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NVBDCP

The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme under the National Health Mission that aims to control and prevent six vector-borne diseases: malaria, kala-azar, filariasis, dengue, Japanese encephalitis, and chikungunya. The programme focuses on disease management, integrated vector management, and supportive interventions like indoor residual spraying and larvivorous fish. Its goals are to reduce mortality from certain diseases and eliminate kala-azar and filariasis by targeted years. The programme is coordinated by the Directorate of NVBDCP and implemented at national, state, district, and local levels.

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NATIONAL VECTOR- BORNE DISEASE CONTROL PROGRAMME Presented by: Dr. Paripurna Baruah, PGT, Deptt. Of Microbiology Moderator: Dr. Monjuri Kotoky, Associate professor, Deptt of Microbiology
INTRODUCTION NVBDCP is an umbrella programme under NHM dedicated to the control and prevention of 6 vector- borne diseases: MALARIA KALA- AZAR FILARIA (LYMPHATIC FILARIASIS) DENGUE/ DHF JAPANESE ENCEPHALITIS CHIKUNGUNYA
INTRODUCTION • Under the programme, it is ensured that the disadvantaged and marginalized sections of the society benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission Goals are achieved. • 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 planning, coordination, implementation, monitoring and evaluation of NVBDCP at all levels.
1953: Launching of national malaria control programme (NMCP) 1958: NMCP was changed to national malaria eradication programme (NMEP) 1977: modified plan of operations implemented 1999: directorate of NMEP was renamed as directorate of National anti malaria programme (NAMP) 2003: National vector borne disease control programme (NVBDCP) National filaria control programme (NFCP) Kala- azar control programme Dengue/ dengue hemorrhagic fever Japanese encephalitis HISTORICAL PERSPECTIVE 2006: Chikungunya brought under the purview
ORGANISATION OF THE PROGRAMME Directorate General Of Health Services, MOHFW Planning and monitoring of the programme Spray operations Management of funds and planning, monitoring of programme activities National level nodal office Directorate of NVBDCP State Vector Borne Disease Control Division State Vector Borne Disease Control Society Zonal offices Technical and administrative responsibilities District Vector Borne Disease Control Society District Malaria Office
MAIN ACTIVITIES OF THE DIRECTORATE OF NVBDCP 1. Formulating policies and guidelines 2. Providing technical guidance to the states 3. Planning 4. Logistics 5. Monitoring and evaluation 6. Coordination of activities through states and UTs 7. Collaboration with international organizations 8. Training 9. Facilitating research through NCDC, RMRC, NIMR etc. 10. Coordinating control activities in inter- state and inter- country border areas
THREE PRONGED STRATEGY Prevention and control of VBDs Disease management Integrated vector management Supportive interventions • Indoor residual spray • ITNs/ LLINs • Larvivorous fish • Source reduction • BCC • PPP • ISC • HRD • OR • M&E • Early case detection • Complete treatment • Referral services • Epidemic preparedness • Rapid response
MISSION STATEMENT • INTEGRATED ACCELERATED ACTION TOWARDS • Reducing mortality on account of MALARIA, DENGUE and JE by half • Elimination of KALA- AZAR by 2010 • Elimination of LYMPHATIC FILARIASIS by 2015
MALARIA Malaria stratification by Annual Parasite Incidence (API) in Indian States for data based on 2014.
PARAMETERS OF MALARIA SURVEILLANCE • API: Annual Parasite Incidence • API= confirmed cases during 1yr/ population under surveillance x 1000 • ABER: Annual Blood Examination Rate • ABER= number of slides examined/ population X 100 • AFI: Annual Falciparum Incidence • SPR: Slide Positivity Rate • SFR: Slide Falciparum Rate
MILESTONES OF MALARIA CONTROL ACTIVITIES IN INDIA YEAR Prior to 1953: Estimated malaria cases: 75 million Deaths due to malaria: 0.8 million 1953 National malaria control programme launched 1958 national malaria eradication programme launched 1965 Cases reduced to 0.1 million 1976 Resurgence of malaria, 6.46 million cases 1977 modified plan of operations implemented World bank assisted EMCP launched 1999 renaming of programme to NAMP 2002 renaming of NAMP to NVBDCP 2005 introduction of RDT 2006 ACT introduced in areas showing chloroquine resistance in falciparum malaria 2008 ACT extended to high Pf predominant districts covering 95% of Pf cases World bank supported NMCP launched 2009 LLINs introduced 2010 new drug policy 2010 2012 bivalent RDT introduced 2013 new drug policy 2013 2016 national framework of malaria elimination in India launched
NATIONAL FRAMEWORK OF MALARIA ELIMINATION IN INDIA (2016- 2030) • Launched in February 2016 • GOALS • Eliminate malaria (zero indigenous cases) throughout the entire country by 2030. • Maintain malaria free status in areas where malaria transmission has been interrupted and prevent re- introduction of malaria. • OBJECTIVES • 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 • By 2024: incidence of malaria to be reduced to less than 1 case/ 1000 population in all states and UTs and their districts • By 2027: indigenous transmission of malaria to be interrupted in all states and UTs of India • By 2030: malaria to be eliminated throughout the entire country and re- establishment of transmission prevented.
PROGRAMME PHASING CLASSIFICATION OF STATES AND UTs FOR MALARIA ELIMINATION IN INDIA CATEGORY DEFINITION CATEGORY 0 Prevention of re- establishment phase States/ UTs with zero indigenous cases of malaria (currently no states) CATEGORY 1 Elimination phase States/ UTs and all their districts reporting API < 1 (15 states/ UTs) CATEGORY 2 Pre-elimination phase States/ UTs with API < 1 but some of their districts reporting API > 1 (11 states) CATEGORY 3 Intensified control phase States/ UTs with API > 1 (10 states/ UTs) • CATEGORY 1: • HP, Punjab, J&K, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand, Haryana, Sikkim, Rajasthan, Daman& Diu, Goa, Delhi, Lakshadweep • CATEGORY 2: • Bihar, TN, Telangana, UP, Karnataka, WB, Andhra Pradesh, Assam, Maharashtra, Gujarat, Nagaland • CATEGORY 3: • Andaman& Nicobar, MP, Dadar& Nagar Haveli, Jharkhand, AP, Chhattisgarh, Odisha, Meghalaya, Tripura, Mizoram
• Malaria-attributable morbidity and mortality in India during 2001–2017. • Malaria positive cases denote confirmed diagnosis by presence of malarial parasite in finger- prick blood-smears; • Pf cases denote positivity for Plasmodium falciparum; • Death cases are attributed to confirmed falciparum malarial infection.
• Distribution of malaria-attributed deaths in different geo-epidemiological regions of India for data based on 2014–2017. • NE refers to group of seven sister States of northeast India including Arunachal Pradesh, Assam, Meghalaya, Manipur, Mizoram, Nagaland and Tripura; • Central States include Madhya Pradesh and Chhattisgarh; Eastern States include Bihar, Jharkhand, Odisha (formerly Orissa) and West Bengal; • Western States include Maharashtra, Goa, Gujarat and Rajasthan. • In the remaining Indian States and Union Territories, death cases were few and far (not shown).
MILESTONES AND TARGETS • By 2020, • All category 1 states (2014) to have completely interrupted malaria transmission and achieved zero indigenous cases and deaths due to malaria • All category 2 states (2014) to enter category 1 • 5 category 3 states (2014) to enter category 2 • 5 category 3 states to reduce disease burden • Estimated malaria burden at national level to reduce by 15- 20% as compared to 2014
• By 2022 • All states/UTs under category 1 and 2 to interrupt malaria transmission and achieve zero indigenous cases and deaths due to malaria • 5 category 3 states to enter category 2 and the other 5 to enter category 1 • Estimated malaria burden at national level to reduce by 30- 35% as compared to 2014
• By 2024, • All states/ UTs and their districts to reduce API to < 1 per 1000 population at risk, sustain zero deaths due to malaria and establish fully functional malaria surveillance to track, investigate and respond to each case • 31 states/ UTs to interrupt transmission of malaria and zero indigenous cases/ deaths due to malaria • 5 states in category 3 in 2014 to enter elimination phase
• By 2027, • Indigenous transmission interrupted • The entire country to have no indigenous cases and no deaths due to malaria • By 2030, • The entire country to sustain status of zero indigenous cases and deaths due to malaria for 3 consecutive years • India to initiate the processes for certification of malaria elimination status
KEY INTERVENTIONS RECOMMENDED FOR EACH CATEGORY • CATEGORY 3 (INTENSIFIED CONTROL PHASE) • Massive scaling up of the existing disease management and preventive approaches • Screening of all fever cases suspected for malaria • Tailored interventions for areas as per malaria epidemiology and risk of transmission • Special interventions for high risk areas: tribal, conflict affected, hard- to- reach • Mobile clinics on fixed days in these areas • Timely referral and treatment of severe malaria cases • Robust supply chain management system • Optimum level of surveillance • Equipping all health institutions with microscopy, RDTs and injectable artemisinin derivatives for treatment of severe malaria
• CATEGORY 2 (PRE- ELIMINATION PHASE) • Particular focus is laid on setting up an elimination surveillance system • Elimination phase activities are set up districts with API < 1 case/ 1000 population/ year
• CATEGORY 1 (ELIMINATION PHASE) • Interruption of local transmission in all active foci of malaria • Mandatory notification of each case of malaria • Adequate case base surveillance and complete case management to handle each case of malaria • Investigation and classification of each malaria foci • Active vector control measures in each foci • Early detection and treatment of all cases by ACD/ PCD • State and national level malaria database
• Effective screening, management and prevention of malaria among mobile and migrant population • Effective epidemic forecasting and response system • Rigorous quality assurance of medicines and diagnostics • National level reference laboratories • All positive and a fixed percentage of negative slides will be referred to this laboratory for confirmation and cross- checking • After elimination has been achieved in each state/ UT, 100% cases to be notified to this laboratory so that a national database can be maintained • Training of master trainers and accreditation/ certification of microscopists as per Indian Public Health Standards • During investigation of foci, all suspected cases of malaria are to be screened for malaria • Surveillance of migrant population and population residing in the vicinity of industrial areas
• CATEGORY 0 (PREVENTION OF RE- ESTABLISHMENT PHASE) • Detection of any re- introduced case of malaria • Prompt notification of all detected cases • Determination of underlying cause of resumed transmission • Rapid curative and preventive measures • Prevent re- introduction and re- establishment of transmission • Maintenance of malaria- free status
INTERACTION OF MALARIA CONTROL WITH OTHER HEALTH PROGRAMMES IDSP Reproductive & child health: IMNCI JSY Antenatal care services Other vector borne disease: Dengue & malaria Malaria & Kala- azar Malaria & Filariasis Malaria control
MAJOR EXTERNALLY SUPPORTED PROJECTS Intensified Malaria Control Project (IMCP) II • Supported by Global Fund Round 9 • Since October 2010 for 5 years in the NE states • Covered population of 46 million in 86 districts • Early diagnosis, complete treatment, integrated vector control Malaria control and kala- azar elimination • Supported by World Bank • 5 years: 2009 to 31 December 2013
LYMPHATIC FILARIASIS • Filariasis is endemic in 250 districts in 16 states and 5 UTs • About 360 million people are exposed to risk of infection
NATIONAL FILARIA CONTROL PROGRAMME • Started in 1955 • In June 1978, the operational component of NFCP was merged with the urban malaria scheme for maximum utilization of available resources. • In 2003- 04 it was merged with NVBDCP • It is being Implemented through 206 filaria control units 199 filaria clinics 27 survey units
REVISED FILARIA CONTROL STRATEGY • The national health policy 2002 aims at elimination of lymphatic filariasis by 2015 • The elimination is defined as “ lymphatic filariasis ceases to be a public health problem when the number of microfilaria carriers is < 1% and the children born after initiation of ELF are free from circulating antigenaemia (presence of adult filarial worm in human body)
GUIDELINES UNDER NVBDCP ELF 2015 Annual mass drug administration of antifilarial drug for 5 yrs or more to the eligible population to interrupt transmission Home based management of lymphoedema cases and upscaling of hydrocele operations in identified CHCs/ district hospitals/ medical colleges 2004 • Annual MDA with single dose DEC • November • 202 districts • 72.4% coverage 2007 • DEC + Albendazole • 250 districts 2014 86.8% coverage 2004 • Door- to- door survey to encourage home based foot care • Upscaling of hydrocele operations 2014 • 8 lacs lymphoedem a cases • 4 lacs hydrocele cases
ACCELERATED PLAN FOR ELIMINATION OF LYMPHATIC FILARIASIS (APELF) 2021 Launched by GoI in October 2018 Triple drug therapy with ivermectin+ DEC + Albendazole in a phased manner The programme to commence in November 2019 across high burden states Triple drug therapy approach will be rolled out across 16 districts of Bihar, Gujarat, Karnataka, Maharashtra and UP By February 2019 IDA was rolled out across 4 endemic districts Arwal (Bihar) Simdega (Jharkhand) Nagpur (Maha) Varanasi (UP)
KALA AZAR • Kala azar is endemic in 33 districts of Bihar, 4 districts of Jharkhand, 11 districts of West Bengal, 6 districts of Uttar Pradesh • The centrally sponsored programme for control of kala azar was launched in 1990- 91 • Brought down the number of cases from 77,102 in 1992 to 7,277 in 2015
GUIDELINES UNDER NVBDCP Kala azar Technical Supervisor along with designated ASHA worker ensure detection, treatment and follow-up of cases Active case search: kala azar fortnight Vector control IEC and inter sectoral convergence Diagnosis Treatment research guidelines Quarterly door-to-door search for cases of kala azar and PKDL 2 rounds of annual DDT spraying in endemic area under direct supervision of NHM institution Encourage environmental sanitation and personal protection from sandfly bite rK39 rapid diagnostic kits • SSG • Miltefosine • Paramomycin
REVISED STRATEGY FOR TOTAL ERADICATION OF KALA AZAR 2015 Launched on 2 September 2014 Rapid diagnostic kits developed by ICMR Single dose Liposomal Amphotericin B (10mg/ kg bw) Free supply of the drug by WHO synthetic Pyrethroid, directed specifically at the sand fly, supplied for spraying on the walls of homes in the endemic regions.
PATIENT CODING SCHEME • The patient and his relatives are counselled properly at the time of registration at the health institution (CHC/PHC/district hospital) about the importance of full treatment • The coding would be arranged in the order of Country Code cum State Code- District Code- PHC Code, Sub-Centre / NGO Code- Patient Code.
DENGUE/ DHF CHIKUNGUNYA Figure 3 Average dengue incidence rates (per million population) by state in India from 1998 to 2014. The map was generated with ArcGIS-10.2.1 software (http://www.esri.in) from dengue case data.
GUIDELINES UNDER NVDCP • Early case detection and management • IVM • Entomological surveys • Larval surveys: containers in houses are examined for larvae and pupae • House Index = no. of houses infected/ no. of houses inspected x 100 • Breteau Index = no of positive containers/ no of houses inspected x 100 An HI > 5% and/or a BI > 20% for a locality is an indication that the locality is dengue sensitive and therefore adequate preventive measures to be taken
GUIDELINES UNDER NVDCP • Container Index = no of positive containers/ no of containers inspected x 100 • Pupae Index = no pf pupae/ no of houses inspected x 100 • Adult surveys: expressed in terms of landing/ biting counts per man hour • Source reduction • Personal protection
Strategic action plan 521 sentinel surveillance hospitals and 14 apex referral laboratories Diagnostic kits supplied by NIV, Pune 2007 Regular monitoring of larval densities in rural and urban areas Collabration with rogi Kalyn samiti for referral and transport of emergency cases VHSC for sanitation and reduction of breeding sites Legislative measures 1. Model civic by- laws 2. Building construction regulation act 3. Environmental health act 4. Health impact assessment
Case definition of Chikungunya • 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 tests done in the acute phase of illness Direct evidence • Virus isolation / Presence of viral RNA by RT-PCR 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.
NVBDCP Laboratory Network • Directorate of National Vector Borne Disease Control Programme, GOI has identified a network of laboratories (Sentinel Surveillance Hospitals and Apex Referral Laboratories) for surveillance of chikungunya fever cases across the country since 2007. • All SSHs are connected to 15 apex referral laboratories (ARLs) • Chikungunya IgM ELISA Test kits (1 Kit= 96 tests) are provided to the identified laboratories through National Institute of Virology (NIV), Pune since 2007. Cost is borne by GOI. Buffer stock is also maintained at NIV, Pune to meet any emergency in case of outbreak in new areas and to avoid stock out. NUMBER OF SSH YEAR 110 2007 137 2008 170 2009 182 2010 311 2011 347 2012 394 2013 439 2014 521 2015 542 2016
Laboratory confirmation in case of Chikungunya outbreak • Outbreak criteria: One or more cases in an area where no case was reported before. • For the Public Health action, it is not necessary to confirm the diagnosis of each and every suspected Chikungunya case. • However, Laboratory confirmation of the suspected cases would be required to validate the clinical diagnosis of the suspected cases. • Confirmation of few cases would be enough to identify the cause of fever outbreak. • Out of the reported suspected Chikungunya fever cases, 5-10% blood samples should be randomly collected for Laboratory test. In case, any blood sample is found positive serologically for Chikungunya IgM antibody the respective area (sub-centre/ Ward ) should be declared as having confirmed outbreak of Chikungunya. There is no need for taking additional blood samples for laboratory diagnosis of Chikungunya from that sub-centre area/Ward and clinically suspected cases should be treated as Chikungunya.
JAPANESE ENCEPHALITIS • First case of JE reported in 1955 • During the recent past (1998- 2004) 15 states and UTs have reported JE incidence NVBDCP. Annual report 2014-15, Govt. of India. DGHS, MoHFW, N-Delhi.
GUIDELINES UNDER NVBDCP • Children between 1- 15 yrs • Initiation in 2006 with single dose live attenuated SA-14-14-2 vaccine in a phased manner • Outdoor fogging with malathion during outbreaks • Anti larval measures • Personal protection • Biological control • Strengthening of referral services • Symptomatic case management • Management of sequelae • Epidemic preparedness and rapid response • Training and capacity building • BCC • Periodic reviews/ reports and field visits for monitoring of JE Supportive interventions Early diagnosis and case management vaccinationIVM
National Programme for Prevention and Control of Japanese Encephalitis/ Acute Encephalitis Syndrome 2014 GOAL : To reduce morbidity, mortality and disability in children due to JE/AES. OBJECTIVES : • 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.
This strategy can be implemented only with the active engagement of the Ministries/ Departments of (i) Health and Family Welfare (ii) Drinking Water and Sanitation (iii) Social Justice and Empowerment (iv) Women and Child Development (v) Urban Development (Housing and Urban Poverty Alleviation) and (vi) Human Resource Development (Department of School Education and Literacy)
JE/ AES SURVEILLANCE This surveillance will be carried out through sentinel sites and other health institutions: • Sentinel Surveillance Sites with laboratories (SSSL) facilities • Sentinel Surveillance Sites without laboratories facilities • Other Informer Units
JE surveillance activities at the district level • The District Vector Borne Disease Officer (DVBDO) or the identified health officer will study all reports received from all SSSL, SSSs without Laboratory and Informer Units and also reconcile data with existing surveillance systems such as IDSP to identify if there are any outbreaks. • In the office of DVBDO, compilation of all information/reports will be undertaken for interpretation and action. Report will be submitted to SPO in form AESF-2, AESF-2A, AESF-3.
Surveillance activities at state level • The District will report to the state on daily/weekly/monthly basis as per requirement depending on the disease situation. • Data from the districts will be compiled and analysed at the state level to understand the disease situation to provide feedback to the districts and to initiate appropriate prevention and control measures. • To strengthen the JE/AES surveillance the state may coordinate with existing ICMR designated Viral Diagnostic Laboratories (VDL). • Final compiled date from the state will be sent to the national level on daily/weekly/monthly basis as desired by the disease situation. • Presently 85 sentinel sites and diagnostic centres exist in different States. • Considering growing number of JE reporting districts, it has been decided to add 20 more such centres with provision of manpower, equipment, kits, capacity building etc.
Periodicity of reports • Daily report should be generated and transmitted in an outbreak situation • Weekly report in transmission period and monthly report in inter- epidemic period. • In outbreak situation action taken report should be sent along with daily report. • Note : The decision on the periodicity of the reports will be made at the state level by the State Programme Officer based on the local JE transmission pattern.
Eco-Entomological Surveillance Objectives of Entomological Surveillance 1. To identify the JE vector mosquitoes in an area 2. To monitor JE vector abundance in JE endemic areas 3. To detect JE virus in vector mosquitoes 4. To suggest appropriate vector control measures
Choice of index villages At least 3 villages in which JE has occurred in the recent past (past five years) At least 2 villages which remained unaffected till date would be monitored in each affected block Sampling would be carried out on fortnightly basis Surveillance would be carried out round the year to known the JE vector density, their resting behavior, feeding behavior and detection/isolation of JE virus from vector mosquitoes.
Entomological surveillance Larval surveys Adult surveys Susceptibility of JE vector mosquitoes and larvae Laboratory support Screening/ isolation of JE virus from suspected JE vector mosquitoes. Vector incrimination would be done in collaboration with NIV Pune, CRME Madurai and NICD, Delhi.
Thermal fogging (ULV) • Thermal fogging with portable fogging is done in outdoor situations (outside human habitation), where large number of JE cases are reported. • Fogging should be carried out in downwind to upwind direction. • During outdoor fogging it is important to direct the fog to all possible adult mosquito resting sites like bushes, tree-shaded areas and other outdoor resting in peri-domestic habitats. • The most effective type of thermal fog for mosquito control is medium / dry fog i.e. it should just moisten the hand when the hand is passed quickly through the fog at a distance of about 2.5 to 3.0 meters in front of the fog tube. • The technical specification recommended for fogging machined should be of BIS standard no. 14855 (Part 1): 2000 for Vector Control. • Under NVBDCP, presently Malathion and Pyrethrum formulations are use for fogging applications. • For thermal fogging: 5 per cent Malathion (Technical) in kerosene/diesel (1 litre of technical Malathion in 19 litres of diluents).
During outbreak situations, fogging applications have to be carried out at 7-10 days interval till a significant reduction in vector densities is achieved.
Personal Protective Measures Protective clothing Mats, coils and aerosols Repellants
Veterinary Based Surveillance • By identifying the prevalence & density of pigs, ducks, and ardeid birds and detecting viral activity in susceptible hosts, veterinary surveillance helps to track the rate of Haemagglutination Inhibition (HI) antibody carriers and the appearance of antibody from fresh infection as an index of the spread of JE virus in animal host. • Veterinary-based surveillance is conducted with the help of animal husbandry department. • Sera sample from these animals is randomly collected for serology to ascertain transmission of JE virus. The objectives of Veterinary based surveillance are: Prevalence of Pigs/Ducks, Ardeid Birds in an area To detect viral activity in susceptible hosts
Institutes for screening for antibody carriers and other virology studies i) National Institute of Virology (NIV), Pune. ii) Centre for Research in Medical Entomology (CRME), Madurai. iii) VBRI (Veterinary Biological Research Institute), Shanthinagar, Hyderabad, Andhra Pradesh. iv) Kyasanoor Forest Disease Laboratory, Shimoga, Karnataka. v) Institute of Vector control and Zoonosis Hosur, Tamil NAdu. vi) Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, U.P. vii) Diagnostic Research Laboratories, RWITC. Ltd. (Approved By Govt. of India
REFERENCES • Park’s textbook of preventive and social medicine, 24th edition. • www.nvbdcp.gov.in • National Framework for Malaria Elimination in India 2016-2030. Directorate of National Vector Borne Disease Control Programme (NVBDCP). Ministry of Health & Family Welfare, Government of India. p. 43. Available from: http://www.nvbdcp.gov.in/malaria [Accessed: 20 February 2018] • National Vector Borne Disease Control Programme, Directorate General of Health Services, Ministry of Health & Family Welfare. Government of India. Malaria. Available from: http://www.nvbdcp.gov.in/malaria [Accessed: February 20, 2018] • Sabesan, Shanmugavelu & Raju, Hari Kishan & Swaminathan, Subramanian & Srivastava, Pradeep & Jambulingam, Purushothaman. (2013). Lymphatic Filariasis Transmission Risk Map of India, Based on a Geo-Environmental Risk Model. Vector borne and zoonotic diseases (Larchmont, N.Y.). 13. 10.1089/vbz.2012.1238.

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NVBDCP

  • 1.
    NATIONAL VECTOR- BORNE DISEASECONTROL PROGRAMME Presented by: Dr. Paripurna Baruah, PGT, Deptt. Of Microbiology Moderator: Dr. Monjuri Kotoky, Associate professor, Deptt of Microbiology
  • 2.
    INTRODUCTION NVBDCP is anumbrella programme under NHM dedicated to the control and prevention of 6 vector- borne diseases: MALARIA KALA- AZAR FILARIA (LYMPHATIC FILARIASIS) DENGUE/ DHF JAPANESE ENCEPHALITIS CHIKUNGUNYA
  • 3.
    INTRODUCTION • Under theprogramme, it is ensured that the disadvantaged and marginalized sections of the society benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission Goals are achieved. • 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 planning, coordination, implementation, monitoring and evaluation of NVBDCP at all levels.
  • 4.
    1953: Launching ofnational malaria control programme (NMCP) 1958: NMCP was changed to national malaria eradication programme (NMEP) 1977: modified plan of operations implemented 1999: directorate of NMEP was renamed as directorate of National anti malaria programme (NAMP) 2003: National vector borne disease control programme (NVBDCP) National filaria control programme (NFCP) Kala- azar control programme Dengue/ dengue hemorrhagic fever Japanese encephalitis HISTORICAL PERSPECTIVE 2006: Chikungunya brought under the purview
  • 5.
    ORGANISATION OF THE PROGRAMME DirectorateGeneral Of Health Services, MOHFW Planning and monitoring of the programme Spray operations Management of funds and planning, monitoring of programme activities National level nodal office Directorate of NVBDCP State Vector Borne Disease Control Division State Vector Borne Disease Control Society Zonal offices Technical and administrative responsibilities District Vector Borne Disease Control Society District Malaria Office
  • 6.
    MAIN ACTIVITIES OFTHE DIRECTORATE OF NVBDCP 1. Formulating policies and guidelines 2. Providing technical guidance to the states 3. Planning 4. Logistics 5. Monitoring and evaluation 6. Coordination of activities through states and UTs 7. Collaboration with international organizations 8. Training 9. Facilitating research through NCDC, RMRC, NIMR etc. 10. Coordinating control activities in inter- state and inter- country border areas
  • 7.
    THREE PRONGED STRATEGY Prevention and controlof VBDs Disease management Integrated vector management Supportive interventions • Indoor residual spray • ITNs/ LLINs • Larvivorous fish • Source reduction • BCC • PPP • ISC • HRD • OR • M&E • Early case detection • Complete treatment • Referral services • Epidemic preparedness • Rapid response
  • 8.
    MISSION STATEMENT • INTEGRATEDACCELERATED ACTION TOWARDS • Reducing mortality on account of MALARIA, DENGUE and JE by half • Elimination of KALA- AZAR by 2010 • Elimination of LYMPHATIC FILARIASIS by 2015
  • 9.
    MALARIA Malaria stratification byAnnual Parasite Incidence (API) in Indian States for data based on 2014.
  • 10.
    PARAMETERS OF MALARIASURVEILLANCE • API: Annual Parasite Incidence • API= confirmed cases during 1yr/ population under surveillance x 1000 • ABER: Annual Blood Examination Rate • ABER= number of slides examined/ population X 100 • AFI: Annual Falciparum Incidence • SPR: Slide Positivity Rate • SFR: Slide Falciparum Rate
  • 11.
    MILESTONES OF MALARIA CONTROL ACTIVITIESIN INDIA YEAR Prior to 1953: Estimated malaria cases: 75 million Deaths due to malaria: 0.8 million 1953 National malaria control programme launched 1958 national malaria eradication programme launched 1965 Cases reduced to 0.1 million 1976 Resurgence of malaria, 6.46 million cases 1977 modified plan of operations implemented World bank assisted EMCP launched 1999 renaming of programme to NAMP 2002 renaming of NAMP to NVBDCP 2005 introduction of RDT 2006 ACT introduced in areas showing chloroquine resistance in falciparum malaria 2008 ACT extended to high Pf predominant districts covering 95% of Pf cases World bank supported NMCP launched 2009 LLINs introduced 2010 new drug policy 2010 2012 bivalent RDT introduced 2013 new drug policy 2013 2016 national framework of malaria elimination in India launched
  • 12.
    NATIONAL FRAMEWORK OFMALARIA ELIMINATION IN INDIA (2016- 2030) • Launched in February 2016 • GOALS • Eliminate malaria (zero indigenous cases) throughout the entire country by 2030. • Maintain malaria free status in areas where malaria transmission has been interrupted and prevent re- introduction of malaria. • OBJECTIVES • 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 • By 2024: incidence of malaria to be reduced to less than 1 case/ 1000 population in all states and UTs and their districts • By 2027: indigenous transmission of malaria to be interrupted in all states and UTs of India • By 2030: malaria to be eliminated throughout the entire country and re- establishment of transmission prevented.
  • 13.
    PROGRAMME PHASING CLASSIFICATION OFSTATES AND UTs FOR MALARIA ELIMINATION IN INDIA CATEGORY DEFINITION CATEGORY 0 Prevention of re- establishment phase States/ UTs with zero indigenous cases of malaria (currently no states) CATEGORY 1 Elimination phase States/ UTs and all their districts reporting API < 1 (15 states/ UTs) CATEGORY 2 Pre-elimination phase States/ UTs with API < 1 but some of their districts reporting API > 1 (11 states) CATEGORY 3 Intensified control phase States/ UTs with API > 1 (10 states/ UTs) • CATEGORY 1: • HP, Punjab, J&K, Kerala, Manipur, Puducherry, Chandigarh, Uttarakhand, Haryana, Sikkim, Rajasthan, Daman& Diu, Goa, Delhi, Lakshadweep • CATEGORY 2: • Bihar, TN, Telangana, UP, Karnataka, WB, Andhra Pradesh, Assam, Maharashtra, Gujarat, Nagaland • CATEGORY 3: • Andaman& Nicobar, MP, Dadar& Nagar Haveli, Jharkhand, AP, Chhattisgarh, Odisha, Meghalaya, Tripura, Mizoram
  • 14.
    • Malaria-attributable morbidity andmortality in India during 2001–2017. • Malaria positive cases denote confirmed diagnosis by presence of malarial parasite in finger- prick blood-smears; • Pf cases denote positivity for Plasmodium falciparum; • Death cases are attributed to confirmed falciparum malarial infection.
  • 15.
    • Distribution ofmalaria-attributed deaths in different geo-epidemiological regions of India for data based on 2014–2017. • NE refers to group of seven sister States of northeast India including Arunachal Pradesh, Assam, Meghalaya, Manipur, Mizoram, Nagaland and Tripura; • Central States include Madhya Pradesh and Chhattisgarh; Eastern States include Bihar, Jharkhand, Odisha (formerly Orissa) and West Bengal; • Western States include Maharashtra, Goa, Gujarat and Rajasthan. • In the remaining Indian States and Union Territories, death cases were few and far (not shown).
  • 16.
    MILESTONES AND TARGETS •By 2020, • All category 1 states (2014) to have completely interrupted malaria transmission and achieved zero indigenous cases and deaths due to malaria • All category 2 states (2014) to enter category 1 • 5 category 3 states (2014) to enter category 2 • 5 category 3 states to reduce disease burden • Estimated malaria burden at national level to reduce by 15- 20% as compared to 2014
  • 17.
    • By 2022 •All states/UTs under category 1 and 2 to interrupt malaria transmission and achieve zero indigenous cases and deaths due to malaria • 5 category 3 states to enter category 2 and the other 5 to enter category 1 • Estimated malaria burden at national level to reduce by 30- 35% as compared to 2014
  • 18.
    • By 2024, •All states/ UTs and their districts to reduce API to < 1 per 1000 population at risk, sustain zero deaths due to malaria and establish fully functional malaria surveillance to track, investigate and respond to each case • 31 states/ UTs to interrupt transmission of malaria and zero indigenous cases/ deaths due to malaria • 5 states in category 3 in 2014 to enter elimination phase
  • 19.
    • By 2027, •Indigenous transmission interrupted • The entire country to have no indigenous cases and no deaths due to malaria • By 2030, • The entire country to sustain status of zero indigenous cases and deaths due to malaria for 3 consecutive years • India to initiate the processes for certification of malaria elimination status
  • 20.
    KEY INTERVENTIONS RECOMMENDEDFOR EACH CATEGORY • CATEGORY 3 (INTENSIFIED CONTROL PHASE) • Massive scaling up of the existing disease management and preventive approaches • Screening of all fever cases suspected for malaria • Tailored interventions for areas as per malaria epidemiology and risk of transmission • Special interventions for high risk areas: tribal, conflict affected, hard- to- reach • Mobile clinics on fixed days in these areas • Timely referral and treatment of severe malaria cases • Robust supply chain management system • Optimum level of surveillance • Equipping all health institutions with microscopy, RDTs and injectable artemisinin derivatives for treatment of severe malaria
  • 21.
    • CATEGORY 2(PRE- ELIMINATION PHASE) • Particular focus is laid on setting up an elimination surveillance system • Elimination phase activities are set up districts with API < 1 case/ 1000 population/ year
  • 22.
    • CATEGORY 1(ELIMINATION PHASE) • Interruption of local transmission in all active foci of malaria • Mandatory notification of each case of malaria • Adequate case base surveillance and complete case management to handle each case of malaria • Investigation and classification of each malaria foci • Active vector control measures in each foci • Early detection and treatment of all cases by ACD/ PCD • State and national level malaria database
  • 23.
    • Effective screening,management and prevention of malaria among mobile and migrant population • Effective epidemic forecasting and response system • Rigorous quality assurance of medicines and diagnostics • National level reference laboratories • All positive and a fixed percentage of negative slides will be referred to this laboratory for confirmation and cross- checking • After elimination has been achieved in each state/ UT, 100% cases to be notified to this laboratory so that a national database can be maintained • Training of master trainers and accreditation/ certification of microscopists as per Indian Public Health Standards • During investigation of foci, all suspected cases of malaria are to be screened for malaria • Surveillance of migrant population and population residing in the vicinity of industrial areas
  • 24.
    • CATEGORY 0(PREVENTION OF RE- ESTABLISHMENT PHASE) • Detection of any re- introduced case of malaria • Prompt notification of all detected cases • Determination of underlying cause of resumed transmission • Rapid curative and preventive measures • Prevent re- introduction and re- establishment of transmission • Maintenance of malaria- free status
  • 26.
    INTERACTION OF MALARIACONTROL WITH OTHER HEALTH PROGRAMMES IDSP Reproductive & child health: IMNCI JSY Antenatal care services Other vector borne disease: Dengue & malaria Malaria & Kala- azar Malaria & Filariasis Malaria control
  • 27.
    MAJOR EXTERNALLY SUPPORTEDPROJECTS Intensified Malaria Control Project (IMCP) II • Supported by Global Fund Round 9 • Since October 2010 for 5 years in the NE states • Covered population of 46 million in 86 districts • Early diagnosis, complete treatment, integrated vector control Malaria control and kala- azar elimination • Supported by World Bank • 5 years: 2009 to 31 December 2013
  • 28.
    LYMPHATIC FILARIASIS • Filariasisis endemic in 250 districts in 16 states and 5 UTs • About 360 million people are exposed to risk of infection
  • 29.
    NATIONAL FILARIA CONTROLPROGRAMME • Started in 1955 • In June 1978, the operational component of NFCP was merged with the urban malaria scheme for maximum utilization of available resources. • In 2003- 04 it was merged with NVBDCP • It is being Implemented through 206 filaria control units 199 filaria clinics 27 survey units
  • 30.
    REVISED FILARIA CONTROLSTRATEGY • The national health policy 2002 aims at elimination of lymphatic filariasis by 2015 • The elimination is defined as “ lymphatic filariasis ceases to be a public health problem when the number of microfilaria carriers is < 1% and the children born after initiation of ELF are free from circulating antigenaemia (presence of adult filarial worm in human body)
  • 31.
    GUIDELINES UNDER NVBDCP ELF 2015 Annualmass drug administration of antifilarial drug for 5 yrs or more to the eligible population to interrupt transmission Home based management of lymphoedema cases and upscaling of hydrocele operations in identified CHCs/ district hospitals/ medical colleges 2004 • Annual MDA with single dose DEC • November • 202 districts • 72.4% coverage 2007 • DEC + Albendazole • 250 districts 2014 86.8% coverage 2004 • Door- to- door survey to encourage home based foot care • Upscaling of hydrocele operations 2014 • 8 lacs lymphoedem a cases • 4 lacs hydrocele cases
  • 32.
    ACCELERATED PLAN FOR ELIMINATION OF LYMPHATIC FILARIASIS (APELF)2021 Launched by GoI in October 2018 Triple drug therapy with ivermectin+ DEC + Albendazole in a phased manner The programme to commence in November 2019 across high burden states Triple drug therapy approach will be rolled out across 16 districts of Bihar, Gujarat, Karnataka, Maharashtra and UP By February 2019 IDA was rolled out across 4 endemic districts Arwal (Bihar) Simdega (Jharkhand) Nagpur (Maha) Varanasi (UP)
  • 33.
    KALA AZAR • Kalaazar is endemic in 33 districts of Bihar, 4 districts of Jharkhand, 11 districts of West Bengal, 6 districts of Uttar Pradesh • The centrally sponsored programme for control of kala azar was launched in 1990- 91 • Brought down the number of cases from 77,102 in 1992 to 7,277 in 2015
  • 34.
    GUIDELINES UNDER NVBDCP Kalaazar Technical Supervisor along with designated ASHA worker ensure detection, treatment and follow-up of cases Active case search: kala azar fortnight Vector control IEC and inter sectoral convergence Diagnosis Treatment research guidelines Quarterly door-to-door search for cases of kala azar and PKDL 2 rounds of annual DDT spraying in endemic area under direct supervision of NHM institution Encourage environmental sanitation and personal protection from sandfly bite rK39 rapid diagnostic kits • SSG • Miltefosine • Paramomycin
  • 35.
    REVISED STRATEGY FOR TOTAL ERADICATION OF KALAAZAR 2015 Launched on 2 September 2014 Rapid diagnostic kits developed by ICMR Single dose Liposomal Amphotericin B (10mg/ kg bw) Free supply of the drug by WHO synthetic Pyrethroid, directed specifically at the sand fly, supplied for spraying on the walls of homes in the endemic regions.
  • 36.
    PATIENT CODING SCHEME • Thepatient and his relatives are counselled properly at the time of registration at the health institution (CHC/PHC/district hospital) about the importance of full treatment • The coding would be arranged in the order of Country Code cum State Code- District Code- PHC Code, Sub-Centre / NGO Code- Patient Code.
  • 37.
    DENGUE/ DHF CHIKUNGUNYA Figure 3Average dengue incidence rates (per million population) by state in India from 1998 to 2014. The map was generated with ArcGIS-10.2.1 software (http://www.esri.in) from dengue case data.
  • 38.
    GUIDELINES UNDER NVDCP •Early case detection and management • IVM • Entomological surveys • Larval surveys: containers in houses are examined for larvae and pupae • House Index = no. of houses infected/ no. of houses inspected x 100 • Breteau Index = no of positive containers/ no of houses inspected x 100 An HI > 5% and/or a BI > 20% for a locality is an indication that the locality is dengue sensitive and therefore adequate preventive measures to be taken
  • 39.
    GUIDELINES UNDER NVDCP •Container Index = no of positive containers/ no of containers inspected x 100 • Pupae Index = no pf pupae/ no of houses inspected x 100 • Adult surveys: expressed in terms of landing/ biting counts per man hour • Source reduction • Personal protection
  • 40.
    Strategic action plan 521 sentinel surveillance hospitals and14 apex referral laboratories Diagnostic kits supplied by NIV, Pune 2007 Regular monitoring of larval densities in rural and urban areas Collabration with rogi Kalyn samiti for referral and transport of emergency cases VHSC for sanitation and reduction of breeding sites Legislative measures 1. Model civic by- laws 2. Building construction regulation act 3. Environmental health act 4. Health impact assessment
  • 41.
    Case definition ofChikungunya • 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 tests done in the acute phase of illness Direct evidence • Virus isolation / Presence of viral RNA by RT-PCR 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.
  • 42.
    NVBDCP Laboratory Network •Directorate of National Vector Borne Disease Control Programme, GOI has identified a network of laboratories (Sentinel Surveillance Hospitals and Apex Referral Laboratories) for surveillance of chikungunya fever cases across the country since 2007. • All SSHs are connected to 15 apex referral laboratories (ARLs) • Chikungunya IgM ELISA Test kits (1 Kit= 96 tests) are provided to the identified laboratories through National Institute of Virology (NIV), Pune since 2007. Cost is borne by GOI. Buffer stock is also maintained at NIV, Pune to meet any emergency in case of outbreak in new areas and to avoid stock out. NUMBER OF SSH YEAR 110 2007 137 2008 170 2009 182 2010 311 2011 347 2012 394 2013 439 2014 521 2015 542 2016
  • 43.
    Laboratory confirmation incase of Chikungunya outbreak • Outbreak criteria: One or more cases in an area where no case was reported before. • For the Public Health action, it is not necessary to confirm the diagnosis of each and every suspected Chikungunya case. • However, Laboratory confirmation of the suspected cases would be required to validate the clinical diagnosis of the suspected cases. • Confirmation of few cases would be enough to identify the cause of fever outbreak. • Out of the reported suspected Chikungunya fever cases, 5-10% blood samples should be randomly collected for Laboratory test. In case, any blood sample is found positive serologically for Chikungunya IgM antibody the respective area (sub-centre/ Ward ) should be declared as having confirmed outbreak of Chikungunya. There is no need for taking additional blood samples for laboratory diagnosis of Chikungunya from that sub-centre area/Ward and clinically suspected cases should be treated as Chikungunya.
  • 44.
    JAPANESE ENCEPHALITIS • First caseof JE reported in 1955 • During the recent past (1998- 2004) 15 states and UTs have reported JE incidence NVBDCP. Annual report 2014-15, Govt. of India. DGHS, MoHFW, N-Delhi.
  • 45.
    GUIDELINES UNDER NVBDCP •Children between 1- 15 yrs • Initiation in 2006 with single dose live attenuated SA-14-14-2 vaccine in a phased manner • Outdoor fogging with malathion during outbreaks • Anti larval measures • Personal protection • Biological control • Strengthening of referral services • Symptomatic case management • Management of sequelae • Epidemic preparedness and rapid response • Training and capacity building • BCC • Periodic reviews/ reports and field visits for monitoring of JE Supportive interventions Early diagnosis and case management vaccinationIVM
  • 46.
    National Programme forPrevention and Control of Japanese Encephalitis/ Acute Encephalitis Syndrome 2014 GOAL : To reduce morbidity, mortality and disability in children due to JE/AES. OBJECTIVES : • 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.
  • 47.
    This strategy canbe implemented only with the active engagement of the Ministries/ Departments of (i) Health and Family Welfare (ii) Drinking Water and Sanitation (iii) Social Justice and Empowerment (iv) Women and Child Development (v) Urban Development (Housing and Urban Poverty Alleviation) and (vi) Human Resource Development (Department of School Education and Literacy)
  • 48.
    JE/ AES SURVEILLANCE Thissurveillance will be carried out through sentinel sites and other health institutions: • Sentinel Surveillance Sites with laboratories (SSSL) facilities • Sentinel Surveillance Sites without laboratories facilities • Other Informer Units
  • 49.
    JE surveillance activitiesat the district level • The District Vector Borne Disease Officer (DVBDO) or the identified health officer will study all reports received from all SSSL, SSSs without Laboratory and Informer Units and also reconcile data with existing surveillance systems such as IDSP to identify if there are any outbreaks. • In the office of DVBDO, compilation of all information/reports will be undertaken for interpretation and action. Report will be submitted to SPO in form AESF-2, AESF-2A, AESF-3.
  • 50.
    Surveillance activities atstate level • The District will report to the state on daily/weekly/monthly basis as per requirement depending on the disease situation. • Data from the districts will be compiled and analysed at the state level to understand the disease situation to provide feedback to the districts and to initiate appropriate prevention and control measures. • To strengthen the JE/AES surveillance the state may coordinate with existing ICMR designated Viral Diagnostic Laboratories (VDL). • Final compiled date from the state will be sent to the national level on daily/weekly/monthly basis as desired by the disease situation. • Presently 85 sentinel sites and diagnostic centres exist in different States. • Considering growing number of JE reporting districts, it has been decided to add 20 more such centres with provision of manpower, equipment, kits, capacity building etc.
  • 52.
    Periodicity of reports •Daily report should be generated and transmitted in an outbreak situation • Weekly report in transmission period and monthly report in inter- epidemic period. • In outbreak situation action taken report should be sent along with daily report. • Note : The decision on the periodicity of the reports will be made at the state level by the State Programme Officer based on the local JE transmission pattern.
  • 53.
    Eco-Entomological Surveillance Objectives ofEntomological Surveillance 1. To identify the JE vector mosquitoes in an area 2. To monitor JE vector abundance in JE endemic areas 3. To detect JE virus in vector mosquitoes 4. To suggest appropriate vector control measures
  • 54.
    Choice of indexvillages At least 3 villages in which JE has occurred in the recent past (past five years) At least 2 villages which remained unaffected till date would be monitored in each affected block Sampling would be carried out on fortnightly basis Surveillance would be carried out round the year to known the JE vector density, their resting behavior, feeding behavior and detection/isolation of JE virus from vector mosquitoes.
  • 55.
    Entomological surveillance Larval surveys Adult surveys Susceptibility of JEvector mosquitoes and larvae Laboratory support Screening/ isolation of JE virus from suspected JE vector mosquitoes. Vector incrimination would be done in collaboration with NIV Pune, CRME Madurai and NICD, Delhi.
  • 56.
    Thermal fogging (ULV) •Thermal fogging with portable fogging is done in outdoor situations (outside human habitation), where large number of JE cases are reported. • Fogging should be carried out in downwind to upwind direction. • During outdoor fogging it is important to direct the fog to all possible adult mosquito resting sites like bushes, tree-shaded areas and other outdoor resting in peri-domestic habitats. • The most effective type of thermal fog for mosquito control is medium / dry fog i.e. it should just moisten the hand when the hand is passed quickly through the fog at a distance of about 2.5 to 3.0 meters in front of the fog tube. • The technical specification recommended for fogging machined should be of BIS standard no. 14855 (Part 1): 2000 for Vector Control. • Under NVBDCP, presently Malathion and Pyrethrum formulations are use for fogging applications. • For thermal fogging: 5 per cent Malathion (Technical) in kerosene/diesel (1 litre of technical Malathion in 19 litres of diluents).
  • 57.
    During outbreak situations,fogging applications have to be carried out at 7-10 days interval till a significant reduction in vector densities is achieved.
  • 58.
  • 59.
    Veterinary Based Surveillance •By identifying the prevalence & density of pigs, ducks, and ardeid birds and detecting viral activity in susceptible hosts, veterinary surveillance helps to track the rate of Haemagglutination Inhibition (HI) antibody carriers and the appearance of antibody from fresh infection as an index of the spread of JE virus in animal host. • Veterinary-based surveillance is conducted with the help of animal husbandry department. • Sera sample from these animals is randomly collected for serology to ascertain transmission of JE virus. The objectives of Veterinary based surveillance are: Prevalence of Pigs/Ducks, Ardeid Birds in an area To detect viral activity in susceptible hosts
  • 60.
    Institutes for screeningfor antibody carriers and other virology studies i) National Institute of Virology (NIV), Pune. ii) Centre for Research in Medical Entomology (CRME), Madurai. iii) VBRI (Veterinary Biological Research Institute), Shanthinagar, Hyderabad, Andhra Pradesh. iv) Kyasanoor Forest Disease Laboratory, Shimoga, Karnataka. v) Institute of Vector control and Zoonosis Hosur, Tamil NAdu. vi) Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, U.P. vii) Diagnostic Research Laboratories, RWITC. Ltd. (Approved By Govt. of India
  • 66.
    REFERENCES • Park’s textbookof preventive and social medicine, 24th edition. • www.nvbdcp.gov.in • National Framework for Malaria Elimination in India 2016-2030. Directorate of National Vector Borne Disease Control Programme (NVBDCP). Ministry of Health & Family Welfare, Government of India. p. 43. Available from: http://www.nvbdcp.gov.in/malaria [Accessed: 20 February 2018] • National Vector Borne Disease Control Programme, Directorate General of Health Services, Ministry of Health & Family Welfare. Government of India. Malaria. Available from: http://www.nvbdcp.gov.in/malaria [Accessed: February 20, 2018] • Sabesan, Shanmugavelu & Raju, Hari Kishan & Swaminathan, Subramanian & Srivastava, Pradeep & Jambulingam, Purushothaman. (2013). Lymphatic Filariasis Transmission Risk Map of India, Based on a Geo-Environmental Risk Model. Vector borne and zoonotic diseases (Larchmont, N.Y.). 13. 10.1089/vbz.2012.1238.