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
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
MALARIA IN INDIA Malaria in India 7000000 6000000 5000000 4000000 3000000 2000000 1000000 0 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 PV Pf Pv% Pf% ABER API SPR SfR
GEOGRAPHICAL DISTRIBUTION OF TOTAL MALARIA & Pf. CASES JAMMU & KASHMIR JAMMU & KASHMIR W N S E GUJARAT RAJASTHAN D&N HAVELI LAKSHADWEEP HIMACHAL PRADESH PUNJAB HARYANA MAHARASHTRA UTTARAKHAND MADHYA PRADESH UTTAR PRADESH TELANGANA ANDHRA PRADESH GOA KARNATAKA TAMIL NADU KERALA CHHATTISGARH ORISSA PONDICHERRY SIKKIM ARUNACHAL PR. ASSAM NAGALAND BIHAR MEGHALAYA MANIPUR TRIPURA JHARKHAND MIZORAM WEST BENGAL API - 2016 <1 >1-2 >2-5 >5-10 >10 & Above A&N ISLANDS GUJARAT RAJASTHAN D&N HAVELI LAKSHADWEEP HIMACHAL PRADESH PUNJAB HARYANA MAHARASHTRA UTTARAKHAND MADHYA PRADESH UTTAR PRADESH TELANGANA ANDHRA PRADESH GOA KARNATAKA TAMIL NADU KERALA CHHATTISGARH ORISSA PONDICHERRY W E S - Northern States and southern states nearly on elimination phase - Malaria mostly concentrated in eastern & NE parts of India N SIKKIM ARUNACHAL PR. ASSAM NAGALAND BIHAR MEGHALAYA MANIPUR TRIPURA JHARKHAND MIZORAM WEST BENGAL SFR - 2016 <1 >1-2 >2-5 >5-10 >10 & Above A&N ISLANDS
DENGUE IN INDIA (2010-2017) Cases 140000 130000 120000 110000 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 129166 0.9 99913 75808 0.5 0.4 50222 40571 28292 29150 0.3 0.3 18860 0.2 0.2 0.2 2010 2011 2012 2013 2014 2015 2016 2017 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 Case Fatality Ratio CFR brought down from 3.3% (1996) to 0.2% in 2016 States reporting most number of Dengue cases in 2017 : Kerala 14606, Tamil Nadu 5968, Karnataka 4643, Andhra Pradesh 798 Gujarat 734, Maharashtra- 718, West Bengal - 571 Cases
DENGUE IN INDIA (SEASONAL TREND) 35000 30000 25000 No. of Cases 20000 15000 10000 5000 0 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec 2014 2015 2016 2017
CHIKUNGUNYA IN INDIA 60000 64057 50000 No. of cases 40000 30000 20000 16049 27553 18805 10000 0 2014 2015 2016 2017
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
CLIMATIC CHANGES WHICH IMPACT VBD Increase in temperature W N S GUJARAT RAJASTHAN D&N HAVELI LAKSHADWEEP E JAMMU & KASHMIR HIMACHAL PRADESH PUNJAB HARYANA MAHARASHTRA UTTARAKHAND MADHYA PRADESH UTTAR PRADESH TELANGANA ANDHRA PRADESH GOA KARNATAKA TAMIL NADU KERALA CHHATTISGARH ORISSA PONDICHERRY BIHAR SIKKIM JHARKHAND WEST BENGAL ARUNACHAL PR. ASSAM MEGHALAYA MANIPUR TRIPURA MIZORAM API - 2016 <1 >1-2 >2-5 >5-10 >10 & Above A&N ISLANDS NAGALAND Increase in humidity Flooding INCREASED MOSQUITOGENIC POTENTIAL INFECTON RESERVOIR PRESENT FREQUENT OUTBREAKS (Malaria, Dengue, chikunguniya Targeted for Malaria Elimination by 2027 GAINS MADE TILL NOW MAY BE REVESRED
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
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
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
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.
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
Transmission Windows of dengue (A1B Scenario) TW criteria: 20-32 0 C Inconclusive, no matching with current distribution
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
MALARIA KEEPS COMING BACK BE PREPARED