Communicable Diseases

Techniques of molecular biology have improved diagnostic sensitivity, accuracy and validity in forensic medicine very much, especially in the field of identification (paternity testing, stain analysis). Since more than 10 years these techniques -meanwhile well established in clinical disciplines -are used also for other applications in forensic medicine: determination of cause and manner of death, tissue identification by mRNA and microRNA, examination of gene expression levels (survival time, time since death, cause of death), toxicogenetics.

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.

This prospective cohort study examined the association between educational level and major causes of death in Japan.A baseline survey was conducted between 1988 and 1990 among 110,792 inhabitants of 45 areas aged 40–79 years. Follow-up surveys were conducted annually and causes of death were identified from death certificates. The analysis was restricted to 16,715 men and 23,284 women.During the follow-up period (377,139 person-years), 6628 deaths were recorded. Individuals with low levels of education had an increased overall risk of death [relative risk (RR) = 1.16, 95% confidence interval (CI): 1.08, 1.25, in men; RR = 1.26, 95% CI: 1.14, 1.39, in women], cancers (RR = 1.17, 95% CI: 1.04, 1.32, in men; RR = 1.10, 95% CI: 0.93, 1.30, in women), and death from external causes (RR = 1.81, 95% CI: 1.29. 2.54, in men; RR = 1.78, 95% CI: 1.18, 2.70, in women). Ischemic heart disease risk was marginally reduced in men with low levels of education (RR = 0.77, 95% CI: 0.58, 1.01).These results show that health inequalities exist in Japan, even though wealth inequalities are relatively low. Social and political initiatives will be needed to correct these inequities between different socioeconomic statuses.

Communicable diseases continue to pose a threat to the health of Singaporeans. Despite advances in medical science and the implementation of good public health infrastructure and hygiene measures, new and old diseases continue to emerge and re-emerge. Family physicians are often the first point of contact for patients infected with communicable diseases. Understanding the epidemiology of communicable diseases in the community would enable the family physician to better manage, prevent and control these ...

Background. After Hurricane Katrina, an estimated 200,000 persons were evacuated to the Houston metropolitan area, 127,000 of whom were housed in 1 large "megashelter," the Reliant Park Complex. We investigated an outbreak of gastroenteritis reported among the evacuees who resided in the Reliant Park Complex to assess the spread of the infectious agent, norovirus, and to implement and evaluate the effectiveness of interventions used for control. Methods. Public health authorities conducted surveillance of gastroenteritis among evacuees treated at the Reliant Park Medical Clinic during 2-12 September 2005. Basic demographic and clinical data were recorded. Specimens of stool and vomitus were collected and tested for bacteria, parasites, and viruses. Shelter census data were used to estimate the daily incidence of disease. Results. During a period of 11 days, 11000 patients were treated at the clinic for gastroenteritis, which accounted for 17% of all clinic visits. Norovirus was the sole enteric pathogen identified, but multiple different strains were involved. Among the evacuees residing in the Reliant Park Complex, the incidence of gastroenteritis was estimated to be 4.6 visits per 1000 persons per day, and among the evacuees who resided there for 9 days, 1 (4%) of 24 persons would have been ill. Intensive public health measures were promptly instituted but did not definitively slow the progression of the outbreak of norovirus gastroenteritis. Conclusions. Our investigation underscores the difficulties in managing such outbreaks in crowded settings and the need for rapid, sensitive laboratory assays to detect norovirus. Additional research is needed to establish more effective measures to control and prevent this highly contagious gastrointestinal illness. On 29 August 2005, Hurricane Katrina, a category 4 storm, made landfall on the Louisiana coast and caused catastrophic damage in many areas, resulting in many deaths and leaving thousands homeless and displaced,

The current study was designed to identify the morbidity pattern of outpatients
attending Urban Health Training Centre in an urban area of a
medical college in Srinagar, Pauri Garhwal district, Uttarakhand, North
India. The present study record-based retrospective study was conducted
among the out-patients attending the regular clinic at the Urban Health
Training Centre, of a medical college in Srinagar city of Uttarakhand State of
North India during the study period of one year in 2014. Data was retrieved
from the OPD registers maintained at the clinic. Data was collected
pertaining to socio-demographic profile, morbidity details and treatment
pattern. Diseases were identified using the International Classification of
Diseases (ICD-10) code. Descriptive analysis was done. During the study
period, a total of 9343 subjects attended the OPD. Among them, majority of
them (60%) were females. More than half (56%) belonged to the age group
of 35-65 year age-group. The association of disease classification was found
to be statistically significant with respect to gender. The leading morbidity of
communicable disease was found to be certain infectious and parasitic
diseases especially Typhoid whereas musculoskeletal system and connective
tissue disorders were the most common cause among morbidity due to
NCDs. Out of all, typhoid was found to cause maximum of morbidity among
the subjects. The present study highlights the morbidity pattern of
communicable and NCDs among the population of hilly areas of Garhwal,
Uttarakhand India. Priority should be preferred for the regular tracking of
diseases in terms of preventive and promotive aspects. Morbidity in the outdoor
clinics reflects the emerging trend of mixed disease spectrum burden
comprising communicable and non-communicable diseases.

Senescence arises from age-specific deterioration of the soma as a consequence of optimization of life history, and such effects of senescence should appear when comparing species that differ in intensity of sexual selection, as well as when comparing, within a species, the two sexes that often differ in intensity of sexual selection. However, any extrinsic cause of mortality that reduces life expectancy will reduce the possibility of detecting sex-specific differences in senescence. We investigated geographical variation in human sex differences in longevity across 121 countries to test whether differences in sexual competition for limiting resources, reflecting intensity of sexual selection, affected sex differences in longevity. Men on average lived 5 years shorter than women. High rates of childhood morbidity and mortality reduced the sex difference in longevity, while increased overall longevity increased the sex difference in longevity. Increased resource availability estimated from gross domestic product per capita reduced the sex difference in longevity, accounting for 10% of the variance, while there was no additional effect of income inequality as reflected by the Gini coefficient. In a separate analysis of sex differences in longevity among the states of the US, there was a strong effect of the Gini coefficient on sex difference in longevity, with the negative effect on male longevity being stronger than that on female longevity. In contrast, there was only a marginal effect of average household income. Thus, there was evidence of increased competition for resources contributing to increased sex differences in longevity within a single nation. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc.

Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resulting in unnecessary antimicrobial resistance. Our aim is to map general practitioners' (GPs') decision-making for common infections, exploring their diagnostic basis for antibiotic prescriptions. Setting General practice in Iceland. Method Ten in-depth qualitative interviews with, and three observations of, GPs in 1995. Diagnostic issues extracted and analysed. In 2006, eight GPs commented on analysis and updated (email/telephone). Main outcome measure Diagnostic variability and reasons for prescribing antibiotics, consistency or changes over time. Results Wide variations were uncovered in diagnostic procedures, although each GP remained consistent through time. Some GPs had developed ''rules-of-thumb''. They often balanced risks against issues like money, time, need for the workforce (perceived importance of the patient's job), client's need for job/earnings (perceived ability to afford a sick day) and doctor-patient relationship (risk of refusal adversely affecting the relationship). Perceptions of risk varied from focusing on resistance development to focusing on possible harm from untreated infections, also ranging between considering both to worrying about neither. Changes over time were not prominent but included increased point-ofcare testing and the perception by GPs that patients were increasingly willing to ''wait and see''. Conclusions Large variability and individuality characterized the GPs' diagnostic procedures, contrasted by consistency through time. If modification of diagnostic routines is needed, provision of ''scientific facts'' and technological aids is insufficient. A prerequisite for changing practice is GPs' acceptance of accuracy of information and of reliability, applicability, and relevance of technology, for physician and/or patient. Keywords Anti-bacterial agents Á Diagnosis Á Evidencebased medicine Á Iceland Á Infection Á Physician's practice patterns Impact of findings on practice • GPs' diagnostic procedures vary between individuals and between infections. • GPs' diagnostic procedures are relatively resistant to changes over time. • GPs only change diagnostic procedures if they consider themselves to have adequate information, indicating that change is beneficial.

In epidemiological models of infectious diseases the basic reproduction number ${\mathcal{R}_0}$ is used as a threshold parameter to determine the threshold between disease extinction and outbreak. A graph-theoretic form of Gaussian elimination using digraph reduction is derived and an algorithm given for calculating the basic reproduction number in continuous time epidemiological models. Examples illustrate how this method can be applied to compartmental models of infectious diseases modelled by a system of ordinary differential equations. We also show with these examples how lower bounds for ${\mathcal{R}_0}$ can be obtained from the digraphs in the reduction process.

During the past 35 years Oman has undergone a rapid socioeconomic and epidemiological transition leading to a steep reduction in child and adult mortality and morbidity due to the decline of various communicable diseases, including vaccine-preventable diseases. Good governance and planning, together with leadership and commitment by the government, has been a critical factor in this reduction. However, with increasing prosperity, lifestyle-related noncommunicable diseases have emerged as new health challenges to the country, with cardiovascular diseases, diabetes and obesity in the lead among other chronic conditions. Appropriate prevention strategies for reducing the burden of noncommunicable diseases are discussed.

Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national noncommunicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from periurban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p < 0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nationwide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study.

8 typically slower than ϳ1 km s −1 ) might differ significantly from what is assumed by current modelling efforts 27 . The expected equation-of-state differences among small bodies (ice versus rock, for instance) presents another dimension of study; having recently adapted our code for massively parallel architectures (K. M. Olson and E.A, manuscript in preparation), we are now ready to perform a more comprehensive analysis.

obtained from other sources such as websites from international organisations, including UN and WHO. Some information came from earlier reviews and books of particular relevance; these works are in the public domain and are referenced here. We also had access to unpublished offi cial reports about the health of Indigenous people in Australia.

Recent work has shown that different theoretical approaches to the dynamics of the susceptible-infectedsusceptible (SIS) model for epidemics lead to qualitatively different estimates for the position of the epidemic threshold in networks. Here we present large-scale numerical simulations of the SIS dynamics on various types of networks, allowing the precise determination of the effective threshold for systems of finite size N . We compare quantitatively the numerical thresholds with theoretical predictions of the heterogeneous mean-field theory and of the quenched mean-field theory. We show that the latter is in general more accurate, scaling with N with the correct exponent, but often failing to capture the correct prefactor.

Complex humanitarian emergencies have been a major political, security and public health feature of the post-Cold War world. These man-made disasters account for more morbidity and mortality than all natural and technological disasters combined. In order to deliver effective aid during complex humanitarian emergencies, international relief agencies must have a solid understanding of the political and social climates in which they are operating. In addition, they should base their health interventions on objective epidemiological data, especially standardized rates of morbidity and mortality. Most deaths during complex humanitarian emergencies are due to preventable causes, especially increased rates of infectious diseases malnutrition and violent trauma. The most appropriate health interventions are therefore based on the models of public health and primary health care, emphasizing disease prevention and health promotion. The field of humanitarian assistance has become increasingly professionalized in recent years, with its own professional standards, literature, research agenda and training opportunities. It is an unfortunate reflection on the current state of international affairs that the number of complex humanitarian emergencies and the enormous levels of suffering associated with them are unlikely to decline in the foreseeable future.

Background: Isfahan healthy heart program (IHHP), a six year, action-oriented, comprehensive and integrated community-based demonstration study, was launched late in 1999 to address the ongoing epidemic of non-communicable diseases (NCDs) and their major risk factors in Iran. It is a quasi-experimental trial that includes a reference area and several levels of evaluation including process, impact and outcome evaluations. IHHP involves individual, community and environmental changes to support health behavior modification. Objectives: To describe the IHHP evaluation design and to assess the extent to which the program has attained its short-term impacts. Methods: The IHHP evaluation includes four annual independent sample surveys in four specific sub-groups (adults, adolescents, health professionals and individuals at high risk for NCD) in both intervention and reference areas. In addition a sixyear cohort study of persons aged P35 years in both areas measures impact on behaviors at the individual level and assesses the risk of myocardial infarction and stroke. The WHO STEPwise risk factor surveillance questionnaires were used to conduct the cross sectional surveys, which evaluate the impacts and outcomes (N. Sarrafzadegan). URLs: www.ihhp.mui.ac.ir, www.crc.mui.ac.ir (N. Sarrafzadegan). Prevention and Control (2006) 2, 73-84 www.elsevier.com/locate/precon of interventions evaluate the impacts and outcomes of interventions undertaken concurrently in 10 distinct component projects designed to improve behaviors, risk factors, and NCD-specific morbidity and mortality. Data collection on ischemic heart disease, stroke, and mortality is ongoing. The results of the first year of evaluation are reported here. Findings: A significant increase in the consumption of oil was observed among males and females in the intervention community compared to the reference area (P < 0.05). While daily smoking decreased and daily exercise increased among males in the intervention community, less favorable changes were observed among women. Daily exercise and oil consumption increased significantly, and attempts to smoke decreased among adolescents in the intervention community (P < 0.05). Knowledge about healthy life style improved significantly in physicians, nurses and health trainees in the intervention compared to reference areas (P < 0.05). Age, sex, level of education and urban or rural place of residence modified the response to intervention activities. Conclusion: The implementation and evaluation of a comprehensive integrated community-based program for NCD prevention in a developing country is feasible and successful in obtaining short-term improvement in several lifestyle behaviors.

Process Automation concentrates on automating structured processes of an organization in order to achieve excellent service delivery by enabling the employees to pay more attention to semi structured or unstructured processes. Achieving service delivery excellence adds value to an organization, increases the customer retention and provides opportunity for strategic growth. The growth of the Sri Lankan healthcare sector is a necessity at this stage due to an increasingly ageing community and a significant increase in noncommunicable diseases. Despite many regulations that govern the sector, it continues to be inundated with many problems in relation to delivery of healthcare services. This paper examines service delivery issues in the healthcare institutions in the Western province and suggests mechanisms for automating standard processes in order to achieve strategic growth.

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared io earlier periods. This decline seemed to have been the result of immunization coveiage, which considerably increased by 1989-90, reaching above 70% of the children under aee 5. The studv further reveals that-the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrhea1 disease, and provision of chlorequine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.

As part of conservation efforts between 1997 and 2001, more than 25% (332 animals) of the endangered Hawaiian monk seal (Monachus schauinslandi) population was sampled in the northwestern Hawaiian Islands. Serum samples were tested for antibodies to viruses, bacteria, and parasites known to cause morbidity and mortality in other marine mammal species. Antibodies were found to phocine herpesvirus-1 by using

Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their developmental potential. We review the evidence linking compromised development with modifi able biological and psychosocial risks encountered by children from birth to 5 years of age. We identify four key risk factors where the need for intervention is urgent: stunting, inadequate cognitive stimulation, iodine defi ciency, and iron defi ciency anaemia. The evidence is also suffi cient to warrant interventions for malaria, intrauterine growth restriction, maternal depression, exposure to violence, and exposure to heavy metals. We discuss the research needed to clarify the eff ect of other potential risk factors on child development. The prevalence of the risk factors and their eff ect on development and human potential are substantial. Furthermore, risks often occur together or cumulatively, with concomitant increased adverse eff ects on the development of the world's poorest children.

The spectrum of human pathogens and the infectious diseases they cause is continuously changing through evolution and changes in the way human populations interact with their environment and each other. New human pathogens most often emerge from an animal reservoir, emphasizing the central role that non-human reservoirs play in human infectious diseases. Pathogens may also re-emerge with new characteristics, such as multidrug-resistance, or in different places, such as West Nile virus in the USA in 1999, to cause new epidemics. Most human pathogens have a history of evolution in which they first emerge and cause epidemics, become unstably adapted, re-emerge periodically, and eventually become endemic with the potential for future outbreaks.

The evolution of an infectious disease outbreak in an isolated population is split into two stages: a stochastic Markov process describing the initial contamination and a linked deterministic dynamical system with random initial conditions for the continued development of the outbreak. The initial contamination stage is well approximated by the randomized SI (susceptible/infected) model. We obtain the probability density function for the early behavior of the epidemic. This provides an appropriate distribution for the initial conditions with which to describe the subsequent deterministic evolution of the system. We apply the method of matching asymptotic expansions to link the two stages. This allows us to estimate the standard deviation of the number of infectives in the developed outbreak, and the statistical characteristics of the outbreak time. The potential trajectories caused by the stochastic nature of the contamination stage show greatest divergence at the initial and fade-out stages and coincide most tightly just after the peak of the epidemic. The time to the peak of the outbreak is not strongly dependent on the initial trajectory.

The objective of this paper was to develop an agentbased modeling framework in order to simulate the spread of influenza virus infection on a layout based on a representative hospital emergency department in Winnipeg, Canada. In doing so, the study complements mathematical modeling techniques for disease spread, as well as modeling applications focused on the spread of antibiotic-resistant nosocomial infections in hospitals. Twenty different emergency department scenarios were simulated, with further simulation of four infection control strategies. The agentbased modeling approach represents systems modeling, in which the emergency department was modeled as a collection of agents (patients and healthcare workers) and their individual characteristics, behaviors, and interactions. The framework was coded in C++ using Qt4 libraries running under the Linux operating system. A simple ordinary least squares (OLS) regression was used to analyze the data, in which the percentage of patients that became infected in one day within the simulation was the dependent variable. The results suggest that within the given instance context, patient-oriented infection control policies (alternate treatment streams, masking symptomatic patients) tend to have a larger effect than policies that target healthcare workers. The agent-based modeling framework is a flexible tool that can be made to reflect any given environment; it is also a decision support tool for practitioners and policymakers to assess the relative impact of infection control strategies. The framework illuminates scenarios worthy of further investigation, as well as counterintuitive findings.

In this paper, we outline the theory of epidemic percolation networks and their use in the analysis of stochastic susceptibleinfectious-removed (SIR) epidemic models on undirected contact networks. We then show how the same theory can be used to analyze stochastic SIR models with random and proportionate mixing. The epidemic percolation networks for these models are purely directed because undirected edges disappear in the limit of a large population. In a series of simulations, we show that epidemic percolation networks accurately predict the mean outbreak size and probability and final size of an epidemic for a variety of epidemic models in homogeneous and heterogeneous populations. Finally, we show that epidemic percolation networks can be used to re-derive classical results from several different areas of infectious disease epidemiology. In an Appendix, we show that an epidemic percolation network can be defined for any time-homogeneous stochastic SIR model in a closed population and prove that the distribution of outbreak sizes given the infection of any given node in the SIR model is identical to the distribution of its out-component sizes in the corresponding probability space of epidemic percolation networks. We conclude that the theory of percolation on semi-directed networks provides a very general framework for the analysis of stochastic SIR models in closed populations. r

Health seeking practices and well-being management has been considered and the determinants are divided into physical, financial, social and political environments. Health knowledge as well as the activities is the key elements that ensure high quality of health. The audit found clear practices that pursue differences in sexual orientation, social conditions, infection occurrences and family economic conditions. In this way, an evidence-based approach must be planned by establishing an understanding of the way happiness practices and social insurance are used, and giving enough credibility to all determinants. By focusing on the benefits (network) factors caused by environment, financial variables, training levels, social beliefs and the human service framework itself, it is feasible to improve the requirements for the use of solid behavior and physical medical services. Men are considered to be the main head of a family. Men’s instruction level is considered higher than women because men are dominant in our society.

The Kombewa Health and Demographic Surveillance System (HDSS) grew out of the Kombewa Clinical Research Centre in 2007 and has since established itself as a platform for the conduct of regulated clinical trials, nested studies and local disease surveillance. The HDSS is located in a rural part of Kisumu County, Western Kenya, and covers an area of about 369 km 2 along the north-eastern shores of Lake Victoria. A dynamic cohort of 141 956 individuals drawn from 34 718 households forms the HDSS surveillance population. Following a baseline survey in 2011, the HDSS continues to monitor key population changes through routine biannual household surveys. The intervening period between set-up and baseline census was used for preparatory work, in particular Global Positioning System (GPS) mapping. Routine surveys capture information on individual and households including residency, household relationships, births, deaths, migrations (in and out) and causes of morbidity (syndromic incidence and prevalence) as well as causes of death (verbal autopsy). The Kombewa HDSS platform is used to support health research activities, that is clinical trials and epidemiological studies evaluating diseases of public health importance including malaria, HIV and global emerging infectious diseases such as dengue fever. Formal data request and proposed collaborations can be submitted at [email protected].

This paper investigates the dynamics of an SIR model of childhood vaccination under the assumption that the vaccination uptake rate depends on past values of disease prevalence. The delay kernel is a high order Erlang function, which allows no instantaneous feedback between prevalence at time t and vaccinations at time t. Multiple types of endemic equilibria are found, as are stable and unstable equilibria, periodic orbits, dependence on initial conditions, and apparent chaos.

Zoonoses are infectious diseases transmissible from animals to humans. They comprise a complex spectrum of diseases due to the diversity of pathogenic agents involved like bacteria, protozoa, fungi, viruses and parasites. Fungal disease agents are widespread and can be isolated from a wide range of sick animals or asymptomatic carriers, which can represent important reservoirs for people in close contact with them. This situation should be considered as an important risk factor for those with impairment of their immune systems and, therefore, anyone working with or handling animals, needs to know about zoonoses and the precautions in order to minimize their risk of infection. In this brief note, it will be emphasized the importance and widespread of dermatophytosis and sporotrichosis in Brazil. Santurio J.M. 2007. Zoonoses micóticas em cães e gatos.

Carbapenem-resistant Enterobacteriaceae, especially New Delhi metallo-β-lactamase type-1-producing strains, exhibit multidrug resistance, thus posing a serious public health threat for treatment of infections caused by Gram-negative bacteria. However, most of the studies on the problem have been confined to hospitalized patients from urban population. The present study was carried out to detect carbapenemase production among Escherichia coli and Klebsiella pneumoniae Isolated from rural population hospitalized with community acquired infections. A total of 296 non-repetitive isolates of E. coli and K. pneumoniae were subjected to Modified Hodge test for carbapenemase detection, Metallo-β-lactamase detection by MIC test strip MBL and molecular detection of bla NDM gene by Polymerase Chain Reaction (PCR). Twenty three (7.8%) of the 296 isolates were detected as carbapenemase producers, of which five (21.7%) were found to harbor bla NDM genes by PCR. Gene sequencing of all the five isolates revealed bla NDM-1 genes. The present study showed the prevalence of carbapenemase-producing E. coli and K. pneumoniae in the rural community of North India and spread of NDM-1.