ICMR BULLETIN VOL. 28-No.-11-NOVEMBER-1998.pdf

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ISSN 0377-4910

ICMR
BULLETIN
November, 1998

A Vol. 28, No. 11

NUTRITION: A CRITICAL DETERMINANT OF RESPONSE TO
VACCINES IN CHILDREN
Information available from epidemiological and
clinical studies supports the association of inadequate
diet and infection and forms the basis for the modern
concept of the vicious cycle of malnutrition and infec­
tion1’2 (Fig.l).

already marginally nourished child. While nutritional
supplements bridge the dietary deficits, prevention and
control of infections ensure optimal utilisation of the
nutrients. Thus, prevention of infections should take an
important place in national programmes aimed at con­
trolling malnutrition in children.

POVERTY

Immunization is the most powerful and cost-effective
tool for preventing infections and promoting child
survival and health in developing countries. However,
the efficacy of various vaccines depends upon the ability
of the host to mount an adequate and appropriate immune
response to the concerned vaccine. Nutrition is an
important modulator of immune response. Severe protein
energy malnutrition (PEM) among preschool children
is a nutritional problem of public health concern which
induces immunosuppression and increases the
susceptibility of the child to infections. It also contributes
to the severity of illness in a malnourished child.

POOR ENVIRONMENT

INFECTION

INADEQUATE DIET

<--------------- >

MALNUTRITION

IMMUNOSUPPRESSION
Fig. 1. Malnutrition-infection. The vicious cycle.

Poverty through food deprivation is the root cause
of malnutrition while infectious diseases act as aggra­
vating factors. This interaction assumes greater signifi­
cance in developing countries where both malnutrition
and infection are widely prevalent and often co-exist.
Infections precipitate malnutrition particularly in an

The host's immune mechanisms may generally be
classified as innate and acquired immune responses. While
innate mechanisms are non-specific and do not carry
memory of the infecting organisms, acquired immune
mechanisms are endowed with the characters of speci­
ficity and memory to the concerned antigen. These two
fundamental characters of acquired immune mechanism
form the basis for vaccination.

Division of Publicahon & Information, ICMR, New Delhi - 110029

Acquired Immune Responses of Children with Severe
pem

Humoral Mechanisms
Children suffering from severe forms of clinical PEM,
such as kwashiorkor/marasmus, have poor response to
typhoid vaccine and certain other bacterial and viral
antigens3. Nevertheless, these children are found to raise
adequate antibody responses to protein antigens like
diphtheria and tetanus and certain viral antigens like
measles4. Total immunoglobulin levels of IgG, IgM and
IgA classes have been documented to be normal or el­
evated in such children5. Their B lymphocyte counts
also remain unaltered. This indicates that humoral mecha­
nisms in children with severe PEM are partly impaired
and the magnitude of the response probably depends
upon the nature of the antigen administered, the route of
administration, dose and cellular interactions required
for raising optimal immune response.
Cell Mediated Immune Mechanisms

Thymolymphatic atrophy has been well documented
in autopsy studies conducted on children dying during
the acute phase of kwashiorkor6. The peripheral blood
T cell count, along with the helper cell subset (CD\)
and their in vitro response to various mitogens and antigens
were found to be impaired, which explain their increased
susceptibility to viral, fungal and intracellular bacterial
infections like tuberculosis78.

poliomyelitis in underprivileged communities has been
attributed to the prevailing malnutrition. Concern has
also been expressed regarding the efficacy and safety of
using live attenuated vaccines in malnourished children
for fear of precipitating vaccine induced illness. I Ise of
live measles vaccine has been viewed with concern in
communities which are endemic for both malnutrition
and tuberculosis because of the potential danger of
activation of latent tuberculosis in immunocompromised
children.
Severe PEM is considered a public health problem
in India. It constitutes only the tip of the iceberg of the
problem of malnutrition among preschool children. A
recent report on the profile of PEM in the country, by
the National Nutrition Monitoring Bureau (NNMB), in­
dicated that the extent of severe PEM (<60% weight for
age) in the community is not more than 10% of the
preschool child population, while more than 80% of the
children look apparently normal but suffer from mild to
moderate grades of malnutrition presenting with growth
retardation (Fig. 2)H. These children constitute the major
beneficiaries of any national health programme, includ­
ing the immunization programme, and their response tc
various vaccines determines the success of the latter.

Macrophage Function

Children with severe PEM also exhibit a number of
functional deficits of macrophages. Macrophages which
play a significant role as accessory cells in cell medi­
ated immune reactions, carry out the functions of anti­
gen processing and presentation to T cells in addition to
providing maturation signals (through interleukins) to
the T cell. This apart, macrophages are powerful phago­
cytic and bactericidal cells. On in vitro activation, pe­
ripheral blood monocytes, obtained from children with
kwashiorkor were significantly less mobile and less bac­
tericidal compared to those in normal children. Their
ability to produce nitrite, an important intracellular
bactericidal agent, was low013.
Based on extrapolation of these results on
immunosuppression in severe PEM, doubts have been
expressed whether immunization programmes would be
successful in communities where malnutrition is widely
prevalent. Persistence of infections like measles and
106

Fig. 2. Prevalence of malnutrition in children (1-5 years).

Source: NNMB Report of Repeal Surveys (1988-90).

Mu d-moderate Malnutrition and Immune Response

Clinical and experimental studies have been conducted
at the National Institute of Nutrition (NIN), Hyderabad,
using immunological methods to determine the degree
of nutritional status that modulates immune responses
in children in general, and the response to various vac­
cines used in the National Immunization Programme in
particular. Children aged 1-5 years were investigated and
their nutritional status assessed using Gomez classifica­
tion and’NCHS Standards. Humoral and cell mediated

immune responses to various vaccines were investi­
gated. Immune responses of children with severe and
mild-moderate grades of malnutrition compared to nor­
mal children are summarised in the Tabic.
Table. Effect of various grades of malnutrition on immune
response.

antibody titres were determined prior to the admin­
istration of the first dose and one month after the second
dose. The antibody titres to both these antigens were
found to be in the protective range and the mean titres
were comparable among all groups of children irre­
spective of their nutritional status.

Effect observed

Severe
malnutrition

Mild- moderate
malnutrition

INNATE IMMUME MECHANISMS

Phagocyte Response

Neutrophil
Macrophage

impaired

Chemotaxis

impaired

Nitrite production

impaired

Interleukin-1 production

impaired

No change

TAB vaccine

Antibodies to 4H’ and 'O’ antigens of Salmonella
typhi were measured in response to two doses of TAB
vaccine administered one month apart. Children with
severe PEM had low mean titres of antibodies to both
these antigens, while mild and moderately malnour­
ished children had higher antibody titres which were
comparable with that of normal children.
BCG vaccine

Humoral Response
Complement & Lysozyme Reduced

Not altered

CELL MEDIATED IMMUNE RESPONSES
T cell number
T cell function

decreased
decreased

not altered
not altered

HUMORAL IMMUNE MECHANISMS
Total immunoglobulin
levels

not altered

not altered

D and T antigens

not altered

not altered

TAB vaccine
(H and 0 antigens)

impaired

not altered

BCG vaccine

not altered

not altered

Measles vaccine

not altered

not altered

Response to vaccines

General Cellular and Humoral Immune Response

Contrary to the observation of immunosuppression
in severe PEM. children with mild and moderate mal­
nutrition showed both T cell number and proliferative
responses adequate on stimulation with mitogens/antigens and were comparable to those of normal children.
IgG, IgM and IgA levels were also in the normal ranges’.

Immune Response to Specific Antigens

Diphtheria and tetanus vaccine
Two doses of diphtheria and tetanus toxoid were
administered at an interval of one month and specific

Though BCG vaccine has been in use for a long
time, its efficacy has been under constant debate, par­
ticularly in children of developing countries. How­
ever, in view of its protective efficacy against
extrapulmonary forms of tuberculosis in children, rou­
tine BCG vaccination is recommended.

Response to BCG vaccine is generally measured
by (Mantoux) skin reaction to PPD following
administration of the vaccine. Very often the Mantoux
reaction is negative in children with severe PEM
and is attributed to the observed immunosuppression.
Contrary to this, children with mild and moderate
grades of malnutrition have positive Mantoux
conversion as in normal children15. Positive response
to a skin test depends on two components v/z., the
inflammatory response and immune reaction to the
injected antigen.

Studies were conducted to assess the status of these
two components under the influence of PEM. Inflam­
matory response to a superficial injury was studied
in children with kwashiorkor, using the skin win­
dow technique. Mobilisation of neutrophil leuko­
cytes and monocytes to the site of injury was stud­
ied periodically over 72 h. In normal children, initially
the neutrophils move to the site of inflammation in
large numbers and are replaced by monocytes by 24
h which persist even at the end of 72 h9. The mono­
nuclear infiltration is responsible for the induration
observed. However, in children with kwashiorkor,
mononuclear mobilization was impaired, and this
107

dysfunction of macrophages could be contributing
to the negative skin test reactions in these children
(Fig. 3).

progressive forms of tuberculosis in malnourished
children as effectively as in wellnourished children16.
Measles vaccine

Fig. 3. Cutaneous inflammatory response in kwashiorkor
N: Normal; K: kwashiorkor

Further studies were also conducted to explore the
effect of malnutrition on immune response to PPD.
Lymphocytes, collected from severely malnourished chil-.
dren 12 weeks after they had received BCG vaccine,
were stimulated in vitro with PPD and the production of
leukocyte migration inhibition factor (MIF) was mea­
sured. It was observed that despite severe malnutrition,
these children were able to produce a positive migration
inhibition response. This study demonstrated that the
sensitization of the lymphocytes to tubercular antigens
is successful even in children with severe malnutrition15.
However, due to lack of macrophage mobilisation, the
Mantoux test was negative. Children with milder grades
of malnutrition developed both inflammatory and im­
mune responses positively. These results indicate that
BCG vaccination even in a malnourished community
could achieve the expected degree of protection against
tuberculosis. This observation was further strengthened
by recent clinical studies by Bhaskaram et al'6 in chil­
dren suffering from tuberculosis.

BCG vaccinated children had a more localised
infection confined to either the cervical or the medias­
tinal lymphnodes. While most of the unvaccinated mal­
nourished children suffered from more severe/progressive forms of tuberculosis, BCG vaccination produced
similar effects of localising the disease even in children
with malnutrition. This observation further strength­
ened the laboratory studies. BCG was found to prevent
108

It is well established that measles is a major con­
tributor to malnutrition in Indian children. Measles
infection is known to cause severe and persistent immu­
nosuppression leading to recurring morbidity in the post
measles period17. Activation of latent tubercular lesions
and worsening of the existing forms of tuberculosis are
common phenomena observed after measles. Doubts have
therefore been expressed and concern has been voiced
regarding administration of measles vaccine to malnour­
ished children living in communities where tuberculo­
sis is prevalent. Specific immune responses were deter­
mined in children after administering measles vaccine
and were correlated with the nutritional status.
Haemagglutination inhibition (HI) antibodies to measles
and in vitro T cell proliferative response to measles antigen
were measured. The results showed that both the anti­
body production and T cell responses were adequate in
all the children irrespective of their nutritional status4.
This also suggests that unlike infection with natural measles
virus, vaccine induced infection did not have immuno­
suppressive properties. Further, malnourished children
did not exhibit any side-effects following vaccination and
there was no evidence of any activation of latent tuber­
cular lesions over a 3 month period of follow up. These
observations indicate the effectiveness of measles vac­
cination and its safety even in communities simultaneously
carrying the load of malnutrition and tuberculosis.
Measles vaccination and morbidity

Apart from these beneficial effects, measles vacci­
nation was found to significantly reduce morbidity in
children probably due to non specific stimulation of
immune mechanisms by activating macrophages4. It has
been reported that measles vaccine not only reduces
morbidity and mortality related to measles but also
prevents the risk of -severe malnutrition in children who
are already undernourished18.

Measles vaccine was introduced in India through the
Universal Immunization Programme (U1P) during 198586. Ina recent retrospective case analysis (Bhaskaram
P. et al, Unpublished observation), it was observed that
the hospital admissions of children with measles and its
' complications were significantly (69%) reduced from the
prevaccination to the postvaccination period. However,
this reduction was far from the mid decade goal of

90% reduction of measles from the prevaccination preva­
lence. Mortality, however, registered a decline of 90%
from the prevaccination to the postvaccination period.
The observations also demonstrated that the incidence
of measles significantly increased in older children (above
5 years) compared to the prevaccination period where
almost 100% of the children were affected by measles
before 5 years of age. Though the UIP focuses on in­
fants, the prevalence of measles in infancy has not shown
any significant decrease over the years. These observa­
tions demonstrate the changing pattern of measles in the
community following the introduction of the immuniza­
tion programme. Persistence of measles in infants de­
spite vaccination at 9 months suggests inadequate cov­
erage while periodic large outbreaks in the community
indicate the accumulation of susceptible children who
trigger the outbreaks. However, to achieve the goal of
elimination of measles by at least 2010, there is need to
intensify the measles vaccination programme and modify
it so as to cover all susceptible children upto 5 years of
age. This strategy is very essential not only to promote
child survival but also to reduce malnutrition.

Poliomyelitis

Persistence of poliomyelitis in India has often been
attributed to associated malnutrition. In a recent outbreak
in Andhra Pradesh, it was observed that the prevalence
of the infection was not related to the nutritional status19.
Out of 400 patients of acute paralytic poliomyelitis
investigated, 49.5% were wellnourished and 50.5%
malnourished. In addition, it was observed that oral polio
vaccine (OPV) conferred low herd immunity20. Lower
antibody titres and also inadequate local immune response
were noticed in natural infection as well as with OPV21.
These impaired responses were not related to the
nutritional status of the children. Thus, sub-optimal
vaccine efficacy and interference by the enteroviruses
in the gut, both being unavoidable problems in tropical
countries, could be the factors responsible for the
development of low levels of immunity leading to
persistence of poliomyelitis in the country. Malnutrition
does not seem to play any role in the persistence of
poliomyelitis. Though the load of poliomyelitis has been
significantly reduced following the implementation of
the Pulse Polio Programme, a strong disease system has
to be established to prevent resurgence of the disease.
Role of Nutrient Supplements in Vaccine Responses

Certain nutrients like B carotene, vitamins A and D3
are known to act as immune adjuvants. Among these,

B carotene and vitamin A have been found to reduce mor­
bidity and mortality due to certain clinical conditions
characterised by immunosuppression.

Immune Adjuvant Effects of Vitamin A
The immunological adjuvant effects of administra­
tion of vitamin A/p carotene are well documented . In l
a study carried out in preschool children, administra­
tion of 100,000 and 200,000 units of vitamin A was
found to significantly enhance the production of bacte­
ricidal molecules like hydrogen peroxide (H2O2) by ph­
agocytes. Non specific activation of immune cells re­
sulted in increase in antibody production on antigenic
challenge22. The large dose of 100,000 IU also led to
increase in interleukin 1 production by in vitro acti­
vated macrophages22.

Interactions between Vitamin A and the Viral Vaccines

Vitamin A deficiency is widely prevalent among
children in developing countries. Apart from
xerophthalmia in 5-10% of preschool children, there
appears to be a much larger problem of subclinical
vitamin A deficiency as evidenced by lowered serum
retinol levels without obvious clinical manifestations
in nearly 30-40% of the children including infants.
Several studies have reported that even mild/subclinical
forms of vitamin A deficiency could increase child
morbidity by increasing susceptibility to mucosal
infections and also increase mortality23’24. Vitamin A
supplements were found to reverse these effects
significantly 25. In view of these beneficial effects of
vitamin A, WHO has recommended the routine
administration of 100,000 IU of vitamin A to infants
above 6 months of age in developing countries to improve
vitamin A status and also child survival. To achieve
the maximum cost-effectiveness, this supplementation
programme is linked with the Universal Immunization
Programme26.
Vitamin A supplements and seroconversion to measles
vaccine

Recent studies from Indonesia, however, raised con­
cerns about the possible immunosuppression that could
be caused by large dose vitamin A administration along
with measles vaccine in young infants who still possess
transplacentally acquired maternal antibodies27. Thus the
combined schedule of large dose vitamin A administra­
tion along with live viral vaccine administration to young
infants has become a subject of intense debate28.
109

In India, administration of 100,000 IU of vitamin A
to infants of 9 months age at the time of measles vacci­
nation has been introduced into the Expanded Programme
on Immunization.
In a recent study conducted by Bhaskaram and Rao29,
seroconversion rates and vitamin A status of infants who
received vitamin A dose at the time of measles vaccine
were compared with those of the infants who received
only the vaccine. Under existing field conditions,
seroconversion to measles vaccine is generally low.
However, in children who received vitamin A, a signifi­
cantly higher percentage seroconverted to measles (84%)
compared to those who received only the vaccine (63%).
Vitamin A status of all the infants improved over the
one month period of the study, the improvement being
significantly higher in children who received vitamin A29.
Vitamin A administration to mothers in puerperium and
response to neonatal dose of OPV

In recent times, in countries with endemic vitamin
A deficiency, the usefulness of administering a large
dose of vitamin A with each dose of DPT and OPV to
infants below the age of 6 months is suggested as a strat­
egy to improve their vitamin A status. However, such
an exercise frequently resulted in the intracranial ten­
sion being raised in a number of infants. Though the
neurological significance of a transient rise in intracra­
nial tension at this age is not known, it is not an ac­
ceptable phenomenon. Administration of about 200,000
IU of vitamin A to mothers soon after delivery has been
suggested as an alternative strategy to improve the vi­
tamin A status of the breastfed infants30.

The WHO has recommended the routine adminis­
tration of a dose of OPV to new boms within the first 3
days of life to supplement the routine 3 dose schedule in
order to achieve better seroconversion rates31.
About 100 women along with their infants were stud­
ied to examine the effect of administering a large dose
-of vitamin A to the mother soon after delivery and the
sero-response to OPV administered to the breastfed new­
borns. Administration of a large dose of vitamin A to
lactating mothers increased vitamin A levels in breast
milk for a short period, thus increasing the vitamin A
intakes of the infants. There was, however, no effect on
the sero-response to OPV. Seroconversion rates to all
the 3 types of polio viruses in the vaccine were compa­
rable between infants belonging to mothers who received
vitamin A and those who did not32. Thus, these studies
110

document the safety of administration of live viral vac­
cines along with a large dose of vitamin A. This obser­
vation is of practical relevance in developing countries
where the interactions between infection and malnutri­
tion pose a serious threat to child health and survival.
Thus, malnutrition does not appear to be a contrain­
dication to immunization programmes. Judicial supple­
mentation of nutrients having immunoadjuvant proper­
ties could improve the results with certain vaccines.

References
1.

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children. Nutr Res. 1: 33,1981.

'3.

Reddy, V., Jagadeesan, V., Raghuramulu. N., Bhaskaram, C.
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Bhaskaram, P., Madhusudan, J., Radhakrishna, K. V. and Raj,
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Rosen, E.V., Geefhuysen, J. and IPP, I. Immunoglobulin levels
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Smythe, P.M., Schon land, M., Brereton-Stiles, G. G., Coovadia,
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Bhaskaram, C. and Reddy, V. Cell mediated immunity in protein
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. ...

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Chandra, R.K., Gupta, S. and Singh, H. Inducer and suppressor
T cell subsets in protein energy malnutrition: Analysis by
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iorkor. Indian J Paediatr. 49: 497, 1982.

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Bhaskaram, P. and Sivakumar, B. Interleukin-1 in malnutrition. Arch Dis child. 61: 182, 1986.

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Bhaskaram, P. Nitrite production by lymphokine activated
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A
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Satyanarayana, K., Bhaskaram, P., Chitti Seshu, V. and Reddy,
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Bhaskaram, P., Hemalatha, P. and Rao, K.V. BCG vaccination
in malnourished child population. Indian Paediatr 29:39,1992.

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mediated immunity. Indian J Med Res 77: 83, 1983.

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Murthy, N., Bhaskaram, P., Murali, M. V., Sukanya, M and
Srinivasa Rao, C.R. An outbreak of poliomyelitis in Andhra
Pradesh, south India. Indian Paediatr 31: 533, 1994.

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Bhaskaram, P., Nair, M., Murthy, N., Hemalatha, P., and Nair,
P. Efficacy of administration of OPV in the new bom period.
J Trop Paediatr 43: 232, 1997.

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Bhaskaram, P., Jyothi,A. S., Rao, K.V. and Narasinga Rao, B.S.
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Sommer, A., Tarwotjo, I., Djunaedi, E., West, K.P. Jr., Loeden,
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35: 217, 1998.

This write-up has been adopted from the article entitled
“Nutrition - immunization interactions and relevance to
child health” by Dr. P. Bhaskaram, published in the
Nutrition News 17(4): 1996.

ABSTRACTS
Some Research Projects Completed Recently

Role of ‘S’ transactivator in hepatocarcinogenesis: In
vitro expression and purification of transactivating
proteins.
The study was carried out to elucidate the effect of
‘S’ (463-851) transactivator on various promotor enhancer
systems; raise monoclonal/polyclonal antibodies against
this transactivator protein prepared either by recombi­
nant DNA method or by using synthetic peptides; and
demonstrate and localize the transactivator protein in
hepatocarcinoma cells.

The association of hepatitis B virus (HVB) in hepa­
tocellular carcinoma (HCC) is well established. Insertional mutagenesis, transactivation by truncated X or pre

S2/S regions and activation of growth regulated genes
or oncogenes have been suggested as possible mecha­
nisms for carcinogenesis. The transactivating properties
of a frequently detected fragment, which form part of
the ‘S’ reading frame, extending from 426 nt. to 855 nt.,
has been reported.
The clones were sequenced and subcloned into
pRSET vectors in all the three reading frames and
expressed using IPTG induction. A Western blot analysis
was done using polyclonal anti HBsAg and the presence
of 19.24 kDa functional protein in the correct reading
frame was obtained. The expressed protein was checked
for by commercial ELISA. However, the antigen could
not be detected by ELISA in any of the three reading
111

frames. The ‘S’ protein was purified by SDA-PAGE
and was used to raise polyclonal antibodies in rabbits.
These polyclonal antibodies were then used to screen
the presence of‘S’ protein in hepatocellular carcinoma
tissues. The ‘S’ region being a very small part of the
surface region of the virus (426-824 ntds), could not be
detected by immunofluorescence. The region, extending
from 426-824 ntds was proved to be a generalized
transactivator ofthe viral promoters and enhancers. Using
chloramphenicol acyl transferase as a reporter gene, in
transfection assays it was found to be capable of activating
HIV promoter, HTLVI promoter, RSV promoter and
enhancer, c-Fos and c-Jun promoter to a high degree.

S.K. Panda
Department of Pathology
All India Institute of Medical Sciences
New Delhi.

summer - extended light conditions). The human
volunteers, divided into two groups were given either
beta adrenergic blocker (atenolol) or placebo.
The results of both the animal and human studies
showed that under the influence of constant dark and light,
sympathetic innervation to the pineal primarily has tonic
inhibitory influence on the suprachiasmatic nucleus, the
biological clock, which alters the amplitude and mean
level of various rhythms to keep the synchrony and
coupling of various physiological and hormonal rhythms.
The rat study also provided convincing data for the presence
of extra-sympathetic inputs (probably neuropeptide-Yergic
and cholinergic) to the pineal which are stimulated only
if melatonin level is severely depressed as in cases of
absence of sympathetic innervation or on exposure to
continuous light.
U. Sachdeva
Department of Physiology
All India Institute of Medical Sciences
New Delhi.

Interaction of melatonin and circadian rhythmicity in
Antarctic conditions.
The study was carried out to evaluate the coupling
pattern of melatonin and other circadian rhythmicity in
the human subjects in Antarctic conditions and on rats
under simulated Antarctic exposure of diversifying light
and dark cycle. The experimental study was carried out
on 42 male Wistar strain rats (200-300 g) divided into 3
groups viz normal (control without surgical
intervention);sham operated; and superior cervical
ganglionectomized. The human study was conducted on
eight volunteers from the 12th Indian scientific expedition
to Antarctica (Antarctic winter - extended dark conditions)
and six volunteers from the 13th expedition (Antarctic

Publications:
1.

Mehta, N., Naidu, M. and Sachdeva, U. Desynchronisation of
circadian rhythms in winter over Antarctic expeditioners. In:
Scientific Report - Txvelth Indian Expedition to Antarctica. Ed.
VJG Dhargalkar. Technical Publication NO. 12 Department of
Ocean Development, New Delhi, p.291, 1996.

2.

Sachdeva, U., Naidu, M. And Sundaresan, G. Biorhythms: Role
of photoperiodicity in regulating hormonal rhythms of human
subjects in Antarctica. In: Pigment Cell and Photobiology :
Proceedings ofGrowth Disorders ofPigment Cells. Ed. B. lyenger.
Livingstone, New Delhi, pl, 1996.

ICMR NEWS
The following meetings of various technical groups/
committees of the Council were held:

Enterovirus Research Centre,
Mumbai

Meetings of the Scientific Advisory Committees of the
following ICMR Institutes/Centres:

Rajendra Memorial Research November 16-17, 1998
Institute for Medical Sciences,
Patna

National Institute of Cholera
and Enteric Diseases, Calcutta

October 25-26, 1998

Central JALMA Institute
for Leprosy Agra

November 13-14, 1998

National AIDS Research
Institute, Pune

November 16-17, 1998

112

November 16-17, 1998

Meeting of the Project Review Committee (PRC) held
at New Delhi:
PRC for Cardiovascular
Diseases, Urology,
Gastroenterology, Nephrology,
Geriatrics and Ophthalmology

October 30, 1998

Participation of ICMR Scientists in Scientific Events:
Dr. D.A. Gadkari, Director, National Institute of
Virology, Pune, participated in a joint meeting of the
United Nations Programme on HIV/AIDS (UNAIDS),
WHO Global Programme on Vaccines and Immuni­
zation and the Japanese National Institute of Infec­
tious Diseases, to discuss AIDS Vaccine in Asia: Needs
and Opportunities at Tokyo (October 28-30, 1998).

Dr. Kamala Krishnaswamy, Director, National in­
stitute of Nutrition (NIN), Hyderabad, participated in a
consultative meeting on Severe Anaemia in Pregnancy
in India and Bangladesh at Dhaka (November 15-17,1998).
Dr. B. Sivakumar, Dy. Director (Sr.Grade), NIN,
Hyderabad, participated in a workshop on Micronutri­
ent Fortification at Dhaka (November 18, 1998).

Workshop:
Dr. Z.M. Patel, Dy. Director and Officer-in-Charge,
ICMR Genetic Research Centre, Mumbai, participated
in the VIII International Conference on Ultrasound at
London (November 1-5, 1998).

Dr. N.K. Ganguly, Director-General, ICMR,
delivered the keynote address at the International
Symposium on Biotechnological Approaches to
Parasitic and Bacterial Diseases at the Indian Institute
of Chemical Biology, Calcutta (November 6, 1998).

Dr. K.D. Ramaiah, Sr. Research Officer, Vector
Control Research Centre, Pondicherry, participated in
a workshop on Economic Research Agenda for the
Global Programme to Eliminate Filariasis at Atlanta
(November 12-13, 1998).

The ICMR-WHO Workshop on New Challenges in
Intellectual Property Rights in Medical Research was
organised in New Delhi during November 17-18,1998.
It was attended by Directors of ICMR Institutes, Chiefs
of Technical Divisions of ICMR Hqrs, senior professionals
from sister agencies and WHO representatives.

Annual Day Celebrations:
As part of the ICMR’s Annual Day celebrations, the
Council organised orations on (i) Molecular Biology: The
Continuing Challenge by Prof. Asis K. Datta, Vice
Chancellor, Jawaharlal Nehru University, New Delhi, and
(ii) Perspectives in Medical Research in India by Prof.
P.N. Tandon, Emeritus Professor, All India Institute of
Medical Sciences, New Delhi on November 19, 1998.

ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Symposium/Seminar/Workshop/
Course/Conference

Date & Place

Contact Address

International Symposium on Major Histocompatibility
Complex.

October 29 November 1,1998;
(at New Delhi)

Dr. N.K. Mehra, Prof, and Head, Department of
Histocompatibility and Immunogenetics, All India
Institute of Medical Sciences, New Delhi-110029.

Precongress Workshop on Andrology and Male Infertility
and National Congress on Andrology and Reproductive
Medicine.

October 29 November 2,1998;
(at Calcutta)

Dr. A.K. Bhattacharya, Organising Secretary ofthe
Congress, Department of Biochemistry, University
College of Science, Calcutta-700019.

Continuing Medical Education-cum-Workshop on Brachy­
therapy for Head and Neck Cancers and Breast Cancer

October 30 November 1,1998;
(at Imphal)

Dr. Th. Tomcha Singh, Organising Secretary of the
Workshop, Department of Radiotherapy, Regional
Institute of Medical Sciences, Imphal-795004.

International Congress and Workshop on Recent Advances
in Medical Toxicology and Legal Medicine

November 2-7,1998;
(at New Delhi)

Dr. O.P. Murthy, Organising Secretary of the
Conference, Department of Forensic Medicine and
Toxicology, All India Institute of Medical
Sciences, New Delhi-110029.

International Conference on Medical Physics and XIX
Annual Conference of Association of Medical Physicists
of India

November 6-9,1998;
(at New Delhi)

Dr. M.M. Rehini, Organising Secretary of the
Conference, Medical Physics Unit, Institute Rotary
Cancer Hospital, All India Institute of Medical
Sciences, New Delhi-110029.

Indo-Japanese Symposium on Frontiers of Electron
Microscopy in the 21st Century and XXII Annual Meeting
of Electron Microscopy Society of India

November 9-11, 1998;
(at Hyderabad)

Dr. P.D. Gupta, Convenor of XXII EMSI Meet­
ing, Centre for Cellular and Molecular Biology,
Hyderabad-500007.

International Workshop on Adverse Drug Reaction
Monitoring

November 9-12,1998;
(at Aligarh)

Prof. K.C. Singhal, Organising Secretary
of the Workshop, Department of Pharmacology,
J.N. Medical College, Aligarh-202002.

113

Symposium/Seminar/Workshop/

Date & Place

Contact Address

Course/Conference

International Workshop on Medical Mycology

November 16-21,1998;
(at Chandigarh)

Dr. A. Chakrabarti, Organising Secretary of the
Workshop, Department of Microbiology, Post­
graduate Institute of Medical Education and
Research, Chandigarh-160012.

Seminar on Integration of Advances in Biostatistics
into Medical Research

November 19-21, 1998;
(at Vellore)

Dr. J. Richard, Prof, and Head. Department of
Biostatistics, Christian Medical College, Vellore632002.

International Conference on Organization and
Management of Blood Transfusion Service, Plans and
Policies

November 22-24,1998;
(at Mumbai)

Dr. Z.S. Bharucha, Prof, and Head, Department
of Transfusion Medicine, Tata Memorial Hospital,
Mumbai-400012.

Workshop on Ending Malnutrition by 2020: An Agenda
for Change in the Millennium

November 23-26,1998;
(at Chennai)

Dr. S. Rajagopalan, Distinguished Fellow, M.S.
Swaminathan Research Foundation, Chennai600113.

Symposia on (i) Public Health Nutrition Problems;
(ii) Frontiers in Nutrition Science; and (iii) Growth and
Development of Children of South- East Asia

November 26-28,1998;
(at Hyderabad)

Dr. T.C. Raghu Ram, Joint Secretary, Nutrition
Society of India, National Institute of Nutrition,
Hyderabad-500007.

XI Annual Conference of Indian Society for Atherosclero­
sis Research and International Symposium/CME on
Prevention of Coronary Artery Disease : Concerns and
Perspectives

November 27-29,1998;
(at New Delhi)

Dr. S. uwivedi, Organising Secretary of the
Conference, Prevention Cardiology Clinic, Univer­
sity College of Medical Sciences, Delhi-110095.

XXXV Guha Research Conference 1998

December 1-5,1998;
(at Port Blair)

Dr. Lalji Singh, Convener, GRC 1998, Centre for
Cellular and Molecular Biology, Hyderabad500007.

All India Workshop/Training Course on Application of
Direct Methods in Crystallography for Solving Small/
Medium sized Molecules

December 1-21,1998;
(at Chennai)

Dr. D. Velmurugan, Convener of the Workshop,
Department of Crystallography and Biophysics.
University of Madras, Chennai-600025.

International Conference on Quality of Psychiatric Care

December 2-4,1998;
(at Calcutta)

Dr. A.N. Chowdhury, Prof, and Head, Department
of Psychiatry, Institute of Postgraduate Medical
Education and Research, Calcutta-700025.

Seminar on Responsiveness in Pulmonary Tuberculosis Clinical Relevance

December 12,1998;
(at Chandigarh)

Dr. S.K. Jindal, Head, Department of Pulmonary
Medicine, Postgraduate Institute of Medical
Education and Research, Chandigarh-160012.

XXVIII Annual Conference of the Endocrine Society of
India

December 14-16, 1998;
(at Varanasi)'

Dr. S.K. Singh, Organizing Secretary of the Con­
ference, Department of Endocrinology, Institute of
Medical Sciences, Banaras Hindu University,
Varanasi-221005.

XXXI Annual Conference of the Indian Pharmacological
Society

December 17-20,1998;
(at Lucknow)

Dr. V.N. Puri, Organisng Secretary of the Confer­
ence, Division of Pharmacology, Central Drug
Research Institute, Lucknow-226001.

V International Symposium on Biochemical Roles of
Eukaryotic Cell Surface Macromolecules

January 4-8. 1999;
(at Bangalore)

Dr. A. Surolia, Convener of the Symposium.
Molecular Biophysics Unit, Indian Institute of
Science, Bangalore-560012.

National Symposium on Biological Control of Insects in
Agriculture, Forestry, Medicine and Veterinary Science

January 21-22,1999;
(at Coimbatore)

Dr. K. Murugan. Organising Secretary of the
Symposium, Division of Entomology, Department
of Zoology. Bharathiar University. Coimbatore641046.

Vll Annual Meeting of Molecular Immunology Forum 1999

February 13-15,1999;
(at Hyderabad)

Dr. Ashok Khar, Convener of the Meeting, Centre
for Cellular and Molecular Biology, Hyderabad500007.

i

114

COUNCIL’S TRAINING PROGRAMMES
Leprosy

•

At the Central JALMA Institute for Leprosy, Agra:

•

Multidrug Therapy Orientation Course in Leprosy for
Medical Officers (October 26-November 6; and
December 7-18, 1998).

Occupational Health
At the National Institute of Occupational Health,
Ahmedabad:

•

Reproductive Biology

At the Institute for Research in Reproduction, Mumbai:
•

Workshop on Andrology for Clinicians (November 1630, 1998)

Postgraduate Certificate Course in Nutrition
(December 1, 1998-February 28, 1999).

Training Course on Environmental Hygiene Practice
(November 16-20,1998).

Biomedical Statistics
At the Institutefor Research in Medical Statistics, Chennai:

Nutrition

•

At the National Institute of Nutrition, Hyderabad:

Basic Course in Statistics for Medical Officers
(November 3 O-December 6, 1998).

ICMR PUBLICATIONS
Price(Rs.)

Nutritive Value of Indian Foods (1985) by C. Gopalan, B.V. Rama Sastri and S.C. Balasubramanian,
Revised and Updated (1989) by B.S. Narasinga Rao, Y.G. Deosthale and K.C. Pant (Reprinted 1996)

23.00

Growth and Physical Development of Indian Infants and Children (1972, Reprinted 1989)

10.00

Studies on Weaning and Supplementary Foods (1974, Reprinted 1996)

15.00

A Manual of Nutrition (Second Edition 1974, Reprinted 1995)

6.00

Low Cost Nutritious Supplements (Second Edition 1975, Reprinted 1996)

5.00

Menus for Low-Cost Balanced Diets and School-Lunch Programmes Suitable for North India
(Second Edition 1977, Reprinted 1994)

4.50

Menus for Low-Cost Balanced Diets and School-Lunch Programmes Suitable for South India
(Fourth Edition 1996)

6.00

Some Common Indian Recipes and their Nutritive Value (Fourth Edition 1977, Reprinted 1995)
by Swaran Pasricha and L.M. Rebello

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Nutrition for Mother and Child (Fourth Edition 1994, Reprinted 1996) by P.S. Venkatachalam and
L.M. Rebello

11.00

Japanese Encephalitis in India (Revised Edition 1980)

5.00

Some Therapeutic Diets (Fifth Edition 1996) by Swaran Pasricha

7.00

Nutrient Requirements and Recommended Dietary Allowances for Indians (1990,Reprinted 1995)

16.00
115

Fruits (Second Edition 1996) by Indira Gopalan and M. Mohan Ram

20.00

Count What You Eat (1989, Reprinted 1997) by Swaran Pasricha

15.00

•The Anophelines of India (Revised Edition 1984) by T.Ramachandra Rao

150.00

Depressive Disease (1986) by A. Venkoba Rao

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•Medicinal Plants of India Vol.2 (1987)

136.00

Diet and Diabetes (Second Edition 1993, Reprinted 1997) by*T.C. Raghuram,Swaran Pasricha and
R.D. Sharma

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Dietary Tips for the Elderly (1992, Reprinted 1997) by Swaran Pasricha and B.V.S. Thimmayamma

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Diet and Heart Disease( 1994,Reprinted 1995) by Ghafoorunissa and Kamala Krishnaswamy

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Dietary Guidelines for Indians - A Manual (1998)

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ihnr

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ami awr

1974,

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(1997)

* 25 per cent discount allowed to individuals

These publications are available on prepayment of cost by cheque, bank draft or postal order (bank and postal charges will
be extra) in favour of the Director-General, Indian Council of Medical Research, New Delhi. Money orders are not acceptable.
All correspondence in this regard should be addressed to the Chief, Division of Publication and Information, Indian Council
of Medical Research, Post Box No.4911, Ansari Nagar, New Delhi-110029 (India).

EDITORIAL BOARD
Members
Dr. Padam Singh
Dr. Lalit Kant
Dr. Bela Shah
Dr. R. Ravi
Dr. V. Muthuswamy

Chairman
Dr. N.K. Ganguly
Director-General

Editor
Dr. N. Medappa

Printed and Published by Shri J.N. Mathur for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110 029
R.N. 21813/71

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