National Vector Borne Disease Control Programme

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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
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About NVBDCP

• 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

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Kala-Azar
6 distt.,11.0 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

33 distt., 62.3 mil
4 districts Pop 6.7 mil
11 districts Pop. 50 mil
4 States 54 Districts 130 million population

• gt 80 of all cases reported from Bihar
• 9 Dist in Bihar contribute 65-70 of cases

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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 gt 1 Mf rate 174 Districts 2012 gt 1 Mf
rate 64 Districts Lymphoedema
877,594 Hydrocele 407,307 Hydrocele
Operation 110,842
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(No Transcript)
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Spatial distribution of Chikungunya since 2006
Chikungunya outbreaks in 1960s-70s
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Target States of JE/AES 60 High Priority
Districts
Bihar 15 Districts
Uttar Pradesh 20 Districts
Assam 10 Districts
West Bengal 10 Districts
Tamil Nadu 5 Districts
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Malaria Cases Deaths Global vs India Scenario
Reported Global SEARO India As 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 As 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
Pv cases 16.40. Mil. 3.3 Mil 0.76 Mil As 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
Pf cases 77.90 Mil. 1.1 Mil 0.83 Mil As 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 deaths 3,45,960 2,426 1,018 As 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
Estimated Malaria deaths 6,55,000 38,000 20,000 As 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

• 7 NE and 9 Other States Odisha, Jharkhand,
  Chhattisgarh, MP, Andhra, Maharashtra, Gujarat,
  Karnataka W Bengal contribute countries' 54
  Population, gt80 Total Malaria, gt90 Pf. Cases
  and gt90 deaths due to malaria

Source World Malaria Report 2011
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Trend of Malaria, India, 2001 - 2013
LLIN
Bivalent RDT

• 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

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MALARIA ENDEMIC AREAS
PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS in 2010 (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS in 2010 (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS in 2010 (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS in 2010 (Compared to the country total) 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
GFATM R-9 (Rs.417 Crore 2010-2015)
Orissa, Jharkhand, Chhattisgarh, MP, Andhra
Pradesh, Maharashtra Gujarat, Karnataka West
Bengal
Erstwhile World Bank Project (Rs.1000 Crore
2008-2013)
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Shrinking Malaria Map- India
Malaria Situation India (2000-2013) Malaria Situation India (2000-2013) Malaria Situation India (2000-2013)
Year Cases Deaths
2000 19,42,318 959
2013 8,81,730 440
Stratification of Districts based on API Stratification of Districts based on API Stratification of Districts based on API Stratification of Districts based on API Stratification of Districts based on API
API 2000 2000 2012 2012
API No. No
gt10 59 10 32 4.9
gt5-10 22 3.7 29 4.4
gt2-5 65 11.14 48 7.3
1-2 72 12.2 58 8.8
lt1 370 63 492 74.7
2013- (Prv) - 515 Districts recorded APIlt1 - 23 States recorded APIlt1 2013- (Prv) - 515 Districts recorded APIlt1 - 23 States recorded APIlt1 2013- (Prv) - 515 Districts recorded APIlt1 - 23 States recorded APIlt1 2013- (Prv) - 515 Districts recorded APIlt1 - 23 States recorded APIlt1 2013- (Prv) - 515 Districts recorded APIlt1 - 23 States recorded APIlt1
2013
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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

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API Stratification for Malaria Pre-Elimination API Stratification for Malaria Pre-Elimination 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

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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

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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 lt 5 kg)
• Dosage Chart for Treatment of falciparum Malaria
  with ACT-AL

35 Kg
25 - lt35 Kg
5 - lt15 Kg
15 - lt 25 Kg
Primaquine 0.75 mg/kg body weight on day 2.
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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

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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

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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

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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
  APIlt1
• Bring Down malaria incidence in areas having
  APIgt1
• 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

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Thank You IMA WHO, India