NVBDCP-GUJARAT

Current Status of Vector Borne Diseases in Gujarat.

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DR.G.C.SAHUDR.G.C.SAHU
ROH&FWROH&FW
GOVT OF INDIAGOVT OF INDIA
AHMEDABADAHMEDABAD

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MOS QUITOS OF P UB LIC HEALTH

MOS QUITOS OF P UB LIC HEALTH
IMP ORTANCEIMP ORTANCE
AEDES-- DENGUEAEDES-- DENGUE
ANOPHELES-MALARIAANOPHELES-MALARIA CULEX--FILERIACULEX--FILERIA
…….AND THE TYPE OF EGGS THEY LAY .
ANO.ANO. AED.AED. CUL.CUL.

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Overall Goals Overall Goals
1.1. To reduce malaria morbidity and mortality by 50 % in 5 years.To reduce malaria morbidity and mortality by 50 % in 5 years.
2. To bring down LF transmission by achieving more than 90 % 2. To bring down LF transmission by achieving more than 90 %
reduction in Mf rate in five years.reduction in Mf rate in five years.
3. To reduce incidence of Dengue as well as Chikungunya by more 3. To reduce incidence of Dengue as well as Chikungunya by more
than 50%.than 50%.
Objectively verifiable indicatorsObjectively verifiable indicators
2.2.Annual parasitic Incidence to be reduced by 50% at the Annual parasitic Incidence to be reduced by 50% at the
end of the project period.end of the project period.
3.3.Reduction in micro filaria rate to less than 1.Reduction in micro filaria rate to less than 1.
4.4.Reduction in mortality due to malaria and dengue.Reduction in mortality due to malaria and dengue.
5.5.Reduction in sero positivity rate for Dengue and Reduction in sero positivity rate for Dengue and
Chikungunya.Chikungunya.
State GoalsState Goals
•Reduction in Annual Parasitic Incidence by 30%.Reduction in Annual Parasitic Incidence by 30%.
•Preventing deaths due to malaria.Preventing deaths due to malaria.
•Reduction in morbidity due to Dengue and Chikungunya by 50%.Reduction in morbidity due to Dengue and Chikungunya by 50%.
•Reducing Micro Filaria Rate by 50%.Reducing Micro Filaria Rate by 50%.

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Organizational chart of NVBDCP in Gujarat.
BHO
Department of Health & Family Welfare
Honorable Health Minister
Additional Chief Secretary Health & FW
Commissioner Health, Medical Services &
Medical education
Additional Director Health Services

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LIFE CYCLE OF MALARIA PARASITE AS IT PROCEEDS IN HUMAN & VECTOR MOSQUITOLIFE CYCLE OF MALARIA PARASITE AS IT PROCEEDS IN HUMAN & VECTOR MOSQUITO
LIFE LIFE CYCLECYCLE OF MAL.PARASITE—P.VIVAX OF MAL.PARASITE—P.VIVAX
Dr.G.C.Sahu/ROH&FW/GoI/A'badDr.G.C.Sahu/ROH&FW/GoI/A'bad 2828
Life CycleLife Cycle
Of Of Pf Pf
LIFE LIFE CYCLECYCLE OF MAL.PARASITE— OF MAL.PARASITE— PF.PF.

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Valsad, Navsari, Bharuch,Jamnagar and JunagadhCoastal malaria
Surat, Valsad, Bharuch,Kutch, Jamnagar.Industrial malaria
Surat,Vadoadara, Ahmedabad, Bharuch.Urban malaria
Surat city, other urban areas.Migration malaria
Central Gujarat :Kheda, Anand, Panchamahal,
Vadodara
Irrigation malaria
4 districts in the Kutch and North Gujarat regionEpidemic prone semi
arid and arid area
11 districts of South, Central and North Gujarat.Tribal malaria
Areas/districts coveredMalaria paradigm
Malaria paradigms in Gujarat
The peculiar geo-ecological conditions in Gujarat State
which consists of diverse topographic features, climatic conditions
and other favorable factors such as rapid industrialization and
urbanization have facilitated the formation of different malaria paradigms

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Malaria Cases, Pf & Deaths
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Cases
100
600
1100
1600
2100
2600
3100
Deaths
Cases Pf Deaths
Malaria situation in India

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0-2
2-5
5-10
>10
Endemic areas for malaria(based on API 2 as baseline)

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Malaria situation in Gujarat 1967 to 2006Malaria situation in Gujarat 1967 to 2006
Epidemiological situation of malaria Gujarat 1967 to 2004
0
200000
400000
600000
800000
1000000
1200000
1400000
1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000' 2001 2002' 2003' 2004' 2005' 2006'
No. of cases
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
% of P. falciparum
Malaria Cases Pf Cases % PF

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Significant increase in
Malaria from 32
nd
to
37
th
week

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Rise in falciparum
incidence
From 32
nd
week to 37
th

week

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Drug resistant blocks identified in Gujarat
Matar, mahudha,MehmdabadNadiadKheda
Olpad, Choryasi,KamrejSuart citySurat
Harij, Radhanpur, Patadi,
Rapar
SamiPatan
Limkheda, DhanpurDevgadhbariaDahod
AnandUmrethAnand
Nakhatrana, Mundra, Mandvi,
Anjar
BhujKutch
Santrampur, Lunawada,
Khanpur
KadanaPanchmahal
Adjoining blocksBlock in which drug
resistance detected
District

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Khavada-Gorewali/Khavada-Gorewali/
Kachchh-bhujKachchh-bhuj
Kadana/Kadana/
Panch mahalsPanch mahals
PHCs where alternatrive drug policy PHCs where alternatrive drug policy is inis in place. place.
GUJARATGUJARAT
Pansora/AnandPansora/Anand
Degawada/DahodDegawada/Dahod
Lolada/PatanLolada/Patan
Surat city(CHQ&ACT)Surat city(CHQ&ACT)
Khanvel-D&NHKhanvel-D&NH

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Dengue Control…..need
for an…..Integrated
Strategy

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Month wise Dengue Cases reported in the Gujarat State during
2006, 2007,2008,2009 & 2010
0
100
200
300
400
500
600
Dengue cases
Case-06 13 14 8 31 26 50 65 120 90 64 56 8
Case-07 12 19 39 34 16 31 36 87 113 97 101 14
Case-08 38 13 11 12 18 23 38 85 197 230 263 137
Case-09 72 34 77 101 127 64 100 251 421 550 387 277
Cases-10104 65 77 141 96 84 121 247 210
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

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50 %
Contribu
tion
by the
Corporat
ions

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AMC reported
more cases in 2010

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Surat, Valsad and
Navsari
reported more cases

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Jamnagar corporation
Reported significant
rise
In cases

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Bhavanagar district and
corporation
Reported more cases.

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Suspected cases of Chikungunya reported in 2006, 2007 , 2008 and
2009
118846
3412
303 489
0
20000
40000
60000
80000
100000
120000
140000
2006 2007 2008 2009
Suspected cases
During 2009 a total of 68confirmed
Chikungunya cases
have been reported from
A,bad (6), Kheda(15), Anand (4), SK (2), Vadodara (10),
PM (2),Bharuch (2), Narmda (6), Rajkot (3)
Junagadh (5), Porbandar (1), VMC (1), SMC (11)

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AS Fauci
GLOBAL EXAMPLES OF EMERGING AND RE-
EMERGING INFECTIOUS DISEASES

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Integrated Strategy
SocialSocial
CommunicationCommunication
EpidemiologicalEpidemiological
SurveillanceSurveillance
EntomologyEntomology
Patient CarePatient CareLaboratoryLaboratory

Integrated

Integrated
StrategyStrategy
ComponentsComponents

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Filaria Endemicity in Gujarat
0
20000
40000
60000
80000
100000
120000
140000
1994'1995'1996'1997'1998'1999'2000'2001'2002'2003'2004'2005'2006'
Persons Examined
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
M.F.rate and Diseases rate
No.of Persons Examined Mf.Rate (%)

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Year BSE MF cases MF rate
2006 73379 142 0.20
2007 80664 112 0.14
2008 71224 81 0.11
2009 64531 45 0.10
Filaria situation of Gujarat State: 2006-2009

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Sr. No Name of District/Corporation
No. of Patients
Total
Lymphoedema Hydorcele
1Surat ® 1422 8792301
2SMC 470 157 627
3Tapi 247 266 513
4Valsad 65 37 102
5Navsari 449 457 906
6Rajkot 45 3 48
7RMC 28 0 28
8Jamnagar 169 0 169
9JMC 250 3 253
10Junagadh ® 59 0 59
11Jun-Cor. 59 4 63
12Porbandar 55 3 58
13Amreli 64 3 67
14Vadodara 11 148 159
Total 3393 19605353
District wise Lymphoedema and hydrocele cases reported in Gujarat State

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85.05284275301158720113624583TOTAL
91.351319855238157339Vadodara8
86.661174632503067580500Porbandar7
85.43488090420069562349131Rajkot6
84.23304178912926241534570Amreli5
84.29706198326811943181020Surat City4
85.78634857625807043008681Surat 3
85.05258147011135451309288Navsari2
84.58320619113567301604054Valsad1
%
Cov.
Consumption
of DEC tablets
Population
covered
Total Pop.DistrictSr.
No
MDA coverage - 2006

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Mass Drug Administration for Elimination of Lymphatic Filariasis
[ Coverage % againast total poulation at rsik]
IN GUJARAT-2005-2009
85.00 85.00 85.00 85 85
83.93
62.09
84.22
89.44
86.02
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009
% OF COV ACHIEVED & EXPECTED
% of coverage expected
% of coverage achieved.
.'

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Coverage under MDA during 2009
Sr.
No
.
District/Corporation
Total
Population
Eligible
population
Pop.
Covered
No. of tablets administered
% pop.
Covered
DEC Alb
1Surat 1658762 1490395 1394526 3738824 1394526 84.07
2Surat Muni.Corp. 4530348 4077313 3992472 10877376 3992472 88.13
3Tapi 835279 751749 689250 1880495 697819 82.52
4Valsad 1661890 1488650 1489881 3665965 1418742 89.65
5Navsari 1380170 1200153 1144648 2872825 1144648 82.94
6Rajkot 2461984 2142686 2150124 5368556 2150124 87.33
7Rajkot Muni.Corp. 1504606 1361830 1163527 3146086 1163527 77.33
8Jamnagar 1705501 1557330 1519045 3776086 1519045 89.07
9Jamnagar Muni.Corp. 588013 470410 445308 1168659 445308 75.73
10Junagah 2768982 2428643 2373654 5940261 2373654 85.72
11Junagadh Muni.Corp. 262600 223210 192760 515870 192760 73.40
12Amreli 1431227 1428000 1295827 3356178 1332259 90.54
13Porbandar 590717 502109 534121 1298614 534121 90.42
14Vadodara(Dabhoi) 58332 57447 56587 147032 56587 97.01
TOTAL 21438411 19179925 18441730 47752827 18415592 86.02

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Integrated Vector Management:
Anti larval measures
Introduction of larvivorous fish in identified water bodies
Insecticide treated bed nets
Indoor Residual Spraying
Parasite elimination:
Early case detection and prompt, complete treatment
Quality Assurance of laboratory diagnosis of malaria
Strengthening of referral services
Cross-cutting interventions:
Capacity Building through integrated training approach
Communication for Behavior Impact
Inter-sectoral collaboration
Operational research
Close monitoring and supervision with periodic reviews/evaluations
STRATEGIES UNDER NVBDCP:MALARIA CONTROL

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STRATEGIES UNDER NVBDCP:DENGUE/CHIKUNGUNYA CONTROL
Integrated Vector Management:Integrated Vector Management:
Anti larval measures/source reductionAnti larval measures/source reduction
Introduction of larvivorous fish in identified water bodies.Introduction of larvivorous fish in identified water bodies.
Indoor space Spraying/foggingIndoor space Spraying/fogging

Case management and surveillanceCase management and surveillance
Sentinel surveillanceSentinel surveillance
Early diagnosis for confirmation and to facilitate preventive stepsEarly diagnosis for confirmation and to facilitate preventive steps
Strengthening of referral services for case managementStrengthening of referral services for case management
Cross-cutting interventions:Cross-cutting interventions:
Capacity Building through integrated training approachCapacity Building through integrated training approach
Communication for Behaviour ImpactCommunication for Behaviour Impact
Inter-sectoral collaborationInter-sectoral collaboration
Operational researchOperational research
Close monitoring and supervision with periodic reviews/evaluations Close monitoring and supervision with periodic reviews/evaluations

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Indicators monitored on a regular basis
•Fever rate in the OPD/community.
•SPR, SFR ,MPI and MBER
•Sero Positivity rate for Dengue and Chikungunya
•Room coverage under IRS.
•Larval indices viz. HI, BI and CILarval indices viz. HI, BI and CI
•Time lag between BSC and complete treatment.
•Case fatality rate for Dengue and falciparum cases.

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EARLY DETECTION OF WRANING
SIGNALS THROUGH REGULAR
WEEKLY AND MONTHLY
MONITORING…..FOR
PREVENTING OUTBREAKS……. A
CONTINUOUS PROCESS

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PHcs and towns showing incresae in the incidence of malaria in
Kachchh district during Feb-07 as compare to Feb-06
0
5
10
15
20
25
30
35
Malaria cases
Malaria Case-061 3 3 4 2 1 5 6 3 1 7 6 3 5 2 2104
Malaria Case-07114 5 5 8 7 6 7 6 2 8 9 4 6 4 3129
Daya
par
Mata
nam
adh
Gadu
li
Desh
alpar
Mang
awar
Vitho
n
Dara
sadi
Godh
ara
Vanki
Manf
ara
SuvaiBela
Fate
hgad
h
Bhim
asar
Kera
Mand
avi
Gand
hidha
m
Rapa
r
Monitoring of comparative
malaria situation is useful to
identify vulnerable spots.

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Year
2006. GIS mapping of
village wise malaria
situation helped to
identify high risk
villages and to plan
containment
measures
accordingly.

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Facilities/institutions available for training in the State
 Regional Office for H&F.W, Ahmedabad.
 Health & F.W Training center- State level (1)
 Divisional Training center (4)
 District Training Team (17)
 Medical colleges (8)
 National Institute of Malaria Research- field station, Nadiad
Technical experts working in the above institutions are capable
of imparting training for the batches proposed in the training.

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Training modules available
•MOPHC
•Technical Supervisor
•Laboratory Technician
•ASHA
•Case management protocol for Dengue and malaria

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Prevention and control of Vector
Borne Diseases
(Preparedness activities)
Series of review meetings are
organized at the State level
which are chaired by
Honorable Chief Minister,
Health Minister, Additional
Chief Secretary Health and
Commissioner Health during
the pre transmission period.

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Surveillance and Case Management.
•All the 18000 villages were screened for fever
cases during the months of March, April, May
and June 2006 by campaign mode.
•Additional manpower ( 2772 Malaria Link
Volunteers and 419 Vector Control Teams of 6
members) was deployed.
•Surveillance was also intensified through the
volunteers of Fever Treatment Depots, Drug
Distribution Centers and ICDS workers.

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•3000 Arogya Melas were
organized in all the
districts of the state.
•More than 10.0 lakh
people took the benefit
out of these camps.
•8 Government Medical
Colleges and 2 Private
Medical Colleges were
involved and the services
of the Specialists from
the Departments of
Medicine, Pediatrics and
Gynecology was utilized
for treating the patients
in the Arogya Melas..
Surveillance and Case Management.

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•Alternate Systems of Medicine
were actively involved in the
campaign against
Chikungunay and 25 lakh
people were provided with
Ayurvedic Preparation as a
prophylactic measure.
•Suspected Chikungunya
patients were provided with
treatment at their doorsteps
through surveillance teams.

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•Management of severely ill patients was
ensured in all the major hospitals of the
state by providing them with free
treatment. These patients were
subsequently followed up.
•The Hospitals and Dispensaries
functioning under ESIS were also opened
to the General Public, more than 30,000
peoples benefited.
Surveillance and Case Management.

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•Larvae eating fishes were
introduced in 67956 permanent
water bodies out of 150267
( 45.22%). This activity which
was initiated from February
2006.
•Biolarvicide ( 9000 Kg) was made
available to each Corporation,
Districts and Nagarpalikas for
anti larval measures.
Vector Control - Biological

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Demonstration of Guppyfishes
to school children

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Vector Control - Chemical
(Insecticides used: Malathion 25 % WDP , Deltamethrine
2.5 % WP & Alphacypermethrine 5 % WP).
•Indoor Residual Spray
commenced in 63.58 lakh
population in May 2006 to
protect the high risk
population.
•13.50 lakh population covered
under Malathion 25% and
50.08 lakh population covered
under Synthetic Pyrethroid.
•Room coverage
achieved-89.78%

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Fogging operations.
•Indoor fogging operation was
undertaken in 40 lakh houses
for adult vector control.
•Outdoor fogging was
undertaken in Surat and
Ahmedabad cities in closed
mills and other public places
to minimize vector density.
•Fogging machines (100 no.s)
provided by UNICEF have
been put in to operation in the
worst affected areas of the
State.

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Vector Control- Insecticide Treated Mosquito Nets
•403508 community owned bed
nets were treated with
insecticide in addition to the
138448 insecticide treated bed
nets distributed under various
projects.
•Insecticide Treated Bed nets
were provided in Hospitals to
prevent the transmission of
vector borne diseases.

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Vector Control – Source reduction.
•419 Vector Control Teams ( each team
comprising 6 members) were deployed on daily
wages basis to intensify vector control measures.
•Elimination of breeding places mainly intra
domestic was taken up on a large scale in the
worst affected areas.
•1.49 Lakhs breeding places were eliminated
during the house to house drive that was
undertaken

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Chemical
Control
Environmental
Management Biological
Control
INTEGRATED VECTOR MANAGEMENT
An Evidence-based decision making process,
rationalizing the use of vector control methods
and emphasizing the engagement of
communities
JUDICIOUS USE & SELECTION OF VECTOR
CONTROL OPTIONS

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Peoples Participation
•Health Minister wrote
letters to all the Sarpanches
of the Village Panchayats
and other elected
representatives of the
District Panchayat,
Nagarpalikas and Municipal
Corporations.
•Health Minister addressed
the people of Gujarat
through Doordarshan
during anti Malaria Month.

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Peoples Participation
•Messages through
Doordarshan, EtV and Zee
TV was relayed for
generating community
awareness.
•Messages through All India
Radio and Radio Mirchi
were also relayed.
•Exhibition/ road shows were
organized.
•Rallies were organized.

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TABLO ORGANISED DURING REPUBLIC
DAY PARADE ON 26
TH
JANUARY 2006 AT
GANDHINAGAR

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GATE ON MAIN TRAFFIC CIRCLES OF
GANDHINAGAR TOWN.
NO ENTRY –
MALARIA,
DENGUE,
CHIKUNGUNYA

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School children and NCC
cadets were involved in
source reduction activities.
Hoardings and posters
were displayed.
10 lakhs of handbills were
printed and distributed.
Social mobilization
through NGOs, and other
sectors was also ensured.
Community was educated
during Krushi Mahotsav
and Anti Malaria Month.

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Highlights of the innovative
steps undertaken.

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•Areas reporting increase in fever incidence as per IDSP
reports and also the weekly reports from the districts are
being monitored on a day to day basis by deploying
surveillance teams.
•Intensive surveillance in high risk areas and follow of
malaria cases detected during 2005 and 2006 was being
carried out as a pre transmission drive in all the districts.
•Biological control and other source reduction activities were
intensified by deploying additional vector control teams on
daily wages basis.
Innovative steps undertaken
by the State.

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•Treating community owned mosquito nets and making
available more mosquito nets out of various sources was
taken up as a priority.
•Additional vector control teams deployed in Dengue prone
areas like Gandhinagar and Ahmedabad for Dengue
prevention and control activities.
•Timely commencement of Indoor Residual Spray.
•Awareness generation activities implemented as a part of
Krushi Mahotsava and Anti Malaria Month.
•Permission given to all districts to outsource the work of
laboratory Technicians by paying Rs. 3/ slide considering the
vacancies.
•To overcome the problem of entomological staff, the work
will also be outsourced through Indian Red Cross.

70. Dr.G.C.Sahu/ROH&FW/GoI/A'Bad 70
This completes This completes
the current the current
presentation.presentation.
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