National Vector Borne Disease Control Programme

1. National Vector Borne Disease Control Programme Dr. Avdhesh Kumar Additional Director National Vector Borne Disease Control Programme Directorate General of Health Services Ministry of Health and Family Welfare, Government of India

2. About NVBDCP • 1953-54 Started as - National Malaria Control Programme (NMCP) dealing with malaria control only • 1958-59 renamed as NMEP • 1971 – Urban Malaria Scheme launched • 1975 – National Filaria Control Programme (NFCP) which was in operation since 1955 under NICD was divided and operational part was brought to NMEP while retaining training part with NICD. • 1977 – Modified Plan of Operation (MPO) launched to reduce morbidity and mortality and also to sustain the gains achieved. • 1991 – 92 Kala-azar Control Programme was launched under NMEP with separate budget head. • 1998-99 renamed as National Anti-Malaria Programme (NAMP) • 2003-04 renamed as NVBDCP with a view to converge Dengue, JE and 3 ongoing centrally sponsored schemes : NAMP,NFCP, Kala azar • In 2006, Chikungunya re-emerged and brought under NVBDCP. 2

3. Generic strategy for Prevention & Control of VBDs • Early diagnosis and complete treatment (No specific drugs against Dengue, Chikungunya and JE) • Integrated Vector Management (IRS, LLIN, larvivorous fish, chemical and bio-larvicide, source reduction) • Supportive intervention: Vaccination only against JE • Annual MDA using DEC and Albendazole for LFE • Behaviour Change Communication

4. Kala-Azar 6 distt.,11.0 mil • Exists in several countries • About 500 000 cases occur annually. • Five countries (India, Sudan, Nepal, Bangladesh and Brazil account for 90% of the global cases. • In the SEA Region, KA occurs in111 districts). • 45 districts of Bangladesh, • 54 districts of India and • 12 districts of Nepal • Endemic in Bihar, West Bengal, Assam, Tamil Nadu during pre DDT era • Re-appeared during seventies • A centrally sponsored VL control Programme launched in 1990-91 33 distt., 62.3 mil 4 districts Pop: 6.7 mil 11 districts Pop. – 50 mil 4 States; 54 Districts; 130 million population • > 80% of all cases reported from Bihar • 9 Dist in Bihar contribute 65-70% of cases

5. Lymphatic Filariasis - Disease Burden in India • 40% of Global Burden • Endemic in 20 States/UT-250 Dist. • 600 million “at risk” • 509 million targeted for MDA 2004 : > 1% Mf rate 174 Districts 2012 : > 1% Mf rate 64 Districts Lymphoedema – 877,594 Hydrocele – 407,307 Hydrocele Operation– 110,842

6. Geographical spread of Dengue in last 2 decades 1996 1991 Dengue Cases/per district 2013

7. Spatial distribution of Chikungunya since 2006 Chikungunya outbreaks in 1960s-70s Sagar - 1965 Kolkata -1963 Nagpur 1965 1977 Barsi - !973, Vishakhapatnam – 1964 Kakinada -1965 Rajahmundry -1965 Chennai - 1964 Pondicherry - 1964

8. Target States of JE/AES: 60 High Priority Districts Bihar 15 Districts Uttar Pradesh 20 Districts Assam 10 Districts West Bengal 10 Districts Tamil Nadu 5 Districts 8

9. Malaria Cases & Deaths: Global vs India Scenario • 7 NE and 9 Other States –Odisha, Jharkhand, Chhattisgarh, MP, Andhra, Maharashtra, Gujarat, Karnataka & W Bengal contribute countries' 54% Population, >80% Total Malaria, >90% Pf. Cases and >90% deaths due to malaria *Source: World Malaria Report 2011

10. Trend of Malaria, India, 2001 - 2013 LLIN Bivalent RDT • ACT& RDT in 2005 : 53.93 % reduction in Malaria Cases • 54.31 % reduction in deaths 2013 against 2005 • LLIN in 2009 : 46.47% reduction in Malaria Cases • 61.54% reduction in deaths in 2013 against 2009

11. MALARIA ENDEMIC AREAS GFATM: R-9 (Rs.417 Crore : 2010-2015) *Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat, Karnataka & West Bengal Erstwhile World Bank Project (Rs.1000 Crore: 2008-2013)

12. Shrinking – Malaria Map- India 2013

13. Prevention and Control strategy • Disease Management (for reducing the load of Morbidity & Mortality) • Early case detection and complete treatment, • Strengthening of referral services, • Epidemic preparedness and rapid response. • Integrated Vector Management (For Transmission Risk Reduction) • Indoor Residual Spraying in selected high risk areas, • use of Insecticide treated bed nets (ITN/LLINs), • use of Larvivorous fish, • anti larval measures in urban areas like source reduction and minor environmental engineering • Supportive Interventions (for strengthening technical & social inputs) • Behaviour Change Communication (BCC), • Public Private Partnership, • Inter-sectoral convergence, • Human Resource Development through capacity building, • Operational research including studies on drug resistance and insecticide susceptibility, • Monitoring & evaluation through periodic reviews/field visits

14. Strategies to be Adopted for various categories of API: • Epidemiological Surveillance and Disease Management for reducing parasite load in the community • Integrated Vector Management for reducing mosquitoes density • Supportive Interventions

15. Treatment of Vivax Malaria Chloroquine: 25 mg/kg body weight divided over three days i.e. • 10 mg/kg on day 1, • 10 mg/kg on day 2 and • 5 mg/kg on day 3. Primaquine*: 0.25 mg/kg body weight daily for 14 days. • Primaquine is contraindicated in infants, pregnant women and individuals with G6PD deficiency. Dosage Chart for Treatment of Vivax Malaria

16. Treatment of Falciparum Malaria: NE States ≥ 35 Kg 25 - <35 Kg 5 - <15 Kg 15 - < 25 Kg ACT-AL Co-formulated tablet of ARTEMETHER (20 mg) - LUMEFANTRINE (120 mg) (Not recommended during 1st trimester of pregnancy and for children weighing < 5 kg) Dosage Chart for Treatment of falciparum Malaria with ACT-AL Primaquine: 0.75 mg/kg body weight on day 2.

17. Treatment of Falciparum Malaria: other than NE States Artemisinin based Combination Therapy (ACT-SP)* Artesunate 4 mg/kg body weight daily for 3 days Plus Sulfadoxine (25 mg/kg body weight) – Pyrimethamine (1.25 mg/kg body weight)on first day. * ACT not to be given in 1st trimester of pregnancy. Primaquine: 0.75 mg/kg body weight on day 2. Dosage Chart for Treatment of falciparum Malaria with ACT-SP

18. IMA Initiative… • To strengthen the Programme: • Elimination, • Eradication • Newer interventions: to increase the coverage • Strengthening surveillance: all cases to be detected to achieve National goal for these diseases • Standard diagnosis & treatment guidelines

19. Role of IMA in Vector Borne Diseases Aligning Diagnosis & Treatment as per National Policy (monotherapy banned) All suspected cases to be tested for Malaria Diagnosis by Good Quality Ag detecting Bivalent RDTs Microscopy still the Gold Standard for diagnosis of malaria Species specific treatment of Malaria to be given Complete treatment be given Reporting of cases through District Malaria Officers IEC to Community

20. Way Forward… • Saturation of malaria endemic population with effective preventive measure (LLIN) • Quality coverage of high-risk population with IRS and provision of EDCT • Sustaining incidence of malaria in areas with API<1 • Bring Down malaria incidence in areas having API>1 • Conducting Technical, Operational and Financial feasibility studies for planning malaria elimination programme • Pave way for elimination of malaria in subsequent years • Ensuring complete reporting of all VBDs including from private sectors

21. Thank You IMA WHO, India