Commonly Asked Questions in National Vector Born Disease Control Program (NVBDCP)

Que. 1. Under NVBDCP, which are the three-pronged strategy for prevention & control of Vector Borne Diseases?

Ans. 1. The three-pronged strategy are as follows-

Disease Management
Integrated Vector Control
Supportive Interventions

Que. 2. When was the National Malaria Control Program launched in India?

Ans. 2. 1953.

Que. 3. When was National Malaria Control Program was renamed as National Malaria Eradication Program?

Ans. 3. 1958

Que. 4. When was National Anti-Malaria Program (NAMP) renamed as National Vector Borne Disease Control Program (NVBDCP)?

Ans. 4. 2002.

Que. 5. When was Rapid Diagnostic Test (RDT) introduced in the program?

Ans. 5. 2005.

Que. 6. When was Long lasting insecticidal Nets (LLINs) introduced in the program?

Ans. 6. 2009.

Que. 7. Who are responsible for case detection, management, and community outreach activities in periphery?

Ans. 7. Multi-purpose workers (MPWs), ASHAs & other community health volunteers.

Que. 8. When was bivalent RDT introduced in the NVBDCP?

Ans. 8. 2012.

Que. 9. What is the role of drug distribution centres in the program?

Ans. 9. Only dispense the anti-malarial drugs as per guideline.

Que. 10. What is the role of fever treatment depots and malaria clinics?

Ans. 10. Collection of blood slides in addition to distribution of anti-malarial drugs.

Que. 11. When was the Urban Malaria scheme launched in India?

Ans. 11. 1971.

Que. 12. Which vector is predominantly responsible for transmission to man in Malaria?

Ans. 12. Infected female anopheline mosquitoes.

Que. 13. Which is the specific population at risk for malaria?

Ans. 13. Following specific population is at risk for malaria –

Young children
Non-immune pregnant women
HIV infected pregnant women
People with HIV/AIDS
International travellers from non-endemic areas
Immigrants and their children

Que. 14. Which are the reasons of childhood mortality in children suffering from malaria?

Ans. 14. Cerebral Malaria & Anaemia.

Que. 15. Which are the main vector mosquitoes for Malaria transmission?

Ans. 15. The main vectors are –

Culicifacies
Stephensi
Fluviatilis
Minimum
Diures
Epiroticus

Que. 16. Which mosquito is the main vector in hilly areas, forests and forest fringes?

Ans. 16. An. Fluviatilis.

Que. 17. Which mosquito is the main vector in urban and industrial areas?

Ans. 17. An. Stephensi.

Que. 18. Which are the factors contributing to malaria transmission in peri-urban area?

Ans. 18. The factors contributing are –

Poor sanitary conditions
Low socio-economic groups
Unplanned settlements

Que. 19. What do you mean by Malaria Control?

Ans. 19. To reduce the malaria disease burden to a level at which it is no longer a public health problem.

Que. 20. What do you mean by malaria elimination?

Ans. 20. The interruption of local borne malaria transmission, reduction to zero of the incidences of infection caused by human malaria parasites in a defined geographical area as a result of massive antimalaria activities. Continued measures to prevent re-establishment of transmission are required.

Que. 21. What are the types of malarial parasite responsible for transmission of malaria in a community?

Ans. 21. P. vivax, P. falciparum, P. malariae and P. Ovale.

Que. 22. How many cycles of development malarial parasite does undergo?

Ans. 22. Two cycles of developments –

Human cycle (asexual cycle)
Mosquito cycle (sexual cycle)

Que. 23. When will the sexual cycle of malarial parasite begin?

Ans. 23. The mosquito cycle/sexual cycle begins when gametocytes are ingested by the vector mosquito when feeding on infected person.

Que. 24. What do you mean by human reservoir of malaria infection?

Ans. 24. A human reservoir is one who harbours the sexual forms (gametocytes) of the parasite. The children are better reservoir than adults.

Que. 25. What is the reason of relapse in P. falciparum & P. malariae?

Ans. 25. Chronic blood Infection (erythrocytic schizogony persisting at a low level).

Que. 26. Why new-born infants have considerable resistance to infection with P. falciparum?

Ans. 26. It is because of high concentration of foetal haemoglobin during the first few months of life, suppressing the development of P. falciparum.

Que. 27. Why are males more affected than females with malaria?

Ans. 27. Because of more outdoor activities of males. Secondly females are better clothed than men.

Que. 28. What is the period of maximum prevalence of malaria in India?

Ans. 28. July to November every year.

Que. 29. After a blood meal, where does anopheles mosquito rest?

Ans. 29. Rests indoors (Endophily).

Que. 30. Where does anopheles mosquito breed?

Ans. 30. Moving water ——An. Fluviatilis

Brackish water —— An. Sundaicus

Wells, cisterns, fountains and overhead tanks ——- An. Stephensi.

Que. 31. What is the biting time of anopheles mosquitoes?

Ans. 31. At Night.

Que. 32. What do you mean by term vectorial capacity?

Ans. 32. It refers to the combined effect of the density of the vector population, its susceptibility to infection, life span and probability of feeding on man.

Que. 33. How does malaria get transmitted?

Ans. 33. By bite of certain species of infected female anopheline mosquito.

Que. 34. What do you mean by congenital malaria?

Ans. 34. Congenital infection of the newborn from an infected mother. Though rare.

Que. 35. What is the incubation period of malaria?

Ans. 35. The incubation period of malaria is as follows-

Falciparum Malaria – 12 days (9-14 days)
Vivax malaria – 14 days 98-17 days)
Quartan malaria – 28 days (18-40 days)
Ovale Malaria – 17 days (16-18 days)

Que. 36. Which are the clinical features of malaria?

Ans. 36. Followings are the clinical features of malaria-

Febrile paroxysm with chills and intermittent periodicity
Nausea, vomiting and diarrhoea
Malaise, myalgia, headache and backpain
Spleen enlargement
Anaemia
Febrile herpes

Que. 37. Which are the complications of malaria?

Ans. 37. In falciparum malaria –

Cerebral Malaria
Acute renal failure
Liver damage
Dehydration
Collapse
Anaemia
Black water Fever

In other plasmodium malaria –

Anaemia
Splenomegaly
Hepatomegaly
Herpes
Renal Complications

Que. 38. Which are the advantages of microscopy in the diagnosis of malaria?

Ans. 38. The advantages of microscopy are as follows –

High Sensitivity
Detects malarial parasite at low densities
Quantifies the parasite load
Help in distinguishing various malarial parasites and their different stages

Que. 39. What is the advantage of serological tests in malarial diagnosis?

Ans. 39. Test is of great value in epidemiological studies and in determining whether a person has had malaria in the past.

Que. 40. How will you categorize malarial transmission in districts based on Annual Parasite Incidence (API)?

Ans. 40. There are 4 categories of the districts –

Category 0 – Prevention of re-establishment phase
Category 1 – Elimination Phase
Category 2 – Pre-elimination phase
Category 4 – Intensified control phase

Que. 41. What does category 1 or elimination phase denote?

Ans. 41. Districts falling under this category have API less than 1 per 1000 population.

Que. 42. What does Category 2 or Pre-elimination phase denote?

Ans. 42. Districts falling under this category have API more than 1 but less than 2 per 1000 population.

Que. 43. What does Category 3 or intensified control phase denote?

Ans. 43. Districts falling under this category have API 2 or above per 1000 population.

Que. 44. What is the goal of national strategic plan strategy?

Ans. 44. Phased elimination of malaria in India by 2030.

Que. 45. Which are the specific objectives of National Strategic Plan (NSP) 2017-22?

Ans. 45. The specific objectives are as follows –

Achieve universal coverage of case detection and treatment services in endemic districts to ensure 100% parasitological diagnosis of all suspected malaria cases and complete treatment of all confirmed cases
Strengthen the surveillance system to detect, notify, investigate, classify, and respond to all cases and foci in all districts to move towards malaria elimination
Achieve near universal coverage of population at risk of malaria with an appropriate vector control intervention
Achieve near universal coverage by appropriate BCC activities to improve Knowledge, awareness, and responsive behaviour regarding effective preventive and curative intervention for malaria elimination
Provide effective program management and coordination at all levels to deliver a combination of targeted intervention for malaria elimination

Que. 46. Which are the challenges of malaria control in India?

Ans. 46. The challenges of malaria control in India are given below –

Large population movements
Shortage of skilled human resources
Insecticide resistance
Lack of integration with Private Sector
Effective procurement and supply chain
Lack of robust monitoring and evaluation system
Access to conflict -affected, tribal areas & other hard to reach areas with high malaria endemicity
Threat of spread of Artemisinin resistance from neighbouring countries
Sustained financial & political commitment with effective partnership

Que. 47. Which are the enabling environments for malaria elimination?

Ans. 47. Swachh Bharat Abhiyan & Digital India

Que. 48. Which are the guiding principles of NSP for Malaria Elimination?

Ans. 48. The guiding principles of NSP for malaria elimination are as follows –

Political commitment, leadership, and ownership
Equitable access to services
Quality health care service delivery
Community mobilization and participation
Intersectoral involvement of all stakeholders
Operational Research
Delegation of responsibility and fixing accountability

Que. 49. Which are the strategies of NSP for malaria elimination?

Ans. 49. Strategies are given below –

Diagnosis and case management
Surveillance and epidemic response
Prevention – Integrated vector Management
Cross-cutting interventions –
Advocacy
Communication and social mobilization
Program management and coordination
M & E
Research & Development

Que. 50. Under the government system, who is responsible for malaria case detection at peripheral level?

Ans. 50. ASHAs and health workers at the community level and through PHCs/CHCs at the institutional level.

Que. 51. Which is the recommended method of malaria detection at CHCs/PHCs?

Ans. 51. Microscopic examination of thick and thin blood smears.

Que. 52. Which is the recommended method of malaria detection at the community level?

Ans. 52. Use of Rapid Diagnostic Tests (RDTs).

Que. 53. Which are the main factors determining the treatment of malaria?

Ans. 53. The main factors are as follows –

The infecting malarial parasite species
The clinical status of the patient
The drug susceptibility of the infecting parasites as determined by the geographical area.

Que. 54. Which is the first line drug for treatment of uncomplicated P. falciparum malaria?

Ans. 54. Artemisinin-based combination therapy (ACT-AL).

Que. 55. Which is the choice of treatment of severe malaria?

Ans. 55. Artesunate/Quinine injection followed by complete oral dose of ACT.

Que. 56. Which is the drug of choice for treatment of uncomplicated P. vivax malaria?

Ans. 56. Chloroquine.

Que. 57. Whether treatment of severe P. vivax malaria is similar to treatment of P. falciparum?

Ans. 57. Yes.

Que. 58. How can one treat mixed infection (P. vivax & P. Falciparum) of malaria?

Ans. 58. Mixed infection (P. Vivax & P. falciparum) should be treated as a case of P. falciparum and treated with ACT and 14 days of radical treatment as prescribed for P. vivax cases.

Que. 59. Enumerate specific objectives of surveillance, in elimination settings?

Ans. 59. The specific objectives are as follows –

Detection of all malaria infections (symptomatic and asymptomatic) as early as possible
Prevention of further transmission from each case through early and complete treatment and vector control measures
Identification, investigation, classification, and management of all transmission foci with appropriate response to stop transmission as early as possible.

Que. 60. What do you mean by term focus?

Ans. 60. Focus is a defined, circumscribed, locally situated in a currently or formerly malaria endemic area with continuous or intermittent epidemiological factors necessary for malaria transmission.

Que. 61. What are the types of malaria foci?

Ans. 61. 3 types –

Active – A focus with continuing transmission.
Residual (non-active) – Transmission interrupted recently (1-3 years ago)
Cleared – A focus with no local transmission for more than 3 years.

Que. 62. What do you mean by Larval source management (LSM)?

Ans. 62. It is the management of aquatic habitats (water bodies) that are potential breeding sites for mosquitoes, in order to prevent the completion of development of the immature stages.

Que. 63. Which are the components of LSM?

Ans. 63. Components of LSM are –

Environmental modification and manipulation – by community participation
Larviciding

Que. 64. Which are the examples of environmental modification and manipulation?

Ans. 64. The examples are as follows –

Land Scaping
Source water drainage
Filling and land reclamation
Coverage of water storage containers with mosquito proof lids or permanent slabs
Water level manipulations

Que. 65. What do you mean by Larviciding?

Ans. 65. It is the regular application of biological or chemical insecticides to chemical bodies.

Que. 66. Which are the chemical larvicides used for mosquito control?

Ans. 66. Temephos EC & Bti are recommended for non-polluted and polluted breeding sites mainly in urban areas.

Que. 67. What do you mean by insect growth regulators (IGR)?

Ans. 67. These are chemical compounds that inhibit the physiology of the insect.

Que. 68. What is the mechanism of action of LLINs?

Ans. 68. They provide not only a physical barrier against the mosquito bites but also kill the mosquitoes or shorten their life span so that they cannot transmit malaria infection.

Que. 69. For best effectiveness of LLINs, what should be its coverage?

Ans. 69. Coverage of population at risk with LLINs must be close to 100% with high utilization rate (>80%).

Que. 70. How long are LLINs effective in field conditions?

Ans. 70. 3 years.

Que. 71. What are the objectives of long-lasting insecticidal nets (LLINs)?

Ans. 71. The objectives of LLINs are as follows –

100% of households in malarious areas own in general at least one LLIN per 1.8 persons
At least 80% of the people at risk of malaria use LLINs

Que. 72. What is the objective of IRS in malaria elimination?

Ans. 72. Increase and maintain IRS coverage to 90% of households in IRS-targeted areas.

Que. 73. Which insecticide is recommended for indoor space spray?

Ans. 73. Pyrethrum/ Cyphenothrin.

Que. 74. What is the purpose of indoor space spray?

Ans. 74. To contain outbreak or epidemic.

Que. 75. What is the process of indoor space spray?

Ans. 75. Space spray in each household should be continued for 7 to 10 consecutive days, preferably in early morning or evening hours and until IRS in all the houses in the locality is completed.

Que. 76. Which vector control measures will you adopt in category 0 and 1 state for Subcentres with API<1?

Ans. 76. The control measures are as follows –

Mapping of potential vector breeding sites
Regular adult vector monitoring (prevalence and density)
Environmental management and modifications
Biological Control – Larvivorous fish
Foci based adult vector control interventions – in and around 50 houses of positive cases – Space spray followed by IRS.

Que. 77. Which vector control measures will you adopt in category 1,2 &3 state for subcentres with API > 1?

Ans. 77. The control measures are as follows –

Universal coverage with LLINs of all subcentres with API > 1
If not covered by LLINs, two regular rounds of supervised IRS (subcentre as unit)
In LLIN covered Subcentres, if there is upsurge of cases, efforts to be made to increase the compliance rate of LLIN usage
In outbreak situations – additional round of IRS
Antilarval measures in urban areas with main focus in slum clusters. In outbreaks, slum clusters can also be covered with IRS.
Larval control through source reduction and biological and environmental measures.

Que. 78. Which indicators will you calculate for interpretation of entomological data?

Ans. 78. The indicators to be calculated are as follows –

Indoor resting collection (per man hour density)
Mosquito abdominal condition
Night landing collections (ethical clearance mandatory)
Feeding habits
Human blood index
Sporozoite rate
Insecticide susceptibility
Density of immature (larval and pupal density)
Mapping of permanent breeding sites

Que. 79. On which date World Malaria Day is celebrated every year?

Ans. 79. 25^th April.

Que. 80. When anti malaria month is observed every year?

Ans. 80. In the month of June.

Que. 81. Which are the causative organisms of lymphatic filariasis?

Ans. 1. Caused by nematode worm, either Woucheria bancrofti or Brugian malayi.

Que. 82. Which are the vectors of lymphatic filariasis?

Ans. 82. Vectors of lymphatic filariasis are mosquitoes of species Culex quinquefasciatus and Mansonia annularis or M. uniformis.

Que. 83. The breeding of which mosquitoes is associated with aquatic plants such as Pistia stratiotes, Salvinia auriculata etc.?

Ans. 83. Mansonia annulifera & M. uniformis

Que. 84. Which is the place of breeding of Culex quinquefasciatus, vector of Woucheria bancrofti?

Ans. 84. Dirty & polluted water.

Que. 85. What is the type of life cycle of the filarial parasite in the vector?

Ans. 85. Cyclo-developmental (where parasites do not multiply).

Que. 86. What do you mean by lymphedema?

Ans. 86. Lymphedema of the extremities is a common chronic manifestation of lymphatic filariasis, which in future course leads to elephantiasis.

Que. 87. How will you grade lymphedema of the limbs?

Ans. 87. Graded as follows –

Grade I lymphedema – Mostly pitting oedema, spontaneously reversible on elevation of limbs.
Grade II lymphedema – Mostly non-pitting oedema, not spontaneously reversible on elevation of limbs.
Grade III lymphedema (Elephantiasis) – Gross increase in volume in a Grade II lymphedema with dermatosclerosis and papillomatous lesions.
Advanced stage – The skin is thickened and thrown into folds, often with hypertrichosis, black pigmentation, nodules, warty growth, and intertrigo in the webs of toes or chronic non-healing ulcers.

Que. 88. After Malaria & TB, which is the third disease with significant DALYs lost?

Ans. 88. Lymphatic Filariasis.

Que. 89. When was National filaria Control Program launched in India?

Ans. 89. 1955.

Que. 90. Which were the strategies of National Filaria control Program?

Ans. 90. The strategies include –

Vector Control
Detection and treatment of filarial cases and
Delimitation of endemic areas

Que. 91. What do you mean by elimination of Lymphatic filariasis?

Ans. 91. It means that lymphatic filariasis ceases to be a public health problem, when the number of microfilaria carriers is less than 1% and the children born after initiation of Elimination of LF are free from circulating antigenemia.

Que. 92. Which are the key advances that form the basis of the strategies for the elimination of lymphatic filariasis?

Ans. 92. The advances are as follows –

Man is the main reservoir of infection in India
Better understanding of the disease dynamics
Better understanding of the parasite
Safe and effective drug availability
Community based delivery system
Easy diagnosis
Over 85% coverage of the population for at least 5 years could effectively interrupt transmission
Operationally feasible MDA
Community participation in form of community mobilization

Que. 93. Which are the two pillars of Lymphatic Filariasis elimination strategy?

Ans. 93. Two pillars are –

Transmission control – by administration of annual single dose of anti-filaria drugs i.e. DEC and / or co-administration of DEC & Albendazole
Disability Prevention & Management – e.g. a) home-based management – Limb hygiene for lymphedema b) Hospital based management – Surgical correction of hydrocele

Que. 94. Which are the major components /tasks towards lymphatic filariasis elimination implementation strategy?

Ans. 94. Major components/tasks are –

Disease burden estimation
Mapping and stratification
Advocacy
Social Mobilization
Implementation of MDA
Implementation of disability prevention and management
Monitoring & Evaluation
Background surveillance to prevent resurgence
Certification

Que. 95. Why disease burden estimation is important?

Ans. 95. The disease burden estimation is important because –

To identify the area that requires intervention
Prepare advocacy package to implement the intervention
Plan, deliver and monitor disability alleviation and prevention strategies
To monitor and evaluate intervention program

Que. 96. What is the concept of Mass Drug Administration (MDA) in filarial program?

Ans. 96. The concept of MDA is to approach every individual in target community and administration of annual single dose of anti-filarial drugs (DEC or DEC + Albendazole). The annual dose is to be repeated every year for the period of 5 years or more aiming at minimum 85% actual drug compliance.

Que. 97. What are the doses of DEC & Albendazole for children more than 15 years and adults?

Ans. 97. DEC – 300 mg (3 tabs of 100 mg each) & Albendazole — 400 mg (Single tab).

Que. 98. Which are the components of lymphedema management?

Ans. 98. The components of lymphedema management are as follows –

Washing
Prevention and cure of early lesions
Elevation of the foot
Exercise
Wearing proper footwear
Management of acute attacks

Que. 99. Which group should not be given DEC for filarial treatment or prevention?

Ans. 99. Following groups should not be given DEC for filarial treatment or prevention –

Children below 2 years of age
Pregnant women
Seriously ill patients.

Que. 100. In which year, Global Program to Eliminate Lymphatic Filariasis (GPELF) was launched by the WHO?

Ans. 100. In 2000.

Que. 101. Which are the combinations of drugs given in MDA under GPELF?

Ans. 101. Two combinations are as follows –

Ivermectin & Albendazole
DEC & Albendazole

Que. 102. Where was first MDA campaign carried out under GPELF?

Ans. 102. Egypt & Samoa.

Que. 103. Name the principal method to enlist all the diseased individuals in the given community.

Ans. 103. Line listing.

Que. 104. For MDA, how will you do projection of DEC requirements?

Ans. 104. DEC – 100 mg tabs — multiply total population in endemic areas by 2.5.

Que. 105. For MDA, how will you do projection of Albendazole requirements?

Ans. 105. Albendazole – 400 mg tabs —– Multiply total population in endemic area by 1.

Que. 106. What do you mean by Dengue fever?

Ans. 106. Dengue is a self-limiting acute mosquito transmitted disease characterized by fever, headache, muscle & joint pain, rash, nausea, and vomiting.

Que. 107. Which virus does cause dengue fever?

Ans. 107. An Arbovirus (Flavivirus).

Que. 108. How does dengue fever spread?

Ans. 108. It spreads by bite of infected female Aedes mosquitoes.

Que. 109. Which are the variants of dengue fever?

Ans. 109. Dengue haemorrhagic fever (DHF) & its severe form Dengue Shock Syndrome (DSS).

Que. 110. Which are the factors responsible for the resurgence of dengue epidemic?

Ans. 110. The factors responsible for resurgence of dengue epidemic are as follows –

Un-precedented human population growth
Un-planned and un-controlled urbanization
Inadequate waste management
Water supply mismanagement
Increased distribution and densities of vector mosquitoes
Lack of effective mosquito control
Deterioration in public health infrastructure

Que. 111. Which dengue serotype viruses are widespread in India?

Ans. 111. DEN-1 & DEN-2.

Que. 112. Which are the most potential vectors of dengue fever?

Ans. 112. Aedes aegypti female mosquitoes.

Que. 113. What is the average adult survival time of Aedes aegypti?

Ans. 113. 15 days.

Que. 114. Which are the important breeding sites of Aedes Aegypti?

Ans. 114. The important breeding sites of Aedes Aegypti are as follows –

Manmade water receptacles found in and around households, construction sites and factories.
Tree holes, leaf axils and coconut shells
Overhead tanks and ground water storage tanks
Unused tyres, flowerpots, and desert coolers

Que. 115. What is the extrinsic incubation period for dengue virus?

Ans. 115. 8-10 days.

Que. 116. Which are the key manifestations of the DHF/DSS?

Ans. 116. The key manifestations of DHF/DSS are as follows –

Sudden onset of shock
Capillary leakage
Haemorrhagic diathesis/ thrombocytopenia occurring at the time of defervescence of fever.

Que. 117. Write about the clinical description of dengue fever.

Ans. 117. Dengue fever is an acute febrile illness of 2-7 days duration with 2 or more of the following manifestations –

Headache, Retro-orbital pain, myalgia, arthralgia, rash & Haemorrhagic manifestations.

Que. 118. Which are the criteria for diagnosis of Dengue Haemorrhagic fever (DHF)?

Ans. 118. – A probable or confirmed case of the dengue plus

Haemorrhagic tendencies evidenced by one or more of the following –

Positive tourniquet test
Petechiae, ecchymosis or purpura
Bleeding from mucosa, GIT, injection site or other sites
Hematemesis or Melena plus

Thrombocytopenia (< 1,00,000 cells per Cu mm) Plus
Evidence of plasma leakage due to increased vascular permeability manifested by one or more of the followings –

A rise in average haematocrit for age and sex equal to or >20%
A more than 20% drop in haematocrit following volume replacement treatment compared to baseline
Signs of Plasma leakage (Pleural effusion, ascites, hypoproteinaemia)

Que. 119. Which are the criteria of diagnosis of Dengue Shock Syndrome (DSS)?

Ans. 119. All features of DHF plus features of circulatory failure (Rapid & weak pulse, narrow pulse pressure i.e. equal to or less than 20 mm of Hg, hypotension, cold and clammy skin, restlessness).

Que. 120. What do you mean by confirmed case of dengue syndrome?

Ans. 120. A case compatible with the clinical description that is laboratory confirmed.

Que. 121. What are the laboratory criteria for diagnosis of dengue?

Ans. 121. Any one or more of the following –

Isolation of the dengue virus from serum, plasma, leucocytes, or autopsy samples
Demonstration of a 4-fold or greater change in reciprocal IgG or IgM antibody titres to one or more dengue virus antigen in paired serum samples
Demonstration of dengue virus antigen in autopsy tissue by immunohistochemistry or immunofluorescence or in serum samples by ELISA.
Detection of viral genomic sequences in autopsy tissue, serum, or CSF samples by polymerase chain reaction (PCR).

Que. 122. Which are the serological tests available for diagnosis of dengue infection?

Ans. 122. Following tests are available for the diagnosis of dengue infection –

Haem agglutination Inhibition (HI)
Compliment fixation (CF)
Neutralization test (NT)
IgM capture enzyme-linked immunosorbent assay (MAC-ELISA) &
Indirect IgG ELISA

Que. 123. When should samples be collected from DF/DHF cases for serological studies?

Ans. 123. – As soon as possible after the onset of illness, hospital admission, or attendance at a clinic (Acute Serum S1)

Shortly before discharge from the hospital or in the event of fatality, at the time of death (Convalescent Serum S2)
In the event if hospital discharge occurs within 1-2 days of the subsidence of the fever collect a third specimen 7-21 days after the acute serum was withdrawn (Late convalescent serum S3).

Que. 124. What are the lab findings of dengue fever?

Ans. 124. Leukopenia & Thrombocytopenia.

Que. 125. What do you mean by Tourniquet test?

Ans. 125. The tourniquet test is performed by inflating a BP cuff to a midpoint between the systolic & diastolic blood pressure for 5 minutes.

Que. 126. What is the significance of tourniquet test?

Ans. 126. The test is considered positive when 10 or more petechiae per 2.5 cm square are observed. In DHF, the test usually gives a definite positive test with 20 petechiae or more.

Que. 127. Whether the tourniquet test may be negative or only mildly positive during the phase of profound shock (DSS)?

Ans. 127. Yes.

Que. 128. When will you discharge a patient of dengue infection?

Ans. 128. When following criteria are fulfilled –

Absence of fever for at least 24 hours without the use of anti-fever therapy
Return of appetite
Visible clinical improvement
Good urine output
Minimum of 2 or 3 days after recovery from shock
No respiratory distress from pleural effusion or ascites
Platelet count > 50,000/cu. Mm

Que. 129. Which are the indications of domiciliary management of dengue infection?

Ans. 129. Indications for domiciliary management are as follows –

No tachycardia
No hypotension
No narrowing of pulse pressure
No bleeding
Platelet count > 1,00,000/ Cu. Mm

Que. 130. During domiciliary management of dengue infection when should the patient report to nearest hospital immediately?

Ans. 130. The conditions are as follows –

Bleeding from any site
Severe abdominal pain, refusal to take orally or poor intake, persistent vomiting
Not passing urine for 12 hours, decreased urinary output
Restlessness, seizures, excessive crying (young infant), altered sensorium, persistent headache, behaviour change
Cold clammy skin
Sudden drop in temperature

Que. 131. How will you grade DHF based on clinical & laboratory findings?

Ans. 131.

Grade	Symptoms/signs	Laboratory findings
I	Fever with 2 or more of the followings – – Headache – Retro-orbital pain – Myalgia – Arthralgia Plus positive tourniquet test, evidence of plasma leakage	Thrombocytopenia Platelet count < 1 lakh/Cu. mm Haematocrit rise 20% or more
II	Above signs and symptoms plus some evidence of spontaneous bleeding in skin or other organs (black stool, epistaxis, bleeding gums etc.)	Thrombocytopenia Platelet count < 1 lakh/Cu. mm Haematocrit rise 20% or more
III	Above signs & symptoms plus circulatory failure	Thrombocytopenia Platelet count < 1 lakh/Cu. mm Haematocrit rise 20% or more
IV	Profound shock with undetectable pulse or BP	Thrombocytopenia Platelet count < 1 lakh/Cu. mm Haematocrit rise more than 20%

Que. 132. What is Chikungunya fever?

Ans. 132. It is a debilitating, but not fatal viral illness that spreads by the bite of infected mosquitoes.

Que. 133. When was Chikungunya epidemic occurred in past?

Ans. 133. In 1963, 1965 & 1973 in various parts of India.

Que. 134. Which infectious agent is responsible for chikungunya fever?

Ans. 134. Chikungunya virus (family togaviridae, genus alphavirus).

Que. 135. How does chikungunya fever spread?

Ans. 135. It spreads by the bite of an Aedes mosquito, primarily Aedes aegypti.

Que. 136. What are the breeding sites of Aedes mosquitoes?

Ans. 136. They breed in a wide variety of man-made containers which are common around human dwellings. These containers include discarded tyres, flowerpots, old oil drums, animal water troughs, water storage vessels and plastic food containers.

Que. 137. Which conditions are conducive to outbreak of chikungunya fever?

Ans. 137. Conditions are as follows –

Lack of public health infrastructure
Factors promoting uncontrolled mosquito breeding

Que. 138. What are the symptoms of chikungunya fever?

Ans. 138. Fever, chills, headache, nausea, vomiting, severe joint pain or rash and stooped posture of patient.

Que. 139. How soon after exposure to chikungunya virus do symptoms appear?

Ans. 139. The time between the bite of a mosquito carrying chikungunya virus and the start of symptoms varies from 1-12 days.

Que. 140. How is chikungunya fever diagnosed?

Ans. 140. By blood tests (ELISA).

Que. 141. Who is at risk for chikungunya fever?

Ans. 141. Anyone who is bitten by an infected mosquito can get chikungunya fever.

Que. 142. What is the treatment for chikungunya fever?

Ans. 142. There is no specific treatment for chikungunya fever. Supportive therapy that helps ease symptoms, such as NSAIDS and getting plenty of rest, may be beneficial.

Que. 143. How can chikungunya fever be prevented?

Ans. 143. Following are the measures to prevent chikungunya fever –

Elimination of mosquito breeding sites
Prevention of mosquito bites –

Use mosquito repellents on skin and clothing
When indoors, stay in well screened areas. Use bed nets if sleeping in areas that are not screened or air conditioned
When working outdoors during daytime, wear long sleeved shirts and long pants to avoid mosquito bite.

Que. 144. How can Aedes mosquito breeding be controlled by using source reduction method?

Ans. 144. Can be controlled in following ways –

By elimination of all potential vector breeding places near the domestic or peri domestic areas
Not allowing the storage of water for more than a week. This could be achieved by emptying and drying the water containers once in a week.
Straining of the stored water by using a clean cloth once a week to remove the larvae of mosquito from the water and water can be reused. The sieved cloth should be dried in the sun to kill immature stages of mosquitoes.

Que. 145. How can Aedes mosquito breeding be controlled by using biological methods?

Ans. 145. By introduction of Larvivorous fish, namely gambusia and guppy in water tanks and other water sources.

Que. 146. What is the incubation period of chikungunya fever?

Ans. 146. 4-7 days.

Que. 147. Which season is favourable for Chikungunya fever?

Ans. 147. Rainy season.

Que. 148. What are the characteristics of rash in chikungunya fever?

Ans. 148. Rash is morbilliform, occasionally with purpura and seen on the trunks and limbs.

Que. 149. How can chikungunya virus be isolated?

Ans. 149. The virus can be isolated from the blood of febrile patients by intracerebral inoculation in suckling mice or on Vero cells.

Que. 150. How is Japanese Encephalitis transmitted?

Ans. 150. It is transmitted by infective bites of female mosquitoes especially Culex tritaeniorhynchus, Culex Vishnui & Culex pseudovishnui.

Que. 151. Which human system is primarily affected by JE virus?

Ans. 151. Central Nervous System.

Que. 152. Where does initial viral replication occur following an infectious mosquito bite?

Ans. 152. Local & regional lymph nodes.

Que. 153. How does JE viral invasion of central nervous system occur?

Ans. 153. Most probably via blood.

Que. 154. Which group is mainly affected by JE?

Ans. 154. Children less than 15 years’ age and aged people > 60 years.

Que. 155. Which animal is major vertebrate host for JE virus and considered as amplifier of the JE virus?

Ans. 155. Pigs.

Que. 156. Which are the extra human hosts for JE virus?

Ans. 156. Pig & Ardeid bird.

Que. 157. Which is the most important breeding places for Culex mosquitoes responsible for JE?

Ans. 157. Rice fields.

Que. 158. What is the incubation period of Japanese encephalitis?

Ans. 158. 5-15 days.

Que. 159. What is the ratio of overt disease to in apparent infection in case of JE/ AES?

Ans. 159. 1: 250 to 1: 1000.

Que. 160. Which are the stages of JE in humans?

Ans. 160. Three stages –

Prodromal stage
Acute encephalitic stage
Late stage & sequelae

Que. 161. What is the case fatality rate in JE/AES?

Ans. 161. 20-40%.

Que. 162. Which are the clinical features of the prodromal stage of JE/AES?

Ans. 162. Duration of this stage is 1-6 days and characteristic clinical features are as follows –

Acute onset
Fever
Headache
Gastro-intestinal disturbances
Lethargy
Malaise

Que. 163. Which are the clinical features of acute encephalitic stage in JE/AES?

Ans. 163. Following are the clinical features of acute encephalitic stage –

Fever – high, 38 to 40.7 degree Celsius
Nuchal rigidity
Focal CNS signs
Convulsions
Signs of raised intracranial pressure
Difficulty of Speech
Dystonia
Ocular palsies, hemi or quadriplegia
Extrapyramidal signs – Coarse tremors, altered sensorium
Coma

Que. 164. When and where the first case of JE was reported in India?

Ans. 164. 1955 in Vellore, Tamilnadu.

Que. 165. What do you mean by Acute Encephalitis Syndrome (AES)?

Ans. 165. It is a general description of clinical presentation of a disease characterized by High Fever, altered consciousness etc. mostly in children below 15 years of age.

Que. 166. What are the goals of National program on prevention & control of JE/AES?

Ans. 166. To reduce morbidity, mortality, and disability in children due to JE/AES.

Que. 167. Which are the major objectives of National Program on prevention and control of JE/AES?

Ans. 167. The major objectives are as follows –

To strengthen and expand JE vaccination in affected districts
To strengthen surveillance, vector control, case management and timely referral of serious and complicated cases
To increase access to safe drinking water and proper sanitation facilities to the target population in affected rural and urban areas
To estimate disability burden due to JE/AES and to provide for adequate facilities for physical, medical, neurological & social rehabilitation
To improve nutritional status of children at risk of JE/AES
To carry out intensified IEC/BCC activities regarding JE/AES

Que. 168. Which departments are involved to implement multi-pronged strategy for JE/AES Prevention and control?

Ans. 168. The departments involved are as follows –

Health & Family Welfare
Drinking water & Sanitation
Social Justice & Empowerment
Women & Child Development
Urban development
Human resource development

Que. 169. What is the role of Ministry of Health & Family Welfare in JE/AES prevention & control?

Ans. 169. Following is the role of Ministry of Health & Family Welfare –

Strengthening & Expanding JE vaccination
Strengthening of public health activities
Better clinical management of JE/AES cases
Physical Medicine & Rehabilitation (PMR)
Establishing of district counselling centres
Monitoring, Supervision & Coordination
Research cum intervention project

Que. 170. What is the recent guideline of GOI for JE vaccination?

Ans. 170. 2 doses of vaccine to be given in UIP, one along with measles at the age of 9 months and second with the DPT booster at the age of 16-24 months w.e.f. April 2013.

Que. 171. What does model action plan include?

Ans. 171. It includes community-based surveillance, entomological surveillance, vector control, capacity building and IEC/BCC.

Que. 172. Why vector control using Ultra Low Volume (ULV) fogging is the only recommended method of vector control in JE?

Ans. 172. Because of outdoor resting habits and crepuscular nature, the vector control using indoor residual spray is technically not feasible. In addition, due to vast and enormous breeding habitats, using anti-larval measures is also not feasible as it is resource intensive.

Que. 173. What is the role of disease surveillance in JE?

Ans. 173. It continuously monitors all factors influencing transmission and effective control of JE, builds up capacity for early recognition of impending outbreaks or epidemics.

Que. 174. When will you consider a patient a case of encephalitis in an epidemic situation?

Ans. 174. In an epidemic situation, fever with altered sensorium presenting for more than 2 hours with a focal seizure or paralysis of any part of the body, is encephalitis.

Que. 175. Which are the monitoring indicators of JE/AES surveillance?

Ans. 175. Following are the monitoring indicators of JE/AES surveillance –

Completeness of monthly reporting
Timeliness of monthly reporting
Percentage of serum samples taken
Percentage of all suspect cases for which specimens were collected
Proportion of AES cases tested for AES
Concurrent evaluation of JE vaccination campaign
JE vaccination coverage under RI
Percentage reduction in CFR

Que. 176. Which are the risk factors for JE outbreak in an area?

Ans. 176. The risk factors for JE outbreak in an area are as follows –

Increase in susceptible population
High density of Culex mosquitoes
Presence of amplifying hosts such as pigs, water birds etc.
Paddy cultivation

Que. 177. What are the objectives of entomological surveillance?

Ans. 177. The objectives of entomological surveillance are as follows –

To identify the JE vector mosquitoes in an area
To monitor JE vector abundance in JE endemic areas
To detect JE virus in vector mosquitoes
To suggest appropriate vector control measures

Que. 178. What is the feeding nature of vectors for JE?

Ans. 178. Vectors of JE are zoophilic and feed outdoor as well as indoor. They prefer to feed on cattle & pigs.

Que. 179. Where is the thermal fogging done?

Ans. 179. Thermal fogging is done in outdoor situations (outside human habitation), Where large number of JE cases are reported.

Que. 180. Which is the most favourable time for ULV fogging?

Ans. 180. Late evening between 17.00 to 19.00 hours.

Que. 181. What should be the frequency of ULV fogging?

Ans. 181. During outbreak situations, should be carried out at 7-10 days interval till a significant reduction in vector densities is achieved.

Que. 182. What are the types of mosquito repellents?

Ans. 182. Two types –

Natural – Citronella oil, lemongrass oil, neem oil.
Chemical – DEET, Permethrin

Que. 183. What is the case definition of a suspected case?

Ans. 183. – Acute onset of fever, not more than 5-7 days duration

Change in mental status with or without –

New onset of seizures (excluding febrile seizures)
Other early clinical findings including irritability, somnolence, or abnormal behaviour greater than seen with usual febrile illness.

Que. 184. Who is a laboratory confirmed JE/AES case?

Ans. 184. A suspected case with any one of following markers –

Presence of IgM antibodies in serum or CSF to a specific virus including JE/ Entero-virus or others
4-fold differences in IgG antibody titre in paired sera.
Virus isolation from brain tissues
Antigen detection by immunofluorescence
Nucleic acid detection by PCR

Que. 185. What do you mean by a probable case of JE/AES?

Ans. 185. A suspected case in close geographic and temporal relationship to a laboratory confirmed case of JE/AES in an outbreak.

Que. 186. What do you mean by acute encephalitis syndrome due to unknown agent?

Ans. 186. A suspected case in which no diagnostic testing is performed/no etiological agent is identified /test results are indeterminate.

Que. 187. What do you mean by Acute Encephalitis Syndrome due to other agents?

Ans. 187. A suspected case in which diagnostic testing is performed and an aetiological agent other than JE/AES is identified.

Que. 188. What are the danger signs of JE/AES?

Ans. 188. Following are the danger signs of JE/AES –

Fever with any one of the following –
Lethargy
Unconsciousness
Convulsions
Paralysis, rash, hepatosplenomegaly
Shock/hypotension/ low BP/feeble thread pulse
Need of ventilators – poor respiratory efforts, Cyanosis not managed by oxygen

Que. 189. What are the steps of treatment of AES/JE?

Ans. 189. The steps of treatment of AES/JE –

Management of airways and breathing
Management of circulation
Control of convulsions and intracranial pressure
Control of temperature
Fluid & Electrolytes and calorie/nutrition
General Management
Specific treatment of any for treatable cause
Investigation, sample collection and transportation
Reporting of a case
rehabilitation

Que. 190. Which is the causative organism of Kala-azar in India?

Ans. 190. A protozoan parasite Leishmania Donovani.

Que. 191. Which system is primarily infected by the parasite Leishmania Donovani?

Ans. 191. Reticulo-endothelial system and may be found in abundance in bone marrow, spleen and liver.

Que. 192. Which are the two forms of leishmaniasis prevalent in India?

Ans. 192. Two forms of leishmaniasis prevalent in India are –

Visceral Leishmaniasis or Kala-azar
Post Kala-azar Dermal Leishmaniasis (PKDL)

Que. 193. When was the Kala-azar Control Program launched in India?

Ans. 193. 1990-91.

Que. 194. What was the strategy for KA control program at the time of launch?

Ans. 194. Strategies were as follows –

Interruption of transmission by reducing vector population by IRS twice a year
Early diagnosis and complete treatment of cases
Health Education program for community awareness/ IEC & BCC

Que. 195. Whether Kala-azar has any animal reservoir in Asian Continent?

Ans. 195. No animal reservoir.

Que. 196. If Kala-azar remain untreated, what is the fatality rate?

Ans. 196. In over 95% cases it is fatal, if remain untreated.

Que. 197. What are the criteria for elimination of Kala-azar?

Ans. 197. Attainment of annual incidence of Kala-azar to less than one per 10,000 population at sub district level (Block PHC Level) in India.

Que. 198. Which are the favourable factors for Kala-azar elimination?

Ans. 198. Favourable factors are as follows –

Man is the only reservoir
Only one species of sand fly (P. argentipes) is the vector
Availability of rapid diagnostic tests
New and effective treatments are available
Limited geographical distribution of the disease
High political commitment

Que. 199. How does PKDL manifest?

Ans. 199. PKDL manifests as hypo pigmented or erythematous macules on any part of the body which may later become popular or nodular especially on face.

Que. 200. When is the disease transmission highest?

Ans. 200. Rainy Season.

Que. 201. Which are the common breeding and resting sites of sand fly, the vector of Kala-azar?

Ans. 201. The Sand fly breeds in humid soil rich in organic matter and near cattle sheds and mud houses. The vector rests most commonly in cracks and crevices of thatched mud houses.

Que. 202. What is the peak biting time of female sand fly?

Ans. 202. Around Midnight.

Que. 203. What are the objectives of KA Elimination Program in India?

Ans. 203. The objectives are as follows –

Reducing the incidence of KA in the endemic communities
Reducing the case fatality rate due to KA
Treatment of PKDL to reduce the parasite reservoir
Prevention of treatment of KA-HIV, KA-TB coinfections

Que. 204. What are the strategies for the KA elimination program in India?

Ans. 204. The strategies are as follows –

Early diagnosis & Complete Treatment
Integrated Vector Management including Indoor residual Spraying (IRS)
Advocacy, communication for behaviour impact and inter-sectoral convergence
Capacity Building
Supervision, monitoring and evaluation

Que. 205. Define Surveillance.

Ans. 205. It is a continuous and systemic process of collection, analysis, interpretation and dissemination of descriptive information for monitoring health problems.

Que. 206. How does case detection possible in KA elimination Program?

Ans. 206. Case detection in done by two means –

Active Case detection – by quarterly active search followed by treatment
Passive Case detection – through the existing primary health care system

Que. 207. Which is the first drug of choice for treatment of Kala-azar?

Ans. 207. Single dose single day treatment with Liposomal Amphotericin B injection.

Que. 208. How suspected Kala-azar case is confirmed?

Ans. 208. By clinical examination and by Rapid Diagnostic Tests (RDT).

Que. 209. What do you mean by Integrated Vector Management (IVM)?

Ans. 209. It is a rational decision-making process for the optimal use of resources for vector control.

Que. 210. What are the main objectives of IVM?

Ans. 210. The main objectives of IVM are as follows –

To reduce longevity of the adult vectors
Elimination of breeding sites
Decrease in contact of vector with humans
Reduction of the density of the vector

Que. 211. Which are the key elements of IVM?

Ans. 211. The key 5 elements are as follows –

Capacity building and training
Advocacy
Collaboration
Evidence-based decision making and
Integrated Approach

Que. 212. What is the use of Disease Surveillance in Kala-azar?

Ans. 212. The uses of disease surveillance are as follows –

Monitoring trends of Kala-azar incidence
In planning IRS through mapping of the areas to be sprayed.

Que. 213. What are the various reporting units at different levels in Kala-azar elimination program?

Ans. 213. Level-1 —- Sub centres & additional PHCs

Level -2 —– Block PHCs

Level -3 —– Sub-divisional hospitals, DH, Specialized hospitals & Medical Colleges

Que. 214. Which are the favourable ecological conditions proliferating the density of sand flies?

Ans. 214. The favourable ecological conditions are as follows –

Alluvial soil
High Sub Soil water
Monthly mean maximum temperature <37 degree Celsius
Annual rainfall of 120 mm or more
Mean annual RH of 70% or more with 80% for at least 3 months
Altitude below 600 meters

Que. 215. Up to which distance, the sand flies can hop?

Ans. 215. 6 Feet (or ½ Meters)

Que. 216. What are the resting sites of the vector in Kala-azar?

Ans. 216. Cracks & crevices, burrows, tree holes, termite hills, earthen mounds, under stone & foliage etc.

Que. 217. What are the entomological sampling techniques?

Ans. 217. Entomological Sampling techniques are as follows –

Hand Collection
Light trap Collection
Sticky Traps

Que. 218. Which is one of the most cost-effective control measures for Kala-azar in India?

Ans. 218. Insecticidal Residual Spray (IRS).

Que. 219. On basis of which criteria, you will select areas for IRS?

Ans. 219. – All villages within a block PHC which reported Kala-azar cases in the past 3 years

New Villages which reported cases during year of spray
Villages free of Kala-azar, but on search were found to have cases confirming to the case definition

Que. 220. Which are the common pumps used mostly for IRS in India?

Ans. 220. The common pumps used are –

Stir up pumps
Hand compression Pumps

Que. 221. Whether diagnosis of Kala-azar case is done by using rapid diagnostic test kits in the field?

Ans. 221. True.

Que. 222. How long does rapid diagnostic test kits take to give a result?

Ans. 222. 10 Minutes.

Que. 223. How much sensitive & specific are rapid diagnostic test kits?

Ans. 223. More than 90% specificity and sensitivity.

Que. 224. How will you interpret the results of rapid diagnostic test kit for diagnosis of Kala-azar?

Ans. 224. Two red lines indicate a positive result while only a single red strand indicates negative result.

Que. 225. In which conditions, chances of false positive results in RDK is likely?

Ans. 225. Suspected Hepatitis & TB.

Que. 226. In which conditions, chances of false negative results in RDK is likely?

Ans. 226. HIV & other Immune compromised conditions.

Que. 227. Which are the recording tools of Kala-azar elimination program?

Ans. 227. The recording tools are as follows –

Treatment Cards
Lab Registers
Kala-azar Registers
Patient Identity Cards

Que. 228. Which are the clinical features of the Kala-azar?

Ans. 228. Main symptoms are –

Prolonged irregular fever (>2 Weeks)
Splenomegaly
Weight Loss

Que. 229. Define a case of visceral leishmaniasis or Kala-azar.

Ans. 229. A case of visceral leishmaniasis is a person showing clinical signs (mainly prolonged irregular fever, splenomegaly and weight loss) with serological and/or parasitological confirmation.

Que. 230. Define a Kala-azar suspect case.

Ans. 230. History of fever of more than 2 weeks and enlarged spleen and liver not responding to anti malaria drugs in a patient from an endemic area.

Que. 231. Define a case of probable PKDL.

Ans. 231. A patient from an area endemic for Kala-azar with multiple hypo pigmented macules, papules or plaques or nodules with no sensory loss and positive with rapid diagnostic test.

Que. 232. Define a confirmed case of PKDL.

Ans. 232. A patient from an area endemic for Kala-azar with multiple hypo pigmented macules, papules, plaques or nodules who are parasite or PCR positive in a slit skin smear or biopsy.

Que. 233. What is the drug of choice at present for visceral leishmaniasis?

Ans. 233. Liposomal amphotericin B – 10 mg/Kg as a single dose by infusion.

Que. 234. What are the different treatment outcomes in Kala-azar?

Ans. 234. Cure, Relapse, Non-Response & Treatment Failure.

Que. 235. What do you mean by Cure in Kala-azar elimination Program?

Ans. 235. A patient is considered clinically cured if he/she has completed full treatment and there are no signs and symptoms of Kaka-azar.

Que. 236. What do you mean by Relapse in Kala-azar elimination program?

Ans. 236. Any appearance of Kala-azar signs and symptoms within a period of 6 months after the end of treatment.

Que. 237. What are the different treatment outcomes of PKDL?

Ans. 237. Two different outcomes are –

Initial Cure – Clinical improvement at the end of treatment – defined as considerable reduction in the number and size of skin lesions.
Final Cure – Clinical Cure 12 months after the end of treatment – defined as a complete resolution of macules, papules, plaques and nodules.

Que. 238. Which are the different approaches of active case detection?

Ans. 238. The different approaches of Active Case Detection are as follows –

House to House search (or blanket screening)
Index case approach (or snow balling)
Camp based approach
Incentive based approach

Que. 239. What do you mean by effective IRS coverage?

Ans. 239. WHO recommendation is to have minimum of 80% households covered under IRS.

Que. 240. Which actions are to be made post IRS?

Ans. 240. The actions to be made post IRS are as follows –

Sprayers should be rinsed and cleaned properly for next day operations.
Residual insecticides at the end of the day should be disposed as per the guidelines
Post IRS Vector density should be checked

Que. 241. What is the purpose of pharmacovigilance?

Ans. 241. The purpose of pharmacovigilance is to detect, assess, understand and prevent any adverse effects or other medicine related problems and to monitor drug unresponsiveness/resistance.

Que. 242. Which are the side effects of miltefosine in Kala-azar treatment?

Ans. 242. The side effects are as follows –

GI effects – pain, vomiting, diarrhoea
Nephrotoxicity
Hepatotoxicity

Que. 243. Which are the side effects of anti-KA drug Sodium antimony gluconate?

Ans. 243. The side effects are –

Cardiotoxicity
Osteo-muscular effects e.g. myalgia, arthralgia
Nephrotoxicity
Hepatotoxicity

Que. 244. Which are the adverse effects of anti-KA drug Amphotericin B?

Ans. 244. The adverse effects are as follows –

Drug Reaction
Nephrotoxicity
Cardiotoxicity
Ototoxicity

Que. 245. How will you calculate % coverage rate of vector control?

Ans. 245. Number of household protected/All household at risk*100.

Que. 246. How will you calculate % treatment completion rate?

Ans. 246. Number of patients who took a full course of first line drugs*100/All new cases that started treatment in a given period.

Que. 247. Which is the causative organism of malaria?

Ans. 247. Malaria is a protozoal disease caused by infection with parasites of the genus plasmodium.

Que. 248. What are the risk groups for malaria?

Ans. 248. Malaria affects mainly poor, underserved & marginalized populations in remote rural areas.

Que. 249. Who are affected least with falciparum infection?

Ans. 249. Individuals with sickle cell trait.

Que. 250. Who are resistant to plasmodium vivax infection?

Ans. 250. Persons whose red blood cells are Duffy negative.

Que. 251. What are the distinct stages in typical attack of malaria?

Ans. 251. The distinct stages in typical attack of malaria are –

Cold stage
Hot stage
Sweating stage

Que. 252. What is the basis of Rapid Malaria diagnostic tests?

Ans. 252. Rapid malaria diagnostic tests are based on the detection of circulating parasite antigens with a simple dipstick format.

Que. 253. In microscopy, what should be seen in positive slides?

Ans. 253. One should see in positive slides for –

Parasite species
Parasite stage
Estimation of parasite density.

Que. 254. What is the main approach for case management in malaria elimination?

Ans. 254. Early diagnosis & complete management.

Que. 255. Whether presumptive treatment is not recommended in Malaria elimination?

Ans. 255. Yes & should be reserved for extreme circumstances only.

Que. 256. In which condition, quinine remains the treatment of choice?

Ans. 256. Quinine remains the treatment of choice in –

Pregnant women
Children < 5 kg of body weight
Treatment failure

Que. 257. What is the utility of National Quality Management System (NQMS) under malaria program?

Ans. 257. To ensure quality assurance of all malaria diagnostic services throughout the country.

Que. 258. What is the utility of LLINs under NVBDCP?

Ans. 258. LLINs are highly practical and cost effective intervention against malaria, and are highly effective against mosquito bites at night.

Que. 259. Which sub-centres of a district are the targets for distribution of LLINs?

Ans. 259. All sub-centres with API > 1 per 1000 identified in a district.

Que. 260. How will you monitor the LLINs distribution?

Ans. 260. Through LLIN registers available with each ASHA, sub-centre & block level CHC.

Que. 261. What is the utility of Indoor Residual Spraying (IRS)?

Ans. 261. IRS is a main component of selective vector control & is targeted to cover epidemic prone areas & malaria affected communities with low access to the health care system.

Que. 262. Which are the sites of entomological surveillance under malaria elimination?

Ans. 262. Sentinel & random sites.

Que. 263. In which type of filariasis, genital lesions or chyluria (milky colour urine) do not occur?

Ans. 263. Brugian filariasis.

Que. 264. Which are the common manifestations of chronic Bancroftian filariasis?

Ans. 264. Hydrocele followed by lymph-oedema, elephantiasis & chyluria.

Que. 265. In which type of filariasis, nocturnal periodicity of microfilariae does occur?

Ans. 265. In both W. bancrofti & B. Malayi infections.

Que. 266. Which infection is the world’s second leading cause of long term disability?

Ans. 266. Lymphatic filariasis.

Que. 267. Which are the highest contributing countries in world’s filarial infection?

Ans. 267. India, Indonesia, Nigeria & Bangladesh (together contribute around 70% of world’s filarial infection).

Que. 268. What is recommended MDA approach in Lymphatic filariasis?

Ans. 268. Recommended MDA approach is supervised drug administration by door to door visit supplemented with drug administration at booths & groups. MDA should be preferably done on a single day with 2 days of mopping up operations.

Que. 269. Which age group of children should be excluded from MDA for lymphatic filariasis?

Ans. 269. Children < 2 years of age.

Que. 270. What is the advantages of MDA in filariasis?

Ans. 270. MDA drugs can safely and effectively reduce the number of circulating microfilariae in blood and prevent further transmission.

Que. 271. What is the favourable period in a year for dengue/ dengue haemorrhagic fever (DHF)?

Ans. 271. July to November every year.

Que. 272. Who are the reservoirs of dengue infection?

Ans. 272. Man & mosquitoes.

Que. 273. Which vector borne disease is transmitted by trans-ovarian transmission?

Ans. 273. Dengue infection.

Que. 274. Whether subsequent dengue infection by different serotypes lead to DHS/DSS?

Ans. 274. Yes it is often observed.

Que. 275. On which factors, clinical presentation of dengue syndrome does depend?

Ans. 275. The factors responsible are –

Age
Immune status of the host
Virus strain

Que. 276. According to WHO, whether Rapid dengue Diagnostic tests should be used in clinical settings to guide management of DF/DHF cases?

Ans. 276. Should not be used in clinical settings.

Que. 277. What is the biting time of Aedes aegypti mosquitoes?

Ans. 277. Day time.

Que. 278. Which drugs will you avoid in chikungunya fever?

Ans. 278. Aspirin & steroids.

Que. 279. Which tests are useful in the diagnosis of chikungunya fever?

Ans. 279. ELISA & RT-PCR.

Que. 280. What is the nature of Japanese encephalitis (JE) virus?

Ans. 280. It is primarily zoonotic in its natural cycle & man is an accidental dead end host. JE transmission occur principally in rural agricultural locations where flooding irrigation is practised.

Que. 281. In which season, JE transmission is highest?

Ans. 281. Rainy season.

Que. 282. In JE, what is the average period between the onset of illness and death?

Ans. 282. 9 days.

Que. 283. When risk of JE transmission does increase?

Ans. 283. When human dwellings & animal sheds particularly piggeries are situated very close to each other.

Que. 284. How kala-azar or visceral leishmaniasis is transmitted?

Ans. 284. By bite of infected female sand fly (Phlebotomus argentipes).

Que. 285. What is the incubation period of Kala-azar?

Ans. 285. 4 months to one year.

Que. 286. How will you do vector control in Kala-azar?

Ans. 286. Vector control is carried out by undertaking 2 rounds of sprays annually with 50% DDT at a dose of 1 gm/ meter square of wall surface inside walls of room surface to a height of 6 feet & full coverage of cattle shed.

Que. 287. Why surveillance of PKDL cases is important?

Ans. 287. As PKDL cases serve as a reservoir for disease transmission during the inter-epidemic period.

Que. 288. From where, you will start active case search in Kala-azar elimination program?

Ans. 288. Start at those villages where KA cases are high in number.

Que. 289. What are included in parasitological diagnosis of KA?

Ans. 289. Spleen, bone marrow & lymph node aspiration procedure.

Que. 290. How will you confirm infection in PKDL cases?

Ans. 290. Either through PCR or slit skin biopsy.

Que. 291. How does rapid diagnostic test in Kala-azar work?

Ans. 291. It is a rapid test for Kala-azar diagnosis and is membrane based immunoassay for detection of antibodies to kala-azar. Whole blood or serum sample may be used for the test.

Que. 292. For which comorbidities, all patients with visceral leishmaniasis should be tested?

Ans. 292. HIV & TB.

Que. 293. As soon as a case of KA is detected, what will be the immediate next step?

Ans. 293. Focal spray in the 500 meter range of an index case of kala-azar. In addition to focal spray, 2 regular rounds of sprays will continue to be applied in targeted endemic villages.

Que. 294. What should be the target of treatment completion rate in any district in KA elimination program?

Ans. 294. Above 90%.

Que. 295. Why pharmacovigilance is important in Kala-azar?

Ans. 295. To ensure the safety of the medicines used in the treatment of Kala-azar.

Que. 296. In which conditions, special attention should be given for adverse effects of miltefosine?

Ans. 296. Pregnancy & comorbidities of KA e.g. HIV & TB.

Commonly Asked Questions in National Vector Born Disease Control Program (NVBDCP)

love and learn community medicine