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NATIONAL STRATEGY FOR PREVENTION AND CONTROL OF DENGUE & COUNTRY SCENARIO - INDIA

TAINAN

T7th December, 2015

Directorate of National Vector Borne Disease Control Programme

Ministry of Health and Family Welfare,

Government of India www.nvbdcp.gov.in

denguenvbdcp@gmail.com

Dengue in India

• Dengue virus first isolated in

Calcutta (present Kolkata) in 1945

• The 1st evidence of dengue

occurrence in 1956 – Vellore, TN N

• Epidemic of DHF first occurred in

Calcutta in 1963 (Clin Microbiol Rev

1998;11; Ind J Ped 1987;54)

• All the States are reporting dengue

• All 4 Serotypes are isolated in India

• Cases are reporting from rural

areas as well

Geographical spread since 1991

Age wise and gender wise distribution of cases in 2015

0

10

20

30

40

50

60

70

<5 Yrs 6-15 yrs 16-45 Yrs >45 Yrs

3.3

15.8

64.3

16.6

3500

3550

3600

3650

3700

3750

3800

3850

3900

Female male

3640

3887

Spreading to rural areas due societal changes

Dengue in the capital during 2015 • Highest nos of cases (15730) & deaths (38)

• Upsurge was reported from August onwards

• DENV 2 predominant, 3 & 4 also isolated

• Health is a state subject, policy & technical guidelines by

Central Govt. implementation is by State Govt

• Situation was monitored constantly at higher level.

• Parliamentary Standing Com.,CoS, HFM, reviewed the

action/ preventive measures

• A Control room & Coordination Committee established

• Hospitals visited, test kits & clinical guidelines ensured

• Entomological indices monitored

• Intensive IEC/BCC through radio, TV, news paper, IPC

7213

6081

3343

2895

2083

1292

1049 783

347 284 162

Week 38(15.09.15 to

20.09.15)

Week 39(21.9.15 to

27.9.15)

Week 40(28.9.15 to04.10.15)

Week 41(5.10.15 to11.10.15)

Week 42(12.10.15 to

18.10.15)

Week 43(19.10.15 to

25.10.15)

Week 44(26.10.15 to

1.11.15)

Week 45(2.11.15 to

8.11.15)

Week 46(9.11.15 to15.11.15)

Week 47(16.11.15 to

22.11.15)

Week 48(23.11.15 to

29.11.15)

Delhi -Weekly Cases

1. Surveillance – Disease and Entomological

Surveillance

2. Case management - Lab diagnosis and Clinical

management

3. Vector management - Environmental

management for Source Reduction, Chemical

control, Personal protection and Legislation

4. Outbreak response - Epidemic preparedness/

Response and Media management

5. Capacity building - Training, Strengthening

Human Resource and Operational research

6. Behaviour Change Communication - Social

mobilization and IEC

7. Inter-sectoral coordination – Different

Ministries (UD, RD, PR, ST, HRD, WS)

8. Monitoring and Supervision - Analysis of

reports, review, field visit and feedback

Strategy for Dengue Specific objectives are:

To reduce incidence of Dengue to bring down the disease burden To reduce the case fatality rate due to dengue

Mid Term Plan has 8 Key elements ‘OCTALOGUE’ - as under:

Disease surveillance

Surveillance

Vector surveillance

Hospitals Public/Private

Sentinel Surveillance Hospitals

Municipal Corporation

State VBDCP

District VBDCP

Rapid Response - preventive measures

Dte.of NVBDCP

State level

Entomological Teams of •State/ Zone • ROHFW • Municipalities •ICMR institutions -field units

Central Cross Checking Organization, NVBDCP

Dte.of NVBDCP

Entomological Teams of • ROHFW • NCDC • NIMR

Diagnostic facilities under NVBDCP network

Total 521 + 15 Laboratories

Role of Sentinel surveillance Hospitals

• Pro active surveillance in non transmission

• Diagnosis

• Maintaining line-listing cases

• Inform dist prog Officer for implementation

vector control measures immediately .

Annual increase of Sentinel Surveillance Hospitals/Labs

ELISA based NS1 (Ag test -1st five days of illness) & IgM Capture ELISA (Ab test after 5 days of illness)

National Inst of Virology, Pune (ICMR) produce & supply IgM Capture ELISA

NS1 kits commercially available

Test kit , training, contingency grant – Central supply

• Medical Colleges 31%

• District Hospitals 57%

• Public Health Labs 12%

Role of Apex referral laboratories

• Advanced diagnostics like PCR, Virus isolation

• Capacity building of Regional & Dist sentinel

surveillance hospitals

• Quality control of laboratory. services

The new guidelines includes

• Introduction

• Epidemiology

• Clinical Manifestations of Dengue, EDS

• Case definition, classification and grading

of severity

• Laboratory Diagnosis

• Management of DF, including co-morbid

illness & co-infections

• Guidelines for Blood Transfusion in

management

• Management and referral of Dengue cases

in primary health care

• Nursing Care for Dengue

• Ready Reckoner

High political and administrative commitment

• Hon’ble Prime Minister addressed the nation to

extend co-operation to combat Dengue in

‘Mann ki Baat’ on Radio & Doordarshan (TV)

• Hon’ble Minister for H&FW reviewed the Dengue

related activities and status 5 times in 2015

• Committee of Secretaries, Parliamentary Standing Committee, Senior

Officers reviewed the programme from time to time.

• Advisories issued by Hon’ble Minister for H&FW to Chief Ministers, Sr

Officers & their counterparts of states to priorities Dengue control activities

Appeal to the Community in News paper

• to participate in the preventive activities

Case Definition • Two types of cases : Probable and Confirmed

Probable Dengue Fever

A case compatible with clinical description (Clinical Criteria) of DF.

(A positive test by RDT will be considered as probable due to poor

sensitivity and specificity of currently available RDTs.)

Confirmed Dengue Fever

A case compatible with the clinical description of Dengue Fever with at least one of the following:

• Demonstration of IgM antibody titre by ELISA positive in single serum sample.

• Demonstration of Dengue virus antigen in serum sample by NS1-ELISA.

• Isolation of the Dengue virus, Detection of virus by PCR.

Vector & Breeding Habitats

Aedes aegypti prefers to breed in Aedes albopictus prefers to breed in

14

• Source reduction - elimination of vector breeding at weekly interval

• Selective use of larvicide (Temephos )

• Biological control - Larvivorous fish

• Mosquito proofing of water tanks, buildings

• Indoor space spray with Pyrethrum extract (2%)

• Fogging (ULV) during outbreaks

• Personnel protection

Wearing full sleeved dress

Use of repellent

Use of mosquito nets during day time

In hospitals - (preferably LLIN)

For infants/children/elderly - day time sleep

Vector Management

Initiatives

• Two diagnostic tests - ELISA based NS1 test which can detect cases

from 1st day of illness & IgM capture ELISA can detect 5th day onwards

• Increasing nos of Labs to augment diagnostic facilities in all districts

• Inter sectoral convergence with various Ministries and departments

• Strengthening entomological monitoring at State/zonal level by filling up

the vacant posts

• Provision for community volunteers in 12th FYP to carry out source

reduction activities

• Incentives to ASHA in high endemic states for source reduction

• Capacity building of doctors on case management

• Dept of Health Research -

• Emphasizing enactment of Bye-laws ( Legislative measure)

• Focused IEC/BCC for community ownership

Intersectoral Collaboration & community ownership are

the key components for prevention and control of Dengue

Community Awareness –

Mass Media campaign

The month of July is observed as anti Dengue month

Community Awareness

Issues & challenges

• Drug & Vaccine --!!!!

• Co-circulation of DENV & CHKV

• Multiple serotypes, involvement of 2 vectors

• Suboptimal Entomological surveillance & early warning

signal in the periphery

• Enactment of Bye-laws

• Effective regional coordination & cooperation among the

countries

• Information & experience sharing and capacity building on

risk management

• Lack donor support like other NTDs

Dengue transmission occurring in all type of eco-epidemiological settings

Source reduction activities are linked to Swachh Bharat

THANK YOU

Visit us at www.nvbdcp.gov.in

Email denguenvbdcp@gmail.com