Malaria and Japanese Encephalitis for NEET PG PSM: NCVBDC Treatment (ACT-SP, ACT-AL, Primaquine), Severe Malaria, Elimination 2030
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🎯 Exam priority: High-yield (Tier 1). Malaria drug policy is a perennial PSM question — which ACT where, primaquine doses and contraindications, treatment in pregnancy. Facts here are from the NCVBDC Guidelines for Diagnosis and Treatment of Malaria (2014), the National Drug Policy on Malaria (2013) and the 2025 ASHA training module.
CBME mapping: CM 8.
Malaria in India: Targets and Diagnosis
The National Framework for Malaria Elimination (2016–2030) aims at zero indigenous cases by 2027 and certification of elimination by 2030. In 2023 India reported 2,27,564 cases and 82 deaths.
Malaria is transmitted by the bite of an infected female Anopheles mosquito.
Microscopy of thick and thin smears is the gold standard; a bivalent RDT (detecting P. falciparum and P. vivax) is used where microscopy is not available quickly.
Epidemiology and Clinical Features
P. falciparum and P. vivax each cause about half of India's malaria; vivax dominates the plains, falciparum the forested and hilly areas.
Fever (intermittent or continuous, often with chills and rigors) is the cardinal symptom; malaria mimics many other fevers, so any suspected case is tested immediately by microscopy or RDT.
Treatment: The National Drug Policy
Situation | Treatment (national guidelines) |
P. vivax | Chloroquine for 3 days (10 + 10 + 5 mg/kg) + primaquine 0.25 mg/kg daily for 14 days (anti-relapse) |
P. falciparum, rest of India | ACT: artesunate + sulfadoxine-pyrimethamine (AS+SP) for 3 days + single-dose primaquine 0.75 mg/kg on day 2 |
P. falciparum, North-Eastern states | ACT: artemether-lumefantrine (AL) + single-dose primaquine (SP resistance reported in the NE) |
Mixed infection | Treat as falciparum; AS+SP does not work for vivax, so use another ACT plus 14-day primaquine |
Pregnancy, falciparum | 1st trimester: quinine; 2nd and 3rd trimesters: ACT |
Pregnancy, vivax | Chloroquine (no primaquine) |
Severe malaria | Parenteral artesunate 2.4 mg/kg at 0, 12 and 24 h, then once daily (IV preferred); quinine is an alternative |
Primaquine is contraindicated in pregnancy, infants and G6PD deficiency (risk of haemolysis).
An ACT combines an artemisinin derivative with a long-acting partner drug (amodiaquine, lumefantrine, mefloquine, piperaquine or sulfadoxine-pyrimethamine).
Artemether-lumefantrine is not recommended in the first trimester or for children under 5 kg.
Severe Malaria
Severe falciparum malaria can develop within 12–24 hours. Any one of these features makes malaria severe:
Feature | Threshold (national guidelines) |
Impaired consciousness / coma; repeated generalized convulsions | — |
Renal failure | Serum creatinine > 3 mg/dl |
Jaundice | Serum bilirubin > 3 mg/dl |
Severe anaemia | Hb < 5 g/dl |
Hypoglycaemia | Plasma glucose < 40 mg/dl |
Shock | Systolic BP < 80 mm Hg (< 50 in children) |
Hyperpyrexia | > 106 °F (> 42 °C) |
Hyperparasitaemia | > 5% of RBCs parasitized |
Others | Pulmonary oedema/ARDS, metabolic acidosis, abnormal bleeding/DIC, haemoglobinuria |
A smear may be negative in severe malaria because parasites are sequestered or partly treated — confirm by RDT or repeat smear, and treat if the picture fits.
Vector Control
Indoor residual spray (IRS) in high-risk rural areas — mosquitoes rest indoors after biting; the residual effect lasts 6–12 weeks; aim to cover at least 85% of targeted households.
Long-lasting insecticidal nets (LLINs) — a cost-effective intervention, with night-time checks on correct use.
Larval source management: source reduction, biological control (larvivorous fish, bacteria) and chemical larvicides.
Japanese Encephalitis and AES
The JE virus is maintained in pigs and water birds (Ardeidae); man is an accidental host.
Vectors are Culex mosquitoes of the vishnui group — Cx. tritaeniorhynchus, Cx. vishnui and Cx. pseudovishnui.
For surveillance, JE is reported under the broad heading of Acute Encephalitis Syndrome (AES); laboratory confirmation is recorded separately.
JE vaccine is part of the immunization schedule in endemic districts (9–11 and 16–23 months; see the immunization article).
Traps the Examiner Sets
North-East = ACT-AL; rest of India = ACT-SP.
Primaquine: vivax 0.25 mg/kg × 14 days; falciparum single dose 0.75 mg/kg on day 2.
No primaquine in pregnancy, infants or G6PD deficiency.
Falciparum in the first trimester: quinine, not ACT.
AS+SP does not cover vivax.
JE: pigs and water birds are the reservoirs; humans are accidental hosts; Culex, not Aedes, is the vector.
Rapid-Revision Cards
Malaria gold standard test
Thick and thin smear microscopy.
Vivax treatment
Chloroquine 10+10+5 mg/kg + primaquine 0.25 mg/kg × 14 days.
Falciparum treatment (most of India)
AS+SP × 3 days + primaquine 0.75 mg/kg single dose day 2.
Falciparum treatment (North-East)
Artemether-lumefantrine + single-dose primaquine.
Primaquine contraindications
Pregnancy, infants, G6PD deficiency.
Falciparum in pregnancy
1st trimester quinine; 2nd/3rd trimester ACT.
Severe malaria
IV artesunate 2.4 mg/kg at 0, 12, 24 h then daily.
Mixed infection
Treat as falciparum, but not with AS+SP.
Severe malaria thresholds
Hb < 5, creatinine > 3, bilirubin > 3, glucose < 40, parasitaemia > 5%, SBP < 80.
IRS
Residual effect 6–12 weeks; ≥ 85% household coverage.
Vivax vs falciparum distribution
Vivax plains; falciparum forests and hills; ~50% each.
Malaria elimination targets
Zero indigenous cases 2027; certification 2030 (NFME 2016–2030).
JE reservoirs
Pigs and water birds; man accidental host.
JE vector
Culex vishnui group (Cx. tritaeniorhynchus).
JE surveillance
Reported as AES; lab-confirmed JE separately.
Sources
Sources
Facts in this article were checked against these documents.
Guidelines for Diagnosis and Treatment of Malaria in India — National Vector Borne Disease Control Programme (now NCVBDC), MoHFW, 2014 (link)
National Drug Policy on Malaria — NVBDCP, MoHFW, 2013 (link)
Malaria Training Module for ASHA — NCVBDC, MoHFW, 2025 (link)
Guidelines for Surveillance of Acute Encephalitis Syndrome (with special reference to JE) — NVBDCP, MoHFW, n.d.
Test Yourself: Practice Questions
Fifteen questions in NEET PG style.
Practice Questions (NEET PG pattern)
Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.
Q1. The gold standard for confirming malaria is
(a) PCR
(b) microscopy of stained thick and thin blood smears
(c) clinical diagnosis
(d) bivalent RDT
Show answer
Answer: (b) — Microscopy remains the gold standard; RDTs are used where microscopy results are not quickly available.
Q2. The anti-relapse dose of primaquine for P. vivax malaria in India is
(a) 0.5 mg/kg daily for 7 days
(b) 15 mg once weekly for 8 weeks
(c) 0.75 mg/kg single dose
(d) 0.25 mg/kg daily for 14 days
Show answer
Answer: (d) — Primaquine 0.25 mg/kg daily for 14 days under supervision prevents relapse from hypnozoites.
Q3. For P. falciparum, a single dose of primaquine is given on day 2 at
(a) 0.5 mg/kg
(b) 0.25 mg/kg
(c) 1 mg/kg
(d) 0.75 mg/kg
Show answer
Answer: (d) — ACT is accompanied by a single 0.75 mg/kg dose of primaquine on day 2.
Q4. Primaquine is contraindicated in all of the following EXCEPT
(a) adult men with normal G6PD
(b) G6PD-deficient patients
(c) infants
(d) pregnant women
Show answer
Answer: (a) — Primaquine is contraindicated in pregnancy, infants and known G6PD deficiency.
Q5. The ACT used for falciparum malaria in the North-Eastern states under the national programme is
(a) artemether-lumefantrine
(b) artesunate-mefloquine
(c) dihydroartemisinin-piperaquine
(d) artesunate + sulfadoxine-pyrimethamine
Show answer
Answer: (a) — NE states use AL because of reported resistance to SP; the rest of India uses AS+SP.
Q6. A woman in her first trimester has P. falciparum malaria. The recommended treatment is
(a) quinine
(b) chloroquine + primaquine
(c) artemether-lumefantrine
(d) AS+SP
Show answer
Answer: (a) — Quinine in the first trimester; ACT in the second and third trimesters.
Q7. P. vivax malaria in pregnancy is treated with
(a) chloroquine (without primaquine)
(b) quinine + primaquine
(c) chloroquine + primaquine
(d) AS+SP
Show answer
Answer: (a) — Vivax can be treated with chloroquine; primaquine is contraindicated in pregnancy.
Q8. Why should a mixed falciparum–vivax infection not be treated with AS+SP?
(a) SP causes haemolysis
(b) AS+SP is unsafe in adults
(c) AS+SP is not effective against vivax
(d) AS is ineffective against falciparum
Show answer
Answer: (c) — Mixed infections are treated as falciparum but with an ACT other than AS+SP, since AS+SP does not work for vivax.
Q9. Parenteral artesunate in severe malaria is given at
(a) 2.4 mg/kg at 0, 12 and 24 hours, then once daily
(b) 4 mg/kg once daily
(c) 10 mg/kg at 0 and 6 hours
(d) 20 mg/kg loading dose
Show answer
Answer: (a) — Artesunate 2.4 mg/kg IV or IM on admission, at 12 and 24 h, then daily; IV preferred. (20 mg/kg is the quinine loading dose.)
Q10. Chloroquine for vivax malaria is given over three days as
(a) 10, 10 and 5 mg/kg
(b) 5 mg/kg daily
(c) 10 mg/kg daily for 3 days
(d) 25 mg/kg on day 1
Show answer
Answer: (a) — Day 1 and 2: 10 mg/kg; day 3: 5 mg/kg (total 25 mg/kg).
Q11. Artemether-lumefantrine is NOT recommended
(a) with food
(b) in the first trimester and for children under 5 kg
(c) in adults over 60
(d) in the third trimester
Show answer
Answer: (b) — AL is not recommended in the first trimester of pregnancy or for children weighing under 5 kg.
Q12. India's National Framework for Malaria Elimination targets zero indigenous malaria cases by
(a) 2030
(b) 2025
(c) 2035
(d) 2027
Show answer
Answer: (d) — Zero indigenous cases by 2027 and certification of elimination by 2030.
Q13. Which of the following defines severe malaria under the national guidelines?
(a) Parasitaemia above 1%
(b) Haemoglobin below 10 g/dl
(c) Haemoglobin below 5 g/dl
(d) Temperature above 101 °F
Show answer
Answer: (c) — Severe anaemia (Hb < 5 g/dl) is a criterion; others include creatinine > 3, bilirubin > 3, glucose < 40 mg/dl and parasitaemia > 5%.
Q14. In a patient with severe falciparum malaria, a blood smear may be negative because of
(a) jaundice
(b) low haemoglobin
(c) high fever
(d) sequestration of parasites
Show answer
Answer: (d) — Asexual parasites may be absent from the smear due to sequestration and partial treatment.
Q15. Indoor residual spraying should cover at least what proportion of targeted households?
(a) 100%
(b) 60%
(c) 85%
(d) 50%
Show answer
Answer: (c) — IRS aims at a minimum coverage of 85% of targeted households; its residual effect lasts 6–12 weeks.
Q16. In India, P. falciparum predominates in
(a) plain areas
(b) forested and hilly areas
(c) coastal deserts
(d) urban slums only
Show answer
Answer: (b) — Vivax is more prevalent in the plains; falciparum predominates in forested and hilly areas.
Q17. The main reservoirs (amplifying hosts) of Japanese encephalitis virus are
(a) dogs and cats
(b) rodents
(c) pigs and water birds
(d) humans
Show answer
Answer: (c) — Pigs and ardeid water birds maintain the virus; man is an accidental host.
Q18. The main vectors of Japanese encephalitis in India belong to the
(a) Culex vishnui group (e.g. Cx. tritaeniorhynchus)
(b) Anopheles culicifacies
(c) Aedes aegypti
(d) Mansonia annulifera
Show answer
Answer: (a) — JE vectors are Culex of the vishnui group — Cx. tritaeniorhynchus, Cx. vishnui, Cx. pseudovishnui.
Q19. For surveillance purposes, JE is reported under the broad heading of
(a) acute encephalitis syndrome
(b) viral haemorrhagic fever
(c) fever of unknown origin
(d) acute flaccid paralysis
Show answer
Answer: (a) — All AES cases are reported; laboratory-confirmed JE is recorded separately.
Active Recall
From memory: give the national treatment for vivax, falciparum (NE and rest of India), mixed infection, malaria in each trimester of pregnancy and severe malaria, with primaquine doses and contraindications; then state India's malaria elimination targets and the reservoirs, vectors and surveillance of Japanese encephalitis.