Lok Sabha Question No. 2270 (UNSTARRED), answered on 2016-07-29
Subject: Epidemic Outbreaks
Ministry: HEALTH AND FAMILY WELFARE
Asked by: B. SREERAMULU, RAMACHANDRAN MULLAPPALLY, KIRIT PREMJIBHAI SOLANKI, ANTO  ANTONY, NALIN KUMAR KATEEL

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

## LOK SABHA UNSTARRED QUESTION NO. 2270 TO BE ANSWERED ON 29 TH JULY, 2016

## EPIDEMIC OUTBREAKS

## 2270. SHRI B. SRIRAMULU:

SHRI MULLAPPALLY RAMACHANDRAN:

DR. KIRIT P. SOLANKI:

SHRI ANTO ANTONY:

SHRI NALIN KUMAR KATEEL:

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

- (a)  whether  a  number  of  epidemic outbreaks  including  dengue  and  other  vector borne  and infectious diseases occur every year, particularly during the monsoon seasons in the country;
- (b)  if  so,  the  details  of  such  epidemics occurred  during  the  last  three  years,  along with  the number of cases and deaths reported, disease and State/UT - wise;
- (c) whether the situation of dengue fever is more worrisome in comparison to previous years, if so, the details thereof; and
- (d) the effective and preventive measures taken up by the Government to combat these diseases and to avoid recurrence of epidemics in the cou ntry?

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

- (a) & (b) Upsurge of cases due to Dengue and other Vector Borne Diseases viz. Malaria Japanese Encephalitis occurs particularly during the monsoon season in the country.   Seasonal upsurge  of  Malaria  and  Japanese  Encephalitis  is  known  during  monsoon  and  post  monsoon season.

Under Integrated Disease Surveillance Programme (IDSP), every week States/UTs repor outbreaks/early warning signals du e to infectious diseases occurring in the country.

The State/UT - wise cases and deaths due to Malaria, Dengue, Chikungunya, and Japanese Encephalitis (JE) occurred during the last three years are at Annexure -I, II, III, & IV.

- (c ): Yes.  The comparative de ngue situation in the country during previous years & current year (till June) is as under:

| Years   |   2014 |   2015 |   2016 |
|---------|--------|--------|--------|
| Cases   |   4399 |   6394 |   8307 |
| Deaths  |      8 |     23 |     10 |

(d) : Steps/actions  taken  to  prevent  and  control  the  vector  borne  diseases  and  infe diseases are as under:

## Dengue/Chikungunya:

During  the  year  2016,  Government  of  India  (GOI)  has  taken  the  following measures  for prevention and control of Dengue & Chiku ngunya in the country: -

- Provided Technical Guidance to the States for prevention and control of dengue, incl clinical management of dengue.
- Periodic  reviews  are  being  done  at  the  level  of  Hon'ble  HFM,  Secretary,  H& FW  and DGHS.  Since  January,  2016,  a  total  number  of  13  review  meetings  have  been  taken  b HFM, Secretary (H&FW), Additional Secretary, DGHS and Spl. DGHS with functionaries of different States/UTs.
- Periodic  advisories  have  been  issued  from  time  to  time fo r  prevention  and  control  of Dengue.  10  advisories  have  been  issued  at  the  levels  of  Secretary  (H&FW)  and  Add Secretary (H&FW) to all concerned for taking timely action in this regard.
- States have been requested to declare Dengue as notifiable disease vi de MOHFW's letter No.7- 165/2016/NVBDCP /DEN dated 9 th June 2016 and the same has been uploaded on the National Vector Borne Disease Control Programme (NVBDCP) website for taking action accordingly.
- Focused  IEC/BCC  activities  are  carried  out  at  National  an d  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 7thApril, 2016.
-  National Dengue Day has been observed on 16th May 2016 th roughout the country.
- Dengue & Chikungunya diagnosis is provided through 527 Sentinel Surveillance Hospita (SSHs) and 15 Apex Referral laboratories (ARLs) across the country.
- Accredited Social Health Activists (ASHAs) are also involved in source reduc tion activities for dengue prevention and control.
- Periodic field visits are made by NVBDCP Officials to States/UTs for review and to pro technical guidance for prevention and control of Dengue & Chikungunya.

## Malaria:

The Government has the following strategy for malaria control in the country:

1. Surveillance and case management
- Early diagnosis and complete treatment
- Case detection (active and passive) -Intensified during high transmission period
- Sentinel surveillance
2. Integrated Vector Management (IVM)
- Insecticide treated bed nets (ITNs) / Long -Lasting Insecticidal nets (LLINs)
- Indoor residual spray (IRS)
- Anti - larval measures including source reduction
3. Epidemic preparedness and rapid response.
4. Supportive interventions
- Behaviour change communication (BCC)
- Capacity building
- Intersectoral collaboration
- Operational research and applied field research
- Monitoring and evaluation (M & E)

Other steps to combat and to avoid recurrence of epidemics of malaria are as follows: -

1. Regular  monitoring  of  the  reports  received  from  the  states  and  feedback  to  the accordingly.
2. Coordination with IDSP to detect Early Warning Signals i.e. any upsurge in fever c or any reports of malaria outbreaks. Suc h reports are verified, followed up and managed accordingly.
3. Regular monitoring through field visits of NVBDCP officers/ consultants.
4. Issuing advisory to the states before the monsoon season to upscale their activit make all the necessary preparat ions.
5. Technical support and guidance.
6. Logistic support.

## Japanese Encephalitis (JE):

A  multipronged  strategy  has  been  adopted  under  the  National  Programme  to  reduce morbidity,  mortality  and  disability  in  children  due  to  JE.  Major  components  under programme are :

- (i) Strengthening of surveillance, vector control by establishing sentinel laboratories.
- (ii)Strengthening and expansion of  JE vaccination in endemic districts;
- (iii) Strengthening  of  case  management  by  setting  10  bedded  pediatric  ICU  in  60  distr hospitals and  timely referral of serious and complicated cases;
- (iv)Provision of adequate facilities for physical, medical, neurological rehabilitation;

and

- (v) Improvement of nutritional status of children at risk and intensified IEC/BCC activit

Establishment of Physical Medicine and Rehabilitation Department in 10 identified med college of five states.

Financial: Funds  are  provided  by  Govt.  of  India  to  the  States  for  prevention  and  contro Vector Borne Diseases (VBDs) including Dengue, to implement the public health activities.

## Integrated Disease Surveillance Programme (IDSP) :

Under  IDSP,  the  districts  and  States  have  been  strengthened  by  providing  additi manpower,  training  of  identified  Rapid  Response  Team  (RRT)  members  for  outbr eak investigations,  strengthening  of  laboratories  for  detection  of  epidemic  prone  diseas equipment for data entry, analysis and data transfer, and provision of funds operationalization.

Funds are released under IDSP to all the States as grant -in -aid to undertake diseases surveillance activities.

## Malaria Situation in the Country

| States/UTs.         | 2013   | 2013   | 2014    | 2014   | 2015*   | 2015*   |
|---------------------|--------|--------|---------|--------|---------|---------|
| States/UTs.         | Cases  | Deaths | Cases   | Deaths | Cases   | Deaths  |
| Andhra Pradesh      | 19787  | 0      | 21077   | 0      | 24588   | 0       |
| Arunachal Pradesh   | 6398   | 21     | 6082    | 9      | 4991    | 3       |
| Assam               | 19542  | 7      | 14540   | 11     | 15555   | 0       |
| Bihar               | 2693   | 1      | 2043    | 0      | 3548    | 1       |
| Chhattisgarh        | 110145 | 43     | 128993  | 53     | 133780  | 8       |
| Goa                 | 1530   | 0      | 824     | 0      | 786     | 1       |
| Gujarat             | 58513  | 38     | 41608   | 16     | 41422   | 1       |
| Haryana             | 14471  | 3      | 4485    | 1      | 2843    | 0       |
| Himachal Pradesh    | 141    | 0      | 102     | 0      | 60      | 0       |
| J&K                 | 698    | 0      | 291     | 0      | 216     | 0       |
| Jharkhand           | 97786  | 8      | 103735  | 8      | 90251   | 4       |
| Karnataka           | 13302  | 0      | 14794   | 2      | 11341   | 0       |
| Kerala              | 1634   | 0      | 1751    | 6      | 1549    | 4       |
| Madhya Pradesh      | 78260  | 49     | 96879   | 26     | 97200   | 16      |
| Maharashtra         | 43677  | 80     | 53385   | 68     | 56603   | 31      |
| Manipur             | 120    | 0      | 145     | 0      | 216     | 0       |
| Meghalaya           | 24727  | 62     | 39168   | 73     | 48603   | 79      |
| Mizoram             | 11747  | 21     | 23145   | 31     | 28593   | 0       |
| Nagaland            | 2285   | 1      | 1936    | 2      | 1527    | 3       |
| Orissa              | 228858 | 67     | 395035  | 89     | 432375  | 78      |
| Punjab              | 1760   | 0      | 1036    | 0      | 633     | 0       |
| Rajasthan           | 33139  | 15     | 15118   | 4      | 11429   | 0       |
| Sikkim              | 39     | 0      | 35      | 0      | 27      | 0       |
| Tamil Nadu          | 15081  | 0      | 8729    | 0      | 5653    | 0       |
| Telangana           |        |        | 5189    | 0      | 10945   | 3       |
| Tripura             | 7396   | 7      | 51240   | 96     | 32525   | 21      |
| Uttarakhand         | 1426   | 0      | 1171    | 0      | 1495    | 0       |
| Uttar Pradesh       | 48346  | 0      | 41612   | 0      | 42563   | 0       |
| West Bengal         | 34717  | 17     | 26484   | 66     | 24054   | 33      |
| A.N.Islands         | 1005   | 0      | 557     | 0      | 409     | 0       |
| Chandigarh          | 150    | 0      | 114     | 0      | 152     | 0       |
| D & N Haveli        | 1778   | 0      | 669     | 1      | 535     | 0       |
| Daman & Diu         | 91     | 0      | 56      | 0      | 82      | 0       |
| Delhi               | 353    | 0      | 98      | 0      | 54      | 0       |
| Lakshadweep         | 8      | 0      | 0       | 0      | 4       | 0       |
| Puducherry          | 127    | 0      | 79      | 0      | 54      | 1       |
| Total * Provisional | 881730 | 440    | 1102205 | 562    | 1126661 | 287     |

## Dengue Situation in the Country

| Sl.no   | States/UTs        | 2013   | 2013   | 2014   | 2014   | 2015   | 2015   |
|---------|-------------------|--------|--------|--------|--------|--------|--------|
| Sl.no   | States/UTs        | Cases  | Deaths | Cases  | Deaths | Cases  | Deaths |
| 1       | Andhra Pradesh    | 910    | 1      | 1262   | 5      | 3159   | 2      |
| 2       | Arunachal Pradesh | 0      | 0      | 27     | 0      | 1933   | 1      |
| 3       | Assam             | 4526   | 2      | 85     | 0      | 1076   | 1      |
| 4       | Bihar             | 1246   | 5      | 297    | 0      | 1771   | 0      |
| 5       | Chhaatisharh      | 83     | 2      | 440    | 9      | 384    | 1      |
| 6       | Goa               | 198    | 2      | 168    | 1      | 293    | 0      |
| 7       | Gujarat           | 6272   | 15     | 2320   | 3      | 5590   | 9      |
| 8       | Haryana           | 1784   | 5      | 214    | 2      | 9921   | 13     |
| 9       | Himachal Pradesh  | 89     | 2      | 2      | 0      | 19     | 1      |
| 10      | J&K               | 1837   | 3      | 1      | 0      | 153    | 0      |
| 11      | Jharkhand         | 161    | 0      | 36     | 0      | 102    | 0      |
| 12      | Karnataka         | 6408   | 12     | 3358   | 2      | 5077   | 9      |
| 13      | Kerala            | 7938   | 29     | 2575   | 11     | 4075   | 25     |
| 14      | Madhya Pradesh    | 1255   | 9      | 2131   | 13     | 2108   | 8      |
| 15      | Meghalaya         | 43     | 0      | 0      | 0      | 13     | 0      |
| 16      | Maharashtra       | 5610   | 48     | 8573   | 54     | 4936   | 23     |
| 17      | Manipur           | 9      | 0      | 0      | 0      | 52     | 0      |
| 18      | Mizoram           | 7      | 0      | 19     | 0      | 43     | 0      |
| 19      | Nagaland          | 0      | 0      | 0      | 0      | 21     | 1      |
| 20      | Odisha            | 7132   | 6      | 6433   | 9      | 2450   | 2      |
| 21      | Punjab            | 4117   | 25     | 472    | 8      | 14128  | 18     |
| 22      | Rajasthan         | 4413   | 10     | 1243   | 7      | 4043   | 7      |
| 23      | Sikkim            | 38     | 0      | 5      | 0      | 21     | 0      |
| 24      | Tamil Nadu        | 6122   | 0      | 2804   | 3      | 4535   | 12     |
| 25      | Tripura           | 8      | 0      | 6      | 0      | 40     | 0      |
| 26      | Telangana         | 0      | 0      | 704    | 1      | 1831   | 2      |
| 27      | Uttar Pradesh     | 1414   | 5      | 200    | 0      | 2892   | 9      |
| 28      | Uttrakhand        | 54     | 0      | 106    | 0      | 1655   | 1      |
| 29      | West Bengal       | 5920   | 6      | 3934   | 4      | 8516   | 14     |
| 30      | A&N Island        | 67     | 0      | 139    | 0      | 153    | 0      |
| 31      | Chandigarh        | 107    | 0      | 13     | 0      | 966    | 1      |
| 32      | Delhi             | 5574   | 6      | 995    | 3      | 15867  | 60     |
| 33      | D&N Haveli        | 190    | 0      | 641    | 1      | 1154   | 0      |
| 34      | Daman & Diu       | 61     | 0      | 46     | 0      | 165    | 0      |
| 35      | Puducherry        | 2215   | 0      | 1322   | 1      | 771    | 0      |
| Total   | Total             | 75808  | 193    | 40571  | 137    | 99913  | 220    |

## Annexure-II

Annexure-III Clinically Suspected Chikungunya Situation in the Country

| Sl.No.   | States/UTs    | 2013   |   2014 |   2015 |
|----------|---------------|--------|--------|--------|
| 1        | Andhra Prd.   | 4827   |   1359 |    817 |
| 2        | Arunachal Pd. |        |      0 |     35 |
| 3        | Assam         | 742    |      0 |      0 |
| 4        | Bihar         | 0      |      0 |      3 |
| 5        | Goa           | 1049   |   1205 |    561 |
| 6        | Gujarat       | 2890   |    574 |    406 |
| 7        | Haryana       | 1      |      3 |      1 |
| 8        | Jharkhand     | 61     |     11 |     21 |
| 9        | Karnataka     | 5295   |   6962 |  20763 |
| 10       | Kerala        | 273    |    272 |    175 |
| 11       | Madhya Prd.   | 139    |    161 |     67 |
| 12       | Meghalaya     | 0      |      0 |     78 |
| 13       | Maharashtra   | 1578   |   1572 |    391 |
| 14       | Odisha        | 35     |     10 |     81 |
| 15       | Punjab        | 0      |      2 |    180 |
| 16       | Rajasthan     | 76     |     50 |      7 |
| 17       | Tamil Nadu    | 859    |    543 |    329 |
| 18       | Telangana     | 0      |   1687 |   2067 |
| 19       | Tripura       | 0      |     34 |    180 |
| 20       | Uttar Prd.    | 0      |      4 |      0 |
| 21       | Uttrakhand    | 0      |      0 |      0 |
| 22       | West Bengal   | 646    |   1032 |   1013 |
| 23       | A&N Islands   | 202    |    161 |     68 |
| 24       | Chandigarh    | 1      |      0 |      1 |
| 25       | Delhi         | 18     |      8 |     64 |
| 26       | D&N Haveli    | 2      |      0 |      0 |
| 27       | Lakshadweep   | 0      |      0 |      0 |
| 28       | Puducherry    | 146    |    399 |    245 |
|          | Total         | 18840  |  16049 |  27553 |

## JE situation in the country

| Sl. No.   | States / UTs      | 2013   | 2013   | 2014   | 2014   | 2015   | 2015   |
|-----------|-------------------|--------|--------|--------|--------|--------|--------|
|           |                   | Cases  | Deaths | Cases  | Deaths | Cases  | Deaths |
| 1         | Andhra Pradesh    | 7      | 3      | 0      | 0      | 0      | 0      |
| 2         | Arunachal Pradesh | 0      | 0      | 32     | 3      | 32     | 2      |
| 3         | Assam             | 495    | 134    | 761    | 165    | 614    | 135    |
| 4         | Bihar             | 14     | 0      | 20     | 2      | 66     | 12     |
| 5         | Delhi             | 0      | 0      | 0      | 0      | 1      | 0      |
| 6         | Goa               | 3      | 1      | 0      | 0      | 0      | 0      |
| 7         | Haryana           | 2      | 0      | 5      | 1      | 2      | 0      |
| 8         | Jharkhand         | 89     | 5      | 90     | 2      | 116    | 8      |
| 9         | Karnataka         | 2      | 0      | 13     | 0      | 27     | 1      |
| 10        | Kerala            | 2      | 0      | 3      | 2      | 2      | 1      |
| 11        | Maharashtr a      | 0      | 0      | 0      | 0      | 7      | 0      |
| 12        | Manipur           | 0      | 0      | 1      | 0      | 6      | 0      |
| 13        | Meghalaya         | 0      | 0      | 72     | 3      | 41     | 8      |
| 14        | Nagaland          | 4      | 0      | 6      | 0      | 0      | 0      |
| 15        | Odisha            |        |        |        |        | 33     | 2      |
| 16        | Punjab            | 0      | 0      | 0      | 0      | 0      | 0      |
| 17        | Tamil Nadu        | 33     | 0      | 36     | 3      | 53     | 0      |
| 18        | Tripura           | 14     | 0      | 14     | 0      | 28     | 4      |
| 19        | Uttarakhand       | 0      | 0      | 2      | 0      | 2      | 0      |
| 20        | Uttar Pradesh     | 281    | 47     | 191    | 34     | 351    | 42     |
| 21        | West              | 140    | 12     | 415    | 78     | 342    | 75     |
| 22        | Bengal Telengana  |        |        | 0      | 0      | 8      | 1      |
| Total     | Total             | 1086   | 202    | 1661   | 293    | 1731   | 291    |

## Annexure-IV