Detail about the Menace of Vector Borne Diseases in India. Planned "Modus Operandi" and Role of Hospitals in managing them.

1. VECTOR BORNE DISEASES
THE GROWING MENACE
Modus Operandi and Role of Hospitals in
controlling Vector Borne Diseases
By – Dr. Rakshit A S (drrakshit.blogspot.in)

2. What Is it?
• Vector – an insect or any living carrier that
transmits an infectious agent to the host.
• Vectors are the Vehicles by which infectious
agents are transmitted via arthropods, domestic
animals, or mammals to the host.
• So, vectors themselves are not an infectious
agents.
• E.g. - mosquito, fly, rodents, tick

3. What is it?
• Vector borne disease - A disease that is
transmitted to humans or other animals by an
insect such as a mosquito or another arthropod is
called a vector-borne disease.
• Mosquito-borne diseases - Malaria, Filariasis, Yellow
fever, dengue, Chikungunya fever, Japanese
Encephalitis.
• Fly-borne disease – Sand fly fever, Leishmaniasis
• Flea-borne diseases – Plague
• Tick-borne diseases – Lyme Disease, Relapsing fever,
Typhus

4. MAGNITUDE OF VECTOR BORNE DISEASES
• The most deadly vector borne disease, Malaria, kills over 1.2 million
people annually.
• In 2011, 1.31 million cases of malaria were noted, in which 0.65
million were of P. Falciparum & reported 463 deaths due to it.
• 27% of the Indian population lives in high malaria transmission
areas.
• Dengue fever, together with associated dengue haemorrhagic fever
(DHF), is the world's fastest growing vector borne disease,
nowadays.
• Worldwide, 25 billion of world population in tropical and subtropical
areas is at risk of Dengue and Chikungunya.
• In India Dengue is endemic in 31 states/UTs.
• In 2011, about 18059 cases of Dengue were noted with 119 deaths
in India.
• Punjab, TN, Kerala, Gujarat and Andhra Pradesh reported maximum
cases.

7. EPIDEMIOLOGICAL TRIAD
Plasmodium,
Arbovirus, etc.
AGENT
VECTOR
HOST
Healthy and
diseased persons,
animals
Anopheles,
Aedes,
mosquito etc.
ENVIRONMENT
Water logging,
open water
sources, etc.

8. Reasons for the emergence of Vector-Borne Diseases
• Demographic and societal changes:
– unplanned and uncontrolled urbanization and
– population growth has put severe constraints on civic
amenities, particularly water supply and solid waste disposal,
thereby increasing the breeding potential of the vector
species.
– Improved communication facilities (Rapid Transportation) has
helped the disease the establish in rural areas.
• Effective mosquito control primarily based on source reduction is
virtually nonexistent in most of the Dengue-Chikungunya
endemic states

9. Reasons for the emergence of Vector-Borne Diseases
• Solid waste management:
– a significant increase in the use of non-biodegradable
plastics, namely paper cups, used tyres, etc. that not only
facilitate increased breeding compounded by nonexistent or
insufficient solid waste collection and management.
• Increased population movement (work, travel, tourism or
pilgrimage) has resulted in a constant exchange of viruses.
• Lack or poor public health infrastructure required to deal with
these diseases
• Decreased resources for surveillance, prevention and control of
vector borne diseases
• Development of insecticide and drug resistance

10. BREEDING SOURCES
Dr. Rakshit A S
(drrakshit.blogspot.in)
10

11. BREEDING SOURCES
Dr. Rakshit A S
(drrakshit.blogspot.in)
11

12. Dr. Rakshit A S
(drrakshit.blogspot.in)
12

13. MODUS OPERANDI
 The basic approach for vector borne diseases control
involves a strategy directed against the parasite and
vector and to enlist the involvement of community in
practicing various preventive measures.
 First organized attempt was made in 1953 on launch of
National Malaria Control Program.
 Then, National vector borne disease control program
was launched in 2003-04 by merging NAMP, NFCP &
Kala Azar Control programs .Japanese B Encephalitis
and Dengue/DHF have also been included in this
program.
 The approach to control Vector borne diseases consists
of three basic things:

14. MODUS OPERANDI

INTEGRATED VECTOR MANAGEMENT
 Source reduction
 Anti Larval measures
 Indoor Residual Spray – IRS
 Insecticide treated bed nets – ITNs

EPIDEMIC PREPAREDNESS AND EARLY RESPONSE
• Early case Detection and Prompt Treatment (EDPT)
 SURVEILLANCE AND CASE MANAGEMENT
• Case Detection (Passive and Active)
• Sentinel Surveillance

SUPPORTIVE INTERVENTIONS
• Capacity building
• Behavior Change Communication
• Inter Sectorial Coordination
• Public Health Engineering Support
• Monitoring & Evaluation
• Operational Research and applied field research

15. INTEGRATED
VECTOR
MANAGEMENT

16. ANTI LARVAL MEASURES
 ENVIRONMENTAL CONTROL
1) Source Reduction – Elimination of Breeding
places
2) Filing of pits and drainage operation
3) Carefully planned water management
4) Provide piped water supply
5) Proper waste disposal
6) Cleanliness in and around houses
7) Focusing more on high risk group of polulation
(API: >2)

18. ANTI LARVAL MEASURES
 CHEMICAL CONTROL
1) Mineral Oils –
• Kerosene, Diesel oil, etc.
• Oil spread over water and make thin film which cuts air
supply to the mosquito larvae and pupae.
• Kills larvae and Pupae in short time.
2) Paris Green –
• Micro crystalline powder, insoluble in water kills
Anopheles larvae because they are surface feeders.
3) Synthetic Insecticides • Fenthion, Chlorpyrifos and Abate – act as larvicides
• DDT

19. ANTI LARVAL MEASURES
 Biological Control
• Larvivorous Fishes – They feed on mosquito larvae.
• Eg. Gambusia affinis & Lebister reticulatus
• Can be used in burrow pits, sewage oxidation ponds,
ornamental ponds, farm ponds
• Best effective when used along with other methods.

20. ANTI – ADULT MEASURES
 RESIDUAL SPRAYS
• Indoor spraying with DDT in dose of 1-2 gm of pure DDT
per sq. meter 1-3 times a year to walls and other
mosquitos rest.
 SPACE SPRAYS
• Insecticidal sprayed into the atmosphere in the form of
mist or fog to kill insects.
• Eg. Pyrenthrum extract, a nerve poison to mosquito
• Ultra Low Volume (ULV) space spraying with malathion
and fenitrothion.

21. PROTECTION AGAINST BITES
 MOSQUITO NETS
• Protects against bites
 SCREENING
• Door and window screening
With nets gives excellent
protection
 REPELLENTS
• Mosquito repellent creams,
Lotions are good as short term personal protective measures
 Wearing Full Sleeve Clothes and covering most of the body
parts against mosquito and fly bites.

22. OTHER METHODS
• Rodent Control
– Construction of rat proof buildings
– Blocking rat burrows with concrete
– Rat trapping and use of Rodenticides
• Fly Control
– Screening of windows with at least 14 mesh net to
control house flies
– Fly peppers
– Fly consciousness through health education.

23. EPIDEMIC
PREPAREDNESS AND
EARLY RESPONSE

24. Early case Detection and Prompt Treatment (EDPT)
– EDPT is the main strategy in malaria and dengue control radical treatment is necessary for all the cases to prevent
transmission.
– Chloroquine is the main anti-malaria drug for uncomplicated
malaria.
– Drug Distribution Centres (DDCs) and Fever Treatment Depots
(FTDs) have been established in the rural areas for providing
easy access to anti-malarial drugs to the community.
– The transmission of filaria can be stopped by treating the
entire eligible population living in filarial endemic areas
with Mass Drug Administration (MDA) with DEC (Diethyle
Carbamazine Citrate)
– Use of rf39 rapid diagnostic kits for Kala Azar detection

25. SUPPORTIVE
INTERVENTIONS

26. SURVEILLANCE AND CASE MANAGEMENT
 Case Detection (Passive and Active)
• Eg. Sentinel Surveillancesurveillance of fever cases in the
community mainly by the Multi Purpose Worker {MPW}.
• Active case detection (ACD) implies that the MPW would visit all
villages within the sub centre area fortnightly and look for fever
cases which occurred between the current and previous visit.
• Passive Case Detection PCD is si done in fever reporting to
peripheral health volunteers/ ASHA/PHCs by examination of blood
smears.
 Sentinel Surveillance
• Established in high endemic districts, 1-3 sentinel sites in large
hospitals for recording of all OPD and IPD cases of Malarial
and Malaria related deaths.

27. SUPPORTIVE INTERVENTIONS




Inter Sectorial Coordination
• Legislation of Water and Sewage management systems in Buildings
• Coordination with Public Welfare Dept.
• Public Health Engineering Support
• Involvement of NGOs /private sector/community
Capacity building
• Training and Development of Manpower
• Infrastructure development
• Quality assurance on laboratory diagnosis
• Improve quality and efficiency of services at primary, secondary and tertiary level
Behavior Change Communication
• Social mobilization,
• IEC through media campaigns and heath awareness and health education programmes
Monitoring & Evaluation
– Monthly Computerized Management Information System(CMIS)
– Field visits by state by State National Programme Officers
– Field visits by Research Centres and other ICMR Institutes
– Feedback to states on field observations for correction actions.

28. Key Elements in Planned Govt. OCTALOGUE
(1) Surveillance • Disease Surveillance
• Entomological Surveillance
(2) Case management
• Laboratory diagnosis
• Clinical management
(3) Vector management
• Environmental management for Source
Reduction
• Chemical control
• Personal protection
• Legislation
(4) Outbreak response
• Epidemic preparedness
• Media management
(5) Capacity building
• Training
• Infrastructure development
• Operational research
(6) Behaviour Change Communication
• Social mobilization,
• IEC
(7) Inter-sectoral coordination
• Health & non health sector
(8) Monitoring & Supervision
• Review, field visit , feedback
• Analysis of reports

29. ROLE OF HOSPITAL IN PREVENTION AND CONTROL
OF VECTOR BORNE DISEASES
 PREVENTION OF VECTOR BORNE DISEASES
•
•
•
•
•
SURVEILLENCE AND CONTAINMENT MEASURES FOR ALL COMMUNICABLE DISEASES
EDUCATION ABOUT HEALTH BY IEC EFFORTS
ACCESSIBILITY TO SAFE LIVING ENVIRONMENT THROUGH LOCAL BODIES &
INTERSECTORIAL LINKAGES
CREATING HEALTH AWARENESS AND KNOWLEDGE ABOUT DISEASE TRANSMISSION
REFERRAL SUPPORT THROUGH THE CHANNEL
– ANGANWADI, ASHA WORKERS
– PHC, CHC
– DIST. & SPECIALITY HOSPITAL
 PROMOTIVE SERVICES
•
•
•
ABOUT DISEASE OUT BREAKS
PROMOTING HEALTHY LIFE STYLE AND IMPORTANCE OF GOOD SANITATION IN
PREVENTION OF VECTOR BORNE DISEASES
COLLABORATION WITH SOCIAL BODIES AND NGOs FOR CAPACITY BUILDING IN
DISEASE PREVENTION

30.  CURATIVE SERVICES
•
•
•
PROVIDING CURATIVE SERVICES TO THE AFFECTED POPULATION AND NOTED CASES
ACCURATE DIAGNOSIS OF THE DISEASE
PARTIVIPATION IN VARIOUS ACTIVITIES RELATED WITH NVBDCP
– MALARIA CLINIC IN EVERY HOSPITAL
– ACTIVE AND PASSIVE SURVEILLANCE OF EPIDEMICS
– EARLY DETECTION AND PROMT TREATMENT OF PATIENTS
• QUININE FOR MALARIA
• DEC FOR FILARIA, ETC.
– GIVING CHEMOPROPHYLAXIS
 EDUCATION AND RESEARCH
•
•
•
GENERATING STASTICAL REPORT FROM DATA COLLECTED
EDUCATION AND TRAINING TO THE FIELD HEALTH WORKERS AND PROVIDING LATEST
INFORMATON ABOUT THE DISEASE CONTROL STRATEGIES
RESEARCH ACTIVITIES RELATED TO VACCINE DEVELOPMENT AND CLINICAL TRIALS

31. THANK YOU.