National Surveillance Programme for Communicable diseases has been launched to strengthen the disease surveillance system so that early warning signals are recognised and appropriate timely follow-up action is initiated. The main objective of the programme is capacity building at district and state levels.

The programme will be implemented through the existing health infrastructure and surveillance system strengthened through training of the medical and para medical personnel, upgradation of laboratories, communication and data processing systems. The programme will be implemented by the state health authorities. The programme at the central level will be co-ordinated by the National Institute of Communicable Diseases Directorate General of Health Services.

In 1997, a pilot project was taken up in 5 districts for operational assessment of strategy of the programme. The districts were Allapuzzha in Kerala, Kolar in Karnataka, Alwar in Rajasthan, Gurgaon in Haryana and Mehsana in Gujarat. Training of state level rapid response team and district level rapid response team for outbreak investigations has been completed. Training of paramedicals in these districts is being undertaken.

Twenty districts were taken up in 1997-98. These districts are Mehboobnagar and East Godawari in Andhra Pradesh, Bijapur and Bellary in Karnataka, Kozhikode and Kottayam in Kerala, Muzzaffarpur and Samastipur in Bihar, Surat and Sabarkantha in Gujarat, Bhiwani and Sonepat in Haryana, Udaipur and Jodhpur in Rajasthan, Bastar and Bhopal in Madhya Pradesh, Satara and Dhule in Maharashtra and Haridwar and Varanasi in Uttar Pradesh. Training of state level rapid response teams has been undertaken in some of these districts. Process of strengthening of laboratories and communication network is under progress.

Funds for the programme will be provided from the plan budget of the NICD. Rs. 30 crores have been earmarked for the 9th plan period. These funds will be sufficient to sustain the programme in the 25 districts and to extend it to a further 75 districts during the plan period. Rs. 2.9 crores were released in 1997-98. Rs. 4.85 crores have been allocated in the BE 1998-99.

The Division continues to function as the nodal agency for planning, co-ordinating, training, monitoring, and periodically evaluating the programme which is implemented through the existing Primary Health Care System in the States of Andhra Pradesh, Gujarat, Karnataka, Madhya Pradesh, Maharasthra, Rajasthan and Tamil Nadu through the strategies of guinea worm disease surveillance, case management, vector control, health education and provision & maintenance of safe drinking water supply in collaboration with the Public Health Engineering Departments.

These well tested strategies enabled the country to achieve zero guinea worm disease status during 1997, the last case being recorded in July 1996 Jodhpur district Rajasthan as compared to an annual guinea work disease incidence of 40,000 cases in 1984.

Two active guinea worm case searches were carried out, one between April and June 97 and the other in December to detect occurrence of any new guinea worm case. The activities of the programme is monitored from NICD, through the Divisional Officers. In addition Epidemiological Surveillance Teams have been deployed by NICD in the State of Andhra Pradesh, Karnataka, Madhya Pradesh (1 team each), Rajasthan (4 teams) and 1 team is stationed at NICD Headquarters (till march) for over all co-ordination of Epidemiological Surveillance Teams.

Comparative Guinea Worm Disease Situation of 1984 & 1997

* affected refers to geographical areas and population there of which had reported guinea worm cases anytime between 1994 & 1996.

The eradication of guinea worm disease from the country would be an important landmark for the country in the field of diseases control after the eradication of small-pox and would prevent the loss of income due to disability occurring to the poor living in remote villages.

The National Institute of Communicable Diseases is now working towards the process of certification of guinea worm disease eradication which will be due in 1999 after completing 3 years of guinea worm disease free status. In this regard a document on the guidelines for preparation for Guinea Work Disease Certification was prepared for the States. During 1997, 54 State and District Level Health Officers were trained in two 3 day workshop held at Bhopal (2-4 Sept. 1997) and Bangalore (21-23 October 1997). In addition 415 PHC Medical Officers were trained in 15 one day workshops held at different centres in the guinea worm endemic States.

§         Yaws is a disfiguring, disabilitating non-venereal treponemal infection and is totally preventable. Early lesions of this disease manifest in the form of skin lesions which on healing show little scarring. The disease can be progressive wherein bone and cartilage are affected leading to disability. The disease can be cured and prevented by a single injection of long acting (benzathine benzyl) penicillin.

§         Yaws is amenable to eradication.

§         Yaws has been endemic in India since long. As per available records, the disease has been reported from 9 states of the country (Andhra Pradesh, Madhya Pradesh, Orissa, Maharashtra, Tamil Nadu, Gujarat, Uttar Pradesh, Bihar and Assam).

About the programme

§         Govt. of India approved Yaws Eradication Programme as a central sector health scheme as a Pilot Project for Koraput district (undivided), Orissa during the financial year 1996-97. The scheme will be extended to the states of Madhya Pradesh, Andhra Pradesh, Maharashtra and Gujarat.

§         The objective of the programme is to interrupt the transmission of yaws infection in the country (i.e. no infectious case) and eradication of yaws (i.e. no sero reactivity toRPR/VDRL in < 5 yr. Children).

§         The programme strategy includes manpower development, detection of case treatment of cases and contacts simultaneously and IEC activities harnessing multisectoral approach.

§         Operational component: The case detection is being done by making house to house visits by trained para-medical workers and community level functionaries at frequent intervals and treatment of case and contacts simultaneously and immediately after detection. Injection Benzathine penicillin is the drug of choice. Alternative erythromycin or tetracycline is used in the recommended doses. To facilitate the detection of cases, a coloured disease recognition card and other health education materials have been developed.

Activities undertaken

§         Manpower development: The medical officers of the districts listed below were trained with support from NICD faculty. The trained medical officers imparted training to paramedical staff in their respective primary health centres.

Andhra Pradesh       Khammam, West Godawari, Vizianagaram

Madhya Pradesh       Baster, Raipur, Bilaspur, Shahdol, Sidhi, Surguja, Rewa

Maharashtra            Gadchirolli, Chandrapur

Orissa             Koraput, Malkangiri, Nabrangpur, Rayagada

Gujarat           Ahwa Dang

§         Active search operation: Active search activity was undertaken as per programme guidelines in the following state and district: