NATIONAL VECTOR

BORNE DISEASE
CONTROL PROGRAMME
BEISAL BABY P
M.SC (N) II YEAR
Introduction
• Vector
• Optimal health
• Economy
• Country without mosquitoes?
• Civilizations
• 5 year plan
National health programs – CDE
• C – Control programs
• D – Developmental programs
• E – Eradication programs
MILESTONES
• 1953 – National Malaria Control Program
• 1955 – National Filariasis Control program
• 1955 – National Japanese encephalitis control program
• 1958- National Malaria Eradication Program
• 1990 – National Kala azar control program
• 1996 – National Dengue fever Control program
• 1999 – National Anti malaria program
• 2003 DEC 2 – NVBDCP under NHM
• 2006 – Chikungunya also added
New milestones
• Identified ACT (Artemisinin based combination therapy
(Artesunate + sulfadoxamine +Pyrimethamine) – 2008
• World bank support – 2008
• Introduction of LLINs – 2009
• Rapid diagnostic kits – 2013
 NVBDCS
• MALARIA
• FILARIASIS
• DENGUE
• JAPANESE ENCEPHALITIS
• KALA AZAR
• CHIKUNGUNYA

MALLIKA’s FILMDAY’S DINNER IS JAPANESE KADAI CHICKEN

ODD ONE ?

Scrub typhus
• Launched in year 2003‐04

• The Directorate of NVBDCP under the Directorate General of Health Services, Ministry of Health
and Family Welfare, Government of India, is the nodal agency responsible for

1. Organization

2. coordination,

3. implementation,

4. monitoring and evaluation of NVBDCP programme at all levels.

 Organization
• At Central level – NVBDCP Directorate
- Technical guidance
- Policies
- Budgeting
- Planning logistics
- Monitoring
- Assessing resource gap
- Equitable support
• State level – State vector borne disease control component
Heirarchy
- State program officer – Dr. B Venkateswar
- Director
- Joint director
- Deputy director
• District level
- District chief Medical and Health Officer
- District Malaria officer
- Assistant Malaria officer
- Senior Malaria inspector
- Total 677 District malaria units

- Total Districts in India???? -

• Malaria, Filariasis, JE, Dengue, Chickengunya – By mosquitoes
• Kala – azar - By sand fly
• VISION

• A well informed and self-sustained healthy India free from vector borne diseases with equitable
access to quality health care.

• MISSION STATEMENT

• An Integrated and Accelerated Action (IAA)

• Reducing mortality on account of malaria dengue, and Japanese Encephalitis by half

• Elimination of kala-azar by 2010

• Elimination of lymphatic filariasis by 2015

OBJECTIVES AND STRATEGY
• 1.Disease management

 Early case detection and complete treatment

 Strengthening of referral services

 Epidemic preparedness and rapid response

• 2. Insecticide resistance in vector: More research will be supported to

understand the causes of resistance and its management.
• 3. Legislative measures

• Civic bye-laws and building bye-laws enforcement ????

• 4. Involvement of NGOs /private sectors/community/local self-government

• 5. Quality assurance on laboratory diagnosis

• 6. Long lasing insecticide treated bed nets(LLIN): Usually bed nets are treated
with insecticide twice in a year to increase the effectiveness of bed nets and
treated net having3-5 years of efficacy have been introduced.

• 7. Improve efficiency and quality of services at primary, secondary and tertiary

level:
 PROGRAM STRATEGIES
• NVBDCP strategies
• Partnerships
• Technical support and logistics
• Improved efficiency and quality of services
• Monitoring and ensuring program implementation
• Environmental management
• Focused attention

National Partner In focused Improved environmental monitoring

 NVBDCP STRATEGIES
DISEASE MANAGEMENT
- Epidemic preparedness, early diagnosis, referral service strengthening,
prompt and complete treatment
INTEGRATED VECTOR MANAGEMNET
- Indoor Residual Spraying, Insecticide Treatment Nets, Long Lasting
Insecticide Nets Larvivorous fishes, Anti Larval Measures (IRS, ITN, LF,
LLIN, ALM)
SUPPORTIVE INTERVENTION
- BCC, PPP, ISC, Annual Mass Drug Administration (LF), Vaccination (JE), web
based MIS, Monitoring and evaluation, Human Resource Development
 Partnerships
• Other NHPs
• NGOs
• Panchayat Raj institutions
• Corporate sectors
• Professional bodies (TNAI, IMC)
Technical support and logistics
• By GOI
 IMPROVE EFFICIENCY AND QUALITY
OF SERVICES
• PRIMARY level – ASHA, AWWs, NGOs, PHCs, CHCs, lab services

• SECONDARY level – MOs, Lab technicians, Community volunteers ,

District hospitals with ventilators, medical audit

• TERTIARY level – medical colleges to manage all the referrals, Rapid

diagnostic kits, efficacy studies
Monitoring and ensuring implementation
• By state Govt
Environmental management
• Proper drainage and sanitation
Focused strategies
• Identify high risk areas
• Focused attention
 MALARIA history
• CHWs – fever inspectors
• Home visit
• Anti malarial drugs for all fever
• 14 days block – JHA, JPHN
MALARIA AMANAGEMENT
• EXTRINSIC INCUBATION PERIOD - GAMETOCYTES – OKKYNATE-
SALIVARY GLAND

• ACTIVE AND PASSIVE SURVEILLANCE

• ANNUAL PARASITIC INCIDENCE (API)

CLIENT WITH MALARIA
• FIND OUT CLIENT – SIGNS AND SYMPTOMS, TRAVEL, BLOOD
COLLECTION

• KILL MOSQUITO – WALLS WITH SPRAY, DDT, SYNTHETIC PYRETHROIDS

(flurothrine), 50 to 100 houses

• PREVENT FURTHER BITE – Chloroquine, synthetic pyrithronines

To kill gametocytes – Primaquine
Outcome
• Kerala became free in 1964

• Out break due to

- political reason
Epidemiological reason

So along with indoor sprays, treated nets are used.

Challenges - Rural and urban
• Anophelus stephensi – tank, well, inside home
• Anophelus varuna – in forest

• Urban malaria scheme

Dengue
• Urban – EADES EGYPTI – Inside home
• Rural – Albopictus

COMPLICATIONS

• DHF
• DSS
MANAGEMENT
• ANTILARVAL MEASURES (But adult mosquitoes are there)
• Anti adult measures - Indoor residual spray – corners, table
• Isolate members to one room and do indoor spraying
• Fogging is not effeective
 Filariasis
• Urban/ sewage – Culex
• Rural/ back waters – Mansonia

• MANAGEMENT
• Antilarval measures
• Antiadult measures
• Engineering measures
• Personal protection – DAY and NIGHT
MODE OF ACTION
• BITE – LYMPHATIC SYSTEM – DILATION

• MALE AND FEMALE – MICROFILARIA – ESINOPHILIA

MASS DRUG ADMINISTRATION OF DIETHYL CARBAMEZAPINE (DEC) –

SINGLE DOSE ANUALLY
- TRANSMISIION ASSESSSMENT SURVEY AFTER 3-5 YEARS
- IMMUNOCHROMATOGRAPHIC TEST FOR ANTIGENS
1. How many tablets should one consume?
• The dose for different age groups is indicated below:

• Record the absentees and their time of availability

• Advise to approach the Subcenter/PHC if any inconvenience is faced.
MALARIA
• It is a life threatening parasitic disease

• It is transmitted by female anopheles mosquito

• There are four kinds of malaria parasites that can infect humans: Plasmodium vivax, P. ovale, P.
malariae, and P. falciparum.

•  Plasmodium vivax, P. falciparum, which are commonly reported from India.

• Incubation period is 10-14 days

HISTORICAL PERSPECTIVES
• Malaria has been a major public health problem in India. Intermittent fever, with high incidence
during the rainy season, coinciding with agriculture, sowing and harvesting, was first recognized
by Romans and Greeks who associated it with swampy areas. They postulated that intermittent
fevers were due to the 'bad odor' coming from the marshy areas and thus gave the name 'malaria'
('mal'=bad + 'air') to intermittent fevers.
Epidemiological status in India
Puducherry – Malaria data
• In Puducherry malarial cases is 79 in 2014
• 21 cases in 2019
• 10 cases in 2020
NATIONAL FRAMEWORK FOR
MALARIA ELIMINATION IN INDIA
(2016-2030)
• DEFINITION OF MALARIA ELIMINATION

• WHO has defined malaria elimination in 2017 as “ Interruption of local transmission (reduction to zero
incidence of indigenous cases) of specified malaria parasite species in a defined geographical area, as a result
of deliberate activities. Continued measures to prevent re-establishment of transmission are required”
• VISION:

• Eliminate malaria nationally and contribute to improved health, quality of life and alleviation of poverty.

• GOALS

 Eliminate malaria(zero indigenous cases) throughout the entire country 2030

 Maintain malaria free status in areas where malaria transmission has been interrupted and prevent re -
introduction of malaria.
• OBJECTIVES

 Eliminate malaria from all 26 low(category 1) and moderate (cat 2) transmission states/ union territories by
2022.

 Reduce the incidence of malaria to less than 1 case per 1000population per year in all states and UT’s and
their district by 2022

 Interrupt indigenous transmission of malaria throughout the entire country , including al high transmission
states and union territories (UTs) (category 3) by 2027.

 Prevent the re establishment of local transmission of malaria in areas where it has been elimated and main
national malaria free status by 2030 and beyond.
• CATEGORY 3(INTENSIFIED CONTROL PHASE)

• Achieve universal coverage with malaria preventive and curative services

 Establish an efficient system to reduce transmission

 Reduce malaria specific morbidity and mortality

• Contain and prevent possible outbreaks of malaria , particularly among non immune, high risk mobile and
migrant population groups

• Emphasise reducing malaria morbidity and mortality in high transmission pockets

• CATEGORY 2 (PRE ELIMINATION PHASE):

• Malaria elimination interventions will be introduced with particular focus on setting up an

elimination surveillance system and initiating elimination phase activities in those districts where
the API has been reduced to less than 1 case per 1000 population at risk per year. The planning of
elimination measures will be based on epidemiological investigations and classification of each
malaria case and focus

• CATEGORY 1 (ELIMINATION PHASE):

• A NATIONAL LEVEL REFERENCE LABORATORY WILL BE ESTABLISHED SERVE THE

FOLLOWING FUNCTIONS:
 Interrupt transmission of malaria.

 Immediately notify each detected case.

 Detect malaria transmission

 Determine the causes of residual transmission

• Forecast and prevent any unusual situations related to malaria, ensure epidemic preparedness and respond
timely and outbreak situations

 Prevent re establishment of local transmission of malaria

• Ascertain elimination of malaria

• CATEGORY 0 (PREVENTION OF RE ESTABLISHMENT PHASE)

 Detect any re introduced case of malaria

 Notify immediately all detected cases of malaria

 Determine the underlying causes of resumed local transmission.

 Apply rapid curative and preventive measures.

 Prevent re introduction and possible re establishment of malaria transmission

 Maintain malaria free status in these areas.

• CROSS CUTTING INTERVENTIONS:

• Policy and planning:

• Monitoring and evaluation

• Stratification
• Surveillance
• Quality assurance
• Intersectoral coordination
• Cross border coordination
• NATIONAL STRATEGIC PLAN 2017-2022:

• VISION:

• Focuses on strategic policies to provide universal intervention package, paving the way for malaria
elimination by 2030.

• GOAL:

 Eliminate malaria by 2022 in all districts – which existing category 1 and 2 and in district having API<1 of
category 3 states.

 All remaining districts (API> 2) to be brought in to elimination and pre elimination phase.

 Maintain malaria free status where malaria transmission has been interrupted and prevent re introduction of
malaria by strengthening surveillance.
• OBJECTIVES

 Achieve universal coverage of case detection and treatment services in endemic districts to
ensure 100% parasitological diagnosis of all malaria cases and complete treatment of all
confirmed cases

 Strengthen surveillance system to detect, notify, investigate ,and respond to all cases

 Near universal coverage of population at risk of malaria by appropriate vector control

intervention and BCC activities.

• Effective programme management and coordination at all levels to deliver a combination of

targeted interventions for malaria elimination
CLASSIFICATION OF DISTRICTS DEFINITION
Category 0 : Prevention of re -establishment phase Reporting no case for last 3 years- vigilance will be
maintained to prevent re introduction of malaria in
view of climate change

Category 1: Elimination phase Districts having API less than 1 per 1000 population

Category 2: Pre Elimination Phase District having API having 1 and above but less than 2
per 1000 population-Positioned for elimination target

Category 3: Intensified control phases Districts having API 2 and above per 1000 population –
Positioned for elimination target
• STRATEGIES:

 Diagnosis and case management

 Surveillance and epidemic response

 Prevention by integrated vector management

 Cross cutting interventions like advocacy, communication and community mobilization; programme
management and coordination ; monitoring and evaluation; research and development

• CERTIFICATION OF MALARIA ELIMINATION:

• WHO certification of malaria elimination is an official recognition of the elimination of all human malaria
parasite species in the country as a whole. This is received after reporting zero indigenous malaria cases for
atleast the past 3 years.
LYMPHATIC FILARIASIS

• Lymphatic filariasis is caused by infection with parasites classified as nematodes (roundworms) of the family
Filariodidea. There are 3 types of these thread-like filarial worms:

• Wuchereria bancrofti, which is responsible for 90% of the cases

• Brugia malayi, which causes most of the remainder of the cases

• Brugia timori, which also causes the disease.

• Adult worms nest in the lymphatic vessels and disrupt the normal function of the lymphatic system. The worms
can live for approximately 6–8 years and, during their life time, produce millions of microfilariae (immature
larvae) that circulate in the blood.

• The National Filaria Control Pragramme was launched in 1955.

• Definition Elimination of Lymphatic Filariasis Programme:

• It is defined as cessation of lymphatic filariasis as public health problem when the number of microfilaria
carriers in the community is less than 1% and children born after initiation of elimination of lymphatic
filariasis are free from circulating antigenemia i.e presence of adult filarial worm in human body.

• GOAL:

• To eliminate lymphatic filariasis from India by 2015 

• TARGET:

 To cover all eligible population living in all Lymphatic Filariasis endemic districts during MDA

 To line the cases of lymphoedema and hydrocele in all the districts and augment home based morbidity
management and hydrocele operations in identified district hospitals/CHC
• OBJECTIVES:

 Progressively reducing and ultimately interrupting the transmission of Lymphatic Filariasis.

 Preventing and reducing disability amongst affected persons through disability alleviation and morbidity
management.

• To eliminate Filariasis, WHO recommends delivery of combination of two medicines to entire population
at risk, by a strategy known as Mass Drug Administration (MDA). This involves four steps

1. Mapping- the geographical distribution of disease

2. Mass drug Administration- for 5 years or more to reduce the number of parasistes in the blood and prevent
transmission

3. Post MDA surveillance –

4. Verification of elimination of transmission

 
• STRATEGY FOR ELIMINATION OF LYMPHATIC FILARIASIS:

•  

1. PREVENTIVE CHEMOTHERAPHY THROUGH MDA: Annual Mass Drug Administration of single

dose of DEC (Diethylcarbamazine citrate) @6mg/kg body weight +Albendazole for minimum 5 years to all
eligible population (except pregnant, children below 2 years of age and seriously ill persons) in endemic
areas to interrupt transmission of diseases. This annual dose is to be repeated every year for a period of 5
years or more aiming at minimum 85% actual drug compliance.

•  
• Options for delivering drugs

 House to house approach:.

 Booth approach.

 Group approach:

 Mopping operations to be done after Mass Drug Administration

• Pre MDA-activities:
• Enumeration and motivation of the community by making at least two visits
• First visit: (Household enumeration)
• Second visit: (Interpersonal contact)

• MDA activities:
• Checklist of items to be carried:
• Identity card
• Sufficient number of tablets including paracetamol
• IEC materials such as hand bills/bit notices
• Family register – updated
• Flash cards on elephantiasis to explain to the community
 
• Drug administration:
• Visit the house at the agreed time
• Identify all the eligible individuals for administering drugs.
• Approach every individual in the household
• Select the correct dose of DEC based on the age of the person
• Co-administer DEC with albendazole
• Ensure that the individual is consuming the drugs in your presence (supervised administration)
• Record the absentees and their time of availability
• Advise to approach the Subcenter/PHC if any inconvenience is faced.
  
• Disability prevention and morbidity management for those who already have the disease:
• Home based management –limb hygiene for lymphoedema
• Hospital based management – surgical correction for hydrocele
JE CASES IN INDIA
• 2014-3323
• 2015-2492
• 2016-2245
• 2017-1372
• 2018-822
• VECTOR CONTROL MEASURES:

•  BEHAVIOUR CHANGE COMMUNICATION:

 KALA -AZAR
 Kala-azar is a slow progressing indigenous disease caused by a protozoan parasite of genus
Leishmania and transmitted to humans by the bite of female phlebotomine sandfly.

 In India Leishmania donovani is the only parasite causing this disease

 The parasite primarily infects reticulo-endothelial system and may be found in abundance in bone
marrow, spleen and liver.
ORGANISM STAY IN
• CEMENT BRICKS

• CLAY BRICKS

• DUST

• MUD WALLS

• SAND FLIES LAY EGGS IN THESE AREAS

 TYPES
• CUTANEOUS – MAIN WORLD WIDE
• VISCERAL – MAIN IN INDIA
 • Signs & Symptoms of Kala-Azar

 Recurrent fever intermittent or remittent with often double rise

 loss of appetite, pallor and weight loss with progressive emaciation

 weakness

 Splenomegaly - spleen enlarges rapidly to massive enlargement, usually soft and nontender

 Liver - enlargement

 Lymphadenopathy - not very common in India

 Skin - dry, thin and scaly and hair may be lost. Light colored persons show grayish discoloration of the skin of
hands, feet, abdomen and face which gives the Indian name Kala-azar meaning "Black fever"

 Anemia - develops rapidly.

• Post Kala-Azar Dermal Leishmaniasis (PKDL)
Post Kala-azar Dermal Leishmaniasis is a condition in which Leishmania donovani parasites are found in
skin. PKDL develops in some of the Indian kala-azar patients usually 1-2 years or more following recovery of
Kala-azar; less commonly without suffering from Kala-azar.

•  
PREVALENCE OF KALA AZAR
 Kala-azar Cases and Deaths in the Country since 2013

Affected States/UTs 2013 2014 2015 2016 2017 2018 2019(P) 2020(P)
Till November

C D C D C D C D C D C D C D C D
1 Assam 4 0 1 0 1 0 0 0 0 0 0 0        
2 Bihar 10730 17 7615 10 6517 5 4773 0 4127 0 3423 0 2416 0 1318 0

3 Delhi* 6 0 0 0 0 0 0 0 0 0 0 0        
4 Jharkhand 2515 0 937 0 1262 0 1185 0 1358 0 752 0 541 0 391 0
5 Kerela 0 0 0 0 4 0 2 0 0 0 0 0  4 0     
6 Punjab* 0 0 0 0 1 0 0 0 0 0 0 0        
7 Sikkim 8 0 5 0 5 0 1 0 0 0 0 0        
8 Uttrakhand 0 0 4 0 3 0 2 0 2 0 0 0        
9 Uttar Pradesh 11 1 11 0 131 0 107 0 115 0 110 0 97 0 48 0
10 West Bengal 595 2 668 1 576 0 179 0 156 0 95 0 87 0 45 0
  Total 13869 20 9241 11 8500 5 6249 0 5758 0 4380 0 3145 0 1802 0

P = Provisional, C = Cases | D = Deaths, * =

Imported
 Post-Kala-azar Dermal Leishmaniasis (PKDL) situation in India since
2013
Sl. Affected States 2013 2014 2015 2016 2017      2018 2019(P) 2020 (P) Till November
No.

Cases Cases Cases Cases Cases Cases Cases Cases

1 Bihar 122 119 247 542 593 731 439 289

2 Jharkhand 304 81 153 873 1211 361 281 160

3 West Bengal 73 221 255 240 166 87 51 32

4 Uttar Pradesh 0 0 0 2 12 66 50 31 

  Total 499 421 655 1657 1982 1245 821 512

• The disease was targeted for elimination, by bringing the incidence of kala azar to less than 1 case per 10,000
at the Block PHC level by 2010, as per National Health Policy 2002.

• Subsequently the date was extended to 2015 as per tripartite agreement between India , Bangladesh and
Nepal, to achieve Kala azar elimination from the South East Asia Region.

• In 2014 , a Penta lateral MOU was signed between India, Bangladesh, Nepal, Bhutan, and Thailand, where
the target date for elimination was revised to 2017 or earlier.

•  Presently all programmatic activities of National Kala azar Elimination Programme are being implemented
through the National Vector Borne Disease Control Programme for prevention and control and is subsumed
under National Health Mission

•  
• A. Kala-azar Elimination Programme

Kala-azar has been a serious medical and public health problem in India since historical times. Bengal is the
oldest known Kala-azar endemic area of the world. The Government of India (GOI) launched a centrally
sponsored Kala-azar Control Programme in the endemic states in 1990-91. The GOI provided drugs,
insecticides and technical support and state governments provided costs involved in implementation. The
program was implemented through State/District Malaria Control Offices and the primary health care system.
The programme brought a significant decline in Kala-azar morbidity but could not sustain the pace of decline
for long.
The National Health Policy-2002 set the goal of Kala-azar elimination in India by the year 2010 which
was revised to 2015.
• Goal

 To improve the health status of vulnerable groups and at-risk population living in Kala-azar endemic areas
by the elimination of Kala-azar so that it no longer remains a public health problem.

• Target

 To reduce the annual incidence of Kala-azar to less than one per 10,000 populations at block PHC level.

• Objectives

 Reducing Kala-azar in the vulnerable, poor and unreached populations in endemic areas;

 Reducing case-fatality rates from Kala-azar to negligible level;

 Reducing cases of PKDL to interrupt transmission of Kala-azar; and

 Preventing the emergence of Kala-azar and HIV/TB co-infections in endemic areas.

• Stratergies for Elimination

• It is a multi pronged approach aand consists of the following main activities

 Early diagnosis and complete treatment (EDCT)

 Integrated Vector Management including Indoor Residual Spraying

 Surveillance

 Capacity building

 Programme management

 Advocacy, communication and social mobilization for behavioural impact and intersectoral convergence

 Supervision , monitoring and evaluation

1. Early Diagnosis and Complete Case Management:

• This is done for eliminating the human reservoir of infection through early case detection along with
complete treatment and monitoring of adverse effects.This strategy will reduce case fatality and will improve
utilization of health services by suffering people from the disease.

• DIAGNOSIS

• Rapid diagnosis Test introduced in the programme for detection of kala -azar cases at PHC and district hospitals.
This results can be read in 10 mins with >90% specificity and sensitivity.

• Parasitological diagnosis includes spleen, bone marrow and lymphnode aspiration procedures.

• In PKDL cases, confirmation of infection is done either PCR or Slit skin biopsy

• Suspected cases as per Standard Case definition are referred for clinical examination and tested with RDT for
confirmation
• CASE DEFINITION

• Visceral Leishmaniasis (VL)/ Kala azar (KA)

 A ‘suspect’ case: history of fever of more than 2 weeks and enlarged spleen and liver not responding to anti
malaria and antibiotic treatment in a patient from an endemic area.

 All patients with above symptoms should be screened with Rapid Diagnostic Test and if found positive
should be treated with an effective drug.

 In cases with history of Kala-azar or in those with high suspicion of Kala-azar but with negative RDT test
result, but found positive by examination of bone marrow/spleen aspirate for LD bodies at appropriate level
(district hospital) equipped with such skills and facilities.
• TREATMENT 

• Kala azar

 Liposomal Amphotericin B injection -single day, single dose, IV

across all age groups @ 10mg /kg body weight including pediatric ,
pregnant and elderly patients

 Miltefosine capsules of 10mg (Pediatric) and 50mg (Adults) in the

age group between 2-65 yrs. Contra indicated to Pregnant and
lactating women and women who refuse contraception during
treatment with Miltefosine.
• PKDL

 First drug of choice, miltefosine 100mg orally per day for 12 weeks.

 Amphotericin ‘B’ deoxycholate injection 1 mg/kg over 4months in

60-80 doses.

 Liposomal Amphotericin B: 5mg/kg per day by infusion two times

per week for 3 weeks for a total dose of 30mg/kg
• 2.Integrated vector management (IVM) including Indoor Residual Spraying (IRS)
The main objective is to reduce longevity of the adult vectors, eliminate the breeding sites, decrease contact
of vector with humans, and reduce the density of the vector. The five key elements of IVM include capacity
building and training, advocacy, collaboration, evidence-based decision-making and integrated approach.

The spray is usually organized in two rounds, 1st round during February - March when sand fly is active
and 2nd round during May – June (months may vary from district-to-district based on entomological data) to
limit sand fly population supplemented with focused IRS in the villages reporting KA cases. 
• SURVEILLANCE:

• Surveillance is the mainstay of any disease control programme. Under national programme it is of two types
active and passive. Case detection is done through the existing primary health care system supplemented by
quarterly active search followed by treatment. Visceral Lieshmaniasis and PKDL cases detected are reported in
prescribed formats and flow of such information is from Block PHC to District to state and then to NVBDCP.

•  CAPACITY BUILDING

• INDUCTION TRAINING

• ON THE JOB TRAINING

• RE ORIENTATION TRAININNG

• OFF THE JOB TRAINING

• PROGRAMME MANAGEMENT
Programme management is the most important operational component for success of Kala-azar elimination.
It involves coordination between centre and state level offices as well as effective coordination and
harmonization of activities with different partners in the programme.

• ADVOCACY, COMMUNICATION AND SOCIAL MOBILISATION FOR BEHAVIOURAL IMPACT

AND INTER SECTORAL CONVERGENCE

• Awareness about the disease, its features, diagnostic and treatment options, prevention, existing schemes and
incentives and other aspects of the disease will be done through all the existing methods (wall writings,
hoardings, banners, pamphlets,radio jingles etc)as per the local context. Opportunities should be explored to
spread the messages during weekly market or any mass gathering.
 SUPERVISION,MONITORING AND EVALUATION:

 Rational use of Rapid Diagnostic Kits as per the programme guidelines.

 Consumption and collection of anti kala azar drugs by the patient.

 Intensive supervison of spray activities to its quality, coverage and implementation of Indoor Residence
Spray rounds.

• To achieve the goal of elimination, the government provides 100% central support including operational cost
of insecticide spray to kala azar endemic states since December 2003.

• NO KALA AZAR REPORTED TO PUDUCHERRY SO FAR

• INITIATIVES UNDERTAKEN FOR KALA AZAR ELIMINATION ARE AS FOLLOWS:

 National Road map for Kala azar Elimination (2014) and operational Guidelines on Kala azar Elimination in India(2015) –
Prepared with clear goal, objectives strategies and functions at appropriate level.

 Rapid Diagnostic Kits introduced in all endemic areas.

 Long duration treatment of 28 days for Kala azar patient reduced to single day single dose treatment and combination
treatment of 10 days for better compliance

 An amount of 500 Rs. is given to each Kala-azar patient   and Rs. 2,000 is given in case of Post-Kala-azar Dermal
Leishmaniasis (PKDL) from Government of India to compensate the loss of wages.

 Rs. 300 is given to the ASHA or health volunteer to bring Kala- azar suspected case to health facility as well as to ensure
complete treatment. Moreover, ASHA is also being paid Rs. 200 during indoor residual spray for social mobilization and
community acceptance to allow spray in their rooms.

 Free diet support to the patient and one attendant accompanying the patient.

 Involvement of stakeholders and other partners on treatment, service delivery and supervision.

 Continuous technical support from World Health Organization

JAPANESE ENCEPHALITIS
• Japanese encephalitis is a zoonotic disease caused by flavivirus.

• Transmitted by Culex .

• They breed in rice fields, shallow ditches and pools.

• Mosquitoes become infected by feeding on domestic pigs and wild birds infected with JE virus.

• Incubation period is 5-14 days.

• It is not transmitted from person- to -person. Only domestic pigs and wild birds are carriers of
the JE virus.
• It primarily affects the Central Nervous System. The disease is highly fatal if early supportive care is not
provided. There is no specific treatment for JE.

• NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF JAPANESE

ENCEPHALITIS/ ACUTE ENCEPHALITIS SYNDROME

• Realising the gravity of the problem of JE and AES in the country, Government of India approved the
National Programme for Prevention and Control of JE/ AES in 2011, with the Ministry of Health and Family
Welfare as the nodal agency and integrating with other Ministries viz Ministry of Drinking Water Supply and
Sanitation; Ministry of Housing & Poverty Alleviation; Ministry of Women and Child Development and
Ministry of Social Justice and Empowerment.
• GOAL

• To reduce morbidity, mortality and disability in children due to JE/AES

 OBJECTIVE

 To strengthen and expand JE vaccination in affected districts

 To strengthen surveillance , vector control, case management and timely referral of serious and complicated
cases.

 To increase access to safe drinking water and proper sanitation facilities to the target population in affected
rural and urban areas.

 To estimate disability burden due to JE/AES and to provide for adequate facilities for physical, medical,
neurological and social rehabilitation.

 To improve nutritional status of children at risk of JE/AES.

 To carry out intensified IEC/BCC/ activities regarding JE/AES.

• STRATEGIES

 Vaccination along with public health measures for prevention of the disease.

 Symptomatic and early case management to minimize risk of death and complications.

 Strengthening and Expanding JE Vaccination

• Live attenuated SA-14-14-2 vaccine against Japanese encephalitis (JE) was introduced in the routine immunization under
Universal Immunization Program in the 181 endemic districts of India. Recently, the Government of India has announced
the introduction of one dose of JE vaccine for adults in endemic districts.

• Two doses of JE vaccine, first at 9months and second at 16-24 months has been incorporated under Routine
Immunization since 2013.

• VECTOR CONTROL

• Because of outdoor resting habits and enormous breeding habits vector control using indoor residual spray is technically
not feasible. Therefore ULV (Ultra low Volume) fogging is the only recommended method of vector control during JE
epidemics also.
• DISEASE SURVEILLANCE

• JE surveillance implies a continuous monitoring of all factors influencing transmission and effective
control of JE, and early recognition of impending outbreaks or epidemics. Hence information needs to be
collected on epidemiologic, clinical laboratory and entomological parameter from the identified sites on a
regular basis.

•  INFORMATION, EDUCATION AND COMMUNICATION

• These activities are carried out through mass media and interpersonal channels focusing on the following

 Keeping pigs away from human dwellings or in pig sites, particularly during dusk to dawn, which is the
biting time for vector mosquitoes

 Avoiding man -mosquito contact by using bed nets and fully covering the body.

 Signs, symptoms of the disease and availability of health services at health centres/ hospitals to promote
early reporting of cases.
• CASE FINDING

• Suspect Case

 Acute onset of fever, not more than 5-7 days of duration

 Change in mental status with/ without

 New onset of seizures, excluding febrile seizures

 Other early clinical findings, which may include irritability, somnolence or abnormal behaviour greater than
that seen with febrile illness.

• NOTE: In an epidemic situation fever with altered sensorium persisting for more than two hours with a
focal seizure or parlysis of any part of the body is encephalitis.

 Presence of rash on body excludes Japanese encephalitis

 AES with symmetrical signs and fever is likely to be cerebral Malaria

.
• CASE MANAGEMENT

1. Management of airways and breathing

2. Management of circulation

3. Control of convulsion and intracranial pressure

4. Control of temperature

5. Fluid and electrolyte balance

6. General management

7. specific treatment of any for treated cause

8. Investigations, sample collection and transpora

9. Reporting of a case

10. Rehabilitation
CHICKUNGUNYA

• It is a debilitating non fatal viral illness transmitted by Aedeas aegypti mosquito.

It can also be transmitted by Aedes albopictus.Outbreaks are likely occur in post
monsoon period when the vector density is very high and accentuates the
transmission. Human beings serve as the Chickungunya virus reservoir during
epidemic period.
• Clinically chikungunya may not be distinguished from dengue fever.
However haemorrhagic manifestations are rare in chikunguya and
shock is not observed. It is characterized by fever with severe joint
pain and rash. Joint pain sometimes persist for a long time even after
the fever has subsided.
• Chickungunya is transmitted in the same manner and by the same
vector as of dengue
SCRUB TYPHUS
• FEVER
• CHILLS
• ISCHAR – NURSES, DOCTORS
• UNDIAGNOSED FEVERS ARE MAINLY SCRUB TYPHUS
• MANAGEMENT IS WITH DOXYCYCLINE
PUDUCHERRY- NO OF DENGUE CASES REPORTED SINCE JAN2019-1039
NO OF CASES SINCE NOV 2019-25
NO OF DEATH -1
PUDUCHERRY- NO OF CHICKUNGUNYA CASES REPORTED SINCE JAN 2019-462
NO OF CASES SINCE NOV 2019-1
NO OF DEATH -0
• PROBABLE OR SUSPECTED CASE: A patient meeting the clinical criteria only

 CONFIRMED (DEFINITIVE ) CASE: A patient meeting both the clinical and laboratory criteria.

 CLINICAL CRITERIA: Acute onset of fever and severe arthralgia/ arthritis with or without skin rash and
residing or having left an epidemic area 15 days prior to onset of symptoms.

 LABORATORY CRITERIA: At least one of the following test done in the acute phase of illness.

• DIRECT EVIDENCE

 Virus isolation/ Presence of viral RNA by RTPCR.

•  INDIRECT EVIDENCE

 Presence of virus specific IgM antibodies in single serum sample collected in acute or convalescent stage.

 Four -fold increase in IgG values in samples collected at least three weeks apart. 

•  
• LONG TERM STRATEGIES FOR PREVENTION AND CONTROL

1. Early case reporting and management

• Case reporting

 Fever alert surveillance

 Sentinel surveillance sites with laboratory support

 Strengthening of referral services

 Involvement of private sector in sentinel surveillance

• Case Management

 Case Management

 Epidemic preparedness and rapid response

• 2.Integrated vector management ( for transmission risk reduction)

 Entomological surveillance including larval surveys

 Anti larval measures

 source reduction

 chemical larvicide

 Larvivorous fish

 Enviornmental management
 Anti adult measures

 Indoor space spraying with pyrethrum extract(2%)

 Fogging during outbreaks

 Personal protective measures

 Protective clothing

 Insecticide treated fabrics and repellents

• 3.Supportive interventions

 Human Resource Development through capacity building

 Behaviour Change Communication(BCC)

 Inter sectoral convergence

 Operational research

 Supervision and monitoring

 Coordination committes

 Legislative support

•  
• FEVER ALERT SURVEILLANCE

• For early detection of any outbreak due to suspected vector borne disease . it is envisaged to train health
workers and gross root level functionaries such as ASHA,AWW, and volunteers at FTDs of NVBDCP , in
identification and reporting of fever syndrome to District Vector Borne Disease Control Officer directly under
intimation to respective PHC/CHC.

• To supplement the surveillance data, a call centre is being set up under Integrated Disease Surveillance
Programme. This call centre will have the facility communication in regional languages. The call centre
would be able to alert the concerned health facility for any unusual increase in the number of cases of an
epidemic borne diseases.

•  
• ESTABLISHMENT OF SENTINEL SURVEILLANCE SITES WITH LABORATORY SUPPORT

 Prediction of dengue outbreak

 Monitor transmission of virus during inter epidemic periods

 Provide information regarding place of transmission, type of serotypes involved and complication

 It will also permit to differentiate whether the illness is dengue or chikungunya as the symptoms are similar in
both the diseases.

 It is aimed to have at least one sentinel surveillance site in each district of the country.

 Introduced ELISA based NSI kits for early diagnosis under this programme from 1 st day of infection.

 IgM capture ELISA tests can detect the cases after 5 th day of infection

 Sentinel surveillance hospitals will carry out various activities like taking blood samples from the suspected
patients with viral syndrome, maintaining line listing of positive cause of dengue and chikungunya and capacity
building of PHC/ CHC within the districts
• INVOLVEMENT OF PRIVATE SECTOR IN SENTINEL SURVEILLANCE

• In addition to sentinel surveillance hospitals the state shall also identify private clinics/ nursing homes for
establishing sentinel surveillance sites for confirmation of dengue or chickungunya.

• Case Management

• Treatment of both dengue fever and chikungunya is symptomatic and supportive. There is no specific
antiviral treatment. In case of dengue the symptomatic treatment should go on until the patient becomes
afebrile and platelet count and haematocrit determination are normal. In case of chikungunya patients should
also be monitored till they become febrile and their joint pain are relieved.
• EPIDEMIC PREPARDNESS AND RAPID RESPONSE

• Prepare a contingency plan dealing with OPD care and emergency hospitalization, making the most
effective use of hospital and treatment facilities in case of outbreak of dengue or chickungunya. This plan
should include requirement of beds, equipment and diagnostic materials drugs and blood arrangement.

•  INTEGRATED VECTOR MANAGEMENT

• Entomological surveillance

 Involvement of community through advocacy and social mobilization, collaboration within health sector and
other sectors, implementation of legislation to prevent mosquito breeding.

 Biological control involves use of larvivorous fish

 During outbreaks fogging operations are undertaken

 Insecticide curtains can be used in the houses

 Insecticide treated bed nets could be used for the young children sleeping in the daytime and in hospitals.

 All states/ local bodies should ensure cleanliness and proper sanitary conditions to make sure that
mosquitoes do not breed

• Rapid Response and Emergency Vector Control

 When the surveillance data suggest increased dengue / chikungunya transmission or introduction of new
dengue virus serotype or strain, the situation should be investigated immediately like determining the source
and implement preventive measures like use of mass media to update and health educate the public, a target
source reduction programme should be undertaken,periodic household spray with pyrethrum 2%
extract ,Ultra Low Volume spray for entire village may be carried out using vehicle mounted equipment.
• SUPPORTING INTERVENTIONS

 CAPACITY BUILDING : It is proposed that dengue/ chickungunya teams should be fully trained and
available at all CHC , district and tertiary care hospitals. Training would also cover private sector.

 BEHAVIOURAL CHANGE COMMUNICATION: Different channels of personal communication, group

educational activites and mass media required to promote awareness among public. Involving other
government department ,local bodies,NGOs and volunteers are involved for mass cleaning compaign and
source of reduction and environmental sanitation.

 INTERSECTORAL COORDINATION: The prevention and control of vectors and vector borne diseases
require close collaboration and partnership between health and non health sectors government , private and
NGOs
• LEGISLATIVE SUPPORT:

• It is necessary to have legislation which ensures prevention of mosquito genic conditions in domestic and
peridomestic areas. Model civic bye laws for urban areas have been prepared by Directorate of NVBDCP and
circulated to all states for promulgation and implementation to reduce mosquito breeding in domestic and
peridomestic situations.
NURSING THEORY –PENDERS HEALTH
PROMOTION MODEL