GUIDED BY PRESENTED BY

DR.SANJAY DIXIT
SHIVANI DUA
DR. BHAGWAN WASKEL
SHRADDHA JAIN
DR. HARISH SHUKLA
SHREYA MISHRA

SONAL BANZAL

SURBHI GODHA
Vector Borne Diseases like Malaria and Filaria pose
immense public health concern and continue to be major
causes of significant morbidity and mortality in the state.

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 Kala-Azar control
programmes. JE and Dengue were also included.
Chikungunya fever was recently introduced.

The directorate of NVBDCP is the nodal agency for
planning, policy making, technical guidance,
monitoring and evaluation of programme
implementation in respect to prevention and control
of these diseases under NRHM.
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 MANAGEMNT
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.SUPPORTI VE INTERVENTIONS
Including BCC, public-private partnership, inter-sectoral convergence,
human resource development, studies on drug resistance and
insecticide susceptibility, 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 Anopheles mosquito
There are two types of parasites of human malaria, P. vivax,
P. falciparum, which are commonly reported from India.
Inside the human host, the parasite undergoes a series of
changes as part of its complex life cycle.
The parasite completes life cycle in liver cells (pre-
erythrocytic 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 severe, 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
ubiquitous mosquito Culex and
Mansonia annulifera/M.uniformis 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 indigenous 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 debilitating, but non-fatal, viral illness that is spread by
the bite of infected mosquitoes. It resembles dengue fever.

Chikungunya is caused by the chikungunya virus, which is classified in the
family Togaviridae, genus Alphavirus.

Chikungunya is spread by the bite of an Aedes mosquito, primarily Aedes
aegypti. Humans are thought to be the major source, or reservoir, of
chikungunya virus for mosquitoes. The mosquito usually transmits the
disease by biting an infected person and then biting someone else.

Chikungunya usually starts suddenly with fever, chills, headache, nausea,
vomiting, joint pain, and rash. In Swahili, "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 (arthritis)
which is the most common feature of the disease.

Infection appears to confer lasting immunity.

The states affected by Chikungunya are Andhra Pradesh,
Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu,
Gujarat & Kerala.
DIAGNOSIS
Chikungunya is diagnosed by blood tests (ELISA). Since the
clinical appearance of both Chikungunya and dengue are
similar, laboratory confirmation is important especially in
areas where dengue is present. Such facilities are, at present,
available at National Institute of Virology (NIV), Pune &
National Institute of Communicable Diseases (NICD), Delhi
TREATMENT
There is no specific treatment for Chikungunya. Supportive
therapy that helps ease symptoms, such as administration of
non-steroidal anti-inflammatory drugs, and getting plenty of
rest, may be beneficial. Infected persons should be isolated
from mosquitoes in as much as possible in order to avoid
transmission of infection to other people.
How can Chikungunya be prevented?
There is neither Chikungunya virus vaccine nor drugs are
available to cure the infection. Prevention, therefore,
centres on avoiding mosquito bites. Eliminating
mosquito breeding sites is another key prevention
measure. To prevent mosquito bites, do the following:

Use mosquito repellents on skin and clothing
When indoors, stay in well-screened areas. Use bed
nets if sleeping in areas that are not screened or air
conditioned.
When working outdoors during day times, wear long-
sleeved shirts and long pants to avoid mosquito bite.



How can we control breeding of
Aedes Aegypti?
Source reduction Method
1. By elimination of all potential vector breeding places near the domestic or peri-
domestic areas.
2. Not allowing the storage of water for more than a week. This could be achieved by
emptying and drying the water containers once in a week.
3. Straining of the stored water by using a clean cloth once a week to remove the
mosquito larvae from the water and the water can be reused. The sieved cloth
should be dried in the sun to kill immature stages of mosquitoes.

Use of larvicides
Where the water cannot be removed but used for cattle or other purposes,
Temephos can be used once a week at a dose of 1 ppm (parts per million).
Pyrethrum extract (0.1% ready-to-use emulsion) can be sprayed in rooms (not
outside) to kill the adult mosquitoes hiding in the house.

Biological control
Like introduction of larvivorous fish, namely Gambusia and Guppy in water tanks and
other water sources.

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 :- Infection rates rises with age upto 20-30 years
and then level off.

SEX:- Higher prevalence in males.

POPULATION MOVEMENT

SOCIAL FACTORS:- Urbanization, Industrialization,
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 program 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
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
Information, education and communication
Filaria Control Strategies
Morbidity management of cases






Presented By :-

Shreya Mishra
Roll No. 93
5/28/2014 Dr. KANUPRIYA CHATURVEDI 41
What is Kala-azar?
Kala-azar also known as visceral leishmaniasis or dum
dum fever, is caused by a protozoan parasite
Leishmania donovani,
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.
PROBLEM STATEMENT
India and neighbouring Nepal, Bangladesh, Sudan &
Brazil are the four largest foci of KALA AZAR.

Currently it is endemic in:
33 districts of Bihar
3 districts of Jharkhand
10 districts of West Bengal
2 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.


LIFE CYCLE
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 region 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 district/zonal 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 Kala-azar incidence.
DDT is the insecticide of choice for phlebotomus
argentipes.
Indoor Residual Spray is carried out in 2 rounds
- 1
st
- Feb to March
- 2
nd
- May to June
BHC 2
nd
line of defence, used in case of
resistance to DDT.
Personal Protection
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 basis of clinical and lab. Findings.
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
Aldehyde test-has the drawback of becoming
positive only 2-3 months after disease onset.
Direct agglutination test
ELISA
Indirect fluorescent antibody test (IFAT)
Leishmanin test


Rapid dipstick rK39 for detection of cases has
replaced aldehyde test for diagnosis.
- Not to be used in Kala-azar relapse cases,
reinfection cases and HIV coinfection
Gold standard for diagnosis is visualisation of
amastigotes in splenic aspirate

4. TREATMENT

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

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.
TREATMENT CONTD.
a) Using 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.

5. IEC



THANKYOU


5/28/2014 Dr. KANUPRIYA CHATURVEDI 64
DENGUE
Dengue is a viral disease and has 4 serotypes.
Vectors-Aedes Aegypti. And aedes albopictus.
The peak biting times of this mosquito are early morning or
late evening.
breeding sites- clean water collections in containers, 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.


The infection maybe asymptomatic or may lead to
1)dengue fever- self limiting flu-like illness
2)DHF without shock- 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 categories-
Category A(bangladesh, india, S.L,thailand,maldives)
Mjr health prob
Leading cause of deathin children
Hyperendemicity with all 4 serotypes present
Spread to rural areas.
Category B-(bhutan and nepal)
Endemicity not certain
Category C-
(DPR and Korea)
No evidence of endemicity.

5/28/2014 Dr. KANUPRIYA CHATURVEDI 66
Control Strategy
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
5/28/2014 Dr. KANUPRIYA CHATURVEDI 67
Strategy contd.
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
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:-Sampling unit :-House & its premises.
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,
mats etc.
Wearing of full sleeve shirts and full pants with
socks
Use of bednets for sleeping infants and young
children during day time to prevent mosquito bite
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 big 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
Sensitilizing and involving the community for detection
of Aedes breeding places and their elimination

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

5/28/2014 Dr. KANUPRIYA CHATURVEDI 73
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)


5/28/2014 Dr. KANUPRIYA CHATURVEDI 74
Contd.
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 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


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.


5/28/2014 Dr. KANUPRIYA CHATURVEDI 76
Transmission
Two cycles-
Pig-mosquito-pig-
Pigs play an important role in the natural cycle and
serve as an amplifiers since they do not manifest any
symptoms but circulate the virus so that mosquitoes
get infected and can transmit virus to man
Ardeid bird-mosquito-Ardied bird
Man an incidental dead-end host the disease
been transmitted by bite of infected mosquitoes.
TWO CYCLES OF TRANSMISSION


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 eco-management, 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.



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.


STRATERGIES
CONTROL OF OUTBREAK

a) Vector control-Aerial or ground fogging
with the ultra-low volume insecticides
(e.g. malathion , fenitrothion)
b) Prevention of man-mosquito contact
c) Prevention of animal reservoir-mosquito contact
d) Community awareness
e) Sentinel surveillance
VACCINATION
There are 3 types of vaccines-
1)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 2
nd
dose.
Draw backs-
Limited duration of protection
Need for multiple doses
Relatively high price per dose
2)Cell cultured derived live attenuated vaccine-
Based on SA-14-14-2 strain
Given as 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 strains.
Vaccination with killed JE vaccine is not
recommended for the control of an outbreak.
Vaccination is used in the inter-epidemic
period to younger population of 1-15 yr.
of age.

5/28/2014 Dr. KANUPRIYA CHATURVEDI 83
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

Surbhi Godha
Roll no. 95
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






National Anti Malaria Program (NAMP) - 1999


NVBDCP


Intensified Malaria Control Project (IMCP) -2005


New Drug Policy -2010
Enhanced Malaria Control Program (EMCP) -1997
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.
RE-CLASSIFICATION OF ENDEMIC AREAS

It is based on annual parasite incidence (API)


API less than 2 API greater than 2







MODIFIED PLAN OF
OPERATION 1977


OBJECTIVES:
Prevention of death due to malaria
Reduction of morbidity due to malaria
Retention of achievements gained so far.


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 )
Certain strains of Bacillus sphaericus (Bs) and Bacillus
thuringiensis israelensis (Bti) produce mosquitocidal
toxins
Biolarvicides
Bacillus sphaericus Bacillus thuringiensis israelensis
Poecilia reticulata Gambusia affinis Aphanius dispar
Larvivorous Fishes


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/m
2
Efficacy
(Wks)
Rounds
DDT-50% WP 1 gm 10-12 2
Malathion-25% WP 2 gm 6-8 3
Deltamethrin-2.5% WP 20 mg 10-12 2
Cyfluthrin-10% WP 25 mg 10-12 2
Lambda Cyhalothrin-
10% WP
25 mg 10-12 2
Space spray

Two forms of space-sprays, namely thermal fogs and
cold fogs can be dispensed by vehicle-mounted or hand-
operated machines (Weekly application).
Commonly used insecticides for space spray: Pyrethrum-
extract(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
Thank YoU.