Status of Vector Control In the EMR

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Status of Vector Control In the EMR

• Abraham Mnzava
• Scientist Vector Control
• RBM WHO/EMRO
• CAIRO, EGYPT

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Background

• Vector-borne diseases a major PH problem
• 11 of global burden found in EMR (8 global
  popln)
• Malaria contributes the greatest burden
• However, 10 countries successfully eliminated
  malaria
• In addition to
• Bancroftian filariasis
• Leishmaniasis
• Onchocerciasis
• Trypanosomiasis
• Arboviruses
• Other vectors/pests of PH importance

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Group 1 10 countries interrupted transmission
Bah, Cyp, Jor, Kuw, Leb, Lib, Pal, Tun, UAE Group
2 4 countries targeting elimination Egy, Mor,
Oma, SyrGroup 3 4 countries low- moderate
endemicity Ira, Iraq, Pak, SAAGroup 4 5
countries high burden Afghanistan, Dji, Som,
Sud, Yem
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Distribution of vector-borne diseases

• Filariasis (Egypt Nile Delta and Sudan)
• Vectors (C. pipiens, An. gambiae, arabiensis and
  funestus)
• Leishmaniasis
• Distribution (Iran, Iraq, Saudi Arabia, Sudan,
  Syria, Tunisia, Afghanistan, Djibouti, Egypt,
  Jordan, Kuwait, Lebanon, Lybia, Morocco, Oman,
  Pakistan, Somalia and Yemen
• Vectors (Ph. Papatasii and Ph. Sergentii) out of
  20 potential vectors in the region

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Distribution of vector-borne diseases

• Onchocerciasis (Southern Sudan and Yemen
• Vectors Simulium damnosum group of species
• Trypanosomiasis (southern Sudan)
• Vectors (Glossina spp. tseseflies)
• Arboviruses (Dengue and Rift Valley Sudan,
  Saudi Arabia, Yemen and Egypt)
• Culicine species
• Other vectors (Distributed widely in the region)
• Flies Trachoma, Fleas, Rodents, Bed bugs, ticks
  etc

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Available control measures

• Source reduction (filling in of breeding sites
  and intermittent irrigation)
• Biological methods (larvivorous fish, insect
  growth regulators, bacteria and other parasites)
• Use of chemicals and oils (e.g Abate)
• Space spraying (during emergency)
• Indoor residual house spraying (IRHS)
• Insecticide-treated bednets (ITNs)
• Repellants
• House improvement

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Impact on rate of disease transmission

• Vectorial capacity (C) is expressed as
• C ma2pn/-loge p
• Where
• m density of vectors in relation to man
• a number of blood meals taken on man per vector
  per day
• p proportion of vectors surviving per day
• n incubation period in the vector (days) - 8
  days
• When they survive (1/-logep) days

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Appropriateness of Control Measures

• Larval and adult control impact on vector
  densities (m)
• Effectiveness of larval control methods depends
  on types of breeding sites
• IRHS and ITNs reduce vector survivorship (p8)
• ITNs unlike IRHS reduce man/vector contact (a2)
• Important to consider cost community acceptance
• Use of safe chemicals for VC seems inevitable at
  least for now

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Amount of insecticide in tonnes of active
ingredient for VC (EMRO, 1995-2000)
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Regional use of insecticides for vector control
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Policy and strategic issues

• Finalized a Regional IVM policy framework
• Finalized national ITN strategic plans in key
  countries
• Developed guidelines on monitoring insecticide
  resistance and
• Established a Regional Network (EMNVR)
• Finalized Regional guidelines on the use
  larvivorous fish for mosquito control
• Developing Regional strategy on pesticide
  management

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Translation of Policies / strategies at country
level

• Establish/strengthen or reorganize services
  through multidisc. approach
• Develop NPOA by 2004 with new guidelines for VC
• Conduct a comprehensive needs assessment to
• Identify resources/deficiencies
• Develop proposal to establish IVM within existing
  NHPS and obtain agreement from authorities
• Develop guidelines and strengthen structure for
  planning, implementation and ME a core group
• Hold consensus meetings with partners to ensure
  inter/intra-sectoral collaboration

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Support of WHO and Partners

• Develop and disseminate guidelines for planning,
  implementation and ME of VC
• Prepare and disseminate guidelines for situation
  analysis and needs assessment of IVM activities
• Provide necessary support to conduct SA, NA,
  planning, implementation, ME of VC based on IVM
  approach
• Fund raising to support countries to implement
  IVM

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Improving quality of IRHS

• Ensure timely application of insecticides
• Continuous training of spray teams
• Appropriate application of of insecticides that
  meet WHO specifications
• Proper maintenance and storage of equipment and
  insecticides
• Strengthening supervision and reporting

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Scaling up of ITNs

• Limited experience with ITNs
• Where implemented coverage is low
• As part of going to scale need clear outcomes
• Increasing coverage of ITNs for epidemiological
  impact
• Increasing re-treatment rates innovative
  approaches and/or LLITNs

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How do ITNs work personal protection or vector
control?

• In repelling mosquitoes and preventing blood
  feeding
• All net users are protected, even when coverage
  rates are low (personal protection). No absolute
  necessity to kill mosquitoes.
• In repelling and killing mosquitoes
• All users are protected as well as the community
  itself if coverage rates are high enough(e.g. gt
  80 , vector control)

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Progress with Scaling up at country level

• Of the 8 key countries earmarked for scaling up
• 5 have finalized national ITN plans with partners
  (SAA, SUD, DJI, YEM, AFG)
• 3 have drafts (SOM, IRN and PAK)
• 5 have GFATM funds 50 is for ITN
  implementation
• All for VBDs control (e.g. SAA about 1 m nets
  for malaria and rift valley fever)

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What is a long lasting insecticidal net?

• A net treated at factory level with an
  insecticide
• Either incorporated into or coated around fibres
• Which resist multiple washes
• Whose biological activity lasts as long as the
  net itself
• 3 to 4 years for polyester nets
• 4 to 5 years for polyethylene nets

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Why do we need LLINs?

• Conventional dipping insecticide is rapidly
  removed by washing or degraded by detergents
• Factory pre-treated nets (conventional dipping)
  are not reliably treated

Dipping of coloured nets a potential problem...
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Advise to control programme managers

• Be informed of WHO recommendations regarding
  updates on LLINs or technical informations on
  netting materials)
• When and where possible, use ITNs for
  multi-disease prevention
• Order WHO recommended LLINs or, if not available,
  non treated nets with insecticide treatment kit
  (s) bundled

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Advise to control programme managers

• Check quality of nets and insecticides
• Ensure regular treatment of conventional nets
  already in use
• Preferably by providing insecticide and treatment
  free (and long lasting dipping when available)

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Conclusions

• VBDs are a huge PH problem in EMR
• VBDs are on the increase because of conflicts
  favoured by conducive ecology
• Last two years have concentrated on policy and
  strategic issues in addition to providing
  technical support
• it is time to translate these into action at
  country level
• Of the various technical tools/interventions
  available for multiple disease prevention focus
  will be on
• Improving the quality of IRHS application
• Expanding the use of ITNs
• Strengthening pesticide management and reporting
• Concentrate on resource mobilisation (technical
  capacity and funding) and networking

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THANK YOU