VECTOR BORNE

DISEASES
(MALARIA)
VECTOR BORNE DISEASES

A vector is defined as an: “arthropod

or any living carrier that transports an
infectious agent to a susceptible
individual”.
Transmission:1.Mechanical
2.Biological
 EPIDEMIOLOGICAL
CLASSIFICATION
• 1) By Vector
a) Invertebrate type
b) Vertebrate type
• 2) By Transmission chain
a) Man-Non vertebrate host
-malaria,schistosomiasis
b) Man-Vertebrate-Non vertebrate host
-plague,J.E encephalitis
c) Man-two intermediate hosts
-fish tape worm.
.
• 3) By methods in which vectors transmit agent
• a) Biting(mosquito)
• b) Regurgitation(flies)
• c) scratching-in of infective faeces(flies,lice)
• d) Contamination of host with body fluids of
vectors
• 4) By methods in which vectors are involved
inthe transmission and propagation of parasites
• a) Mechanical transmission(flies)
• b) Biological transmission(mosquito)
Factors which influence ability of
vector to transmit disease
• a) host feeding preferences(frequency)
• b) infectivity(dose)
• c) susceptibility(immunity)
• d) survival rate(vector)
• e) domesticity(indoor)
• f) suitable environmental factors
• (breeding places)
 MALARIA
EPIDEMIOLOGY
• AGENT FACTORS:4 species
in man
• Plasmodium vivax
• Plasmodium falciparum
• Plasmodium malariae
• Plasmodium ovale
• RESERVOIR OF
INFECTION:
• Humans
LIFE CYCLE OF PLASMODIUM
• CRITERIA: Harbour
• a) both the sexes of gametocyte
• b) mature
• c) viable
• d) sufficient density
• PERIOD OF COMMUNICABILITY: As long as
mature, viable gametocytes exist in the circulating
blood in sufficient density to infect mosquitoes.
• Relapses: 1-2 yrs for falciparum
• >3 yrs for vivax & ovale
• HOST FACTORS
• -all ages
• -males more exposed
• -AS Hb: falciparum resistance
• -Duffy negative RBC: vivax resistance
• -intra uterine death in pregnancy
• -low socio economic development
• -poor housing
• -population mobility
• -agricultural practices
• -human habits
HOST FACTORS
• Immunity: repeated exposure
• maternal antibody in infants
• ENVIRONMENTAL FACTORS:
• -season: July to November
• -optimum temp : 20deg C to 30deg C
• -Rain fall: breeding of mosquitoes
• -Humidity: length of life
• -Altitude
• MAN MADE MALARIA: Human undertakings like
garden pools, irrigation channels & engineering
projects.
 VECTOR OF MALARIA
• Female Anopheline
mosquito
• 45 species
• An.culicifacies - rural
• An.stephensi - urban
• FACTORS
• critical density
• life span:10-12 days
after blood meal
• choice of host:
An.fluviatilis –
anthrophilic
• -Endophily or Exophily
• -Breeding: An.fluviatilis(moving water)
• -Time of biting: night
• -Vectorial capacity
• -Resistance to insecticides
• MODE OF TRANSMISSION:
• 1)Vector Transmission-Mosquito bite
• 2)Direct Transmission-Blood or
Plasma
• 3)Congenital malaria
• INCUBATION PERIOD:
• P.v-8-17 days P.m-18-40 days
• P.f-9-14 days P.o-16-18 days
• CLINICAL FEATURES:
• 1)Cold stage: Lassitude, headache, nausea, chills
followed by rigors, cold skin ,rapid weak pulse
• 2)Hot stage : Hot skin ,headache, rapid respiration
• 3)Sweating stage: Profuse sweating, skin cool
& moist
• Followed by an afebrile period.
 DIAGNOSIS
Demonstration of parasite in blood
Blood films:
thick film-search for parasite
thin film-to identify the species
Flourescent Ab test: epidemiological
studies.
Latest: Dip stick assay –P.f
 CONTROL OF MALARIA
• 1) Management of cases
• 2) Active intervention measures
DISEASE CONTROL STRATIGIES
• a) Case detection
• b) Treatment :
HIGH RISK AREAS LOW RISK SEVERE &
AREAS COMPLICATED
MALARIA
PRESUMPTIVE: PRESUMPTIVE: Quinine injection(10mg/kg
Day1-tab chloroquine(600mg) +tab Day1-tab body wt)I V 8 hourly
primaquine(45mg) chloroquine(600mg) followed by oral dose
Day2-tab chloroquine(600mg)
Day3-tab chloroquine(300mg)

RADICAL: RADICAL: Artimisinine(10mg/kg body

P.v-tab primaquine(15mg) daily for 5 days P.v-tab chloroquine(600mg) wt)-5days with double
single dose+tab primaquine divided dose on 1st
daily for 5 days Artesunate
P.f-tab chloroquine(600mg)
P.f-no treatment required Artemether
+tab primaquine(45mg)
Artether

Chloroquine resistant P.f area:

Sulfadoxine(25mg/kg bw)
+pyrimethamine(1.25mg/kg bw)
There after tab primaquine(0.75mg/kg bw)
ANTI-MALARIALS
• Toxic hazards of drugs:
• Chloroquine - nausea, vomiting, blurring of vision,
headache, retinal damage.
• Primaquine-CNS, GI tract, cardio vascular
manifestations.
• -contra indicated in pregnancy, infants, G6PD
deficiency.
• CHEMO PROPHYLAXIS:
• -soldiers, police, labour forces, travelers
• chloroquine, proguanil, mefloquine, doxycycline
• 2)Active intervention measures
• a)Stratification of problem: Under modified
plan of operation-endemic areas-stratified as
• areas with API<2
• areas with API>2
 b)Vector control strategies
• 1)Anti-adult measures:
• -Residual sprays
• DDT, malathion
• -Space sprays
• pyrethrum insecticide
• -Genetic control
• 2)Antilarval measures:
• -Env.control
• source reduction:
• eliminate breeding
places.
• management of water
level.
• -Chemical control
• larvicides parisgreen
• -Biological control
• gambusia affinis
• lebister reticulatus
Mosquito breeding areas
• 3)Protection against
mosquito bites:
• -mosquito net
• -screening of houses
• -repellents
• diethyl toluamide,
• indalone
 MALARIAL VACCINES

• 1)Asexual blood stage vaccine:

• To reduce complications
• 2)Second type:
• To arrest development of parasites
• SPf66- for Plasmodium falciparum
• Pfs25- transmission blocking vaccine
 MEASUREMENT OF MALARIA
• PRE ERADICATION ERA: clinically diagnosed
cases

• a) spleen rate
• b) average enlarged spleen

• c) parasitic rate
• d) parasite density index
• e) infant parasite rate
• f) proportional case rate
• ERADICATION ERA: microscopic diagnosis
• a) Annual parasite incidence
 confirmed cases during one year
• API= ----------------------------------- x1000
population under surveillance
• b) Annual blood examination rate:
number of slides
• ABER= -----------------------x 100
population
• c) Annual falciparum incidence
• d) Others- slide positivity rate, slide falciparum rate
• VECTOR INDICES: human blood index
sporozoite rate
mosquito density
man biting rate

inoculation rate
 NATIONAL ANTI-MALARIA
PROGRAMME
-April 1953 –1958
-80% reduction of malaria problem
-indoor residual spraying with DDT twice a year in endemic
areas where spleen rates were over 10%.
NATIONAL MALARIA ERADICATION PROGRAMME:
-1958
REVISED STRATEGY:
MODIFIED PLAN OF OPERATION(1977):
1) Objectives: -prevent deaths.
-reduce morbidity.
-maintain agricultural & industrial
production.
-consolidate gains so far achieved.
• 2) Reclassification of endemic areas:
• API-2 & above-spray operations
• 3) Areas with API>2:
• spraying-DDT
• entomological assessment
• surveillance-blood smears
• treatment: presumptive & radical
• 4) Areas with API<2:
• focal spraying
• surveillance- active & passive
• treatment:radical
• follow-up
• epidemiological investigation
• 5) Drug distribution centers& fever
treatment depots:
• distribution of anti malarial tablets
• collection of blood slides
• 6) Urban malaria scheme:-1971
• anti larval measures & drug treatment
• 7) P.falciparum containment
• 8) Research
• 9) Health education
• 10) Reorganization-anti malaria units
• Malaria control through PHC:
• demands national commitment, community
participation, intersectoral participation.
• malaria action plan-1995
• -voluntary link workers, MPW
• ENHANCED MALARIA CONTROL PROJECT:
• Selection of PHC-criteria
• API>2 for last 3 years
• P.f cases >30% of total cases
• 25% or more population –tribal
• reported deaths
NATIONAL ANTI MALARIA
PROGRAMME:-1999
a)early case detection &prompt treatment
b)integrated vector management
c)use of larvivorous fish
d)epidemic control measures
e)IEC-awareness about malaria
Intensified Malaria Control Project:2005