NATIONAL VECTOR BORNE DISE
The National Vector Borne Disease Control Programme is an umbrella which includes the Programmes for prevention and control of Vector Borne Diseases viz., Malaria, Filaria, JE, Dengue/DHF, Chikungunya & Kala Azar . The Programme is implemented as per the National Policy of Government of India, Directorate of NVBDCP, Delhi.
This Programme is being implemented since December 2003 in Karnataka.
SITUATION OF VECTOR BORNE DISEASES IN KARNATAKA TILL SEPTEMBER 2015
2015 (till Sept)
NATIONAL HEALTH POLICY AND GOALS UNDER NATIONAL RURAL HEALTH MISSION:
Towards reduction of Vector Borne Disease burden, the National Health Policy 2002 envisaged a goal of reducing mortality by 50% by 2010 and efficient morbidity control. Reduction of Malaria Morbidity and Mortality is also included in the Millennium development Goals to meet the overall objectives of reducing poverty. Reduction in Mortality on account of Dengue and Japanese Encephalitis by 50% and Elimination of Lymphatic Filariasis by 2015 are also the declared goals under the National Health Policy.
Further, A revised National Health Policy draft is under process.
The NRHM - launched by the Hon’ble Prime Minister of India, in April 2005, refers to strengthening of Public Health System for efficient service delivery, particularly at village level and primary levels, equitable access to quality Health Care, reduction of Communicable Diseases and promotion of healthy behaviour as well as enabling Community ownership and creating demand for quality services.
Organogram of NVBDCP at State Level
Malaria : a mosquito borne disease – continues to pose a serious Public Health problem in the State.
Main Objectives of the Programme are:
i) To prevent deaths due to malaria.
ii) To bring down the malaria morbidity to the lowest level
iii) To maintain the gains achieved.
iv) To encourage community participation in malaria control.
Vectors of Malaria in Karnataka:
• Anopheles Culicifacies
• Anopheles Fluviatilis
• Anopheles Stephensi
Common Breeding Places for Malaria Vectors
(Malaria Incidence since 2006)
THE MAJOR REGULATORY FUNCTIONS/STRATEGIES UNDER THE PROGRAMME ARE:
1. EDPT: (Early Detection and Complete Treatment)
a) Surveillance and Case detection,
b) Examination and Treatment
Algarithm for Regular Surveillance:
Procedure for drawing Thick and Thin Blood Smears during Fever Surveillance:
An Ideal Thick and Thin Blood Smear for further processing and subsequent Malaria Microscopy
Diagnosis Of Malaria Parasite Species (Human Plasmodium)
Plasmodium Falciparum as seen in Thin and Thick Blood Smears during Microscopy
Plasmodium Vivax as seen in Thin and Thick Blood Smears during Microscopy
TREATMENT OF MALARIA CASES
Complete treatment of Malaria confirmed cases is administered free of cost and as per the species of Malaria. The Drug policy for administering the treatment is prescribed by the Directorate of NVBDCP, Delhi and is being modified from time to time according to the status of drug resistance and other such criteria.
The current Drug Policy is as follows:
• Malaria should be suspected in patents residing in endemic areas / patients who have recently visited an endemic area and presenting the following symptoms:
– Intermittent fever with or without periodicity or continuous.
– Chills & Rigors.
– Often accompanied by headache, myalgia, arthralgia, anorexia, nausea and vomiting
• The following causes of fever – to be ruled out before administering treatment for suspected Malaria case :
– Running nose, cough and other signs of respiratory infection.
– Diarrhoea / dysentery.
– Burning micturition and/or lower abdominal pain.
– Skin rash/infections.
– Painful swelling of joints.
– Ear discharge.
TREATMENT OF UNCOMPLECATED MALARIA CASES
TREATMENT OF SUSPECTED MALARIA CASE WITH CHLOROQUINE TABLETS
|Age in Years||mg. Base||No. of Tablets|
75mg each on D1 & D2 + 37.5mg on D3
½ x 2 days + ¼ x 1 day
150mg each on D1&D2 + 75mg on D3
1x 2 days + ½ x 1 day
300mg each on D1 & D2 + 150mg on D3
2 x 2 days + 1 x 1 day
450mg each on D1 & D2 + 225mg on D3
3 x 2 days + 1½ x 1 day
15 & >
600mg each on D1 & D2 + 300mg on D3
4 x 2 days + 2 x 1 day
2. INTEGRATED VECTOR MANAGEMENT
a) Indoor Residual Insecticide Spray Operation:
|Insecticide||Preparation of suspension in Water||Dosage per Sq. Meter – Active ingredient||Area to be covered for |
10 Lts. suspension
DDT 50% wdp
1 Kg/10 Ltrs
500 Sq. mts
MAL 25% wdp
2 Kgs/10 Ltrs
250 Sq. mts
Deltamethrin 2.5% wp
400 gm/10 Ltrs
500 Sq. mts
Alphacypermethrin 5% wp
250 gm/10 Ltrs
500 Sq. mts
Lambdacyhalothrin 10% wp
125 gm/10 Ltrs
500 Sq. mts
Cyfluthrin 10% wp
125 gm/10 Ltrs
500 Sq. mts
Bifenthrin 10% wp
125 gm/10 Ltrs
500 Sq. mts
b) Biological Methods of Vector Control using Larvivorus Fish:
c) Use of Insecticide Treated Bed Nets.
d) Environmental management & Minor Engineering methods for source reduction.
3. ENTOMOLOGICAL SURVEILLANCE
a) Vector Prevalence.
b) Bionomics of Vector Species.
c) Resistance Status to conventional Insecticides.
4. INFORMATION, EDUCATION AND COMMUNICATION ACTIVITIES
a) Inter-Sectoral Co-ordination.
b) Behavioural Change Communication and Social Mobilization through Health Education activities like Advocacy sessions at Panchayat levels, Mass Media communications, Electronic Media, Print Media.
c) Inclusion of Health related sectors, Faith Based Organisations, Self Help Groups.
5. EPIDEMIC PREPAREDNESS AND RAPID RESPONSE: a) Formation of District Epidemiological Control Team.
b) Provision of a Vehicle for mobility.
c) Intensification of Surveillance and Treatment activities.
d) Establishment of Field Laboratory.
e) Emergency Vector Control measures.
6. CAPACITY BUILDING:
a) Training activities for different Medical and Para-medical categories as per prescribed modules of Government of India (includes Medical Officers, Private Medical Practioners/Family Physicians, Medical Lab Technologists, Jr Health Assistants and ASHA volunteers).
7. MONITORING AND EVALUATION:
a) Monitoring, Supervision and Evaluation is done using the relevant M&E reporting formats.
b) Analysis of situation and proper guidance is given from time to time.
URBAN MALARIA SCHEME:
The scheme is implemented in 8 cities/towns of the State viz., Bangalore, Bellary, Hospet, Belgaum, Raichur, Hassan, Chikmagalur and Tumkur through the concerned local bodies. The objective of the programme is to control Malaria in Urban areas and is in vogue since 1972.
The main activities under the scheme are:
1. Anti-mosquito measures – i.e. anti larval operations by weekly application of larvicides.
2. Source reduction measures – to prevent the breeding of mosquitoes.
3. Adulticidal measures – with Pyrethrum space spray in and around houses where Malaria cases are detected.
4. Detection and Treatment activities are also taken up in Urban Slums.
Filaria control activities are implemented in the districts of Gulbarga, Bagalkot, Bidar, Raichur, D. Kannada, U. Kannada and Udupi. At present there are 25 Filaria Clinics, 8 Filaria Control Units and 1 Survey Unit functioning in these districts.
The Main activities under the Programme are:
1. Anti mosquito measures – i.e. weekly anti larval measures carried out through Filaria Control Units.
2. Detection and Treatment of Micro-filaria and Disease cases through Filaria Clinics and Control Units through night blood surveys.
3. Survey Unit at Raichur is to Conduct Filaria Surveys and Map out the problem of Filariasis in the district.
Major Vectors of Filaria: Culex quinqueufaciatus
COMMON BREEDING PLACES FOR VECTORS:
LIFE CYCLE OF FILARIA PARASITE:
MASS DRUG ADMINISTRATION:
With a objective to Eliminate Lymphatic Filariasis, the Government of India under NVBDCP, has taken up the Programme since 2004 with 100% Cash Assistance. The Programme is implemented in 8 endemic districts of Gulbarga, Bagalkot, Bidar, Raichur, Bijapura, D Kannada, U Kannada and Udupi. DEC is being administered on a Single day to the Eligible population (above 2 Yrs of age). The Programme is proposed for 5 to 7 years consecutively in order to eliminate Lymphatic Filariasis in the State.
Apart from MDA, management of Lymphoedema cases and Operations to Hydrocele cases is also being taken up in these districts under the Programme.
District Wise MDA Coverage during 2014 round
Persons covered under MDA
% of coverage
Trend of MicroFilaria Rate in the State since 2004
ACUTE ENCEPHALITIS SYNDROME/JAPANESE ENCEPHALITIS (AES/JE):
Japanese Encephalitis is a Mosquito borne Viral disease regularly occurring in the districts of Bellary, Raichur, Kolar and Koppal. It is also reported to some extend from other neighbouring districts. The disease usually occurs during the post monsoon period and continues upto January. Children below 15 yrs are usually affected severely and the mortality rate among children is very high (upto 30%).
The activities under the programme are:
1. Epidemiological Surveillance, Diagnosis, Treatment and Management of all suspected JE cases.
2. Segregation of Pigs – 3 Kms away from human habitation.
3. Mosquito control measures, Out door fogging operations.
4. Intensive Health Education and Personal Protection measures.
INCIDENCE OF AES/JE IN THE STATE SINCE 2006
District Wise JE Vaccination Coverage
Year of vaccination
(1 to 15 years)
JE VACCINATION PROGRAMME:
Vaccination programme was introduced in the state against JE, during 2006. Bellary district was taken up under the programme for immunizing children between 1-15 yrs during July 2006. This has now been included in the regular UIP. Similarly, Raichur and Kolar districts have been selected for Vaccination campaign during 2007. In subsequent years districts of Koppal, Mandya, Vijayapura, Dharwad and Chitradurga were included under the JE Vaccination programme. The programme is sponsored by Government of India.
DENGUE / CHIKUNGUNYA
Dengue Fever is a mosquito borne viral disease. The epidemic occurs during the pre and post monsoon periods. The vector mosquito viz., “Aedes aegypti” usually breeds in domestic and Peri-domestic water collections such as Cement tanks, drums, old tyres, tins, coconut-shells, air coolers, and so on. The diagnosis is by serological methods and the treatment is symptomatic.
Major Vectors of Dengue: Aedes Aegypti
COMMON BREEDING PLACES FOR VECTORS
Source reduction methods, Larvicides, Adulticides and fogging operations as well as IEC activities are some of the important control activities adopted. Dengue is prone in BBMP, Dakshina Kananda, Bengaluru Urban, Mysuru, Kolar, Ballari, Udupi, Chitradurga, Davangere, Tumkur, Raichur, Haveri, Chikballapura, Shivamogga, Kodagu and Ramanagar. However, depending on the water storage practices, migration of population, the disease has also reported in other districts of the State.
Dengue Incidence in State since 2007
Dengue Percentage Contribution During 2015 (Till September)
Chikungunya is also a viral disease spread from the same Dengue vector mosquito. The disease is prone in BBMP, Bengaluru Urban, Tumkur, Kolar, Chitradurga, Shivamogga, Mysuru, Haveri, Mandya, Chikkamagaluru, Ramanagar, Bangalore Rural District, Davangere, Chamrajnagar, Kodagu and Chikballapur.However, the disease is not fatal. The control activities are similar to that of Dengue/DHF disease.
Chikungunya Incidence in the State since 2007
Chikungunya Percentage Contribution During 2015 (till September)
ROLE OF VARIOUS SECTORS IN PREVENTION & CONTROL OF VBDs
(i) Rural Development and Panchayat Raj
1. Minor engineering works like filling up of burrow pits, pot holes to avoid water stagnation.
2. Avoidance of leakages from pipes of mini water supply.
3. Provide mosquito proof lids to all Over Head Tanks and also to the water storage tanks under urban and rural water supply schemes.
4. Regular meetings to discuss rural sanitation and study the situation of epidemic disease along with health authorities.
5. Gram Panchayats should actively participate in eliminating mosquito breeding sources as well as in maintaining rural sanitation involving VHSNCs
. 6. To ensure regular water supply on fixed schedule to avoid long duration water storage.
7. Bore well water should be collected in the storage tank and it should not be directly supplied from the bore well to the public.
(ii) Urban Development
1. Civic bye laws to be promulgated to monitor construction of overhead tanks and sump tanks as mosquito proof, in municipal areas, where such bye laws have not been introduced.
2. Civic bye laws should be strictly implemented in cities/towns where it already exists.
3. Weekly spraying of larvicides in mosquito breeding areas under proper supervision.
4. Periodic Inspection of water pipes for detecting and rectifying leakages.
5. Proper chlorination of water, before distribution & maintenance of log books it all storage sites.
6. Regular inspection of sanitary lines and supply lines. Rectification and correction of defects.
(iii) Education Department
1. To include vector borne diseases and their control in regular syllabus in schools.
2. Health Education classes are to be conducted in schools regularly
3. Involvement of Primary and Secondary school teachers in implementation of National Health Programme.
4. Disseminating information on spread of vector borne diseases and their preventive aspects during prayer assembly.
5. Literatures on vector borne and other communicable diseases to be made available in school libraries.
6. School premises should be free of mosquito breeding.
7. Fever cases among students should be notified to the nearest health institution and in case of cluster of fever the same should be notified to taluk and district health authorities.
(iv) Woman and Child Welfare
1. Maintenance of proper sanitation & mosquito free environment in and around the Anwangadi centres.
2. Anganwadi workers should actively be involved in creating awareness about vector borne and other communicable diseases, personal protection measures and importance of environmental sanitation.
(v) Social Welfare Department
1. Involvement of Non-Governmental Organizations, Yuva Kendras, Stree Shakthi Groups, Faith based Organizations etc., in awareness programmes/advocacy sessions of the Vector Borne Diseases & other communicable diseases and to advocate Behavioral Change Communication in the Community.
2. Mosquito proofing has to be ensured in in all the hostels & residential Schools. Maintenance of proper sanitation in and around the hostels.
(vi) Fisheries Department
1. To maintain larvivorous fish (Guppy and Gambusia) hatcheries throughout the state and monitor their availability and supply to the health authorities as and when required.
2. District wise GIS mapping of all water bodies (like river, streams, wells, ponds, tanks etc) and sharing with Health Department for biological control.
3. Technical guidance to the Health staff for maintaining larvivorous fish stock.
(vii) Agriculture Department
1. Encouraging suitable water management systems like intermittent irrigation, biological control and use of bio fertilizers.
(viii) Revenue Department 1. Regular inter sectoral co-ordination committee meetings headed by Deputy Commissioner to be held at district and Taluka level to review the situation and control epidemic diseases.
2. Deputy Commissioner to ensure regular water supply, rodent control and sanitation through Corporation/Municipality.
3. Promoting Health education to public through suitable media.
(viii) Irrigation Department 1. Movement of people working in the irrigation project should be informed to the Health Dept well in advance.
2. Engineering methods need to be developed to reduce the breeding of mosquitoes like leakage through channels which is a major source for breeding of mosquitoes.
3. All the projects should avail “No Objection Certificate” from Local Public Health Authority and proper arrangements/Plan for prevention of mosquito breeding sources should also be ensured.