. We detected 3 subclinical infections; 2 persons had IgM and IgG and 1 only IgM against Nipah virus.

Summary What is already known about this topic? India is committed to eliminating measles and controlling rubella and congenital rubella syndrome (CRS) by 2020. Before 2016, India did not have a systematic CRS surveillance system. What is added by this report? CRS surveillance in five sentinel sites from 2016 identified 207 suspected CRS cases; 72...

Rubella infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). The 11 countries in the World Health Organization (WHO) South-East Asia Region are committed to the elimination of measles and control of rubella and CRS by 2020. Until 201...

Hepatitis A and hepatitis E viruses (HAV and HEV) are the most common etiologies of viral hepatitis in India. To better understand the epidemiology of these infections, laboratory surveillance data generated during 2014-2017, by a network of 51 virology laboratories, were analyzed. Among 24,000 patients tested for both HAV and HEV, 3,017 (12.6%) te...

Introduction Dengue is the most extensively spread mosquito-borne disease; endemic in more than 100 countries. Information about dengue disease burden, its prevalence, incidence and geographic distribution is critical in planning appropriate control measures against dengue fever. We conducted a systematic review and meta-analysis of dengue fever in...

Abstracted data of included studies. (XLSX)

Prevalence (proportion) of laboratory confirmed dengue among clinically suspected patients by study type. (PDF)