NVBDCP in nutshell

1. Dr Anupkumar T N
Junior Resident
Dept of Community Medicine
Govt Medical College,Thrissur

2. “SMALL BITE – BIG
THREAT”

4. We go through….
 Brief history
 NVBDCP origin
 Malaria
 Filaria
 Kala azar
 Dengue and Chikungunya fever
 Japanese encaphilitis

5. Vector:
It is defined as an arthropod or any living carrier
that transport an infectious agent to a susceptible
individuals. The transmission by a vector may be
mechanical or biological.
Vector borne disease:
A disease that is transmitted to humans or other
animals by an insect such as a mosquito or another
arthropod is called a vector-borne disease.

6. Factors increases VBD
 Urbanisation
 Shortage of water supply
 Traditional water storage
 Poor waste management
 Life style changes
 Rapid transport
 Lack of surveillance
 Lack of lab facilities,man power

7. What is NVBDCP…??
 Under NRHM
 6 diseases
 Malaria, Filaria ,Kala azar, Dengue,
Chikungunya,Japanese encephalitis
 Various factors
 Most comprehensive and multifaceted

12. Some history
 1946-Bhore committee
 1953-National malaria control programme
 1958-National malaria eradication
programme
 1971-urban malaria scheme
 1977-modified plan of operation
 1995-malaria action programme

13.  1997-enhanced malaria eradication
programme
 1999-national antimalaria programme
 2002-national health policy
 2004-NVBDCP
 2005-Intensified malaria control
project,NRHM

14. 1946-Bhore committee
 75million cases and 0.8 million deaths
 Recommended a countrywide programme

15. 1953-NMCP
 To bring down transmission and maintain
 By residual spray,surveillance,treatment
 Spectacular success

16. 1958-NMEP
 8th World health assembly
 Nil death in1965
 Constraints
 No attention for urban areas
 Resurgance

17. 1971-UMS
 Significant problem
 Urban to rural shift
 By 1976 6.46 million cases

18. 1977-MPO
 Eradication attempts stopped
 To eliminate deaths,decrease
morbidity,maintain acheivements
 Based on API separate strategies
 API>2 :spray,entomology
studies,surveillance,treatment,pf
containment in rural areas,lab to PHC
level,DDC/FTD establishment

19.  API<2:Local spray of DDT in pf
cases,surveillance and radical
treatment,investigation
 Was able to control death
 1994 –resurgance
 Expert review
 High risk areas

20. 1995-MAP
 100% central sponsorship
 4 areas
 Hardcore, epidemic prone,project,triple
insect. Resistant, urban
 MPW ‘s,IEC,early case finding and
presumptive treatment,capacity building at
PHC,alternate drugsblood slide collection

21. 1997-EMCP
 Central govt sought help
 World bank funded
 Most affected areas
 API>2/Pf>30%/25%pop tribal/reports death
due to malaria
 To control morbidity, prevent death,
consolidate gains
 Through early case detection,vector control
by IRS,health education ,community
participation

22.  Case detection-link worker,microscopy
centre,dipstick test,FTD,utilising
MPW/ANM,alternate drugs,private sector
 Vector control-
fishes,biocides,environmental
modification,spray in Pf cases
 Legislative measures
 Personal protection-MMN

23.  Planning,RRT,coordination
 Capacity strengthening,MIS,research
 Community participation
 Covered 62.2million people
 79% districts show decline in Pf incidence

24.  1999-NAMP
 Eventually part of NVBDCP
 NHP-2002:Goal to reduce mortality50% by
2010
 NVBDCP-2004
 NRHM-2005 to achieve goal no:6 of
MDG,public health focus,improve
access,halt and reverse malaria incidence

25. IMCP-2005
 GFATM funded
 NE states,orissa,jharkhand,west bengal
 More access to diagnosis and treatment,
larvivorous fish use, bednet more
participation and awareness

26. NVBDCP
 vision: well informed self sustained
healthy India free of VBD with
equitable access to health care
 Mission:reduce mortality on account
of malaria

27. Objectives
 Reduce malaria mortality and
morbidity 50% by2012
 Targets-ABER>10%,API≤1.3,Reduced
mortality
 Indicators-%of blood smears,number
of lab confirmed cases,number of
deaths

28. Strategies
 Basically against parasite and vector
 Disease mangement
 Insecticide resistance
 Legislative measures
 Involvement of
NGOs/private/community/LSGD
 Quality assurance in lab diagnosis

29.  LLIN
 Improve efficacy and quality of
services
 Environmental management
 Monitoring and evaluation
 Collaboration
 Inter sectoral convergance
 Behavioural change communication

30. Disease management
 Early case detection
 Complete treatment
 Strengthening referral
 Epidemic preparedness
 Rapid response

31. Insecticide resistance
 Research needed
 Cause
 Mangement

32. Legislative measures

33. Qualityassurance

34. Insecticide treated nets
 Treated twice a year
 Intensive and challenging task
 LLIN efficacy of 3-5 years

35. Improve efficiency and
quality
 Primary level-training,in patient
facility,lab facility with PPP
 Secondary level-trainingin govt&
private,DH having ventilators &lab
services,medical audit
 Tertiary level-referral cases to med
colleges,Rdkits,mangaing severe cases

36. Environmental management
Settlements
 same level
 gentle slope
 making dikes
 enbank costal area

37. Hydraulic engineering
 Draining,streamcanalizing,lining
 Land levelling and filling
 Seepage control,piped/covered canals
 Weed control
 Sluicing and slushing of stream water

38.  Wells with platforms and drainage
Waste water disposal system
 Smooth surface,more
radius&gradients
 Underground/covered
 Regular cleaning
 Water flushed weekly

39. Mosquito control
Construction
 Gradient
 Minimum excavation
 Overflow water drained


40. Railway and road construction
 Inspection and cleaning drains
 Staff
 Drainage systems track,colonies
Factories and quarries
 3km away from dwelling
 drainage

41.  Moats around zoos
 City drainage

42. Monitoring &evaluation
 Sentinel sites
 NAMMIS
 Field review and visits
 Collaboration in research with med
colleges & NIMAR

43. INTERSECTORAL
CONVERGENCE
 PPP in outreach
services,microscopy,treatment,llin,larv
ivorous fish,IRS
 Other departments

44. Behaviour change
communication
 Social mobilization
 Care providers/planners/political
 Media
 To promote good values/attitude
 To build support
 Maintain demand for services
 Improving quality

50. Comments
 Design of programme
 Tribal malaria
 Changing terminologies
 Sanitation not addressed
 Political will
 Community bparticipation

51.  Diagnosis
 Resistance
 Treatment
 Drug availability
 Surveillance
 Human resources
 lack of faith

52.  In line with the WHO Global Technical
Strategy for Malaria 2016–2030
(GTS) and the Asia PacificLeaders
Malaria Alliance Malaria Elimination
(APLMA)Roadmap
 National Framework for Malaria
Elimination in India 2016–2030

53.  Vision:Eliminate malaria nationally and
contribute to improved health, quality
of life and alleviation of poverty

54. GOALS(2016-30)
 Eliminate malaria (zero indigenous
cases) throughout the entire country
by 2030; and
 Maintain malaria–free status in
alrteady interrupted areas and
prevent re-introduction of malaria

55. Objectives
 Eliminate malaria from all 26 low
(Category 1) and moderate (Category
2) transmission states/union
territories (UTs) by 2022;
 Reduce the incidence of malaria to
less than 1 case per 1000 population
per year in all states and UTs and
their districts by 2024;

56.  Interrupt indigenous transmission of
malaria throughout the entire
country, including all high transmission
states and union territories (UTs)
(Category 3) by 2027
 Prevent the re-establishment of local
transmission of malaria in areas where
it has been eliminated and maintain
national malaria-free status by 2030
and beyond

57. Strategic approaches in 2016-
30
1. Programme phasing
2. District as the unit of planning and
implementation
3. Focus on high transmission areas
4. Special strategy for P. vivax
elimination

58. Programme phasing
 Phased manner
 Variations
 API
 ABER,SPR
 Case and foci based Surveillance
system
 Private participation
 Reporting and notificartion

62. District as the unit of
planning and implementation
 further classify their districts
 sub-classify districts

63. Focus on high transmission
areas
 70% cases
 Odisha, Chhattisgarh, Jharkhand,
Madhya Pradesh, Maharashtra,Tripura
and Meghalaya
 hilly, tribal,forested and conflict-
affected areas

64. Special strategy for P. vivax
elimination
 80% of the global P. vivax burden
is contributed by 3 countries
 Good quality microscopy
 Operational research
 Appropriate vector control measures
 ensuring
 good compliance to primaquine in
affected individuals

66. By end of 2016
 All states/UTs have included malaria
elimination in their broader health
policies and
 planning frameworks

67. By 2020
 Transmission of malaria interrupted
and zero indigenous cases and deaths
due tomalaria attained in all 15
states/UTs under Category 1
(elimination phase) in 2014(base year).
 All 11 states/UTs under Category 2
(pre-elimination phase) in 2014 enter
into Category 1 (elimination phase).

68.  An estimated reduction in malaria of
15–20% at the national level compared
with 2014.
 progressive states with strong health
systems may implement accelerated
malaria elimination programmes to
achieve interruption of transmission
and demonstrate early elimination
followed by sustinance of zero
indigenous cases

69. By 2022
 Transmission of malaria interrupted and
zero indigenous cases and deaths due
tomalaria attained in all 26 states/UTs that
were under Categories 1 and 2 in 2014.
 Five states/UTs which were under
Category 3 (intensified control phase) in
2014 enter into elimination phase.
 Five states/UTs which were under
Category 3 (intensified control phase) in
2014 enterinto pre-elimination phase.
 An estimated reduction in malaria of 30–
35% at the national level compared with
2014

70.  Five states/UTs under Category 3
(intensified control phase) in 2014
enter into Category 2 (pre-elimination
phase).
 Five states/UTs under Category 3
(intensified control phase) in 2014
reduce malaria transmission but
continue to remain in Category

71. By 2024
 All states/UTs and their respective
districts reduce API to less than 1 case per
1000 population at risk and sustain zero
deaths due to malaria while maintaining fully
functional malaria surveillance to track,
investigate and respond to each
casethroughout the country.
 Transmission of malaria interrupted and
zero indigenous cases and deaths due
tomalaria attained in all 31 states/UTs.
 Five states/UTs which were under
Category 3 (intensified control phase) in
2014 enter into elimination phase.

72.  By 2027
The indigenous transmission of malaria
in India interrupted
 By 2030
The re-establishment of local
transmission prevented in areas where
malaria hasbeen eliminated.
The malaria-free status maintained
throughout the nation.

74. In Cat 3 areas

77. Cross-cutting interventions
 Formation of national level committee
 Technical committee
 Revision of guidelines
 Revision of policy
 New surveillance &reporting strategy
(China’s ‘1-3-7’strategy,3T approach)
 Parameters of eachlevel qualification

78.  Verify acheivements
 Formulate plan to sustain and ensure
participation

79. Monitoring and evaluation
1. Introduction of a new web-based reporting system
2. Revision of monitoring and evaluation formats.
3. Estimation of vector control coverage, including
long(LLIN) ,(ITN) ,(IRS) coverage,in all levels
4. Use of an annual scoring system for evaluating
progress.
5. Data validation by an external agency when any
state/UT achieves malaria elimination/transition
6. Grading of all areas within a state/UT for
endemicity /risk of malaria on the basis of fixed
parameters.

80. Stratification
1. Stratification of all states/UTs into
four categories
2. Sub-stratification of all districts
using the same criteria.
3. Further stratification of CHCs, PHCs,
SCs and implementation of strata-
specific strategies.
4. Feasibility assessment of each
state/UT before planning elimination

81. Surveillance
1. all entomological units in the country
to be made functional and
strengthened.
2. Strengthening of routine surveillance,
and establishing case-based
surveillance as a core intervention for
elimination areas.

82. Quality assurance
1. Quality assurance of all medicines,
diagnostics, treatment and vector control
supplies.
2. All malaria microscopy services in the
country to be quality assured.
3. All testing facilities for malaria across
states/UTs to be part of a national quality
management network.
4. Private sector laboratories providing malaria
diagnosis in the country to be identified
and laboratory technicians certified

83. Intersectoral collaboration
 Formulation of clearly defined roles
and responsibilities for private
providers, NGOs ,Armed Forces,
CRPF,BSF.
 District-wide mapping of all private
hospitals and NGOs in all states/Uts

84.  Integration of data on private hospitals
with the national Malaria Information
System (MIS).
 Advocacy with private hospitals and
practitioners on a regular basis to ensure
adoptionof national guidelines for diagnosis
and treatment of malaria.
 Explore scope and establish collaboration
with other fdeptswater department for
safe water practices and
 Tourism industry for preventing malariain
travellers and cross-border spread of
malaria

85. Cross-border collaboration
 Screening of populations at international
border crossings.
 Training of security personnel at
international border crossings with
provision of diagnostic and treatment
facilities.
 Implementation of a mechanism for
monthly data collection from
international borderareas and
integration into national MIS.

86.  Joint planning and implementation of
malaria prevention and control activities
with neighbouring countries.
 Sharing of information and policies for
malaria prevention and control with
neighbouring countries.
 Harmonization of policies and
synchronization of activities for malaria
eliminaiton inbordering countries.
 Support from multilateral agencies for
facilitation of cooperation and
information sharing between countries

87. SPECIAL GROUPS
 Tribal malaria action plan
 Migrants
 Community groups
 Training in the groups
 Regular data collection

88. IEC/BCC
 Revision of IEC/BCC strategy with
special emphasis on elimination.
 This strategy will be tailored
according to the endemicity of malaria
in a region

89. INNOVATION
 Vector control
 Standard outbreak procedures
 Financing
 Service delivery

90. Capacity building
 Preparation of annual training
curricula .
 Review of training status and
schedules by programme twice
annually.
 Identification and training of a group
of national level trainers in areas such
as
.

91. Research
1. Facilitating research on devising
methods to increase efficacy of
IRS/LLIN
2. Surveys by states/UTs on
behaviour of mosquito vectors
3. Surveys on community behaviour
such as resource use, means of
livelihood,patterns of sleeping

92. 4. Longitudinal surveys on malaria vector
population dynamics.
5. Research on drug resistance
monitoring, therapeutic efficacy
studies.
6. Cost-benefit analysis of interventions
used for malaria elimination once
every five years.

93.  evaluated at regular intervals
 focus on monitoring the operational
aspects of the programme
 committees will be set up to oversee
progress towards elimination goals
 An elimination database that can
serveas the state- and national
repository

95. Cost
 not only poor, but economic growth
dismal
 More support from govt
 every Rupee invested in malaria
controla direct return of Rupees
19.70 could be expected

96. References
 World Health Organization. World
malaria report 2015. Geneva: WHO,
2015.
 http://www.rollbackmalaria.org/
about/about-rbm/aim-2016-2030 -
accessed 20 jun 2016.
 Gupta I, Chowdhury S. Economic burden
of malaria in India: the need for
effective spending. WHO South-East
Asia Journal of Public Health. 2014;
3(1):95-102

97.  World Health Organization. Global
technical strategy for malaria 2016–
2030. Geneva: WHO, 2015.
 http://nvbdcp.gov.in/Doc/Strategic-
Action-Plan-Malaria-2012-17-Co.pdf
 - accessed 20 jun 2016

106. THANK YOU………….

109.  Visceral leishmaniasis
 L.donovani
 Fever,anaemia,black colour
 Eastern India
 WHO goal for SEAR-eliminate by
2016

110. National health policy
 Eliminate by 2010
 11 th plan
 Poor implementation
 Increasing incidence
 Poor quality vector control
 Incomplete traeatment
 Poor
surveillance,monitoring,supervision

111.  Objectives-elimination by 2010
 Target-,1/10000 population
 Indicators-cases1/10000,fatality rate
 Starategies-parasite
elimination&disease management
 Integrated vector management
 Supportive intervention

112.  Miltefosine,paramomycin
 DOTS,coding
 Rk39 kits
 Strengthened surveillance,DDT
spray,notifiabled/s,treatment
protocol
 Human resource,PPP,linkages

113. NVBDCPStrategies
 Integrated vector control
 Case detection&treatment
 Rk39 kits
 Behavioural change,intersectoral
coordi nation
 Capacity building
 Monitoring,evaluation,supervision
 Operational research

114. Integrated vector control
 Sandfly control-DDT-2 rounds-
100mg/sq feet
 BHC in resistance

115. Enhanced case
detection+complete
treatment
 Clinical findings+lab test
 LD bodies in aspirates,aldehyde test
 Rk 39 tests,ELISA
 Sod antimony
stilbogluconate20mg/kg* 20days
 Pentamidine3mg/kg* 10 days
 Miltefosine
 Amphotericin-b1 mg/kg *20 days

116. BCC,Coordination
 Health education
 Personal protection
 Environmental modifications

117. Capacity building
 Training
 Monitoring, supervision&evaluation
 Linked with other diseases

118. Operational research
 Cost effective well sutained IVM
 Satellite based mapping
 Attitude and acceptance to bednets
 Drug compliance studiesw

119.  Treatment cost
 Quacks,private
 Coinfection with HIV
 Delay in fund
 Underreporting
 Drug unresponsiveness,compliance
 Poor social mobilization
 IRS quality,coverage

122.  Banchroftian/Brugian filariasiS
 Adult in vessels
 Microfilaria in blood

124. Filarial indices
 Microfilaria rate
 Filaria endemicity rate
 Microfilaria density
 Average infestation rate
 Entomological indices
Vector density/10men catch,%of
mosquitoes for all stage larvaes,for
infective larvae,types of breeding
places

125. Clinical features
 Fever,pain,tenderness along vessels
 Epidydimitis,orchitis
 Adult coiled in lymphatics
 Microfilariae between 9pm-2am
 Allergic inflammation ,bacterial
infection

126. History
 World health assembly resolution to
eliminate by1997
 Global programme to eliminate lymph
filariasis-1998
 NHP2002-elimination by 2015
 11 th plan-more training,hydrocele
treatment,managing
lymphoedema,more involvement,MIS

128. Objectives
 Progressively reducing and ultimately
interrupting the transmission of
Lymphatic Filariasis (LF).
 Preventing and reducing disability
amongst affected persons through
disability alleviation and morbidity
management

129. Targets
 To cover all eligible population living in
all (presently 255) Lymphatic
filariasis endemic districts during
MDA.
 To line list the cases of lymphoedema
and hydrocele in all the districts and
augment home based morbidity
management and hydrocele operations
in identified district hospitals/CHCs

130. Indicators
 -% ofpersons consumed
 microfilaria rates in sentinel sites
 hospitals equipped for operatios
 number of surgeries
 Complications
 lymphoedema cases on home
mangement

131. Strategies
 Mapping- the geographical distribution
of disease
 Mass drug administration (MDA)- for 5
years or more to reduce the number of
parasites in the blood
 Post-MDA surveillance- after MDA is
discontinued; and
 Verification of elimination of
transmission

132. evaluation
 Coverage and compliance assessed
 30 houses in 3 clusters
 Microfilaria survey
 Sideeffects

133. Transmission Assessment
Survey (TAS)
 To assess whether the interventions
have succeeded in lowering the
prevalence of infection to a level at
which transmission is no longer likely
to be sustainable.
 Transmission assessment survey
(TAS) is a decision making tool
 A simple, robust survey design for
documenting

134.  Prevalence of lymphatic filariasis
among 6–7 year old children is below a
predetermined threshold.
 It provides the evidence base that
MDA can be stopped
 To assure that programme has
achieved elimination goal

139. Morbidity management&disabilty
prevention
 Globally 120 million people are
infected.
 One third of them live in India.
 An estimated 40 million people
globally have clinically significant
manifestations

140. Goal
 to alleviate suffering in people with
ADLA, lymphedema, and hydrocele and
to improve quality of life
 Aim -is to provide access to the
recommended basic care for every
person with these manifestations

142. Minimum services
 Treatment of episodes of ADLA among
people with lymphangiitis and
elephantiasis
 Prevention of disabilities, painful
episodes of ADLA and progression of
lymphedema
 Provide access to hydrocele surgery
 Provide anti-filarial medicines to destroy
any remaining worms,MDA

143. Challenges
 Drug delivery and high treatment
coverage to bring desired impact
 Social Mobilization will help in
improved programme performance
 Phasing out of MDA after validation
for which availability of ICT is
limiting factor.

144.  Morbidity management and disability
prevention should be fully integrated
into the health system.
 Unusual delay in submission of
SOE/UC by.
 Timely preparation and
implementation of micro-Plan of
state and district as per national
guidelines.

145.  Continued training and sensitization of
State and District level officer by central
team.
 Timely availability of DEC to be purchased
by the States
 Timely procurement of ICT cards for
TAS.
 Timely conduction of MDA is very crucial.

148. Vector control
 Antimosquito-1/2 rounds DDT spray
 Antilarval measures-temephos.min oils
 Biol;ogical-larvivorous fish
 Enviromental engineering-source
reduction,water management
 BCC
 Capacity building

155.  Mosquito borne zoonotic viral disease
 maintained in animals, birds, pigs,
particularly the birds belonging to
family Ardeidae
 amplifier hosts
 man and horse are ‘dead end hosts
 vishnui group culex

156.  Incubation period 5 to 14 days
 25% of the affected children die in
survivors about 30-40% suffers from
physical & mental impairment

157. History
 The first case of Japanese Encephalitis
(JE) was reported in India in 1955 from
Vellore, Tamil Nadu
 The first major JE outbreak in 1973
from Burdwan district of West Bengal
 A major outbreak of Japanese
Encephalitis was reported from eastern
UP during 2005 resulting in recording of
more than 6000 cases and 1500 deaths

158.  introduction of vaccine in high
endemic areas
 NVBDCP developed surveillance and
case management guidelines for
syndromic reporting of Acute
Encephalitis Syndrome including
Japanese Encephalitis

159.  Acute Encephalitis Syndrome (AES) is
high fever altered consciousness etc
mostly in children below 15 years of
age
 JE virus is only one of the many
causative agents of Encephalitis

160. Data analysis2008-13
 Most vulnerable age group between 1-
5 years followed by 5-10 years and
10-15 years in that order.
 Least JE infections in infants (0-1
year).
 All the endemic States except Assam
start reporting JE cases from July
onwards attaining a peak in
September- October.

161.  In Assam the cases start appearing
from February and attain a peak in
the month of July.
 Due to circulation of entero-viruses
particularly in Eastern Uttar Pradesh
AES cases are reported round the
year.

162.  Goal-to reduce morbidity, mortality and
disability in children due to JE/AES
 Objectives
(i) to strengthen and expand JE vaccination
in affected districts;
(ii) to strengthen surveillance, vector
control, case management and timely
referral of serious and complicated cases;
(iii) to increase access to safe drinking
water and proper sanitation facilities to
the target population in affected rural
and urban areas;

163. (iv)to estimate disability burden due
to JE/AES, and to provide for
adequate facilities for physical,
medical, neurological and social
rehabilitation;
(v)to improve nutritional status of
children at risk of JE/AES;
(vi)to carry out intensified IEC/BCC
activities regarding JE/AES.

164. Multi-pronged strategy
 Strengthening and Expanding JE
Vaccination
 Strengthening of Public Health
Activities
 Vector Control
 Disease Surveillance
 Advocacy Meeting


165. BCC / IEC
Monitoring & Supervision
Neuro-rehabilitation
component
Paediatric Intensive Care
Unit (PICU


166.  All cases of Acute Encephalitis
Syndrome (AES) should be reported
 Sentinel Surveillance Sites with
laboratories (SSSL) facilities
 Sentinel Surveillance Sites without
laboratories facilities
 Other Informer Units

169. Monitoring indicators
 Completeness of monthly reporting
 Timeliness of monthly reporting
 Percentage of serum samples taken
 Percentage of all suspect cases for
which specimens were collected
 Proportion of AES cases tested for JE
 Concurrent evaluation of JE vaccination
campaign
 JE vaccination coverage under RI
 Percentage reduction in CFR

170. Vector control
 JE virus has been isolated from 17
mosquito species
 Culex vishnui group consisting of Cx.
tritaeniorhynchus, Cx. vishnui and Cx.
pseudovishnui
 exophillic endophagic in nature
 vector control using ULV fogging
(ultra low volume) is the only
recommended method of vector
control

174. Chikungunya fever
 Viral illness that is spread by
theTogaviridae, genus Alphavirus
 The disease resembles dengue fever
 Severe, sometimes persistent, joint
pain(arthiritis) with fever and rash
 Rarely life-threatening

175. History
 India a major epidemic of Chikungunya
fever was reported during the last
millennium
 viz.; 1963 (Kolkata), 1965 (Pondicherry
and Chennai in Tamil Nadu,
Rajahmundry,Vishakapatnam and
Kakinada in Andhra Pradesh; Sagar in
Madhya Pradesh; and Nagpurin
Maharashtra) and 1973, (Barsi in
Maharashtra

177.  Incubation period 4-7 days
 Symptoms 4-7 days
 fever, chills, headache, nausea,
 vomiting, severe joint pain (arthralgia)
and rash
 joints of the extremities in particular
become swollen and painful to touch

178.  Residual arthritis, with morning
stiffness,swelling and pain on
movement may persist for weeks or
months

179. Dengue fever
 An acute febrile illness of 2-7 days
duration with two or more of the
following manifestations:
 headache, retro-orbital pain, myalgia,
arthralgia, rash, haemorrhagic
manifestations, leucopenia

180. Dengue Haemorrhagic Fever
(DHF)
 positive tourniquet
test,
 petechiae,ecchymo
ses , purpura
 bleeding from
mucosa,GIT,
injection site, nasal
bleeding or other
sites,haematemesis
or melaena
 thrombocytopenia
i.e platelet count
(1lakh cells per mm.
or less)
 evidence of plasma
leakage due to
increased vascular
permeability

181. Dengue Shock Syndrome(DSS):
 All the above criteria for DHF plus
evidence of circulatory failure
manifested by rapid and weak pulse,
and
 narrow pulse pressure (< 20 mm Hg) or
hypotension for age, and cold,
clammy skin and restlessness

183. A. Early Case reporting and
management
 Case reporting
 Fever alert surveillance
 Sentinel Surveillance sites with
laboratory support
 Strengthening of referral services
 Involvement of Private sector in sentinel
surveillance
 Case management
 Epidemic preparedness and rapid
response

185. B. Integrated vector management
(for transmission risk reduction):
 Entomological Surveillance including
larval surveys
 Anti-larval measures
 Source reduction
 Chemical larvicide / biocide
 Larvivorous fish
 Environmental management

186.  Anti- adult measures
 Indoor Space Spraying with
Pyrethrum extract (2%)
 Fogging during outbreaks
 Personal protection measures
 Protective clothing
 Insecticide treated bed nets and
repellents

187. The 13 apex laboratories will
be as follows
 (i) National Institute of Virology,
Pune.
 (ii) National Institute of
Communicable Diseases, Delhi.
 (iii) National Institute of Mental
Health & Neuro-Sciences,
Bangalore.
 (iv) Sanjay Gandhi Post-Graduate
Institute of Medical Sciences,
Lucknow.
 (v) Post- Graduate Institute of
Medical Sciences, Chandigarh.
 (vi) All India Institute of Medical
Sciences, Delhi.
 (vii) ICMR Virus Unit, Kolkata
 (viii) Regional Medical
Research Centre (ICMR),
Dibrugarh, Assam.
 (ix) King.s Institute of
Preventive Medicine, Chennai.
 (x) Institute of Preventive
Medicine, Hyderabad.
 (xi) B J Medical College,
Ahmedabad.
 (xii) State Virology Institute,
Allappuzha, Kerala
 (xiii) DRDE, Gwalior, Madhya
Pradesh

188. C. Supporting Interventions:
 Human Resource Development
through capacity building
 Behaviour Change Communication
(BCC)
 Inter-sectoral convergence
 Operational Research
 Supervision and Monitoring
 Coordination Committees
 Legislative support

189. At Household level:
 Ae. aegypti mosquito
 Day time biter
 Peak biting time
 Pyrethroid based sprays
 repellants during daytime
 Source reduction
 Cover water containers
 Have infants sleep under bed nets
during the day

190.  Wear protective clothing
 Use tight-fitting screens/wire mesh
on doors and windows.
 Clogged gutters and flat roofs to be
checked regularly
 Water in bird baths and plant pots or
drip trays changed at least
twice each week.

191.  Pets water bowls need to be emptied
daily.
 In ornamental water tanks/garden,
larvivorous fish (e.g., Gambusia,
Guppy)

192. At school level
 Health beducation
 Source reduction
 Personal protection

193. Indoor space spraying
 pyrethrum extract after dilution is
sprayed with Flit pump orhand operated
fogging machine fitted with micro-
discharge nozzle.
 one part of2% pyrethrum extract with
19 parts of kerosene (volume/volume).
Thus, one litre of
 One litre of .ready-to-spray formulation
is sufficient tocover 20 households, each
household having 100 cubic metres of
indoor space.
 .

194. Community based
 Rapid action team
 Source reduction
 Dry day
FRIDAY,SATURDAY,SUNDAY

195. Advantages of Indoor
pyrethrum space spray
 non-toxic to humans and other non-
target organisms e
 The spray equipment is simple, cheap
and readily available at affordable
prices
 The householders can spray
themselves
 not yet developed resistance

196. Outdoor spraying
 Ultra low volume spray
 Thermal fogging

197. ULV spray
 Minimum volume/unit area
 Organophosphorous compounds used
 40-80 micron droplets form cloud
 No diluent
 Effective than thermal
 No visible fog
 portable motorized knapsack blowers
and cold aerosol generators

198. Advantages
 Relatively less use of insecticide
 readyto use formulation reducing operator
exposure
 Low fire hazard and more environment-
friendly
 Efficient application - finer size droplets at
higher density with less volume of
insecticide
 Practically no visibility reduction due to
ULV fog
 The cold fog is not visible like thermal fog
but this is not a technical disadvantage

199. Thermal fogging
 Vapourize,condense,clouding
 With wind goes to diff directions
 Malathion/pyrethrum
 Psychologically acceptable
 portable thermal fogger ,mist blowers
 Vehicle mounted
 more expensive and epidemiologically
less effective

200. Disadvantage
 large volume of diluent
 Thick fog
 Not environment friendly
 Highly inflammable

201. Antilarval measures

203.  Removal, disposal, burying or burning
of all unused tins, cans, jars,
bottles,tyres, coconut shells and
husks and other items that can collect
and hold water.
 Keeping tyres, metal boxes,
discarded appliances, sinks, basins,
cementtanks, pots and parts of other
items in industrial and commercial
premises,in sheltered areas protected
from rainfall.

204.  Arranging clean up campaigns once or
twice a year by the local health
 authorities or community leaders in
order to collect and remove all
unusualcontainers and potential
breeding sites in and around houses.
 Turning water drums and small
earthen jars upside down once a week.
 , inlets and overflow outlets
withmosquito wire mesh

205.  Emptying and cleaning procedures are
easier when the water level is low.
 Periodically scrubbing the inside of
water containers to destroy Aedes
eggsat the time of container cleaning.
 Regularly emptying water in flower
vases in houses and offices at least once
a week.
 Covering large volume water storage
tanks

206.  Construction of rectangular cement
tanks with a plug at the bottom to allow
easy draining for weekly cleaning.
 Shredding or cutting old tyres into flat
pieces and disposing them in properly
constructed and managed landfills away
from populated areas.
 Puncturing holes in tyres used for
recreational purposes by children in
schools and parks

207.  Draining water logged tree holes.
 Turning tin cups used to collect sap
from rubber tree in rubber
plantations upside down when not in
use.
 Pouring boiling water into small
earthen ware jars to kill larvae when
the water level is low.
 Leveling or filling in the top bamboo
fences to prevent the accumulation of
water and breeding.

208.  Filtering water from one container to
another through cloth in order to trap
and dislodge larvae and pupae.
 Introducing larvivorous fish in water
storage containers to eat mosquito
larvae.
 In case, water containers can not be
emptied, Temephos (1 ppm) should be
applied on weekly basis.

219. THANK YOU………….