This is the first epidemic report of invasive meningococcal disease from the north east India. Chloramphenicol acts well in areas with penicillin or cephalosporin resistance. Mortality reduces significantly with early diagnosis and prompt intervention.

The risk of meningococcal transmission is increased with crowding and prolonged close proximity between people. There have been numerous invasive meningococcal disease (IMD) outbreaks associated with mass gatherings and other overcrowded situations, including cramped accommodation, such as student and military housing, and refugee camps. In these conditions, IMD outbreaks predominantly affect adolescents and young adults. In this narrative review, we examine the situation in India, where the burden of IMD-related complications is significant but the reported background incidence of IMD is low. However, active surveillance for meningococcal disease is suboptimal and laboratory confirmation of meningococcal strain is near absent, especially in non-outbreak periods. IMD risk factors are prevalent, including frequent mass gatherings and overcrowding combined with a demographically young population. Since overcrowded situations are generally unavoidable, the way forward relies on preventive measures. More widespread meningococcal vaccination and strengthened disease surveillance are likely to be key to this approach.

c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 5

Background: Neonatal skin care practices that are often guided by personal experience and preferences result in substantial variation in the practices being followed across hospital settings. The objective of this consensus recommendations was to provide guidance to health care practitioners on evidence-based neonatal skin care practices for adoption in hospitals: from delivery to discharge.Methods: A Scientific Advisory Board meeting on “Evidence-based Neonatal Skin Care Practices and Protocols” was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynaecologists and a pediatric dermatologist were invited. A comprehensive literature search was performed using the PubMed and Google Scholar databases to source relevant evidence.Results: Recommendations were developed on critical aspects of skin care in healthy full-term neonates, including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, use of cleansers and emollients, and the criteria to choose appropriate skin care products. The newborn’s first bath should occur only once cardiorespiratory and thermal stability have been achieved, anywhere between 6 to 24 hours after birth. Bathing with water alone or water with a mild liquid cleanser demonstrated appropriate for newborn does not impact the developing skin barrier. The use of emollients to maintain and enhance skin barrier function was encouraged for neonates with risk factors that can affect skin barrier integrity. Skin assessment should become an integral part of routine neonatal care. Skin Care Advice with “Do’s and Don’ts” should be a part of the neonatal discharge checklist. The importance of rigorous quality control, high-quality clinical trials to evaluate the safety and efficacy of baby products, usage of products that contain only ingredients and which are formulated appropriately for newborn babies, and full label transparency for baby products were highlighted. The panel further identified gaps in the existing literature and discussed the scope for future research. Conclusions: The consensus recommendations may help standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings. This may also improve the quality of care that the neonates receive in the hospital and facilitate improvement in overall neonatal health outcomes.

No abstract