NVBDCP 110723.pptx

Vector born disease control programme

1. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME 1 -Dr Sudip Bhavsar 11/07/2023

2. Malaria Filaria Kala- azar Japanese Encephalitis Dengue / Dengue Hemorrhagic fevers Chikungunya NVBDCP is implemented in states/UT for prevention & control of major vector borne diseases of public health importance like 2

3. 3 MALARIA The programme began originally as National Malaria Control Programme in 1953 . Because of the spectacular success achieved in the control of malaria, the control programme , was converted in 1958 into an eradication programme , with the objective of eradicating malaria once and for all from the country. 1999: renamed as National Anti Malaria Programme (NAMP). 2002: Renaming of NAMP to National Vector Borne Disease Control Programme .

4. 4 Every state has a Vector Borne Disease Control Division under its Department of Health and Family Welfare. It is headed by the State Programme Officer (SPO) who is responsible for supervision, guidance and effective implementation of the programme and for coordination of the activities with the neighbouring States/UTs. District Health Societies (under NRHM) have been established to assist the management of funds and planning, and monitoring of programme activities.

5. 5 The main activities of the programme 1. Formulating policies and guidelines . 2. Technical guidance. 3. Plannin g. 4. Logistic s. 5. Monitoring and evaluation . 6. Coordination of activities through the Stales/Union Territories and in consultation with national organizations such as National Centre for Disease Control (NCDC), National Institute of Malaria Research (NIMR). 7. Coordinating control activities in the inter-state and inter-country border areas 8. Collaboration with international organizations like the WHO, World Bank, GFATM and other donor agencies. 9. Training . 10. Facilitating research through NCDC, NIMR, Regional Medical Research Centres etc.

6. 6 DRUG DISTRIBUTION CENTRES AND FEVER TREATMENT DEPOTS…developed at some subcentres Drug Distribution Centres are only to dispense the anti-malarial tablets as per NMEP schedules. Fever Treatment Depots collect the blood slides in addition to the distribution of anti-malarial tablets. URBAN MALARIA SCHEME: launched in 1971 to reduce or interrupt malaria transmission in towns and cities . The methodology comprises vector control by intensive antilarval measures and drug treatment Use of larvivorous fish in the water bodies such as slow moving streams, ornamental ponds etc. is recommended. Larvicides are used for water bodies which are unsuitable for fish use

7. 7 The urban malaria scheme presently protects 130 million population from malaria and other mosquito borne diseases in 131 towns in 19 states and Union Territories. National Framework for Malaria Elimination in India (2016-2030) Goals: (1) Eliminate malaria (zero indigenous cases) throughout the entire country by 2030; (2)Maintain malaria-free status in areas where malaria transmission has been interrupted and prevent reintroduction of malaria. Objectives: - By 2024 , i ncidenc e of malaria to be reduced to < 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; and - By 2030, malaria to be eliminated throughout the entire country, and re-establishment of transmission prevented .

8. 8 Programme phasing Malaria elimination in India will be carried out in a phased manner because the various States/UTs have different levels of malaria burden While some low burden states are in a position to plan action for malaria elimination right now, the high burden states will need to reduce the malaria burden first before proceeding towards elimination. Therefore, states and UTs have been categorized into phases, based on their API as primary criterion with due consideration given to ABER and SPR as secondary criteria.

9. 9 If want to know current situation of states in different categories: https://ncvbdc.mohfw.gov.in/index1.php?lang=1&level=1&sublinkid=5879&lid=3957

10. 10 (as per 2014) Category 1 states/UTs are: Himachal Pradesh, Punjab Jammu & Kashmir, Kerala, Manipur, Puducherry ’ Chandigarh, Uttarakhand , Haryana, Sikkim, Rajasthan Daman & Diu, Goa, Delhi and Lakshadweep. Category 2 states/UTs are: Bihar, Tamil Nadu, Telangana , Uttar Pradesh, Karnataka, West Bengal, Andhra Pradesh’ Assam, Maharashtra, Gujarat and Nagaland. Category 3 states/UTs are: Andaman & Nicobar islands, Madhya Pradesh, Dadar & Nagar Haveli, Jharkhand, Arunachal Pradesh, Chattisgarh , Odisha , Meghalaya, Tripura and Mizoram.

11. 11 Milestones and targets set for malaria elimination By the end of the year 2016 All states and UTs to have included malaria elimination in their broader health policies and planning framework. By the year 2020 1. All 15 states/UTs that were under category 1 (elimination phase) in 2014 to completely interrupted malaria transmission and achieved zero indigenous cases and deaths due to malaria; 2. All 11 states/UTs under category 2 (pre-elimination phase) in 2014 to enter into category 1 (elimination phase); 3. 5 states/UTs under category 3 (intensified control phases) in 2014 to enter into category 2 (pre-elimination phase) 4. 5 states/UTs under category 3 (intensified control phase) in 2014 to reduce disease burden but continue to remain in category 3; and 5. Estimated malaria burden at national level to reduce by 15-20% as compared to 2014.

12. 12 By the year 2022 1. All 26 states/UTs that were under categories 1 and 2 in 2014 to interrupt malaria transmission and achieved zero indigenous cases and deaths due to malaria; 2. 5 states/UTs which were under category 3 (intensified control phases) in 2014 to enter into category 1 (elimination phase); 3. 5 states/UTs which were under category 3 (intensified control phases) in 2014 to enter into category 2 (pre-elimination phase); and 4. Estimated malaria burden at national level reduced by 30-35% as compared to 2014. By the year 2024 1. All states and UTs and their districts to reduce API to less than 1 case per 1000 populations at risk, sustain zero deaths due to malaria and establish fully functional malaria surveillance to track, investigate and respond to each case, 2 31 states/UTs to interrupt transmission of malaria and zero indigineous cases and deaths attained- and 3. 5 states/UTs which were under category 3 (intensified control phases) in 2014 to enter into elimination phase.

13. 13 By the year 2027 Indigenous transmission of malaria interrupted and the entire country to have no indigenous cases and no deaths due to malaria. By the year 2030 The entire country to sustain status of zero indigenous cases and deaths due to malaria for 3 consecutive years; and India to initiate the processes for certification of malaria elimination status. Focus on High-Endemic Areas and Tribal Population: Most of the malaria cases in India are reported from Andhra Pradesh, Chattisgarh , Jharkhand, Madhya Pradesh, Maharashtra, Meghalaya, Mizoram, Odisha , Telangana and Tripura. The high incidence in these states is particularly noted in tribal populations living in foothills forested or conflict - affected areas. The malaria programme plans to scale up interventions in these areas along with innovative strategies.

14. 14 As per Operational Manual for Malaria Elimination in India 2016 (Version 1), Special strategy for P. vivax elimination should be developed as…. India accounts for more than 50% of the estimated P. vivax cases in the world. Elimination of P. vivax from India is a serious challenge due to its magnitude as well as the need for a special strategy as P vivax usually disappears from an area much after P. falciparum , because: (1) P. vivax hypnozoites prolong the parasite's lifespan and are difficult Io detect; (2) RDTs currently available to detect P. vivax are less sensitive than RDTs for P falciparum detection; (3) Radical treatment for P vivax requires 14 days of primaquine therapy to kill the hypnozoites whereas treatment for P falciparum can be completed in only 3 days; and (4) P. vivax strains have a longer incubation period

15. 15 district as the unit of planning and implementation: Each district should stratify its PHCs and sub- centres (with their population) into the following five strata, as those 1. Zero cases 2. API > 0 to < 1 3. API 1 to < 2 4. API 2 to < 5 5. API ≥5

16. 16 The broad strategies of the malaria elimination framework are: • Early diagnosis and radical treatment • Case-based surveillance and rapid response • Integrated vector management ( IVM) - Indoor residual spray ( IRS) - Long-lasting insecticidal nets ( LLIN s) / Insecticide treated bed nets (ITNs) - Larval source management (LSM) • Monitoring and evaluation Epidemic preparedness and early response • Advocacy, coordination and partnerships • Behaviour change communication and community mobilization • Programme planning and management

17. 17 Surveillance aim is to target control interventions in high transmission areas and assessing their impact. Surveillance also plays a key role in the early detection of outbreaks Active case detection (ACD) is carried out in rural areas with blood smears collected by MPWs/ANM during fortnightly house visits. Passive case detection (PCD ) is done in fever cases reporting to peripheral health volunteers/ ASHAs and at sub- centres , malaria clinic, CHC, and other secondary and tertiary level health institutions that patients visit for treatment. Parameters of malaria surveillance Annual parasite incidence (API); Annual blood examination rate (ABER); Annual falciparum incidence (AFI); Slide positivity rate (SPR); and Slide falciparum rate (SFR).

18. 18 Sentinel surveillance One of the weakness of the existing malaria surveillance system is the lack of articulation with hospitals, which means that severe malaria cases are not reported separately and that only a small fraction of malaria deaths are recorded. Therefore, sentinel surveillance is being established in high endemic districts, by selecting in each district, depending on its size, 1-3 sentinel sites in large hospitals for recording of all out-patient and in-patient cases of malaria , and malaria related deaths. Case management According to the revised drug policy, there is no scope of presumptive treatment in malaria control. The new drug policy of 2013 is being followed in the country .

19. 19 Integrated vector management (IVM) The NVBDCP aims to achieve effective vector control by the appropriate biological, chemical and environmental interventions of proven efficacy, separately or in combination as appropriate to the area through the optimal use of resources The measures of vector control and protection include : - Measures to control adult mosqui toes : Indoor Residual Spray (IRS). - Antilarval measures : chemical, biological and environmental. - Personal protection : use of bed-nets, including insecticide treated nets.

20. 20 The population living in areas with API ≥ 5 is planned to be covered by LLINs and API 2 to 5 : Conventional nets treated with insecticides will continue to be used IRS is still the preferred method of vector control in areas with very hot summers and where ITNs are not acceptable to population. coverage by IRS is limited by the low community acceptance due to the white marks left on plastered surface, acrid smell associated with malathion

21. 21 Malaria paradigms/ecotypes The North-East has specific difficulties in implementation and monitoring due to various reasons. A large section of tribal population lives in inaccessible terrains, forest, hilly and riverbed conditions, and characterized by high degree of mobility, poverty, inadequate clothing, outdoor sleeping habits, forest based economy etc. Presence of efficient vectors, triple insecticide resistance and innumerous breeding sites add to the problem. Moreover, health infrastructure is generally found to be inadequate in these areas.

22. 22 The key interventions are as follows : 1. Strengthening surveillance . 2. Provision of hamlet-wise ASHAs instead of village-wise . 3. Wherever engagement of ASHAs is not possible, anganwadi workers of ICDS, faith healers, local medical/ health care providers, village headmen, PRIs or school teachers may be trained and provided relevant logistics to diagnose and treat malaria cases . In forest areas, involvement of forest department in diagnosis and treatment may be done. 4. In areas with civic disturbance, provision of well informed and pre-scheduled mobile health services . 5. Involvem ent of locally available, credible NGO s. 6. Strengthening of PHCs with quality microscopy facilities . 7. Provision of diagnosis and treatment facilities by contractors/owners of development projects to the laborers on site, should be made mandatory . 8. On the spot, species-specific radical treatment of all positive cases of malaria.

23. 23 9. Identification of serious cases and early referral to specialized health facilities, ensuring free transport services. 10. Mass screening of migrants wherever necessary . 11. Integrated Vector Management (IVM) for appropriate vector control. Prioritization of villages according to degree of risk for taking appropriate vector control measures (IRS/LLINs or treatment of community- owned bed nets with insecticides). 12. Social marketing to increase usage of bed nets . 13. Minor environmental engineering like cleaning/de-silting of drainage, filling pits and ditches, solid waste management through Village Health, Sanitation andNutrition Committee (VHSN&C) as well as MNREGA. 14. Regular and efficient supply chain management . 15. Intensive training for all cadres of staff, ASHAs/community volunteers 16. Community mobilization by utilizing traditional IEC/BCC tools and practices

24. 24 Behaviour change communication (BCC) BCC is a systematic process that motivates individuals families and communities to change their inappropriate or unhealthy behaviour , or to continue a healthy behaviour . BCC is a key supportive strategy for malaria prevention and treatment under NVBDCP. BCC is directed at : early recognition of signs and symptoms of malaria; early treatment seeking from appropriate provider; adherence to treatment regimens; (d) ensuring protection of children and pregnant women ; (e) use of ITNs/LLINs ; and (f) acceptance of IRS , etc.

25. 25 Anti-malaria month campaign Anti-malaria month is observed every year in the month of June throughout the country, prior to the onset of monsoon and transmission season, to …….. enhance the level of awareness and encourage community participation through……… mass media campaign inter-personal communication consolidate inter- sectoral collaborative efforts with other government departments, corporate and voluntary agencies at national, state and district levels Interaction of malaria control with other health programmes : Integrated Disease Surveillance Project (IDSP) : with weekly fever alerts for providing the early warning signals on malaria outbreaks Reproductive and child health : Distribution of LLINs to pregnant women IMNCI: update management of malaria cases as per guidelines

26. 26 AGENT FACTORS : Organism-vector W uchereria bancrofti – Culex (India- C. quinquefasciatus ) Brugia malayi – Mansonia (India- m. annulifers , m.uniformis ) Brugia timori – Anopheles & Mansonia Clinical incubation period : time interval from invasion of infective larvae to the development of clinical manifestation. ( 8- 16 months or may be longer). Environmental factors: Drainage : asso . with bad drainage, because vectors breed profusely in polluted water. Few points about Filaria

27. 27 Feeding Habits: bites man by night indoors and outdoors, Resting Habit: rests by day in dark corners of bed rooms, shades, drainpipe Culex quinquefasciatus Breeding places: Cesspools, soakage pits, ill maintained drains, septic tank, open ditches, burrow pits , etc

28. 28 (B) ELIMINATION OF LYMPHATIC FILARIASIS The National Filaria Control Programme has been in operation since 1955. Filaria control strategy includes vector control through…. anti larval operations, source reduction, detection and treatment of microfilaria carriers, morbidity management IEC In India, the National Health Policy (2002), envisages elimination of lymphatic filariasis (ELF) by 2015. elimination is defined as “lymphatic filariasis ceases to be public health problem, when the number of microfilaria carriers is less than 1 per cent and the children born after initiation of ELF are free from circulating antigenaemia (presence of adult filaria worm in human body)”

29. 29 The strategy of lymphatic filariasis elimination is through : (a) Annual Mass Drug Administration (MDA) of single dose of antifilarial drug for 5 years or more to the eligible population (except pregnant women, children below 2 years of age and seriously ill persons) to interrupt transmission of the disease. (b) Home based management of lymphoedema cases and up-scaling of hydrocele operations in identified CHCs/ district hospitals/medical colleges. In 2004 the GOI launched annual MDA with single dose of DEC tablets in addition to scaling-up home based foot care and hydrocele operation. The co-administration of DEC + Albendazole has been upscaled since 2007. The microfilaria survey in all the implementation units is being done through night blood survey before MDA

30. 30 Let us aim to eliminate Lymphatic Filariasis by 2027, three years ahead of the global target , through the five-pronged roadmap as said by Union Health & Family Welfare minister Dr Mansukh Mandaviya said in press note on 13 Jan 2023 Multi-drug administration (MDA) Campaign twice a year synchronized with National Deworming Day (10th Feb and 10th August) Early diagnosis and treatment; engagement of medical colleges for strengthening Morbidity management and disability (MMDP) services Integrated Vector Control with multi sectoral coordinated efforts For inter sectoral convergence with allied departments and ministries Leveraging existing digital platforms for LF and exploring alternate diagnostics

31. Agent: L. donovani Reservior : Dogs, jackals, foxes, etc (only man in india ) Vector: Phlebotomus argentipes ( Sandfly ) 31 female Phlebotomus argentipes feeding on a human arm Extrinsic incubation period is 6-9 days. Few points about Kala Azar

32. 32 P. Argentipes ( Sandfly ) found within a radius of about 20 yards of a dwelling house, in dark, humid soil protected from sunlight. Breeds in cracks & crevices in the soil & buildings, tree holes, caves,etc . Breeding places: Resting Habits: resting shelters are protected from sunlight and excessive temperature (mostly indoor) Feeding Habits: active after dusk hrs

33. 33 (C) KALA-AZAR Kala- azar is now endemic in 33 districts of Bihar , 4 districts of Jharkhand , 11 districts of West Bengal and 6 districts of Uttar Pradesh , besides sporadic cases in few other districts of Uttar Pradesh. A centrally sponsored programme was launched in 19 90 -91. The strategies for Kala- azar elmination are : Enhanced case detection and complete treatment including introduction of rK39 rapid diagnostic kits and oral drug Miltefosine for treatment of Kala- azar cases; Interruption of transmission through vector control . It has been decided to replace DDT with synthetic pyrethroid for the purpose of fogging to eliminate sandfly , as the insect is becoming resistant to DDT; Communicatio n for behavioural impact and intersectoral convergence; Capacity building ;

34. 34 (e) Monitoring, supervision and evaluation ; and (f) Research guidelines on prevention and control of Kala- azar have been developed and circulated to the states. ACTIVE CASE SEARCH : The frequency of case searches has been increased from a single annual case search to quarterly case searches. The active case searches are carried out during a fortnight designated as the “ Kala- azar Fortnight ”, during which the peripheral health workers and volunteers are engaged to make door-to-door search and refer the cases conforming to the case definition of kala-azar and PKDL (Post Kala Azar Dermal Leishmaniasis ) to the treatment centres for definitive diagnosis and treatment.

35. 35 An incentive amount of Rs. 300 is provided to ASHA for identifying each case of kala-azar and Rs. 100 for ensuring one round and Rs. 200 for two rounds of insecticide spraying. Even the patient being treated in the hospital will be given Rs. 500 as compensation of daily wage for the time he spends in the hospital during the treatment for kala-azar and Rs. 2,000 for PKDL. This revised strategy of total eradication of kala-azar was launched on 2nd September 2014. The new strategy also includes introduction of Rapid Diagnostic Kit developed by ICMR into the programme and single dose treatment with Liposomal Amphoterecin B , which is given intravenously in 10 mg/ kgbw dose. It is to reduce the human reservoir of infection. WHO will supply the drug free of cost

36. 36 India is committed to eliminating Kala Azar from the country by 2023 as said by Union Health and family welfare minister Dr Mansukh Mandaviya while chairing a meeting with State Health Ministers of Uttar Pradesh, Bihar, West Bengal & Jharkhand to review the progress of elimination of Kala Azar disease in these States. (99.8%) endemic blocks have already achieved elimination status. (Ref: https://newsonair.com/2023/01/05/india-is-committed-to-eliminating-kala-azar-from-the-country-by-2023-union-health-minister/)

37. Agent: group B arbovirus ( Flavivirus ) Vector: Culicine mosquito(C. tritaeniorhynchus , C.vishnui , C. gelidus ) Mode of transmission: bite of infected female culicine mosquito Transmission Cycle: Pig-mosquito-pig. Man is accidental dead end. Man to man transmission hasn’t recorded. 37 Few points about JE

38. 38 C.Tritaeniorhynchus & C. vishnui Rice Field Shallow Ditches at Field Breeding Places: Resting Habits: These vectors are primarily outdoor resting in vegetation and other shaded places but in summer may also rest in indoors.

39. 39 (D) JAPANESE ENCEPHALITIS Japanese encephalitis is a disease with high mortality rate and those who survive do so with various degrees of neurological complications. During the last few years it has become a major public health problem. States of Andhra Pradesh, West Bengal, Assam, Tamil Nadu, Karnataka, Bihar, Maharashtra, Manipur, Haryana, Kerala and Uttar Pradesh are reporting maximum number of cases.

40. 40 strategies for prevention and control of JE include .. strengthening of the surveillance activities through sentinel sites in tertiary health care institutions, early diagnosis and proper case management , As there is no specific cure for this disease, early management is very important to minimize the risk of complications and death. integrated vector control , particularly personal protection and use of larvivorous fishes, As the JE vectors are outdoor resters , indoor residual spray is not effective. The states are advised to use malathion for outdoor fogging as outbreak control measure in the affected areas capacity building and IEC and Behaviour change communication . JE vaccination is recommended for children between 1 to 15 years of age.

41. 41 Emphasis should be given on keeping pigs away from human dwellings, particularly during dusk to dawn , which is the biting time of vector mosquitoes Use of clothes which cover the body fully to avoid mosquito bites are advocated. Use of bed-nets is also very important precaution. Epidemiological monitoring of the disease for effective implementation of preventive and control measure and technical support is provided on request by the state health authorities.

42. Agent : DENV-1,DEN-2, DEN-3 & DEN-4 serotypes of genus flavivirus . Vector: Aedes Aegypti  (Mainly)& Aedes Albopticus mosquito Transmission Cycle Few points about Dengue 42 Extrinsic incubation period: It takes about 8 to 10days to develop the virus in its body and transmit the disease. Man develops disease after 5-6 days (3-10 days) of being bitten by an infective mosquito

43. Small, black mosquito with white stripes Approximately 5 mm in size   43 Aedes Aegypti Feeding Habit Strongly anthrophillic ( feeds on human)in domestic, peridomestic areas Day biter Bites more than 1 host to complete blood meal It leads to multiple cases & clusters of cases

44. 44 Resting Habit Rests in the domestic and peridomestic situations Rests in the dark corners of the houses, on hanging objects like clothes, umbrella, etc. or under the furniture Breeding Habits Any type of man made containers or storage containers having even a small quantity of water Eggs of  Aedes aegypti  can live without water for more then one year Aedes Aegypti

45. Disease is prevalent throughout India in most of the metropolitan cities and towns Outbreaks have also been reported from rural areas of Haryana, Maharashtra & Karnataka 45 Common Breeding places of Ae . Aegypti

46. 46 (E) DENGUE FEVER/ DENGUE HAEMORRHAGIC FEVER During 1996, an outbreak of dengue was reported in Delhi. Since then dengue has been reported from other states also. In view of this major outbreak of the disease a “Guideline of Preparation of Contingency Plan in case of outbreak/epidemic of Dengue/Dengue haemorrhagic fever” was prepared and sent to all the states. It includes all the important aspects of control measures like identification of outbreak, demarcation of affected area, containment of outbreak, case management, vector control, IEC activities about Do’s and Don'ts for prevention of dengue, monitoring and reporting etc

47. 47 The GOI has taken the following steps for prevention and control of dengue - Monitoring the situation through reports received from state health authorities. A mid-term plan for prevention and control of dengue has been developed in 2011 and circulated to the states for implementation. The main components of mid term plan for prevention and control of dengue are as follows: (a) Surveillance : Disease and entomological surveillance. Government of India in consultation with states has identified 521 sentinel surveillance hospitals with laboratory support in the endemic states. Further, for advanced diagnosis and back-up support 14 Apex Referral Laboratories have been identified and linked with sentinel surveillance hospitals

48. 48 (b) Case mangement : Laboratory diagnosis and clinical management. For early diagnosis ELISA based NS1 kits have been introduced under the programme which can detect the cases from 1st day of infection. IgM capture ELISA tests can detect the cases after 5th day of infection . These kits are provided free of cost by NIV,Pune . Alerting the hospitals for making adequate arrangements for management of dengue/dengue haemorrhagic fever cases has also been advised. (c) Vector management : Environmental management for source reduction, chemical control, personal protection and legislation. (d) Outbreak response : Epidemic preparedness and media management.

49. 49 (e) Capacity building : Training, strengthening human resource and operational research. (f) Behavioural change communication : Social mobilization, and information, education and communication (IEC). Since early reporting of cases is crucial to avoid any complication and mortality, the community is given full information about the signs and symptoms as well as availability of health services at health centres /hospitals. (g) Inter- sectoral coordination : with ministries of urban development, rural development, panchayati raj, education sector. (h) Monitoring and supervision : Analysis of reports, review, field visit and feed-back.

50. Agent: chikungunya virus Vector: Aedes Aegypti mosquito (in Asia) Incubation period: 4-7 days Transmission cycle 50 Few points about Chikungunya

51. 51 (F) CHIKUNGUNYA FEVER Chikungunya fever is a debilitating non-fatal viral illness. Since same vector is involved in the transmission of dengue and chikungunya , strategies for transmission risk reduction by vector control are also the same. Support in the form of logistics and funds are provided to the states. For carrying out proactive surveillance and enhancing diagnostic facilities for chikungunya , the 521 sentinel surveillance hospitals involved in dengue in the affected states also carry out chikungunya tests. The diagnostic kits are provided through National Institute of Virology, Pune , by the central government.

52. 52 Thank You….