Dengue

DENGUE- A GLOBAL CONCERN AND NEED OF INTEGRATED VECTOR CONTROL MEASURES

1. DENGUE-A GLOBAL CONCERN MODERATOR DR. RAUF – UR-RASHID KAUL ADDITIONAL PROFESSOR S.R. INCHARGE DR. FEROZ AH. WANI SENIOR RESIDENT PRESENTED BY DR. UROOSA FAROOQ POST GRADUATE STUDENT

2. Table of contents INTRODUCTION HISTORY MAGNITUDE :GLOBALLY , SEAR AND INDIA EPIDEMIOLOGY MANIFESTATIONS OF DENGUE VIRUS INFECTION WHO CLASSIFICATION OF DENGUE CLINICAL SIGN/SYMPTOMS AND TREATMENT GLOBAL STRATEGY FOR PREVENTION AND CONTROL 2012-2020

3. Introduction - What is Dengue ? Dengue is a mosquito-borne, viral infection. The infection causes flu-like illness, and occasionally develops into a potentially lethal complication called severe dengue. Common name of the disease is ‘break-bone fever’

4. (WHO 2011) History The first epidemic of dengue was recorded in 1635 in the French West Indies, although a disease outbreak compatible with dengue had been reported in China as early as 992 AD.

5. Epidemics of an illness resembling dengue occurred in 1779, 1780 in three continents-Asia, Africa and North America. First epidemic of DHF occurred in Manila, Philippines 1950. In India dengue virus was first isolated in Calcutta in 1945. Epidemic of DHF first occurred in Calcutta in 1963. (WHO 2011)

6. MAGNITUDE GLOBALLY SEAR INDIA

7. ( WHO 2011)

8. GLOBALLY: The global incidence of dengue has grown dramatically in recent decades. – The incidence of dengue has increased 30-fold over the last 50 years. –Up to 50-100 million infections are now estimated to occur annually in over 100 (only 9 counties in 1955) endemic countries . – Almost half of the world’s population at risk.

9. (Who2011)

10. Average number of dengue and severe dengue cases reported to WHO annually in 1955–2007 and number of cases reported in recent years, 2008–2010

11. SEAR: Some 2.5 billion people – two fifths of the world's population in tropical and subtropical countries – are at risk. An estimated 50 million dengue infections occur worldwide annually. About 500 000 people with DHF require hospitalization each year. A very large proportion (approximately 90%) of them are children aged less than five years, and about 2.5% of those affected die. ( WHO 2011)

12. Variable endemicity for DF/DHF in countries of the SEA Region (Who2011)

13. STATE CASES DEATHS Andhra pradesh 990 1 Assam 4526 2 Delhi 5574 6 Chandigarh 7132 6 Goa 1255 9 Gujarat 6170 15 Haryana 1751 4 Karnataka 6408 12 Kerela 7911 25 Maharashtra 5432 48 Punjab 4114 11 Rajhasthan 3160 8 Tamil nadu 6122 Uttar pradesh 1409 5 West bengal 5920 6 TOTAL 74168 168 (NATIONAL HEALTH PROFILE 2013) INDIA

14. VIRUS The cause MOSQUITO transmitter of disease ENVIRONMENT Helps transmission

15. Dengue Virus Causes dengue and dengue hemorrhagic fever It is an arbovirus Transmitted by mosquitoes Composed of single-stranded RNA Has 4 serotypes (DEN-1, 2, 3, 4)

16. Each serotype provides specific lifetime immunity, and short-term cross-immunity All serotypes can cause severe and fatal disease Genetic variation within serotypes Some genetic variants within each serotype appear to be more virulent or have greater epidemic potential

17. AEDES AEGYPTI Dengue transmitted by infected female mosquito Primarily a daytime feeder Lives around human habitation Lays eggs and produces larvae preferentially in artificial containers

18. The most common epidemic vector of dengue in the world is the Aedes aegypti mosquito. It can be identified by the white bands or scale patterns on its legs and thorax.

19. AEDES ALBOPICTUS: is second most important vector of dengue AEDES AEGYPTI: HIGHLY DOMESTICATED NERVOUS FEEDER DISCORDANT SPECIES AEDES ALBOPICTUS : BREEDS IN PEREPHERAL AREAS OF URBAN CITIES AGGRESSIVE FEEDER CONCORDANT SPECIES

20. Life Cycle of a Mosquito

21. ENVIRONMENTAL CONDITIONS HELP IN TRANSMISION Dengue transmission usually occurs during the rainy season when the temperature and humidity are conducive for build-up of the vector population breeding in secondary habitats as well as for longer mosquito survival. In arid zones where rainfall is scanty during the dry season, high vector population builds up in man-made storage containers. THEY GROW WELL AT A TEMP. OF 16 TO 30 DEGREE AND HUMIDITY OF 60-80%

22. The virus is inoculated into humans with the mosquito saliva. The virus localizes and replicates in various target organs, for example, local lymph nodes and the liver. The virus is then released from these tissues and spreads through the blood to infect white blood cells and other lymphatic tissues. The virus is then released from these tissues and circulates in the blood.

23. The mosquito ingests blood containing the virus. The virus replicates in the mosquito midgut , the ovaries, nerve tissue and fat body. It then escapes into the body cavity, and later infects the salivary glands. The virus replicates in the salivary glands and when the mosquito bites another human, the cycle continues.

24. HIGH RISK GROUP INCLUDES: 1 INFANTS AND ELDERLY 2 OBESITY 3 PREGNANCY 4 PEPTIC ULCER DISEASE 5 MENSTRUATING WOMEN 6 HAEMOLYTIC DISEASE 7 CHD 8 DIABETES, RENAL FAILURE, LIVER CIRRHOSIS AND ASTHMA 9 PATIENTS ON STEROIDS OR NSAID TREATMENT

25. Manifestation of dengue virus infection

26. WHO CLASSIFICATION AND GRADING OF SEVERITY OF DENGUE INFECTION

27. Clinical characteristics

28. Signs and Symptoms of Encephalitis/Encephalopathy Associated with Acute Dengue Infection Decreased level of consciousness: lethargy, confusion, coma Seizures Nuchal rigidity Paresis

29. LABORATORY DIAGNOSIS: 1 VIRUS ISOLATION WITHIN FIRST 6 DAYS 2 VIRAL NUCLEIC ACID DETECTION BY RT-PCR 3 IMMUNOLOGICAL : NT, CFT, HIA AND IgM/IgG RATIO 4 VIRAL ANTIGEN DETECTION BY ELISA 5 RDT FOR IgM AND IgG ANTIBODY DETECTION 6 PLATELET COUNT AND HAEMATOCRIT MUST BE CLOSLY MONITORED

30. Treatment of Dengue fever: Fluids Rest Antipyretics (avoid aspirin and non-steroidal anti-inflammatory drugs) Monitor blood pressure, hematocrit, platelet count, level of consciousness

31. Rx of DHF I & II

32. Rx of DHF III & IV

33. Dengue vaccine No licensed vaccine at present Recently Tetravalent Dengue Vaccine phase 3 trial completed in Asia.

34. Prevention & Control

35. Global strategy for dengue prevention & control 2012- 20 To reduce dengue mortality by at least 50% by 2020 To reduce dengue morbidity by at least 25 % by 2020 To estimate the true burden of disease by 2015 (WHO 2012)

36. (WHO 2013)

37. National Vector Born Disease Control Program Surveillance Case management Vector management Outbreak response Behavioral change communication Inter- sectoral coordination Monitoring & supervision

38. Disease Surveillance: Epidemiological and Entomological Epidemiological surveillance Epidemiological surveillance is an ongoing systematic collection, recording, analysis, interpretation and dissemination of data for initiating suitable public health interventions for prevention and control. Objectives of surveillance The objectives of public health surveillance applicable to dengue are to detect epidemics early for timely intervention; • measure the disease burden; • monitor trends in the distribution and spread of dengue over time; • assess the social and economic impact of dengue on the affected community; • evaluate the effectiveness of prevention and control programmes ; and • facilitate planning and resource allocation based on the lessons learnt from programme evaluation.

39. Components of a surveillance system The surveillance system comprises passive surveillance, active surveillance and event-based surveillance. All three surveillance components require a good public health laboratory to provide diagnostic support in virology, bacteriology and parasitology . The laboratory need not be able to test for all agents but should know where to refer specimens for testing, for example, select samples for the WHO collaborating centers for reference and research. Individually, the three components are not sensitive enough to provide effective early warning. But when used collectively they can often accurately predict epidemic activity.

40. Indices used to assess the levels of Ae . aegypti infestations

41. Pupal Index: Number of pupae per house Pupal Index (PI) = Number of pupae/Number of houses inspected X 100 In order to compare the relative importance of larval habitats, the Pupal Index can be disaggregated by “useful”, “non-essential” and “natural” containers, or by specific habitat types such as tyres , flower vases, drums, clay pots, etc.

42. ANTI LARVAL MEASURES 1.ENVIRONMENTAL CONTROL 2.CHEMICAL CONTROL 3.BIOLOGICAL CONTROL

43. ANTI ADULT MEASURES 1.RESIDUAL SPRAY 2.SPACE SPRAY 3.GENETIC CONTROL

44. PROTECTION AGAINST MOSQUITO BITES 1.MOSQUITO NETS 2.SECREENING 3.REPELLENTS

45. • Don’t allow water to remain stagnant in and around your house. Fill the ditches . • Clean the blocked drains . • Empty the room air coolers and flower vases completely at least once in seven days and then refill them. • Tray below the fridge also to be cleaned. Anti-larval measures-Environmental Control

46. Dispose off old containers tins and tyres etc. Properly. • Keep the water tanks and water containers tightly covered so that the mosquitoes can not enter them and start breeding.

47. • Keep the surroundings of your house clean . • Don’t litter garbage . • Don’t allow wild herbs etc.to grow around your house. Do inform and take help from your local health Centre ,panchayat or municipality incase you notice abnormal density of mosquitoes or too many cases of fever are occurring in your area .

48. Anti-larval measures-chemical control •TEMEPHOS an insecticide can be used to kill larva in water. or • Put about two tablespoons (30 ml) of petrol or kerosene oil into 100 liters of water.

49. Anti-larval measures-Biological control • Some types of small fish ( Gambusia , Lebister ) which eat mosquito larva, can be obtained from local administrative bodies. • These fish can be used in burrow pits , sewage oxidation pounds, ornamental pounds, Cisterns and farm ponds.

50. ANTI-ADULT MEASURES-Residual spray & Space spray • Don’tforgettospraybehindthephoto-frames,curtains,calendars,cornersofhouseandstores. • Useinsecticidalspraysinallareaswithinthehouseat-leastonceaweek.

51. Don’t turn away spray workers whenever they come to spray your house.

52. Protection Against Mosquito Bites • Wear clothes which cover the body as much as possible. • Use Wire mesh on windows and doors. • Usemosquitorepellentsprays,creams,coils,matsorliquidstodriveaway/kill the mosquitoes ..

53. It is advisable to always keep the patient of Dengue fever under a mosquito net in the first 5-6 days of the illness so that mosquitoes don’t have an access to him/her . The characteristics of net are it should be rectangular, the size of opening should not exceed 0.0475 inch and the no. of holes in 1sq inch is usually 150.

54. RECENT OUTBREAK OF DENGUE IN INDIA IN THE YEAR 2014 NEAR ABOUT TEN THOUSAND CASES WHERE REPORTED AND 37 DEATHS HAD OCCURRED. WHILE IN YEAR 2015 THE CASE LOAD UPTO NOVEMBER IS NINTEEN THOUSAND AND 41 DEATHS. AMOUNG THESE HIGHEST NO. OF CASES WHERE REPORTED FROM DELHI 1259 AND 25 DEATHS.

55. DENGUE FEVER CAN BE EASILY PREVENTED ITS YOUR ,MINE AND OUR RESPONSIBILITY

56. Thank You