slides on Dengue

1. DENGUE
Presented By
Tina yadav
MPH2018

2. INTRODUCTION
• Dengue is a mosquito born viral infection which causes flu like illness,and
occasionally develops into a potentially lethal complications.
• It is transmitted by the infective bite of female Aedes Aegypti mosquito
•Man develops disease after 5-6 days of being bitten by an infective
mosquito.
•It occurs in two forms: Dengue Fever and Dengue Haemorrhagic
Fever(DHF called severe dengue.)

3. Incedence:390 million
dengue infections per
year of which 96 million
manifest clinically
Prevalence:3.9 billion
people in 128 countries
No. of cases reported
increased from 2.2
million in 2010 to 3.2
million in 2015.
Global burden of
Dengue

4. DISTRIBUTION TRENDS
• Before 1970- only 9 countries experienced severe dengue epidemics.
• Now :endemic in more than 100 countries in WHO regions of Africa, the
Americas, the Eastern Mediterranean, South-East Asia and Western Pacific.
• 2010:local transmission of disease was reported for the first time in France
and Croatia
• 2012:an outbreak of dengue on the Maderia island of Portugal in over 2000
case and imported cases were detected in mainland Portugal and 10 other
countries in Europe
• 2014:trend indicates increase in number of cases in the People’s Republic
of China,the Cook Islands,Fiji,Malaysia and Vanuata, with Dengue Type
3(DEN 3) affecting the Pacific Island countries after a lapse of over 10 yrs .
Also reported in Japan after a lapse of 70 years.

5. Continue.....
• 2015: Delhi,India, recorded its worst outbreak since 2006 with over
15000 cases.The Island of Hawaii, United States of America was
affected by an outbreak with 181 cases and ongoing transmission in
2016. The Pacific island countries of Fiji, Tonga and French Polynesia
have continued to record cases.
• 2016: large outbreaks worldwide; the American regions:2.38 million
cases, Brazil:>1.5 million cases,1032 dengue deaths,The Wesrern
Pacific Region<375000 cases, of which Phillipines:176411 cases and
Malaysia:100 028 cases,The Solomon Island: outbreak of 7000
suspected cases,the African region,Burkina Faso:outbreak of 1061
cases

6. Continue....
• 2017:significant reduction in number of cases in tge Americas-from
2177 171 cases in 2016 to 584 263 cases in 2017 i.e. 73% reduction,
Panama,Peru and Aruba showed increase in number of cases;53%
reduction in severe dengue this year
• 2018:In the first quarter of the year a reduction of 27% of
cases,Paraguay and Argentina ,reported outbreak,cases were also
reported from
Bangladesh,Cambodia,India,Myanmar,Malaysia,Pakistan,Philippines,T
hailand, and Yemen

7. Continue...
• An estimated 500 000 people with severe dengue require
hospitalization each year, and 2.5% case fatality annually
• Globally 28% decline in case fatality between 2010 and 2016 with
significant improvement.

8. In context of Nepal
• The earliest cases was detected in 2005,sporadic cases and outbreaks
in 2006 and 2010.
• Indigenous cases are also being reported
• Chitwan, Kanchanpur, Kailali, Baken, Bardiya, Dang,Kaoilvastu, Parsa,
Rupendehi,Rautahat, Sarlahi, Saptari and Jhapa districts of Nepal
reflect the spread of the disease throughout the Terai plains from
west to east
• In 2011 79 confirmed cases were reported from 15 districts with
highest number in Chitwan(55).

10. Treatment
No specific treatment for dengue fever
Symptomatic treatment
Maintenance of patient’s body fluid volume is critical to severe
dengue care.

11. Immunization
• The first dengue vaccine ,Dengvaxia(CYD-TDV) developed by Sanofi
Pasteur was licensed in December 2015.
• Approved by regulatory authorities in 20 countries for use in endemic
areas in person ranging from 9-45 years of age as clinical trial.
• In April 2016,WHO issued a conditional reccomendation on the use of
the vaccine for areas in which dengue is highly endemic.
• The live attenuated vaccine is safe and efficacious in person who have
had a previous dengue virus infection but carries an increased risk of
severe dengue in those experiencing their first natural dengue
infection.

12. Prevention and Control
• At present the main method to control or prevent the transmission of
dengue vrus is to combat through:
• Preventing mosquitoes from accessing egg lying habitats by environmental
management and modification;
• Disposing of solid waste properly and removing artificial man made
habitats;
• Covering ,emptying and cleaning of domestic water storage containers on
a weekly basis;
• Applying appropriate insecticides to water storage outdoor containers;
• Using of personal househoid protection such as window screens,long
sleeved clothes, insecticides treated materials, coils and vaporizers;

13. Continue..
• Improving community participation and mobilization for sustained
vector control;
• Applying insecticides as space spraying during outbreaks as one of the
emergency vector-control measures;
• Active monitoring and survillence of vector should be carried out to
determine effectiveness of control interventions.

14. Global Strategy
For Dengue Prevention And Control
• Goal And Objectives
The goal of the global strategy is to reduce the burden of dengue.It’s
specific objectives are:
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 the disease by 2015

16. Nepal’s Dengue Control Programme
• Goal-To reduce morbidity and mortality due to dengue fever,dengue
haemorrhagic fever and dengue shock syndrome.
• Objectives
• To develop an integrated vector management approach for
prevention and control.
• To develop capacity on diagnosis and case management of dengue
fever,DHF,DSS.
• To inensify health education and IEC activities.
• To strengthen the survillence system for predection,early detection,
preparedness early response to dengue outbreaks.

17. strategies
• Early case detection, diagnosis , management, and reporting of
dengue fever, DHF and DSS
• Regular monitoring of dengue fever, DHF and DSS cases and
survillence through EWARS.
• Mosquito vector survillance in municipalities.
• The integrated vector control approach where a combination of
several approaches are directed towards containment and source
reduction.

18. Major activities in 2073/74
• Trained physicians, nurses, paramedics and laboratory technicians on
dengue case detection, diagnosis, management, and reporting.
• Orientated municipality stakeholders in 25 programme districts.
• Supplied rapid diagnostic test kits(IgM).
• Dengue case monitoring and vector survillance.
• Search and destruction of dengue vector larvae (A. Aegypti) in 25
programme districts.
• Developed and disseminated health education messages.

19. Achivements
• A total of 1527 dengue cases were reported from 42 districts in
2073/74 . The most were from Chitwan (687) followed by Jhapa and
Rupendehi. And there was one confirmed deaths due to dengue in
Chitwan.
• The number of reported dengue cases has decreased significantly
since 2010 with high percent increase in the last three years from 302
to 134 to 1527 in the current year.the majority of cases have been
reported from Chitwan,Jhapa and Rupendehi with more than 46% of
2073/74 cases from Chitwan.

20. References
• www.who.int
• Annual health report of Nepal 2073/74
• Global Strategy for dengue prevention and control,2012-2020

21. THANK YOU!!