National Vector Born Disease Control Programme

Vector Borne Diseases
Control Program
Dr. Kunal Modak
District Malaria Officer,
Gadchiroli

2
Vector Borne Diseases Control
Programme
 Launched in 2003-04 by merging
NAMP,NFCP & Kala Azar Control
programmes .Japanese B Encephalitis and
Dengue/DHF have also been included in
this Program
 Directorate of NAMP is the nodal agency
for prevention and control of major Vector
Borne Diseases

3
Strategies for National
Vector Control Program
The basic approach for vector borne
diseases control involves a strategy
directed against the parasite and vector
and to enlist the involvement of
community in practicing various
preventive measures

4
Strategies contd.
 Disease management
 Insecticide resistance
 Involvement of NGOs /private
sector/community
 Quality assurance on laboratory diagnosis
 Long lasting insecticide treated nets

5
Contd.
 Improve quality and efficiency of services
at primary, secondary and tertiary levels
 Environmental management
 Monitoring and evaluation
 Collaboration with National Malaria
Institute of malaria research and medical
colleges
 Inter-sectoral collaboration

6
National
Anti Malaria Programme
 Started in 1953 as NMCP with Two rounds of
residual insecticidal (DDT) spray as the mainstay of
the program.
 Dramatic reduction of malaria mortality and
morbidity lead to National Malaria Eradication
Programme with malaria eradication as a goal in
1958.
 Reverses to the programme and resurgence of
malaria due to Technical, Operational and
Administrative causes necessitated changing it to
‘Modified Plan of Operation’ in1977.
 Malaria Action Plan 1995-identification of High risk
areas as per SPR and Pf %

7
‘Modified Plan of Operation’
 Objectives
- to prevent deaths due to malaria
- to reduce malaria morbidity
- to maintain agriculture and Industrial
- production through intensive anti malaria
measures in such areas
-to consolidate the gains achieved so far
 Areas were reclassified based on the Annual Parasitic
Incidence (API) as those having API > 2 and those having <
than 2 for operational purposes

8
Areas having Annual Parasite Index
(API) > 2
 Regular 2 rounds of insecticidal spray with
Synthetic Pyrethroids at the dose of 0.5 mg/sq
meter.
 Entomological assessment for vector behavior and
development of insecticidal resistance
 Active and passive surveillance is carried outon
regular basis every fortnight
 Presumptive Treatment to all fever cases Where
Examination result do not get within 24 hrs. and
Rdk is not available . Radical treatment to all slide
positive cases is given

9
Areas having Annual Parasite
Index(API) < 2
 Regular spray is not carried out but ‘focal’ spray is
carried out around falciparum cases detected
during surveillance
 Regular Active surveillance once in a fortnight
 Treatment –All positive cases to receive radical
treatment
 Follow up- All positive cases to be followed up for
6 month at monthly intervals after completion of
radical treatment
 Epidemiological investigation of all malaria positive
cases .

10
 Urban Malaria Scheme (UMS ) was launched in
1971 to over come the increasing incidence of
malaria in urban areas, where the vector was found
to be An. Stephansi. Intensive anti larval measures
and drug treatment are the mainstay of UMS
 P. falciparum containment Programme was
launched in October 1977 with the assistance of
SIDA to contain the spread of falciparum malaria
This programme is operative in the North Eastern
States, and parts of Orissa, Bihar, WB, AP ,MP,
Gujrat, Maharashtra and Rajasthan

11
 Reorganization - Malaria Units under NMEP
were reorganized to conform to the geographical
boundaries of the district and the DHO was made
responsible for implementation of the programme
Laboratory services-
Laboratory Technician with the necessary facilities
is now located at each PHC

12
 Investigation of all Malaria Deaths-
All cases suspected to have died due to malaria are to be
investigated
 Monitoring and control of all epidemics and
focal out breaks of malaria –
Any increase in the number of fever cases suggestive of
malaria should be promptly investigated and
measures to contain the outbreak should be
instituted.

Magnitude of the problem
 Annual data of Nagpur Division for the year 2021
reveals the largest numbers of cases in the Division
were reported by Dist. Gadchiroli, followed by Dist.
Chandrapur, Dist. Gondia,
 12999 cases of malaria (including 10985 P.falciparum
cases) and 14 deaths were reported from Nagpur
Division in 2021. In 2022 till 21 April 22 Malaria
cases were 1943 (including 1445 P.falciparum cases) &
3 Death were reported.
 % of Pf cases of Nagpur division in 2021 was
85,whereas % of Pf cases in Gadchiroli dist. was 87.
 Annual data of Nagpur Division for the year 2021
reveals the largest numbers Malaria deaths in the
Division were reported by Dist. Gadchiroli-8, followed
by, Dist. Gondia-1, Dist. Chandrapur-5

2017 2018 2019 2020 2021
Cases 6642 3033 2728 7051 12999
Pf 5238 2499 2391 6278 10985
Death 8 7 6 13 14
8 7
6
13
14
0
2
4
6
8
10
12
14
16
0
2000
4000
6000
8000
10000
12000
14000
Year wise Malaria Trend in Nagpur Division

Districtwise Malaria Situation
Sr.No Dist
2019 2020 2021
Cases Pf Death Cases Pf Death Cases Pf Death
1 Bhandara 7 4 0 14 11 2 7 7 0
2 Gondia 224 180 3 347 317 2 499 328 1
3 Chandrapur 53 44 1 196 179 3 152 120 5
4 Gadchiroli 2428 2161 1 6485 5769 6 12326 10522 8
5 Nagpur 10 2 1 3 1 0 7 5 0
6 Wardha 4 0 0 0 0 0 3 2 0
7 NMC 2 0 0 6 1 0 5 1 0
Division Total 2728 2391 6 7051 6278 13 12999 10985 14

16
Vectors of malaria
 Anopheles culicifacies is the main vector of malaria
 1. Feeding habits
 It is a zoophilic species
 When high densities build up relatively large numbers feed
on men
 2. Resting habits
 Rests during daytime in human dwellings and cattle sheds

17
Contd.
 3. Breeding places
 Breeds in rainwater pools and puddles, borrow
pits, river bed pools, irrigation channels,
seepages, rice fields, wells, pond margins,
sluggish streams with sandy margins.
 Extensive breeding is generally encountered
following monsoon rains.

18
Contd.
 4. Biting time
 Biting time of each vector species is determined by its
generic character, but can be readily influenced by
environmental conditions.
 Most of the vectors, including Anopheles culicifacies,
start biting soon after dusk. Therefore, biting starts
much earlier in winter than in summer but the peak time
varies from species to species.

19
Contd.
2. Vector Control
 (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

20
Chemical control- I.R.S.
 In Maharashtra state.Alfacypermethrin5% is used for
IRS.
 Dilution-200gm/10 lit of Water.
 2750 Kg. Alf Cy.5% is required for 2round in 1lack
population.
 Discharge rate of nozzle tip-740cc to 850cc per min.
 Spray lance should be 45cm from the wall.
 The swaths should be parallel overlapping 1/3 area of
the preceding swath.
 The pump man should give 20 to 26 strocks per min. to
obtain the proper discharge rate i.e.10 PSI pressure
 The spray nozzle should not be against wind direction

21
Contd.
 (ii) Biological Control
 Use of larvivorous fish in ornamental tanks, fountains etc.
 Use of biocides.
 ( iii) Personal Prophylactic Measures that
individuals/communities can take up
 Use of mosquito repellent creams, liquids, coils, mats etc.
 Screening of the houses with wire mesh
 Use of bed nets treated with insecticide
 Wearing clothes that cover maximum surface area of the
body

EPIDEMIOLOGICAL INDICES:
Monthly Blood Examination Rate
No. of B.S. Examined during the Month
MBER= -------------------------- X 100
Population covered under surveillance

MONTHLY BLOOD EXAMINATION RATE
NO. OF B.S. EXAMINED DURING THE MONTH
MBER= --------------------------------- X 100
POPULATION COVERED UNDER SURVEILLANCE

SLIDE POSITIVITY RATE
NO. OF B.S. FOUND +VE FOR M. PARASITE
S.P.R. = ---------------------------X 100
NO. OF B.S. EXAMINED

NO. OF B.S. FOUND +VE FOR P.F.
P. FALCIPARUM %: -------------------------X 100
NO. OF B.S. FOUND +VE FOR M. PARASITE

ANNUAL PARASITE INCIDENCE
NO. OF B.S. FOUND POSITIVE FOR PARASITE
A.P.I.: ------------------------------------------------X 1000
TOTAL POPULATION UNDER SURVEILLANCE

HOUSE INDEX
TOTAL HOUSES POSITIVE FOR LARVAE
HI =--------------------------------------------------------------------------------------X 100
TOTAL HOUSES CHACKED
Entomological Indices
27

CONTAINER INDEX
TOTAL CONTAINER POSITIVE FOR LARVAE
CI =--------------------------------------------------------------------------------------X 100
TOTAL CONTAINER CHACKED
28

BRATUE INDEX
TOTAL CONTAINER POSITIVE FOR LARVAE
BI =--------------------------------------------------------------------------------------X 100
TOTAL HOUSES CHACKED
29

30
Malaria control strategies
 1. Early case Detection and Prompt Treatment
(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 drug of choise in Pv cases and ACT
is drug of choise in Pf cases.

SURVEILLACE
Active Survey-
M.O. Should plan fortnightly sueveillace programme of MPW/ANM
in such a way that each house in every village should be covered in
Active survey in respective sub center.
Mpw should visit 150 house per day.
 ANM Should visit 50 house in Sub center Hq. Village.
If No. House are more Surveillance from Asha worker should be
done in her Hq village i.e. 40 house per day.
B.S. collected from villages must be sent on the same day to the
PHC laboratory.
Positive malaria patient must get full radical treatment .
Primaquine is gametocytocydal drug which is used in radical
treatment .
31

SURVEILLACE
Passive Survey-
 All fever cases in the OPD should be Examined for
M.P.
 Suspected Malaria patient must be tested for M.P.
immediately in laboratory. If the post of Technician
is not available use RDK.
 In any case time lag of B.S. coll and Examination
should not be more than 1 day
 MO Should ensure the completion & Consumption of
Radical Treatment to the paitent by HA.
 First dose of radical treatment should be given by
HA and remaining doses by ASHA 32

33
Control strategies contd.
4. 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 private sector.

34
Contd.
 5. Environmental Management & Source
Reduction Methods
 Source reduction i.e. filling of the breeding
places
 Proper covering of stored water
 Channelization of breeding source

35
Contd.
6. Monitoring and Evaluation of the
Program
 Monthly Computerized Management Information
System(CMIS)
 Field visits by state by State National Program
Officers
 Field visits by Malaria Research Centers and other
ICMR Institutes
 Feedback to states on field observations for
correction actions.

National Drug Policy on
Malaria
2013

Diagnosis and Treatment for Malaria
Where microscopy result is available within 24 hours
Suspected malaria case
Take slide and send for microscopic examination
Result ?
Positive for Pv
Treat with CQ
3
days+PQ0.25
mg per kg
B.W. for 14
days
Positive for Pf
Treat with
ACT-Sp for 3
days+PQ
single dose on
second day
Positive for
Mix
infectiion
SP –ACT
3days+ PQ
0.25 mg
per kg B.W.
for 14 days
Negative
No
antimalarial
treatment treat
as per clinical
dignosis

Where microscopy result is not available within 24 hours and
monovalent RDT is used
Where Tfr>=1% and Pf%>30% in any of
last 3years
Do RDT for detection of malaria &
prepare slide
Positive for Pf
Treat with ACT-
SP for 3days+ PQ
single dose on
second day
RDT negative:
wait for slide
result give CQ
25mg/kg over
3daysonly if high
suspicious of
malaria
If confirmed
as Pv CQ if not
already given
PQ 0.25mg
/kg/day over 14
days
In other areas
Wait for slide result give CQ
25mg/kg over 3daysonly if high
suspicious of malaria
Positive for
Pv CQ if not
already given
PQ 0.25mg
/kg/day over
14 days
Positive for
Pf Treat with
ACT-SP for
3days+ PQ
single dose on
second day

Where microscopy result is not available within 24
hours and Bivalent RDT is used
Do RDT and Prepare slide
Positive for Pv
Discard slide
Treat with CQ 3
days+PQ0.25
mg per kg B.W.
for 14 days
Positive for
Pf Discard
slide treat
with :i ACT-
Sp for 3
days+PQ
single dose
on second
day
Positive for
Mix
infectiion
Discard slide
SP –ACT
3days+ PQ
0.25 mg per
kg B.W. for
14 days
Negative No
anti-malarial
treatment
However,if
malaria
suspected
send slide
for
microscopy

Treatment of Vivax Malaria
 Chloroquine:25mg/kg BW divided over three
days
 10 mg/kg bw on day 1
 Primaquine: 0.25 mg/kg bw daily for 14
days
Primaquine is contraindicated in infants,ANCs,&
G6PD deficiency individuals

Doses chart for treatment of Pv
Age Day 1 Day 2 Day 3 Day 4 to
14
CQ
(250
mg)
PQ
(2.5m
g)
CQ
(250
mg)
PQ
(2.5mg
)
CQ
(250 mg)
PQ
(2.5mg)
PQ(2.5mg)
Less
than1Year
1/2 0 1/2 0 1/4 0 0
1-4years 1 1 1 1 ½ 1 1
5-8 year 2 2 2 2 1 2 2
9-14 years 3 4 3 4 1 +1/2 4 4
15 years
or more
4 6 4 6 2 6 6
pregnancy 4 0 4 0 2 0 0

Treatment of uncomplicated Pf cases
Artemisinin based combination therapy(
ACT-SP)
 Artesunate 4mg/kg bw daily for 3 days
pluse Sulfadoxine( 25mg/kg bw)-
Pyrimethemine(1.25mg/kg bw) on first
day
 Primaquine: 0.75mg/kg bw on day 2
ACT is not to be given in first trimester of
pregnancy.

Doses chart for treatment of Pf
Artemisinin based combination therapy
Age Day 1 Day 2 Day 3
AS SP AS PQ AS
Less than1Year 25 mg 250+12.5
mg
25 mg 0 25 mg
1-4years 50 mg 500+25 mg 50 mg 7.5 mg 50 mg
5-8 year 100 mg 750+37.5
mg
100 mg 15 mg 100 mg
9-14 years 150 mg 1000+50mg 150 mg 30 mg 150 mg
15 years or
more
200 mg 1500+75mg 200 mg 45 mg 200 mg

Pf Treatment for ANC
 Ist Trimester : Quinine 10mg/Kg TDS for
7 days.
(It may induce hypoglycemia, pregnant
woman should not start taking Quinine
on an empty stomach and should eat
regularly while on Quinine Treatment.)
 IInd and IIIrd Trimester : Full course of
ACT. (Primaquine should not be given)

Chemoprophylaxis
For short stay up to 6 week in high endemic
areas-
Doxycycline100mg. once daily for adult and
children above 8 years 1.5mg/kg Body wt.
The drug should be started 2days before travel &
continued for 4 weeks after leaving the malarious
area
( not recommended for pregnant women and children less
than 8 years.)

Chemoprophylaxis
For Longer stay More than 6 week in high
endemic areas-
Mefloquine 250mg. weekly for adult
The drug should be started 2weeks before travel &
continued for 4 weeks after leaving the malarious
area
(Contraindicated in individuals with history of
convulsions,neuropsychiatric problems and cardiac
condition.)

Note:
47
Pregnant women with severe malaria in any trimester can be
treated with artemisinin
derivatives, which, in contrast to quinine, do not risk
aggravating hypoglycaemia.
 The parenteral treatment should be given for minimum of 48
hours
 Once the patient can take oral therapy, give:
 Quinine 10 mg/kg three times a day with doxycycline 100 mg
once a day or
clindamycin in pregnant women and children under 8 years of
age, to complete 7 days of treatment, in patients started on
parenteral quinine.
 Full course of ACT to patients started on artemisinin
derivatives.
 Use of mefloquine should be avoided in cerebral malaria due
to neuropsychiatric complications associated with it.

Criteria for immediate referral to R.H./G.H.
48
a) Persistence of fever after 24 hours of initial treatment.
b) Continuous vomiting and inability to retain oral drugs.
c) Headache continues to increase
d) Severe dehydration – dry, parched skin, sunken face
e) Too weak to walk in the absence of any other obvious
reason
f) Change in sensorium e.g. confusion, drowsiness,
blurring of vision, photophobia,disorientation
g) Convulsions or muscle twitchings
h) Bleeding and clotting disorders
i) Suspicion of severe anaemia
j) Jaundice
k) Hypothermia

49
National
Filaria Control Program

50
Magnitude of the problem
 Filariasis has been a major public health problem in
India next only to malaria. The discovery of
microfilariae (mf) in the peripheral blood was made first
by Lewis in 1872 in Calcutta (Kolkata).
 Indigenous cases have been reported from about 250
districts in 20 states/Union Territories.
 The North-Western States/UTs are known to be free from
indigenously acquired filarial infection.
 Cases of filariasis have been recorded from Andhra
Pradesh, Assam, Bihar, Chhattisgarh, Goa, Jharkhand,
Karnataka, Gujarat, Kerala, Madhya Pradesh,
Maharashtra, Orissa, Tamil Nadu, Uttar Pradesh, West
Bengal, Pondicherry, Andaman & Nicobar Islands, Daman
& Diu, Dadra & Nagar Haveli and Lakshadweep(20)

51
Signs and symptoms of Filariasis
 Recurrent fever intermittent or remittent with
often double rise
 loss of appetite, pallor and weight loss with
progressive emaciation
 weakness
 Splenomegaly – spleen enlarges rapidly to
massive enlargement, usually soft and nontender
 Liver – enlargement not to the extent of spleen,
soft, smooth surface, sharp edge

52
Contd.
 Lymphadenopathy – not very common in India
 Skin – dry, thin and scaly and hair may be lost.
Light colored persons show grayish discoloration
of the skin of hands, feet, abdomen and face
which gives the Indian name Kala-azar meaning
“Black fever”
 Anemia – develops rapidly
 Anemia with emaciation and gross splenomegaly
produces a typical appearance of the patients

53
National Filaria Control Program
 This program was started in 1955
 In 1998 the operational component was
merged with Urban Malaria Scheme
 In 2003 -04 it was merged with
NVBDCP
 Filariasis has been a major public health
problem in India next only to malaria.
 Indigenous cases have been reported from
about 250 districts in 20 states/Union
Territories.

54
Revised Filaria Control Strategy
 The National Health Policy 2002 aims at
Elimination of Lymphatic Filariasis by 2015
 REVISED STRATEGY
 Annual Mass Drug Administration with single dose of
Diethyl carbamazine(DEC)was taken up as a pilot
 During 2004 about 400 million population were
brought under MDA.
 This strategy is to be continued for 5 years or more to
the population excluding children below two years,
pregnant women and seriously ill persons in affected
areas to interrupt transmission of disease.

55
Contd.
 Vector control through anti larval spray
at weekly intervals.
 Biological control through larvivorous
fishes
 Environmental engineering through
source reduction and water management
 Information, education and
communication

Filaria Report Yearwise and Districtwise
MF Rates
District
Filaria Report Districtwise
Year MF Rate Year MF Rate Year MF Rate
Wardha
2019
0.04
2020
0.00
2021
0.01
Nagpur
0.02 0.02 0.03
Gondia
0.03 0.08 0.03
Bhandara
0.09 0.08 0.02
Chandrapur
0.37 0.22 0.15
Gadchiroli
0.45 0.28 0.25

58
WHAT IS DENGUE ?
 Dengue is a viral disease
 It is transmitted by the infective bite of Aedes Aegypti
 Man develops disease after 5-6 days of being bitten by
an infective mosquito
 It occurs in two forms: Dengue Fever and Dengue
Haemorrhagic Fever(DHF)
 Dengue Fever is a severe, flu-like illness
 Dengue Haemorrhagic Fever (DHF) is a more severe
form of disease, which may cause death
 Person suspected of having dengue fever or DHF must
see a doctor at once

National Vector Born Disease Control Programme

60
Dengue/DHF
 There was a major out break of Dengue /DHF
in Delhi in 1996
 Since than many focal outbreaks have been
reported from different areas of the country
mainly from urban areas.
 This disease has been included in NVBDCP in
2003 -04

Strategies: Dengue & Chikungunya
Early case detection and prompt treatment
• Identified 13 Apex Referral Laboratories for advanced diagnosis
and regular surveillance in India.
• Identified 137 sentinel surveillance hospitals for proactive
surveillance in India.
• NIV Pune entrusted to supply ELISA test kits to these institutes
• In Maharashtra 26 sentinel Centers are established for
examination of serum sample,Out of which 5 sentinel Centers are
establised in Nagpur Division ( IGMC-Nagpur, GMC- Nagpur,
Datke- Nagpur, MGIMS- Sevagram, General Hosp.-Chandrapur,
GMC- Gondia, G.H.Bhandara, G.H.Gadchiroli.)

62
Control Strategy
 Public awareness and community
involvement is the key issue in the
strategy to control Dengue/DHF
 All efforts should be made against the
breeding of Aedes egypti mosquitoes
by source reduction
 Protection from mosquito bites
 Early diagnosis and prompt treatment of
cases

63
Strategy contd.
 Programme strategy included:
 - Vector control through Insecticidal residual
spray (IRS )with Synthetic Pyrethroid up to 6 feet
height from the ground twice annually
 - Early Diagnosis and Complete treatment
 - Information Education Communication
 - Capacity Building
 Programme intensified in 1991-92 which led to
improved case registration through primary health
care system

64
Contd.
 (ii) Biological Control
 Use of larvivorous fish in ornamental tanks, fountains etc.
 Use of biocides.
 ( iii) Personal Prophylactic Measures that
individuals/communities can take up
 Use of mosquito repellent creams, liquids, coils, mats etc.
 Screening of the houses with wire mesh
 Use of bed nets treated with insecticide
 Wearing clothes that cover maximum surface area of the
body

2019 2020 Up to Nov 2021
Coll. 5007 2514 18491
+ve 1316 503 3595
Death 11 2 17
0
2
4
6
8
10
12
14
16
18
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Yearwise Dengue Coll, +ves & Deaths in Nagpur Division

Districtwise Dengue Situation
Sr.No Dist
2019 2020 Up to Nov 2021
Susp
Cases
Posi Death
Susp
Cases
Posi Death
Susp
Cases
Posi Death
1 Bhandara 279 10 1 92 8 0 695 54 1
2 Gondia 219 37 0 93 4 0 982 177 0
3
Chandrapur
1349 465 2 931 204 0 2231 585 4
4 Gadchiroli 125 11 0 132 16 0 159 70 0
5 Nagpur 371 94 3 267 54 1 4286 1242 5
6 Wardha 307 72 3 356 110 0 2084 415 2
7 NMC 2367 627 2 643 107 1 8015 1052 5
Division Total 5007 1316 11 2514 503 2 18491 3595 17

6/5/2022 Dr. KANUPRIYA CHATURVEDI 68

70
Japanese encephalitis
control

71
Japanese encephalitis
 Japanese Encephalitis is a viral disease
 It is transmitted by infective bites of female
mosquitoes mainly belonging to Culex
tritaeniorhynchus, Culex vishnui and Culex
pseudovishnui group. However, some other
mosquito species also play a role in
transmission under specific conditions
 JE virus is primarily zoonotic in its natural
cycle and man is an accidental host.
 JE virus is neurotorpic and arbovirus and
primarily affects central nervous system

72
Contd.
 Japanese Encephalitis is becoming a health problem
in a number of States especially in AP, TN, Kerala,
Karnataka , WB, Assam, Bihar, & Haryana,
 There was no national programme for this disease
and the affected states were managing the problem
with the technical Assistance from the centre
 This disease was included under the NVBDCP
in 2003-04

73
How JE is transmitted?
 Japanese encephalitis is a vector borne disease.
 Several species of mosquitoes are capable of
transmitting JE virus.
 JE is a zoonotic infection. Natural hosts of JE virus
include water birds of Ardeidae family (mainly
pond herons and cattle egrets). Pigs play an
important role in the natural cycle and serve as an
amplifier host since they allow manifold virus
multiplication without suffering from disease and
maintain prolonged viraemia.

74
Contd.
 Due to prolonged viraemia, mosquitoes get
opportunity to pick up infection from pigs easily.
 Man is a dead end in transmission cycle due to
low and short-lived viraemia. Mosquitoes do not
get infection from JE patient

75
Sign and Symptoms of JE
 JE virus infection presents classical symptoms
similar to any other virus causing encephalitis
 JE virus infection may result in febrile illness of
variable severity associated with neurological
symptoms ranging from headache to meningitis or
encephalitis. Symptoms can include headache,
fever, meningeal signs, stupor, disorientation, coma,
tremors, paralysis (generalized), hypertonia, loss of
coordination, etc.
 Prodromal stage may be abrupt (1-6 hours), acute
(6-24 hours) or more commonly subacute (2-5
days)

76
Contd.
 In acute encephalitic stage, symptoms noted in prodromal
phase convulsions, alteration of sensorium, behavioural
changes, motor paralysis and involuntary movement
supervene and focal neurological deficit is common.
Usually lasts for a week but may prolong due to
complications.
 Amongst patients who survive, some lead to full recovery
through steady improvement and some suffer with
stabilization of neurological deficit. Convalescent phase is
prolonged and vary from a few weeks to several months.
 Clinically it is difficult to differentiate between JE and other
viral encephalitis
 JE virus infection presents classical symptoms similar to
any other virus causing encephalitis

Strategies: Japanese Encephalitis
Early case detection and prompt treatment-
• Clinical surveillance in endemic areas
JE Vaccination Program-
• In 2006, 11 endemic districts of 4 states covered
• Children in 1-15 years age group immunized as an integral
component of Universal Immunization
• Mouse-brain derived inactivated JE vaccine manufactured by
CRI kasauli
• 3 doses of 0.5 to 1 ml (day 0, 7, 30) followed by Booster
• In Nagpur Division JE Vaccination Programme is carried out
in Bhandara, Gadchiroli ,Nagpur & Gondia dist.

78
Control Strategy
1. Care of the patient to prevent sequaele
2. Development of a safe & Standard vaccine
3. Sentinel surveillance including clinical
surveillance of suspected cases.
4. Studies to identify high risk cases
5. Epidemiological monitoring of the disease
and effective implementation of preventive
and control measures

0
50
100
150
200
250
2019 2020 Up to Nov 2021
S.Coll. 239 51 5
+ve 35 2 1
Death 10 1 0
Yearwise J.E.Serum S.Coll. +ves & Deaths in Nagpur Division

Districtwise JE Situation
Sr.No Dist
2019 2020 Up to Nov 2021
Cases Death Cases Death Cases Death
1 Bhandara 1 0 0 0 0 0
2 Gondia 1 1 0 0 0 0
3
Chandrapur
14 5 1 0 1 0
4 Gadchiroli 10 3 1 1 0 0
5 Nagpur 1 0 0 0 0 0
6 Wardha 8 1 0 0 0 0
7 NMC 0 0 0 0 0 0
Division Total 35 10 2 1 1 0

CHANDIPURA VIRAL
ENCEPHALITIES
Chandipura viral encephalities is
important Sandfly viral disease and
one of the leading causes of viral
encephalitis and neurological infections
in india.

The discovery of CHV(1965)
 An outbreak of febril illness was reported from
Nagpur city in India during April to June 1965.
 Two serum sample from the cases were nagative
from Dengue and CHK viruses, but produce
cytopathic effect when innoculated in BS-C-1 cells .
 The filterable agent recovered was identified as a
new virus “Chandipura virus’’.
 The studies on sera collected earlier showed that
virus was widely prevalent in many parts of India
both in human and variety of animals.

Virus isolated from Encephalopathy
case 1980
 CHP was isolated from serum of a case
of acute encephalopathy during an
outbreak of viral encephalitis in Raipur ,
Jabalpur and MP in India 1980.

Discovery of CHP Encephalitis
2003
 In 2003 between June to August there was outbreak
of acute encephalits involving 329 children with 183
deaths from many districts of AP.
 CHP was found to be etiological agent.
 During the same period 15 districts of MS outbreak of
acute encephalitis involving 400 cases and 115
deaths were reported in this outbreak also CHP virus
was important etiological virus.
 Thus in about 40 yrs.after the discovery of CHP virus
in 1965, an acute encephalitis disease with high
mortality was attributed to this virus.

Clinical Characteristic
 High grade fever of short duration , vomiting,
altered sensorium, generalised convulsions,
and decerebrate posture leading to grade iv
coma, acute encephalopathy and death
within a few to 48 hrs. of hospitalisation.
 Transmission of CHP virus- CHP Virus is
transmitted by Infected sndflies

SANDFLIES
 Sandflies are small insects, light or dark
brown in colour. They are smaller than
mosquitoes, measuring 1.5 to 2.5 mm in
length with their bodies and wings densely
clothed with hair.
 Some 30 species of sand-flies have been
recorded in India.
 The important ones are –Phlebotomus
argentipes, P.papatasii, P.sergenti and
Sergentomyia punjabensis

HABITS
 Sandflies are troublesome noctural pests. Their bite
is irritating and painful, while their presence is
scarcely observed.
 They infest dwellings during night and take shelter
during day in holes and crevices in walls, holes in
trees, dark rooms, stables and store rooms.
 The females alone bite, as they require a blood meal
every third or fourth day for oviposition .
 Sandflies are incapable of flying over long distances,
they merely hop about from one place another.
Sandflies are generally confined to within 50 yards
of their breeding places.

CONTROL OF SANDFLIES
 Sandflies are easily controlled because they do not move
long distances from the place of their breeding.
 Insecticides : Resistance to DDT has not been
demonstrated. A single application of 1 to 2 g/m2 of DDT or
0.25 g/m2 of lindane has been found effective in reducing
sandflies. DDT residue may remain effective for a period of
1 to 2 yrs. And lindane only for a period of 3 months.
Spraying should be done in the human dwellings, cattle
sheds and other places.
 Sanitation : Sanitation measures such as removal of
shrubs and vegetation within 50 yards of human dwellings,
filling up cracks and crevices in walls and floors, and
location of cattle sheds and poultry houses at a fair
distance from human habitations should receive attention.

CHANDIPURA/AES – NAGPUR DIVISION
Year O.Bs Attacks
CHP
+ve
Ch/
Deaths
AES/
Deaths
2016 3 50 0 0 4
2017 1 1 1 0 1
2018 1 1 0 0 1
2019 11 79 0 0 11
2020 0 0 0 0 0
2021 0 0 0 0 0

National Vector Born Disease Control Programme

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