NATIONAL VECTOR BORNE DISEASES Dr R.
Prahan Kumar
Associate Professor
CONTROL PROGRAM Dept of Community Medicine
INTRODUCTION
➢Vector borne diseases are a major public health problem in India
➢Many vectors including mosquitoes, sandflies, ticks, mites, etc are
contribute to the burden of vector borne diseases
➢Factors facilitating vector borne disease transmission are complex
including ecological, biological, social and economic
NVBDCP- AN INTRODUCTION
➢NVBDCP is a program under the umbrella program of NHM
➢The Directorate of NVBDCP under the DGHS, MOHFW is the
nodal agency responsible for planning, coordination,
implementation, monitoring and evaluation of the program at all
levels
➢Every state has state vector borne diseases control component
under the Directorate of Health Services
DISEASES COVERED UNDER NVBDCP
Malaria
Filariasis
Kala Azar
Japanese Encephalitis
Dengue
Chikungunya
STRATEGY OF NVBDCP
➢Disease management
➢Integrated Vector Management
➢Supportive interventions
DISEASE MANAGEMENT UNDER NVBDCP
➢Early case detection and complete treatment
➢Strengthening of referral services
➢Epidemic preparedness and rapid response
INTEGRATED VECTOR MANAGEMENT
➢Indoor residual spraying in selected high risk areas
➢Use of insecticide treated bed nets
➢Use of larvivorous fishes
➢Anti-larval measures in urban areas
➢Source reduction
➢Minor environmental engineering
SUPPORTIVE INTERVENTIONS
➢Behaviour change communication
➢Public private partnership and intersectoral convergence
➢Human resource development through capacity building
➢Operational research
➢Monitoring and evaluation
➢Web based management information system
MALARIA
➢One of the major public health problem in India
➢The control program for Malaria has evolved since past 70 years when it
was started as National Malaria Control Program in 1953
➢Although there were period when we moved towards elimination, however,
impact of Malaria worsened time and again
➢Some of the milestones include National Malaria Eradication Program
(1958), Enhanced Malaria Control Project (1997), National Anti Malaria
Program (1999), National Vector Borne Disease Control Program (2002).
DEFINITION OF MALARIA ELIMINATION
“Interruption of local transmission (reduction to zero
incidence of indigenous cases) of specified malaria
parasite species in a defined geographical area as a
result of deliberate activities and continued measure to
prevent re-establishment of transmission”
NATIONAL STRATEGIC PLAN (NSP) FOR MALARIA
ELIMINATION (2017-2022)
➢The National Strategic Plan (NSP) for Malaria Elimination (2017-2022) has
been developed based on the National Framework for Malaria Elimination
(NFME) of NVBDCP, MoHFW and WHO’s Global Technical Strategy for
Malaria Elimination (2016-2030).
GOALS OF NSP FOR MALARIA
ELIMINATION
1. Eliminate malaria (zero indigenous cases) by 2022 in all the districts
of 26 States/UTs of existingcategory-1 and2 and in districts having
API <1 of Category-3 states.
2. All remaining districts (having API > 2) to be brought into pre-
elimination and elimination phase; and
3. Maintain malaria-free status in areas where malaria transmission
has been interrupted and prevent re-introduction of malaria by
strengthening surveillance.
CLASSIFICATION OF DISTRICTS FOR MALARIA
ELIMINATION IN INDIA (2015)
Category Definition
Category 0: Prevention of re- Districts/units historically considered to be without
establishment phase local transmission and reporting no case for last 3
year Vigilance will be maintained in these districts
to prevent reintroduction of malaria in view of
climate change (75 districts)
Category 1: Elimination Phase Districts/units having API less than 1 per 1ooo
Population (448 districts)
Category 2: Pre-elimination phase Districts/units having API more than 1, but less than
2 per 1000 population. These are targeted for
elimination in the subsequent years (46 districts)
Category 3: Intensified control phase Districts/units having API 2 and above per 1000
population. These are positioned for elimination
targeting inthe subsequent years (109 districts)
OBJECTIVES OF NATIONAL STRATEGIC PLAN
1) Achieve universal coverage of case detection and treatment services in
endemic districts, to ensure 100% parasitological diagnosis of all malaria
cases and complete treatment of all confirmed cases
2) Strengthen surveillance to detect, notify, investigate, classify and respond
to all cases
3) Achieve near universal coverage of population at risk by vector control
intervention
4) Near universal coverage of population at risk by appropriate BCC
activities
5) Effective program management and coordination at all levels to deliver a
combination of targeted interventions for malaria elimination
STRATEGIES OF NATIONAL STRATEGIC PLAN
1) Diagnosis and Case management
2) Surveillance and Epidemic response
3) Integrated Vector Management
4) Cross-cutting interventions- Advocacy, Communication and community
mobilization, Program management and coordination, Monitoring and
evaluation, Research and development
DIAGNOSIS AND CASE MANAGEMENT
➢Microscopic examination of thick and thin blood smears is the 'Gold Standard’.
Being a skilled procedure, peripheral smear examination is recommended for malaria
diagnosis at the institutional level i.e. PHCs/CHCs/District hospitals etc.
➢Rapid diagnostic tests (RDTs) are recommended for use at the community level i.e
villages/subcentres etc by ASHAs/health workers for passive as well as active case
detection.
➢Thick blood smears are more sensitive for malaria parasite detection because the
concentration of blood is more.
➢Thin smears aid in parasite species identification and quantification.
➢Positive slides should be read for parasite species, parasite stage and estimation of
parasite density.
DIAGNOSIS AND CASE MANAGEMENT
➢Early detection and complete treatment is the policy for case management.
➢"Presumptive treatment" is not recommended and should be reserved for extreme
circumstances only, when there is a strong clinical suspicion accompanied by severe
disease and obtaining prompt parasitological confirmation by microscopy or RDT is
not possible.
➢The Artemisinin-based combination therapy (ACT-AL) is the first line drug for
treatment of uncomplicated P.falciparum malaria as per the revised treatment
guidelines in entire country.
➢Artesunate/Quinine injection is the drug of choice for treatment of severe malaria,
followed by complete oral dose of ACT.
➢Chloroquine remains the drug of choice for treatment of uncomplicated P.vivax
malaria.
SURVEILLANCE AND EPIDEMIC RESPONSE
ln elimination settings, surveillance should comprise of the following specific
objectives:
1. Detection of all malaria infections (symptomatic and asymptomatic) as
early as possible;
2. Prevention of further transmission from each case through early & complete
treatment and vector control measures; and
3. Identification, investigation, classification and management of all
transmission foci with appropriate response to stop transmission as soon as
possible.
OUTBREAK PREPAREDNESS AND RESPONSE
➢In elimination targeted districts, local cases need to be responded
immediately.
➢NBVDCP, in collaboration with NCDC and other stakeholders would develop
'outbreak preparedness and response (OPR) standard operating procedures'
for outbreak identification, alert mechanism and response activities.
➢NVBDCP will collaborate with RRTs (IDSP) working at district and state level
for quick investigation and response.
INTEGRATED VECTOR MANAGEMENT
➢Key components are:
➢Larval source management (LSM)
➢Long lasting insecticidal nets (LLINs)
➢Indoor residual spraying (IRS)
➢Space spray
➢Reducing human-vector contact through Personal Protection
➢Prioritization of vector control
➢Strengthening of Entomological Surveillance
FILARIASIS
➢National Health Policy envisages to achieve and maintain
elimination status of lymphatic filariasis in endemic pockets by
2017
➢Elimination of Lymphatic Filariasis (LF) is defined as cessation
of lymphatic filariasis as a public health problem when the
number of microfilaria carriers in the community is less than
1% and children born after initiation of elimination program
are free from circulating antigenemia.
OBJECTIVES OF FILARIASIS ELIMINATION
PROGRAM
➢To reduce and eliminate transmission of lymphatic filariasis by
Mass Drug Administration of DEC in endemic areas
➢To reduce and prevent morbidity in affected persons
➢To strengthen the existing health care services
STRATEGIES OF FILARIASIS ELIMINATION
PROGRAM
➢Single day mass drug administration annually with DEC and
albendazole
➢Morbidity management
➢Transmission Assessment Survey (TAS)
➢Vector control measures
➢Behavior Change Communication (BCC)
ANNUAL MASS DRUG ADMINISTRATION
➢Annually mass drug administration is to be done with
Diethylcarbamazine citrate (DEC) (6mg/kg body weight) and
albendazole
➢Annual MDA is targeted for all eligible population in endemic
areas for a minimum of 5 years or more aiming at minimum 85%
actual drug compliance
➢Not given for pregnant women, children below 2 years and
seriously ill persons
TRANSMISSION ASSESSMENT SURVEY
(TAS)
➢WHO recommends conduct of TAS in every
implementation unit after minimum of five effective
rounds of MDA with more than 65% coverage
➢TAS is done after a minimum of 6 months after
the last MDA using immunochromatographic test
(ICT) card with finger-tip blood in the field
OTHER STRATEGIES OF FILARIASIS ELIMINATION
PROGRAM
➢Vector control measures are implemented as per the principle of
Integrated Vector Management
➢Behavior change communication focuses on vector control,
compliance to MDA and home-based management of morbidity in
lymphedema patients
KALA-AZAR
➢Elimination of Kala-azar indicates annual incidence of the disease
in less than 1 per 10000 population
➢As per National Health Policy, the target for elimination of Kala-
azar to be achieved by 2017
OBJECTIVES
➢Reducing the incidence of kala-azar in the endemic communities
including the poor, vulnerable, and hard to reach population
➢Reducing case fatality rate due to kala-azar
➢Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) to reduce
the parasite reservoir
➢Prevention and treatment of kala-azar and HIV, TB coinfections
STRATEGIES FOR KALA AZAR ELIMINATION
➢Early diagnosis and complete treatment
➢Integrated vector management including indoor residual spraying
➢Surveillance
➢Capacity building
➢Supervision, monitoring and evaluation of program
EARLY DIAGNOSIS AND COMPLETE TREATMENT
➢Kala-azar is diagnosed using rapid diagnostic kits at PHC and
district hospital level
➢Parasitological diagnosis includes spleen, bone marrow and lymph
node aspiration procedures.
➢PKDL is diagnosed using slit skin biopsy
➢Treatment of VL is single day single dose of 10 mg/kd body
weight of intravenous Liposomal Amphotericin B (LAMB)
➢For PKDL, drug of choice is Miltefosine 100 mg orally per day
for 12 weeks
VECTOR MANAGEMENT FOR KALA AZAR
➢Indoor residual spraying upto a height of 6 feet with 50% DDT at
a dose of 1gm/square meter of wall surface is done twice a year
including complete coverage of cattle sheds in Kala-azar endemic
areas
➢Synthetic pyrethroids are suggested in districts with DDT
resistance
JAPANESE ENCEPHALITIS
➢Japanese encephalitis (JE) presents
as acute encephalitis and is classified
under Acute encephalitis syndrome
(AES)
➢JE is predominantly affects children
and is endemic in some states in India
including Uttar Pradesh, parts of
Tamil Nadu, etc.
OBJECTIVES
➢To strengthen and expand JE vaccination in affected districts
➢To strengthen surveillance, vector control case management
and timely referral of serious and complicated cases.
➢To estimate disability burden due to JE/AES, and to provide
for adequate facilities for physical, medical, neurological and
social rehabilitation
➢To improve nutritional status of children at risk of JE/AES
➢To carry out intensified IEC/BCC activities regarding JE/AES
STRATEGIES
➢Vaccination against JE
➢JE vaccine is being given as part of UIP in endemic states
➢JE/AES surveillance
➢Epidemiological surveillance for AES, entomological surveillance and
veterinary surveillance
➢Case management
➢Vector control
➢Main focus is outdoor space spray with ultra-low volume fogging
➢Information, education and communication
DENGUE AND CHIKUNGUNYA FEVER
➢Due to the transmission by Aedes mosquito, NVBDCP mandates
the same prevention and control strategies for Dengue and
Chikungunya fever
➢Dengue manifests in a wide range of clinical presentation from
mild fever to life threatening Dengue Shock Syndrome
STRATEGIES
➢Early diagnosis and management
➢Epidemiological surveillance
➢Integrated vector management
➢Supportive interventions
EARLY DIAGNOSIS AND TREATMENT
➢Sero-diagnosis of Dengue is the preferred diagnostic method
fulfilling following criteria:
➢Detection of dengue virus RNA
➢Detection of anti-dengue virus IgM
➢Detection of anti-dengue IgG antibody
➢ELISA and RT-PCR are the method of diagnosis for Chikungunya
fever
SURVEILLANCE OF DENGUE FEVER
➢Epidemiological surveillance
➢Laboratory surveillance
➢Entomological surveillance
INDICATORS FOR VECTOR SURVEILLANCE
➢Larval surveys
➢House Index (HI)
➢Container Index (CI)
➢Breteau index (BI)
➢Aedes aegypti index
➢Pupae surveys
INDICATORS FOR VECTOR SURVEILLANCE
➢House index (HI): Number of houses found positive for larvae of Aedes
aegypti per 100 houses searched
➢Container index (CI): Number of water-holding containers positive for Aedes
aegypti larvae breeding per100 wet containers. This is very helpful in
drawing vector control strategies.
➢Breteau index (BI): Number of positive containers for Aedes aegypti per
100 houses inspected
➢Aedes aegypti index: Ratio of number of houses surveyed which had Aedes
aegypti breeding sites around to the total number of houses surveyed in that
area
EPIDEMIOLOGICAL INTERPRETATION OF VARIOUS
INDICES
Entomological index High risk of Low risk of
transmission transmission
Breteau index >50% <5%
House index >10% 1%
Larval house index >10% <1%
THANK YOU…
