Lok Sabha Question No. 605 (UNSTARRED), answered on 2016-11-18
Subject: Neglected Tropical Diseases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RAJENDRA AGRAWAL

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 605 TO BE ANSWERED ON 18 TH NOVEMBER, 2016

## NEGLECTED TROPICAL D ISEASES

## 605. SHRI RAJENDRA AGRAWAL:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether India has high prevalence of tropical and vector - borne diseases, and if so, the details thereof and the reasons therefor;
- (b) whether any study has been conducted by World Health Organisation (WHO) in this regard;
- (c) if so, the details thereof; and
- (d) the details of the measures taken/ proposed to be taken by the Government to deal with such neglected tropical diseases?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

- (a): Yes , Dengue is endemic in 35 States/UTs in the country. Chikungunya  in 30 States/UTs in country. The number of dengue cases and deaths and clinically suspected Chikungunya cases in the country as reported by the States/UTs during last three years and current year are  at Annexure-I and Annexure-II.

The reasons for the prevalence of Dengue and Chikungunya in the country are rampant due  to unplanned  urbanization, population migration, unregulated construction activities,  inadequate  provisions  and  implementation  of  civil  and  building  bye-laws  for preventing mosquitogenic conditions.

Kala-azar is endemic in 33 districts of Bihar, 4 districts of Jharkhand, 11 districts of West Bengal and sporadic cases from 6 districts of eastern Uttar Pradesh.

Lymphatic Filariasis is endemic in 256 districts. The details of clinical/manifested cases like  lymphoedema and Hydrocele reported by the states/UTs in last three years are at Annexure-III.

## (b) & (c) No such information is available in the concerned Directorate of the Ministry.

## (d): Dengue & Chikungunya:

Government of India (GOI) has taken the following measures for prevention and control of Dengue & Chikungunya in the country during 2016:

- o GOI  provides  Technical  Guidelines  to  the  States  for  prevention  and  control of dengue, including clinical management of dengue and Chikungunya.
- o Periodic reviews are  done at the level of Hon'ble HFM, Secretary, (H&FW) and DGHS. Since January,  2016,  a  total  number  of  22  review  meetings  have  been held by HFM, Secretary (H&FW), Additional Secretary, DGHS and Spl DGHS with functionaries of different States/UTs.
- o Periodic advisories have been issued from time to time for prevention and control of  Dengue  and  Chikungunya.  12  advisories  have  been  issued  at  the  levels  of Secretary (H&FW) and Addl. Secretary (H&FW) to all concerned for taking timely action for prevention & control of Dengue in their respective States/UTs.
- o States have been requested to declare Dengue as notifiable disease by MOHFW vide letter No.7-165/2016/NVBDCP/DEN dated 9th June 2016 and the same has been  uploaded  on  the  National  Vector  Borne  Disease  Control  Programme (NVBDCP) website for taking action accordingly by all the states and UTs.
- o First  version  draft  of  'Strategy  and  Plan  of  action  for  Effective  Community Participation  for  Prevention  and  Control  of  Dengue'  has  been  uploaded  on  the NVBDCP website on 15 th June, 2016.
- o Focused IEC/BCC activities are carried out at National and State level with media mix strategies focusing on source reduction and personal protective measures.
-  A  user  friendly  Dengue  App  'India  Fights  Dengue'  has  been  launched by HFM, on 7th April, 2016.
-  'National Dengue Day' has been observed on 16th May 2016 throughout the country.
- o Dengue & Chikungunya diagnosis is provided through 542 Sentinel Surveillance Hospitals (SSHs) and 15 Apex Referral laboratories (ARLs) across the country.
- o Accredited Social Health Activists (ASHAs) are also involved in source reduction activities for dengue prevention and control.
- o Periodic field visits were made by NVBDCP Officials to States/UTs for review and to provide technical guidance for prevention and control of Dengue  & Chikungunya.

## Kala-azar:

The effective and preventive measures are as under:

- o Interruption of transmission through vector control by Indoor Residual Spray in the affected area.
- o Early  diagnosis  &  complete  treatment  through  Primay  Health  Care  System is  in place.
- o Health Educaiton and Community Participation.

## Besides these the following initiative are also taken:

- o Kala-azar  eliminaiton  is  being  reviewed at highest  level  by  PMO,  Union  Health Minister & by Senior officers of Ministry of Health & Family Welfare.
- o National  Road  Map  on  Kala-azar  Elimination  with  defined  time  line  has  been developed and programme is adhering to it.
- o Treatment  with  single  day  single  dose  Ambisome  Injection  to  Kala-azar  patient has been introduced which has improved treatment complianc close to 94-96%.
- o NITI  Aayog  has  provisioned  Rs.  20.00  crore    to  endemic  states  for  strengthing Kala-azar implementation activities.
- o Incentive to patients & honorarium to ASHA.
- o Rs.  500/as  incentive  to  Patient  for  loss  of  wages  irrespective  of  drug  regimen and Rs. 2,000/- to PKDL cases
- o Similarly,  Govt  of  Bihar  has  provisioned  Rs.  6,600/- under Bihar Chief Ministers Kala-azar Relief Funds.
- o Strengthening of human resource component by involving development partners for supervised monitoring.
- o Ensuring supply of drugs & Diagnostic Kits.
- o IEC/BCC for community awareness & social mobilization.
- o Expansion of  Synthetic  Pyrethorid  insecticide  for  indoor  residual  spray  in  all  54 districts during 2017.
- o Programme  is  focusing  151  identified  villages  (hand  core)  reports  more  than  5 cases.

Lymphatic Filariasis:

Measures taken/proposed to be taken by the Government for elimination of Lymphatic Filariasis are as under:

- o The  disease  has  been  targeted  for  elimination  by  reducing  microfilaria  rate  at community level in endemic districts.
- o The  campaign  for  elimination  was  launched  in  2004  by  Government  of India. Following supports are provided to states/UTs:
- o Financial support to States/UTs.
- o Technical support to states through guidelines, field visits and  supportive supervision.
- o Strengthening of capacity building of states/districts and PHC.
- o Strengthening of IEC/BCC through prototype, TV/Radio spot and its telecast/broadcast.
- o Identification of Nodal officers for supportive supervision

Annexure-I State/UT-wise Dengue cases and deaths in the country

| Sl. No.   | State         | 2013   | 2013   | 2014   | 2014   | 2015   | 2015   | 2016 (Prov till 31 st Oct)   | 2016 (Prov till 31 st Oct)   |
|-----------|---------------|--------|--------|--------|--------|--------|--------|------------------------------|------------------------------|
| Sl. No.   | State         | Cases  | Deaths | Cases  | Deaths | Cases  | Deaths | Cases                        | Deaths                       |
| 1         | Andhra Pd.    | 910    | 1      | 1262   | 5      | 3159   | 2      | 1712                         | 0                            |
| 2         | Arunachal Pd. | 0      | 0      | 27     | 0      | 1933   | 1      | 13                           | 0                            |
| 3         | Assam         | 4526   | 2      | 85     | 0      | 1076   | 1      | 3429                         | 4                            |
| 4         | Bihar         | 1246   | 5      | 297    | 0      | 1771   | 0      | 1308                         | 0                            |
| 5         | Chhattisgarh  | 83     | 2      | 440    | 9      | 384    | 1      | 311                          | 2                            |
| 6         | Goa           | 198    | 2      | 168    | 1      | 293    | 0      | 113                          | 0                            |
| 7         | Gujarat       | 6272   | 15     | 2320   | 3      | 5590   | 9      | 4778                         | 12                           |
| 8         | Haryana       | 1784   | 5      | 214    | 2      | 9921   | 13     | 1927                         | 0                            |
| 9         | Himachal Pd.  | 89     | 2      | 2      | 0      | 19     | 1      | 57                           | 0                            |
| 10        | J & K         | 1837   | 3      | 1      | 0      | 153    | 0      | 49                           | 0                            |
| 11        | Jharkhand     | 161    | 0      | 36     | 0      | 102    | 0      | 365                          | 1                            |
| 12        | Karnataka     | 6408   | 12     | 3358   | 2      | 5077   | 9      | 5230                         | 8                            |
| 13        | Kerala        | 7938   | 29     | 2575   | 11     | 4075   | 25     | 6497                         | 12                           |
| 14        | Madhya Pd.    | 1255   | 9      | 2131   | 13     | 2108   | 8      | 2238                         | 5                            |
| 15        | Meghalaya     | 43     | 0      | 0      | 0      | 13     | 0      | 91                           | 0                            |
| 16        | Maharashtra   | 5610   | 48     | 8573   | 54     | 4936   | 23     | 5391                         | 22                           |
| 17        | Manipur       | 9      | 0      | 0      | 0      | 52     | 0      | 35                           | 0                            |
| 18        | Mizoram       | 7      | 0      | 19     | 0      | 43     | 0      | 1                            | 0                            |
| 19        | Nagaland      | 0      | 0      | 0      | 0      | 21     | 1      | 0                            | 0                            |
| 20        | Odisha        | 7132   | 6      | 6433   | 9      | 2450   | 2      | 7865                         | 11                           |
| 21        | Punjab        | 4117   | 25     | 472    | 8      | 14128  | 18     | 7862                         | 6                            |
| 22        | Rajasthan     | 4413   | 10     | 1243   | 7      | 4043   | 7      | 1428                         | 12                           |
| 23        | Sikkim        | 38     | 0      | 5      | 0      | 21     | 0      | 8                            | 0                            |
| 24        | Tamil Nadu    | 6122   | 0      | 2804   | 3      | 4535   | 12     | 1895                         | 4                            |
| 25        | Tripura       | 8      | 0      | 6      | 0      | 40     | 0      | 32                           | 0                            |
| 26        | Telangana     | 0      | 0      | 704    | 1      | 1831   | 2      | 1983                         | 3                            |
| 27        | Uttar Pradesh | 1414   | 5      | 200    | 0      | 2892   | 9      | 5456                         | 29                           |
| 28        | Uttrakhand    | 54     | 0      | 106    | 0      | 1655   | 1      | 1944                         | 3                            |
| 29        | West Bengal   | 5920   | 6      | 3934   | 4      | 8516   | 14     | 11069                        | 28                           |
| 30        | A&N Island    | 67     | 0      | 139    | 0      | 153    | 0      | 85                           | 0                            |
| 31        | Chandigarh    | 107    | 0      | 13     | 0      | 966    | 1      | 740                          | 0                            |
| 32        | Delhi         | 5574   | 6      | 995    | 3      | 15867  | 60     | 3650                         | 4                            |
| 33        | D&N Haveli    | 190    | 0      | 641    | 1      | 1154   | 0      | 2493                         | 0                            |
| 34        | Daman & Diu   | 61     | 0      | 46     | 0      | 165    | 0      | 64                           | 0                            |
| 35        | Puducherry    | 2215   | 0      | 1322   | 1      | 771    | 0      | 345                          | 2                            |
| TOTAL     | TOTAL         | 75,808 | 193    | 40,571 | 137    | 99,913 | 220    | 80,464                       | 168                          |

Annexure-II State/UT-wise Clinically Suspected Chikungunya cases in the country

| Sl. No   | Name of the State   | 2013   | 2014   | 2015   | 2016 (Prov till 31 st Oct)   |
|----------|---------------------|--------|--------|--------|------------------------------|
| 1        | Andhra Pradesh      | 4827   | 1359   | 817    | 660                          |
| 2        | Arunachal Pradesh   | 0      | 0      | 35     | 217                          |
| 3        | Assam               | 742    | 0      | 0      | 38                           |
| 4        | Bihar               | 0      | 0      | 3      | 394                          |
| 5        | Goa                 | 1049   | 1205   | 561    | 265                          |
| 6        | Gujarat             | 2890   | 574    | 406    | 952                          |
| 7        | Haryana             | 1      | 3      | 1      | 2399                         |
| 8        | Himachal Pradesh    | 0      | 0      | 0      | 1                            |
| 9        | J&K                 | 0      | 0      | 0      | 1                            |
| 10       | Jharkhand           | 61     | 11     | 21     | 42                           |
| 11       | Karnataka           | 5295   | 6962   | 20763  | 11951                        |
| 12       | Kerala              | 273    | 272    | 175    | 118                          |
| 13       | Madhya Pradesh      | 139    | 161    | 67     | 418                          |
| 14       | Meghalaya           | 0      | 0      | 78     | 248                          |
| 15       | Maharashtra         | 1578   | 1572   | 391    | 4799                         |
| 16       | Odisha              | 35     | 10     | 81     | 1                            |
| 17       | Punjab              | 0      | 2      | 180    | 2098                         |
| 18       | Rajasthan           | 76     | 50     | 7      | 1686                         |
| 19       | Tamil Nadu          | 859    | 543    | 329    | 55                           |
| 20       | Telangana           | 0      | 1687   | 2067   | 541                          |
| 21       | Tripura             | 0      | 34     | 180    | 171                          |
| 22       | Uttar Pradesh       | 0      | 4      | 0      | 1947                         |
| 23       | Uttrakhand          | 0      | 0      | 0      | 35                           |
| 24       | West Bengal         | 646    | 1032   | 1013   | 921                          |
| 25       | A&N Island          | 202    | 161    | 68     | 9                            |
| 26       | Chandigarh          | 1      | 0      | 1      | 1315                         |
| 27       | Delhi               | 18     | 8      | 64     | 10851                        |
| 28       | D&N Haveli          | 2      | 0      | 0      | 0                            |
| 29       | Lakshadweep         | 0      | 0      | 0      | 0                            |
| 30       | Puducherry          | 146    | 399    | 245    | 248                          |
| Total    | Total               | 18,840 | 16,049 | 27,553 | 42,381                       |

No death due to Chikungunya has been reported in India.

## Line listing of Clinically Manifested cases of Lymphatic Filariasis

| Sl.No.   | LF endemic State   |    2013 |    2014 |    2015 |
|----------|--------------------|---------|---------|---------|
| 1        | Andhra Pradesh     |   90065 |   90019 |   90423 |
| 2        | Telangana          |   57423 |   58525 |   57423 |
| 3        | Assam              |    2189 |    2044 |    2189 |
| 4        | Bihar              |  389972 |  389972 |  389972 |
| 5        | Chhattisgarh       |   13921 |   13921 |   13921 |
| 6        | Goa                |     118 |     118 |     199 |
| 7        | Gujarat            |    7153 |    6529 |    7153 |
| 8        | Jharkhand          |  138664 |  138122 |  164837 |
| 9        | Karnataka          |   17769 |   17819 |   19654 |
| 10       | Kerala             |   17734 |   16471 |   18462 |
| 11       | Madhya Pradesh     |    8597 |    8597 |    9926 |
| 12       | Maharashtra        |   71674 |   69348 |   74542 |
| 13       | Orissa             |  116997 |  116997 |  116997 |
| 14       | Tamil Nadu         |   59131 |   59131 |   59131 |
| 15       | Uttar Pradesh      |  115712 |  128191 |  125099 |
| 16       | West Bengal        |   95407 |   95407 |   96562 |
| 17       | A&N Islands        |     194 |     194 |     194 |
| 18       | D & N Haveli       |     118 |     118 |     118 |
| 19       | Daman & Diu        |     136 |     136 |     136 |
| 20       | Lakshadweep        |     254 |     254 |     254 |
| 21       | Pondicherry        |    1304 |    1304 |    1304 |
|          | Total              | 1204532 | 1213217 | 1248496 |