vector borne diseases and NVBDCP

• 1. VECTOR BORNE DISEASES AND NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME(NVBDCP) DR SANJAYA KUMAR SAHOO AIIH&PH,KOLKATA

2. World Health Day theme 2014: vector borne diseases SMALL BITE BIG THREAT 3. INTRODUCTION: With this World Health Day, WHO is drawing attention to a group of diseases that are spread by insects and other vectors, the heavy health and economic burdens they impose, and what needs to be done to reduce these burdens. Vector-borne diseases cause more than one million deaths each year and Over half the world's population is at risk from vector-borne diseases such as malaria and dengue. Vectors like mosquitoes, ticks, and fleas transmit parasites, viruses, or bacteria between people or between animals and people. But death counts, though alarming, vastly underestimate the human misery and hardship caused by these diseases, as many people who survive infections are left permanently debilitated, disfigured or blind. . 4. Vector-borne diseases: Key facts Marking the World Health Day, WHO has released some key facts and figures based on this year's theme: Vector-borne diseases are commonly found in tropical and sub-tropical regions and places with problems surrounding safe drinking-water and sanitation systems. Vector-transmitted diseases account for 17% of the estimated global burden of all infectious diseases. Malaria is the most deadly vector-borne disease. It caused an estimated 660,000 deaths in 2010 and 627,000 deaths in 2012, most of whom were African children. Dengue is the world's fastest growing vector-borne disease with a 30-fold increase in disease incidence over the last 50 years. Nearly 40% of the world's population is at risk from dengue. An estimated 1.3 million new cases of leishmaniasis, caused by sandflies, occur annually. Globalisation of trade and travel, climate change and urbanisation are all having an impact on the global spread of vector-borne diseases. 5. What Is it? Vector: It is defined as an arthropod or any living carrier that transport an infectious agent to a susceptible individuals. The transmission by a vector may be mechanical or biological. So, vectors themselves are not an infectious agents. E.g. - mosquito, fly, rodents, tick Vector borne disease: A disease that is transmitted to humans or other animals by an insect such as a mosquito or another arthropod is called a vector-borne disease. 6. Launched in 2003-04 by convergence of three ongoing programmes on malaria,filaria & Kala Azar and inclusion of Japanese Encephalitis and Dengue/DHF.In 2007 chikungunya fever added to this programme due to re-emergence of the diseases in 2006. This program is now runs under the umbrella of NRHM. NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMME(NVBDCP) 7. DISEASES INCLUDED UNDER NVBDCP: 1. Malaria 2. Dengue 3. Chikungunya 4. Japanese Encephalitis 5. Kala-Azar 6. Filaria (Lymphatic Filariasis) 8. VISION: A Well informed and self-sustained, healthy india free from vector borne diseases with equitable access to quality health care. MISSION: An integrated and accelerated action towards reducing mortality on account of malaria, dengue and JE BY HALF Elimination of kala-azar by 2010 Elimination of lymphatic filariasis by 2015 9. 12 STRATEGIES OF NVBDCP: - Early case detection and complete treatment, - strengthening of referral services, -epidemic preparedness and rapid response. 1.DISEASE MANAGEMENT 2.INTEGRATED VECTOR MANAGEMENT(IVM) -Behavioural change communication(BCC) -Intersectoral convergence -public private partnership -Operational research -Monitoring and evaluation 3.SUPPORTIVE INTERVENTIONS: Entomological surveillance Anti-larval measures Anti adult nmeasures 10. Japanese encephalitis(JE) 11. History 1870s: Japan Summer encephalitis epidemics 1924: Great epidemic in Japan 6,125 human cases; 3,797 deaths 1935: Virus first isolated From a fatal human encephalitis case 1938: Isolated from Culex tritaeniorhynchus 1952: First evidence of J E 1955:First case in India 1958:First viral isolation in India 1973:First outbreak in Bankura/Burdwan 1978:widespread occurance/monitoring NMEP Initiation of immunisation in 2006 JE vaccine included in UIP in 11 endemic district of four states. In October 2013 India launched its indigenous vaccine named janvac developed by NIV,ICMR AND BIOTECH Ltd. 12. BURDEN OF JE: Japanese Encephalitis is becoming a health problem in a number of States especially in AP, TN, Kerala, Karnataka , WB, Assam, Bihar, & Haryana and has been reported from 26 states and UTs since 1978. There was no national programme for this disease and the affected states were managing the problem with the technical Assistance from the centre. This disease was included under the NVBDCP in 2003-04. 13. EPIDEMIOLOGICAL TRIAD FOR JE: AGENT HOST ENVIRONMENT VECTOR Group-B arbovirus(flavivirus) NEUROTROPIC VIRUS c. Tritaenicorhynchus c.Vishuni & Culex pseudovishnui JE virus is primarily zoonotic in its natural cycle and man is an accidental host. Natural hosts of JE virus include water birds of Ardeidae family (mainly pond herons and cattle egrets). Pigs play an important role as an amplifier host since they allow manifold virus multiplication without suffering from disease and maintain prolonged viraemia. 85% cases occur among children 1yr) visiting rural areas of endemic countries for atleast 2 weeks. vaccination: 3 doseson days 0,7 &28 or 2 doses 4 weeks apart. 17. PREVENTION: Vector control Eliminate mosquito breeding areas Adult and larvae control( chemical larvicides, larvivorous fish) Environmental management Vaccination Equine and swine Humans Personal protective measures Avoid prime mosquito hours Use of repellants /ITN/curtains Space spray-Fogging with pyrethrum/malathion(Spraying should cover the vegetation around the houses,breeding sites and animal shelter.unaffected villages falling within 2-3 kms radius of the infected village should also receive spraying as a preventive measures) 18. VACCINATION Mouse brain derived -inactivated -Nakayama or Beijing strain of JE Cell cultured derived -inactivated Based on Beijing p-3 strain Cell cultured derived -Live attenuated Based on SA-14-14-2 strain In India SA 14-14-2 Live attenuated vaccine used for immunization in 83 endemic districts in UP,ASSAM,WEST BENGAL AND KARNATAKA IN AGE GROUP 1-15 under UIP. Shedule: At 16-24 months 0.5ml,S.C Single dose BOOSTER AFTER 1 YEAR . 19. NVBDCP developed surveillance guidelines for endemic states and advised that all the JE cases be reported under Acute Encephalitis syndrome(AES) Case definition of suspected cases: -Acute onset of fever not more than 5-7 days duration. -Change in mental status with or without -New onset of seizure(Excluding febrile seizure) -Other early clinical findings may include irritability,somnolence or abnormal behavior greater than that seen with usual febrile illness. GUIDELINES FOR MANAGEMENT OF AES INCLUDING JE IN INDIA(-2009) 20. CASE CLASSIFICATION: 2.Probable cases: suspected cases in close relation to confirmed cases 1.Laboratory- confirmed cases: -IgM in serum/CSF -4 fold increase in IgG in paired sera -Virus isolation in brain tissue Nucleic acid ditection by PCR 4.AES due to unknown agent 3.AES due to other agents 21. CHIKUNGUNYA 22. In India major epidemic of chikungunya fever was reported during 60s & 70s; 1963Kolkata 1965---TN,MP,AP& Maharastra 1973---Maharastra The disease re-emerged in the country after a gap of three decades.During 2006 a total of 1.39 million clinically suspected chikungunya cases reported in the country involving 16 states.The outbreak first noticed in AP then subsequently spread to TN and other states. There were no reported deaths attributed to chikungunya. 23. CHIKUNGUNYA Clinically Supected Chikungunya Fever Cases Since 2008 Sl. No. Affected States/UTs 2008 2009 2010 2011 2012 2013* 2014** 1 Andhra Pradesh 5 591 116 99 2827 4827 895 2 Assam 0 0 0 0 0 742 0 3 Bihar 0 0 0 91 34 0 0 4 Goa 52 1839 1429 664 571 1049 306 5 Gujarat 303 1740 1709 1042 1317 2890 200 6 Haryana 35 2 26 215 9 1 1 7 Jharkhand 0 0 0 816 86 61 0 8 Karnataka 46510 41230 8740 1941 2382 5295 1584 9 Kerala 24685 13349 1708 183 66 219 18 10 Madhya Pd. 0 30 113 280 20 139 71 11 Meghalaya 0 0 16 168 0 0 0 12 Maharashtra 853 1594 7431 5113 1544 1432 879 13 Orissa 4676 2306 544 236 129 35 0 14 Punjab 0 0 1 0 1 0 1 15 Rajasthan 3 256 1326 608 172 76 0 16 Tamil Nadu 46 5063 4319 4194 5018 859 181 17 Uttar Pradesh 11 0 5 3 13 0 0 18 Uttarakhand 0 0 0 18 0 0 0 19 West Bengal 17898 5270 20503 4482 1381 646 190 20 A& N Island 0 0 59 96 256 202 64 21 Chandigarh 0 0 0 1 0 0 0 22 D&N Haveli 0 0 0 0 100 2 0 23 Delhi 14 18 120 110 6 18 1 24 Lakshadweep 0 0 0 0 0 0 0 25 Puduchery 0 0 11 42 45 146 183 Total 95091 73288 48176 20402 15977 18639 4574 * Provisional till 31st December | ** Provisional till 30th June | NR=Not Received 24. EPIDEMIOLOGICAL TRIAD FOR CHIKUNGUNYA: AGENT HOST ENVIRONMENT VECTOR Chikungunya virus(family Togaviridae, genus Alphavirus) Aedes mosquito(Aedes aegypti.) (PEAK BITING TIME FEW HOURS AFTER DAWN AND LATE AFTERNOON) Artificial accumulations of water in and around human dwellings such as discarded tins,broken bottles,flower pots,coconut shells,earthen pots etc Humans are thought to be the major source, or reservoir, of chikungunya virus for Mosquitoes) 25. In cubation period: 4-7 days( Ranges from 2-12 days) Symptoms: Sudden onset of Fever with chills , A petechial or maculopapular rash usually involving the limbs and trunk, Arthralgia or arthritis affecting multiple joints like metacarpophalangeal jt.,wrist,elbow,shoulderwhich can be debilitating. The name Chikungunya is derived from the Makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease headache,anorexia Conjunctival congestion and slight photophobia. Disease is self limiting . No death have been attributed to chikungunya fever. Dr.G.C.Sahu/ROH&FW/GoI/Ahmedabad 26. DIAGNOSIS: Chikungunya is diagnosed by blood tests. Since the clinical appearance of both chikungunya and dengue are similar, laboratory confirmation is important, especially in areas where dengue is present. Key Diagnostic Tests: Detection of antigens or antibody to the agent in the blood (serology) If ELISA is available An IgM capture ELISA is necessary to distinguish the disease from dengue fever 27. TREATMENT: There is no specific treatment for CHIK V . -Symptomatic treatment only. -No vaccine or preventive pill is available . The illness is usually self-limiting. No relapses occur no second attacks. The acute phase of the chikungunya fever lasts for 3-10 days but the convalescent phase can usually last from weeks to months with accompanying joint pain, swelling and tenderness. Sometimes it can last for even a year or more. Infected persons should be isolated from mosquitoes as much as possible in order to avoid transmission of infection to other people. Drugs like aspirin and steroids should be avoided. 28. PREVENTION: There is no separate programme for chikungunya fever as control stratergies for dengue and chikungunya are same. Eliminating mosquito breeding sites in and around the house. Use of larvicides such as abate and biological control by larvivorous fish like gambusia . Anti adult measures like aerosol spray of malathion/sumithion. Prevention of mosquito bites by personal prophylactic measures. 29. DENGUE : Emerging Public Health Problem 30. Magnitude of Problem: The world's fastest growing vector-borne disease is dengue, with a 30-fold increase in disease incidence over the last 50 years. Dengue in particular is emerging as a serious public health concern. In 2012, it ranked as the most important mosquito-borne viral disease with epidemic potential in the world. Dengue and DHF is now endemic in more than 100 countries. Around 2.5 billion people i.e two fifth of the worlds population in tropical and subtropical countries are at risk of the diseases. An estimated 50 million dengue infection occur worldwide annually and about 50000 people wiyh DHF require hospitalization each year. Approximately 90% of them are children aged less than five years and about 2.5% of those affected die. 31. INDIAN SCENARIO: The first evidence of occurrence of DF in the country was reported during 1956 from Vellore district in Tamil Nadu. The first DHF outbreak occurred in Calcutta (West Bengal) in 1963 with 30%of cases showing haemorrhagic manifestations. During 1996, one of the most severe outbreaks of DF/DHF occurred in Delhi where,10,252 cases and 423 deaths occurred. In 2006, the country witnessed another outbreak of DF/DHF, total 12,317 cases and 184 deaths were reported in 21 states/UTs. 32. The number of dengue cases has been steadily rising since 2008 when the count was 12,561 witnessing a dip only in 2011. The number of deaths due to the disease has increased from 80 in 2008 to 242 in 2012 and 167 in 2013. The dengue morbidity trend, or the proportion of deaths in comparison to the number of cases, has been coming down. The dengue fatality rate was 3.3% in 1996 when the number of cases reported was 16,517. This has dropped to 0.5% in 2012 and 0.2% in 2013. Among the NE States Manipur has reported Dengue outbreak for the first time in 2007. Every year during the period of July-Nov there is an upsurge in the cases of Dengue/DHF. All the four serotypes i.e. Dengue 1,2,3 and 4 have been isolated in India. 33. Dengue Cases and Deaths in the Country since 2008 Sl. No. Affected States/UTs 2008 2009 2010 2011 2012 2013* 2014** C D C D C D C D C D C D C D 1 Andhra Pradesh 313 2 1190 11 776 3 1209 6 2299 2 910 1 74 0 2 Arunachal Pradesh 0 0 0 0 0 0 0 0 346 0 0 0 0 0 3 Assam 0 0 0 0 237 2 0 0 1058 5 4526 2 12 0 4 Bihar 1 0 1 0 510 0 21 0 872 3 1246 4 0 5 Chattisgarh 0 0 26 7 4 0 313 11 45 0 52 1 0 0 6 Goa 43 0 277 5 242 0 26 0 39 0 198 2 55 0 7 Gujarat 1065 2 2461 2 2568 1 1693 9 3067 6 6170 15 220 0 8 Haryana 1137 9 125 1 866 20 267 3 768 2 1784 5 3 0 9 Himachal Pd. 0 0 0 0 3 0 0 0 73 0 86 2 0 0 10 J & K 0 0 2 0 0 0 3 0 17 1 1837 3 0 0 11 Jharkhand 0 0 0 0 27 0 36 0 42 0 161 0 12 Karnataka 339 3 1764 8 2285 7 405 5 3924 21 6408 12 528 0 13 Kerala 733 3 1425 6 2597 17 1304 10 4172 15 7911 25 651 2 14 Madhya Pd. 3 0 1467 5 175 1 50 0 239 6 1255 9 174 0 15 Meghalaya 0 0 0 0 1 0 0 0 27 2 46 0 0 0 16 Maharashtra 743 22 2255 20 1489 5 1138 25 2931 59 5432 48 963 0 17 Manipur 0 0 0 0 7 0 220 0 6 0 9 0 0 0 18 Mizoram 0 0 0 0 0 0 0 0 6 0 7 0 0 0 19 Nagaland 0 0 25 0 0 0 3 0 0 0 0 0 0 20 Orissa 0 0 0 0 29 5 1816 33 2255 6 7132 6 21 0 21 Punjab 4349 21 245 1 4012 15 3921 33 770 9 4114 11 32 0 22 Rajasthan 682 4 1389 18 1823 9 1072 4 1295 10 4413 4 89 23 Sikkim 0 0 0 0 0 0 2 0 2 0 38 0 0 0 24 Tamil Nadu 530 3 1072 7 2051 8 2501 9 12826 66 6122 0 677 0 25 Tripura 0 0 0 0 0 0 0 0 9 0 0 0 0 0 26 Uttar Pradesh 51 2 168 2 960 8 155 5 342 4 1409 5 2 0 27 Uttrakhand 20 0 0 0 178 0 454 5 110 2 54 0 0 28 West Bengal 1038 7 399 0 805 1 510 0 6456 11 5920 6 59 0 29 A& N Island 0 0 0 0 25 0 6 0 24 0 67 0 34 0 30 Chandigarh 167 0 25 0 221 0 73 0 351 2 107 0 0 0 31 Delhi 1312 2 1153 3 6259 8 1131 8 2093 4 5574 6 12 0 32 D&N Haveli 0 0 0 0 46 0 68 0 156 1 190 0 7 0 33 Daman & Diu 0 0 0 0 0 0 0 0 96 0 61 0 0 0 34 Puduchery 35 0 66 0 96 0 463 3 3506 5 2215 0 150 0 Total 12561 80 15535 96 28292 110 18860 169 50222 242 75454 167 3763 2 34. DENGUE/ DENGUE HAEMORRHAGIC FEVER MAGNITUDE OF THE PROBLEM 35. As per endemicity SEAR divided into 3 categories: CATEGORY-A:(HYPERENDEMIC)(india, Bangladesh,Srilanka,Myanmar,Maldives, Thailand and Timor-leste) a.Major public health problem b.Leading cause of hospitalisation and death among children c.Hyperendemicity with all 4 serotypes circulating in urban areas d.Spreading to rural areas. CATEGORY-B:(Bhutan, Nepal) a.Endemicity uncertain. b.Bhutan and Nepal reported their first outbreak in 2004. CATEGORY-C:(DPR Korea) No evidence of endemicity. 36. EPIDEMIOLOGICAL TRIAD FOR DENGUE AGENT HOST ENVIRONMENT VECTOR flavivirus (4 SEROTYPES DEN-1,2,3 &4) Aedes aegypti and aedes albopictus(becomes infective by feeding on a patient from the day before onset to the 5th of illness.) Artificial accumulations of water in and around human dwellings such as discarded tins,broken bottles,flower pots,coconut shells,earthen pots etc Humans are thought to be the major source, or reservoir, of Dengue virus for Mosquitoes.Under-5 children are more vulnerable. Infection with any one serotype confers lifelong immunity to that virus serotype).secondary infection with another serotype/multiple inf. With diff. serotype leads to severe form of dengue. 37. Clinical Presentation Of Dengue Dengue Virus Infection Asymptomatic Symptomatic Undifferentiated fever (viral syndrome) Dengue fever syndrome Without hemorrhage With unusual hemorrhage Dengue hemorrhagic fever (plasma leakage) No shock Dengue shock syndrome Dengue fever Dengue hemorrhagic Fever WHO 95629 38. Dengue Clinical Syndromes Undifferentiated fever Classical dengue fever Dengue hemorrhagic fever(DHF) Dengue shock syndrome(DSS) 39. LAB. DIAGNOSIS: 1.VIRUS ISOLATION(specimen:acute phase serum,washed buffy coat,autopsy tissue from fatal cases and mosquito collected from affected area) 2.VIRAL NUCLEIC ACID DETECTION 3.SEROLOGICAL TESTS: Haemagglutination-Inhibition (HI), Complement Fixation (CF), Neutralization test (NT), IgMcapture enzyme-linked immunosorbent assay (MAC-ELISA), an Indirect IgG ELISA 4.VIRAL ANTIGEN DITECTION: Nonstructrual protein 1 (NS 1) and Envelope/membrance(EM) antigen 5.RAPID DIAGNOSTIC TEST(RDT) ditects IgM and IgG antibody 6.ANALYSIS OF HAEMATOLOGICAL PARAMETERS: NVBDCP IS CURRENTLY FOLLOWING IgM ANTIBODY CAPTURED ELISA (MAC ELISA) FOR DIAGNOSIS OF DENGUE INFECTION IN THE NETWORK OF SENTINEL SURVEILLANCE LAB. IT HAS ESTABLISHED/IDENTIFIED 40. MANAGEMENT: DENGUE FEVER(DF): Management of Dengue fever is symptomatic and supportive i. Bed rest is advisable during the acute phase. ii. Use cold sponging to keep temperature below 39 C. iii. Antipyretics may be used to lower the body temperature. Aspirin/NSAID like Ibuprofen etc should be avoided since it may cause gastritis, vomiting, acidosis and platelet disfunction. iv. Oral fluid and electrolyte therapy are recommended for patients with excessive sweating or vomiting. v. Patients should be monitored in DHF endemic area until they become afebrile for one day without the use of antipyretics and after platelet and haematocrit determinations are stable, platelet count is >50,000/ cumm. 41. INDICATIONS OF RED CELL TRANSFUSION: Loss of blood(overt blood) -10%ormore of total blood volume . Preferably whole blood/ component to be used Refractory shock despite adequate fluid administration and declining haematocrit Replacement volume should be 10ml/kg body wt at a time and coagulogram should be done If fluid overload is present PCV is to be given INDICATIONS OF PLATELET TRANSFUSION: In general there is no need to give prophylactic platelets even at < 20,000/cumm Prophylactic platelet transfusion may be given at level of 5 AND BI>20 CATEGORY-III HI12 years) weighing (less than 25kg): 50mg,miltefosine daily as one capsule (50 mg) in the morning, after meals for 28 days. iii. Children (2-11 years): miltefosine will be given at 2.5 mg/kg daily after meals for 28 days, i.e., 50mg once daily. iv. The drug is not to be used in the case of children below 2years of age. 109. Drug Policy under Kala-azar Elimination Programme as per recommendations of Expert Committee (2000) Short Term: Long Term: Areas with SSG sensitivity >90% Areas with SSG sensitivity 20%) Areas with SSG sensitivity >80% SSG IM/IV 20mg/kg/day X 30 days Amphotericin B 1mg/kg b.w. IV infusion daily or alternate day for 15-20 infusions. Dose can be increased in patients with incomplete response with 30 injections Miltefosine 100 mg daily x 4 weeks SSG IM/IV 20mg/kg/day X 30 days Miltefosine 100 mg daily x 4 weeks First Line Drugs: 110. Second Line Drugs SSG Failures SSG and Miltefosine Failures Amphotericin B 1mg/kg b.w. IV infusion daily or alternate day for 15-20 infusions. Dose can be increased in patients with incomplete response with 30 injections Liposomal Amphotericin B (when final results are available with proven efficacy and safety) Treatment of PKDL SSG in usual dosages for KA could be given up to 120 days Repeated 3-4 courses of Amphotericin B can be given in patients failing SSG trea 111. KALA AZAR CONTROL PROGRAMME: An organized centrally sponsored Control Programme launched in endemic areas in 1990-91 Government of India provided kala-azar medicines, insecticides and technical support and the State governments implemented the programme through primary health care system and district/zonal and State malaria control organizations and provided other costs involved in strategy implementation. GOAL OF NATIONAL HEALTH POLICY (INDIA) 2002: ELIMINATION OF KALA AZAR 2010 Elimination Programme is 100 per cent Centrally Supported (except regular staff of State governments & infrastructure) In addition to kala-azar medicines and insecticides, cash assistance is being provided to endemic state s since December 2003 to facilitate effective strategy implementation by state GOI also signed a tripartite memorandum of understanding with Nepal and Bangladesh in May 2004 for elimination of Kala-azar from South-east Asian region by2015 112. STRATEGY FOR KALA-AZAR ELIMINATION: Programme strategy included: - enhanced case detection and complete treatment including introduction of rK39 rapid diagnostic kits and oral drug miltefosine for treatment of kala-azar. - Vector control through insecticidal residual spray (IRS ) with DDT up to 6 feet height from the ground twice annually - Early Diagnosis and Complete treatment - Information Education Communication - Capacity Building -Monitering ,supervision and evaluation -Operational research 113. Active case search by KALA-AZAR FORTNIGHT PROGRAMME During this programme HW and volunteers are engaged to make door to door search and refer cases confirming the case definition of kala-azar and PKDL to the treatment centres for definitive diagnosis and treatment. -Conducted four times in a year Incentives of Rs100/ provided to HW and ASHA for referring a suspected case and to ensure complete treatment . Kala-azar case Definition: Persons with fever of more than 15 days duration not responding to anti- malarials and antibiotics with splenomegaly is a suspected case of Kala-azar. PKDL: Persons with depigmented patches on the body with sensation and with a history of kala-azar in the past is a suspected case of PKDL. 114. ANOPHELES AEDES CULEX SAND FLY Sophisicated Mosquito Tiger Mosquito Nuisance Mosquito DISEASE SPREAD Malaria 1. Dengue 2. Yellow Fever 3. Chikungunya 1. Japanese Encephalitis 2. Filariasis Kala-Azar SPECIES Foot-Hill Region: -Anopheles Fluviatilis -Anopheles Minimus Coastal Region: -Anopheles Sundaicus -Anopheles Stephensi Plains: -Anopheles Culicifaciens -Anopheles Philippinesis Aedes aegypti Others: Aedes vittatus Aedes albopictus Culex fatigans:Filariasis Culex tritaniorhynichus: JE Phlebotomus argentipes EGG(48hrs) -Laid singly -Boat shaped -Posses lateral flots -Laid singly -Dont have lateral floats -CIGAR SHAPED -Laid in clusters -Dont have lateral floats -laid singly -Large, torpedo shaped with longitudinal wavy lines on the outer side 115. LARVAE(5-7 days) -Floats horizontally in water -No siphon tube -Suspended in water with head downwards -Siphon tube situated on the 8th abdominal segment -Hairy maggots with distinct head,thorax and abdominal segment -Last abd. Segment carries two pairs of long,stout hairs one pair is remarkably long PUPA(1-2 days) -Siphon tube is broad and short -Siphon tube long and narrow Lasts 1 weeks ADULT(2 weeks) --Wings spotted --when at rest inclined at an angle to surface --It has white stripes on a black body and striped or banded character of their legs, called tiger mosquito. BREEDING PLACE Clean water --An. Stephensi: overhead Tanks,wells, Fountains --An. Fluviatilis: moving Water --An. Sundaicus:Brackish water Artificial accumulations of water in and around human dwellings such as discarded tins,broken bottles,flower pots,coconut shells,earthen pots etc In dirty water collection e.g:stagnant drains,cesspools,septic tanks,burrow pits etc can breed all type of water collection. --Cracks and crevices in walls,holes in trees,dark rooms --Damp dark places in the vicinity of cattle sheds and poultry. BITING HABBIT Mostly nocturnal( between dusk and dawn.) Mostly during the day Enters the house at dusk and reaches max. density by midnight. Peak biting time is about midnight -Bite usually at night. -Bite is irritating and painful RANGE OF FLY 3-5 KM 100 METRES 11 KM Incapable of flying,merely hop about from one place to other.so confined within 50 yards of their breeding place. 116. 135 Thank You