by Benelyne M. Balag-ey.

With currently no vaccines, therapeutic treatment or cure,

the best protection against dengue fever is to control its vector, the Aedes
Aegyptimosquito. Preventing or reducing dengue virus transmission depends entirely in
controlling the mosquito vectors or interruption of human-vector contact. WHO promotes
the strategic approach known as Integrated Vector Management (IVM) to control
mosquito vectors, including those of dengue.

IVM is defined as ‘rational decision-making process for the optimal use of resources for
vector control’ the aims are to improve efficacy, cost effectiveness, ecological soundness
and sustainability.

Control of the Aedes aegypti mosquito is extremely important as not only does this
mosquito transmit dengue fever, but it also transmit other diseases such as yellow fever
and chikungunya. There is still no universal consensus over the best method to control
the dengue mosquito.

In an effort to control the dengue virus transmission in the Cordilleras, the DOHCAR Office
acted to intensify its anti-dengue mandate through the conduct of at least three dengue
vector surveillance training for the region.

The first was conducted at Valley Hotel in La Trinidad, Benguet on June 9-11, 2014 and
was attended by the different Municipal Health Officer’s, Sanitary Inspectors and other
Health personnel from the different municipalities of Benguet. During said training, the
participants collected mosquito samples from around the strawberry fields and residences
in the nearby area. Results from these samples showed that they are high risk for dengue
transmission because of the presence of the dengue vector. This means that there is a
potential rise of dengue cases once persons fall prey to these mosquitoes.

Another training also followed in Bangued, Abra last June 17-19, 2014 and at Banaue,
Ifugao last July 22-24, 2014. The results of the mosquito samples taken in these trainings
were likewise high risk for dengue transmission. The participants learned how to identify
the dengue mosquito using microscope.

These trainings were aimed at bringing forth awareness to the public and health workers
alike that fighting dengue is everybody’s concern. the campaign of the DOH such as the
the “Four o’clock habit”, search and destroy” were once reiterated to all participants. They
were expected to practice, teach or re-echo in their respective areas after the training.

These training activities were conducted in line with the Asean Dengue Day Celebration
which was hosted this year by the Philippines last June 15, 2014 in Clark Pampanga and
also to commemorate the Dengue Awareness Month slated every month of June.
DENGUE PREVENTION AND CONTROL PROGRAM

BACKGROUND

Dengue is the fastest spreading vector-borne disease in the world endemic in 100 countries·

 Dengue virus has four serotypes (DENV1, DENV2, DENV3 and DENV4)

 First infection with one of the four serotypes usually is non-severe or asymptomatic, while
second infection with one of other serotypes may cause severe dengue.

 Dengue has no treatment but the disease can be early managed.

 The five year average cases of dengue is 185,008; five year average deaths is 732; and five year
average Case Fatality Rate is 0.39 (2012-2016 data).

TRANSMISSION

Dengue virus is transmitted by day biting Aedes aegypti and Aedes albopictus mosquitoes.

DENGUE CASE CLASSIFICATION AND LEVEL OF SEVERITY

 Dengue illness is categorized according to level of severity as dengue without warning signs,
dengue with warning signs and severe dengue.

 Dengue without warning warnings can be further classified according to signs and symptoms
and laboratory tests as suspect dengue, probable dengue and confirmed dengue.

a. dengue without warning signs

a.1 suspect dengue

- a previously well individual with acute febrile illness of 1-7 days duration plus two of the following:
headache, body malaise, retro-orbital pain, myalgia, arthralgia, anorexia, nausea, vomiting, diarrhea,
flushed skin, rash (petechial, Hermann’s sign)

a.2 probable dengue

- a suspect dengue case plus laboratory test: Dengue NS1 antigen test and atleast CBC (leukopenia with or
without thrombocytopenia) or dengue IgM antibody test (optional)

a.3 confirmed dengue

- a suspect or probable dengue case with positive result of viral culture and/or Polymerase Chain Reaction
(PCR) and/or Nucleic Acid Amplification Test- Loop Mediated Amplification Assay (NAAT-LAMP) and/
or Plaque Reduction Neutralization Test (PRNT)

b. dengue with warning signs

• a previously well person with acute febrile illness of 1-7 days plus any of the following: abdominial pain
or tenderness, persistent vomiting, clinical signs of fluid accumulation (ascites), mucosal bleeding, lethargy
or restlessness, liver enlargement, increase in haematocrit and/or decreasing platelet count

c. severe dengue

severe plasma leakage leading to

 shock (DSS)

 fluid accumulation with respiratory distress

severe bleeding

 as evaluated by clinician

severe organ impairment

 Liver: AST or ALT ≥ 1000

 CNS: e.g. seizures, impaired consciousness
 Heart:and other organs (i.e. myocarditis, renal failure)

PHASES OF DENGUE INFECTION

a. Febrile Phase
 Usually last 2-7 days
 Mild haemorrhagic manifestations like petechiae and mucosal membrane bleeding (e.g
nose and gums) may be seen.
 Monitoring of warning signs is crucial to recognize its progression to critical phase.
b. Critical Phase
 Phase when patient can either improve or deteriorate.
 Defervescence occurs between 3 to 7 days of illness. Defervescence is known
as the period in which the body temperature (fever) drops to almost normal
(between 37.5 to 38°C).
 Those who will improve after defervescence will be categorized as Dengue
without Warning Signs, while those who will deteriorate will manifest warning
signs and will be categorized as Dengue with Warning Signs or some may
progress to Severe Dengue.
  When warning signs occurs, severe dengue may follow near the time of
defervescence which usually happens between 24 to 48 hours.
c. Recovery Phase
 Happens in the next 48 to 72 hours in which the body fluids go back to normal.
 Patients’ general well-being improves.
 Some patients may have classical rash of “isles of white in the sea of red”.
 The White Blood Cell (WBC) usually starts to rise soon after defervescence but the normalization
of platelet counts typically happens later than that of WBC.

MANAGEMENT (based on patient type)

1. Group A- patients who may be sent home

These are patients who are able to:

 Tolerate adequate volumes of oral fluids

 Pass urine every 6 hours
 Do not have any of the warning signs particularly when the fever subsides
 Have stable haematocrit
2. Group B- patient who should be referred for in-hospital management

Patients shall be referred immediately to in-hospital management if they have the following conditions:

Warning signs\
Without warning signs but with co-existing conditions that may make dengue or its management
more complicated ( such as pregnancy, infancy, old age, obesity, diabetes mellitus, hypertension,
heart failure, renal failure, chronic haemolytic diseases such as sickle- cell disease and autoimmune
diseases, etc.)
 Social circumstances such as living alone or living far from health facility or without a reliable
means of transportation.
 The referring facility has no capability to manage dengue with warning signs and/or severe dengue.
3. Group C- patient with severe dengue.requiring emergency treatment and urgent referral

These are patients with severe dengue who require emergency treatment and urgent referral because they are in the
critical phase of the disease and have the following:

 Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress;
 Severe haemorrhages;
 Severe organ impairment (hepatic damage, renal impairment, cardiomyopathy, encephalopathy or
encephalitis)

Patients in Group C shall be immediately referred and admitted in the hospital within 24 hours.

LABORATORY TESTS

Test
 Requested between 1-5 days o
1. Dengue NS1 RDT  Use to detect dengue virus ant
 Test is for free in all health ce
  Requested beyond five days o
 Use to detect dengue antibodie
2. Dengue IgM/IgG  May give false positive result
 May cross react with other arb
 DOH augmentation is limited
 One of the gold standard labor
3. Polymerase Chain Reaction (PCR)  Molecular based test confirma
 Available only in dengue sub-
 A novel molecular-based conf
4. Nucleic Acid Amplification Test- Loop Mediated Isothermal Amplification Assay (NAAT-LAMP)  Work just like PCR but cheap
 In the pipeline to be introduce
 Gold standard to characterize
5. Plaque Reduction Neutralization Test (PRNT)
 Available only at the dengue n
6. Other tests:

-Total While Blood Cell (WBC) count

 Routinely used in hospitals as
 Look for trend of decreasing W
-Platelet

-Hematocrit

NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM

Vision A dengue free Philippines

Mission Ensure healthy lives and promote well-being for all at all ages

Goal To reduce the burden of dengue disease

Objectives/ 1.) To reduce dengue morbidity by atleast 25% by 2022

Indicators Morbidity rate = No. of suspect, probable & confirmed cases x100,000

total population

(baseline: 198.1 per 100,000 population)

(2015 data: 200,145/100,981,437 x 100,000)

2.) To reduce dengue mortality by atleaset 50% by 2022

Mortality rate = No of dengue (probable & confirmed) deaths x 100,000

total population

(baseline: 0.59 per 100,000 population)

 (2015 data: 598/100,981.437 x 100,100)

3.) To maintain Case Fatality Rate (CFR) to < 1% every year.

CFR = no. of dengue (probable & confirmed) deaths x 100

no. of probable & confirmed cases

PROGRAM COMPONENTS

1. Surveillance
 Case Surveillance through Philippine Integrated Disease Surveillance and Response
(PIDSR)
 Laboratory-based surveillance/ virus surveillance through Research Institute for Tropical
Medicine (RITM) Department of Virology, as national reference laboratory, and sub-
national reference laboratories.
 Vector Surveillance through DOH Regional Offices and RITM Department of
Entomology

2. Case Management and Diagnosis

 Dengue Clinical Management Guidelines training for hospitals.

 Dengue NS1 RDT as forefont diagnosis at the h ealth center/ RHU level.
 PCR as dengue confirmatory test available at the sub-national and national reference
laboratories.
 NAAT-LAMP as one of confirmatory tests will be available at district hospitals,
provincial hospitals and DOH retained hospitals.

3. Integrated Vector Management (IVM)

 Training on Vector Management, Training on Basic Entomology for Sanitary Inspector,

Training on Integrated Vector Management (IVM) for health workers.
 Insecticide Treated Screens (ITS) as dengue control strategy in schools.

4. Outbreak Response

 Continuous DOH augmentation of insectides such as adulticides and larvicides to LGUs

for outbreak response.

5. Health Promotion and Advocacy

 Celebration of ASEAN Dengue Day every June 15

 Quad media advertisement
 IEC materials

6. Research
STRATEGIES

 Enhanced 4S Strategy

S - earch and Destroy

S - eek Early Consultation

S - elf Protection Measures

S - ay yes to fogging only during outbreaks

LINKS TO PROGRAM POLICIES AND GUIDELINES

AO 2016-
Guidelines for the nationwide Implementation of Dengue Rapid Diagnostic Test
0043
AO 2012-006 Revised Dengue Clinical Management Guidelines
Guidelines on the Application of Larvicides on the Breeding Sites of Dengue Vector M
AO 2001-0045
Domestic Water
Implementation Guidelines for Initial Implementation of Nucleic Acid Amplification A
DM 2017-0353 Mediated Isothermal Assay (LAMP) as One of Dengue Confirmatory Tests to Support
RDT
Reactivation of Dengue Fast Lanes and Continuing Improvement of Systems for Deng
DM 2015-0309
Management and Services
Technical Guidelines, Standards and other Instructions for Reference in the Implement
DM 2014-0112
Sentinel-based Active Dengue Surveillance

DOH calls on public to

search and destroy mosquito
breeding sites
on August 25, 2015
BAGUIO CITY (PIA) – – The Department of Health (DOH) calls on the public anew to
practice the search and destroy campaign against possible mosquito breeding sites as
monitoring shows rise in Dengue cases regionwide.
 DOH Cordillera Regional Director Dr. Amelita Pangilinan, in a kapihan forum last week,
reported a total of 2,383 Dengue cases from January to August 8, which is 103 percent
increase compared to the recorded cases during the same period last year.

Based on the DOH Surveillance Report, increase in cases was noted in all the six
provinces in the region, including Baguio City.

In terms of most number of cases, Benguet recorded the highest with 544, followed by
Baguio City with 332, Mountain Province (314), Abra (289), Kalinga (276), Apayao (252)
and Abra with 85. There were also 291 dengue patients from outside the region that
were recorded treated in Cordillera hospitals.

Three dengue- related deaths were also recorded in Cordillera- an 85 year old male
from San Jose, Luna, Apayao, a seven year old from Rosario, La Union and an 89 year
old male from Cervantes, Ilocos Sur.

Pangilinan reminds local government units, barangay officials and the general public of
the “Search and Destroy” advocacy against dengue which involves getting rid or
cleaning all possible mosquito breeding sites in the communities .

Pangilinan shared that she just came from Kalinga where there is saturation of Dengue
patients in the provincial hospital. But one good news is that one municipality,
Pinukpuk, has no reported Dengue case as the LGU and the community initiated anti-
dengue campaign as early as February of this year.
DESCRIPTION:
Dengue is known to be transmitted primarily by a mosquito vector Aedes Aegypti, and in some instances, by Aedes albopictus.The
dengue viruses are of two (2) genotypes – Asian 2 and Cosmopolitan; and four (4) serotypes - DEN1, DEN2, DEN3 and DEN4
which are circulating in the Philippines. Humans are the main host of the virus. The virus circulates in The blood of infected humans
for 2-7 days, at approximately the same time as they have fever. The extrinsic incubation period lasts from 8 to 12 days while the
intrinsic incubation period covers 5 to 7 days.

VISION
A DENGUE-DEATH FREE PHILIPPINES

MISSION
To reduce the burden of dengue as a disease on the physical, mental, emotional, social and economic well-being of Filipinos

OBJECTIVES
1. To enhance Philippine Dengue Prevention and Control
a. Program ( PDPCP ) management and implementation
b. capacity of national, regional and local levels
2. To expand coverage of quality anti-dengue preventive
. and control services
3. To improve compliance to national and local policies in
. dengue prevention control
4. To reduce financing of dengue from out-of- pocket
. source
PROGRAM COMPONENTS

TARGET POPULATION/CLIENT

AREA OF COVERAGE

PARTNER INSTITUTIONS

POLICIES AND LAWS

STRATEGIES, ACTION POINTS, AND TIMELINE

Objective 1 strategies :
Strategy 1 – Establish good governance practices and management
system in support to dengue prevention and control
in the DOH and LGUs
Strategy 2 – Generate and utilize quality and timely information for
PDPCP policy direction, planning, implementation and
Management

Objective 2 strategies :
Strategy 3 – Expand and sustain the provision of quality diagnostic and treatment services
Strategy 4 – Promote behavior change among communities towards practice of early consults and responsive personal
and environmental vector prevention practices
Strategy 5 – Operationalized area stratified integrated vector management

Objective 3 strategies :
Strategy 6 – Institutionalize mechanism to ensure PDPCP protocol compliant LGUs

Objective 4 strategies :
Strategy 7 – Support financing schemes to reduce out-of-pocket expenses for dengue especially among the poor
STRATEGY 8 – strengthen advocacy and mobilization of support and involvement of all concerned
partners at various levels

PROGRAM ACCOMPLISHMENTS/STATUS
 Search and destroy activities in school s ( RONDA ESKWELA)
 Intensify dengue information campaign through radio plugging and Newsprint publication on “4 S Laban Sa dengue”
 Distribution of Dengue IEC Materials both for public and private Schools
 School-based dengue free zone project expansion