Vector Borne Disease Control Programme Research Articles

Present Status and Progress towards Kala-Azar Elimination Programme in Uttar Pradesh, India

Kala-azar (KA) and Lymphatic Filariasis (LF), two out of the six vector borne diseases slated for elimination from the country by Government of India. Kala-azar or Visceral Leishmaniasisis prevalent in the eastern part of Uttar Pradesh mainly in the districts bordering to Bihar, the state known for high endemicity of the disease. This disease has been targeted for elimination not only from thestate butfrom the country by 2020 by bringing down the Kala-azar prevalenceto <1 per 10000 population at sub district/block level. The two important interventions in Kala-azar control Programme includes Indoor residual spray (IRS) and Active Case Searches (ACS) in the endemic districts. The disease has been existed since long back in the state and the efforts made towards elimination are inadequate and deviated from the guidelines laid down by Directorate of National Vector Borne Disease Control Programme (NVBDCP).If the population of the sub district/ block is considered basic unit for calculating the prevalence of Kala-azar case<1 per 10000 population, then the state has achieved the same and as no activity pertaining to Kala-azar intervention measure is needed but in order to achieve the real target, it is suggested to consider the population of Health Sub-Center (HSC) for calculating the parameter of Kala-azar case <1 per 10000 population, for which a long way is required by undertaking measures like (a) active cases search drive for at least up to three years sweeping the whole population of the district, (b) complete treatment of the KA cases (both VL & PKDL), (c) complete coverage of population with IRS following the time line and quality of IRS as per NVBDCP guidelines, and (d) intervention activities needs to be synchronized with neighboring states or country subjecting their areas for KA elimination. Present study revealed the current status and progress towards elimination of the disease.

Foldscope: Diagnostic Accuracy and Feasibility of its Use in National Malaria Control Program.

Malaria has been an important public health all over the globe. Although conventional light microscopy is the gold standard of diagnosis, light microscopes are heavy, fragile, costly, and electricity dependent. Rapid diagnostic tests (RDTs) have become more popular but perform badly in temperate climate. This is because the RDT kits require maintenance of cold chain for its optimal use. In this regard, there is a recent interest in handheld malaria microscopy at the point of care in the field setting. Foldscopes are cheap, handy, nonfragile, and use mobile camera for illumination. The purpose of the study was to find whether foldscope can be used in the national vector borne disease control program (NVBDCP) in India. Ten laboratory technicians were trained in identifying malaria parasites using foldscope and their mobiles. Later, they were provided with unassembled foldscope to document their test results for the preidentified malaria slides. The blood smears were stained as per the protocol of NVBDCP. The report of the index test (foldscope microscopy) was compared with the reference test (conventional microscopy). The sensitivity and specificity of the index test was found to be 13.3% (6.257-26.18), specificity of 97.78% (88.43-99.61), positive predictive value 85.71% (48.69-97.43), and negative predictive value 53.01% (42.38-63.38). The devise failure rate and test failure rate were 20% and 11.7%. The kappa agreement between the index and reference microscopy was only 11% and the McNemar P < 0.01. The ×400 foldscope at its present magnification and illumination cannot be utilized in the field under NVBDCP.

Dengue risk assessment using multicriteria decision analysis: A case study of Bhutan.

BackgroundDengue is the most rapidly spreading vector-borne disease globally, with a 30-fold increase in global incidence over the last 50 years. In Bhutan, dengue incidence has been on the rise since 2004, with numerous outbreaks reported across the country. The aim of this study was to identify and map areas that are vulnerable to dengue in Bhutan.Methodology/Principal findingsWe conducted a multicriteria decision analysis (MCDA) using a weighted linear combination (WLC) to obtain a vulnerability map of dengue. Risk factors (criteria) were identified and assigned with membership values for vulnerability according to the available literature. Sensitivity analysis and validation of the model was conducted to improve the robustness and predictive ability of the map. Our study revealed marked differences in geographical vulnerability to dengue by location and season. Low-lying areas and those located along the southern border were consistently found to be at higher risk of dengue. The vulnerability extended to higher elevation areas including some areas in the Capital city Thimphu during the summer season. The higher risk was mostly associated with relatively high population density, agricultural and built-up landscapes and relatively good road connectivity.ConclusionsUsing MCDA, our study identified vulnerable areas in Bhutan during specific seasons when and where the transmission of dengue is most likely to occur. This study provides evidence for the National Vector-borne Disease Control programme to optimize the use of limited public health resources for surveillance and vector control, to mitigate the public health threat of dengue.

Epidemiology of Post-Kala-azar Dermal Leishmaniasis.

Post-kala-azar dermal leishmaniasis (PKDL) is a cutaneous sequel of visceral leishmaniasis (VL) or kala-azar and has become an entity of epidemiological significance by virtue of its ability to maintain the disease in circulation during inter-epidemic periods. PKDL has been identified as one of the epidemiological marker of “kala-azar elimination programme.” Data obtained in 2018 showed PKDL distribution primarily concentrated in 6 countries, which includes India, Sudan, south Sudan, Bangladesh, Ethiopia, and Nepal in decreasing order of case-burden. In India, PKDL cases are mainly found in 54 districts, of which 33 are in Bihar, 11 in West Bengal, 4 in Jharkhand, and 6 in Uttar Pradesh. In West Bengal the districts reporting cases of PKDL cases include Darjeeling, Uttar Dinajpur, Dakshin Dinajpur, Malda, and Murshidabad. The vulnerability on the young age is documented in various studies. The studies also highlights a male predominance of the disease but recent active surveillance suggested that macular form of PKDL shows female-predominance. It is recommended that along with passive case detection, active survey helps in early identification of cases, thus reducing disease transmission in the community. The Accelerated plan for Kala-azar elimination in 2017 introduced by Government of India with the goal to eliminate Kala-azar as a public health problem, targets to reduceing annual incidence <1/10,000. Leishmania donovani is the established causative agent, but others like L. tropica or L. infantum may occasionally lead to the disease, especially with HIV-co-infection. Dermal tropism of the parasite has been attributed to overexpression of parasite surface receptors (like gp 63, gp46). Various host factors are also identified to contribute to the development of the disease, including high pretreatment IL 10 and parasite level, inadequate dose and duration of treatment, malnutrition, immuno-suppression, decreased interferon-gamma receptor 1 gene, etc. PKDL is mostly concentrated in the plains below an altitude of 600 mts which is attributed to the environment conducive for the vector sand fly (Phlebotumus). Risk factors are also linked to the habitat of the sand fly. Keeping these things in mind “Integrated vector control” is adopted under National vector borne disease control programme as one of the strategies to bring down the disease burden.

National Vector Borne Disease Control Programme: Current Updates

Vector-borne diseases are a group of communicable diseases transmitted by mosquitoes and other vectors. National Vector Borne Disease Control Programme is the programme for prevention &amp; control of these diseases. Many new initiatives have been undertaken in the programme which includes National Programme for Prevention &amp; Control of JE/AES, Strategic Plan for Malaria control in India (2012-2017), National Drug Policy on Malaria-2013, Environmental Codes of Practice, etc. in order to make India free from vector borne diseases with equitable access to quality health care.

El Ni\xf1o Southern Oscillation as an early warning tool for dengue outbreak in India

BackgroundDengue is rapidly expanding climate-sensitive mosquito-borne disease worldwide. Outbreaks of dengue occur in various parts of India as well but there is no tool to provide early warning. The current study was, therefore, undertaken to find out the link between El Niño, precipitation, and dengue cases, which could help in early preparedness for control of dengue.MethodsData on Oceanic Niño Index (ONI) was extracted from CPC-IRI (USA) while the data on monthly rainfall was procured from India Meteorological Department. Data on annual dengue cases was taken from the website of National Vector Borne Disease Control Programme (NVBDCP). Correlation analysis was used to analyse the relationship between seasonal positive ONI, rainfall index and dengue case index based on past 20 years’ state-level data. The dengue case index representing ‘relative deviation from mean’ was correlated to the 3 months average ONI. The computed r values of dengue case index and positive ONI were further interpreted using generated spatial correlation map. The short-term prediction of dengue probability map has been prepared based on phase-wise (El Niño, La Niña, and Neutral) 20 years averaged ONI.ResultsA high correlation between positive ONI and dengue incidence was found, particularly in the states of Arunachal Pradesh, Chhattisgarh, Haryana, Uttarakhand, Andaman and Nicobar Islands, Delhi, Daman and Diu. The states like Assam, Himachal Pradesh, Meghalaya, Manipur, Mizoram, Jammu & Kashmir, Uttar Pradesh, Orissa, and Andhra Pradesh shown negative correlation between summer El Niño and dengue incidence. Two - three month lag was found between monthly ‘rainfall index’ and dengue cases at local-scale analysis.ConclusionThe generated map signifies the spatial correlation between positive ONI and dengue case index, indicating positive correlation in the central part, while negative correlation in some coastal, northern, and north-eastern part of India. The findings offer a tool for early preparedness for undertaking intervention measures against dengue by the national programme at state level. For further improvement of results, study at micro-scale district level for finding month-wise association with Indian Ocean Dipole and local weather variables is desired for better explanation of dengue outbreaks in the states with ‘no association’.

Assessment of effectiveness of DAMaN: A malaria intervention program initiated by Government of Odisha, India.

India, a persistently significant contributor to the global malaria burden, rolled out several anti-malaria interventions at the national and state level to control and recently, to eliminate the disease. Odisha, the eastern Indian state with the highest malaria burden experienced substantial gains shown by various anti-malaria initiatives implemented under the National Vector-borne Disease Control Programme (NVBDCP). However, recalcitrant high-transmission "pockets" of malaria persist in hard-to-reach stretches of the state, characterised by limited access to routine malaria surveillance and the forested hilly topography favouring unbridled vector breeding. The prevalence of asymptomatic malaria in such pockets serves as perpetual malaria reservoir, thus hindering its elimination. Therefore, a project with the acronym DAMaN was initiated since 2017 by state NVBDCP, targeting locally identified high endemic 'pockets' in 23 districts. DAMaN comprised biennial mass screening and treatment, provisioning of long-lasting insecticidal net (LLIN) and behavioural change communication. Subsequently, to inform policy, assessment of DAMaN was conceived that aims to estimate the coverage of the various components of the project; the prevalence of malaria, even at sub-patent level especially among pregnant/lactating women and children; and its impact on malaria incidence. A survey of DAMaN beneficiaries will measure coverage; and knowledge and practices related to LLIN; along with collection of blood specimens from a probability sample. A multi-stage stratified clustered sample of 2228 households (~33% having pregnant/lactating women) will be selected from 6 DAMaN districts. Routine DAMaN project data (2017-2018) and NVBDCP data (2013-2018) will be extracted. Rapid Diagnostic Test, Polymerase Chain Reaction and blood smear microscopy will be conducted to detect malarial parasitemia. In addition to measuring DAMaN's coverage and malarial prevalence in DAMaN pockets, its impact will be estimated using pre-post differences and Interrupted Time Series analysis using 2017 as the "inflection" point. The assessment may help to validate the unique strategies employed by DAMaN.

Evaluation of bio-efficacy and durability of long-lasting insecticidal nets distributed by malaria elimination programme in Eastern India

BackgroundLong-lasting insecticidal nets (LLINs) are the most favoured vector control tools worldwide. Timely monitoring and evaluation of LLINs is important to sustain the impact of this promising vector control method and for replacement of worn-out and those rendered ineffective. During the mid-2017, LLINs were distributed by the National Vector Borne Disease Control Programme (NVBDCP) in high malaria endemic districts of the eastern coastal state of Odisha. The study was carried out to assess the field performance of the LLINs post 30 months of distribution in Koraput district of Odisha state.MethodsA total of 130 households were randomly selected from three villages of Laxmipur CHC in Koraput district, Odisha, India; one each from hilltop, foothill and plain terrain. The net users were interviewed to elicit information on usage, washing practices, physical integrity, bio-efficacy and survivorship of LLINs to confirm the claimed three-year life of the LLINs.Results74.8% of the LLINs were physically present after 30 months of distribution. The numbers (%) of LLINs used previous night varied from 30 to 61% between study villages. 74% respondents were using the LLINs throughout the year and 26% only seasonally. Of the total, 85% of the nets were reported to be washed and 95% nets were dried under shade as recommended. Altogether, 58% of the surveyed nets were found torn with holes. Of these, 74 (57%) nets were in good condition, 10 (8%) nets were in serviceable and 45 (35%) nets were badly torn and needed replacement. A total of 45 (93.75%), 68 (80%) and 71 (63.8%) LLINs were physically present in hilltop, foothill and plain villages, respectively. The LLINs did meet the efficacy criteria, given the 100% mortality to the exposed Anopheles jeyporiensis mosquitoes post 30 months distribution.ConclusionsThe findings of this study were communicated to the programme officials of the state and LLINs were replenished soon after 31st month post-distribution of LLINs.

A spatio-temporal analysis to identify the drivers of malaria transmission in Bhutan

At a time when Bhutan is on the verge of malaria elimination, the aim of this study was to identify malaria clusters at high geographical resolution and to determine its association with local environmental characteristics. Malaria cases from 2006–2014 were obtained from the Vector-borne Disease Control Program under the Ministry of Health, Bhutan. A Zero-Inflated Poisson multivariable regression model with a conditional autoregressive (CAR) prior structure was developed. Bayesian Markov chain Monte Carlo (MCMC) simulation with Gibbs sampling was used to estimate posterior parameters. A total of 2,062 Plasmodium falciparum and 2,284 Plasmodium vivax cases were reported during the study period. Both species of malaria showed seasonal peaks with decreasing trend. Gender and age were not associated with the transmission of either species of malaria. P. falciparum increased by 0.7% (95% CrI: 0.3%, 0.9%) for a one mm increase in rainfall, while climatic variables (temperature and rainfall) were not associated with P. vivax. Insecticide treated bed net use and residual indoor insecticide coverage were unaccounted for in this study. Hot spots and clusters of both species were isolated in the central southern part of Bhutan bordering India. There was significant residual spatial clustering after accounting for climate and demographic variables.

Pattern of time utilization by multipurpose health workers male in district Sonipat, Haryana

Background: A multipurpose health worker is the key functionary in a sub centre. They associate with the community at grass-root levels. This study explores time utilization pattern of multipurpose health workers in the multifarious domains of their activities.Methods: A time motion study conducted among health workers (HWs) male of all subcentres of district Sonipat, Haryana. Participants self‑reported their daily activities on a time measurement workbook for one month. Data were entered in Excel and analyzed using statistical package for social studies software.Results: Time utilization patterns revealed that HWs spent nearly one third (31.5%) of their time on national vector born disease control programme. Documentation constituted nearly 16.3% of their time. Others activities include maternal and child health (7.4%), service for minor ailment (6.7%), revised national tuberculosis control programme (6.7%) and meetings (4.5%). They spent 13.9% of their time on non-productive activities. The proportion of time spent on field-based activities was 63.2% and on sub center based activities was 22.9% of the total working time. A negative correlation of field-based activities was found with age, job experience and residing in joint family.Conclusions: The study reflects the time spent by HWs male in various domains of activities in relations to their job responsibilities and the multipurpose nature of their works. Some of the health programmes were ignored by HWs and were also found to be spending significant time on non-productive works.

A study on “clinical epidemiology of filarial lymphedema patients attending filariasis clinic in Pondicherry”

Introductionlymphatic filariasis (LF) is a vector-borne disease of the tropical and sub-tropical countries due to infection by filarial worms, which invade the lymphatics of humans initiating pathological changes leading to various clinical sequela, one major sequel of infection is lymphoedema of the limbs. MethodsThe study was carried out among the filarial lymphoedema patients attending Vector Control Research Centre & National vector Borne Disease Control Programme (NVBDCP) Clinic at Pondicherry. ResultsThe study showed that. Unilateral LE was predominant and more than 40% of the patients are from 60+ age group. LE grade was clinically assessed based on the four stage WHO criteria 1982. Over all, prevalence of LE Grade of lower extremities was Grade I 14.5%, Grade II 37.5%, Grade III 22.5% and Grade IV 25.15% and 52.1% and 76.2% were obese among male and female LE patients respectively. Frequency of more than 3 ADLA episodes was higher among grade III lymphoedema patients requiring antibiotic prophylaxis. ConclusionPrevalence of Intertrigo and frequent ADLA episodes were higher in grade III LE patients. In total 9/143 (6.29%) of LE patients had more than 3 ADLA Episodes in 1 year and these patients require antibiotic (penicillin/doxycycline prophylaxis).

The burden of Japanese encephalitis, the catch-up vaccination campaign, and health service providers\u2019 perceptions in Myanmar: 2012\u20132017

BackgroundMyanmar is endemic for Japanese encephalitis (JE) and has experienced several outbreaks in recent years. The vector-borne disease control (VBDC) program has collected hospital-based surveillance data since 1974. There is an urgent need to collate, analyze, and interpret the most recent information. The study aimed to describe (i) hospital-based JE cases and deaths between 2012 and 2017, (ii) a catch-up vaccination campaign in children in 2017, and (iii) health service provider perceptions about JE in one township in 2018.MethodsThis was a cross-sectional study of cases, deaths, and catch-up childhood vaccinations using secondary data from program records and a survey database of health service provider perceptions.ResultsBetween 2012 and 2017, there were 872 JE cases and 79 deaths with a case fatality rate of 91 per 1000; 2016 was the year with most cases and deaths. Most cases (n = 324) and deaths (n = 37) occurred in children aged 5–9 years. Large case numbers were reported in delta and lowland regions (n = 550) and during the wet season (n = 580). The highest case fatality rates were observed in the hills and coastal regions (120 and 112 per 1000, respectively). Nationwide coverage of the catch-up JE vaccination campaign among 13.7 million eligible children was 92%, with coverage lower in the hills and coastal regions (84%) compared with delta and lowland regions and plains (94%). More vaccinations (65%) occurred through school-based campaigns with the remainder (35%) vaccinated through community-based campaigns. Structured interviews in one township showed that service providers (n = 47) had good perceptions about various aspects of JE, although perceived benefits of specific vector control measures were poor: spraying/fumigation (38%), garbage removal (36%), larvicide use (36%), and drainage of standing/stagnant water (32%).ConclusionThe catch-up vaccination campaign was a successful response to high JE case numbers and deaths in children. However, ongoing surveillance for JE needs to continue and be strengthened to ensure comprehensive reporting of all cases, more knowledge is needed on disability in JE survivors, and all attempts must be made to ensure high percentage coverage of vaccination through routine and catch-up campaigns.

Frequency and trend of dengue fever in a tertiary care hospital in Kancheepuram, Tamilnadu: three-year retrospective study

Background: Dengue is a mosquito borne viral disease which is endemic in the tropical and subtropical regions. In the recent years it has become a significant public health problem and its incidence is increasing in India. In 2016 1.1 lakh new dengue cases were reported in India. The objectives of the study was to describe the frequency and distribution of dengue infection and to determine the association between dengue infection and selected variables.Methods: The study is a hospital based retrospective study conducted in a tertiary care hospital in a rural area of Kancheepuram district. Three-year data (January 2015 to December 2017) was collected from the medical records department of the hospital. Dengue cases were diagnosed by ELISA test.Results: Among 340 dengue patients admitted in the hospital 240 (74.5%) were male and 100 (25.5%) were female. In this study, 306 (90%) patients were of the classical dengue type and 34 (10%) patients belong to dengue haemorrhagic fever type. There is a spike in the case load after the monsoons. There was a positive statistical significant association (p&lt;0.0001) between dengue infection and male sex, low socioeconomic status and platelet count at the time of admission.Conclusions: Results of the study indicate that there should be proper education of the public through various available Medias and awareness campaigns. All dengue patients must be appropriately treated in order to prevent complications. The national vector borne disease control program must extend its coverage to combat dengue infection.

Epidemiology of malaria and chloroquine resistance in Mizoram, northeastern India, a malaria-endemic region bordering Myanmar

BackgroundMizoram, a northeastern state in India, shares international borders with Myanmar and Bangladesh and is considered to be one of the key routes through which drug-resistant parasites of Southeast Asia enter mainland India. Despite its strategic location and importance, malaria epidemiology and molecular status of chloroquine resistance had not been well documented, and since chloroquine (CQ), as the first-line treatment in Plasmodium falciparum infection was discontinued since 2008, it was expected that CQ-sensitive haplotype would be more abundant.MethodsMalaria epidemiology data for the period 2010 to 2018 was collected from the office of State Vector Disease Control Programme. Plasmodium falciparum-positive blood samples were collected from government district hospitals, community health centres, primary health centres, sub-centres, and diagnostic centres from six malaria-prone districts. The samples were processed and analysed using genes–P. falciparum chloroquine-resistant transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) via sequencing of PCR amplicon from 2015 to 2017.ResultsMalaria occurred throughout the year and P. falciparum accounted for > 89% of total malaria cases. During 2010–2018, the highest number of malaria incidence was recorded in Lawngtlai (36% of total malaria cases; average API2010–2018 of 34.8) while Champhai remained consistently low (0.4%; average API2010–2018 of 0.04). Males of ≥ 15 years old contributed maximum (35.7%) among gender and age malarial distribution recorded during 2014–2018. Death due to malaria gradually decreased over the years. A higher abundance of mutated pfcrt (58.5% of the total sample analysed) and a lower prevalence of mutated pfmdr1 (48.7%) were observed. All mutations identified for pfcrt belong to the Southeast Asian CVIET haplotype. Only a single point mutation was observed at 86 (N → Y) position in pfmdr1 (48.7%). The key N86Y mutation in pfmdr1 that had been shown to modulate CQR was found in 67.1% of the samples positive for the CVIET haplotype.ConclusionsThis is the first report that details malaria epidemiology and also the molecular status of CQ-resistance in P. falciparum population of the region. The efforts of the State Vector Borne Disease Control Programme have proved to be quite effective in controlling the malaria burden in the state. Despite the discontinuation of CQ for a decade, local P. falciparum is observed with decreased CQ-sensitive haplotype. It is believed that the present findings will form a basis for further studies on genetic diversity in P. falciparum, which could confer better understanding of the complexity of the disease in Southeast Asia.

Trend Analysis of Three Major Mosquito Borne Diseases in Punjab, India

Background & Objectives: Understanding the distribution and prevalence of three major mosquito borne diseases in an area is critical for the development of effective vector control strategies and public health interventions. The present study is therefore aimed to explore the epidemiological trend of malaria, dengue and chikungunya from 2012 to 2018 in Punjab. Methods: Quantitatively retrospective data was collected from Department of Health and Family Welfare, the National Vector Borne Disease Control Programme (NVBDCP), Punjab from 2012 to March 2018. The collected data was statistically analysed. Results: In case of malaria highest prevalent districts in Punjab are Mansa and Bathinda, for dengue Patiala, Ludhiana and S.A.S. Nagar and Patiala for chikungunya. Malaria was reported mainly from rural areas while dengue and chikungunya were found more in urban areas. For all three mosquito borne diseases, males were infected more as compared to females. Malaria cases were reported in months of August and September while dengue cases increased from July to November whereas chikungunya cases were highest in months of August to October. Conclusions: These findings help in concluding the trend analysis which in turn helps us to increase our focus on disease endemic districts along with boosting the vector control strategies in respective districts. Further the control of these mosquito borne diseases can be solved by employing adequate human resources, by increasing awareness in the community by conducting health camps and strengthening the entomological surveillance for timely reduction in the breeding of the vectors, especially before the repeated rise in cases during the period from July to November each year.

Malaria case detection in Chhattisgarh, 2015–2019: Comparison of cases reported by the National Vector Borne Disease Control Programme and community health workers

Malaria case detection in Chhattisgarh, 2015–2019: Comparison of cases reported by the National Vector Borne Disease Control Programme and community health workers

Japanese encephalitis in Uttar Pradesh, India: A situational analysis.

Introduction:Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Disease Control Programme uses the term Acute Encephalitis Syndrome (AES). In this study, an attempt has been made to ascertain the status and trends of AES and JE in Uttar Pradesh, India.Methodology:This is a record-based retrospective study. The data were obtained from the Directorate of Medical and Health Services of Uttar Pradesh and analyzed using software SPSS version 24.0.Results:In Uttar Pradesh, there were 47,509 reported cases of AES from 2005 to 2018,. With yearly fluctuations, the average Case Fatality Rate of AES was 17.49% with highest in 2005 (24.76%) and lowest in 2018 (8%). Among the patients with AES, 9.98% were found positive for JE. The most commonly affected age group is 1-5 years for both AES and JE, closely followed by the age group of 5-10 years. Peak occurrence of both AES and JE was recorded in month of September. Among the AES-affected patients 53.8% were males and 46.2% were females.Conclusion:The most commonly affected age group was 1-5 years with peak occurrence in the month of September. Though there was a downward trend in CFR, awareness activities like “Dastak” campaign and intersectoral preventive activities, needs to be strengthened.

Forecasting of Malaria in India Using Time Series Analysis

Background: Although there has been marked reduction in the number of malaria cases in India under National Vector Borne Disease Control Programme (NVBDCP), malaria still is the leading cause of infectious diseases with the development of drug resistant Plasmodium species and insecticide resistant mosquitoes. Keeping this in view, the present study attempts to forecast the malaria cases in India. Methods: We adopted an Auto Regressive Integrated Moving Average (ARIMA) models on the data collected on the number of malaria cases from 1990 to 2017 .The same has been used to predict the number of cases till 2025 without any additional intervention. Results: The results also showed a decreasing trend in the actual and forecasted numbers of malaria cases. The appropriate ARIMA (10, 1, 9) model was selected based on Bayesian Information Criteria (BIC) values. Conclusions: Hence, to achieve the target of Sustainable Developmental Goal by 2030, additional interventions with an increase in the intensity of existing interventions and support of the international community along with WHO is essential.

Malaria risk map for India based on climate, ecology and geographical modelling.

Mapping the malaria risk at various geographical levels is often undertaken considering climate suitability, infection rate and/or malaria vector distribution, while the ecological factors related to topography and vegetation cover are generally neglected. The present study abides a holistic approach to risk mapping by including topographic, climatic and vegetation components into the framework of malaria risk modelling. This work attempts to delineate the areas of Plasmodium falciparum and Plasmodium vivax malaria transmission risk in India using seven geo-ecological indicators: temperature, relative humidity, rainfall, forest cover, soil, slope, altitude and the normalized difference vegetation index using multi-criteria decision analysis based on geographical information system (GIS). The weight of the risk indicators was assigned by an analytical hierarchical process with the climate suitability (temperature and humidity) data generated using fuzzy logic. Model validation was done through both primary and secondary datasets. The spatio-ecological model was based on GIS to classify the country into five zones characterized by various levels of malaria transmission risk (very high; high; moderate; low; and very low. The study found that about 13% of the country is under very high malaria risk, which includes the malaria- endemic districts of the states of Chhattisgarh, Odisha, Jharkhand, Tripura, Assam, Meghalaya and Manipur. The study also showed that the transmission risk suitability for P. vivax is higher than that for P. falciparum in the Himalayan region. The field study corroborates the identified malaria risk zones and highlights that the low to moderate risk zones are outbreak-prone. It is expected that this information will help the National Vector Borne Disease Control Programme in India to undertake improved surveillance and conduct target based interventions.

1785. Dengue Outbreaks and Predominant Circulating Virus Serotypes and Genotypes over More Than Two Decades in a Hyper-endemic Region

BackgroundDengue is the most widespread arboviral disease globally. Serotyping of dengue viruses and their genotyping is important in tracing the epidemiology of the disease, monitoring trends and anticipating the possibility of outbreaks in a community.MethodsThis study is a retrospective analysis, based on data from a tertiary care center from Delhi, India and their correlation with reported literature on circulation and outbreaks of dengue in this region of north India since 1996, when the first virus isolation confirmed outbreak of dengue was reported by our virology laboratory (an Apex Laboratory of the National Vector Borne Disease Control Program, Government of India).Circulating serotypes of DENV were detected and identified from serum samples of suspected dengue patients with fever of 5 days duration or less, by virus isolation in cell culture and/or by real-time or conventional reverse transcription polymerase chain reaction (PCR). Representative serum samples of patients with suspected dengue with duration of fever <5 days were inoculated onto the C6/36 clone of Aedes albopictus cells, and the isolates were identified by indirect immunofluorescence using serotype-specific monoclonal antibodies. Sequencing was done for representative strains as required.ResultsThe predominant serotypes identified were DENV 2 (1996), followed temporally by DENV 1 (1997–2002), DENV 3 (2003–2007), DENV 1 (2008–2012), DENV 2 (2013–2015), and DENV 3 (2016–2018). In 2003, Delhi became hyper-endemic for dengue, with all dengue serotypes co-circulating. Predominant serotypes continued to circulate for 3–6 years. Outbreaks occurred either in the year a serotype was re-introduced after a gap of a few years to become the predominant serotype, or in the following year; except in 2015, when there was a genotypic lineage change in a DENV 2 serotype which had been predominant since 2 years prior to the outbreak year.ConclusionRe-introduction of a dengue serotype which was out of circulation for a few years can precipitate an outbreak. Analysis of temporal patterns and close monitoring of circulating virus strains, particularly at either end of the transmission season, may help in early prediction of the trend for a given year, providing an opportunity to put in place control measures well in time.Disclosures All authors: No reported disclosures.