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Burden of Vector Borne Diseases
Dr. Pradip AwateState Surveillance Officer, IDSP,
Maharashtra
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Fossil Mosquito
Almost 30 million years old found in geologic strataBharati Vidyapith CME 3 AUG 14
Vector Borne Diseases• Vectors are organisms that transmit pathogens and
parasites from one infected person (or animal) toanother.
• Commonly found in tropical and sub-tropical regions.• Over half the world's population is at risk from vector-borne
diseases such as malaria and dengue.• Vector-borne diseases account for 17% of the estimated
global burden of all infectious diseases.• The most deadly vector-borne disease, malaria.• The world's fastest growing vector-borne disease is
dengue.
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VECTOR BORNE
DISEASES
VECTOR BORNE
DISEASES
MalariaMalaria
DengueDengue
ChikungunyaChikungunya
FilariasisFilariasis
Japanese Encephalitis
Japanese Encephalitis
ChandipuraEncephalitisChandipuraEncephalitis
Kala AzarKala AzarCongo Cremean
Hemorrhagic Fever
Congo Cremean
Hemorrhagic Fever
ChagasDiseaseChagasDisease
Trypanosomiasis
Trypanosomiasis
Yellow FeverYellow Fever
Lyme Disease
Lyme Disease
PlaguePlague
DracunculosisDracunculosis
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Important VBDs with respect to IndiaSr. No VBD Responsible Vector
1 Malaria Anopheles
2 Dengue Aedes aegypti and Aedes albopictus
3 Chikungunya Aedes aegypti and Aedes albopictus
4 Japanese Encephalitis
Culex tritaeniorhynchus, Culex vishnuiand Culex pseudovishnui
5 ChandipuraEncephalitis & Kala
Azar
Sandfly (genus Phlebotomus )
6 Filariasis Culex quinquefasciatus and Mansonia annulifera/M.uniformis
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Malaria
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जो जीता वह सकंदर• Alexander the Great was killed by malaria at
the height of his power.• After virtually conquering the entire known
world.• He had set out to subjugate the earth but just
as he was to depart with his army in earlyJune 323 B.C., he contracted Malaria and thevoyage was postponed.
• Malaria, by striking Alexander, had altered thecourse of history.
• Had the military leader survived, he mightwell have succeeded in uniting east and west,fusing Greeks and Asians into a single nation.
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Global Malaria Scenario
• In 2010 - 216 million cases of Malaria globally.• 91% - Pf cases.• 81 % from African region.• 13 % from South East Asia Region.• Total Malarial Deaths - - 6,55,000. ( 3% SE
Asia)• Under 5 mortality – 7% deaths due to Malaria
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Malaria estimates in Pre-control era
It was estimated in 1947 that out of a population of 340 million in the country, annual malaria incidence was 75 million (nearly 22% of population) with 0.8 million deaths
Epidemics at an interval of 5 to 7 years Economic loss due to malaria to the nation was
estimated at Rs. 7500 crores annually in 1940(Rupee value of the reporting year)
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Malaria Epidemics in Pre Independent India
Year Area Affected Deaths
1852Malaria epidemic wiped out the entire village of Ula and then spread
across the Bhagirathi River to Hooghly and continued to devastate populations for many years in Burdwan
1892 Punjab 2,83,223
1900Punjab
Ludhiana, Amballa, Karnal, Gurdaspur & Raya
2,54,580
1908 Punjab - Amristar, Delhi, Palwal, Miani,Gugarat 3,07,316
1920
Bengal
7,30,000
1943 6,80,000
1944 7,63,220Bharati Vidyapith CME 3 AUG 14
3.29
2.07
1.681.36 1.36 1.37
1.1
1995 2000 2005 2008 2009 2010 2011
API
1.56 1.6
1.311.09
0.88
2009 2010 2011 2012 2013
Malaria Cases(Figures in Millions)
Indian Situation
• 27 % Population living in high transmission areas.• 50 % Pf cases • 1000 + deaths every year
• 92 % cases & 97 % deaths are from •NEstates, Chhatisgarh,Jharkhand, MP, Orissa, AP, Maharashtra, Gujarat, Rajasthan,WB & Karnataka
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MALARIA ENDEMIC AREA OF THE STATE
API less than 1 API 1 -5 API more than 5
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POST GLOBALIZATION MALARIA
Malaria in the 1990s, presented new features which were not commonly seen before, namely,
Vector resistance to insecticides; pronounced exophilic behaviour of vectors;extensive breeding sites created by development projects, urbanization and industrialization;change in parasite equation in favour of P.falciparumandresistance of P. falciparum to chloroquine and other antimalarial drugs
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MALARIA IN MAHARASHTRA 2006-2013
5442067849 67333
93818
139198
96577
58499
43676
133
182
148
227
200118
9680
0
50
100
150
200
250
0
20000
40000
60000
80000
100000
120000
140000
160000
2006 2007 2008 2009 2010 2011 2012 2013
Cases Death
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Dengue
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Global Dengue Scenario• World's fastest growing vector-borne disease is dengue, with a 30-fold
increase in disease incidence over the last 50 years.• Over 2.5 billion people – over 40% of the world's population – are now at
risk from dengue.• WHO currently estimates there may be 50–100 million dengue infections
worldwide every year. • Before 1970, only nine countries had experienced severe dengue
epidemics. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific.
• The American, South-east Asia and the Western Pacific regions are the most seriously affected.
• Foot Prints of Dengue in new areas –2010 – First time in France & Croatia2012 – Portugal2013 – Florida (US)
• An estimated 500 000 people with severe dengue require hospitalization each year, a large proportion of whom are children.
• About 2.5% of those affected die.
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Determinants of Dengue
Rise
Unplanned Urbanization
Substandard Housing
Inadequate Water Supply
Inadequate Solid Waste & Sewerage
System Increased Population
Density
International trade
(Used tires)
Rapid population movement
Traditional water
storage
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DISTRIBUTION OF GLOBAL DENGUE RISK
High suitability
Low suitabilityUnsuitable or non endemic
75% of the global population exposed to Dengue lives in Asia Pacific region.
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WHEN DENGUE LEADS TOHAVOC…….
Jan – April 2008 1,58,000 Dengue Cases 9000 Admissions 230 deaths Military deployed for
vector control Call for International
aid US $ 1 billion spent. 2010- 1.2 million cases
Dengue major emerging disease in Saudi Arabia, Yemen & Pakistan.
Frequent OBs in urban areas
In 2011 – 300 deaths in Lahore city alone.
Rio De Janerio - Brazil Lahore - Pakistan
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Dengue In India
12561 15535 28292 18860 50222 75454
8096 110
169
301277
0
50
100
150
200
250
300
350
0
10000
20000
30000
40000
50000
60000
70000
80000
2008 2009 2010 2011 2012 2013
Cases Deaths
• 31 States/UTs are Dengue endemic.• All 4 serotypes isolated from India. • DENV-1 & DENV-2 are prevalent.
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DENGUE IN MAHARASHTRA
618 743
2255
15741138
4305
5432
24 22 209
25
118
138
0
20
40
60
80
100
120
140
160
0
1000
2000
3000
4000
5000
6000
Yr 2007 Yr 2008 Yr 2009 Yr 2010 Yr 2011 Yr 2012 Yr 2013
Cases Deaths
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8
4
1
10
2
2
2
10
2
3
7
13
12
3
88
42
27
4
2
Dengue Deaths from Rural Maharashtra 2013
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Filariasis
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HISTORY
6th Century – Susrut recorded Filaria in his ‘Susrut Samhita’ .
7th Century - Madhavkara described signs & symptoms of Filaria in his ‘ Madhava Nidhana’
1709 – Clarke called elephantoidlegs in Cochin as ‘ Malbar Legs’.
Lewis – Discovery of microfilariae in peripheral blood in Kolkata ( 1872).
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LF – GLOBAL BURDEN
World’s second leading cause of long term debility.
LF doesn’t kill but – causes debility imposes severe social & economical burden Destroys marriages & family relationships. Cause & effect of poverty
o 120 million people from 83 countries infected with LF.
o 1/5 World population at risk.o 70 % Infection world wide is from
India, Nigeria, Bangladesh & Indonesia.
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LF - INDIA
20 States250 districts600 million population is at risk. 2010 Survey – 8 Lac cases of Elephantiasis & 4 Lac cases of Hydrocele in India.
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MAHARASHTRA FILARIA SITUATION
Elephantiasis – 43,987Hydrocele - - 28,975Total - 72,968
In Maharashtra, 17 districts are endemic for LF.
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2.86
1.431.23 1.13
0.44 0.46 0.51 0.54 0.43
Maharashtra Mf Rate
1.241.02 0.98
0.64 0.530.65
0.41 0.37 0.410.27
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
India Mf rate
Elimination of Filarisis by 2015
Mass Drug Administration is core strategy to achieve it.
•In Nalganda district of AP,Mf rate is reduced from 17 (2004) to 0.8 in 2009.• 192 out of 250 endemic districts are having below 1 Mf rate in 2011. Bharati Vidyapith CM
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Chikungunya
• Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952.
• Kolkata outbreak – 1963-64• Chennai Outbreak – 1965 – 3
Lac cases in Chennai City alone.• Return of Chikungunya after 41
years – 16 states involved – 1.39 million cases reported. ( Attack Rate – 45% in some areas)
The name ‘chikungunya’ derives from a word inthe Kimakondelanguage,meaning "to becomecontorted" anddescribes thestooped appearance of sufferers with joint pain
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Bharati Vidyapith CME 3 AUG 14
95091
73288
48176
2040215977 18639
2008 2009 2010 2011 2012 2013
Chikungunya Cases In India
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Japanese Encephalitis• Japanese encephalitis (JE) is a flavivirus related to
dengue, yellow fever and West Nile viruses, and isspread by mosquitoes.
• JE is the main cause of viral encephalitis in manycountries of Asia with nearly 68 000 clinical casesevery year.
• The case-fatality rate 30%.• Permanent neurologic or psychiatric sequelae can
occur in 30%–50% of those with encephalitis.• 24 countries in the WHO South-East Asia and
Western Pacific regions have endemic JEtransmission, exposing more than 3 billion peopleto risks of infection.
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India – JE+ AES Situation
4292
5628 5722
9463 9089 8911
754 882 7911350 1396 1475
2008 2009 2010 2011 2012 2013
Cases Deaths
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YEARJE CHANDIPURA AES TOTAL
Cases Deaths Cases Deaths Cases Deaths Cases Deaths
2007 2 0 0 0 0 0 2 0
2008 1 0 4 3 24 13 29 16
2009 8 0 52 15 36 15 96 30
2010 7 1 50 16 29 16 86 33
2011 13 0 11 3 13 11 37 14
2012 11 0 20 1 41 26 72 27
2013 -- -- -- -- 5 5 5 5
Maharashtra – JE, Chandipura & AES Situation
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Bharati Vidyapith CME 3 AUG 14
What lies ahead ?
? ?Opportunities Risks
Human Ecology
GlobalizationDemography
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Increased Temperature
Rate of blood meal digestion increases
Acceleration the ovarian development & egg- laying
Reduction in duration of the gonotrophic cycle
More frequency of feeding on hosts
Increasing the probability of transmission
•By 2100 it is estimated that average global temperatures will have risen by 1.0–3.50 C.
•This will increase likelihood of many vector-borne diseases in new areas.
What Climate Change will lead to ?
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Increased International Travel
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Will Yellow Fever Come to India ?• India – Yellow Fever ‘receptive’ area.• Vector – aedes aegypti is found in
abundance.• Climatic condition – favourable• Common monkey in India (
Macacus spp) – susceptible to Yellow Fever
• Missing link is --- Chain of transmission…
• An infected traveler OR mosquito ???
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Bharati Vidyapith CME 3 AUG 14
New Research…… New Hope…..Bharati Vidyapith CME 3 AUG 14
Bharati Vidyapith CME 3 AUG 14
Bharati Vidyapith CME 3 AUG 14
No one in the 21st
century should diefrom the bite of a mosquito, a sand fly,a black fly or a tick.
Margaret Chan Director General
World Health Orgnization
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