National Vector Borne Disease Control

Programme

Dr. Avdhesh Kumar Additional Director

National Vector Borne Disease Control Programme

Directorate General of Health ServicesMinistry of Health and Family Welfare,

Government of India

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• 1953-54 Started as - National Malaria Control Programme (NMCP) dealing with malaria control only

• 1958-59 renamed as NMEP• 1971 – Urban Malaria Scheme launched • 1975 – National Filaria Control Programme (NFCP) which was in

operation since 1955 under NICD was divided and operational part was brought to NMEP while retaining training part with NICD.

• 1977 – Modified Plan of Operation (MPO) launched to reduce morbidity and mortality and also to sustain the gains achieved.

• 1991 – 92 Kala-azar Control Programme was launched under NMEP with separate budget head.

• 1998-99 1998-99 renamed as National Anti-Malaria Programme renamed as National Anti-Malaria Programme (NAMP)(NAMP)• 2003-04 2003-04 renamed as renamed as NVBDCPNVBDCP with a view to converge Dengue, JE and 3 with a view to converge Dengue, JE and 3

ongoing centrally sponsored schemes : NAMP,NFCP, Kala azarongoing centrally sponsored schemes : NAMP,NFCP, Kala azar• In 2006, Chikungunya re-emerged and brought under NVBDCP.In 2006, Chikungunya re-emerged and brought under NVBDCP.

About NVBDCP

Generic strategy for Prevention & Control of VBDs

Early diagnosis and complete treatment

(No specific drugs against Dengue, Chikungunya and JE)

Integrated Vector Management (IRS, LLIN, larvivorous fish,

chemical and bio-larvicide, source reduction)

Supportive intervention: Vaccination only against JE

Annual MDA using DEC and Albendazole for LFE

Behaviour Change Communication

Kala-Azar

4 States; 54 Districts; 130 million population

6 distt.,11.0 mil

4 districtsPop: 6.7 mil

33 distt., 62.3 mil

11 districtsPop. – 50 mil

•Exists in several countries•About 500 000 cases occur annually. •Five countries (India, Sudan, Nepal, Bangladesh and Brazil account for 90% of the global cases.

•In the SEA Region, KA occurs in111 districts).

•45 districts of Bangladesh, •54 districts of India and •12 districts of Nepal•Endemic in Bihar, West Bengal, Assam, Tamil Nadu during pre DDT era

•Re-appeared during seventies •A centrally sponsored VL control Programme launched in 1990-91

•Exists in several countries•About 500 000 cases occur annually. •Five countries (India, Sudan, Nepal, Bangladesh and Brazil account for 90% of the global cases.

•In the SEA Region, KA occurs in111 districts).

•45 districts of Bangladesh, •54 districts of India and •12 districts of Nepal•Endemic in Bihar, West Bengal, Assam, Tamil Nadu during pre DDT era

•Re-appeared during seventies •A centrally sponsored VL control Programme launched in 1990-91 • > 80% of all cases reported from Bihar

• 9 Dist in Bihar contribute 65-70% of cases

Lymphatic Filariasis - Disease Burden in India

•40% of Global Burden•Endemic in 20 States/UT-250 Dist.•600 million “at risk”•509 million targeted for MDA

2004 : > 1% Mf rate 174 Districts2012 : > 1% Mf rate 64 Districts Lymphoedema – 877,594 Hydrocele – 407,307 Hydrocele Operation– 110,842

1991

Geographical spread of Dengue in last 2 decades

2013

Dengue Cases/per district

1996

Spatial distribution of Chikungunya since 2006

Kolkata -1963

Vishakhapatnam – 1964

Kakinada -1965

Rajahmundry -1965

Chennai - 1964

Pondicherry - 1964

Nagpur 1965 1977

Barsi - !973,

Sagar - 1965

Chikungunya outbreaks in 1960s-70s

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

UTTAR PRADESH

KARNATAKA

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

DELHI

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

CHANDIGARH

DAMAN & DIU

N

EW

S

SONITPUR

TINSUKHIA

JORHAT

DHEMAJI

DIBRUGARH

GOLAGHATBARPETA

LAKHIMPUR

SIBSAGAR

UDALGURI

ASSAM

GAYA

PATNA

SARAN

ARARIASIWAN

NAWADA

CHAMPARAN WEST

NALANDA

CHAMPARAN EAST

VAISHALI

DARBHANGAMUZAFFARPUR

SAMASTIPUR

GOPALGANJ

JEHANABAD

BIHAR

VILLUPURAM

MADURAI

KARURTHANJAVUR

THIRUVARUR

TAMIL NADU

SAMASTIPUR

BIHAR

KHERI

HARDOISITAPUR

GONDA

BASTI

BAHRAICH

BALLIA

MAUAZAMGARH

DEORIA

SAHARANPUR

RAEBARELI

BALRAMPUR

KUSHINAGAR

GORAKHPUR

SRAWASTI

KANPUR(DEHAT)

MAHARAJGANJ

SANT KABIR NAGAR

SIDDHARTHNAGAR

UTTAR PRADESH

Target States of JE/AES: 60 High Priority Districts

Assam 10 Districts

Bihar 15 Districts

West Bengal 10 DistrictsTamil Nadu 5 Districts

Uttar Pradesh 20 Districts

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Reported* Global SEARO IndiaAs per WMR* India is at• 18th position- total malaria• 21st position deaths.

India contributed to world malaria*•1.7% of malaria cases • 4.6% of Pv cases•1.1 % of Pf cases •0.3% of malaria deaths

Malaria cases 94.30 Mil. 4.44 Mil 1.59 Mil

Pv cases 16.40. Mil. 3.3 Mil 0.76 Mil

Pf cases 77.90 Mil. 1.1 Mil 0.83 Mil

Malaria deaths 3,45,960 2,426 1,018Estimated

Malaria deaths6,55,000 38,000 20,000

Malaria Cases & Deaths: Global vs India Scenario

*Source: World Malaria Report 2011

7 NE and 9 Other States –Odisha, Jharkhand, Chhattisgarh, MP, Andhra, Maharashtra, Gujarat, Karnataka & W Bengal contribute countries' 54% Population, >80% Total Malaria, >90% Pf. Cases and >90% deaths due to malaria

Trend of Malaria, India, 2001 - 2013

•ACT& RDT in 2005 : 53.93 % reduction in Malaria Cases 54.31 % reduction in deaths 2013 against 2005

•LLIN in 2009 : 46.47% reduction in Malaria Cases• 61.54% reduction in deaths in 2013 against 2009

LLIN

Bivalent RDT

MALARIA ENDEMIC AREAS

**Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat, Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat, Karnataka & West BengalKarnataka & West Bengal

PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS in 2010

(Compared to the country total)

States%

Population

% Malaria cases

%Pf

cases% Death

N.E. States

4 11 16 21

Other high endemic states*

42 71 79 70

Other 54 18 5 9

API - 20100-1>1-2>2-5>5-10>10

Erstwhile World Bank Project(Rs.1000 Crore: 2008-2013)

GFATM: R-9 (Rs.417 Crore : 2010-2015)

Shrinking – Malaria Map- India

Stratification of Districts based on API

API2000 2012

No. % No: %

>10 59 10 32 4.9

>5-10 22 3.7 29 4.4

>2-5 65 11.14 48 7.3

1-2 72 12.2 58 8.8

<1 370 63 492 74.7

2013- (Prv) - 515 Districts recorded API<1 - 23 States recorded API<1

2013

Malaria Situation –India (2000-2013)

Year Cases Deaths

2000 19,42,318 959

2013 8,81,730 440

Prevention and Control strategy• Disease Management (for reducing the load of Morbidity & Mortality)

• Early case detection and complete treatment, • Strengthening of referral services, • Epidemic preparedness and rapid response.

• Integrated Vector Management (For Transmission Risk Reduction) • Indoor Residual Spraying in selected high risk areas, • use of Insecticide treated bed nets (ITN/LLINs), • use of Larvivorous fish, • anti larval measures in urban areas like source reduction and minor environmental engineering

• Supportive Interventions (for strengthening technical & social inputs)• Behaviour Change Communication (BCC), • Public Private Partnership, • Inter-sectoral convergence, • Human Resource Development through capacity building, • Operational research including studies on drug resistance and insecticide susceptibility,• Monitoring & evaluation through periodic reviews/field visits

API Stratification for Malaria Pre-EliminationNo. Category Definition

1. Category 1 States with API less than one, and all the districts in the state with API less than one

2. Category 2 States with API less than one and few districts reporting API more than one

3. Category 3 States with API more than one and either all the districts with API more than one or few districts with API less than one and few with API more than one

Strategies to be Adopted for various categories of API:•Epidemiological Surveillance and Disease Management for reducing parasite load in the community•Integrated Vector Management for reducing mosquitoes density•Supportive Interventions

Treatment of Vivax Malaria

Treatment of Falciparum Malaria: NE States• ACT-AL Co-formulated tablet of ARTEMETHER (20 mg) - LUMEFANTRINE (120 mg) (Not

recommended during 1st trimester of pregnancy and for children weighing < 5 kg)

Dosage Chart for Treatment of falciparum Malaria with ACT-AL

Primaquine: 0.75 mg/kg body weight on day 2.

15 - < 25 Kg5 - <15 Kg 25 - <35 Kg ≥ 35 Kg

Treatment of Falciparum Malaria: other than NE States

• Artemisinin based Combination Therapy (ACT-SP)*• Artesunate 4 mg/kg body weight daily for 3 days Plus Sulfadoxine (25 mg/kg body weight) – Pyrimethamine

(1.25 mg/kg body weight)on first day.* ACT not to be given in 1st trimester of pregnancy.• Primaquine: 0.75 mg/kg body weight on day 2.

Dosage Chart for Treatment of falciparum Malaria with ACT-SP

IMA Initiative…– To strengthen the Programme:

–Elimination,

–Eradication

– Newer interventions: to increase the coverage

– Strengthening surveillance: all cases to be detected to achieve National goal for these diseases

– Standard diagnosis & treatment guidelines

Role of IMA in Vector Borne Diseases • Aligning Diagnosis & Treatment as per National Policy

(monotherapy banned)• All suspected cases to be tested for Malaria• Diagnosis by Good Quality Ag detecting Bivalent RDTs• Microscopy still the Gold Standard for diagnosis of malaria• Species specific treatment of Malaria to be given• Complete treatment be given• Reporting of cases through District Malaria Officers• IEC to Community

Way Forward…

Saturation of malaria endemic population with effective preventive measure (LLIN)

Quality coverage of high-risk population with IRS and provision of EDCT Sustaining incidence of malaria in areas with API<1 Bring Down malaria incidence in areas having API>1 Conducting Technical, Operational and Financial feasibility studies for

planning malaria elimination programme Pave way for elimination of malaria in subsequent years

Ensuring complete reporting of all VBDs including from private sectors

Thank You

IMAWHO, India