Coronavirus Vaccine Updates: What Is A Human Challenge Trial And Can It Speed Up COVID-19 Vaccine Development?

Coronavirus Vaccine Updates: What Is A Human Challenge Trial And Can It Speed Up COVID-19 Vaccine Development?

Human Challenge Trial is regarded by some as a faster way to develop a vaccine but, according to experts, in case of a contagious disease such as COVID-19, this method comes with big risks as it involves deliberately infecting younger and healthier volunteers
Coronavirus Vaccine, News
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Coronavirus Vaccine Updates: What Is A Human Challenge Trial And Can It Speed Up COVID-19 Vaccine Development?According to experts, while human challenge trials can help expedite coronavirus vaccine development to a great extent, deliberately infecting healthy people is unethical, given there is no definitive cure for COVID-19
Highlights
  • Challenge Trials are ideally done where a virus causes mild disease: Expert
  • Some researchers believe challenge trials can help develop vaccine fast
  • Challenge trials are risky as much is still unknown about COVID-19: Experts

New Delhi: As the COVID-19 pandemic continues to rage, pharmaceutical firms and scientists all over the world have been working relentlessly and racing against time to develop a safe vaccine against coronavirus. According to the Centres for Disease Control and Prevention (CDC), the major stages of vaccine development include initial research followed by a series of pre-clinical trials which are mostly done on animals and clinical or human trials consisting of three phases and each of the steps can take two or more years to complete. Vaccine development takes years because the process involves studying and determining for how long the vaccine will provide protection and also observing volunteers for any side-effects, says Dr. KK Agarwal, President, Confederation of Medical Associations in Asia and Oceania (CMAAO). The fastest ever vaccine to be developed is the one for mumps – and even that took four years, he said. However, for countering the COVID-19 pandemic and provide a vaccine at the earliest, the steps involved in vaccine development are being rapidly accelerated. Experts say that ‘Human Challenge Trial’ or deliberately exposing volunteers to the virus during the Phase-3 clinical trials is also a way of accelerating vaccine trials. According to Dr. Chandrakant Lahariya, epidemiologist, vaccinologist, and public health and policy expert based in Delhi, the researchers across the globe are currently divided on the matter of considering this method of studying the performance of a vaccine candidate for COVID-19.

Also Read: Millions Of COVID-19 Cases Went Undetected In India, Research Paper Estimates

On July 15, 153 academics, doctors, epidemiologists, and scientists wrote an open letter to health regulatory bodies in the U.S. like CDC, National Institutes of Health, the Coronavirus Task Force, the Department of Health and Human Services, the Food and Drug Administration and international bodies like the World Health Organisation (WHO) asking for human challenge trials to address the urgent need for a vaccine to curb the pandemic. They wrote in the letter,

If challenge trials can safely and effectively speed the vaccine the development process, there is a formidable presumption in favour of their use, which would require a very compelling ethical justification to overcome.

What Are Human Challenge Trials?

According to Satyajit Rath, an immunologist and specialist in infections and diseases with the Indian Institute of Science Education and Research (IISER), Pune, in human challenge trials, volunteers are deliberately infected with the virus causing disease to test whether a vaccine provides enough protection. Human challenge trials or Human infectious microbial challenge studies, also referred to as the ‘Controlled Human Infection Model” or CHIM studies, are different from the standard late-stage vaccine trials where the developers have to wait for people to be exposed to an illness naturally, he said. Mr. Rath further added,

Mostly, the challenge trials are intended to provide well-controlled human infection situations for analysis, where the type, dose, route of intake, and time of infection are well known which is not likely to be the case in actual, naturally occurring infections. So, typically, researchers will deliberately give infections to healthy people, and follow various study parameters like the course of the infection and immune responses, and/or the effects of various drugs/medications, or vaccine.

Also Read: Serum Institute To Resume COVID-19 Vaccine Trials In India After Nod From Drugs Controller General Of India

Could Human Challenge Trials Be Used To Speed Up The Process Of COVID-19 Vaccine Development?

According to Dr. Aggarwal, challenge trials have improved vaccine development for seasonal flu, cholera, among other diseases and there is now an increasing discussion that preparations should begin for COVID-19 challenge trials in case needed. He added that in July, the team behind the Oxford COVID-19 proposed to start human challenge trials by the end of the year and Professor Adrian Hill of Oxford University, that is developing a vaccine candidate with pharmaceutical company AstraZeneca, has said that challenge trials may be done in parallel with Phase-3 trials or after these trials are completed.

During an online discussion organised by Indian Council of Medical Research (ICMR) on July 30, Professor Adrian Hill of Oxford University, reiterated,

There are multiple therapies in use now to consider both challenge trials as well as randomised control trials to get quicker results, and that these had been conducted for other viruses like malaria and cholera without any issues.

During the same discussion, other experts like Dr Anthony S Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), US, expressed concerns over conducting ‘human challenge trials’ to accelerate vaccine development for COVID-19. He said,

Purposely exposing someone to the coronavirus is unnecessary and unethical in the case of a disease for which we have no proven cure yet.

The WHO has also acknowledged that challenge trials will accelerate the process and help in increasing the likelihood that the most effective candidate vaccines will ultimately become available, validate tests of immunity, and improve knowledge about SARS-CoV-2 infection and transmission. In its guidance document on criteria for conducting challenge clinical trials and providing clinical care for the participants, WHO says,

Well designed human challenge studies provide one of the most efficient and scientifically powerful means for testing vaccines, especially because animal models are not adequately generalizable to humans. SARS-CoV-2 challenge studies could add value to other types of vaccine research by enabling (a) accurate assessment of asymptomatic infection, (b) more rapid and standardized testing of multiple vaccine candidates, and (c) testing vaccines in contexts where there is little continuing transmission (for example, due to public health measures or during inter-epidemic periods).

Also Read: Three COVID-19 Vaccines At Clinical Trial Stage In India: Indian Council of Medical Research

WHO further says that SARS-CoV-2 challenge studies should be conducted in specialized facilities, with especially close monitoring and ready access to early supportive treatment for participants, including critical care if required.

Dr. Paul Offit, an American Pediatrician and specialist in infectious diseases, vaccine, immunology and virology, however, said that challenge trials are not needed in case of COVID-19 as the natural infection is already widely present across the globe. He further added,

Human challenge trials don’t exactly mimic the real infection because when you are out there in the real world, you may get exposed to different quantities of virus. Sometimes you may get exposed to a large quantity of virus that may make you sicker as compared to a smaller quantity of virus.

Ethical Concerns Regarding The Use Of Human Challenge Trials For COVID-19 Vaccine Development

According to Mr. Rath, there are major ethical difficulties in any SARS-CoV-2 human challenge trial study. This is because challenge studies are ideally done in situations where the disease caused is expected to be mild and where the infection can be quickly treated and eliminated if the need arises. However, in the case of COVID-19, there is no definitive cure which means that even the young and healthy people who are considered low-risk can become very ill and some could even die. Along with this, as much is still unknown about the SARS-CoV-2, there is not much clarity about the long-term effect of the infection on humans and so deliberately infecting anyone would pose an ethical difficulty, said Mr. Rath.

Dr. Lahariya said that it will be upto the countries to decide whether they would take this route and device regulations regarding it.

WHO’s guidance document says that an important principle in human challenge studies is that subjects must give their informed consent in order to take part. This means they should be provided with all the relevant information about the risk they are considering. However, Mr. Rath says,

As of now, informed consent is not possible because there is a lot to be learnt about the disease like potential long-term implications of it since it is such a new disease. This means that no volunteer is able to give true informed consent.

Also Read: Scientists Predict That COVID-19 Will Become A Seasonal Virus – But Not Yet

According to an official of the Ministry of Health and Family Welfare human challenge trials are not being considered for any of the vaccine candidate being developed in the country. He said,

Sure, there are scientists debating the usefulness and the risks involved in challenge trials but India is not considering it as of now. All of our vaccine candidates are currently undergoing Phase 1 or Phase 2 of clinical trials while human challenge trials take place in Phase 3. Also, there is already enough infection out there and many volunteers who are ready to participate. It is highly unlikely that we take the challenge trial route.

Talking about if there is any risk of using monetary rewards as motivation to bring in participation for trials, the official said,

We have highly elaborate regulations for vaccines trials. While volunteers can be given a little compensation for the time that they divert from their daily work/routine to the trials and thus helping in vaccine development but it is never given as a way for earning money.

Also Read: ‘Excellent Safety’ Of Two Indigenous COVID Candidate Vaccines Revealed During Phase-I Trials: Minister

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

World

3,22,27,134Cases
90,11,771Active
2,22,32,414Recovered
9,82,949Deaths
Coronavirus has spread to 188 countries. The total confirmed cases worldwide are 3,22,27,134 and 9,82,949 have died; 90,11,771 are active cases and 2,22,32,414 have recovered as on September 25, 2020 at 3:43 am.

India

58,18,570 86052Cases
9,70,116 3734Active
47,56,164 81177Recovered
92,290 1141Deaths
In India, there are 58,18,570 confirmed cases including 92,290 deaths. The number of active cases is 9,70,116 and 47,56,164 have recovered as on September 25, 2020 at 2:30 am.

State & District Details

State Cases Active Recovered Deaths
DistrictCases
Akola757
Aurangabad1974
Dhule228
Jalgaon1039
Mumbai45478
Mumbai Suburban5363
Nagpur692
Nashik1575
Palghar1421
Pune9920
Satara629
Solapur1291
Thane13660
Yavatmal150
Ahmednagar190
Amravati291
Beed54
Bhandara41
Buldhana88
Chandrapur32
Hingoli208
Jalna201
Kolhapur646
Latur139
Nanded176
Nandurbar42
Parbhani78
Raigad1462
Ratnagiri350
Sangli145
Gadchiroli42
gondia69
Osmanabad125
Sindhudurg114
Wardha11
Washim13

1282963 19164

275404 1521

973214 17184

34345 459

DistrictCases
Chittoor319
Guntur511
Krishna557
Kurnool795
Sri Potti Sriramulu Nell*296
Anantapur428
East Godavari356
Prakasam104
Srikakulam183
Visakhapatnam103
West Godavari199
Y.S.R.205
Vizianagaram23

654385 7855

69353

579474 8807

5558 52

DistrictCases
Bengaluru Rural40
Bengaluru Urban529
Mysuru107
Bagalkote103
Ballari60
Belagavi337
Bidar219
Chikkaballapura149
Dakshina Kannada179
Dharwad61
Gadag45
Kalaburagi669
Mandya346
Tumakuru36
Uttara Kannada95
Vijayapura201
Chamarajanagara0
Chikkamagaluru19
Chitradurga14
Davangere204
Hassan205
Haveri24
Kodagu4
Kolar29
Koppal5
Raichur369
Ramanagara3
Shivamogga67
Udupi1176
Yadgir538

548557 7710

95568 897

444658 6748

8331 65

DistrictCases
North Goa57
South Goa69

30552 673

5822 176

24347 490

383 7

DistrictCases
Chengalpattu1314
Chennai23324
Kanchipuram503
Madurai322
Namakkal83
Ranipet133
Thanjavur130
Thiruvallur774
Thiruvarur67
Tiruppur116
Vellore71
Virudhunagar185
Ariyalur444
Coimbatore188
Cuddalore477
Dharmapuri15
Dindigul175
Erode75
Kallakurichi324
Kanniyakumari110
Karur88
Nagapattinam99
Perambalur133
Pudukkottai53
Ramanathapuram119
Salem258
Sivaganga46
Tenkasi103
The Nilgiris17
Theni129
Tiruchirappalli119
Tirunelveli433
Tirupathur45
Tiruvannamalai496
Tuticorin333
Villupuram509
Krishnagiri43

563691 5692

46405 156

508210 5470

9076 66

DistrictCases
Kannur357
Kottayam73
Alappuzha76
Idukki40
Kasaragod333
Kollam118
Kozhikode90
Malappuram119
Palakkad224
Pathanamthitta98
Thiruvananthapuram104
Thrissur106
Ernakulam60
Wayanad36

154456 6324

45993 3135

107850 3168

613 21

DistrictCases
Raipur46
Korba100
Balod41
Baloda Bazar85
Balrampur17
Bastar2
Bemetara21
Bijapur2
Bilaspur100
Dantewada0
Dhamtari6
Durg31
Gariyaband10
Janjgir-Champa56
Jashpur77
Kabirdham52
Kanker19
Kondagaon0
Korea39
Mahasamund54
Mungeli87
Narayanpur0
Raigarh47
Rajnandgaon52
Sukma0
Surajpur9
Surguja14

95623 2272

36038 188

58833 2060

752 24

DistrictCases
Hyderabad2475
MedchalMalkajgiri75
Ranga Reddy183
Suryapet87
Vikarabad40
Warangal Urban32
Adilabad22
Jagitial77
Jangoan8
Jayashankar Bhupalapally9
Jogulamba Gadwal40
Kamareddy11
Karimnagar17
Khammam26
Kumuram Bheem Asifabad8
Mahabubnagar30
Mancherial43
Medak11
Nalgonda33
Narayanpet3
Nirmal21
Nizamabad76
RajannaSircilla16
Sangareddy26
Bhadradri Kothagudem5
Mahabubabad10
Mulugu3
Nagarkurnool8
Peddapalli5
Siddipet7
Wanaparthy1
Warangal Rural4
YadadriBhuvanagiri40

181627 2381

30387 350

150160 2021

1080 10

DistrictCases
Baleshwar190
Bhadrak137
Jajapur322
Dhenkanal36
Kalahandi33
Kendrapara164
Khordha238
Koraput16
Sundargarh102
Anugul26
Balangir129
Bargarh16
Boudh34
Cuttack155
Deogarh33
Gajapati61
Ganjam581
Jagatsinghapur91
Jharsuguda8
Kandhamal28
Kendujhar34
Malkangiri20
Mayurbhanj73
Nabarangpur2
Nayagarh86
Nuapada69
Puri103
Rayagada2
Sambalpur16
Sonepur29

196888 4340

35092 545

161044 3779

752 16

DistrictCases
Barwani60
Bhopal1880
Dewas140
Dhar132
East Nimar266
Gwalior211
Indore3839
Jabalpur276
Ujjain799
Agar Malwa15
Alirajpur3
Betul35
Burhanpur351
Chhindwara16
Dindori29
Harda4
Hoshangabad37
Khargone196
Mandsaur112
Morena109
Raisen71
Ratlam51
Sagar228
Shajapur39
Shandol14
Sheopur26
Tikamgarh18
Vidisha37
Anuppur22
Ashoknagar13
Balaghat9
Bhind87
Chhatarpur35
Damoh26
Datia12
Guna8
Jhabua14
Katni3
Mandla15
Narsinghpur17
Neemuch319
Niwari0
Panna20
Rajgarh31
Rewa39
Satna24
Sehore12
Seoni2
Shivpuri15
Sidhi17
Singrauli13
Umaria10

115361 2304

22744

90495 2327

2122 45

DistrictCases
Ahmadabad17125
Anand107
Arvalli134
Banas Kantha147
Bhavnagar146
Gandhinagar410
PanchMahals107
Surat2311
Vadodara1555
Bharuch56
Botad55
Chhotaudepur37
Dang5
Dohad43
GirSomnath45
Jamnagar63
Kachchh99
Kheda98
Mahesana159
Mahisagar125
Narmada25
Naysari35
Patan105
Rajkot135
SabarKantha101
Surendranagar55
Tapi6
Valsad47
Amreli16
DevbhumiDwarka22
Junagadh31
Morbi4
Porbandar11

128787 1408

16327

109079 1505

3381 14

DistrictCases
Ajmer379
Banswara91
Bharatpur563
Jaipur2177
Jhalawar329
Jodhpur1748
Kota503
Nagaur500
Alwar90
Barmer34
Bhilwara250
Bikaner112
Chittorgarh188
Churu81
Dausa61
Dholpur60
Dungarpur374
Hanumangarh31
Jaisalmer53
Jhunjhunu64
Karauli17
Pali352
Rajsamand140
SawaiMadhopur26
Sikar231
Tonk171
Udaipur724
Baran59
Bundi5
Ganganagar8
Jalore164
Pratapgarh14
Sirohi130

122720 1981

18993 1

102330 1965

1397 15

DistrictCases
Faridabad867
Sonipat404
Ambala93
Bhiwani60
CharkiDadri43
Fatehabad38
Gurugram2950
Hisar98
Jhajjar114
Jind38
Kaithal48
Karnal104
Kurukshetra55
Nuh68
Palwal120
Panchkula39
Panipat78
Rohtak145
Sirsa50
Yamunanagar19
Mahendragarh47
Rewari56

118554 1698

18889

98410 2063

1255 22

DistrictCases
Agra933
Aligarh215
Amroha80
Bareilly17
Bijnor157
Bulandshahr166
Firozabad190
Gautam Buddha Nagar1119
Kanpur Nagar286
Lucknow386
Mathura129
Meerut504
Moradabad252
Muzaffarnagar117
Rae Bareli78
Rampur203
Saharanpur298
Sant Kabeer Nagar132
Varanasi243
Auraiya37
Ayodhya120
Azamgarh138
Baghpat68
Bahraich73
Balrampur49
Banda27
Basti214
Bhadohi60
Budaun23
Etah52
Etawah46
Ghaziabad794
Ghazipur159
Gonda59
Gorakhpur166
Hapur225
Hardoi49
Jalaun41
Jaunpur194
Jhansi41
Kannauj69
Kasganj16
Kaushambi6
Mainpuri46
Mau48
Mirzapur22
Pilibhit15
Pratapgarh15
Prayagraj30
Sambhal116
Shamli40
Shravasti23
Sitapur32
Sultanpur97
Unnao42
Ambedkar Nagar92
Amethi206
Ballia60
Barabanki168
Chandauli38
Chitrakoot4
Deoria143
Farrukhabad36
Fatehpur3
Hamirpur3
Hathras43
Kanpur Dehat4
Kheri72
Kushi Nagar67
Lalitpur3
Maharajganj85
Mahoba3
Shahjahanpur25
Siddharth Nagar159
Sonbhadra10

374277 4591

61300

307611 4922

5366 67

DistrictCases
Central4817
East2472
New Delhi3405
North3059
North East1914
North West5463
Shahdara1580
South2329
South East2446
South West2391
West4768

260623 3834

31125 289

224375 3509

5123 36

DistrictCases
Dhubri30
Goalpara19
Marigaon50
Baksa14
Barpeta28
Biswanath16
Bongaigaon12
Cachar80
Charaideo29
Chirang6
Darrang20
Dhemaji47
Dibrugarh61
Dima Hasao86
Golaghat203
Hailakandi57
Hojai89
Jorhat24
Kamrup42
Kamrup Metro276
KarbiAnglong13
Karimganj85
Kokrajhar37
Lakhimpur57
Majuli2
Nagaon143
Nalbari23
Sivasagar20
Sonitpur27
South SalmaraMancachar4
Tinsukia84
Udalguri28
West KarbiAnglong5

165582 2091

29830

135144 2432

608 11

DistrictCases
East District3
North District0
South District3
West District0

2692 64

607 32

2054 31

31 1

DistrictCases
Buxar134
Gaya115
Munger188
Patna279
Rohtas256
Arwal52
Aurangabad75
Banka134
Begusarai243
Bhagalpur266
Bhojpur103
Darbhanga143
Gopalganj123
Jehanabad178
Kaimur (bhabua)105
Lakhisarai72
Madhepura82
Madhubani199
Nalanda123
Nawada122
PurbiChamparan138
Purnia135
Saran101
Siwan139
Vaishali87
Araria68
Jamui47
Katihar175
Khagaria253
Kishanganj75
Muzaffarpur96
Pashchim Champaran57
Saharsa88
Samastipur139
Sheikhpura118
Sheohar20
Sitamarhi73
Supaul87

174071 1217

13015 57

160178 1156

878 4

DistrictCases
24 Paraganas North1031
24 Paraganas South281
Darjeeling97
Howrah1435
Jalpaiguri88
Kalimpong18
Kolkata2777
Maldah235
Medinipur East153
Medinipur West159
Hooghly604
Murshidabad125
Nadia139
Paschim Bardhaman70
Purba Bardhaman130
Alipurduar39
Bankura116
Birbhum206
Coochbehar210
Dinajpur Dakshin50
Dinajpur Uttar216
Jhargram9
Purulia66

237869 3196

25221 120

208042 3014

4606 62

DistrictCases
South Andamans33
Nicobars1
North And Middle Andaman1

3744 32

189 23

3503 9

52

DistrictCases
Pondicherry111
Karaikal2
Mahe4
Yanam0

24895 668

5097 244

19311 418

487 6

DistrictCases
Anjaw0
Changlang31
Dibang Valley0
East Kameng0
East Siang1
Kamle0
KraDaadi0
KurungKumey0
Leparada0
Lohit3
Longding0
Lower Dibang Valley0
Lower Siang0
Lower Subansiri0
Namsai2
PakkeKessang1
Papum Pare8
Shi Yomi0
Siang0
Tawang1
Tirap0
Upper Siang1
Upper Subansiri0
West Kameng0
West Siang1

8416 283

2331 115

6071 168

14

DistrictCases
Dimapur20
Kiphire3
Kohima7
Longleng0
Mokokchung0
Mon8
Peren2
Phek1
Tuensang3
Wokha0
Zunheboto0

5730 59

1088

4626 90

16

DistrictCases
Dadra And Nagar Haveli20

2977 15

190

2785 30

2

DistrictCases
Ranchi148
Bokaro16
Deoghar5
Dhanbad32
Garhwa80
Giridih19
Hazaribagh110
Jamtara2
Koderma58
Simdega48
Chatra1
Dumka5
East Singhbum170
Godda2
Gumla28
Khunti10
Latehar14
Lohardaga8
Pakur4
Palamu27
Ramgarh75
Sahebganj0
SaraikelaKharsawan20
West Singhbhum21

76438 1349

12841

62945 1386

652 4

DistrictCases
Gomati74
North Tripura14
Dhalai196
Khowai24
Sepahijala174
South Tripura53
Unakoti49
West Tripura45

24130 341

6378

17487 509

265 5

DistrictCases
Kargil77
LehLadakh43

3969 36

1022

2893 49

54 3

DistrictCases
Anantnag395
Bandipora175
Shopian255
Srinagar300
Baramulla271
Budgam110
Ganderbal37
Jammu138
Kathua53
Kulgam295
Kupwara231
Rajouri39
Ramban151
Reasi26
Samba25
Udhampur155
Mirpur0
Muzaffarabad0
Doda27
Kishtwar10
Poonch35
Pulwama108

68614 1104

19451

48079 1549

1084 22

DistrictCases
Chamba29
Hamirpur117
Kangra105
Sirmaur11
Solan32
Una41
Bilaspur21
Kinnaur2
Kullu4
Lahaul And Spiti0
Mandi21
Shimla10

13386 337

3984 34

9252 293

150 10

DistrictCases
Jalandhar297
Ludhiana293
Patiala132
Amritsar485
Barnala25
Faridkot74
Firozepur50
Gurdaspur154
Hoshiarpur140
Kapurthala44
Mansa31
Moga65
Pathankot86
S.A.S Nagar137
Sangrur107
Shahid Bhagat Singh Nagar (Nawanshahr)99
Sri Muktsar Sahib71
Tarn Taran163
Bathinda60
Fatehgarh Sahib57
Fazilka53
Rupnagar (Ropar)74

105220 1756

20679

81475 2231

3066 76

DistrictCases
Haridwar94
Dehradun370
Nainital323
Almora71
Bageshwar31
Chamoli36
Champawat45
PauriGarhwal36
Pithoragarh43
Rudraprayag30
Tehri Garhwal110
Udam Singh Nagar83
Uttar Kashi24

44404 684

11507

32355 1031

542 13

DistrictCases
Bishnupur7
Chandel5
Churachandpur32
Imphal East10
Imphal West21
Jiribam3
Kakching2
Kamjong5
Kangpokpi26
Noney1
Pherzawl3
Senapati6
Tamenglong2
Tengnoupal9
Thoubal18
Ukhrul4

9537 161

2106

7369 261

62

DistrictCases
Chandigarh313

10968 242

2482

8342 293

144 4

DistrictCases
East Khasi Hills22
East Garo Hills0
East Jaintia Hills0
North Garo Hills1
Ribhoi0
South Garo Hills0
South West Garo Hills4
South West Khasi Hills0
West Garo Hills5
West Jaintia Hills1
West Khasi Hills1

5078 117

1977

3058 199

43 1

DistrictCases
Aizawl10
Champhai0
Hnahthial0
Khawzawl0
Kolasib11
Lawngtlai2
Lunglei2
Mamit8
Saiha0
Saitual1
Serchhip0

1786 73

681 63

1105 10

0

DistrictCases
Lakshadweep District0

0

0

0

0

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