Dengue and Malaria

By Nishan Kharel
Msc PHDE
Public Health
Pokhara University
Introduction
• Dengue and malaria are the two very common, mosquito-borne infections, which may have
significant morbidity and mortality if not managed properly.
• In general, malaria is a protozoa infection, the pathogen is one of five human pathogenic species of
Plasmodium. The main mosquito vector is Anopheles.
• Whereas dengue is a viral infection. The pathogen is dengue virus (DENV). The main mosquito
vector is Aedes.
• Both diseases can cause acute febrile illness. However, malaria can be chronic while dengue
cannot.
• It is no doubt that in a tropical country, the high prevalence of malaria and dengue can be seen.
However, concurrent malaria and dengue infection is not common.
• Concurrent malaria and dengue infection is a scenario that both malaria and dengue exists in a
patient at the same time.
Causes
Dengue
• Caused by the bite of a Aedes Mosquito
causing a viral infection in a human being.
These mosquitos are known to bite in daylight
hours.
• The virus responsible for causing dengue, is
called dengue virus (DENV). There are four
DENV serotypes, meaning that it is possible
to be infected four times.
• The virus cannot be transmitted from human
to human.
Malaria
• Caused by Plasmodium parasites. The
parasites are spread to people through the bites
of infected female Anopheles mosquitoes,
called "malaria vectors."
• There are 5 parasite species that cause malaria
in humans, and 2 of these species – P.
falciparum and P. vivax – pose the greatest
threat.
Symptoms/Signs
Dengue Malaria
• Sudden, high fever • Shaking chills that can range from moderate to
severe
• Severe headaches
• Pain behind the eyes • High fever

• Severe joint and muscle pain • Profuse sweating

• Headache
• Fatigue
• Nausea • Nausea

• Vomiting • Vomiting
• Abdominal pain
• Skin rash, which appears two to five days after
the onset of fever • Diarrhea
Risk Factors (Agent, Host and Environment)
Dengue
Agents & Vectors
 Aedes aegypti and Aedes Albopictus are the two most important vectors of dengue.
 Both the mosquitoes carry vectorial competency for dengue virus (high susceptibility to infecting
virus, ability to replicate the virus and ability to transmit the virus to another host.
 Causative agent is the dengue virus (DEN) single-stranded RNA viruses of the genus Flavivirus,
comprises four distinct serotypes (DEN-1, DEN-2, DEN-3 and DEN-4).
 Infection with any one serotype confers a life long immunity to that serotype.
Cont.…
Host
 Humans are the only vertebrate hosts of the virus. There is a jungle cycle between monkeys and mosquitoes,
but this plays no role in human disease.
 Infective Stage: 1 day before onset of fever to day 5
 Intrinsic Incubation Period: 4- 6 days
 The People of all ages and both genders are at risk (more in <15 yrs. age groups & in females)
 High Risk Patients: Extremes of Age, Pregnancy, Any condition prone to heavy blood loss, Peptic ulcer
disease, menstruation, haemolytic anaemia.
Environmental Factors
• Tropical& Sub- tropical
• Rapid Unplanned uncontrolled urbanization,
• Transportation: human movement and congregation
• Consumerism- Non biodegradable plastic, mismanaged solid waste disposal
• Poor water storage and management
• Seasonal Pattern: Post Monsoon
Malaria
Agents & Vectors
• Malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400
different species of Anopheles mosquito; around 30 are malaria vectors of major importance.
• Malaria in man is caused by four distinct species of the malaria plasmodium parasite.
• Plasmodium vivax, Plasmodium falciparum, Plasmodium malariae & Plasmodium ovale.
Host
• The parasite has a complex, multistage life cycle occurring within two living beings, the vector
mosquitoes and the vertebrate hosts.
• Mosquitoes are the definitive hosts for the malaria parasites, wherein the sexual phase of the
parasite’s life cycle occurs
• Man is the intermediate host for malaria, wherein the asexual phase of the parasite’s life cycle
occurs.
• Malaria affects all ages. Newborn infants have considerable resistance to infection due to a high
concentration of foetal haemoglobin during the first months of life.
• Males are more frequently exposed more than females due to their outdoor life. • Females are
better clothed than males.
Cont.…
Environmental Factors
 Climate influences density, longevity, and behaviours of vectors and duration of sporogony
 Rainfall influences the number of breeding places and their characteristics
 Role of impounding reservoirs, irrigations canals and seepage of water from canals
 High temperature and humidity
• Lower survival of mosquitoes
• Affect blood meal frequency
• Affect sporogony
Diagnosis
Dengue Malaria
• Several methods can be used for diagnosis of • All cases of suspected malaria can be
DENV infection. These include virological confirmed using parasite-based diagnostic
tests (that directly detect elements of the testing (either microscopy or rapid diagnostic
virus) and serological tests (detect human- test) before administering treatment.
derived immune components that are • Results of parasitological confirmation can be
produced in response to the virus). available in 30 minutes or less.
• The virus may be isolated from the blood
during the first few days of infection. Various
reverse transcriptase–polymerase chain
reaction (RT–PCR) methods are available.
• Serological methods, such as enzyme-linked
immunosorbent assays (ELISA), may confirm
the presence of a recent or past infection, with
the detection of IgM and IgG anti-dengue
antibodies.
Treatment
Dengue
• There is no specific treatment for dengue
fever.
• Fever reducers and pain killers can be taken to
control the symptoms of muscle aches and
pains, and fever. The best options to treat
these symptoms are acetaminophen or
paracetamol.
• For severe dengue, medical care by physicians
and nurses experienced with the effects and
progression of the disease can save lives –
decreasing mortality rates from more than
20% to less than 1%.
Malaria
• Early diagnosis and treatment of malaria reduces
disease and prevents deaths. It also contributes to
reducing malaria transmission.
• The best available treatment, particularly for P.
falciparum malaria, is artemisinin-based
combination therapy (ACT).
• RTS,S/AS01 (RTS,S) is the first and, to date, the
only vaccine to show that it can significantly reduce
malaria, and life-threatening severe malaria, in
young African children
• It acts against P. falciparum, the most deadly malaria
parasite globally and the most prevalent in Africa.
Preventive Measures
Prevention of mosquito breeding:
• Preventing mosquitoes from accessing egg-laying habitats by environmental management and
modification.
• Disposing of solid waste properly and removing artificial man-made habitats that can hold water
• Covering, emptying and cleaning of domestic water storage containers on a weekly basis.
• Applying appropriate insecticides to water storage outdoor containers.
Personal protection from mosquito bites:
• Using of personal household protection measures, such as window screens, repellents, insecticide
treated materials, coils and vaporizers. These measures must be observed during the day both
inside and outside of the home (e.g.: at work/school) because the primary mosquito vectors bites
throughout the day;
• Wearing clothing that minimizes skin exposure to mosquitoes is advised
Cont.…
 Community engagement:
• Educating the community on the risks of mosquito-borne diseases.
• Engaging with the community to improve participation and mobilization for sustained vector
control.
Reactive vector control:
• Emergency vector control measures such as applying insecticides as space spraying during
outbreaks may be used by health authorities.
Active mosquito and virus surveillance:
• Active monitoring and surveillance of vector abundance and species composition should be carried
out to determine effectiveness of control interventions.
• Prospectively monitor prevalence of virus in the mosquito population, with active screening of
sentinel mosquito collections.
Prevalence
Dengue
• A study on the prevalence of dengue estimates
that 3.9 billion people in 128 countries are at
risk of infection with dengue viruses.
Malaria
• Globally about 3.2 billion people are at risk of
malaria and an estimated 212 million cases
were reported worldwide, leading to 429,000
deaths in 2015, particularly in parts of sub-
Saharan Africa and South Asia, Latin America
and the Middle East countries.
Incidence
Dengue
Malaria
• There are an estimated 100-400 million • According to the latest World malaria report,
infections each year. released in December 2019, there were 228
• The number of dengue cases reported to WHO million cases of malaria in 2018 compared to
increased over 8 fold over the last two 231 million cases in 2017.
decades, from 505,430 cases in 2000, to over
2.4 million in 2010, and 4.2 million in 2019. • The estimated number of malaria deaths stood
at 405 000 in 2018, compared with 416 000
• The first dengue fever case was reported on deaths in 2017.
May 13, 2019, from the Sunsari district in the
east of the country followed by Makwanpur, • In Nepal, the incidence of malaria has now
southwest of Kathmandu, on July 27, 2019. been reduced to 4,000-5,000 cases from about
• As of late September, 2019, more than 10 000 15,000 cases annually
cases of dengue fever and six deaths were
officially reported by the Epidemiology and
Disease Control Division, Ministry of Health,
Kathmandu, Nepal.
Global Distribution of malaria, 2018
National and International Policies
Dengue
WHO responds to dengue in the following ways:
• supports countries in the confirmation of
outbreaks through its collaborating network of
laboratories.
• provides technical support and guidance to
countries for the effective management of
dengue outbreaks.
• supports countries to improve their reporting
systems and capture the true burden of the
disease.
• provides training on clinical management,
diagnosis and vector control at the country and
regional level with some of its collaborating
centres.
Malaria
• In response to the increasing malaria burden and
the opportunities presented by new tools, the
Roll Back Malaria (RBM) Partnership1 was
launched in 1998, with the aim of reducing the
malaria burden by at least 50% by the year 2010.
• The WHO Global Malaria Programme (GMP) is
responsible for coordinating WHO's global
efforts to control and eliminate malaria.
• The American Red Cross, CDC, and the UN
Foundation with support from the Federation,
WHO and UNICEF, is working with Ministries
of Health and national governments for
worldwide vaccines program.
THANK YOU