BackgroundIndia contributes to 80% of diphtheria cases. Many diphtheria outbreaks were reported from Bijapur district of Karnataka state, India. Analysis of burden and drug sensitivity pattern might help to identify risk groups and to provide guidelines for treatment of diphtheria cases. Our objectives were to describe epidemiology and drug susceptibility of diphtheria cases in Bijapur district.MethodsWe did cross-sectional study between 2012 and 2015. We defined a probable case as inflammation of upper respiratory tract with adherent membranes. We defined a confirmed case as a probable case that was laboratory confirmed by throat culture. We collected line list of probable and confirmed diphtheria cases, population details in Bijapur district and antibiotic sensitivity of culture reports. We calculated attack rates and case fatality rate by taluks of Bijapur district. We calculated proportion of antibiotic resistance among lab confirmed cases.ResultsThere were 229 probable cases and 26 confirmed cases of diphtheria. Attack rate was 110/million and case fatality rate was 2% (5/255). Median age of males was 5 years (range: 3 months to 18 years) and females was 6 years (range: 1 year to 18 years). Highest attack rate (290/million) was in Bagewadi taluk, followed by Sindagi taluk (130/ million). Attack rate in Bijapur, Indi and Muddebihal were 80, 80and 70 per million respectively. Incidence of diphtheria cases was 3/million in 2012, 15/million in 2013, 80/million in 2014 and 14/million in 2015. Penicillin resistance was found among 92% (24/26) of cases, cotrimaxozole resistance among 27% cases (7/26) and ampicillin resistance among 15% cases (4/26)}. Multidrug resistance for penicillin and cotrimoxazole was found among 23% (6/26) of cases. Multidrug resistance to penicillin and ampicillin was found among 15% (4/26) of cases). All cases were sensitive to azithromycin, erythromycin, doxycycline, clindamycin, ciprofloxacin, cefotaxime, gentamycin and tetracycline.ConclusionDiphtheria incidence increased between 2012 and 2014. Incidence reduced in 2015. Penicillin resistance was common. We recommend sensitising health workers about penicillin resistance and educating them not to use penicillin. We recommend estimating vaccine coverage and vaccine effectiveness among children.Disclosures All authors: No reported disclosures.

Background: Annually, an estimated 1.03 million leptospirosis cases lead to 2.9 million disability adjusted life years. A cluster of fever cases was reported in Keerakadu village, Kollihills block in Namakkal district of Tamilnadu state, India, on April 28, 2017. We investigated to control the outbreak. Methods: We did a cross-sectional survey between April 29 and May 1. We defined a case of fever as any resident of Keerakadu village with fever for >2 days, with or without headache or myalgia, between April 15 and May 1, 2017. We conducted active surveillance. We reviewed medical records. We collected the line list from nearby health centers. We computed proportions to calculate the attack rate. We collected 11 serum samples and tested for dengue, scrub typhus, hepatitis A and leptospirosis by IgM ELISA method. We did a Widal slide agglutination test. We conducted an environmental survey to identify water sources. We performed a dengue larval survey. We collected 5 water samples: 1 from unprotected well, 1 from overhead tank and 3 from the houses of residents. We tested for fecal coliforms in the district public health laboratory. Results: The population of Keeradu village was 540. We identified 11 cases, for an attack rate of 2% (11 of 540). The hospitalization rate of cases was 81% (9 of 11). Median age was 45 years (range, 23–65). Of 11 samples, 3 were positive for leptospirosis; all were negative for dengue, scrub typhus, hepatitis A, and typhoid. The single water source for the whole village was an open, unprotected well. This well supplied water every day to the community, both for drinking purpose and domestic use. No breeding of dengue larva was observed. All the 5 water samples tested positive for fecal coliforms. Water was not chlorinated regularly. All patients were isolated and treated in the primary health center. Prophylactic antibiotics were given to the whole community. Conclusions: There was a leptospirosis outbreak in Keerakadu village, probably due to contaminated water from unprotected well. There were no cases after May 1, 2017. We recommended that the community chlorinate the water regularly and protect the well. We also recommend continued surveillance and a rodent survey.Funding: NoneDisclosures: None

Background: Countries that have good rubella surveillance, report ∼10,000–20,000 rubella cases annually. In India, not many cases of rubella are reported. The Hebballi Agasi ward of Dharwad district in Karnataka state, India, reported rubella cases on the last week of January 2015. Objective: We investigated the outbreak by time, place, person, and clinical symptoms. Methods: We performed a cross-sectional study. We defined a case as any resident of Heballi Agasi who had fever and rash, with or without lymphadenopathy, arthralgia, conjunctivitis, coryza, and cough, after December 15, 2014. We collected sociodemographic details and clinical symptoms of patients. We collected 5 serum samples and sent them to the National Measles Laboratory, Bangalore. We tested for measles and rubella antibodies. We drew an epidemic curve and a spot map. We computed mean age of cases, and we calculated attack rates by mean age and gender. We calculated proportions to describe clinical symptoms, and we interviewed stakeholders regarding rubella vaccination. We continued surveillance until March 2015. Results: The population of Heballi Agasi was 1,458. We identified 15 rubella cases (9 girls and 6 boys). The outbreak lasted between December 10, 2014, and February 21, 2015, with a peak on January 16, 2015. The overall attack rate was 1% (15 of 1,458). The mean age of the cases was 6 years (range, 1–23). The attack rate was high (7.7%) among those aged 1–6 years (11 of 143). The attack rate among those aged >6 years was 0.3% (4 of 1,315). In addition to fever and rash, 93% of cases (14 of 15) had coryza, 47% had cough (7 of 15), and 40% had conjunctivitis (6 of 15). Lymphadenopathy was present in only 1 case (1 of 15), and arthralgia was absent among all 15 cases. There was no death among the cases. All 5 sera were positive for rubella and negative for measles. Rubella vaccination was not given for any of the cases because no rubella vaccination is provided in the routine immunization program. Conclusions: There was a rubella outbreak in Heballi Agasi ward. Children aged 1–6 years were most affected. We recommend rubella vaccination in the routine immunization.Funding: NoneDisclosures: None