NVBDCP National Vector Borne Disease Control Program

Dr. Mihir Rupani
Assistant Professor
Department of Community Medicine
Government Medical College, Bhavnagar
NATIONAL VECTOR BORNE
DISEASE CONTROL PROGRAM:
Guidelines for program
implementation

INTRODUCTION
• Vector borne diseases:
Pose an immense public health concern
Major impediments in the path of socio-
economic development

Historical perspective
• National Malaria Eradication Programme
(NMEP) which was being implemented in the
country since 1958, was reviewed in 1977 and
revised guidelines for Modified Plan of
Operation (MPO) were issused to all States &
UTs

• Due to various outbreaks in the country
malaria situation was reviewed in 1994 by
an Expert Committee.
• In pursuance of the Expert Committee's
recommendations, the Directorate of NMEP
brought out operational manual for Malaria
Action Programme (MAP) in 1995

• The Directorate of NMEP was renamed as
Directorate of National Anti Malaria
Programme (NAMP) in March, 1999.
• Directorate of NAMP was dealing with three
centrally sponsored schemes namely Malaria,
Filaria and Kala-azar control and in addition,
was looking after the prevention and control
of Dengue and Japanese Encephalitis.

• With a view to converge Dengue/Dengue
Haemorrhagic feverand Japanese Encephalitis
with the three on-going centrally sponsored
schemes [National Anti-Malaria Programme
(NAMP), National Filaria Control Programme
(NFCP) and Kala-azar Control Programme],
the integrated scheme was renamed as
National Vector Borne Disease Control
Programme (NVBDCP) from 2nd December,
2003.

• In 2006, Chikungunya re-emerged in the
country and this was also brought within the
purview of Directorate of NVBDCP.

NVBDCP – National Vector Borne
Disease Control Program
• Earlier the Vector Borne Diseases were managed
under separate National Health Programs
• NVBDCP is an umbrella program for prevention
and control of 6 vector borne diseases namely:
Malaria
Dengue
Chikungunya
Japanese Encephalitis
Kala-Azar
Filaria (Lymphatic Filariasis)

• It is an integral component of NHM and is
implemented under the overall umbrella of
NHM
• The Programme is monitored at the National
level through the mechanisms established
under NHM.
NVBDCP

NVBDCP
• The Directorate is responsible for framing
technical guidelines & policies as to guide the
states for implementation of Program
strategies.
• Responsible for budgeting and planning the
logistics pertaining to central sector.
• Monitoring of implementation through
regular reports and returns of MIS is done.

NVBDCP
• The Directorate carries out evaluation of
Program implementation from time to time.
• The resource gap is also assessed as to
provide an equitable support based on the
magnitude of the problem.
• Under the Union Ministry of H&FW, GoI, 17
ROH & FW are functioning.

NVBDCP
• Every state has state vector borne diseases
control component under the Directorate of
Health Services
• There is a system of coordination between the
state and centre for effective implementation
and monitoring of Program.

NVBDCP
• At the district level, District Malaria Offices
have been established under District Chief
Medical and Health Offices by the states.
• Key unit for planning and monitoring of
Program under a technical officer.
• At present, 565 District Malaria Units are
functioning.

Program objectives and strategies
• NVBDCP strategies comprise
Early diagnosis, prompt and complete
treatment
Integrated vector management including
promotion of personal protective measures
and biological measures
BCC, capacity building through integrated
training at all tiers of health care delivery
system
Monitoring and evaluation

• Partnerships
Other national health programs
Non-health sector departments
Civil society organizations (NGOs, CBOs, self-
help groups, panchayati raj institutions)
Corporate sectors
Medical academia and professional bodies

• LLINs
Having efficacy of 3-5 years have been
introduced

• Improve efficiency and quality of services at
primary, secondary and tertiary levels
• Primary level
ASHA under NHM, Anganwadi workers of ICDS
and Community Volunteers of NGOs would be
trained to serve Fever Treatment Depots
(FTDs)
PHCs, CHCs: equipped to manage PF malaria
Lab surveillance enhanced

• Secondary level
Training of Medical Officers, Lab Technicians
and Community Volunteers of public and
private sector
District level hospitals: equipped with
ventilators and lab services
Medical audit

• Tertiary level
Medical college hospital: manage all referrals
Undertake therapeutic efficacy studies of
combi-pack and effectiveness of rapid
diagnostic kits
Rapid diagnosis for management of severe
malaria cases

• Environmental Management
Proper drainage and sanitation

• Government of India provides technical
support as well as logistics
• State governments ensure program
implementation
• The centre and the states monitor the
program closely and high-risk areas are
identified for focused attention

Malaria – problematic states
• Chattisgarh, Jharkhand, Maharashtra, West
Bengal and Orissa – have registered maximum
malaria cases in India (since 2007)
• Out of them, Orissa and Maharashtra have
contributed to most of the deaths due to
malaria
• Other high malaria burden states – MP, UP,
Gujarat, Rajasthan, Karnataka

MALARIA
• The program aims to maintain Annual Blood
Examination Rate (ABER) of > 10% by active
and passive surveillance and bring down
Annual Parasite Incidence (API) to 1.3 or less
by 2012
• 25% reduction in morbidity and mortality by
2010 and 50% by 2012 (baseline year 2006)

MALARIA
• To strengthen malaria control, GoI is providing
cash assistance to states for engaging multi-
purpose workers (MPWs) on contractual basis
in about 200 identified high endemic districts
during the XI Five Year Plan

MALARIA
• Provision has been made under external
assistance for positioning Malaria Technical
Supervisors (MTS) in high endemic areas to
strengthen supportive supervision and micro-
level monitoring
• Each MTS to cover a population of 2.5 lacs in
selected areas of the high endemic districts

MALARIA
• Under NVBDCP, all fever cases are required to
be immediately examined
• Positive cases are provided prompt and
complete treatment
• Incentives have been considered for ASHAs
for performing Rapid Diagnostic Tests (RDTs),
preparation of slides and administering
complete treatment

MALARIA
• ASHA can also arrange to transport severe
malaria cases to the referral centers with the
expenditure borne out of funds from untied
grants of NHM
• Funds available with the Village Health and
Sanitation Committee (VHSC) can also be
utilized (this grant may also be utilized for
source reduction of mosquito breeding sites)

GUIDELINES UNDER NVBDCP:
MALARIA
• Surveillance and case management
Conventional diagnostic method through
microscopy remains the gold standard
However, rapid diagnostic kits (Pf kits) are
provided for quick treatment in difficult and
inaccessible areas with P. falciparum
predominance

• Integrated Vector Control Management
IRS: 2 rounds of DDT/synthetic pyrethroid or 3
rounds of malathion based on the insecticide
resistance studies and epidemiological
information.
IRS to be done in all areas with API>2 or
above.
Priority of spray to be given to high risk areas
with API or SPR 5 and above
MALARIA

• Integrated Vector Control Management
(contd.)
Use of ITMN
Reduction of breeding sites: use of larvivorous
fish – Gambusia and Poecilia (Guppy)
MALARIA

• Epidemic preparedness and Response (EPR)
Objectives are early identification and control
of epidemic
Early warning signals which include
epidemiological & entomological parameters ,
climatic factors (rain fall, temperature and
humidity), operational factors (inadequacy
and lack of trained manpower) are monitored
MALARIA

• Epidemic preparedness and Response (EPR)
Proper linkage with Integrated Diseases
Surveillance Programme (IDSP) at district level
for obtaining early warning signals on regular
basis
District should have rapid response team
consisting of epidemiologist, entomologist, lab
technician, Medical Officer, health workers,
supervisors, community volunteers
MALARIA

• Supportive interventions
Training and capacity building
Integrated training programme have been
designed for different categories of health
care functionaries
MALARIA

Behaviour Change Communication
Empowers people to take rational and
informed decisions through appropriate
knowledge
Inculcates necessary skills and optimism
Stimulates pertinent action
Reinforces the same through peers and
influencers.
MALARIA

Inter-sectoral Collaboration
Anti Malaria Month is being observed with
enhanced level of campaigning just before
the peak transmission season
MALARIA

• Innovations/modifications have been
proposed to be intensified during XI Five Year
Plan
For focused interventions, 206 districts have
been identified as high malaria endemic
Of which, 100 districts – high API and Pf
rate>30%
Further out of these 100, 61 districts
identified as very high malaria endemic
districts
MALARIA

Plan
Geographical Information System (GIS)
mapping for focused intervention in high risk
prioritized districts
MALARIA

Plan
Linkage with NHM and use of NHM
Institutions for prevention and control of
VBDs
Up-scaling use of bed nets /Long Lasting
Insecticide Treated Nets (LLINs)
MALARIA

Plan
Early diagnosis and treatment by
Strengthening of human resource
Scaling up of Rapid Diagnostic Kit (RDK)
Scaling up of Artemisinin-based Combination
Therapy (ACT)
MALARIA

• Monitoring of drug resistance and insecticide
resistance:
15 studies are conducted in a year through Pf
monitoring teams through ROH&FWs and
National Institute of Malaria Research (NIMR)
at different places
Based on their report, resistance areas are
identified and their drug policy changed
MALARIA

FILARIA (endemicity)
• Indigenous cases have been reported from
about 250 districts in 20 states/Union
Territories.

• Indigenous filaria cases 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.

• States free from indigenously acquired filarial
infection: North-Western States/UTs namely
Jammu & Kashmir, Himachal Pradesh, Punjab,
Haryana, Chandigarh, Rajasthan, Delhi and
Uttaranchal and North-Eastern States namely
Sikkim, Arunachal Pradesh, Nagaland,
Meghalaya, Mizoram, Manipur and Tripura

FILARIA
• Population living in endemic countries is now
covered with annual MDA with DEC +
Albendazole, with aim of elimination of Filaria
by 2015
• Patients suffering from hydrocele are
motivated for surgery
• ASHA and other volunteers, after due training,
would be involved in MDA by the local health
authority

• ELF by 2015:
LF ceases to be a public health problem i.e.
the number of microfilaria carriers is less than
one per cent in endemic population
Children born after initiation of ELF are free
from circulating antigenaemia.
Absence of antigenaemia among children is
considered as evidence for absence of
transmission and new infection.
FILARIA

FILARIA
• National Filaria Control Program is being
implemented in the country through 206
filaria control units, 199 filaria clinics and 27
survey units
• Strategies under NFCP:
Detection and treatment to the patients with
anti-filaria drug
Anti-larval work in urban areas covered under
NFCP

• Filaria has been targeted for elimination
globally by 2020
• National Health Policy (2002) aims to
eliminate lymphatic filariasis (ELF) by 2015
• MDA being implemented since 2004 in 250
districts in 15 states and 5 UTs
MDA to be undertaken by District Malaria
Officer or District Vector Borne Disease
Control Officer with staff and officials of NFCP
FILARIA

Major activities under ELF
• Sensitization and training of district and state
level officers
• Media sensitization and District Co-ordination
Committee meeting under the chairmanship
of district collector
• Microfilaria survey by trained technicians
(especially for collection of blood in the night
and its examination) before MDA in sentinel
and random sites in each district

• Identification of manifestations (lymphedema
or hydrocele), line-listing of cases and
updating every year with addition or deletion
on yearly basis to provide services for
morbidity management
• Collection, compilation and analysis of data
and feedback to state as well as centre
• Assessment through involvement of medical
college faculty, ROH&FW and ICMR
institutions

• Hydrocele operations for relief of the patients
• Training on home based care for morbidity
management
• Vector control: one or two rounds of IRS with
DDT (1g/m2
) in endemic areas
• Anti-larval measures: temphos in water tanks
every week and application of Mineral
Larvicidal Oils (MLO) on water surface
• Biological control; Environmental engineering

Kala Azar endemicity
• Endemic in eastern States of India namely
Bihar, Jharkhand, Uttar Pradesh and West
Bengal
• 48 districts endemic; sporadic cases reported
from a few other districts
• Estimated 129 million population at risk in 4
states
• Mostly poor socio-economic groups of
population primarily living in rural areas are
affected

KALA AZAR
• Annual incidence of Kala Azar will be reduced
to less than 1 per 10,000 population at sub-
district level with the aim of eliminating Kala
Azar by 2010
• Kala Azar Technical Supervisors (KTS) are
provided in affected districts to strengthen
early detection, complete treatment and
prevention and control including residual
spray (supported under World Bank assisted
project)

• It is proposed that ASHA workers will be
involved in identification of Kala azar cases
and ensuring their complete treatment
KALA AZAR

KALA AZAR
• Main strategic components for elimination:
Case detection and treatment: done through
the existing Primary health care system
supplemented by periodic annual active
searches (Kala azar fortnight)
Interruption of transmission through vector
control: undertaking 2 rounds of DDT spray
annually in PHC areas reporting kala azar
incidence under direct supervision and
monitoring by NHM institutions

• First round of IRS: february-march
• Second round: may-june
Just before the onset of monsoon as some
parts of Bihar become inaccessible in
monsoon
• IRS (with DDT 50%) is supplemented with
efforts to improve sanitation
• In addition, environmental measures and
personal protection from sandfly bites are
encouraged
KALA AZAR

• IEC & inter-sectoral convergence
• Diagnosis: Suspected cases as per the
standard case definition are referred for
clinical case examination and tested with
rapid dipstick test rK39
KALA AZAR

• Treatment: as per the drug policy of GoI,
Sodium Stibo Gluconate (SSG) is the first line
treatment of Kala azar
The oral drug, Miltefosine has been
introduced on a pilot basis in 6 districts of
Bihar and 2 districts each of Jharkhand and
West Bengal
Paramomycin has also been approved
KALA AZAR

• Vector control:
Selection of areas to be sprayed: all villages
within a PHC which reported Kala azar cases in
the past 5 years; all villages which reported
cases during the year of spray
Dosage: 1g/m2
of the wall surface; upto 6 feet
height
Cattle sheds and kala azar positive and
KALA AZAR

Kala azar – Patient Coding Scheme
• The patient and his relatives are counseled
properly at the time of registration at the
health institution (CHC/PHC/district hospital)
about the importance of full treatment
• The coding would be arranged in the order of
Country Code cum State Code- District Code-
PHC Code, Sub-Centre / NGO Code- Patient
Code.

• As per the patient coding scheme, each Kala-
azar case will have the country code IND along
with the state code and have a 10 digit
numerical code. (IND2-01-01-01-001...... IND2-
01-01-01-999).
• No two patients will have the same 10 digit
numerical code during a period of 5 years /
Kala-azar Elimination Program period.
Kala azar – Patient Coding Scheme

Example of Patient Coding System

• Disease is prevalent throughout India in most
of the metropolitan cities and towns
• Outbreaks have also been reported from rural
areas of Haryana, Maharashtra & Karnataka
Dengue endemicity

DENGUE/DHF
• Early case reporting and management
Disease surveillance through grass root level
health workers, sentinel surveillance sites with
laboratory support
Case management including early referral of
cases
Epidemic preparedness and rapid response
No specific anti-viral drug; symptomatic Rx

• Integrated vector management:
Larval surveys – entomological surveillance
Source reduction
Personal protection
DENGUE/DHF

• Larval surveys: containers in house-holds are
examined for presence of mosquito larvae and
pupae
• Four indices:
 House index: percentage of houses infected
= no. of houses infected with larvae/pupae x 100
no. of houses inspected
DENGUE/DHF

• Larval surveys:
Container index: percentage of water holding
containers infected with larvae/pupae
= no. of positive containers x 100
no. of containers inspected
DENGUE/DHF

• Larval surveys:
Breteau Index: no. of positive containers per
100 houses inspected
= no. of positive containers x 100
DENGUE/DHF

• Larval surveys:
Pupae Index: no. of pupae per 100 houses
= no. of pupae x 100
DENGUE/DHF

• An HI >5% &/or a BI >20 for any locality is an
indication that the locality is dengue sensitive
and therefore adequate preventive measures
should be taken
DENGUE/DHF

• Adult surveys:
Landing/biting collection: presence of aedes
aegypti mosquito can be reliable indicator of
clear proximity to hidden larvae habitats
Laborious
Expressed in terms of landing/biting counts
per man hour
DENGUE/DHF

• Adult surveys:
Resting collection: mosquitoes typically rest
indoors, especially in bedrooms and mostly in
dark places, such as cloth closets and other
sheltered sites
Mosquito searched with the aid of flashlight
Recorded as number of adults per house per
man hour of human efforts
DENGUE/DHF

• Adult surveys:
Oviposition traps: Ovitraps are devices used
to detect presence of Aedes aegypti where
population density is low (BI < 5) (urban areas)
Used to evaluate impact of adulticidal space
spraying on female adult mosquito population
DENGUE/DHF

• Following points were emphasized in the
strategic action plan:
Suspected cases should be referred at the
earliest for diagnosis and its proper
management
Strengthening through 110 Sentinel
Surveillance Hospitals (SSHs) and 13 Apex
Research Laboratories (ARLs)
DENGUE/DHF

strategic action plan (contd.):
Diagnostic kits are supplied by NIV (Pune), for
which the cost is borne by NVBDCP
Monitoring of larval density of Aedes
mosquitoes in urban and rural areas regularly
DENGUE/DHF

strategic action plan (contd.):
Involvement of NHM institutions namely Rogi
Kalyan Samiti for facilitating emergency cases
in referral and transportation
Involvement of VHSC for improvement in
sanitation and reduction in breeding sites
ASHA should be involved in educating the
community to avoid the stagnation of stored
water kept in and around houses
DENGUE/DHF

• Legislative measures
Model civic by-laws: fine/punishment is
imparted, if breeding is detected.
Strictly imposed by Mumbai, Navi Mumbai,
Chandigarh and Delhi Municipal Corporations.
Building construction regulation act: for
overhead/underground tanks, etc.
In Mumbai, builders deposit a fee for
controlling mosquitogenic conditions at site
DENGUE/DHF

• Legislative measures
Environmental Health Act: by-laws for proper
disposal/storage of junk, discarded tins, old
tyres and other debris
Health Impact Assessments: prior to any
development projects/major constructions
DENGUE/DHF

CHIKUNGUNYA
• No specific anti-viral drug; symptomatic Rx
• Strategies for prevention and control are the
same as for dengue

Japanese encephalitis endemicity

JE - Extent of problem
• JE viral activity has been widespread in India.
• The first evidence of presence of JE virus dates
back to 1952.
• First case was reported in 1955
• During recent past (1998-2004), 15 states and
Union Territories have reported JE incidence

GUIDELINES UNDER NVBDCP: JE
• Early diagnosis and case management
Strengthening of referral services: available
at district/sub-district levels
Proper case management:
No specific anti-viral drug for JE and cases are
managed symptomatically
Improved care by medical and para-medical
health care providers, improved lab services
for diagnosis, availability of drugs

• Proper case management (contd.):
Management of sequel: rehab at district
Epidemic preparedness and rapid response:
team constituted in all JE endemic districts
• Vaccination:
Vaccination of children between 1-15 yrs age:
Initiated since 2006 with single dose live
attenuated SA-14-14-2 vaccine under UIP in a
phased manner

• Integrated vector Management
Fogging with Malathion for outdoor is
recommended during outbreaks for
immediate killing of infected mosquitoes
Anti- larval operations
Personal protective measures for using
insecticides treated bed nets and curtains,
wearing full sleeve clothes during evening
hours etc.
Biological control using larvivorous fishes

• Supportive interventions:
Training and capacity building
Through training of clinicians and nurses in
case management and laboratory technicians
and laboratory in charge/microbiologists in all
sentinel laboratories in diagnosis by MAC
ELISA method in a phased manner.

Behaviour Change Communication
Early case reporting and early referral of
patients
Increasing awareness of clinical signs
Personal protection including segregation of
pigs away from human population
Mosquito proofing of pigsties

• Supervision and monitoring
Periodic reviews/reports and field visits for
proper monitoring for JE

Incentives to ASHAs under NVBDCP

S.No Activities Incentive Remarks
1 Preparation of slides Rs.5/- per slide Irrespective of RDT based
or slide based
confirmation
2. Taking slides to PHC
laboratories, getting reports and
providing complete treatment to
malaria positive case
Rs.5O/- per positive
case for complete
Treatment
This incentive is to
facilitate the
transportation cost
3.
RDT testing and complete
treatment of Pf malaria cases
Rs.20/-per positive
Pf malaria case for
complete treatment
In remote and
inaccessible areas, for
complete treatment of
Pf malaria cases

Incentives for filaria
• Under the ELF program, MDA is administered
by health workers (male/female) and
volunteers
• ASHAs could also be involved by local health
authorities
• Payment of Rs.100/- to each
volunteer/worker/ASHA for drug distribution
to 250 persons in approx 50 houses

Incentives for Kala azar
• Identification of case – Rs. 50/- per case
• For follow up and ensuring complete
treatment – Rs. 150/- per case
• From funds allocated for operational costs
under cash grant of NVBDCP (kala azar) funds

Dengue/Chikungunya/JE
• The untied funds available with the
subcentres for referral to district hospitals can
be utilized for transportation of the severe
cases to the identified referral centres

Public Private Partnership
• Categories: NVBDCP initiatives for PPP are
classified into 2 categories
Category 1: with local self government
(panchayat) or panchayat level CBO
(population coverage – minimum 5000
population)
Category 2: block level NGO/FBO (population
coverage – minimum 100000 population)

• Schemes:
• Provision of EDPT
Scheme 1: Provision of outreach services –
Fever Treatment Depot & Drug Distribution
Centre
Scheme 2: Provision of microscopy and
treatment services
Scheme 3: Hospital based treatment and care
of severe complicated malaria cases

• Integrated Vector Control
Scheme 4: Promotion of ITMN, insecticide
treatment of community owned bed nets and
distribution of ITMN in selected areas
Scheme 5: Promotion of larvivorous fish
Scheme 6: Indoor Residual Spray

NVBDCP National Vector Borne Disease Control Program

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