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Diseases/Types of Vaccines/Latest Updates

Diseases Vaccine and its Types Recent Initiatives

Diseases

Health is described as the state of complete physical, mental and social well being. Being healthy is far more than just being free from disease. Disease is a condition of disturbed functioning of the body caused by infection, defective diet, heredity, environment or deprived condition of brain. Health is a state of complete physical, mental and social well being.

Disease may be a response to
• Environmental factors (as malnutrition, industrial hazards or climate)
• Specific infective agents (as worms, protozoans, fungi, etc)
• Inherent defects of the organism (as genetic anomalies.)
• Combination of these factors

Causes of Diseases/Disease Agents
Disease agent is organism, substance or force which causes disease due to its excessive presence, deficiency or absence.

Pathogens/Biological Agents: They are biological entities which cause infectious diseases, e.g., viruses (mumps, chicken pox, small pox), mycoplasma (e.g, bronchitis, acute leukemia), chlamydia (e.g, trachoma), bacteria (e.g. cholera, tetanus), fungi (ringworm, thrush, moniliasis, pulmonary aspergillosis), protozoa (e.g. giardiasis, sleeping sickness), helminths (e.g., filariasis, ascariasis, taeniasis), other organisms (e.g., scabies).

Nutrient Agents: Deficiency of vitamins (e.g., beriberi, scurvy, night blindness), minerals (e.g., anaemmia, rickets), carbohydrates, fat and proteins (e.g., kwashiorkar, marasmus), or excess of food (e.g., obesity).

Chemical Agents: Endogenous Agents– Excess presence of uric acid, reduced secretion of ADH (diabetes insipidus) or insulin (diabetes mellitus). Exogenous Agents- Pollutants (e.g., pneumoconiosis), allergens (allergy).

Physical Agents: Heat (e.g., stroke), cold (frost bite), radiations, sound (impaired hearing), humidity, etc.

Mechanical Agents: Fractures, sprains, dislocation, injury, chronic friction.

Genetic Agents: Excess or deficiency of chromosomes, mutations, harmful alleles, e.g, colour blindness, albinism, haemophilia, Turner’s syndrome.

Degeneration: They include old age change like peptic ulcers, hypertension, atherosclerosis.

Types of Disease
1. Congenital diseases: Congenital disorders can be due to fault in the chromosome structure or damage inflicted to the development embryo. These could be caused by radiations, diseases contracted by the mother (German measles), use of certain drugs, excessive smoking and alcohol intake by the pregnant mother; for example, Hare-lip, club foot and Mongolism.

2. Hereditary Diseases: Diseases that are transmitted from parent to offspring from generation to generation are termed hereditary diseases. E.g., Haemophilia and colour blindness.

3. Acquired diseases: Acquired diseases develop in an individual after birth.These are of two kinds –

(I) Communciable diseases: These are caused due to the entry of disease-causing germs called pathogens into the body and are easily transmitted from person to person by direct or indirect contact or through a carrier which is called vector, e.g., mosquito (Anopheles) is a vector of malaria. Indirect contact may be through clothes, beddings, utensils, etc.
Communicable diseases are further classified into several types depending on the types of causative agents:
(i) Viral (ii) Bacterial, (iii) Protozoan (iv) Helminthic (v) Fungal.

(II) Non-Communicable diseases: These are restricted to the persons suffering and they are of the following types:

(a) Degenerative Diseases: These diseases are due to degeneration of tissues in old age, that is, diseases caused due to decline in the ability of the body to repair its tissues. It leads to malfunctioning of the heart, lungs and central nervous system E.g., Parkinson’s disease, cataract and arteriosclerosis.

(b) Cancer: It is caused due to uncontrolled growth of tissues in any part of the body. This disease has become a challenge to medical science as it is incurable in later stages.

(c) Allergies: These are caused due to hypersensitivity of the body to certain foreign substances called as Allergens. E.g., Hay fever, asthama, nettle rash.

DISEASES IN NEWS
1. Rotavirus
Rotavirus is a most common virus that contaminates the bowels. It causes diarrhoea among infants and children throughout the world and causes over 450,000 deaths worldwide annually inclusive of 110,000 deaths in India which is accounts for 22 per cent of the estimated global deaths from diarrhoea-causing rotavirus.

Symptoms
• Rotavirus affects the body in many ways and multiple infections can be noticed.
• Vomiting
• Low grade Fever
• Watery diarrhoea
• Nausea

What is Rotavirus vaccine?
• Rotavirus vaccine prevents diarrhoea virus to enter the body which causes death
• RotaShield is a Rotavirus vaccine by Wyeth was licensed in 1998 in the United States
• In 1999, however the manufacturer withdrew it from the market risking bowel obstruction in one of every 12,000 vaccinated infants
• The vaccine was under trial for 8 years since the withdrawal. After efficient research Rotarix by GlaxoSmithKline and RotaTeq by Merck were manufactured which is effective and safe

2. Zika Virus
• Zika virus infection is caused by the bite of an infected Aedes mosquito. It is spread by mosquitoes of the Aedes genus (Aedes aegypt) which can breed in a pool of water as small as a bottle cap and usually bite during the day. The Asian tiger mosquito, Aedes albopictus, is also known to transmit the virus.
Symptoms

a) The illness is usually mild with symptoms lasting for several days to a week.
b) The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week.
c) There are concerns that pregnant women who become infected with Zika virus can transmit the disease to their unborn babies, with potentially serious consequences. Reports from several countries, most notably Brazil, demonstrate an increase in severe foetal birth defects and poor pregnancy outcomes in babies whose mothers were infected with Zika virus while pregnant.
d) The new born infants are suffering from Microcephaly. It is a rare condition where a baby has an abnormally small head. This is due to abnormal brain development of the baby in the womb or during infancy. Babies and children with microcephaly often have challenges with their brain development as they grow older.

Transmission
a) Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (A. aegypti and A. albopictus). These are the same mosquitoes that spread dengue and chikungunya viruses.
b) These mosquitoes typically lay eggs in and near standing water in things like buckets, bowls, animal dishes, flower pots and vases.
c) Mosquitoes that spread chikungunya, dengue, and Zika are aggressive daytime biters. They can also bite at night.
d) Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.
e) It is possible that Zika virus could be passed from a mother to her baby during pregnancy. Studies are going on how some mothers can pass the virus to their babies.
f) To date, there are no reports of infants getting Zika virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.
g) Spread of the virus through blood transfusion and sexual contact has also been reported.

Prevention
a) No vaccine exists to prevent Zika virus disease (Zika). Hence prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people.
• The World Health Organization has recently declared the Zika virus and its suspected link to birth defects as an international public health emergency, a rare move that signals the seriousness of the outbreak and gives countries new tools to fight it.

• India’s Health Ministry issued health advisory, appointing National Centre for Disease Control (NCDC); as the nodal agency for investigation of outbreak. Integrated Disease Surveillance Programme (IDSP) through its community and hospital based data gathering mechanism would track clustering of acute febrile illness and seek primary case, if any, among those who travelled to areas with ongoing transmission in the 2 weeks preceding the onset of illness.

3. Ebola Virus
• Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans.

• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.

• Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals.

• In Africa, infection has been noticed among those handling infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope found ill or dead or in the rainforest. Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids.

• Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD when infection control precautions are not strictly practiced.

Signs and symptoms: EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

• In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

• World Health Organisation (WHO) has approved the ReEBOV Antigen rapid test kit for Ebola virus disease (EVD).

4. Middle East Respiratory Syndrome virus
• MERS stands for Middle East Respiratory Syndrome virus. You may remember having heard of it last year or the year before.
• It was first seen in Saudi Arabia in 2012. It’s a coronavirus – a family of viruses that usually cause common colds and that can infect both animals and people. It’s a relative of SARS, the Severe Acute Respiratory Syndrome virus that swept around the world, infecting more than 8,000 people globally and killing 774 before it was stopped in 2004.
• MERS can cause fever, cough, shortness of breath, diarrhea, body aches, nausea and, in the most serious cases, pneumonia and kidney failure, according to the U.S. Centers for Disease Control and Prevention. Its incubation period is usually 5 or 6 days, but people can be contagious for up to 14.
• The virus kills by causing respiratory or kidney failure, or septic shock, an infection that overwhelms the body’s defenses.
• The South Korean outbreak of MERS began in May 2015 when a traveler returned from Saudi Arabia, and infected many people before officials realized he had the disease. So far, around 180 people have been infected in South Korea, and nearly 30 have died.

5. Swine Flu
• Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking cough, decreased appetite, and listless behaviour.

• The virus spreads by tiny droplets that are released when a person coughs or sneezes. The droplets reach a distance of about one metre (3ft). These droplets remain suspended in the air for a short duration, and then settle on a surface. The virus suspended in airborne droplets can infect a person, if the person inhales the contaminated droplet.

• Common objects such as door handles, remote control, hand rails and computer keyboards can get contaminated with the virus when the droplet settles on these surfaces. If a person touches these surfaces and places the contaminated hands on their mouth or nose he or she can get the infection.

• They can spread it further by touching other things. If the droplets land on a hard surface the virus can survive for about 24 hours, and on a soft surface it survives for about 20 minutes.

• Symptoms of swine flu are similar to most influenza infections: fever (100 0F or greater), cough, nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients also get nausea, vomiting, and diarrhea.

• Some patients develop severe respiratory symptoms and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients.

• H1N1 swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. These antiviral drugs are most effective when taken within 48 hours of the start of flu symptoms. It’s resistant to older flu drugs. A third antiviral drug, peramivir, can be used only in hospitalized patients with severe flu.

• In 2015 the states of Gujarat and Rajasthan are the worst effected by Swine Flu.

Types of Vaccines

Vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins. The agent stimulates the body’s immune system to recognize the agent as foreign, destroy it, and “remember” it, so that the immune system can more easily recognize and destroy any of these microorganisms if it encounters in future.

Properties of ideal vaccine:
• Provide long lasting immunity.
• Should induce both humoral and cellular immunity.
• Should not induce autoimmunity or hypersensitivity.
• Should be inexpensive to produce, easy to store and administer.

Vaccines must also be perceived to be safe. The vaccine vial may contain relevant antigen, adjuvant (usually alum), preservatives and/or traces of protein derived from the cells in which the vaccine agent was cultured e.g. egg protein

Types of vaccines:
a) Inactivated vaccines: When inactivated vaccines are made, the bacteria are completely killed using a chemical, usually formaldehyde. Dead pieces of disease-causing microorganisms (usually bacteria) are put into the vaccine. Because the antigens are dead, the strength of these vaccines tends to wear off over time, resulting in less long-lasting immunity. So, multiple doses of inactivated vaccines are usually necessary to provide the best protection. The benefit of inactivated vaccines is that there is zero chance of developing any disease-related symptoms — allergic reactions are possible but extremely rare.
Examples of inactivated vaccines are hepatitis A, hepatitis B, poliovirus, hemophilic influenza type b, meningococcal, pneumococcal and the injected form of influenza.

b) Live-attenuated vaccines: Live-attenuated basically means alive, but very weak. These vaccines are made when the virus is weakened to such a level that they reproduce only about 20 times in the body.
When the vaccine is made, the virus or bacteria is weakened in a laboratory to the point where it’s alive and able to reproduce, but can’t cause serious illness. Its presence is enough to cause the immune system to produce antibodies to fight off the particular disease in the future. They typically provoke more durable immunological responses and are preferred for healthy adults.
Examples include the viral diseases yellow fever, measles, rubella, and mumps and the bacterial disease typhoid.

c) Recombinant Vector vaccine – by combining the physiology of one micro-organism and the DNA of the other, immunity can be created against diseases that have complex infection processes.

There are four genetically-engineered vaccines are currently available:

• Hepatitis B vaccines are produced by insertion of a segment of the hepatitis B virus gene into the gene of a yeast cell. The modified yeast cell produces pure hepatitis B surface antigen when it grows.
• Human papillomavirus vaccines are produced by inserting genes for a viral coat protein into either yeast (as the hepatitis B vaccines) or into insect cell lines. Viral-like particles are produced and these indice a protective immune response.
• Live typhoid vaccine (Ty21a) is Salmonella typhi bacteria that has been genetically modified to not cause illness.
• Live attenuated influenza vaccine (LAIV) has been engineered to replicate effectively in the mucosa of the nasopharynx but not in the lungs.

d) DNA vaccination – in recent years a new type of vaccine called DNA vaccination has been created from an infectious agent’s DNA. As in complex diseases the DNA quality of the infection changes thus no vaccine works on it.DNA vaccine works by insertion and expression, triggering immune system recognition of viral or bacterial DNA into human or animal cells. Some cells of the immune system that recognize the proteins expressed will mount an attack against these proteins and cells expressing them.

e) Polysaccharide vaccines – Polysaccharide vaccines are a unique type of inactivated subunit vaccine composed of long chains of sugar molecules that make up the surface capsule of certain bacteria. Pure polysaccharide vaccines available include: pneumococcal, meningococcal, and Salmonella typhi.

f) Anti-Idiotypic Vaccine: An antigen binding site in an antibody (paratope) is a reflection of the three-dimensional structure of part of the antigen (epitope). This unique amino acid structure in the antibody is known as the idiotype, which can be considered as a mirror of the epitope in the antigen. Antibodies can be raised against the idiotype by injecting the antibody into another animal. This anti-idiotype antibody mimics part of the three dimensional structure of the antigen. This can be used as a vaccine. When the anti-idiotype antibody is injected into a vaccinee, antibodies (antianti-idiotype antiobodies) are formed that recognize a structure similar to part of the virus and might potentially neutralize the virus.

MISSION INDRADHANUSH
The ultimate goal of Mission Indradhanush is to ensure full immunization with all available vaccines for children up to two years and pregnant women.

The Mission is strategically designed to achieving high quality routine immunization coverage while contributing to strengthening health systems that can be sustained over years to come. In the last few years, India’s full immunization coverage has increased only by 1% per year. The Mission has been launched to accelerate the process of immunization and achieve full immunization coverage for all children in the country.

The Government has identified 201 high focus districts across 28 states in the country that have the highest number of partially immunized and unimmunized children.

Mission Indradhanush will target these districts through intensive efforts and special immunization drives to improve the routine immunization coverage in the country.

The recommended immunizations for children 0-6 years of age include:

• Hepatitis B
• Rotavirus
• Diphtheria, tetanus, pertussis
• Haemophilus influenzae type B
• Pneumococcal
• Poliovirus
• Influenza
• Measles, mumps, rubella
• Varicella (chickenpox)
• Hepatitis A
• Meningococcal

Four new vaccines are being introduced as part of UIP including Inactivated Polio Vaccine (IPV), Rotavirus vaccine, Measles, Rubella (MR) vaccine, and Adult Japanese Encephalitis (JE) vaccine. With these new vaccines, India’s UIP will provide free vaccines against 12 life threatening diseases, to 27 million children annually, the largest birth cohort in the world. IPV has been introduced in six states from 30 Nov 2015 for provide double protection against Polio.

Inactivated polio vaccine (IPV) Inactivated polio vaccine (IPV) was developed in 1955 by Dr Jonas Salk. Also called the “Salk vaccine”, IPV consists of inactivated (killed) poliovirus strains of all three poliovirus types. IPV is given by intramuscular injection and needs to be administered by a trained health worker.

The inactivated polio vaccine produces antibodies in the blood to all three types of poliovirus. In the event of infection, these antibodies prevent the spread of the virus to the central nervous system and protect against paralysis.

Advantages
• As IPV is not a ‘live’ vaccine, it carries no risk of vaccine-associated polio paralysis.
• IPV triggers an excellent protective immune response in most people.

Disadvantages
• IPV induces very low levels of immunity in the intestine. As a result, when a person immunized with IPV is infected with wild poliovirus, the virus can still multiply inside the intestines and be shed in the faeces, risking continued circulation.
• IPV is over five times more expensive than oral polio vaccine.
• Administering the vaccine requires trained health workers and sterile injection equipment and procedures.

Latest Updates

1. IT in Health
To improve the healthcare system in India Information and Communication Technologies have been implemented.

Some of the initiatives are:
National eHealth Authority
National eHealth Authority (NeHA) is a proposed body as a promotional, regulatory and standards setting organization to guide and support India’s journey in e-Health and consequent realization of benefits of ICT(Information and Communication Technology) intervention in Health sector in an orderly way.

Health Management Information System
To monitor the performance and quality of the health services being provided under the NHM, it is important to introduce mechanisms that would strengthen the monitoring and evaluation systems, through performance statistics, surveys, community monitoring, quality assurance etc.
The Health Statistics Information Portal facilitates the flow of physical and financial performance from the District level to the State HQ and the Centre using a web based Health Management Information System (HMIS) interface. The portal will provide periodic reports on the status of the health sector.

Electronic Health Records
An electronic health record (EHR) is a digital version of a patient’s paper chart.
EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.
While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.
Introducing and streamlining EHR in Indian health care would help government address Health care from a futuristic approach than a causal one.

SEHAT
To provide healthcare facilities in rural areas, the government today launched a telemedicine initiative in collaboration with Apollo Hospitals under which people can consult doctors through video link.
The CSCs will also provide diagnostic services and promote sale of generic drugs through collaboration with Ministry of Health, by setting up Jan Aasudhi Stores.

Advantages of Information and Communication Technology in Health Care are:

• Improved timeliness (better quality of healthcare delivery)
• Effectiveness (right intervention / audit trails for adverse events)
• Efficiency (less resources in terms of manpower, time and cost)
• Informed patients and their caregivers
• Better access
• Diagnostic accuracy
• Reduced waiting times
• Better referral management

2. Health geo-mapping project
• Lack of authentic data on healthcare resources has long been one of the biggest impediments to health planning in India. It is universally acknowledged that doctors and health facilities are far more easily available in urban than in rural areas but there has never been an attempt in the past to quantify the gap in density and to plan accordingly.
• For the first time, the government will map health facilities, doctors and specialists available in all districts of the country. The health geo-mapping project has already been completed in four districts chosen as a pilot. When the entire country is covered, the project will cost around Rs 100 crore.
• The Bill and Melinda Gates Foundation is partnering the project.
• The four districts that have been covered by the Bill and Melinda Gates Foundation are Hazaribagh (Jharkhand), Vellore (Tamil Nadu), Dungarpur (Rajasthan) and Dimapur (Nagaland). Both government and private health facilities will be mapped, as will be availability and distribution of chemists.
• In the first phase, the government is looking at covering eight states though the names are yet to be finalised.
• The mapping of specialists would also ensure that in future planning for medical education, the skewed distribution of seats — specialties such as oncology have very few doctors passing out every year because of the low number of seats — could be addressed keeping in mind the health profile of the country.

3. Project sunrise for AIDS
• Union Ministry of Health and Family Welfare has launchedProject Sunrise on for prevention of AIDS in the 8 North-Eastern states. The funding of project is done by the Centre for Disease Control of the United States.
• The objective of this AIDS prevention project is to diagnose 90 per cent of such drug addicts with HIV and put them under treatment by 2020.

Key highlights
• The project will create more awareness about the disease in these N-E states.
• This programme will be implemented in 20 districts of the eight states including four districts of Manipur- Imphal East, Bishnupur, Ukhrul and Churachandpur.
• The project will cover one lakh people suffering with HIV/AIDS the government will provide them treatment and care facilities free of cost.
• In addition with the existing projects of the National AIDS Control Organization (NACO) it will also be implemented in the North East
• NACO will unswervingly reassign its funding to State AIDS Control Societies as a substitute of the existing system for financial support through state governments.

AIDS Control programs in India
• Setting up of State AIDS bodies in 25 states and 7 union territories in 1992.
• India’s first National AIDS Control Programme NACP-I was launched in 1992.
• National AIDS Control Organization (NACO) was put into operation.
• The National AIDS Committee was formed in the Ministry of Health and Family Welfare.

4. 2nd national Deworming initiative launched
• The Ministry of Health and family welfare has launched the national deworming initiative on the eve of the National deworming day.
• This will be a path breaking initiative focused primarily to reduce the threat of parasitic worm infections and other forms of stomach worms seen in millions of children across the nation.
• The target is to make India worm free by deworming all pre-school and school age children between the ages of 1 to 19 years. In the first phase nearly 14 crore children across 11 states and union territories will be covered and in the second phase around 10 crore will be covered the remaining will be covered by the mop up round.
• The National Deworming Initiative was launched first in 2015 in a few states of India to protect children in the age group of 1-19 form intestinal worms. This year onwards, this will cover all the states in the country.
• The target has now been extended to benefit more than 270 million children in 536 districts of the country.
• It started with implementation in 11 States and Union Territories (UTs) covering all Government and Government-aided schools and Anganwadi centres targeting children aged 1 to 19 years and now aims to cover the whole country.
• It focuses on parasitic worms which interfere with nutrient intake in children and can contribute to anaemia, malnourishment, and impaired mental and physical development.
• National Deworming Initiative will mobilise health personnel, state governments and other stakeholders to prioritise investment in control of Soil Transmitted Helminth (STH) infections, while highlighting that apart from the most effective and low-cost STH treatment of administering Albendazole tablets, behaviour change practises in terms of cleanliness and hygiene are also important to reduce incidents of re-infection.
• Community mobilisation and outreach efforts are also underway at the state and local level, to engage community-based health workers, like ASHAs, Gram Sabhas and others, to spread awareness and encourage participation in the program.

5. Rotavac vaccine:
• Rotavirus is a virus that infects the bowels. Children under five years of age, especially those between 6 months and two years are most vulnerable to this disease. Rotaviruses are estimated to be responsible for approximately 5, 27,000 deaths each year, with more than 85% of these deaths occurring in low-income countries in Africa and Asia, and over two million are hospitalized each year with pronounced dehydration.
• Rotavirus affects populations in all socio-economic groups and is equally prevalent in industrialized and developing countries.
• The new vaccine ROTAVAC has been developed under an innovative public-private partnership model. It involved partnership between the Ministry of Science and Technology, the institutions of the US Government, various government institutions and NGOs in India, supported by the Bill and Melinda Gates Foundation.
• ROTAVAC is an oral vaccine and is administered to infants in a three-dose course at the ages of 6, 10, and 14 weeks. It is given alongside routine immunizations in the UIP vaccines recommended at these ages.
• It is on the World Health Organization’s List of Essential Medicines, a list of the most important medication needed in a basic health system.

6. Smart drugs
Smart drug is a term given to those medicines or drugs which help any person to stay awake or increase one’s physical and mental capacity. Hence termed as SMART.

Reason for taking smart drugs
• Helps to keep alert
• Increase productivity
• High stress lives
• To work for long hours
• To work harder
• For studies
• Increasing efficiency in the work
• Some use as an effective way to deal with jet lags

7. Swachh Swasth Sarvatra initiative
Union Government launched Swachh Swasth Sarvatra initiative to strengthen health centres in open defecation-free (ODF) blocks. The objective of this initiative is to strengthen community health centres in 708 ODF blocks across the country to enable them to achieve higher levels of cleanliness and hygiene.

8. Swasthya Raksha Programme
The Union AYUSH Ministry has launched ‘Swasthya Raksha Programme’ to promote health and health education in villages.

Aims and objectives of Swasthya Raksha Programme

• Organize Swasthya Parikshan Camps, Swasthya Rakshan OPDs and Health and Hygiene awareness programme
• Create awareness about cleanliness of domestic surroundings and environment.
• Provide medical aid and incidental support in the adopted villages and colonies.
• Document demographic information, hygiene conditions, food habits, seasons, lifestyle etc., incidence and prevalence of disease and their relation to the incidence of disease.
• Assess health status and propagation of Ayurvedic concept of pathya-apathya and extension of health care services.

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