6.1. VECTOR BORNE DISEASES
- Define: Vector-borne diseases are human illnesses caused by parasites, viruses and bacteria that are transmitted by mosquitoes, sandflies, blackflies, ticks, tsetse flies, mites, snails and lice etc.
- Example: Diseases such as malaria, dengue, Visceral leishmaniasis, kala-azar/ Dumdum Fever), yellow fever, Japanese encephalitis, Chikungunya, Zika etc.
National Vector Borne Disease Control Programme (NVBDCP)
- It is an umbrella programme for prevention and control of vector borne diseases and is subsumed under National Health Mission.
- Directorate of NVBDCP is the central nodal agency for the prevention and control of vector borne diseases
- Vector borne diseases that are being targeted: Malaria, Dengue, Lymphatic Filariasis, Kala Azar, Japanese Encephalitis, chikungunya
Directorate of National Vector Borne Diseases Control Programme
- It’is the central nodal agency for the prevention
- and control of vector borne diseases i.e. Malaria, Dengue, Lymphatic Filariasis, Kala-azar, Japanese Encephalitis and Chikungunya in India
- It is under the aegis of Union Ministry of Health and Family Welfare.
- Function: National level Technical Nodal office for framing technical guidelines & policies as to guide the states for implementation of Programme strategies.
6.1.1. INDIA AND ZIKA VIRUS
Why in news?
- Recently the United States sent out an advisory informing its citizens in India about the number of confirmed Zika infections in India.
- The WHO has placed India as a ‘Category-2’ country for Zika risk.
- A Category-2, the second highest on a four-point scale and that also includes 2015 Zika-hotspot Brazil, indicates that the virus is being actively transmitted within the country.
- Until April, India was a Category-4 country
About zika virus
- Zika virus disease is caused by a virus transmitted primarily by Aedes mosquitoes. Aedes aegypti is a known vector of several other viruses including yellow fever virus, dengue virus and chikungunya virus.
- Zika can be passed through sex from a person with Zika to his or her partners.
- People with Zika virus disease can have symptoms including mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache. These symptoms normally last for 2-7 days.
- There is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome.
- An additional area of concern is the difference between Zika on the one hand and dengue or chikungunya on the other. While the latter conditions occur soon after a mosquito bite, the presence of the Zika virus will be known six months later, after the birth of microcephalic infants.
- US scientists have developed a plant-based Zika vaccine that could be more potent, safer and cheaper to produce than other medicines being developed for the disease.
- It is developed using tobacco plant and targets a key protein called DIII, which envelopes the outside of the Zika virus and plays a key role for the virus to infect people.
6.1.2. MONKEY FEVER
Why in news?
- Scientists have traced the source of a re-emerging disease, Kyasanur Forest Disease (KFD) or “monkey fever”, to cashew plantations in Goa.
Monkey Fever Symptoms
- High fever with headache, followed by haemorrhagic symptoms such as bleeding from the nose, throat and gums
- Gastrointestinal bleeding,
- Muscle stiffness, tremors, absent reflexes and
- Mental disturbances.
What is monkey fever?
- It is caused by Kyasanur forest disease virus (KFDV), a member of the virus family Flaviviridae, which also causes yellow fever and dengue.
- It was first detected in 1957 in Shimoga, Karnataka and is endemic to South Asia.
- Monkey fever is so named because it primarily affects black-faced langurs and red-faced bonnet monkeys and result in death. Even when the monkey dies still the KFD virus gets transmitted through ticks thriving on monkeys.
- The Hard ticks (Hemaphysalis spinigera) are the reservoir of KFDV. These ticks are known to thrive in the Western Ghats and transmit the disease to humans.
Why in news?
- Recently, it was speculated that Government will miss out the set deadline to eliminate Elephantiasis.
Elephantiasis or Lymphatic Filariasis
- It is a parasitic disease caused by the parasitic worms called filial worms which is spread by the bite of the infected black flies and mosquitoes.
- The disease parasite is usually acquired during childhood. The larvae in the human can live in human beings for up-to 5-8 years without showing any symptoms; however the lymphatic system is damaged.
- Elephantiasis leads to severe swelling in arms, legs, knees and genitals causes disfigurement and disability.
Burden of Disease
- India alone accounts for 40% of world’s disease burden with over 31 million microfilaraemics, 23 million cases of symptomatic filariasis, and about 500 million individuals at risk of contracting the disease.
- India had set the ambitious target to eradicate the disease by 2020 which was earlier set at 2015 under the National Health Policy 2002.
Efforts to eradicate the Disease in India
- In 1995, government launched National Filaria Control Program
- In India, since 2004, Mass Drug Administration (MDA) is being carried on as a part of the Hathipaon Mukt Bharat (Filaria Free India) programme for preventive
6.1.4. KALA AZAR
Why in news?
- India has missed the deadline (December 2017) of eliminating Kala Azar (Visceral leishmaniasis or Black fever or Dum Dum fever).
- In 2017 budget speech, the Finance Minister had announced for elimination (reducing to less than one case in 10,000) of Kala Azar by 2017. It was also reiterated by the National health policy 2017.
- In 2014, the government launched the Kala Azar Elimination Programme with support from various international agencies.
- However, endemic blocks have increased from 61 to 68 in 17 districts of Bihar and Jharkhand.
Ancient remedy for Kala Azar
- Scientists from Indian Institute of Chemical Biology in Kolkata tested ancient remedy described in Charaka Samhita to fight drug-resistant kala-azar.
- The compound called mahanine was isolated from leaves of curry plant commonly used in Indian kitchens has been found to inhibit the growth of kala-azar parasite.
6.1.5. JAPANESE ENCEPHALI TIS (JE)
Why in news
- In August 2017, around 30 children affected by JE admitted at Gorakhpur’s BRD Medical College had died over shortage of oxygen supply.
- Encephalitis: It is a non-communicable disease that results in inflammation of the brain. The patient’s central nervous system is affected. It can be caused due to bacterial or viral infections of the brain, injection of toxic substances or increased complications of an infectious disease.
- It’s transmitted by the infective bite of the Culex species of mosquitoes
- It belong to the same genus as dengue, yellow and West Nile viruses
- Japanese Encephalitis is covered under Universal
- Immunisation Programme (UIP).
- Acute Encephalitis Syndrome (AES) including Japanese Encephalitis (JE) is a group of clinically similar neurologic manifestation caused by several different viruses, bacteria, fungus, parasites, spirochetes, chemical/ toxins etc
- It is characterized by an acute onset of fever and clinical neurological manifestation that includes mental confusion, disorientation, delirium, or coma.
- JENVAC: It’s first indigenous vaccine to protect children from Japanese encephalitis. It’s also the first vaccine to be manufactured in the public-private partnership mode between the Indian Council of Medical Research and Bharat Biotech.
6.2. NEGLECTED TROPICAL DISEASES
Why in news
- WHO (World Health Organisation) in it’s report on neglected tropical disease (NTD) applauded the progress made on elimination of NTD.
What are Neglected Tropical Diseases
- WHO defines NTDs as a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries.
- Vulnerability: Populations living in poverty, without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock are those worst affected.
- Situation in India: Diseases that are most prevalent in India include lymphatic filariasis, soil transmitted helminthiases, trachoma, visceral leishmaniasis, dengue, rabies, cysticercosis, Japanese encephalitis and intestinal worm infections (hookworms, whipworms and Ascaris worms).
National Programmes in relation to tropical diseases are being implemented:
- National Vector Borne Disease Control Programme (NVBDCP): For control of Dengue and elimination of Kala-azar and Lymphatic Filariasis.
- National Leprosy Eradication Programme: India has achieved the elimination of leprosy at national level in December 2005. Focus is now to achieve elimination of leprosy at district level.
- National Programme for Control of Blindness: Services are provided for the control of Trachoma.
- School Health Programme: services are provided for the prevention of Soil-transmitted Helminthiases.
- National Deworming Day (February 10): Children between ages 1 to 19 through schools and anganwadi centres were dewormed in order to improve their nutritional status and well-being
- WASH strategy: It’s a critical component of prevention and care for all NTDs. Provision of safe water, sanitation and hygiene is one of the five key interventions in the global NTD road map.
- WHO NTD roadmap: It outlined bold targets for the control, elimination or eradication of 17 NTDs by 2020
- Uniting to Combat NTDs: Leaders of several prominent global health and development organizations, together with industry partners, met in London in 2012 and pledged to unite in their efforts to support the achievement of the WHO 2020 goals in respect to 10 NTDs.
- Pledge is known as London Declaration on NTDs
- 10 NTDs are: Guinea worm disease, lymphatic filariasis, blinding trachoma, sleeping sickness,leprosy,helminthes,schistosomiasis, river blindness, Chagas disease and visceral leishmaniasis (Kala Azar).
6.2.1. NATIONAL DEWORMING MISSION
Why in news?
- Recently government celebrated the National Deworming Day.
About National Deworming Day
- It was started in 2015 as a part of the National Health Mission, implemented in 11 States/UTs across all Government and Government-aided schools and Anganwadi centres.
- It entails single fixed day approach to treat intestinal worms in all the children from 1 to 19 years on February 10 and August 10 each year.
- Along with administering Albendazole tablets, some other activities are also performed such as behaviour change practices, cleanliness and hygiene guide, use of toilets, wearing shoes or slipper, washing hands before eating food and after using toilet, etc. in order to reduce the incidents of re-infection.
Soil Transmitted Helminth (STH) infection
- It is caused by different species of parasitic worms which can live and replicate in the gastrointestinal system.
- The STHs (hookworms, roundworms, whipworms) are transmitted by eggs present in human faeces, which contaminate the soil in areas where sanitation is poor.
- Infected children are nutritionally and physically impaired. While deworming has been shown to reduce absenteeism in schools; improve health, nutritional, and learning outcomes; and increase the likelihood of higher-wage jobs later in life.
6.3. POLIO VACCINE
Why in news?
- The World Health Organization has declared Gabon a “polio-free country”, given the lack of new reported or suspected cases in the central African country.
- Now the disease is endemic only in Afghanistan and Pakistan, where the WHO recorded four cases this year—two in each country.
Polio: A fact sheet
- Polio (or Poliomyelitis) is a highly-infectious viral disease which mainly affects young children and can result in permanent paralysis.
- The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies
in the intestine, from where it can invade the nervous system and can cause paralysis.
- There is no cure and it can only be prevented through immunisation.
- Types: Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since 2012.
- Difference between Oral Polio Vaccine (OPV) and IPV: OPV is made up of attenuated or weakened poliovirus and there is a risk of vaccine derived polio. IPV is made up of inactivated (killed) polio virus and will provide immunity from all three strains of polio.
- India status: India was officially decalred Polio free by WHO in 2014.
- However, samples from some states showed the presence of Type 2 vaccine derived polio virus (VDVP), which had undergone ten nucleotide changes.
- If six or more nucleotide changes happen then it is called vaccine-derived poliovirus (VDVP).
- VDVP is extremely rare and found in children with immune-deficiency and among populations with low immunity levels.
6.4. MOTHER-TO-CHILD TRANSMISSION OF HIV
- What is it: HIV transmitted from a HIV positive mother to her child during pregnancy, delivery or breast feeding is called mother-to-child transmission (MTCT).
National Aids Control Organisation (NACO)
- It is an organisation which was set up under Ministry of Health and Family Welfare for formulation of policies and implementation of programs for prevention and control of HIV/AIDS.
Child Friendly HIV Drug
- Recently, Central Drugs Standard Control Organisation (CDSCO) has registered the child-friendly and heat-stable oral pellet formulation of the HIV drug lopinavir/ritonavir (LPV/r).
- Significance: The lack of child-friendly HIV formulations is a major reason for a large treatment gap between adults and children. Due
- to this gap paediatric HIV is considered neglected disease. The registration of the pellets is a positive sign as the needs of children are being addressed.
- Major functions include: Regulatory control over the import of drugs, approval of new drugs and clinical trials, meetings of Drugs Consultative Committee (DCC) and Drugs Technical Advisory Board (DTAB), approval of certain licences as Central LicenceIt is the national regulatory body for Indian
- pharmaceuticals and medical devices under Ministry of Health and Family Welfare.
6.5. NOROVIRUS AT WINTER OLYMPICS
Why in news?
- At the Winter Olympics in Pyeongchang, South Korea, there have been many cases of infection with Norovirus.
- Norovirus is a very contagious virus. It’s a common cause of gastroenteritis, or inflammation of the intestine.
- It spreads from an infected person mainly by direct contact (such as shaking hands), by touching an infected surface or though contaminated water and food.
6.6. BIRD FLU
Why in news?
- India has declared itself free from Bird Flu (highly pathogenic Avian Influenza – H5N1 and H5N8) and notified it to the World
Organisation for Animal Health.
- The move will help it resume export of poultry products to the countries which had banned trade in such items early this year.
- There are 3 types of influenza viruses: types A, B, and C. Influenza A viruses infect humans and many different animals
- Influenza type A viruses are classified into subtypes according to the combinations of different virus surface proteins Haemagglutinin (H) and Neuraminidase (N).
- Influenza A viruses can be classified as avian influenza, swine influenza, or other types of animal influenza viruses
- Examples include avian influenza “bird flu” virus subtypes such as A (H5N1) and A(H9N2).
World organization for Animal Health
- It is recognised as a reference organisation by the World Trade Organization (WTO) and in 2017 has a total of 181 Member Countries.
- It maintains permanent relations with 71 other international and regional organisations.
- Ban is lifted after 90 days of the surveillance is done by the organization.
6.7. H1N1 VIRUS (SWINE FLU)
Why in news?
- Government removed antiviral drugs-oseltamivir and zanavir – from schedule X category allowing all pharmacies to sell and stock these drugs.
- These drugs were earlier restricted as their misuse and overuse can lead to drug resistance.
- Drugs and Cosmetics Rules, 1945: Any sale of medicine in the country is regulated under this act.
- Drugs specified in Schedules H, H1 and X cannot be sold except on, and in accordance with the prescription of a Registered Medical Practitioner from a licensed premises.
About H1N1 Virus
- It is a contagious respiratory disease caused by Type A strains of the Swine Influenza virus.
- It enters body through inhalation of droplets or is transferred from a contaminated surface to eyes, nose or mouth and can spread from human to human.
- It is called swine flu because in the past, the people who caught it had direct contact with pigs.
Why in News?
- A joint study conducted by Foundation for Innovative New Diagnostics (FIND) and Revised National TB Control Programme (RNTCP), has found that the Multi-Drug Resistant (MDR) TB is higher among children than expected.
- Paediatric MDR-TB cases had not been documented so far.
- Children are more prone to primary MDR –TB infection as they are in close contact with infected person.
- TB diagnosis in children is complicated due to challenges associated with sample collection and poor sensitivity of tests like the Acid fast bacilli (AFB) smear.
- Thus, the foundation FIND started rolling out GeneXpert to diagnose TB
- Government had issued a specific guideline for paediatric TB under Revised National TB
Control Program (RNTCP).
- RNTCP aims at diagnosing and treating TB throughout the country. It uses DOTS
- (Directly Observed Treatment Short course) and DOTS-plus strategy (where there are significant cases of MDR-TB)
- Recently, Moscow Declaration was also adopted in WHO Global Ministerial Conference on Ending Tuberculosis with an aim towards achieving SDG Goal 3.3.2 to end epidemic of TB incidence per 1000 population.
Drug Resistant TB
- It is TB that does not respond to at least isoniazid and rifampicin (2 of the most powerful first line drugs)
- It is developed due to
- Inappropriate or incorrect use of antimicrobial drugs,
- Use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions)
- Premature treatment interruption.
- Recently, Ministry of Health has approved Delamanid drug in order to combat the increasing burden of MDR-TB.
- Delamanid will be inducted parallel to Bedaquiline under Revised National Tuberculosis Control Program (RNTCP) and not replace it
- It is resistant to at least four of the core anti-TB drugs such as levofloxacin or moxifloxacin, amikacin, capreomycin or kanamycin.)
- Developed due to same mechanism as MDR-TB.
TDR-TB or XXDR-TB
- TB which is resistant to all the first and second line TB drugs.
- This makes it almost but not totally impossible to treat.
GeneXpert MTB/RIF Test
- It detects the presence of TB bacteria (Mycobacterium tuberculosis), as well as tests for resistance and genetic mutation to the drug Rifampicin.
6.9. HOME GROWN VACCINE FOR LEPROSY:
MYCOBACTERIUM INDICUS PRANII
Why in News?
- National Institute of Immunology has developed Mycobacterium Indicus Pranii (MIP), an indigenous vaccine for leprosy.
What is Leprosy?
- Bacterial disease caused by Mycobacterium leprae,
- Affects the skin and peripheral nerves.
- Long incubation period generally 5-7 years.
- Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disability.
- India has been declared Leprosy free country in 2005 because of less than one case per 10,000 population.
- MIP is now being introduced into the National Leprosy Elimination Programme (NLEP). It will boost the immune system against the bacterial disease.
6.10. INTENSIFIED DIARRHOEA CONTROL FORTNIGHT
Why in news?
- The Ministry of Health and Family Welfare has launched the Intensified Diarrhea Control Fortnight (IDCF) in order to reduce child deaths due to diarrhea.
- WHO estimated diarrhea is second leading cause of death under five year age of children worldwide.
- Despite of consistent decline in Infant Mortality Rate (IMR) and Under-Five Mortality Rate (U5MR) there has been 1 lakh deaths due to diarrhoea in India.
Intensified Diarrhea Control Fortnight (IDCF)
- ASHA worker would undertake distribution of ORS packets to households with under-five children in her village.
- ORS-Zinc Corners will be set-up at health care facilities and non-health facilities such as Schools and Anganwadi centres.
- Apart from oral medicine Health ministry introduced Rotavirus vaccine under UIP will also help in reducing diarrhoea mortality.
What is Diarrhea?
- Can be causes by virus, bacteria and parasite.
- Diarrhea is having frequent, loose stools which causes dehydration
- Can be spread from affected person, contaminated food or drinking contaminated water.
- Can be prevented with safe drinking water, sanitation, breastfeeding/appropriate nutrition and hand-washing.
What is ORS (Oral Rehydration Salt Solution)?
- ORS is a glucose-electrolyte solution containing salt and sugar water.
- It can be simple, cheap and effective for all age
- Supplemented with Zinc tablet, the duo is called ORS Jodi.
National Oral Rehydration Therapy (ORT) Program in 1985-86
- Improving maternal knowledge related to the use of home available fluids.
- Ensuring availability of ORS packets at health facilities.
- Integrated part of Child Survival and Safe Motherhood (CSSM) Program.
6.11. FIRST INDIA-DESIGNED VACCINE PASSED WHO TEST
Why in news?
- Recently, India made ROTAVAC vaccine and Typbar Typhoid Conjugate Vaccine received WHO pre-qualification.
- It is a low cost vaccine developed by Bharat
- Biotech Limited under an innovative PPP model involving Ministry of Science and
- Technology, institutions of the US Government and various NGOs.
- It has been included in India’s Universal Immunization Program in 2016.
Typbar Typhoid Conjugate Vaccine
- It is the world’s first typhoid vaccine, developed by Bharat Biotech limited that can be given to infants older than six months. It and confers long-term protection against typhoid fever.
Significance of Pre-Qualification
- Accelerate availability of the vaccine to the developing countries with highest burden of diseases
- Increases the scope for credible industrial, scientific and regulatory processes to develop more vaccines in the country.
- ecessary for United Nation agencies like UNICEF, the Pan American Health Organization (PAHO) and GAVI (a vaccine alliance) to purchase the vaccine in partnership with developing countries.
- It is the most common cause of diarrhoea among infants and young children.
- It usually transmitted by the faecal-oral route and infects and damages the cells in the small intestines and causes gastroenteritis.
- It is caused by the bacteria Salmonella typhi.
- The infection is often passed on through contaminated food and drinking water, and it is more prevalent in places where hand washing is less frequent.
6.12. NEW DEVELOPMENTS IN NON-COMMUNICABLE DISEASES
- According to India State Level Disease Burden Report, over the past 26 years the pattern of diseases has shifted from communicable, maternal, neonatal, and nutritional diseases (CMNNDs) to non-communicable diseases (NCDs) and injuries.
6.12.1. INDIA HYPERTENSION MANAGEMENT INITIATIVE (IHMI)
Why in news?
- Ministry of Heath and Family Welfare (MoHFW) and Indian Council of Medical Research (ICMR) launched IHMI.
More about IHMI
- Aim: To reduce disability and death related to cardiovascular disease (CVD), by improving the control of high blood pressure (hypertension), reducing salt consumption and eliminating artificial trans-fats, leading risk factors for CVD.
- This initiative will strengthen the cardiovascular disease component of the Health Ministry’s National Program for
- Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and is aligned with WHO’s Global HEARTS Initiative and National Guidelines.
6.12.2. JEEVAN BINDI
Why in news?
- A Singapore based marketing agency and Maharashtra based NGO developed a Vermillion (Bindi) named Jeevan-Bindi which contains iodine.
- It is a trace mineral and a nutrient found naturally in the body and can be easily fortified with salt.
- Humans need iodine for the production of thyroid hormones.
- It needed for the cells to convert food into energy.
- Deficiency leads to goiter, hyperthyroidism, stunted growth or intellectual disabilities.
- Source: seafood, daily products, and other protein National Iodine Deficiency Disorders Control Programme 1992
- It aims at bring the prevalence of IDD( to below 5% in the country
- It ensures 100% consumption of adequately iodated salt (15ppm) at the household level.
- Iodate the entire edible salt in the country.
- It is medically enhanced version of regular bindi, embedded with iodine along with the adhesive base.
- Bindi delivers the daily requirement of iodine 100-150 adsorption through the skin.
- It needs to be worn every day for up to eight hour to be effective.
- This initiative is supplemented with iodine pills available at community health centre.
- The initiative focus pregnant women because the effects of iodine deficiency are most severe in them and reflected in new-born.
Why in News?
- On World Thalassemia day (May 8) various researchers and health experts called for National Policy on Thalassemia.
What is Thalassemia?
- It is a genetic blood disorder with no cure except bone marrow transplant (BMT).
- Characterised by abnormal production of haemoglobin in the body. The abnormality results in improper oxygen transport and destruction of red blood cells.
- Lead to iron overload, bone deformities and in severe cases can cause heart diseases.
- It requires regular blood transfusions as an effective measure to prolong life.
- Thalassaemia is now considered as a disability under Rights of Persons with Disabilities Act 2016, rather than a health issue.
6.13. ANTIBIOTIC RESISTANCE: WHO REVISES ANTIBIOTICS PROTOCOL
Why in news?
- WHO has revised antibiotics protocol to curb antibiotic resistance. This is the biggest revision of the antibiotics section in the essential medicines list (EML)
Antimicrobial Resistance (AMR)
- It occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections and causing them ineffective.
- It is the broader term for resistance in different types of microorganisms and encompasses resistance to antibacterial, antiviral, antiparasitic and antifungal drugs.
- It occurs naturally but is also facilitated by the inappropriate use of medicines.
- Microorganisms that become resistant to most antimicrobials are often referred to as“superbugs”.
- It affects the, medical procedures such as organ transplantation, cancer chemotherapy, major surgeries etc. making them very risky.
WHO (World Health Organization)
- It is a specialised agency of UN concerned with international public health.
- It was established on 7 April 1948, headquartered in Geneva, Switzerland.
- The WHO publishes World Health Report. WHO “Global action plan on antimicrobial resistance” 2015: it has 5 strategic objectives:
- To improve awareness and understanding of antimicrobial resistance.
- To strengthen surveillance and research.
- To reduce the incidence of infection.
- To optimize the use of antimicrobial medicines.
- To ensure sustainable investment in countering antimicrobial resistance.
Other International Initiatives
- ‘One Health’ approach: to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes against the food safety, the control of zoonoses (diseases that can spread between animals and humans, such as flu, rabies), antimicrobial resistance etc.
- World Antibiotic Awareness Week.
- The Global Antimicrobial Resistance Surveillance System.
- Interagency Coordination Group on Antimicrobial Resistance.
WHO has divided the drugs into three categories: access, watch and reserve.
- The ‘access’ category includes commonly used antibiotics. They will be available at all times as treatment for a wide range of common infections.
- The ‘watch’ group covers antibiotics that are recommended as first or second choice treatment for a small number of infections.
- Prescription of these drugs should be reduced to avoid further development of resistance.
- The ‘reserve’ category includes antibiotics that are considered last-resort options and used only in the most severe circumstances such as for life-threatening infections due to multidrug-resistant bacteria.
- Recently, Ministry of Science and Technology have released the Scoping Report on Antimicrobial Resistance in India.
Highlights of the report
- In 2014, India was the highest consumer of antibiotics, followed by China and the United However, the per capita consumption of antibiotics in India is much lower than in several other high income countries.
- India has some of the highest antibiotic resistance rates among bacteria that commonly cause infections in the community and healthcare facilities.
- It has also pointed that the resistance to carbapenem class of antibiotics (one of the last-resort antibiotics to treat serious bacterial infections in humans) among various bacteria was extremely high.
- Antibiotic-resistant bacterial infections are also increasingly reported among neonates.
- Essential medicines are the medicines that “satisfy the priority health care needs of the population”.
- These are the medications to which people should have access at all times in sufficient amounts. The prices should be at generally affordable levels.
- The WHO publishes Model List of Essential Medicines (EML) every two years since 1977. It is used by countries to develop their own local lists of essential medicine.
Factors responsible for antibiotic resistance in India
- Self-medication (to avoid financial burden)
- Access to antibiotics without prescription
- Use of pharmacies and informal healthcare providers as sources of healthcare.
- Inadequate public sector diagnostic laboratory and Unaffordability of private labs
- Mass bathing as part of religious occasions
- Antibiotics as growth promoters in food animals and poultry
- Effluents from the antibiotic manufacturing units leading to contamination of rivers and lakes
- Disposal of untreated sewage into water bodies
- Prevalence of various Healthcare Associated Infections (HAI).
Hospital Acquired Infections (HAI)
- Also called nosocomial infections, HAI are passed onto the patients after being admitted at the hospital facility.
- International Nosocomial Infection Control Consortium is an international scientific organisation that works to fight against healthcare associated infections.
- Creates additional suffering for patients and comes at a high cost for their families.
- It increases hospital stays and creates long-term disability
- Increases resistance to antimicrobials
- Increases cost burden for healthcare systems and causes unnecessary deaths.
Causes of HAI
- Lack of proper Equipment, Understaffing and Overcrowding, Lack of knowledge of injection and blood transfusion safety, Prolonged and inappropriate use of invasive devices and antibiotics etc.
- Recently, a Bengaluru firm received the international CARB-X grant to develop antibiotics to treat HAI. CARB-X a public-private international partnership to address the gap in antibiotic R&D and to improve diagnosis & treatment of drug-resistant infections.
Policy/Initiatives of Government
- National Policy for Containment of AMR 2011 provided regulations for use of antibiotics for humans as also for veterinary use along with a hospital based surveillance system for monitoring antibiotic resistance.
- Indian Council of Medical Research (ICMR) has set up a National Anti-Microbial Resistance Research and Surveillance Network (AMRRSN) to enable compilation of National Data of AMR at different levels of Health Care.
- FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.
- Recently, Ministry Of Health has notified an amendment to the Food Safety & Standards (Contaminants, Toxins & Residues) Regulations, 2011, to set maximum permissible limits for the presence of antibiotics and other drugs in meat and meat products, including chicken.
- Red Line Campaign on Antibiotics 2016, was launched to create awareness regarding rational usage and limiting the practice of self-medication of antibiotics among the general public.
- National Health Policy 2017 envisions a holistic framework against AMR.
- The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 has assigned coordinated tasks to multiple government agencies involving health, education, environment, and livestock to change prescription practices and consumer behaviour and to scale up infection control and antimicrobial surveillance.
- The strategic objectives of NAP-AMR are aligned with the WHO’s Global Action Plan on AMR (GAP-AMR).
6.14. PLANT DISEASES
- Plant disease is an impairment of the normal state of a plant that interrupts or modifies its vital functions. Types of Plant diseases.
- Rust: Fungal disease that attacks roses, hollyhocks, snapdragons, daylilies, beans, tomatoes and lawns.
- Wheat blast: Fungal disease that attacks the standing crop. Fungus responsible for the wheat blast disease is known as Magnaporthe oryzae
- Pink Bollworm: It is a type of insects attack on cotton which has severely impacted cotton plantations in various parts of the country.
- Blight: Blight is easily recognizeable by the suddent death of all plant tissue including leaves, stems and flowers. Blight is typically casued by wet and humid conditions.
- Cotton Whitefly: Whiteflies are sucking insects and their feeding removes nutrients from the plant
- Chlorosis (discoloration): Chlorosis is when a green tissue turns yellow. It has many causes including pathogens, lack of nutrients, and lack of water.
- Leaf Spot: Leaf spots are yellow or brown lesions (often look like burn marks) that takes place on leaves. These are caused by pathogens, fungi, pesticide damage and insect feeding.
6.15. FORTIFIED FOODS TO TACKLE MALNUTRITION
Why in news?
- Targeting children, Rajasthan, MP, Haryana and Himachal Pradesh governments have begun using fortified oil for their mid-day meal schemes.
- West Bengal and A&N Islands are distributing fortified wheat flour through the public distribution system.
- Enrichment of food is a process by which nutrients are added. Typically, the added nutrients were present in the food in its original form, but were removed at some point during processing.
- Fortification of food is the practice of deliberately increasing the content of an essential micronutrient, i.e. vitamins and minerals (such as iron, iodine, zinc) in a food, so as to improve the nutritional quality of the food supply
- Biofortification is the process by which the nutritional quality of food crops is improved through agronomic practices, conventional plant breeding, or modern biotechnology. It aims to increase nutrient levels in crops during plant growth rather than through manual means during processing of the crops.
- The Food Safety and Standards Authority of India (FSSAI) released a set of standards and a logo (+F logo) last year for all fortified packaged food.
6.16. MILK ADULTERATION
Why in news?
- A recent study on milk samples in Delhi found wide adulteration.
- Adulteration: Most common harmful adulterants include starch, chlorine, hydrated lime, sodium carbonate, formalin and ammonium sulphate. Milk producers use these to scrimp on milk portions and prepare “synthetic milk” by mixing urea, caustic soda, refined oil and common detergents.
|Common Adulterant||Used for|
|Calcium Carbide and Copper Sulphate||For ripening of Fruit
|Colours (Metallic- not permitted)||To enhance the appearance of Fruits & vegetable
|Oxytocin (triggers early puberty among girls, male breast etc.)||Induce growth in Vegetable and animals
|Saccharin||Induce sweetness in fruits
|Parrafin Wax||For Shiny appearance of fruits
|Metanil yelllow||For colouring yellow dal
• Neutralizers are substances added to prevent
curdling and increase the shelf life of milk. They could be added in the form of caustic soda, sodium bicarbonate and sodium carbonate.
- curdling and increase the shelf life of milk. They could be added in the form of caustic soda, sodium bicarbonate and sodium carbonate.