The National Institute of Communicable Disease (NICD) has launched the following programs.

The outbreaks of plague (1994) Malaria (1995) and Dengue Haemorrhagic Fever (1996) in the country have highlighted the weakness in the existing surveillance system and urgency for its strengthening so that early warning signals are recognised and follow up action is initiated in a timely manner. To meet it, the Government of India constituted a number of high powered committees. Technical Advisory Committee on Plague, Bajaj Committee on Revamping of Public Health System, Dayal Committee on Environmental Sanitation and Surveillance. All these committees  recommended strengthening of disease surveillance activities across the country.  The government of India, keeping the urgency of the matter, constituted a National Apical Advisory committee (NAAC)  under the chairmanship of Union Secretary Health.

On the recommendation of the committee, Government of India launched National Surveillance Programme for Communicable Diseases (NSPCD) as a pilot project with the goal for improving the health status of the people. The main objective of the programme is to strengthen the disease surveillance system, so that early warning signals are recognised and appropriate and timely follow-up action is initiated.  The main programme component is capacity building at districts and state levels. The programme is implemented by the state health authorities through the existing health infrastructure. Surveillance system is being strengthened by training of medical and para medical personnel, up-gradation of laboratories, communication and data processing systems. Programme at the central level is coordinated by the National Institute of Communicable Diseases, Directorate General of Health Services.

Programme implementation

In 1997, a pilot project was taken up in 5 districts for operational assessment of strategy of the programme. Twenty more districts were taken up in 1997 – 98. Presently the programme is in operation in 80 districts of 28 states/ UTs.  During 2001 – 02, it is proposed to cover 20 more districts so as to have the programme in 100 districts of all 35 states/ UTs (list of districts taken up till 2000-01, and proposed for inclusion during 2001-02 is annexed).

Rapid Response Teams (RRTs)

At state & district levels multidisciplinary RRTs have been identified. These teams comprise of four members from different specialty viz. Epidemiology, Clinical medicine, Microbiology/ Bacteriology and Medical entomology. After RRT has been identified, training is given. RRTs, have been in place in all the 20 states/ UTs and 45 districts. Training of RRt members from five states (Punjab, Sikkim, Tripura, Uttranchal and West Bengal) was organised during 3-14 September, 2001. Training in respect of remaining five states (Assam, Chandigarh, Chattisgarh, Jammu & Kashmir and Meghalaya) was started on 17^th September, 2001, and would be completed on 28^th September, 2001.

Case definitions of common communicable diseases

To have uniformity in reporting and also to facilitate detection & reporting of cases by field workers, NICD have prepared a module on case definitions of common communicable diseases. A copy of the same has been sent to all the state and district officials for  use by them.

Communication material

Almost all the state & district level Epidemiology cells have procured computers, FAX machines and telephones for data processing and rapid communication of information.

Laboratory strengthening

            District level -  District laboratories have been strengthened through procurement of scientific equipments, reagents and rapid diagnostic kits etc. These district laboratories support in confirmation of diagnosis of common communicable diseases.

            Regional level - In ten programme states, either the state level or a medical college laboratory has been identified as regional laboratory and has been strengthened by provision of scientific and communication equipment, besides chemicals/ reagents and rapid diagnostic test kits. These laboratories act as referral laboratories besides undertaking some more sophisticated tests, which are beyond the purview of district laboratories.

Networking

Networking between district, state, regional laboratories and other specialised institutes of repute in the country besides national level has been initiated. Soon a web-site connecting all the 80 districts will be operational. 

Healthcare and response

The programme implementation was assessed by a WHO and NICD, joint team in seven states during 1999-2000. The assessment revealed that there is an overall improvement in outbreak detection and response mechanism in the programme districts.

Subsequently the programme activities are being reviewed regularly.

Capacity building

State nodal officers, district nodal officers have been trained at NICD. Some of them have also undergone 3 months Field Epidemiology Training Programme (FETP). All the professionals and para-professionals of the district have been trained at the district/ PHC. Laboratory staff also has been trained. A large number of professionals have also been trained, in Training workshops on Epidemic Preparedness & Response, organised at; Delhi (10-19 April 2000), Pune (20-28 September 2000), Chennai (2-11 January 2001) and Lucknow (21-30 May 2001).

NICD, Delhi is als organising Regional Training Programme on Prevention and Control of Communicable Diseases for paramedical personnel. In this preference is given to those who are working under NSPCD.

District response

The district response to surveillance, outbreak investigation and data analysis is improving. They have started sending reports on weekly basis regarding any outbreaks, any health events as reported in the newspapers and on monthly basis the reports of cases/ deaths due to communicable diseases. This improved response system will help in achieving the goal for improving the health status of the people.

Programme expansion

During 2001-02, it is proposed to extend the programme to include 20 more districts, so as to have the programme in 100 districts of all the 35 states/ UTs.

It is strongly recommended to expand the programme to all the districts of the country during 10^th Plan period. 

Review of the programme indicated  that there is an urgent need to expand the programme throughout the country. If funds from the country are not available, then possibility of funding from external agencies such as World Bank may be sought. 

Major Issues

1. Ownership of the programme – Presently the programme is on a pilot basis and supported by Government of India. The surveillance activity is the prime responsibility of state governments. Therefore it is urged that the state government should own the programme. The central government should provide support for capacity building, providing operational guidelines, monitoring & review communication and scientific equipments, diagnostic reagents and kits etc..

2. Microbiological laboratory support – Laboratories of district hospital provide clinico-pathological investigative support. Microbiological support is essential for early diagnosis and timely appropriate response. The state governments should provide the personnel support and central government should provide other assistance such as for scientific laboratory and communication equipments, reagents & kits etc.

3. Strengthening of district epidemiological setup – Strengthening is to be provided through capacity building and communication facilities like computers, Fax machines and e-mail. The same should be supported by Government of India.

4. Involvement of Preventive & Social Medicine and Microbiology Departments Medical Colleges –The expertise in the fields of Epidemiology and microbiology is available in medical colleges. They should be appropriately involved.

5. Private laboratories – where qualified professionals are available, those laboratories should be appropriately linked.

6. Field Epidemiology Training Programme (FETP) - steps should be taken up by state governments that those officers who are involved with NSPCD, are sent for 3 months Field Epidemiology Training Programme (FETP).

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

The 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 are monitored from NICD, through the Divisional Officers. In addition Epidemiological Surveillance Teams have been deployed by NICD in the States of Andhra Pradesh, Karnataka, Madhya Pradesh (I team each), Rajasthan (4 teams) and 1 team is stationed at NICD Headquarters (till March) for over all co-ordination of Epidemiological Surveillance Teams.

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 Worm Disease Certification was prepared for the States. During 1997, 54 State and District Level Health Officers were trained in two 3-day workshops 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.

1. About the disease:

1.1 Yaws is a disfiguring, disabilitating non-venereal treponemal infection. It is a contagious disease transmitted by direct (person-to-person) contact with the infectious yaws lesion. 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.

1.2 Yaws is amenable to eradication as it does not have any extra human reservoir of infection, organism is sensitive to a single dose of long acting penicillin and yaws infection is limited to a small pocket.

1.3 Yaws has been endemic in India since long. As per available records, the disease has been reported from 10 states of the country (Andhra Pradesh, Assam, Chhattishgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu, and Uttar Pradesh). The problem is perpetuating in remote, inaccessible, hilly and forest tribal areas. 

1.4 In India, the disease is mostly known by the name of the tribe affected most in any region. Some of the common names of yaws are as under:

Madhya Pradesh      :      Gondi rog, Maria rog, Shevaya, Aparas, Chakawer

Maharashtra            :      Madia rogam

Andhra Pradesh       :      Koya rogam

Orissa                      :      Koya rog, Bhata phuta, Sabaya

Tamil Nadu               :      Peekali mariyerha, Urubai kilangomariyerha

Uttar Pradesh          :      Vyadhi, Dakhinia

Assam                      :      Domaru Khahu, Pachwari

2. About the programme:

2.1 Govt. of India approved Yaws Eradication Programme as a central sector health scheme as a Pilot Project for undivided Koraput district, Orissa during the financial year 1996-97. Subsequently, the scheme was extended to the States of Andhra Pradesh, Gujarat, Madhya Pradesh, and Maharashtra. In March 1999, the Standing Finance Committee of Government of India approved extension of the scheme in all the endemic states. As per the revised allocation, an amount of Rs. 3.7 crores has been earmarked for the programme during 9th plan period.   

2.2 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 to RPR/VDRL in < 5 yr children).

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

2.4 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 given in single dose. In penicillin sensitive cases,  erythromycin or tetracycline is used in the recommended doses for a period of 15 days. To facilitate the detection of cases, a coloured disease recognition card showing different manifestations of the disease (photographs shown) and other health education materials have been developed.

2.5 Programme management: The National Institute of Communicable Diseases (NICD) has been identified as the nodal agency by Government of India for planning, guidance, co-ordination, monitoring and evaluation of the programme. The programme is implemented by the State Health Directorate of yaws endemic states utilizing existing health care delivery system with the co-ordination and collaboration of Department of Tribal Welfare and other related institutions. 

3. Activities undertaken:

3.1 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 centers.

3.2 Active search operation: Active search activity is being undertaken as per programme guidelines in the above listed states and districts. In 1997, 8,515 cases of yaws were reported while in the year 2000, a total of 1,764 cases were detected.

3.3 Review Meeting of programme officers was held at Bhopal on 25-26 February 1999. The meeting was attended by state and district nodal officers of Andhra Pradesh, Madhya Pradesh, Maharashtra and Orissa. During 2001, review meeting was organized at Nagpur during 24-25 May. The meeting was attended by state nodal officers of Andhra Pradesh, Chhattishgarh, Gujarat, Maharashthra, Orissa, Uttar Pradesh and Tamil Nadu. The programme activities were reviewed and action plan for 2001 was drawn.

3.4 A multisectoral meeting on the programme was held at NICD, Delhi on 23-24 December 1999 and at Bilaspur on 25-26 February 2000. The meeting was attended by senior officer of Union Ministry of Tribal Affairs, project officer of Integrated Tribal Development Agency (ITDA) and state and district nodal officers. The areas for collaboration and plan of action for 2000 were discussed.  

3.5 First independent appraisal of the programme was carried out during 24 April to 03 May 2000. As per the observations and recommendations of the experts, follow-up actions are being undertaken. Second appraisal of the programme is proposed to be undertaken in early 2002.

3.6 A task force has been constituted under the Chairmanship of Dr. S. P. Agarwal, Director General of Health Services, Government of India in April 2000. The meeting of the task force was held on 18th August 2000. The meeting was attended by the senior officers from Dte.GHS, SEARO, ICMR, Safdarjung Hospital, CHEB, NICD, Union Ministry of Tribal Affairs and state health directorates of Andhra Pradesh, Madhya Pradesh, Maharashtra and Orissa. The progress made in the implementation of the Programme and strategies to strengthen the Programme were reviewed. Second meeting of the task force was held on 23.10.2001

4. Budget and Expenditure

The funds for the programme are being sent to the State Governments as grants-in-aid for undertaking different activities. Till 1997-98, commodity assistance in the form of drugs was provided to the state governments but now drugs are being procured by state governments from the grants-in-aid as per SFC Memorandum approved by the Govt. of India in March 1999.

The total allocation for the scheme is Rs 3.7 crore for the entire 9th Five Year Plan.

Yaws Endemic States & Districts of India