Presentation describing the dissertation undertaken. Author: Dr Christa Maria Joel Module: MPH Dissertation Supervisors: Dr William Mackay Gordie and Dr Steven Kelly University of the West of Scotland

1. INCIDENCE OF DENGUE, EFFECT OF
CLIMATE ON DENGUE TRANSMISSION, AND
PREVENTIVE MEASURES AGAINST DENGUE
VIRUS INFECTION IN INDIA
CHRISTA MARIA JOEL
B00495281
NAME OF THE SUPERVISORS: STEVEN KELLY
AND WILLIAM MCKAY GORDIE

2. TABLE OF
CONTENTS
• Introduction
• Incidence of dengue in India
• Effect of climate on dengue transmission in India
• Preventive interventions against dengue
• Dissertation- topic, objectives and research question
• PICO Framework
• PRISMA Flowchart
• Preliminary results of the study
• Future directions for systematic study
• References

3. OBJECTIVES OF THE PRESENTATION
• To present the current scenario of dengue incidence in India, climatic conditions and how it
influences dengue transmission and preventive interventions to control dengue infection.
• To present the topic, research objectives, research question and methodology.

4. INCIDENCE
OF DENGUE
IN INDIA
• Mosquito-borne disease that is predominant in India (Ganeshkumar et al..,
2018).
• Causative agent: dengue virus and its serotypes – DEN 1, 2, 3, and 4 belonging
to the Flaviviridae family, transmitted by infected female Aedes mosquito due to
globalisation, urbanisation, and ecological factors (Khetarpal, Khanna, 2016).
• Incidence in India: increasing over the last fifty years (Khetarpal, Khanna,
2016).
• National Center for Vector Borne Disease Control (NCVBDC): more than
100,000 confirmed dengue cases in 2021 (NCVBDC, 2021).

5. EFFECT OF CLIMATIC
CONDITIONS ON DENGUE
TRANSMISSION IN INDIA
• Climatic parameters like
temperature, rainfall, El Nino
Southern Oscillation and La Nina
phenomena have a direct correlation
with dengue transmission
(Mutheneni et al., 2017; Pramanik et
al., 2020).
Climatic conditions Incidence
Winter (January,
February)
Decrease
Summer (March, April,
May)
Overall decrease with an
exception in a few states.
Monsoon (June, July,
August, September)
Increase across the whole
country with a peak
incidence in August and
September.
Post-Monsoon (October,
November, December)
Decreased incidence
compared to the monsoon
season but still prevalent
across the country.

6. PREVENTIVE INTERVENTIONS
AGAINST DENGUE
Preventive interventions Functions Limitations
Surveillance NCVBDC and IDSP- are national
programs, monitor and track cases at the
national, state and district levels (Pilot et al.,
2020)
Lack of adequate infrastructure,
workforce and IT (Pilot et al., 2020).
Vector control Mosquito nets, repellents, chemical
insecticides, plant-based compounds
(Gupta, Reddy, 2014)
Chemical insecticides: negative
impact on humans and the
environment (Gupta, Reddy, 2014).
Vaccines Global and indigenous vaccines
(Swaminathan, Khanna, 2019)
Still undergoing trials and nothing
affirmative to roll out (Swaminathan,
Khanna, 2019).
Community education
programs
Enhance knowledge of the public (Gopalan
et al., 2021)
Attitude and perception of the public
may be limited (Mathur et al., 2020)
GIS mapping Remote technology to track and contain
dengue infections (Singh, Chaturvedi,
2021).
Still not available across the country
due to a lack of resources and funds
(Gandhi et al., 2017).

7. DISSERTATION- TOPIC, OBJECTIVES,
AND RESEARCH QUESTION
• Topic: Incidence of dengue, the effect of climate on dengue transmission, and preventive measures against
dengue virus infection in India.
• Methodology: Systematic review.
• Research objectives: Explore the incidence of dengue infection based on serotypes, vectors and incidence
rates, analyse the association between Indian climatic factors and dengue transmission and understand the
different preventive strategies used to control dengue infection in India.
• Research question: How do the Indian climatic factors and the different preventive measures adopted by
the Indian public health systems affect the transmission of the dengue infection?

8. PICO FRAMEWORK
Population (36) Andaman and Nicobar Islands, Andhra Pradesh, Arunachal
Pradesh, Assam, Bihar, Chandigarh, Chattisgarh, Daman & Diu,
Haveli, Delhi, Goa, Gujarat, Haryana, Himachal Pradesh,
Jammu & Kashmir, Jharkhand, Karnataka, Kerala,
Lakshadweep, Madhya Pradesh, Maharashtra, Manipur,
Meghalaya, Mizoram, Nagaland, Odisha, Puducherry, Punjab,
Rajasthan, Sikkim, Tamil Nadu, Tripura, Telangana, Uttar
Pradesh, Uttarakhand, West Bengal
Interventions (5) Vector control AND Surveillance AND community program
AND vaccination for dengue AND GIS mapping
Comparison (2) Incidence of dengue and effect of climatic factors on dengue
across different states of India
Outcome (2) Incidence of dengue AND effect of Climatic factors on dengue

9. SELECTION CRITERIA
Inclusion Criteria Exclusion Criteria
Population: all age groups and genders from 28 states
and 8 union territories of India.
Articles irrelevant to the research question: dengue
transmission in other countries, genetic studies, and
animal models.
Language: Completed articles in English. Language: Articles in other languages.
Publication date: From 1st January 2010 to 30th June
2022.
Publication date: Before January 1st 2010
Studies: Systematic reviews, randomised control trials
and meta-analyses with appropriate abstracts, results
and discussions.
Studies: without a significant introduction or abstract,
results and discussions.

10. SEARCH STRATEGY
• Searched via two databases- PubMed and Web of Science
• Publications dating from 1st January 2010 to 30th June 2022.
• Inclusion criteria, exclusion criteria and Boolean terms were used to identify the articles in English
• Duplicate articles were removed manually and articles describing dengue in India were considered.
• Eligible studies were articles describing the dengue virus's microbiology, clinical picture, dengue
incidence in India, dengue transmission association with Indian climatic factors, and preventive
strategies.

11. SEARCH TERMS
• Specific keywords: Dengue, India, epidemiology, incidence, prevalence, economic and social
impact, climatic factors, vectors, preventive measures, vaccines, surveillance, health education,
biological control, and vector control.
• Boolean terms: “dengue and/or epidemiology in India”, “dengue, and/or incidence in India”,
“dengue and/or economic and social impact in India”, “dengue and/or south India”, “dengue and/or
north India”, “dengue and/or climatic factors in India”, “dengue and/or vectors”, “dengue and/or
preventive measures in India”, “dengue and/or vaccines in India”, “dengue and/or surveillance in
India”, “dengue and/or health education in India”, “dengue and/or biological or chemical control in
India”.

12. Articles from PubMed= 683
Articles from Web of Science= 300
Total articles = 983
Articles for initial screening
(n= 746)
Articles after eligibility
testing (n=124)
Articles included for study
(n=38)
Duplicate articles removed (n=
237).
Articles excluded after initial
screening (n= 396)
Articles excluded after further
screening (n= 226)
PRISMA
FLOWCHART
Identification
Screening
Eligibility
Including
Articles after further
screening (n= 350)
Articles excluded after further
eligibility testing (n=86)

13. PRELIMINARY RESULTS OF THE STUDY
• Seroprevalence: DENV 2 predominant (Alagarasu et al., 2021)
• Vector prevalence : Aedes aegypti common (Alagarasu et al.,
2021).
• Regional incidence: Uttar Pradesh- highest, Lakshadweep- lowest
(NCVBDC, 2021).
• Elevated temperature and rainfall: main climatic parameters that
positively correlate with dengue transmission (Mutheneni et al.,
2017).
• Surveillance: the main pillar of dengue prevention in India
integrated with vector control (Pilot et al., 2020).

14. CONCLUSION
• Dengue: public health menace in India for the last fifty years.
• Incidence varies across geographical, demographical domains and serotypes.
• Climate: main driver of dengue transmission.
• Temperature and rainfall: main climatic parameters that influence dengue transmission.
• Many effective preventive interventions have been used to control dengue transmission like surveillance
systems, vector control, vaccinations, educative programs and technologies to track infections.

15. REFERENCES
• Alagarasu, K., Patil, J.A., Kakade, M.B., More, A.M., Yogesh, B., Newase, P., Jadhav, S.M., Parashar, D., Kaur, H., Gupta, N., Vijay, N.,
Narayan, J., Shah, P.S., VRDL Team. Serotype and genotype diversity of dengue viruses circulating in India: a multi-centre retrospective
study involving the Virus Research Diagnostic Laboratory Network in 2018. International journal of infectious diseases: IJID, 111,
pp.242-252. Doi: 10.1016.j.ijid.2021.08.045.
• Gandhi, G., Chapla, J., Naik, B.R. (2017). Data mapping of vector-borne disease with geographical information system and global
position system technology: in tribal areas Khammam district, Telangana State. International Journal of Mosquito Research, 4(2), pp.39-
43. Available at: http://www.dipterajournal.com/pdf/2017/vol4issue2/PartA/3-6-10-404.pdf (Accessed on 10/06/2022).
• Ganeshkumar, P., Murhekar, M.V., Poornima, V., Saravanakumar, V., Sukumaran, K., Anadaselvasankar, A., John, D., Mehendale, S.M.
(2018). Dengue infection in India- a systematic review and meta-analysis. PLOS Neglected Tropical Diseases, 12(7): e0006618. Doi:
10.1371/journal.pntd.0006618.
• Gopalan, R.B., Babu, B.V., Sugunan, A.P., Murali, A., Ma, M.S., Balasubramanian, R., Philip, S. (2021). Community engagement to
control dengue and another vector-borne disease in Alappuzha municipality, Kerala, India. Pathogens and Global Health, 115(4), p.258-
266. Doi: 10.1080/20477724.2021.1890886.
• Gupta, B., Reddy, B.P.N. (2014). Fight against dengue in India: progresses and challenges. Parasitology Research, 112, pp.1367-1378.
Doi: 10.1007/s00436-013-3342-2

16. • Khetarpal, N., Khanna, I. (2016). Dengue fever: Causes, complications, and vaccine strategies. Journal of Immunology Research, 2016:
6803098. Doi: 10.1155/2016/6803098.
• Mathur, D., Patel, M., Vyas, P., Kaushal, R., Dash, G.C., Goel, A.D., Bhardwaj, P., Gupta, M.K., Joshi, N.K. (2020). Revitalising
community engagement and surveillance challenges for strengthening dengue control in Jodhpur, Western Rajasthan, India- a mixed
method study. Journal of infection and public health, 13(11), pp.1755-1761. Doi: 10.1016/j.jiph.2020.08.005. (Accessed on 06/07/2022).
• Mutheneni, S.R., Morse, A.P., Caminade, C., Upadhyayula, S.M. (2017). Dengue burden in India: recent trends and importance of
climatic parameters. Emerging microbes and infections, 6(8): e70. Doi: 10.1038/emi.2017.57.
• National Center for Vector-Borne disease control (NCVBDC) (2021). Dengue/DHF situation in India. Available at:
https://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=431&lid=3715
• Pilot, E., Nittas, V., Murthy, G.V.S. (2020). Understanding India’s urban dengue surveillance: a qualitative policy analysis of Hyderabad
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• Pramanik, M., Singh, P., Kumar, G., Ojha, V.P., Dhiman, R.C. (2020). El Nino Southern Oscillation as an early warning tool for dengue
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