Burden of Vector Borne Diseases Past, Present & Future

Burden of Vector Borne
Diseases
Dr. Pradip Awate
State Surveillance Officer, IDSP,
Maharashtra

Bharati Vidyapith CME 3 AUG 14

Fossil Mosquito
Almost 30 million years old found in
geologic strataBharati Vidyapith CME 3 AUG 14

Vector Borne Diseases
• Vectors are organisms that transmit pathogens and
parasites from one infected person (or animal) to
another.
• Commonly found in tropical and sub-tropical regions.
• Over half the world's population is at risk from vector-borne
diseases such as malaria and dengue.
• Vector-borne diseases account for 17% of the estimated
global burden of all infectious diseases.
• The most deadly vector-borne disease, malaria.
• The world's fastest growing vector-borne disease is
dengue.

VECTOR
BORNE
DISEASES
VECTOR
BORNE
DISEASES
MalariaMalaria
DengueDengue
ChikungunyaChikungunya
FilariasisFilariasis
Japanese
Encephalitis
Japanese
Encephalitis
Chandipura
Encephalitis
Chandipura
Encephalitis
Kala AzarKala AzarCongo
Cremean
Hemorrhagic
Fever
Congo
Cremean
Hemorrhagic
Fever
Chagas
Disease
Chagas
Disease
Trypanos
omiasis
Trypanos
omiasis
Yellow
Fever
Yellow
Fever
Lyme
Disease
Lyme
Disease
PlaguePlague
DracunculosisDracunculosis

Important VBDs with respect to India
Sr. No VBD Responsible Vector
1 Malaria Anopheles
2 Dengue Aedes aegypti and Aedes albopictus
3 Chikungunya Aedes aegypti and Aedes albopictus
4 Japanese
Encephalitis
Culex tritaeniorhynchus, Culex vishnui
and Culex pseudovishnui
5 Chandipura
Encephalitis & Kala
Azar
Sandfly (genus Phlebotomus )
6 Filariasis Culex quinquefasciatus and
Mansonia annulifera/M.uniformis

Malaria

जो जीता वह सकं दर
• Alexander the Great was killed by malaria at
the height of his power.
• After virtually conquering the entire known
world.
• He had set out to subjugate the earth but just
as he was to depart with his army in early
June 323 B.C., he contracted Malaria and the
voyage was postponed.
• Malaria, by striking Alexander, had altered the
course of history.
• Had the military leader survived, he might
well have succeeded in uniting east and west,
fusing Greeks and Asians into a single nation.

Global Malaria Scenario
• In 2010 - 216 million cases of Malaria globally.
• 91% - Pf cases.
• 81 % from African region.
• 13 % from South East Asia Region.
• Total Malarial Deaths - - 6,55,000. ( 3% SE
Asia)
• Under 5 mortality – 7% deaths due to Malaria

Malaria estimates in Pre-control era
 It was estimated in 1947 that out of a population of
340 million in the country, annual malaria incidence
was 75 million (nearly 22% of population) with 0.8
million deaths
 Epidemics at an interval of 5 to 7 years
 Economic loss due to malaria to the nation was
estimated at Rs. 7500 crores annually in 1940
(Rupee value of the reporting year)

Malaria Epidemics in Pre Independent
India
Year Area Affected Deaths
1852
Malaria epidemic wiped out the entire village of Ula and then spread
across the Bhagirathi River to Hooghly and continued to devastate
populations for many years in Burdwan
1892 Punjab 2,83,223
1900
Punjab
Ludhiana, Amballa, Karnal, Gurdaspur &
Raya
2,54,580
1908
Punjab - Amristar, Delhi, Palwal, Miani,
Gugarat
3,07,316
1920
Bengal
7,30,000
1943 6,80,000
1944 7,63,220

3.29
2.07
1.68
1.36 1.36 1.37
1.1
1995 2000 2005 2008 2009 2010 2011
API
1.56 1.6
1.31
1.09
0.88
2009 2010 2011 2012 2013
Malaria Cases
(Figures in Millions)
Indian Situation
• 27 % Population living in
high transmission areas.
• 50 % Pf cases
• 1000 + deaths every year
• 92 % cases & 97 % deaths are
from
•NEstates, Chhatisgarh,Jharkhand, MP,
Orissa, AP, Maharashtra, Gujarat, Rajasth
an,WB & Karnataka

MALARIA ENDEMIC AREA OF THE STATE
API less than 1
API 1 -5
API more than 5
BharatiVidyapithCME3AUG14

POST GLOBALIZATION MALARIA
 Malaria in the 1990s, presented new features which
were not commonly seen before, namely,
Vector resistance to insecticides;
pronounced exophilic behaviour of vectors;
extensive breeding sites created by development
projects, urbanization and industrialization;
change in parasite equation in favour of P.falciparum
and
resistance of P. falciparum to chloroquine and other
antimalarial drugs

MALARIA IN MAHARASHTRA
2006-2013
54420
67849 67333
93818
139198
96577
58499
43676
133
182
148
227
200
118
96
80
0
50
100
150
200
250
0
20000
40000
60000
80000
100000
120000
140000
160000
2006 2007 2008 2009 2010 2011 2012 2013
Cases Death

Dengue

Global Dengue Scenario
• World's fastest growing vector-borne disease is dengue, with a 30-fold
increase in disease incidence over the last 50 years.
• Over 2.5 billion people – over 40% of the world's population – are now at
risk from dengue.
• WHO currently estimates there may be 50–100 million dengue infections
worldwide every year.
• Before 1970, only nine countries had experienced severe dengue
epidemics. The disease is now endemic in more than 100 countries in
Africa, the Americas, the Eastern Mediterranean, South-east Asia and the
Western Pacific.
• The American, South-east Asia and the Western Pacific regions are the
most seriously affected.
• Foot Prints of Dengue in new areas –
2010 – First time in France & Croatia
2012 – Portugal
2013 – Florida (US)
• An estimated 500 000 people with severe dengue require hospitalization
each year, a large proportion of whom are children.
• About 2.5% of those affected die.

Determinants
of Dengue
Rise
Unplanned
Urbanization
Substandard
Housing
Inadequate
Water
Supply
Inadequate
Solid Waste
& Sewerage
System
Increased
Population
Density
International
trade
(Used tires)
Rapid
population
movement
Traditional
water
storage

DISTRIBUTION OF GLOBAL DENGUE RISK
High suitability
Low suitability
Unsuitable or non endemic
75% of the global population exposed to
Dengue lives in Asia Pacific region.

WHEN DENGUE LEADS TO
HAVOC…….
 Jan – April 2008
 1,58,000 Dengue Cases
 9000 Admissions
 230 deaths
 Military deployed for
vector control
 Call for International
aid
 US $ 1 billion spent.
 2010- 1.2 million cases
 Dengue major
emerging disease in
Saudi Arabia, Yemen
& Pakistan.
 Frequent OBs in
urban areas
 In 2011 – 300 deaths
in Lahore city alone.
Rio De Janerio - Brazil Lahore - Pakistan

Dengue In India
12561 15535 28292 18860 50222 75454
80
96
110
169
301
277
0
50
100
150
200
250
300
350
0
10000
20000
30000
40000
50000
60000
70000
80000
2008 2009 2010 2011 2012 2013
Cases Deaths
• 31 States/UTs are Dengue endemic.
• All 4 serotypes isolated from India.
• DENV-1 & DENV-2 are prevalent.

DENGUE IN MAHARASHTRA
618 743
2255
1574
1138
4305
5432
24 22 20
9
25
118
138
0
20
40
60
80
100
120
140
160
0
1000
2000
3000
4000
5000
6000
Yr 2007 Yr 2008 Yr 2009 Yr 2010 Yr 2011 Yr 2012 Yr 2013
Cases Deaths

8
4
1
10
2
2
2
10
2
3
7
1
3
1
2
3
8
8
4
2
2
7
4
2
Dengue Deaths from
Rural Maharashtra 2013

Filariasis

HISTORY
6th Century – Susrut recorded
Filaria in his ‘Susrut Samhita’ .
7th Century - Madhavkara described
signs & symptoms of Filaria in his ‘
Madhava Nidhana’
1709 – Clarke called elephantoid
legs in Cochin as ‘ Malbar Legs’.
Lewis – Discovery of microfilariae in
peripheral blood in Kolkata ( 1872).

LF – GLOBAL BURDEN
 World’s second leading cause of long term
debility.
 LF doesn’t kill but –
 causes debility
 imposes severe social & economical burden
 Destroys marriages & family relationships.
 Cause & effect of poverty
o 120 million people from 83 countries infected
with LF.
o 1/5 World population at risk.
o 70 % Infection world wide is from
India, Nigeria, Bangladesh & Indonesia.

LF - INDIA
 20 States
250 districts
600 million population is at
risk.
 2010 Survey – 8 Lac cases of
Elephantiasis & 4 Lac cases
of Hydrocele in India.

MAHARASHTRA FILARIA SITUATION
 Elephantiasis – 43,987
Hydrocele - - 28,975
Total - 72,968
In Maharashtra, 17 districts are endemic for LF.

2.86
1.43
1.23 1.13
0.44 0.46 0.51 0.54 0.43
Maharashtra Mf Rate
1.24
1.02 0.98
0.64
0.53
0.65
0.41 0.37 0.41
0.27
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
India Mf rate
Elimination of
Filarisis by 2015
Mass Drug
Administration is core
strategy to achieve it.
•In Nalganda district of
AP,Mf rate is reduced
from 17 (2004) to 0.8 in
2009.
• 192 out of 250 endemic
districts are having below
1 Mf rate in 2011.

Chikungunya
• Chikungunya is a mosquito-
borne viral disease first
described during an outbreak in
southern Tanzania in 1952.
• Kolkata outbreak – 1963-64
• Chennai Outbreak – 1965 – 3
Lac cases in Chennai City alone.
• Return of Chikungunya after 41
years – 16 states involved – 1.39
million cases reported. ( Attack
Rate – 45% in some areas)
The name
‘chikungunya’
derives from a word in
the Kimakonde
language,
meaning "to become
contorted" and
describes the
stooped appearance
of sufferers with joint
pain

95091
73288
48176
20402
15977
18639
2008 2009 2010 2011 2012 2013
Chikungunya Cases In India

Japanese Encephalitis
• Japanese encephalitis (JE) is a flavivirus related to
dengue, yellow fever and West Nile viruses, and is
spread by mosquitoes.
• JE is the main cause of viral encephalitis in many
countries of Asia with nearly 68 000 clinical cases
every year.
• The case-fatality rate 30%.
• Permanent neurologic or psychiatric sequelae can
occur in 30%–50% of those with encephalitis.
• 24 countries in the WHO South-East Asia and
Western Pacific regions have endemic JE
transmission, exposing more than 3 billion people
to risks of infection.

India – JE+ AES Situation
4292
5628 5722
9463
9089 8911
754 882 791
1350 1396 1475
2008 2009 2010 2011 2012 2013
Cases Deaths

YEAR
JE CHANDIPURA AES TOTAL
Cases Deaths Cases Deaths Cases Deaths Cases Deaths
2007 2 0 0 0 0 0 2 0
2008 1 0 4 3 24 13 29 16
2009 8 0 52 15 36 15 96 30
2010 7 1 50 16 29 16 86 33
2011 13 0 11 3 13 11 37 14
2012 11 0 20 1 41 26 72 27
2013 -- -- -- -- 5 5 5 5
Maharashtra – JE, Chandipura & AES Situation

What lies ahead ?
? ?
Opportunities Risks
Human Ecology
GlobalizationDemography

Increased Temperature
Rate of blood meal
digestion increases
Acceleration the ovarian
development & egg- laying
Reduction in duration of
the gonotrophic cycle
More frequency of feeding
on hosts
Increasing the probability
of transmission
•By 2100 it is estimated that
average global temperatures
will have risen by 1.0–3.50 C.
•This will increase likelihood of
many vector-borne diseases in
new areas.
What Climate Change will
lead to ?

Increased International Travel

Will Yellow Fever Come to India ?
• India – Yellow Fever ‘receptive’ area.
• Vector – aedes aegypti is found in
abundance.
• Climatic condition – favourable
• Common monkey in India (
Macacus spp) – susceptible to
Yellow Fever
• Missing link is --- Chain of
transmission…
• An infected traveler OR mosquito
???

New Research…… New Hope…..

No one in the 21st
century should die
from the bite of a
mosquito, a sand fly,
a black fly or a tick.
Margaret Chan
Director General
World Health Orgnization

Burden of Vector Borne Diseases Past, Present & Future

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