FROM THE DIRECTOR'S DESK

 Dr. G. BALAKRISH NAIR
 Director

Diarrhoeal disease is one of the leading causes of illness and death in young children particularly in developing countries. Global death from diarrhoea in children below 5 years of age is estimated to be approximately 1.87 million, annually. African and South-East Asian regions together account for nearly 78% of them. India alone contributes about 20% of all global under-5 diarrhoeal deaths. The major causative agents are rotavirus, Vibrio cholerae, Shigella spp, diarrhoeagenic E. coli and Salmonella spp. That after 37 years of ORT knowledge and 30 years of implementing diarrhoeal diseases control programme, many children die due to diarrhoea is essentially due to the fact that implementation of ORS in India is not satisfactory and a big section of Indian population is subjected to abject poverty. This section of population do not have access to safe drinking water, have poor food, hence, suffers from malnutrition and practice poor hygiene and sanitation at home. The other factors that have coupled to make the situation grim are lack of knowledge among the mothers, health workers and apathy of the practitioners. There is a conscientious need for information programmes for mothers and supplemental training for health care providers emphasizing the importance of ORT, increased fluid intake, continuing feeding including breast feeding, zinc supplementation and discouraging indiscriminate use of drugs in treating childhood diarrhoea. If ORT and other sound diarrhoea management measures are administered early and correctly, mothers could prevent up to 90% of diarrhoeal deaths. Zinc supplementation combined with correct use of ORT can reduce child’s chance of death by 50%. Immunizing a child against measles is one of the most important measures a mother can take in preventing diarrhoea. However, information by itself is not enough. It has to be appropriately communicated, received, understood and implemented in order to bring about the change. Preventing diarrhoeal deaths is thus not an issue to be dealt by the health sector alone. Water, sanitation, education and communication are among the other sectors usually involved. Thus a comprehensive multidisciplinary approach needs to be adopted for preventing diarrhoeal deaths in India.

Of the pathogens that cause acute diarrhoea, Vibrio cholerae deserves special mention. “Asiatic cholera”, as it was sometimes called, has been endemic in south Asia, especially the Ganges delta region. The world has faced seven pandemics. The current (seventh) pandemic now has involved almost the entire globe. This pandemic began in Indonesia, rather than the Ganges delta, and the causative agent was a biotype of V. cholerae serogroup O1 called El Tor. In 1992, a newly described, non-O1 serogroup of V. cholerae, designated O139 Bengal, caused unusual cholera outbreaks in India and Bangladesh. More recently, researchers from this Institute and the International Centre for Diarrhoeal Diseases Research, Bangladesh have also discovered the evolution of new hybrid strains of Vibrio cholerae labeled as altered El Tor which is believed to cause more severe cholera. There has been a sharp increase in the number of cholera cases worldwide. Though due to administration of ORS has brought down the mortality rate considerably, the morbidity rate remains high. The most concerning fact is that there are a number of countries where cholera has re-emerged after having been absent for several years. In countries in Africa there is a significant increase in the number of cholera cases and Central Asia has been affected by several outbreaks. Indian subcontinent reported about 46% of all cases notified from Asia as per 2005 WHO report. Thus there is a clear trend that cholera is re-emerging in parallel with the ever-increasing proportion of vulnerable populations who live in unsanitary conditions. Attempts are being made to develop cost effective oral cholera vaccines to prevent Vibrio cholerae O1 and Vibrio cholerae O139 infections. New oral vaccines for treating cholera are showing great promise. NICED is involved in a variety of ways in conducting field research to evaluate the new generation cholera vaccines in collaboration with the International Vaccine Institute in Korea.

HIV is another killer disease that is threatening the entire human population the world over. India accounts for 2.5 million of 33.2 million cases of HIV infected persons the world over. The figures are rising at an alarming rate. A collaborative effort at the national and international level is required in finding out an effective vaccine against this dreaded disease. Till invention of such a vaccine is a reality, health education, use of condoms, awareness and empowerment of women and control of STD are the only ways to stall the disease killing millions of people the world over.

NICED, one of the eminent ICMR institutes in India, is conducting research and training on diarrhoeal diseases and also on HIV. Presently it is also conducting research on Influenza viruses with particular reference to Bird Flu. Among its noteworthy achievements, special mention can be made of the implementation of ORT in community and hospitals in 1970s which drastically reduced the mortality rate of cholera and the discovery of a highly virulent epidemic strain of Vibrio cholerae of a novel serotype O139 that caused major cholera outbreaks in India and Bangladesh during 1990s. In addition to its persistent research work on different enteric pathogens, NICED is also committed to the cause of HIV and conducts basic as well as epidemiological research on HIV. It has built up NACO HIV Reference Centre. For generation of better research output and exchange of information, this institute has established collaborations not only at national level with different universities and biomedical institutes but also at the international level with World Health Organization, Centers for Disease Control & Prevention in Atlanta, Okayama University of Japan, Maryland University of USA, International Vaccine Institute of Korea and Japan International Cooperation Agency to thwart the menace of diarrhoeal and other infectious diseases that haunt developing countries. It is a WHO collaborating centre for research and training on diarrhoeal diseases in India. It has built up state-of-the-art research facilities that help the scientists to generate information and strategies that are used extensively for treatment, prevention and control of diseases threatening the nation’s health.

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VISION

The vision, of the National Institute of Cholera and Enteric Diseases (NICED), is to perform research and develop strategies for treatment, prevention and control of enteric infections and HIV/AIDS threatening the Nation’s health.
 

MISSION

In order to fulfill its vision, National Institute of Cholera and Enteric Diseases (NICED) will

• Identify enteric infections and HIV genotypes of national health priority.
   
• Initiate appropriate multidisciplinary research (epidemiology, bacteriology, virology, parasitology, clinical medicine, immunology and molecular biology) to develop strategies for treatment, control and prevention of enteric infections and HIV/AIDS of national health priority.
   
• Collaborate with other national and international scientists who are working for the same vision.