VECTOR BORNE DISEASES AND CLIMATIC CHANGES Dr. Neeraj Dhingra Additional Director National Vector Borne Disease Control Porgramme (NVBDCP Ministry of Health & Family Welfare Government of India Conserving Now, Preserving Future
PREVENTION AND CONTROL OF VECTOR BORNE DISEASES IN INDIA NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMME (NVBDCP) - Under Ministry of Health & Family Welfare, Government of India deals with following vector borne diseases - Malaria - Dengue - Chikunguniya - Japanese Encephilitis - Kala- azar - Filairiasis - Zika Virus Website: www.ndvbcp.gov.in MOH website: www.mohfw.gov.in Conserving Now, Preserving Future
MALARIA IN INDIA Malaria in India 7000000 100.00 90.00 6000000 80.00 5000000 70.00 60.00 4000000 50.00 3000000 40.00 30.00 2000000 20.00 1000000 10.00 0 0.00 Pf% PV Pf Pv% ABER API SPR SfR Conserving Now, Preserving Future
GEOGRAPHICAL DISTRIBUTION OF TOTAL MALARIA & Pf. CASES JAMMU & KASHMIR JAMMU & KASHMIR HIMACHAL PRADESH HIMACHAL PRADESH PUNJAB PUNJAB UTTARAKHAND UTTARAKHAND HARYANA HARYANA ARUNACHAL PR. ARUNACHAL PR. SIKKIM SIKKIM RAJASTHAN UTTAR PRADESH ASSAM RAJASTHAN UTTAR PRADESH ASSAM NAGALAND NAGALAND BIHAR MEGHALAYA BIHAR MEGHALAYA MANIPUR MANIPUR TRIPURA JHARKHAND TRIPURA GUJARAT MIZORAM MADHYA PRADESH JHARKHAND WEST BENGAL GUJARAT MADHYA PRADESH MIZORAM WEST BENGAL CHHATTISGARH CHHATTISGARH ORISSA ORISSA D&N HAVELI API - 2016 SFR - 2016 D&N HAVELI MAHARASHTRA <1 MAHARASHTRA <1 >1-2 TELANGANA >1-2 TELANGANA >2-5 PONDICHERRY >2-5 PONDICHERRY >5-10 ANDHRA PRADESH GOA ANDHRA PRADESH >5-10 >10 & Above KARNATAKA GOA KARNATAKA >10 & Above A&N ISLANDS A&N ISLANDS N TAMIL NADU LAKSHADWEEP KERALA TAMIL NADU W E N LAKSHADWEEP KERALA S W E - Northern States and southern states– nearly on elimination phase S - Malaria mostly concentrated in eastern & NE parts of India Conserving Now, Preserving Future
DENGUE IN INDIA (2010-2017) • CFR brought down from 3.3% 129166 1.0 140000 (1996) to 0.2% in 2016 130000 0.9 0.9 120000 • States reporting most number of 0.8 99913 110000 Dengue cases in 2017 : 0.7 100000 Case Fatality Ratio 90000 75808 0.6 Kerala – 14606, Tamil Nadu – 80000 Cases 0.5 0.5 70000 5968, Karnataka – 4643, Andhra 50222 40571 60000 0.4 0.4 Pradesh – 798 Gujarat – 734, 50000 29150 0.3 0.3 28292 40000 0.3 Maharashtra- 718, West Bengal - 0.2 18860 0.2 30000 0.2 0.2 571 20000 0.1 10000 0.0 0 2010 2011 2012 2013 2014 2015 2016 2017 Cases Conserving Now, Preserving Future
DENGUE IN INDIA (SEASONAL TREND) 35000 30000 25000 20000 No. of Cases 15000 10000 5000 0 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec 2014 2015 2016 2017 Conserving Now, Preserving Future
CHIKUNGUNYA IN INDIA 64057 60000 50000 No. of cases 40000 27553 30000 18805 16049 20000 10000 0 2014 2015 2016 2017 Conserving Now, Preserving Future
CLIMATIC CHANGES AND VECTOR BORNE DISEASE TRANSMISSION VBD transmission is dependent upon Sufficient numbers of Anopheline, Culex or Aedes mosquitoes Large enough reservoir of pool of infection in humans and animals Mosquitoes proliferation strongly influenced by: Temperature Rainfall Humidity Wind Sunlight Conserving Now, Preserving Future
CLIMATIC CHANGES WHICH IMPACT VBD • Increase in temperature • Increase in humidity JAMMU & KASHMIR • Flooding HIMACHAL PRADESH PUNJAB UTTARAKHAND HARYANA ARUNACHAL PR. SIKKIM INCREASED MOSQUITOGENIC POTENTIAL – RAJASTHAN UTTAR PRADESH ASSAM NAGALAND BIHAR MEGHALAYA MANIPUR TRIPURA JHARKHAND GUJARAT MIZORAM • INFECTON RESERVOIR PRESENT MADHYA PRADESH WEST BENGAL CHHATTISGARH ORISSA D&N HAVELI API - 2016 MAHARASHTRA <1 >1-2 TELANGANA >2-5 PONDICHERRY >5-10 ANDHRA PRADESH GOA >10 & Above • FREQUENT OUTBREAKS (Malaria, KARNATAKA Dengue, chikunguniya A&N ISLANDS N TAMIL NADU KERALA LAKSHADWEEP W E Targeted for Malaria Elimination by 2027 GAINS MADE TILL NOW MAY BE REVESRED S Conserving Now, Preserving Future
CLIMATIC CHANGES IN INDIA Melting glaciers- • Flooding in rivers, valleys followed by diminished flow and droughts General warming in mean annual temperature with decreased range of diurnal • temperature variation Warming of 0.5 0 C by 2030 Maximum increase in northern areas of India Increased precipitation- including monsoons • Fewer rainy days but more days of extreme rainfall events Conserving Now, Preserving Future
IMPACT OF CLIMATIC CHANGES ON VBD IN INDIA Increased number of months of high humidity, precipitation and increased temperature and pooling • of water would lead to: - Seasonality of VBD may change - Early onset of diseases or maybe through out the year - Disease burden may change - Likely higher transmission rates for VBD – severe forms of disease would increase – more Pf malaria - Typical preventive measures like LLIN may not work- people may not sleep under them - Health services capacities to deal with this increase - Quicker onset of drug and insecticide resistance Socioeconomic impact • - Health inequity – poorer more affected - Longer duration of hospitalization – out of pocket expenses would increase - Impact on tourism - Refugees- move towards larger inhabitations – urbanization – poor infrastructure- more Culex mosquitoes– Lymphatic filiarisis - Deforestation, etc Conserving Now, Preserving Future
MITIGATING EFFECT OF CLIMATIC CHANGES ON VBD 1. Adaptability to adjust to climatic changes No prediction models available- research needeD – Longitudinal Studies – changes in VBD based on climatic studies- multi-disciplinary studies – Response mechanisms weaker in less endemic areas as of now – Shifting of human infrastructure based on endemicity – Adding newer skilled staff on environment management in the health programmes – Capacity building and sensitization – Increased resources – budget and manpower – Conserving Now, Preserving Future
MITIGATING EFFECT OF CLIMATIC CHANGES ON VBD 2. Monitoring of climatic changes in co-relation to VBD – Mapping the present landscape in terms water collections, rivers,lakes,etc – Information exchange on climatic changes – rainfall, humidity, floods, glacier melting, etc. with health programmes especially VBD – GIS/spatial maps with climatic changes/water pooling at local levels – Monitoring the VBD incidence in northern areas of India– track of any slight increase- involve all facilities government, private, NGOs, etc. – Mapping/Monitoring the mobility- intrastate, interstate, etc. Conserving Now, Preserving Future
Transmission Windows of malaria based on T & RH (A1B Scenario, by 2030) By 2030s - Few foci in Himalayan region are likely to open; intensity of transmission more in NE states; reduction in east-coast projected Conserving Now, Preserving Future
Transmission Windows of dengue (A1B Scenario) TW criteria: 20-32 0 C Inconclusive, no matching with current distribution Conserving Now, Preserving Future
MITIGATING EFFECT OF CLIMATIC CHANGES ON VBD 3. Changes in the approaches to VBD Highly skilled manpower in the NVBDCP – capacity to predict changes in climate and VBD – Enhancement of staff at State/regional/district levels – Very strong and institutional mechanisms of inter-sectoral coordination – Newer researches on diagnostics, drug and insecticides and better methods to detect resistance – Sensitization and capacity building of northern states – Highly flexible structure – decision making and resource allocation may change from year to year – or with an year as well Conserving Now, Preserving Future
MALARIA KEEPS COMING BACK – BE PREPARED
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