Transcript Vector Borne Diseases Control Program

Vector Borne Diseases
Control Program
DR. KANUPRIYA CHATURVEDI
Vector Borne Diseases Control
Programme
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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
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Strategies for National
Vector Control Program
The basic approach for vector borne
diseases control involves a strategy
directed against the parasite and vector
and to enlist the involvement of
community in practicing various
preventive measures
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Strategies contd.
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Disease management
Insecticide resistance
Involvement of NGOs /private
sector/community
Quality assurance on laboratory diagnosis
Long lasting insecticide treated nets
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Contd.
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Improve quality and efficiency of services
at primary, secondary and tertiary levels
Environmental management
Monitoring and evaluation
Collaboration with National Malaria
Institute of malaria research and medical
colleges
Inter-sectoral collaboration
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National
Anti Malaria Programme
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Started in 1953 as NMCP with Two rounds of
residual insecticidal (DDT) spray as the mainstay of
the program.
Dramatic reduction of malaria mortality and
morbidity lead to National Malaria Eradication
Programme with malaria eradication as a goal in
1958.
Reverses to the programme and resurgence of
malaria due to Technical, Operational and
Administrative causes necessitated changing it to
‘Modified Plan of Operation’ in1977.
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Magnitude of the problem
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Provisional data for the year 2004 reveals the largest
numbers of cases in the country were reported by
Orissa, followed by Gujarat, Chhattisgarh, West
Bengal, Jharkhand, Karnataka, Uttar Pradesh and
Rajasthan and the largest numbers of deaths were
reported by Orissa, followed by West Bengal,
Mizoram, Jharkhand, Meghalaya, Karnataka, Tripura
and Assam.
1.87 million cases of malaria (including 0.86million
P.falciparum cases) and 1006 deaths were reported
from the country in 2003.
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Vectors of malaria
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Anopheles culicifacies is the main vector of malaria
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1. Feeding habits
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It is a zoophilic species
When high densities build up relatively large numbers
feed on men
2. Resting habits
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Rests during daytime in human dwellings and cattle
sheds
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Contd.
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3. Breeding places
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Breeds in rainwater pools and puddles, borrow
pits, river bed pools, irrigation channels,
seepages, rice fields, wells, pond margins,
sluggish streams with sandy margins.
Extensive breeding is generally encountered
following monsoon rains.
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Contd.
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4. Biting time
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Biting time of each vector species is determined by its
generic character, but can be readily influenced by
environmental conditions.
Most of the vectors, including Anopheles culicifacies,
start biting soon after dusk. Therefore, biting starts
much earlier in winter than in summer but the peak time
varies from species to species.
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Malaria control strategies
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1. Early case Detection and Prompt Treatment
(EDPT) is the main strategy of malaria control – radical
treatment is necessary for all the cases of malaria to
prevent transmission of malaria
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Chloroquine is the main anti-malaria drug for uncomplicated malaria.
Drug Distribution Centers (DDCs) and Fever Treatment Depots
(FTDs) have been established in the rural areas for providing easy
access to anti-malarial drugs to the community.
Alternative drugs for chloroquine resistant malaria are recommended
as per the drug policy of malaria.
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Contd.
2. Vector Control
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(i) Chemical Control
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Use of Indoor Residual Spray (IRS) with insecticides
recommended under the programnme
Use of chemical larvicides like Abate in potable water
Aerosol space spray during day time
Malathion fogging during outbreaks
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Contd.
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(ii) Biological Control
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Use of larvivorous fish in ornamental tanks, fountains etc.
Use of biocides.
( iii) Personal Prophylactic Measures that
individuals/communities can take up
Use of mosquito repellent creams, liquids, coils, mats etc.
Screening of the houses with wire mesh
Use of bed nets treated with insecticide
Wearing clothes that cover maximum surface area of the
body
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Control strategies contd.
4. Community Participation
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Sensitizing and involving the community for
detection of Anopheles breeding places and their
elimination
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NGO schemes involving them in programme
strategies
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Collaboration with private sector.
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Contd.
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5. Environmental Management & Source
Reduction Methods
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Source reduction i.e. filling of the breeding
places
Proper covering of stored water
Channelization of breeding source
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Contd.
6.
Monitoring and Evaluation of the
Program
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Monthly Computerized Management Information
System(CMIS)
Field visits by state by State National Program
Officers
Field visits by Malaria Research Centers and other
ICMR Institutes
Feedback to states on field observations for
correction actions.
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‘Modified Plan of Operation’
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Objectives
- to prevent deaths due to malaria
- to reduce malaria morbidity
- to maintain agriculture and Industrial
- production through intensive anti malaria
measures in such areas
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-to consolidate the gains achieved so far
Areas were reclassified based on the Annual Parasitic
Incidence (API) as those having API > 2 and those having <
than 2 for operational purposes
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Areas having Annual Parasite Index
(API) > 2
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Regular 2 rounds of insecticidal spray with DDT/
Malathion / Synthetic Pyrethroids at the dose of 1,
2, 0.5 mg/sq meter respectively.
Entomological assessment for vector behavior and
development of insecticidal resistance
Active and passive surveillance is carried outon
regular basis every fortnight
Presumptive Treatment to all fever cases and
radical treatment to all slide positive cases is given
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Areas having Annual Parasite
Index(API) < 2
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Regular spray is not carried out but ‘focal’ spray is
carried out around falciparum cases detected
during surveillance
Regular passive surveillance once in a fortnight
Treatment –All positive cases to receive radical
treatment
Follow up- All positive cases to be followed up for
1 year at monthly intervals after completion of
radical treatment
Epidemiological investigation of all malaria positive
cases .This may also include mass blood survey.
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 Urban Malaria Scheme (UMS )was launched in
1971 to over come the increasing incidence of
malaria in urban areas where the vector was found
to be An. Stephansi. Intensive anti larval measures
and drug treatment are the mainstay of UMS
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P. falciparum containment Programme was
launched in October 1977 with the assistance of
SIDA to contain the spread of falciparum malaria
This programme is operative in the North Eastern
States, and parts of Orissa, Bihar, WB, AP ,MP,
Gujrat, Maharashtra and Rajasthan
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 Reorganization - Malaria Units under NMEP
were reorganized to conform to the geographical
boundaries of the district and the DHO was made
responsible for implementation of the programme
 Recentralization of Laboratory servicesLaboratory Technician with the necessary facilities
is now located at each PHC
 Establishment of Drug Distribution Points
(DDPs) and Fever Treatment Depots (FTDs)
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 Investigation of all Malaria DeathsAll cases suspected to have died due to malaria are to be
investigated
 Monitoring and control of all epidemics and
focal out breaks of malaria –
Any increase in the number of fever cases suggestive of
malaria should be promptly investigated and
measures to contain the outbreak should be
instituted.
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National
Filaria Control Program
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Magnitude of the problem
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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).
Indigenous cases have been reported from about 250
districts in 20 states/Union Territories.
The North-Western States/UTs are known to be free from
indigenously acquired filarial infection.
Cases of filariasis 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
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Signs and symptoms of Filariasis
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Recurrent fever intermittent or remittent with
often double rise
loss of appetite, pallor and weight loss with
progressive emaciation
weakness
Splenomegaly – spleen enlarges rapidly to
massive enlargement, usually soft and nontender
Liver – enlargement not to the extent of spleen,
soft, smooth surface, sharp edge
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Contd.
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Lymphadenopathy – not very common in India
Skin – 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
“Black fever”
Anemia – develops rapidly
Anemia with emaciation and gross splenomegaly
produces a typical appearance of the patients
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National Filaria Control Program
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This program was started in 1955
In 1998 the operational component was
merged with Urban Malaria Scheme
In 2003 -04 it was merged with
NVBDCP
Filariasis has been a major public health
problem in India next only to malaria.
Indigenous cases have been reported from
about 250 districts in 20 states/Union
Territories.
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Revised Filaria Control Strategy
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The National Health Policy 2002 aims at
Elimination of Lymphatic Filariasis by 2015
REVISED STRATEGY
 Annual Mass Drug Administration with single dose of
Diethyl carbamazine(DEC)was taken up as a pilot
 During 2004 about 400 million population were
brought under MDA.
 This strategy is to be continued for 5 years or more to
the population excluding children below two years,
pregnant women and seriously ill persons in affected
areas to interrupt transmission of disease.
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Contd.
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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
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Kala Azar Control Program
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What is Kala-azar?
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Kala-azar is a slow progressing indigenous disease
caused by a protozoan parasite of genus
Leishmania
In India Leishmania Donavan is the only parasite
causing this disease
The parasite primarily infects reticuloendothelial
system and may be found in abundance in bone
marrow, spleen and liver.
Post Kala-azar Dermal Leishmaniasis (PKDL) is a
condition when Leishmania donovani invades skin
cells, resides and develops there and manifests as
dermal leisions.
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Kala-Aar spread
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Currently Kala-Azar is endemic in
33 Districts of Bihar
3 Districts of Jharkhand
10 Districts of West Bengal &
2 Districts of UP
Started as a Centrally Sponsored
Programme in1990-91
It was merged with NVBDCP in 2003-04
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Signs & Symptoms of Kala-Azar
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Recurrent fever intermittent or remittent with often
double rise
loss of appetite, pallor and weight loss with progressive
emaciation
Splenomegaly - spleen enlarges rapidly to massive
enlargement, usually soft and non tender
Liver - enlargement not to the extent of spleen, soft,
smooth surface, sharp edge
Skin - 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 "Black fever"
Anemia - develops rapidly
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Diagnosis
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Clinical:
 A case of fever of more than 2 weeks duration
not responding to antimalarials and
antibiotics. Clinical laboratory findings may
include anemia, progressive leucopenia
thrombocytopenia
 hypergammaglobulinemia
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HIV and Kala-azar co-infection
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Visceral leishmaniasis (VL) has emerged
as an opportunistic infection in HIV and
other immunosuppressed patients
More than 1000 cases of HIV and VL are
reported from 25 countries. However, in
India yet not a serious problem
VL may be first Opportunistic Infection in
asymptomatic HIV-I infected person
Also occurs in advanced stage of AIDS
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Contd.
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Also occurs in advanced stage of AIDS
All co-infected patients are not symptomatic
Diagnosis may be altered because symptoms
may be of short duration; fever and spleen may
not be marked; Leishmania antibodies may be
undetectable.
However peripheral blood smears of buffycoat
and blood culture may yield good results
Response to treatment is poor; drug side effects
may be more and relapses may be common
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Treatment of Kala - Azar
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Kala-azar Drugs available in India
Sodium Stibogluconate (indigenous manufacture,
registered for use & sale)
 Pentamidine Isethionate: (imported, registered for use)
 Amphotericin B: (indigenous manufacture, registered for
use and sale)
 Liposomal Amphotericin B: (indigenous manufacture &
import, registered for use and sale)
 Miltefosine (imported/ registered for use & sale)
Drug Policy under Kala-azar Elimination Programme as per
recommendations of Expert Committee (2000
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Control Strategy
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An organized centrally sponsored Control
Programme launched in endemic areas in 1990-91
Government of India provided kala-azar medicines,
insecticides and technical support and the State
governments implemented the programme through
primary health care system and district/zonal and
State malaria control organizations and provided
other costs involved in strategy implementation
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Strategy contd.
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Programme strategy included:
- Vector control through insecticidal residual spray
(IRS ) with DDT up to 6 feet height from the ground
twice annually
- Early Diagnosis and Complete treatment
- Information Education Communication
- Capacity Building
Programme intensified in 1991-92 which led to improved
case registration through primary health care system
Programme Achievements
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Control of Dengue/DHF
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WHAT IS DENGUE
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Dengue is a viral disease
It is transmitted by the infective bite of Aedes Aegypti
Man develops disease after 5-6 days of being bitten by
an infective mosquito
It occurs in two forms: Dengue Fever and Dengue
Haemorrhagic Fever(DHF)
Dengue Fever is a severe, flu-like illness
Dengue Haemorrhagic Fever (DHF) is a more severe
form of disease, which may cause death
Person suspected of having dengue fever or DHF must
see a doctor at once
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Dengue/DHF
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There was a major out break of Dengue /DHF
in Delhi in 1996
Since than many focal outbreaks have been
reported from different areas of the country
mainly from urban areas.
This disease has been included in NVBDCP in
2003 -04
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Control Strategy
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Public awareness and community
involvement is the key issue in the
strategy to control Dengue/DHF
All efforts should be made against the
breeding of Aedes egypti mosquitoes
by source reduction
Protection from mosquito bites
Early diagnosis and prompt treatment of
cases
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Strategy contd.
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Programme strategy included:
- Vector control through Insecticidal residual
spray (IRS )with DDT up to 6 feet height from the
ground twice annually
- Early Diagnosis and Complete treatment
- Information Education Communication
- Capacity Building
Programme intensified in 1991-92 which led to
improved case registration through primary health
care system
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Japanese encephalitis
control
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Japanese encephalitis
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Japanese Encephalitis is a viral disease
It is transmitted by infective bites of female
mosquitoes mainly belonging to Culex
tritaeniorhynchus, Culex vishnui and Culex
pseudovishnui group. However, some other
mosquito species also play a role in
transmission under specific conditions
JE virus is primarily zoonotic in its natural
cycle and man is an accidental host.
JE virus is neurotorpic and arbovirus and
primarily affects central nervous system
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Contd.
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Japanese Encephalitis is becoming a health problem
in a number of States especially in AP, TN, Kerala,
Karnataka , WB, Assam, Bihar, & Haryana,
There was no national programme for this disease
and the affected states were managing the problem
with the technical Assistance from the centre
This disease was included under the NVBDCP
in 2003-04
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How JE is transmitted?
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Japanese encephalitis is a vector borne disease.
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Several species of mosquitoes are capable of
transmitting JE virus.
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JE is a zoonotic infection. Natural hosts of JE virus
include water birds of Ardeidae family (mainly
pond herons and cattle egrets). Pigs play an
important role in the natural cycle and serve as an
amplifier host since they allow manifold virus
multiplication without suffering from disease and
maintain prolonged viraemia.
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Contd.
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Due to prolonged viraemia, mosquitoes get
opportunity to pick up infection from pigs easily.
Man is a dead end in transmission cycle due to
low and short-lived viraemia. Mosquitoes do not
get infection from JE patient
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Sign and Symptoms of JE
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JE virus infection presents classical symptoms
similar to any other virus causing encephalitis
JE virus infection may result in febrile illness of
variable severity associated with neurological
symptoms ranging from headache to meningitis or
encephalitis. Symptoms can include headache,
fever, meningeal signs, stupor, disorientation, coma,
tremors, paralysis (generalized), hypertonia, loss of
coordination, etc.
Prodromal stage may be abrupt (1-6 hours), acute
(6-24 hours) or more commonly subacute (2-5
days)
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Contd.
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In acute encephalitic stage, symptoms noted in prodromal
phase convulsions, alteration of sensorium, behavioural
changes, motor paralysis and involuntary movement
supervene and focal neurological deficit is common.
Usually lasts for a week but may prolong due to
complications.
Amongst patients who survive, some lead to full recovery
through steady improvement and some suffer with
stabilization of neurological deficit. Convalescent phase is
prolonged and vary from a few weeks to several months.
Clinically it is difficult to differentiate between JE and other
viral encephalitis
JE virus infection presents classical symptoms similar to
any other virus causing encephalitis
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Control Strategy
1. Care of the patient to prevent sequaele
2. Development of a safe & Standard vaccine
3. Sentinel surveillance including clinical
surveillance of suspected cases.
4. Studies to identify high risk cases
5. Epidemiological monitoring of the disease
and effective implementation of preventive
and control measures
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