Dengue Fever in the Philippines

VILORIA, Klarissa D.Yamzon, Liana Alpha T.

3F-PH

What is Dengue Fever? Mosquito: Aedes Aegypti Also known as breakbone fever. Common in tropical countries like Philippines Symptoms : mild to high grade fever,

headache, joint and muscle pain, rash Complication: Dengue Hemorrhagic Fever –

Lethal!

Dengue Serotypes DEN-1 DEN-2 DEN-3 DEN-4

Serotypes – each has different interactions with the antibodies in human blood serum

Share approximately 65% of their genomes The four dengue serotypes share the same

geographic and ecological niche.

1970’s DEN-1 and DEN-2 were found in Central America

and Africa all four serotypes were present in Southeast Asia

2004 the geographical distribution of the four serotypes

had spread widely At present

all four dengue serotypes circulate together in tropical and subtropical regions around the world

Scientists hypothesize that the dengue viruses evolved in nonhuman primates and jumped from these primates to humans in Africa or Southeast Asia between 500 and 1,000 years ago.

After recovering from an infection with one dengue serotype, a person has immunity against that particular serotype.

Individuals are protected from infections with the remaining three serotypes for two to three months after the first dengue infection.

No long-term protection After that short period, a person can be

infected with any of the remaining three dengue serotypes.

Impact of Dengue in the Philippines 1996-2005

Dengue Incidence Manila, Philippines 1996 -2005

Transmission of Dengue VECTOR: Transmitted to

humans by bite of female aedes aegypti mosquito. Dengue mosquitos lay eggs in areas with water

HOST: Humans become host of virus. Virus incubation is 4-10 days then produce dengue symptoms

TRANSMISSION: Humans get infected from bite of infected aedes mosquito. Mosquitos get infected when they bite infected humans.

Transmission

Infected person

Healthy person

Infected mosquito

Incubation Period: 3 to 14 daysMost commonly 4 to 7 days

Diagnosis Basis: reported symptoms and physical

examinations

However, early disease can be difficult to differentiate from other viral infections.

Probable diagnosis: Fever plus two of the ff. nausea and vomiting, rash, generalized pains, low

white blood cell count, positive tourniquet test, or any warning sign in someone who lives in an endemic area.

Tourniquet test particularly useful in settings where no laboratory

investigations are readily available application of a blood pressure cuff at between the

diastolic and systolic pressure for five minutes, followed by the counting of any petechial hemorrhages

a higher number makes a diagnosis of dengue more likely with the cut off being more than 10 to 20 per 1 inch2 (6.25 cm2).

Diagnosis should be considered in anyone who develops a fever within two weeks of being in the tropics or subtropics.

Difficult to distinguish dengue fever and chikungunya

Cause similar symptoms, such as malaria, leptospirosis, viral hemorrhagic fever, typhoid fever, meningococcal disease, measles, and influenza

Dengue fever (WHO 1997 classification) undifferentiated fever dengue fever dengue hemorrhagic fever

Dengue fever (WHO 2009 classification) Uncomplicated Severe

Severe dengue defined as that associated with

severe bleeding, severe organ dysfunction, or severe plasma leakage while all other cases are uncomplicated.

Dengue hemorrhagic fever was subdivided further into grades I–IV. Grade I is the presence only of easy bruising or a

positive tourniquet test in someone with fever Grade II is the presence of spontaneous bleeding

into the skin and elsewhere Grade III is the clinical evidence of shock Grade IV is shock so severe that blood pressure

and pulse cannot be detected.

Grades III and IV are referred to as "dengue shock syndrome".

LABORATORY TESTS Microbiological laboratory testing

virus isolation in cell cultures nucleic acid detection by PCR, viral antigen detection (such as for NS1) specific antibodies (serology)

Treatment no specific medication for treatment for a

dengue infection adequate hydration and pain control- will help

the person through the infection

Nonsteroidal anti-inflammatory agents (aspirin, ibuprofen) should be avoided because of the tendency of the dengue

viruses to cause hemorrhages. The NSAIDs may add to the hemorrhage symptoms.

Other medications such as acetaminophen, codeine, or other agents that are not NSAIDs may be used.

For those with dengue fever (hemorrhagic and shock syndrome) usually require additional supportive treatments: Hospitalization IV hydration blood transfusions platelet transfusions blood pressure support

Prevention

Environmental Management

Biological Control Chemical Control

ENVIRONMENTAL MANAGEMENT

Modification

Manipulation

Changes in Human Behavior

CHEMICAL CONTROL

Use of insecticides Fogging Use of mosquito coils Repellents

BIOLOGICAL CONTROL

Fish (poecilia reticulata)

Predatory copepods (copepoda cyclopoidea)

Lethal ovitraps

Epidemiology Fatality rate

1–5%, and less than 1% with adequate treatment up to 26% for those who develop significantly low

blood pressure

More common in 110 countries infects 50 to 528 million people worldwide a year half a million hospitalizations approximately 25,000 deaths

12 countries in Southeast Asia were estimated to have about 3 million infections and 6,000 deaths annually

most commonly acquired in the urban environment

increased the number of epidemics and circulating viruses expansion of villages, towns and cities in the areas

in which it is common, and the increased mobility of people

Rates of dengue increased 30 fold between 1960 and 2010 due to a combination of urbanization, population

growth, increased international travel, and global warming

An infection with dengue is second only to malaria as a diagnosed cause of fever among travelers returning from the developing world.

It is the most common viral disease transmitted by arthropods, and has a disease burden estimated at 1,600 disability-adjusted life years per million population.

The World Health Organization counts dengue as one of seventeen neglected tropical diseases.

Anti-Dengue Programs in the Philippines

June 2011: Dengue Prevention Month

Massive anti-dengue campaign

Anti-Dengue Programs in the Philippines

Distribution and training on use of mosquito OL trap (ovicidal-larvicidal trap)

Anti-Dengue Programs in the Philippines

Multi-sectoral mosquito “search and destroy” cleanup campaign

ReferencesWEBSITES: World Health Organization http://www.who.int/topics/dengue/en/ Centers for Disease Control and Prevention

http://www.cdc.gov/dengue/ WHO. Dengue Haemorrhagic fever ealy recognition diagnosis and

hospital management. An audiovisual guide for healthcrae workers responding to outbreaks.http://www.who.int/csr/don/archive/disease/dengue_fever/dengue.pdf

WHO. Global Alert and response. http://www.who.int/csr/disease/dengue/en/

World Heath Organization. Guidelines for treatment of demgue fever/dengue hemorrhagic fever in small hospitals. http://www.searo.who.int/LinkFiles/Dengue_Guideline-dengue.pdf

CDC, Clinicians Reference card.http://www.cdc.gov/Dengue/resources/Dengue%20Case%20Management_card_125085_12x6_Zcard_Dengue.pdf

CDC. Information for health care practitioners. http://www.cdc.gov/dengue/resources/Dengue&DHF%20Information%20for%20Health%20Care%20Practitioners_2009.pdf

CDC. Basic facts on Dengue http://www.cdc.gov/dengue/resources/CS_205910-A.Dengue%20patient%20Ed%20Eng.FINAL.pdf

ReferencesJOURNALS/ARTICLES: Bernardo, E. C. (2008). Solid-Waste Management Practices of Households in

Manila, Philippines. Annals Of The New York Academy Of Sciences, 1140420-424. doi:10.1196/annals.1454.016

Johansson, MA, F Dominici, & GE Glass. Local and global effects of climate on dengue transmission in Puerto Rico. PLoS Neglected Tropical Diseases. 3(2): e382 (2009).

Barrera R. 2009. Simplified Aedes aegypti’s pupal-surveys for entomological surveillance and dengue control. American Journal of Tropical Medicine and Hygiene 81: 100-107. http://www.ajtmh.org/cgi/reprint/81/1/100

Barrera R, Amador M, Díaz A. Joshua Smith, Muñoz-Jordán JL, Rosario Y. 2008. Unusual productivity of Aedes aegypti in septic tanks and its implications for dengue control. Medical and Veterinary Entomology 22:62-69. http://www3.interscience.wiley.com/cgi-bin/fulltext/119401311/PDFSTART

Group on Dengue Meeting 1-5 October 2006, Special Programme for Research and Training in Tropical Diseases UNICEF/UNDP/World Bank and WHO.

ReferencesWorld Health Education ( 2009).Dengue guidelines for diagnosis treatment prevention and control. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf Centers for Disease Control and Prevention (2009). Dengue frequently asked questions. Retrieved from http://www.cdc.gov/Dengue/faqFacts/index.html

World Health Organization (2006). Dengue hemorrhagic fever early recognition diagnosis and hospital management an audiovisual guide for health careworkers responding to outbreaks. retrieved from http://www.who.int/csr/don/archive/disease/dengue_fever/dengue.pdf

Department of Health (2011) Disease surveillance report morbidity week 36. Retrieved from http://dev1.doh.gov.ph/sites/default/files/2011Den36WMR_draft.pdf

Sia Su, G. L. (2008). Correlation of Climatic Factors and Dengue Incidence in Metro Manila, Philippines. AMBIO - A Journal Of The Human Environment, 37(4), 292-294. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=5&hid=12&sid=c81b1f84-903a-4856-81e3-d2a7b75da458%40sessionmgr14&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9h&AN=33116717

ReferencesCenters for Disease and Control Prevention ( 2010) . Transmission of dengue virus

retrieved from http://www.cdc.gov/Dengue/epidemiology/index.html#transmission

Centers for Disease and Control Prevention ( n.d.) how to prevent the spread of mosquito that causes dengue. Retrieved from http://www.cdc.gov/dengue/resources/Vector%20control%20sheet%20dengue.pdf

Centers for disease control and prevention (2010). Larval control and other vector control preventions. Retrieved from http://www.cdc.gov/malaria/malaria_worldwide/reduction/vector_control.html

Elias, M. Islam, M. Kabir, M & Rahman,M. ( 1995, August). Biological control of mosquito larvae by guppy fish. Bangladesh medical research council bulletin.21(2):81-6. Department of medical entomology. Institute of preventative and social medicine Mohakhali, Dhaka.Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8815867

Department of health ( 2011). Dengue surge in Luzon. Retrieved from http://dev1.doh.gov.ph/content/dengue-surge-luzon

ReferencesDepartment of science and technology (n.d.).Mosquioto OL trap. Retrieved from www.science.ph/oltrap/

Department of Health (2011) . National dengue prevention and control program. Retrieved form http://www.doh.gov.ph.content/national-dengue-prevention-and-control-program

World Health Organization (2012) Dengue epidemiology philippines. World health organization Western pacific region Retrieved from http://www.wpro.who.int/sites/mvp/epidemiology/dengue/phl_profile.htm