vector borne diseases and climatic changes - india @ cop...

VECTORBORNEDISEASESANDCLIMATICCHANGES

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Dr.NeerajDhingraAdditionalDirector

NationalVectorBorneDiseaseControlPorgramme (NVBDCPMinistryofHealth&FamilyWelfare

GovernmentofIndia

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PREVENTIONANDCONTROLOFVECTORBORNEDISEASESININDIA

NATIONALVECTORBORNEDISEASESCONTROLPROGRAMME(NVBDCP)- UnderMinistryofHealth&FamilyWelfare,GovernmentofIndiadealswith

followingvectorbornediseases- Malaria- Dengue- Chikunguniya- JapaneseEncephilitis- Kala- azar- Filairiasis- Zika Virus

Website:www.ndvbcp.gov.inMOHwebsite:www.mohfw.gov.in

MALARIA IN INDIA

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0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

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100.00

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

MalariainIndia

PV Pf Pv% Pf% ABER API SPR SfR

GEOGRAPHICALDISTRIBUTIONOFTOTALMALARIA&Pf.CASES

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RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

TELANGANA

CHHATTISGARH

ANDHRA PRADESH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

N

EW

S

API - 2016<1>1-2>2-5>5-10>10 & Above

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

TELANGANA

CHHATTISGARH

ANDHRA PRADESH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEPN

EW

S

SFR - 2016<1>1-2>2-5>5-10>10 & Above

- NorthernStatesandsouthernstates– nearlyoneliminationphase- Malariamostlyconcentratedineastern&NEpartsofIndia

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DENGUEININDIA(2010-2017)

2829218860

50222

75808

40571

99913

129166

291500.4

0.9

0.5

0.3 0.3

0.2 0.2 0.2

0.00.10.20.30.40.50.60.70.80.91.0

0100002000030000400005000060000700008000090000

100000110000120000130000140000

2010 2011 2012 2013 2014 2015 2016 2017

CaseFatality

Ratio

Cases

Cases

• 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

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DENGUEININDIA(SEASONALTREND)

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25000

30000

35000

Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

No.ofC

ases

2014 2015 2016 2017

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CHIKUNGUNYA IN INDIA

16049

27553

64057

18805

0

10000

20000

30000

40000

50000

60000

2014 2015 2016 2017

No.

of c

ases

CLIMATICCHANGESANDVECTORBORNEDISEASETRANSMISSION

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VBDtransmissionisdependentupon

SufficientnumbersofAnopheline,Culex orAedesmosquitoes

Largeenoughreservoirofpoolofinfectioninhumansandanimals

Mosquitoesproliferationstronglyinfluencedby:

Temperature

Rainfall

Humidity

Wind

Sunlight

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CLIMATICCHANGESWHICHIMPACTVBD• Increaseintemperature• Increaseinhumidity• Flooding

– INCREASEDMOSQUITOGENICPOTENTIAL

• INFECTONRESERVOIRPRESENT

• FREQUENTOUTBREAKS(Malaria,Dengue,chikunguniya

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

TELANGANA

CHHATTISGARH

ANDHRA PRADESH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

N

EW

S

API - 2016<1>1-2>2-5>5-10>10 & Above

TargetedforMalariaEliminationby2027 GAINSMADETILLNOWMAYBEREVESRED

CLIMATICCHANGESININDIA

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• Meltingglaciers-

Floodinginrivers,valleysfollowedbydiminishedflowanddroughts

• Generalwarminginmeanannualtemperaturewithdecreasedrangeofdiurnal

temperaturevariation

Warmingof0.50Cby2030

MaximumincreaseinnorthernareasofIndia

• Increasedprecipitation- includingmonsoons

Fewerrainydaysbutmoredaysofextremerainfallevents

IMPACTOFCLIMATICCHANGESONVBDININDIA

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• Increasednumberofmonthsofhighhumidity,precipitationandincreasedtemperatureandpoolingofwaterwouldleadto:- SeasonalityofVBDmaychange- Earlyonsetofdiseasesormaybethroughouttheyear- Diseaseburdenmaychange- LikelyhighertransmissionratesforVBD– severeformsofdiseasewouldincrease– morePfmalaria- TypicalpreventivemeasureslikeLLINmaynotwork- peoplemaynotsleepunderthem- Healthservicescapacitiestodealwiththisincrease- Quickeronsetofdrugandinsecticideresistance

• Socioeconomicimpact- Healthinequity– poorermoreaffected- Longerdurationofhospitalization– outofpocketexpenseswouldincrease- Impactontourism- Refugees- movetowardslargerinhabitations– urbanization– poorinfrastructure- moreCulexmosquitoes– Lymphaticfiliarisis- Deforestation,etc

MITIGATINGEFFECTOFCLIMATICCHANGESONVBD

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1. Adaptabilitytoadjusttoclimaticchanges– Nopredictionmodelsavailable- researchneedeD

– LongitudinalStudies– changesinVBDbasedonclimaticstudies- multi-disciplinarystudies

– Responsemechanismsweakerinlessendemicareasasofnow

– Shiftingofhumaninfrastructurebasedonendemicity

– Addingnewerskilledstaffonenvironmentmanagementinthehealthprogrammes

– Capacitybuildingandsensitization

– Increasedresources– budgetandmanpower

MITIGATINGEFFECTOFCLIMATICCHANGESONVBD

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2. Monitoringofclimaticchangesinco-relationtoVBD– Mappingthepresentlandscapeintermswatercollections,rivers,lakes,etc– Informationexchangeonclimaticchanges– rainfall,humidity,floods,glacier

melting,etc.withhealthprogrammesespeciallyVBD

– GIS/spatialmapswithclimaticchanges/waterpoolingatlocallevels– MonitoringtheVBDincidenceinnorthernareasofIndia– trackofanyslight

increase- involveallfacilitiesgovernment,private,NGOs,etc.– Mapping/Monitoringthemobility- intrastate,interstate,etc.

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By2030s-FewfociinHimalayanregionarelikelytoopen;intensityoftransmissionmoreinNEstates;reductionineast-coastprojected

Transmission Windows of malaria based on T & RH (A1B Scenario, by 2030)Baseline and A1B Scenario Projected Map of Open Months for Malaria Transmission

(Based on T. & RH.)

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Transmission Windows of dengue (A1B Scenario)

TWcriteria:20-320 CInconclusive,nomatchingwith

currentdistribution

MITIGATINGEFFECTOFCLIMATICCHANGESONVBD

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3.ChangesintheapproachestoVBD– HighlyskilledmanpowerintheNVBDCP– capacitytopredictchangesinclimateandVBD

– EnhancementofstaffatState/regional/districtlevels

– Verystrongandinstitutionalmechanismsofinter-sectoralcoordination

– Newerresearchesondiagnostics,drugandinsecticidesandbettermethodstodetectresistance

– Sensitizationandcapacitybuildingofnorthernstates

– Highlyflexiblestructure– decisionmakingandresourceallocationmaychangefromyeartoyearorwithanyearaswell

MALARIAKEEPSCOMINGBACK–BEPREPARED