macao’s experience in dengue prevention and control
DESCRIPTION
Macao’s Experience in Dengue Prevention and Control. Dr. Koi Kuok Ieng Department of Health, Macao SAR 200 4.03.05. Outline. Epidemiology Prevention Control Experience. Epidemiology. Reported Cases. …… 1996 – 1 (imported) …… 2001 – 1418 2002 – 2 (imported) 2003 – 28 (death = 0). - PowerPoint PPT PresentationTRANSCRIPT
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Macao’s Experience in Macao’s Experience in Dengue Prevention and ControlDengue Prevention and Control
Dr. Koi Kuok Ieng
Department of Health, Macao SAR
2004.03.05
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OutlineOutline
Epidemiology Prevention Control Experience
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EpidemiologyEpidemiology
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Reported CasesReported Cases ……
1996 – 1 (imported)
……
2001 – 1418
2002 – 2 (imported)
2003 – 28
(death = 0)
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2001 epidemic2001 epidemic Duration : August to December Total no. of reported cases : 1418 Attack rate : 3.2/1000 Dengue Hemorrhage Fever : 0 Death : 0 DEN-2 (a few DEN-1)
Vector : Aedes albopictus
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Temporal distribution of reported cases of Dengue in 2001Temporal distribution of reported cases of Dengue in 2001
( Total = 1418)
0
100
200
300
400
500
600
700
800
1 2 3 4 5 6 7 8 9 10 11 12
Month
Case
Supposed beginning
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Spatial distribution of reported cases of Dengue in 2001
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Typical “Black spot” in focus
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Interpersonal distribution of reported cases of Dengue in 2001Interpersonal distribution of reported cases of Dengue in 2001
0
2
4
6
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0-14 15-24 25-34 35-44 45-54 55-64 >=65
Age groups
Attack rate (1/1000)
Male
Female
Total
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2003 outbreak2003 outbreak Duration : 2003.10.09 ~ 11.02
Total no. of reported cases : 28
Dengue Hemorrhage Fever : 0
Death : 0
DEN-1
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Spatial distribution of reported cases of Dengue in 2003
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PreventionPrevention
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Comprehensive strategiesComprehensive strategies Central strategy:
SOURCE REDUCTION
Supplementary strategies: Health education and community mobilization Early detection, isolation and treatment of case Vector surveillance and study Chemical control Legislation Communication
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Source reductionSource reduction Two main problems encountered
More than 600 “black spots” in the city area
More than 200 thousands apartments
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Cleaning of “black spots”Cleaning of “black spots”
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Community campaignsCommunity campaigns
School campaignsSchool campaigns
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Ovitrap surveillanceOvitrap surveillance
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10 11 12
Month
Positive rate
20022003
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Household larva surveillanceHousehold larva surveillance
0
2
4
6
8
10
12
2002.06 2002.09 2003.06 2003.09
Breateau Index
House In d e x
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ULV sprayingULV spraying
FoggingFogging
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ControlControl
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2
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8
9
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Case
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13
Date of onset
2003 limited outbreak
Detection& responses
Longest IP 14 d
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Contingency PlanContingency Plan Delineation of focus of infection : 200 m
Immediate response:
1. Emergency community meetings
2. Chemical control
3. Door-to-door Inspection and mobilization
4. Examination and cleaning of abandoned houses and sites
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ExperienceExperience
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Community participationCommunity participation Effective community participation is the key to
Disease management Problems encountered :
Ineffectiveness of traditional health education activities in community involvement
Behavioral change of population against Dengue not sustain
Prospect :
Healthy City Project
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Whole city mobilizationWhole city mobilization
DOH
Publicservices
Media
Associations
SchoolsSpecialgroups
Medical facilities
Volunteers
Private
CitizensCitizens
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Local community mobilizationLocal community mobilization
Community Health
Committee
CommunityEntities
HealthCenter
SanitaryTeam
CDCResidents
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Source reductionSource reduction Source reduction remains to be the
central control strategy Problems encountered :
Hygiene problem of private properties
Sustainability of measures
Prospect : Legislation
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Early detection of epidemicEarly detection of epidemic Early detection is crucial to stop a potential epidemic
Problems encountered : Delay in diagnosis and reporting In 2003 outbreak, onset to consultation was 2
days ; and from onset to case report was 6.4 days Prospect :
Education for citizens Guideline for clinicians Accessibility of laboratory analysis
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Control measuresControl measures If adopted early, planned and sufficient
control measures can stop a potential epidemic
Problems encountered : “safety coefficient” insufficient
Prospect :
Review extent, method adopted and frequency of chemical control