Lok Sabha Question No. 94 (STARRED), answered on 2021-12-03
Subject: Mucormycosis and Dengue Cases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Keshari Devi Patel

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

## LOK SABHA STARRED QUESTION NO.94 TO BE ANSWERED ON THE 3 RD  DECEMBER, 2021 MUCORMYCOSIS AND DENGUE CASES

## †*94. SHRIMATI KESHARI DEVI PATEL:

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

- (a) the number of cases of Black Fungus or Mucormycosis reported till date in each State/UT including Prayagraj in Uttar Pradesh and Jamui in Bihar;
- (b) the steps taken by the Government to tackle such cases;
- (c) the preventive measures initiated by the Government in controlling and treating the increasing number of dengue cases in the country;
- (d) whether the Government has any proposal to provide special package to States/UTs in order to enhance the treatment facilities being provided to Dengue patients; and
- (e) if so, the details thereof, State/UT-wise particularly in Rajasthan, Uttar Pradesh and Bihar?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. MANSUKH MANDAVIYA)

- (a) to (e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 94* FOR 3 RD  DECEMBER, 2021

(a) to (e) A  total of 51,775 cases of Mucormycosis  have  been  reported till 29 th November  2021.  State  wise  cases  of  Mucormycosis  reported  till  29 th November 2021 are at Annexure 1.

Further, 28 cases have been reported in Prayagraj, UP  &  2  cases of Mucormycosis are reported in Jamui, Bihar.

Health  is  a  state  subject.  Union  Ministry  of  Health  has  proactively  supported states to tackle the challenge posed by cases of Mucormycosis during the second surge of Covid-19.

MOHFW had asked all states vide DO letter dated 19 th May and 24 th May to make Mucormycosis a notifiable disease so as get details of Mucormycosis incidence in the country. A unified portal was created by MoHFW for States to enter surveillance data of Mucormycosis cases.

The Ministry of  Health  & Family  Welfare  has issued  national  comprehensive guidelines  for  the  management  of  post  covid  sequelae  including  mucormycosis  as available on https://www.mohfw.gov.in/pdf/NationalComprehensiveGuidelinesforManagementofP ostCovidSequelae.pdf.

The clinical management guidelines for managing COVID-19 cases by Ministry of Health & Family Welfare advocates rational use of steroids for managing moderate to severe cases of COVID-19  under  strict medical  supervision. Further noting relationship between use of steroids and other immune-suppressive drugs 'Advisory for rational  use  of  Steroids  and  Tocilizumab  in  the  treatment  of  Covid  -19  patients'  was issued by Directorate General of Health Services.

Since  early  May,  2021  the  details  of  production,  stock,  supplies  made  and purchase  orders  were  obtained  from  the  manufacturers  and  their  co-operation  was sought to overcome the gap between supply and demand.

Department of Pharmaceuticals (DoP), Central Drugs Standard Control Organisation  (CDSCO)  &  National  Pharmaceutical  Pricing  Authority  (NPPA)  have been  jointly  monitoring  the  production  and  availability  of  critical  (COVID)  drugs including Amphotericin-B injections.

Central  Government  has  placed  Amphotericin  B  under  restricted  category  for export  vide  Notification  dated  1st  June,  2021  for  ensuring  continuous  availability  of medicines for treatment of Mucormycosis cases domestically.

Central Government has undertaken steps to procure the Amphotericin-B from various available sources around the globe and made efforts to increase the production of existing Manufacturers/Importers for the said drug in the country.

Central  Drugs  Standard  Control  Organisation  (CDSCO)  under  MoHFW  has given permission to 11 new manufacturers of Liposomal Amphotericin- B. A total of 16,08,291  vials  of  Liposomal  Amphotericin-B  were  jointly  allocated  by  Dept.  of Pharmaceuticals and MoHFW  to  various States/UTs up to 24th July 2021 on commercial basis.

Further, 3 lakhs vials of Liposomal Amphotericin-B procured by MoHFW has been allocated to States/UTs and Central Health Institutions free of cost.

Ministry  of  External  Affairs  (MEA)  contacted  various  manufacturers  abroad. Through  its missions all over the world,  MEA  has  identified  new  sources  of Amphotericin  B/  Liposomal  Amphotericin  B  injections  and  alternative  drugs  for treatment of Mucormycosis.

For  equitable  distribution,  allotments  have  been  made  to  the  States/  UTs  in accordance  with  the  proportion  of  their  reported  case  load  in  respect  of  the  entire country.

Supply  arrangements  have  been  monitored  by  the  National  Pharmaceuticals Pricing Authority (NPPA) so as to ensure expeditious availability of the drug.

NPPA has put in place a strongly responsive system to ensure timely supplies of allocated volumes and maintains continuous contact with States/UTs and suppliers to trouble shoot any issues in reaching the drugs to the Health Departments of States/ UTs.

Both first-  and  second-line  drugs  used  for  managing  Mucormycosis  cases  i.e. Amphotericin B Deoxycholate and Posaconazole are currently amplyavailable in Indian markets

During 2021(as on 21 st November) total number of 1,64,103 dengue cases were reported as against 2,05,243 cases in 2019. Through the efforts of Government of India and States the Case Fatality Rate (deaths per 100 cases) has been sustained <1% since 2008. The case fatality rate has remained at extremely low level of 0.1% since 2019.

Some steps taken by MoHFW to tackle rise in Dengue cases in country are:

-  In  2021,  multidisciplinary  Central  Teams  were  deputed  to  15  States  and  UTs  of Gujarat,  Haryana,  Punjab,  Kerala,  Madhya  Pradesh,  Maharashtra,  Odisha,  Rajasthan, Tamil  Nadu,  Tripura,  Uttar  Pradesh,  Telangana,  Uttarakhand,  Delhi  and  Jammu  & Kashmir from 28th August to 19th November 2021.
-  Government  of  India  has  shared  National  guidelines  on  Dengue  case  management during Covid-19 Pandemic, developed in consultation with experts, with all States/UTs.
-  Government of India has also taken the following measures for prevention and control of dengue in the country:
- i) Provided Technical Guidelines for prevention and control, case management & effective community participation to the States for implementation. 15 advisories were issued from time to time to States/UTs for prevention and control of dengue in 2021.
- ii) Free  diagnostic  facilities  through  713  Sentinel  Surveillance  Hospitals  and  17 Apex Referral laboratories identified across the country are fully functional. 7.26 Lakh IgM tests have been provided by Government of India. Additional fund has also been provided to states for procurement of NS1 kits for early diagnosis.
- iii) The  details  of  diagnostic  facilities  and  IgM  tests  supplied  to  Rajasthan,  Uttar Pradesh and Bihar is given below:

|   S.N. | State         |   Number of identified Sentinel Surveillance Hospitals | IgM tests supplied   |
|--------|---------------|--------------------------------------------------------|----------------------|
|      1 | Rajasthan     |                                                     50 | 66,624               |
|      2 | Uttar Pradesh |                                                     54 | 82,656               |
|      3 | Bihar         |                                                      9 | 4896                 |

Annexure I State wise distribution of Mucormycosis Cases in India as on 29 th Nov, 2021

| S.No   | State/UT          |   Total Cases (Overall) |
|--------|-------------------|-------------------------|
| 1      | Andaman &Nicobar  |                     317 |
| 2      | Andhra Pradesh    |                    5107 |
| 3      | Assam             |                      12 |
| 4      | Bihar             |                     842 |
| 5      | Chandigarh        |                     739 |
| 6      | Chhattisgarh      |                     429 |
| 7      | Delhi             |                    2069 |
| 8      | Goa               |                      33 |
| 9      | Gujarat           |                    7257 |
| 10     | Haryana           |                    1792 |
| 11     | Himachal Pradesh  |                      38 |
| 12     | Jammu and Kashmir |                      58 |
| 13     | Jharkhand         |                     132 |
| 14     | Karnataka         |                    4025 |
| 15     | Kerala            |                     148 |
| 16     | Madhya Pradesh    |                    2381 |
| 17     | Maharashtra       |                   10366 |
| 18     | Manipur           |                       8 |
| 19     | Nagaland          |                       1 |
| 20     | Odisha            |                     227 |
| 21     | Puducherry        |                     225 |
| 22     | Punjab            |                     691 |
| 23     | Rajasthan         |                    3711 |
| 24     | Tamil Nadu        |                    5007 |
| 25     | Telangana         |                    2638 |
| 26     | Tripura           |                       1 |
| 27     | Uttar Pradesh     |                    2603 |
| 28     | Uttarakhand       |                     590 |
| 29     | West Bengal       |                     328 |
|        | TOTAL             |                   51775 |