5.1 introduction · 2016. 10. 15. · 2011 130316971 142502 13910 9.77 2.07 0.21 147 2012 130329138...

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Disease Control Programmes [nHm]

5Chapter

5.1 INTRODUCTIONSeveral National Health Programmes such as the National Vector Borne Disease Control Programme, Leprosy Eradication, TB Control, Blindness Control and Iodine Deficiency Disorder Control Programmes have come under the umbrella of National Health Mission (NHM).

5.2 NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMME (NVBDCP)

The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of vector borne diseases viz. Malaria, Japanese Encephalitis (JE), Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis. Out of these six diseases, two diseases namely Kala-azar and Lymphatic Filariasis have been targeted for elimination by 2015. The States are responsible for implementation of programme, whereas the Directorate of NVBDCP, Delhi provides technical assistance, policies and assistance to the States in the form of cash & commodity, as per approved pattern. Malaria, Filaria, Japanese Encephalitis, Dengue and Chikungunya are transmitted by mosquitoes whereas Kala-azar is transmitted by sand-flies. The transmission of vector borne diseases depends on prevalence of infective vectors and human-vector contact, which is further influenced by various factors such as climate, sleeping habits of human, density and biting of vectors etc.

The general strategy for prevention and control of vector borne diseases under NVBDCP is described below:

(i) Integrated Vector Management including Indoor Residual Spraying (IRS) in selected high risk areas, Long Lasting Insecticidal Nets (LLINs), use of larvivorous fish, anti-larval measures in urban areas including bio-larvicides and minor environmental engineering including source reduction.

(ii) Disease Management including early case detection with active, passive and sentinel surveillance and complete effective treatment, strengthening of referral services, epidemic preparedness and rapid response.

(iii) Supportive Interventions including Behaviour Change Communication (BCC), Inter-sectoral Convergence and Human Resource Development through capacity building.

(iv) Vaccination only against J.E.

(v) Annual Mass Drugs Administration (only against Lymphatic Filariasis)

5.2.1 Malaria

● Malaria is an acute parasitic illness caused by Plasmodium falciparum or Plasmodium vivax in India. The diagnosis is confirmed by microscopic examination of a blood smear

Annual Report 2015-16

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and Rapid Diagnostic Tests. Majority of the patients recover from the acute episode within a week. Malaria continues to pose a major public health threat in different parts of the country, particularly due to Plasmodium falciparum which may be fatal, if not treated early.

● In India, out of 9 species of Malaria vectors, the major vector for rural malaria is Anopheles culicifacies, found all over the country and breeds in clean ground water collections. Other important Anopheline species namely An.minimus and An.fluviatilis breed in running channels, streams with clean water. Some of the vector species also breed in forest areas, mangroves, lagoons, etc, even in those with organic pollutants.

● In urban areas, malaria is mainly transmitted by Anopheles stephensi which breeds in

man-made water containers in domestic and peri-domestic situations such as tanks, wells, cisterns, which are more or less of permanent nature and hence can maintain density for malaria transmission throughout the year. Increasing human activities, such as urbanization, industrialization and construction projects with consequent migration, deficient water and solid waste management and indiscriminate disposal of articles (tyres, containers, junk materials, cups, etc.) create mosquitogenic conditions and thus contribute to the spread of vector borne diseases.

Epidemiological Situation: The status of total cases, Pf cases, deaths and API from 2006 to 2015 is given in the table and the Graph as follows. The state-wise data on malaria cases & deaths since 2011 is at Appendix -1.

Malaria Situation in the country during 2006-2015

Year Cases (in millions) Deaths API

Total Pf

2006 1.79 0.84 1707 1.66

2007 1.50 0.74 1311 1.39

2008 1.53 0.78 1055 1.36

2009 1.56 0.84 1144 1.36

2010 1.60 0.83 1018 1.37

2011 1.31 0.67 754 1.10

2012 1.01 0.53 519 0.88

2013 0.88 0.46 440 0.72

2014 1.10 0.72 562 0.89

2015 (Till October) 0.92 0.60 245 0.75


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Pre-independence estimates of Malaria were about 75 million cases and 0.8 million deaths annually. The problem was virtually eliminated in the mid-sixties but resurgence led to an annual incidence of 6.47 million cases in 1976. Modified Plan of Operation was launched in 1977 and annual malaria incidence started declining. The cases were contained between 2 to 3 million cases annually till 2006 afterwards the cases have further started declining.

During 2011, the malaria incidence was around 1.31 million cases, 0.67 million Pf cases and 754 deaths; while during 2012, 1.01 million cases, 0.53 Pf cases and 519 deaths were reported. About 91% of malaria cases and 99% of deaths due to malaria are reported from high disease burden States namely North Eastern (NE) States, Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, Rajasthan and West Bengal. However, other States are also vulnerable and have local and focal upsurge. During 2013, 0.88 million cases, 0.46 Pf cases and 440 deaths have been reported. During 2014, the malaria incidence was around 1.10 million cases, 0.72 million Pf cases and 562 deaths. During 2015(till October) 0.92 million cases, 0.60 Pf cases and 245 deaths have been reported.

Resistance in Plasmodium falciparum to Chloroquine was observed to be very high and frequent in the studies conducted during 2001 onwards. Therefore, Artemisine based Combination Therapy (ACT) is now being used as

first line of treatment for all Pf cases in whole of the county. However, in North-Eastern States early signs of resistance to currently used Artesunate+ Sulfadoxinepyrimethamine (SP-ACT), has been noticed and so, as per the advice of Technical Advisory Committee, effective combination of Artemether-Lumefantrine (ACT-AL) has been recommended for the treatment of Pf cases in the North Eastern States. For strengthening surveillance, Rapid Diagnostic Test (RDT) for diagnosis of P.falciparum malaria was introduced in high endemic areas and also it is being scaled up.

Considering that about 50% of the malaria cases are due to P vivax in the country, bivalent RDT (detecting both Pvand Pf infection) has been introduced in the country at the field level from this year. ASHAs have been trained in diagnosis and treatment of malaria cases and are involved in early case detection and treatment. The Government of India provides technical assistance and logistics support including Anti Malaria drugs, DDT, larvicides, etc. under NVBDCP within overall umbrella of NHM. State Governments have to implement the programme and required human resource and other logistics are to be ensured.

Externally supported projects: Additional support for combating malaria is provided through external assistance in high malaria risk areas. i) Global Fund Supported Intensified Malaria Control Project (IMCP-II) is currently being implemented for Malaria control and, ii) World Bank Supported Project on Malaria Control & Kala-azar Elimination has closed on 31.12.2013.

The areas covered under these projects are as under:

i) The Global Fund supported ‘Intensified Malaria Control Project- Phase II’ (IMCP-II)

Global fund Round 9 supported Intensified Malaria Control Project (IMCP-II) is being


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implemented since October 2010 for a period of five years in 7 North Eastern States. The project area covers a population of 46 million in 89 districts in the country. The strategies of the project are early diagnosis and complete treatment, integrated vector control including promotion of Insecticide Treated Bed Net (Long-Lasting Insecticidal Nets-LLINs), through intensive IEC and capacity building & training of the health workers & community volunteers. Specific inputs are provided to these project areas in the form of manpower, RDTs, drugs and LLINs. The period for first phase was for two years starting from October 2010 to Sept. 2012. The Phase-II is of three years starting from October 2012 to September, 2015. CARITAS India is a complementing partner and Principal Recipient 2 (PR2) in the project.

Additional Support provided in project area is listed below:

● Human resource such as Consultants and support staff for project monitoring units at state and district level and Malaria

Technical Supervisor (MTS) and Laboratory Technicians (LTs.) at sub-district level;

● Capacity building of District VBD consultant, MTS Medical Officer/Lab. Technicians/ Health/Volunteers as ASHA, CHV etc.;

● Commodities such as Long-Lasting Insecticidal Nets (LLINs), Rapid Diagnostic tests for quick diagnosis of Malaria, drugs Artemesinin based Combination ACT- AC Pv total of Pf malaria Therapy (ACT) and Inj. Artesunate for treating severe malaria cases and

● Planning & administration including mobility support, monitoring, evaluation and operational research (studies on drug resistance and entomological aspects).

The impact of the project activities is reflected in sharp reduction of malaria cases and deaths due to malaria in project states (7) as shown in the graph.

The Urban Malaria Scheme (UMS) under NVBDCP was sanctioned in 1971 by Government of India with main objectives of preventing deaths due to malaria and reduction in transmission and morbidity. This scheme is currently being implemented in 131 towns in 19 States and Union Territories protecting about 130 million population. Under this scheme, the larvicides are supported by Government of India through cash assistance, however, the entire staff for implementation


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and operational cost is to be borne by the state/corporation/municipality.

Epidemiological Situation: About 10% of the total cases of malaria are reported from urban areas. Maximum numbers of malaria cases are

Comparative Epidemiological profile of malaria in 19 States under UMS during 2011-2015

Year Population Total cases P.f P.f % SPR SFR Deaths

2011 130316971 142502 13910 9.77 2.07 0.21 147

2012 130329138 82554 8236 9.98 1.35 0.14 61

2013 131279000 65568 5463 8.33 1.04 0.09 43

2014 74919964 203486 15129 7.43 -- -- 14

2015 1058242338 17395 1566 9.00 -- -- --P.f = Plasmodium falciparum, SPR= Slide positivity rate, SFR= Slide falciparum rate.

reported from Ahmedabad, Chennai, Kolkata, Mumbai, Vadodara, Vishakapatnam, Vijayawada etc. The comparative epidemiological profile of malaria during 2011-2015 in all urban towns of the country is given below:

Control Strategy: Under UMS, Malaria Control strategies are for (i) Parasite Control & (ii) Vector Control:

(i) Parasite Control: Treatment is done through passive agencies viz. hospitals, dispensaries both in private & public sectors. In mega cities malaria clinics are established by each health sector/malaria control agencies viz. Municipal Corporations, Railways, Defence services

(ii) Vector Control: Source reduction, use of larvicides, use of larvivorous fish, space spray, minor engineering and legislative measures.

The control of urban malaria depends primarily on the implementation of urban Bye-laws to prevent mosquito breeding in domestic and peri-domestic areas or residential blocks and government/commercial buildings, construction sites. The Bye-laws have been enacted and being implemented in Delhi, Chennai, Mumbai, Chandigarh, Ahmedabad, Bhavnagar, Surat, Rajkot, Bhopal, Agartala and Goa etc.

In addition, problem of Dengue is also being increasingly reported from urban areas. Hence, during 12th Plan period, Urban VBD Scheme has been started.

5.2.2 Elimination of Lymphatic FilariasisLymphatic Filariasis, a parasitic disease, is mainly caused by Wuchereria bancrofti and is transmitted mainly by mosquito Culex quinquefasciatus which breeds in dirty and polluted water; however, it can

Lymphatic Filariasis Affected Areas


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also breed in clear water in the absence of polluted water. The infection is prevalent in both urban and rural areas. The disease runs a chronic course and mainly manifested as Lymphoedema and Hydrocele. The disease is also caused by another parasite namely Brugiamalayi which is transmitted mainly by mosquito Mansonia annulifera which is the principal vector of this parasite. M.uniformisis the secondary vector for transmission of brugia infection. As per reports available, prevalence of brugia infection is restricted to small foci in Kerala State.

The disease is reported to be endemic in 255 districts in 16 states and 5 UTs. About 630 million population in these 255 districts is at risk of developing lymphatic filariasis. Besides disability, this disease causes economic loss and personal trauma to the affected persons and is associated with social stigma, even though it is not fatal.

Government of India is signatory to the World Health Assembly Resolution in 1997 for Global Elimination of Lymphatic Filariasis. The target year for Global elimination of this disease is by the year 2020. The National Health Policy (2002)

has envisaged elimination of Lymphatic Filariasis in India by 2015.

The strategy of lymphatic Filariasis elimination is through:

● Annual single dose Mass Drug Administration (MDA) to all at risk for five 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 and

● Promotion of home based management of lymphoedema cases and up-scaling of hydrocele operations in identified CHCs/District hospitals/Medical colleges.

To achieve elimination of Lymphatic Filariasis, the Government of India during 2004 launched MDA with single dose of DEC tablets. The co-administration of DEC+ Albendazole was initiated during 2007. The programme covered 202 districts in 2004 and by the year 2007, all the 250 LF endemic districts (now 255 districts due to bifurcation) were covered. The MDA coverage has improved from 72.4% in 2004 to 86.8% in 2014.

● To emphasize the improvement in drug compliance during ELF activity, MDA was observed as National Filaria Week


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during 14-20 December, 2014. However, all the 184 districts targeted in 17 States/UTs scattered the dates to intensify their supervision. The MDA campaign started from 14th December, 2014 and the last state completed was Bihar in May, 2015. The population covered against target was 86.8% during MDA.

● Upto October, 2015, 53 districts (5 of Assam, 2 of Goa, 5 of Gujarat, 3 of Karnataka, 4 of Kerala, 6 of Maharashtra, 16 of Tamil Nadu, 6 of Odisha, 4 of West Bengal and 1 each of Daman & Diu and Puducherry) have successfully completed first Transmission Assessment Survey (TAS) and qualified for MDA stoppage.

● Another 65 districts are preparing for first TAS and remaining 137 districts will observe MDA 2015 round. The state wise coverage of MDA 2014 round is indicated in Appendix-7.

● During 2015-16, five training workshops have been organized with the support of WHO and 150 officials from State and districts have been trained both for MDA and TAS activities.

The Line listing of lymphoedema and Hydrocele cases was initiated since 2004 by door to door survey in these filaria endemic districts. The enlisted cases are regularly being updated by state health authorities and more cases are being recorded. This increase is mainly due to incomplete surveys during initial years and reluctance on part of community to reveal their manifestations of lymphoedema and Hydrocele. The updated figure till 2014 reveals about 12 lakh cases with clinical manifestations (8 lakhs lymphoedema and 4 lakhs Hydrocele). A total of 1.29 lakh hydrocele cases have been operated. The initiatives have also been taken to demonstrate the simple washing

of foot to maintain hygiene for prevention of secondary bacterial and fungal infection in chronic lymphoedema cases so that the patients get relief from frequent acute attacks. The states regularly update the list and intensify the hydrocele operations in their respective states.

The microfilaria survey in all the implementation units (districts) is being done through night blood survey before MDA. The survey is done in 4 sentinel and 4 random sites collecting total 4000 slides (500 from each site). The data provided by the states indicate reduction in overall microfilaria rate in the MDA districts (1.24% in 2004 to 0.44% in 2014).

5.2.3 Kala-AzarKala-azar is caused by a protozoan parasite Leishmania donovani and spread by sand-fly (Phelbotomus argentipes) which breeds in shady, damp and warm places in cracks and crevices in the soft soil, in masonry and rubble heaps, etc. Proper sanitation and hygiene are critical to prevent sand fly breeding. The disease has also been targeted for elimination by 2015 as per National Health Policy (2002). In pursuance to achieve the elimination goal, case detection and treatment compliance, the programme strengthened Rapid Diagnostic Test for Kala-azar and single day single dose Liposomal Amphotericin B injection and shorter duration of combination drug regimen. National Road Map on Kala-azar elimination

Conducting TAS in Daman & Diu


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was developed in August’2014 with specific time line, roles & responsibility for State & District level VBD Consultants, Kala-azar Technical Supervisor (KTS) with motor cycle for monitoring & supervision.

Kala-azar Endemic Areas (54 Districts in 4 States)

Kala-azar is endemic in 54 districts (33 in Bihar, 4 in Jharkhand, 11 in West Bengal and 6 in Uttar Pradesh). The Kala-azar Control Programme was launched in 1990-91. The peak annual incidence of Kala-azar was seen in 1992 when 77102 cases and 1419 deaths were reported from the endemic

States. The reported cases of 44533 in 2007 were reduced to 24212 in 2009. In 2013, Kala-azar cases reduced by 32.67% & death by 31.03% in comparison with the year 2012. During 2014, Kala-azar cases reduced by 33.37% & death by 45% in comparison with the year 2013. The same declining trend observed in 2015 till October showing 7277 cases & 4 deaths. The state-wise data on Kala-azar cases & deaths since 2011 is at Appendix - 6.

Strategy for Kala-azar elimination:● Parasite elimination and disease

management

o Early case detection and complete treatment

o Strengthening of referral

● Integrated vector control

o Indoor Residual Spraying (IRS)

o Environmental management by maintenance of sanitation and hygiene

● Supportive interventions

o Behaviour Change Communication for social mobilization

o Inter-sectoral convergence

o Capacity Building by Training and Monitoring and Evaluation

To realize the goal of elimination of Kala-azar, the Govt. of India provides 100% operational costs on spray to the State Governments, besides anti-kala-azar medicines, diagnostic and DDT 50% since December 2003.

Initiatives undertaken for Kala-azar elimination are as follows:

● National Roadmap for Kala-azar Elimination (2014) has been circulated to States with clear goal, objectives, strategies, timelines


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with activities and functions at appropriate level. This document has been developed for focused intervention at national, state, district and sub-district levels;

● Long duration treatment of 28 days for Kala-azar patient has been reduced to single day treatment and introduction of combination treatment of 10 days for better treatment compliance;

● Strengthening of human resource component by positioning State consultants, District VBD consultants and Kala-azar technical supervisor for effective monitoring and supervision with motorcycles for monitoring;

● Incentive to Kala-azar activist/health volunteer/ASHA @ Rs.300/- for referring a suspected case and ensuring complete treatment and Rs. 100/- during one round of Indoor Residual Spray i.e. Rs. 200/- for both the two rounds of spray for generating awareness for acceptance of sprat by the community;

● Rs. 500/- as incentive to patient for loss of wages irrespective of drug regimen and Rs. 2,000/- to PKDL cases and free diet support to patient and one attendant;

● Construction of pucca houses for poor and marginalised community (Mahadalit Community) which are worst affected, in collaboration with Ministry of Rural Development;

● Operational research;

● Adequate supply of drugs & Diagnostic Kits;

● IEC/BCC for community awareness & social mobilization;

● Stakeholders like Bill & Melinda Gates

Foundation (BMGF)/CARE, Medecins Sans Frontieres (MSF), Drug for Neglected Disease initiatives (DNDi), PATH, KalaCORE, Surveillance Medical Officers from National Polio Surveillance Project (NPSP), Rajendra Memorial Research Institute (RMRI) National Centre for Disease Control (NCDC) Patna and WHO are working in close collaboration with the programme for service delivery and supportive supervision in hard core areas;

● Capacity building & training of consultants & medical officer through Rajendra Memorial Research Institute of Medical Sciences, ICMR, Patna with support of NVBDCP;

● Use of Synthetic Pyrethorid insecticide in seven districts of Bihar in place of DDT in 2015. Proposed to extend in 21 high endemic district of Kala-azar and

● Periodic review of Kala-azar elimination programme by higher officers and by Prime Minister Office (PMO).

Achievement● Continuing decline in number of Kala-azar

cases and deaths since 2012. In 2014, Kala-azar cases reduced by 33.36% & death by 45% in comparison with the year 2013. During the year 2015 till Sept., 6763 cases & 4 deaths have been reported.

● Out of 611 endemic blocks PHCs 454 (74%) block PHCs have achieved the target of less than one case per 10 thousand populations during the year 2014. In the year 2013, the achievement was 67%.

● Till date 3589 patients treated with single day by Liposomal Amphotericin B.

● Stakeholders are actively monitoring the programme jointly with state counterparts.


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5.2.4 Japanese Encephalitis (JE)Japanese Encephalitis (JE) is a zoonotic disease which is transmitted by vector mosquito mainly belonging to Culex vishnui group. The transmission cycle is maintained in the nature by animal reservoirs of JE virus like pigs and water birds. Man is the dead end host. Outbreaks are common in those areas where there is close interaction between pigs/birds and human beings. The vectors of JE breed in large water bodies rich in aquatic vegetations such as paddy fields. The population at risk is about 375 million.

JE is reported under Acute Encephalitis Syndrome (AES). Data reported from states are for total AES including JE cases. Confirmed JE cases are also segregated.

Epidemiological Situation: JE has been reported from different parts of the country. The disease is endemic in 204 districts of 21 States of which Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal have been reporting more than 80% of disease burden. During 2014, 10867 AES cases including JE and 1719 deaths have been reported. During 2015 till 30.11.2015, 8079 AES cases including JE and 1112 deaths have been reported from the states.

State-wise AES and JE cases with deaths as reported by states are given in Appendix – 5A & 5B.

There is no specific cure for this disease. Symptomatic and early case management is very important to minimize risk of death and complications. Govt. of India launched JE vaccination campaign in 2006 with single dose live attenuated JE (SA- 14-14-2) for children between 1 and 15 years of age which is followed by one dose under Routine Immunization (RI) at the age of 16-24 months to cover the new cohorts. Further after recommendation of the expert group, two dose of JE vaccine first at the age of 9 months and second at the age of 16-24 months have been incorporated under RI since April 2013. However, 182 districts have been covered under JE Vaccination (till Nov 2015).

In addition, implementation of public health measures such as, Social Mobilization through different media, inter-personal communication, etc. for disseminating appropriate messages in the community is crucial. The emphasis is given on keeping pigs away from human dwellings or in pigsties particularly during dusk to dawn which is the biting time of vector mosquitoes. Sensitization of the community regarding avoidance of man-mosquito contact by using bed nets and fully covering the body are also advocated. Since early reporting of cases is crucial to avoid any complication and mortality, community is given

JE Affected Districts


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full information about the signs and symptoms as well as availability of health services at health centres/hospitals. Besides, the states are advised fogging with Malathion (technical) as an outbreak control measure in the affected areas.

Realizing the gravity of the situation mainly due to non JE viruses in Uttar Pradesh, Group of Ministers (GoM) was constituted on 4.11.11 which suggested a multi-pronged strategy for combating the menace of encephalitis. GoM met four times (21st November, 25th November, 9th December, 2011 and 2nd February, 2012). The recommendation of GoM was approved by the Cabinet on 18.10.2012. The main thrust is on an integrated approach for strengthening prevention and control measures in 60 high priority districts in states of Assam, Bihar, Uttar Pradesh, West Bengal and TamilNadu, with involvement of following Ministries:

1. Ministry of Health & Family Welfare as the nodal ministry

2. Ministry of Drinking Water Supply & Sanitation

3. Ministry of Housing and Urban Poverty Alleviation

4. Ministry of Women & Child Development

5. Ministry of Social Justice & Empowerment

The major thrust areas are:

● Strengthening public health measures;

● Establishment of Paediatrics ICUs in 60 district hospitals;

● JE vaccination in 62 additional districts;

● Establishing PMR in 10 different medical colleges across 5 States;

● Providing safe drinking water, sanitation in rural and slum areas;

● Setting up of District Rehabilitation and Counseling Centers in 60 identified districts;

● Improving the nutritional status of the children in endemic areas and

● Involvement of ASHAs for helping in early referral of encephalitis cases.

5.2.5 Dengue Fever/Dengue Haemorrhagic Fever

Dengue Fever is an outbreak prone viral disease, transmitted by Aedes mosquitoes. Both Aedes aegypti and Ae albopictus are involved in transmission. Aedes aegypti mosquitoes prefer to breed in manmade containers, viz., cement tanks, overhead tanks, underground tanks, tyres, desert coolers, pitchers, discarded containers, junk materials, etc., in which water stagnates for more than a week. This is a day biting mosquito and prefers to rest in hard to find dark areas inside the houses. Aedes albopictus mosquitoes prefer to breed in natural habitats like tree holes, plantation etc. The risk of dengue has increased in recent years due to rapid urbanization, and deficient water management including improper water storage practices in urban, peri-urban and rural areas, leading to proliferation of mosquito breeding sites. The cases peak after monsoon and it is not uniformly distributed throughout the year. However, in the southern states and Gujarat the

Junk Materials


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transmission is perennial. Dengue is a self-limiting acute disease characterized by fever, headache, muscle, joint pains, rash, nausea and vomiting. Some infections results in Dengue Haemorrhagic Fever (DHF) and in its severe form Dengue Shock Syndrome (DSS) can threaten the patient’s life primarily through increased vascular permeability and shock due to bleeding from internal organs. Though during 2014, 40571 cases and 137 deaths were reported. The case fatality ratio (CFR) which was 3.3 % in 1996 had come down to 0.4% in 2010 and 0.3 in 2014. The disease is spreading to newer geographical areas every year.

Epidemiological Situation: Dengue is endemic in 35 States/UTs. After 1996 outbreak (total 16517 cases and 545 deaths) upsurge of cases were recorded in 2003, 2005, 2008, 2010, 2012 and 2013. In 2011 total 18860 cases and 169 deaths have been reported. During 2012, 50222 cases and 242 deaths and during 2013, 75808 cases and 193 deaths were reported. During 2014, 40571 cases and 137 deaths were reported. Highest number of deaths were reported by Maharashtra (54) followed by Madhya Pradesh (13) and Kerala (11). During 2015 (till November), 90040 cases and 181 deaths have been reported. (Appendix -2).

There is no specific anti-viral drug or vaccine against dengue infection. Mortality can be

Open Overhead Tanks

Discarded Tyres

Dengue Affected Area


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minimized by early diagnosis and prompt symptomatic management of the cases. New National Guidelines for clinical management of Dengue fever has been developed and sent to the states for wider circulation and capacity building of Clinicians by imparting training. A Mid Term plan has been approved by Committee of Secretaries (CoS) on 26/5/2011 for prevention and control of Dengue which have been shared with the States for implementation. The main components of Mid Term Plan (known as ‘Octalogue’) for Prevention and control of Dengue are as follows:

● Surveillance- Disease and Entomological Surveillance;

● Case Management- Laboratory diagnosis and Clinical Management;

● Vector Management- Environmental management for source reduction, chemical control, personal protection and legislation;

● Outbreak response- Epidemic preparedness and Media Management;

● Capacity building- Training, strengthening human resource and operational research;

● Behaviour Change Communication (BCC)- Social mobilization and Information Education and Communication (IEC);

● Inter- sectoral coordination with Ministries of Urban Development, Rural Development, Panchayati Raj, Surface Transport and Education sector;

● Monitoring and Supervision - Analysis of reports, review, field visit and feedback.

Intensive health education activities through print, electronic and inter-personnel media, outdoor publicity as well as an inter-sectoral collaboration with civil society organization (NGOs/CBOs/ Self-Help Groups), PRIs and Municipal bodies

have been emphasized. The month of July is observed as Anti Dengue Month when States are undertaking widespread campaigns for community awareness, social mobilization and inter-personal communication, etc. in addition to regular IEC/BCC activities.

Regular supervision and monitoring is conducted by the Programme. The Government of India in consultation with States has identified 521 sentinel surveillance hospitals with laboratory support for augmentation of diagnostic facilities in the endemic states. Further, for advanced diagnosis and back-up support 15 Apex Referral Laboratories have been identified (Appendix – 8) and linked with sentinel surveillance hospitals.

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.

5.2.6 ChikungunyaChikungunya is a debilitating non-fatal viral illness caused by Chikungunya virus. The disease re-emerged in the country after a gap of three decades. In India a major epidemic of Chikungunya fever was reported during 60s & 70s; 1963 (Kolkata), 1965 (Puducherry and Chennai in Tamil Nadu, Rajahmundry, Vishakapatnam and Kakinada in Andhra Pradesh; Sagar in Madhya Pradesh and Nagpur in Maharashtra) and 1973 (Barsi in Maharashtra). This disease is also transmitted by Aedes mosquito. Both Ae.aegypti and Ae. albopictus can transmit the disease. Humans are considered to be the major source or reservoir of Chikungunya virus. Therefore, the mosquitoes usually transmit the disease by biting infected persons and then biting others. The infected person cannot spread the infection directly to other person (i.e. it is not contagious disease). Symptoms of Chikungunya fever are most often clinically


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indistinguishable from those observed in dengue fever. However, unlike dengue, hemmorrhagic manifestations are rare and shock is not observed in Chikungunya virus infection. It is characterized by fever with severe joint pain (arthralgia) and rash. Chikungunya outbreaks typically result in large number of cases but deaths are rarely encountered. Joint pains sometimes persist for a long time even after the disease is cured.

During 2006, total 1.39 million clinically suspected Chikungunya cases reported in the country. Out of 35 States/UTs, 28 were - Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Goa, Gujarat, Haryana, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Meghalaya, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Tripura, Uttar Pradesh, Uttrakhand, West Bengal, A&N Island, Chandigarh, Delhi, D&N Haveli, Lakshadweep and Puducherry. There are no reported deaths directly related to Chikungunya. In2007, total 14 states were affected and reported 59535 suspected Chikungunya fever cases with nil death. Subsequently in 2008, 2009, 2010, 2011, 2012 and 2013 - 95091, 73288, 48176, 20402,

15977 and 18840 suspected Chikungunya fever cases with nil death were reported. During 2014, 16049 suspected Chikungunya cases were reported whereas during 2015 (till November) 24997 suspected Chikungunya cases have been reported (Appendix -3).

As already mentioned, Aedes mosquitoes bite during the day and breed in a wide variety of man-made containers which are common around human dwellings. These containers such as discarded tyres, flower pots, old water drums, family water trough, water storage vessels an plastic food containers collect rain water and become the source of breeding of Aedes mosquitoes. Ae.aegypti played the major role in transmitting the disease in all the states except Kerala, where Ae. albopictus played the major role. Ae.albopictus breeding was detected in latex collecting cups of rubber plantations, shoot-off leaves of areca palm, fruit shells, leaf axils, tree holes etc.

There is neither any vaccine nor drugs available to cure the Chikungunya infection. Supportive therapy that helps to ease symptoms, such as administration of non-steroidal anti-inflammatory drugs and getting plenty of rest are found to be beneficial.

Government of India continuously monitor the situation, sending guidelines and advisories for prevention and control of Chikungunya fever


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to the states. Since same vector is involved in the transmission of Dengue and Chikungunya, strategies for transmission risk reduction by vector control are also same. A comprehensive Mid Term Plan for prevention & control of Chikungunya and Dengue/Dengue Haemorrhagic Fever has been prepared and disseminated for guidance to the states. Support in the form of logistics and funds are provided to the states. The central teams are deputed to the affected states for technical guidance of the State health authorities. As most transmission occurs at home, therefore, community participation and co-operation is of paramount importance for successful implementation of programme strategies for prevention and control of Chikungunya. For effective community participation, people are informed about Chikungunya and the fact that major epidemics can be prevented by taking effective preventive measures by community itself. Therefore, considerable efforts have been made through advocacy and social mobilization for community education and awareness.

For carrying out proactive surveillance and enhancing diagnostic facilities for Chikungunya, the 521 Sentinel Surveillance hospitals involved in dengue (Appendix - 4) in the affected states also carries out Chikungunya tests. Both Dengue and Chikungunya Diagnostic kits (IgM capture ELISA) to these institutes are provided through National Institute of Virology, Pune and cost is borne by Government of India (GoI). Further,

rapid response by the concerned health authorities has been envisaged on report of any suspected case from the Sentinel Surveillance Hospitals to prevent further spread of the disease.

Budget & ExpenditureThe BE, RE & Expenditure during 12th plan period in as under:

(Figures in crore)

Year BE RE FE

2012-13 572.00 455.00 304.38

2013-14 572.00 310.48 324.28

2014-15 572.00 572.00 480.00

2015-16 505.65 - -

5.3 NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)

Since the inception of National Leprosy Eradication Programme (NLEP) in the year 1983 spectacular success have been made in reducing the burden of Leprosy. The country achieved the goal of leprosy elimination as a public health problem i.e. Prevalence Rate (PR) of less than 1 case/10,000 population at national level by December 2005, as set by National Health Policy 2002. Although prevalence has come down at national and state level, new cases are being continuously detected and these cases will have to be provided quality leprosy services through General Healthcare (GHC) system.

The plan budget has been substantially increased from Rs. 219.00 crore in 11th plan to Rs. 500.00 crore in the 12th plan. The budget approved for 2014-15 was 51 crore and expenditure incurred was 42.54 crore.

Background● The National Leprosy Control Programme


66

was launched by the Govt. of India in 1955. Multi Drug Therapy (MDT) came into wide use from 1982 and the National Leprosy Eradication Programme was introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease burden. India achieved the goal set by the National Health Policy, 2002 of elimination of leprosy as a public health problem, defined as less than 1 case per 10,000 population at the national level in December 2005.

● Following are the programme components:

○ Case Detection and Management

○ Disability Prevention and Medical Rehabilitation

○ Information, Education and Communication (IEC) including Behaviour Change Communication (BCC)

○ Human Resource and Capacity building

○ Programme Management

Epidemiological Situation● 34 States/UTs have achieved leprosy

elimination status. Only Chhattisgarh and Dadra & Nagar Haveli are yet to achieve elimination. Chhattisgarh and Dadra &

Nagar Haveli have remained with PR between 2 and 5 per 10,000 population. Four other State/UT viz. Odisha, Lakshadweep, Delhi and Chandigarh, which have achieved elimination earlier have shown slight increase in P.R. (1-2) in the current year. 125785 new cases were detected during 2014-15 and prevalence rate as on March 31st 2015 was 0.69. Further, a total of 532 districts (79.52%) out of total 669 districts have PR<1/10,000 population.

● At the end of March 2015, there were 88833 leprosy cases on record (under treatment).

● In 2014-15, total 125785 new leprosy cases were detected and put under treatment as compared to 126913 leprosy cases detected during corresponding period of previous year, giving Annual New Case Detection Rate (ANCDR) of 9.73 per 1,00,000 population.

● 2883 Reconstructive Surgeries were conducted in 2014-15 for correction of disability in leprosy affected persons.

● Out of 215656 global leprosy cases reported in 2013, 126913 cases were reported by India. Thus India contributed about 58.8 % of new cases detected globally.

The trend of Prevalence and Annual New Case Detection Rate per 10,000 population since 2004


67

1. District wise situation on the basis of ANCDR as on 31st March 2015 is: 477 districts out of total 669 have ANCDR < 10 per 100,000 population and 78 districts have ANCDR > 20/100,000. Only 14 districts with ANCDR > 50/100,000 population are in Bihar (2), Chhattisgarh (3), Gujarat (5), Maharashtra (3) and Dadra & Nagar Haveli (1).

2. Elimination (Less than 1 case per 10,000 pop.) in all the districts is the objective in 12th plan period. Number of districts yet to achieve elimination are 137, on March 2015.

Initiatives:i. Special Activity in High Endemic District:

- 209 Districts had reported ANCDR more than 10 per lakh population in 17 States/UTs. Special activity for early detection and complete treatment, capacity building and extensive IEC, adequate availability of MDT, strengthening of District. Nucleus, regular monitoring, supervision and review, regular follow up for neuritis and reaction, self-care practices, supply of MCR footwear in adequate quantity and improvement in

RCS performance through camp approach have been carried out since 2013-14.

ii. Disability Prevention and Medical Rehabilitation:- An amount of Rs. 8000/- is provided as incentive to leprosy affected persons for undergoing each major reconstructive surgery in identified Govt./NGO institutions to compensate loss of wages during their stay in hospital. Support is also provided to Government institutions in the form of Rs. 5000/- per RCS conducted, for procurement of supply & material and other ancillary expenditure incurred for the surgery. Additional Rs. 5000/- is paid per RCS conducted in Camps.

iii. Involvement of ASHA: – A scheme to involve ASHAs was drawn up to bring out leprosy cases from their villages for diagnosis at PHC and follow up cases for treatment completion. To facilitate involvement, they are being paid an incentive as below:

● On confirmed diagnosis of case brought by them – Rs. 250/-

● On completion of full course of treatment of the case within specified time– Paucibacillary (PB) leprosy case– Rs. 400/- and Multi-bacillary (MB) Leprosy case–Rs. 600/-. The scheme has been extended to involve any other person who brings in or reports a case of leprosy.

● An early case before onset of any visible deformity – Rs 250

● A new case with visible deformity in hands, feet or eye – Rs 200

5.4 REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP)

The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment


68

Short-course (DOTS) strategy, was launched in 1997 expanded across the country in a phased manner. Full nation-wide coverage was over a billion population (1114 million) in March 2006, expanding to 1247 million people in first quarter of 2013. Though India is the second-most populous country in the world, it accounted for 23% of all the TB cases in 2014.

5.4.1 Estimated TB burden in India● Incidence: 2.2 million new TB cases

annually- 167 cases per 100,000 population

● Prevalence: 2.5 million cases - 195 cases per 100,000 population

● Deaths: About 220,000 deaths each year – 17 deaths per 100,000 population

● Approximately 5% of TB patients estimated to be HIV+ve

● DR-TB (Drug resistant-TB)

o 2.2% in New cases and

o 15% in previously treated cases

Of the estimated 9.6 million people who developed TB in 2014, India accounted for 23% of total cases, 2-2.3 million were estimated to have occurred in India, with a best case estimate of 2.2 Million cases as per the WHO Global Report 2014.

5.4.2 Goal of the ProgrammeThe Goal of TB Control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

5.4.3 Objectives of the programme● To reduce the incidence of and mortality due

to TB;

● To prevent further emergence of drug resistance and effectively manage drug-resistant TB cases;

● To improve outcomes among HIV-infected TB patients;

● To involve private sector on a scale commensurate with their dominant presence in healthcare services and

● To further decentralize and align basic RNTCP management units with NRHM block level units within general health system for effective supervision and monitoring.

5.4.4 Achievements of the programme

● Progress towards Millennium Development Goal achieved for Incidence and Prevalence:

o The Incidence of Tuberculosis has come down from 209/lakh population in 2005 to 167/lakh population in 2014;

o The Prevalence has come down from 365/ lakh population in 2005 to 195/lakh population in 2014 and

o The Mortality from Tuberculosis has reduced from 36 in 2005 to 17 in 2013.

● RNTCP has treated over 7.1 million cases during the last five years.

● The programme screened 8.7 million TB suspects in the year 2014.

● During the last five years 1.3 million additional deaths have been averted.

● Treatment success rates have tripled from 25% in pre-RNTCP era to 88% presently (2014) and TB death rates have been reduced from 29% to 4% during the same period.

● The notification of all cases of Tuberculosis has been made mandatory.

● Commercial serology tests for TB diagnosis have been banned.


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● More than 13,000 Designated Microscopy Centres (DMCs) for quality assured diagnosis established. In addition 64 labs for drug susceptibility testing for first line and 25 for second line have been established. A total of 121 CBNAAT machines are being used within the programme for rapid diagnosis of Rifampicin resistant Tuberculosis.

● Nation-wide coverage of programmatic management of drug resistant TB services started from March 2013. In 2014 the programme screened 255408 MDR suspects and diagnosed 25652 cases of which 24073 were initiated on treatment.

● NACP (National AIDS Control Programme) & RNTCP have developed "National framework of Joint TB/HIV Collaborative activities" in 2007 and revised it in 2009. The framework articulates the policy of TB/HIV collaborative activities in the country. HIV co-infected TB services under RNTCP is now available across the country. In 2014, 1034712 TB patients (72% of total TB patients registered) were tested for HIV; 44171 (4% of those tested) were diagnosed as HIV positive and were offered access to HIV care. 94% of these patients were put on Cotrimoxazole Prophylactic Therapy (CPT) while 91% of them received Anti-Retroviral Therapy (ART).

● To improve access to tribal and other marginalized groups the programme has developed a Tribal action plan which is being implemented with the provision of additional TB Units and DMCs in tribal/difficult areas, additional staff, compensation for transportation of patient & attendant and higher rate of salary to contractual staff.

● All States are implementing the 'Supervision and Monitoring strategy'-

detailing guidelines, tools and indicators for monitoring the performance from the PHC level to the national level.

● The NIKSHAY, case based web based TB case management system is being used by the programme for data management and its various modules are gradually being scaled up.

● The ACSM activities are inbuilt into the programme and are implemented intensively from the National level to the most peripheral level of the community, essentially for generating demand for RNTCP services, motivating providers for standardized TB care, changing the attitude and practices and creating awareness about the disease.

5.4.5 New Initiatives

● Information communication technology enabled TB control programme (e-Nikshay);

● Nationwide Anti-TB drug resistance survey;

● Innovative intensified TB Case finding and appropriate treatment at high burden ART center's in India and

● Pharmacovigilance & Adverse Drug Reaction (ADR) monitoring.

5.4.6 Twelfth Five Year Plan - Key Activities being undertaken

The following key activities are being undertaken during the 12th five year plan for achieving the objectives of RNTCP including universal access:

● Ensuring early and improved diagnosis of all TB patients, through improving outreach, vigorously expanding case-finding efforts among vulnerable populations, deploying better diagnostics and by extending services to patients diagnosed and treated in the private sector.


70

● Improving patient-friendly access to high-quality treatment for all diagnosed cases of TB, including scaling-up treatment for MDR-TB nationwide.

● Re-engineering programme systems for optimal alignment with NRHM at block level and human resource development for all health staffs.

● Enhancing supervision, monitoring, surveillance and programme operations for continuous quality improvement and accountability for each TB case, with programme based research for development and incorporation of innovations into effective programme practice.

5.4.7 Financial Allocation to RNTCPThe actual allocation and expenditure from the Ministry of Health and Family Welfare is as under:

(Rs. in crore)

S. No

Year Actual Allocation

Release/Exp.

1 2012-13 467.00 466.152 2013-14 516.76 516.553 2014-15 640.00 639.944 2015-16 640.00* 511.47

*Budget Estimate

5.5 NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP)

Iodine is an essential micronutrient required daily at 100-150 micrograms for the entire population for normal human growth and development. Deficiency of Iodine can cause physical and mental retardation, cretinism, abortions, stillbirth, deaf, mutism, squint, loss of IQ, compromised school performance & various types of goiter etc. Results of sample surveys conducted in 386 districts

covering all the States/Union Territories have revealed that 335 districts are endemic where the prevalence of Iodine Deficiency Disorders (IDD) is more than 5%. No State/UT is free from IDD.

Objectives:● Surveys to assess the magnitude of the

Iodine Deficiency Disorders in districts;

● Supply of iodized salt in place of common salt;

● Resurveys to assess iodine deficiency disorders and the impact of iodized salt after every 5 years in districts;

● Laboratory monitoring of iodized salt and urinary iodine excretion and

● Health education and publicity.

Significant achievements: ● Consequent upon liberalization of Iodated

salt production, so far 777 salt iodization plants were established and the iodization capacity was 222 lakh tones.

● The production and supply of iodized salt from April 2015 to August 2015 was 26.44 lakh tones and 25.17 lakh tones respectively.

● For effective implementation of National Iodine Deficiency Disorders Control Programme, 33 States/UTs have established Iodine Deficiency Disorders Control Cells in their State Health Directorate.

● In order to monitor the quality of Iodized salt and Urinary Iodine excretion 34 States/UTs have already set-up Iodine Deficiency Disorders monitoring laboratories while the remaining States are in the process of establishing the same.

● Four zonal level meetings to review the implementation of NIDDCP by States/UTs were convened at Chennai, Ahmedabad, Guwahati and Chandigarh during 3rd and 4th quarter of 2014-15.


71

● Four day training programme on ‘management of laboratory monitoring of iodated salt and urinary iodine excretion’ to Lab Technician/Lab Assistant of the State/UT IDD monitoring laboratory was conducted at AIIH&PH, Kolkata in first week of November, 2015.

Inaugural Session of Lab Technicians Training under NIDDCP at AIIH&PH, Kolkata on 2nd November, 2015

● For estimation of iodine content in iodized salt, a total of 11494 salt samples were analyzed till August, 2015 out of which 10826 (94%) salt samples were found confirming to the standard (iodine content > 15 ppm).

● For estimation of urinary iodine excretion for bio-availability of iodine, 3586 urine samples were collected and analyzed till August, 2015 out of which 3467 samples were found confirming to the standard (97%).

● For ensuring the quality of iodized salt at consumption level, a total of 1820398 salt samples were tested by salt testing kit till August, 2015 out of which 1355406 (74%) salt samples indicated normal quality i.e salt having iodine >15ppm.

● Meetings are being organized for development of Audio/Video spots and radio jingles on IDD for different media in

different languages for creating enhanced awareness regarding consumption of iodated salt.

Information Education & Communication (IEC) Activitiesa) Activities through Doordarshan: IDD

spots containing messages on consequences of Iodine Deficiency Disorders and benefits of consuming iodated salt are being telecast through Doordarshan channels (National Network, DD News & DD Sports) daily.

b) Activities through All India Radio: IDD spots containing messages on major consequences of iodine deficiency disorders and benefits of consuming iodated salt in 18 regional languages are broadcast by the All India Radio through its 114 primary channels and in 6 regional languages through 37 Vividha Bharthi channels. Messages are also broadcast through 24 FM channels (including 4 FM Gold channels).

c) Activities through DAVP and Railways: Global IDD Prevention day was observed throughout the country on 21st October, 2015. Messages on benefits of consumption of iodized salt in prevention and control of IDD were published in national & regional newspapers on the eve of Global IDD Prevention Day through DAVP. Messages on IDD and consumption of Iodated salt are being carried out through computerized railway reservation tickets in 12 different railway zones covering 16 -18 States/UTs.

d) Activities through the State Health Directorate: State Governments have also been provided grants for undertaking IEC activities at the local level in their regional languages to make the impact of IEC activities more effective including celebration of Global IDD Prevention Day in all districts.


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Appendix -1State wise Malaria situation in the Country

Sl. No.

States / UTs 2011 2012 2013 2014 2015 (Provisional Upto Oct.)

C D C D C D C D C D1 Andhra Pradesh 34949 5 24699 2 19787 0 21077 0 21176 02 Arunachal Pradesh 13950 17 8368 15 6398 21 6082 9 4461 33 Assam 47397 45 29999 13 19542 7 14540 11 11918 04 Bihar 2643 0 2605 0 2693 1 2043 0 3123 15 Chhattisgarh 136899 42 124006 90 110145 43 128993 53 96774 86 Goa 1187 3 1714 0 1530 0 824 0 680 17 Gujarat 89764 127 76246 29 58513 38 41608 16 36732 18 Haryana 33401 1 26819 1 14471 3 4485 1 2176 09 Himachal Pradesh 247 0 216 0 141 0 102 0 56 010 Jammu & Kashmir 1091 0 864 0 698 0 291 0 189 011 Jharkhand 160653 17 131476 10 97786 8 103735 8 69847 312 Karnataka 24237 0 16466 0 13302 0 14794 2 9401 013 Kerala 1993 2 2036 3 1634 0 1751 6 1274 214 Madhya Pradesh 91851 109 76538 43 78260 49 96879 26 77035 1415 Maharashtra 96577 118 58517 96 43677 80 53385 68 42902 2716 Manipur 714 1 255 0 120 0 145 0 168 017 Meghalaya 25143 53 20834 52 24727 62 39168 73 40477 6518 Mizoram 8861 30 9883 25 11747 21 23145 31 24308 019 Nagaland 3363 4 2891 1 2285 1 1936 2 1386 320 Orissa 308968 99 262842 79 228858 67 395035 89 361825 6421 Punjab 2693 3 1689 0 1760 0 1036 0 608 022 Rajasthan 54294 45 45809 22 33139 15 15118 4 9321 023 Sikkim 51 0 77 0 39 0 35 0 26 024 Tamilnadu 22171 0 18869 0 15081 0 8729 0 4980 025 Telangana* -- -- -- -- -- -- 5189 0 9361 326 Tripura 14417 12 11565 7 7396 7 51240 96 29047 1927 Uttarakhand 1277 1 1948 0 1426 0 1171 0 1419 028 Uttar Pradesh 56968 0 47400 0 48346 0 41612 0 38137 029 West Bengal 66368 19 55793 30 34717 17 26484 66 20198 3030 A & N Islands 1918 0 1539 0 1005 0 557 0 363 031 Chandigarh 582 0 201 0 150 0 114 0 148 032 D & N Haveli 5150 0 4940 1 1778 0 669 1 502 033 Daman & Diu 262 0 186 0 91 0 56 0 64 034 Delhi 413 0 382 0 353 0 98 0 54 035 Lakshdweep 8 0 9 0 8 0 0 0 2 036 Puducherry 196 1 143 0 127 0 79 0 50 1 Total 1310656 754 1067824 519 881730 440 1102205 562 920188 245

*Newly created state in 2014 carved out from erstwhile Andhra Pradesh. Data before 2014 clubbed in Andhra Pradesh.Note: C= Cases D= Deaths


73

Appendix -2State-wise Dengue Situation in Country

Sl. No.

States / UTs 2011 2012 2013 2014 2015 (Prov till 30th Nov.)

Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths1 Andhra Pradesh 1209 6 2299 2 910 1 1262 5 2891 22 Arunachal Pradesh 0 0 346 0 0 0 27 0 1933 13 Assam 0 0 1058 5 4526 2 85 0 1011 14 Bihar 21 0 872 3 1246 5 297 0 1700 05 Chhattisgarh 313 11 45 0 83 2 440 9 362 16 Goa 26 0 39 0 198 2 168 1 254 07 Gujarat 1693 9 3067 6 6272 15 2320 3 4905 98 Haryana 267 3 768 2 1784 5 214 2 8066 129 Himachal Pradesh 0 0 73 0 89 2 2 0 19 110 J & K 3 0 17 1 1837 3 1 0 137 011 Jharkhand 36 0 42 0 161 0 36 0 91 012 Karnataka 405 5 3924 21 6408 12 3358 2 4691 913 Kerala 1304 10 4172 15 7938 29 2575 11 3740 2514 Madhya Pradesh 50 0 239 6 1255 9 2131 13 1592 615 Meghalaya 0 0 27 2 43 0 0 0 13 016 Maharashtra 1138 25 2931 59 5610 48 8573 54 4164 2117 Manipur 220 0 6 0 9 0 0 0 52 018 Mizoram 0 0 6 0 7 0 19 0 43 019 Nagaland 3 0 0 0 0 0 0 0 9 020 Odisha 1816 33 2255 6 7132 6 6433 9 2304 221 Punjab 3921 33 770 9 4117 25 472 8 13731 1822 Rajasthan 1072 4 1295 10 4413 10 1243 7 3466 723 Sikkim 2 0 2 0 38 0 5 0 21 024 Tamil Nadu 2501 9 12826 66 6122 0 2804 3 3841 625 Tripura 0 0 9 0 8 0 6 0 36 026 Telangana 0 0 0 0 0 0 704 1 1740 227 Uttar Pradesh 155 5 342 4 1414 5 200 0 2662 928 Uttrakhand 454 5 110 2 54 0 106 0 1382 129 West Bengal 510 0 6456 11 5920 6 3934 4 6822 1030 A&N Island 6 0 24 0 67 0 139 0 143 031 Chandigarh 73 0 351 2 107 0 13 0 848 032 Delhi 1131 8 2093 4 5574 6 995 3 15730 3833 D&N Haveli 68 0 156 1 190 0 641 1 1038 034 Daman & Diu 0 0 96 0 61 0 46 0 110 035 Puducherry 463 3 3506 5 2215 0 1322 1 493 0

TOTAL 18860 169 50222 242 75808 193 40571 137 90040 181


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Appendix -3State-wise Clinically Suspected Chikungunya Cases in Country

Sl.No

Name of the States/UTs

2011 2012 2013 2014 2015 (Prov. till 30th Nov.)

1 Andhra Pradesh 99 2827 4827 1359 6962 Arunachal Pradesh 0 0 0 0 353 Assam 0 0 742 0 04 Bihar 91 34 0 0 15 Goa 664 571 1049 1205 4716 Gujarat 1042 1317 2890 574 2827 Haryana 215 8 1 3 18 Jharkhand 816 86 61 11 219 Karnataka 1941 2382 5295 6962 1947510 Kerala 183 66 273 272 16411 Madhya Pradesh 280 20 139 161 4512 Meghalaya 168 0 0 0 7813 Maharashtra 5113 1544 1578 1572 15414 Odisha 236 129 35 10 8115 Punjab 0 1 0 2 016 Rajasthan 608 172 76 50 717 Tamil Nadu 4194 5018 859 543 28118 Telangana 0 0 0 1687 202319 Tripura 0 0 0 34 15120 Uttar Pradesh 3 13 0 4 021 Uttrakhand 18 0 0 0 022 West Bengal 4482 1381 646 1032 72223 A&N Island 96 256 202 161 6324 Chandigarh 1 1 1 0 025 Delhi 110 6 18 8 2326 D&N Haveli 0 100 2 0 027 Lakshadweep 0 0 0 0 028 Puducherry 42 45 146 399 223

Total 20402 15977 18840 16049 24997


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Appendix -4List of Sentinel Surveillance Hospitals (SSHs) for Dengue & Chikungunya

Sl. No. State Number of SSHs 1 A & N Island 32 Andhra Pradesh 193 Arunachal Pradesh 74 Assam 135 Bihar 76 Chandigarh 17 Chhattisgarh 48 Delhi 339 Daman & Diu 210 Dadra & Nagar Haveli 111 Goa 312 Gujarat 3213 Haryana 2214 Himachal Pradesh 515 Jammu 1016 Jharkhand 517 Karnataka 3218 Kerala 2619 Lakshadweep 120 Madhya Prd 3621 Maharashtra 3722 Manipur 223 Meghalaya 324 Mizoram 125 Nagaland 226 Odisha 3527 Puducherry 528 Punjab 2129 Rajasthan 2730 Sikkim 231 Tamil Nadu 3032 Telangana 1633 Tripura 234 Uttar Pradesh 3735 Uttrakhand 736 West Bengal 32 Total 521


76

Appendix -5AState-wise AES cases including JE in the country

Sl. No.

States / UTs 2011 2012 2013 2014 2015 (till 30.11.2015)

Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths

1 Andhra Pradesh 73 1 64 0 345 3 31 0 23 02 Arunachal Pradesh 0 0 0 0 0 0 102 11 73 23 Assam 1319 250 1343 229 1388 272 2194 360 1323 2604 Bihar 821 197 745 275 417 143 1358 355 255 805 Delhi 9 0 0 0 0 0 0 0 1 06 Goa 91 1 84 0 48 1 17 0 0 08 Haryana 90 14 5 0 2 0 6 1 2 07 Jharkhand 303 19 16 0 270 5 288 2 143 19 Karnataka 397 0 189 1 162 0 75 0 243 110 Kerala 88 6 29 6 53 6 6 2 13 111 Meghalaya 0 0 0 0 0 0 212 3 74 812 Maharashtra 35 9 37 20 0 0 0 0 43 013 Manipur 11 0 2 0 1 0 16 0 34 014 Nagaland 44 6 21 2 20 0 20 1 10 115 Punjab 0 0 0 0 0 0 2 0 1 016 Tamil Nadu 762 29 935 64 77 8 346 4 714 017 Tripura 0 0 0 0 211 0 323 0 350 418 Uttarakhand 0 0 174 2 0 0 2 0 2 019 Uttar Pradesh 3492 579 3484 557 3096 609 3329 627 2736 42520 West Bengal 714 58 1216 100 1735 226 2385 348 1938 32921 Telengana* -- -- -- -- -- -- 155 5 101 0

Total 8249 1169 8344 1256 7825 1273 10867 1719 8079 1112

*State created in 2014


77

Appendix -5BState-wise JE situation in the country

Sl. No.

States / UTs 2011 2012 2013 2014 2015 (P)(till 30.11.2015)

Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths

1 Andhra Pradesh 4 1 3 0 7 3 0 0 0 0 2 Arunachal Pradesh 0 0 0 0 0 0 32 3 30 23 Assam 489 113 463 100 495 134 761 165 614 1354 Bihar 145 18 8 0 14 0 20 2 62 105 Delhi 9 0 0 0 0 0 0 0 1 0 6 Goa 1 0 9 0 3 1 0 0 0 07 Haryana 12 3 3 0 2 0 5 1 2 08 Jharkhand 101 5 1 0 89 5 90 2 42 19 Karnataka 23 0 1 0 2 0 13 0 21 110 Kerala 37 3 2 0 2 0 3 2 2 112 Maharashtra 6 0 3 0 0 0 0 0 6 013 Manipur 9 0 0 0 0 0 1 0 6 011 Meghalaya 0 0 0 0 0 0 72 3 39 814 Nagaland 29 5 0 0 4 0 6 0 0 015 Punjab 0 0 0 0 0 0 0 0 0 016 Tamil Nadu 24 3 25 4 33 0 36 3 46 017 Tripura 0 0 0 0 14 0 14 0 23 418 Uttarakhand 0 0 1 0 0 0 2 0 2 019 Uttar Pradesh 224 27 139 23 281 47 191 34 340 3920 West Bengal 101 3 87 13 140 12 415 78 308 6721 Telengana* -- -- -- -- -- -- 0 0 4 0

Total 1214 181 745 140 1086 202 1661 293 1548 268

*State created in 2014


78

Appendix -6State-wise Kala-azar Situation in Country

Sl. No. Affected States 2011 2012 2013 2014 2015 (P)

C D C D C D C D C D

1 Bihar 25222 76 16036 27 10730 17 7615 10 5654 4

2 Jharkhand 5960 3 3535 1 2515 0 937 0 1071 0

3 West Bengal 1962 0 995 0 595 2 668 1 440 0

4 Uttar Pradesh 11 1 5 0 11 1 11 0 103 0

5 Uttarakhand 0 0 7 1 0 0 4 0 3 0

6 Delhi * 19 0 11 0 6 0 0 0 2 0

7 Assam 5 0 6 0 4 0 1 0 1 0

8 Sikkim 7 0 5 0 8 0 5 0 3 0

9 Himachal Pradesh 1 0 0 0 0 0 0 0 0 0

Total 33187 80 20600 29 13869 20 9241 11 7277 4

Note: C = Cases, D = Deaths, * = Imported, (P) = Provisional.

(as on 02.12.2015)


79

Appendix -7Population Coverage (%) during Mass Drug Administration (MDA)

for Lymphatic Filariasis Elimination

Sl. No. States/UTs 2011 round 2012 round 2013 round 2014 round

1 Andhra Pradesh 92.48 93.84 92.32 92.34

2 Telangana 93.23 92.36 93.70 90.02

3 Assam 78.10 81.19 78.67 90.66

4 Bihar ND 86.38 ND 87.75

5 Chhattisgarh 90.06 ND 89.18 87.61

6 Goa 96.21 MDA Stopped

7 Gujarat 97.66 99.04 99.38 98.42

8 Jharkhand 86.53 84.36 ND 85.29

9 Karnataka 91.81 93.84 93.70 76.71

10 Kerala 89.62 80.90 73.33 82.29

11 Madhya Pradesh 89.27 87.88 87.89 91.45

12 Maharashtra 89.28 89.24 91.00 93.58

13 Odisha 90.55 ND 91.10 88.39

14 Tamil Nadu 93.58 94.76 (4 districts) ND 97.26

15 Uttar Pradesh 80.45 83.15 70.69 83.63

16 West Bengal 79.23 84.83 86.95 85.19

17 A & N Islands 90.15 90.06 88.93 95.94

18 D & N Haveli 98.51 96.88 95.83 96.15

19 Daman & Diu 90.89 MDA Stopped

20 Lakshadweep 73.94 ND 94.22 ND

21 Puducherry 97.14 MDA Stopped

Total 87.97 86.82 81.80 86.80

ND: - Not Done


80

Appendix - 8

APEX REFERRAL LABORATORIES

1. National Institute of Virology, Pune.

2. National Centre for Disease Control (former NICD), Delhi.

3. National Institute of Mental Health & Neuro-Sciences, Bengaluru.

4. Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow.

5. Post- Graduate Institute of Medical Sciences, Chandigarh.

6. All India Institute of Medical Sciences, Delhi.

7. ICMR Virus Unit, National Institute of Cholera & Enteric Diseases, Kolkata.

8. Regional Medical Research Centre (ICMR), Dibrugarh, Assam.

9. King’s Institute of Preventive Medicine, Chennai.

10. Institute of Preventive Medicine, Hyderabad.

11. B J Medical College, Ahmedabad.

12. State Public Health Laboratory, Thiruvananthapuram, Kerala.

13. Defence Research Development and Establishment, Gwalior.

14. National Institute for Research in Tribal Health (NIRTH), (ICMR) Jabalpur, Madhya Pradesh.

15. Regional Medical Research Centre, (ICMR), Bhubaneswar, Odisha.

5.1 introduction · 2016. 10. 15. · 2011 130316971 142502 13910 9.77 2.07 0.21 147 2012 130329138...

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