VECTOR BORNE DISEASES THE GROWING MENACE

Modus Operandi and Role of Hospitals in controlling Vector Borne Diseases

By – Dr. Rakshit A S (drrakshit.blogspot.in)

What Is it?

• Vector – an insect or any living carrier that transmits an infectious agent to the host.

• Vectors are the Vehicles by which infectious agents are transmitted via arthropods, domestic animals, or mammals to the host.

• So, vectors themselves are not an infectious agents.

• E.g. - mosquito, fly, rodents, tick

What is it?

• 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.

• Mosquito-borne diseases - Malaria, Filariasis, Yellow fever, dengue, Chikungunya fever, Japanese Encephalitis.

• Fly-borne disease – Sand fly fever, Leishmaniasis• Flea-borne diseases – Plague• Tick-borne diseases – Lyme Disease, Relapsing fever,

Typhus

MAGNITUDE OF VECTOR BORNE DISEASES

• The most deadly vector borne disease, Malaria, kills over 1.2 million people annually.

• In 2011, 1.31 million cases of malaria were noted, in which 0.65 million were of P. Falciparum & reported 463 deaths due to it.

• 27% of the Indian population lives in high malaria transmission areas.

• Dengue fever, together with associated dengue haemorrhagic fever (DHF), is the world's fastest growing vector borne disease, nowadays.

• Worldwide, 25 billion of world population in tropical and subtropical areas is at risk of Dengue and Chikungunya.

• In India Dengue is endemic in 31 states/UTs.• In 2011, about 18059 cases of Dengue were noted with 119 deaths

in India.• Punjab, TN, Kerala, Gujarat and Andhra Pradesh reported

maximum cases.

EPIDEMIOLOGICAL TRIAD

AGENT

HOST ENVIRONMENT

VECTOR

Plasmodium, Arbovirus, etc.

Anopheles, Aedes, mosquito etc.

Water logging, open water sources, etc.

Healthy and diseased persons, animals

Reasons for the emergence of Vector-Borne Diseases

• Demographic and societal changes: – unplanned and uncontrolled urbanization and – population growth has put severe constraints on civic

amenities, particularly water supply and solid waste disposal, thereby increasing the breeding potential of the vector species.

– Improved communication facilities (Rapid Transportation) has helped the disease the establish in rural areas.

• Effective mosquito control primarily based on source reduction is virtually nonexistent in most of the Dengue-Chikungunya endemic states

Reasons for the emergence of Vector-Borne Diseases

• Solid waste management: – a significant increase in the use of non-biodegradable

plastics, namely paper cups, used tyres, etc. that not only facilitate increased breeding compounded by nonexistent or insufficient solid waste collection and management.

• Increased population movement (work, travel, tourism or pilgrimage) has resulted in a constant exchange of viruses.

• Lack or poor public health infrastructure required to deal with these diseases

• Decreased resources for surveillance, prevention and control of vector borne diseases

• Development of insecticide and drug resistance

Dr. Rakshit A S (drrakshit.blogspot.in)

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BREEDING SOURCES

Dr. Rakshit A S (drrakshit.blogspot.in)

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BREEDING SOURCES

Dr. Rakshit A S (drrakshit.blogspot.in)

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MODUS OPERANDI

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.

First organized attempt was made in 1953 on launch of National Malaria Control Program.

Then, National vector borne disease control program was launched in 2003-04 by merging NAMP, NFCP & Kala Azar Control programs .Japanese B Encephalitis and Dengue/DHF have also been included in this program.

The approach to control Vector borne diseases consists of three basic things:

MODUS OPERANDI

INTEGRATED VECTOR MANAGEMENT Source reduction Anti Larval measures Indoor Residual Spray – IRS Insecticide treated bed nets – ITNs

EPIDEMIC PREPAREDNESS AND EARLY RESPONSE• Early case Detection and Prompt Treatment (EDPT) SURVEILLANCE AND CASE MANAGEMENT• Case Detection (Passive and Active)• Sentinel Surveillance

SUPPORTIVE INTERVENTIONS• Capacity building• Behavior Change Communication• Inter Sectorial Coordination• Public Health Engineering Support• Monitoring & Evaluation• Operational Research and applied field research

INTEGRATED VECTOR

MANAGEMENT

ANTI LARVAL MEASURES

ENVIRONMENTAL CONTROL

1) Source Reduction – Elimination of Breeding places

2) Filing of pits and drainage operation

3) Carefully planned water management

4) Provide piped water supply

5) Proper waste disposal

6) Cleanliness in and around houses

7) Focusing more on high risk group of polulation (API: >2)

ANTI LARVAL MEASURES

CHEMICAL CONTROL

1) Mineral Oils – • Kerosene, Diesel oil, etc.• Oil spread over water and make thin film which cuts air

supply to the mosquito larvae and pupae.• Kills larvae and Pupae in short time.

2) Paris Green – • Micro crystalline powder, insoluble in water kills

Anopheles larvae because they are surface feeders.

3) Synthetic Insecticides - • Fenthion, Chlorpyrifos and Abate – act as larvicides • DDT

ANTI LARVAL MEASURES

Biological Control• Larvivorous Fishes – They feed on mosquito larvae.• Eg. Gambusia affinis & Lebister reticulatus• Can be used in burrow pits, sewage oxidation ponds,

ornamental ponds, farm ponds• Best effective when used along with other methods.

ANTI – ADULT MEASURES

RESIDUAL SPRAYS• Indoor spraying with DDT in dose of 1-2 gm of pure DDT

per sq. meter 1-3 times a year to walls and other mosquitos rest.

SPACE SPRAYS• Insecticidal sprayed into the atmosphere in the form of

mist or fog to kill insects.• Eg. Pyrenthrum extract, a nerve poison to mosquito• Ultra Low Volume (ULV) space spraying with malathion

and fenitrothion.

PROTECTION AGAINST BITES

MOSQUITO NETS• Protects against bites

SCREENING• Door and window screening

With nets gives excellent

protection REPELLENTS

• Mosquito repellent creams,

Lotions are good as short term personal protective measures Wearing Full Sleeve Clothes and covering most of the body

parts against mosquito and fly bites.

OTHER METHODS

• Rodent Control– Construction of rat proof buildings– Blocking rat burrows with concrete– Rat trapping and use of Rodenticides

• Fly Control– Screening of windows with at least 14 mesh net to

control house flies– Fly peppers– Fly consciousness through health education.

EPIDEMIC PREPAREDNESS AND

EARLY RESPONSE

Early case Detection and Prompt Treatment (EDPT)

– EDPT is the main strategy in malaria and dengue control - radical treatment is necessary for all the cases to prevent transmission.

– Chloroquine is the main anti-malaria drug for uncomplicated malaria.

– Drug Distribution Centres (DDCs) and Fever Treatment Depots (FTDs) have been established in the rural areas for providing easy access to anti-malarial drugs to the community.

– The transmission of filaria can be stopped by treating the entire eligible population living in filarial endemic areas with Mass Drug Administration (MDA) with DEC (Diethyle Carbamazine Citrate)

– Use of rf39 rapid diagnostic kits for Kala Azar detection

SUPPORTIVE INTERVENTIONS

SURVEILLANCE AND CASE MANAGEMENT

Case Detection (Passive and Active)• Eg. Sentinel Surveillancesurveillance of fever cases in the

community mainly by the Multi Purpose Worker {MPW}. • Active case detection (ACD) implies that the MPW would visit all

villages within the sub centre area fortnightly and look for fever cases which occurred between the current and previous visit.

• Passive Case Detection PCD is si done in fever reporting to peripheral health volunteers/ ASHA/PHCs by examination of blood smears.

Sentinel Surveillance• Established in high endemic districts, 1-3 sentinel sites in large

hospitals for recording of all OPD and IPD cases of Malarial and Malaria related deaths.

SUPPORTIVE INTERVENTIONS

Inter Sectorial Coordination• Legislation of Water and Sewage management systems in Buildings• Coordination with Public Welfare Dept.• Public Health Engineering Support• Involvement of NGOs /private sector/community

Capacity building

• Training and Development of Manpower

• Infrastructure development • Quality assurance on laboratory diagnosis

• Improve quality and efficiency of services at primary, secondary and tertiary level Behavior Change Communication

• Social mobilization, • IEC through media campaigns and heath awareness and health education programmes

Monitoring & Evaluation– Monthly Computerized Management Information System(CMIS)– Field visits by state by State National Programme Officers– Field visits by Research Centres and other ICMR Institutes– Feedback to states on field observations for correction actions.

Key Elements in Planned Govt. OCTALOGUE

(1) Surveillance -

• Disease Surveillance

• Entomological Surveillance

(2) Case management

• Laboratory diagnosis

• Clinical management

(3) Vector management

• Environmental management for Source Reduction

• Chemical control

• Personal protection

• Legislation

(4) Outbreak response

• Epidemic preparedness

• Media management

(5) Capacity building

• Training

• Infrastructure development

• Operational research

(6) Behaviour Change Communication

• Social mobilization,

• IEC

(7) Inter-sectoral coordination

• Health & non health sector

(8) Monitoring & Supervision

• Review, field visit , feedback

• Analysis of reports

ROLE OF HOSPITAL IN PREVENTION AND CONTROL OF VECTOR BORNE DISEASES

PREVENTION OF VECTOR BORNE DISEASES• SURVEILLENCE AND CONTAINMENT MEASURES FOR ALL COMMUNICABLE DISEASES• EDUCATION ABOUT HEALTH BY IEC EFFORTS• ACCESSIBILITY TO SAFE LIVING ENVIRONMENT THROUGH LOCAL BODIES &

INTERSECTORIAL LINKAGES• CREATING HEALTH AWARENESS AND KNOWLEDGE ABOUT DISEASE TRANSMISSION• REFERRAL SUPPORT THROUGH THE CHANNEL

– ANGANWADI, ASHA WORKERS– PHC, CHC– DIST. & SPECIALITY HOSPITAL

PROMOTIVE SERVICES

• ABOUT DISEASE OUT BREAKS• PROMOTING HEALTHY LIFE STYLE AND IMPORTANCE OF GOOD SANITATION IN

PREVENTION OF VECTOR BORNE DISEASES• COLLABORATION WITH SOCIAL BODIES AND NGOs FOR CAPACITY BUILDING IN DISEASE

PREVENTION

CURATIVE SERVICES

• PROVIDING CURATIVE SERVICES TO THE AFFECTED POPULATION AND NOTED CASES• ACCURATE DIAGNOSIS OF THE DISEASE• PARTIVIPATION IN VARIOUS ACTIVITIES RELATED WITH NVBDCP

– MALARIA CLINIC IN EVERY HOSPITAL– ACTIVE AND PASSIVE SURVEILLANCE OF EPIDEMICS– EARLY DETECTION AND PROMT TREATMENT OF PATIENTS

• QUININE FOR MALARIA• DEC FOR FILARIA, ETC.

– GIVING CHEMOPROPHYLAXIS

EDUCATION AND RESEARCH

• GENERATING STASTICAL REPORT FROM DATA COLLECTED• EDUCATION AND TRAINING TO THE FIELD HEALTH WORKERS AND PROVIDING LATEST

INFORMATON ABOUT THE DISEASE CONTROL STRATEGIES • RESEARCH ACTIVITIES RELATED TO VACCINE DEVELOPMENT AND CLINICAL TRIALS

THANK YOU.