District Malaria Office
Introduction:
The National Center for Vector Borne Diseases Control (NCVBDC) administers an umbrella programme, namely, National Vector Borne Diseases Control Programme (NVBDCP) for prevention and control of vector borne diseases namely Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis. Out of them three diseases namely, Malaria, Lymphatic Filariasis and Kala-azar are targeted for elimination. Malaria, Dengue and JE are outbreak prone and climate sensitive. Under the Union Ministry of Health and Family Welfare, Government of India, 17 Regional Offices for Health and Family Welfare (ROH & FW) are functioning. These offices are located at different state headquarters. The offices are manned by technical people to coordinate and monitor all national health and family welfare Programmes in the concerned states through close liaison and field visits. They are also capable for providing technical advice as well as assistance to the state. Under National Center for Vector Borne Diseases Control these offices are entrusted with the responsibility of conducting the entomological studies in collaboration with zonal entomological setup of the state, drug resistance studies, cross checking of blood slides for quality control, capacity building of the states, etc. At the district level, District Malaria Offices have been established. This Unit is the key unit for planning and monitoring of Programme under a technical officer. Passive surveillance for malaria is carried out by Primary Health Centres (PHC), Community Health Centres (CHC) and other secondary and tertiary level Health institutions to which patients visit for treatment. Active surveillance is carried out by Health workers.
Contact Us:
NATIONAL CENTER FOR VECTOR BORNE DISEASES CONTROL (NCVBDC)
O/o the District Malaria Officer,
Dibrugarh-786001
(Landmark : Opp. Dibrugarh Municipal Board)
E-MAIL : dmodibrugarh@gmail.com
Vision:
Prevention and control of vector borne diseases namely Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis.
Mission:
Elimination of Malaria, Lymphatic Filariasis and Kala-azar.
Objective:
Prevention and control of incidence of Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis. To prevent deaths due to malaria.
Key Function:
Prevention and control of vector borne diseases namely Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis.
GENERAL Overview:
The National Center for Vector Borne Diseases Control (NCVBDC) administers an umbrella programme, namely, National Vector Borne Diseases Control Programme (NVBDCP) is an umbrella programme for prevention and control of Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis. The NCVBDC under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, is the nodal agency responsible for planning, coordination, implementation, monitoring and evaluation of NVBDCP programme at all levels.
The National Center for Vector Borne Diseases Control (NCVBDC), Ministry of Health & Family Welfare,GOI already has a website https://nvbdcp.gov.in The repository has been built to ensure that all the information related to the vector borne diseases i.e. Malaria, Dengue, Lymphatic Filariasis, Kala-azar, Japanese Encephalitis and Chikungunya, can be found and downloaded easily.
Malaria
What is malaria?
Malaria is a mosquito-borne disease caused by a plasmodium parasite and spread by the Female Anopheles mosquito.
What are the symptoms of malaria?
It is a flu-like illness, which begins with a high fever and chills. Other symptoms include vomiting and nausea, headaches, body pain, weakness, and fatigue.
What is the treatment for malaria? Where to get the treatment?
The treatment for malaria involves the use of prescribed anti-malarial medication, mainly Artemisinin Combined Therapy (ACT), Chloroquine (CQ) & Primaquine (PQ). The dosage and type of medication will depend on a variety of factors, including age, type of malaria, pregnancy etc.
The treatment of Malaria available in each and every government health facilities (Medical Colleges, District Hospitals, PHCs, CHCs, SD, HWC & SC) and health workers (MPW, SW, ASHA). The treatment is free of cost. The drugs are supplied by NCVBDC.
How can one find out if they have malaria? What are the tests available to diagnose malaria?
Malaria can be promptly diagnosed by a rapid diagnostic test (RDT) or microscopy (laboratory blood test). This involves examining a drop of the patient’s blood to determine presence of the malaria parasite. RDTs are available at each and every government health facilities (Medical Colleges, District Hospitals, PHCs, CHCs, SD, and HWC & SC) and health workers (MPW, SW and ASHA) for early diagnosis of malaria cases, especially in hard-to-reach areas where access to adequate health services is limited. Malaria detection by microscopy is done in all the microscopic centres (Medical Colleges, District Hospitals, PHCs, CHCs, SD). A nucleic acid amplification-based test is also available to detect malaria in areas where malaria is not very common.
JAPANESE ENCEPHALITIS (JE)
What is 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.
What are the symptoms of Japanese Encephalitis?
Following an incubation period of 5-15 days after an infective mosquito bite a prodrome of fever, headache, nausea, diarrhea, vomiting, and myalgia occurs lasting for few days followed by irritability, altered behavior, convulsions and coma.
What is the treatment for Japanese Encephalitis?
There is no specific anti-viral medicine available against JE virus. The cases are managed symptomatologically. Clinical management of JE is supportive and in the acute phase is directed at maintaining fluid and electrolyte balance and control of convulsions, if present. Maintenance of airway is crucial.
How Japanese Encephalitis is diagnosed?
Several laboratory tests are available for JE virus detection which include:
• Antibody detection: Heam-agglutination Inhibition Test (HI), Compliment Fixation Test (CF), Enzyme Linked Immuno-Sorbant Assay (ELISA) for IgG (paired) and IgM (MAC) antibodies, etc.
• Antigen Detection: RPHA, IFA, Immunoperoxidase etc.
• Genome Detection - RTPCR
• Isolation - Tissue culture, Infant mice, etc
• In view of the limitations associated with various tests, IgM ELISA is the method of choice provided samples are collected 3-5 days after the infection.
Japanese Encephalitis detection test, IgM ELISA done at Govt. Medical Colleges & District Hospitals. The kits are supplied by NCVBDC.
DENGUE
What is DENGUE?
Dengue is a viral disease. It is transmitted by the infective bite of Aedes aegypti mosquito. Person 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, which may cause death. Person suspected of having dengue fever or DHF must see a doctor at once.
What are the symptoms of Dengue?
Abrupt onset of high fever. Severe frontal headache. Pain behind the eyes which worsens with eye movement. Muscle and joint pains. Loss of sense of taste and appetite. Measles-like rash over chest and upper limbs. Nausea and vomiting
What is the treatment for Dengue?
With early detection and proper case management and symptomatic treatment, mortality can be reduced substantially
How Dengue is diagnosed?
The clinician should record the temperature and perform a tourniquet test and look for the petechiae. All suspected cases of fever with bleeding should be investigated thoroughly for low platelet count.
Following tests are available for the diagnosis of dengue infection
• Haemagglutination-Inhibition (HI),
• Complement Fixation (CF),
• Neutralization test (NT),
• IgM capture enzyme-linked immunosorbent assay (MAC-ELISA), and
• Indirect IgG ELISA
Dengue detection test, IgM-capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA) done at Govt. Medical Colleges & District Hospitals. The kits are supplied by NCVBDC.
FILARIASIS
What is Filariasis?
Filariasis is caused by several rounds, coiled and thread-like parasitic worms belonging to the family filaridea. The disease is caused by the nematode worm, either Wuchereria bancrofti or Brugia malayi and transmitted by ubiquitous mosquito species Culex quinquefasciatus and Mansonia annulifera/M.uniformis respectively. The disease manifests often in bizarre swelling of legs, and hydrocele and is the cause of a great deal of social stigma. Filariasis is caused by several rounds, coiled and thread-like parasitic worms belonging to the family filaridea. These parasites after getting deposited on skin penetrate on their own or through the opening created by mosquito bites to reach the lymphatic system.
Lymphoedema Management
Filaria patients with damaged lymphatic vessels often have more bacteria on the skin than usual. The large number of bacteria on the skin, multiple skin lesions, slow lymph fluid movement and the reduced ability of the lymph nodes to filter the bacteria cause inflammation characteristic of an acute attack. Repeated bacterial infections precipitate frequent acute attacks, which further damage the tiny lymphatic vessels in the skin, reducing their ability to drain fluid. This vicious cycle continues, aggravating the condition of the patient.
The Lymphoedema management involves the following components:
• Washing,
• Prevention and cure of entry lesions,
• Elevation of the foot,
• Exercise
• Wearing proper footwear,
• Management of acute attacks.
KALA-AZAR
What is Kala-Azar?
• Kala-azar is a slow progressing indigenous disease caused by a protozoan parasite of genus Leishmania
• In India Leishmania donovani 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. Some of the kala-azar cases manifest PKDL after a few years of treatment. Recently it is believed that PKDL may appear without passing through visceral stage. However, adequate data is yet to be generated on course of PKDL manifestation
What are signs & symptoms of kala-Azar?
• 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 non tender
• Liver - enlargement not to the extent of spleen, soft, smooth surface, sharp edge Lymphadenopathy - not very common in India
• 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"
• Anemia - develops rapidly
How kala-Azar is diagnosed?
Clinical:
• A case of fever of more than 2 weeks duration not responding to anti-malarials and antibiotics. Clinical laboratory findings may include anemia, progressive leucopenia thrombocytopenia and hyper gamma globulinemia
Laboratory:
• Serology tests: Variety of tests is available for diagnosis of Kala-azar. The most commonly used tests based on relative sensitivity; specificity and operationally feasibility include Direct Agglutination Test (DAT), rapid test dipstick and ELISA. However all these tests detect IgG antibodies that are relatively long lasting. IgM detecting tests are under development and not available for field use.
• Parasite demonstration in bone marrow/ spleen/ lymphnode aspiration or in culture medium is the confirmatory diagnosis. However, sensitivity varies with the organ selected for aspiration. Though spleen aspiration has the highest sensitivity and specificity (considered gold standard) but a skilled professional with appropriate precautions can perform it only at a good hospital facility.
Differential Diagnosis:
• Typhoid
• Miliary tuberculosis
• Malaria /
• Brucellosis
• Amoebic liver abscess
• Infectious mononucleosis
• Lymphoma, Leukemia
• Tropical Splenomegaly
• Portal hypertension
CHIKUNGUNYA
What is Chikungunya?
Chikungunya fever is a viral disease transmitted to humans by the bite of infected Aedes aegypti mosquitoes.
What are signs & symptoms of Chikungunya?
As the clinical manifestations of Chikungunya fever resemble those of dengue and other fevers caused by arthropod borne viruses of the Alphavirus genus, laboratory diagnosis is critical to establish the cause of diagnosis and initiate specific public health response.
How Chikungunya is diagnosed?
Virus isolation:
Virus isolation provides the most definitive diagnosis, but takes one to two weeks for completion and must be carried out in bio safety level III laboratories to reduce the risk of viral transmission. The technique involves exposing specific cell lines to samples from whole blood
and identifying Chikungunya virus-specific responses. The isolation process is time consuming and the degree of success is dependent on a number of complicating factors, for example, time of collection, transportation, maintenance of cold chain, storage and processing of samples.
Serological diagnosis:
Serological diagnosis requires a larger amount of blood than the other methods, and uses an ELISA assay to measure Chikungunya-specific IgM levels in the blood serum. Chikungunya antibody tests are generally appropriate after the first week of symptom onset and onward. Serum obtained from 10-15 ml of whole blood is required. An acute phase serum must be collected immediately after the onset of illness and the convalescent phase serum 10-14 days later. The blood specimen is transported at 4° Celsius and not frozen for
Immediate transfer to the laboratory. Only if the testing cannot be done immediately, the serum specimen should be separated and then stored and shipped frozen. ELISA test is quite specific with very little cross reactivity with related alpha viruses. Serologic diagnosis can be made by demonstration of four-fold rise in antibody titre in acute and convalescent sera or by demonstrating IgM antibodies specific for CHIK virus. A commonly used test is the Immunoglobulin M Antibody (IgM) capture enzyme-linked immunosorbent assay (MAC-ELISA). Results of MAC-ELISA can be available within same day. The kits supplied by NCVBDC. It is available at Assam Medical College & Hospital, Dept. of Microbiology.
RT-PCR:
Reverse Transcriptase, (RT) PCR technique using nested primer pairs is used to amplify several Chikungunya-specific genes from whole blood, generating thousands to millions of copies of the genes in order to identify them. The Chikungunya virus reverse transcriptase (RT)-PCR assay is appropriate in the early days of symptom onset, since CHIKV RNA can be detected during the acute phase of illness (≤8 days after symptom onset).
RT-PCR can also be used to quantify the viral load in the blood. Using RT-PCR, diagnostic results can be available in one to two days.
All the guidelines and details on the above mentioned diseases available at https://nvbdcp.gov.in
ADMINISTRATIVE SET UP:
District Level:
• CM&HO (CD)
• District Malaria Officer
• Assistant Malaria Officer
• District VBD Consultant
Block Level:
• Senior Malaria Inspector
• Malaria Inspector
• Microscopist
• Laboratory Technician
• Surveillance Inspector
• VBDTS
Sub-Centre/HWC
• Surveillance Worker
