National Vector Borne Disease Control Programme (NVBDCP) in Alipurduar covers Malaria, Dengue, Japanese encephalitis and now, recently Scrub typhus. Chikunguniya was reported for some areas of Madarihat-Birpara block in 2011-12 but thereafter no cases have been reported. Cases of elephantiasis have been reported from some areas infrequently but no confirmation of active transmission of filaria has been found yet.
Alipurduar is endemic for malaria. Till a few years back the proportion of Pf malaria was high and malaria deaths were not infrequent. However, over the years, malaria cases and proportion of Pf malaria have come down and malaria deaths range between 1-2 per year at present. Focal Pv malaria outbreaks are, however, frequent.
Facilities for detection of malaria using bi-valent diagnostic kits (RDKs) are decentralised up to the village level for use by ASHA workers. There are XX Microscopy centres and a Daily Fever Surveillance system is in place. Appropriate medicines are available at the Sub-centre level (Oral drugs) and the PHCs/hospitals (Oral drugs and injectables). The DH, Alipurduar and SGH, Birpara function as Sentinel Hospitals for malaria in the district. External Quality Assurance is in place, whereby malaria slides are sent to the Regional Headquarters of GOI at Kolkata for cross-checking.
Apart from Daily Fever Surveillance, Entomological Surveillance is also in place. An entomologist has been posted in the district and the district is proud to have an Entomological laboratory with adult mosquito and larva collecting equipments & Compound and Stereoscopic microscopes with the capacity to identify the species of mosquitoes and conduct parasite incrimination tests. Vector density indices, larval indices and detection of vector breeding sites are also conducted.
For the prevention of malaria, apart from awareness programmes involving various stakeholders, routine Indoor Residual Spray (IRS) with DDT (50%) and focal IRS is done.
Long Lasting Insecticidal treated Bed Nets (LLINs) too are provided to the community as per government norms free of cost. A total of 46000 LLINs were distributed in 2017-18.
Since 2012 Dengue has been detected in Alipurduar with outbreaks in 2016 and 2017. At the district level, the diagnostic facility for dengue consisting of ELISA based NS1 and IgM is available only the DH, Alipurduar. It is proposed to commence testing for dengue using ELISA based NS1 and IgM in 2018 at Birpara SGH too.
As Rapid Test Kits for dengue are not confirmatory and many a times misleading, screening for dengue using RDK are not recommended at any level.
As complicated cases of dengue have low levels of blood platelets (thrombocytopenia) and on many occasions provision of platelets is life saving, a Platelet Agitator machine has been installed at the DH, Alipurduar to preserve a few units of platelets for usage during crisis period.
As dengue can be effectively prevented by active community participation, including weekly clearing/removing all water from containers in and around houses/buildings, the prime thrust for prevention is the 'Weekly Pulse Cleaning' activities at all levels.
In the Alipurduar Municipality and Jaigaon Development Authority area in Kalchini block, a fortnightly 5 day House to House visit is conducted to spread awareness on prevention of dengue as well as monitor the pulse cleaning activities, including generation of 'Larval indices' to guide focussed 'Source reduction' activities.
The major shift in dengue control has been the recognition of all stakeholders, including the Municipalities, Panchayats, PWD, PHE, School Education, Rural Development units, Tea Gardens etc. and their involvement in the prevention and control of dengue.
Acute Encephalitis Syndrome (AES) and Japanese encephalitis (JE) has become endemic since 2011. All cases of AES are screened for malaria, JE and scrub typhus. Most of the AES/JE and complicated scrub typhus cases are managed at the CCU attached to the DH, Alipurduar.
Presently, an aliquot of serum or CSF is sent to the JE Sentinel laboratory at Coochbehar DH on a bi-weekly basis.
As AES/JE basically require supportive management and in some cases ventilator support, referral to other distant hospitals is not recommended as there are chances of aspiration pneumonia during transport. The CCU of Alipurduar DH is very well equipped to manage complicated JE/AES cases. Very soon the Birpara SGH would also be having a CCU after starting as a HDU.
The DH, Alipurduar has the facility for ELISA based IgM test for scrub typhus. IEC materials in 3 vernacular languages have been prepared and provided to all health units. As suspicion is the key and cure is possible with very common antibiotics, management of ST needs more emphasis.
