https://orcid.org/0000-0001-6674-6401
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ABSTRACT
Background
Seasonal Hyperacute Panuveitis (SHAPU) is an eye disease of unclear aetiology occurring cyclically during the autumn in odd years in Nepal causing blindness within a week. This study is the first of its type to investigate the risk factors of SHAPU.
Methods
A multicentric national level case–control study was performed during the 2017 SHAPU outbreak. Cases were matched to controls in a 1:3 ratio based on age, sex and geographic area.
Questionnaire-based personal interview was used and risk factors were categorized as biological and behavioral. For univariate analysis, frequency, median and interquartile range was calculated. Chi-squared test with/without continuity correction and Fisher’s exact test were used. Multivariate conditional logistic regressions were used for all the independent variables for p <0.1 in the univariate analyses.
Results
We identified 35 cases and 105 controls; 71.4% were children≤16 years (38-day infant to 50-year-old). All were immunocompetent individuals, males were 57.1% and females 42.9%. Potential risks such as visible moths/butterfly activity, contact with livestock, and attending mass gatherings of people were not reported more frequently in cases vs controls in univariate analyses. Differences in possibly protective factors such as self-reported mosquito net use, light off at night while sleeping, and habit of hands/face washing after physical contact/touch with any insects/butterflies/birds were not statistically significant between both groups. In multivariate model, SHAPU cases were significantly more likely than controls to report physical contact with butterflies/white moths (Adjusted OR:6.89; CI:2.79–17.01,p < .001).
Conclusions
Direct physical contact with butterflies/moths was associated with significantly increased odds of SHAPU cases.
Abbreviations
| BPKLCOS | = | B.P. Koirala Lions’ Centre for Ophthalmic Studies |
| CHEERS | = | Hospital for Children, Eye, ENT and Rehabilitation ServicesEDCD - Epidemiology and Disease Control Division |
| HEH | = | Himalaya Eye Hospital |
| NHRC | = | Nepal Health Research Council |
| SHAPU | = | Seasonal Hyperacute Panuveitis |
| TIO | = | Tilganga Institute of Ophthalmology |
| WEDS | = | WHO Emergency District Support |
Acknowledgments
We are grateful to Dr Bibek Kumar Lal and the entire Epidemiology and Disease Control Division Nepal for granting permission to conduct this study in the involved districts.
We would like to deeply acknowledge Dr. Rajan Rayamajhi from WHO Nepal countryside office for all the efforts and hardwork undertaken to conduct this study. We are also grateful to the WHO Emergency Officers for contributing in the data collection and quality control.
This study would not have been complete without the continuous efforts of Mr. Bijay Khatri, Mr. Rajan Shrestha and Mr. Janak Raj Bhattarai from BP Eye Foundation – Hospital for Children, Eye ENT and Rehabilitation Services who were thoroughly involved in data collection, data entry, analysis and dissemination program.
We are highly obliged to L. Jeyaseelan, Professor and Head of Biostatistics at Christian Medical College CMC, Vellore and Ambily Nadaraj from Vellore for their support in data analysis and interpretation of our study.
We are also grateful to Dr. Anadi Khatri for his constant suggestions in planning and cases management. Finally, we would like to extend our gratitude to Mr. Suresh Sharma for photographic documentation of all SHAPU cases.
Authors’ contributions
MPU and RKS designed the study, SNJ, AM, PK, HG, IM, RKS were involved in evaluating and managing the case.MPU, RKS, EWG, BRK and AM were involved in report writing and data analysis. MPU, SNJ, BRK and EWG are involved in critical analysis and review of manuscript. RKS, EWG were involved in drafting the manuscript. All authors have read the manuscript carefully and approved its submission.
Availability of data and material
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Consent for publication
Obtained.
Competing interests
The authors declare that they have no competing interests.
Ethics approval and consent to participate
Ethical approval for the study was obtained from the Nepal Health Research Centre (NHRC) and consent to participate was obtained from all the cases and controls.