GUIDED BY

PRESENTED BY SHIVANI DUA SHRADDHA JAIN SHREYA MISHRA SONAL BANZAL SURBHI GODHA

DR.SANJAY DIXIT
DR. BHAGWAN WASKEL DR. HARISH SHUKLA

 Vector Borne Diseases like Malaria and Filaria pose immense public health concern and continue to be major causes of significant morbidity and mortality in India. These diseases are prevalent both in rural and urban areas mostly among lower socio-economic groups of the population, the marginalized and disadvantaged.

The dynamics of these diseases are largely determined by eco-epidemiological, socio-economic and water management systems.
Children, young adults, representing economically productive sections and pregnant women are the most vulnerable groups, although all age groups are affected.

WHO HEALTH DAY THEME 2014 : VECTOR BORNE DISEASES

SMALL CREATURES, BIG THREAT

 When NRHM was launched, one of its key points was integration with already existing programmes for example, IDSP, RNTCP, RCH etc. NVBDCP was one of them.
Launched in the year 2003-2004 by merging NAMP (National anti-Malarial programme), NFCP (National Filaria control programme) and KalaAzar control programmes. JE and Dengue were also included. Chikungunya fever was recently introduced.

DISEASES INCLUDED UNDER NVBDCP

Earlier the Vector Borne Diseases were managed under separate National Health Programmes, but now NVBDCP covers all 6 Vector borne diseases namely: 1. Malaria 2. Dengue 3. Chikungunya 4. Japanese Encephalitis 5. Kala-Azar 6. Filaria (Lymphatic Filariasis)

3 PRONGED STRATEGY
1.DISEASE MANAGEMENT
Including early case detection, complete treatment, strengthening of referral services, epidemic preparedness and rapid response.

2.INTEGRATED VECTOR MANAGEMENT

Including indoor residual spraying in high risk areas, use of insecticide treated bed nets, use of larvivorous fish, anti-larval measures, source reduction and minor environmental engineering

3.SUPPORTIVE INTERVENTIONS
Including BCC, public-private partnership, inter-sectoral convergence, human resource development, studies on drug resistance and insecticide sensitivity, monitoring and evaluation.

MALARIA
Malaria is a potentially life threatening parasitic disease caused by parasites known as P.vivax, P.falciparum, P.malariae and P.ovale. (Plasmodium is a protozoan parasite) It is transmitted by the infective bite of female Anopheles mosquito There are two types of parasites of human malaria, P. vivax, P. falciparum, which are commonly reported from India. The parasite completes life cycle in liver cells (preerythrocytic schizogony) and red blood cells (erythrocytic schizogony) Infection with P.falciparum is the most deadly form of malaria.

DENGUE
Dengue is a viral disease It is transmitted by the infective bite of Aedes Aegypti mosquito 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 flu-like illness Dengue Haemorrhagic Fever (DHF) is a more severe form of disease, which may cause death.

FILARIA
Filariasis is caused by several round, coiled and thread-like parasitic worms belonging to the family filaridea.

These parasites after getting deposited on skin penetrate on their own or through the opening created by mosquito bites to reach the lymphatic system.
The disease is caused by the nematode worm, either Wuchereria bancrofti or Brugia malayi and transmitted by Culex and Mansonia respectively. The disease manifests often in bizarre swelling of legs, and hydrocele and is the cause of a great deal of social stigma.

KALA AZAR
Kala-azar is a slow progressing disease caused by a protozoan parasite of genus Leishmania In India Leishmania donovani 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 leisons.

JAPANESE ENCEPHALITIS
Japanese Encephalitis is a viral disease It is transmitted by infective bites of female mosquitoes mainly belonging to the culex family. JE virus is primarily zoonotic in its natural cycle and man is an accidental host. JE virus is neurotorpic arbovirus and primarily affects central nervous system.

Chikungunya is a non-fatal, viral illness that is spread by the bite of infected mosquitoes. It resembles dengue fever and therefore differentiating between the two is important. Chikungunya is caused by the Chikungunya virus, which is classified in the family Togaviridae, genus Alphavirus. Chikungunya is spread by the bite of Aedes mosquito, primarily Aedes aegypti. Humans are thought to be the major source, or reservoir, of chikungunya virus for mosquitoes. Chikungunya starts suddenly with fever, chills, headache, nausea, vomiting, joint pain, and rash. Chikungunya" means "that which contorts or bends up". This refers to the contorted (or stooped) posture of patients who are afflicted with the severe joint pain and artheritis which is the most common feature of the disease.

 The states affected by Chikungunya are Andhra Pradesh, Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu, Gujarat & Kerala. DIAGNOSIS ELISA ( Enzyme linked immuno-sorbent assay ) TREATMENT There is no specific treatment for Chikungunya. Supportive therapy is provided which includes 1. NSAIDS 2. Plenty of rest 3. Isolation to avoid transmission of infection to other people

Aedes Aegypti

www.drsarma.in

Aedes albopictus

16

Mosquitoes dwell and get drawn to the following : Dark clothes Ponds and puddles Still or stagnant water that is contaminated Grass and weeds that are long and not trimmed Dirty garbage cans and drain pipes Damp soil in gardens, farms, or even in potted plants
www.drsarma.in 17

 Use insect repellent on exposed skin. Wear long sleeves & pants Have secure screens on windows and doors, using insecticide treated bed-nets and impregnated nets. Get rid of mosquito breeding sites by
Emptying standing water from flower pots, buckets etc., Change the water in pet dishes in bird baths weekly Drill holes in tires so that the water drains out Cover all tanks, barrels, containers Remove old tires, tins, buckets and bottles Clogged gutters and drains need to be cleared Tanks need to be covered and cleaned - 2 weeks Weeds and tall grass to be cut short to decrease hiding spots

How can we control mosquito bites?

LYMPHATIC FILARIASIS
Presented By:-

SHRADDHA JAIN Roll No. 92

INTRODUCTION
Lymphatic Filariasis is a parasitic disease caused by thread like nematode worms. Infection is transmitted to man by the bites of infective mosquitoes. The adult worms settle in lymph nodes and the female worm give birth to millions of young ones known as microfilariae (Mf). The mf circulate in peripheral blood system of infected people and lead to further transmission of Filariasis.

PROBLEM STATEMENT
It is a global problem (mainly Africa, Asia, West pacific & Americas) About 95% of cases of lymphatic filariasis are caused by infection with W. bancrofti; other parasites include Brugia malayi and B. timori. An estimated 600 million people are at risk of lymphatic filariasis infection in 250 endemic districts in 20 states/UT in India. Lymphatic filaria is prevalent in 18 states and union territories. Bancroftian filariasis is widely distributed while Brugian filariasis caused by Brugia Malayi is restricted to 6 states- UP, Bihar, Andhra Pradesh, Orissa, Tamilnadu, Kerala, and Gujarat.

EPIDEMIOLOGIC DETERMINANTS
AGENT :-

1. W. bancrofti 2. Brugia malayi 3. Brugia timori

Periodicity: The maximum density of mf in the blood is between 10pm -2 am

HOST FACTORS
AGE :- All ages are susceptible to infection but Infection rates rises with age upto 20-30 years and then level off. SEX:- Higher prevalence in males. Immunity:- man may develop resistance to infection only after many years of exposure. SOCIAL FACTORS:- Urbanization, Industrialization, migration of people, Illiteracy, Poverty and Poor sanitation.

ENVIRONMENT FACTORS
Favourable temperature for Culex is between 22 38 deg C with relative humid environment. Also associated with bad drainage as the vector breed profusely in polluted water. Inadequate sewage disposal and lack of town planning have aggravated the problem in India. The common breeding place are cesspools, soakage pits, ill maintained drains, septic tanks, open ditches, burrow pits, etc.

CLINICAL MANIFESTATIONS

TYPES

1. LYMPHATIC FILARIASIS

2. OCCULT
FILARIASIS

LYMPHATIC FILARIASIS
(i) Asymptomatic amicrofilaraemia :- No symptom & no microfilariae. (ii) Asymptomatic microfilaraemia:- No symptom but mf present in the blood. (iii)Stage of Acute manifestation:- Filarial fever, lymphangitis, lymphadenitis and lymphoedema. (iv)Stage of Chronic Obstructive Lesions:- Hydrocele, Elephantiasis and chyluria.

Elephantiasis

Hydrocele

WHY FILARIA CAN BE ELIMINATED ???

Because : Parasite does not multiply in the insect vector. Infective larva cant multiply in the human host. Life cycle of the parasite is very long (15 yrs or more). The breeding place of the mosquito specific is dirty contaminated stagnant water. The parasite doesnt have any animal host in India. The maximum density of the microfilaria in blood is during 10pm to 2 am & mosquito bites only in the night.

NATIONAL FILARIASIS CONTROL PROGRAMME

Operational since 1955 Operated through 206 filarial units,199 filarial clinics, 27 survey units , primarily in endemic urban town under the District Health Officer. National health policy 2002 envisages Elimination of Lymphatic Filariasis (ELF) by 2015 In 1998 the operational component was merged with Urban Malaria Scheme. In 2003-04 it was merged with NVBDCP. The disease has been targeted for elimination globally by 2020.

Objectives
Reduction of the disease in un surveyed areas. Control in urban areas through recurrent anti-larval and anti-parasitic measures.

CONTROL STRATEGY

CHEMO-THERAPY VECTOR CONTROL STRATEGY

CHEMOTHERAPY
1. (a) DEC(Diethyl carbamazine)
Dosage:- 6mg/kg body wt. per day orally for 12 days. Effective in killing the microfilariae.
(b) FILARIA CONTROL IN COMMUNITY

- Mass Drug Administration - Selective treatment - DEC Medicated salt

(1-4 g of DEC/kg mixed with common salt.)
2. IVERMECTIN Dosage:- 20-400ug/kg body wt. per day orally for 7 days.

MASS DRUG ADMINISTRATION (MDA)

Implemented since 2004 Indicated in highly endemic areas for people at risk. In India, DEC and Albendazole are given in combination. Dosage 6mg/kg bodyweight C/I :- i) Children < 2 years ii) Pregnant women iii) Seriously ill person

VECTOR CONTROL
ANTILARVAL MEASURE
- Chemical control:- (i) Mosquito larvicidal oil (ii) Pyrosene oil-E (iii) Organophosphorus larvicides - Removal of Pistia Plant - Minor Environmental Measures :Filling up ditches and cesspools, drainage of stagnant water and adequate maintenance of Septic tanks and soakage pits.

 ANTI ADULT MEASURES - Vector mosquitoes have become resistant to DDT and Dieldrin. - Though it is sensitive to pyrethrum, use only for temporary protection and has no value in present day vector control programme. PERSONAL PROPHYLAXIS -The most effective preventive measure is avoidence of mosquito bite(reduction of man mosquito contact) by using mosquito nets. Screening of houses can be substantially reduce transmission, but it is expensive.

Revised Filaria Control Strategy

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.

Contd.
Vector control through anti larval spray at weekly intervals. Biological control through larvivorous fishes Environmental engineering through source reduction and water management

Filaria Control Strategies

Morbidity management of cases

Presented By :-

Shreya Mishra Roll No. 93

What is Kala-azar?
Kala-azar also known as visceral leishmaniasis or dum dum fever, is caused by a protozoan parasite Leishmania donovani Leads to darkening of skin of the face ,hands,feet and abdomen,hence the name(KALA AZAR =black sickness). In India the sandfly phlebotomus argentipes is the only kala azar vector, transmitting the disease by its bite. 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 and manifests as dermal leisions.

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PROBLEM STATEMENT
India and neighbouring Nepal, Bangladesh, Sudan &
Brazil are the four largest foci of KALA AZAR.
Currently it is endemic in: 31 districts of Bihar 4 districts of Jharkhand 11 districts of West Bengal 6 districts of Uttar Pradesh

EPIDEMIOLOGIC DETERMINANTS
AGENT:L. donovani is the causative agent of Kala azar

HOST:AGE :- All age groups are susceptible peak age is 5-9 years of age.
SEX:- M:F ratio is 2:1 SOCIOECONOMIC STATUS:- More common in the poor. OCCUPATION:- Farming, forestry, fishing, mining

ENVIRONMENT FACTORS
It is confined mostly to the Plains and rural areas. High prevalence during and after rains Overcrowding, ill ventilation and accumulation of organic matter facilitate transmission. Sand fly breed in cracks and crevices in the soil & buildings.

MASSIVE SPLENOMEGALY

POST-KALA-AZAR DERMAL LEISHMANIASIS (PKDL)

About 5 to 10% of persons treated for visceral leishmaniasis in India develop Postkala-azar dermal leishmaniasis (PKDL). Characterised by a macular, maculopapular and nodular rash in a patient who has recovered from KALAAZAR and who is otherwise well. The rash usually starts around the mouth from where it spreads to other parts of the body.

PKDL

HIV and Kala-azar co-infection

Visceral leishmaniasis (VL) has emerged as an opportunistic infection in HIV and other immunosuppressed patients ,but in India yet not a serious problem

KALA AZAR CONTROL PROGRAMME

Launched in 1990-91.
National Health Policy 2002 set the goal of Kala-azar elimination by 2010. GOI also signed a tripartite memorandum of understanding with Nepal and Bangladesh in May 2004 for elimination of Kala-Azar from South-east Asian regions by 2015

The Programme sponsored by the central government, launched in endemic areas, provided kala-azar medicines, insecticides and technical support and the State governments implemented the programme through primary health care system and State malaria control organizations and provided other costs involved in strategy implementation

MAIN STRATEGIC COMPONENTS

1) Case Detection & Treatment 2) Interruption of transmission through vector control 3) Diagnosis 4) Treatment 5) Information, Education, Communication(IEC)

1. CASE DETECTION
Done through existing Primary Health Care System
Active Case Search:-every case of fever of more than 15 days duration in endemic areas, not responding to antiviral treatment or antibiotics with spleenomegaly is screened. - KALA AZAR FORTNIGHT Carried out by health workers and volunteers by door to door search and referring the cases for proper treatment.

2. INTERRUPTION OF TRANSMISSION THROUGH VECTOR CONTROL

Carried out by undertaking 2 rounds anually of insecticidal residual spray (IRS) with DDT upto 6 feet height from the ground in PHC areas reporting Kalaazar incidence. DDT is the insecticide of choice for phlebotomus argentipes. Indoor Residual Spray is carried out in 2 rounds - 1st - Feb to March - 2nd - May to June BHC 2nd line of defence, used in case of resistance to DDT. Personal Protection-health education,insect repellents.No drugs for personal prophylaxis.

HOW TO USE
75% of DDT of 1 kg can be mixed in 3 gallons of water or 50% of DDT of 1.5 kg can be mixed in 3 gallons of water, to cover an area of 6000 sq. feet.

3. DIAGNOSIS
On the basis of clinical and lab. findings A case of fever of more than 2 weeks duration not responding to antimalarials and antibiotics. Laboratory findings include anemia, progressive leucopenia, thrombocytopenia,hypergammaglobulinemia. Aldehyde test-1-2ml of serum is added to a drop of 40% formalin.Jellification to milky white opacity within 2-20min. Is strongly positive. Has the drawback of becoming positive only 2-3 months after disease onset. Non specific

Direct agglutination test ELISA Indirect fluorescent antibody test (IFAT) Leishmanin test-0.1ml of leishmanin preparation is injected intradermally on flexor surface of forearm.After 48-72hrs induration of 5mm or more is considered positive. Negative during the active phase of kala azar,because of impaired cell mediated immunity. Rapid dipstick rK39, based on recombinant k 39 protein . An immunochromatographic assay for qualitative detection of antibodie.s to L.donovani in human serum Gold standard for diagnosis is visualisation of amastigotes in splenic aspirate

4. TREATMENT
Available in all govt. hospitals and dispensaries free of cost. a) Pentavalent Antimonial Compounds Sodium stibogluconate - 1st line drug Meglumine antimonate b) Amphotericin B Deoxycholte - 2nd line drug (Currently used as 1st line drug in Bihar.) c) Lipid formulation of AmB Developed to replace the deoxycholate formulation. -This is the only drug approved in US d) Paromomycin

TREATMENT CONTD.
e) Miltefosine - First oral compound approved for the treatment of leishmaniasis. - Given for 28 days
MULTI DRUG THERAPY:- It is likely to be preferred in the future.

HIV/VL Co-infection :- Liposomal AmB is the drug of choice both for primary treatment and for treatment of relapse.

5. IEC
a) Using fine bednets b)avoid sleeping on floor c)All cracks and crevices should be closed by cement. d) Cleaning of environment & clean shelters e) Animal house, cow-shed & dairy should be kept clean. f) Water well should be kept closed. g) Wear full clothing while sleeping.

Programme Achievements
Within 3 years of intensification (1995 as compared to 1992) 70.66% decline in annual incidence 80.48% decline in deaths By 2003 as compared to 1992 76.38% decline in incidence 85.20% decline in deaths.

 Dengue is an arboviral disease and its virus has 4 serotypes. Vectors-Aedes Aegypti. And aedes albopictus. The peak biting times of these mosquitoes are early in the morning or late in the evening. Breeding sites- water collections in containers or tanks disposable junk material- discarded buckets, utensils, tyres flower pots etc. The disease mainly occurs in hot and humid climate. Man develops disease after 5-6 days of being bitten by an infective mosquito . 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.
3/23/2014 Dr. KANUPRIYA CHATURVEDI 66

The infection maybe asymptomatic or may lead to 1)dengue fever- self limiting flu-like illness 2)DHF- severe form of disease has 4 phases 3)DHF with shock (DSS) Dengue is endemic in almost 100 countries which have been divided in 3 categoriesCategory A bangladesh, india, S.L,thailand,maldives Major health prob Leading cause of death in children Hyperendemicity with all 4 serotypes present Spread to rural areas. Category B bhutan and nepal Endemicity not certain Category C DPR Korea No evidence of endemicity.

Prevention and control

a) Surveillance :disease and entomological surveillance b) Case management :Early diagnosis and treatment c) Vector control: environmental m/m for source reduction, chemical control, personal protection and legislation. d) Outbreak response: epidemic preparedness and media m/m e) Capacity building: training, strengthening human resource and occupational research. f) Behavior change communication:social mobilization and I.E.C g) Intersectoral coordination: with ministries of urban dev,rural dev. panchayati raj and educational sector h) Monitoring and supervision: analysis of reports, review, field visit and feedback

VECTOR SURVEILLANCE
Larval surveys:Four Indices commonly used : 1.House Index (HI) 2.Container Index (CI) 3.Breteau Index (BI) 4.Pupae Index (PI)

Adult surveys
1.Landing/biting collection 2.Resting collection 3.Ovi -position traps

VECTOR CONTROL MEASURES

1. PERSONAL PROPHYLATIC MEASURES Use of mosquito repellent creams, liquids, coils etc. Wearing of full sleeved shirts and pants with socks Use of bednets for sleeping infants and young children during day time to prevent mosquito bites. 2. BIOLOGICAL CONTROL Use of larvivorous fishes in ornamental tanks, fountains, etc. Use of biocides

3. CHEMICAL CONTROL Use of chemical larvicides like abate in breeding containers Aerosol space spray during day time 4. ENVIRONMENTAL

MANAGEMENT & SOURCE REDUCTION METHODS

Detection & elimination of mosquito breeding sources Management of roof tops, porticos and sunshades Proper covering of stored water Reliable water supply Observation of weekly dry day

5. HEALTH EDUCATION Impart knowledge to common people regarding the disease and vector through various media sources like T.v., Radio, Cinema slides, etc.

6. COMMUNITY PARTICIPATION Sensitizing and involving the community for detection of Aedes breeding places and their elimination

7. LEGISLATIVE MEASURES Model civic byelaws Building proper construction regulation acts Environmental health act Health impact assessment 8. EPIDEMIC CONTROL Application of insecticides as space sprays Regular monitoring of vectors susceptibility to insecticides

JAPANESE ENCEPHALITIS

 JE is a mosquito borne encephalitis caused by flavivirus that is transmitted by culicine mosquitoes. It is also the leading cause of v.encephalitis in Asia primarily zoonotic. (birds and pigs)

Vectors Culex tritaeniorhynchus Culex vishnui Culex gelidus Breeding sites : rice fields and standing water. Majority of infections occur in rural areas and between July and Oct (monsoon and post-monsoon period)
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 It is primarily a childhood disease(<15 yrs) because people develop immunity through exposure. Almost 10% cases occur above 60 yrs due to low immunity. There was no national programme for this disease earlier 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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JE IN INDIA
JE viral activity has been widespread in India. The first evidence of presence of JE virus dates back to 1952. First case was reported in 1955 it is becoming a rising health problem and is endemic in 14 States especially in Assam, Bihar, Haryana, UP, TN and Karnataka (80%).

Year wise occurrence 2010-5167 cases and 679 deaths. 2011-7838 C and 1137 D.

Transmission
Two cycles-

Pig-mosquito-pig Pigs play an important role in the natural cycle and serve as an amplifiers since they do not show any symptoms but circulate the virus so that mosquitoes get infected and can transmit virus to man

Ardeid bird-mosquito-Ardied bird Man is an incidental dead-end host to whom the

disease has been transmitted by bite of the infected mosquitoes.
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CYCLES-

PREVENTION & CONTROL

The preventive measures are directed at reducing the vector density and in taking personal protection against mosquito bites using insecticide treated mosquito nets. The reduction in mosquito breeding requires ecomanagement, as the role of insecticides is limited. There is no specific treatment of JE. Clinical management is supportive and in the acute phase is directed at maintaining fluid and electrolyte balance and control of convulsions, if present. Maintenance of airway is crucial.

STRATEGIES
1) Strengthening the surveillance activities 2) Early diagnosis and proper case management. 3) Behavior change communication of community 4) Integrated vector control measures 5) Capacity building 6) Development of a safe & standard indigenous vaccine.

CONTROL OF OUTBREAK
a) Vector control-Aerial or ground fogging
with the ultra-low volume insecticides (e.g. malathion , fenitrothion) b) Prevention of man against mosquito bites. c) Prevention of animal reservoir d) Community awareness e) Sentinel surveillance

VACCINATION
There are 3 types of vaccines1)Mouse brain derived- purified and inactivated vaccine. Based on nakayama or beijing strains. Dosage-2 doses 4 wks apart and booster 1 yr later and then at 3 yr intervals upto 10-15 yrs of age. Route-s.c 0.5ml (<3 yrs) Immunity-develops 1 mth after 2nd dose.

Draw backs Limited duration of protection Need for multiple doses Relatively high price per dose

2)Cell cultured derived live attenuated vaccineBased on SA-14-14-2 strain Dosage- single dose of 0.5 ml subcutaneously followed by a booster 1 year later. Integral part of UIP in 83 endemic districts of india 3)Cell culture derived inactivated JE vaccine Based on P3 strain Vaccination is used in the inter-epidemic period to younger population of 1-15 yr. of age. Vaccination with killed JE vaccine is not recommended for the control of an outbreak.

Thank you

MILESTONES OF MALARIA CONTROL ACTIVITIES IN INDIA

National Malaria Control Program (NMCP) - 1953
spectacular success

National Malaria Eradication Program (NMEP) -1958

Urban Malaria Scheme (UMS) - 1971

resurgence

Modified Plan of Operations (MPO) - 1977

Enhanced Malaria Control Program (EMCP) -1997

National Anti Malaria Program (NAMP) - 1999

NVBDCP

Intensified Malaria Control Project (IMCP) -2005

New Drug Policy -2010

NATIONAL MALARIA CONTROL PROGRAMME 1953 OBJECTIVES:

To hold down malaria transmission at low level

STRATEGIES:
Indoor residual spray (IRS)

Malaria control teams to survey and monitor incidence.

ACHIEVEMENTS:
Decline in incidence from 75 million to only 2 million in 1958

NATIONAL MALARIA ERADICATION PROGRAMME 1958

OBJECTIVES:
To eradicate malaria from India in 7 to 9 years

ACTIVITIES:
Spraying operation Fortnightly active case detection Radical treatment Investigation of positive cases and remedial measures

ACHIEVEMENTS :
Lowest ever incidence of 0.1 million in 1965 No reported deaths due to malaria

RESURGENCE OF MALARIA 1965

Sudden withdrawal of assistance and insecticides led to steep rise in malaria incidence.

URBAN MALARIA SCHEME 1971

Involved 139 towns in 19 states and Union Territories.

OBJECTIVES:
a) To prevent deaths due to malaria. B) Reduction in transmission and morbidity.

NORMS:
The towns should have a minimum population of 50,000. The API (Annual Parasite Incidence) should be 2 or above.

METHODOLOGY:
It Comprises vector Control by intensive antilarval measures and drug treatment.

MODIFIED PLAN OF OPERATION 1977

OBJECTIVES:
Prevention of death due to malaria Reduction of morbidity due to malaria Retention of achievements gained so far. RE-CLASSIFICATION OF ENDEMIC AREAS It is based on annual parasite incidence (API) API less than 2 API greater than 2

Control in AREAS WITH API > 2:

Spraying insecticides Entomological assessment Surveillance Treatment of cases Decentralisation of laboratory services at- PHC Establishment of drug distribution centres (DDC) and fever treatment depots (FTDs)

Control in AREAS WITH API < 2:

Focal spraying of insecticides Surveillance and treatment Follow up Epidemiological investigation

DRUG DISTRIBUTION CENTRE

Dispense anti malarial drugs

FEVER TREATMENT DEPOT

Collect blood slides Distribute anti malarial drugs

MALARIA CONTROL STRATEGIES under NVBDCP

1.SURVEILLANCE AND CASE MANAGEMENT:
Case detection(passive and active) Early diagnosis and complete treatment Sentinal surveillance

2.INTEGRATED VECTOR MANAGEMENT

Indoor residual sprays(IRS) Insecticide treated bed nets(ITBN) / Long lasting insecticidal nets(LLINs)) Anti larval measures including source reduction

3.EPIDEMIC PREPAREDNESS AND EARLY RESPONSE 4.SUPPORTIVE INTERVENTION

Capacity building Behaviour change communication(BCC) Intersectoral collaboration Monitoring and evaluation Operational research and applied field research

SURVEILLANCE
AIM:
Case detection through lab services To provide facilities for proper treatment Active Types Passive

ACTIVE SURVEILLANCE Carried out by surveillance workers

PASSIVE SURVEILLANCE Search for cases by local health agencies Cases those escaped active surveillance are screened

INTEGRATED VECTOR MANAGEMENT

The IVM includes safe use of insecticides and monitoring of insecticide resistance. The measures of vector control and protection include:

ANTI-LARVAL MEASURES
o Source reduction o chemical control o Biological control

ANTI -ADULT MEASURES

oResidual sprays oSpace sprays

GENETIC CONTROL PROTECTION AGAINST MOSQUITO BITES

oMosquito net oScreening oRepellents

Larval Control Strategy :

Environmental Management / Manipulation Anti larval methods : Chemical : Paris Green, Temephos and Fenthion, Primiphos methyl, Monomolecular films. Biolarvicide : B. thuringiensis ( liquid, granules and tablet formulations), B. sphaericus

Biological Control: Larvivorous fishes (Gambusia affinis, Poecilia reticulata and Aphanius disper )

Biolarvicides
Certain strains of Bacillus sphaericus (Bs) and Bacillus thuringiensis israelensis (Bti) produce mosquitocidal toxins

Bacillus sphaericus

Bacillus thuringiensis israelensis

Larvivorous Fishes
Poecilia reticulata Gambusia affinis Aphanius dispar

Residual insecticidal spray

The indoor residual insecticidal spraying operation should be started simultaneously along with indoor space spray. The insecticide of choice will be the insecticide to which the local vector is amenable to control.

Apply the recommended dose of insecticide chosen.

Insecticides for IRS

Insecticide-formulation Dosage/m2 DDT-50% WP 1 gm Efficacy (Wks) 10-12 Rounds 2

Malathion-25% WP
Deltamethrin-2.5% WP Cyfluthrin-10% WP

2 gm
20 mg 25 mg

6-8
10-12 10-12

3
2 2

Lambda Cyhalothrin10% WP

25 mg

10-12

Space spray
Two forms of space-sprays, namely thermal fogs and cold fogs can be dispensed by vehicle-mounted or handoperated machines (Weekly application). Commonly used insecticides for space spray: Pyrethrumextract(2%), Malathion, Fenitrothion, Pirimiphos methyl, Permethrin, Deltamethrin, Lambda-cyhalothin and Cyphenothrin. These insecticides instantly kill the mosquitoes, but lack any residual effects.

Behaviour change communication (BCC)

BCC is a systematic process that motivates individuals,

families and communities to change their inappropriate or unhealthy behaviour. BCC is directed at:
Early recognition of signs and symptoms of malaria. Early treatment seeking from appropriate provider. Adherence to treatment regimens. Ensuring protection of children and pregnant ladies. Use of insecticide treated bed nets (ITNs). Acceptance of indoor residual sprays (IRS), etc.

INTENSIFIED MALARIA CONTROL PROJECT

Launched in July 2005 with assistance of global fund for AIDS,TB and malaria in NE states, Orissa ,Jharkhand and WB OBJECTIVES: 1-Increase access rapid diagnosis and treatment through community participation 2-Reduce transmission by use of insecticide treated bed nets and larvivorous fishes. 3-Enhance awareness about malaria control 4-To promote community, NGO and private sector participation