Dr JAY K. SHETH
@amcmet.org
ASSOCIATE PROFESSOR, DEPARTMENT OF COMMUNITY MEDICINE
AMC MET MEDICAL COLLEGE, AHMEDABAD
RESEARCH INTERESTS
PREVENTIVE MEDICINE, PUBLIC HEALTH, COMMUNITY MEDICINE, COMMUNITY HEALTH
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Jay Sheth, Kshem Prasad, and Tapasvi Puwar
Medsci Publications
Entire world was eagerly waiting for the vaccine against SARS-CoV2 ever since Covid19 pandemic started. India is the second largest populous nation and is among the very few nations who has developed a vaccine against SARS-CoV2. India is also a major vaccine producing hub supplying large quantum of vaccines to the rest of the world. Efficacy, advantages and comparison between various covid vaccine has been largely discussed by the scientific community. However, there are various other factors affecting the vaccine situation in a nation, may it be the plan, strategy, it’s implementation, local context, health infrastructure etc. While there are many news and views related to covid-19 vaccine, one need to look beyond & into so many other aspects related to the factors affecting this situation. Through discussion of some of these key factors, we tried to draw an overall picture of the Covid19 vaccine situation in India. Keeping in line with our objective, we keep the focus of our discussion on vaccine development & manufacturing issues, diplomatic decisions on vaccine & the reasons behind the same, international factors etc. We have purposefully restricted our discussion to these factors and did not go in details of the national level policy and its implementation details in this article.
Om Prakash, Bhavin Solanki, Jay Sheth, Mehul Acharya, Mina Kadam, Sheetal Vyas, Aparajita Shukla, and Hemant Tiwari
Faculty of Medicine Prince of Songkla University
Objective: To estimate Covid19 seropositivity among contacts of cases and to compare the seropositivity among different types of contact for assessing the differential risk & transmission dynamics.Material and Methods: A large-scale population-based serosurvey was carried out among the general population of Ahmedabad during the second half of October 2020. The contacts of cases were selected based on the population proportion and enrolled as an additional category. The seropositivity among the contacts was estimated using the enzyme-linked immunosorbent assay and compared with different types of contact and available demographic factors.Results: As of October 2020, the seropositivity against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) among contacts of cases in Ahmedabad was 26.0% [95% confidence interval 24.2–28.0]. The seropositivity among family contacts was significantly higher (28.8%) compared to other contacts (24.4%) (Z=2.19, p-value=0.028). This trend was seen across all age groups and both sexes. The seropositivity was higher among females (27.7%) compared to males (24.5%) but the difference was statistically not significant (Z=1.64, p-value=0.101). In terms of age groups, the positivity had an increasing trend up to 60 years but declined after that.Conclusion: A seropositivity of 26.0% among contacts indicates that a large proportion of contacts demonstrated Immunoglobulin-G antibodies. This highlights asymptomatic transmission and/or low sensitivity of the diagnostic tests. The current strategy for contact tracing and testing among contacts is justified based on the significantly higher seropositivity among family contacts.
Om Prakash, Bhavin Solanki, Jay Sheth, Govind Makwana, Mina Kadam, Sheetal Vyas, Aparajita Shukla, Jayshri Pethani, and Hemant Tiwari
Elsevier BV
Background
Health Care Workers (HCWs) are at higher risk for Covid19. Sero-surveillance among HCWs using IgG antibodies can add further value to the scientific findings.
Objectives
To estimate seropositivity among HCWs and to correlate it with various factors affecting seropositivity.
Methods
Population based large scale sero-surveillance among HCWs was carried out during second half of August’20 in Ahmedabad using “Covid-Kavach” IgG Antibody Detection ELISA kits. Seropositivity among HCWs was estimated and compared with various demographic & other factors to understand their infection & immunity status. Proportions and Z-test were used as appropriate.
Results
As on August’20, Seropositivity among HCWs from Ahmedabad is 23.65% (95% Confidence Interval 21.70–25.73%). Seropositivity of 25.98% (95%CI 23.47–28.66) among female HCWs is significantly higher than 19.48% (95%CI 16.53–22.80) among male HCWs. The zone wise positivity among HCWs closely correlate with cases reported from the respective zone. The sero-positivity among HCWs from the earliest and worst affected zones have lower level of seropositivity as compared to the zones affected recently. This might be pointing towards the fact that the IgG Antibodies may not be long lasting.
Conclusion
As on August 2020, the seropositivity of 23.65% in HCWs indicate high level of disease transmission and higher risk of infection among HCWs in Ahmedabad. The seropositivity is significantly higher among female HCWs. Zone wise seropositivity, closely correlate with the reported cases from the respective zone. Their comparison also indicates the possibility of reducing IgG seropositivity, which necessitates further in-depth scientific research to generate greater scientific evidences.
Om Prakash, Bhavin Solanki, Jay Sheth, Chirag Shah, Mina Kadam, Sheetal Vyas, Aparajita Shukla, and Hemant Tiwari
ScopeMed
Om Prakash, Bhavin Solanki, Jay K Sheth, Bhavin Joshi, Mina Kadam, Sheetal Vyas, Aparajita Shukla, Hemant Tiwari, Sanjay Rathod, Anil Rajput,et al.
BMJ
ObjectivesTo study the percentage seropositivity for SARS-CoV-2 to understand the pandemic status and predict the future situations in Ahmedabad.Study designCross-sectional study.SettingsField area of Ahmedabad Municipal Corporation.ParticipantsMore than 30 000 individuals irrespective of their age, sex, acute/past COVID-19 infection participated in the serosurvey which covered all the 75 Urban Primary Health Centres (UPHCs) across 48 wards and 7 zones of the city. Study also involved healthcare workers (HCWs) from COVID-19/non-COVID-19 hospitals.InterventionsSeropositivity of IgG antibodies against SARS-CoV-2 was measured as a mark of COVID-19 infection.Primary and secondary outcomesSeropositivity was used to calculate cumulative incidence. Correlation of seropositivity with available demographic detail was used for valid and precise assessment of the pandemic situation.ResultsFrom 30 054 samples, the results were available for 29 891 samples and the crude seropositivity is 17.61%. For all the various age groups, the seropositivity calculated between 15% and 20%. The difference in seropositivity for both the sex group is statistically not significant. The seropositivity is significantly lower (13.64%) for HCWs as compared with non-HCWs (18.71%). Seropositivity shows increasing trend with time. Zone with maximum initial cases has high positivity as compared with other zones. UPHCs with recent rise in cases are leading in seropositivity as compared with earlier and widely affected UPHCs.ConclusionsThe results of serosurveillance suggest that the population of Ahmedabad is still largely susceptible. People still need to follow preventive measures to protect themselves till an effective vaccine is available to the people at large. The data indicate the possibility of vanishing immunity over time and need further research to cross verify with scientific evidences.
Om Prakash, B. Solanki, Jay K Sheth, Mina Kadam, S. Vyas and Serosurveillance Research TeamFNx01
Background: Multiple serosurveillance studies have focused on the presence of antibodies against severe acute respiratory syndrome coronavirus 2 in the general population and confirmed cases. However, seroprevalence of immunoglobulin G (IgG) among contacts of confirmed cases can add further value to the scientific findings. Objectives: The objective is to estimate COVID-19 seropositivity among contacts of COVID-19 cases and to compare the seropositivity between types of contact for the assessment of differential risk and transmission dynamics. Methods: Large scale population-based serosurveillance on contacts of COVID-19 cases was carried out during the second half of August 2020 in Ahmedabad using the COVID-Kavach. The seropositivity among contacts was estimated and correlated-compared with type of contact and other demographic factors. Results: With 1268 positive for IgG antibodies from 3973 samples, the seropositivity against COVID-19 among contacts of cases in Ahmedabad was 31.92% (95% confidence interval 30.48%–33.38%). The seropositivity among family contacts was significantly higher (39.36%) as compared to other contacts (28.72%) (Z = 6.60, P < 0.01). This trend is seen across all age groups and both the sex groups. The seropositivity has increasing trend with increasing age and is significantly higher among females (35.11%) than males (28.95%) (Z = 4.16, P < 0.01). Conclusion: Seropositivity of 31.92% among contacts indicates that a large proportion of contacts have already acquired immunity on account of their contact with the case. Higher seropositivity among family contacts justifies the risk categorization and testing strategy adopted for the contacts of the cases. This also reaffirms the need for contact tracing strategy for controlling the inevitable spread of pandemic.
Calvin Ke, Rajeev Gupta, Denis Xavier, Dorairaj Prabhakaran, Prashant Mathur, Yogeshwar V Kalkonde, Patrycja Kolpak, Wilson Suraweera, Prabhat Jha, Shazia Allarakha,et al.
Elsevier BV
Summary Introduction India accounts for about a fifth of cardiovascular deaths globally, but nationally representative data on mortality trends are not yet available. In this nationwide mortality study, we aimed to assess the trends in ischaemic heart disease and stroke mortality over 15 years using the Million Death Study. Methods We determined national and subnational cardiovascular mortality rates and trends by sex and birth cohort using cause of death ascertained by verbal autopsy from 2001 to 2013 among 2·4 million households. We derived mortality rates for ischaemic heart disease and stroke by applying mortality proportions to UN mortality estimates for India and projected the rates from 2000 to 2015. Findings Cardiovascular disease caused more than 2·1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. At ages 30–69 years, of 1·3 million cardiovascular deaths, 0·9 million (68·4%) were caused by ischaemic heart disease and 0·4 million (28·0%) by stroke. At these ages, the probability of dying from ischaemic heart disease increased during 2000–15, from 10·4% to 13·1% in men and 4·8% to 6·6% in women. Ischaemic heart disease mortality rates in rural areas increased rapidly and surpassed those in urban areas. By contrast, the probability of dying from stroke decreased from 5·7% to 5·0% in men and 5·0% to 3·9% in women. A third of premature stroke deaths occurred in the northeastern states, inhabited by a sixth of India’s population, where rates increased significantly and were three times higher than the national average. The increased mortality rates of ischaemic heart disease nationally and stroke in the northeastern states were higher in the cohorts of adults born in the 1970s onwards, than in earlier decades. A large and growing proportion of the ischaemic heart disease nationally and stroke deaths in high-burden states reported earlier diagnosis of cardiovascular disease, but low medication use. Interpretation The unexpectedly diverse patterns of cardiovascular mortality require investigation to identify the role of established and new cardiovascular risk factors. Secondary prevention with effective and inexpensive long-term treatment and adult smoking cessation could prevent substantial numbers of premature deaths. Without progress against the control of cardiovascular disease in India, global goals to reduce non-communicable diseases by 2030 will be difficult to achieve. Funding Fogarty International Center of the US National Institutes of Health, Dalla Lana School of Public Health, University of Toronto, Indian Council of Medical Research, and the Disease Control Priorities.
Mireille Gomes, Rehana Begum, Prabha Sati, Rajesh Dikshit, Prakash C. Gupta, Rajesh Kumar, Jay Sheth, Asad Habib, and Prabhat Jha
Health Affairs (Project Hope)
Progress toward the United Nations 2030 Sustainable Development Goals requires improved information on mortality and causes of death. However, causes of many of the fifty million annual deaths in low- and middle-income countries remain unknown, as most of the deaths occur at home without medical attention. In 2001 India began the Million Death Study in 1.3 million nationally representative households. Nonmedical staff conduct verbal autopsies, which are structured interviews including a half-page narrative in local language of the family's story of the symptoms and events leading to death. Two physicians independently assess each death to arrive at an underlying cause of death. The study has thus far yielded information that substantially altered previous estimates of cause-specific mortality and risk factors in India. Similar robust studies are feasible at low cost in other low- and middle-income countries, particularly if they adopt electronic data management and ensure high quality of fieldwork and physician coding. Nationwide mortality studies enable the quantification of avoidable premature mortality and key risk factors for disease, and provide a practicable method to monitor progress toward the Sustainable Development Goals.
Shaza A Fadel, Reeta Rasaily, Shally Awasthi, Rehana Begum, Robert E Black, Hellen Gelband, Patrick Gerland, Rajesh Kumar, Li Liu, Colin Mathers,et al.
Elsevier BV
BACKGROUND
Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1-59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India.
METHODS
Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1·3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001-13 with annual UN estimates of national births and deaths (partitioned across India's states and rural or urban areas) for 2000-15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1-59-month-old children.
FINDINGS
The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1-59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11·9 per 1000 livebirths in 2000 to 4·0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9·0 per 1000 livebirths in 2000 to 2·2 per 1000 livebirths in 2015. At 1-59 months, the mortality rate from pneumonia fell by 63% from 11·2 per 1000 livebirths in 2000 to 4·2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9·4 per 1000 livebirths in 2000 to 3·2 per 1000 livebirths in 2015 (with narrowing girl-boy gaps). The neonatal tetanus mortality rate fell from 1·6 per 1000 livebirths in 2000 to less than 0·1 per 1000 livebirths in 2015 and the 1-59-month measles mortality rate fell from 3·3 per 1000 livebirths in 2000 to 0·3 per 1000 livebirths in 2015. By contrast, mortality rates for prematurity or low birthweight rose from 12·3 per 1000 livebirths in 2000 to 14·3 per 1000 livebirths in 2015, driven mostly by increases in term births with low birthweight in poorer states and rural areas. 29 million cumulative child deaths occurred from 2000 to 2015. The average annual decline in mortality rates from 2000 to 2015 was 3·3% for neonates and 5·4% for children aged 1-59 months. Annual declines from 2005 to 2015 (3·4% decline for neonatal mortality and 5·9% decline in 1-59-month mortality) were faster than were annual declines from 2000 to 2005 (3·2% decline for neonatal mortality and 4·5% decline in 1-59-month mortality). These faster declines indicate that India avoided about 1 million child deaths compared with continuation of the 2000-05 declines.
INTERPRETATION
To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1-59-month mortality and accelerate declines in neonatal mortality (to >5% annually) from 2015 onwards. Continued progress in reduction of child mortality due to pneumonia, diarrhoea, malaria, and measles at 1-59 months is feasible. Additional attention to low birthweight is required.
FUNDING
National Institutes of Health, Disease Control Priorities Network, Maternal and Child Epidemiology Estimation Group, and University of Toronto.
Pallavi Dagli, Jyotsna Singh, Jay Sheth, and Khyati Kakkad
Nepal Journals Online (JOL)
Introduction: Dental health problems in children are often overlooked. Poor oral health negatively affects growth, learning, communication, self-esteem and rarely can also lead to serious fatal infection. Paediatrician can play key role in screening dental health problems. The objectives of this study were to screen children for dental caries in paediatric office and correlate with socio-demographic, dietary and oral hygiene risk factors.Material and Methods: After basic oral health training, paediatrician assessed oral health risk factors with pre-validated questionnaire and carried out dental examination at paediatric OPD.Results: Dental health problems were found in 364(42.8%) out of 850 subjects. Age was significantly associated (p<0.0001) with type of teeth involved. Incisors were most affected in infants and involvement of posterior teeth increased with age. Statistically significant (p<0.05) oral health risk factors were increasing age, lower socio-economic status, malnutrition, lower parents’ education, positive family history, bottle feeding, increased consumption of biscuits, fizzy drinks and chewing gum; delayed start and less time spent on brushing, infrequent change of toothbrush, incorrect brushing technique, inadequate parental knowledge and supervision.Conclusion: Dental screening can easily be incorporated in busy paediatric practice. An identification and record of individual risk factor is useful in selecting counselling strategies and monitoring.
Anna J Dare, Joshua S Ng-Kamstra, Jayadeep Patra, Sze Hang Fu, Peter S Rodriguez, Marvin Hsiao, Raju M Jotkar, J S Thakur, Jay Sheth, and Prabhat Jha
Elsevier BV
BACKGROUND
Few population-based studies quantify mortality from surgical conditions and relate mortality to access to surgical care in low-income and middle-income countries.
METHODS
We linked deaths from acute abdominal conditions within a nationally representative, population-based mortality survey of 1·1 million households in India to nationally representative facility data. We calculated total and age-standardised death rates for acute abdominal conditions. Using 4064 postal codes, we undertook a spatial clustering analysis to compare geographical access to well-resourced government district hospitals (24 h surgical and anaesthesia services, blood bank, critical care beds, basic laboratory, and radiology) in high-mortality or low-mortality clusters from acute abdominal conditions.
FINDINGS
923 (1·1%) of 86,806 study deaths at ages 0-69 years were identified as deaths from acute abdominal conditions, corresponding to 72,000 deaths nationally in 2010 in India. Most deaths occurred at home (71%) and in rural areas (87%). Compared with 567 low-mortality geographical clusters, the 393 high-mortality clusters had a nine times higher age-standardised acute abdominal mortality rate and significantly greater distance to a well-resourced hospital. The odds ratio (OR) of being a high-mortality cluster was 4·4 (99% CI 3·2-6·0) for living 50 km or more from well-resourced district hospitals (rising to an OR of 16·1 [95% CI 7·9-32·8] for >100 km). No such relation was seen for deaths from non-acute surgical conditions (ie, oral, breast, and uterine cancer).
INTERPRETATION
Improvements in human and physical resources at existing government hospitals are needed to reduce deaths from acute abdominal conditions in India. Full access to well-resourced hospitals within 50 km by all of India's population could have avoided about 50,000 deaths from acute abdominal conditions, and probably more from other emergency surgical conditions.
FUNDING
Bill & Melinda Gates Foundation, Dalla Lana School of Public Health, Canadian Institute of Health Research.
Lukasz Aleksandrowicz, Varun Malhotra, Rajesh Dikshit, Prakash C Gupta, Rajesh Kumar, Jay Sheth, Suresh Kumar Rathi, Wilson Suraweera, Pierre Miasnikof, Raju Jotkar,et al.
Springer Science and Business Media LLC
BackgroundVerbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India’s ongoing, nationally-representative Indian Million Death Study (MDS).MethodsPerformance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions.ResultsThe introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding.ConclusionsSimple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available.
Marvin Hsiao, Ajai Malhotra, J S Thakur, Jay K Sheth, Avery B Nathens, Neeraj Dhingra, Prabhat Jha, and
BMJ
Objectives To quantify and describe the mechanism of road traffic injury (RTI) deaths in India. Design We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports. Setting 1.1 million homes in India. Participants Over 122 000 deaths at all ages from 2001 to 2003. Primary and secondary outcome measures Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained. Results The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods. Conclusions In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.
Babasaheb V. Tandale, Padmakar S. Sathe, Vidya A. Arankalle, R.S. Wadia, Rahul Kulkarni, Sudhir V. Shah, Sanjeev K. Shah, Jay K. Sheth, A.B. Sudeep, Anuradha S. Tripathy,et al.
Elsevier BV
BACKGROUND
In addition to classical manifestations of Chikungunya infection, severe infections requiring hospitalization were reported during outbreaks in India in 2006.
OBJECTIVES
To describe the systemic syndromes and risk groups of severe Chikungunya infections.
STUDY DESIGN
We prospectively investigated suspected Chikungunya cases hospitalized in Ahmedabad, Gujarat during September-October 2006, and retrospectively investigated laboratory-confirmed Chikungunya cases hospitalized with neurologic syndromes in Pune, Maharashtra. Hospital records were reviewed for demographic, comorbidity, clinical and laboratory information. Sera and/or cerebrospinal fluid were screened by one or more methods, including virus-specific IgM antibodies, viral RNA and virus isolation.
RESULTS
Among 90 laboratory-confirmed Chikungunya cases hospitalized in Ahmedabad, classical Chikungunya was noted in 25 cases and severe Chikungunya was noted in 65 cases, including non-neurologic (25) and neurologic (40) manifestations. Non-neurologic systemic syndromes in the 65 severe Chikungunya cases included renal (45), hepatic (23), respiratory (21), cardiac (10), and hematologic manifestations (8). Males (50) and those aged >or=60 years (50) were commonly affected with severe Chikungunya, and age >or=60 years represented a significant risk. Comorbidities were seen in 21 cases with multiple comorbidities in 7 cases. Among 18 deaths, 14 were males, 15 were aged >or=60 years and 5 had comorbidities. In Pune, 59 laboratory-confirmed Chikungunya cases with neurologic syndromes were investigated. Neurologic syndromes in 99 cases from Ahmedabad and Pune included encephalitis (57), encephalopathy (42), and myelopathy (14) or myeloneuropathy (12).
CONCLUSIONS
Chikungunya infection can cause systemic complications and probably deaths, especially in elderly adults.