Lok Sabha Question No. 3 (UNSTARRED), answered on 2019-06-21
Subject: H1N1 Virus in Kerala
Ministry: HEALTH AND FAMILY WELFARE
Asked by: T.N. Prathapan

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

## LOK SABHA UNSTARRED QUESTION NO. 3 TO BE ANSWERED ON 21 ST JUNE, 2019

## H1N1 VIRUS IN KERALA

## 3. SHRI T.N. PRATHAPAN:

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

- (a) whether the Government proposes to take any measures to prevent the spread of epide like Chikungunya and H1N1 in Kerala particularly during monsoon season;
- (b) if so, the details thereof;
- (c)  whether  the  Go vernment  has  taken  any  measures  to  monitor  the  possible  threat  from migratory birds which causes easy deadly virus transfer in some cases;
- (d) if so, the details thereof; and
- (e)  whether the  Government  would  likely  to  take  any  measures  to  ensure  efficient  was management  in  States  like  Kerala  in  view  of  huge  health  hazards  due  to  inefficient management especially during monsoon season?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY O F HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a) and (b):Public Health is a State subject. Government of India (GoI), however, provi necessary  assistance  and  guidance  to  State  Governments  for  strengthening  their  healt system. Measures t aken by GoI during 2019 to prevent Chikungunya and H1N1 in the country, including in Kerala, particularly during monsoon season are at Annexure -I .
- (c ) and (d): India has launched the National Action Plan (NAP) for Conservation of Migr Birds  and  their  Habitats  along  Central  Asian  Flyway  (2018 - 2023).  Building  capacity  and protocols  for  disease  surveillance  in  wild  birds  is  one  of  the  activities  unde r  the  Capacity Development  of  the  Action  Plan.  Six  regional  committees  have  also  been  formed  f implementing  the  NAP.  Under  the  Centrally  Sponsored  Scheme,  funds  are  provided  to  th concerned State Governments to procure the Personal Protective Equipment (PPE) for the Avian Influenza (H5N1) disease surveillance.
- (e):  The  Ministry  of  Environment,  Forest  and  Climate  Change,  in  supersession  of  Munic Solid Waste (Management and Handling) Rules, 2000, has notified the Solid Waste Managemen Rules, 2016. A detailed note is at Annexure -II .

## Detailed statement on measures taken by Government of India (GoI) to prevent the spread of epidemics like Chikungunya and H1N1

## I. Chikungunya:

GoI has taken the following steps to prevent Chikungunya in the country during 2019 :

- Provided  Technical  Guidelines  for  prevention  and  control,  case  management  an effective community participation to the States for implementation.
- Conducted trainings for capacity building of doctors on case management.
- Advised States  to  monitor  and  supervise  for  early  case  detection  and  prevention control.
- Till date, 7 advisories have been issued and 5 reviews held.
- Provided free diagnostic facilities through 673 Sentinel Surveillance Hospitals ( and 16 Apex Referral l aboratories (ARLs) identified across the country. Out of these, SSHs and 1 ARL have been identified in the State of Kerala.
- Supplied 631 Chikungunya (1 Kit=96 tests) IgM test kits through National Institut Virology, Pune till date, out of which 21 C hikungunya IgM kits were supplied to Kerala.
- Information  Education  and  Communication  (IEC)/  Behaviour  Change  Communication (BCC) activities were undertaken to disseminate knowledge for prevention and control

## II. H1N1 :

- Health  being  a  State  subject,  the  Stat e  Governments  are  expected  to  take  prompt measures  for  preventing  the  spread  of  seasonal  influenza  A/  H1N1  virus  and  f diagnosis, case management and treatment of the patients. The Central Government h been pro - active in assisting the State Governments , in this regard and technical guidelines have been shared with the State.
- Till date (09.06.2019), 25958 laboratory confirmed cases of seasonal Influenza A (H have been reported in the country in 2019, out of which 1061 have died. Majorit cases  and deaths  were  reported  from  Rajasthan,  Gujarat,  Delhi,  Punjab  and  Haryana followed  by  Himachal  Pradesh,  Uttar  Pradesh,  Telangana,  Kerala,  Kashmir  (J&K), Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu and West Bengal. The decline in trend of cases and de aths in the country was observed since 8th week ending on 24th February, 2019.
- Regular  review  meetings  are  being  held  at  the  highest  level  and  preparedness response measures are being reviewed. These have been held at the level of Health Family  Wel fare  Minister,  Secretary  (Health),  Director  General  of  Health  Servi (DGHS), Additional Secretary (Health) and Joint Secretary (Public Health) in 2018 - 2019. On  the  last  occasion  the  situation  was  reviewed  by  DGHS  in  a  meeting  of  Joi Monitoring Group he ld on 12.06.2019.
- A  Public  Health  Team  was  deputed  in  2019  to  Rajasthan,  Gujarat,  Punjab,  an Uttarakhand to assess the situation and assist the States in strengthening respons increase in cases.
- Advisories for preparedness for seasonal influenza A (H1N1) have been issued from t to time during 2019 by Union Secretary (Health), Joint Secretary (Public Health), Director, National Centre for Disease Control (NCDC).
- Integrated Disease Surveilla nce Programme (IDSP) and its State units have enhanced the surveillance  for  Influenza  like  Illness  (ILI)  and  Severe  Acute  Respiratory  Infe (SARI).
- IDSP assisted lab network of 12 Laboratories are providing laboratory support in ter testing,  qual ity  assurance,  guidance,  providing  viral  transport  mediums  and  diagnost reagents. The laboratory network of ICMR (41 labs) has also been activated to tes H1N1  cases  and  beyond  these  laboratories,  States  also  have  their  identified Government an d Private laboratories for testing clinical samples of seasonal influe (H1N1). In addition, NCDC is providing diagnostic kits and Viral Transport Medium k to States as per identified need to be used in laboratories/ hospitals identified b e Governments.
- The States have been asked to follow the guidelines of Ministry of Health and Fa Welfare  (MoHFW),  GoI  (Risk  Categorization,  Clinical  management  Protocol,  Use  of masks  for  healthcare  workers,  Guidelines  for  vaccination  with  influenza  vacc ine  and Providing Home care) on seasonal influenza A (H1N) available at MoHFW and NCDC websites.
- Oseltamivir is the drug recommended by WHO. The drug is made available through the Public Health System free of cost. Oseltamivir was also made available unde r Schedule H1 by Govt. of India so that the drugs are readily available to the needed. All th have  been  advised  to  complete  the  procurement  of  required  logistics  for  manag seasonal influenza A (H1N1) from State budget. However, during crisis in States, Govt. of  India  is  supplying  logistics  (drugs,  PPE  kits,  N - 95  face  masks).  Currently  in  2019, Govt.  of  India  has  supplied  the  logistics  to  Bihar,  Haryana,  Himachal  Pradesh, Pradesh, Jammu & Kashmir, Chandigarh, Himachal Pradesh, Delhi and Andh ra Pradesh.
- MOHFW  has  recommended  vaccination  for  health  care  workers  and  other  priority groups. The guidelines for influenza vaccination have been shared with all States details of manufactures of vaccine (as per recommendation of Govt. of India) pr ovided from Drug Controller General of India (DCGI), has been shared with all States.
- 3  batches  of  training  were  organized  on  ventilator  management  and  management  o critically ill influenza patients in coordination with Emergency Medical Relief divi sion in the months of May and June 2018 in which 14 States with 102 participa were oriented. Another 3 sets of trainings were provided on Seasonal Influenza A (H1 guidelines to States Surveillance officers and to State Epidemiologist and Data Ma of SSU (IDSP).
- IEC  material  i.e.  infographics  on  seasonal  flu  for  general  public  was  shared  wi States  on  05.10.2018.  The  other  IEC  materials  including  audio  spot  is  availabl MoHFW website since 2015.
- The  situation  is  being  monitored  regularly  through  Strategic  Health  Operation  Ce (SHOC), situated at NCDC and status is being shared with MoHFW.

## Note on Solid Waste Management Rules, 2016

The Rules prescribe that no waste generator s hall throw, burn or bury the solid waste generated by him, on streets, open public spaces outside his premises or in the drain bodies. Further, the Rules direct the waste generators to segregate the waste at source over the segregated was te to authorised waste pickers or waste collectors. Under the duties responsibilities of local authorities and village Panchayats, the Rules direct street swe burn tree leaves collected from street sweeping and store them separately and han dover to the authorised  waste  collectors.  The  Rules  mandate  the  Urban  Local  Bodies  to  frame  Bye -Laws incorporating  the  provisions  of  Solid  Waste  Management  Rules,  2016  and  ensure  time implementation.

The  Ministry  of  Housing  and  Urban  Affairs  (MoHUA)  has overall  mandate  to  take periodic review of the measures taken by the States and local bodies for improving thei waste management practices. The Rules mandated various Ministries, Government departments, Municipalities  and  even  village  panchayats  to abide  by  certain  activities  and  timelines  for effective implementation of the rules. The Rules mandate the Central Pollution Control Board (CPCB) to co - ordinate with State Pollution Control Boards and review the implementation of th Rules in the country.

Apart from framing the policy, the Central Government is also supporting the effor State Governments in establishing the infrastructure related to proper implementation o waste  management  in  their  States.  Ministry  of  Housing  and  Urban  Affairs (MoHUA)  is implementing the Swachh Bharat Mission (Urban) project under which various projects ha been  taken  up.  Under  this  programme,  during  the  mission  period  of 2014- 15  to  2019 - 20,  an allocation of Rs. 7424.24 Cr has been made for Solid Waste Managem ent Projects.

## Annexure -II