National Vector Borne Disease Control Programme (NVBDCP)

Overview

1. Malaria
2. Lymphatic Filariasis
3. Kala-azar (Visceral Leishmaniasis)
4. Japanese Encephalitis (JE)
5. Dengue
6. Chikungunya

Three-Pronged Strategy

1. Disease Management - Early case detection and complete treatment; strengthening referral services; epidemic preparedness and rapid response.
2. Integrated Vector Management (IVM) - Indoor residual spraying (IRS) in high-risk areas; insecticide-treated bed-nets (ITNs/LLINs); larvivorous fish; anti-larval measures in urban areas; source reduction; minor environmental engineering.
3. Supportive Interventions - Behaviour Change Communication (BCC); public-private partnership; inter-sectoral convergence; human resource development; operational research (drug resistance, insecticide susceptibility); monitoring and evaluation; web-based MIS; vaccination against JE; annual Mass Drug Administration (MDA) against lymphatic filariasis.

(A) Malaria

Historical Background

• 1953: National Malaria Control Programme (NMCP) launched during the First Five Year Plan.
• Programme converted to National Malaria Eradication Programme (NMEP) after spectacular early success.
• Eventually downgraded to "control" programme due to resurgence.
• Now subsumed under NVBDCP.

Organizational Structure

Drug Distribution Centres (DDCs) and Fever Treatment Depots (FTDs)

• Established to address inadequate drug supply through only surveillance workers and medical institutions.
• DDCs: Dispense anti-malarial tablets as per NMEP schedules only.
• FTDs: Collect blood slides in addition to drug distribution.
• Both are manned by voluntary workers from the community.

Urban Malaria Scheme

• Launched in 1971 to reduce/interrupt transmission in towns and cities.
• Methodology: vector control by intensive antilarval measures + drug treatment.
• Protecting ~130 million population in 131 towns in 19 States/UTs.
• Urban vectors breed in man-made containers: overhead tanks, water coolers, cisterns, flower vases, old tyres, construction sites.
• Control: civic bye-laws, larvivorous fish, larvicides.

Malaria Elimination Targets (National Strategic Plan)

District Stratification by API

1. Zero cases
2. API > 0 to < 1
3. API 1 to < 2
4. API 2 to < 5
5. API ≥ 5

Special Strategy for P. vivax Elimination

• Hypnozoites prolong parasite lifespan
• RDTs for P. vivax less sensitive than for P. falciparum
• 14-day primaquine course required (vs 3-day ACT for P. falciparum)
• Longer incubation period

Surveillance

• Active surveillance for malaria parasites in high-endemic districts.
• Sentinel surveillance established in large hospitals (1-3 sentinel sites per district).
• Blood smears collected by ASHA/FTD + MPW dispatches to PHC lab twice weekly.
• Rapid Diagnostic Kits (RDKs) deployed at community level.

Case Management

• No presumptive treatment (revised drug policy 2013).
• Confirmed diagnosis required before treatment.

Integrated Vector Management (IVM)

• Primary tool in rural areas: Indoor Residual Spraying (IRS).
• Primary tool in urban areas: Anti-larval measures.
• Additional: Insecticide-treated nets (conventional) and Long-Lasting Insecticidal Nets (LLINs).
• Population with API ≥ 5: covered by LLINs.
• Population in endemic areas with API ≥ 2: covered with conventional ITNs.
• Coverage target: >80% whatever the intervention.

External Support

• Global Fund (IMCP II): 7 North East states, 86 districts, 46 million population. Provides LLINs, RDTs, ACT, arteether.
• World Bank: Malaria Control and Kala-azar Elimination Project (2009-2013).

(B) Elimination of Lymphatic Filariasis

• Endemic in 256 districts, 16 States and 5 UTs; ~630 million people at risk.
• National Filaria Control Programme (NFCP) in operation since 1955.
• In June 1978, operational component merged with Urban Malaria Scheme.
• Training at 3 Regional Filaria Training and Research Centres: Calicut (Kerala), Rajahamundry (AP), Varanasi (UP) under NICD Delhi.

Elimination Strategy

• Single dose of DEC + Albendazole to all eligible population.
• Excludes: pregnant women, children < 2 years, seriously ill persons.
• Target: 5+ consecutive years.
• Co-administration of DEC + Albendazole upscaled from 2007.
• Coverage: improved from 72.4% (2004) to 86.8% (2014).
• National Filaria Day every November.
• Minimum coverage required: >80% persistently for 5-6 years.

• Home-based management of lymphoedema; foot care education.
• Up-scaling of hydrocele operations in CHCs/district hospitals/medical colleges.

Elimination Definition

Progress

• 94 districts with 152 evaluation units (~221 million population) completed 1st Transmission Assessment Survey (TAS) and stopped MDA (as of August 2017).
• ~12.5 lakh cases line-listed: 8.7 lakh lymphoedema + 3.8 lakh hydrocele.

Surveillance

• Night blood survey before MDA (4 sentinel + 4 random sites = 4000 slides/500 per site).

(C) Kala-azar (Visceral Leishmaniasis)

• Endemic in 33 districts of Bihar, 4 districts of Jharkhand, 11 districts of West Bengal, 6 districts of Uttar Pradesh (plus sporadic cases).
• Centrally sponsored programme for control.
• Vector: sandfly (Phlebotomus argentipes).

HWM Duties in Kala-azar Endemic Areas

1. Enquire about fever >15 days duration in every family.
2. Guide suspected cases to nearest PHC/CHC for diagnosis and treatment.
3. Maintain records and ensure completion of treatment.
4. Health education about Kala-azar.

(D) Japanese Encephalitis (JE)

• JE is covered under NVBDCP.
• Vaccination against JE is part of NVBDCP's supportive interventions.
• In endemic areas, HWM enquires about fever with symptoms of encephalitis from each family, guides cases to PHC/CHC, and maintains records.

(E) Dengue

Mid-Term Plan (2011)

(F) Chikungunya

• Re-emerged as epidemic outbreaks after a gap of three decades.
• Non-fatal but debilitating viral illness.
• Same vector as dengue (Aedes aegypti) - therefore same vector control strategies apply.
• 521 sentinel surveillance hospitals (involved in dengue surveillance) also carry out chikungunya testing.
• Diagnostic kits provided through National Institute of Virology (NIV), Pune.
• Guidelines for prevention and control prepared by Government of India.

Intersectoral Convergence Under NVBDCP

1. Other VBDs: Dengue-malaria overlap in urban areas; malaria-kala-azar overlap in some Jharkhand districts; malaria-filariasis overlap in parts of Odisha.
2. Reproductive and child health: LLINs distributed to pregnant women under antenatal care; provision under Janani Suraksha Yojana; malaria case management included in IMNCI.

Key Facts at a Glance