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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 25  |  Issue : 1  |  Page : 39-44

Trend and seasonality of infectious diseases – An overview from a tertiary care hospital of West Bengal, India


1 Department of Medicine, ID and BG Hospital, Kolkata, West Bengal, India
2 Department of Community Medicine, ID and BG Hospital, Kolkata, West Bengal, India
3 Department of Community Medicine, Shri Ramkrishna Institute of Medical Sciences and Sanaka Hospital, Durgapur, West Bengal, India

Date of Submission28-Aug-2019
Date of Acceptance04-Feb-2020
Date of Web Publication14-Apr-2020

Correspondence Address:
Dr. Baisakhi Maji
“Sathi,” Radhanagar Road, Chitra, Paschim Burdwan, Asansol - 713 325, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_56_19

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  Abstract 


Background: Most of the developing countries still suffer from a high burden of communicable diseases. The paucity of proper data about the current trends and seasonal variations of different infectious diseases (IDs) further prevents the policy makers from devising an effective, preventive, and curative response. Hospital ID wards are a useful source of surveillance data that can indicate changing health-care requirements. Materials and Methods: A retrospective analysis of inpatient hospital database of past 5 years (January 2014–December 2018) was done to identify the pattern and trend of different IDs including seasonal variations. Results: Among 127,762 admissions during 2014–2018, diarrheal diseases (87%) were most common, followed by dengue (6.6%), chicken pox (2.4%), measles (1.6%), and diphtheria (1.2%). Measles and chicken pox cases had shown peak during February–May months, whereas dengue in September–October, and swine flu cases were at peak during the winter season. Over the past 5 years, the admission rate of measles cases showed a cyclical rising trend, chicken pox showed an inclining trend, whereas tetanus showed a declining trend. The admission trend of diphtheria cases was more or less similar throughout consecutive years except a fall in 2018. The admission rate of dengue cases showed a steep rise in 2016, followed by gradual decline in respective years. However, swine flu admission rate showed a zigzag pattern over the past 5 years. Conclusion: The review of hospital records provided information regarding the overall burden and pattern of admissions in the IDs hospital.

Keywords: Hospital records, infectious disease, Kolkata, seasonality, trend


How to cite this article:
Roy R, Maji B, Haldar A, Chatterjee T. Trend and seasonality of infectious diseases – An overview from a tertiary care hospital of West Bengal, India. J Mahatma Gandhi Inst Med Sci 2020;25:39-44

How to cite this URL:
Roy R, Maji B, Haldar A, Chatterjee T. Trend and seasonality of infectious diseases – An overview from a tertiary care hospital of West Bengal, India. J Mahatma Gandhi Inst Med Sci [serial online] 2020 [cited 2020 May 25];25:39-44. Available from: http://www.jmgims.co.in/text.asp?2020/25/1/39/282358




  Introduction Top


The 20th century has witnessed a substantial reduction in spread and burden of various infectious diseases (IDs) worldwide owing to socioeconomic development. In spite, the “Global Burden of Disease Project” suggests that about 30% of disease burden in India is attributable to infections.[1]

In India, data collected by community-based surveillance are highly inadequate. Tremendous disease burden, huge land, and population size coupled with state-wise variability in health-care infrastructure and policy further reduce the data reliability.[1]

In this context, data from ID hospitals constitute the basic and primary source of information for surveillance to comprehend changing ID trend and relevant health-care requirements.


  Materials and Methods Top


The present study was carried out in a tertiary level ID hospital to assess the current burden of IDs, its trend, and seasonality with the idea of suggesting measures for the prevention and management of such diseases in future. A retrospective analysis of inpatient hospital database over 5-year period (January 2014–December 2018) was done during January–March 2019 after obtaining necessary permission from the institutional ethics committee. All the hospital registers and bedhead tickets of all the patients admitted with IDs during 2014–2018 were reviewed from the ID wards and hospital record section. Data were collected in a predesigned schedule. Information retrieved from the records included patient demographics, diagnosis, and timing of admission. The first-listed diagnosis in the records was used for coding each of the diagnosis.

In this hospital, chicken pox, measles, and tetanus cases were diagnosed on the basis of clinical features. Dengue was confirmed by either detection of NS1 antigen by enzyme-linked immunosorbent assay (ELISA) method or immunoglobulin M by MacELISA method. Cholera was confirmed by stool culture. Swine flu with H1N1 strain was confirmed by taking nasopharyngeal swab and nucleic acid amplification test. Diphtheria was mainly diagnosed clinically, and later, throat swab for Klebs–Loffler bacillus was done to support the diagnosis. Collected data were entered in Microsoft Excel and analyzed using the software IBM SPSS 16, Statistical Package for the Social Sciences (SPSS), developed by IBM corporation, is an American multinational information technology company headquartered in Armonk, New York,. Data were presented in the form of proportions and line diagram.

Exclusion criteria

  1. The morbidity that coexisted with the primary diagnosis during stay in the hospital was not included
  2. Complications arising out of the primary IDs were not taken into consideration
  3. Following categories of patients were not included – patients aged <6 months, immunocompromised patients, and patients with nondiphtheritic exudative pharyngitis
  4. Data related to dengue patients were not available before 2016, and there were fewer numbers of cases of swine flu in this part of the country before 2016. Hence, records for dengue and swine flu were not analyzed before 2016.



  Results Top


The present study found that a total of 127,762 patients were admitted in ID wards during 2014–2018. The mean number of annual admissions was 25,552.4 ± 2114.6.

The most common disease seen during the past 5 years was acute diarrheal disease with 1,11,097 cases (87%), followed by dengue with 8455 cases (6.6%), chicken pox in 3008 cases (2.4%), measles in 2037 (1.6%) cases, and diphtheria in 1538 cases (1.2%). Rabies was least commonly seen only in 199 (0.2%) cases and followed by swine flu in 378 cases (0.3%) [Table 1].
Table 1: Distribution of the admitted patients according to diagnosis and year of admission (n=127,762)

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Overall, there were 34% of males and 66% of females among admitted patients at ID wards. There was a slight female preponderance in admitted cases of measles and diphtheria. However, male patients outnumbered females in admission with chicken pox and rabies. While there was similar number of cases for both genders admitted with dengue, swine flu, and tetanus [Table 2].
Table 2: Distribution of patients according to diagnosis and gender (n=127,762)

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Year wise admission rate of different diseases revealed that there was no change in admission rate for rabies patients over the past 5 years [Table 1]. In the year 2014, the number of measles cases admitted in this hospital was 274, then a slight increase in 2015, followed by declining trend in 2016, and after that from 2017, again it showed inclining trend. There was a peak rise in measles admission in 2015 and also another peak in 2018, so it showed more or less a cyclical trend. Record showed an increase in the admission rate of chicken pox over the past 5 years with slight variations except 2017 which showed much higher admission rate. Inclining trend showed by the admission of chicken pox cases in 2015 (nearly doubled the number compared to 2014), followed by the stationary phase and again higher admission in 2017. The admission rate of diphtheria patients was similar from 2014 to 2017, followed by a decline in 2018. The trend of admission of tetanus cases showed a declining trend with slight variation over the 5-year time period [Figure 1].
Figure 1: Line diagram showing trend of admission of chicken pox, measles, diphtheria, and tetanus cases during the past 5 years

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The admission trend of dengue cases indicated that there were few cases during 2014 and 2015, followed by a sharp rise in 2016, after that almost declining trend was noticed throughout the consecutive years. It was observed that the trend of swine flu was rising and declining in alternate years in a zigzag manner [Figure 2].
Figure 2: Line diagram showing trend of admission of dengue and swine flu cases during past 5 years

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Seasonality of different diseases also indicated variation. Measles cases showed a peak during February–May, and plateau maintained during July–January [Figure 3]. Chicken pox cases also showed peak during March–April [Figure 4]. Diphtheria cases occurred throughout the year in both gender [Figure 5].
Figure 3: Line diagram showing seasonal distribution of measles cases during the past 5 years (2014–2018) (n1 = 2037)

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Figure 4: Line diagram showing seasonal distribution of chicken pox cases during the past 5 years (2014–2018) (n2 = 3008)

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Figure 5: Line diagram showing seasonal distribution of diphtheria cases during the past 5 years (2014–2018) (n3 = 1538)

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Dengue cases since 2016 showed seasonal peak during September–October in both genders during the past 3 years [Figure 6].
Figure 6: Line diagram showing seasonal distribution of dengue cases over the past 3 years (2016–2018)

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Swine flu cases showed three seasonal peaks during February–March (winter), May (summer), and August–September (post monsoon) months [Figure 7].
Figure 7: Line diagram showing seasonal distribution of swine flu cases over the past 3 years (2016–2018)

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  Discussion Top


Our study revealed that a total of 127,762 patients were admitted, with mean annual admissions of 25,552.4 ± 2114.6 cases. Earlier study done by Orlando et al.[2] in Italy found that there were 26,253 admissions at the ID department during January 1995–December 2011 with mean annual admission of 1544 ± 200.4.

The findings of the present study regarding gender distribution of admitted patients (34% male, 66% female) did not corroborate with earlier studies done by Basak et al.[1] (59% male, 41% female) and Orlando et al.[2] (67.5% male, 32.5% female).

The present study indicated that the most common disease seen in all 5 years was acute diarrheal disease with 111,097 cases (87%), followed by dengue with 8455 cases (6.6%), chicken pox in 3008 cases (2.4%), measles in 2037 (1.6%) cases, diphtheria in 1538 cases (1.2%), swine flu in 378 cases (0.3%), and rabies in 199 (0.2%) cases. Basak et al.[1] also found that diarrheal diseases were the major cause of admission (84.28%), followed by chicken pox (4.5%), tetanus (4.1%), rabies (3.6%), measles (2%), and diphtheria (1%). Findings of the study conducted by Kalyani and Shankar[3] in Hyderabad did not corroborate with the findings of the present study in regard to acute diarrheal diseases which contributed only 26.5%, but similarity was found with rabies as it was least commonly seen (0.26%).

Measles admission showed more or less a cyclical trend. Oyefolu et al.[4] also observed periodic upsurge of cases every 2 years in Nigeria. However, Basak et al.[1] found that the trend of admission of measles had decreased over the years (2008–2012).

Inclining trend showed by the admission rate of chicken pox cases over the past 5 years with slight variations; this corroborated with the findings of Basak et al.,[1] but contradictory to the findings of Saleh and Al Moghazy[5] which revealed a decreasing trend from 2007 to 2012.

The admission rate of diphtheria patients was more or less similar from 2014 to 2017, followed by a decline in 2018; most of the cases occurred in unvaccinated or partially vaccinated children and adults. This observation was different from Basak et al.[1] which showed proportion of diphtheria cases had increased over time, whereas Patel et al.[6] in Gujarat found that diphtheria cases declined from 1985 to 1997, and thereafter, cases increased till 2002.

The trend of admission of tetanus cases showed a declining trend with slight variation over the 5-year time period; similar decreasing trend was also found by Basak et al.[1]

The admission trend of dengue cases indicated that there was a sharp rise in 2016, probably because exposure of nonimmune population to dengue serotype-I in 2016, associated with poor vector control measures, particularly at construction sites. Pol et al.[7] found a sharp increase in the trend of dengue cases in Maharashtra from 2009 to 2015.

The trend of swine flu disease was rising and declining in alternate years in a zigzag manner.

The present study did not found any change in the trend of admission of rabies cases, whereas Basak et al.[1] noticed a declining trend over the years.

It was revealed from the present study that measles cases showed peak during February–May. Similar findings were observed by Kalyani and Shankar,[3] with peak measles incidence during January–February, but were contradictory to the findings of Oyefolu et al.[4] who reported peak incidence of measles between August and April, followed by a rapid decline during May–July in Nigeria.

The present study revealed that the peak incidence of chicken pox was during March–April; this finding corroborates with study findings of Kalyani and Shankar[3] (in March) and Saleh and Al Moghazy[5] (peak in March and April in Saudi Arabia during 2007–2012).

The occurrence of diphtheria cases was noticed throughout the year in both genders, whereas Kalyani and Shankar[3] narrated that diphtheria is more evident in January and Patel et al.[6] observed peak incidence of diphtheria in the month of August–October.

The present study showed that peak incidence of dengue cases during September–October months in both genders. Similar finding was also described by Kalyani and Shankar[3] (peak at September) and Pol et al.[7] (peak during September–October from 2009 to 2015 in Maharashtra).

In 2016–2018, seasonality of swine flu cases showed three peaks during February–March (winter), May (summer), and August–September (post monsoon) months. In earlier study conducted by Gelotar et al.[8] in Gujarat during 2009–2013 described two peaks for swine flu cases during September–October and January–February. Bhatnagar and Singhal[9] also noticed peak incidence during winter (February) in Southern Rajasthan during 2015. Another study done by Kulkarni et al.[10] revealed two peaks in India during 2017: February–April (winter) and August–October (summer) months. It was observed from the present study that swine flu cases occurred mostly during winter months in eastern part of India, whereas Kulkarni et al.[10] noticed peak incidence of swine flu cases during winter months in southern and western India but during summer in Northern India.

It has been observed from the present study that there was a slight female preponderance in cases of measles during all seasons, whereas Oyefolu et al.[4] found male predominance in measles admission.

The present study revealed that cases of chicken pox and rabies occurred more in males, whereas measles and diphtheria occurred more in females. Sex distribution was found to be almost equal for dengue, swine flu, and tetanus. Saleh and Al Moghazy[5] and Pol et al.[7] observed male predominance in cases of chicken pox and dengue, respectively. Kalyani and Shankar[3] revealed almost equal sex distribution in all the IDs except diphtheria which showed slight female predominance.

By identifying time trends, the investigators tried to assess the diseases (increasing/decreasing) and which are the emerging health problems, the effectiveness of the measures to control existing diseases.


  Conclusion Top


Although noncommunicable diseases constitute a major threat in recent years, the present study indicated that IDs are still dominant and constitute a major health problem in India. The analysis of various IDs to identify their trend and seasonality attempted by this present study highlighted the need for emphasis on preventive measures such as vaccination program, strengthening of existing surveillance system, and preparedness for outbreak management. The interpretation of disease outbreak data for seasonality may help to take measures during preseasonal period.

Observations of the present study about pattern, trend, and seasonality of IDs may provide valuable information to detect the structural and organizational changes needed for more efficient management of IDs including new emerging health problems.

Recommendation

  • Strengthening of the routine surveillance system should be done in all the hospitals treating IDs
  • Awareness generation program must be done through “Information Education Communication” and “Behavior Change Communication” activities either through interpersonal communication or mass media approach for community people to disseminate the knowledge about causation and modes of transmission of various IDs, prophylactic and preventive measures against them
  • Prompt and early reporting of any such illness to health facility must be ensured in order to minimize the morbidity and mortality
  • Establishment of “health education clinic” can be done for providing preventive services to the beneficiaries through trained personnel
  • Early preventive measures must be ensured through community participation and intersectoral collaboration.


Acknowledgment

We are grateful to the hospital authority for giving us permission to collect the valuable hospital inpatient data for this research purpose and to the staffs of hospital record section for their constant help and assistance in retrieving the relevant case records necessary for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Basak M, Chaudhuri SB, Ishore K, Bhattacherjee S, Das DK. Pattern and Trend of Morbidity in the Infectious Disease Ward of North Bengal Medical College and Hospital. J Clin Diagn Res 2015;9:LC01-4. Availabe from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668438/pdf/jcdr-9-LC01.pdf. [Last assessed on 2020 Feb 21].  Back to cited text no. 1
    
2.
Orlando G, Gubertini G, Negri C, Coen M, Ricci E, Galli M, et al. Trends in hospital admissions at a Department for Infectious Diseases in Italy from 1995 to 2011 and implications for health policies. BMC Public Health 2014;14:980. Availabe from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180147/pdf/12889_2013_Article_7088.pdf. [Last assessed on 2020 Feb 21].  Back to cited text no. 2
    
3.
Kalyani D, Shankar K. Assessment and seasonal variations of communicable diseases: 3 years study. Int J Res Med Sci 2016;4:1186-92. Available from: https://pdfs.semanticscholar.org/acb2/70a415a4b47956ec5162594aed27fb257d9b.pdf. [Last accessed on 2019 Apr 08].  Back to cited text no. 3
    
4.
Oyefolu AO, Oyero OG, Anjorin AA, Salu OB, Akinyemi KO, Omilabu SA. Measles Morbidity and mortality trend in Nigeria: A 10-year hospital-based retrospective study in Lagos State, Nigeria. J Microbiol Infect Dis 2016;6:12-8. Available from: https://dergipark.org.tr/download/article-file/325323. [Last accessed on 2019 Apr 08].  Back to cited text no. 4
    
5.
Saleh N, Al Moghazy B. Seasonal variation and trend of chicken pox in the southern region of Saudi Arabia (2007-2012). J Egypt Public Health Assoc 2014;89:143-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25534179. [Last assessed on 2020 Feb 21].  Back to cited text no. 5
    
6.
Patel UV, Patel BH, Bhavsar BS, Dabhi HM, Doshi SK. A retrospective study of diphtheria cases, Rajkot, Gujarat, Indian J Community Med 2004;29:161-3. Available from: http://www.ijcm.org.in/article.asp?. [Last assessed on 2020 Feb 21].  Back to cited text no. 6
    
7.
Pol SS, Rajderkar SS, Gokhe SS. Trends of dengue cases reported at tertiary care hospital of metropolitan city of Maharashtra: A record based study. Natl J Community Med 2017;8:411-5. Available from: http://njcmindia.org/uploads/8-7_411-415.pdf. [Last assessed on 2020 Feb 21].  Back to cited text no. 7
    
8.
Gelotar PS, Duran K, Gandha KM, Sanghavi MM. Epidemiological characteristics including seasonal trend of hospital based swine flu cases in Jamnagar region, Gujarat, India, J Res Med Dental Sci 2015;3:39-42. Available from: https://www.researchgate.net/publication/277632609_Epidemiological_characteristics_including_seasonal_trend_of_hospital_based_swine_flu_cases_in_Jamnagar_region_Gujarat_India. [Last assessed on 2020 Feb 21].  Back to cited text no. 8
    
9.
Bhatnagar R, Singhal YK. Demographic analysis of influenza-like illness categories including seasonal trend of swine flu cases attending a teaching hospital in Southern Rajasthan, India. Int J Med Sci Public Health 2019;8:526-9. Available from: https://www.ejmanager.com/mnstemps/67/67-1553916641.pdf?t=1562258498. [Last assessed on 2020 Feb 21].  Back to cited text no. 9
    
10.
Kulkarni SV, Narain JP, Gupta S, Dhariwal AC, Singh SK, Macintyre CR. Influenza A (H1N1) in India: Changing epidemiology and its implications. Natl Med J India 2019;32:107-8. Available from: http://www.nmji.in/temp/NatlMedJIndia322107-6651896_182838.pdf. [Last assessed on 2020 Feb 21].  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
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  [Table 1], [Table 2]



 

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