Epidemiology & prevention of Dengue Fever by

DR AMIR IQBAL MEDICAL SPECIALIST SOCIAL SECURITY HOSPITAL LAHORE.

Dengue Fever

Dengue virus Most prevalent vectorborne viral illness in the world Main mosquito vector is Aedes aegypti Year round transmission

Incidence

50-100 million dengue fever infections per year globally 500,000 cases of severe dengue, dengue hemorrhagic fever or dengue shock syndrome 100-200 cases annually in U.S. Average case fatality 5%

Distribution

Endemic in more than 100 tropical and subtropical countries Pandemic began in Southeast Asia after WW II with subsequent global spread Several epidemics since 1980s Distribution is comparable to malaria

Virology

Flavivirus family Small enveloped viruses containing single stranded positive RNA Four distinct viral serotypes (Den-1, Den-2, Den-3, Den-4)

Mosquito Borne Illnesses

Protozoa: Malaria Filariasis, dirofilariasis Alphaviruses: Chikungunya fever, Mayaro fever, Ross River fever, Eastern, Western, and Venezuelan equine encephalitis Flaviviruses: West Nile fever, Zika fever, St. Louis encephalitis, Japanese encephalitis, Yellow Fever Bunyaviruses: LaCrosse encephalitis, Oropouche virus, Bwamba fever, California encephalitis

Pathophysiology

Transmitted by the bite of Aedes mosquito (Aedes aegypti) Incubation 3-14 days Acute illness and viremia 3-7 days Recovery or progression to leakage phase

Clinical Presentation

Spectrum of illness non-specific febrile illness classic dengue dengue hemorrhagic fever dengue shock syndrome other (CNS dysfunction, liver failure, myocarditis)

Prevention
Dengue

control programmes in the Region have in general not been very successful, primarily because they have relied almost exclusively on space spraying of insecticides for adult mosquito control. However, space spraying requires specific operations which were often not adhered to, and most countries found it cost prohibitive. In order to achieve sustainability of a successful DF/DHF vector control programme, it is essential to focus on larval source reduction,

Developing economies in countries of the SouthEast Asia Region have recognized many social, economic and environmental problems which promote mosquito breeding. The dengue problem thus exceeds the capabilities of ministries of health. The prevention and control of dengue requires close collaboration and partnerships between the health and non-health sectors (both government and private), nongovernmental organizations (NGOs) and local communities. During epidemics such cooperation becomes even more critical, since it requires pooling of resources from all groups to check the spread of the disease.

Prevention
Personal: clothing to reduce exposed skin insect repellent especially in early morning, late afternoon. Bed netting is of little utility. Environmental: reduced vector breeding sites solid waste management public education

Prevention
Biological: Target larval stage of Aedes in large water storage containers Larvivorous fish (Gambusia), endotoxin producing bacteria (Bacillus), copepod crustaceans (mesocyclops) Chemical: Insecticide treatment of water containers Space spraying (thermal fogs)

PREVENTION
Personal

level Household level Mohalla level City level

Personal level (stop mosquito bites)

Cover

arms and legs especially late evenings Re-enforce door/window nettings Use mosquito repellant device Apply mosquito repellant cream: only DEET(N, N diethyl-3 methylbenzamide) is effective in strength of 24% up to 5 hours

Household level

Clean and dry any breeding sites inside or outside the house Shake, spray curtains, bundles of clothes, shoes, bags, inside cupboards, behind sofas Outside: ornamental pools, fish or lotus ponds in gardens, overhead and underground water tanks Change water in flower vases, bamboo plants, money plants every 3-5 days Larvaea-eating fish in lakes and ponds should be researched

Mohalla level

Form groups/committees to go out and check on breeding places in your neighbourhood Mosquitoes breed in ANY standing water. Clean up garbage; empty bottles, tins, tyres and any thing in which water can collect. Remove water that collects under the flower/plant containers, AC and fridge. Cover toilet commodes Keep all water storage containers e.g. tanks and mutkas covered. Scrub matkas and other utensils for water storage at least weekly.

City Level
Insecticide

spray is impractical, uneconomical and not sustainable. Even if done properly it kills adult mosquitoes not larvae Dry up ponds, rain water collection Repair leaky water pipes Repair clogged drainage Repair pot holes and ditches

Vaccination

No current dengue vaccine Estimated availability in 5-10 years Vaccine development is problematic as the vaccine must provide immunity to all 4 serotypes Lack of dengue animal model Live attenuated tetravalent vaccines under phase 2 trials New approaches include infectious clone DNA and naked DNA vaccines