Pakistan continues to be dealing with a polio outbreak as four fresh cases have emerged, pushing the national tally to 37 this year, according to health officials on October 19, 2024. Health officials said that the regional reference laboratory for polio eradication at the National Institute of Health in Islamabad confirmed wild poliovirus type-1 (WPV1) in two children-one from each Balochistan and Khyber-Pakhtunkhwa.

In recent cases, a girl has been affected from Pishin, and two boys from Chaman and Noshki of Balochistan, and a girl from Lakki Marwat in KP. These are the first detections of the virus within Noshki and Lakki Marwat this year; isolated cases of poliovirus were previously reported within Chaman and Pishin. The province of Balochistan was the worst hit with 20 cases, Sindh had 10, Khyber Pakhtunkhwa had five, and Punjab and Islamabad had one case each.

A gigantic fight against polio has been on going in Pakistan- especially in Balochistan and southern KP-over the last two years. Immunisation campaigns have often been suspended or delayed because of local protests, insecurity, and community boycotts. Consequently, quite a number of children did not get the necessary vaccinations, making existing patches of vulnerability for the virus to flow within those pockets.

Noshki, located near Afghanistan's border, and Lakki Marwat have also recently reported some positive environmental samples that confirm the virus is present here, said a local reference laboratory official. Samples of latest cases are currently under genetic sequencing for checking spread of virus and origin.

As the threat of polio continues to grow, Pakistan has vowed to mount a nationwide campaign against it beginning from October 28. With the zeal to tackle the menace in the most effective manner, over 45 million children under the age of five will be vaccinated across the country.

Today, Afghanistan and Pakistan remain one of the few countries where polio has not yet been eradicated. The WHO said the virus remains a potential serious public health threat in areas with low vaccination coverage and weak surveillance.

India On Alert Against Polio

The country declared itself polio-free since 2014 and has kept the disease on bay almost a decade with very robust vaccination programs; however, two cases of vaccine-derived poliovirus cases reported in recent days from Meghalaya create some amount of doubts over a possible resurgence. Experts observe that in India, despite these detections taking place, strong coverage of vaccination at 90-95% and mandatory surveillance measures keep the risk of this widespread outbreak at bay.

The experts point out, however, that such stable situation in India requires continued surveillance. "Countries like Pakistan and parts of Africa remain at a high risk because vaccination rates in those areas are much lower," Dr. Siddharth, public health expert, said. Vaccination is an indispensable act in order to avoid the spread of this incapacitating disease that manifests most importantly as a nervous system affliction leading to the paralysis of a long period.

With concerted efforts from health authorities, there is hope someday that the scourge of polio will be completely eradicated from the face of the earth and future generations will never suffer from its effects.

Leprosy will soon be a notifiable disease in India’s national capital, Delhi, in a move to boost surveillance, improve early diagnosis and treatment, the state health department has said.

The Delhi Health Department has submitted the proposal, under the Delhi Epidemic Diseases Act, for necessary approval. Once approved, Delhi will join states like Tamil Nadu, Maharashtra, Karnataka, and West Bengal that have already made leprosy notifiable.

“Leprosy is completely curable. Making it a notifiable disease will help us find hidden cases, stop transmission, and ensure every patient gets standard treatment with dignity. This is a critical step towards honoring our commitment to a leprosy-free Delhi and supporting India’s journey towards the interruption of its transmission by 2030,” Health Minister Pankaj Singh said, in a statement.

Why Notifying Leprosy Is Important?

More than 40 per cent of leprosy patients are managed by private health facilities in India, revealed a recent pan-India study. As a result, most go unreported to the National Leprosy Eradication Programme (NLEP).

Cases that go unreported continue to spike the risk of transmission. The variance in treatment protocols also raises the threat of drug resistance. WHO's Independent Evaluation of the NLEP program in India suggests that leprosy should be included in the list of diseases mandatory for notification.

According to the Ministry, the notification will mandate all government and private healthcare providers, including clinics, hospitals, and individual practitioners, to report every new leprosy case to the District Leprosy Officer.

Mandatory notification will

• boost surveillance
• boost targeted interventions
• lead to early diagnosis
• prompt early treatment with standard Multi-Drug Therapy (MDT)
• reduce disability risk
• prevent transmission through timely contact tracing and post-exposure prophylaxis (PEP),
• reduce stigma and discrimination by normalizing leprosy as a treatable medical condition,
• improve treatment compliance and reduced defaulter rates,
• boost ownership among all healthcare establishments toward the common goal of leprosy eradication.

The proposed notification will be issued following the advice of the Delhi Government as per the GNCTD Act 1991. Detailed reporting formats and guidelines will be shared with all health institutions and practitioners across the National Capital Territory of Delhi.

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What Is Leprosy?

Leprosy is also known as Hansen's disease. It is a chronic infectious disease that is caused by the bacterium Mycobacterium leprae. It affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes.

If it is not treated promptly, it could lead to permanent nerve damage, disabilities, and social stigma. However, the condition is fully curable with multidrug therapy, and early detection could prevent further complications.

Leprosy is also a neglected tropical disease (NTD), which occurs in more than 120 countries, with around 2,00,000 new cases reported every year.

The Prevalence Of Leprosy In India

India achieved the official elimination of leprosy as a public health problem (less than 1 case per 10,000 population) nationally in December 2005. However, the country still accounts for approximately 59 per cent of global annual new leprosy cases.

As per data from the Health Ministry, till March 2025, 31 states/UTs and 638 districts have achieved less than 1 case per 10,000 population of leprosy, with a prevalence rate of 0.57 per 10,000.

The NLEP now targets "Zero Transmission, Zero Leprosy" by 2027 through early detection, free multidrug therapy (MDT), and stigma reduction.

Under the NLEP, the government provides services such as free diagnosis and treatment (MDT) at all government health facilities, microcellular rubber footwears for patients, free assistive devices for leprosy patients, self-care kits for patients with ulcers, and reconstructive surgery for Grade 2 deformities with a welfare allowance of Rs 12,000.

All services under NLEP are available free of cost at all government health facilities.

The Supreme Court of India has urged the All India Institute of Medical Sciences (AIIMS) to set up an expert panel

to examine how brain death is certified in India.

The apex Court has sought to know whether additional tests, such as electroencephalogram (EEG) and angiogram, are needed to declare a person brain dead.

A bench of Justices Vikram Nath and Sandeep Mehta was hearing a petition filed by Kerala-based medic and activist S Ganapathy, alleging malpractices in brain death certification, Times of India reported.

Ganapathy alleged that patients who may not be brain dead are sometimes declared so to facilitate organ donation. The petition also questioned the reliability of the apnea test—the standard method used to confirm brain death—calling it subjective and claiming that the legal requirement of video graphing the procedure is often not followed.

What is Brain Death?

Brain death, technically referred to as brain-stem death, is the irreversible end of all brain activity.

In India, according to the Transplantation of Human Organs (THO) Act, 1994 (Subsection 6 of Section 3), 'brain stem death' refers to the stage at which all functions of the brain stem have permanently and irreversibly ceased.

This is to be certified by a 'Board of Medical Experts' consisting of:

(1) The medical superintendent (MS)/In-Charge of the hospital in which 'brain stem' death has occurred,

(2) a specialist,

(3) a neurologist or a neurosurgeon nominated by the MS, from a panel approved by the Appropriate Authority, and the doctor under whose care the 'brain- stem' death has occurred.

Amendments in the THO Act 2011 have allowed the selection of a surgeon/physician and an anesthetist, if an approved neurosurgeon or neurologist is unavailable.

“Brain stem death has to be certified by a panel of four independent doctors, including a neurologist or neurosurgeon, and confirmed twice with a minimum gap of six hours. The process is carried out with due diligence and seriousness,” Dr Manjari Tripathi, head of neurology at AIIMS, was quoted as saying.

“While the guidelines require the team of doctors to meet and declare brain death at least twice, we end up doing it sometimes three times for the patients. The current guidelines require various bedside tests for the declaration of brain death. It does not specify the need for tests such as an EEG or angiogram,” added Dr. Tripathi.

Experts said additional tests could add to the system burden. EEG is not routinely recommended for brainstem death certification, while an angiogram is used only in select cases where the apnea test cannot be performed. Globally, the apnea test remains the gold standard. These criteria are clearly laid down and cannot be altered, said experts.

Challenges To Brain Death Certification In India

The Indian Express reported that the lack of knowledge even among physicians is a significant challenge in India.

This leads to several patients never being officially declared and asked to be organ donors.

An AIIMS-led study, published in the journal Neurology India last year, found that more than half the doctors — including neurosurgeons, neurologists, and critical care specialists who are most commonly included in the certification process — did not receive any training on brain death certification at the time of their graduation.

The US Food and Drug Administration (FDA) has approved Merck's Idvynso (doravirine/islatravir), a new, once-daily pill for the treatment of HIV-1 infection in adults.

The two-drug single tablet replaces the current antiretroviral regimen in those who are virologically suppressed (HIV-1 RNA <50 copies per mL).

The single tablet contains 100 mg doravirine and 0.25 mg islatravir. The FDA has approved it for adults on a stable antiretroviral regimen with no history of virologic treatment failure and no known substitutions associated with resistance to doravirine.

“IDVYNSO combines islatravir, a next-generation NRTI with multiple mechanisms of action, including translocation inhibition, with doravirine, an NNRTI with an established efficacy and safety profile,” said Dr. Eliav Barr, senior vice president and chief medical officer, Merck Research Laboratories, in a statement.

How Was The Pill Approved?

The approval is based on data from two randomized, active-controlled, noninferiority trials. In the double-blind Trial 052, participants were randomly assigned to stay on Glilead's Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide; 171 individuals) or switch to Idvynso (342 individuals).

Results showed that 1 per cent of participants in both groups had a viral load of ≥50 copies/mL at 48 weeks.

In the open-label Trial 051, participants were randomly assigned to stay on their oral antiretroviral therapy (ART) regimen (185 individuals) or switch to Idvynso (366 individuals).

Results showed that 1 per cent of participants who were switched to Idvynso had a viral load of ≥50 copies/mL at week 48 versus 5 per cent who continued on ART.

"As the only two-drug, non-integrase strand transfer inhibitor, tenofovir-free regimen, Idvynso expands therapeutic diversity beyond the currently available oral treatment options," Barr said.

"As the health needs of adults living with HIV change over time, Idvynso gives clinicians a new choice for HIV treatment."

What Is IDVYNSO? How Does It Work?

IDVYNSO is a fixed-dose combination of two medicines, doravirine with islatravir.

Doravirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) that inhibits HIV-1 replication by non-competitive inhibition of HIV-1 reverse transcriptase.

Islatravir is a potent, next-generation nucleoside analog reverse transcriptase inhibitor (NRTI) that blocks HIV-1 replication by multiple mechanisms, including:

• inhibition of reverse transcriptase translocation, resulting in immediate chain termination,
• induction of structural changes in the viral DNA (delayed chain termination).

Global Burden Of HIV

According to the latest data from UNAIDS, 40.8 million people globally were living with HIV in 2024. Of these, 39.4 million were adults (15 years or older) and 1.4 million were children (0–14 years).

While 1.3 million people became newly infected with HIV in 2024, 630,000 died from AIDS-related illnesses.

About 87 per cent of all people living with HIV knew their HIV status, and 5.3 million people did not know that they were living with HIV.