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Dengue prevention & control
This document discusses dengue prevention and control. It notes that dengue occurs widely in tropical areas and is transmitted by Aedes mosquitoes. Prevention and control requires integrated vector management including larval source reduction through environmental modification, chemical and biological control of immature mosquitoes, and personal protection measures. Disease surveillance and prompt diagnosis/treatment of cases is also important. No vaccine or antiviral currently exists for dengue, so prevention through reducing human-vector contact is key to control.
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Dengue prevention & control
- 1. Dengue- Prevention &Control Dr Geetha M
- 2. Synopsis • Distribution anddeterminants • Dynamics of Dengue transmission with Dengue prevention & control • Vector- Aedes spp. • Vector control – Integrated Vector management • Recent initiatives & Advances in Dengue control
- 3. Dengue occurs throughoutmuch of the tropical world
- 4. Dengue: Determinants- Asnapshot Agent (virus) Environment (Abiotic & biotic) Host (Man & mosquito)
- 5. Chain of infection Sourceor Reservoir Modes of transmission Susceptible host
- 6. Exposure Infection Disease Death Recovery V e c t o r Dengue Aedes aegypti Reduce human- vectorcontact To control larval habitats WHO/CSR Early diagnosis & proper management •Controlling reservoir •Interruption of transmission •Protection of susceptible host
- 7. Prevention & controlof Dengue • To control larval habitats • To reduce human-vector contact • To ensure prompt diagnosis of cases of fever & appropriate treatment No specific antiviral treatment or vaccine against Dengue is available INTEGRATED VECTOR MANAGEMENT
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- 9. Aedes mosquitoes • Tigermosquitoes • Day biter • Breeds inside & around the house • Bites repeatedly • Container mosquitoes • Eggs can live without water for more than one year
- 10. Aedes mosquitoes Aedes aegypti •Highly domesticated • Strongly anthropophilic • Nervous feeder • Discordant species • Diurnal species Aedes albopictus • Has feral moorings • Feeds on animals & humans • Aggressive feeder • Concordant species
- 14. Chain of Denguetransmission
- 15. Risk factors associatedwith DF/DHF • Demographic & societal changes • Water supply • Solid waste management • Mosquito control infrastructure • Consumerism • Increased travel & globalization of trade • Microevolution of viruses
- 19. Disease mostly occursin the rainy season and immediately afterwards (July to October) in India
- 20. Integrated vector management •Prevent mosquito breeding • Prevent mosquito-human contact
- 21. Integrated Vector Management(IVM) A rational decision-making process for the optimal use of resources for vector control • Improved efficacy • Cost-effectiveness • Ecological soundness • Sustainability
- 22. IVM Strategy- 5elements • Integrated approach • Evidence-based decision-making • Intra- and inter-sectoral collaboration • Advocacy, social mobilization & legislation • Capacity building
- 23. Integration in IVM •Collaboration within health sector and with other sectors through the optimal use of resources, planning, monitoring and decision- making. • Integration of non-chemical and chemical vector control methods • integration with other disease control measures.
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- 25. Vector control • Environmentalmanagement • Chemical control • Biological control
- 26. Environmental management • Aim:to prevent or minimize vector propagation and human contact with the vector-pathogen Environmental modification Environmental manipulation Changes to human habitation or behaviour
- 27. Environmental modification • Improvementof water supply and water- storage systems • Mosquito-proofing of water-storage containers • Solid waste management • Street cleansing • Building structures
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- 31. Changes to humanhabitation or behaviour Actions to reduce human–vector contact • Mosquito screens • Mosquito nets • Mosquito repellent sprays, creams, coils, mats or liquids
- 32. Biological control • Larvivorousfish: Gambusia affinis & Poecilia reticulata (Guppy fish) can be obtained from local administrative bodies • Can be used in burrow pits, sewage oxidation ponds, ornamental ponds, cisterns & farm ponds
- 33. Biological control • Endotoxin-producing bacteria,Bacillus thuringiensis serotype H-14 (Bt H-14) & Bacillus sphaericus found to be an effective mosquito control agent.
- 34. Chemical control • 1%Temephos (Abate) sand granules: an insecticide to kill larvae in water; about 5 g for 50 litres of water • Methoprene briquettes: 1 briquette for 284 litres of water
- 35. Chemical control • Insectgrowth regulators (IGRs) • Interfere with chitin synthesis • 2 compounds recommended under programme – Pyriproxifen – Diflubenzuron • Pheremones as ‘Attract & kill approach’
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- 37. Residual spray &space spray • Destruction of flying mosquitoes by contact with insecticides in the air • Don’t forget to spray behind photo-frames, curtains, calendars, corners of house • Supplement larval source management during outbreaks
- 38. Residual spray &space spray • Limited evidence for sustained impact • Not cost-effective for routine delivery during outbreaks • Efficacy variable • During emergency, every 2– 3 days for 10 days • Then once or twice/ week to sustain suppression of adult vector population Don’t turn away spray workers
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- 40. Disease surveillance Epidemiological surveillance •Passive • Active • Event-based Entomological or Vector surveillance • Larval surveys • Pupal/ demographic surveys • Adult surveys
- 41. Surveillance tools &Indicators
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- 43. IVM- Other components •Community participation • Model development • Social mobilization • Health education • Intersectoral coordination • Legislative support
- 44. When to implement?Where to implement? • Background interventions in endemic areas • Scaling up & additional interventions during outbreaks • Early warning systems
- 45. Who will deliver? •All hospitals, health facilities • Municipalities, urban centres, PRI • Urban VBD scheme • MoDWSS, Water supply companies • MoHUPA • MoAFW, Plantation owners • MIB, Mass media • Municipalities & waste collection companies • PWD • Research Institutions, NGOs • Schools & workplaces • IMD • Tyre manufacturers , sellers • Fisheries • Ministry of Road transport • Ministry of Railways • Ministry of Environment, Forests & climate change • Sea & air ports • MoHRD • Local Govt. • Community
- 46. Vector control- Routinecontrol At all settings At certain settings Personal protection •Container larviciding using insecticides (temephos) or microbial larvicides •Environmental modification •Environmental manipulation •Social mobilisation campaigns •Insecticide treated curtains •Screening of doors & windows •Legislation •LLINs •IRS •Perifocal insecticide spraying (tyres with residual insecticides) •Topical repellants, protective clothing, household insecticides
- 47. Vector control (Epidemiccontrol) Tools recommended Tools recommended at certain settings •Indoor space spraying using pyrethrum •Fogging or Ultra Low Volume (ULV) spray using malathion or cyphenothrin •Intensified social mobilisation campaigns •Epidemic control legislation •LLINs (for Dengue patients) •IRS
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- 50. Fight Dengue TNapp TN Toll-free no. 1800 425 1868
- 51. Advances in Denguecontrol • One licensed vaccine- CYD-TDV, Recombinant, chimeric, tetravalent dengue vaccine • Use of Wolbachia bacteria strains to infect Ae. aegypti mosquitoes • GM mosquitoes
- 52. WHO Global strategyfor Dengue prevention & control, 2012-2020 • To reduce the burden of Dengue • To reduce mortality from Dengue by 2020 by atleast 50% (using 2010 as baseline) • To reduce morbidity from Dengue by 2020 by atleast 25% (using 2010 as baseline)
- 53. Dengue fever canbe easily prevented IT IS A COLLECTIVE RESPONSIBILITY
- 54. Three-pronged strategy Prevention & Control ofDengue Disease management IVM Supportive interventions Early diagnosis & tt. Referral services Epidemic preparedness Rapid response Environmental Biological Chemical BCC, PPP, ISC, HRD, OR, M&E, GIS
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- 56. References • GOI, MOHFW,Operational manual for Integrated Vector Management in India. March 2016. • Pang T, Mak TK, Gubler DJ. Prevention and control of dengue- the light at the end of the tunnel. Lancet Infectious Diseases, 2017; 17:e79-87. • Comprehensive Guidelines for Prevention & Control of Dengue & DHF, SEARO, WHO, 2011. • WHO, Dengue control. • www.nvbdcp.gov.in Government of India (2006), National Vector Borne Disease Control Programme. MOHFW, New Delhi
- 59. • Abolish orcontrol larval habitats • Modify human behaviour • Create awareness • Be prepared: Early diagnosis & prompt management • Notification of cases
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