sensitizing community and health care professionals with regard to vector borne diseases.

1. WORLD HEALTH DAY CELEBRATIONS. ESI
HOSPITAL,RAMACHANDRA PURAM.
7, APRIL,2014.
THEME:VECTOR BORNE DISEASES-
SMALL BITE, BIG THREAT.(W.H.O)
C.M.E ON :
PREVENTION OF VECTOR BORNE
DISEASES-MALARIA,DENGUE,etc.
BY DR P SUDHAKAR NAIK.
C.A.S.
ESI HOSPITAL,RAMACHANDRA PURAM.
MEDAK DIST.

3. World Health Day is celebrated on 7 April every year to
mark the anniversary of the founding of WHO in 1948.
Each year a theme is selected that highlights a priority area of
public health.
The Day provides an opportunity for individuals in every
community to get involved in activities that can lead to better
health.
The theme for 2014 is vector-borne diseases. with the slogan
“Small bite, big threat”.
More than half the world’s population is at risk from diseases such as
malaria, dengue, leishmaniasis, Lyme disease, schistosomiasis, and
yellow fever, carried by mosquitoes, flies, ticks, water snails and other
vectors.
Every year, more than 1 billion people are infected and more than 1
million die from vector-borne diseases.

12. DEMOGRAPHIC DIVIDEND

13. WHAT ARE VECTORS AND VECTOR-BORNE
DISEASES?
Vectors are organisms that transmit pathogens and parasites from one
infected person (or animal) to another.
Vector-borne diseases are illnesses caused by these pathogens and
parasites in human populations.
They are most commonly found in tropical areas and places where access
to safe drinking-water and sanitation systems is problematic.
The most deadly vector-borne disease, malaria, caused an estimated 660
000 deaths in 2010.
However, the world's fastest growing vector-borne disease is dengue, with
a 30-fold increase in disease incidence over the last 50 years.

15. World Health Day 2014 will spotlight some of the most commonly known
vectors – such as mosquitoes, sandflies, bugs, ticks and snails – responsible
for transmitting a wide range of parasites and pathogens that attack humans
or animals.
Mosquitoes, for example, not only transmit malaria and dengue, but also
lymphatic filariasis, chikungunya, Japanese encephalitis and yellow fever.

16. GOAL: BETTER PROTECTION FROM VECTOR-
BORNE DISEASES
The campaign aims to raise awareness about the threat posed by vectors
and vector-borne diseases and to stimulate families and communities to take
action to protect themselves.
More broadly, through the campaign, we are aiming for the following:
families living in areas where diseases are transmitted by vectors know how to
protect themselves;
in countries where vector-borne diseases are a public health problem,
ministries of health put in place measures to improve the protection of their
populations; and
in countries where vector-borne diseases are an emerging threat, health
authorities work with environmental and relevant authorities locally and in
neighbouring countries to improve integrated surveillance of vectors and to
take measures to prevent their proliferation
.

17. VECTOR ECOLOGY AND MANAGEMENT (VEM)
Vector-borne diseases (VBDs) account for 16 % of the estimated
global burden of communicable diseases
Vector control is an important component in the prevention and control of
VBDs, especially for transmission control.
VEM, as a cross-cutting activity, develops and promotes strategies,
guidelines and standards for vector control, including sound managment of
pesticides.
VEM promotes integrated vector management to improve efficacy, cost-
effectiveness, ecological soudness and sustainability of vector control
interventions for VBD control.

18. DENGUE
Key facts
Dengue is a mosquito-borne viral infection.
The infection causes flu-like illness, and occasionally develops into a potentially
lethal complication called dengue Hemorrhagic fever and dengue shock
syndrome.
The global incidence of dengue has grown dramatically in recent decades.
About half of the world's population is now at risk.
Dengue is found in tropical and sub-tropical climates worldwide, mostly in
urban and semi-urban areas.
There is no specific treatment for dengue/ severe dengue, but early detection
and access to proper medical care lowers fatality rates below 1%.
Dengue prevention and control solely depends on effective vector control
measures.

19. There are four distinct, but closely related, serotypes of the virus that cause
dengue (DEN-1, DEN-2, DEN-3 and DEN-4).
Recovery from infection by one provides lifelong immunity against that
particular serotype.
However, cross-immunity to the other serotypes after recovery is only partial
and temporary.
Subsequent infections by other serotypes increase the risk of developing
severe dengue.
Global burden of dengue
The incidence of dengue has grown dramatically around the world in recent
decades. Over 2.5 billion people – over 40% of the world's population – are
now at risk from dengue.
WHO currently estimates there may be 50–100 million dengue infections
worldwide every year.

20. TRANSMISSION
The Aedes aegypti mosquito is the primary vector of dengue. The virus is
transmitted to humans through the bites of infected female mosquitoes.
After virus incubation for 4–10 days, an infected mosquito is capable of
transmitting the virus for the rest of its life.
Infected humans are the main carriers and multipliers of the virus, serving as a
source of the virus for uninfected mosquitoes.
The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-
made containers. Unlike other mosquitoes Ae. aegypti is a daytime feeder; its
peak biting periods are early in the morning and in the evening before dusk.

22. SYMPTOMS
Dengue fever is a severe, flu-like illness that affects infants, young children and
adults, but seldom causes death.
Dengue should be suspected when a high fever (40°C/ 104°F) is accompanied
by two of the following symptoms: severe headache, pain behind the eyes,
muscle and joint pains, nausea, vomiting, swollen glands or rash.
DENGUE HEMORRHAGIC FEVER is a potentially deadly complication due to
plasma leaking, fluid and electrolyte losses, respiratory distress, severe
bleeding, thrombocytopenia ,hemoconcentration and organ impairment.
Petechiae are present on extremities ,axilla,face and palate.there is easy
bruisability.
Warning signs include: severe abdominal pain, persistent vomiting, rapid
breathing, bleeding gums, fatigue, restlessness, blood in vomit.
DENGUE SHOCK SYNDROME supervenes after 2-7 days of fever ,if not
treated appropriately.

23. DIAGNOSIS:
Clinical diagnosis corroborated by
1. raised hematocrit,
2.thrombocytopenia and
3. positive torniquet test.
4.Four fold rise in dengue hemagglutin inhibition antibody titre or
complemet fixing antibody.
Treatment
There is no specific treatment for dengue fever.
Management of hyperpyrexia ,body pains and fluid loss constitutes the
treatment.
DHF: Oral fluid intake,Anti pyretics such PCM for hyperpyrexia,early and
effective replacement of plasma losses with plasma expander,fluidS and
electrolytes .
Transfusion of fresh blood or platelet suspended in plasma is given for severe
bleeding and associated thrombocytopenia.

24. DSS;
-Idicates loss of body fluids by more than 10%.
-immediate and rapid volume replacement is needed.
-monitoring with hematocrit value,if it is raising,administer plasma or 5%albumin.
-declining hematocrit s/o internal bleeding…Rx with fresh whole blood.
-concentrated platelet transfusion or fresh frozen plasma is indicated in cases
where coagulopathy causes massive bleeding.
-Maintenance of the patient's body fluid volume is critical to severe dengue care.
Immunization
There is no vaccine to protect against dengue. Developing a vaccine against
dengue/severe dengue has been challenging although there has been recent
progress in vaccine development.
Several candidate vaccines are in various phases of trials.

25. Prevention and control
At present, the only method to control or prevent the transmission of dengue
virus is to combat vector mosquitoes through:
preventing mosquitoes from accessing egg-laying habitats by environmental
management and modification;
disposing of solid waste properly and removing artificial man-made habitats;
covering, emptying and cleaning of domestic water storage containers on a
weekly basis;
applying appropriate insecticides to water storage outdoor containers;
using of personal household protection such as window screens, long-sleeved
clothes, insecticide treated materials, coils and vaporizers;
improving community participation and mobilization for sustained vector control;
applying insecticides as space spraying during outbreaks as one of the
emergency vector control measures;
active monitoring and surveillance of vectors should be carried out to determine
effectiveness of control interventions.

26. MALARIA
Caused by Plasmodium parasites.
The parasites are spread to people through the bites of
infected Anopheles mosquitoes, called "malaria vectors", which bite mainly
between dusk and dawn
About 3.4 billion people – half of the world's population – are at risk of malaria.
Increased prevention and control measures have led to a reduction in malaria
mortality rates by 42% globally since 2000 and by 49% in the WHO African
Region.
People living in the poorest countries are the most vulnerable to malaria.
There are four parasite species that cause malaria in humans:
Plasmodium falciparum,vivax,malariae,ovale;
Pl vivax infection is most common,Pl falcifarum infection is deadliest

27. Transmission
Malaria is transmitted exclusively through the bites
of Anopheles mosquitoes.
The intensity of transmission depends on factors related to the parasite,
the vector, the human host, and the environment.
Transmission also depends on climatic conditions that may affect the
number and survival of mosquitoes, such as rainfall patterns,
temperature and humidity.
In many places, transmission is seasonal, with the peak during and just
after the rainy season.
Malaria epidemics can occur when climate and other conditions
suddenly favour transmission in areas where people have little or no
immunity to malaria.
They can also occur when people with low immunity move into areas
with intense malaria transmission, for instance to find work, or as
refugees.

28. Symptoms
Malaria is an acute febrile illness.
Symptoms appear seven days or more (usually 10–15 days)
The first symptoms – fever, headache, chills and vomiting – may be mild and
difficult to recognize as malaria.
If not treated within 24 hours, P. falciparum malaria can progress to severe illness
often leading to death.
Children with severe malaria frequently develop one or more of the following
symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or
cerebral malaria.
In adults, multi-organ involvement is also frequent. In malaria endemic areas,
persons may develop partial immunity, allowing asymptomatic infections to occur.

29. SYMPTOMS OF SEVERE AND COMPLICATED MALARIA
The symptoms are a history of high fever, plus at least one of the following:-
Prostration (inability to sit),
altered consciousness
lethargy
Breathing difficulties
Severe anaemia
Generalized convulsions/fits
coma
Inability to drink/vomiting,
Dark and/or limited production of urine
Patients with prostration and/or breathing difficulties should, if at all possible, be
treated with parenteral antimalarials and antibiotics. .

30. SIGNS OF SEVERE AND COMPLICATED MALARIA
Cerebral malaria, defined as unarousable coma not attributable to any other
cause in a patient with falciparum malaria.
Generalized convulsions. ,
Normocytic anaemia.
Renal failure.
Hypoglycaemia.
Fluid, electrolyte and acid-base disturbances.
Pulmonary oedema.
Circulatory collapse and shock ("algid malaria").
Spontaneous bleeding (disseminated intravascular coagulation).
haemoglobinuria

31. MALARIA IN PREGNANCY
Pregnant women are particularly vulnerable to malaria as pregnancy reduces
a woman’s immunity to malaria, making her more susceptible to malaria
infection and increasing the risk of illness, severe anaemia and death.
For the unborn child, maternal malaria increases the risk of spontaneous
abortion, stillbirth, premature delivery and low birth weight - a leading cause of
child mortality
Based on available evidence, WHO recommends a three pronged approach
to treat malaria in pregnancy
)
Insecticide-treated nets (ITNs),
Intermittent preventive treatment
Effective case management of malarial illness

32. LABORATORY DIAGNOSIS.
1.Microscopic examination of blood film:
Thick smear for quick detection of parasites and thin smear for species
2.DETECTION OF HISTIDINE RICH PROTEIN-2
3.LACTIC DEHYDROGENASE ANTIGENS
4.QUANTITATIVE BUFFY COAT METHOD.
5. POLYMERASE CHAIN REACTION.
6. SEROLOGY

34. TREATMENT.
UNCOMPLICATED MALARIA.
A. Vivax malaria: chloroquine for 3 days+primaquine for 14
days.
B. In chloroquine resistant cases quinine+doxycyclin for 7
days+primaquine for 14 days.
C. Chloroquine sensitive falciparum malaria: chloroquine
for 3 days +primaquine single dose.
D. Chloroquine resistant falciparum malaria:artesunate for
3 days+sulfadoxine-pyrimethamine single dose
(or),artesunate 3 days+mefloquine on 2 and 3rd day,(or
) quinine +doxycycline for 7 days.
COMPLICATED MALARIA.
I V Quinine sulphate for 7 days DOC.
I V Artesunate,arteether,artemether for 7 days…

35. Prevention -WHO Strategy
Vector control is the main way to reduce malaria transmission at the community
level.
Intervention that can reduce malaria transmission from very high levels to close
to zero.
For individuals, personal protection against mosquito bites represents the first
line of defence for malaria prevention.
Two forms of vector control are effective in a wide range of circumstances.
Insecticide-treated mosquito nets (ITNs)
Long-lasting insecticidal nets (LLINs) are the preferred form of ITNs for public
health distribution programmes.
WHO recommends coverage for all at-risk persons; and in most settings.
The most cost effective way to achieve this is through provision of free LLINs,
so that everyone sleeps under a LLIN every night.

36. Indoor spraying with residual insecticides
Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly
reduce malaria transmission.
Its full potential is realized when at least 80% of houses in targeted areas are
sprayed.
Indoor spraying is effective for 3–6 months, depending on the insecticide used
and the type of surface on which it is sprayed. DDT can be effective for 9–12
months in some cases
Insecticide resistance
Much of the success to date in controlling malaria is due to vector control.
In recent years, mosquito resistance to pyrethroids has emerged in many
countries.
In some areas, resistance to all four classes of insecticides used for public
health has been detected.
Fortunately, this resistance has only rarely been associated with decreased
efficacy, and LLINs and IRS remain highly effective tools in almost all settings.

37. Vaccines against malaria
There are currently no licensed vaccines against malaria or any other human
parasite.
One research vaccine against P. falciparum, known as RTS,S/AS01, is most
advanced.
This vaccine is currently being evaluated in a large clinical trial in 7 countries in
Africa.
A WHO recommendation for use will depend on the final results from the large
clinical trial.
These final results are expected in late 2014, and a recommendation as to
whether or not this vaccine should be added to existing malaria control tools is
expected in late 2015.

38. MALARIA CONTROL STRATEGIES UNDER NVBDCP-GOVT OF
INDIA.
1. Early case Detection and Prompt Treatment (EDPT)
EDPT is the main strategy of malaria control - radical treatment is necessary for
all the cases of malaria to prevent transmission of malaria.
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.
Alternative drugs for chloroquine resistant malaria are recommended as per the
drug policy of malaria.
2. Vector Control

39. (i) Chemical Control
Use of Indoor Residual Spray (IRS) with insecticides recommended under
the programnme
Use of chemical larvicides like Abate in potable water
Aerosol space spray during day time
Malathion fogging during outbreaks
(ii) Biological Control
larvivorous fish Gambusia in ornamental tanks, fountains , Use of
biocides.etc.
(iii) Personal Prophylatic Measures
Use of mosquito repellent creams, liquids, coils, mats etc.
Screening of the houses with wire mesh
Use of bednets treated with insecticide
Wearing clothes that cover maximum surface area of the body
3. Community Participation
Sensitizing and involving the community for detection of Anopheles breeding
places and their elimination
NGO schemes involving them in programme strategies
Collaboration with CII/ASSOCHAM/FICCI

44. 4. Environmental Management & Source Reduction Methods
Source reduction i.e. filling of the breeding places
Proper covering of stored water
Channelization of breeding source
5. Monitoring and Evaluation of the programme
Monthly Computerized Management Information System(CMIS)
Field visits by state by State National Programme Officers
Field visits by Malaria Research Centres and other ICMR Institutes
Feedback to states on field observations for correction actions.

46. CHIKUNGUNYA
Key facts
Chikungunya is a viral disease transmitted to humans by infected mosquitoes.
It causes fever and severe joint pain. Other symptoms include muscle pain,
headache, nausea, fatigue and rash.
The disease shares some clinical signs with dengue, and can be misdiagnosed in
areas where dengue is common.
There is no cure for the disease. Treatment is focused on relieving the symptoms.
The proximity of mosquito breeding sites to human habitation is a significant risk
factor for chikungunya.
The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades
mosquito vectors of chikungunya have spread to Europe and the Americas.

47. JAPANESE ENCEPHALITIS
Key facts
Japanese encephalitis (JE) is a flavivirus related to dengue, yellow fever and
West Nile viruses, and is spread by mosquitoes.
JE is the main cause of viral encephalitis in many countries of Asia with
nearly 68 000 clinical cases every year.
Although symptomatic JE is rare, the case-fatality rate among those with
encephalitis can be as high as 30%. Permanent neurologic or psychiatric
sequelae can occur in 30%–50% of those with encephalitis.
24 countries in the WHO South-East Asia and Western Pacific regions have
endemic JE transmission, exposing more than 3 billion people to risks of
infection.
There is no cure for the disease. Treatment is focused on relieving severe clinical
signs and supporting the patient to overcome the infection.
Safe and effective vaccines are available to prevent JE. WHO recommends JE
vaccination in all regions where the disease is a recognised public health
problem.

48. LEISHMANIASIS
Key facts
There are three main forms of leishmaniases – visceral (often known as
kala-azar and the most serious form of the disease), cutaneous (the most
common), and mucocutaneous.
Leishmaniasis is caused by the protozoan Leishmania parasites which are
transmitted by the bite of infected sandflies.
The disease affects the poorest people on the planet, and is associated with
malnutrition, population displacement, poor housing, a weak immune system
and lack of resources.
Leishmaniasis is linked to environmental changes such as deforestation,
building of dams, irrigation schemes and urbanization.
An estimated 1.3 million new cases and 20 000 to 30 000 deaths occur
annually.

49. YELLOW FEVER
Key facts
Yellow fever is an acute viral haemorrhagic disease transmitted by infected
mosquitoes.
The "yellow" in the name refers to the jaundice that affects some patients.
Up to 50% of severely affected persons without treatment will die from yellow
fever.
There are an estimated 200 000 cases of yellow fever, causing 30 000 deaths,
worldwide each year, with 90% occurring in Africa.
The virus is endemic in tropical areas of Africa and Latin America, with a
combined population of over 900 million people.
The number of yellow fever cases has increased over the past two decades due
to declining population immunity to infection, deforestation, urbanization,
population movements and climate change.

50. There is no specific treatment for yellow fever.
Treatment is symptomatic, aimed at reducing the symptoms for the comfort of
the patient.
Vaccination is the most important preventive measure against yellow fever.
The vaccine is safe, affordable and highly effective, and a single dose of yellow
fever vaccine is sufficient to confer sustained immunity and life-long protection
against yellow fever disease and a booster dose of yellow fever vaccine is not
needed.
The vaccine provides effective immunity within 30 days for 99% of persons
vaccinated.