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Background: Although DPT immunization has been a part of universal immunization program since its inception, still diphtheria continues to be endemic in India and also leading to morbidity in children, especially in areas in the border of the two states. Cases coming to tertiary care level are only tip of iceberg. Objectives: To study the clinical profile, morbidity, and mortality of the diphtheria cases admitted to the Pediatrics Department of a tertiary care hospital and to study their immunization status. Materials and Methods: A hospital-based cross-sectional study was conducted from 1 January, 2012, to 31 June, 2013, on clinically suspected diphtheria cases. Detailed history and clinical examination were done, and their immunization status was recorded. Results: Total 36 clinically suspected children of diphtheria were studied. Sex ratio was 1:1. 12 cases were from 1 to 5 years age group, whereas 15 cases were between 6 and 10 years and remaining 9 cases aged more than 10 years. Among 36 cases, 4 (11.11%) were fully, 11 (30.55%) were partially immunized, and 21 (58.33%) were not immunized. The most common symptom observed was fever in 34 (94.44%) cases followed by throat pain in 25 (69.44%) cases and difficulty in swallowing in 23 (63.88%) cases. Case fatality rate was 13.88%. Maximum numbers of cases were observed during the rainy season. Conclusion: High prevalence of diphtheria in the age group of 5-15 years suggests the need for completing immunization schedule specially booster doses. Immunization activity needs to be strengthened in borderline districts as most of the cases in the present study were from the areas in the border between states.

COVID-19 pandemic has affected all age groups globally including pregnant women and their neonates. The aim of the study was to understand outcomes in neonates of mothers with COVID-19 during the first and second waves of COVID-19 pandemic. A retrospective analysis of 2524 neonates born to SARS-CoV-2-infected mothers was conducted during the first wave (n = 1782) and second wave (n = 742) of the COVID-19 pandemic at five study sites of the PregCovid registry in Maharashtra, India. A significant difference was noted in preterm birth, which was higher in the second wave (15.0%, 111/742) compared to the first wave (7.8%, 139/1782) (P < 0.001). The proportion of neonates requiring NICU admission was significantly higher in the second wave (19.0%, 141/742) as compared to that in the first wave (14.8%, 264/1782) (P < 0.05). On comparing regional differences, significantly higher neonatal complications were reported from Mumbai metropolitan region (P < 0.05). During the second wave of COVID-19, birth asphyxia and prematurity were 3.8-and 2.1fold higher respectively (P < 0.001). Neonatal resuscitation at birth was significantly higher in second wave (3.4%, 25/742 vs 1.8%, 32/1782) (P < 0.05). The prevalence of SARS-CoV-2 infection in neonates was comparable (4.2% vs 4.6%) with no significant difference between the two waves.Conclusion: Higher incidence of adverse outcomes in neonates born to SARS-CoV-2-infected mothers in the second wave of COVID-19 as compared to the first wave. Trial registration: PregCovid study is registered with the Clinical Trial Registry of India (CTRI/2020/05/025423, Registered on 28/05/2020). What is Known:• The second wave of COVID-19 was more lethal to pregnant women than the first wave. Newborns are at risk of developing complications. What is New:• Birth asphyxia, prematurity, and neonatal resuscitation at birth were significantly higher in the second wave as compared to those in the first wave of the COVID-19 pandemic in India. Keywords Neonatal complications • NICU • SARS-CoV-2 • Second wave Abbreviations COVID-19 Coronavirus disease 2019 NICU Neonatal intensive care unit SARS-CoV-2 Severe acute respiratory syndrome coronavirus-2 * Rakesh Waghmare

Introduction: Immunization is a process whereby a person is made immune to infectious diseases. In 1985, Universal Immunization Programme started in India with the aim of achieving at least 85% coverage of primary immunization. A child is considered fully immunized if he/she received one dose each of Bacille Calmette-Guérin and measles and three doses of oral polio vaccine, hepatitis B virus, and DPT before the age of 1 year. Objectives: To determine primary immunization coverage among 12-23 months old children and the factors affecting primary immunization coverage. Materials and Methods: A cross-sectional community-based study conducted from March 2011 to June 2011 in Miraj city of Maharashtra. The WHO 30 by 7 cluster sampling technique was used to collect data from 210 study subjects. Results: Among 210 (100%) children, 127 (60.5%) children were fully immunized while remaining 83 (39.5%) were partially immunized or unimmunized. Negligence of parents toward immunization was the main reason for incomplete immunization status of children. Conclusion: Health education activities for parents, especially in mothers, emphasizing the importance and need of immunization of children at right time could be arranged in communities. Equitable, participatory and intersectoral approach is need of hour for health care of children.

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