Vector Borne Disease Control Programme Research Articles

Epidemiological Trends of Dengue in One of the Western Hilly Areas of Himachal Pradesh

Background: Dengue is one of the neglected tropical diseases, with a wide spectrum of diseases, ranging from acute febrile illness dengue fever to life-threatening dengue hemorrhagic fever or dengue shock syndrome. In recent years, it has become a major public health concern in many nonendemic areas as well. Materials and Methods: A secondary data analysis of records available with district Integrated Disease Surveillance Programme cell was conducted to study distribution (time, place, and person) of dengue from 2017 to 2022 in Kangra, a sub-Himalayan district of Himachal Pradesh (HP). Results: In the evaluated period (2017–2022), a total of 6008 cases suspected of dengue were tested and test positivity of 7% (441) with male gender predominance was found. Mean age of the diagnosed cases was 37.7 ± 16.8 years. A seasonal trend was observed starting from late August to November in all study years. Conclusion: Dengue is still a neglected disease, but it has shown its presence especially in this part of HP, indicating the need for better preparation and sensitization of vector-borne disease control program activities, especially in post-monsoon, to prevent future epidemics.

Role of homoeopathy of Ayush in dengue fever

In 21st century, dengue came to the limelight. Earlier, it was taught that this is one of the eruptive fevers in human beings where in dengue, the eruption appears typically on the 6th day of the fever. Knowledge and approaches to dengue took a paradigm shift in 21st century. It came to be clubbed under the National Vector Borne Disease Control Program. A mosquito borne single stranded RNA virus is the leading cause of arthropod borne viral diseases like dengue globally. All the types of dengue virus are capable of inducing severe diseases like dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). No one wants to be in DHF or DSS stage as these are mortal stages while other stages are morbid. A vector borne disease (VBD) transmitted by mosquito has no specific cure in modern medicine. To add to that, the issue of platelet transfusion that is made universal because of the inherent panic does more harm than good. It is here that homoeopathy has a role to play therapeutically. The article discusses the disease and the related physiology as well as pathology that goes inside the body during an episode of dengue fever. Along with the diagnosis and management approaches, the article elicits the role of homoeopathy through a suggested treatment protocol. Through the inherent properties of homoeopathy such as cost effectiveness, clinical effectiveness and zero side effects, the article proposes large scale application of homoeopathy at all levels.

Strength in struggle: unravelling the journey of national vector borne disease control programme India: a comprehensive SWOT analysis

India, like many other regions, faces the substantial burden of vector-borne diseases. Initially confined to tropical and sub-tropical regions, vector-borne diseases are now spreading to new geographies due to increasing unplanned urbanization, changes in land use, growing international travel, and the impact of climate and environmental dynamics. To address these challenges, India implemented the National Vector Borne Disease Control Program (NVBDCP) in 2003-04, which targets the prevention and control of the six vector-borne diseases. Over the years, numerous initiatives have been undertaken to combat the challenges posed by vector-borne diseases in India. The successes, such as streamlined resource utilization and the introduction of effective tools, have led to substantial reductions in disease burden. Nevertheless, issues like manpower shortages, logistical hurdles, and a lack of research resources remain as challenges. Moreover, the program must confront emerging threats posed by urbanization, climate change, and resistance to treatments. NVBDCP's roadmap for the future includes embracing opportunities like vaccine development, and research, as well as fostering collaborations with partners. By addressing its weaknesses and effectively managing the threats at hand, the program can continue its vital mission of combatting vector-borne diseases in India. The implementation of these strategies is essential to ensure the sustained success of disease control and prevention efforts in the country.

Coverage evaluation of mass drug administration with triple drug regimen in an evaluation unit in Nagpur district of Maharashtra, India.

Triple drug regimen (IDA; Ivermectin, Diethylcarbamazine, Albendazole) recommended for accelerating elimination of lymphatic filariasis was launched in India in December 2018. Nagpur district in Maharashtra was one of the first five districts where this strategy was introduced. The National Vector Borne Disease Control Programme (NVBDCP) at the district reported ~85.0% treatment coverage in the first round of mass drug administration (MDA) with IDA implemented in EU-2 in Nagpur district in January 2019. As per the national guideline, a coverage evaluation survey was carried out and both quantitative and qualitative data were collected to assess the treatment coverage, the level of community preparation and identify the gaps, if any, for improvement. A Coverage Evaluation Survey (CES) following the WHO recommended protocol was conducted in one of the two evaluation units (EU-2) in Nagpur district in March 2019. Coverage Sample Builder (CSB) V2.9 tool was used to calculate the sample size, select sites and estimate drug coverage. The CSB tool followed a two-stage cluster sampling procedure to select 30 primary sampling units (ward/village as a cluster) and a list of random numbers for selecting households (HHs) in each cluster. The results were analyzed for operational indicators. Stata ver. 14.0 software was used to construct the 95% confidence limits accounting for clustering. A total of 1601 individuals aged 5-85 years of both gender from 328 HHs were surveyed from the 30 randomly selected clusters in EU-2. The mean age was 33.8±17.6 years. Among the surveyed population, 78.0% received the drugs (programme reach) and 66.1% consumed the drugs (survey coverage). Survey coverage was significantly higher in rural (82.6%) than in urban (59.4%) and peri-urban (58.6%) areas (P<0.001). Directly observed treatment (DOT) among the surveyed population was 51.6%. Adverse events were reported among 6.9% respondents who reported to have consumed the drugs. The IDA based MDA strategy could achieve just the required level of treatment coverage (~65%) in EU-2, Nagpur district, which had previously undergone several rounds of DA-MDAs (Diethylcarbamazine, Albendazole). Having achieved an effective treatment coverage of >80% in rural areas, the coverage in urban and peri-urban areas need to be improved in order to attain the impact of IDA-MDA. It is imperative to strengthen drug delivery and community preparation activities along with improved DOT especially in urban and peri-urban areas to achieve the required level of treatment coverage. Addition of ivermectin did not have any additional perceived adverse events.

Semantic web-based diagnosis and treatment of vector-borne diseases using SWRL rules

Vector-borne diseases (VBDs) are a kind of infection caused through the transmission of vectors generated by the bites of infected parasites, bacteria, and viruses, such as ticks, mosquitoes, triatomine bugs, blackflies, and sandflies. If these diseases are not properly treated within a reasonable time frame, the mortality rate may rise. In this work, we propose a set of ontologies that will help in the diagnosis and treatment of vector-borne diseases. For developing VBD’s ontology, electronic health records taken from the Indian Health Records website, text data generated from Indian government medical mobile applications, and doctors’ prescribed handwritten notes of patients are used as input. This data is then converted into correct text using Optical Character Recognition (OCR) and a spelling checker after pre-processing. Natural Language Processing (NLP) is applied for entity extraction from text data for making Resource Description Framework (RDF) medical data with the help of the Patient Clinical Data (PCD) ontology. Afterwards, Basic Formal Ontology (BFO), National Vector Borne Disease Control Program (NVBDCP) guidelines, and RDF medical data are used to develop ontologies for VBDs, and Semantic Web Rule Language (SWRL) rules are applied for diagnosis and treatment. The developed ontology helps in the construction of decision support systems (DSS) for the NVBDCP to control these diseases.

Recognizing Local Champions in Infection Prevention and Control.

Recognizing Local Champions in Infection Prevention and Control.

Coverage of mass drug administration (MDA) and operational issues in elimination of lymphatic filariasis in selected districts of Jharkhand, India.

Despite annual rounds of mass drug administration (MDA) being carried out every year since 2004 to break the transmission of lymphatic filariasis, India has not achieved elimination status in many areas of country. This study was conducted to determine the operational issues in the implementation of MDA for elimination of lymphatic filariasis in selected districts of Jharkhand. Two districts of Jharkhand state were selected for present cross-sectional study. Multi-staged cluster sampling was adopted to select study participants. Data were collected with use of prescribed questionnaire of National Vector Borne Disease Control Programme (NVBDCP) from the study participants. Data related to socio-demographic details, coverage and compliance of MDA and operational issues were collected. Findings of independent assessment show that percentage of MDA coverage and compliance for Hazaribag district was 96.02% and 88.90%, respectively. On the other hand, percentage of MDA coverage and compliance was found to be only 67.06% and 48.44% in Chatra district. Overall drug consumption was significantly associated with age group (p-value = 0.045), educational status (p-value = <0.0001) and socio-economic status (p-value <0.0001) of eligible population. Most common reason for not swallowing the drugs was found to be absence of family members at the time of MDA rounds followed by no visit of house by drug distributors. Coverage and compliance of MDA was better in Hazaribag district as compared to Chatra district. In order to increase compliance, socio-demographic factors must also be addressed apart from other operational issues.

A study to assess knowledge of primary health workers on malaria epidemiology, diagnosis, and treatment in Patiala district, India

Background: India accounts for (4%) of all malaria cases worldwide. The World malaria report 2017 showed that, by 2016, global progress against malaria had stalled and was off track to meet the Global Technical Strategy milestones for 2020. Aims and Objectives: The aim of the study is to assess knowledge of rural medical officers (RMO) and health workers on malaria epidemiology, diagnosis, and treatment as per National Vector Borne Disease Control Program of India guidelines. Materials and methods: A descriptive, observational, and cross-sectional study was done among government health personnel’s using a semi-structured questionnaire. Results: In the present study, 258 health personnel’s participated comprising multipurpose health workers female (MPHW-F), multipurpose health worker male (MPHW-M), and RMO. The standardized score on knowledge of vector biology and epidemiology was 72% and 54% for RMO and (MPHW-M), respectively. On malaria diagnosis, MPHW-M has got median score (53%) as compared to RMO (46%). On national malaria drug policy, there is a marginal difference between median score of RMO (42%) and MPHW-M (40%). Overall, there is incomplete and poor knowledge of treatment of malaria among all health personnel’s with lack of concept about presumptive treatment. Training showed some positive impact on the knowledge of MPHW-F but no impact on MPHW-M. Graduates and experienced workers have got better knowledge than undergraduates and MPHW-M have more knowledge than MPHW-F. There is poor knowledge of reporting formats, and usage of rapid diagnostic kits among all the health personnels. There was no significant impact of education qualification, in service training and work experience on the knowledge of Male health workers. Conclusion: Training needs to be suitably tailored as there is a lot of scope of improvement in the knowledge regarding malaria diagnosis and treatment among health workers.

Insecticide resistance status of malaria vectors in the malaria endemic states of India: implications and way forward for malaria elimination

BackgroundIn 2012, the World Health Organization (WHO) released the Global Plan for Insecticide Resistance Management in malaria vectors to stress the need to address insecticide resistance. In a prospective multi-centric study commissioned by the Indian Council of Medical Research (ICMR), we assessed the insecticide susceptibility status of the primary malaria vectors in India from 2017 through 2019. MethodsThe insecticide susceptibility status of the prevalent primary malaria vectors – An. culicifacies, An. fluviatilis, An. stephensi, An. minimus and An. baimaii and secondary malaria vectors - An. aconitus, An. annularis and An. philippinensis/nivepes from 328 villages in 79 districts of 15 states of India were assessed following the WHO method mainly to insecticides used in vector control, organochlorine (DDT), organophosphate (malathion), and other pyrethroids (alpha-cypermethrin, cyfluthrin, lambda-cyhalothrin and permethrin). The study sites were selected as suggested by the National Vector Borne Disease Control Programme. ResultsThe primary malaria vector An. culicifacies showed resistance to DDT (50/50 districts including two districts of Northeastern India), malathion (27/44 districts), and deltamethrin (17/44 districts). This species was resistant to DDT alone in 19 districts, double resistant to DDT-malathion in 16 districts, double resistant to DDT-deltamethrin in 6 districts, and triple resistant to DDT-malathion-deltamethrin in 9 districts. An. minimus and An. baimaii were susceptible in Northeastern India while An. fluviatilis and the secondary malaria vector An. annularis was resistant to DDT in Jharkhand. ConclusionIn this study we report that among the primary vectors An. culicifacies is predominantly resistant to multiple insecticides. Our data suggest that periodic monitoring of insecticide susceptibility is vital. The national malaria program can take proactive steps for insecticide resistance management to continue its push toward malaria elimination in India.

Prevention and Elimination of Malaria in India

India, just like many other countries in the world, has been combating malaria for a long time. Its geographical location along with its climate and general economic situation, have been causing the country to be a common habitat for malaria, which is a vector-borne disease carried by mosquitoes, as they mainly thrive in swamps or undrained ponds that are prevalent in India throughout the year. Witnessing the rise of the spread of malaria in India, the government does not just sit back and practice non-intervention, rather, over the past decades, the government, though not often entirely successful, have been developing various strategies and programs in countering the disease. Some of the most crucial ones include the National Malaria Control Programme in 1953 and agencies established include the National Vector Borne Disease Control Programme that has been developing plans for total eradication of malaria by 2030. Some of the strategies include traditional use of pesticides, while others are about distributing medications and improving surveillance programs in tracking the disease.

Spatio-temporal distribution and hotspots of Plasmodium knowlesi infections in Sarawak, Malaysian Borneo

Plasmodium knowlesi infections in Malaysia are a new threat to public health and to the national efforts on malaria elimination. In the Kapit division of Sarawak, Malaysian Borneo, two divergent P. knowlesi subpopulations (termed Cluster 1 and Cluster 2) infect humans and are associated with long-tailed macaque and pig-tailed macaque hosts, respectively. It has been suggested that forest-associated activities and environmental modifications trigger the increasing number of knowlesi malaria cases. Since there is a steady increase of P. knowlesi infections over the past decades in Sarawak, particularly in the Kapit division, we aimed to identify hotspots of knowlesi malaria cases and their association with forest activities at a geographical scale using the Geographic Information System (GIS) tool. A total of 1064 P. knowlesi infections from 2014 to 2019 in the Kapit and Song districts of the Kapit division were studied. Overall demographic data showed that males and those aged between 18 and 64 years old were the most frequently infected (64%), and 35% of infections involved farming activities. Thirty-nine percent of Cluster 1 infections were mainly related to farming surrounding residential areas while 40% of Cluster 2 infections were associated with activities in the deep forest. Average Nearest Neighbour (ANN) analysis showed that humans infected with both P. knowlesi subpopulations exhibited a clustering distribution pattern of infection. The Kernel Density Analysis (KDA) indicated that the hotspot of infections surrounding Kapit and Song towns were classified as high-risk areas for zoonotic malaria transmission. This study provides useful information for staff of the Sarawak State Vector-Borne Disease Control Programme in their efforts to control and prevent zoonotic malaria.

IMPACT OF HABITAT QUALITY VARIATIONS ON SOMEBEHAVIOURAL ASPECTS OF LARVIVOROUS FISH

Over 85 per cent of all known animal species belong to Arthropoda which includes the vectors of most important diseases. They affect our health either directly by bites, stings or indirectly throughdisease transmission. Several genera of Arthropods like mosquitoes, flies, ticks and mites play animportant role in human disease transmission. The most significant vector borne disease transmission is by blood feeding insects. Utilization of larvivorous fish in vector borne disease control programme is gaining momentum. Poecilia reticulata survives in all types of water bodies and can tolerate high degree of pollution. It is prolific breeder and surface feeder, carnivorous, thus efficient larvivorous fish. Present investigation reveals that low oxygen content in sewage water and surface feeding nature make it to stay at surface waters for longer time as compared to pond water.

Implementation and acceptance of government-sponsored malaria control interventions in Meghalaya, India

BackgroundIndia has made considerable progress in malaria reduction over the past two decades, with government-sponsored indoor residual spraying (IRS) and insecticide-treated bed net (ITN) or long-lasting insecticidal nets (LLIN) distribution being the main vector-related prevention efforts. Few investigations have used non-participant observational methods to assess malaria control measures while they were being implemented, nor documented people’s perceptions and acceptance of IRS or LLINs in India, and none have done so in the northeast region. This study evaluated household (HH)-level operation of IRS and distribution of LLINs by India’s National Vector Borne Disease Control Programme (NVBDCP) in 50 villages of Meghalaya state, and documented their acceptance and use.MethodsStudy field teams accompanied the government health system teams during August-October, 2019 and 2020 to observe deployment of LLINs, and record HH-level data on LLIN numbers and use. In addition, NVBDCP spray teams were followed during 2019–2021 to observe IRS preparation and administration. HH members were interviewed to better understand reasons for acceptance or refusal of spraying.ResultsA total of 8386 LLINs were distributed to 2727 HHs in 24 villages from five Primary Health Centres, representing 99.5% of planned coverage. Interviews with 80 HH residents indicated that they appreciated the LLIN dissemination programme, and generally made regular and appropriate use of LLINs, except during overnight travel or when working in agricultural fields. However, HH-level IRS application, which was observed at 632 HHs, did not always follow standard insecticide preparation and safety protocols. Of 1,079 occupied HHs visited by the spray team, 632 (58.6%) refused to allow any spraying. Only 198 (18.4%) HHs agreed to be sprayed, comprising 152 (14.1%) that were only partly sprayed, and 46 (4.3%) that were fully sprayed. Reasons for refusal included: inadequate time to rearrange HH items, young children were present, annoying smell, staining of walls, and threat to bee-keeping or Eri silk moth cultivation.ConclusionsThese findings are among the first in India that independently evaluate people's perceptions and acceptance of ongoing government-sponsored IRS and LLIN programmes for malaria prevention. They represent important insights for achieving India's goal of malaria elimination by 2030.

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Background: India is one of the 7 identified countries in south-east Asia region regularly reporting dengue fever outbreaks. Dengue can present with varying degrees of severity of illness in Indian children, present study is aimed at studying the clinical presentation lab findings and mortality risk among patients of dengue fever admitted in PICU in a tertiary care centre in South-east Rajasthan. Methods: It is a retrospective observational study. All dengue seropositive patients admitted in PICU from August 2021 to October 2021 were included in the study. Patients were classified based on National Vector Borne Disease Control Program (NVBDCP). Clinical presentation laboratory findings and mortality risk among patient were studied. esults: Out of 61 patients with dengue, 28(46%) were males and 33(54%) were females. Fever was present in 100% cases followed by GI symptoms vomiting(54.1%), pain abdomen(52.5%) and bleeding manifestations(26.2%) were common presenting complaints. On examination common findings were conjunctival congestion (57%) , hepatomegaly (44%) and flushing (26%). Among complications hypotension/shock (51%) was the commonest followed by hemorrhage (31%), pleural effusion and hepatitis each 21%. Most common bleeding manifestation was melena (19%). Most common affected age group was between10-15 years (42.6%).

Trend of emerging vector borne diseases in India: way forward

There has been a drastic change in climate patterns in the recent past, the impact of which can be observed in the rapidly changing trend of many diseases particularly vector borne diseases. India has been endemic for many vector borne diseases namely malaria, filaria and kala azar. Implementation of strict public health measures and calculated strategies under the vector borne disease control program has been successful in controlling these diseases. However, the country is witnessing an emergence and increasing threat of new vector borne diseases in the form of Chikungunya, Nipah virus, Zika virus and others. This article discusses the epidemiological aspects of some important emerging vector borne diseases in the context of changing ecology and transmission pattern along with the public health implications, and way forward for preparedness to combat their further spread.

Radiological features of dengue fever in cases and control

Background: Dengue (pronounced DENgee) fever is a painful, debilitating mosquito-borne disease caused by any one of four closely related dengue viruses. Aim of the study was to study radiological features of dengue fever in cases and control.Methods: Randomized, double blind, placebo controlled, parallel group study conducted among 100 seropositive dengue patients,18-60 years of age (fulfilling inclusion and exclusion criteria) at Lala Lajpat Rai hospital, Kanpur for December 2019 October 2021. Selected patients were subjected to history, examination, necessary investigations and then were managed according to national vector borne disease control programme (NVBDCP) guidelines. A total of 100 serology proven dengue patients were included and followed up. Two groups (fifty in each) were allocated by simple first and then systematic random sampling. Case group was given doxycycline and control group was given placebo.Results: USG findings commonly seen in both the cases and control group were hepatomegaly, splenomegaly, ascites right pleural effusion, thickened GB wall and edema. In both the groups, pleural effusion was the most common complication.Conclusions: Ultrasound examinations detected plasma leakage in multiple body compartments around time of defervescence. Presence of plasma leakage in form of ascites and pleural effusion was more in control group as compared to case group seems doxycycline decrease the plasma leakage. Pleural effusion is most common finding of plasma leakage.

A Study of Malaria in Chhattisgarh State of India

Background: In 2019, Chhattisgarh contributed 2.29% of the population of India and 18% of Malaria cases in the country. Bastar Division contributed 76% of cases in the state. Objectives: To study the distribution of Malaria in Chhattisgarh and measures being adopted by the state government to tackle it. Methods: Analysis of the annual reports of the Malaria Division of the National Vector Borne Disease Control Programme (NVBDCP). Also, an analysis of NVBDCP annual reports from Chhattisgarh’s Department of Health website. In addition, a web search was made of reports pertaining to the recently held “Malaria-Mukt Bastar Abhiyan” campaigns held in Chhattisgarh. Results: The impact of the Phase 1 and Phase 2 campaigns were as follows. In the year prior to November 2019, there were 5272 cases of Malaria in the Bastar region. During the next year until November 2020, there were only 2696 cases. In other words, there was a reduction of about half in the number of Malaria cases. Conclusion: Therefore, some beneficial effects of these campaigns emerged in that the reservoirs of the malarial parasite, which is, the humans were effectively treated thereby reducing the number of those persons who could be sources of infection to the female Anopheline mosquito.

A Study of Malaria in Jharkhand State

Background: The aim of India is to reach zero Malaria cases by 2027 and then wait for three years before WHO can grant Malaria-free status certification. It is already the beginning of 2022 and India is about to reach the halfway mark of the Malaria Elimination framework period of 2016 to 2027. Objectives: To see how far Jharkhand has reached about Malaria elimination targets. Methods: By reviewing documents published by the National Vector Borne Disease Control Programme (NVBDCP). Results: The Latehar District of Jharkhand had a very high Annual Parasite Incidence (API) of 10.86 during 2018. Conclusions: If interventions like the treatment of positive patients and asymptomatic carriers occur, the API will be expected to decrease drastically.

ROAD TO VISCERAL LEISHMANIASIS ELIMINATION IN BIHAR: A SITUATIONAL ANALYSIS.

Visceral Leishmaniasis (VL) is endemic in very few countries and the predominant incidence is in the Indian state of Bihar. We aimed to study the implementation of key elimination strategies in Bihar in the last 5 years. We studied secondary data obtained from the National Vector Borne Disease Control Programme. Variables studied were VL case count, adequacy of drug and diagnostics supply and also of coverage of insecticide residual spray. Our results show a drastic decrease in VL case count in Bihar although some hot spots still remain. Case count does not show any specic trend with drug and diagnostic supply. The continuous drug availability and diagnostic kits along with indoor residual spray(IRS) is key to VL elimination.

The Outbreaks of Acute Encephalitis Syndrome in Uttar Pradesh, India (1978-2020) and Its Effective Management: A Remarkable Public Health Success Story.

IntroductionAcute encephalitis syndrome (AES) is a major public health enigma in India and the world. Uttar Pradesh (UP) is witnessing recurrent and extensive seasonal AES outbreaks since 1978. Government of India and UP state government have devised various mitigation measures to reduce AES burden and AES associated mortality, morbidity and disability in Uttar Pradesh. The aim of this study was to describe the public health measures taken in order to control seasonal outbreaks of AES in UP between 1978 and 2020.MethodsWe used literature review as a method of analysis, including the Indian government policy documents. This review utilized search engines such as PubMed, Google Scholar, Research Gate, Cochrane, Medline to retrieve articles and information using strategic keywords related to Acute Encephalitis Syndrome. Data was also collected from progress reports of government schemes and websites of Indian Council of Medical Research (ICMR), National Vector Borne Disease Control Programme (NVBDCP) and Integrated Disease Surveillance Programmes (IDSP).ResultsThe incidence of AES cases in UP have declined from 18.2 per million population during 2005-2009 to 15 per million population during 2015-2019 [CI 12.6–20.6, P-value < 0.001] and case fatality rate (CFR) reduced from 33% during 1980-1984 to 12.6% during 2015-2019 [CI 17.4–30.98, P-value < 0.001]. AES incidence was 9 (2019) and 7 (2020) cases per million populations respectively and CFR was 5.8% (2019) and 5% (2020). This decline was likely due to active surveillance programs identifying aetiological agents and risk factors of AES cases. The identified etiologies of AES include Japanese encephalitis virus (5–20%), Enterovirus (0.1–33%), Orientia tsutsugamushi (45–60%) and other viral (0.2–4.2%), bacterial (0–5%) and Rickettsial (0.5–2%) causes. The aggressive immunization programs against Japanese encephalitis with vaccination coverage of 72.3% in UP helped in declining of JE cases in the region. The presumptive treatment of febrile cases with empirical Doxycycline and Azithromycin (EDA) caused decline in Scrub Typhus-AES cases. Decrease in incidence of vector borne diseases (Malaria, Dengue, Japanese Encephalitis and Kala Azar) i.e., 39.6/100,000 population in 2010 to 18/100,000 population in 2017 is highlighting the impact of vector control interventions. Strengthening healthcare infrastructure in BRD medical college and establishment of Encephalitis Treatment Centre (ETC) at peripheral health centres and emergency ambulance services (Dial 108) reduced the referral time and helped in early treatment and management of AES cases. The AES admissions increased at ETC centres to 60% and overall case fatality rate of AES declined to 3%. Under clean India mission and Jal Jeevan mission, proportion of population with clean drinking water increased from 74.3% in 1992 to 98.7% in 2020. The proportion of household having toilet facilities increased from 22.9% in 1992 to 67.4% in 2020. Provisions for better nutritional status under state and national nutrition mission helped in reducing the burden of stunting (52%) and wasting (53.4%) among under five children in 1992 to 38.8% (stunting) and 36.8% (wasting) in year 2018. These factors have all likely contributed to steady AES decline observed in UP.ConclusionThere is a recent steady decline in AES incidence and CFR since implementation of intensive AES surveillance system and JE immunization campaigns which is highlighting the success of interventions made by central and state government to control seasonal AES outbreaks in UP. Currently, AES incidence is 9 cases per million population (in year 2019) and mortality is 5.8%.