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 The Division of Communicable Diseases of Indian Council of Medical Research (ICMR) has listed important pathogens causing critical infectious syndromes in India to guide patient management, public health policies, and biomedical research and development (R&D).
This will help and guide in syndromic surveillance of infectious diseases and identify priority pathogens to be tested in Indian clinical settings.
The laboratory testing algorithms for infectious diseases currently followed in India are varied, institute/region-specific, and largely directed towards individual diseases with sequential testing. There is also limited availability of scientific literature on countrywide prevalence and trends of pathogens to guide India-specific surveillance and testing policies. Consequently, pathogen testing in clinical microbiology laboratories differs as per institutional requirements and available laboratory resources, often missing out on common/critical pathogens, thereby hampering patient care and aggravating public health problems such as antimicrobial resistance.
The priority pathogen lists have been developed in consultation with eminent clinicians, laboratory experts, and epidemiologists from across the country over a series of 44 meetings. Working groups of subject experts have conducted extensive review of literature from India and other similar settings, and drawn on their individual experiences to draft syndrome-wise lists of priority pathogens based on their prevalence, trends, outbreak potential, disease elimination targets, and availability of diagnostics/therapeutics. These lists have been reviewed, edited and approved by eminent review committee members.
This document lists priority pathogens causing acute febrile illness (including acute undifferentiated fever, fever with rash, fever with lymphadenopathy), acute encephalitis syndrome, acute respiratory illness, and acute diarrhoeal disease, and is intended to guide medical practitioners, laboratory experts, epidemiologists and policymakers on the diagnostic and surveillance approaches for these syndromes. These lists are also meant to guide indigenous industry partners for development of customized India-specific cost-effective medical countermeasures of public health importance.
The pathogens are listed in a graded approach, from commonly encountered microbes to rare/exotic/high-risk pathogens.
Priority 1A lists commonly detected pathogens in clinical settings that are crucial to diagnose before initiating treatment. Priority 1B lists other commonly detected pathogens in clinical settings. Priority 2 lists fewer common pathogens found in clinical settings. Priority 3 lists rare pathogens, which may not be detected in routine clinical settings and may be detected during specialized laboratory testing as a part of surveillance.
These pathogens include Dengue virus, Salmonella Paratyphi A, B, Orientia tsutsugamushi, influenza virus (influenza A (H1N1), A(H3N2), influenza B), chikungunya virus, Chandipura virus, Zika virus, Kyasanur forest disease virus, Enteroviruses including Coxsackieviruses, human herpesvirus, hantavirus, ebola virus, marburg virus, yellow fever virus, Langya henipavirus and rift valley fever among others.
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