“scenario of leptospirosis in gujarat public health scenario of leptospirosis in gujarat &...

““Scenario of Leptospirosis in Gujarat Scenario of Leptospirosis in Gujarat &&

Public Health InterventionsPublic Health Interventions””

DR.S.J.GANDHIDeputy Director (Epidemic)

Commissionerate of Health,Gandhinagar,Gujarat.

INTRODUCTION

• Leptospirosis is a contemporary zoonosis affecting all warm and cold blooded vertebrates.

• It prevailed through out the world however their distribution is concentrated in tropical and sub tropical countries where the soil pH and moistureare favourable for their survival .

• It produces acute, sub acute and chronic infections especially in livestock's with varied manifestations.

• Leptospirosis is an economically important disease especially in livestock industry due to the mortality, reduction in milk yield, abortion, repeat breeding and infertility.

INTRODUCTION Contd...• In Human beings most of the infections go mildly as

influenza like symptoms and only virulent strains are capable of producing severe illness with icterus and hemorrhagic signs.

• The domestic animals may act as carrier and disseminator to their own species and also to other species of animals and man.

• Rodents plays important role in the continuous maintenance of Leptospira and disseminate them in the surroundings.

• It is an occupational disease in man who acquires the infection by virtue of his association with the work related to animal industries.

MODE OF TRANSMISSION• Leptospira enters the body through intact

mucous membranes and abraded skin.• Conjunctival, oral and nasal mucous

membranes are the major routes of entry in susceptible hosts through food, inhalation or contact with infected water and other materials.

• Direct contact may occur when handling infected animals or their tissues after slaughter or death and the mopping of urine during husbandry practices.

Spectrum of Leptospirosis

Anicteric Leptospirosis

90%

Icteric Leptospirosis

10%

• Clinical Types---1 Anicteric Leptospirosis--- 90%2 Icteric Leptospirosis --- 10%

What about Gujarat?

Clinical types of LeptospirosisAnicteric Leptospirosis• It is the milder form of the

diseases• Patients have

fever,Myelgia but do not have Jaundice

• Almost 90% of patients have this type of illness.

Icteric Leptospirosis• It is the severer form of

the diseases• Almost 5-10% of patients

have these type of manifestations.

• It is characterized by jaundice.

• It may or may not be associated with involvement of other organs.

Clinical profileFever, Headache, Myalgia, Conjunctival suffusion, Jaundice,

Renal failure, Acute respiratory distress, Meningism, Cardiac disturbances

Leptospirosis Management

Kidney

LiverHeart

BrainEyes

Lungs

Blood

Muscles

16.8 %26.8 %

38.7%

67%

0

10

20

30

40

50

60

70

Percentage of Patients

1999 2002 2007 2008

Year

LUNG HAEMORHAGE

All deaths due to leptospirosis occur due to lung hemorrhage

Changing Clinical Profile

35

26

31

0

5

10

15

20

25

30

35

Percentage of Patients

2005 2006 2007 2008

Year

No. of Dialysis Performed

Change Is Global

• India• Andaman

• 1931 First case of leptospirosis • 1994 First case of lung involvement

detected• 1997 28 out of 58(48%)

? Immune Pathogenesis Of Hemorrhage

• Two phases of the disease.septicemic and immune

• Infectious vasculitis

• Majority of other lung haemorrhages are of immune origin

Standard Treatment Protocol

• Antibiotics• Mechanical ventilation with PEEP• Correction of thrombocytopenia

14.6%

20.65%

28.5% 25.43%20.8%

0

5

10

15

20

25

30

2004 2005 2006 2007 2008

Case Fatality Rate

• GEOGRAPHICAL ANALYSIS

Year wise Scenario of Leptospirosis in,2006& 2007, & Up to 30/8/08in Gujarat

No of Affected Taluka

No.of Affected PHCS No. of Affected Villages

2006 2007 2008 2006 2007 2008 2006 2007

37 92

Tapi - - 3 - - 14 - - 36

74

33

-

-

5

202

152

105

61

3

6

6

329

32

16

0

0

1

86

48

34

23

3

0

0

107

2008

Surat 11 11 7 27 79

Navsari 5

5

0

0

1

22

5 29 59

Valsad

5

5

2

1

2

5 24 36

Bharuch 0 0 0

SMC 0 0 5

Other 1 2 2

TOTAL 26 21 96 217

AffectedDistricts/

Years

YEAR DISTRICT1 2 3 4 >5

2003 SURAT 34 11 8 2 3NAVSARI 61 14 8 5 2VALSAD 48 2 5 2 0





NO OF CASESYEAR & NO OF LEPTO-CASE WISE AFFECTED VILLAGES

Year wise Trend of Affected Villages

4

41

238

362

256

203

334

217

0

50

100

150

200

250

300

350

400

2001 2002 2003 2004 2005 2006 2007 2008 (Up to30/8/08)

YEAR

No

of A

ffect

ed V

illag

es

NIZAR

CHORYASI

Affected Villages—24Suspected Case—39Death--7












Affected Areas—6Suspected Case—6Death--4

Taluka wise Map of Affected Villages, Cases & Deaths Dist.Surat (As on 19/10/2007)

NIZAR

CHORYASI

New Affected Taluka In Surat District in Year 2007

Umarpada

Uchhal

Status of Affected Villages, Cases & Deaths of last three years : Surat Municipal Corporation

5

379

6 5

43

4 10

50

100

150

200

250

300

350

400

2006 2007 2008 ( Up to 30/8/08)

No of Affected Zones No of Cases No of Deaths

Spot Map of Cases

Taluka wise Map of Affected Villages, Cases & Deaths Dist.Navasari (As on 19/10/2007)

Affected Villages--35Case :- 68Death :- 12





Affected Areas-1Case-3Death-1

Navsari City

Spot Map of CasesValsad

City

DharampurPardi

KaparadaUmargam

Affected Villages-20Case-28Death-6


Affected Villages-11Case-19Death-8Affected Villages-8

Case-15Death-4

Affected Villages-1Case-1Death-0


Taluka wise Map of Affected Villages, Cases & Deaths Dist.Valsad (As on 19/10/2007)

STATISTICAL ANALYSIS

Cases & Deaths status in other Leptospirosis endemic states

Sr.No

Name of State Situation on

No Of Cases No of Deaths

1 Gujarat 31/10/2007 521 135

2 Maharashtra 6/10/2007 1016 70

3 Karnataka 23/8/2007 62 4

4 Kerala 30/6/2007 294 15

5 Andaman Year-2006 218 22

Year & Taluka wise comparison of Surat DistrictFrom 2006 to 2008 (30/8/08)

Sr.No. Taluka 2006 2007 2008

Cases Deaths Cases Death Cases Death4202800391

2

12 SMC 379 43 6 4 5 132

1 Mahuva 26 9 40 7 202 Valod 25 4 44 7 73 Mandvi 9 5 22 6 104 Choryasi 3 0 2 2 55 Bardoli 18 9 38 13 366 Kamrej 9 4 4 1 67 Nizar 1 0 0 0 08 Palsana 6 5 39 11 279 Vyara 18 4 29 3 53

10 Songadh 3 2 10 1 4

11 Olpad 1 0 1 0 5

Total 498 85 238 55 178

Year & Taluka wise comparison of Navsari DistrictFrom 2006 to 2008(30/8/08)

Sr Taluka 2006 2007 2008Cases Deaths Cases Death Cases Death

5201715

1 Navsari 30 10 14 5 142 Jalalpore 18 6 32 16 133 Gandevi 21 4 46 16 134 Chikhali 31 7 68 12 245 Vansda 9 2 10 2 18

TOTAL 109 29 170 51 82

Year & Taluka wise comparison of Valsad DistrictFrom 2006 to 2008 (30/8/08)

Sr.No. Taluka 2006 2007

2008 (30/8/08)

Cases Deaths Cases Death Cases Death

1

4

1

1

2

1

10

1 Valsad 4 0 29 7 12

2 Pardi 23 6 21 8 13

3 Dharampur 3 0 26 5 7

4 Kaparada 2 0 1 0 2

5 Umargam 5 1 19 5 6

6 Valsad City 3 0 6 1 1

TOTAL 40 7 102 26 41

Trends of Disease• Changes in Disease Profile: It has been observed over last few years

that earlier patients use to report with hepatic & renal complications.

• But over last two to three years numbers of patients are reporting with pulmonary (respiratory) complications in which patients become critically ill within a short span of life so very less time is available for their survival even at the level of well equipped Medical College Hospital.

• Even in the affected districts newer areas are getting involved in Leptospirosis and even in the same village more numbers of cases are occurring.

Trends of Disease

• It is also observed that few cases of Leptospirosis are being reported in the neighboring districts like Bharuch, Ahmedabad etc and probably the disease is also shifting in few urban areas too.

• In spite of the best available laboratory methods applied, diagnosis of Leptospirosis could not be established in more than 50% of suspected Lepto cases and we are dealing with problem at field level with a very broad case definition which is used by paramedical field staff.

Trends of Disease

• It is observed that Leptospirosis is also occurring amongst the persons who are not engaged in theagriculture activities, cattle rearing or dairy activities which are usually considered as high risk population.

• The role of rodents (rats), cows, buffalo, sheep, goats and other animals has to be explored and defined by Sero surveillance by Department of Animal Husbandry.

Age wise Prevalence

Age & Gender wise Distribution of Case & Deaths in Surat, Navsari, & Valsad(2007)

Cases DeathsMale Female Male Female

=<20 39 18 1056 13

151313108

17

99

596350392449

379

621-25 17 326-30 12 131-35 26 336-40 20 841-45 11 246-50 7 1>50 14 5

Total 125 29

Age Group

Comparison of Age wise distribution of cases & deaths due to Leptospirosis in year 2006 & 2007 in Surat Navsari & Valsad.

Age Group2006 2007 2006 2007

=<20 22 57 3 1621-25 36 73 10 1626-30 47 71 11 1631-35 44 89 13 1636-40 36 70 13 2141-45 31 50 11 1246-50 24 31 11 9>50 28 63 6 22Total 268 504 78 128

Cases Deaths

Prevalence & Gender

Sex Wise Distribution-Surat, Navsari, Valsad2006

Sex Cases Death CFR%

Male 210 69 32.8

Female 58 9 15.5

Total 268 78 29.1

210

69

32.8

58

9 15.5

0

50

100

150

200

250

Male Female

Male 210 69 32.8Female 58 9 15.5

Case Death CFR

Sex Wise Distribution-Surat, Navsari, Valsad2007


Male 379 99 26.12

Female 125 29 23.2

Total 504 128 25.4

379

99

26.12

125

29 23.2

0

50

100

150

200

250

300

350

400

Male Female

Male 379 99 26.12Female 125 29 23.2

Case Death CFR

Sex Wise Distribution-Surat, Navsari, Valsad2008 (As on 22/8/08)


Male 150 24 16

Female 37 10 27.02

Total 187 34 18.18

150

2416

37

10

27.02

0

20

40

60

80

100

120

140

160

Male Female

Male 150 24 16Female 37 10 27.02

Case Death CFR

Prevalence & Occupation

Occupation wise Distribution-Surat, Navsari, Valsad2006

Occupation Cases Death Occupation Cases Death

Farm Lab 197 59 Other Labour 16 5

Ani.Hus. 20 5 Banana-Lari 1 0

Diamond Lab. 4 2 LT 1 0

Driver 1 1 Mechanic 1 0

Dying Lab 1 0 Quarry labor 2 1

House Wife 10 4 Student 2 0

Kadiakam 3 0 Vegetable Merchant 2 1

Kariyana Lab 2 0 Data NA 2 0

Black-Smith 1 0 Tea-Lari 1 0

Electrc Wireman 1 0

Total Cases -268, Total Deaths - 78

Occupation wise Case & Death PrevalenceSurat, Navsari & Valsad 2007

Surat Navsari TOTAL

D D

47 38

0

0

13

51

0

0

4

51

C

123

0

0

47

170

C

211

1

5

15

232

ValsadOccupation/

Case & Death C D C D

418 109

0

0

19

128

1

5

80

504

Farm Labour&AnimalHandler

84 24

House Wife 0 0Student 0 0

Others 18 2

Total 102 26

Month Wise Analysis

ofCases and Deaths

In Surat, Navsari, & Valsad-Year- 2007

Month wise Cases and Deaths in affected districts--2007

Surat Navsari Valsad TotalCase Death Case Death Case Death Case Death

July 41 8 13 1 2 1 56 10August 76 11 80 20 22 10 178 41

Sept. 90 22 46 18 48 13 184 53Oct. 25 10 31 12 30 2 86 24Total 232 51 170 51 102 26 504 128

Month

Month wise Graph of CASES in affected districts of South Gujarat--2007

0

41

76

90

25

0

13

80

46

31

0 2

22

48

30

0102030405060708090

100

JUNE JULY AUGUST SEPTEMBER OCTOBER

SURAT NAVSARI VALSAD

Relationship between

Incidence of Suspected Cases &

Rain Fall

Month wise Relationship between Rainfall (In mms)& Cases of Leptospirosis in Surat From YEAR 2005 to 2007

2005 2006 2007

Rain Fall Cases Rain Fall

Cases Rain Fall Cases

June 11958 0 5074 0 0

25 49

78

83

22

0

65

24

4

1

17

85

53

30

0

2453

July 7929 15936 6918

August 6150 6638 7101

September 6733 1404 4657

October 00 00 00

November 00 00 00

Month

Month wise Relationship between Rainfall (In mms)& Cases of Leptospirosis in Surat From YEAR 2005 to 2007

YEAR 2005

05000

1000015000

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Rai

n Fa

ll (M

ms)

020406080100

Case

s

Rain Fall Cases

Year 2006

0

5000

10000

15000

20000

Jun Jul Aug Sep Oct Nov

Rain

Fal

l (M

ms)

0

20

40

60

80

Case

sRain Fall Cases

Year 2007

0

1000

2000

3000

4000

5000

6000

7000

8000


Rain

Fal

l (M

ms)

0

10

20

30

40

50

60

70

80

90

Case

s

Rain Fall Cases

Month wise Relationship between Rainfall (In mms)& Cases of Leptospirosis in Navsari From YEAR 2005 to 2007

Month 2005 2006 2007

Rain Fall Cases

Rain Fall


June 6876 0 1103 0 15

26 79

45

31

0

0

54

25

4

0

21

37

38

18

0

799

July 9805 6520 3941

August 11915 9451 7044

September 14322 10231 8663

October 00 10433 0

November 00 1893 0

Month wise Relationship between Rainfall (In mms)& Cases of Leptospirosis in Navsari From YEAR 2005 to 2007

YEAR 2005

05000

100001500020000

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Rain

Fal

l (M

ms)

010203040

Case

s

Rain Fall Cases

Year 2006

0

5000

10000

15000


Rain

Fal

l (M

ms)

0

20

40

60

Cas

esRain Fall Cases

Year 2007

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000


Rain

Fal

l (M

ms)

0

10

20

30

40

50

60

70

80

90

Case

s

Rain Fall Cases

Month wise Relationship between Rainfall (In mms)& Cases of Leptospirosis in ValsadFrom YEAR 2005 to 2007

Month 2005 2006 2007

Rain Fall Cases Rain Fall


June 1378 0 383 0 0

5 3

32

52

15

0

18

17

0

0

4

38

38

8

0

350July 608 1028 669August 538 813 759September 580 199 467October 9 0 0November 0 0 0

Month wise Relationship between Rainfall (In mms)& Cases of Leptospirosis in Valsad From YEAR 2005 to 2007

YEAR 2005

0

500

1000

1500


Rain

Fal

l (M

ms)

0

10

20

30

40

Case

s

Rain Fall Cases

Year 2006

0

500

1000

1500


Rain

Fal

l (M

ms)

0

5

10

15

20

Cas

es

Rain Fall Cases

Year 2007

0

100

200

300

400

500

600

700

800


Rai

n Fa

ll (M

ms)

0

10

20

30

40

50

60

Cas

es

Rain Fall Cases

Preventive Actions:• An International Leptospirosis Conference was organized at Medical

College Surat in the 20th to 22nd January 2005 in which ICMR centre for Leptospirosis & NICD Delhi played lead role and during thisworkshop various experts, researchers, treating physicians, Microbiologists, epidemiologists were invited from affected States of the country as well as delegates from international level.

• An Inter- departmental training workshop was organized in January 2006 at Surat by involving Agriculture, Veterinary, Health officials, Surat Municipal Corporation as well as delegates from sugar & dairy cooperatives to discuss implementation of antirodent measures in a scientific way at field level to prevent transmission of Leptospirosis.

Preventive measures for Leptospirosis- 2007

Details Surat Navsari ValsadTotal Houses 502776 274360 322264No of Houses visited 2616694 1842140 160266

Total Population 2339591 1371800 1611285Surveyed Population 12051216

(Five Rounds)8691082

(Six Rounds)692493

(Five Rounds)

NO. Susp.Lepo cases found 232 170 102No .of fever cases found 100487 90100 64850No. of cases found +ve for Malaria 109 273 372Chloriquin Tab. distributed 410858 331755 264174

Primaquin Tab. distributed 1738 2194 28336Cap. Doxy. as Chemoprophylaxis 2796572 2361689 1102934Cap. Doxy. as Therapeutic 00 1498 27573No. of meetings 31173 33414 3813IEC activities 4404935 4427989 212407

Preventive measures for Leptospirosis- 2008 (30/8/08)Details Surat(21/8/08) Tapi(21/8/08) Navsari(23/8) Valsad(23/8)

Total Houses 312864 127845508004

(4th Round)

7724682340050(4th Round)

51No of Deaths 18 11 15 10

2130920

157819

1700205484

45121025723

274360 322264No of Houses Surveyed 1152732

(4th Round)1108120(4th Round)

829919(3rd Round)

Total Population 1540139 1371800 1613325Surveyed Population 5260175

(4th Round)5527462(4th Round)

4470900(3rd Round)

NO. Susp.Lepto cases found 97 82 41

No .of fever cases found 42878 48038 51697No. of cases found +Ve for Malaria.

17 53 224

Chloriquin Tab. distributed 356678 398875 369139

Primaquin Tab. distributed 278 3389 68244Cap. Doxy given to presumptive case

362460 433398 533868

No. of meetings 15949 17691 2049IEC activities 1838237 2260135 536214

Antirodent Activities:- Surat District:-

YearTaluka Covered

Village covered

Rodenticide Used

No. of Rats killed

Name of Rodenticide

Lepto. Case

Death

2000 9 330 5436 Kg. 446621 78 10

2001 11 330 7431 Kg. 244515 0 0

2002 14 1062 9149 Kg. 389955 23 2

2003 14 1043 9756 Kg. 321689 154 22

2004 0 0 0 0 0 285 34

2005 14 4118 kg 133783 185 43

2006 14 905 4305 kg 138338 119 42

2007 No Anti-Rodent Activities Carried Out 238 55

Bromadiolin 0.005

Bromadiolin 0.005

Antirodent Activities:- Navsari District:-

YearTaluka Covered

Village covered

Rodenticide Used

No. of Rats killed

Name of Rodenticide

Lepto. Case

Death

2000 5 388 705008 Tab.2115kg

524619 56% 50 2

2001 5 387 882388 Tab.8823Kg

615268 Brmadiolin 0.005 2 0

2002 5 387 1618700 Tab.6214 kg

290686 Brmadiolin 0.005 25 1

2003 5 384 7352 kg 488741 Brmadiolin 0.005 154 27

2004 246 43

2005 2 146 4122 kg 288600 Brmadiolin 0.005 114 26

2006 5 385 4100 Kg. 137330 Brmadiolin 0.005 109 29

2007 No Anti-Rodent Activities carried out. 170 51

Antirodent Activities:- Valsad District:-

YearTaluka Covered

Village covered

Rodenticide Used

No. of Rats killed

Name of Rodenticide

Lepto. Case

Death

2000 5 465 484380 Tab. 286419 Bromadiolin 0.005 28 4

2001 5 465 484326 Tab.8073 Kg.

81576 Bromadiolin 0.005 0 0

2002 5 465 484344 Tab.8073 kg

115858 Bromadiolin 0.005 12 0

2003 5 90 1360652268 kg

30355 Bromadiolin 0.005 72 9

2004 5 106 140734 Tab.2352 kg

15332 Bromadiolin 0.005 98 15

2005 5 107 158820 Tab.2347 kg

26057 Bromadiolin 0.005 88 11

2006 5 106 175248 Tab.2920 kg

127664 Bromadiolin 0.005 40 7

2007 5 131 175041 Tab.2917.35 Kg

57897 Bromadiolin 0.005 102 26

Criteria for selection of villages for Chemoprophylaxis

• Those villages which were affected for more then one year with Leptospirosis during last five years.

• Those villages which reported >1 case of Leptospirosis in the previous year.

• Those villages in which Death occurred even in single case of clinically suspected Leptospirosis

• Those villages in which cases of Leptospirosis are reported for the first time during current year

(This criteria will be invariably added from 2008 after consultation with NICD)

Specific Preparedness for Leptospirosis for Year 2008

• An international training workshop was organized on10 to12 Dec 2007 and 13 to 15 Dec 2007 respectively for laboratory techniques for diagnosis of leptospirosis and it’s practical demonstration, at Microbiologydepartment, Government Medical College Surat.

• International experts participated and provided their valuable directives.

• Assistant professors (Microbiology) and laboratory technicians of all Govt medical colleges took the advantage of this workshop.


• A meeting was held on 22/01/2008 under the chairmanship of respected Commissioner Health atGandhinagar to discuss out the modalities of controlling Leptospirosis in Endemic Districts of South Gujarat, by isolating circulating Lepto Serovars amongst cattle population & co-relation or them, if any, to increasing mortality & extension of Human Leptospirosis in newer areas of South Gujarat.

• Rs 25 Lakhs has been allotted to Microbiology department GMC Surat for this project.

Culture PCR

Total Result Tested Positive Negative Pending

Rat Kidney 359 UnderProcess

278 32 165 81

Animal Urine 503 UnderProcess

359 24 283 108

Animal Serum

168 UnderProcess

142 20 96 26

Goat Kidney 6 UnderProcess

6 1 5 NIL

Samples

As per the latest information regarding the status of Cattle Serovars project till 30/8/08


• Soil samples are also taken for the pH analysis from high risk villages of south Gujarat by Agriculture department as per recommendation by NICD Delhi.

• List of 84 high risk villages of Surat, 43 of Navsari and 31 villages of Valsad districts are given to Agriculture Department for soil collection and analysis from Health Department.

• Total 292 soil samples are collected and tested by Agriculture Dept and results of tests have been sent to Krishi University Navsari.

• No recommendations for Gypsum or Bio Fertilizers are given by Krishi University Navsari.


• An Interdepartmental meeting was organized on 22nd April 2008 under the chairmanship of Principal Secretary involving senior officers of Health, Agriculture, Animal Husbandry, Irrigation, etc from State and expert from ICMR Andaman to discuss about important issues pertaining to the prevention and control of Leptospirosis in Gujarat State.

• Minutes and specific task to be taken by respective department was sent.


• IEC activities were carried out during ‘Krishi Rath Mahotsav’ to educate and inform community regarding leptospirosis during 7/5/08 to 6/6/08 in the Surat , Navsari and Valsad districts.

• Grant of Rs.10 Lakhs has been allotted to HEB for IECactivities.

• Guidelines are prepared and distributed to all districts for prevention and control of Leptospirosis for the year 2008 for implementation in districts which was prepared by PSM Department, Medical College Surat on 19/06/2008 after multiple meetings with experts.


• An active surveillance has been started from 1st June 2008 in leptospirosis endemic districts like Surat, Navsari and Valsad. All fever cases (> 15 years of age) surveyed are given CapsuleDoxycycline 100 mg./ twice a Day for 7 days along with antimalarial treatment as per the decided guidelines.

• The 24 hours working control room has been started from 15/6/2008 at district Panchayat of Surat, Navsari, Valsad and Regional Deputy Director Office Surat.

• Modular Training was given to Block Health Officers, Medical officers and paramedical staffs of Surat, Navsari and Valsad districts in last week of June 2008.

• Sarpanchs, Talatis, Gram sevaks, TDOs, elected representatives and members of milk cooperative societies of Surat, Navsari and Valsad districts are given training in the first week of July 2008.


• Following 5 treatment centers are established in South Gujarat to provide comprehensive treatments to all suspected cases of leptospirosis.

– New Civil Hospital Surat– Civil Hospital Navsari– Civil Hospital Valsad– CHC Bardoli– CHC Vyara


• An inter-state meeting was held on 2/5/2008 at NICD Delhi for a pilot project to be initiated as a ‘New Initiative’ in the 11th Five year plan to prevent morbidity and mortality due to Leptospirosis by GOI, in which Surat, Navsari, and Valsad districts of Gujarathave been taken as pilot districts.

• This pilot project will be completed in a span of two years from January 2008-December 2009.

• The pilot project is budgeted at an estimated total cost of Rs.2,05,18,000/-.

• Out of this amount State of Gujarat will be allotted Rs.1,17,10,000/-for the period 2008 and 2009.


• A training for core group trainers under this project is held on 19/6/2008 at PSM Department, Government Medical College Surat, and training had been given to officers of health, medical services, medical college Surat, and Animal Husbandry department involved in leptospirosis preventive activities by National experts Dr. U V S Rana from NICD Delhi.

• The focus of the project will be on :– Strengthening diagnostic laboratories in pilot project areas– Strengthening of patient care management facilities in pilot project areas

and supplementary provision of drugs for chemoprophylaxis.– Development of trained manpower.– Create awareness regarding timely detection and appropriate treatment of

patients.– Sensitization of Animal Husbandry and Agriculture personnel.– Information, Education.


• Anti-rodent activities are to be done by Agricultural Department of State and budget of Rs 30 Lakhs have been prepared by them. 10% of this budget i.e. Rs 3 Lakhs has been allotted by Health Department.

• For the current year (2008-09)Budget provision and allotment of funds of Rs 300 Lakhs (Rs150 Lakhs under Tribal Head, Rs. 50 Lakhs under Non-Tribal head and Rs. 100 Lakhs under Special Components) have been done by State Government to control and prevent Leptospirosis.


• With reference to deaths reported due to Leptospirosis a request had been sent to the Director EMR Delhi on 14/8/08 for deputing a ‘Central Team’ ofexperts to investigate and guide, case management protocols to Head of Department of Medicine, Govt Medical College Surat in serious patients developing acute pulmonary hemorrhage. Central Team from GOI visited Lepto affected district during 26/8/08 to 29/8/08 with Deputy Director (Epidemic).

• As a result of such phenomena percentage of occurrence of pulmonary hemorrhage has been found increasing from 39% (Year-2007) to 60% in the current year and patients are observed to expire within a short span of time after onset of disease.

Patient Management in hospitals• If there is a scope of patient care with alternative regimes with

steroids or other antibiotics ,they require to be explored and suggested to us.

• It is a humble submission that if agreed , a separate meeting may be called at National level for treating physicians of affected states for recent advances & interactions on these aspects.

• CHEMOTHERAPY & CHEMOPROPHYLAXIS

District Opening Balance (District & Pipeline 30/ 6/07)

Supplied through CMSO in Year 2007

TOTALStock

Consumption up to 31/10/07

Balance on 31/10/07

Surat 840000 2500000 3340000 2796515 543485

Navsari 1614000 1500000 3114000 2363187 750813

Valsad 1443000 1000000 2443000 1130507 1312493

TOTAL 3897000 5000000 8897000 6290209 2606791

Balance sheet of Supply & Consumption of Cap. Doxycycline in Year 2007

Alternative drugs for chemoprophylaxis?

• Cap Doxy. has been in use in south Gujarat for many years.

• Possibility exisists for its resistance in population.

• Possibility of long term toxicity has to kept in consideration.

• Other less toxic and more effective drugs may be suggested in coming years.

• Studies on chemotherapeutic efficacy of Doxycycline are requested from current year by NICD or ICMR as field research.

Strategy for rest of Gujarat• Suggestions are welcome for rest of the districts and municipal

corp. and other urban areas of the state which may report sporadic cases of Lepto. in current year since there may be fancy .since it is a new subject for them.

• As a matter of precaution National guidelines on Lepto. Published by NICD & WHO have been provided to all districts & have been requested to follow the same

• Training lectures had been covered in IDSP trainings as a state specific subject

• Still diagnostic protocols are requested to be provided from GOI/NICD for low endemic areas

• Problems are anticipated as per last years experience from private sector as well as corporate hospitals

Issues on Chemotherapy• Whether it is indicated for all fever cases occurring throughout the

district or requires to be limited?

• If we have to restrict, then who are the priority groups: high risk group of persons or identified endemic villages of Leptospirosis, may pl. be clarified.

• Whether such a cap. Doxy. chemotherapy is also applicable to high risk group of persons residing in low or non endemic districts of the state, requires to be clarified

Which strategy is a priority?• Many a times due to various administrative problems and situations

beyond our control the massive requirement of cap. Doxy (roughly3-3.5 crores) may not be available locally during the rainy months

• In that case which mode of prevention is likely to provide better results and should be considered in field operations, chemoprophylaxis or chemotherapy?

• Whether chemotherapy with cap.Doxy. For all cases of fever for 7days is also indicated in endemic area of Surat Municipal Corporation is to be made clear pre-monsoon ,since during 2006 it had been debated seriously during heavy floods

Consumption Of Cap. Doxycycline2006 & 2007 (31/10/2007)

Chemoprophylaxis Chemotherapeutic Total

2006 2007 2006 2007 2006 2007

Surat 1939657 2796512 1220141 0 2796512

1498 2363187

1130507

2290

6292556

27573

0

29071

2361689

1102934

2290

6263485

3159798

Navsari 1870186 810548 2680734

Valsad 987167 544922 1532089

Bharuch 0 0 2290

Total 4797010 2575611 7374911

District

NB: Chemotherapy with Cap Doxy. Of all fever cases was discontinued in 2007as per revised NICD Guidelines.

Consumption Of Cap. Doxycycline2007 & 2008 (8/9/08)

Chemoprophylaxis Chemotherapeutic Total

2007 2008 2007 2008 2007 2008

Surat 2796512 - 0 399028 399028

498544 498544

593452

390824

1881848

593452

390824

1881848

-

-

-

2796512

Navsari 2361689 1498 2363187

Valsad 1102934 27573 1130507

Tapi

Total 6263485 29071 6292556

District

NB: Chemotherapy with Cap Doxy. Of all fever cases was discontinued in 2007as per revised NICD Guidelines.

Associated Laboratory Findings

• Other Diagnostic Tests were found positive in 57 patients who were admitted as suspected Leptospirosis in New Civil Hospital, Surat as shown in table.

Malaria 23

Hepatitis 14

Dengue 10

Hepatitis E 10

• MISCELLANEOUS MANAGEMENT ISSUES

Different Departmental Role in Control of Leptospirosis

Socialscientists

AnimalHusbandry

Agriculture

Laboratory

Medical

Health

Leaders

Administration

Stakeholders

ACTION PLAN BY AGRICULTURE DEPARTMENT OF LEPTOSPIROSIS FOR THE YEAR 2008-2009

SR.NO

.

STAKEHOLDER

ISSUES TO BE DISCUSSED BY STAKE HOLDER

ACTION PLAN

1 DirectorAgricultureDepartment

• Action Plan of Agriculture Department For Anti-rodent activities and its planning, implementation, time frame, funding, monitoring & interdepartmental.

• Detail Action plan prepare by District Agriculture officer in month of Feb/March to control rat.

• Purchase of Rodent control material in month of April.• Rodent material use in month of May to first week of June.• Implementation done by Garam-sevak with the help of

farmer.• Generally fund comes from MACRO MANAGEMENT

SCHEME. A provision of Rs. 30 Lakh is made for the year 2008-09.

• Monitoring Done by Extension officer, Assistant Director of Agriculture, District Agriculture Officer.

• Co-operation with Agriculture, Animal Husbandry and Health Department

• Rodent mapping. • Manually calculated by Gram-sevak

• Result of Soil Samples collected from Lepto endemic villages & their implications.

• In the year 2007-08, total 292 Soil Samples collected from 73 Lepto endemic villages.

• Extension Education activities of farming community against Leptospirosis

• Various camps arrange by Agriculture Department before Rodent activities start.

• During Krishi Mahotsav-2008, awareness programme will be carried out in the Lepto endemic villages.

Result of Soil Samples collected from lepto endemic villages & their implications in District ,Valsad

Sr. no. No.of villages

No. ofSamples

Item Total

Low Medium High1 2 3 4 5 6 7 8

PH 84 4 75 5EC 84 84 0 0N 84 52 32 0P 84 19 65 0K 84 0 8 76

Samples Reading Position

1

Local situations• Lot of problems are being raised in PRESS as well as under RTI

ACT for above issues ,which have to be addressed satisfactorily and with authenticity

• South Gujarat districts have large no. of tribal population & Leptospirosis is emerging as more & more sensitive issue

• Hon .C.M. of Gujarat has recently covered Lepto under his priority programme Vanbandhu Kalyan Yojna for all the actions to reduce morbidity & high CFR due to leptospirosis

• Sickle Cell Anaemia Diagnosis & Control Programme across the state under GOG-NGO partnership is also covered under above scheme & it is a time for undertaking an active field research to establish any links, if at all they exist in above two conditions among tribal population.

Year wise (1995 to 2008 (30/08/08) )Trend of CASE FATALITY RATE (%) amongst Leptospirosis cases

in Gujarat State

14.3

22.5

11.5

7.88.7

10.2

0

3.4

15.3614.6

20.51

18.55

25.91

19

0

5

10

15

20

25

30

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Up

to 3

0/8/

08

CFR % Linear (CFR %)

“scenario of leptospirosis in gujarat public health scenario of leptospirosis in gujarat &...

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