ROLE OF VECTOR IN

CAUSATION OF DISEASE &

NATIONAL VECTOR BORNE
DISEASE CONTROL PROGRAM
 WHAT IS A VECTOR
• Vector is defined as arthropod or any living carrier( eg snail) that
transports an infectious agent to susceptible individual. Tansmission can
be mechanical or biological.

• Vector borne diseases are human illnesses caused by parsites,viruses,

and bacteria that are transmitted by vectors.

• Every year there are more than 70,000 deaths from diseases such as
malaria, dengue,schistomatosis, human african trypanosomiasis,
leishmaniasis , chagas disease, yellow fever, JE and onchocerasis.

• The burden of disease is highest in tropical and subtropical areas, and

they disproportionately affect poorest populations.
Method in which vector transmit agent
1. Biting
2. Regurgitation
3. Scratching -in of infective faeces
4. Contamination of host with bodily fluids of vector

Method in which vectors are involved in transmission and

propagation if parasites.
a) Mechanical transmission-The infectious agent is
mechanically transported by crawling, or flying arthropod
through soiling of its feet or proboscis .or passage of
organism through its GITand passively excreted.
b) Biological transmission- Infectious agent agent
undergoingg replication,development or both ,vector require
incubation period before vector can transmit
• Propagative- agent merely multiplies in vector but not
change form eg. plague bacilli in rat fleas
• Cyclo propagative-Agent changes in form and no. eg malaria
parasite in mosquito
• Cyclo developmental- The diease agent undergoes only
development but not multiplication eg. microflaria in
mosquito.

Factors influencing ability of vector to transmit disease

• Infectivity, that is ability to transmit disease agent

• Suceptiblity,that is ability to become infected
• Survival rates of vector in environment
• Domecity that is degree of association with man
• Suitable environmental factors
 INTRODUCTION
• NVBDCP is an umbrella program for
prevention and control of ‘6 vector borne
diseases’.
 HISTORY
• MILESTONES
• 1953- Launching of National Malaria Control Program
• 1958- NMCP was changed to National Malaria Eradication Program.

• 1999-renaming of program to National Anti Malaria Program (NAMP)

• 2002-Renaming of NAMP to National Vvector borne Disease Control Program
• 2005-NVDCPbecame part of NRHM and introduction of RDT in program
• 2006-ACT introduced in areas showing chloroquine resistance in falcifarum malaria
• 2009-introduction of LLINs
• 2010-new drug policy
• 2012-introduction of bivalent RDT
• 2013-new drug policy
• 2016-Ntional framework for malaria Elimination in India.
• 2017-National strategic plan for Malaria Elimination in in India 2017-2022 launched
 Organisation
• There are 19 regional offices for health and
family welfare under Directorate General of
Health Services ,Ministry of Health and Family
Welfare located in 19 states which play crucial
role in monitoring the activities under NVDCP.
• AT CENTRAL LEVEL
The NVDCP directorate is responsible for
- Framing technical guidelines and policies
- Budgeting and planning the logistics
- Monitoring of implementation
• AT STATE LEVEL
-Every state has vector borne disease
control component under directorate of
health services
- State program officer with different
designation such as Director/joint director/
each state has established which is
responsible for supervision,guidance, and
effective implementation of program and
coordination of activities with neighbouring
states/UTs.
 AT DIVISIONAL LEVEL
Zonal officers have technical and administrative responsibility of
rogram in their area under the overall supervision of Senior
Divisional Officers
AT DISTRICT LEVEL
District Malaria offices have been established under district chief
medical and health offices at states.
District Malaria officer/District VBD officer.
Assistant Malaria officer
Senior Malaria inspector –key unit for planning and monitoring of
rogram under a technical officer
Spray operations are the district responsibilities of DMO/DVBC officer
n the entire district underall supervision of CMO and collaborative
upervision by PHCs

he medical officer at PHC has overall responsiblity of surveillance

Drug distribution centres and fever depots
-Drug distribution centres are only to dispense anti malarial
tablets as per NMEP schedules.
-Fever treatment depots collect the blood slides in addition to
distribution of anti malaria tablets

Urban malaria scheme

-Urban malaria scheme was launched in 1971 to reduce or
interrupt
Malaria transmission in towns and cities.
-Control of urban malaria lies primarily in implementation of civil
bye laws to prevent mosquito breeding in domestic areas
-Use of larvivorous fish in water bodies such as slow moving
streams, ornamental ponds etc.
-This scheme is protecting 130 million population from malaria
and other mosquito borne disease in 131 towns in 19states and
 National Framework For Malaria Elimination In
India (2016-2030)

• It was launched in feb 2016

GOALS
-Eliminate malaria (zero indigenous case) throughout the country by 2030
-Maintain malaria free status in areas where malaria transmission has been
interrupted and prevent re-introduction of malaria.
OBJECTIVES
-By 2022 transmission of malaria interrupted and zero indigenous cases to
be attained in all 26 states/UTs and their districts
-BY 2024 incidence of malaria to be reduced to less than 1 case per 1000
population in all states and UTs and their districts
-By 2027 indigenous transmission of malaria to be interrupted in all states
and UTs of india and
-By 2030 malaria to be eliminated throughout the entire country, and re-
establishment of transmission prevented.
 STRATEGIC APPROACHES
1)PROGRAM PHASING
Malaria elimination in India will be carried out in phase manner because
various states/UTs have different level of malaia burden.
2)FOCUS ON HIGH TRANSMISSION AREAS
Most malaria cases in india are from AP, Chhatisgarh, Jharkahnd ,MP, Jharkhand, Maharashtra,
Meghalaya, Mizoram, Odisha, Telangana, Tirupura.
-Aggressive scaling up of existing interventions and intensification of malaria control activities will be
carried out along with innovative strategies.

3)DISTRICT AS UNIT OF PLANNING AND IMPLEMENTATION

-State and UTs should categorize their districts so that even if given state UTs not yet in elimination
phase their district with API<1 should be eligible for initiating elimination phase categories .
-all district should categorise into blocks and blocks into diff phases based on their API and and further
each block into PHCs and PHCs into SCs
Each district should stratify its PHCS and SCs into –
-zero cases
-API>0 to <1
-API 1 to <2
-API 2 to <5
-API >_5
MILESTONES AND TARGETS
BY THE END OF YEAR 2016- All states and UTs to have included malaria elimination in their broade
health policies and planning framework .

BY THE END OF YEAR 2020- All 15 states/Uts that were in category 1(elimination nphase) in 2014 t
completely interrupted malaria transmission and achieved 0 indigenous cases and deaths due to malaria.
-All 11 states/Uts under category 2(pre-elimination)in 2014 to enter into category 1(elimination) phase
-5 states/UTs under category 3(intensified control phase)in 2014 to enter category 2(pre -elimination phase
-5 states/UTs under category 3 (intensifies control phase)in 2014 to reduce diseases burden but continue t
remain in category 3
-Estimated malaria burden at national level to reduce by 15-20% as compared to 2014

BY THE END OF YEAR 2022- All 26 states/UTs that were in categories 1 and 2 in 2014 to interru
malaria transmission and achieved zero indigenous cases and death due to malaria
-5 states/UTs which were in category 3 (intensified control phase) in 2014 to enter in category 1(elimination
phase)
-5 states/UTs which were in category 3 (intensifies control phase) in 2014 to enter into category 2(pre-
elimination phase)
- estimated malaria burden at national level reduced to 30-35% compared to 2014
• TARGETS FOR MALARIA
BY 2024 31 States/ UTs to interrupt transmission of malaria and zero indigenous
ELIMINATION
cases and death attained
5 states/UTs which were under category 3(intensified control phase)in 2014
to enter into elimination phase.
All states and UTs and their districts to reduce API to less than 1 case per
1000 population at risk, sustain zero death due to malaria .

BY 2027 Indigenous transmission of malaria interrupted and the entire country to have no
indigenous cases and no death due to malaria

BY 2030 Entire country to sustain status of zero indigenous cases and death due to
malaria for 3 consecutive years, and india to initiate process for certification of
malaria elimination status
STRATEGIES OF MALARIA CONTROL

Broad strategies of malaria elimination framework are-

-Early diagnosis and radical treatment

-Case based surveillance and rapid response
-Integrated vector management
-Indoor residual spray(IRS)
-Long lasting insecticidal nets (LLINs)/Insecticide treated bed Nets(ITNs)
-Larval source management(LSM)
-Epidemic preparedness and early response
-Monitoring and evaluation
-Advocacy, coordination and partnerships
-Behaviour change communication and community mobilization
-Program planning and management
-
• Early diagnosis and treatment

-surveillance activities would identify every suspected case of malaria and

confirm it by parasitological diagnosis prior to initiation of treatment by quality
assured test i.e. microscopy or rapid diagnostic test RDT.

-RDTs have advantage of provision result immediately at lowest health facility

and this helps in reinforcing confidence in pts through immediate diagnosis and
initiation of treatment.

-Microscopy is a gold standard and mainstay for malaria diagnosis in

elimination. essentially required in certain instances where there is need to
determine parasite densities ,follow up of malaria cases, monitoring of drug
resistance, medicines, differentiation of parasite species and detection of lesser
known parasite species other than Pf and Pv.

It has high sensitivity

Specific key interventions recommended for each category

1. Category 3 (Intensified control phase/ UTs with API >_1)

• Massive scaling up of existing disease management and
preventive approaches
• Screening of all fever caes suspected for malaria
• Strenghtening of intersectoral collaboration
• One stop centres or mobile clinics on fixed days in tribal or
conflict affected areas to provide malaria diagnosis and
treatment
• Timely referal and treatment of severe malaria cases to
reduce malaria related mortality
• maintainance of optimum level of surveillance using
appropriate diagnostic measures
2. Category 2 (Pre elimination phase State/ UTs with API <1 but
some of their districts reporting API>_1)

• Malaria interventions will introduced with particular focus on

setting up an elimination surveillance system and initiating
elimination phase activities.

3. Category 1 (Elimination phase: States/UTs with API<1, and

all their districts reporting API <1)

• Interrupting local transmission in all active foci of malaria

• Mandatory notification of each case of malaria from private
sector.
• Adequate cased based surveillance and complete case
management.
• Investigation and classification of all foci of malaria.
• Early detection and treatment of all cases of malaria by
means of ACD and/or PCD to prevent onward transmission
4) Category 0 (prevention of re-establishment phase)

• when any area whether a state/UT or a district within a

state/UT has achieved malaria elimination specific
objectives will be as follows-
1. Detect any re introduced case of malaria
2. Notify immediately all detected cases of malaria
3. Determine the underlying causes of resumed local
transmission
4. Apply rapid curative and preventive measures
5. Maintain malaria free status in these states.
 SURVEILLANCE
• The malaria surveillance is the process of ongoing
systematic collection,analysis, and interpretation of
malaria specific data for purpose of planning ,decision
making,and dissementation of relevant data.
• Active case detection is carried out in rural areas with
blood smear collected by MPWs/ANMs during fortnightly
house visits.
• Passive case detection is done in fever cases reporting to
peripheral health volunteers/ASHAs and sub
centres ,malaria clinics, CHC and other secondary and
tertiary level health institution.
• ASHA and other volunteers workers provide diagnostic
services by RDTs and at PHCs by examination blood
smear.
• There are about 100 million blood slides collected
annually from fever cases in india from which about 1.5
million malaria cases detected.
PARAMETERS of MALARIA SURVELLANCE
1) API Annual parasite incidence
confirmed cases during 1 year
_______________________X1000
population under survellance
2) ABER Annual blood examination Rate
No of slides examined
——————————-X100
Population
*At present about 100 million fever cases are
screened everyyear in india. Target is to screen
10percet of population
3)Annual falcifarum incidence

4) Slide positivity rate

5) Slide falcifarum rate

 INTEGRATED VECTOR MANAGEMENT
• NVBDCP aims to achieve effective vector control by appropriate
biological, chemcial and environmental interventions.
• 1)Anti adult measures
• a)Residual spray spraying indoor surfaces with DDT,
malathion,fenitrothion
• most effective way
• b) space application- It involves application of pesticides in form of fog
or mist using
• c) Individual protection- Use of repellents ,protective clothing,bed
nets( preferably impregnated with safe long acting repellents), mosquito
coils

• 2)Anti larval measures-

• a)Larvicides-Temephops confer long effective with less
• b)source reduction- To reduce mosquto breeding sites which include
drainage of filling, deepening or flushing, management of water level
changing salt content of water
• c) Integrated control- It includes bioenvironemental and personal
protection methods.
• Population living in areas with API>_5 is planned to cover by
LLINS(long lasting insecticidal nets) and population living in
enedmic areas registeres API>_2 covered with conventional
net treated with insecticides and IRS.

• DDT is insecticide of choice in areas where vector shown

resistance, malathion and pyrethroids used.

• 2 rounds of DDT and pyrethroid spray and 3 rounds of

malathion is required during transmission season.
 BEHAVIOUR CHANGE COMMUNICATION
• BCC is a systematic process that motivates individuals,families
andcommunities to change their in appropriate behaviour or to continue
healthy behaviour.
• BCC is directed as
1. Early recognition of signs and symptoms of malaria
2. Early treatment seeking from appropriate provide
3. Adherence to treatment regimens
4. ensuring protectionto pregnant womens and children
5. Use of ITNS/LLINs
Acceptance of IRS

ANTI MALARIA MONTH CAMPAIGN

• Anti malaria month is observed in the June of every year, prior to onetof
monsoon and transmission season
• It is done to enhance awareness, encourage community participation
through mass media campaign,inter personal
communication,intersectoral collaborative efforts.
 INITIATIVES FOR SPECIAL POPULATION
GROUPS
• Implemwntation of TRIBAL MALARIA ACTION PLAN ( TMAP) for
intensification of malaria prevention and control activities in tribal group
• A total of 96 districts with API of more than 1 case per 1000 people at
risk and a tribal population of more than 25% being included in this
plan.
• Interventions done are
a. Strengthening of existing health systems and introduction of mobiles
based surveillance where routine health facilities / services not
available
b. On the spot species specific treatment of all positive cases of malaria
with full course of antimalaria as per NVBDCP guidelines
c. Referal of severe cases to refferal centres/districts hospital/ any other
health facility
d. Follow up of all positive cases to ensure completion of treatment and
integrated vector management
e. Priortisation of villages acc to degree of risk for eg a high proportion of
 MONITORING AND EVALUATION
• Introduction of new web based reporting system to facilitate timely
notification and analysis of malaria transmission
• Revision of monitorinf and evaluation format
• Estimation of vector control covetage including ILNs or ITN use of
IRS in state/UTs at district,sub district, black and village level
• Grading of all areas within a state/UTs for endemicity or risk of
malaria on basis of fixed parameters.
 KEY CHALLENGES IN MALARIA CONTROL
a)Population movements ,often uncontrolled across states/UTs and sharing
of large international borders with neighbouring malaria endemic
countries
• some of high enedemic states share thier borders with neighbouring
countries such as myanmar and Bangladesh where malaria still
prevelant and there is persistent threat of influx of malaria cases from
these countries.
• There is growing threat of soread of malaria multi drug resistance
including ACT as result of sharing international borders.
b) Shortage of skilled human resources
• Program is affected by an insufficient no of sanvtioned posts of health
workers and other program staff in diff parts of country
c) Insecticide resistance
• Extensive use of insecticides particulary DDT under vector control
program, controlled malaria to great extent but extended high selection
pressure on vector population to develop resistance.
Achievements under NFME in India
• The country has achieved a reduction of 84% in malaria morbidity and
76% in malaria mortality between 205 and 2020

• Among 177 tribal districts there has been 86.6% reduction in malaria
morbidity and 83.4% reduction in mortality between 2015 and 2020

• Malaria has been notifiable in 31 states/UTs

• Till september 2021 28 states have constituted state task force and
district task force of malaria elimination

• Malaria microscopy has been strenghtened for malaria elimination

• Mass screening and treatment campaign has been initiated in the high
burden district of Tripura and Mizoram.

• Availability of Bivalent Rapid Diagnostic Tests and anti malarias with

ASHA’s for early diagnosis and prompt treatment

• During last 6 years 9.7 crore LLINs have been didtributed in the high
malaria endemic areas of various states/UTs.
 ELIMINATION of LYMPHATIC FILARIASIS
• TheNational Filaria Control Program has been in operation since 1955.
• In June 1978 operational component of NFCP merged with Urban Malaria
Scheme
• NFCP is being implemented through 206 filaria control units 199 filaria
clinics and 27 survey units.
• Strategies
a. Annual Mass drug Administration of single dose of antifilaria drug for 5
yers or more to the eligible population(except pregnant
women,childrenbelow 2 years of age and seriously ill pts) to interrupt
transmission of diseases
b. Home based management to lymphoedema cases and up scaling of
hydrocoele operations in identified CHCs/ district hospitals/ medical
colleges.
 MDA
• Single dose of DEC tablets in addition to scaling up of home based foot
care and hydrocoele operation.
• co administration of DEC+Albendazile has been upscaled since 2007
• Program covered 202 districts in 2004 wheteas by year 2007, all 250 LF
endemic district covered.
• Presently antifilaria drug i.e. DEC+Albendazole(DA)/Ivermectin
+DEC+Albendazole(IDA) administered.
• DEC should be taken once in a year on Natinal Filaria Day.
• Should be taken after food
• Dose
 SURVEY
• The microfilaria survey in all implementation unit is dine through night
blood survey before MDA .
a. Mass blood survey
b. Clinical survey
c. Serological tests
d. Xenodiagnosis
e. Entomological surveys
 KALA-AZAR
• Kala azar is now enedemic in 33 districts of Bihar,4 districts of
Jharkhand,11 districts, of WB and 6 districts of UP,besides sporadic
cases in few other district of UP.
• Startegies are
a. Enhanced cse detection and complete treatement including introduction
of rK39 rapid diagnostic kits and oral drug Miltefosine for treatment of
Kala azar cases.
b. Interruption of transmission through vector control.It has been decided to
replace DDT with synthetic pyrethroid for purpose of fogging to eliminate
sandfly asinsect becoming resistant to DDT
c. Communication for behavioural impact and intersectoral convergance
d. Capacity building
Monitoring ,supervision and evaluation
Research guidelines on prevention and control of kala azar have been
developed and circulated to states.
Active case search
• Active case search is carried out during fortnight designated as ‘kala
azar fortnight’ during which peripheral health workers engaged to make
door to door search and refer cases conforminf to case definition of kala
azar and PKDL.
• Incentive of Rs 300 provided to ASHA fir identifying case of Kala Azar
and Rs 200 for two rounds of insecticide spraying
• Pt treated in hospital is given Rs 500 as compensation if daily wage for
time spends in hospital during treatment of kala azar
• Rs 2000 for PKDL
• New strategy includes introduction of Rapid diagnostic kit developed by
ICMR and single dose treatment with Liposomal Amphotrecin B given I/V
in 10/mg/kgb.

CASE DEFINITION OF KALA AZAR- A case of kala azar is defined as a

person from an endemic area with fever of more than 2 weeks duration and
with splenomegaly who is confirmed by an RDT or a biopsy.
ACHIEVEMENTS
• In 2020 out of 633 endemic blocks,only 16 blocks (12 blocks in
Jharkhand and 4 blocks in Bihar) reported above elimination threshold

• Remaining 97.5% block achieved elimination target.

• There has been 40% decline in KA cases upto August 2021, compared
to corresponding period of 2020
 JAPANESE ENCEPHALITIS
• JE is a disease with high mortality and those who survive do so with
neurological complications
• It has become major health problem in states of Andhra Pradessh,West
Bengal,Assam,Tamil Nadu,Karnataka, Bihar, Maharashtra,
Manipur,Haryana, Kerala, and UP
• Strategies are
a. Strengthening of of the surveillance activities sentinel sitesin tertiary
health care institution
b. Early diagnosis and proper case management
c. Integrated Vector control
d. Capacity building and behaviour change communication
MANAGEMENT
• Early case management is very important to minimise the risk of
complication and deaths
• JE vaccination is recommended for children between 1 to 15 years of
age.
• Health Education through different media and interpersonal
communication for community.
• Keep pigs away from huam dwellings or in pigsites.
• use of full clothes and bed nets
 DENGUE FEVER/DHF
• During 1996 an outbreak of dengue was reported in Delhi.
• Since then dengue has been reported from states also.
• In view of this major outbreak of. disease a ‘Guideline of preparation of
contigency plan in case of outbreak/epidemic of dengue/dengue
hemorrhagic fever’
• GOI in consultation with states has identified 521 sentinel surveillance
hospitals with lab support for augmentation of diagnostic facilities in
endemic areas
• For early diagnosis ELISA based NSI kits have been introduced under
program to detect cases from 1st day of infection
• IgM capture ELISA test detect cases after 5th day infection
• GOI’s steps in prevention and control of dengue
a. Monitoring situation through reports received from state health
authorities
b. Mid term plan for prevention and control of dengue has been developed
in 2011
components of plan are
• Surveillance -Disease and entomological surveillance

• Case Management- Lab diagnosis and clinical management

• Vector management- Env management for source reduction,chemical

control, personal protection and legislation

• Outbreak response-Epidemic preparedness and media managemnt

• Capacity building-Training, stranghtening huamn resource and
operational research

• BCC-Social mobilisation,and information, education and

communication

• Intersectoral coordination-With ministries of urban develop,ent, rural

development, panchayati raj, surface transport and education sector.

• Monitoring and supervision-Analysis of reports,review, field visit and

feed back