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CORONA VIRUS : THE 2019-nCoV OUTBREAK

In December 2019 there was a cluster of Pneumonia cases in Wuhan province of China. Investigations found it was caused by a previously unknown virus now known as 2019-novel corona virus.

Corona viruses are a large group of viruses that cause infections in various mammals . It derives its name from the latin word ” Corona” which means crown because of its distinctive appearance under electron microscope.

There are different types of Corona virus which generally cause respiratory disease. In most cases the disease is mild with symptoms of common cold. But there are a view varieties of the virus which cause severe disease in human.

SARS CoV Severe Acute Respiratory Distress Syndrome Corona virus which was first identified in China in 2003

MERS CoV Middle East respiratory syndrome related Corona virus which was first identified in Saidi Arabia in 2012

The latest strain NoCoV 2009 Novel Corona Virus 2009 which was first identified in China in 2019.

The disease initialled occured in a group of people suffering pneumonia having association with the Sea food and live meat market in Wuhan district.From them it spread to their family and health care workers. The disease has since spread exponentially and outbreaks have been reported in countries other than China.

ORIGIN OF THE VIRUS

The Corona Virus circulate in a range of animals. Sometimes these viruses can make the jump from animals to humans called “spillover”. It can be due to many factors like mutations in viral gene or increased contact to animals.

For eg: the animal reservoir for the MERS CoV are camels and that of SARS CoV are civet cats. The animal reservoir of the 2009 NoCoV is suspected to be bats and snake .

TRANSMISSION

Respiratory viruses are generally transmitted through inhaled droplets when an infected individual coughs or sneezes or through something that has been contaminated with the virus.

The exact dynamics of transmission of NoCoV 2009 virus are not known but evidence suggests it is also a droplet infection.

GROUPS AT RISK

  • Close contact with animals eg: live animal market workers
  • Family members of infected individuals and healthcare workers.

SYMPTOMS:

Symptoms range from mild to severe. Patients can present with fever, cold , could, shortness of breath. In severe cases they may develop pneumonia, kidney failure and even death.

INCUBATION PERIOD:

The time lag between infection with the virus to development of disease is 2 to 10 days and the virus spreads during the phase of maximum illness.

DIAGNOSIS:

The virus can be diagnosed on the basis of a test called PCR ( polymerase chain reaction) of blood sample and nasal swab . In this test the virus is identified by its genetic fingerprint.

TREATMENT

There is currently no specific treatment for Corona virus.

PREVENTION OF DISEASE:

There are standard hygiene practices to limit the spread of the disease:

  1. During coughing or sneezing cover the mouth and nose with tissue , paper or flexed elbow ( not with hands)
  2. Avoid close contact with people who are sick and ahowing the above symptoms.
  3. Use of masks and adequate personnel protective equipments in healthcare workers. As per CDC guidelines there are no recommendations for use of masks in general public to prevent spread of infection.
  4. Hand washing with soap and water or alcohol based hand rub.

ACTIONS THAT CAN BE TAKEN TO PREVENT INFECTION FROM AN ANIMAL SOURCE INCLUDE:

  1. Avoid unnecessary contact with animals. And if any contact happens wash hands thouroughly.
  2. Ensure animal products are cooked properly before they are consumed.

If you are sick take rest and seek medical advice at the earliest.

MYTHBUSTERS FOR CORONA VIRUS

  1. People receiving mail from China are not at risk of contracting the disease.
  2. There are no evidence to prove that garlic or sesame oil can treat infection. Even though they have antimicrobial properties their effectiveness is not proven.
  3. Use of herbal tea cannot protect from Corona virus. General measures like hydration , warm liquids can provide some symptomatic relief but cannot alter the course of the disease.

The above text has been carefully compiled by collecting data from WHO , CDC and NEJM GUIDELINES.

Doctor’s Odyssey

Bruised bodies and broken bones of my colleagues around,

Yet I know, to serve and heal I am duty bound.

I have worked hard and fought with force,

The study of medicine was a tough course.

Understaffed and overworked I am on the days many,

The scarcity of beds and medicines is not my fault any.

The politicians and politics are all that come to play

They are aware of the problems the healthcare faces everyday.

Why do they not increase the hospital beds and number of doctors ever,

Putting up the question to them, I have seen you never.

A bridge course, is the plan to produce state sponsored quacks,

Will the politicians ever entrust their lives in these pseudo-doctor’s hands?

We are lectured about how we should be doing more charity,

Believe me, the pay we get we are already doing our duty.

Hungry, thirsty , sleepless and without proper sanitation,

That is how many doctors are serving the nation with full devotion.

Believe you may not, to save your loved one we try with dedication,

When we fail, your grief may make you question our integration.

But you leave us with bruised and battered body and mind,

I can never understand how can one be so unkind!

The lack of beds , medicines , equipments or manpower,

You took away our dignity for a fault that was never our.

The loss of your dear one may have been God’s decision,

But how could you hurt us with so much aggression!

The politicians and media make us look like villains,

Courage , hopes and dreams from our minds they drain.

Even when you leave us shattered and hurt,

How are we expected to serve you with all our heart!

I wish things could have been much better between us,

The doctor and patient could get rid of the mutual distrust.

CERVICAL CANCER AND HPV VACCINE: SURVIVAL STRATEGIES

What is HPV vaccine: Its Importance

HPV vaccine or vaccination against Human papilloma virus has emerged as a powerful tool in our fight against cervical cancer in the recent years. Since in almost 95% of cases of cervical cancer , the HPV virus is isolated it has become an important modality in the primary prevention of cervical cancer.

INCIDENCE OF CERVICAL CANCER:

India alone accounts for one-fourth of global burden of cervical cancers. It is estimated that cervical cancer will occur in approximately 1 in 53 Indian women during their lifetime compared with 1 in 100 women in more developed regions of the world. It is the second most commonest form of cancer in women after breast cancer. Approximately, 1.3 lakh new cases of cervical cancer is detected every year in India alone . 67,000 women in India die of cervical cancer alone every year.
Unlike many other cancers, cervical cancer occurs early and strikes at the productive period of a woman’s life.The incidence rises in 30–34 years of age and peaks at 55–65 years, with a median age of 38 years (age 21–67 years).

HUMAN PAPILLOMA VIRUS:

Key facts

  • There are about 100 types of HPV that affect different parts of the body. 
  • Of those, about 14 types are considered “high risk,” for leading to cervical cancer. Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions.
  • HPV infection is a sexually transmitted disease. It is transmitted through sexual contact ; vaginal , anal and oral sex.
    Most of the times the disease is self-limiting.
    They can cause warts anywhere in the genitalia including in the perianal region and affects both men and women.
  • HPV infection can increase a man’s risk of getting genital cancers, although these cancers are not common.
  • Cancers Associated with Human Papillomavirus (HPV) Cervical cancer is the most common HPV-associated cancer.Cancer of the vulva, vagina, penis, anus, and oropharynx (back of the throat, including the base of the tongue and tonsils) are also caused by HPV.
    The strategy for primary prevention of HPV is same as any other Sexually transmitted disease: education about safe sex practices, use of latex condoms, personal hygiene, being in a mutually monogamous relationship. The infection can be transmitted from both men to women and vice versa.
    The most important and prominent strategy that is being adopted worldwide for prevention of HPV infection and cervical cancer is vaccination.

  • CERVICAL CANCER: STRATEGIES TO FIGHT THE DISEASE:

    • Who are at risk of contracting cervical cancer:
    • Every woman of reproductive age group who are sexually active are at risk.
    • In women having relation with multiple sex partners or having relation with men who have multiple sex partner.
    • Women suffering from other STDs and immunocompromised status.
    • Early marriage , early childbearing and multiple childbirth
    • Use of oral contraceptive pills.
    • Lack of proper hygiene.
  • Who needs to be screened:
  • Currently in India there is a lack of organized screening programmes at the government level. In the private sector facilities for PAP smear are available at the tertiary care centres.
  • Current WHO guidlines recommend
      • No need for any test for women under 21 years
      21-29 Should have PAP test every three years
      30-65 PAP test every 3 years or PAP plus HPV testing every 5 years
      65+ no need for screening
  • Women who have undergone hysterectomy donot need screening.

    • Women who have abnormal Pap results or positive HPV tests often have a follow-up test called a colposcopy, during which a woman’s cervix is closely examined and a biopsy may be taken to look for abnormal cells. 

    A woman who tests negative for high-risk HPV can be confidently reassured that she has a very low risk of developing cervical cancer before the next round of screening.

  • Vaccinated women need to continue screening as vaccines donot protect against all HPV virus that cause cancer.
  • Until now there have been no blood tests to detect HPV infection in blood.

  • VACCINATION AND PRIMARY PREVENTION:

    • Vaccination programs have had a major impact on the health and longevity of our population. The HPV vaccine has revolutionized the prevention of Cervical Cancer. These vaccines can reduce cervical cancer deaths by more than 60%.

    Characteristics Of HPV vaccination:

    HPV vaccine is available in two forms in India

    QUADRIVALENT VACCINE: It provides protection against HPV subtypes 6,11,16,18. Thus it can prevent both cervical cancer and genital warts.

    BIVALENT VACCINE: It provides protection against HPV subtypes 16, 18 thereby preventing only Cervical cancer.

    NONAVALENT VACCINE: This vaccine targets HPV types 6, 11, 16, and 18, the types targeted by the quadrivalent HPV vaccine (4vHPV), as well as five additional types, HPV types 31, 33, 45, 52, and 58. This is not available in India.

    HPV VACCINES CAN BE SAFELY GIVEN TO:

    • People with minor illness like diarrhea , cough cold with or without fever.
    • Women with abnormal PAP smear test. It cannot provide any therapeutic effect but can protect against reinfection
    • Immunocompromised patient
    • Breastfeeding women

    SHOULD NOT BE GIVEN TO:

    • People with allergy to any vaccine component
    • Moderate to severe illness
    • Pregnant women: pregnancy test is not recommended before administration of vaccine and if a pregnant woman receives vaccine no intervention needed.
  • The vaccine is administered through the intramuscular route.

    • The vaccine can be safely administered with TT, acellular pertussis vaccine , diptheria, poliomyelitis , hepatitis B and influenza vaccine.

    VACCINE SCHEDULE:

    The vaccination schedule depends on the age of the vaccine recipient. The primary target group in most of the countries recommending HPV vaccination is young adolescent girls, aged 9-14.

    The vaccination schedule as recommended by WHO:

    • Females <15 years at the time of first dose>a 2-dose schedule (0, 6 months) is recommended. 
      • If the interval between doses is shorter than 5 months, then a third dose should be given at least 6 months after the first dose. 
    • Females ≥15 years at the time of first dose: a 3-dose schedule (0, 2, 6 months) is recommended.

    NB: A 3-dose schedule remains necessary for those known to be immunocompromised and/or HIV-infected.

    What happens if the teen is late for the second and/or third vaccine – do you restart the series?Do not restart – recommendations similar to those for other childhood vaccinesResume vaccination when teen re-presents for care.

    The upper age limit for women to receive HPV vaccination is 26 years. Beyond 26 years the effectivity of the vaccine reduces.

    HPV VACCINATION IN MALE:

    Studies are underway to determine the usefulness of HPV vaccine in males in prevention of cancers caused by HPV in male population. Even though WHO does not recommend, certain countries have introduced HPV vaccination for boys as well.

    Boys can be vaccinated from the age of 9 and the upper age limit for receiving vaccination is 21years. Beyond 21 years the vaccination is not effective. The schedule is same as in females.

    It is recommended the best time for your child to get the vaccine is before he or she becomes sexually active. This is because the vaccine works best before there is any chance of infection with HPV.

    Cervical cancer is one of the most preventable and treatable forms of cancer as long as it is prevented with HPV vaccination, detected early, and managed effectively.