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. About NVBDCP
Started as - National Malaria Control Programme (NMCP) dealing with malaria control only
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.
renamed as National Anti-Malaria Programme (NAMP)
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

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 Exists in several countries
6 distt.,11.0 mil
Exists in several countries
About 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
33 distt., 62.3 mil
4 districts
Pop: 6.7 mil
11 districts
Pop. – 50 mil
4 States; 54 Districts; 130 million population
> 80% of all cases reported from Bihar
9 Dist in Bihar contribute 65-70% of cases 4

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

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

8. Target States of JE/AES: 60 High Priority Districts
Bihar 15 Districts
Uttar Pradesh 20 Districts
Assam
10 Districts
West Bengal 10 Districts
Tamil Nadu
5 Districts 8

9. Malaria Cases & Deaths: Global vs India Scenario
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
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
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

10. Trend of Malaria, India, 2001 - 2013
LLIN
Bivalent RDT
ACT& RDT in 2005 : % 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

11. (Compared to the country total)
MALARIA ENDEMIC AREAS
PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS in 2010
(Compared to the country total)
States
% Population
% 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
GFATM: R-9
(Rs.417 Crore : )
Erstwhile World Bank Project
(Rs.1000 Crore: )
*Orissa, Jharkhand, Chhattisgarh, MP, Andhra Pradesh, Maharashtra Gujarat, Karnataka & West Bengal 11 11

12. Shrinking – Malaria Map- India
Malaria Situation –India ( )
Year
Cases
Deaths
2000
19,42,318
959
2013
8,81,730
440
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) Districts recorded API<1
- 23 States recorded API<1
2013

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

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