Dengue patients should defer blood donation for up to 6-12 months post-infection

Should screening for dengue be mandatory before blood transfusion?

I recently came across a story in The Muscat Daily (Jan. 23, 2019) which said “the Ministry of Health (MoH) and the Department of Blood Banks Services in Oman have announced on their Twitter accounts that “those affected by dengue virus will not be allowed to donate blood for six months”. Dengue cases are being reported in the country. The latest figures by the Ministry of Health revealed that until January 22, there were 52 recorded cases of dengue fever. In a statement, MoH said, “As a precautionary measure to prevent the spread of the infection, residents and citizens of the dengue-affected areas will also not be allowed to donate blood for 28 days.”  According to the Ministry, this is being put in place to help “prevent others from contracting the disease”.

Travel is a risk factor for spread of any infectious disease. With increasing travel, there is a chance of the disease appearing in another part of the country or the globe, where it did not occur previously. Consequently, the prevalence of dengue has increased several-folds across the world.

The dengue virus was recognized as a transfusion-transmitted pathogen in 2008 (World J Virol. 2015; 4(2):113-23). Chikungunya virus is also a transfusion-transmissible infection, as per the World Health Organization (WHO).

Since then, there has been concern about the risk of transmission of dengue via blood transfusion. Dengue virus becomes a blood-borne pathogen during the period of viremia, which coincides with the febrile period (World J Virol. 2015; 4(2):113-23).

 “In 2009, the American Association of Blood Banks placed dengue virus in the highest category of emerging infectious agents for their potential impact on transfusion recipient safety for the next years in North America” (World J Virol. 2015; 4(2):113-23).

Although rare, cases of transfusion-transmitted dengue fever have been reported. So far, five cases of transfusion-transmitted dengue, including one case of dengue hemorrhagic fever, have been formerly documented (World J Virol. 2015; 4(2):113-23).

Blood donors have been recognized as likely vehicles for transmission of the infection in endemic areas.

Dengue has become endemic in India, particularly in Delhi, where it has become a perennial infection.

In a study conducted to determine the prevalence of dengue virus infection in blood donors in a tertiary care centre, high seroprevalence (58%) of dengue infection in healthy asymptomatic blood donors was found; but, no active viremia was detected (J Clin Diagn Res. 2016;10(10): DC08–DC10). 

Seroprevalence is still a risk to blood safety and is a potential source for transfusion-transmitted infections.

NACO National Blood Transfusion Council “Guidelines for Blood donor selection and Blood Donor Referral 2017” recommend that blood donation should be deferred for 6 months following full recovery in case of history of dengue or Chikungunya. A person who has visited a Dengue and/or Chikungunya endemic area is deferred for 4 weeks following return from the endemic area if no febrile illness is noted.

In its 2012 “Guidelines on Assessing Donor Suitability for Blood Donation”, the WHO also recommends that individuals with a history of dengue or chikungunya virus in endemic areas should defer for 6 months following full recovery from infection. It further says that individuals who have visited an area endemic for dengue or chikungunya should defer for 28 days following return. And, those who have suffered a febrile illness during or following return from an endemic region should defer for 6 months following full recovery from infection

Dr NK Bhatia, Medical Director, Mission Jan Jagriti Blood Bank is a renowned name in blood banking with more than three decades of experience the field. According to Dr NK Bhatia, “Dengue patients are not allowed to donate blood for one year after treatment. If there is a history of blood/blood products transfusion, the same deferral period applies. This is also true for Chikungunya patients. Any person who has a ‘normal’ viral fever is not allowed to donate blood for 7 days after the active phase is over. Some extend this duration to one year.”

Hence, a medical history becomes very important when assessing eligibility of a prospective blood donor.

Always ask a history of dengue/Chikungunya, history of blood/blood product transfusion and history of any viral fever.

Dengue patients should defer blood donation for up to 6-12 months post-infection.

But, a question then arises “Should screening for dengue be mandatory before blood transfusion as is for hepatitis B virus, hepatitis C virus, HIV, syphilis, malaria” as many dengue patients go undetected in acute febrile illness?

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Exercise training programs in type 2 diabetes should be adapted to the patient’s preferences and commodities

Patients with type 2 diabetes should be prescribed physical activity to control their blood sugar and also to improve heart health, recommends a position paper from the European Association of Preventive Cardiology.

The position paper emphasizes that simply advising patients to exercise is not enough. Patients must be asked for their personal preferences as far as the type of exercise is concerned and an individualized exercise training program, taking into consideration the risk status, must be designed for them to reach the desired goals. The target goals must be achievable and measurable.

Here are some key recommendations from the position paper published in the European Journal of Preventive Cardiology.

·         Increasing cardiorespiratory fitness (CRF) and glycemic control are key clinical targets of exercise training programs in patients with type 2 diabetes with cardiac comorbidities. Patients should be evaluated for CRF to classify them according to their risk and optimal exercise prescription.

·         Other clinical targets include BP control, improvement in vascular function and dyslipidemia and reduction in inflammation.

·         Although a higher BMI is associated with worse prognosis, weight loss is not necessarily a relevant target of exercise training for these patients. Exercise alone is not enough for weight loss; a multidisciplinary intervention which includes nutrition is required to achieve this.

·         More than the weight loss, a better motivational parameter is increasing exercise and physical fitness.

·         Adherence to exercise program is very important to achieve its desired effects. To improve adherence, the type, intensity and duration of activity needs to be carefully adapted to the patient’s preferences and comorbidities and adjusted to training progress over time.

·         High-volume moderate intensity training is recommended for improving body composition and cardiovascular risk factors, preferably by combining training with dietary interventions and counseling/education. But, it may not be safe for patients who develop arrhythmias during exercise or have ischemia.

·         Patients with long-standing type 2 diabetes should be carefully monitored for cardiac autonomic neuropathy and hypoglycemia in particular.

·         At-risk patients or severely detrained patients should start exercising at low intensity, with each increment to be supervised closely, aiming at integration of regular physical activity into daily routine.

(Source: ESC news release, Jan. 15, 2019; Eur J Prev Cardiol. 2019 Jan 14:2047487318820420)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Indian Hands-only CPR Records

 1. 2017 Edition: “First hands-only CPR training of all PCR staff

Dr KK Aggarwal, President Heart Care Foundation of India trained (one to one) all the operational PCR staff of Delhi police in hands only single rescuer CPR (CPR 10, First responder Bystander CPR). From July 7-August 10, 2015, 7204 policemen were trained. Indian Medical Association and Delhi Red Cross Society were also involved. Incidentally, this was the first police force to have 100% of their operational PCR staff trained in hands-only CPR.”

2. 2014 edition of the Limca Book of Records: “Most people trained on CPR

Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President, Heart Care Foundation of India, Sr Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Hospital, Delhi trained 10,392 people on hands-only Cardio Pulmonary Resuscitation (CPR) using the multiple rescuer mode as well as the single rescuer mode at nine different venues in Delhi as part of the 19th MTNL Perfect Health Mela held from Nov 1-16, 2012. The breakdown of the sessions was as follows:

1,050 children and teachers trained in one session in multiple rescuer hands only CPR using 200 human mannequins at Birla Vidya Niketan School on Nov 1, 2012:

201 nurses trained in one session in single rescuer hands-only CPR using 201 mannequins at Constitution Club of India, Rafi Marg on Nov 9, 2012;

96 physically and mentally challenged students trained in one session in single rescuer hand-only CPR at Constitution Club of India using 96 human mannequins on Nov 9, 2012;

1,430 school boys trained at MCCP School, Baprola, Tughlakabad on Dec 3, 2012;

2,402 school girls trained at SKVC1, Yamuna Nagar in single rescuer CPR on Dec 13, 2012;

2,217 members of the general public trained in single rescuer hands-only CPR at Constitution Club of India on Nov 8, 2012.

Dr Aggarwal continued his training sessions after the health mela and trained 10,200 more people, taking the total number of people trained in hands-only CPR in 43 days from Nov 1-Dec 13, 2012 to 20,592.” 

3. 2014 edition of the Limca Book of Records: “Most people trained on CPR in least time

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President, HCFI, Sr Consultant medicine & Cardiology, Dean Board of medical education, Moolchand Hospital, Delhi trained 11,543 students (8913 female and 2630 male) in 8 hr (8.00 am – 4.00 pm) on hands-only CPR 10 using mannequins at Dr Sampurnanand Sarvodaya Kanya Vidyalaya, Delhi on April 6, 2013.

Formula of 10 (CPR-10): To revive after sudden cardiac arrest, within 10 minutes of cardiac arrest (earlier the better), for the next ‘at least’ 10 minutes, compress the center of the chest, continuously and effectively, with a speed of 10x10 (100) per minute.”

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Intermittent fasting plus lower-calorie diet helps better to reduce body weight

Overweight women who ate a lower-calorie diet (70% of their required energy) and fasted 3 days a week lost more weight and had better cardiometabolic markers than women who only reduced their calorie intake, or only fasted, or did neither in a small, 8-week randomized trial by Amy T. Hutchison, post-doctoral researcher, Adelaide Medical School, University of Adelaide, Australia.

These new findings from the Effects of Periodic Fasting Versus Daily Energy Restriction on Metabolic Health (PREFER) trial were published in the January issue of Obesity.

This study is adding to evidence that intermittent fasting, at least in the short term, may provide better outcomes than daily continuous diet restriction for health and potentially for weight loss.

·         A continuous reduced calorie diet is the cornerstone lifestyle intervention to reduce the risk of developing type 2 diabetes and cardiovascular disease in overweight people

·         Intermittent fasting might be a better strategy, because people find it difficult to stick to a low-calorie eating plan. 

·         A combination may be still better

This is also the principle mentioned in Ayurveda.

Weekly fast with added one additional fast on Ekadashi and four nine-day fasts on Navratri in a year along with eating less (what comes in your outstretched hands) with a mix of all seven colors and six tastes.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

On this Republic Day, what constitutional amendments do we need in health sector?

Tomorrow, the whole country will celebrate the 70^th Republic Day, which marks the day when the Constitution of India first came into effect on 26^th January in 1950. The Constitution was first adopted by the Indian Constituent Assembly on Nov. 26, 1949, which is observed as the “Constitution Day”.

Amendments are needed to keep pace with the changing times and conditions. This is how the constitution evolves and also how we evolve as individuals and as a society.

The medical profession is going through difficult times. Somewhere along the years, the image of this noble profession has been damaged; trust, which forms the foundation of the doctor-patient relationship, has corroded and must be restored urgently.

The medical fraternity has been awaiting action from the Government for their various demands for the last few years.

On the eve of this national celebration, here are few constitutional amendments that we need with regard to healthcare.

This is an open letter to the Prime Minister and the Health Minister seeking their intervention to expedite matters in this regard.

1.      No penal provisions for clerical errors in the PCPNDT Act: There is a need for amendment in the PCPNDT Act by which only acts relating to sex selective abortions are penalized and acts such as “clerical errors in Form F, not wearing of apron, non-display of notice board, not keeping a handbook on the PCPNDT Act” should not be equated with criminal offense. Currently, the Act provides for equal punishment for sex determination and aforementioned clerical errors.

2.      Health insurance should be a “must” and not an “option”: Everyone should have health insurance. Govt./PSU employees are automatically insured; corporates also have their insurance policies. Yet there are many who still do not have a health insurance. Ayushman Bharat, launched last year, envisages taking care of more than 50 crore, is a welcome initiative. The govt. should provide 100% insurance in general ward category; those who want private care, higher than this, should opt for private insurance. Once 100% people are insured, health care will become affordable over time to everyone. Treatment costs will automatically reduce. Ayushman Bharat should be implemented across the country and be made mandatory for every hospital.

3.      One India-One Health Policy: Similar to the Goods & Services Tax (GST) which stands for “One Country, One Tax”, there should be “One India-One Health Policy”. All public health initiatives or national health programs need to be routed through the states.

4.      One drug - One company - One price: Uniformity in pricing of medicines in India still remains a distant dream. The answer to high cost of drugs is a “one drug-one price-one company” policy and the govt. should ensure that the manufacturers market drugs under this policy. This has been a major demand of the medical fraternity for quite a long time now.

5.      Central law for prevention of violence on doctors and health establishments: Violence against doctors is escalating across the country. Enactment of a stringent central act against violence making violence against doctors a non-bailable offense punishable with up to 14 years imprisonment on the lines of abatement of a murder is an urgent need of the hour. This was also a recommendation of the inter-ministerial committee in 2015, which is yet to be implemented. About 18 states have acts against violence, but unless there is amendment to the CrPC and police manual through a central act, the state acts could still be weak and ineffective.

In his speech on the occasion of the centenary celebrations of Sabarmati Ashram in Gujarat in June last year, the Prime Minister Shri Narendra Modi had addressed the issue of violence against doctors. “If a patient dies due to an unsuccessful operation, relatives burn down hospitals and beat up doctors. An accident is an accident. When people die or are injured in accidents, a group of people come together and burn vehicles,” he said (Indian Express, June 30, 2017). He had also taken a clear stand against violence, when he had said, “No person in this nation has the right to take the law in his or her own hands in this country.” We still await these words to come to fruition.

6.      Amendment of Section 152 IPC to also include doctors: Section 152 of The Indian Penal Code protects public servants from assaults. It states: “Whoever assaults or threatens to assault, or ob­structs or attempts to obstruct, any public servant in the dis­charge of his duty as such public servant, in endeavouring to disperse an unlawful assembly, or to suppress a riot or affray, or uses, or threatens, or attempts to use criminal force to such public servant, shall be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both.” A similar immunity should be provided to doctors, so that they can work with a free mind without the fear of criminal prosecution.

7.      Capping of compensation: There is a need for amendment in the Consumer Protection Act to cap the maximum allowable compensation awarded in any case of medical negligence. Sometimes, compensation is awarded on emotional grounds and sometimes multiplier method is used to award compensation.  There is capping of compensation in sterilisation failures and related deaths, deaths due to natural calamities, plane crash/ train accidents, death occurring in the course of clinical trials etc. so why not in medical negligence cases.

8.      Amendment in Clinical Establishment Act: The CEA Act should be amended to exclude single doctor clinic, family doctors and general practitioners from the purview of the CEA and to facilitate single window registration of medical establishments.

9.      National list of essential devices, equipments, disposables and reagents: Similar to the National List of Essential Medicines (NLEM), a National list of essential devices, equipments, disposables and reagents should be created. It is only through such a list that the govt. can cap the cost of essential drugs.

10.    Uniform age of definition of child under POCSO, for marriage, juvenile act, etc: The POCSO defines child as “any person below the age of 18 years”. The legal age of marriage in India is 18 years for girls and 21 years for boys.  The voting age is 18 years. The legal drinking age for alcohol varies from state to state and ranges between 18 and 25 years. There should be a uniform age of definition of child.

11.    Nationalization of disease treatment protocols of diseases of national importance: To eliminate or eradicate diseases, all health programs in the country and diseases of national importance such as TB should be “nationalized” with uniform diagnostic and treatment protocols across the country, whether in the govt. sector or private sector. The only difference may be that in the private sector, the doctors can charge their consultation fee.

12.    Pay parity in govt. and private sectors: A uniform pay scale across the country, in both the govt. and private sectors should be implemented.

13.    All doctors should be covered under CGHS: Not just govt. doctors, doctors in the private sector too should be made beneficiaries of the Central Government Health Scheme (CGHS) and be allowed to seek treatment in empanelled hospitals.

14.    Health in concurrent list: Public health is a state subject. This has been the reason for discordance between the state and the center, when any centralized healthcare scheme is rolled out. The government must pass an ordinance to bring health under the concurrent list.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Eating tilkut detoxifies the mind

Ganesh Sankasht Chaturthi is observed every month on the fourth date of Krishna Paksha. It is also called tilkut chaturthi and is observed on 4th day after Paush Purnima in the month of Magh (January/February).

A fast is observed for the entire day and in the evening, a katha is read. The fast ends when the moon is sighted. One should eat ‘Tilkut’ on this day. During the ritual, Tilkut is put in a bowl and kept near durwa grass. Water is offered to the Sun; both til and durwa grass are offered to the Moon while worshiping Ganesha.

Tilkut is a sweet savory made of sesame seeds (Sesamum indicum) and jaggery or gur, shakkar- unrefined sugar or sugar. The sugar tilkut is white in color, the shakkar tilkut is light brown in colour and the gur/jaggery tilkut is dark brown in colour.

Sesame seeds are said to have a greater ability to absorb pure (sattva) frequencies than any other seed, with the black variety in addition being an extremely good source of calcium, protein, phosphorous, iron and magnesium.

Jaggery is considered wholesome sugar, retaining more mineral salts than refined sugar and is a good source of both calcium and iron. Together, they both generate body heat and prevent the ill-effects of the cold weather, which translates into increased immunity for the coming months.

In Maharashtra, they say: “Tilgul ghya, gud gud bola”, which literally means “Eat tilgul or tilkut and talk sweet”. The deeper meaning behind it is that eating tilkut detoxifies the mind so that one talks sweetly.

Our mythology says that Lord Shiva blessed Ganesh on this day by saying that Moon will get down from his head to Ganesh’s head and help remove the obstacles (detoxification of the mind). On this day, the fast ends only after worshipping Ganesha and Moon at night.

Tilkut and durva grass are therefore natural detoxifiers and hence worshiped so that they can be eaten to remove the obstacles from the life. Apart both are good source of calcium and needs to be taken during the whole of Magh month with sun exposure (vitamin D).

Other natural detoxifiers are:

·         Wheat grass used in navrataras for detoxification of the mind body and soul

·   Durva grass and tilkut for removing obstacles (Ganesh Pooja) and removing attachments (black sesame used in shradhs)

·         Kusha grass for removing attachments (used in shradhs)

·         Pranayama (for attachments as mentioned in Hanuman Chalisa)

·         Chanting with concentration in the heart.

·         Tulsi water (used in Satya Narayana ki Katha)

·         Neem water (used in Safi)

·         Meditation

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

201 cases of polio-like acute flaccid myelitis in 2018

201 people, mostly young kids, developed a polio-like condition known as acute flaccid myelitis (AFM) in 2018, as per US Centers for Disease Control (CDC) who still does not have a prime suspect. This number may well increase, as it can take long to confirm a suspected case.

AFM resembles polio, is likely caused by a virus.

Coxsackievirus A16, EV-A71, and EV-D68 viruses have been isolated in the spinal fluid of four of 527 confirmed cases of AFM since 2014. No pathogen has been detected in the spinal fluid in other cases.

Also, it is not easy to isolate a virus in patients who are not acutely infected. AFM often appears as an infection wanes, and it can take days for doctors to suspect the condition and start testing.

More than 80% of patients have had fevers and respiratory illnesses of some sort. EV-A71 and EV-D68 both cause respiratory infections. Coxsackievirus A16 causes hand, foot and mouth disease. Several patients have also had rhinovirus, which causes the common cold.

It is also unclear whether a virus is directly attacking nerves, as poliovirus does, or is causing an autoimmune reaction, as seen in Guillain-Barré syndrome.

No deaths have been reported but some of the patients are severely disabled.

The last case of polio from India was reported in the year 2011; the non-polio acute flaccid paralysis (NPAFP) rate in India was 13.35/100,000 in this year, which was much higher than the expected rate of 1-2/100,000. Some states had a higher rate of NPAFP than others. In 2011, the NPAFP rate in UP was 25/100,000; in Bihar, the rate was 35/100,000 (Int J Environ Res Public Health. 2018;15(8):pii:E1755).

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA