Lok Sabha Question No. 91 (UNSTARRED), answered on 2019-06-21
Subject: Separate Ward for Dengue Patients
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rahul Ramesh Shewale, Bhartruhari Mahtab

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

## LOK SABHA UNSTARRED QUESTION NO. 91 TO BE ANSWERED ON 21 ST JUNE,2019

## SEPARATE WARD FOR DENGUE PATIENTS

## 91. SHRI RAHUL RAMESH SHEWALE: SHRI BHARTRUHARI MAHTAB:

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

- (a) whether the cases of dengue and swine flu have been reported in the country throughout the year  and  if  so,  the  details thereof  along  with  the  number  of  deaths therefrom  in the  country during the current year, State/UT - wise;
- (b)  whether  separate  wards  for  dengue a d  swine  flu  have  been  earmarked  in Central Government Hospitals throughout the year, if so, the details thereof, Hospital - wise;
- (c)  whether  the  Government  has re ceived  complaints  about  healthcare workers  getting inadequate  protection while  dealing  with  patients  of  dengue  and swine  flu  in  Central Government Hospitals, if so, the details thereof during each of the last three years and the current year; and
- (d)  the corrective  steps  taken  by  the Government  to  keep  dengue  and  swine  flu cases  under control and protect the life of people and healthcare workers?

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

- (a): During 2019 (till 9 th June), a total of 6210 cases and 6 deaths have been reported due Dengue in the country. State - wise dengue cases and deaths reported in the country during the current year (till 9 th June) are at Annexure-I.

The States/Union Territo es (UTs) wise cases and deaths reported for seasonal influenz A (H1N1)/Swine flu for the current year are at Annexure-II .

- (b): Government of India (GoI) guidelines on Dengue case management advise for having a dengue  corner  in  the  hospitals  including  i n  Central  Government  Hospitals  during  the transmission season which is functional round the clock with adequate trained manpower logistics. The treatment facilities for seasonal influenza A (H1N1)/Swine flu are available Government  health  facili t es/Hospitals  in  all  States.  A  statement  regarding  the  three  Cen Government  hospitals  namely  Dr.  Ram Manohar  Lohia  Hospital,  New  Delhi,  Safdarjung Hospital, New Delhi and Lady Harding Medical College, New Delhi is at Annexure -III .

(c): No suchcomplaints have been received in this regard.

(d): Public Health is a State subject. Government of India (GoI) provides necessary assi and guidance to State Governments for strengthening their health care system and to take measures to keep D engue and Swine flu cases under control and protect the lives of people healthcare workers. Detailed statement on steps taken in this regard is at Annexure-IV .

## Annexure-I

## State-wise Dengue cases and deaths reported in the country in 2019 (as on 9 th June)

| Sl. No.   | State             | 2019 (Prov. till 9 th June)   | 2019 (Prov. till 9 th June)   |
|-----------|-------------------|-------------------------------|-------------------------------|
| Sl. No.   | State             | Cases                         | Deaths                        |
| 1         | Andhra Pradesh    | 352                           | 0                             |
| 2         | Arunachal Pradesh | 0                             | 0                             |
| 3         | Assam             | 14                            | 0                             |
| 4         | Bihar             | 3                             | 0                             |
| 5         | Chhattisgarh      | 88                            | 0                             |
| 6         | Goa               | 81                            | 0                             |
| 7         | Gujarat           | 363                           | 0                             |
| 8         | Haryana           | 2                             | 0                             |
| 9         | Himachal Pradesh  | 14                            | 0                             |
| 10        | Jammu & Kashmir   | 0                             | 0                             |
| 11        | Jharkhand         | 27                            | 0                             |
| 12        | Karnataka         | 1303                          | 0                             |
| 13        | Kerala            | 469                           | 4                             |
| 14        | Madhya Pradesh    | 59                            | 0                             |
| 15        | Meghalaya         | 0                             | 0                             |
| 16        | Maharashtra       | 767                           | 2                             |
| 17        | Manipur           | 3                             | 0                             |
| 18        | Mizoram           | 6                             | 0                             |
| 19        | Nagaland          | 0                             | 0                             |
| 20        | Odisha            | 2                             | 0                             |
| 21        | Punjab            | 48                            | 0                             |
| 22        | Rajasthan         | 375                           | 0                             |
| 23        | Sikkim            | 7                             | 0                             |
| 24        | Tamil Nadu        | 988                           | 0                             |
| 25        | Tripura           | 35                            | 0                             |
| 26        | Telangana         | 767                           | 0                             |
| 27        | Uttar Pradesh     | 60                            | 0                             |
| 28        | Uttrakhand        | 0                             | 0                             |
| 29        | West Bengal       | Not reported                  | Not reported                  |
| 30        | A&N Islands       | 25                            | 0                             |
| 31        | Chandigarh        | 0                             | 0                             |
| 32        | Delhi             | 60                            | 0                             |
| 33        | D&N Haveli        | 20                            | 0                             |
| 34        | Daman & Diu       | 0                             | 0                             |
| 35        | Lakshadweep       | 0                             | 0                             |
| 36        | Puducherry        | 272                           | 0                             |
|           | Total             | 6210                          | 6                             |

| S. No.   | States/UTs          | 2019 (As on 09.06.2019)   | 2019 (As on 09.06.2019)   |
|----------|---------------------|---------------------------|---------------------------|
| S. No.   | States/UTs          | Cases                     | Deaths                    |
| 1        | Andaman &Nicobar    | 0                         | 0                         |
| 2        | Andhra Pradesh      | 308                       | 13                        |
| 3        | Arunachal Pradesh   | 0                         | 0                         |
| 4        | Assam               | 33                        | 1                         |
| 5        | Bihar               | 47                        | 0                         |
| 6        | Chandigarh          | 54                        | 3                         |
| 7        | Chhattisgarh        | 144                       | 27                        |
| 8        | Dadra &Nagar Haveli | 6                         | 2                         |
| 9        | Daman &Diu          | 8                         | 1                         |
| 10       | Delhi               | 3572                      | 31                        |
| 11       | Goa                 | 92                        | 2                         |
| 12       | Gujarat             | 4770                      | 149                       |
| 13       | Haryana             | 1033                      | 16                        |
| 14       | Himachal Pradesh    | 332                       | 40                        |
| 15       | Jammu& Kashmir      | 438                       | 27                        |
| 16       | Jharkhand           | 73                        | 3                         |
| 17       | Karnataka           | 1698^                     | 87^                       |
| 18       | Kerala              | 550                       | 18                        |
| 19       | Lakshadweep         | 0                         | 0                         |
| 20       | Madhya Pradesh      | 653                       | 145                       |
| 21       | Maharashtra         | 1635                      | 183                       |
| 22       | Manipur             | 0                         | 0                         |
| 23       | Meghalaya           | 0                         | 0                         |
| 24       | Mizoram             | 0                         | 0                         |
| 25       | Nagaland            | 0                         | 0                         |
| 26       | Odisha              | 201                       | 5                         |
| 27       | Puducherry          | 9                         | 0                         |
| 28       | Punjab              | 534                       | 31                        |
| 29       | Rajasthan           | 5021                      | 205                       |
| 30       | Sikkim              | 8                         | 0                         |
| 31       | Tamil Nadu          | 403                       | 2                         |
| 32       | Telangana           | 1208                      | 20                        |
| 33       | Tripura             | 31                        | 0                         |
| 34       | Uttarakhand         | 243                       | 6                         |
| 35       | Uttar Pradesh       | 1969                      | 25                        |
| 36       | West Bengal         | 885 #                     | 19 #                      |
|          | Total               | 25958                     | 1061                      |

|   S. No. | Name of the Central Government Hospital         | Details                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|----------|-------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|        1 | Dr. Ram Manohar Lohia (RML) Hospital, New Delhi | Separate wards for Swine Flu patients have been earmarked in this hospital throughout the year and for dengue patients separate wards are created as per requirement or the number of Dengue patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|        2 | Safdarjung Hospital, New Delhi                  | 10% beds in each medical ward have been earmarked for Dengue patients. However, when cases exceed beyond this number, a separate ward is prepared with all facilities for this purpose. A separate ward for patients of Swine Flu is allotted. For the last 3 years Swine Flu patients are being treated in a separate ward with bed strength of 27-30 beds. As such patients require isolation, they are not kept in other medical wards. If a sporadic case of Swine Flu is admitted, such patients are kept away from rest of the patients as per the policy. A separate 6 bedded Intensive Care unit (ICU) and 6 bedded High Dependency Unit (HDU) for H1N1 patients has been established in the Department of Pulmonary, Critical care and Sleep medicine. |
|        3 | Lady Harding Medical College (LHMC), New Delhi  | LHMC and associated hospital has separate ward for Dengue and Swine flu.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |

## Detailed  statement  on  measures  taken  by  Government  of  India  (GoI)  to  keep Dengue and Swine flu cases under control and protect the lives of people and healthcare workers

## I. Dengue:

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

- Provided Technical Guidelines for prevention and control, case management & 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 advisori es have been issued and 5 reviews held so far.
- Provided free diagnostic facilities through 673 Sentinel Surveillance Hospitals ( and 16 Apex Referral laboratories (ARLs) identified across the country.
- Supplied  1207  Dengue  (1  Kit=96  tests)  IgM test  kits  through  National  Institute  of Virology, Pune till date.
- Observation of National Dengue Day on 16th May across the country
- Information  Education  and  Communication  (IEC)/  Behaviour  Change  Communication (BCC) activities to disseminate knowledge fo r prevention and control.

## II. Swine flu :

- Health  being  a  State  subject,  the  State  Governments  are  expected  to  take  pro measures  for  preventing  the  spread  of  seasonal  influenza  A/  H1N1  virus  and  f diagnosis, case management and treatment of the patients. The Central Government has been pro - active in assisting the State Governments, in this regard and technical guid have been shared with the state.
- Till date (09.06.2019), 25958 laboratory confirmed cases of seasonal Influenza A (H have been repor ted in the country in 2019, out of which 1061 have died. Majority cases  and  deaths  were  reported  from  Rajasthan,  Gujarat,  Delhi,  Punjab  and  Harya followed  by  Himachal  Pradesh,  Uttar  Pradesh,  Telangana,  Kerala,  Kashmir  (J&K), Karnataka, Maharashtra, Ma dhya Pradesh, Tamil Nadu and West Bengal. The decline in trend of cases and deaths in the country was observed since 8th week ending on 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 an

Family  Welfare  Minister,  Secretary  (Health),  Director  General  of  Health  Servi (DGHS), Additional Secretary (Health) and Joint Secretary (Public Health) in 2018 - 2019. On  the  last  occasio n  the  situation  was  reviewed  by  DGHS  in  a  meeting  of  Joint Monitoring Group held 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 to the 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 Surveillance Programme (IDSP) and its State units have enhanced surveillance  for  Influenza  like  Illness  (ILI)  and  Severe  Acute  Respiratory  Infe (SARI).
- IDSP assisted lab network of 12 Laboratories are providing laboratory suppo rt in terms of testing,  quality  assurance,  guidance,  providing  viral  transport  mediums  and  diagn reagents. The laboratory network of ICMR (41 labs) has also been activated to tes H1N1  cases  and  beyond  these  laboratories,  States  also  have  their  id entified  State Government and 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/ hosp it ls identified by the State 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  vac cination  with  influenza  vaccine  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 under 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, Hima chal Pradesh, Delhi and Andhra 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 recommen dation of Govt. of India) provided 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 Emergen cy Medical Relief (EMR) division in the months of May and June 2018 in which 14 States with 102 particip were oriented. Another 3 sets of trainings were provided on Seasonal Influenza A (H1 guidelines to States Surveillance officers and to State Epi demiologist and Data Manager 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  Centre (SHOC), situated at NCDC and status is being shared with MoHFW.
- III. The three Central Government hospitals namely Dr. Ram Manohar Lohia Hospital, New Delhi, Safdarjung Hospital, New Delhi and Lady Harding Medical College, New Delhi also take several measures to protect the lives of people and health care workers. inter alia include, r egular survey of areas where there is collection of water for detec larvae of aedes mosquitoes, weekl y Dengue vectors surveillance (Aedes Larva), regular fogging,  regular  spraying  with  anti  larva  agents,  maintenance  of  cleanliness  san and hygiene, regular training of sanitation workers, Multi Tasking Staff etc. on vector  Surveillance,  vaccin ation  for  swine  flu  to  health  care  workers  such  as  doctors nurses and staff, availability of personal protective measures such as gloves, mask aprons and any other article required is ensured, regular reporting of Dengue cases Ministry on w eekly basis.