Introduction
Vector-borne diseases pose a significant public health threat in India, with the mosquito being the deadliest vector. A single species of mosquito is capable of transmitting multiple diseases—Aedes aegypti (dengue, chikungunya, Zika, yellow fever), Culex species (Japanese encephalitis, West Nile virus), and Anopheles mosquitoes (malaria). In response to this public health crisis, the Government of India launched the National Vector Borne Disease Control Programme (NVBDCP) in 2002 as an umbrella strategy to combat six major diseases—malaria, dengue, chikungunya, lymphatic filariasis, kala-azar, and Japanese encephalitis.
Why NVBDCP?
NVBDCP was initiated due to the shared vector and transmission modes of these diseases, allowing for cost-effective, integrated surveillance and control strategies. The benefits include:
- Unified national reporting,
- Resource optimization,
- Flexibility for regional disease burdens,
- Enhanced intersectoral coordination, and
- Holistic policy-making.
Vector-borne diseases in India account for 15–20% of all communicable disease burden and are a major contributor to Disability-Adjusted Life Years (DALYs), especially during monsoon months (June–November).
Epidemiological Overview (2023 Estimates)
| Disease | Estimated Cases | Deaths | Major Endemic States |
|---|---|---|---|
| Malaria | ~170,000 | <100 | Odisha, Chhattisgarh, Jharkhand |
| Dengue | 200,000–250,000 | 300–500 | PAN India |
| Chikungunya | ~80,000 | 0 | Karnataka, Maharashtra, Delhi |
| Lymphatic Filariasis | ~23 million | Rare | Bihar, UP, Tamil Nadu |
| Kala-azar | <900 | <10 | Bihar, Jharkhand, UP |
| Japanese Encephalitis | ~1,000–1,200 | 100–200 | Assam, UP, Bihar |
Objectives of NVBDCP
- Prevention & Control of all six diseases through integrated interventions.
- Disease Elimination Targets:
- Kala-azar by 2027
- Malaria and Lymphatic Filariasis by 2030
- Early Diagnosis & Treatment: Ensure 100% coverage, especially in high-risk and tribal areas.
- Integrated Vector Management (IVM): Use IRS (Indoor Residual Spraying), LLINs (Long-lasting insecticidal nets), and fogging.
- Capacity Building: Training of personnel and lab/entomological support.
- IEC/BCC: Public awareness via Information, Education & Communication.
- Surveillance & Evaluation: Strengthen MIS-based monitoring systems.
- Intersectoral Collaboration: With urban development, water, sanitation, and education sectors.
Key Strategies
- Early Case Detection and Treatment
- Vector Control
- Mass Drug Administration (MDA)
- Vaccination (for JE)
- Intersectoral Convergence
- Surveillance & Endemic Preparedness
- Community Engagement via IEC/BCC
Treatment Protocols by Disease
1. Malaria
- P. vivax:
- Chloroquine: 25 mg/kg over 3 days
- Primaquine: 0.25 mg/kg for 14 days (contraindicated in pregnancy and infants)
- P. falciparum:
- North-East: ACT-AL (Artemether + Lumefantrine)
- Rest of India: ACT-SP + Primaquine 0.75 mg/kg single dose on Day 2
2. Lymphatic Filariasis
- Triple Drug Therapy (IDA):
- Ivermectin (200 µg/kg), DEC (6 mg/kg), Albendazole (400 mg)
- Morbidity Management (MMDP):
- Hygiene for lymphoedema, hydrocelectomy for hydrocele, antibiotics for ADLA
3. Dengue
- WHO Classification:
- Without Warning Signs: Outpatient care, hydration (80–100 mL/kg/day), paracetamol
- With Warning Signs: IV fluids (5–7 mL/kg/hr), frequent vitals and hematocrit monitoring
- Severe Dengue: Rapid resuscitation (10–20 mL/kg), ICU care, blood transfusion if needed
4. Chikungunya
- Acute Phase (0–10 days):
- Paracetamol, fluids, rest
- Post-Acute Phase (10 days–3 months):
- NSAIDs after ruling out dengue, physiotherapy
- Chronic Phase (>3 months):
- Rheumatologist consult, DMARDs, corticosteroids if persistent
5. Japanese Encephalitis (JE)
- Supportive Treatment:
- Paracetamol, anticonvulsants, mannitol, hydration, antibiotics if bacterial infection suspected
- Vaccination:
- Live SA-14-14-2 JE vaccine under UIP for 9 months–15 years (2 doses)
6. Kala-azar
- Causative Agent: Leishmania donovani
- Vector: Phlebotomus argentipes (sandfly)
- Treatment:
- Liposomal Amphotericin B (LAmB) 10 mg/kg single dose
- Prevention:
- IRS twice yearly, PKDL surveillance and treatment
Integrated Vector Management and IEC
To reduce disease transmission, NVBDCP promotes:
- Use of LLINs and repellents
- Eliminating breeding grounds (Dry Day techniques)
- Compliance with IRS
- Early healthcare-seeking behavior
- Wearing protective clothing
Conclusion
The NVBDCP is a landmark public health intervention that exemplifies India’s commitment to controlling and eliminating vector-borne diseases through scientific strategy, intersectoral coordination, public participation, and robust surveillance. As India approaches elimination targets for kala-azar, malaria, and filariasis, continuous investments in infrastructure, IEC campaigns, vector control, and equity in healthcare access remain critical.
By integrating clinical management, vector control, and community engagement, NVBDCP sets the blueprint for comprehensive disease control in tropical nations.
MCQs
- Which of the following diseases is not covered under the NVBDCP?
A) Dengue
B) Typhoid
C) Malaria
D) Chikungunya
Answer: B) Typhoid - What is the vector for Japanese Encephalitis (JE)?
A) Aedes aegypti
B) Anopheles mosquito
C) Culex species
D) Sandfly
Answer: C) Culex species - What is the elimination goal year for Kala-azar under NVBDCP?
A) 2025
B) 2027
C) 2030
D) 2023
Answer: B) 2027 - Which vector transmits malaria in India?
A) Culex
B) Aedes aegypti
C) Anopheles
D) Phlebotomus argentipes
Answer: C) Anopheles - What is the standard single-dose treatment for Kala-azar under NVBDCP?
A) Amphotericin B
B) Chloroquine
C) Liposomal Amphotericin B 10 mg/kg
D) Miltefosine
Answer: C) Liposomal Amphotericin B 10 mg/kg - Which of the following is contraindicated in pregnant women for malaria treatment?
A) Chloroquine
B) Primaquine
C) Artemether
D) Sulfadoxine
Answer: B) Primaquine - Which vaccine is used under the Universal Immunization Programme for JE?
A) LAV-2
B) Live SA-14-14-2
C) JE-23
D) Yellow fever vaccine
Answer: B) Live SA-14-14-2 - In which phase of chikungunya does NSAID use begin?
A) Acute
B) Pre-acute
C) Subacute/Post-acute
D) Febrile
Answer: C) Subacute/Post-acute - What does LLIN stand for?
A) Long-lasting Insecticide Net
B) Line-Laced Insecticide Net
C) Light Layered Indoor Net
D) Low-Level Insecticide Nebulizer
Answer: A) Long-lasting Insecticide Net - Which test is used to assess capillary fragility in suspected dengue patients?
A) Widal test
B) Tourniquet test
C) Coombs test
D) Mantoux test
Answer: B) Tourniquet test - What is the ACT regimen for P. falciparum malaria in North-Eastern states of India?
A) Artesunate + Sulfadoxine-Pyrimethamine
B) Artemether + Lumefantrine
C) Chloroquine + Primaquine
D) Artesunate + Mefloquine
Answer: B) Artemether + Lumefantrine - What is the dosage of paracetamol recommended for children with dengue without warning signs?
A) 5 mg/kg every 4 hrs
B) 10–15 mg/kg every 6 hrs
C) 20 mg/kg every 8 hrs
D) 15–20 mg/kg every 12 hrs
Answer: B) 10–15 mg/kg every 6 hrs - Which is NOT a component of triple-drug therapy (IDA) for filariasis?
A) DEC
B) Ivermectin
C) Doxycycline
D) Albendazole
Answer: C) Doxycycline - The chronic phase of chikungunya may require which of the following treatments?
A) High-dose paracetamol
B) NSAIDs only
C) Disease Modifying Anti-Rheumatic Drugs (DMARDs)
D) Antibiotics
Answer: C) DMARDs - For how many days is Primaquine administered in P. vivax malaria?
A) 3 days
B) 7 days
C) 14 days
D) 1 single dose
Answer: C) 14 days - What is the target urine output in hospitalized dengue patients with warning signs?
A) ≥1.0 mL/kg/hr
B) ≥0.75 mL/kg/hr
C) ≥0.5 mL/kg/hr
D) ≥1.5 mL/kg/hr
Answer: C) ≥0.5 mL/kg/hr - Under NVBDCP, what API (Annual Parasite Incidence) defines Category 1 districts for malaria?
A) API ≥ 1
B) API = 0
C) API < 1 in all districts
D) API < 1 in some districts only
Answer: C) API < 1 in all districts - Which clinical feature is NOT a warning sign in dengue?
A) Mucosal bleeding
B) Rash
C) Hepatomegaly
D) Persistent vomiting
Answer: B) Rash - Which drug combination is used on Day 1 in ACT-SP for malaria?
A) Artemether + Mefloquine
B) Artesunate + Sulfadoxine-Pyrimethamine
C) Chloroquine + Primaquine
D) Lumefantrine + Sulfadoxine
Answer: B) Artesunate + Sulfadoxine-Pyrimethamine - Which state is not endemic for Japanese Encephalitis in India?
A) Assam
B) Uttar Pradesh
C) West Bengal
D) Rajasthan
Answer: D) Rajasthan
DoctorDP 