dengue fever and how to prevent it

Dengue fever is a virus infection caused by the dengue virus. There are 4 kinds of dengue viruses.

What is dengue fever?

Close up of Aedes aegypti Mosquito

50-100 million dengue fever infections per year globally

500,000 cases of severe dengue, dengue hemorrhagic fever or dengue shock syndrome

Average case fatality 5%

Incidence

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.

Distribution

Most Common Preys of Mosquito BitePeople of Humid Areas

• New infections annually: 50 million• Deaths: 24,000 annually• People at risk: 2.5-3 billion• Hospitalized cases: 500 000/year

(90% of those affected are children)• Disease burden: 465,000 DisabilityAdjusted Life Years (DALY)

GLOBAL STATUS

Aedes mosquito

Aedes aegypti Aedes albopictus

Symptoms of Dengue Fever

Dengue fever and dengue hemorrhagic fever are the most common mosquito-borne viral disease in the world.

Only the female mosquito feeds on blood. This is because they need the protein found in blood to produce eggs. Male mosquitoes feed only on plant nectar.

Do you know…

The mosquito is attracted by the body odors, carbon dioxide and heat emitted from the animal or humans.

•The female Aedes mosquito searches for suitable places to lay their eggs.

•Aedes are day-biters, most active during dawn and dusk.

Do you know…

Life Cycle Of Aedes Aegypti 14-21 days

4-5 Days 2 – 3 Days Eggs =300LarvaePupae

1-2 Days

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

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

Manifestation Of Dengue Virus Infections

ASYMPTOMATIC

DSS

SYMPTOMATICWithout haemorrhage

With unusual haemorrhage

No shock

Undifferentiated Fever

Dengue Fever

DengueHaemorrhagicFever

May be the most common manifestation of dengue

Prospective study found that 87% of students infected were either asymptomatic or only mildly symptomatic

Other prospective studies including all age- groups also demonstrate silent transmission

DS Burke, et al. A prospective study of dengue infections in Bangkok. Am J Trop Med Hyg 1988; 38:172-80.

A) Undifferentiated Fever

Skin hemorrhages: petechiae, purpura, ecchymoses Gingival bleeding Nasal bleeding Gastro-intestinal bleeding:

hematemesis, melena, hematochezia Hematuria Increased menstrual flow

2B)Hemorrhagic Manifestationsof Dengue

purpura petechiae

Gingival bleeding Nasal bleeding

hematemesis

1. Fever, or recent history of acute fever2. Hemorrhagic manifestations3. Low platelet count (100,000/mm3 or less)4. Objective evidence of “leaky capillaries:”

◦ elevated hematocrit (20% or more over baseline)

◦ low albumin◦ pleural or other effusions

C1) Clinical Case Definition forDengue Hemorrhagic Fever

Abdominal pain - intense and sustained Persistent vomiting Abrupt change from fever to hypothermia,

with sweating and prostration Restlessness or somnolence

Martínez Torres E. Salud Pública Mex 37 (supl):29-44, 1995.

Danger Signs inDengue Hemorrhagic Fever

Fluids Rest Antipyretics (avoid aspirin and non-steroidal

anti-inflammatory drugs) Monitor blood pressure, hematocrit, platelet

count, level of consciousness

Treatment of Dengue Fever & DHF I & II

All above treatment + – In case of severe bleeding, give fresh whole blood

20 ml/kg as a bolus – Give platelet rich plasma transfusion exceptionally

when platelet counts are below 5,000–10,000/ mm3 .

– After blood transfusion, continue fluid therapy at 10 ml/kg/h and reduce it stepwise to bring it down to 3 ml/kg/h and maintain it for 24-48 hrs

Treatment of DHF III & IV

Papaya Juice vs. Dengue ? Raw papaya leaves, 2 pcs just cleaned and pound and

squeeze with filter cloth. You will only get one tablespoon per leaf. So two tablespoon per serving once a day.

Do not boil or cook or rinse with hot water, it will loose its strength. Only the leafy part and no stem or sap.

Source: from Indonesia March 2005

Treatment of Dengue Fever

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

Timings Of the Mosquito Bite

Dawn Dusk

People Sleeping In Open Areas

People with more exposure

Common Sites of Aedes Growth

LEVELS OF DENGUE CONTROL

A. STATE/ GOVERNMENT LEVEL MEASURES

B. COMMUNITY LEVEL MEASURES

C. INDIVIDUAL MEASURES

1. ERADICATION OF MOSQUITO BREEDING SITES & MOSQUITO ERADICATION

1. FORMULATE A HEALTH RELATED REPRESENTAIVE BODY

1. SHEILDING THE HOME , OWNSELF & FAMILY FROM MOSQUITOES

2. STOP FORMATION OF MOSQUITO BREEDING SITES & DO MOSQUITO ERADICATION

2. MOSQUITO ERADICATION

2. HEALTH EDUCATION 3. PARTICPATION IN HEALTH PROGRAMMES

3. EDUCATING MEMBERS OF FAMILY

3. DIAGNOSIS & TREATMENT OF DENGUE CASES

4. COMMUNITY BASED MECHANISM OF REFERAL & TRANSPORTATION OF SUSPECTED CASES

4. CONSULTING THE PHYSICIANS ON SEEING SYMPTOMS AND SIGNS AS EARLY AS POSSIBLE.

A. State responsibilities

It is the prime duty of the government to clean up all mosquito breeding sites e.g.

Stagnant Water Ponds Garbage Heaps Choked Sewerage and drainage system Regular Anti Mosquito spray in all localities 3.Lifting the living standard of people and

bringing them out of slums

A. State responsibilities1. Eradication of Mosquito breeding sites

State Responsibilities1. Eradication of Mosquito Breeding Sites

Stagnant Wate r Ponds

A. State responsibilities1. Eradication of Mosquito breeding sites

Regular emptying of Garbage Drums

A. State responsibilities1. Eradication of Mosquito breeding sites

CHOKED SEWERAGE & DRAINAGE SYSTEM MUST BE REPAIRED

State Responsibilities1. Eradication of Mosquito Breeding Sites

Regular Anti Mosquito Sprays in Homes/ Farms/ Ponds and other potential mosquito breeding sites

State ResponsibilitiesLIFTING THE LIVING STANDARD OF PEOPLE

Raise the standard of living of its people and bring them out of filth

State Responsibilities2. Health Education

HEALTH EDUCATION IS KEY STEP IN PREVENTION OF ANY HEALTH PROBLEM

State Responsibilities2. Health Education

Disperse the information through electronic & Print media and Personal Communication

State Responsibilities3. Early Diagnosis & Treatment of Dengue Cases

Early Diagnosis And Treatment can Save All Lives

B . Community Responsibilities

Community Responsibilities1. Formulate a Health Related Representative Body

I. Continuous liaison with Health DepartmentII. To be aware of and spread the awareness about the

Health Programmes offered by the Government and to efficiently participate in them.

III. To raise funds for the betterment of community health

IV. To keep a vigilant eye on proper execution of Health Related Programmes offered by Government.

The functions of this body should include:

B. Community Responsibilities1. Stop Formation Of Mosquito Breeding Sites

Do not pollute your area

Keep Lid Covered Dusts Bins in Streets

Ask Municipality to regularly Collect

the Garbage

C. Individual Responsibilities

The 10-MinuteMosquito Wipe-Out Exercise

This is what you can do to help…

C. Individual Responsibilities1. Eradication of Mosquito Breeding Sites

Change water in vases on alternate days.

Remove water from flowerpot plates on alternate days.

Turn over all pails and water storage containers.

Clear blockages and put Bti insecticide in roof gutters

monthly.

Do not litter. Rubbish such as cups and bottles can collect rain water and breed

mosquitoes.

If you are going on a holiday or vacating your home

C. Individual Level Measures

2.Ways to keep the Mosquitoes away

Ways to keep the Mosquitoes away

Use Of Anti Mosquito Sprays

Ways to keep the Mosquitoes away

Use of Coils Mats Electric Devices

Ways to keep the Mosquitoes away

Use of Mosquito Nets and Mosquito Repellent Oils

Ways to keep the Mosquitoes away

Use Doors with net

Spread the dengue prevention message to others…

C. Individual Responsibilities

Let your family, friends and neighbours know about the dangers

Quiz

Why is the Aedes mosquito dangerous to us?

It can carry the dengue virus and infect a healthy person with dengue fever.

ANSWER:

Name the 5 steps in the 10-Minute Dengue Wipe-out Exercise

1. Change water in vases on alternate.

2. Remove water from flowerpot plates on alternate days.

3. Turn over all pails and water storage containers.

4. Cover bamboo pole holders when not in use.

5. Clear blockages and put in Bti insecticide in roof gutters monthly.

ANSWER:

What are the things that you should do before going for a holiday?

• Cover all toilet bowls in your home.

• Seal off the overflow pipe of the flushing cistern.

• Cover all gully/floor traps.

• Add sand granular insecticide to places that mosquitoes could potentially breed, such as flower vases and places where stagnant water could not be removed.

• Clear blockages and add Bti insecticide in roof gutters.

• Turn over all pails and water storage containers.

• Ask a relative or close friend to check your home regularly for stagnant water if you are going away for a long period of time.

• Leave your contact with your neighbours or the neighbourhood police post/ centre so that you can be reached easily.

Thank You!