# Malaria and Japanese Encephalitis for NEET PG PSM: NCVBDC Treatment (ACT-SP, ACT-AL, Primaquine), Severe Malaria, Elimination 2030 Source: https://tracknation.in/story/malaria-and-japanese-encephalitis-for-neet-pg-psm-ncvbdc-treatment-act-sp-act-al-primaquine-severe-malaria-elimination-2030 (TrackNation β€” free UPSC notes with PYQs) > NEET PG Community Medicine: malaria diagnosis (microscopy gold standard, bivalent RDT), treatment of vivax (chloroquine + 14-day primaquine) and falciparum (ACT-SP; ACT-AL in the North-East; single-dose primaquine), malaria in pregnancy, severe malaria (IV artesunate), the 2027/2030 elimination targets, and Japanese encephalitis/AES β€” vectors, reservoirs and surveillance β€” all from official NCVBDC documents, with verified MCQs and cards. ## Start Here 🎯 **Exam priority: High-yield (Tier 1).** *Malaria drug policy is a perennial PSM question β€” 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 | β€” | | 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 Β°F (> 42 Β°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 β€” confirm by RDT or repeat smear, and treat if the picture fits. ## Vector Control - **Indoor residual spray (IRS)** in high-risk rural areas β€” 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)** β€” 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** β€” *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 Γ— 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 - Thick and thin smear microscopy. - Chloroquine 10+10+5 mg/kg + primaquine 0.25 mg/kg Γ— 14 days. - AS+SP Γ— 3 days + primaquine 0.75 mg/kg single dose day 2. - Artemether-lumefantrine + single-dose primaquine. - Pregnancy, infants, G6PD deficiency. - 1st trimester quinine; 2nd/3rd trimester ACT. - IV artesunate 2.4 mg/kg at 0, 12, 24 h then daily. - Treat as falciparum, but not with AS+SP. - Hb < 5, creatinine > 3, bilirubin > 3, glucose < 40, parasitaemia > 5%, SBP < 80. - Residual effect 6–12 weeks; β‰₯ 85% household coverage. - Vivax plains; falciparum forests and hills; ~50% each. - Zero indigenous cases 2027; certification 2030 (NFME 2016–2030). - Pigs and water birds; man accidental host. - Culex vishnui group (Cx. tritaeniorhynchus). - 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 β€” National Vector Borne Disease Control Programme (now NCVBDC), MoHFW, 2014 (link) - National Drug Policy on Malaria β€” NVBDCP, MoHFW, 2013 (link) - Malaria Training Module for ASHA β€” NCVBDC, MoHFW, 2025 (link) - Guidelines for Surveillance of Acute Encephalitis Syndrome (with special reference to JE) β€” 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, βˆ’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 **Answer: (b)** β€” 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 **Answer: (d)** β€” 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 **Answer: (d)** β€” 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 **Answer: (a)** β€” 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 **Answer: (a)** β€” 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 **Answer: (a)** β€” 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 **Answer: (a)** β€” 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 **Answer: (c)** β€” 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 **Answer: (a)** β€” 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 **Answer: (a)** β€” 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 **Answer: (b)** β€” 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 **Answer: (d)** β€” 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 Β°F **Answer: (c)** β€” 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 **Answer: (d)** β€” 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% **Answer: (c)** β€” 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 **Answer: (b)** β€” 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 **Answer: (c)** β€” 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 **Answer: (a)** β€” JE vectors are Culex of the vishnui group β€” 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 **Answer: (a)** β€” 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.