TRAINING-MODULE-Introduction to dengue basics and biodynamics.pptx

Training Module on Dengue Awareness

1. INTRODUCTION TO DENGUE (BASICS AND BIODYNAMICS) INSTRUCTOR: MELODINA R. BABANTE, PCW II

2. DENGUE Dengue is a viral infection transmitted to humans through the bite of infected mosquitoes. Dengue virus has four serotypes (DENV1, DENV2, DENV3 and DENV4) Prevention and control of dengue depend on vector control. There is no specific treatment for dengue/severe dengue, and early detection and access to proper medical care greatly lower fatality rates of severe dengue.

3. Most people who get dengue will not have symptoms. But for those who do, the most common symptoms are high fever, headache, body aches, nausea, and rash. Most will get better in 1–2 weeks. Some people develop severe dengue and need care in a hospital. In severe cases, dengue can be fatal. DENGUE

4. Classification of Dengue A. Dengue without warning signs​​ 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) 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) 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)

5. Classification of Dengue B. Dengue with warning signs A previously well person with acute febrile illness of 1-7 days plus any of the following: abdominal pain or tenderness, persistent vomiting, clinical signs of fluid accumulation (ascites), mucosal bleeding, lethargy or restlessness, liver enlargement, increase in hematocrit and/or decreasing platelet count C. Severe dengue Severe plasma leakage leading to Dengue Shock (DSS) Fluid accumulation with respiratory distress Severe bleeding severe organ impairment Liver: AST or ALT ≥ 1000 CNS: e.g. seizures, impaired consciousness Heart and other organs (i.e. myocarditis, renal failure)

6. ​PHASES OF DENGUE INFECTION Febrile Phase Usually last 2-7 days Mild hemorrhagic 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. ​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.

7. ​PHASES OF DENGUE INFECTION 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.

8. SIGNS AND SYMPTOMS Most people with dengue have mild or no symptoms and will get better in 1–2 weeks. Rarely, dengue can be severe and lead to death. If symptoms occur, they usually begin 4–10 days after infection and last for 2–7 days. Symptoms may include: High fever (40°C/104°F) Severe headache Pain behind the eyes Muscle and joint pains Nausea Vomiting Swollen glands rash. Individuals who are infected for the second time are at greater risk of severe dengue.

9. SIGNS AND SYMPTOMS Severe dengue symptoms often come after the fever has gone away: severe abdominal pain persistent vomiting rapid breathing bleeding gums or nose fatigue restlessness blood in vomit or stool being very thirsty pale and cold skin feeling weak. People with these severe symptoms should get care right away. After recovery, people who have had dengue may feel tired for several weeks.

10. DIAGNOSTICS Dengue NS1 RDT Dengue IgM/IgG Polymerase Chain Reaction (PCR) CBC-HEMATROCRIT TESTING

11. VECTOR (ANIMAL CARRIER) Aedes aegypti Aedes albopectus

12. Aedes aegypti characteristics These mosquitoes are aggressive daytime biters that feed both indoors and outdoors. Their peak feeding times are during the early morning and late afternoon, however they will bite anytime during the day. The life span for adult mosquitoes is around three weeks. They have a short flight range (250 m – 300 m), so egg laying sites are likely to be close to where the mosquitoes are found.

13. MOSQUITO LIFE CYCLE

14. PREVENTION AND CONTROL Search and Destroy Breeding Areas Secure Self and Family Protection Seek Early Consultation Support Indoor and Outdoor Spraying only in Hot Spot Areas Sustain Hydration

15. Search and Destroy Breeding Areas

16. Secure Self and Family Protection

17. Seek Early Consultation

18. Support Indoor and Outdoor Spraying only in Hot Spot Areas

19. Sustain Hydration

20. DENGUE NS1 TESTING (METHODS, STORAGE, AND PROTOCOLS) INSTRUCTOR: MELODINA R. BABANTE, PCW II

21. DENGUE NS1 AG TEST Requested between 1-5 days of illness Use to detect dengue virus antigen during early phase of acute dengue infection Test is for free in all health centers and selected public hospitals nationwide. However, In Davao City, it will depend on the supply provided

22. DENGUE NS1 AG TEST A positive NS1 test result is indicative of a dengue infection but does not provide serotype information. Knowing the serotype of the infecting virus is not necessary for patient care. A positive NS1 test result is indicative of a dengue virus infection. A negative NS1 test result does not rule out infection. People with negative NS1 and negative or unavailable RT-PCR test results should be tested for the presence of dengue IgM antibodies to determine possible recent dengue exposure.

23. DENGUE NS1 AG TEST Steps Label the test cassete with Name, date of collection, time of collection, and reference number Place all specimens, test device and allow them to reach room temperature prior to testing (15 – 30 min.). Perform the test immediately after removing the device from the aluminum foil pouch. With a disposable dropper, add 3 drops (approx. 75 µL) of specimen (Whole Blood, Serum or Plasma) into the sample well in the test device. In case of whole blood add 1 drop of dengue antigen buffer in the sample well after sample addition. Read the test results at 10 minutes. Do not interpret the result after 20 minutes.

24. DENGUE NS1 AG TEST Storage and transport Place in a refrigerator at temperature not less than 2 degrees Celsius and not more than 8 degrees Celsius During transport keep the test kits away from direct sunlight During transport, ensure that test kits will not be stored in temperatures exceeding 25 degrees Celsius.

25. DENGUE VECTOR SURVEILLANCE INSTRUCTOR: MELODINA R. BABANTE, PCW II

26. VECTOR SURVEILLANCE Used to determine the geographic density of a vector Used to evaluate programs Identify high risk areas and population

27. TRAINING ON INFORMATION, EDUCATION, AND COMMUNICATION CAMPAIGNS INSTRUCTOR: Patrick Gwynn R. Babante, CBDE II

28. GOALS OF INFORMATION, EDUCATION, AND COMMUNICATION To deliver the factual, research-based, and necessary information to the community To increase the awareness of the community regarding a specific topic To ensure that the community gets the information they need.

29. WAYS TO IMPROVE INFORMATION, EDUCATION, AND COMMUNICATION CAMPAIGN AS A SPEAKER

30. Basics of Vector Control Management (Chemical Application, Chemical Safety, PPE Donning and Doffing, and Poisoning and Incident First Aid). INSTRUCTOR: Patrick Gwynn R. Babante, CBDE II

31. Chemical Application Proven, cost-effective vector control tools and interventions include long-lasting insecticidal nets, indoor residual spraying, space sprays, larvicides, molluscicides and environmental management for specific target vectors. WHO recommends a coordinated approach to vector control, which entails a rational decision-making process to optimize the use of available resources for this strategic intervention.  Use of integrated vector management helps vector control programs to find and use more local evidence, to integrate interventions where appropriate, and to collaborate across the health sector and other sectors, as well as with households and communities.

32. COMMON INSECTICIDE USED FOR MOSQUITO PREVENTION AND CONTROL

33. COMMON INSECTICIDE USED FOR MOSQUITO PREVENTION AND CONTROL

34. Chemical Safety Chemical Safety is achieved by undertaking all activities involving chemicals in such a way as to ensure the safety of human health and the environment. It covers all chemicals, natural and manufactured, and the full range of exposure situations from the natural presence of chemicals in the environment to their extraction or synthesis, industrial production, transport use and disposal. Chemical safety has many scientific and technical components. Among these are toxicology, ecotoxicology and the process of chemical risk assessment which requires a detailed knowledge of exposure and of biological effects.

35. STORAGE AND SAFETY Chemicals, Diesel, and Gasoline must be stored in a cool and dry place away from direct sunlight or any open flame. Avoid smoking near the chemicals and other flammable materials. Account chemical stocks each month to ensure the management on the usage of chemicals. A dedicated personnel must be in charge of dispensing the chemicals PER REQUEST ONLY

36. PPE Donning and Doffing Personal Protective Equipment (PPE) should be worn at all times during chemical handling and operations. Personal Protective Equipment (PPE) required depends on the hazard posed by the chemicals. Personnel Decontamination must be done after the operations. Used PPE must be disposed properly.

37. PPE Donning and Doffing

38. Poisoning and Incident First Aid Most sources recommend that water rinsing or flushing following skin or eye contact with a chemical should continue for 15 or 20 minutes. Remove the Patient from the scene of accident and remove any hazardous debris or equipment. Identify the nature of accident (Spills, Inhalation, Ingestion, trauma). Call Emergency Services (911) and the SPMC Poison Treatment and Control Center ( 0999 225 0208) Perform necessary First-aid and Perform CPR if Patient is not Breathing

39. Poisoning and Incident First Aid Decontaminate the scene, the patient, and the personnel involved in the accident. Use soapy water on the Knapsack sprayer for the decontamination. Always keep the packaging of the chemical for it to be endorsed to the Emergency Medical Technicians or Doctors.