Division of Parasitic Diseases

Full Mailing Address:

Department of Parasitic Disease,
National Centre for Disease Control,
Ministry of Health and Family Welfare
Telephone: 011-23913028

Head of the Division:

Dr Vinay Garg
M.B.B.S, M.D.(CHA), D.T.C.D
Joint Director & HoD
Email ID- vinay.garg@gov.in

*Other Staff in the Division

Dr Ankur Garg
MBBS, MD
Deputy Director
Email ID: ankur.garg@ncdc.gov.in

Dr Shubha Garg
M.B.B.S, M.D(Microbiology)
Deputy Director
Email ID: shubha.garg@ncdc.gov.in

*Other Staff in the Division

R K Meena
B.Sc
Assistant Research Officer

Vijayananth P
M.Sc                                       
Research Assistant                                    
Email ID: vijayananthp@ncdc.gov.in

Vidya Vardhini
M.Sc.
Research Assistant
Email ID: vidyavardhini@ncdc.gov.in

Ravi Shankar P Goswami
M.Sc
Technician
 

Anand Singh
M.Sc.
Technician

Saroj Bala
10th
Technician

Venkata Rao
MSc. Biochemistry
Technician   

Dinesh Kumar
10th
Lab Assistant

Sarla
Field worker

Details of National Programmes

1. National Programmes implemented through division are as under

National Programme Name: Guinea Worm Eradication Programme(GWEP)

Email ID of Programme: dpdncdc@gmail.com

Officer In-charge: Dr. Ankur Garg

Programme details-

GUINEA WORM ERADICATION PROGRAMME (GWEP)

INTRODUCTION

Certification of India as a Guinea Worm disease free country by the World Health Organisation in February 2000 is a major milestone in the Public Health in India. Guinea Worm disease (Dracunculiasis) was an important public health problem in many states of India before eradication. 

Guinea Worm emerging from foot of an infected patient

TRANSMISSION DYNAMICS AND CLINICAL PRESENTATION OF GUINEA WORM DISEASE (DRACUNCULIASIS)

Dracunculiasis is caused by a large nematode, Dracunculus medinensis. The parasite is transmitted mostly when people drink stagnant water contaminated with parasite-infected water fleas. The Guinea worm passes its life cycle in two hosts – Man and Cyclops. Man (Definitive host) harbours the adult parasites in the subcutaneous tissues, especially of legs, arms and back, parts of body which are likely to come in contact with water. Clinical manifestations of Guinea worm disease appear 10-14 months after infection and include constitutional symptoms (such as low-grade fever, itchy rash, nausea, vomiting, diarrhea, dizziness) followed by a localized swelling developing into a painful blister, most often on a lower limb. The blister appears when the gravid adult female (about 60-100 cm long worm) is ready to discharge its larvae. To soothe the associated burning pain, patients often immerse the affected part of the body in water. The worm(s) then releases thousands of larvae (baby worms) into the water. These larvae are ingested by tiny crustaceans or copepods, also called water fleas (Intermediate host) and develop into infective stage in about 2 weeks. People swallow the infected Cyclops in drinking water from step wells or ponds. The larvae are liberated in the stomach, cross the duodenal wall, and enter the retro-peritoneal connective tissues where they grow and mature. The males die after mating. The females migrate in about 6 months to parts which come in contact with water. Multiple and repeated infection may occur in the same person. The worm takes about 10–14 months to emerge after infection.

Life Cycle of Guinea worm Disease

Source: CDC

Diagnosis is made by visual recognition of adult worm protruding from a skin lesion or by microscopic identification of larvae.

EPIDEMIOLOGICAL DETERMINANTS OF GUINEA WORM DISEASE

Guinea worm disease cases occur in areas which have natural or artificial ponds or step-wells as sources of drinking water. Chances of infection increase before the arrival of monsoon when the water level becomes low in ponds/wells and people step into these water bodies to fetch water. More cases occur in adults, especially males due to increased frequency of exposure.

The prevention/control measures include: -

• Ensuring wider access to improved drinking-water supplies to prevent infection;
• Converting step wells to draw wells;
• Preventing contamination of drinking-water by preventing infected people and infected animals (dogs and cats) with blisters/emerging worms from wading into water;
• Filtering drinking water from open water bodies in endemic areas through fine mesh/Guinea worm sieve (pore size 100 micrometers) to remove Cyclops,
• Implementing vector control of Cyclops by using the larvicide temephos;
• Increasing awareness among endemic communities about the disease and its control

CURRENT GLOBAL SCENARIO OF GUINEA WORM DISEASE

Dracunculiasis was endemic in 20 countries worldwide in the mid-1980s, but now the active foci are found only in some countries of Africa. The World Health Assembly had adopted Resolution WHA 44.5 in May 1991 to eradicate dracunculiasis by 1995.

The disease is endemic only in 5 African countries at present (Angola, Chad, Ethiopia, Mali and South Sudan). Worldwide, only 15 human cases of Guinea worm disease were reported in 2021 which was further reduced to 13 cases in 2022.

HISTORICAL PERSPECTIVE: MAGNITUDE OF THE GUINEA WORM DISEASE PROBLEM IN INDIA BEFORE YEAR 2000

In 1984, at the beginning of the Programme, there were around 39792 GW cases in 12,840 villages of 89 districts in seven endemic States of India (Table 1).

Table 1: Human Guinea Worm Cases in India, 1984

Almost two-thirds of the total cases occurred in Rajasthan (38%) and Madhya Pradesh (29%)

Figure 2: Erstwhile Guinea worm Affected States in India

Table 2: List of Erstwhile Guinea Worm Disease Endemic Districts in India

GUINEA WORM ERADICATION PROGRAMME IN INDIA

Ministry of Health & Family Welfare, Government of India launched the National Guinea Worm Eradication Programme (GWEP) in 1983-84 as a centrally sponsored scheme on a 50:50 sharing basis between Centre and States with the objective of eradicating guinea worm disease from the country. National Centre for Disease Control (erstwhile National Institute of Communicable Diseases, Delhi) was designated as the nodal agency for planning, co-ordination, guidance and evaluation of GWEP in the country. The Programme was implemented by the endemic State Health Directorates through the Primary Health Care system. The Ministry of Rural Development, Govt. of India, State Public Health Engineering Departments, and the Rajiv Gandhi National Drinking Water Mission (Rural Water Supply) assisted the Programme in provision and maintenance of safe drinking water supplies and conversion of unsafe drinking water sources, on priority, in the Guinea worm affected areas.

Strategy of GWEP

Based on the life cycle of the worm, Guinea Worm Eradication Programme envisaged the efficient implementation following strategies:

• Guinea worm case detection and continuous surveillance through three active case search operations and regular monthly reporting
• GW case management
• Vector control by the application of Temephos (50% EC) in unsafe water sources eight times a year and use of fine nylon mesh/double layered cloth strainers by the community to filter cyclops in all the affected villages
• Provision and maintenance of safe drinking water supply on priority in GW endemic villages
• Trained manpower development and
• Intensive health education
• Concurrent evaluation and operational research.

NCDC with financial support from the World Health Organization deployed epidemiological surveillance teams in endemic states which closely monitored the Programme and helped the district/local authorities in effective implementation of various GWEP operational components; especially surveillance and GW case containment measures.

The cases and the number of affected villages declined over a period of time. State-wise trends are shown in Table 3 & 4 respectively.

Table 3: Trend of decline in Guinea worm Cases in India, 1984-1997

Note: Last cases in the country occurred in Rajasthan in 1996.

Table 4: Decline in Guinea worm affected villages in India, 1984-1992

Once the state remained disease free for 3 years consecutively, it was deleted from the list of endemic states. Gujarat was deleted from the list of endemic states on 31 December 1993. Andhra Pradesh and Maharashtra were deleted on 31 December 1995, while Karnataka and MP were deleted from the list on 31 December 1997. The last Guinea worm cases occurred in July 1996 when 9 guinea worm cases were reported in three villages from district Jodhpur (Rajasthan). Eventually, Rajasthan was deleted from the list of endemic states on 31 December 1999.

TOWARDS CERTIFICATION OF GUINEA WORM ERADICATION IN INDIA

Last case of Guinea worm in India

• 6 July 1996
• Village: Aau, PHC: Peelwa
• District: Jodhpur, Rajasthan
• Family members had history of Guinea worm infection in last one year

During April 1999, Seventh Independent Evaluation of GWEP was conducted by independent experts; twenty teams were sent to seven erstwhile endemic states and fourteen non-endemic states/UTs. The results validated the zero Guinea worm status in India.

• A National Commission for Certification of Guinea Worm Eradication was set up by the Ministry of Health and Family Welfare. The Commission comprised of eight highly experienced independent experts in the field of Public Health drawn from across the country and the Director and Joint Director and Head of Parasitology Division of the erstwhile National Institute of Communicable Diseases. The Seventh Independent Evaluation was carried out under the guidance of the Commission in April 1999.
• The country completed three years of Guinea worm disease free period in July 1999. Subsequently, International Certification Team (ICT) from International Commission for Certification of Dracunculiasis Eradication (ICCDE), WHO visited India from 9th -25th November, 1999 to assess the status of guinea worm disease in the country and to prepare a report for presentation to International Commission at Geneva.
• A meeting was organised in January, 2000 in Vigyan Bhawan to mark the eradication of Guinea worm disease from India which was presided by Hon’ble Union Minister of State, MoHFW, GoI  Sh. N. T.Shanmugam and Dr. Gro Harlem Brundtland, Director General, WHO was the Chief Guest.

• The International Certification Team, presented its report on Guinea worm disease status in India to the ICCDE in the meeting held in February 2000 in Geneva. On the basis of ICT report, India was declared as Guinea Worm disease free country in the year 2000.

The International Certification Team has recommended that, until the global goal of eradication is achieved, the following measures should be assiduously implemented:

• Health education regarding Guinea worm, with special emphasis on children and women in rural areas
• Guinea worm rumour registration and investigation
• Maintaining guinea worm disease on the list of notifiable disease and continuing surveillance in all previously infected areas
• Careful supervision of the functioning of hand pumps and other sources of safe drinking water, and provision of additional units wherever necessary.

CURRENT ACTIVITIES UNDER THE PROGRAMME

• Health education regarding Guinea worm disease.
• Maintaining continuing surveillance in all erstwhile 7 endemic States (now 8 including Telangana) /Districts through State/District Health Departments.
• Guinea worm rumour surveillance and investigation: rumours have been received from the many Indian States viz Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Kerala, Uttar Pradesh, Goa and Rajasthan, Uttarakhand since certification of Guinea worm Disease free status. All such rumours/publications reported to NCDC after 2000, have been thoroughly investigated and have been found to be not due to Guinea worm Disease.

Department of Parasitic Diseases, NCDC

 Department of Parasitic Diseases Laboratory

Soil Transmitted Helminthiasis Prevalence Surveys

STH Survey: 1. Demonstrating students about specimen collection

2.Collecting health parameters of students:

3. Sample processing using Kato-Katz Method

4. Microscopic examination of stool slides on field survey

5.Lymphatic Filariasis- Patients with Lymphoedema

6.Lymphoedema Management

Guinea worm (Dracunculiasis)

Preserved Worm Specimen from last case of Guinea worm Disease in India

Details of Laboratories/Units:

1. Laboratories/ units under the Division:

1. Lab/Unit name: Guinea Worm Eradication Programme (GWEP)

  Officer in Charge of Lab/Unit: Dr Ankur Garg

• Lab/Unit details: Guinea Worm disease (Dracunculiasis), a crippling parasitic disease was an important public health problem in seven states of India before it was eradicated in 2000. India had launched the National Guinea Worm Eradication Programme (GWEP) in 1983-84 with NCDC Delhi as the nodal agency for planning, co-ordination and evaluation of the programme in the country. However, the surveillance activities are continuing and verification of suspect cases for Guinea worm disease are being carried out under the programme till the global eradication is achieved. Guinea worm rumors have been received from the many Indian States viz Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Kerala, Uttar Pradesh, Goa and Rajasthan, Uttarakhand since certification of Guinea worm Disease free status. All such rumours/publications reported to NCDC after 2000, have been thoroughly investigated both epidemiologically and by morphology/molecular methods to rule out Guinea worm disease.

2. Lab/Unit name: Soil Transmitted Helminths (STH)

  Officer in Charge of Lab/Unit: Dr Ankur Garg

  Lab/Unit details:

• Since 1963, NCDC has been conducting STH surveys in different parts of the country.
• From 1999, WHO sampling methodology and Kato-Katz technique have been adopted for stool sample examination and STH surveys have been conducted at selected sentinel sites in different ecological zones across the country.
• NCDC has completed the baseline countrywide mapping of the STH prevalence and Intensity among school children.
• This country wide STH survey provided data support to the National Deworming Day initiative and would help in monitoring the effect of de-worming activities in school children and to find out the appropriate effective interval of de-worming.
• NCDC is currently undertaking STH Resurveys at previously selected sentinel sites across the country

3. Lab/Unit name: Lymphatic Filariasis

Officer in Charge of Lab/Unit: Dr Shubha Garg

Lab/Unit details: The Department of Parasitic Diseases, NCDC provide technical support to the activities under the National Filaria Control Programme (NFCP) being implemented by the National Vector Borne Disease Control Programme. The Department is providing necessary diagnostic services through filarial antigen and antibody testing and staining and examination of night blood smears for microfilaria at the NCDC Headquarters.

In addition, the three NCDC branches at Kozhikode, Rajamahendravaram and Varanasi are running regular filaria day and night clinics and lymphedema management clinics. In these clinics, besides the diagnostic services, the patients are provided lymphedema management services, IEC and drug treatment.

In addition, the branches are involved in development of trained technical manpower through 5 days training in Filariology for Medical Officer/District Programme Officers and 10 days training courses for Technicians at the three branches. In all, 4 trainings are organized at each of the three NCDC branches every year.

The branches are also supporting the NFCP in the Transmission Assessment Surveys.

4. Lab/Unit name: Malariology

Officer in Charge of Lab/Unit: Dr Shubha Garg

Lab/Unit details: The malaria laboratory provides diagnostic support to patients referred by hospitals from Delhi, Haryana and Uttar Pradesh through microscopic examination of stained blood slides for the presence of malaria parasites and by use of rapid diagnostic kits for malaria.

Besides this, the Division also undertakes examination of blood slides for assisting in outbreak investigation and cross examination of slides for verification related to field and laboratory-based research activities.

      NCDC Branches under the Division:

• Kozhikode Branch, National Centre for Disease Control, Kerala (formerly RFT&RC, Kozhikode)
• Rajamahendravaram Branch, National Centre for Disease Control, Andhra Pradesh (formerly RFT&RC Rajahmundry)
• Varanasi Branch, National Centre for Disease Control, Uttar Pradesh (formerly RFT&RC Varanasi)

2. Mandate of the Division:

• Providing data through periodic STH prevalence surveys in school aged children on the STH prevalence across the Country and supporting Child Health Division, MoHFW in conducting mass deworming activity under National Deworming Days Initiative
• Capacity building in management of Lymphatic Filariasis through training of healthcare manpower (medical/paramedical) at NCDC branches.
• Educating lymphedema patients about self-care and managing morbidity through Filaria clinics at NCDC branches
• Post eradication surveillance and rumor investigation of Dracunculiases
• Operational research in prevention and control of parasitic diseases
• Technical resource center for prevention and control of concerned parasitic diseases in the country
• Coordination of the orientation cum educational visits to NCDC of undergraduate and postgraduate nursing, homeopathic and post graduate students and in- service govt personnel from different institutions across the Country.
• Diagnostic support for malaria to referred patients

3. Research projects and Publication (With website link): 

         Articles:

1. Garg A, Garg VK, Dwivedi A et al. Effect of Multiple Rounds of Mass Drug Administration under Lymphatic Filariasis Elimination Program on Prevalence of Soil-Transmitted Helminthiasis in One of the Co-endemic Districts of India. J Commun Dis 2018; 50(1): 1-7.
2. Jain SK, Dwivedi A, Shrivastava A, et al. Prevalence of Soil-Transmitted Helminthic Infection in India in Current Scenario: A Systematic Review. J. Commun. Dis. 2016;48(2):24-35.
3. Regu K, Rajendran R, Showkath MK,et al. Current Status of Bancroftian Filariasis in Palakkad District, Kerala. J. Commun. Dis.2016;48(4): 21-5.
4. Garg V, Jain SK, Jogdand S, et al. Prevalence of STH Infection among School Going Children in Delhi: Study of Contributing Factors in Varied Demographic Settings. J. Commun. Dis.2015; 47(3):13-18. https://www.researchgate.net/publication/298716622_Prevalence_of_STH_infection_among_school_going_children_in_Delhi_Study_of_contributing_factors_in_varied_demographic_settings