National health programs for communicable diseases

NATIONAL HEALTH PROGRAMS FOR
COMMUNICABLE DISEASES
-DR. RITU RANDAD
-08/02/2022
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Content page
SR.NO TITLE
1 INTRODUCTION
2 COMMUNICABLE DISEASES
3 INTEGRATED DISEASE SURVEILLANCE PROGRAMME (IDSP)
4 REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTBCP)
5 NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)
2

SR. NO TITLE
6 NATIONAL AIDS CONTROL PROGRAMME (NACP)
7 PULSE POLIO PROGRAMME (PPP)
8 NATIONAL VIRAL HEPATITIS CONTROL PROGRAMME(NVPCP)
9 NATIONAL RABIES CONTROL PROGRAMME (NRCP)
10 NATIONAL PROGRAM FOR VECTOR BORNE DISEASE (NPVBD)
11 PROGRAMME FOR PREVENTION AND CONTROL OF LEPTOSPIROSIS (PPCL)
12 NATIONAL PROGRAMME ON CONTAINMENT OF ANTI MICROBIAL
RESISTANCE (NPCAMR)
13 CONCLUSION
14 REFERENCES
3

INTRODUCTION
• Despite enormous advances in medical sciences and their applications in public health,
infectious diseases remain a central challenge for public health in the 21st century.
• Globalization has facilitated the spread of many infectious agents to all corners of the globe.
Mass travel, economic globalization, and climate change, along with accelerating
urbanization of human populations, are causing environmental disruption, including
global warming. There are and will be more consequences in international transmission of
infectious diseases, in humans and wildlife.
4
Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi: 10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10.
PMCID: PMC7171903.

• A communicable disease is an illness due to a specific infectious agent or its toxic
products that arises through transmission of that agent or its products from an
infected person, animal, or inanimate reservoir to a susceptible host. Transmission
may be direct from person to person, or indirect through an intermediate plant or
animal host, vector, or the inanimate environment.
Heymann DL, editor. Control of communicable diseases manual. 19th ed. Washington,
DC: American Public Health Association; 2008.
PMCID: PMC7171903.
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• Illnesses caused by viruses or bacteria that people spread to one another through contact
with contaminated surfaces, bodily fluids, blood products, insect bites, or through the
air.
• Some of the communicable diseases, some of which require reporting to appropriate
health departments or government agencies in the locality of the outbreak.
• Most common forms of spread include fecal-oral, food, sexual intercourse, insect
bites, contact with contaminated fomites, droplets, or skin contact.
COVID-19 ,HIV, hepatitis A, B and C, measles, salmonella, measles, and blood-borne illnesses etc.
PMCID: PMC7171903.
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• Each disease has its own characteristic organism and natural history from onset to
resolution. Many infectious diseases may remain at a pre-symptomatic or subclinical
stage without progressing to clinical symptoms and signs but may be transmissible to
other people. Even a subclinical disease may cause an immunological effect,
producing immunity.
PMCID: PMC7171903.
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• Variety of methods:
1. by clinical syndrome,
2. mode of transmission, and
3. methods of prevention (e.g., vaccine
preventable)
• Major organism,
1. viral,
2. bacterial,
3. fungal, and
4. parasitic disease.
CLASSIFICATION OF
PMCID: PMC7171903.
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• Time duration:
1. Acute infectious diseases are intense or short term but may have long-
term sequelae of great public health importance, such as
poststreptococcal glomerulonephritis or rheumatic heart disease.
2. Chronic infections have their own long-term effects, such as HIV
infection or peptic ulcers. Infections may have both short-term and long-
term morbidity, as with viral hepatitis infections.
PMCID: PMC7171903.
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TERMS USED IN IMMUNOLOGY OF
• Infectious agent – a pathogenic organism (e.g., virus, bacterium, rickettsia, fungus, protozoa,
helminth, pollen, or chemical) is one capable of producing infection or an infectious disease in
humans, animals, and plants.
• Infection – the process of entry, development, and proliferation of an infectious agent in the
body tissue of a living organism overcoming the host’s defense mechanisms, resulting in a
non-apparent or clinically manifest disease.
• Innate immunity – includes the cough reflex, skin, mucus, and stomach acidity as barriers
which protect the body against infection.
• Acquired immunity – developed as result of natural exposure or deliberate exposure by
immunization to an infectious agent or its antigenic components which protects against later
exposure to the active live agent.
PMCID: PMC7171903.
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• Cellular immunity (cell-mediated immunity) – immunity acquired with T lymphocyte
cells producing chemicals which activate natural killer cells (macrophages).
• Herd immunity – resistance of a group to an infectious disease when a large percentage
of the population at risk is immune through previous exposure to the disease or by
immunization.
• Antisera or antitoxin – materials prepared in animals for use in passive immunization
against infection or toxins.
- Last JM. Dictionary of public health. New York:
Oxford University Press; 2007.US National Library of Medicine
PMCID: PMC7171903.
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• Surveillance of disease is the continuous inspection of all aspects of the occurrence and
spread of a disease relevant to effectively control that disease.
• Maintaining ongoing surveillance is one of the basic duties of a public health system and
National Programs, and is vital to the control of communicable disease, providing the
essential data for tracking of disease, planning interventions, and responding to future
disease challenges.
• Surveillance of infectious disease relies on reports of notifiable diseases by physicians,
supplemented by individual and summary reports of public health laboratories. Concerned
with the completeness and quality of reporting and potential errors and artifacts.
PMCID: PMC7171903.
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INTEGRATED DISEASE SURVEILLANCE
PROGRAMME (IDSP)
• 2004- The Integrated Disease Surveillance Program (IDSP) was initiated in assistance with World bank.
• The Programme continues during 12th Plan (2012–17) under National Health Mission with a budget of Rs.
64.04 Crore from domestic budget. The Central Surveillance Unit (CSU) at the National Centre for Disease
Control (NCDC), receives disease outbreak reports from the States/UTs on weekly basis. Even NIL weekly
reporting is mandated, and compilation of disease outbreaks/alerts is done on weekly basis.
• Data collected at 3 specified reporting formats,
1. “S” (suspected cases),
2. “P” (presumptive cases) and
3. “L” (laboratory confirmed cases) filled by Health Workers, Clinicians and Laboratory staff respectively.
• State/District Surveillance Units analyses this data weekly, to interpret the disease trends and seasonality of
diseases.
To strengthen disease surveillance for infectious diseases to detect and respond to outbreaks immediately.
• https://www.nhp.gov.in/integrated-disease-surveillance-program-(idsp)_pg
• https://ncdc.gov.in/index1.php?lang=1&level=1&sublinkid=106&lid=54
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• Objective:
1. To develop skilled manpower.
2. To strengthen surveillance activities for early detection.
3. To strengthen laboratory support.
4. To institute a network of effective communication link between district and state level.
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• Programme Components:
1. Integration and decentralization of surveillance activities through the establishment of
surveillance units at Centre, State and District level.
2. Human Resource Development – Training of State Surveillance Officers, District
Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff
on principles of disease surveillance.
3. Use of Information Communication Technology for collection, collation, compilation,
analysis and dissemination of data.
4. Strengthening of public health laboratories.
5. Inter sectoral Co-ordination for zoonotic disease.
15

• IDSP is combined with Integrated Health Information Platform (IHIP).The IHIP is a web-
enabled near-real-time electronic information system that is embedded with applicable
Government of India's e-Governance standards, information technology (IT), data &
metadata standards to provide state-of-the-art single operating picture with geospatial
information for managing disease outbreaks and related resources.
• In the first phase, was launched in selected districts of 7 States of Karnataka, Andhra
Pradesh, Himachal Pradesh, Odisha, Uttar Pradesh, Telangana & Kerala in 2018.
16

REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAMME (RNTBCP)
• https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg
• https://tbcindia.gov.in/showfile.php?lid=3314
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YEAR OF
DEVELOPMENT
MILESTONES
1962 Launched by the Government of India in the form of District TB Centre model involved with BCG
vaccination and TB treatment.
1978 BCG under the Expanded Programme on Immunization. Government of India, World Health
Organization (WHO) and the Swedish International Development Agency (SIDA) .
1992 Programme, managerial weaknesses, inadequate funding, over-reliance on x-ray, non-standard
treatment regimens, low rates of treatment completion, and lack of systematic information on
treatment outcomes.
1993 The Government of India revitalized NTP as Revised National TB Control Programme
(RNTCP).
1997 DOTS was officially launched as the RNTCP. (directly observed treatment short-course)

End of 2006 the entire country was covered under the programme.
2006–11 Second phase improved the quality and reach of services and worked to reach global
case detection and cure targets.(achieved by 2007-08).
Despite these achievements, undiagnosed and mistreated cases continued to drive the TB
epidemic.
19
(DOT is a specific strategy, to improve adherence by any person observing the patient taking
medications in real time. The treatment observer does not need to be a health-care worker, but could
be a friend, a relative or a lay person who works as a treatment supervisor or supporter.

• Tuberculosis is a specific infectious disease caused by M. tuberculosis, affecting lungs
causing pulmonary tuberculosis.
• Affects intestine, meninges, bones and joints, lymph nodes, skin and other tissues of the
body.
• Chronic with various clinical manifestations.
• Also affects animals, ‘bovine tuberculosis’.
20
K Park, Textbook of Preventive and Social Medicine, 25th Edition, Bhanot, Jabalpur

Problem statement of
India
Highest burden in the world with maximum number of
incident cases occurring each year.
¼ of all the global cases.
TB affects population in their most productive years of
life (25-54 years)
2/3 cases are male, but larger toll among young females
with cases before age 34 years.
1/3 of infertility among women in due to TB
Disease of poor. Migrant labourers, slum
dwellers, residents of backward areas and
tribal pockets. Poor living conditions,
malnutrition, shanty housing and
overcrowding.
21

NEED OF THE PROGRAMME
AGENT- photochromogens, scotochromogens, non-photochromogens and
rapid growers.
SOURCE OF INFECTION- human source and bovine source (infected milk).
COMMUNICABILITY- infective as long as not treated. Effective microbial
treatment reduces infectivity by 90% within 48 hours.
MODE OF TRANSMISSION- droplet infection and droplet nuclei by sputum
positive patients. Coughing caries maximum number of droplets.
INCUBATION PERIOD- 3 to 6 weeks, and development depends on closeness
of contact, extend of disease and sputum productivity.
1. Affects all age group
2. 20% in age of 15-24
years.
3. Males than females
22

• TB was the leading cause of illness and death among persons living with
HIV/AIDS and large number of multidrug resistant TB (MDR-TB) cases
were reported every year. “TB free India”, National Strategic Plan for
Tuberculosis Control 2012-2017 was documented with the goal of
‘universal access to quality TB diagnosis and treatment for all TB
patients in the community’.
23

INTERVENTIONS AND INITIATIVES
Significant interventions and initiatives in terms of mandatory notification of all TB cases,
integration of the programme with the general health services (National Health Mission),
1. expansion of diagnostics services,
2. programmatic management of drug resistant TB (PMDT) service expansion,
3. single window service for TB-HIV cases,
4. national drug resistance surveillance and
5. revision of partnership guidelines.
24

Goal ahead for the programme
• To eliminate TB by 2025, five years ahead of the global target, a framework to guide the
activities of all stakeholders including the national and state governments, development
partners, civil society organizations, international agencies, research institutions, private
sector, and many others whose work is relevant to TB elimination in India is
formulated by RNTCP as National Strategic Plan for Tuberculosis Elimination
2017-2025.
25

National strategic plan for tuberculosis
elimination 2017-2025
• RNTCP has released a ‘National strategic plan for tuberculosis 2017-2025’ (NSP) for the
control and elimination of TB in India by 2025.
four strategic pillars of “Detect – Treat – Prevent – Build” (DTPB).
1. Detect:
• find all drug sensitive TB cases (DS-TB) and drug resistant TB cases (DRTB) with an
emphasis on reaching TB patients seeking care from private providers and undiagnosed TB
cases in high-risk populations.
• Early diagnosis and treatment of TB cases in the community is an important step in TB
elimination.
26

• Ministry of Health and Family Welfare, Government of India since 2012.
• Notify every TB case to district health officer, chief medical officer of a
district, and municipal health officer of a municipal corporation/
municipality) every month.
• With its amendment in 2015, all laboratories are also included to notify TB
cases.
• 2018, all chemists to notify as well.
NOTIFICATION
OF TB CASES
• RNTCP has developed a case-based web-based TB surveillance system
called “NIKSHAY” (https://nikshay.gov.in ) for both government and
private health care facilities.
• Future enhancements are for patient support, logistics management,
direct data transfers, adherence support and to support interface
agencies which are supporting programme to expand the reach.
NIKSHAY
27

• For promotion of public-private mix (PPM) in TB
prevention and care, incentives for TB case
notification, and for ensuring treatment adherence
and treatment completion. The incentives are
provided through direct beneficiary transfer.
PUBLIC
PRIVATE
PARTNERSHIP
The incentives to the Private Sector TB Care Provider are as follows:
•Rs 250/- on notification of a TB case diagnosed as per Standards for TB Care in India (STCI)
•Rs 250/- on completion of every month of treatment
•Rs 500/- on completion of entire course of TB treatment
•Rs 2750/ for notification and management of a drug-sensitive patient over 6-9 months as per STCI
•Rs 6750/-for notification and correct management of a drug-resistant case over 24 months as per STCI
28

• Free drugs and diagnostic tests to TB patients in private sector-
1. is access to programme- provided drugs and diagnostics through attractive linkages; and
2. is reimbursement of market- available drugs and diagnostics.
• Significant cost reduction of select diagnostics is achieved by ‘Initiative for Promoting
Affordable and Quality TB Tests’ (IPAQT). 131 private sector labs networked to provide four
quality tests at ‘ceiling prices.
For TB diagnosis more than 14,000 designated microscopy centres spread across the country.
Reference laboratories have been established at state and national levels which provide culture
and drug sensitivity test.
29

2.Treat:
• Provision of free TB drugs as daily fixed dose combinations (FDCs) for all TB cases
is advised with the support of directly observed treatment (DOT).
• First line treatment of drug-sensitive TB consists of a two-months (8weeks)
intensive phase with four drug FDCs followed by a continuation phase of four
months (16 Weeks) with three drug FDCs.
30

• Nikshya poshak yozana: It is centrally sponsored scheme under National
Health Mission (NHM), financial incentive of Rs.500/- per month is
provided for nutritional support to each notified TB patient for duration for
which the patient is on anti-TB treatment.
Incentives are delivered through Direct benefit transfer (DBT) scheme to bank
accounts of beneficiary.
31

Expending options for ICT based treatment
adherence support mechanisms:
• Mobile based “Pill-in-Hand”
adherence monitoring tool
• Interactive Voice Response (IVR),
SMS reminders.
• Patient Compliance toolkit: a mobile
app for patients to report treatment
compliance using video, audio or text
message
• Automated pill loading system
• Innovatively designed ICT enabled
smart cards SMS gateway
• TB-HIV
• Diabetics, Tobacco use and Alcohol
dependence
• Poor, undernourished, economically and
socially backward communities
• TB control in hilly and difficult terrains
• Substance dependence and sexual minorities
• TB and pregnancy
• Paediatric population
• Prison Inmates and staff of prisons/jails
• Management of extra pulmonary TB
32

3. Prevent:
1. Scale up air-borne infection control measures at health care facilities
2. Treatment for latent TB infection in contacts of bacteriologically-confirmed cases
3. Address social determinants of TB through intersectoral approach.
a) Air borne infection control measures
b) Contact tracing
c) Isoniazid Preventive Therapy (IPT)
d) BCG vaccination
33

4. Build:
• Recommended in the form of building and strengthening enabling policies,
• empowering institutions and
• human resources with enhanced capacities.
34

NATIONAL LEPROSY ERADICATION
PROGRAMME (NLEP)
• Centrally sponsored Health Scheme of the Ministry of Health and Family Welfare, Govt. of India.
• Headed by the Deputy Director of Health Services under the administrative control of the
Directorate General Health Services Govt. of India. Strategies and plans are formulated centrally,
the programme implemented by States/UTs.
• Partners by the World Health Organization, The International Federation of Anti-leprosy
Associations (ILEP) and few other Non-Govt. Organizations.
• Four Research & Training Institutes were established, namely Central Leprosy Training and
Research Institute (CLTRI) Chengalpattu, Regional Leprosy Training and Research Institute
(RLTRI) at Raipur, Gauripur and Aska. With a Training Centre was established at Agra under
ICMR.
• https://dghs.gov.in/content/1349_3_NationalLeprosyEradicationProgramme.aspx
• https://www.nhp.gov.in/national-leprosy-eradication-programme_pg
35

• 34 States/ UTs had attained the level of leprosy elimination. A total of 542 districts
(84.7%) out of total 640 districts elimination by March 2012. A total of 209 high risk
districts were identified for special actions during 2012-13. A total of 1792 blocks and
150 urban areas were identified for special activity plan (SAP- 2012).
• The States trained District Leprosy Officer in all the districts.
• In addition, one officer is identified to strengthen the process of supervision and
monitoring. Active house to house survey was the main strategy along with capacity
building of workers and volunteers.
36

Current situation in India
• Widely prevalent in India, present throughout the
country but unevenly distributed.
• 1981- 57.6:10,000 to less than 1:10,000 in 2005,
achieved goal of leprosy elimination at national level.
• Out of 1.35 lac, 1.19 lac completed their treatment with
Tripura, Mizoram, Daman Diu whereas Lakshadweep
has poor performance.
37
1991, WHO states
resolved to decrease the
level of leprosy by
90%.
Fall is due to
improvement in
management of cases,
low rates of relapse,
high cure rates,
absence of drug
resistance and shorter
duration of treatment
with MDT

VISION AND MISSION 38
• VISION:
“Leprosy-free India” is the vision of the NLEP.
• MISSION:
To provide quality leprosy services free of cost to all sections of the
population, with easy accessibility, through the integrated healthcare
system, including care for disability after cure of the disease.

OBJECTIVES
• Objectives:
1. To reduce Prevalence rate less than 1/10,000 population at sub national and district
level.
2. To reduce Grade II disability % < 1 among new cases at National level.
3. To reduce Grade II disability cases < 1 case per million population at National level.
4. Zero disabilities among new Child cases.
5. Zero stigma and discrimination against persons affected by leprosy.
39

PROGRAM COMPONENTS
1. Case Detection and Management
2. Disability Prevention and Medical Rehabilitation (DPMR).
3. Information, Education and Communication (IEC) including Behaviour Change
Communication (BCC)
4. Human Resource and Capacity building
5. Programme Management
40

SALIENT FEATURES
1. Centrally sponsored scheme of Government of India.
2. Functions under the umbrella of National Health Mission (NHM).
3. Follows decentralized health planning and funds are sent to the states through State
Health Societies.
4. Quality of services and sustainability is the main-focus.
5. Disability Prevention & Medical Rehabilitation (DPMR) is a priority.
6. Removal of stigma and discrimination is a part of the strategy.
41

Various leprosy endemicity
maps from 1981 to 2020,
showing the prevalence of
leprosy at different points of
time
42

NATIONAL AIDS CONTROL PROGRAMME
(NACP) 43
• Launched in year 1987 by Ministry of Health and
Family Welfare as a separate wing to implement
and closely monitor.
• AIM:-
1. prevent further transmission of HIV,
2. decrease morbidity and mortality associated
with HIV and
3. minimize the socio-economic impact.
https://www.nhp.gov.in/national-aids-control-programme_pg

Milestones of NACP 44
year milestones
1986 First HIV case detected, AIDS task force set up by ICMR, National AIDS committee
established.
1990 Medium Term Plan launched for 4 states and 4 metros
1992 NACP-1 launched to slow down spread of HIV infection, National AIDS Control Board
constituted, NACO launched
1999 NACP-2 launched, State AIDS Control Societies established
2002 National AIDS Control Policy adopted, National Blood Policy adopted
2006 National Policy for Paediatric ART formulated, National Council on AIDS under
chairmanship of the Prime Minister
2007 NACP-3 launched for 5 years (2007-2012)
2014 NACP -4 for 5 years (2012-2017)
2017 National Strategic Plan for HIV/AIDS and STIs 2017-2024

• Objectives:
1. To reduce spread of HIV infection in India.
2. Strengthen India's capacity to respond to HIV/AIDS on a long-term basis.
• Reflecting the extreme urgency with which HIV prevention and control need to be
pursued in India, the AIDS - II project of the National AIDS Control Programme is
across all States and Union Territories and a Centrally Sponsored Scheme with
100% financial assistance from Government of India direct to State AIDS Control
Societies and selected Municipal Corporations/AIDS Control Societies.
45

COMPONENTS OF NATIONAL STRATEGY
1. Establishment of surveillance centres to cover whole country.
2. Identification of high risk group and their regular screening.
3. Issuing specific guidelines for management of detected cases and their follow up
4. Formulating guidelines for blood banks.
5. Information, education and communication activities for reducing personal and social
impact of the disease.
6. Control of sexually transmitted diseases and,
7. Condom programme.
46

• High prevalence states: Maharashtra, Tamil Nadu, Karnataka,
Andhra Pradesh, Manipur and Nagaland
• 5 % mark in high risk group and 1% or more in antenatal women.
CATEGORY 1
• Moderate prevalence states: Gujarat, Goa and Puducherry
• 5 % mark in high risk group and infection below 1% in antenatal
women
CATEGORY 2
• Low prevalence states: remaining states where high risk group
is less than 5% and infection below 1% in antenatal women.
CATEGORY 3
47
Prevention and Care, Support & Treatment (CST) form the two key pillars of all the AIDS control efforts
in India. Strategic Information Management and Institutional Strengthening activities provide the
required technical, managerial and administrative support for implementing the core activities under NACP-
III at national, state and district levels.

HIV testing for Tuberculosis patients
PREVENTION
Airborne infection control
Awareness generation
Isoniazid preventive treatment
EARLY DETECTION
100% coverage of PITC in TB patients
Rapid diagnostics for detection
ICF activities at all HIV settings
PROMPT TREATMENT
Early initiation of ART
Prompt treatment of TB treatment
MANAGEMENT OF SPECIAL CASES
TB/HIV in children
TB/HIV in pregnant women
Drug Resistance TB/HIV
TB/HIV co-ordination to
reduce mortality
48

National Strategic Plan for HIV/AIDS and STI
2017-2024
• Goal- to achieve 0 new infections, 0 AIDs related deaths and 0 AIDS related stigma and
discrimination.
49
number objectives
1 Reduce 80% new infection by 2024
2 Ensure 95% of PLHIV know their status by 2024
3 Ensure 95% PLHIV have ART initiation and reduction by 2024
4 Eliminate mother-child transmission of HIV and syphilis
5 Eliminate HIV/AIDS related stigma and discrimination by 2024`
6 Facilities sustainable NACP service delivery by 2024.

PULSE POLIO PROGRAMME (PPP)
• With the global initiative of eradication of polio in 1988 following World Health Assembly
resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995.
• Children of 0-5 years are administered polio drops during National and Sub-national
immunization rounds every year. Around 17.4 crore children across the country are given
polio drops.
• 13th January 2011-The last polio case in the country was reported from Howrah district
of West Bengal.
• WHO on 24th February 2012 removed India from the list of countries with active endemic
wild polio virus transmission.
50
https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme

AIM AND OBJECTIVE
• AIM: to immunize children through improved social mobilization, plan mop-up
operations in areas where poliovirus has almost disappeared and maintain high
level of morale among the public.
• OBJECTIVE: to achieve 100% coverage under Oral Polio Vaccine.
51

Steps taken by Government of India to
maintain polio free status
• Maintaining community immunity- quality National and Sub National polio rounds each
year.
• Environmental surveillance (sewage sampling) established as programmatic interventions
strategically in Mumbai, Delhi, Patna, Kolkata, Punjab and Gujarat.
• All States and Union Territories- Rapid Response Team (RRT) to respond to any polio
outbreak in the country.
• International border vaccination is being provided through continuous vaccination
teams (CVT) eligible children. These are provided through special booths set up at the Indian
border shared with Pakistan, Bangladesh, Bhutan, Nepal and Myanmar.
52

• Government of India has issued guidelines for mandatory requirement of polio vaccination
to all international travelers before their departure from India to polio affected countries
namely: Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia, Syria and Cameroon,
from 1st March 2014.
• A rolling emergency stock of OPV is being maintained to respond to detection/importation
of wild poliovirus (WPV).
• National Technical Advisory Group on Immunization (NTAGI) has recommended Injectable
Polio Vaccine (IPV) introduction as an additional dose along with 3rd dose of DPT in the
entire country in the last quarter of 2015 as a part of polio endgame strategy.
53

NATIONAL VIRAL HEPATITIS CONTROL
PROGRAM (NVHCP)
• The National Viral Hepatitis Control Program has been launched by Ministry of Health and
Family Welfare, Government of India on the World Hepatitis Day, 28th July 2018.
• This is a comprehensive plan covering the entire gamut from Hepatitis A, B, C, D & E, and
the whole range from prevention, detection and treatment to mapping treatment
outcomes. Operational Guidelines for National Viral Hepatitis Control Program,
National Laboratory Guidelines for Viral Hepatitis Testing and National Guidelines
for Diagnosis and Management of Viral Hepatitis are part of the programme.
54
https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg

AIMS AND OBJECTIVES
AIMS
1.Combat hepatitis and achieve country
wide elimination of Hepatitis C by
2030.
2. significant reduction in the infected
population, morbidity and mortality
associated with Hepatitis B and C.
3.Reduce the risk, morbidity and
mortality due to Hepatitis A and E.
OBJECTIVES
1.Community awareness and stress on preventive
measures among general population.
2.Provide early diagnosis and management of
viral hepatitis.
3.Develop standard diagnostic and treatment
protocols.
4.Develop linkages with the existing National
programs towards awareness, prevention,
diagnosis and treatment for viral hepatitis.
5.Develop a web-based “Viral Hepatitis
Information and Management System” to
maintain a registry of persons affected with viral
hepatitis and its sequelae.
55
https://www.nhp.gov.in/national-viral-hepatitis-control-
program-(nvhcp)_pg

Components of NVHCP
PREVENTIVE COMPONENT
1.Awareness generation &
behaviour change communication
2.Immunization of Hepatitis B
3.Safety of blood and blood
products
4.Injection safety, safe socio-
cultural practices
5.Safe drinking water, hygiene and
sanitary toilets
DIAGNOSIS AND TREATMENT
1.Screening of pregnant women for HBsAg to be
done in areas where institutional deliveries are
< 80% to ensure their referral for birth dose
Hepatitis B vaccination.
2.Free screening, diagnosis and treatment for
both hepatitis B and C made available at all
levels of health.
3.Engagement with community/peer support to
enhance and ensure adherence to treatment.
56

MONITORING AND EVALUATION,
SURVEILLANCE AND RESEARCH
• Effective linkages to the surveillance
system would be undertaken through
Department of Health Research
(DHR).
• Standardized monitoring &
evaluation framework to be
developed for an online web-based
system is established.
TRAINING AND CAPACITY BUILDING
• A continuous process to be supported by NCDC
(National Centre for Disease Control), ILBS
(Institute of Liver and Biliary Sciences) and
state tertiary care institutes and coordinated
by NVHCP.
• Various platforms available for enabling
electronic, e-learning and e-courses.
57

National Viral Hepatitis Control
Management Unit
• The NVHCP is coordinated by the units at the centre and the states.
1. The NVHCMU is established at the centre with in the NHM (National Health Mission) and is
responsible for implementation of program in the country, headed by a Joint Secretary
who will report to the Mission Director (NHM).
2. State Viral Hepatitis Management Unit (SVHMU)- nodal officer and required essential
manpower will coordinate the program at state level.
3.District Viral Hepatitis Management Unit (DVHMU)- A program officer at the district level
to supervise the program and facilitate the logistics, supply chain, outreach, training at
district level.
58

NATIONAL RABIES CONTROL PROGRAMME
(NRCP)
Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the
warm-blooded animals. The virus is found in wild and some domestic animals and is
transmitted to other animals and to humans through their saliva.
In India, dogs are responsible for about 97% of human rabies, followed by cats
(2%), and others (1%).
The disease is invariably fatal which the sick person is tormented at the same time
with thirst and fear of water (hydrophobia). The post-exposure treatment of animal
bite cases are of prime importance.
59
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• National Centre for Disease Control (formerly National Institute of Communicable
Diseases), Delhi, WHO Collaborating Centre for Rabies Epidemiology, organized an
expert consultation in 2002 to formulate national guidelines for rabies prophylaxis to bring
out uniformity in post-exposure prophylaxis practices.
• Under the 12 five-year plan, National Rabies Control Programme (NRCP) has been
approved. The NRCP has both human and animal health components.
60

VARIOUS COMPONENTS
HUMAN COMPONENT
Implemented in all the states & UTs. National
Centre for the Diseases control is the nodal
agency. The strategies are:
• Training of health professionals
• Implementing use of intra-dermal route of
inoculation of cell culture vaccines
• Strengthening surveillance of human rabies
• Information Education & Communication
• Laboratory strengthening
ANIMAL COMPONENT
Being pilot tested in the Haryana & Chennai. The Animal
Welfare Board of India, Ministry of Environment &
Forests is the Nodal agency. The strategies are:
• Population survey of dogs
• Mass vaccination of dogs
• Dog population management
61

NATIONAL VECTOR BORNE DISEASE
CONTROL PROGRAMME
• the National Vector Borne Disease Control Programme (NVBDCP) – Malaria, Filariasis,
Kala azar, Japanese Encephalitis, Dengue and Chikungunya.
• The Directorate of NVBDCP is nodal for planning, policy making and technical
guidance and monitoring and evaluating the programme.
• Covered under the overall umbrella of National Rural Health Mission.
• The States are responsible for the planning and implementation and supervision of the
programme.
62
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• Under the NVBDCP, the three pronged strategy for prevention and control of vector borne
disease is as follows:
1. Disease management including early case detection and complete treatment,
strengthening or referral services, epidemic preparedness and rapid response.
2. Integrated vector management including indoor residual spraying in selective high-
risk areas, use of insecticide treated bed nets, source reduction and minor environmental
engineering.
3. Supportive intervention include behaviour change communication, intersectoral
convergence, human resource development and annual drug administration.
63

MALARIA
• Before 1953, estimated malaria cases in India-75 million, Deaths due to malaria -0.8
million.
• 1953, National Malaria Control Programme, during FIRST FIVE YEAR PLAN.
• 1958, after the success achieved in control of malaria, the control program was
converted to eradication program.
• 1972, cases reduced to 1-2 million AND 0 deaths.
64

Milestones of NATIONAL ANTI- MALARIA
PROGRAMME
YEAR MILESTONES
1977 Modified Plan of Operations implemented
1997 World Bank assisted Enhanced Malaria Control Project launched.
1999 Renaming of programme to NATIONAL ANTI- MALARIA PROGRAMME .
2002 Global fund assisted Intensified Malaria Control Project launched.
2005 NVBDCP became integral part of NRHM
2005 Introduction of RDT in the programme
2006 ACT introduced in areas showing chloroquine resistance in falciparum malaria.
65

2008 ACT extended to high P falciparum predominant district covering about 95% pf
cases.
2008 World Bank supported National Malaria Control Project launched.
2009 Introduction of LLINs (long lasting insecticidal nets)
2010 New drug policy 2010
2012 Introduction of bivalent RCT
2013 New drug policy 2013
2016 National Framework for Malaria Elimination in India launched
2017 National Strategy Plan for Malaria Elimination in India 2017-2022 launched.
66

MAIN ACTIVITIES OF THE PROGRAMME
1. Formulating policies and guidelines.
2. Technical guidance
3. Planning
4. Logistics
5. Monitoring and evaluation
6. Coordination of activities through the States/UT and in consultation with National
Centre for Disease Control , National Institute of Malaria Research.
7. Training
8. Facilitating research through NCDC, NIMR, Regional Medical Research Centres etc.
9. Coordinating control activities in the inter-state and inter- country border areas.
67

Organization
• 19 Regional Offices for Health and Family Welfare under Directorate General of Health Services,
Ministry of Health and Family Welfare, located in 19 states.
• Offices are equipped with malaria trained staff.
• Headed by- State Programme Officer (SPO) who is responsible for supervision, guidance and
effective implementation.
• At the divisional level, zonal officers have technical and administrative responsibilities of the
programme in their areas under Senior Division Officer (SDO).
• At district level- the Chief Medical Officer/ District Health Officer with one Assistant Malaria
Officer and Malaria Inspector to assist him.
68

NATIONAL FRAMEWORK FOR MALARIA
ELIMINATION IN INDIA (2016-2030)
• The vision of India’s malaria control programme has been shifted to sustained malaria
elimination to contribute more effectively to improve health and quality of life of the
people.
• The NATIONAL FRAMEWORK FOR MALARIA ELIMINATION IN INDIA 2016-2030 was
launched in February 2016.
69

Goals of the programme
1. eliminate malaria (indigenous cases) throughout the entire country by
2030.
2. Maintain malaria-free status in areas where malaria transmission has
been interrupted and prevent re-introduction of malaria.
70

Programme phasing
• Category 1 States/ UTs : Himachal Pradesh, Punjab, Jammu
Kashmir, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand,
Haryana, Sikkim, Rajasthan, Daman Diu, Goa and Delhi.
• Category 2 States/ UTs : Bihar, Tamil Nadu, Telangana, Uttar
Pradesh, Karnataka, West Bengal, Andhra Pradesh, Assam,
Meghalaya, Maharashtra, Gujarat and Nagaland.
• Category 3 States/ UTs :Andaman and Nicobar islands, MP, Dadar
and Nagar Haveli, Jharkhand, Arunachal Pradesh, Chhattisgarh,
Odisha and Mizoram.
71
Category 0-
Prevention of Re-
establishment phase
Category 1-
elimination phase
Category 2- Pre-
elimination phase
Cateogry3 – intensified
control phase

Goals of the programme
1. By 2022, transmission of malaria interrupted and zero indigenous cases to be
attained in all 26 states/UTs that were under Categories 1 and 2 in 2014.
2. By 2024, incidence of malaria to be reduced to less than 1 case per 1000
population in all States and UTs, and their districts.
3. By 2027, indigenous transmission of malaria to be interrupted in all States and
UTs of India.
4. By 2030, malaria to be eliminated throughout the entire country, and re-
established of transmission prevented.
72

Milestones and targets
• By the year 2016:
All states and UTs to have included malaria elimination in their broader health policies and
planning framework.
• By year 2020.
1. All the 15 states/UTs that were under category 1 in 2014 to completely interrupted
malaria transmission and achieved zero indigenous cases and deaths due to malaria.
2. All 11 states/ UTs under category 2 in 2014 to enter into category 1 .
3. 5 states/ UTs under category 3 in 2014 to enter into category 2.
4. 5 states/ UTs under category 3 in 2014 to reduce the disease burden and remain in
category 3.
73

• By the year 2022
1. All 26 states that were under category 1 and 2 in 2014 to interrupt malaria transmission
and achieve 0 indigenous cases and deaths due to malaria.
2. 5 states/ UTs under category 3 in 2014 to enter into category 1.
3. 5 states/ UTs under category 3 in 2014 to reduce the disease burden and remain in
category 2.
4. Estimated malaria burden at national level reduced by 30-35 % as compared to 2014.
74

• By year 2024
1. All states/UTs and their respective districts to reduce less than 1 case per 1000
population at risk and sustain zero deaths due to malaria while maintaining
fully functional malaria surveillance to track, investigate and respond to each
case throughout the country.
2. Transmission of malaria interrupted and zero indigenous cases and deaths due
to malaria attained in all 31 states/UTs.
3. Five states/UTs which were under Category 3 (intensified control phase) in
2014 enter elimination phase.
75

• By year 2027
The indigenous transmission of malaria in India interrupted along with no
indigenous cases and deaths due to malaria.
• By year 2030
1. The re-establishment of local transmission prevented in areas where malaria
has been eliminated.
2. The malaria-free status maintained throughout the nation.
3. Initiate the certification of malaria elimination status.
76

Success rate of the programme
• Amply demonstrating the success of the National Vector Borne Disease Control Programme
(NVBDCP) is the fact that 75 million cases and 0.8 million deaths annually due to
malaria in the pre-independence era fell to 1.1 million cases and 562 deaths in 2014.
• These achievements are due to new tools such as rapid diagnostic tests, artemisinin-
based combination therapy (ACT) and long-lasting insecticidal nets (LLINs). Also,
human resources, capacity building, community level awareness building and
mobilization, partnerships, strengthened monitoring and evaluation, and investments
from domestic and external sources such as the Global Fund and the World Bank.
77

Strategies
• Early diagnosis, response and radical treatment
• Case- based surveillance and rapid response
• Integrated vector management
• Monitoring and evaluation
• Advocacy, coordination and partnerships
• Behaviour change communication and community mobilization
• Programme planning and management.
78

NATIONAL 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.
• 1990-1991, Concerned with the increasing problem of Kala-azar in the country, the
Government of India (GOI) launched a centrally sponsored Kala-azar Control
Programme in the endemic states.
• 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.
79

Goal and target
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.
Target
• To reduce the annual incidence of Kala-azar to less than one per 10,000
populations at block PHC level.
80

Objectives
To reduce the annual incidence of Kala-azar to less than one per 10 000 population at
block PHC level by the end of 2015 by:
1. reducing Kala-azar in the vulnerable, poor and unreached populations in
endemic areas;
2. reducing case-fatality rates from Kala-azar to negligible level;
3. reducing cases of PKDL to interrupt transmission of Kala-azar; and
4. preventing the emergence of Kala-azar and HIV/TB co-infections in endemic areas.
81
Revised strategy of total elimination of Kala
azar was launched on 2nd Sept 2014.

Elimination strategy
The national strategy for elimination of Kala-azar is a multipronged approach which is in line
with WHO Regional Strategic Framework for elimination of Kala-azar from the South-
East Asia Region (2011-2015) and includes:
I. Early diagnosis & complete case management
II. Integrated Vector Management and Vector Surveillance
III. Supervision, monitoring, surveillance and evaluation
IV. Strengthening capacity of human resource in health
V. Advocacy, communication and social mobilization for behavioral impact and inter-
sectoral convergence
VI. Programme management
82

NATIONAL FILARIA CONTROL PROGRAMME
• Bancroftian filarisis caused by Wuchereria bancrofti, which is transmitted to man by the
bites of infected mosquitoes - Culex, Anopheles, Mansonia and Aedes.
• Lymphatia filaria is prevalent in 18 states and union territories.
• Brugian filariasis caused by Brugia malayi is restricted to 7 states - UP, Bihar, Andhra
Pradesh, Orissa, Tamil Nadu, Kerala, and Gujarat.
• The National Filaria Control Programme was launched in 1955. The activities were
mainly confined to urban areas. However, the programme has been extended to rural
areas since 1994.
83
OBJECTIVE - delimiting the problem, to undertake control measures
in endemic areas and to train personnel to man the programme

Objectives and strategies
• Objectives:
1. Reduction of the problem in un-surveyed areas
2. Control in urban areas through recurrent anti-larval and anti-parasitic measures.
• Strategies:
1. Recurrent anti-larval measures at weekly intervals.
2. Environmental methods including source reduction by filling ditches, pits, low lying areas,
de-weeding, etc.
3. Biological control of mosquito breeding through larvivorous fish.
4. Anti-parasitic measures through 'detection' and 'treatment' of microfilaria carriers and
disease person with Filaria Clinics in towns covered under the programme.
84

Achievements
• Significant as till August 2017, 94 districts with 152 evaluation units had, successfully
completed 1st Transmission Assessment Survey (TAS), 20 more districts were to
observed 1st TAS during 2017.
85

JAPANESE ENCEPHALITIS CONTROL
PROGRAMME
• Japanese encephalitis (JE) is a zoonotic disease and caused by an arbovirus, group B
(Flavivirus) and transmitted by Culex mosquitoes.
• The fatality rate varies between 10% - 40% and those who survive do so with various
degrees of neurological complications like paralysis and cognitive deficiencies.
• The most disturbing feature of JE has been the regular occurrence of outbreak in
different parts of the country.
86
The clinical manifestations of the disease are characterized with high-grade fever, convulsion,
confusion, stiffness of neck and altered levels of consciousness from stupor to deep coma.

Disease burden
• Recently this disease have caused many epidemics and become a major public health
problem.
• This disease has been reported from 26 states and UTs since 1978, only 15 states are
reporting JE regularly.
• The case fatality in India is 35% which can be reduced by early detection, immediate
referral to hospital and proper medical and nursing care. The total population at risk is
estimated 160 million.
87

Strategy for prevention and control
1. Strengthening early diagnosis and prompt case management at PHCs, CHCs and
hospitals through training of medical and nursing staff.
2. IEC for community awareness to promote early case reporting, personal protection,
etc.
3. Vector control measures mainly fogging during outbreaks, space spraying in animal
dwellings, and antilarval operation where feasible; and
4. Development of a safe and standard indigenous vaccine.
88

Dengue and Dengue Haemorrhagic Fever
• One of the most important resurgent tropical infectious diseases is dengue. Dengue
Fever and Dengue Hemorrhagic Fever (DHF) are acute fevers caused by four
antigenically related but distinct dengue virus serotypes (DEN 1,2,3 and 4)
transmitted by the infected mosquitoes, Aedes Aegypti.
• Dengue outbreaks have been reported from urban areas from all states. All the four
serotypes of dengue virus (1, 2, 3 and 4) exist in India.
89

Objectives
1. Surveillance for disease and outbreaks
2. Early diagnosis and prompt case management
3. Vector control through community participation and social mobilization
4. Capacity building
5. Intersectoral coordination
6. Outbreak response
7. Behavioral change communication
90

PROGRAMME FOR PREVENTION AND
CONTROL OF LEPTOSPIROSIS 91
• Leptospirosis is a zoonotic disease caused by the Leptospira bacteria found in the urine
of rodents, cattles, etc.
• Major health problem in India in states of Kerala, Tamil Nadu, Maharashtra, Gujarat
and Karnataka.
• In view of burden of disease- Govt of India launched the PROGRAMME FOR
PREVENTION AND CONTROL OF LEPTOSPIROSIS in 12th 5 year plan in
endemic states and UTs under National Centre for Disease Control .

Objective and strategies
• Objective:
1. To reduce the morbidity and mortality due to leptospirosis in Humans.
• Strategies:
1. Developing trained manpower
2. Robust surveillance of disease in humans
3. Strengthening of diagnostic labs in programme states
4. Strengthening of patient management facilities in programme states
5. Creating awareness among people
6. Reinforcing inter-sectoral coordination among states for detection, prevention and control.
92

Impact of the programme
• Even after being in its growing stage, the programme has been strongly recognized by
the states.
• The surveillance of the disease is being done through the Integrated Diseases
Surveillance Programme Portal.
93

NATIONAL PROGRAMME ON CONTAINMENT OF
ANTI-MICROBIAL RESISTANCE (AMR)
• Antimicrobial resistance in pathogens causing important communicable diseases has become
a matter of great public health concern globally. Resistance has emerged even to newer &
more potent antimicrobial agents like Carbapenems.
• The rapid spread of multi-resistant bacteria and the lack of new antibiotics to treat infections
have caused rapid increasing threat to public and animal health and needs prevention for
untreatable illness becoming a reality.
• Government of India has launched a “National Programme on Containment of
Antimicrobial Resistance” under the 12th five-year plan (2012-2017).
94
https://www.nhp.gov.in/national-programme-on-containment-of-anti-microbial-resistance-(amr)_pg

Objectives of the programme
1. To establish a laboratory-based AMR surveillance system of 30 network labs in the
country and to generate quality data for public health importance.
2. To strengthen infection control guidelines and practices and promote rationale
use of antibiotics.
3. To generate awareness among healthcare providers and in the community about
rationale use of antibiotics
95

ACTIVITIES CARRIED UNDER PROGRAMME
• Activities to be carried out under the programme
1. Surveillance for Containment of Antimicrobial Resistance in various geographical
regions.
2. Development & implementation of national infection control guidelines.
3. Training and capacity building of professionals in relevant sectors.
4. IEC for dissemination of information about rational use of antibiotics.
5. Development of National Repository of Bacterial strains / cultures.
96

CONCLUSION
• Disease reporting systems has similar problems in the country. Change, improvement,
updating and continuous monitoring of the reporting system are very important. Although
the disease reporting process in different regions can be different; however, timeliness and
completeness are two major principles in system design. Therefore, detailed explanations
of duties and providing appropriate instructions are important points in integrating an
efficient reporting system for the national health programmes.
97

REFERENCES
• Tulchinsky TH, Varavikova EA. Communicable Diseases. The New Public Health. 2014:149–236. doi:
10.1016/B978-0-12-415766-8.00004-5. Epub 2014 Oct 10. PMCID: PMC7171903.
• https://www.nhp.gov.in/national-programme-on-containment-of-anti-microbial-resistance-(amr)_pg
• https://www.nhp.gov.in/national-rabies-control-programme_pg
• https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg
• https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme
• https://www.nhp.gov.in/national-aids-control-programme_pg
98

• https://vikaspedia.in/health/nrhm/national-health-programmes-1/pulse-polio-programme
• K Park, Textbook of Preventive and Social Medicine, 25th Edition, Bhanot, Jabalpur
99

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