National health programs for communicable diseases

Government assisted health programs, their milestones and achievement in reaching the goals set for the 5 year plans for the community

1. NATIONAL HEALTH PROGRAMS FOR COMMUNICABLE DISEASES -DR. RITU RANDAD -08/02/2022 1

2. Content page SR.NO TITLE 1 INTRODUCTION 2 COMMUNICABLE DISEASES 3 INTEGRATED DISEASE SURVEILLANCE PROGRAMME (IDSP) 4 REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTBCP) 5 NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP) 2

3. SR. NO TITLE 6 NATIONAL AIDS CONTROL PROGRAMME (NACP) 7 PULSE POLIO PROGRAMME (PPP) 8 NATIONAL VIRAL HEPATITIS CONTROL PROGRAMME(NVPCP) 9 NATIONAL RABIES CONTROL PROGRAMME (NRCP) 10 NATIONAL PROGRAM FOR VECTOR BORNE DISEASE (NPVBD) 11 PROGRAMME FOR PREVENTION AND CONTROL OF LEPTOSPIROSIS (PPCL) 12 NATIONAL PROGRAMME ON CONTAINMENT OF ANTI MICROBIAL RESISTANCE (NPCAMR) 13 CONCLUSION 14 REFERENCES 3

4. INTRODUCTION Despite enormous advances in medical sciences and their applications in public health, infectious diseases remain a central challenge for public health in the 21 st century. Globalization has facilitated the spread of many infectious agents to all corners of the globe. Mass travel, economic globalization, and climate change, along with accelerating urbanization of human populations, are causing environmental disruption, including global warming . There are and will be more consequences in international transmission of infectious diseases, in humans and wildlife. 4 Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 .

5. A communicable disease is an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal, or inanimate reservoir to a susceptible host. Transmission may be direct from person to person, or indirect through an intermediate plant or animal host, vector, or the inanimate environment .   Heymann DL, editor. Control of communicable diseases manual. 19th ed. Washington, DC: American Public Health Association; 2008. Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 5

6. COMMUNICABLE DISEASES I llnesses caused by viruses or bacteria that people spread to one another through contact with contaminated surfaces, bodily fluids, blood products, insect bites, or through the air. Some of the communicable diseases, some of which require reporting to appropriate health departments or government agencies in the locality of the outbreak. Most common forms of spread include fecal-oral, food, sexual intercourse, insect bites, contact with contaminated fomites, droplets, or skin contact . COVID-19 ,HIV, hepatitis A, B and C, measles, salmonella, measles, and blood-borne illnesses etc. Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 6

7. Each disease has its own characteristic organism and natural history from onset to resolution. Many infectious diseases may remain at a pre-symptomatic or subclinical stage without progressing to clinical symptoms and signs but may be transmissible to other people. Even a subclinical disease may cause an immunological effect, producing immunity. Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 7

8. V ariety of methods: by clinical syndrome, mode of transmission, and methods of prevention (e.g., vaccine preventable) M ajor organism , viral, bacterial, fungal, and parasitic disease. CLASSIFICATION OF COMMUNICABLE DISEASES Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 8

9. Time duration : Acute infectious diseases are intense or short term but may have long-term sequelae of great public health importance, such as poststreptococcal glomerulonephritis or rheumatic heart disease. C hronic infections have their own long-term effects, such as HIV infection or peptic ulcers. Infections may have both short-term and long-term morbidity, as with viral hepatitis infections. Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 9

10. TERMS USED IN IMMUNOLOGY OF COMMUNICABLE DISEASES   Infectious agent  – a pathogenic organism (e.g., virus, bacterium, rickettsia, fungus, protozoa, helminth, pollen, or chemical) is one capable of producing infection or an infectious disease in humans, animals, and plants.   Infection  – the process of entry, development, and proliferation of an infectious agent in the body tissue of a living organism overcoming the host’s defense mechanisms, resulting in a non-apparent or clinically manifest disease. Innate immunity  – includes the cough reflex, skin, mucus, and stomach acidity as barriers which protect the body against infection.   Acquired immunity  – developed as result of natural exposure or deliberate exposure by immunization to an infectious agent or its antigenic components which protects against later exposure to the active live agent.   Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 10

11. Cellular immunity (cell-mediated immunity)  – immunity acquired with T lymphocyte cells producing chemicals which activate natural killer cells (macrophages). •  Herd immunity  – resistance of a group to an infectious disease when a large percentage of the population at risk is immune through previous exposure to the disease or by immunization. Antisera or antitoxin  – materials prepared in animals for use in passive immunization against infection or toxins. - Last JM. Dictionary of public health. New York: Oxford University Press; 2007.US National Library of Medicine Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 11

12. Surveillance of disease is the continuous inspection of all aspects of the occurrence and spread of a disease relevant to effectively control that disease. Maintaining ongoing surveillance is one of the basic duties of a public health system and National Programs, and is vital to the control of communicable disease, providing the essential data for tracking of disease, planning interventions, and responding to future disease challenges . Surveillance of infectious disease relies on reports of notifiable diseases by physicians, supplemented by individual and summary reports of public health laboratories. C oncerned with the completeness and quality of reporting and potential errors and artifacts. Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903 . 12

13. INTEGRATED DISEASE SURVEILLANCE PROGRAMME (IDSP) 2004- The Integrated Disease Surveillance Program (IDSP) was initiated in assistance with World bank. The Programme continues during 12th Plan (2012–17) under National Health Mission with a budget of Rs. 64.04 Crore from domestic budget . The Central Surveillance Unit (CSU) at the National Centre for Disease Control (NCDC), receives disease outbreak reports from the States/UTs on weekly basis. Even NIL weekly reporting is mandated, and compilation of disease outbreaks/alerts is done on weekly basis. Data collected at 3 specified reporting formats, “S” (suspected cases), “P” (presumptive cases) and “L” (laboratory confirmed cases) filled by Health Workers, Clinicians and Laboratory staff respectively. State/District Surveillance Units analyses this data weekly, to interpret the disease trends and seasonality of diseases. To strengthen disease surveillance for infectious diseases to detect and respond to outbreaks immediately. https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54 13

14. Objective : To develop skilled manpower. To strengthen surveillance activities for early detection. To strengthen laboratory support. To institute a network of effective communication link between district and state level. https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54 14

15. Programme Components : Integration and decentralization of surveillance activities through the establishment of surveillance units at Centre, State and District level. Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance. Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data. Strengthening of public health laboratories . Inter sectoral Co-ordination for zoonotic disease. 15 https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54

16. IDSP is combined with Integrated Health Information Platform (IHIP). The IHIP is a web-enabled near-real-time electronic information system that is embedded with applicable Government of India's e-Governance standards, information technology (IT), data & metadata standards to provide state-of-the-art single operating picture with geospatial information for managing disease outbreaks and related resources. In the first phase, was launched in selected districts of 7 States of Karnataka, Andhra Pradesh, Himachal Pradesh, Odisha, Uttar Pradesh, Telangana & Kerala in 2018 . https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54 16

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18. REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTBCP) https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 18 YEAR OF DEVELOPMENT MILESTONES 1962 Launched by the Government of India in the form of District TB Centre model involved with BCG vaccination and TB treatment. 1978 BCG under the Expanded Programme on Immunization. Government of India, World Health Organization (WHO) and the Swedish International Development Agency (SIDA) . 1992 Programme, managerial weaknesses, inadequate funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion, and lack of systematic information on treatment outcomes . 1993 The Government of India revitalized NTP as Revised National TB Control Programme (RNTCP). 1997 DOTS was officially launched as the RNTCP. (directly observed treatment short-course)

19. End of 2006 the entire country was covered under the programme . 2006–11 Second phase improved the quality and reach of services and worked to reach global case detection and cure targets .(achieved by 2007-08). Despite these achievements, undiagnosed and mistreated cases continued to drive the TB epidemic. 19 https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 (DOT is a specific strategy, to improve adherence by any person observing the patient taking medications in real time. The treatment observer does not need to be a health-care worker, but could be a friend, a relative or a lay person who works as a treatment supervisor or supporter.

20. Tuberculosis is a specific infectious disease caused by M. tuberculosis, affecting lungs causing pulmonary tuberculosis. Affects intestine, meninges, bones and joints, lymph nodes, skin and other tissues of the body. Chronic with various clinical manifestations. Also affects animals, ‘ bovine tuberculosis’. 20 K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

21. Problem statement of India Disease of poor. Migrant labourers, slum dwellers, residents of backward areas and tribal pockets. Poor living conditions, malnutrition, shanty housing and overcrowding. 21 K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

22. NEED OF THE PROGRAMME Affects all age group 20% in age of 15-24 years. Males than females 22 K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

23. TB was the leading cause of illness and death among persons living with HIV/AIDS and large number of multidrug resistant TB (MDR-TB) cases were reported every year. “TB free India”, National Strategic Plan for Tuberculosis Control 2012-2017 was documented with the goal of ‘ universal access to quality TB diagnosis and treatment for all TB patients in the community ’. https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 23

24. INTERVENTIONS AND INITIATIVES Significant interventions and initiatives in terms of mandatory notification of all TB cases, integration of the programme with the general health services (National Health Mission), expansion of diagnostics services, programmatic management of drug resistant TB (PMDT) service expansion, single window service for TB-HIV cases, national drug resistance surveillance and r evision of partnership guidelines . 24

25. Goal ahead for the programme T o eliminate TB by 2025, five years ahead of the global target, a framework to guide the activities of all stakeholders including the national and state governments, development partners, civil society organizations, international agencies, research institutions, private sector, and many others whose work is relevant to TB elimination in India is formulated by RNTCP as National Strategic Plan for Tuberculosis Elimination 2017-2025 . https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 25

26. National strategic plan for tuberculosis elimination 2017-2025 RNTCP has released a ‘National strategic plan for tuberculosis 2017-2025’ (NSP) for the control and elimination of TB in India by 2025 . four strategic pillars of  “Detect – Treat – Prevent – Build”  (DTPB). Detect : find all drug sensitive TB cases (DS-TB) and drug resistant TB cases (DRTB) with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB cases in high-risk populations. Early diagnosis and treatment of TB cases in the community is an important step in TB elimination. https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 26

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28. The incentives to the Private Sector TB Care Provider are as follows : Rs 250/- on notification of a TB case diagnosed as per Standards for TB Care in India (STCI) Rs 250/- on completion of every month of treatment Rs 500/- on completion of entire course of TB treatment Rs 2750/ for notification and management of a drug-sensitive patient over 6-9 months as per STCI Rs 6750/-for notification and correct management of a drug-resistant case over 24 months as per STCI https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 28

29. Free drugs and diagnostic tests to TB patients in private sector- is access to programme- provided drugs and diagnostics through attractive linkages; and is reimbursement of market - available drugs and diagnostics. Significant cost reduction of select diagnostics is achieved by ‘Initiative for Promoting Affordable and Quality TB Tests’ (IPAQT) . 131 private sector labs networked to provide four quality tests at ‘ceiling prices. For TB diagnosis more than 14,000 designated microscopy centres spread across the country. Reference laboratories have been established at state and national levels which provide culture and drug sensitivity test. 29

30. 2.Treat : Provision of free TB drugs as daily fixed dose combinations (FDCs) for all TB cases is advised with the support of directly observed treatment (DOT). First line treatment of drug-sensitive TB consists of a two-months (8weeks) intensive phase with four drug FDCs followed by a continuation phase of four months (16 Weeks) with three drug FDCs . https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 30

31. Nikshya   poshak yozana :  It is centrally sponsored scheme under National Health Mission (NHM), financial incentive of Rs.500/- per month is provided for nutritional support to each notified TB patient for duration for which the patient is on anti-TB treatment. Incentives are delivered through Direct benefit transfer (DBT) scheme to bank accounts of beneficiary. https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 31

32. Expending options for ICT based treatment adherence support mechanisms: Mobile based “Pill-in-Hand” adherence monitoring tool Interactive Voice Response (IVR), SMS reminders. Patient Compliance toolkit : a mobile app for patients to report treatment compliance using video, audio or text message Automated pill loading system I nnovatively designed ICT enabled smart cards SMS gateway TB-HIV Diabetics, Tobacco use and Alcohol dependence Poor, undernourished, economically and socially backward communities TB control in hilly and difficult terrains Substance dependence and sexual minorities TB and pregnancy Paediatric population Prison Inmates and staff of prisons/jails M anagement of extra pulmonary TB https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 32

33. 3. Prevent : Scale up air-borne infection control measures at health care facilities Treatment for latent TB infection in contacts of bacteriologically-confirmed cases Address social determinants of TB through intersectoral approach. a)  Air borne infection control measures b) Contact tracing c) Isoniazid Preventive Therapy (IPT) d) BCG vaccination https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 33

34. 4. Build : R ecommended in the form of building and strengthening enabling policies, empowering institutions and human resources with enhanced capacities. https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 34

35. NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP) C entrally sponsored Health Scheme of the Ministry of Health and Family Welfare, Govt. of India . H eaded by the Deputy Director of Health Services under the administrative control of the Directorate General Health Services Govt. of India . Strategies and plans are formulated centrally, the programme implemented by States/UTs. Partners by the World Health Organization, The International Federation of Anti-leprosy Associations (ILEP) and few other Non-Govt. Organizations. Four Research & Training Institutes were established, namely Central Leprosy Training and Research Institute (CLTRI) Chengalpattu, Regional Leprosy Training and Research Institute (RLTRI) at Raipur, Gauripur and Aska . With a Training Centre was established at Agra under ICMR. https://dghs.gov.in/content/1349_3_NationalLeprosyEradicationProgramme.aspx https://www.nhp.gov.in/national-leprosy-eradication-programme_pg 35

36. 34 States/ UTs had attained the level of leprosy elimination. A total of 542 districts (84.7%) out of total 640 districts elimination by March 2012. A total of 209 high risk districts were identified for special actions during 2012-13. A total of 1792 blocks and 150 urban areas were identified for special activity plan (SAP- 2012) . The States trained District Leprosy Officer in all the districts. In addition, one officer is identified to strengthen the process of supervision and monitoring. Active house to house survey was the main strategy along with capacity building of workers and volunteers. https://dghs.gov.in/content/1349_3_NationalLeprosyEradicationProgramme.aspx https://www.nhp.gov.in/national-leprosy-eradication-programme_pg 36

37. Current situation in India Widely prevalent in India, present throughout the country but unevenly distributed. 1981- 57.6:10,000 to less than 1:10,000 in 2005, achieved goal of leprosy elimination at national level . Out of 1.35 lac, 1.19 lac completed their treatment with Tripura, Mizoram, Daman Diu whereas Lakshadweep has poor performance. 37 K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur 1991, WHO states resolved to decrease the level of leprosy by 90%. Fall is due to improvement in management of cases, low rates of relapse, high cure rates, absence of drug resistance and shorter duration of treatment with MDT

38. VISION AND MISSION 38 K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur VISION: “Leprosy-free India” is the vision of the NLEP. MISSION: T o provide quality leprosy services free of cost to all sections of the population, with easy accessibility, through the integrated healthcare system, including care for disability after cure of the disease.

39. OBJECTIVES Objectives:    To reduce Prevalence rate less than 1/10,000 population at sub national and district level.  To reduce Grade II disability % < 1 among new cases at National level.   To reduce Grade II disability cases < 1 case per million population at National level.  Zero disabilities among new Child cases.   Zero stigma and discrimination against persons affected by leprosy. https://dghs.gov.in/content/1349_3_NationalLeprosyEradicationProgramme.aspx https://www.nhp.gov.in/national-leprosy-eradication-programme_pg 39

40. PROGRAM COMPONENTS   Case Detection and Management Disability Prevention and Medical Rehabilitation (DPMR). Information, Education and Communication (IEC) including Behaviour Change Communication (BCC) Human Resource and Capacity building Programme Management 40

41. SALIENT FEATURES 1. C entrally sponsored scheme of Government of India. 2.  F unctions under the umbrella of National Health Mission (NHM). 3. Follows decentralized health planning and funds are sent to the states through State Health Societies. 4.  Quality of services and sustainability is the main-focus. 5. Disability Prevention & Medical Rehabilitation (DPMR) is a priority. 6. Removal of stigma and discrimination is a part of the strategy. 41

42. Various leprosy  endemicity maps  from 1981 to 2020, showing the prevalence of leprosy at different points of time 42

43. NATIONAL AIDS CONTROL PROGRAMME (NACP) 43 Launched in year 1987 by Ministry of Health and Family Welfare as a separate wing to implement and closely monitor. AIM:- prevent further transmission of HIV, decrease morbidity and mortality associated with HIV and minimize the socio-economic impact . https://www.nhp.gov.in/national-aids-control-programme_pg

44. Milestones of NACP 44 year milestones 1986 First HIV case detected, AIDS task force set up by ICMR, National AIDS committee established. 1990 Medium Term Plan launched for 4 states and 4 metros 1992 NACP-1 launched to slow down spread of HIV infection, National AIDS Control Board constituted, NACO launched 1999 NACP-2 launched, State AIDS Control Societies established 2002 National AIDS Control Policy adopted, National Blood Policy adopted 2006 National Policy for Paediatric ART formulated, National Council on AIDS under chairmanship of the Prime Minister 2007 NACP-3 launched for 5 years (2007-2012) 2014 NACP -4 for 5 years (2012-2017) 2017 National Strategic Plan for HIV/AIDS and STIs 2017-2024

45. Objectives: To reduce spread of HIV infection in India. 2. Strengthen India's capacity to respond to HIV/AIDS on a long-term basis. Reflecting the extreme urgency with which HIV prevention and control need to be pursued in India, the AIDS - II project of the National AIDS Control Programme is across all States and Union Territories and a Centrally Sponsored Scheme with 100% financial assistance from Government of India direct to State AIDS Control Societies and selected Municipal Corporations/AIDS Control Societies . 45 https://www.nhp.gov.in/national-aids-control-programme_pg

46. COMPONENTS OF NATIONAL STRATEGY Establishment of surveillance centres to cover whole country. Identification of high risk group and their regular screening. Issuing specific guidelines for management of detected cases and their follow up Formulating guidelines for blood banks. Information, education and communication activities for reducing personal and social impact of the disease. Control of sexually transmitted diseases and, Condom programme. 46 https://www.nhp.gov.in/national-aids-control-programme_pg

47. 47 Prevention and Care, Support & Treatment (CST) form the two key pillars of all the AIDS control efforts in India. Strategic Information Management and Institutional Strengthening activities provide the required technical, managerial and administrative support for implementing the core activities under NACP-III at national, state and district levels. https://www.nhp.gov.in/national-aids-control-programme_pg

48. HIV testing for Tuberculosis patients 48

49. National Strategic Plan for HIV/AIDS and STI 2017-2024 Goal- to achieve 0 new infections, 0 AIDs related deaths and 0 AIDS related stigma and discrimination . 49 number objectives 1 Reduce 80% new infection by 2024 2 Ensure 95% of PLHIV know their status by 2024 3 Ensure 95% PLHIV have ART initiation and reduction by 2024 4 Eliminate mother-child transmission of HIV and syphilis 5 Eliminate HIV/AIDS related stigma and discrimination by 2024` 6 Facilities sustainable NACP service delivery by 2024.

50. PULSE POLIO PROGRAMME (PPP) With the global initiative of eradication of polio in 1988 following World Health Assembly resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995 . Children of 0-5 years are administered polio drops during National and Sub-national immunization rounds every year. Around 17.4 crore children across the country are given polio drops. 13 th January 2011-The last polio case in the country was reported from Howrah district of West Bengal. WHO on 24th February 2012 removed India from the list of countries with active endemic wild polio virus transmission. 50 https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme

51. AIM AND OBJECTIVE AIM : to immunize children through improved social mobilization, plan mop-up operations in areas where poliovirus has almost disappeared and maintain high level of morale among the public . OBJECTIVE: to achieve 100% coverage under Oral Polio Vaccine . 51 https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme

52. Steps taken by Government of India to maintain polio free status Maintaining community immunity- quality National and Sub National polio rounds each year. Environmental surveillance (sewage sampling) established as programmatic interventions strategically in Mumbai, Delhi, Patna, Kolkata, Punjab and Gujarat. All States and Union Territories- Rapid Response Team (RRT) to respond to any polio outbreak in the country . I nternational border vaccination is being provided through continuous vaccination teams (CVT) eligible children. These are provided through special booths set up at the Indian border shared with Pakistan, Bangladesh, Bhutan, Nepal and Myanmar. 52 https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme

53. Government of India has issued guidelines for mandatory requirement of polio vaccination to all international travelers before their departure from India to polio affected countries namely:  Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia, Syria and Cameroon , from 1 st  March 2014. A rolling emergency stock of OPV is being maintained to respond to detection/importation of wild poliovirus (WPV). National Technical Advisory Group on Immunization (NTAGI) has recommended Injectable Polio Vaccine (IPV) introduction as an additional dose along with 3rd dose of DPT in the entire country in the last quarter of 2015 as a part of polio endgame strategy . 53 https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme

54. NATIONAL VIRAL HEPATITIS CONTROL PROGRAM (NVHCP) The National Viral Hepatitis Control Program has been launched by Ministry of Health and Family Welfare, Government of India on the World Hepatitis Day, 28th July 2018 . This is a comprehensive plan covering the entire gamut from Hepatitis A, B, C, D & E, and the whole range from prevention, detection and treatment to mapping treatment outcomes . Operational Guidelines for National Viral Hepatitis Control Program, National Laboratory Guidelines for Viral Hepatitis Testing and National Guidelines for Diagnosis and Management of Viral Hepatitis are part of the programme. 54 https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg

55. AIMS AND OBJECTIVES AIMS Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030 . significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C . Reduce the risk, morbidity and mortality due to Hepatitis A and E. OBJECTIVES C ommunity awareness and stress on preventive measures among general population. Provide early diagnosis and management of viral hepatitis. Develop standard diagnostic and treatment protocols . Develop linkages with the existing National programs towards awareness, prevention, diagnosis and treatment for viral hepatitis . Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae. 55 https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg

56. Components of NVHCP PREVENTIVE COMPONENT Awareness generation & behaviour change communication Immunization of Hepatitis B Safety of blood and blood products Injection safety, safe socio-cultural practices Safe drinking water, hygiene and sanitary toilets DIAGNOSIS AND TREATMENT Screening of pregnant women for HBsAg to be done in areas where institutional deliveries are < 80% to ensure their referral for birth dose Hepatitis B vaccination. Free screening, diagnosis and treatment for both hepatitis B and C made available at all levels of health. Engagement with community/peer support to enhance and ensure adherence to treatment. 56 https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg

57. MONITORING AND EVALUATION, SURVEILLANCE AND RESEARCH Effective linkages to the surveillance system would be undertaken through Department of Health Research (DHR) . Standardized monitoring & evaluation framework to be developed for an online web-based system is established. TRAINING AND CAPACITY BUILDING A continuous process to be supported by NCDC (National Centre for Disease Control), ILBS (Institute of Liver and Biliary Sciences) and state tertiary care institutes and coordinated by NVHCP. V arious platforms available for enabling electronic, e-learning and e-courses. 57 https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg

58. National Viral Hepatitis Control Management Unit The NVHCP is coordinated by the units at the centre and the states. The NVHCMU is established at the centre with in the NHM (National Health Mission) and is responsible for implementation of program in the country , headed by a Joint Secretary who will report to the Mission Director (NHM). State Viral Hepatitis Management Unit (SVHMU)- nodal officer and required essential manpower will coordinate the program at state level. District Viral Hepatitis Management Unit (DVHMU)- A program officer at the district level to supervise the program and facilitate the logistics, supply chain, outreach, training at district level. 58 https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg

59. NATIONAL RABIES CONTROL PROGRAMME (NRCP) Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the warm-blooded animals. The virus is found in wild and some domestic animals and is transmitted to other animals and to humans through their saliva. In India, dogs are responsible for about 97% of human rabies, followed by cats (2%), and others (1%) . The disease is invariably fatal which the sick person is tormented at the same time with thirst and fear of water (hydrophobia). T he post-exposure treatment of animal bite cases are of prime importance. 59 https://www.nhp.gov.in/national-rabies-control-programme_pg

60. National Centre for Disease Control (formerly National Institute of Communicable Diseases), Delhi, WHO Collaborating Centre for Rabies Epidemiology , organized an expert consultation in 2002 to formulate national guidelines for rabies prophylaxis to bring out uniformity in post-exposure prophylaxis practices. Under the 12 five-year plan, National Rabies Control Programme (NRCP) has been approved. The NRCP has both human and animal health components. 60 https://www.nhp.gov.in/national-rabies-control-programme_pg

61. VARIOUS COMPONENTS HUMAN COMPONENT Implemented in all the states & UTs. National Centre for the Diseases control is the nodal agency. The strategies are: Training of health professionals Implementing use of intra-dermal route of inoculation of cell culture vaccines Strengthening surveillance of human rabies Information Education & Communication Laboratory strengthening ANIMAL COMPONENT Being pilot tested in the Haryana & Chennai . The Animal Welfare Board of India, Ministry of Environment & Forests is the Nodal agency. The strategies are: Population survey of dogs Mass vaccination of dogs Dog population management 61 https://www.nhp.gov.in/national-rabies-control-programme_pg

62. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME the National Vector Borne Disease Control Programme (NVBDCP) – Malaria, Filariasis, Kala azar, Japanese Encephalitis, Dengue and Chikungunya. The Directorate of NVBDCP is nodal for planning, policy making and technical guidance and monitoring and evaluating the programme. Covered under the overall umbrella of National Rural Health Mission . The States are responsible for the planning and implementation and supervision of the programme. 62 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

63. Under the NVBDCP, the three pronged strategy for prevention and control of vector borne disease is as follows: Disease management including early case detection and complete treatment, strengthening or referral services, epidemic preparedness and rapid response. Integrated vector management including indoor residual spraying in selective high-risk areas, use of insecticide treated bed nets, source reduction and minor environmental engineering. Supportive intervention include behaviour change communication, intersectoral convergence, human resource development and annual drug administration. 63 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

64. MALARIA Before 1953, estimated malaria cases in India-75 million, Deaths due to malaria -0.8 million. 1953, National Malaria Control Programme , during FIRST FIVE YEAR PLAN. 1958, after the success achieved in control of malaria, the control program was converted to eradication program. 1972, cases reduced to 1-2 million AND 0 deaths. 64 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

65. Milestones of NATIONAL ANTI- MALARIA PROGRAMME YEAR MILESTONES 1977 Modified Plan of Operations implemented 1997 World Bank assisted Enhanced Malaria Control Projec t launched. 1999 Renaming of programme to NATIONAL ANTI- MALARIA PROGRAMME . 2002 Global fund assisted Intensified Malaria Control Project launched. 2005 NVBDCP became integral part of NRHM 2005 Introduction of RDT in the programme 2006 ACT introduced in areas showing chloroquine resistance in falciparum malaria. 65 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

66. 2008 ACT extended to high P falciparum predominant district covering about 95% pf cases. 2008 World Bank supported National Malaria Control Project launched. 2009 Introduction of LLINs (long lasting insecticidal nets) 2010 New drug policy 2010 2012 Introduction of bivalent RCT 2013 New drug policy 2013 2016 National Framework for Malaria Elimination in India launched 2017 National Strategy Plan for Malaria Elimination in India 2017-2022 launched. 66 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

67. MAIN ACTIVITIES OF THE PROGRAMME Formulating policies and guidelines. Technical guidance Planning Logistics Monitoring and evaluation Coordination of activities through the States/UT and in consultation with National Centre for Disease Control , National Institute of Malaria Research. Training Facilitating research through NCDC, NIMR, Regional Medical Research Centres etc. Coordinating control activities in the inter-state and inter- country border areas. 67 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

68. Organization 19 Regional Offices for Health and Family Welfare under Directorate General of Health Services, Ministry of Health and Family Welfare, located in 19 states. Offices are equipped with malaria trained staff. Headed by- State Programme Officer (SPO) who is responsible for supervision, guidance and effective implementation. At the divisional level, zonal officers have technical and administrative responsibilities of the programme in their areas under Senior Division Officer (SDO) . At district level- the Chief Medical Officer/ District Health Officer with one Assistant Malaria Officer and Malaria Inspector to assist him. 68 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

69. NATIONAL FRAMEWORK FOR MALARIA ELIMINATION IN INDIA (2016-2030) The vision of India’s malaria control programme has been shifted to sustained malaria elimination to contribute more effectively to improve health and quality of life of the people . The NATIONAL FRAMEWORK FOR MALARIA ELIMINATION IN INDIA 2016-2030 was launched in February 2016 . 69 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

70. Goals of the programme eliminate malaria (indigenous cases) throughout the entire country by 2030. Maintain malaria-free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria. 70 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

71. Programme phasing Category 1 States/ UTs : Himachal Pradesh, Punjab, Jammu Kashmir, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand, Haryana, Sikkim, Rajasthan, Daman Diu, Goa and Delhi . Category 2 States/ UTs : Bihar, Tamil Nadu, Telangana, Uttar Pradesh, Karnataka, West Bengal, Andhra Pradesh, Assam, Meghalaya, Maharashtra, Gujarat and Nagaland . Category 3 States/ UTs : Andaman and Nicobar islands, MP, Dadar and Nagar Haveli, Jharkhand, Arunachal Pradesh, Chhattisgarh, Odisha and Mizoram . 71 Category 0- Prevention of Re-establishment phase Category 1- elimination phase Category 2- Pre-elimination phase Cateogry3 – intensified control phase https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

72. Goals of the programme By 2022, transmission of malaria interrupted and zero indigenous cases to be attained in all 26 states/UTs that were under Categories 1 and 2 in 2014. By 2024, incidence of malaria to be reduced to less than 1 case per 1000 population in all States and UTs, and their districts. By 2027, indigenous transmission of malaria to be interrupted in all States and UTs of India. By 2030, malaria to be eliminated throughout the entire country, and re-established of transmission prevented . 72 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

73. Milestones and targets By the year 2016 : All states and UTs to have included malaria elimination in their broader health policies and planning framework. By year 2020 . All the 15 states/UTs that were under category 1 in 2014 to completely interrupted malaria transmission and achieved zero indigenous cases and deaths due to malaria . All 11 states/ UTs under category 2 in 2014 to enter into category 1 . 5 states/ UTs under category 3 in 2014 to enter into category 2. 5 states/ UTs under category 3 in 2014 to reduce the disease burden and remain in category 3. 73 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

74. By the year 2022 All 26 states that were under category 1 and 2 in 2014 to interrupt malaria transmission and achieve 0 indigenous cases and deaths due to malaria. 5 states/ UTs under category 3 in 2014 to enter into category 1. 5 states/ UTs under category 3 in 2014 to reduce the disease burden and remain in category 2. Estimated malaria burden at national level reduced by 30-35 % as compared to 2014. 74 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

75. By year 2024 All states/UTs and their respective districts to reduce less than 1 case per 1000 population at risk and sustain zero deaths due to malaria while maintaining fully functional malaria surveillance to track, investigate and respond to each case throughout the country . Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 31 states/UTs . Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter elimination phase . 75 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

76. By year 2027 The indigenous transmission of malaria in India interrupted along with no indigenous cases and deaths due to malaria. By year 2030 The re-establishment of local transmission prevented in areas where malaria has been eliminated. The malaria-free status maintained throughout the nation. Initiate the certification of malaria elimination status. 76 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

77. Success rate of the programme Amply demonstrating the success of the National Vector Borne Disease Control Programme (NVBDCP) is the fact that 75 million cases and 0.8 million deaths annually due to malaria in the pre-independence era fell to 1.1 million cases and 562 deaths in 2014 . These achievements are due to new tools such as rapid diagnostic tests, artemisinin-based combination therapy (ACT) and long-lasting insecticidal nets (LLINs). Also, human resources, capacity building, community level awareness building and mobilization, partnerships, strengthened monitoring and evaluation, and investments from domestic and external sources such as the Global Fund and the World Bank. 77 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

78. Strategies Early diagnosis, response and radical treatment Case- based surveillance and rapid response Integrated vector management Monitoring and evaluation Advocacy, coordination and partnerships Behaviour change communication and community mobilization Programme planning and management. 78 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

79. NATIONAL KALA AZAR ELIMINATION PROGRAMME Kala-azar has been a serious medical and public health problem in India since historical times. Bengal is the oldest known Kala-azar endemic area of the world. 1990-1991, Concerned with the increasing problem of Kala-azar in the country, the Government of India (GOI) launched a centrally sponsored Kala-azar Control Programme in the endemic states . The GOI provided drugs, insecticides and technical support and state governments provided costs involved in implementation. The program was implemented through State/District Malaria Control Offices and the primary health care system. 79 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

80. Goal and target G oal To improve the health status of vulnerable groups and at-risk population living in Kala-azar endemic areas by the elimination of Kala-azar. Target To reduce the annual incidence of Kala-azar to less than one per 10,000 populations at block PHC level. 80 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

81. Objectives To reduce the annual incidence of Kala-azar to less than one per 10 000 population at block PHC level by the end of 2015 by: reducing Kala-azar in the vulnerable, poor and unreached populations in endemic areas; reducing case-fatality rates from Kala-azar to negligible level; reducing cases of PKDL to interrupt transmission of Kala-azar; and preventing the emergence of Kala-azar and HIV/TB co-infections in endemic areas. 81 Revised strategy of total elimination of Kala azar was launched on 2 nd Sept 2014. https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

82. Elimination strategy The national strategy for elimination of Kala-azar is a multipronged approach which is in line with WHO Regional Strategic Framework for elimination of Kala-azar from the South-East Asia Region (2011-2015) and includes: Early diagnosis & complete case management Integrated Vector Management and Vector Surveillance Supervision, monitoring, surveillance and evaluation Strengthening capacity of human resource in health Advocacy, communication and social mobilization for behavioral impact and inter-sectoral convergence Programme management 82 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

83. NATIONAL FILARIA CONTROL PROGRAMME Bancroftian  filarisis  caused by Wuchereria bancrofti , which is transmitted to man by the bites of infected mosquitoes - Culex, Anopheles, Mansonia and Aedes. Lymphatia filaria is prevalent in 18 states and union territories. B rugian filariasis caused by Brugia malayi is restricted to 7 states - UP, Bihar, Andhra Pradesh, Orissa, Tamil Nadu, Kerala, and Gujarat . The National Filaria Control Programme was launched in 1955. The activities were mainly confined to urban areas. However, the programme has been extended to rural areas since 1994 . 83 OBJECTIVE - delimiting the problem, to undertake control measures in endemic areas and to train personnel to man the programme

84. Objectives and strategies Objectives : Reduction of the problem in un-surveyed areas Control in urban areas through recurrent anti-larval and anti-parasitic measures. Strategies : Recurrent anti-larval measures at weekly intervals. Environmental methods including source reduction by filling ditches, pits, low lying areas, de-weeding, etc. Biological control of mosquito breeding through larvivorous fish. Anti-parasitic measures through 'detection' and 'treatment' of microfilaria carriers and disease person with Filaria Clinics in towns covered under the programme. 84 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

85. Achievements Significant as till August 2017, 94 districts with 152 evaluation units had, successfully completed 1 st Transmission Assessment Survey (TAS), 20 more districts were to observed 1 st TAS during 2017. 85 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

86. JAPANESE ENCEPHALITIS CONTROL PROGRAMME Japanese encephalitis (JE) is a zoonotic disease and caused by an arbovirus, group B (Flavivirus) and transmitted by Culex mosquitoes. The fatality rate varies between 10% - 40% and those who survive do so with various degrees of neurological complications like paralysis and cognitive deficiencies.   The most disturbing feature of JE has been the regular occurrence of outbreak in different parts of the country. 86 The clinical manifestations of the disease are characterized with high-grade fever, convulsion, confusion, stiffness of neck and altered levels of consciousness from stupor to deep coma. https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

87. Disease burden Recently this disease have caused many epidemics and become a major public health problem. This disease has been reported from 26 states and UTs since 1978, only 15 states are reporting JE regularly . The case fatality in India is 35% which can be reduced by early detection, immediate referral to hospital and proper medical and nursing care. The total population at risk is estimated 160 million. 87 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

88. Strategy for prevention and control 1. Strengthening early diagnosis and prompt case management at PHCs, CHCs and hospitals through training of medical and nursing staff. 2. IEC for community awareness to promote early case reporting, personal protection, etc. 3. Vector control measures mainly fogging during outbreaks, space spraying in animal dwellings, and antilarval operation where feasible; and 4. Development of a safe and standard indigenous vaccine. 88 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

89. Dengue and Dengue Haemorrhagic Fever One of the most important resurgent tropical infectious diseases is dengue. Dengue Fever and Dengue Hemorrhagic Fever (DHF) are acute fevers caused by four antigenically related but distinct dengue virus serotypes (DEN 1,2,3 and 4) transmitted by the infected mosquitoes, Aedes Aegypti . Dengue outbreaks have been reported from urban areas from all states. All the four serotypes of dengue virus (1, 2, 3 and 4) exist in India. 89 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

90. Objectives Surveillance for disease and outbreaks Early diagnosis and prompt case management Vector control through community participation and social mobilization Capacity building Intersectoral coordination Outbreak response Behavioral change communication 90 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

91. PROGRAMME FOR PREVENTION AND CONTROL OF LEPTOSPIROSIS 91 Leptospirosis is a zoonotic disease caused by the Leptospira bacteria found in the urine of rodents, cattles , etc. Major health problem in India in states of Kerala, Tamil Nadu, Maharashtra, Gujarat and Karnataka. In view of burden of disease- Govt of India launched the PROGRAMME FOR PREVENTION AND CONTROL OF LEPTOSPIROSIS in 12 th 5 year plan in endemic states and UTs under National Centre for Disease Control . https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

92. Objective and strategies Objective: T o reduce the morbidity and mortality due to leptospirosis in Humans. Strategie s: Developing trained manpower Robust surveillance of disease in humans Strengthening of diagnostic labs in programme states Strengthening of patient management facilities in programme states Creating awareness among people Reinforcing inter-sectoral coordination among states for detection, prevention and control. 92 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

93. Impact of the programme Even after being in its growing stage, the programme has been strongly recognized by the states. The surveillance of the disease is being done through the Integrated Diseases Surveillance Programme Portal . 93 https://www.nhp.gov.in/national-vector-borne-disease-control-programme_pg K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur

94. NATIONAL PROGRAMME ON CONTAINMENT OF ANTI-MICROBIAL RESISTANCE (AMR) Antimicrobial resistance in pathogens causing important communicable diseases has become a matter of great public health concern globally. Resistance has emerged even to newer & more potent antimicrobial agents like Carbapenems. The rapid spread of multi-resistant bacteria and the lack of new antibiotics to treat infections have caused rapid increasing threat to public and animal health and needs prevention for untreatable illness becoming a reality . Government of India has launched a “National Programme on Containment of Antimicrobial Resistance” under the 12th five-year plan (2012-2017). 94 https://www.nhp.gov.in/national-programme-on-containment-of-anti-microbial-resistance-(amr)_pg

95. Objectives of the programme To establish a laboratory-based AMR surveillance system of 30 network labs in the country and to generate quality data for public health importance. To strengthen infection control guidelines and practices and promote rationale use of antibiotics . To generate awareness among healthcare providers and in the community about rationale use of antibiotics 95 https://www.nhp.gov.in/national-programme-on-containment-of-anti-microbial-resistance-(amr)_pg

96. ACTIVITIES CARRIED UNDER PROGRAMME Activities to be carried out under the programme Surveillance for Containment of Antimicrobial Resistance in various geographical regions. Development & implementation of national infection control guidelines . Training and capacity building of professionals in relevant sectors. IEC for dissemination of information about rational use of antibiotics. Development of National Repository of Bacterial strains / cultures . 96 https://www.nhp.gov.in/national-programme-on-containment-of-anti-microbial-resistance-(amr)_pg

97. CONCLUSION Disease reporting systems has similar problems in the country. Change, improvement, updating and continuous monitoring of the reporting system are very important. Although the disease reporting process in different regions can be different; however, timeliness and completeness are two major principles in system design. Therefore, detailed explanations of duties and providing appropriate instructions are important points in integrating an efficient reporting system for the national health programmes. 97

98. REFERENCES Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903. https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54 https://www.nhp.gov.in/national-programme-on-containment-of-anti-microbial-resistance-(amr)_pg https://www.nhp.gov.in/national-rabies-control-programme_pg https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme https://www.nhp.gov.in/national-aids-control-programme_pg 98

99. https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg https://tbcindia.gov.in/showfile.php?lid=3314 https://dghs.gov.in/content/1349_3_NationalLeprosyEradicationProgramme.aspx https://www.nhp.gov.in/national-leprosy-eradication-programme_pg https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54 K Park, Textbook of Preventive and Social Medicine, 25 th Edition, Bhanot , Jabalpur 99