Burden of  Vector Borne Diseases Past, Present & Future
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Burden of Vector Borne Diseases Past, Present & Future

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Bharati Vidyapeeth Pune has recently organized National CME on VBDs. I delivered a speech on " Burden of Vector Borne Diseases Past, Present & Future". ...

Bharati Vidyapeeth Pune has recently organized National CME on VBDs. I delivered a speech on " Burden of Vector Borne Diseases Past, Present & Future".
This presentation deals with burden of prominent VBDs globally & in India with special reference to Maharashtra.

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  • 1. Burden of Vector Borne Diseases Dr. Pradip Awate State Surveillance Officer, IDSP, Maharashtra
  • 2. Bharati Vidyapith CME 3 AUG 14
  • 3. Fossil Mosquito Almost 30 million years old found in geologic strataBharati Vidyapith CME 3 AUG 14
  • 4. Vector Borne Diseases • Vectors are organisms that transmit pathogens and parasites from one infected person (or animal) to another. • Commonly found in tropical and sub-tropical regions. • Over half the world's population is at risk from vector-borne diseases such as malaria and dengue. • Vector-borne diseases account for 17% of the estimated global burden of all infectious diseases. • The most deadly vector-borne disease, malaria. • The world's fastest growing vector-borne disease is dengue. Bharati Vidyapith CME 3 AUG 14
  • 5. VECTOR BORNE DISEASES VECTOR BORNE DISEASES MalariaMalaria DengueDengue ChikungunyaChikungunya FilariasisFilariasis Japanese Encephalitis Japanese Encephalitis Chandipura Encephalitis Chandipura Encephalitis Kala AzarKala AzarCongo Cremean Hemorrhagic Fever Congo Cremean Hemorrhagic Fever Chagas Disease Chagas Disease Trypanos omiasis Trypanos omiasis Yellow Fever Yellow Fever Lyme Disease Lyme Disease PlaguePlague DracunculosisDracunculosis Bharati Vidyapith CME 3 AUG 14
  • 6. Important VBDs with respect to India Sr. No VBD Responsible Vector 1 Malaria Anopheles 2 Dengue Aedes aegypti and Aedes albopictus 3 Chikungunya Aedes aegypti and Aedes albopictus 4 Japanese Encephalitis Culex tritaeniorhynchus, Culex vishnui and Culex pseudovishnui 5 Chandipura Encephalitis & Kala Azar Sandfly (genus Phlebotomus ) 6 Filariasis Culex quinquefasciatus and Mansonia annulifera/M.uniformis Bharati Vidyapith CME 3 AUG 14
  • 7. Malaria Bharati Vidyapith CME 3 AUG 14
  • 8. जो जीता वह सकं दर • Alexander the Great was killed by malaria at the height of his power. • After virtually conquering the entire known world. • He had set out to subjugate the earth but just as he was to depart with his army in early June 323 B.C., he contracted Malaria and the voyage was postponed. • Malaria, by striking Alexander, had altered the course of history. • Had the military leader survived, he might well have succeeded in uniting east and west, fusing Greeks and Asians into a single nation. Bharati Vidyapith CME 3 AUG 14
  • 9. Global Malaria Scenario • In 2010 - 216 million cases of Malaria globally. • 91% - Pf cases. • 81 % from African region. • 13 % from South East Asia Region. • Total Malarial Deaths - - 6,55,000. ( 3% SE Asia) • Under 5 mortality – 7% deaths due to Malaria Bharati Vidyapith CME 3 AUG 14
  • 10. Malaria estimates in Pre-control era  It was estimated in 1947 that out of a population of 340 million in the country, annual malaria incidence was 75 million (nearly 22% of population) with 0.8 million deaths  Epidemics at an interval of 5 to 7 years  Economic loss due to malaria to the nation was estimated at Rs. 7500 crores annually in 1940 (Rupee value of the reporting year) Bharati Vidyapith CME 3 AUG 14
  • 11. Malaria Epidemics in Pre Independent India Year Area Affected Deaths 1852 Malaria epidemic wiped out the entire village of Ula and then spread across the Bhagirathi River to Hooghly and continued to devastate populations for many years in Burdwan 1892 Punjab 2,83,223 1900 Punjab Ludhiana, Amballa, Karnal, Gurdaspur & Raya 2,54,580 1908 Punjab - Amristar, Delhi, Palwal, Miani, Gugarat 3,07,316 1920 Bengal 7,30,000 1943 6,80,000 1944 7,63,220 Bharati Vidyapith CME 3 AUG 14
  • 12. 3.29 2.07 1.68 1.36 1.36 1.37 1.1 1995 2000 2005 2008 2009 2010 2011 API 1.56 1.6 1.31 1.09 0.88 2009 2010 2011 2012 2013 Malaria Cases (Figures in Millions) Indian Situation • 27 % Population living in high transmission areas. • 50 % Pf cases • 1000 + deaths every year • 92 % cases & 97 % deaths are from •NEstates, Chhatisgarh,Jharkhand, MP, Orissa, AP, Maharashtra, Gujarat, Rajasth an,WB & Karnataka Bharati Vidyapith CME 3 AUG 14
  • 13. MALARIA ENDEMIC AREA OF THE STATE API less than 1 API 1 -5 API more than 5 BharatiVidyapithCME3AUG14
  • 14. POST GLOBALIZATION MALARIA  Malaria in the 1990s, presented new features which were not commonly seen before, namely, Vector resistance to insecticides; pronounced exophilic behaviour of vectors; extensive breeding sites created by development projects, urbanization and industrialization; change in parasite equation in favour of P.falciparum and resistance of P. falciparum to chloroquine and other antimalarial drugs Bharati Vidyapith CME 3 AUG 14
  • 15. MALARIA IN MAHARASHTRA 2006-2013 54420 67849 67333 93818 139198 96577 58499 43676 133 182 148 227 200 118 96 80 0 50 100 150 200 250 0 20000 40000 60000 80000 100000 120000 140000 160000 2006 2007 2008 2009 2010 2011 2012 2013 Cases Death BharatiVidyapithCME3AUG14
  • 16. Dengue Bharati Vidyapith CME 3 AUG 14
  • 17. Global Dengue Scenario • World's fastest growing vector-borne disease is dengue, with a 30-fold increase in disease incidence over the last 50 years. • Over 2.5 billion people – over 40% of the world's population – are now at risk from dengue. • WHO currently estimates there may be 50–100 million dengue infections worldwide every year. • Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. • The American, South-east Asia and the Western Pacific regions are the most seriously affected. • Foot Prints of Dengue in new areas – 2010 – First time in France & Croatia 2012 – Portugal 2013 – Florida (US) • An estimated 500 000 people with severe dengue require hospitalization each year, a large proportion of whom are children. • About 2.5% of those affected die. Bharati Vidyapith CME 3 AUG 14
  • 18. Determinants of Dengue Rise Unplanned Urbanization Substandard Housing Inadequate Water Supply Inadequate Solid Waste & Sewerage System Increased Population Density International trade (Used tires) Rapid population movement Traditional water storage BharatiVidyapithCME3AUG14
  • 19. DISTRIBUTION OF GLOBAL DENGUE RISK High suitability Low suitability Unsuitable or non endemic 75% of the global population exposed to Dengue lives in Asia Pacific region. BharatiVidyapithCME3AUG14
  • 20. WHEN DENGUE LEADS TO HAVOC…….  Jan – April 2008  1,58,000 Dengue Cases  9000 Admissions  230 deaths  Military deployed for vector control  Call for International aid  US $ 1 billion spent.  2010- 1.2 million cases  Dengue major emerging disease in Saudi Arabia, Yemen & Pakistan.  Frequent OBs in urban areas  In 2011 – 300 deaths in Lahore city alone. Rio De Janerio - Brazil Lahore - Pakistan BharatiVidyapithCME3AUG14
  • 21. Dengue In India 12561 15535 28292 18860 50222 75454 80 96 110 169 301 277 0 50 100 150 200 250 300 350 0 10000 20000 30000 40000 50000 60000 70000 80000 2008 2009 2010 2011 2012 2013 Cases Deaths • 31 States/UTs are Dengue endemic. • All 4 serotypes isolated from India. • DENV-1 & DENV-2 are prevalent. Bharati Vidyapith CME 3 AUG 14
  • 22. DENGUE IN MAHARASHTRA 618 743 2255 1574 1138 4305 5432 24 22 20 9 25 118 138 0 20 40 60 80 100 120 140 160 0 1000 2000 3000 4000 5000 6000 Yr 2007 Yr 2008 Yr 2009 Yr 2010 Yr 2011 Yr 2012 Yr 2013 Cases Deaths BharatiVidyapithCME3AUG14
  • 23. 8 4 1 10 2 2 2 10 2 3 7 1 3 1 2 3 8 8 4 2 2 7 4 2 Dengue Deaths from Rural Maharashtra 2013 Bharati Vidyapith CME 3 AUG 14
  • 24. Filariasis Bharati Vidyapith CME 3 AUG 14
  • 25. HISTORY 6th Century – Susrut recorded Filaria in his ‘Susrut Samhita’ . 7th Century - Madhavkara described signs & symptoms of Filaria in his ‘ Madhava Nidhana’ 1709 – Clarke called elephantoid legs in Cochin as ‘ Malbar Legs’. Lewis – Discovery of microfilariae in peripheral blood in Kolkata ( 1872). BharatiVidyapithCME3AUG14
  • 26. LF – GLOBAL BURDEN  World’s second leading cause of long term debility.  LF doesn’t kill but –  causes debility  imposes severe social & economical burden  Destroys marriages & family relationships.  Cause & effect of poverty o 120 million people from 83 countries infected with LF. o 1/5 World population at risk. o 70 % Infection world wide is from India, Nigeria, Bangladesh & Indonesia. BharatiVidyapithCME3AUG14
  • 27. LF - INDIA  20 States 250 districts 600 million population is at risk.  2010 Survey – 8 Lac cases of Elephantiasis & 4 Lac cases of Hydrocele in India. BharatiVidyapithCME3AUG14
  • 28. MAHARASHTRA FILARIA SITUATION  Elephantiasis – 43,987 Hydrocele - - 28,975 Total - 72,968 In Maharashtra, 17 districts are endemic for LF. BharatiVidyapithCME3AUG14
  • 29. 2.86 1.43 1.23 1.13 0.44 0.46 0.51 0.54 0.43 Maharashtra Mf Rate 1.24 1.02 0.98 0.64 0.53 0.65 0.41 0.37 0.41 0.27 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 India Mf rate Elimination of Filarisis by 2015 Mass Drug Administration is core strategy to achieve it. •In Nalganda district of AP,Mf rate is reduced from 17 (2004) to 0.8 in 2009. • 192 out of 250 endemic districts are having below 1 Mf rate in 2011. BharatiVidyapithCME3AUG14
  • 30. Chikungunya • Chikungunya is a mosquito- borne viral disease first described during an outbreak in southern Tanzania in 1952. • Kolkata outbreak – 1963-64 • Chennai Outbreak – 1965 – 3 Lac cases in Chennai City alone. • Return of Chikungunya after 41 years – 16 states involved – 1.39 million cases reported. ( Attack Rate – 45% in some areas) The name ‘chikungunya’ derives from a word in the Kimakonde language, meaning "to become contorted" and describes the stooped appearance of sufferers with joint pain Bharati Vidyapith CME 3 AUG 14
  • 31. Bharati Vidyapith CME 3 AUG 14
  • 32. 95091 73288 48176 20402 15977 18639 2008 2009 2010 2011 2012 2013 Chikungunya Cases In India Bharati Vidyapith CME 3 AUG 14
  • 33. Japanese Encephalitis • Japanese encephalitis (JE) is a flavivirus related to dengue, yellow fever and West Nile viruses, and is spread by mosquitoes. • JE is the main cause of viral encephalitis in many countries of Asia with nearly 68 000 clinical cases every year. • The case-fatality rate 30%. • Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis. • 24 countries in the WHO South-East Asia and Western Pacific regions have endemic JE transmission, exposing more than 3 billion people to risks of infection. Bharati Vidyapith CME 3 AUG 14
  • 34. India – JE+ AES Situation 4292 5628 5722 9463 9089 8911 754 882 791 1350 1396 1475 2008 2009 2010 2011 2012 2013 Cases Deaths Bharati Vidyapith CME 3 AUG 14
  • 35. YEAR JE CHANDIPURA AES TOTAL Cases Deaths Cases Deaths Cases Deaths Cases Deaths 2007 2 0 0 0 0 0 2 0 2008 1 0 4 3 24 13 29 16 2009 8 0 52 15 36 15 96 30 2010 7 1 50 16 29 16 86 33 2011 13 0 11 3 13 11 37 14 2012 11 0 20 1 41 26 72 27 2013 -- -- -- -- 5 5 5 5 Maharashtra – JE, Chandipura & AES Situation Bharati Vidyapith CME 3 AUG 14
  • 36. Bharati Vidyapith CME 3 AUG 14
  • 37. What lies ahead ? ? ? Opportunities Risks Human Ecology GlobalizationDemography Bharati Vidyapith CME 3 AUG 14
  • 38. Increased Temperature Rate of blood meal digestion increases Acceleration the ovarian development & egg- laying Reduction in duration of the gonotrophic cycle More frequency of feeding on hosts Increasing the probability of transmission •By 2100 it is estimated that average global temperatures will have risen by 1.0–3.50 C. •This will increase likelihood of many vector-borne diseases in new areas. What Climate Change will lead to ? Bharati Vidyapith CME 3 AUG 14
  • 39. Increased International Travel Bharati Vidyapith CME 3 AUG 14
  • 40. Will Yellow Fever Come to India ? • India – Yellow Fever ‘receptive’ area. • Vector – aedes aegypti is found in abundance. • Climatic condition – favourable • Common monkey in India ( Macacus spp) – susceptible to Yellow Fever • Missing link is --- Chain of transmission… • An infected traveler OR mosquito ??? Bharati Vidyapith CME 3 AUG 14
  • 41. Bharati Vidyapith CME 3 AUG 14
  • 42. New Research…… New Hope….. Bharati Vidyapith CME 3 AUG 14
  • 43. Bharati Vidyapith CME 3 AUG 14
  • 44. Bharati Vidyapith CME 3 AUG 14
  • 45. No one in the 21st century should die from the bite of a mosquito, a sand fly, a black fly or a tick. Margaret Chan Director General World Health Orgnization Bharati Vidyapith CME 3 AUG 14