SUJEET Kumar jha NVBDCP community medicine

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1. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM (NVBDCP ) MENTOR - DR. GEETIKA MAAM BY- DR.SUJEET KUMAR JHA(intern)

2. Outlines of the topic:- -Introduction -Milestones -Vision -mission -Objectives - strategies -Implementation of strategies -Reference

3. Introduction . National Vector borne disease control programme (NVBDCP )- - one of the most comprehensive and multifaceted public health activities in the country and concerned with prevention and control of vector borne diseases. . The prevention and control of these vector include environmental management and chemical methods. .Proper solid waste disposal and improved water storage practices prevent breeding of mosquitoes . It is an integrated component of NHM(National Health Mission) & is implemented under the overall umbrella of NHM in 2003 -2004.

4. NVBDCP is an umbrella program for prevention and control of 6 vector born diseases namely

5. MILESTONE OF NVBDCP . Bhore Committee Report 1946 . National Malaria Control Program1953 .The National filarial Control Program was launched in 1955 .National Malaria Eradication Program1958 .Urban Malaria Scheme1971 . National Dengue fever control programme (NDCP) 1996 .National Anti Malaria Program1999 .National Health Policy2002 .National Vector Borne Dis. Cont. Program 2004 .Newer insecticide and larvicide introduced 2014 .National Framework for Malaria Elimination in India 2016-2030

6. Factors increase the risk of vector borne disease outbreak Increasing urban population Shortage of water supply Traditional water shortage Poor garbage collection Changing life style (eg: use of water coolers ,not using mosquito net) Rapid transportation Lack of surveillance of clinical cases Lack of laboratory facilities for diagnosis Lack of professional manpower such as epidemiologist ,entomologists , etc.

7. Vision NVBDCP A well informed and self –sustained ,healthy India free from vector borne diseases with equitable access to quality health care.

8. MISSION STATEMENT OF NVBDCP Integrated Accelerated Action (IAA) towards ✓ Reducing mortality on account of Malaria, Dengue, and JE by half . Elimination of Kala-azar by 2010 (which then pushed to 2015, then 2017 then 2020 but yet to achieve ). ✓The government of India reviewed kala-azar control programme in the year 2000 and recommended feasibility of its elimination from the country . the national health policy (2002)envisaged kala-azar Elimination by 2010 which was revised later to 2015. Now kala-azar is targeted for elimination by 2023 through WHO NTD Road Map goal is 2030 ✓ Elimination of lymphatic Filariasis by year 2015 (Later extended to 2021 yet to achieve). :-

9. Program objectives of NVBDCP: Reduce malaria morbidity and mortality by 50% by 2012(Base line year is taken 2006). Targets:- Annual Blood Examination Rate(ABER) Annual parasite incidence (API)1.3 or less 25% Reduction in morbidity and mortality due to malaria by 2010 and 50% by 2012. Indicators:- Percentage of blood smears examined from population under surveillance during the year. Number of laboratory confirmed malaria cases per 1000 population (API) Number of malaria deaths per 100,000 population

10. STRATIGIES A. NVBDCP strategies •Three pronged strategy for prevention and control of vector born 1. DISEASE MANAGEMENT 1a) Early diagnosis /case detection 1b)Prompt & complete treatment 1c)Referral services strengthening 1d)Epidemic preparedness and Rapid

11. 2.INTEGRATED VECTOR MANAGMENT For transmission risk reduction a) Indoor residual spraying (IRS) eg. DDT, Malathion . b) Use of insecticide treated nets (ITN's ) c) Use long lasting insecticidal net's (LLIN's ) d) Use of (larvivorous fish) Anti larval measures (ALM) eg . Gappi , Gambusia fish etc.

12. 3.Supportive interventions a)Behaviour change communication b)Public private partnership c)Inter sectorial convergence d)Human resource development e) Monitoring evaluation f)Vaccination for JE g)Web based management information system h)Annual mass drug administration

13. 4.Improve efficiency and quality of services at primary level , secondary level and Tertiary level Primary level 1 . ASHA under NHM Anganwadi workers of ICDS and Community volunteers of NGO's would be trained to serve Fever Treatment Depot's (FTD's) early Rx. 2. PHC's, CHC's equipped to manage Pf. Malaria. 3. Lab Surveillance enhanced program.

14. b. Secondary level: 1. Training- Medical officers- Lab Technicians and- Community volunteers of public & private sector. 2. District level hospitals: Equipped with ventilators and lab services 3. Medical audit.

15. c. Tertiary Level: 1. Medical college hospital to manage all referrals cases. 2. Under take therapeutic efficacy studies of combi pack and effectiveness of rapid diagnostic kits. 3. Rapid diagnosis for management of severe malaria cases

16. Directorate of National Vector borne Disease National Centre For Disease Control The National Institute of Communicable Disease (NICD) has been renamed as the National Centre for Disease Control (NCCDC) which was inaugurated on 26th July 2009

17. Priority Activities for 2017-2022 National and regional vector control strategic plans developed or adapted to align with the global vector control response . 1.National vector control needs assessment conducted or updated and resource mobilization plan developed, including for outbreak response . 2. National entomology and cross-sectoral workforce appraised and enhanced to meet identified requirements for vector control 3. Relevant staff from health ministries or supporting institutions trained in public health entomology . 4. National and regional institutional networks to support training and/or education in public health entomology

18. 5.National agenda for basic and applied research on entomology and vector control established and/or progress reviewed. 6. National inter-ministerial task force for multisectoral engagement in vector control established and functioning . 7. National plan for effective community engagement and mobilization in vector control developed . 8. National vector surveillance systems strengthened and integrated with health information systems to guide vector control 9. National targets for protection of at-risk population with appropriate vector control aligned across vector borne diseases.

19. Controlling Authorities The directorate of NVBDCP is the nodal agency/ State level nodal department for planning policy making and technical guidance and monitoring and evaluation of program implementation in respect of prevention and control of major vector born diseases but involvement of community at each step considered to be vital for its success.

20. MALARIA 1. Early case Detection and Prompt Treatment is the main strategy of malaria control radical treatment is necessary for all the cases of malaria to prevent transmission of malaria. Chloroquine is the main anti-malaria drug for uncomplicated malaria. Drug Distribution Centres (DDCs) and Fever Treatment Depots (FTDs) have been established in the rural areas for providing easy access to anti-malarial drugs to the community. Alternative drugs for chloroquine resistant malaria are recommended as per the national drug policy of malaria 2014

21. 2.Vector control ( i ) Chemical Control Use of Indoor Residual Spray (IRS) with insecticides recommended under the programme, Use of chemical larvicides like Abate in potable water. Aerosol space spray during day time. Malathion fogging during outbreaks (ii) Biological Control Use of larvivorous fish in ornamental tanks, fountains etc. Use of biocides.

22. (iii) Personal Prophylactic Measures that individuals/communities can take up Use of mosquito repellent creams, liquids, coils, mats etc . Screening of the houses with wire mesh Use of bed nets treated with insecticide Wearing clothes that cover maximum surface area of the body 3 .Community participation Sensitizing and involving the community for detection of Anopheles breeding places and their elimination

23. 4.Environmental Management & Source Reduction Methods Source reduction i.e. filling of the breeding places Proper covering of stored water Channelization of breeding source

24. 5.Monitoring and Evaluation of the program Monthly Computerized Management Information System (CMIS ) Field visits by state by State National Program Officers Field visits by Malaria Research Centres and other ICMR Institutes Feedback to states on field observations for correction actions.

25. 6. Newer Intervention for Prevention and Control Integrated Vector Management Long Lasting Insecticidal Nets (LLINs ) Bio-Larvicides Larvivorous fishes Mono & bivalent RDTs ( Monovalent , Valent RDT) ACT Operational Research on insecticidal resistance, Chloroquine resistance and therapeutic efficacy studies on ACT-AL, Q of RDT . Strategy for Malaria pre-elimination in the country by 2017 . Genomic studies for better malaria control Development of vaccine for malaria.

26. Vaccine The RTS,S/AS01 vaccine has been recommended by the World Health Organization (WHO) for the reduction of malaria morbidity and mortality in children living in endemic areas Certainly! In 2024, India’s Serum Institute shipped its first batch of the  R21/Matrix-M malaria vaccine  to Africa. Developed in collaboration with the University of Oxford and Novavax, this vaccine is authorized for use in children in malaria-endemic regions

27. The National Framework for Malaria Elimination in India (2016-2030): Has divided states into 3 categories ✓ Category 0 (with 0 indigenous cases) states/UTs: None ✓ Category 1 (with API <1 in all the districts)15 states/UTs are: Himachal Pradesh, Punjab, & Kashmir, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand, Haryana, Sikkim, Rajasthan, Daman & Diu, Goa, Delhi and Lakshadweep .

28. ✓ Category 2 (with API >1 in some districts)11 states/UTs are: Bihar, Tamil Nadu, Telangana, Uttar Pradesh, Karnataka, West Bengal, Andhra Pradesh Assam, Maharashtra, Gujarat and Nagaland. ✓ Category 3 (with API >1)10 states/UTs are: Andaman &Nicobar islands, Madhya Pradesh, Dadar & Nagar Haveli, Jharkhand, Arunachal Pradesh, Chhattisgarh, Odisha, Meghalaya, Tripura and Mizoram.

29. Has formulated the following objectives: ✓ 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 1000population 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.

30. District as the unit of planning and implementation: ✓ States and UTs should categorize their districts so that even if the given state/UT is not yet in the elimination phase, their districts with API < 1 could be considered eligible for initiating elimination phase activities. ✓ In addition, each district may sub-categorize its blocks into different phases based on their API; and further each block into its PHCs, PHC into SCs and SC to villages. ✓ This would facilitate some category 2 districts to start elimination activities in their blocks falling in category 1.

31. KALA-AZAR Kala-azar or visceral leishmaniasis is a chronic disease caused by an intracellular protozoan (leishmaniasis species) and transmitted to man bite of infected female phlebotomus sand fly.   Specifically, it affects 33 out of 38 districts in Bihar In 2023, India hit target towards eliminating Kala Azar, first time India has achieved the target of reporting less than one case per 10,000 population across all blocks in 2023

32. Kala-azar was declared a “Notifiable disease” in Bihar and West Bengal. This decision was made as part of efforts to eradicate the disease by 2015, and it signifies that health authorities must report cases of Kala-azar promptly Key indicators in the KA elimination Detection rate (%) Treatment completion rate(%) Coverage rate of vector control(%)

33. LYMPHATIC FILIARASIS Bancroftian Filariasis caused by Wucheria Bancroft , which is transmitted to man by the bites of infected mosquitoes .Culex ,Anopheles ,Mansonia and Aedes Filariasis has been a major public health problem in India next only to malaria WORLD HEALTH ASSEMBLY RESOLUTION FOR- Elimination of lymphatic Filariasis in 1997 and India was also signatory. WHO announced the global Program to eliminate Lymphatic Filariasis in 1998

34. ELIMINATION OF LYMPHATIC FILARASIS 1.Commitment to Elimination In 1997, the World Health Organization (WHO) and its Member States committed to eliminating LF as a public health problem by 2020. India set a goal to eliminate LF by 2015, later extended to 2021 2 . S trategies for Elimination 2a)Mass Drug Administration (MDA ) 2b) Morbidity Management and Disability Prevention (MMDP ) •.

35. 3 Current status India has 257 LF endemic districts across 16 states and 5 union territories. Approximately 650 million people are at risk, with 31 million infected cases and 23 million suffering from lifelong disability. The population coverage during MDA has improved from 73% in 2004 to 87.33% in 2019 (provisional data) 4. Participating States The 11 endemic states include Assam, Bihar, Uttar Pradesh, Jharkhand, Odisha, Chhattisgarh, Karnataka, Kerala, Madhya Pradesh, West Bengal, and Gujara

36. 5. High Burden in Eastern and North-Eastern States India accounts for over 40% of global LF cases, predominantly from eastern and north-eastern states. Odisha is historically recognized as one of the highly endemic regions In summary, India remains committed to eliminating LF, with ongoing efforts to reach the target by 2027.  The focus is on MDA, morbidity management, and disability prevention to reduce the burden of this disease

37. JAPANESE ENCEPHALITIS Japanese encephalitis is a zoonotic disease and caused by an arbovirus group B (flavivirus) and transmitted by Culex mosquitoes. There are two cycles of transmission ;one is pig-mosquito-pig and another Ardeid bird –mosquito-Ardeid bird, The disease is transmitted to man by the bite of infected mosquito . Japanese encephalitis is a endemic in roughly 21 states of India

38. Case fatality rate 20-40% Investigation by : Igm E lisa Prevention : 1.Vaccination - Killed : Beijing and nakayama strain Live : South African 14-14-2(the only strain used India) 2. Integrated vector management

39. DENGUE Dengue and Dengue Haemorrhagic fever is an acute viral disease cause by a group B arbovirus, Disease is prevalent throughout India in most of the metropolitan cities and towns Following initiatives of the government are started: Observance of National Dengue Day on 16th May, 2016. A mobile App called 'India Fights Dengue' has been developed by NVBDCP/M0HFW, Gol in coordination with National Health Portal (NHP)/ National Institute for Smart Government (NISG).

40. This App was launched by Hon'ble Union Minister for Health and Family Welfare on the event of World Health Day celebration on 7th April, 2016. • It is android based and can be downloaded from Google play store and can be run on internet and mobile phone. • The basic idea of developing this App is to empower the Community for their involvement and active participation in Dengue control especially in source reduction activities.

41. Challenges in Dengue Control Multiple implementing agencies involved Entomological monitoring & timely interpretation of data Enactment of building & civic bye laws (Delhi malaria bye laws 1976 needs to be updated ) Sustainability of effective community based vector control Platelet dependency for case management-CME of doctors on national guidelines Increased use of non bio- degradable plastics Effective interdepartmental coordination on dengue control Capturing cases diagnosed in private sector

42. ( confirmed/probable) • Actual disease burden (improved reporting ) Coexistence of Chikungunya and threat of Zika transmitted by same vector Maintenance of Aedes surroundings of International Airport DENGUE Vaccine Dengvaxia  is basically  a live, attenuated dengue virus  which has to be administered in people of ages  9 to 16  who have laboratory-confirmed previous dengue infection and who live in endemic areas

43. CHIKUNGUNIYA Chikungunya word derived from the word “kungunyala” in the Makonde language of south eastern Tanzania and northern Mozambique, which means “to dry up or become contorted”. Chikungunya caused by chikungunya virus, which is classified by Togaviridae family India is a major epidemic of Chikungunya fever was reported during the last millennium viz.; 1963 (Kolkata ) Total Confirmed Cases : Approximately  12,205  cases reported in 2024 Diagnosed by ELISA test The disease resembles as dengue fever and is characterized by severe and persistent joint pain

44. References: PARK text book 26 th EDITION IAPSM 2 nd EDITION NATIONAL HEALTH PROGRAM OF INDIA 14 TH EDITION Kala-azar elimination in a highly-endemic district of Bihar, India: A success story - PMC (nih.gov ) https:// www.theweek.in/news/health/2023/11/11/india-committed-to-eliminate-lymphatic-filariasis-by-2027-all-you-need-to-know.html CHIKUNGUNYA SITUATION IN INDIA :: National Center for Vector Borne Diseases Control (NCVBDC) (mohfw.gov.in ) India’s First DNA Vaccine for Dengue (drishtiias.com ) FAQ - JAPANESE ENCEPHALITIS :: National Center for Vector Borne Diseases Control (NCVBDC) (mohfw.gov.in ) https://www.indiatoday.in/health/story/serum-institute-india-ships-first-batch-r21-matrix-m-malaria-vaccine-africa-who-2541499-2024-05-20

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