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  1. 1. Dengue<br />
  2. 2. Introduction<br />Potentially fatal disease caused by Dengue virus transmitted by bite of infected Aedesaegypti<br />Incubation period is 5-6 days.<br />History<br /><ul><li>First confirmed case report by Benjamin Rush.
  3. 3. Viral etiology and transmission by mosquitoes discovered by Sir John Burton Cleland.
  4. 4. Pandemic of dengue began in Southeast Asia after World War II and spread around the globe since then.</li></li></ul><li>Burden of Disease Worldwide<br />
  5. 5. Burden of Disease in India<br />Source -<br />
  6. 6. Magnitude of problem in India<br />Source -<br />In year 2009<br /><ul><li>Max no of cases were reported by Gujrat followed by Maharashtra
  7. 7. Max no of deaths occurred in Maharashtra followed by Rajasthan</li></ul>In this year till June 2010<br /><ul><li>Max no of cases were reported by Kerela (1338) followed by Gujrat (544)
  8. 8. Max no of deaths occurred in Kerela (4) followed by Maharashtra (2)</li></li></ul><li>Symptoms and signs<br />Fever<br />Headache, <br />Retro-orbital pain<br />Myalgia<br />Arthralgia<br />Rash<br />Haemorrhagic manifestations<br />Thrombocytopenia (<100,000 cells per cumm)<br />
  9. 9. Diagnosis<br />Dengue fever<br />Acute febrile illness of 2-7 days with two or more of the following<br /><ul><li>Headache,
  10. 10. retro-orbital pain
  11. 11. Myalgia
  12. 12. Arthralgia
  13. 13. rash
  14. 14. Haemorrhagic manifestations.</li></ul>Dengue Haemorrhagic Fever<br />A confirmed case of dengue<br />PLUS<br />Haemorrhagic tendencies<br /><ul><li>positive tourniquet test
  15. 15. Petechiae/Ecchymoses
  16. 16. bleeding from mucosa,GIT, nasal bleeding or other sites
  17. 17. haematemesisor melaena</li></ul>PLUS<br />Thrombocytopenia<br />PLUS<br />Evidence of<br />plasma leakage due to increased vascular permeability.<br />Dengue Shock Syndrome<br />DHF plus<br />evidence of circulatory failure<br />rapid and weak pulse<br />narrow pulse pressure (<20 mm Hg) or hypotension for<br />age, cold and clammy skin and restlessness<br />
  18. 18. Treatment<br />Dengue Fever<br />Mainly symptomatic and supportive<br />Bed rest.<br />Cold sponging.<br />Antipyretics-Paracetamolis preferable<br />Oral fluid and electrolyte therapy in patients with excessive sweating or vomiting.<br />Dengue Haemorrhagic Fever<br />Treatment is same as above except:<br />Need hospitalization<br />IV fluid therapy if rise in haemoconcentration<br />Observed for signs of shock<br />Dengue Shock Syndrome<br />Fresh whole blood in volumes of 10ml/kg/hour<br />Oxygen therapy<br />
  19. 19. Chikunguniya<br /><ul><li>Debilitating non-fatal illness caused by Chikunguniya virus transmitted by bite of infected Aedesaegypti.
  20. 20. Human beings are major reservoir.</li></ul>History<br /><ul><li>Epidemic in 2006 after about three decades
  21. 21. There were 1.39 million cases
  22. 22. There is no attributed deaths to chikunguniya
  23. 23. During 2008 95,091 cases were reported.
  24. 24. It was not part of NVBDCP till 2006 but after outbreak it was added to the programme</li></li></ul><li>Sign and symptoms<br />It presents same as dengue except<br /><ul><li>Haemorrhagic manifestations are rare
  25. 25. Shock is not observed</li></li></ul><li>Diagnosis and Management<br />Diagnosis<br />IgM ELISA<br />Management<br />Bed rest.<br />Cold sponging.<br />Antipyretics-Paracetamol is preferable<br />Oral fluid and electrolyte therapy in patients with excessive sweating or vomiting.<br />
  26. 26. GOI initiatives for Dengue and Chikunguniya<br />National guidelines for clinical management of Dengue Fever, Dengue Hammorragic Fever, Dengue Shock Syndrome.<br />Long Term Action Plan for Prevention and Control of Dengue and chikunguniya.<br />Established 110 Sentinel Surveillance Hospitaland all these are linked with 13 Apex Referral Laboratories.<br />To maintain the uniformity and standard of diagnostics.<br />Diagnosis of Dengue and Chikungunya is provided to the community at free of cost.<br />Since 2007, every year in the 1st quarter Directorate of NVBDCP prepare the tentative allocation of test kits.<br />Kits are supplied by NIV.<br />Buffer stocks maintainance.<br />State wise allocation of Dengue and Chikungunya test kits.<br />Ensuring the diagnostic facility and availability of kits is the responsibility of the respective State Programme Officers, NVBDCP.<br />
  27. 27. Long Term Action Plan<br />The long term strategies for prevention and control of DF/DHF/DSS and Chikungunyain India is three-pronged and is as follows:<br />Early Case reporting and management<br />Integrated vector management (for transmission risk reduction)<br />Supporting Interventions<br />
  28. 28. Case Reporting and Management<br />Case reporting<br />Fever alert surveillance<br />Sentinel surveillance sites with lab support<br />Strengthening of referral services<br />Involving private sector<br />Case management<br />Case management<br />Epidemic preparedness and rapid response<br />
  29. 29. Vector Surveillance<br /><ul><li>Larval surveillance
  30. 30. House Index = No of houses infected X 100</li></ul> No of houses inspected<br /><ul><li>Container Index = No of positive containers X 100</li></ul> No of containers inspected<br /><ul><li>Breteau Index = No of positive containers X 100</li></ul>No of houses inspected<br /><ul><li>Pupae Index = No of pupae X 100</li></ul> No of houses inspected<br /><ul><li>Adult surveys
  31. 31. Landing/Biting collection
  32. 32. Resting collection
  33. 33. Oviposition traps</li></ul>Anti-larval measures<br /><ul><li>Source reduction
  34. 34. Chemical larvicide
  35. 35. Temephos
  36. 36. Biological control
  37. 37. Larvivorous fish
  38. 38. Bacillus thuringiensis serotype H-14 (Bt H-14)
  39. 39. Environmental management
  40. 40. Environmental modification
  41. 41. Environmental manipulation
  42. 42. Changes in human habitations</li></ul>Anti-adult measures<br /><ul><li>Indoor spraying
  43. 43. Pyrethrum
  44. 44. Fogging
  45. 45. Malathion
  46. 46. Personal protection measures
  47. 47. Protective clothing
  48. 48. Repellents
  49. 49. Insecticide treated bed nets limited role</li></li></ul><li>Supporting Interventions<br />Capacity building<br />BCC<br />Legislative Measures<br /><ul><li>Model civic byelaws
  50. 50. Building Construction Regulation Act
  51. 51. Environmental Health Act
  52. 52. Health Impact Assessments</li></ul>Health education for community mobilization and inter-sectoral convergence<br /><ul><li>At Household Level
  53. 53. At Community Level
  54. 54. At Institutional Level</li></li></ul><li>