National Vector Borne Disease Control

Programme
Dr. Avdhesh Kumar
Additional Director
National Vector Borne Disease Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare,
Government of India
 About NVBDCP
• 1953-54 Started as - National Malaria Control Programme (NMCP) dealing
with malaria control only
• 1958-59 renamed as NMEP
• 1971 – Urban Malaria Scheme launched
• 1975 – National Filaria Control Programme (NFCP) which was in
operation since 1955 under NICD was divided and operational part was
brought to NMEP while retaining training part with NICD.
• 1977 – Modified Plan of Operation (MPO) launched to reduce morbidity
and mortality and also to sustain the gains achieved.
• 1991 – 92 Kala-azar Control Programme was launched under NMEP with
separate budget head.
• 1998-99 renamed as National Anti-Malaria Programme (NAMP)
• 2003-04 renamed as NVBDCP with a view to converge Dengue, JE and 3
ongoing centrally sponsored schemes : NAMP,NFCP, Kala azar
• In 2006, Chikungunya re-emerged and brought under NVBDCP.
2
Generic strategy for Prevention & Control of VBDs

 Early diagnosis and complete treatment

(No specific drugs against Dengue, Chikungunya and JE)

 Integrated Vector Management (IRS, LLIN, larvivorous fish,
chemical and bio-larvicide, source reduction)
 Supportive intervention: Vaccination only against JE

 Annual MDA using DEC and Albendazole for LFE

 Behaviour Change Communication

 Kala-Azar
6 distt.,11.0 mil 33 distt., 62.3 mil • Exists in several countries
• About 500 000 cases occur annually.
• Five countries (India, Sudan, Nepal,
Bangladesh and Brazil account for
90% of the global cases.
4 districts • In the SEA Region, KA occurs in111
Pop: 6.7 mil
districts).
• 45 districts of Bangladesh,
• 54 districts of India and
11 districts
• 12 districts of Nepal
Pop. – 50 mil • Endemic in Bihar, West Bengal,
Assam, Tamil Nadu during pre DDT
4 States; 54 Districts; 130 million era
population • Re-appeared during seventies
• A centrally sponsored VL control
• > 80% of all cases reported from Bihar
• 9 Dist in Bihar contribute 65-70% of cases
Programme launched in 1990-91
Lymphatic Filariasis - Disease Burden in India
•40% of Global Burden
•Endemic in 20 States/UT-250
Dist.
•600 million “at risk”
•509 million targeted for MDA

2004 : > 1% Mf rate 174 Districts

2012 : > 1% Mf rate 64 Districts
Lymphoedema – 877,594
Hydrocele – 407,307
Hydrocele Operation– 110,842
Geographical spread of Dengue in last 2 decades
1991 1996

Dengue Cases/per district

2013
Spatial distribution of Chikungunya since 2006
Chikungunya outbreaks in 1960s-70s

Sagar - 1965

Kolkata -1963
Nagpur 1965 1977
Barsi - !973,
Vishakhapatnam – 1964
Kakinada -1965
Rajahmundry -1965

Chennai - 1964
Pondicherry - 1964
 Target States of JE/AES: 60 High Priority Districts
Bihar 15 Districts
CHAMPARAN WEST

Uttar Pradesh 20 Districts

SAHARANPUR

CHAMPARAN EAST
GOPALGANJ

ARARIA
SIWAN MUZAFFARPUR
DARBHANGA
SARAN
KHERI
SAMASTIPUR
VAISHALI
SRAWASTI
BAHRAICH BIHAR
SITAPUR BALRAMPUR PATNA
HARDOI SIDDHARTHNAGAR
MAHARAJGANJ
GONDA NALANDA
SANT KABIR NAGAR KUSHINAGAR JEHANABAD
UTTAR PRADESH BASTI
GORAKHPUR
DEORIA
JAMMU & KASHMIR
NAWADA
KANPUR(DEHAT) RAEBARELI GAYA
MAU
AZAMGARH
BALLIA SAMASTIPUR
HIMACHAL PRADESH DHEMAJI TINSUKHIA
BIHAR DIBRUGARH
PUNJAB
CHANDIGARH
LAKHIMPUR
UTTARAKHAND

HARYANA SIBSAGAR
DELHI ARUNACHAL PR. SONITPUR
UDALGURI
SIKKIM JORHAT

RAJASTHAN UTTAR PRADESH ASSAM

NAGALAND BARPETA ASSAMGOLAGHAT
BIHAR MEGHALAYA
MANIPUR
WEST BENGAL TRIPURA
GUJARAT MADHYA PRADESH JHARKHAND MIZORAM

CHHATTISGARH
ORISSA
DAMAN & DIU
D&N HAVELI
MAHARASHTRA

ANDHRA PRADESH
Assam
GOA
KARNATAKA 10 Districts
VILLUPURAM A&N ISLANDS
PONDICHERRY

TAMIL NADU N
TAMIL NADU
LAKSHADWEEP KERALA

W E

S
KARUR
THANJAVUR
THIRUVARUR

MADURAI West Bengal 10 Districts

Tamil Nadu
5 Districts
8
 Malaria Cases & Deaths: Global vs India Scenario
Reported* Global SEARO India
As per WMR* India is at
Malaria cases 94.30 Mil. 4.44 Mil 1.59 Mil •
18th position- total malaria
Pv cases 16.40. Mil. 3.3 Mil 0.76 Mil • 21st position deaths.
Pf cases 77.90 Mil. 1.1 Mil 0.83 Mil
India contributed to world
Malaria deaths 3,45,960 2,426 1,018
malaria*
Estimated
Malaria deaths
6,55,000 38,000 20,000 •1.7% of malaria cases
• 4.6% of Pv cases
•1.1 % of Pf cases
•0.3% of malaria deaths
7 NE and 9 Other States –Odisha, Jharkhand, Chhattisgarh, MP, Andhra, Maharashtra,
Gujarat, Karnataka & W Bengal contribute countries' 54% Population, >80% Total Malaria,
>90% Pf. Cases and >90% deaths due to malaria *Source: World Malaria Report 2011
 Trend of Malaria, India, 2001 - 2013
LLIN

Bivalent
RDT

•ACT& RDT in 2005 : 53.93 % reduction in Malaria Cases

54.31 % reduction in deaths 2013 against 2005
•LLIN in 2009 : 46.47% reduction in Malaria Cases
• 61.54% reduction in deaths in 2013 against 2009
 MALARIA ENDEMIC AREAS

PERCENTAGE CONTRIBUTION OF POPULATION,

MALARIA CASES, PF CASES AND DEATHS in 2010
(Compared to the country total)

% % %
States Popula Malaria Pf % Death
API - 2010 tion cases cases
0-1
>1-2
>2-5 N.E.
>5-10 4 11 16 21
>10 States
Other
high
42 71 79 70
endemic
states*
GFATM: R-9
(Rs.417 Crore : 2010-2015) Other 54 18 5 9
*Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat,
Erstwhile World Bank Project Karnataka & West Bengal
(Rs.1000 Crore: 2008-2013)
Shrinking – Malaria Map- India
Malaria Situation –India (2000-2013)
Year Cases Deaths
2000 19,42,318 959
2013 8,81,730 440

Stratification of Districts based on API

2000 2012
API
No. % No: %
>10 59 10 32 4.9
2013
>5-10 22 3.7 29 4.4
>2-5 65 11.14 48 7.3
1-2 72 12.2 58 8.8
<1 370 63 492 74.7
2013- (Prv) - 515 Districts recorded API<1
- 23 States recorded API<1
 Prevention and Control strategy
• Disease Management (for reducing the load of Morbidity & Mortality)
• Early case detection and complete treatment,
• Strengthening of referral services,
• Epidemic preparedness and rapid response.

• Integrated Vector Management (For Transmission Risk Reduction)

• Indoor Residual Spraying in selected high risk areas,
• use of Insecticide treated bed nets (ITN/LLINs),
• use of Larvivorous fish,
• anti larval measures in urban areas like source reduction and minor environmental engineering

• Supportive Interventions (for strengthening technical & social inputs)

• Behaviour Change Communication (BCC),
• Public Private Partnership,
• Inter-sectoral convergence,
• Human Resource Development through capacity building,
• Operational research including studies on drug resistance and insecticide susceptibility,
• Monitoring & evaluation through periodic reviews/field visits
 API Stratification for Malaria Pre-Elimination
No. Category Definition
1. Category 1 States with API less than one, and all the districts in the state with API
less than one
2. Category 2 States with API less than one and few districts reporting API more than
one
3. Category 3 States with API more than one and either all the districts with API
more than one or few districts with API less than one and few with API
more than one

Strategies to be Adopted for various categories of API:

•Epidemiological Surveillance and Disease Management for reducing parasite load in the
community
•Integrated Vector Management for reducing mosquitoes density
•Supportive Interventions
Treatment of Vivax Malaria
 Treatment of Falciparum Malaria: NE States
• ACT-AL Co-formulated tablet of ARTEMETHER (20 mg) - LUMEFANTRINE (120 mg) (Not
recommended during 1st trimester of pregnancy and for children weighing < 5 kg)

Dosage Chart for Treatment of falciparum Malaria with ACT-AL

5 - <15 Kg 15 - < 25 Kg 25 - <35 Kg ≥ 35 Kg

Primaquine: 0.75 mg/kg body weight on day 2.

 Treatment of Falciparum Malaria: other than NE States
• Artemisinin based Combination Therapy (ACT-SP)*
• Artesunate 4 mg/kg body weight daily for 3 days Plus Sulfadoxine (25 mg/kg body weight) – Pyrimethamine
(1.25 mg/kg body weight)on first day.
* ACT not to be given in 1st trimester of pregnancy.
• Primaquine: 0.75 mg/kg body weight on day 2.

Dosage Chart for Treatment of falciparum Malaria with ACT-SP

 IMA Initiative…
– To strengthen the Programme:
–Elimination,
–Eradication
– Newer interventions: to increase the coverage
– Strengthening surveillance: all cases to be detected to
achieve National goal for these diseases
– Standard diagnosis & treatment guidelines
 Role of IMA in Vector Borne Diseases
• Aligning Diagnosis & Treatment as per National Policy
(monotherapy banned)
• All suspected cases to be tested for Malaria
• Diagnosis by Good Quality Ag detecting Bivalent RDTs
• Microscopy still the Gold Standard for diagnosis of malaria
• Species specific treatment of Malaria to be given
• Complete treatment be given
• Reporting of cases through District Malaria Officers
• IEC to Community
 Way Forward…
 Saturation of malaria endemic population with effective preventive
measure (LLIN)
 Quality coverage of high-risk population with IRS and provision of EDCT
 Sustaining incidence of malaria in areas with API<1
 Bring Down malaria incidence in areas having API>1
 Conducting Technical, Operational and Financial feasibility studies for
planning malaria elimination programme
 Pave way for elimination of malaria in subsequent years

 Ensuring complete reporting of all VBDs including from private sectors

Thank You

IMA
WHO, India