Dengue Fever Prevention and Control

Saleem M. Rana, PhD

The Dengue Fever a Global Problem

During epidemics of dengue, infection rates among those who have not been previously exposed to the virus are often 40% to 50%, but can reach 80% to 90%. An estimated 500 000 people with DHF require hospitalization each year, a very large proportion of whom are children. About 2.5% of those affected die. Without proper treatment, DHF fatality rates can exceed 20%. Wider access to medical care from health providers with knowledge about DHF - physicians and nurses who recognize its symptoms and know how to treat its effects can reduce death rates to less than 1%.

Aedes aegypti

Aedes albopictus

Aedes aegypti

Aedes albopictus

Behavior

Day-time biter Lives outside

But comes indoors May lay eggs indoors Anything that can hold water

Lays eggs in artificial containers

Rests in low, shaded areas.

Under tables, chairs In machinery- if damp

More behavior

Day-time biter also in lighted rooms at night. Silent flier no buzz in your ear. Very gentle on skin and not easily felt biting. Adults not active under 15-16 degrees. Adults not killed by cold, just go inactive. Eggs laid containers of water Egg to Larva to Adult in one week or less.

Movies

Comparison of Aedes (Larvae)

Characters
ANTENNAE HEAD THORAX COMB SCALES SIPHON GILLS
Ae. aegypti
single hair near middle upper & lower hairs single heavy hooks on sides pitchfork-shaped; 7-12 in 1 row index 2.0; pectin evenly spaced all the same length, rounded; longer than anal segment

Ae.albopictus
single hair near saddle upper & lower hairs single weak or no hooks on side thorn-like; in 1 row pectin evenly spaced all the same length, rounded; longer than anal segment

Comparison of Aedes (Adult)

Characters
PALPS PROBOSCIS SCUTUM THORAX WINGS ABDOMEN HIND LEGS
dark dark with white lyreshaped pattern dark with patches of white scales dark dark with narrow white basal bands dark with white basal bands

Ae. aegypti
dark with white tip; clypeus white

Ae.albopictus
dark with white tip; clypeus black dark dark with white median stripe dark with patches of white scales dark dark with narrow white basal bands dark with white basal bands

Possible Weapons to Fight Dengue Fever

Drugs that kill the virus in humans Insecticides that kill the mosquito vector Vaccines

1. Drugs
No specific anti viral Symptomatic treatment

2. Insecticides:
Mosquitoes Quickly Acquire Resistance
Before During After

Biologic niche intact

Mosquitoes return

3. Vaccine
Does not exist (yet)

Mosquito Breeding

No comments

Before sunrise

Near sunset

Symptoms
Dengue fever is a flu-like illness with varying characteristics:
Infants and youths often experience an undifferentiated febrile disease with rash. Older children and adults may have a mild febrile syndrome but more typically experience:
high fever, severe headache, pain behind the eyes, muscle and joint pains and rash.

Typically, a person will develop dengue fever as a result of initial exposure to one serotype. Upon recovery, a patient develops immunity to this single serotype.

SYMPTOMS
Upon second infection with a different serotype:
the patient stands a greater risk of developing dengue haemorrhagic
fever (DHF), a more serious and potentially fatal disease.
DHF is characterized by:

High fever, haemorrhagic phenomena, enlarged liver and circulatory failure. o A sudden onset of fever is the first indication of DHF, accompanied by facial flush and other symptoms of dengue fever. o The fever persists for 2-7 days and can reach 41 C, followed by febrile convulsions and haemorrhagic phenomena.

SYMPTOMS
The patient may recover and symptoms abate. But if left untreated, the patient may go into shock (DSS) with a rapid, weak pulse, followed by signs of circulatory failure such as cool, blotchy skin. Without proper treatment, the patient may die within 12-24 hours.

Strategies for Dengue Control

National Strategy.
VECTOR CONTROL

SOLID WASTE MANAGEMENT

SURVEILLANCE

DENGUE CELL

CASE MANAGEMENT

ACSM

CAPACITY BUILDING

Control Strategy
Selective integrated vector control, with community and intersectoral participation Active disease surveillance based on a strong health information system-involves clinical and laboratory-based vector surveillance for monitoring and evaluation of control programmes.

Control Strategy
Emergency preparedness for development of emergency and contingency plans, including education of the medical community, hospitalization plans, case management and emergency vector control. Capacity building and training for surveillance, laboratory diagnosis, case management and vector control at professional, supervisory, technical and field levels. Vector control research including studies on vector biology and control, disease relationships, design and management of control programmes (including social and economic approaches) and cost benefit analyses. The relative impact of the components of integrated vector control require further elucidation.

Problems And Challenges

demographic changes
uncontrolled population growth Mobility unplanned urbanization. man-made larval habitats e.g. household water storage
containers, discarded solid waste items, such as plastics, glass containers and used automobile tyres.

NEW APPROACH:
GENETIC MODIFICATION OF MOSQUITOES

1 ) G E N E T I C A L LY E N G I N E E R M O S Q U I TO E S

TO M A K E T H E M R E S I S TA N T TO V I R U S

2)

I N T R O D U C E T H E R E F R A C TO RY G E N E ( S ) I N TO M O S Q U I TO P O P U L AT I O N S

LESS TRANSMISSION

LESS DENGUE FEVER

DF +ve cases larvae IRS 100 8080

Aedes egypti Fogging

Aedes albopictus larvicide 93 67 60 27 7 3rd week 96 60 31 24 12 36 20

88

86 71 57 24 2727

40 33

40 20

33 19

1st week

2nd week

4th week

Monthly Temperature, Rainfall and DF 2008 in Lahore

Correlation between dengue fever prevalence, vector density and control activities 2008 in Lahore

Annual correlation between dengue fever, temperature and rainfall 2008 in Lahore

Message
Start Active disease surveillance based on : a strong health information system to involves the clinical and laboratory-based dengue surveillance for early detection of epidemics, and Develop a quick reporting system from:
FLCF ----EDOH---DGHS

vector surveillance for monitoring and evaluation of control programmes. Aware the Community

Thanks