National Polio Surveillance Program (NPSP)😊

National Polio Surveillance Program (NPSP)

Poliovirus

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  • Causes descending flaccid paralysis
  • Phases:
    • Alimentary phase
    • Lymphatic phase → cervical, mesenteric LN
    • Viremic phase → blood
    • Neural phase → spinal cord, brain
  • 90% infections → asymptomatic/subclinical

Types of Polio Infection & Percentage of All Infections

Types
Percentage of all infections
Inapparent infection
90–95%
Abortive infection (Self-limiting)
4–8%
Non-paralytic aseptic meningitis
1%
Paralytic polio
Rare

Carrier Stage

  • For 1 infected child
    • Approx. 75 adult carriers
    • Approx. 1000 child carriers

Clinical features

  • Asymmetric involvement
  • Most commonly affected muscle: Quadriceps
    • Result in Hand knee gait
      • D/t Quadriceps weakness
  • Most common muscle with complete paralysis: Tibialis anterior
  • Most common hand muscle involved: Opponens pollicis
  • Neurology
    • Pure motor paralysis
    • No sensory loss
  • Knee deformity (severe cases)
    • Triple deformity
      • Flexion
      • Posterior subluxation
      • External rotation

Polio Vaccine strains and adverse effects

Strains
EDA
P1
M/c/c of Epidemic
P2
VDPP
P3
VAPP

OPV vs. IPV

Feature
Oral Polio Vaccine (OPV):
↳ P₁, P₃
Inactivated Polio Vaccine (IPV):
↳ P₁, P₂, P₃
Strain
SABIN
SALK
Type
Live
Killed
Route
Oral
ID
Immunity
Local & humoral (Blood)
Only humoral
Use in epidemic
⊕⊕
⊖⊖
A/w VDPV, VAPP
↑↑
↓↓ (Safer)

Vaccine-Derived Polio Virus (VDPV) vs.
Vaccine-Associated Paralytic Polio (VAPP)

Feature
Vaccine Derived Polio Virus (VDPV)
Vaccine Associated Paralytic Polio (VAPP)
Cause
Viral mutation
Random host immune reaction
Associated
OPV P₂ (m/c)
OPV P₃ (m/c)
Transmission
⊕⊕ (more dangerous)
−−

Timeline in India

Eradication Dates & Locations of Last Cases in India

Date
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Location of last case
24 October 1999
Eradication of P2 strain
Uttar Pradesh
13 October 2010
Eradication of P3 strain
Jharkhand
13 January 2011
Eradication of P1 strain
Howrah, West Bengal
27 March 2014
Polio-free India
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2015
End Game Strategic Plan
↳ Introduction of fractional IPV (fIPV)
↳ 2 doses
All over India
25th April 2016
National switch day
↳ Trivalent OPV → Bivalent OPV (P1 & P3)
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1st January 2023
Third dose fIPV
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  • 9, 10, 11 → 14, 15, 16
  • Note: P1 strain →most epidemics
  • Bivalent OPV
    • Pink colour liquid stored at -20°C.
    • Most heat-sensitive vaccine.

Fractional IPV Schedule

Dose
Schedule
Dosage & Route
Sites
1ˢᵗ dose
6 weeks
0.1 mL ID
Right upper arm
2ⁿᵈ dose
14 weeks
0.1 mL ID
Right upper arm
3ʳᵈ dose
9 months
0.1 mL ID
Left upper arm

National Polio Surveillance Program

  • Started in 1995 with pulse polio immunization
    • ↑↑ Herd immunity
      • Requires >65% coverage.

Surveillance

  • Continuous monitoring
    • With support/feedback

Acute Flaccid Paralysis (AFP) Surveillance

  • Age group <15 years.
  • Surveillance MO (SMO)

Investigation:

  • Within 48 hours of AFP reporting
    • 1ˢᵗ stool sample
    • 2ⁿᵈ stool sample
      • Gap: 24 hrs to 14 days of onset of AFP
  • Reach Laboratory within 72 hours
    • Quality:
      • Temperature of 2-8°C by reverse cold chain
      • (Carrier: Red)
    • Quantity:
      • >8g/Thumb size.
  • Residual paralysis check:
    • within 60 days of reporting.

Lab Diagnosis:

  • Throat swab, rectal swab, fecal samples
  • Isolation rare
  • Sewage samples → epidemiological burden

Surveillance Indicators & Targets

Surveillance Indicators
Target
Sensitivity of surveillance:
↳ Most important Impact indicator
• >1 AFP/lakh/year in age <15 years
Completeness of case investigation
↳ Operational indicator
• >80% adequate stool sample collection.
• Operation → investigation - collection
Completeness of follow up
• >80% AFP cases should have residual paralysis check at 60 days
Operation efficacy
• Stool sample should reach the laboratory within 72 hours of collection

Note: Causes of AFP

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  • Poliomyelitis
  • Guillain-Barré syndrome
  • Traumatic neuritis
  • Traumatic myelitis
  • Enterovirus A71

National Program for Control of Blindness & Visual Impairment (NPCBVI)

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Program Details

  • Funding: Danish International Development Agency (DANIDA).
  • Target: Blindness rate <0.25% in community by 2025

Terminology for Visual Impairment

Terminology
Visual acuity in the better eye with available/best possible correction
Visual impairment
<6/18
Blindness
<3/60

Definitions of Blindness:

  • Clinically:
    • No perception of light.
  • According to NPCBVI (As amended in 2017) and WHO:
    • Visual acuity <3/60 in the better eye with best possible correction.
    • OR
    • Limitation of Visual field <10 degrees from centre of fixation
Terminology
Visual acuity in the better eye
with available/best possible correction
Visual impairment
<6/18
Blindness
<3/60
Term
Definition
Blindness (BCVA/Pinhole)
Best corrected visual acuity <3/60 in better eye.
Blindness
(<3m from chart)
<3/60 in better eye with available correction
Severe Visual Impairment (SVI)
(kasera aduppikuka → from 6m to 3m)
6/60 – 3/60 in better eye
Moderate Visual Impairment (MVI)
(18-60)
6/18 – 6/60 in better eye
Early Visual Impairment (EVI)
(12→18)
6/12 – 6/18 in better eye
Functional Low Vision
6/18 or visual field <10° from fovea
+ usable vision retained
WHO ICD
NPCB
Visual Acuity
Correlate
Low Vision
LESMA
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Category (1)
Low vision
6/18 - 6/60
Moderate Visual Impairment
Category (2)
Economic blindness
Work Vision
6/60 - 3/60
Severe Visual Impairment
Blindness
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Category (3)
Social blindness
Walk Vision
3/60 - 1/60
Blindness
Category (4)
Manifest blindness
<1/60 - perceptions of light
Blindness
Category (5)
Absolute blindness
No perceptions of light
Blindness

Cataract Intervention in Community/Village/Population

Reach-In Approach

  • NPCBVI program:
    • Patient
      • Taken in a mobile van To Base hospital
      • Perform surgery, Post-op care
      • Brought back To Community/Village.
  • Note: Reach-out approach/ makeshift hospitals
    • discontinued due to cataract surgery complications.
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Strategy

Centres under NPCBVI Strategy

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WHO ICD vs. NPCB

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  • Most Common (M/C) Causes:
    • Blindness (India & Worldwide):
      • Cataract
        • Responsible for 66-67% (2/3ʳᵈ) of blindness.
    • Visual Impairment (India):
      • Cataract
    • Ocular Morbidity:
      • Uncorrected refractive error
    • Preventable Blindness:
      • Children: Vitamin A deficiency
      • Adults: Cataract

Causes of Blindness:

Age Group
Blindness
Visual Impairment (<6/18)
≥50 years
- Cataract (m/c)
- Corneal opacity
- Cataract (m/c)
- Refractive error
0–49 years
- Non trachomatous Corneal opacity (m/c)
- Amblyopia
- Refractive error (m/c)
- Cataract
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COOA
CRRC

Vision 2020

Overview

  • Launched: 1999, Geneva
  • Adopted in India: 2001, Goa

Aims

  • Reduce blindness to 25 million by 2020
  • Eliminate avoidable blindness
  • Leading cause of childhood blindness that can be prevented?
    • Vitamin A Deficiency
  • Added later → Glaucoma
  • In India, the recent addition to the Vision 20/20 program
    • Refractive error and low vision

Diseases Covered

Region
Diseases
India
- Cataract
- Refractive errors
- Childhood blindness
- Trachoma (Endemic)
- Glaucoma
- Diabetic retinopathy
- Corneal blindness
Globally
- Cataract
- Refractive errors
- Childhood blindness
- Trachoma (Endemic)
- Onchocerciasis

National Leprosy Eradication Programme (NLEP)

Hansen's disease

Lepromatous leprosy
Lepromatous leprosy
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Program History

  • 1955: Started leprosy control programme
  • 1983: Started multi-drug therapy & NLEP
    • MOHFW: Ministry of Health & Family Welfare

NLEP Essential Indicators, Target Rate & Rate in India

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Essential Indicators
Target Rate
Rate in India
1
Prevalence rate
<1/10,000 population
0.45
2
Annual New Case Detection Rate
↳ Best for significance of the health system
<10/1 lakh population
5.5
3
Grade-2 Disability (G2D)
↳ Best for leprosy awareness.
<1/10 lakh population
0.2
4
Treatment completion Rate (TCR)
↳ as proxy cure rate
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  • Vision: Leprosy mukt Bharat by 2027.

Leprosy Awareness Programme

Health and Family
Health and Family
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  • SPARSH: To ↓ leprosy discrimination

Newer Strategies

  • Welfare allowance:
    • Rs 8000–12,000 for reconstructive surgeries.
  • Asha-Based Surveillance for Leprosy Suspects (ABSULS).
  • Nikusth 2.0 launched:
    • mobile applications for leprosy notification.

Vaccine

  • M. indicus prani.
    • Immunomodulator
  • Mycobacterium indicus pranii (MIP) vaccine:
    • Produced in India.
    • For leprosy.
  • MW vaccine: Old

NIDDCP & IDSP

National Iodine Deficiency Disorder Control Programme (NIDDCP)

  • 1962: National goitre control programme
  • 1992: NIDDCP
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  • Organization: At district level.
  • Target: Goitre rate <5% in children.

Strategy

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  • Iodization of salt: Potassium iodate used
    • Not potassium Iodide
    • Ensured by salt commissioner under:
      • Ministry of Commerce & Industry.
      • Headquarters in Jaipur, Rajasthan.
    • Levels
      • At production: >30 ppm.
      • At Consumer: >15 ppm.

Programme Indicators

Category
Indicator
Process indicators
• Iodine in household salt
• Process in house
Principal impact indicators
• Epidemiological indicator
• Urinary iodine excretion > 100 U/dl
• Impact principal by urination
Environmental iodine deficiency indicator
• ↓↓ Iodine in diet
• Neonatal hypothyroidism rate
• Environment = Neonates
Long term impact indicators
• Goitre rate
• Long goitre

Integrated Disease Surveillance Programme (IDSP)

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  • Started in 2004.
  • Components
    • Syndromic, Probable case, Laboratory case (SPL)
    • Eye, ear, nose → For control of epidemic prone diseases.
  • Weekly surveillance data reporting (52/year).

Integrated Health Intelligence Platform (IHIP)

  • Newer version of IDSP.
  • Under Central Bureau of Health Intelligence (CBHI).

Types of Surveillance

IDSP Types of Surveillance

Type
Syndromic
Probable
Laboratory
Done by
Health workers
Medical officers
Laboratories
Based on
Syndromes & field surveys
1. Fever
2. Cough <2 weeks
3. AFP <15 years age
4. Diarrhea ≥3 stool/day
5. Jaundice
6. Unusual death/hospitalization
• History &
• Clinical examination
• Laboratory results

NCD Programmes

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National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD)

  • Earlier term:
    • National programme for prevention & control of
      • cancer, diabetes, cardiovascular diseases & stroke.
  • Prevention of: COPD, CKD, rheumatic fever, NAFLD.
  • Integration with:
    • AYUSH/NPCDCS.
    • NTEP/NPCDCS.

Targets

  • WHO Global action plan (Till 2030).

WHO Global Action Plan Targets for NCDs

Target (Relative Reduction)
Variable
30%
Salt intake
Smoking
10%
Alcohol intake
Physical inactivity
25% (Outcome)
Premature mortality
(CVD, Ca, DM, chronic respiratory disease)

Obesity

  • Indicators:
    • Body mass index (BMI): m/c
      • Quetelet index
      • BMI = Weight (in kgs) / Height² (in metres)
      • Ideal BMI (India): 18.5 – 22.9 kg/m ².
    • Others: Broca’s index, corpulence index.
        • ㅤ
        Reference male
        Reference female
        (        Non-pregnant)
        Weight (Kg)
        65
        55
        Age (years)
        19 to 39
        =
        Height
        (95th centile)
        1.77 m
        1.62 m
        BMI (Kg/m2)
        Normal:
        18.5 to 22.9
        20.75
        20.95
        Activity
        • Occupation: 8 hours 
        •         Sleep: 8 hours 
        •         Sitting/moving around: 4 to 6 hours 
        • Walking (        Active recreation): 2 hours
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  • Obesity cut-offs
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      Measure
      Males
      Females
      Waist circumference
      <102
      <88
      Waist hip ratio
      <0.9
      <0.85
      Skin fold thickness :
      ↳ Using herpenden's calliper (4 sites)
      <40 mm
      <50 mm
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Hypertension

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  • Rule of halves:
    • 50% are diagnosed with HTN
    • 50% on Rx
    • 50% with controlled BP
  • Tracking of blood pressure:
    • Primary level prevention.
    • Maintenance of normal BP from childhood onwards.

Cancer Registry

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  • Incidence in India:
    • According to Globocan 2020,
      • m/c in
        • Males: Lip/oral > Lung > Stomach/oesophagus.
        • Females: Breast > Cervix uteri > Ovary.
        • Overall: Breast > Lip/oral > Cervix uteri.
    • Female predominance.
  • Mortality: Breast Ca > Cervical Ca.

WHO STEPS Approach

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Used for: Surveillance of risk factors for Non-Communicable Diseases (NCDs)

Core Steps

Step
Component
Includes
Step 1
Questionnaire
Lifestyle,
Behavioral,
Psychological factors
Step 2
Anthropometric
Height, Weight, Waist & Hip circumference
Step 3
Biochemical
Blood glucose, Serum lipids
Not included: Therapeutic interventions
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School Health & POSHAN

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Vision screening

  • 1 teacher /150 students
  • If < 6/9 → refer to PHC
  • Ma() Le() ria - 25

1. School Health Services/Programme

  • In charge:
    • Medical officer of PHC (Under MOHFW)

School Health Service Criteria

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Land
Classroom
Toilets
Primary school: >5 acres 

Higher secondary school: >10 acres
Capacity:
maximum of 40 students 

Space:
minimum of 10 sq. Ft. per student 

Color of walls:
white 

Light:
Preferably shines from left side 

Desk: minus type
Urinal: 1/60 students 

Latrine: 1/100 students 

Separate for boys & girls

Initiatives:

  • Screening:
    • Diseases (32 under RBSK).
    • Mental health disorders.
    • Vit A deficiency.
  • Supplements:
    • Weekly iron & folic acid.
  • Menstrual hygiene:
    • Free sanitary pads.

POSHAN x 2

POSHAN Abhiyaan

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  • Prime Minister Overarching Scheme for Holistic Nourishment (2018).
  • Abhi - overacting
  • Under Ministry of Women & Child Development (WCD).
  • Integrated with
    • National nutrition mission.
    • Anemia mukt Bharat.
  • Target: SULA
    • ↓ Anemia prevalence by 3% per year.
    • ↓ Low birth weight by 2% per year.
  • Nutritional status improvement
    • Children (0-6 years).
    • Adolescent, Pregnant & lactating females.

Poshan Shakti Nirman Scheme (2021)

  • Mid-day meal scheme under Ministry of Education.
  • 1/2 protein and 1/3 calorie requirements
  • Beneficiaries: Balvatika (<Class I) + Class I-VIII students.
      • ㅤ
      For primary classes
      For upper primary classes
      Calorie
      450
      700
      Proteins (g)
      12
      20
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Integrated Child Development Services (ICDS) Scheme

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  • Under Ministry of Women & Child Development (MoWCD).
  • Beneficiaries:
    • Children: 0 to 6 years.
    • Adolescent girls: 10 to 19 years.
    • Women of reproductive age: 15 to 49 years.
    • Pregnant & lactating women.
    • All females except 6-10 years and over 50 years
    • Male only upto 6 years
  • Note:
    • National Health Mission → Ministry of health and family welfare
    • ICDS →MoWCD

Structure:

  • Anganwadi:
    • Population 500 to 800.
    • Single best ans: 800
  • Anganwadi supervisor:
    • Supervise 25 - 30 anganwadi
    • Population 25,000.
  • CDPO (Child Development Project Officer):
    • Population 1,00,000.