G

1. 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

2. 2
• 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.
About NVBDCP

3. 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

4. Kala-Azar
4 States; 54 Districts; 130 million
population
6 distt.,11.0 mil
4 districts
Pop: 6.7 mil
33 distt., 62.3 mil
11 districts
Pop. – 50 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.
•In the SEA Region, KA occurs in111
districts).
•45 districts of Bangladesh,
•54 districts of India and
•12 districts of Nepal
•Endemic in Bihar, West Bengal,
Assam, Tamil Nadu during pre DDT
era
•Re-appeared during seventies
•A centrally sponsored VL control
Programme launched in 1990-91
• > 80% of all cases reported from Bihar
• 9 Dist in Bihar contribute 65-70% of cases

5. 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

6. 1991
Geographical spread of Dengue in last 2 decades
2013
Dengue Cases/per district
1996

7. Spatial distribution of Chikungunya since 2006
Kolkata -1963
Vishakhapatnam – 1964
Kakinada -1965
Rajahmundry -1965
Chennai - 1964
Pondicherry - 1964
Nagpur 1965 1977
Barsi - !973,
Sagar - 1965
Chikungunya outbreaks in 1960s-70s

8. RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
UTTAR PRADESH
KARNATAKA
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYA
NAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
DELHI
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
CHANDIGARH
DAMAN & DIU
N
E
W
S
SONITPUR
TINSUKHIA
JORHAT
DHEMAJI
DIBRUGARH
GOLAGHAT
BARPETA
LAKHIMPUR
SIBSAGAR
UDALGURI
ASSAM
GAYA
PATNA
SARAN
ARARIA
SIWAN
NAWADA
CHAMPARAN WEST
NALANDA
CHAMPARAN EAST
VAISHALI
DARBHANGA
MUZAFFARPUR
SAMASTIPUR
GOPALGANJ
JEHANABAD
BIHAR
VILLUPURAM
MADURAI
KARUR
THANJAVUR
THIRUVARUR
TAMIL NADU
SAMASTIPUR
BIHAR
KHERI
HARDOI
SITAPUR
GONDA
BASTI
BAHRAICH
BALLIA
MAU
AZAMGARH
DEORIA
SAHARANPUR
RAEBARELI
BALRAMPUR
KUSHINAGAR
GORAKHPUR
SRAWASTI
KANPUR(DEHAT)
MAHARAJGANJ
SANT KABIR NAGAR
SIDDHARTHNAGAR
UTTAR PRADESH
DEORIA
BANKURA
BARDHAMAN
JALPAIGURI
HUGLI
BIRBHUM
MALDAH
PASCHIM MEDINIPUR
DARJILING
HOWRA
DAKSHIN DINAJPUR
WEST BENGAL
Target States of JE/AES: 60 High Priority Districts
Assam
10 Districts
Bihar 15 Districts
West Bengal 10 Districts
Tamil Nadu
5 Districts
Uttar Pradesh 20 Districts
8

9. Reported* Global SEARO India
As per WMR* India is at
• 18th position- total malaria
• 21st position deaths.
India contributed to world
malaria*
•1.7% of malaria cases
• 4.6% of Pv cases
•1.1 % of Pf cases
•0.3% of malaria deaths
Malaria cases 94.30 Mil. 4.44 Mil 1.59 Mil
Pv cases 16.40. Mil. 3.3 Mil 0.76 Mil
Pf cases 77.90 Mil. 1.1 Mil 0.83 Mil
Malaria deaths 3,45,960 2,426 1,018
Estimated
Malaria deaths
6,55,000 38,000 20,000
Malaria Cases & Deaths: Global vs India Scenario
*Source: World Malaria Report 2011
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

10. Trend of Malaria, India, 2001 - 2013
•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
0
200
400
600
800
1000
1200
1400
1600
1800
0
500000
1000000
1500000
2000000
2500000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Malaria Cases Pf Cases Pv Cases Deaths
Pv,
Pf
&
Total
Cases
Deaths
ACT & RDT
LLIN
Bivalent
RDT

11. MALARIA ENDEMIC AREAS
*Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat,
Karnataka & West Bengal
PERCENTAGE CONTRIBUTION OF POPULATION,
MALARIA CASES, PF CASES AND DEATHS in 2010
(Compared to the country total)
States
%
Popula
tion
%
Malaria
cases
%
Pf
cases
% Death
N.E.
States
4 11 16 21
Other
high
endemic
states*
42 71 79 70
Other 54 18 5 9
API - 2010
0-1
>1-2
>2-5
>5-10
>10
Erstwhile World Bank Project
(Rs.1000 Crore: 2008-2013)
GFATM: R-9
(Rs.417 Crore : 2010-2015)

12. Shrinking – Malaria Map- India
Stratification of Districts based on API
API
2000 2012
No. % No: %
>10 59 10 32 4.9
>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
2013
Malaria Situation –India (2000-2013)
Year Cases Deaths
2000 19,42,318 959
2013 8,81,730 440

13. 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

14. 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

15. Treatment of Vivax Malaria
Chloroquine: 25 mg/kg body weight divided over three days i.e.
• 10 mg/kg on day 1,
• 10 mg/kg on day 2 and
• 5 mg/kg on day 3.
Primaquine*: 0.25 mg/kg body weight daily for 14 days.
• Primaquine is contraindicated in infants, pregnant women and individuals with G6PD deficiency.
Dosage Chart for Treatment of Vivax Malaria

16. 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
Primaquine: 0.75 mg/kg body weight on day 2.
15 - < 25 Kg
5 - <15 Kg 25 - <35 Kg ≥ 35 Kg

17. 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

18. 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

19. 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

20. 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

21. Thank You
IMA
WHO, India