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WORLD HEALTH DAY-2014 THEME - “Vector Borne Diseases”
Small Bite , Big Threat
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World Health Organization (WHO)
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Dr Priya BansalAssistant Professor
Department of Community MedicineDayanand Medical College & Hospital,
Ludhiana
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Why this theme was chosen
• 17% of all infectious diseases
• 1 million deaths annually.
• 2.5 billion people in over 100 countries are at risk
• Malaria causes more than 6,00,000 deaths every year glob
ally.
• Other VBDs diseases such as Chagas disease, leishmanias
is & schistosomiasis
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Who are affected?• These diseases affect urban, peri-urban & rural communiti
es - Poor living conditions - Safe drinking water - Sanitation.
• Malnourished people are especially vulnerable.
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Economic Effect
• Vector-borne diseases play a major role in economic downgrowth
• Countries with intensive malaria have income levels of only one third of those that do not have it
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Definition
• Vector-borne disease (VBD) : an illness caus
ed by an infectious microorganism (pathogen)
that is transmitted to humans by a vector, usual
ly arthropods
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88
Common Vectors
– Mosquitoes (Aedes, Anopheles, Culex, Mansonia)– Fly (Sandfly, Housefly, Tsetse Fly, Black Fly )– Flea (Rat Flea, Sand Flea )– Ticks (Hard Tick & Soft Tick)– Lice / Bugs/ Mites/ Cyclops
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Major Vector Borne Diseases in World
• Malaria
• Filaria
• Kala-azar
• Japanese Encephalitis
• Dengue / Dengue Hemorrhagic fevers
• Chikungunya
• Chagas Diseases (American Trypanosomiasis)
• Yellow Fever• Leishmaniases• Onchocerciasis (River
Blindness)• CCHF (Crimean Congo
Haemorrhagic Fever)• Lyme Disease• Tick Borne Encephalitis• Schistosomiasis
(Bilharzia)04/12/23
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Major Vector Borne Diseases in India
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Malaria• Life-threatening disease
• Caused by plasmodium species
• Transmitted through bite of female anopheles
• Plasmodium - four parasite species
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Malaria- Burden
Globally-2012
• Approx 207 million cases & 6,27,000 deaths
• 97 countries- 3.4 billion people at ris
k
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Malaria-Burden
India-2011• 1.31 million cases, inclu
ding 6,50,000 Pf cases & 463 deaths
• 27% of population resides in Malaria High Transmission areas
• 58% in Low Transmission areas
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PUNJAB
Year Cases
2011 2660
2012 1689
2013 1764
LUDHIANA
Year Cases
2011 381
2012 197
2013 210
Malaria-Burden
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Malaria Kills More People than AIDS
• Malaria kills in one year ,what AIDS kills in 15 years
• For every death due to HIV/AIDS, there are about 50 deaths due to malaria
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WHO are at High Risk?
• Young children
• Pregnant women
• People living with HIV
• Natural disasters
• Non-immune travellers movin
g into Endemic areas
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Malaria
• Early diagnosis & treatment is key
• If left untreated, disease can lea
d to severe illness & death • Artemisinin -based combinati
on therapy (ACT)
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Vaccine
• No commercially available vaccine
• Vaccine against P. Falciparum is currently under trial.
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Dengue fever
• Most rapidly spreading viral disease in the world
• In past 50 years, incidence has increased 30-fold
• Pattern changing from urban to rural settings
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Dengue
• There are four known serotypes of dengue virus (DEN 1 to 4).
• Recovery from infection by one provides lifelong immunity
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Dengue-Burden
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Globally
• Estimated 5,00,000 people with severe dengue require hospitalization each year
• About 2.5% of those affected die
Dengue-Burden
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Dengue-Burden
India-2011
• Endemic in 31 states/UTs.
• About 18059 cases were reported with 109 deaths.
• Case Fatality rate was 0.65%
• Highest Number of cases were reported from Punjab, followed by TamilNadu, Gujarat, Kerala & Andhra Pradesh.
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PUNJAB
Year Cases Deaths
2011 3921 33
2012 770 ----
2013 4117 -----
LUDHIANA
Year Cases Deaths
2011 1662 23
2012 269 2
2013 1033 7
Dengue-Burden
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Dengue
• No effective antiviral medications exist
• No commercial vaccine available
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Japanese Encephalitis
• Transmitted to humans through infected Culex mosquitoes.
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Japanese Encephalitis
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Japanese Encephalitis- Burden
Globally
• 50,000 cases &10,000 deaths every year
• Majority (85%) of cases occur in <15 years of age
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Distribution Of Japanese Encephalitis in IndiaDistribution Of Japanese Encephalitis in India // //
J E Cases And Deaths Reported in 2011 Case Death
U P 3490 579
Total 7838 1137
Japanese Encephalitis Endemic areas
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Japanese Encephalitis
• No specific treatment
• Vaccine (SA 14-14-2) - most effective preventive measure
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CHIKUNGUNYA
• Occurs in Africa, Asia & Indian subcontinent
• In recent decades, there
have been outbreaks of the disease in countries
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Burden-Chikungunya• Earlier reported in 1965
with 3,00,000 cases in Kolkata & Chennai
• 2006- Reappeared in 16 states
• 17,472 cases were reported by the GOI in 2011
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CHIKUNGUNYA
• Shares same vectors, symptoms & geographical distribution as dengue, except for the presence of joint pains
• No specific treatment
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Prevention & Control
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STRATEGIES
• Needs sound knowledge of the
Bionomics
Distribution
Seasonal prevalence
Vectorial capacity
Insecticide susceptibility status
Role of arthropods in disease transmission
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" Integrated Approach"
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Integrated Vector Management
• " the utilization of all appropriate technological & management techniques to bring about an effective degree of vector suppression in a cost effective manner"
• Best approach to strengthen vector control in a way that is compatible with national health systems
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• Evidence-based decision-making
• Monitoring & Evaluation
• Advocacy & Social mobilization
• Intra & intersectoral Collaboration
• Capacity-building
• Legislation & Regulation
Key Elements of IVM
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Methods of Control
Environmental Control
Chemical Control
Biological Control
Personal Protective measures
Genetic control
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Methods of Control
Environment(Source reduction,Waste management)
HUMAN(PPM, Repellants)
Vector(Chemical Control, Biological Control,
Genetic Control)
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Environmental Control• Eliminate their
breeding places
• Known as "source reduction"
• Results are generally permanent
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Filling
Levelling & drainage of breeding places
Water management (intermittent irrigation)
Source Reduction
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Chemical ControlOiling (diesel oil,fuel
oil, kerosene oil)
Paris green
Synthetic Insecticides (Fenthion, malathion, chlorpyrifos, abate)
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Indoor residual spraying
• Most widely used method
• Effective way to reduce sandflies & bugs inside homes
• 80% of houses in targeted area need to be sprayed.
• Effective for 3–6 months, depending on the insecticide used & type of surface
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Indoor residual spraying
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Outdoor spraying• Spraying outer surface
s of - Domestic animal shel
ters, - Outdoor latrines & - Damp places
• Aerial spraying -- control mosquitoes during epidemics of dengue & yellow fever.
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Biological Control
• Introduction of bacterial larvicides & larvivorous fish
• Target vector larvae without generating ecological impacts of chemical use
• Regular monitoring & restocking is important
GAMBUSIA FISHES
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Genetic Control• "Use of any treatment
that reduce the reproductive potential by replacing the hereditary material"
Sterile male technique Hybrid male technique Sex distortion Gene replacement
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Personal protection• First line of defence
• Prevent vectors from biting & feeding on host
• Acheived by wearing long sleeved, light-coloured shirts, trousers, socks, shoes & by the use of repellents like Benzyl benzoate, DEET (N,N-diethyl-m-tolumide)
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Long-lasting Insecticidal Nets• Most efficient & cost-ef
fective method
• WHO recommends that everyone at risk of malaria sleeps under a net
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Waste Management• Empty tins, plastic bot
tles, unused drums, coconut shells & used car tyres can serve as important breeding sites
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Housing Modification• Door & window screens
• Plaster walls & concrete floors in good condition
• Cracks & entry points sealed up
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Challenges in the Control ofVector-Borne Diseases
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Challenges in the Control ofVector-Borne Diseases
Emerging insecticide resistance Major threat Widespread use of synthetic insecticides
Lack of expertise in vector control Expertise of entomologists is critical ; an extreme sh
ortage
Lack of Surveillance In many high-burden settings, there is almost no dat
a
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Entomological Skills
• WHO calls for countries to increase their investment in training people with entomological skills, as well as the corresponding infrastructure
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Sanitation and Access toSafe Drinking Water
• Poor sanitation & lack of access to clean drinking water allows many vectors to thrive
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Environmental Change
• Climate change is likely to exacerbate impact
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Role of Health Education
• Active Community participation
• Strict enforcement of legislation for wastes disposal
• Unless man himself changes his behavior & becomes vector conscious & stops creating breeding places , no one can eliminate
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Health Education Material on Dengue
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Health Education Material on Malaria
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Conclusion
• VBDs - greatest contributors to human mortality & morbidity in tropical settings & beyond.
• Significant progress is being made in combating diseases such as Malaria, Filariasis & Chagas disease
• Dengue continue to spread at an alarming pace
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Conclusion• Resistance to insecticides threatens the gains
made through vector control & calls for concerted planning & collaboration across sectors
• Areas where VBDs overlap, integrated management of insecticide resistance is essential, supported by adequate capacity of trained personnel
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04/12/23 6363
Thank You!Thank You!