Neglected tropical diseases in India (NTDs) are a group of bacterial, parasitic, viral, and fungal infections that are common in low income countries but receive little funding to address them. Neglected tropical diseases are common in India.

1. Neglected
Tropical
Diseases
in India

2. Introduction
• Neglected tropical diseases (NTDs) are caused by diverse pathogens,
majority being parasites.
• Overlooked in the global health agenda.
• Collective burden equivalent to HIV/AIDS, tuberculosis, or malaria.
• Found in places with low socioeconomic progress, where:
I. Substandard housing,
II. Lack of access to safe water and sanitation
III. Filthy environments
IV. Abundant insects and other vectors contribute to efficient
transmission of infection
2

3. NeglectedTropical Diseases as Identified by
WHO
3
Source -unitingtocombatntds.org
Diseases not present in india

4. Epidemiology
( India)
4
Source :Global Burden of Disease Study 2016 (GBD 2016) Data Resources
Neglected tropical disease Cases in India
India's percent
of global total
India's incidence rank
Ascariasis 222 million 28% 1
Hookworm infection 102 million 23% 1
Trichuriasis 68 million 16% 1
Dengue fever 53 million 53% 1
Lymphatic filariasis 8.7 million 29% 1
Trachoma 1.8 million 53% 1
Cysticercosis 819,538 31% 1
Leprosy 187,730 36% 1
Echinococcosis 119,320 12% 1
Visceral leishmaniasis 13,530 45% 1
Rabies 4,370 33% 1
India’s major NTDs and rank.

5. NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming
Leishmania Donovani
Mud walls
Dampness in houses
Peri domesticVegetation
Humans
Men and children
Visceral Leishmaniasis
(Sandlfy – Phlebotomus
Argentipes)
5

6.  Cases- 1958 (Jan 2020)
 Deaths – 0
 Notifiable disease in Bihar andWest Bengal
 Control strategy
1.Integrated vector control
2.Enhanced case detection
3.Complete treatment (PKDL)
4.Capacity building
5.Operational research
 NVBDCP - National Kala-azar Elimination
Programme (1990-91)
 Target – to reduce AI of K.A. to <1 /10,000
population at block PHC level
Source
https://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=474&lid=3749
6

7. Dengue virus
Standing water in
various items and
places.
Humans
1.Dengue
7
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming
Aedes mosquito

8. Source
https://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=474&lid=3749
8
• Cases- 32796(Jan 2020)
• Deaths – 16
• Control strategy
1. Personal prophylactic measures
2. Biological and chemical control
3. Environment management
4. Health education and community
participation
• NVBDCP – Long term action plan for prevention
and control for Dengue / DHF and Chikungunya

9. Rabies lyssavirus
Incidence Increases
during breeding
season of dogs
Mammals (Wild and
domestic)
MC- Dogs
3.Rabies
9
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

10.  Incidence- 1.7/100000 population
 DALY’s -3.7 million (Global)
 Dog man ratio – 1:35
 One rabid dog can infect up to 65 humans
 Prevention
1.Prevent human deaths by strengthening
post exposure treatment
2.Reduce canine rabies by mass animal
vaccination
 National Rabies Control Programme
(NRCP)which has both human and animal
health components.
Regional variation of estimated rabies deaths and death rates: India, 2005
Source article - Deaths from Symptomatically Identifiable Furious Rabies in India: A Nationally Representative Mortality Survey
10

11. Mycobacterium Leprae
Living in leprosy endemic
area
Close contact with
infected person
Human
1.Leprosy
11
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

12.  Prevalence- 0.57 /10000 population (31st March
2020)
 National Leprosy Eradication Programme
(NLEP)
1.The National LeprosyControl Programme
was launched by GOI in 1955.
2.After introduction of Multi DrugTherapy in
1982, the program was converted into
National Leprosy Eradication Programme
(NLEP)
3.Till 31st March, 2018, 29 States/ UTs had
attained the level of leprosy elimination i.e.,
prevalence rate of less than 1 case of leprosy
per 10000 population and 572 districts
(81.13%) out of total 705 districts also
achieved elimination level.
https://www.who.int/docs/default-source/ntds/leprosy/global-
consultation-on-global-leprosy-strategy-2021-2030/05-
challenges-india.pdf
12

13. Chlamydia trachomatis
Lack of water, absence
of latrines or toilets,
flies, close proximity to
cattle, and crowding
Human ( MC in Children
and Women)
2.Trachoma
13
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

14.  Trachoma Control Pilot Project-India (ICMR) conducted epidemiological studies
 Distribution pattern of the disease obtained-
(1) High Endemic Region: -
Gujarat (56.0%), Rajasthan (74.2%), Punjab (79.9%) and Uttar Pradesh (72.7%).
Complications due to trachoma were found also to be high in this region.
(2) Moderate Endemic Region
Madhya Pradesh (43.3%), Bihar 35.1%, Assam 25.2% and Mysore (22.6%).
(3) Low Endemic Region:
West Bengal (0.5%), Orissa (2.72%), Maharashtra (11.3%), Madras (4.6%), Andhra Pradesh
(5.3%) and Kerala (8.7%)
 On December 08, 2017, Shri J P Nadda, Union Minister of Health and FamilyWelfare released
the NationalTrachoma Survey Report (2014-17) declared India free from 'infective trachoma'
Source article - https://www.ijo.in/article.asp?issn=0301-4738;year=1964;volume=12;issue=2;spage=39;epage=49;aulast=Gupta
14

15. Treponema palladium
pertenue
Warm and humid climate
Tribal people
Poor personal hygiene
Low standard of living
Human ( MC in Children and
Adolescents )
3.Yaws
On 19 September 2006 – after 3 consecutive years of reporting of zero cases GOI declared India yaws free. 15
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

16. https://www.ijmr.org.in/article.asp?issn=0971-
5916;year=2015;volume=141;issue=5;spage=608;epage=613;aulast=Narain
 Yaws eradication Programme (YEP) since 1996-97
 On 19 September 2006 – after 3 consecutive years of reporting
of zero cases GOI declared India yaws free.
 Programme strategy
1. Creating yaws consciousness and awareness in health
professionals and community members,
2. Trained manpower development,
3. Detection and treatment of cases and contacts,
4. Monitoring and evaluation, and
5. IEC activities harnessing multi-sectoral approach
 In post elimination phase apart from ongoing activities three
new activities were started:
1. Sero-survey among children to assess cessation of
transmission of infection for 3-5 years
2. Rumour reporting
3. Investigation and cash incentive scheme to encourage
voluntary reporting of the cases by the community.
 WHO Director General declared India free of Yaws at Geneva
on 5th May, 2016
16
Source Article- https://www.ijmr.org.in/article.asp?issn=0971-5916;year=2015;volume=141;issue=5;spage=608;epage=613;aulast=Narain

17. Leptospira
Faeces or urine of
infected animal
shed in soil or water
Human ( MC in
Children )
4.Leptospirosis
17
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

18. https://www.ijmr.org.in/article.asp?issn=0971-
5916;year=2015;volume=141;issue=5;spage=608;epage=613;aulast=Narain
 Cases – 2434 ( July 2020 )
 Seasonal disease- Starts at onset on rainy season and
declines as the rains recede .
 In floods – Epidemic Potential
 Prevention and control measure
1. Personal protection - Hygiene
2. Health education – Awareness
3. Chemoprophylaxis- Doxycycline 200 mg, once a
week given to agricultural workers
4. Rodent control
5. Vaccination
18
Source - https://idsp.nic.in/showfile.php?lid=5166

19. Ascaris lumbricoides,
Trichuris trichiuria,
Hookworm,Taenia, and
Hymenolepis nana
Contaminated food,
water and soil
Humans (children aged
1–14 years)
1.SoilTransmitted Helminth Infections
19
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

20. The district-level endemicity map of lymphatic filariasis in India based on historical data (Sabesan et al.
2000).
 TheWHO estimates that in India around 241 million children
between the ages of 1- 14 are at a risk of parasitic intestinal
worm infestation.
 Control is achieved by targeted use of
1. chemotherapy
2.improvement of sanitation, drinking water
3. use of pit-latrines instead of open defecation
4.good hygiene practices
 Programs
1. National Filaria Control Programme (NFCP) 1955
2.National deworming day -To deworm all preschool and
school-age children (enrolled and non-enrolled)
between the ages of 1-19 years through the platform of
schools and Anganwadi Centers
20
Source-https://www.nhp.gov.in/disease/digestive/helminthiasis-soil-
transmitted-helminth-infections

21. Filarial worms
Insanitation and
stagnant water
Human
2.Lymphatic filariasis
21
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming
Culex mosquito

22. The district-level endemicity map of lymphatic filariasis in India based on historical data (Sabesan et al.
2000).
 National Filaria Control Programme (1955)
 Control measures
1. Recurrent anti-larval measures at weekly intervals.
2.Environmental methods including source reduction by
filling ditches, pits, low lying areas, deweeding, desilting,
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 DEC by
Filaria Clinics in towns covered under the programme.
The district-level endemicity map of LF in India based on historical
data (Sabesan et al. 2000).
Source article -Lymphatic FilariasisTransmission Risk Map of India,
Based on a Geo-Environmental Risk Model
22

23. India was declaredas guineawormdisease freecountrybyWHOin2000.
Dracunculus
medinensis
Infected
water bodies
Humans
3.Guinea-worm disease
23
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

24.  GW disease was endemic in 89 districts in seven states.
 Last case of Guinea worm in India 6 July 1996
 Strategy
1. Guinea worm case detection and continuous
surveillance through three active case search
operations and regular monthly reporting
2.GW case management
3. Vector control by the application ofTemephos in
unsafe water sources
4.Provision and maintenance of safe drinking water
supply on priority in GW endemic villages
5.Trained manpower development and
6.Intensive health education
7. Concurrent evaluation and operational research.
Source - https://nvbdcp.gov.in
24

25. Sarcoptes scabiei
Humid spaces ,
overcrowding for sleeping
space and sharing of
clothes, towel, etc
Humans
Scabies
25
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming
• Incidence – ranges from 13%-
15 % in rural and urban areas
• Prevention
1. Early treatment for cases
and contacts
2. Increase MDA and follow
up
3. integration into existing
clinical and public health
programmes
Source- https://www.nhp.gov.in/disease/scabies

26. Venomous Snakes
Rural cropping and livestock
workers, hunter/gathers .
Lack of footwear
contributes to snakebite.
Humans
Snakebite envenoming
26
NeglectedTropicalDiseasesof
India
1.Protozoaninfections
2.Viralinfections
3.Bacterialinfections
4.Helminthinfections
5.Ectoparasiticinfections
6.Snakebiteenvenoming

27. https://elifesciences.org/articles/54076
 1.2 million snakebite deaths (58000/year)(2009-
2019)
 90% in rural areas ( males – middle aged and
children )
 Prevention
1.Better Health infrastructure
2.Development of antivenoms
3.Awareness
 Under- reporting
27
Estimated deaths in states with high prevalence of snakebite deaths, 2005.
Source article https://elifesciences.org/articles/54076

28. Elimination
Strategy
The World Health Organization
(WHO) conceived an innovative
strategy in the early 2000s to
combat NTDs as a group of
diseases, based on a combination
of five public health interventions
28
Image source -https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-0630-9

29. Goals related
to NTD’s
Short term
 Develop Strong and sustained political will based on evidence
 Lack of resources is the single most roadblock
 Reduce stigma and discrimination
 Resource mobilization and Public- Private partnerships
 Effective surveillance and monitoring
Long term
 Operational research to generate evidence for post elimination
strategy
 Ensure development of Community based rehabilitation programs
for Disabled persons and their reintegration
29

30. Take Home
messages
 NTDs-
1. cause devastating health and economic problems
2. disability that hinders school attendance, care of families,
and earning wages.
3. disrupt productivity and already unstable economies.
 Contrasted with the big three infectious diseases (HIV/AIDS,
tuberculosis, and malaria), which generally receive greater
treatment and research funding..
 India carries the burden of at least 14 of NTD’S.
 Global efforts, Political will and evidence generation is the need of
the hour.
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