Efforts upped for tracing AY.4.2 Covid strain, boosting vaccination

INSACOG expanded, ASHA workers doing man to man surveys, tracking and tracing on

Amid concerns about the AY.4.2 mutation, a sub-lineage of the AY.4 (Delta) variant, chief of India’s immunisation strategy group N K Arora says that efforts are being upped not only to track and trace new cases of infections and variants, but also have a ‘man-to-man marking’ at the ground level to ensure each unvaccinated individual gets a Covid-19 jab.

Arora, chief of National Technical Advisory Group on Immunisation in India (NTAGI) and also member of the India SARS-CoV-2 Genome Consortium (INSACOG) said that the number of institutions who are a part of INSACOG, the body that tracks emergence of new variants, has been further expanded.  INSACOG is a multi-laboratory, multi-agency, pan-India network to monitor genomic variations in the SARS-CoV-2 by a sentinel sequencing effort.

“A few more institutions were added last week. INSACOG is doing regular surveillance of the Sars-Cov-2 virus in circulation to pre-empt any new mutation,” Arora told Business Standard.

He added that the NTAGI, INSACOG, Health Ministry and the Indian Council of Medical Research, are working together to spot any sudden outburst or upsurge of cases in a particular city or region. “Then we go into investigation – is it because of festivities, social issues, is it because of a new variant, or some new migrants have come. We make a diagnostic assessment. The appropriate action is taken to contain the spread of infection in that area,” Arora said. The network is working to pick up any variant of interest (VoI), variant of concern (VoC) or variant of unknown or uncertain significance (VUS), he said.

What’s more, India plans to take a Polio campaign-like approach to Covid19 vaccination to ensure universal coverage within a stipulated time.

“We have to pull the remaining 18 crore people and give them the vaccine shots. We are taking a ground-up approach. The ASHA workers have prepared lists of people in their villages who have missed their jabs, or are due for their second dose. If I want to know exactly where these 18 crore people are, we can pull out a list instantly through our ground-level healthcare workers,” Arora said.

The feedback from the ASHA workers on what kind of challenges they face on the ground are being given to the government, he adds. “It is like a strategy used in football – man to man marking. We have to cover every individual. We have already done this in the Khasi Hills in the North East, Bareilly in Uttar Pradesh, Palwal (in Haryana) to name a few,” Arora explains.

Is a celebrity led campaign planned on the lines of the Polio campaign to raise awareness levels? Arora says that would not be necessary as Covid19 is already getting wide media coverage. A ground-up approach may be more effective, he feels.

Union Health Minister Mansukh Mandaviya has recently said that the health ministry will soon launch a "Har Ghar Dastak" campaign in the poor performing districts to enthuse and motivate people towards full Covid vaccination.

Tracking and testing of Delta and Delta Plus variants are being done. INSACOG has said in its latest bulletin that Delta (B.1.617.2 and AY.x) continues to be the main VOC in India. No new VOI or VOC are noted in India. It has also noted that AY.4.2 is 'very infrequent' in India as of now.

“Most sequences from India that are being classified by PANGO as AY.4.2 have only either Y145H or A222V in Spike, not both mutations appearing together,” the INSACOG said. Pangolin was developed to implement the dynamic nomenclature of SARS-CoV-2 lineages, known as the Pango nomenclature.

This mutation has been found to cause infections in the UK, and India so far around 20 confirmed cases have been reported.

“We are also keeping a close watch on any sudden spike in any region. The spike in Kerala, North-East – around 43 districts – was due to pockets of un-immunised population,” Arora says.

Status of immunisation and virus in circulation are important factors in determining strategy.

“I look at three things when investigating – what is the status of immunisation, which virus is circulating, have any variants come through migration,” he adds.

• ASHA workers preparing lists to track people left out from vaccination

• New institutions added to existing 28 labs in INSACOG

• Door-to-door campaigns planned

• AY.4.2 not a Variant of Concern in India yet

• AY.4.2 very infrequent in India