You are on page 1of 60

Arthropod borne

Diseases
Dr. Rahul Netragaonkar
Associate Professor

Dengue
Plague
Yellow fever
Onchocerciasis
Loaiasis
West African
Trypanosomiasis

Typhus
Q fever
Louse-borne
relapsing fever
Leischmaniasis

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

9/16/16

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.
9/16/16

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.
9/16/16

10

STRATEGIES FOR MALARIA


CONTROL
Surveillance - Early Diagnosis and Prompt
Treatment- Alternative drugs for drug resistant
cases.
Selective Vector Control (Integrated Vector
Control Measure)
Promotion of Personal Protection Methods Bed Nets
Management Information System (MIS)
Early Detection & Containment of Epidemics
IEC/BCC - Community Involvement

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 the main anti-malaria drug for uncomplicated
malaria.
Drug Distribution Centers (DDCs) and Fever Treatment
Depots (FTDs) have been established in the rural areas for
providing easy access to anti-malarial drugs to the
community.
Alternative drugs for chloroquine resistant malaria are
recommended as per the drug policy of malaria .
9/16/16

12

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

9/16/16

13

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

9/16/16

14

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.
9/16/16

15

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

9/16/16

16

Contd.
6.

9/16/16

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.
17

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
9/16/16

18

Areas having Annual Parasite


Index (API) > 2

9/16/16

Regular 2 rounds of insecticidal spray with


DDT/ Malathion / Synthetic Pyrethroids at
the dose of 1, 2, 0.5 mg/sq meter
respectively.
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
and radical treatment to all slide positive
cases is given

19

Areas having Annual Parasite


Index(API) < 2

9/16/16

Regular spray is not carried out but focal


spray is carried out around falciparum cases
detected during surveillance
Regular passive surveillance once in a
fortnight
Treatment All positive cases to receive
radical treatment
Follow up- All positive cases to be followed
up for 1 year at monthly intervals after
completion of radical treatment
Epidemiological investigation of all malaria
positive cases .This may also include mass
blood survey.
20

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

9/16/16

21

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
Recentralization of Laboratory servicesLaboratory Technician with the necessary facilities
is now located at each PHC
Establishment of Drug Distribution Points
(DDPs) and Fever Treatment Depots (FTDs)
9/16/16

22

Investigation of all Malaria DeathsAll 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.
9/16/16

23

National
Filaria Control Program

9/16/16

24

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
9/16/16
25

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
9/16/16

26

9/16/16

27

9/16/16

28

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.
9/16/16

29

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.

9/16/16

30

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
9/16/16

31

Kala Azar Control Program


9/16/16

32

What is Kala-azar?
Kala-azar is a slow progressing indigenous
disease caused by a protozoan parasite of
genus Leishmania
In India Leishmania Donavan is the only
parasite causing this disease
The parasite primarily infects
reticuloendothelial system and may be
found in abundance in bone marrow, spleen
and liver.
Post Kala-azar Dermal Leishmaniasis (PKDL)
is a condition when Leishmania donovani
invades skin cells, resides and develops
there and manifests as dermal leisions.
9/16/16

33

Kala-Aar spread

Currently Kala-Azar is
endemic in
33 Districts of Bihar
3 Districts of Jharkhand
10 Districts of West Bengal
&
2 Districts of UP
Started as a Centrally
Sponsored
Programme in1990-91
It was merged with
NVBDCP in 2003-04
9/16/16

34

Signs & Symptoms of Kala-Azar


Recurrent fever intermittent or remittent with
often double rise
loss of appetite, pallor and weight loss with
progressive emaciation
Splenomegaly - spleen enlarges rapidly to
massive enlargement, usually soft and non
tender
Liver - enlargement not to the extent of spleen,
soft, smooth surface, sharp edge
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"
9/16/16
35
Anemia - develops rapidly

Diagnosis
Clinical:
A case of fever of more
than 2 weeks duration
not responding to
antimalarials and
antibiotics. Clinical
laboratory findings may
include anemia,
progressive leucopenia
thrombocytopenia
9/16/16
hypergammaglobuline

36

HIV and Kala-azar co-infection


Visceral leishmaniasis (VL) has
emerged as an opportunistic
infection in HIV and other
immunosuppressed patients
More than 1000 cases of HIV and VL
are reported from 25 countries.
However, in India yet not a serious
problem
VL may be first Opportunistic
Infection in asymptomatic HIV-I
infected person
Also occurs in advanced stage of
9/16/16

37

Contd.
Also occurs in advanced stage of AIDS
All co-infected patients are not
symptomatic
Diagnosis may be altered because
symptoms may be of short duration; fever
and spleen may not be marked;
Leishmania antibodies may be
undetectable.
However peripheral blood smears of
buffycoat and blood culture may yield
good results
Response to treatment is poor; drug side38
9/16/16
effects may be more and relapses may be

Treatment of Kala - Azar


Kala-azar Drugs available in India
Sodium Stibogluconate (indigenous manufacture,
registered for use & sale)
Pentamidine Isethionate: (imported, registered for
use)
Amphotericin B: (indigenous manufacture,
registered for use and sale)
Liposomal Amphotericin B: (indigenous
manufacture & import, registered for use and
sale)
Miltefosine (imported/ registered for use & sale)
Drug Policy under Kala-azar Elimination Programme
9/16/16
39
as per recommendations of Expert Committee (2000

Control Strategy

An organized centrally sponsored Control


Programme launched in endemic areas in 199091 Government of India provided kala-azar
medicines, insecticides and technical support and
the State governments implemented the
programme through primary health care system
and district/zonal and State malaria control
organizations and provided other costs involved
in strategy implementation

9/16/16

40

Strategy contd.
Programme strategy included:
- Vector control through insecticidal residual spray

(IRS ) with DDT 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
Programme Achievements
9/16/16

41

Control of Dengue/DHF
9/16/16

42

9/16/16

43

WHAT IS DENGUE

Dengue is a viral disease


It istransmitted 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,whichmay cause death
Person suspected of having dengue fever or DHF
must see a doctor at once
9/16/16

44

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

9/16/16

45

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

9/16/16

46

Strategy contd.
Programme strategy included:
- Vector control through Insecticidal residual
spray (IRS )with DDT 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

9/16/16

47

9/16/16

Japanese encephalitis
control

48

9/16/16

49

9/16/16

50

9/16/16

51

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
9/16/16

52

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

9/16/16

53

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.

9/16/16

54

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

9/16/16

55

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)
9/16/16

56

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
9/16/16

57

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

9/16/16

58

Principles of arthropod control

Environmental control
Chemical control
Biological control
Genetic control

THANKS