Transcript Slide 1

National Vector Borne Disease Control
Programme
Dr. Avdhesh Kumar
Additional Director
National Vector Borne Disease Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare,
Government of India
About NVBDCP
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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 renamed as National Anti-Malaria Programme (NAMP)
• 2003-04 renamed as NVBDCP with a view to converge Dengue, JE and 3
ongoing centrally sponsored schemes : NAMP,NFCP, Kala azar
• In 2006, Chikungunya re-emerged and brought under NVBDCP.
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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
6 distt.,11.0 mil
33 distt., 62.3 mil
4 districts
Pop: 6.7 mil
11 districts
Pop. – 50 mil
4 States; 54 Districts; 130 million
population
• > 80% of all cases reported from Bihar
• 9 Dist in Bihar contribute 65-70% of cases
•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
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 Districts
2012 : > 1% Mf rate 64 Districts
Lymphoedema
– 877,594
Hydrocele
– 407,307
Hydrocele Operation– 110,842
Geographical spread of Dengue in last 2 decades
1991
1996
Dengue Cases/per district
2013
Spatial distribution of Chikungunya since 2006
Chikungunya outbreaks in 1960s-70s
Sagar - 1965
Kolkata -1963
Nagpur 1965 1977
Barsi - !973,
Vishakhapatnam – 1964
Kakinada -1965
Rajahmundry -1965
Chennai - 1964
Pondicherry - 1964
Target States of JE/AES: 60 High Priority Districts
SAHARANPUR
Bihar 15 Districts
CHAMPARAN WEST
Uttar Pradesh 20 Districts
CHAMPARAN EAST
GOPALGANJ
ARARIA
MUZAFFARPUR
SIWAN
DARBHANGA
SARAN
KHERI
SAMASTIPUR
VAISHALI
SRAWASTI
BAHRAICH
HARDOI
BIHAR
PATNA
BALRAMPUR
SITAPUR
SIDDHARTHNAGAR
MAHARAJGANJ
GONDA
KANPUR(DEHAT)
NALANDA
JEHANABAD
SANT KABIR NAGAR KUSHINAGAR
BASTI
GORAKHPUR
DEORIA
UTTAR PRADESH
JAMMU & KASHMIR
NAWADA
GAYA
RAEBARELI
MAU
AZAMGARH
BALLIA
SAM AS TIP UR
DHEMAJI
HIMACHAL PRADESH
BIHAR
CHANDIGARH
LAK HIMPUR
UTTARAKHAND
SIBSAGAR
HARYANA
DELHI
ARUNACHAL PR.
UDALGURI
SIKKIM
RAJASTHAN
TINSUKHIA
DIB RUGARH
PUNJAB
UTTAR PRADESH
ASSAM
BIHAR
BARPETA
NAGALAND
SONITPUR
JORH AT
ASSAMGOLAGHAT
MEGHALAYA
MANIPUR
GUJARAT
MADHYA PRADESH
WEST BENGAL
JHARKHAND
TRIPURA
MIZORAM
CHHATTISGARH
ORISSA
DAMAN
& DIU
D&N HAVELI
MAHARASHTRA
ANDHRA PRADESH
DARJILING
JALPAIGURI
GOA
DEORIA
KARNATAKA
VILLUPURAM
Assam
10 Districts
A&N ISLANDS
PONDICHERRY
TAMIL NADU
LAKSHADWEEP KERALA
TAMIL NADU
N
W
KARUR
DAKSHIN DIN AJPUR
E
MALDAH
S
THANJAVUR
THIRUVARUR
WEST BENGAL
West Bengal 10 Districts
BIR BHUM
MADURAI
Tamil Nadu
5 Districts
BARDHAMAN
BANKURA
HUGLI
HOWRA
PASCHIM MEDINIPUR
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Malaria Cases & Deaths: Global vs India Scenario
Reported*
Global
SEARO
India
Pv cases
16.40. Mil.
3.3 Mil
As per WMR* India is at
1.59 Mil • 18th position- total malaria
st position deaths.
•
21
0.76 Mil
Pf cases
77.90 Mil.
1.1 Mil
0.83 Mil India contributed to world
Malaria cases
94.30 Mil. 4.44 Mil
Malaria deaths
3,45,960
2,426
1,018
Estimated
Malaria deaths
6,55,000
38,000
20,000
malaria*
•1.7% of malaria cases
• 4.6% of Pv cases
•1.1 % of Pf cases
•0.3% of malaria deaths
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
*Source: World Malaria Report 2011
Trend of Malaria, India, 2001 - 2013
2500000
Pv, Pf & Total Cases
LLIN
2000000
1500000
1000000
500000
0
2001
2002
Malaria Cases
2003
2004
2005
2006
Pf Cases
2007
2008
2009
2010
Pv Cases
•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
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61.54% reduction in deaths in 2013 against 2009
2011
2012
2013
Deaths
Deaths
1800
1600
1400
Bivalent 1200
RDT
1000
800
600
400
200
0
ACT & RDT
MALARIA ENDEMIC AREAS
PERCENTAGE CONTRIBUTION OF POPULATION,
MALARIA CASES, PF CASES AND DEATHS in 2010
(Compared to the country total)
%
Popula
tion
%
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
States
API - 2010
0-1
>1-2
>2-5
>5-10
>10
GFATM: R-9
(Rs.417 Crore : 2010-2015)
Erstwhile World Bank Project
(Rs.1000 Crore: 2008-2013)
*Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat,
Karnataka & West Bengal
Shrinking – Malaria Map- India
Malaria Situation –India (2000-2013)
Year
Cases
Deaths
2000
19,42,318
959
2013
8,81,730
440
Stratification of Districts based on API
2000
API
2013
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
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)
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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)
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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-Elimination
No.
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
Chloroquine: 25 mg/kg body weight divided over three days i.e.
• 10 mg/kg on day 1,
• 10 mg/kg on day 2 and
• 5 mg/kg on day 3.
Primaquine*: 0.25 mg/kg body weight daily for 14 days.
• Primaquine is contraindicated in infants, pregnant women and individuals with G6PD deficiency.
Dosage Chart for 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
5 - <15 Kg
Primaquine: 0.75 mg/kg body weight on day 2.
15 - < 25 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
IMA
WHO, India