Madan Prasad Upadhyay1, Ranju Kharel Sitaula2, Anu Manandhar3, Emily W Gower4, Pratap Karki2, Haramaya Gurung5, Indraman Maharjan5, Sameul Reuben6, Biraj Man Karmacharya7, Sagun Narayan Joshi2. 1. Professor and HOD Ophthalmology, Tribhuvan University, Chair Emeritus BP Eye Foundation, Children Hospital for Eye ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal. 2. Uveitis Specialist, Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal. 3. Consultant Ophthalmologist, Uveitis SpecialistAssociate Professor, NAMS Tilganga Institute of Ophthalmology, Gaushala, Bagmati Bridge, Kathmandu, Nepal. 4. Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. 5. Consultant Ophthalmologist and retina specialist, Himalayan Eye Hospital, Pokhara, Nepal. 6. WHO Health Emergencies Programme (WHE), WHO Country Office for Nepal. 7. Public Health and Community Programs, Associate Professor, Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
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.
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.
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Keywords:
Hypopyon; Moth; Nepal; SHAPU; White Pupil; vitritis