3. INTRODUCTION
⢠Launched in 2003-04 by merging NAMP,NFCP
& Kala Azar Control programmes .Japanese B
Encephalitis and Dengue/DHF have also been
included in this Program
⢠Directorate of NAMP is the nodal agency for
prevention and control of major Vector Borne
Diseases
4. Historical perspective
⢠National Malaria Eradication Programme
(NMEP) which was being implemented in the
country since 1958, was reviewed in 1977 and
revised guidelines for Modified Plan of
Operation (MPO) were issused to all States &
UTs
5. ⢠Due to various outbreaks in the country
malaria situation was reviewed in 1994 by
an Expert Committee.
⢠In pursuance of the Expert Committee's
recommendations, the Directorate of NMEP
brought out operational manual for Malaria
Action Programme (MAP) in 1995
Historical perspective
6. ⢠The Directorate of NMEP was renamed as
Directorate of National Anti Malaria
Programme (NAMP) in March, 1999.
⢠Directorate of NAMP was dealing with three
centrally sponsored schemes namely Malaria,
Filaria and Kala-azar control and in addition,
was looking after the prevention and control
of Dengue and Japanese Encephalitis.
Historical perspective
7. ⢠With a view to converge Dengue/Dengue
Haemorrhagic feverand Japanese Encephalitis
with the three on-going centrally sponsored
schemes [National Anti-Malaria Programme
(NAMP), National Filaria Control Programme
(NFCP) and Kala-azar Control Programme],
the integrated scheme was renamed as
National Vector Borne Disease Control
Programme (NVBDCP) from 2nd December,
2003.
Historical perspective
8. ⢠In 2006, Chikungunya re-emerged in the
country and this was also brought within the
purview of Directorate of NVBDCP.
Historical perspective
9. NVBDCP â National Vector Borne
Disease Control Program
⢠NVBDCP is an umbrella program for
prevention and control of 6 vector borne
diseases namely:
ďMalaria
ďDengue
ďChikungunya
ďJapanese Encephalitis
ďKala-Azar
ďFilaria (Lymphatic Filariasis)
10. ⢠It is an integral component of NHM and is
implemented under the overall umbrella of
NHM
⢠The Programme is monitored at the National
level through the mechanisms established
under NHM.
NVBDCP
11. NVBDCP
⢠The Directorate is responsible for framing
technical guidelines & policies as to guide the
states for implementation of Program
strategies.
⢠Responsible for budgeting and planning the
logistics pertaining to central sector.
⢠Monitoring of implementation through
regular reports and returns of MIS is done.
12. NVBDCP
⢠The Directorate carries out evaluation of
Program implementation from time to time.
⢠The resource gap is also assessed as to
provide an equitable support based on the
magnitude of the problem.
⢠Under the Union Ministry of H&FW, GoI, 17
ROH & FW are functioning.
13. NVBDCP
⢠Every state has state vector borne diseases
control component under the Directorate of
Health Services
⢠There is a system of coordination between the
state and centre for effective implementation
and monitoring of Program.
14. NVBDCP
⢠At the district level, District Malaria Offices
have been established under District Chief
Medical and Health Offices by the states.
⢠Key unit for planning and monitoring of
Program under a technical officer.
⢠At present, 565 District Malaria Units are
functioning.
15. Mission statement
⢠Integrated accelerated action towards
â reducing mortality on account of Malaria, Dengue
and JE by half
â Elimination of Kala-azar by 2010
â elimination of lymphatic filariasis by year 2015.
15
16. Program objectives and strategies
⢠NVBDCP strategies comprise
ďEarly diagnosis, prompt and complete
treatment
ďIntegrated vector management including
promotion of personal protective measures
and biological measures
ďBCC, capacity building through integrated
training at all tiers of health care delivery
system
17. ⢠Partnerships
ďOther national health programs
ďNon-health sector departments
ďCivil society organizations (NGOs, CBOs, self-
help groups, panchayati raj institutions)
ďCorporate sectors
ďMedical academia and professional bodies
ďMonitoring and evaluation
Program objectives and strategies
18. ďHaving efficacy of 3-5 years have been
introduced
Program objectives and strategies
19. ⢠Improve efficiency and quality of services at
primary, secondary and tertiary levels
⢠Primary level
ďASHA under NHM, Anganwadi workers of ICDS
and Community Volunteers of NGOs would be
trained to serve Fever Treatment Depots
(FTDs)
ďPHCs, CHCs: equipped to manage PF malaria
ďLab surveillance enhanced
Program objectives and strategies
20. ⢠Improve efficiency and quality of services at
primary, secondary and tertiary levels
⢠Secondary level
ďTraining of Medical Officers, Lab Technicians
and Community Volunteers of public and
private sector
ďDistrict level hospitals: equipped with
ventilators and lab services
ďMedical audit
Program objectives and strategies
21. ⢠Improve efficiency and quality of services at
primary, secondary and tertiary levels
⢠Tertiary level
ďMedical college hospital: manage all referrals
ďUndertake therapeutic efficacy studies of
combi-pack and effectiveness of rapid
diagnostic kits
ďRapid diagnosis for management of severe
malaria cases
Program objectives and strategies
23. ⢠Government of India provides technical
support as well as logistics
⢠State governments ensure program
implementation
⢠The centre and the states monitor the
program closely and high-risk areas are
identified for focused attention
Program objectives and strategies
24. MALARIA
⢠The program aims to maintain Annual Blood
Examination Rate (ABER) of > 10% by active
and passive surveillance and bring down
Annual Parasite Incidence (API) to 1.3 or less
by 2012
⢠25% reduction in morbidity and mortality by
2010 and 50% by 2012 (baseline year 2006)
26. Malaria â problematic states
⢠Chattisgarh, Jharkhand, Maharashtra, West
Bengal and Orissa â have registered maximum
malaria cases in India (since 2007)
⢠Out of them, Orissa and Maharashtra have
contributed to most of the deaths due to
malaria
⢠Other high malaria burden states â MP, UP,
Gujarat, Rajasthan, Karnataka
27. MALARIA
⢠To strengthen malaria control, GoI is providing
cash assistance to states for engaging multi-
purpose workers (MPWs) on contractual basis
in about 200 identified high endemic districts
during the XI Five Year Plan
28. MALARIA
⢠Provision has been made under external
assistance for positioning Malaria Technical
Supervisors (MTS) in high endemic areas to
strengthen supportive supervision and micro-
level monitoring
⢠Each MTS to cover a population of 2.5 lacs in
selected areas of the high endemic districts
29. MALARIA
⢠Under NVBDCP, all fever cases are required to
be immediately examined
⢠Positive cases are provided prompt and
complete treatment
⢠Incentives have been considered for ASHAs
for performing Rapid Diagnostic Tests (RDTs),
preparation of slides and administering
complete treatment
30. MALARIA
⢠ASHA can also arrange to transport severe
malaria cases to the referral centers with the
expenditure borne out of funds from untied
grants of NHM
⢠Funds available with the Village Health and
Sanitation Committee (VHSC) can also be
utilized (this grant may also be utilized for
source reduction of mosquito breeding sites)
31. GUIDELINES UNDER NVBDCP:
MALARIA
⢠Surveillance and case management
ďConventional diagnostic method through
microscopy remains the gold standard
ďHowever, rapid diagnostic kits (Pf kits) are
provided for quick treatment in difficult and
inaccessible areas with P. falciparum
predominance
32. ⢠Integrated Vector Control Management
ďIRS: 2 rounds of DDT/synthetic pyrethroid or 3
rounds of malathion based on the insecticide
resistance studies and epidemiological
information.
ďIRS to be done in all areas with (Annual
Parasite Index) API>2 or above.
ďPriority of spray to be given to high risk areas
with API or SPR 5 and above
GUIDELINES UNDER NVBDCP:
MALARIA
33. ⢠Integrated Vector Control Management
(contd.)
ďUse of ITMN
ďReduction of breeding sites: use of larvivorous
fish â Gambusia and Poecilia (Guppy)
GUIDELINES UNDER NVBDCP:
MALARIA
34. ⢠Epidemic preparedness and Response (EPR)
ďObjectives are early identification and control
of epidemic
ďEarly warning signals which include
epidemiological & entomological parameters ,
climatic factors (rain fall, temperature and
humidity), operational factors (inadequacy
and lack of trained manpower) are monitored
GUIDELINES UNDER NVBDCP:
MALARIA
35. ⢠Epidemic preparedness and Response (EPR)
ďProper linkage with Integrated Diseases
Surveillance Programme (IDSP) at district level
for obtaining early warning signals on regular
basis
ďDistrict should have rapid response team
consisting of epidemiologist, entomologist, lab
technician, Medical Officer, health workers,
supervisors, community volunteers
GUIDELINES UNDER NVBDCP:
MALARIA
36. ⢠Supportive interventions
ďTraining and capacity building
ďźIntegrated training programme have been
designed for different categories of health
care functionaries
GUIDELINES UNDER NVBDCP:
MALARIA
37. ⢠Supportive interventions
ďBehaviour Change Communication
ďźEmpowers people to take rational and
informed decisions through appropriate
knowledge
ďźInculcates necessary skills and optimism
ďźStimulates pertinent action
ďźReinforces the same through peers and
influencers.
GUIDELINES UNDER NVBDCP:
MALARIA
38. ⢠Supportive interventions
ďInter-sectoral Collaboration
ďźAnti Malaria Month is being observed with
enhanced level of campaigning just before
the peak transmission season
GUIDELINES UNDER NVBDCP:
MALARIA
39. ⢠Innovations/modifications have been
proposed to be intensified during XI Five Year
Plan
ďFor focused interventions, 206 districts have
been identified as high malaria endemic
ďOf which, 100 districts â high API and Pf
rate>30%
ďFurther out of these 100, 61 districts
identified as very high malaria endemic
districts
GUIDELINES UNDER NVBDCP:
MALARIA
40. ⢠Innovations/modifications have been
proposed to be intensified during XI Five Year
Plan
ďGeographical Information System (GIS)
mapping for focused intervention in high risk
prioritized districts
GUIDELINES UNDER NVBDCP:
MALARIA
41. ⢠Innovations/modifications have been
proposed to be intensified during XI Five Year
Plan
ďLinkage with NHM and use of NHM
Institutions for prevention and control of
VBDs
ďUp-scaling use of bed nets /Long Lasting
Insecticide Treated Nets (LLINs)
GUIDELINES UNDER NVBDCP:
MALARIA
42. ⢠Innovations/modifications have been
proposed to be intensified during XI Five Year
Plan
ďEarly diagnosis and treatment by
ďźStrengthening of human resource
ďźScaling up of Rapid Diagnostic Kit (RDK)
ďźScaling up of Artemisinin-based Combination
Therapy (ACT)
GUIDELINES UNDER NVBDCP:
MALARIA
43. ⢠Monitoring of drug resistance and insecticide
resistance:
ď15 studies are conducted in a year through Pf
monitoring teams through ROH&FWs and
National Institute of Malaria Research (NIMR)
at different places
ďBased on their report, resistance areas are
identified and their drug policy changed
GUIDELINES UNDER NVBDCP:
MALARIA
45. Magnitude of the problem
⢠Filariasis has been a major public
health problem in India next only to
malaria. The discovery of
microfilariae (mf) in the peripheral
blood was made first by Lewis in
1872 in Calcutta (Kolkata).
⢠The North-Western States/UTs are
known to be free from indigenously
acquired filarial infection.
47. FILARIA (endemicity)
⢠Indigenous filaria cases have been recorded
from Andhra Pradesh, Assam, Bihar,
Chhattisgarh, Goa, Jharkhand, Karnataka,
Gujarat, Kerala, Madhya Pradesh,
Maharashtra, Orissa, Tamil Nadu, Uttar
Pradesh, West Bengal, Pondicherry, Andaman
& Nicobar Islands, Daman & Diu, Dadra &
Nagar Haveli and Lakshadweep.
48. FILARIA (endemicity)
⢠States free from indigenously acquired filarial
infection: North-Western States/UTs namely
Jammu & Kashmir, Himachal Pradesh, Punjab,
Haryana, Chandigarh, Rajasthan, Delhi and
Uttaranchal and North-Eastern States namely
Sikkim, Arunachal Pradesh, Nagaland,
Meghalaya, Mizoram, Manipur and Tripura
49. 49
Signs and symptoms of Filariasis
⢠Recurrent fever intermittent or remittent with often
double rise
⢠loss of appetite, pallor and weight loss with
progressive emaciation
⢠weakness
⢠Splenomegaly â spleen enlarges rapidly to massive
enlargement, usually soft and nontender
⢠Liver â enlargement not to the extent of spleen, soft,
smooth surface, sharp edge
50. 50
Contd.
⢠Lymphadenopathy â not very common in India
⢠Skin â dry, thin and scaly and hair may be lost.
Light colored persons show grayish
discoloration of the skin of hands, feet,
abdomen and face which gives the Indian
name Kala-azar meaning âBlack feverâ
⢠Anemia â develops rapidly
⢠Anemia with emaciation and gross
splenomegaly produces a typical appearance
of the patients
51. 09/03/18 51
National Filaria Control ProgramNational Filaria Control Program
⢠This program was started in 1955This program was started in 1955
⢠In 1998 the operational component wasIn 1998 the operational component was
merged with Urban Malaria Schememerged with Urban Malaria Scheme
⢠In 2003 -04 it was merged withIn 2003 -04 it was merged with
NVBDCPNVBDCP
⢠Filariasis has been a major public health problem inFilariasis has been a major public health problem in
India next only to malaria.India next only to malaria.
⢠Indigenous cases have been reported from aboutIndigenous cases have been reported from about
250 districts in 20 states/Union Territories.250 districts in 20 states/Union Territories.
52. 09/03/18 52
Revised Filaria Control StrategyRevised Filaria Control Strategy
⢠The National Health Policy 2002 aims at EliminationThe National Health Policy 2002 aims at Elimination
of Lymphatic Filariasis by 2015of Lymphatic Filariasis by 2015
⢠REVISED STRATEGYREVISED STRATEGY
â Annual Mass Drug Administration with singleAnnual Mass Drug Administration with single
dose of Diethyl carbamazine(DEC)was taken up asdose of Diethyl carbamazine(DEC)was taken up as
a pilota pilot
â During 2004 about 400 million population wereDuring 2004 about 400 million population were
brought under MDA.brought under MDA.
â This strategy is to be continued for 5 years orThis strategy is to be continued for 5 years or
more to the population excluding children belowmore to the population excluding children below
two years, pregnant women and seriously illtwo years, pregnant women and seriously ill
persons in affected areas to interruptpersons in affected areas to interrupt
transmission of disease.transmission of disease.
53. 09/03/18 53
Contd.
⢠Vector control through anti larval spray at
weekly intervals.
⢠Biological control through larvivorous fishes
⢠Environmental engineering through source
reduction and water management
⢠Information, education and communication
54. NFCP
⢠Population living in endemic countries is now
covered with annual MDA with DEC +
Albendazole, with aim of elimination of Filaria
by 2015
⢠Patients suffering from hydrocele are
motivated for surgery
⢠ASHA and other volunteers, after due training,
would be involved in MDA by the local health
authority
55. ⢠ELF by 2015:
ďLF ceases to be a public health problem i.e.
the number of microfilaria carriers is less than
one per cent in endemic population
ďChildren born after initiation of ELF are free
from circulating antigenaemia.
ďAbsence of antigenaemia among children is
considered as evidence for absence of
transmission and new infection.
FILARIA
56. GUIDELINES UNDER NVBDCP:
FILARIA
⢠National Filaria Control Program is being
implemented in the country through 206
filaria control units, 199 filaria clinics and 27
survey units
⢠Strategies under NFCP:
ďDetection and treatment to the patients with
anti-filaria drug
ďAnti-larval work in urban areas covered under
NFCP
57. ⢠Filaria has been targeted for elimination
globally by 2020
⢠National Health Policy (2002) aims to
eliminate lymphatic filariasis (ELF) by 2015
⢠MDA being implemented since 2004 in 250
districts in 15 states and 5 UTs
ďMDA to be undertaken by District Malaria
Officer or District Vector Borne Disease
Control Officer with staff and officials of NFCP
GUIDELINES UNDER NVBDCP:
FILARIA
58. Major activities under ELF
⢠Sensitization and training of district and state
level officers
⢠Media sensitization and District Co-ordination
Committee meeting under the chairmanship
of district collector
⢠Microfilaria survey by trained technicians
(especially for collection of blood in the night
and its examination) before MDA in sentinel
and random sites in each district
59. ⢠Identification of manifestations (lymphedema
or hydrocele), line-listing of cases and
updating every year with addition or deletion
on yearly basis to provide services for
morbidity management
⢠Collection, compilation and analysis of data
and feedback to state as well as centre
⢠Assessment through involvement of medical
college faculty, ROH&FW and ICMR
institutions
Major activities under ELF
60. ⢠Hydrocele operations for relief of the patients
⢠Training on home based care for morbidity
management
⢠Vector control: one or two rounds of IRS with
DDT (1g/m2
) in endemic areas
⢠Anti-larval measures: temphos in water tanks
every week and application of Mineral
Larvicidal Oils (MLO) on water surface
⢠Biological control; Environmental engineering
Major activities under ELF
62. Kala Azar endemicity
⢠Endemic in eastern States of India namely
Bihar, Jharkhand, Uttar Pradesh and West
Bengal
⢠48 districts endemic; sporadic cases reported
from a few other districts
⢠Estimated 129 million population at risk in 4
states
⢠Mostly poor socio-economic groups of
population primarily living in rural areas are
affected
63. KALA AZAR
⢠Annual incidence of Kala Azar will be reduced
to less than 1 per 10,000 population at sub-
district level with the aim of eliminating Kala
Azar by 2010
⢠Kala Azar Technical Supervisors (KTS) are
provided in affected districts to strengthen
early detection, complete treatment and
prevention and control including residual
spray (supported under World Bank assisted
project)
64. ⢠It is proposed that ASHA workers will be
involved in identification of Kala azar
cases and ensuring their complete
treatment.
KALA AZAR
65. GUIDELINES UNDER NVBDCP:
KALA AZAR
⢠Main strategic components for elimination:
ďCase detection and treatment: done through
the existing Primary health care system
supplemented by periodic annual active
searches (Kala azar fortnight)
ďInterruption of transmission through vector
control: undertaking 2 rounds of DDT spray
annually in PHC areas reporting kala azar
incidence under direct supervision and
monitoring by NHM institutions
66. ⢠First round of IRS: february-march
⢠Second round: may-june
ďJust before the onset of monsoon as some
parts of Bihar become inaccessible in monsoon
⢠IRS (with DDT 50%) is supplemented with
efforts to improve sanitation
⢠In addition, environmental measures and
personal protection from sandfly bites are
encouraged
GUIDELINES UNDER NVBDCP:
KALA AZAR
67. ⢠IEC & inter-sectoral convergence
⢠Diagnosis: Suspected cases as per the
standard case definition are referred for
clinical case examination and tested with
rapid dipstick test rK39
GUIDELINES UNDER NVBDCP:
KALA AZAR
68. ⢠Treatment: as per the drug policy of GoI,
Sodium Stibo Gluconate (SSG) is the first line
treatment of Kala azar
ďThe oral drug, Miltefosine has been
introduced on a pilot basis in 6 districts of
Bihar and 2 districts each of Jharkhand and
West Bengal
ďParamomycin has also been approved
GUIDELINES UNDER NVBDCP:
KALA AZAR
69. ⢠Vector control:
ďSelection of areas to be sprayed: all villages
within a PHC which reported Kala azar cases in
the past 5 years; all villages which reported
cases during the year of spray
ďDosage: 1g/m2
of the wall surface; upto 6 feet
height
Cattle sheds and kala azar positive and
suspected cases to be given priority
GUIDELINES UNDER NVBDCP:
KALA AZAR
70. Kala azar â Patient Coding Scheme
⢠The patient and his relatives are counseled
properly at the time of registration at the
health institution (CHC/PHC/district hospital)
about the importance of full treatment
⢠The coding would be arranged in the order of
Country Code cum State Code- District Code-
PHC Code, Sub-Centre / NGO Code- Patient
Code.
71. ⢠As per the patient coding scheme, each Kala-
azar case will have the country code IND along
with the state code and have a 10 digit
numerical code. (IND2-01-01-01-001...... IND2-
01-01-01-999).
⢠No two patients will have the same 10 digit
numerical code during a period of 5 years /
Kala-azar Elimination Program period.
Kala azar â Patient Coding Scheme
76. ⢠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
Dengue endemicity
77. GUIDELINES UNDER NVBDCP:
DENGUE/DHF
⢠Early case reporting and management
ďDisease surveillance through grass root level
health workers, sentinel surveillance sites with
laboratory support
ďCase management including early referral of
cases
ďEpidemic preparedness and rapid response
ďNo specific anti-viral drug; symptomatic Rx
79. ⢠Larval surveys: containers in house-holds are
examined for presence of mosquito larvae and
pupae
⢠Four indices:
ď House index: percentage of houses infected
= no. of houses infected with larvae/pupae x 100
no. of houses inspected
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
80. ⢠Larval surveys:
ďContainer index: percentage of water holding
containers infected with larvae/pupae
= no. of positive containers x 100
no. of containers inspected
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
81. ⢠Larval surveys:
ďBreteau Index: no. of positive containers per
100 houses inspected
= no. of positive containers x 100
no. of houses inspected
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
82. ⢠Larval surveys:
ďPupae Index: no. of pupae per 100 houses
= no. of pupae x 100
no. of houses inspected
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
83. ⢠An HI >5% &/or a BI >20 for any locality is an
indication that the locality is dengue sensitive
and therefore adequate preventive measures
should be taken
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
84. ⢠Adult surveys:
ďLanding/biting collection: presence of aedes
aegypti mosquito can be reliable indicator of
clear proximity to hidden larvae habitats
ďźLaborious
ďźExpressed in terms of landing/biting counts
per man hour
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
85. ⢠Adult surveys:
ďResting collection: mosquitoes typically rest
indoors, especially in bedrooms and mostly in
dark places, such as cloth closets and other
sheltered sites
ďźMosquito searched with the aid of flashlight
ďźRecorded as number of adults per house per
man hour of human efforts
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
86. ⢠Adult surveys:
ďOviposition traps: Ovitraps are devices used
to detect presence of Aedes aegypti where
population density is low (BI < 5) (urban areas)
ďźUsed to evaluate impact of adulticidal space
spraying on female adult mosquito population
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
87. ⢠Following points were emphasized in the
strategic action plan:
ďSuspected cases should be referred at the
earliest for diagnosis and its proper
management
ďStrengthening through 110 Sentinel
Surveillance Hospitals (SSHs) and 13 Apex
Research Laboratories (ARLs)
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
88. ⢠Following points were emphasized in the
strategic action plan (contd.):
ďDiagnostic kits are supplied by NIV (Pune), for
which the cost is borne by NVBDCP
ďMonitoring of larval density of Aedes
mosquitoes in urban and rural areas regularly
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
89. ⢠Following points were emphasized in the
strategic action plan (contd.):
ďInvolvement of NHM institutions namely Rogi
Kalyan Samiti for facilitating emergency cases
in referral and transportation
ďInvolvement of VHSC for improvement in
sanitation and reduction in breeding sites
ďASHA should be involved in educating the
community to avoid the stagnation of stored
water kept in and around houses
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
90. ⢠Legislative measures
ďModel civic by-laws: fine/punishment is
imparted, if breeding is detected.
Strictly imposed by Mumbai, Navi Mumbai,
Chandigarh and Delhi Municipal Corporations.
ďBuilding construction regulation act: for
overhead/underground tanks, etc.
In Mumbai, builders deposit a fee for
controlling mosquitogenic conditions at site
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
91. ⢠Legislative measures
ďEnvironmental Health Act: by-laws for proper
disposal/storage of junk, discarded tins, old
tyres and other debris
ďHealth Impact Assessments: prior to any
development projects/major constructions
GUIDELINES UNDER NVBDCP:
DENGUE/DHF
92. CHIKUNGUNYA
⢠No specific anti-viral drug; symptomatic Rx
⢠Strategies for prevention and control are the
same as for dengue
94. JE - Extent of problem
⢠JE viral activity has been widespread in India.
⢠The first evidence of presence of JE virus dates
back to 1952.
⢠First case was reported in 1955
⢠During recent past (1998-2004), 15 states and
Union Territories have reported JE incidence
95. GUIDELINES UNDER NVBDCP: JE
⢠Early diagnosis and case management
ďStrengthening of referral services: available
at district/sub-district levels
ďProper case management:
ďźNo specific anti-viral drug for JE and cases are
managed symptomatically
ďźImproved care by medical and para-medical
health care providers, improved lab services
for diagnosis, availability of drugs
96. ⢠Proper case management (contd.):
ďManagement of sequel: rehab at district
ďEpidemic preparedness and rapid response:
team constituted in all JE endemic districts
⢠Vaccination:
Vaccination of children between 1-15 yrs age:
ďInitiated since 2006 with single dose live
attenuated SA-14-14-2 vaccine under UIP in a
phased manner
GUIDELINES UNDER NVBDCP: JE
97. ⢠Integrated vector Management
ďFogging with Malathion for outdoor is
recommended during outbreaks for
immediate killing of infected mosquitoes
ďAnti- larval operations
ďPersonal protective measures for using
insecticides treated bed nets and curtains,
wearing full sleeve clothes during evening
hours etc.
ďBiological control using larvivorous fishes
GUIDELINES UNDER NVBDCP: JE
98. ⢠Supportive interventions:
ďTraining and capacity building
ďźThrough training of clinicians and nurses in
case management and laboratory technicians
and laboratory in charge/microbiologists in all
sentinel laboratories in diagnosis by MAC
ELISA method in a phased manner.
GUIDELINES UNDER NVBDCP: JE
99. ⢠Supportive interventions:
ďBehaviour Change Communication
ďźEarly case reporting and early referral of
patients
ďźIncreasing awareness of clinical signs
ďźPersonal protection including segregation of
pigs away from human population
ďźMosquito proofing of pigsties
GUIDELINES UNDER NVBDCP: JE
100. ⢠Supportive interventions:
⢠Supervision and monitoring
ďPeriodic reviews/reports and field visits for
proper monitoring for JE
GUIDELINES UNDER NVBDCP: JE
102. S.No Activities Incentive Remarks
1 Preparation of slides Rs.5/- per slide Irrespective of RDT based
or slide based
confirmation
2. Taking slides to PHC
laboratories, getting reports and
providing complete treatment to
malaria positive case
Rs.5O/- per positive
case for complete
Treatment
This incentive is to
facilitate the
transportation cost
3.
RDT testing and complete
treatment of Pf malaria cases
Rs.20/-per positive
Pf malaria case for
complete treatment
In remote and
inaccessible areas, for
complete treatment of
Pf malaria cases
103. Incentives for filaria
⢠Under the ELF program, MDA is administered
by health workers (male/female) and
volunteers
⢠ASHAs could also be involved by local health
authorities
⢠Payment of Rs.100/- to each
volunteer/worker/ASHA for drug distribution
to 250 persons in approx 50 houses
104. Incentives for Kala azar
⢠Identification of case â Rs. 50/- per case
⢠For follow up and ensuring complete
treatment â Rs. 150/- per case
⢠From funds allocated for operational costs
under cash grant of NVBDCP (kala azar) funds
105. Dengue/Chikungunya/JE
⢠The untied funds available with the
subcentres for referral to district hospitals can
be utilized for transportation of the severe
cases to the identified referral centres
106. Public Private Partnership
⢠Categories: NVBDCP initiatives for PPP are
classified into 2 categories
ďCategory 1: with local self government
(panchayat) or panchayat level CBO
(population coverage â minimum 5000
population)
ďCategory 2: block level NGO/FBO (population
coverage â minimum 100000 population)
107. Public Private Partnership
⢠Schemes:
⢠Provision of EDPT
ďScheme 1: Provision of outreach services â
Fever Treatment Depot & Drug Distribution
Centre
ďScheme 2: Provision of microscopy and
treatment services
ďScheme 3: Hospital based treatment and care
of severe complicated malaria cases
108. Public Private Partnership
⢠Integrated Vector Control
ďScheme 4: Promotion of ITMN, insecticide
treatment of community owned bed nets and
distribution of ITMN in selected areas
ďScheme 5: Promotion of larvivorous fish
ďScheme 6: Indoor Residual Spray
109. JOURNAL/ RESEARCH ABSTRACTS
⢠Burden of Malaria in India: Retrospective and Prospective View
⢠Am. J. Trop. Med. Hyg., 77(6_Suppl), 2007, pp. 69-78
Copyright Š 2007 by The American Society of Tropical Medicine
and Hygiene
⢠Ashwani Kumar, Neena Valecha, Tanu Jain, AND Aditya P.
Dash
National Institute of Malaria Research, Field Station, Panaji, Goa,
India; National Institute of Malaria Research, Delhi, India
⢠In India, nine Anopheline vectors are involved in transmitting
malaria in diverse geo-ecological paradigms. About 2 million
confirmed malaria cases and 1,000 deaths are reported annually,
although 15 million cases and 20,000 deaths are estimated by WHO
South East Asia Regional Office. India contributes 77% of the total
malaria in Southeast Asia. Multi-organ involvement/dysfunction is
reported in both Plasmodium falciparum and P. vivax cases.
110. ⢠Most of the malaria burden is borne by economically
productive ages. The states inhabited by ethnic tribes
are entrenched with stable malaria, particularly P.
falciparum with growing drugresistance. The profound
impact of complicated malaria in pregnancy includes
anaemia, abortions, low birth weight in neonates, still
births, and maternal mortality. Retrospective analyses
of burden of malaria showed that disability adjusted
life years lost due to malaria were 1.86 million years.
Costâbenefit analysissuggests that each Rupee invested
by the National Malaria Control Program pays a rich
dividend of 19.7 Rupees.
111. BIBLIOGRAPHY:
Park.K, Textbook of prevention and social medicine.
20th
edition. Jabalpu,India: M/s Banarsidas Bhanot
publications; 2009.
KK Gulani. Community Health Nursing- Principles &
Practices. Delhi: Kumar Publishing House; 2008.
Sunita Pateny. Textbook of Community Health
Nursing. 1st
edition. Delhi: Modern Publishers;
2005.
⢠BT Basavanthapa. Community Health Nursing 2nd
edition. Jaypee Brothers Medical publishers; 2008.
These offices are located at different state headquarters.
Objective of the partnership is to provide uniformity in diagnosis, treatment and monitoring through a wider base in the country to maximize access to treatment and improve acceptability of appropriate and locally suitable vector control measures.
Lab surveillance from private sector would be enhanced by coordination with private practitioner and private laboratories
Medical audit to measure effectiveness of program
with emphasis on malaria diagnosis, treatment and prevention and control activities including residual spray and bed-net impregnation, distribution and use
Slide positivity rate â no. of blood smears found positive for malaria parasite / no. of blood smears examined x 100
Annual Blood examination rate â no. of blood smears examined during the year / population covered under surveillance x 100
API â confirmed cases of malaria during one year / population covered under surveillance x 100
Although larvivorous fish have been used successfully in some parts of the country, it is important that their use is scaled-up substantially to achieve demonstrable positive impact. Individuals and communities can reduce mosquito breeding by the following activities:
 o Remove discarded containers that might collect water.
o Cover cisterns (water tanks) with lids or mosquito nets.
o Clear away or remove vegetation and other matter from the banks of streams to
make the flow of water smooth and reduce breeding.
o Eliminate the pools of water caused by leaking taps, spillage of water around
pipes and wells or poor drains by repairing.
o Use larvivorous fish in permanent water bodies with potential breeding sites
Malaria is one of the epidemic prone diseases, specially in relatively low endemic areas with unstable transmission dynamics.
The integrated training guidelines aim to standardize the training contents for each category of the health care workers as well as non health care functionaries in order to improve the quality of training and to improve in delivery of services. For this purpose integrated course curriculum has been developed for all three categories. Besides, training of Private Medical Practitioners and other inter sectoral partners are also conducted to sensitize. them about the National Strategies for VBD control. Specialized trainings for entomologists and laboratory technicians are also conducted through some identified Apex Institute having expertise on the concerned field. The capacity building at state, district and PHC level need to be planned and continued to keep the well trained human resource available with the programme for programme implementation.
June is observed as anti-malaria month, World Malaria Day â April 25
Red zones are free from filaria
Bancrftian filariasis caused by Wucheria Bancrofti is transmitted in man by the bite of infected mosquites â culex and mansonia. This infection causes lymphangitis ,lymphadenitis , elephantiasis of genitals, legs and arms and causes tropical eosinophilia due to hypersensitivity.
600 million people are at risk and 60 million are infected in S-E Asia.In India 454 million are at risk and 48 million are infected.
NFCP launched in 1955, activities mainly in urban areas. Extended to rural areas since 1994.
Eradicable diseases: Polio, Leprosy, Guinea Worm, Filariasis/Onchocerciasis, Measles and Chagas Disease.
For individual case treatment: DEC 6 mg/kg b.w. orally daily for 12 days. Doxycycline for 14 days also effective.
MDA: 1 tab albendazole 400mg &gt; 2 yrs; DEC: 2-5 yrs-1 tab, 5-14 yrs- 2 tab, &gt;14 yrs- 3 tab (300mg)
Single dose of ivermectin has been found to be effective.
National Filaria Day: 15th November
Temphos dose: 1 ppm
No case of Kala Azar in Gujarat since 2007
Sandfly Phlebotomus argentipus
The active case search will be carried out during one fortnight for which will be decided by each of the endemic states. The case search operation is a community based operation, to detect all suspected cases of kala-azar according to the case definition of kala-azar and PKDL. Community must therefore be aware of the purpose of house to house visits by workers and the workers who visit villages should be familiar with case definition, the reporting formats and the treatment schedules, etc. The fever cases detected during the Fortnight are to be treated with the appropriate regime of the prescribed drugs, sufficient quantities of which should be available at the PHC and district levels. Active case search is to be carried out in all villages of the endemic district where transmission of kala-azar is possible.
Kala-azar case Definition
Persons with fever of more than 15 days duration not responding to anti-malarials and antibiotics with splenomegaly is a suspected case of Kala-azar.
PKDL
Persons with depigmented patches on the body with sensation and with a history of kala-azar in the past is a suspected case of PKDL.
Avoiding sleeping on the floor, using fine-mesh bed nets, clean shelters for animals, no cracks crevices, water well to be kept closed, not to sleep naked, application of home-made mustard oil lotion
RK 39 rapid diagnostic kit and ELISA are better and fast
2nd line drug: Pentamidine isothionate. Amphotericin B is also used.
In case of resistance to DDT, BHC is recommended.
From the year 2003-04, 100% assistance is provided by the centre.
Fogging by 95% or pure technical malathion (equipment is portable motorized knapsack blowers and cold aerosol generators)
Pyrethrum spray: Indoor; 0.1 â 0.2 % @ 30-60 ml / 1000 cu. ft
One liter of 2% pyrethrum extract is diluted by kerosene into 20 litres to make 0.1% pyrethrum formulation (equipment: flit pump or hand operated fogging machine fitted with microdischarge nozzle)
In SMC, fogging is done by 0.1% formulation (2% extract) pyrethrum and IRS by 5 % alpha cypermethrin.
Commercial formulation of 2% pyrethrum extract is diluted with kerosene in the ratio one part of 2% pyrethrum extract with 19 parts of kerosene (volume/volume). Thus, one litre of 2% pyrethrum extract is diluted by kerosene into 20 litres of 0.1% pyrethrum extract
.ready-to-spray formulation.. One litre of .ready-to-spray formulation is sufficient to cover 20 households, each household having 100 cubic metres of indoor space.
A person exposes his feet while using mechanical aspirator for collecting landing mosquitoes at each collection site. Usually between 6:00 PM to 6:00 AM.
Oviposition traps are traps designed to attract and sample gravid female mosquitoes, either directly or via eggs deposited within the trap.
Trap design varies depending on the mosquito species of interest. (D68) A black jar, containing water and with a hardboard paddle placed inside it, to provide an attractive oviposition site for container breeding mosquitoes. (D70)
The Reiter gravid trap samples female Culex spp. mosquitoes looking to deposit eggs.
It is selective for females which have taken at least one blood meal. (D68)
Small ovitraps are used for sampling eggs of Aedes spp. mosquitoes.
Larger ovitraps, usually with an attractant or infusion, are used for sampling eggs of Culex spp. mosquitoes.
For sampling of gravid female mosquito population (gravid trap) or eggs to estimate gravid population size from number of egg rafts (ovitrap). As only female mosquitoes which have fed at least once are attracted to these traps the individuals caught are more likely to be infected. (D70) There is a greater chance of collecting infected females when using gravid traps which retain the mosquitoes (compared to use of light traps), as only females which have already ingested at least one blood meal should be attracted to the trap. (D68) Gravid trap counts may have a higher correlation with disease transmission than other traps. (D68, D70) Useful for mosquito species which breed in containers (D70) &quot;More sensitive and economical than larval or adult surveys of Aedes aegypti.â
Ovitraps which do not retain the ovipositing females only sample the eggs;Â These traps can be used to estimate the ovipositing adult female mosquito population but not to give information regarding the rate of infection with arboviruses.
Health education: special campaigns may be carried out through mass media including newspapers, TV, radio, local cable networks, outdoor like miking.
At household level: use of pyrethroid-based aerosols like âAll OUTâ or âHITâ; keeping room closed for 15-20 minutes; during early morning or late afternoon.
Personal protective measures â full sleeved clothes, ITMN.
Using mosquito repellents like odomos, burning neem leaves, coconut shells.
Using tight-fitting screens/wire mesh on doors and windows. Covering all water containers in the house.
Introducing larvivorous fishes (eg. Gambusia, poecilia â guppy).
At community level: applying temphos (1 ppm) on weekly basis in coordination with health authorities.
At institutional level: weekly checking for aedes larval habitats in overhead tanks, ground water storage, introducing larvivorous fishes, carrying out indoor spraying with 2% pyrethrum, notification of fever cases.