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Dengue
• Each year, up to 400 million people
get infected, 100 million people get
sick, and 40,000 die from severe
dengue
• Biological agent for dengue is a type
of flavivirus, 4 types of related
dengue-viruses (DV1, DV2, DV3 and
DV4). Single person can be infected 4
times
• Spread through the bite of infected
Aedes species (Ae. aegypti or Ae.
albopictus) mosquito (also vectors of
chikungunya, yellow fever and Zika
viruses) Image Credit @CDC
(CDC, 2021)
@Bayer, 2021
Reservoir: Humans and Mosquitoes
Distribution
Severe dengue was first recognized in the 1950s during dengue epidemics in the
Philippines and Thailand. Before 1970, only 9 countries had experienced severe
dengue epidemics.
Aedes aegypti mosquitoes originated in Africa, but they have spread through
tropical and subtropical regions around the world. Today, almost half of the
world’s population live in areas with a risk of dengue, including the Americas,
Africa, the Middle East, Asia, and the Pacific Islands
Dengue fever is now considered the most critical mosquito-borne viral disease in
the world
Number of cases increased dramatically in recent years, WHO(2022) notes
increasing travel and trade, changing land patterns and climate crisis.
CDC,
2021
Transmission
Through infected mosquito
bites (Aedes species)
From mother to child
during birth
Through infected blood,
laboratory, or healthcare
setting exposures (rare)
CDC, 2021
WHO, 2022
Transmission
Symptoms
• Can be mild or severe.
• Develop within 4 to 10 days of infected mosquito
bite
• 1 in 4 infected will get sick
• Most common symptoms include fever (break-
bone fever), nausea, vomiting, rash, aches and
pains (behind the eyes) or any warning signs
• Warning signs usually begin 24-48 hours after the
fever is gone. Includes belly pain, tenderness,
vomiting, bleeding from nose or gums, blood in
vomit or stool, restlessness or fatigue
Severe Dengue
1 in 20 infected will develop severe symptoms
Can be life-threatening
Can result in shock, internal bleeding, and even
death
Past exposure increases the chances for severe
dengue
Pregnant women and infants at higher risk
Need to immediately see an HCP if any warning
signs
CDC, 2021
WHO, 2022
Diagnosis of Dengue
• Depending upon time of patient presentation, different diagnostic methods can
be used.
1. Virus isolation- Virus may be isolated from the blood during first few days of
infection, various RT–PCR tests can be performed
2. Virus may also be detected by testing for a virus-produced protein, called NS1
using rapid diagnostic tests.
3. Serological- Serological methods, such as enzyme-linked immunosorbent
assays (ELISA), may confirm the presence of a recent or past infection
Treatment
• No specific treatment for dengue fever
• Patients should rest, stay hydrated and seek medical advice
• Supportive care such as fever reducers and pain killers (acetaminophen or
paracetamol) can be used to reduce pain and aches
WHO,
2022
History of Dengue in Brazil
• The first case described in Brazil in 1685.
• Aedes aegypti was eradicated in Brazil in the 1950s, but returned in the 1980s
• Endemo-epidemic outbreaks occurred every three to five years in Brazil until
2010
• In 2016, dengue cases exceeded 1.6 million, record high at the time
• In 2017 and 2018, the number of annually reported dengue cases declined to
~250,000, the lowest since 2005
• In 2019, dengue cases again rebounded, setting a new record of ~2.1 million
reported cases in Brazil
Brito et al, 2021
Current dengue situation in Brazil
• Currently, Brazil is the country with highest number of dengue cases worldwide
(In 2022, and as of February 7, Brazil already had 29,886 cases), alongside
high COVID-19 cases
• The Brazilian Ministry of Health reported 544,460 dengue cases, including 240
deaths, recorded between 3 January 2021 and 1 January 2022.
• Three out of four Brazilian municipalities are heavily infested with the
mosquito Ae. aegypti.
ECDC, 2022
Worldometer, 2022
Prevention and control measures for dengue in Brazil
Federal- provides guidelines
for vector control, allocates
resources to the states,
purchases insecticides and
equipment such as vehicles
with chemical sprayers
State - assist and
supervise municipalities,
acquire consumables
and small equipment
such as nylon nets and
lids for water tanks or
mosquito traps, and
gather information about
the municipalities
Municipal-
Operations such as
management of vector
control, professionals
and actions, following
central-level
recommendations.
• All three level of
government
responsible
• Dengvaxia vaccine
is approved but only
recommended for
individuals with a
history of dengue
infection
Vaccines for Dengue
• Dengvaxia was launched in 2016, with Philippines being the first country to access it. In 2017,
after 830,000 children received the first dose, a controversy emerged after alleged deaths of
healthy children following vaccination
• Currently, Dengvaxia is approved for use but only recommended for individuals with a history of
dengue infection. It is associated with an increased risk for hospitalization and severe dengue
among those who have their first natural infection after vaccination
• 3 doses of the vaccine is administered every 6 months
Challenges in controlling Dengue
• Reducing the density of Ae. aegypti, the main link in the transmission chain,
remains a challenge.
• Some vector control initiatives have been conducted like re-emphasizing
insecticide use, but most mosquito populations are resistant
• Initiatives such as sterilizing mosquitoes by genetic modification or irradiation or
even infecting mosquitoes with Wolbachia, have so far shown no success in
vector control
• Ongoing battle against water accumulation near dwellings in regions with
tropical and subtropical climates due to the insecure system of water supply,
sewage and solid waste collection, among others. These conditions favor the
proliferation of the Ae. aegypti mosquito in cities, making it difficult or almost
impossible to combat the vector
How to stop Dengue spread?
• Conduct community surveillance, remove sources of water for breeding as well as
control mosquito populations using adulticides/larvicides
• People should be educated on using measures to prevent mosquito bites like using
mosquito repellents, nets, mosquito traps, wear protective clothing, have well-screened
houses.
• Without vaccines, effective drugs, or sensitive diagnostic tests, the only available
response to reduce disease severity and case fatality is early intervention and clinical
management through enhanced care, supported by accessible, sensitive and specific
useful diagnostic tests
• It is important to continue to support the research for more effective diagnosis and
treatment of dengue and for new methodologies of vector control and disease
prevention.
Onlyslappingwon’t cure Dengue
Credit
References:
https://www.cdc.gov/dengue/about/index.html
https://www.who.int/news-room/fact-
sheets/detail/dengue-and
https://www.ecdc.europa.eu/en/dengue-monthly
https://doi.org/10.1038/s41467-021-22921-
7
https://doi.org/10.1186/s13071-018-2830-8

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Dengue.pptx

  • 1. Dengue • Each year, up to 400 million people get infected, 100 million people get sick, and 40,000 die from severe dengue • Biological agent for dengue is a type of flavivirus, 4 types of related dengue-viruses (DV1, DV2, DV3 and DV4). Single person can be infected 4 times • Spread through the bite of infected Aedes species (Ae. aegypti or Ae. albopictus) mosquito (also vectors of chikungunya, yellow fever and Zika viruses) Image Credit @CDC (CDC, 2021)
  • 3. Distribution Severe dengue was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Before 1970, only 9 countries had experienced severe dengue epidemics. Aedes aegypti mosquitoes originated in Africa, but they have spread through tropical and subtropical regions around the world. Today, almost half of the world’s population live in areas with a risk of dengue, including the Americas, Africa, the Middle East, Asia, and the Pacific Islands Dengue fever is now considered the most critical mosquito-borne viral disease in the world Number of cases increased dramatically in recent years, WHO(2022) notes increasing travel and trade, changing land patterns and climate crisis. CDC, 2021
  • 4. Transmission Through infected mosquito bites (Aedes species) From mother to child during birth Through infected blood, laboratory, or healthcare setting exposures (rare) CDC, 2021 WHO, 2022 Transmission
  • 5. Symptoms • Can be mild or severe. • Develop within 4 to 10 days of infected mosquito bite • 1 in 4 infected will get sick • Most common symptoms include fever (break- bone fever), nausea, vomiting, rash, aches and pains (behind the eyes) or any warning signs • Warning signs usually begin 24-48 hours after the fever is gone. Includes belly pain, tenderness, vomiting, bleeding from nose or gums, blood in vomit or stool, restlessness or fatigue Severe Dengue 1 in 20 infected will develop severe symptoms Can be life-threatening Can result in shock, internal bleeding, and even death Past exposure increases the chances for severe dengue Pregnant women and infants at higher risk Need to immediately see an HCP if any warning signs CDC, 2021 WHO, 2022
  • 6. Diagnosis of Dengue • Depending upon time of patient presentation, different diagnostic methods can be used. 1. Virus isolation- Virus may be isolated from the blood during first few days of infection, various RT–PCR tests can be performed 2. Virus may also be detected by testing for a virus-produced protein, called NS1 using rapid diagnostic tests. 3. Serological- Serological methods, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of a recent or past infection
  • 7. Treatment • No specific treatment for dengue fever • Patients should rest, stay hydrated and seek medical advice • Supportive care such as fever reducers and pain killers (acetaminophen or paracetamol) can be used to reduce pain and aches WHO, 2022
  • 8. History of Dengue in Brazil • The first case described in Brazil in 1685. • Aedes aegypti was eradicated in Brazil in the 1950s, but returned in the 1980s • Endemo-epidemic outbreaks occurred every three to five years in Brazil until 2010 • In 2016, dengue cases exceeded 1.6 million, record high at the time • In 2017 and 2018, the number of annually reported dengue cases declined to ~250,000, the lowest since 2005 • In 2019, dengue cases again rebounded, setting a new record of ~2.1 million reported cases in Brazil Brito et al, 2021
  • 9. Current dengue situation in Brazil • Currently, Brazil is the country with highest number of dengue cases worldwide (In 2022, and as of February 7, Brazil already had 29,886 cases), alongside high COVID-19 cases • The Brazilian Ministry of Health reported 544,460 dengue cases, including 240 deaths, recorded between 3 January 2021 and 1 January 2022. • Three out of four Brazilian municipalities are heavily infested with the mosquito Ae. aegypti. ECDC, 2022 Worldometer, 2022
  • 10. Prevention and control measures for dengue in Brazil Federal- provides guidelines for vector control, allocates resources to the states, purchases insecticides and equipment such as vehicles with chemical sprayers State - assist and supervise municipalities, acquire consumables and small equipment such as nylon nets and lids for water tanks or mosquito traps, and gather information about the municipalities Municipal- Operations such as management of vector control, professionals and actions, following central-level recommendations. • All three level of government responsible • Dengvaxia vaccine is approved but only recommended for individuals with a history of dengue infection
  • 11. Vaccines for Dengue • Dengvaxia was launched in 2016, with Philippines being the first country to access it. In 2017, after 830,000 children received the first dose, a controversy emerged after alleged deaths of healthy children following vaccination • Currently, Dengvaxia is approved for use but only recommended for individuals with a history of dengue infection. It is associated with an increased risk for hospitalization and severe dengue among those who have their first natural infection after vaccination • 3 doses of the vaccine is administered every 6 months
  • 12. Challenges in controlling Dengue • Reducing the density of Ae. aegypti, the main link in the transmission chain, remains a challenge. • Some vector control initiatives have been conducted like re-emphasizing insecticide use, but most mosquito populations are resistant • Initiatives such as sterilizing mosquitoes by genetic modification or irradiation or even infecting mosquitoes with Wolbachia, have so far shown no success in vector control • Ongoing battle against water accumulation near dwellings in regions with tropical and subtropical climates due to the insecure system of water supply, sewage and solid waste collection, among others. These conditions favor the proliferation of the Ae. aegypti mosquito in cities, making it difficult or almost impossible to combat the vector
  • 13. How to stop Dengue spread? • Conduct community surveillance, remove sources of water for breeding as well as control mosquito populations using adulticides/larvicides • People should be educated on using measures to prevent mosquito bites like using mosquito repellents, nets, mosquito traps, wear protective clothing, have well-screened houses. • Without vaccines, effective drugs, or sensitive diagnostic tests, the only available response to reduce disease severity and case fatality is early intervention and clinical management through enhanced care, supported by accessible, sensitive and specific useful diagnostic tests • It is important to continue to support the research for more effective diagnosis and treatment of dengue and for new methodologies of vector control and disease prevention.