Institute of Hygiene and Public Health

Kolkata, India

Institute of Hygiene and Public Health

Kolkata, India
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Vo T.H.,Institute of Hygiene and Public Health | Le N.H.,Institute of Hygiene and Public Health | Patel M.S.,Vietnam Field Epidemiology Training Program FETP | Phan L.T.,Vietnam Field Epidemiology Training Program FETP | Tran Minh N.N.,Vietnam Field Epidemiology Training Program FETP
Foodborne Pathogens and Disease | Year: 2012

In early October 2009, pediatricians in hospitals in Ho Chi Minh City (HCMC) reported an unusual increase in the number of children presenting with an acute onset of itchy rash and some with breathing difficulties shortly after drinking milk products. The pediatricians considered the illness to be an allergic reaction to milk. The objective of our investigation was to identify the cause of this acute illness. Following early case reports, all hospitals in HCMC were requested to report cases of this illness. Parents were advised to take children with symptoms to a hospital immediately. A case-series was conducted to generate hypotheses on the possible causes of the illness and was followed by a case-control study to test the hypothesis. Parents of all cases and controls were interviewed face-to-face. The association between food items and the allergy was tested using conditional logistics regression. From 9 to 28 October 2009, 19 cases fulfilled the case definition, and 16 of the 17 cases included in the study had consumed milk supplemented with galacto- oligosaccharides (GOS) shortly before the onset of illness. Fifty age-matched, neighborhood controls were enrolled into the case control study. Of the 30 food items consumed by study participants in the preceding 24 h, only the odds ratio (OR) of milk supplemented with GOS was statistically significant: OR=34.0 (95% CI=3.9, 294.8). Laboratory tests of this milk product did not reveal any unusual properties, chemicals, or other toxic substances. This is the first report of an acute allergic reaction to fresh milk supplemented with GOS. However, the specific allergen in this product was not identified. Further cases were not reported once this product was withdrawn from sale. Vietnam's food safety authorities should expand laboratory capacity to detect allergens in food products. © 2012, Mary Ann Liebert, Inc.


Vo T.H.,University of Tampere | Le N.H.,Institute of Hygiene and Public Health | Le A.T.N.,Institute of Hygiene and Public Health | Tran Minh N.N.,Ministry of Health | Nuorti J.P.,University of Tampere
Food Control | Year: 2015

Frequent foodborne outbreaks occurring in large canteens of factories and schools are a public health concern in Vietnam. Potential for contamination of food during the preparation phase has not yet been addressed by public health authorities, particularly the food-handlers' knowledge, attitudes and practices (KAP) regarding food safety. To identify training needs, we conducted an analytical cross-sectional study assessing KAP of food-handlers in large canteens of schools and factories in 2012. From a sampling frame of 169 large canteens (50 in schools and 119 in factories; a total of 3399 employees) in Southern Vietnam, 40 schools and 26 factories were selected on the basis of type of establishment; all food-handlers (N=909) in the selected canteens were interviewed by using standard questionnaire. After descriptive analysis, potential confounders were controlled by using logistic regression models to calculate prevalence odds ratios (PORs) and 95% confidence intervals (CI) for differences in KAP between employees in schools and factories. A qualitative study of ten focus groups with participants selected by using maximum variation sampling was also conducted to identify training needs. Of the 909 food-handlers participating the study, 76% were females, 84% had secondary school or higher education; median age and work experience were 38 years and 36 months, respectively. Proportions of all participants whose KAP were considered adequate were 26%, 36%, and 26%, respectively. There were associations between knowledge and attitudes, and knowledge and practices. After controlling for gender, age, educational level, and length of work experience in logistic regression models, the odds of food-handlers in schools reporting adequate KAP were about twice as high as those for food-handlers in factories. Among 66 investigated canteens, 9% did not separate raw food from cooked food area and 52% did not have standard rest rooms. Food-handlers' suggestions for training needs included appropriate location of the training venue at the work place, involvement of managers, fewer trainees per course, more practical exercises, and longer course duration. KAP of food-handlers were generally poor, especially among food-handlers working in factories. Public health authorities in Vietnam should prioritize food-handlers in factories for training courses. © 2015 Elsevier Ltd.


Vo T.H.,University of Tampere | Le N.H.,Institute of Hygiene and Public Health | Cao T.T.D.,Food Safety Agency | Nuorti J.P.,University of Tampere | Minh N.N.T.,Vietnam Field Epidemiology Training Programme
International Journal of Infectious Diseases | Year: 2014

Objectives: To identify the vehicle, source, and causative agent of a community-wide food-borne outbreak of gastroenteritis. Methods: We conducted a case-control study. Cases were city residents diagnosed with gastroenteritis and hospitalized in Ben Tre City from 22 to 25 May 2013; 41 cases were selected randomly from a list of hospitalized patients. Controls were age- and gender-matched healthy neighbours of cases. Participants were interviewed using a standard questionnaire. Samples from patients and food were tested at reference laboratories. We used conditional logistic regression to calculate matched odds ratios (mORs) for the association of gastroenteritis with food items consumed. Results: Of the 41 cases enrolled in the study, 61% were males and the median age was 33 years; cases resided in 12 wards of the City. Of 13 food items consumed by the cases, only stuffed bread was significantly associated with gastroenteritis (mOR 21.3, 95% confidence interval 6.3-71.8). Among the 29 cases who ate stuffed bread, the median time to illness onset was 9. h. Patient stool samples and bread samples were positive for Salmonella species. Conclusions: Stuffed bread was the likely vehicle of the outbreak. The laboratory testing capacity for serotypes of Salmonella should be strengthened in Vietnam. Food-handler training in basic food safety measures should be improved. © 2014 The Authors.


Pal A.K.,Vivekananda Institute of Medical science | Sur S.,Vivekananda Institute of Medical science | Pal J.,Vivekananda Institute of Medical science | Gupta A.K.,Institute of Hygiene and Public Health
Journal of Nepal Paediatric Society | Year: 2015

Introduction: The objectives of this study were to study the incidence and risk factors of retinopathy of prematurity (ROP) among preterm low birth weight babies and its association with oxygen therapy. Material and Methods: During one year study period, 50 neonates, who had fulfilled the inclusion criteria (born at gestational age ≤ 35 wks), were included in the present study. They were examined by indirect ophthalmoscopy by an ophthalmologist in NICU or ophthalmology outdoor. Staging of ROP was done according to the International classification. Data obtained from this study were entered in Microsoft Excel and subsequently analysed in SPSS version 20.0. Results: Among study population, 12 neonates (24%) showed evidence of retinopathy of prematurity, and Stage 2 ROP was most common (41.7%) within this group. Those neonates who had born ≤28 wks gestational age, showed more incidence (75%) of ROP. There was significant association between ROP and prematurity, low birth weight, mechanical ventilation, duration and concentration of oxygen therapy. Conclusion: Apart from prematurity and low birth weight, oxygen therapy also carries significant risk for ROP. Thus, judicious use of oxygen in premature babies can reduce incidence of ROP significantly. © 2015, Nepal Paediatric Society (NEPAS). All rights reserved.


Vo T.H.,Institute of Hygiene and Public Health | Le N.H.,Institute of Hygiene and Public Health | Nuorti J.P.,University of Tampere
Journal of Infection in Developing Countries | Year: 2013

On July 20, 2010, three cases of cholera were reported from a district hospital in Ca Mau province, Vietnam. We investigated the likely source and mode of transmission of the outbreak. All hospitals in the province were requested to notify cases of acute watery diarrhoea. Epidemiological, clinical, and laboratory data were collected. Between July 12 and 22, seven cases with positive culture for Vibrio cholera were identified. Six cases were epidemiologically linked to the index case. Basic infection control practices were not in place at the hospital. Clinicians and public health staff should consider the possibility of nosocomial cholera transmission even in non-endemic areas. © 2013 Vo et al.


PubMed | Institute of Hygiene and Public Health
Type: Journal Article | Journal: Foodborne pathogens and disease | Year: 2012

In early October 2009, pediatricians in hospitals in Ho Chi Minh City (HCMC) reported an unusual increase in the number of children presenting with an acute onset of itchy rash and some with breathing difficulties shortly after drinking milk products. The pediatricians considered the illness to be an allergic reaction to milk. The objective of our investigation was to identify the cause of this acute illness. Following early case reports, all hospitals in HCMC were requested to report cases of this illness. Parents were advised to take children with symptoms to a hospital immediately. A case-series was conducted to generate hypotheses on the possible causes of the illness and was followed by a case-control study to test the hypothesis. Parents of all cases and controls were interviewed face-to-face. The association between food items and the allergy was tested using conditional logistics regression. From 9 to 28 October 2009, 19 cases fulfilled the case definition, and 16 of the 17 cases included in the study had consumed milk supplemented with galacto-oligosaccharides (GOS) shortly before the onset of illness. Fifty age-matched, neighborhood controls were enrolled into the case control study. Of the 30 food items consumed by study participants in the preceding 24h, only the odds ratio (OR) of milk supplemented with GOS was statistically significant: OR=34.0 (95% CI=3.9, 294.8). Laboratory tests of this milk product did not reveal any unusual properties, chemicals, or other toxic substances. This is the first report of an acute allergic reaction to fresh milk supplemented with GOS. However, the specific allergen in this product was not identified. Further cases were not reported once this product was withdrawn from sale. Vietnams food safety authorities should expand laboratory capacity to detect allergens in food products.


PubMed | Institute of Hygiene and Public Health
Type: Journal Article | Journal: Journal of infection in developing countries | Year: 2013

On July 20, 2010, three cases of cholera were reported from a district hospital in Ca Mau province, Vietnam. We investigated the likely source and mode of transmission of the outbreak. All hospitals in the province were requested to notify cases of acute watery diarrhoea. Epidemiological, clinical, and laboratory data were collected. Between July 12 and 22, seven cases with positive culture for Vibrio cholera were identified. Six cases were epidemiologically linked to the index case. Basic infection control practices were not in place at the hospital. Clinicians and public health staff should consider the possibility of nosocomial cholera transmission even in non-endemic areas.


PubMed | University of Tampere, Food Safety Agency of Binh Duong, Institute of Hygiene and Public Health and Vietnam Field Epidemiology Training Program
Type: Journal Article | Journal: Journal of food protection | Year: 2014

An outbreak of gastroenteritis occurred among workers of company X after eating lunch prepared by a catering service. Of 430 workers attending the meal, 56 were hospitalized with abdominal pain, diarrhea, vomiting, and nausea, according to the initial report. We conducted an investigation to identify the extent, vehicle, and source of the outbreak. In our case-control study, a case was a worker who attended the meal and who was hospitalized with acute gastroenteritis; controls were randomly selected from non-ill workers. Cases and controls were interviewed using a standard questionnaire. We used logistic regression to calculate adjusted odds ratios for the consumption of food items. Catering service facilities and food handlers working for the service were inspected. Food samples from the catering service were tested at reference laboratories. Of hospitalized cases, 54 fulfilled the case definition, but no stool specimens were collected for laboratory testing. Of four food items served during lunch, only squash and pork soup was significantly associated with gastroenteritis, with an adjusted odds ratio of 9.5 (95 % CI 3.2, 27.7). The caterer did not separate cooked from raw foods but used the same counter for both. Cooked foods were kept at room temperature for about 4 h before serving. Four of 14 food handlers were not trained on basic food safety principles and did not have health certificates. Although no microbiological confirmation was obtained, our epidemiological investigation suggested that squash and pork soup caused the outbreak. Hospitals should be instructed to obtain stool specimens from patients with gastroenteritis. Food catering services should be educated in basic food safety measures.


PubMed | Water Center, Institute of Hygiene and Public Health and University of Duisburg - Essen
Type: Journal Article | Journal: International journal of hygiene and environmental health | Year: 2016

Along the intense industrialization of the Ruhr valley (Germany), the River Ruhr became increasingly polluted. Over time, using it for recreational purposes became a serious health hazard and bathing was banned due to chemical and microbiological risks. The purpose of the collaborative project Safe Ruhr was to verify the current status and to provide a scientific basis for lifting the bathing ban. As the river also provides a raw water source for drinking water production, it was investigated how well the treatment procedures control possible hygienic risks. As study area, the barrier Lake Baldeney was chosen as it embraces earlier bathing sites and tributes to river bank filtration water for drinking water treatment plants. The hygienic condition of the river water was determined over 18 months by measuring general physical, chemical and microbiological water quality parameters including fecal indicators, bacterial obligate and facultative pathogens, parasitic protozoa, enteric viruses and schistosome parasites (Trichobilharzia). Samples were taken at eight locations including sites before and after receiving the discharge of stormwater and treated wastewater, potential future bathing sites and a raw water abstraction point for potable water production. In summary, for all investigated physico-chemical parameters no significant difference between the eight investigated sampling locations on a distinct sampling date were observed. This study focused on hygienically relevant bacteria and parasitic protozoa. Fecal indicators, Escherichia coli, intestinal enterococci and Clostridium perfringens as well as coliform bacteria were detected in 94-100% of the water samples. Enteric pathogens, including Campylobacter spp. and Salmonella enterica, were isolated from 33% and 28% of the samples, respectively, in relatively low concentrations. Among the environmental facultative pathogens, P. aeruginosa was detected at a high frequency of 82% of all samples, but in low numbers, while Aeromonas spp. were found in all water samples in relative high concentrations. The levels of all target organisms were not clearly associated with sources of pollution, with the exception of slightly enhanced numbers of coliform bacteria and E. coli downstream of a sewage discharge point from a wastewater treatment plant. Seasonal variations were observed with higher detection rates of Campylobacter spp. in winter and S. enterica in autumn and winter in contrast to the other bacterial groups, which showed no significant fluctuations throughout the year. Precipitation within two days prior to sampling resulted in a trend of enhanced numbers of coliform bacteria, E. coli, intestinal enterococci and Aeromonas. Sampling and analysis of parasitic protozoa was carried out in accordance to the European bathing water guideline and the ISO 15553 method. Characteristics of the river (flow, vegetation, birds protection zone, bathing of people, sewage etc.) were compared to the number of organisms detected. All in all 184 samples were investigated for Cryptosporidium spp. and Giardia spp. 80% of the samples were positive for Giardia spp. with a mean of 5cysts/100l (0.1-157.9). Highest values were achieved in autumn and winter, lowest values during the assumed bathing season. There seemed to be a trend to lower values in and after a reservoir in the river course, but with no statistical significance. A statistical significance could be shown for higher concentrations after heavy rainfall that led to discharge of combined sewage overflows in the city of Essen. Only 29% of the samples were positive for Cryptosporidium spp. with a single maximum value of 27.7 and all other concentrations below 5 oocysts/100l. On a low level there seemed to be slightly higher findings during summer and bathing season than in autumn and winter. No correlation to heavy rainfall could be found. The findings correspond to earlier results from the River Rhine (Germany). The influence of sewage on the water quality of the Ruhr could be shown from the correlation of Giardia load and activity of combined sewage overflows after heavy rainfall. The rare and low findings of Cryptosporidium spp. lead to the same conclusion, that microbial water quality in the investigation area is rather influenced from sewage water than from diffuse water sources into the River Ruhr.


PubMed | Institute of Hygiene and Public Health
Type: Journal Article | Journal: Biological trace element research | Year: 2013

Starting from experimental observations demonstrating that a high ratio of zinc to copper led to hypercholesterolemia in rats, serum Zn and Cu levels were measured by atomic absorption spectrophotometry in 65 normolipemic controls and in 100 subjects with various types of hyperlipoproteinemia (HLP). Serum Zn levels did not significantly differ from control values in any type of HLP. However, hyperlipoproteinemic patients with obvious clinical atherosclerosis displayed significantly lower serum-Zn concentration than hyperlipo-proteinemic subjects without clinical symptoms. On the other hand, when compared to control subjects, serum Cu levels were not found to be decreased, but rather increased, in hyperlipoproteinemic patients with or without atherosclerosis. As a result, the ZnCu ratio appeared to be lower than normal in hyperlipoproteinemic patients with cardiovascular disease. It is conceivable that changes of these trace elements should be rather connected to vessel injury and associated disease than to HLP which, at least in humans, is not accompanied by a high ZnCu ratio.

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