Browsing by Author "Chapagain, Ram Hari"
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Publication Adverse Events Following COVISHIELD and VERO CELL Vaccination Campaigns Against COVID-19(Nepal Health Research Council, 2023) Adhikari, Santosh; Maharjan, Jessica; Bhattarai, Sushan; Kunwar, Kshitij; Agrawal, Sumit; Dangal, Raj Kumar; Chapagain, Ram Hari; Bista, Tek Bahadur; Bhattarai, SrijanaAbstract Background: Vaccination against COVID-19 for Nepalese was initiated in January 2021 for various age groups. People were anxious about receiving the vaccines and were concerned about the safety profile of the vaccine they received. In this study, we have tried to observe the Adverse Events Following Immunization of two different vaccines namely COVISHIELD (ChAdOx1 nCOV-19) and VERO CELL (CZ02 strain), used in different phases of vaccination by the government of Nepal. Methods: We conducted a cross-sectional study among people who received COVID-19 vaccines in this study using a self-administered questionnaire. Data was cleaned and then exported to IBM SPSS v.20 for analysis, Chi-square test was used to see the association between different variables and a p-value<0.05 was considered statistically significant. Results: Out of 303 respondents, all had received the first and 270 participants had received the second dose of the COVID-19 vaccine, among which, 133 (43.89%) reported at least one side effect after the first dose of vaccination while 58 (21.48%) had self-reported side effects after the second dose of vaccination. Seventeen percent of the respondents had COVID-19 infection within the past 3 months before receiving COVID-19 vaccine. Three percent of participants had re-infection with COVID-19 after receiving the first or the second dose of the COVID-19 vaccine. Among participants who experienced adverse events, 42% and 62.1% of participants experienced mild adverse events following the first dose and second dose of the vaccine, respectively. Conclusions: The adverse events following immunization for both vaccines after both doses of vaccination were quite low, with 43.89% of participants reporting side effects after the first dose and 21.48% of participants reporting side effects after the second dose. Adverse events were most frequently reported within 24 hours of vaccination and were mostly mild. There was no statistical significance of adverse events between both vaccines. Keywords: Adverse events following immunization (AEFI); COVID-19; COVISHIELD; VERO CELL. Author Biographies Santosh Adhikari, Kanti Children's Hospital, Kathmandu, Nepal Sushan Bhattarai, Kanti Children's Hospital, Kathmandu, Nepal Raj Kumar Dangal, Kathmandu University School of Medical Sciences, Dhulikhel hospital, Dhulikhel, Nepal Srijana Bhattarai, Paropakar Maternity and Women's Hospital, Kathmandu, NepalPublication Burden of enteric fever and antibiotic sensitivity in Nepalese Children Prior to Typhoid Vaccine in National Immunization Program(Nepal Health Research Council, 2023) Chapagain, Ram Hari; Adhikari, Santosh; Bhattarai, Tribhuwan; Basaula, Yubanidhi; Bhattarai, SrijanaAbstract Background: Enteric fever is a major public health problem in developing and under developed countries. Case fatality rate without treatment is 10-30% and with appropriate treatment is only 1-4%. Gold standard for diagnosis is isolation of Salmonella enterica from blood or bone marrow. Antibiotics resistance is skyrocketing with emergence of multidrug resistance S. typhi and extensively drug resistant S. typhi. Methods: The blood culture done in Kanti children hospital in last six years were taken from the data base and the culture positive cases were taken from which the salmonella species positive cases along with the drug sensitivity pattern were used in our study. Results: The culture positivity rate was 2.8% and 7.6% (n=136) among the culture positive cases were Salmonella species. Salmonella typhi (121; 88.9%) was the most frequently isolated species, followed by Salmonella paratyphi A (13; 9.5%) and Salmonella paratyphi B (2;1.4%). Children with age 5-10 years was the most affected age group for infection with Salmonella, 50.0% (n=68). Nalidixic acid is resistant in 89.9% Salmonella typhi; followed by ciprofloxacin (31.8%), ofloxacin (18.2%), ampicillin (9.6%), azithromycin (8.4%), chloramphenicol (8.2%), cotrimoxazole (5.4%), cefixime (4%), ceftriaxone (2.5%) and cefotaxime (0.0%). Cefixime, ceftriaxone, cefotaxime are 100% sensitive to Salmonella paratyphi, followed by cotrimoxazole (92.9%), ofloxacin (81.8%), chloramphenicol (75%), azithromycin (66.7%), ampicillin (60%), ciprofloxacin (50%) and Nalidixic acid (23.1%). Conclusions: Salmonella species culture isolatation are declining every year. Fluoroquinolones have more resistance than first line drugs of typhoid, azithromycin resistance is rising but 3rd generation cephalosporins are sensitive to Salmonella species. Keywords: Drug sensitivity; enteric fever; salmonella paratyphi; salmonella typhi; typhoid vaccinePublication Immunogenicity and Safety Profile of Typhoid Conjugate Vaccine (Vi-DT) Among Nepali Children(Nepal Health Research Council, 2025) Adhikari, Santosh; Rai, Ganesh Kumar; Chapagain, Ram Hari; Giri, Bishnu Rath; Joshi, Prakash; Shrestha, Nisha Jyoti; Manandhar, Bina Prajapati; Tamang, Suresh Man; Maharjan, Jessica; Thapaliya, Bibesh; Gupta, Birendra Prasad; Kim, Deok Ryun; Vemula, Sridhar; Sahastrabuddhe, Sushant; Saluja, TarunBackground: Typhoid fever remains a major concern in tropical countries. The availability of an effective vaccine could be an important inclusion to currently available interventions. We reported on our evaluation of the immunogenicity and safety of the typhoid conjugate vaccine (Vi-DT) among Nepali children. Methods: The study was an observer blinded, active controlled, randomized phase III clinical trial in children above 6 months and less than 18 years old. Three different lots of Vi-DT(Vi- Diptheria Toxoid); test vaccine and Vi-TT ( Vi-Tetanus Toxoid); comparator vaccines were administered to eligible children. Seroconversion was assessed with blood samples collected at baseline and 4 weeks after the vaccination. A rise of at least 4-fold vi-antibody titer from the baseline was used to indicate positive seroconversion. Data on solicited and unsolicited adverse events were collected. Results: Four hundred and eighty-eight children participated in the study. Seroconversion rate was 98.61% and 98.36% among participants who received Vi-DT and Vi-TT vaccines respectively. One immediate adverse event was observed only for Vi-DT group. One hundred forty-two and 66 solicited AEs within 7 days were observed with test and comparator vaccine respectively. Unsolicited AEs within 28 days were 125 for test vaccine compared and 77 for the comparator vaccine. Two SAEs were reported which were Not- related to study vaccine. Conclusions: The overall seroconversion in Vi DT vaccine was non inferior to the comparator vaccine and the safety profile of the vaccine was good without any life-threatening events. Keywords: Immunogenicity; Nepal; safety profile; typhoid conjugate vaccine; Vi-DTPublication Risk Factors and Clinico-laboratory Characteristics of Scrub Typhus in Children Admitted to a Tertiary Pediatric Hospital of Nepal(Nepal Health Research Council, 2024) Chapagain, Ram Hari; Adhikari, Santosh; Bista, Bihungum; Bhattarai, Tribhuwan; Thapa, PrabhatBackgrounds: Scrub Typhus is a re-emerging illness with considerable morbidity and mortality and affected children have nonspecific sign symptoms. This study was conducted to find out the risk factors, clinical characteristics and laboratory profile and treatment outcome of scrub typhus among the children admitted in tertiary level pediatric hospital for febrile illness. Methods: A case control study was conducted among hospitalized children with acute febrile illness in a government pediatric referral hospital of central Nepal for two years (2021 to Sept 2023), who were tested using Scrub Typhus Antibody Rapid Test Kit. Results: We recruited 137 participants, comprising 68 cases of scrub typhus and 69 controls who had fever as a presenting complain, tested negative for scrub typhus and are matched with case in terms of age, gender, place of residence, and most importantly devoid of chronic health issues like leukemia, solid tumor, tuberculosis or kala-azar. Almost all cases i.e. 98.5% (n=67) had fever which is followed by abdominal pain 19.1% (n=13), headache 11.8%(n=8), vomiting 10.3%(n=7) and abdominal distension 8.8%(n=6). Hepatomegaly was commonest finding among scrub typhus positive cases comprising 50% (n=34) followed by lymphadenopathy 29.4% (n=20), splenomegaly 27.9% (n=19), eschar 17.6% (n=12) and rashes 10.3% (n=7). Cases having thrombocytopenia and leukocytosis were 51.5% (n=35) and 32.3% (n=22) respectively. Among scrub typhus cases, 17.6% (n=12) needed pediatric intensive care, 20.6% (n=14) had some sort of complications (i.e., meningitis, acute kidney injury, septic shock, acute respiratory distress syndrome), 46.3% (n=31) became afebrile within 24 hours of therapy, 29.8% (n=20) needed 48 hours to become afebrile. There were about 80% cases with the habit of taking naps on the ground. Those who reside other than cemented houses were with an increased risk factor of about 72%. Those who were not having good beds were at an increased risk factor of almost 100%. There were 62% of cases with bushes near their home and about 100% cases where they store animal fodder in their home. There were 63% who have any sort of animal in their bedroom. Conclusions: Engaging in agricultural work like working on fields, planting and livestock, working with bare hands/ feet, and having naps on the ground and living in houses made of mud dung and wood are the risk factors for the scrub factor. Fever, lymphadenopathy, hepatomegaly, splenomegaly are the common signs and symptoms and thrombocytopenia and increased levels of creatinine are the significant laboratory finding of scrub typhus in children. Keywords: Children; clinico-laboratory; Nepal; risk factor; scrub typhus.