Website www.mukhmohit.com www.psmsimplified.

com
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Facebook update page @mukhmohitdr
Facebook Discussion forum Mukhmohit’s community and medicine discussion
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REVISED European society of hypertension and European society of cardiology (ESH/ESC)

guidelines for classification of hypertension
May 2019
Website www.mukhmohit.com www.psmsimplified.com
YouTube Dr Mukhmohit’s Community medicine Simplified
Facebook update page @mukhmohitdr
Facebook Discussion forum Mukhmohit’s community and medicine discussion Td Vaccine
ü WHO prequalified
Telegram https://t.me/mukhmohit01 ü VVM 30
ü Shelf life: 24-36 months
ü Preservative: Thiomersal
ü Td is freeze and heat
sensitive.
ü Open vial policy is
applicable to Td vaccine.
ü Shake test applicable
 Influenza Update 2018
(A part of Dr. Mukhmohit’s PSM Lecture series)

Categorization of cases:
Category A:
Patients with mild fever (less than 380 C) plus cough / sore throat with or without body ache, headache,
diarrhoea and vomiting will be categorized as Category-A.
Recommendations:
 The patients should be monitored for their progress and reassessed at 24 to 48 hours by the
doctor
 Confine to home and avoid public exposure

Category B
1. Category B(i): In addition to all the signs and symptoms mentioned under Category A, if the
patient has high grade fever (more than 38 deg C) and severe sore throat.
2. Category B(ii): along with category A symptoms, if the patient may have the any of the
following risk factors:
• Children with mild illness but with predisposing risk factors as age < 5 years or
immunocompromised status, inborn errors, congenital diseases
• Pregnant females
• Persons aged 65 years or older
• Patients with lung diseases, heart disease, liver disease, Kidney disease, blood disorders,
diabetes, neurological disorders, cancer and HIV/AIDS
• Patients on long term cortisone therapy
Recommendations:
1. No testing is required for H1N1 for category B(i) and B(ii) cases
2. Home confinement and avoid public contact
3. Oseltamivir may be advised

Category C
in addition to category B and C symptoms, if the patient has the following:
• Breathlessness, chest pain, drowsiness, fall in BP, sputum mixed with blood, bluish
discoloration of nails.
• Irritability among small children, refusal to accept feed.
• Worsening of underlying chronic conditions.
Recommendations:
1. Immediate hospitalization and management of the case

In patients who •have persistent severe illness despite

oseltamivir treatment, there are few licensed alternative
antiviral treatments.
In these situations, clinicians have considered intravenous administration of alternative antiviral
drugs such as zanamivir, peramivir, and ribavirin.
The use of such treatments should be done only with following cautions:
1) Ribavirin should not be administered as monotherapy;
2) Ribavirin should not be administered to pregnant women
3) Zanamivir formulated as a powder -for inhalation should not be delivered via nebulization
due to the presence of lactose , which may compromise ventilator function

For more updates visit www.psmsimplified.com/updates

Chemoprophylaxis:
Oseltamivir is the drug of choice for chemoprophylaxis to health care personnels and close
contacts of suspected, probable or confirmed case of pandemic influenza A (H1N1).
It should be given till 10 days after last exposure.
The dose by body weight is a follows :
> 15 kg - 30 mg OD
15-23 kg - 45 mg OD
24-40 kg - 60 mg OD
> 40 kg - 75 mg OD

Note: OSELTAMIVIR:
- It is a neuraminadase inhibitor
- It is taken orally activated by hepatic estarase.
- Dose is 75 mg twice daily for 5 days as treatment.
- 75 mg once daily as prevention.
- Modified in renal patients.
- Half life is 6-10 hours.

WHO Update H1N1 Flu vaccine for southern hemisphere

Flu – INACTIVATED VACCINE
1. Egg based quadrivalent vaccines for use in the 2019 southern hemisphere influenza
season contain the following:
i. An A/Michigan/45/2015 (H1N1)pdm09-like virus;
ii. A/Switzerland/8060/2017 (H3N2)-like virus
iii. B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
iv. B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).

2. Egg based trivalent vaccines for use in the 2019 southern hemisphere influenza season
contain the following:
i. A/Michigan/45/2015 (H1N1)pdm09-like virus;
ii. A/Switzerland/8060/2017 (H3N2)-like virus; and
iii. B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).

3. Non Egg Based Vaccine:

i. A/Singapore/INFIMH-16-0019/2016-like virus (H3N2 component) along with other
vaccine components
Route: Single dose I’m injection – upper arm

FLU LIVE ATTENUATED VACCINE – via nasal spray

LAIV contraindications
• Immunocompromised patients
• Pregnant women

For more updates visit www.psmsimplified.com/updates

 • individuals who have taken an influenza antiviral medication within the previous 48
hours
• Adults aged ≥50 years
NOTE: vaccines are associated with higher risk of GBS

Indications:
The influenza vaccine is recommended only for the category of ‘high-risk children’.
This category contains the following:
• Chronic cardiac, pulmonary (excluding asthma)
• Hematologic and Renal (including nephrotic syndrome) condition,
• Chronic liver diseases
• Congenital or acquired immunodeficiency (including HIV infection)
• Children on long term salicylates therapy

WHO suggests the following groups for vaccination according to their order of priority :
(a)pregnant women
(b) individuals aged more than 6 months with one of the several chronic medical conditions;
(c) healthy young adults between age 15-49 years
(d) healthy children
(e) healthy adults between age 49-65 years
(f) healthy adults aged more than 65 years

Recent Advance #influenza#

Baloxavir marboxil is a novel oral selective inhibitor of influenza cap-dependent endonuclease
that blocks influenza proliferation by inhibiting the initiation of mRNA synthesis.
Baloxavir was associated with more rapid declines in infectious viral load than placebo or
oseltamivir.
Dose-
• for 40 to <80kg- 40mg PO single dose
• for 80kg and more- 80mg PO single dose
FDA approved (24/10/18) baloxavir for the treatment of acute uncomplicated influenza (flu) in
patients 12 years of age and older who have been symptomatic for no more than 48 hours.

Recent updates and high yield topics by Dr Mukhmohit Singh

3 Hrs session includes:-

 Recent updates from Park latest edition.

 Recent updates in National Health Programs
 Recent advances in Communicable / non communicable diseases
 And a lot more…

Date: 10th April 2019

Time: 3PM to 6PM
To Register Visit www.psmsimplified.com
Helpline: 8699014009

For more updates visit www.psmsimplified.com/updates

Copy protected with Online-PDF-No-Copy.com
 Website www.mukhmohit.com www.psmsimplified.com
YouTube Dr Mukhmohit’s Community medicine Simplified
Facebook update page @mukhmohitdr
Facebook Discussion forum Mukhmohit’s community and medicine discussion
Telegram https://t.me/mukhmohit01

“MEENA” – The UNICEF symbol | SAPNA – the Indian Version

Success of UNICEF’s Meena-a symbol of Girl Empowerment can be transformed into Sapna: A
role model for Leprosy Elimination.

Meena is an imaginary cartoon character, relevant to any South Asian region, who is a spirited,
nine-year-old girl, striving to change the present situation of children for better world where their
rights are fully realized in terms of education, health, protection or participation.
Meena stories revolve around the adventures of Meena, her brother Raju, her pet parrot Mithu and
members of her family and community. They form the core element of Meena Communication
Initiative (MCI)—a mass communication project of UNICEF to change the perception and
behaviours that stand in way of realizing survival, protection and development rights of girl
children in South Asia
 Website www.mukhmohit.com www.psmsimplified.com
YouTube Dr Mukhmohit’s Community medicine Simplified
Facebook update page @mukhmohitdr
Facebook Discussion forum Mukhmohit’s community and medicine discussion
Telegram https://t.me/mukhmohit01

“Zero malaria starts with me”

WORLD MALARIA DAY 25 April 2019
Mosquirix - RTS,S is the first, and to date the only, vaccine
that has demonstrated it can significantly reduce malaria in
children. In clinical trials, the vaccine was found to prevent
approximately 4 in 10 malaria cases, including 3 in 10 cases
of life-threatening severe malaria

Details for RTS,S vaccine (Mosquirix TM):

RTS,S is a scientific name given to this malaria vaccine
candidate and represents its composition.
v The ‘R’ stands for the central repeat region of
Plasmodium (P.) falciparum ‘circumsporozoite
protein (CSP);
v The ‘T’ for the T-cell epitopes of the CSP;
v the ‘S’ for hepatitis B surface antigen (HBsAg).

Financial partner: GSK, bill and Melinda gates foundation, world bank
Source:
1) The RTS,S Clinical Trials Partnership. NEJM 2011; 365: 1863-75.
2) The RTS,S Clinical Trials Partnership. NEJM 2012; 367: 2284-95.
3) Intention to Treat analysis (ITT)
4) The RTS,S Clinical Trial Partnership, PloS Medicine, 2014; 11(7): e1001685
5) https://www.medscape.com/viewarticle/760009_8
6) Expert Rev Vaccines. 2016 Dec;15(12):1481-1493.
7) www.who.int/news
Website www.mukhmohit.com www.psmsimplified.com
YouTube Dr Mukhmohit’s Community medicine Simplified
Facebook update page @mukhmohitdr
Facebook Discussion forum Mukhmohit’s community and medicine discussion
Telegram https://t.me/mukhmohit01
 Bimonthly Issue 6, 2019

Rota Talk
NEWSLETTER
Government of India (GoI) has planned to introduce
Our Main News Rotavirus vaccine under Universal Immunization
Rotavirus vaccine to be universalized.... Programme in the rest of India by 2019.
... Page no. 1

Milestones of Rotavirus vaccine introduction

... Page no. 2
56% (14.5
State workshop for Rotavirus vaccine introduction million)
... Page no. 4 of India’s
birth cohort
Key Highlights covered
Stories from the field
... Page no. 4

Mind Games
... Page no. 6

Rotavirus vaccine to be expanded to

remaining states of India
Phase 1 States
India has been the first Asian country to launch
indigenous Rotavirus vaccine (RVV) in the Universal Phase 2 States

Immunization Program (UIP) in March 2016. With Phase 3 State

the introduction of the Rotavirus vaccine in Uttar
Pradesh an estimated 56% of the annual birth Yet to be introduced

cohort of the country is now covered. Now the

Ministry of Health and Family Welfare (MoHFW),
9% 25% 22% 44%
Date of Roll out of
State Phase
RVV Map Showing the phase wise introduction of RVV
1. Himachal Pradesh 15th March 2016
For the first time in the history of UIP in India,
2. Odisha 06th April 2016
I two types of Rotavirus vaccines, the oral liquid
3. Haryana 13th April 2016 and oral freeze-dried, are being used. Both these
4. Andhra Pradesh 22nd April 2016 vaccines are being introduced in the final phase of
5. Tripura 18th February introduction in the remaining 18 States and 7 Union
2017 Territories of the country. Currently, the oral freeze-
dried vaccine is being used in Jharkhand while the
6. Rajasthan 23rd March 2017 oral liquid vaccine is used in the other 10 states.
7. Madhya Pradesh 02nd April 2017
II
8. Assam 14th June 2017
Rota Talk Newsletter

9. Tamil Nadu 17th September

2017
10. Jharkhand 07th April 2018
11. Uttar Pradesh 04th September
III Oral lyophilized vaccine Oral liquid vaccine
2018
1
 Print material for the oral liquid Rotavirus vaccine

Milestones of Rotavirus vaccine

introduction in India
Liquid RVV

Lyophilized RVV Milestones of RW Introduction in India

RVV yet to be introduced

• NTAGI • JSI awarded the • RVV exoert

6 May 2015 grant for Phase 26 March 2016
group identifies
rerecommends
Map showing the distribution of type of RVV under UIP phased wise • RVV expert
one of RVV
• RVV phase I
5 states for
introduction in Phase II and 1
introduction of group identifies fours states launched state for Phase
RVV
Training package for RVV introduction
four states for III
phase I of RVV
12 June 2014 introduction 8 Oct 2015 16 Oct 2016

Two sets of training materials have been developed

for the two types of RVV. These includes Operational
• PIT report • JSI awarded • Phase III of
Guidelines (OG), Frequently Asked Questions (FAQs) submitted on
23 Nov 2016 supplemental 18 Feb 2017
RVVI launched
grant for RVV
for Medical Officers, FAQs for Health Workers and learning from
Phase I
• Partner’s expansion • Phase II RVVI
meeting to launched
Mobilizer Pamphlets. All of them have been updated discuss the
and revised in March 2019 for use in the upcoming 21 Oct 2016
strategy for
Phase II of RVVI Dec 2016 4 Sep 2018
trainings. The two sets of guidelines are colour coded.
The trainings for the two types of RVV are also being
done separately. A one pager comprising of Dos and
Don’ts for bundling approach as well as the steps Rotavirus Vaccine Introduction
of administration of the lyophilized RVV has been Multi-Country Workshop at
developed and will be used in the RVV training.
Bangkok, Thailand,
15-17 January 2019
Rotavirus Accelerated Vaccine Introduction
Network (RAVIN), is a partnership between the
International Vaccine Access Center (IVAC) at the
Johns Hopkins Bloomberg School of Public Health

Print material for the oral freeze-dried Rotavirus vaccine

Rota Talk Newsletter

Dr. Arup Deb Roy, Sr. Program Manager, JSI-India making a

A one pager of Dos and Dont’s for bundling approach presentation at RAVIN Workshop

2
 (lead institution), JSI Research & Training Institute,
Inc. (JSI), and the U.S. Centers for Disease Control
and Prevention (CDC). Dr. Arup Deb Roy, Sr.
Program Manager, JSI India was invited to share the
experience of the process of roll out of Rotavirus
vaccine in India at the RAVIN workshop in Bangkok,
Thailand, 15-17 January 2019. India’s experience
with the two different types of Rotavirus vaccines
created interest amongst the participants from
various countries, who are planning to introduce
RVV in the coming years.
IPHACON at Kakinada, Andhra
Pradesh, India,
31 January - 3 February 2019
The 63rd Annual National Conference of the
Indian Public Health Association (IPHA) has been
organized by Department of Community Medicine,
Dr. Arup Debroy moderating the sessions
Rota Talk Newsletter
The Panellists Dr. Sanjay Gandhi (GSK), Dr. S N Bagchi (JSI),
Dr. Danish Ahmed (WHO-NPSP) and Dr. T S Rao (DBT)
3
Rangaraya Medical College, Kakinada Smart City
and AP State Branch of IPHA from 31st January to
3rd February, 2019. The IPHA is the most prestigious
association of the Public Health professionals of
India working for the promotion and advancement
of public health and allied sciences in their different
branches in India, protection and promotion
of public and personal health of the people of
the country and promotion of co-operation and
fellowship among the members of the Association.
The conference offered a wonderful opportunity to
discuss various health issues, exchange ideas and
share information on recent advances in the field of
public health. JSI was invited in a panel discussion
which was scheduled on the 3rd of February.
The topic of discussion was “Recent initiatives in
Universal Immunization Program (UIP) with special
focus on new vaccine introduction”. The panellists
were Dr. S N Bagchi (JSI), Dr. Danish Ahmed (WHO-
NPSP), Dr. T S Rao (DBT) and Dr. Sanjay Gandhi
(GSK). The session was moderated by Dr. Arup Deb
Roy (JSI). Dr. SN Bagchi spoke about the Rota virus
vaccine introduction in India. The current scenario
in the states that have already launched the
vaccine was discussed. The panellists mentioned
about how for the first time in the history of UIP
in India the 2 types of RVV is in use and specially
mentioned about the Jharkhand experience where
the lyophilized Rotavirus vaccine was successfully
introduced for the first time under the UIP with
the technical assistance from JSI. They also spoke
about the history of the clinical trial of indigenous
Rotavirus vaccine in India, and the issues and
challenges for consistent supply of new vaccines
in the UIP of the country. The session was greatly
appreciated by the audience in the hall. Several
questions, especially on Rotavirus vaccines, were
asked by the audience which were promptly
answered by the panellists to their satisfaction.
Monitoring RVVI in Uttar Pradesh
Since the launch of RVVI in UP on 4th September
2018, supportive supervision and monitoring of RI
sessions and cold chain points have facilitated the
introduction of Rotavirus vaccine into a large state
like Uttar Pradesh with 75 districts. Monitoring has
also improved the update of RVV coverage data by
the state.
 Capacity Building for Rotavirus
Success Stories from the field
vaccine introduction- Experiences
Rotavirus Vaccine: Vaccinators
and way forward
priority. The extensive cascade of trainings have not only
helped in the successful roll out of the RVV but also
Session Site: Nawadiya village, Block: Milak,
had a positive impact on the capacity building of the
District: Rampur
health staff on the overall immunization program.
19th January 2019. The major activities for capacity building of health
staff is a key to successful vaccine introduction.
Robust hands on training of medical officers, cold
An outreach session at village Nawadiya was
chain handlers, vaccinators (ANMs) and mobilizers
held on 19 Jan 2019. There were 13 beneficiaries (ASHAs and AWWs) has been the key to successful
for RVV in the due list. The ANM, named Nafis introduction of RVV till date in the 11 states.
Bano, found that only 2 vials of RVV (5 dose
vial of liquid RVV) were supplied from the cold Cadre Trained Trained Trained Total
chain point (CCP). With these 2 vials she was in Phase in Phase in Phase trained
1 2 3 in all 3
able to vaccinate only 10 children and for rest Phases
she needed one more vial. Medical Officer 2,849 11,705 4,492 19,046
Cold Chain 4,223 8,513 1,484 14,220
Handler
Auxilary Nurse 26,554 92,584 24,058 1,43,186
Midwife (ANM)
Accredited 90,525 1,37,222 1,43,925 3,71,692
Social Health
Activist (ASHA)
Anganwadi 1,12,768 2,22,765 1,44,173 4,79,706
Worker (AWW)

State workshop for Rotavirus

ANM Nafis Bano vaccinating the child at out reach session
Immediately, she requested the alternate
vaccine delivery (AVD) person to go and bring
one more vial of RVV from the CCP. The AVD
person went to the CCP immediately and
brought back one vial of RVV. The ASHA went
out to the village and mobilized the remaining
3 beneficiaries to the session site. All of them
received RVV and none were left out. This
proved the ANM’s proactiveness and initiative
to immunize all children on the vaccination
day. She said “the children should not miss the
due dose due to our mistakes”. It is a lesson for
everyone in the field who is providing health
vaccine introduction in
Maharashtra, Pune, India,
2-4 April 2019
The preparation for RVV introduction starts with
the Regional/State training of trainers (ToTs). The
Maharashtra state training of the trainers was held
at Pune during 2-4 April, 2019. It was a successful
training program with participation of govt officials
from all districts and municipal corporations, and
also representatives from all partner agencies. The
updated operational guidelines for the lyophilized
RVV were released at the inaugural programme.
Dr. Pradeep Haldar, Deputy Commissioner (I/C
Immunization), MoHFW, GoI, Dr. Anup Kumar
Yadav, Commissioner of Health Services and
MD-NHM, Government of Maharashtra, and
Dr. Archana Patil, Director, Health Services,
Rota Talk Newsletter

care services to community that little effort

and proactiveness goes a long way in getting
desired result and achievement.
Government of Maharashtra addressed the
participants and pointed out the importance of
robust RVV training before launch of the vaccine.
The participants were given hands on training on
the steps of administration of oral lyophilized RVV
during the ToT.
4
 Image Gallery: State workshop for RVVI in Maharashtra

Dr. Anup Kumar Yadav, Commissioner of Health Services and MD- Dr. Pradeep Haldar, Deputy Commissioner (I/C Immunization),
NHM, Government of Maharashtra, addressing the participants MoHFW, GoI, addressing the participants

Inauguration of the Training by the Chief guests and honourable Release of the revised Operational Guidelines for the oral freeze
dignitaries by lighting the lamp dried Rotavirus vaccine introduction at the workshop

Dr. Archana Patil, Director, Health Services, Government of Participants at the Maharashtra State ToT
Maharashtra, addressing the participants

Station approach: Demonstration of the steps of administration Station approach: Hands on training of the participants on the
of oral freeze dried RVV steps of administration of oral freeze dried RVV
Rota Talk Newsletter

Station approach: Cold chain and vaccine logistics management Station approach: AEFI management

5
 Rotavirus vaccine coverage
dashboard Rota quick facts
Do you know?
√ Rotavirus vaccine has already been
introduced in eleven states of India.
√ India to introduce Rotavirus vaccine in
the remaining 18 states and 7 union territories
by 2019.
√ Both the liquid as well as the lyophilized
forms of Rotavirus vaccine are being used in the
UIP of India.

Mind Power Games

Match the following:
RVV 1 coverage
(April 2018 to March 2019) 1. Supply of the Lyophilized a. Rotavirus
>80% form of Rotavirus vaccine diarrhea
requires
50% - 80%
2. Both the liquid and freeze- b. MR vaccine
<50%
dried vaccines are available
under UIP
3. Vaccine administered at 9 c. Bundling
months age
4. Vaccine preventable disease. d. Td vaccine
5. Vaccine which prevents e. Rotavirus
Tetanus and Diphtheria vaccine

For answers:
Please scan the QR Code

RVV 3 coverage
(April 2018 to March 2019)
Editorial Board
Dr. Pradeep Haldar, MoHFW
>80%
Dr. M K Agarwal, MoHFW
50% - 80% Dr. Arindam Ray, Bill & Melinda Gates Foundation
<50% Dr. S N Bagchi, JSI
Dr. Arup Deb Roy, JSI
Dr. Mayank Shersiya, MoHFW
Doses Coverage for 11 states (in million) Dr. Subhasis Bhandari, JSI
RVV 1 9.58 Dr. S F Quadri, JSI
RVV 2 8.66
RVV 3 8.14 Field Reporters
Rota Talk Newsletter

Total 26.38
Field Reporters- JSI State Team-UP
Source: HMIS data

For details, please contact:

Plot No. 5&6, Local Shopping Complex, Nelson Mandela Marg (Beside Post Office), Vasant Kunj, New
Delhi-110070, India, Ph.: +91-7065332255, email: saumendra_bagchi@in.jsi.com

6
SOURCE: Shibendu Ghosh, Prabuddha Mukhopadhyay. Management of snake bites in India.
Chapter 113, API India.

The first aid being currently recommended is based around the mnemonic.
“CARRY NO R.I.G.H.T.” It consists of the following:
website www.mukhmohit.com www.psmsimplified.com
YouTube Dr Mukhmohit’s Community medicine Simplified
Facebook update page @mukhmohitdr
Facebook Discussion forum Mukhmohit’s community and medicine discussion
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May 2019