Dengue control programme kma 7 oct. copy
- 1. Dengue Control Programme Dr. Anjali V. Wagh Professor & Head Dept.of Community Medicine D.Y.Patil Medical College, Kolhapur.
- 2. • Most common arthropod borne viral disease • One of the most important Emerging diseases of the tropical & subtropical regions affecting urban & peri-urban areas. • Multifaceted epidemiology Dengue fever
- 3. Dengue virus Group B arbovirus , genus -flavivirus There are four serotypes of dengue (1 to 4) closely related to one another. Recovery from one serotype provides lifelong immunity Sequential infection increases the risk of more serious disease resulting in DHF. Serotypes=Genotypes /subtypes DENV-1 = 3 DENV-2 = 6 DENV-3 = 4 DENV-4 = 5
- 4. Pune, 164,15% Kolhapur,491,45% Aurangabad,58,5.3% Nagpur,29, 2.7% PMC– 53 Pune(R) -25 Satara- 28 Solapur(R)– 39 SolapurMC- 18 KolhapurMC– 347 Kolhapur(R)- 92 Sangli- 29 Nashik,154,14.1% NashikMC- 117 Nashik(R)- 23 Thane,115, 10.5% Gr.Mumbai - 54 Palghar- 41 Nanded-37 AurangabadMC- 21 Inter-regional variation may possibly be attributable to artefacts including reporting bias Total Dengue Cases = 1091 Death = 1 Latur, 62, 5.7% Akola, 18,1.6% Division wise distribution of dengue Up to June 2018
- 5. Watch out ! This Mosquito • Day biting – Female mosquito normally catches us unaware • Domestic breeder - urban mosquito • Breeding habit - artificially collected water in homes • Resting habit – endophilic , Dark corners of home • Feeding habit - Anthrophilic • Nervous feeder ( bite more than one host) • Discordant species (more than one feed for complete gonotrophic cycle) • Transovarian transmission of virus • Dispersal – 100 mt. only Aedes aegypti Aedes albopictus “Tiger Mosquito”
- 6. Breeding habits Aedes aegypti • Aedes aegypti mosquito breeds in any type of man made containers or storage containers having even a small quantity of water • Eggs of Aedes aegypti can survive without water up to one year. But water is essential during first 8 days of life of mosquito.
- 7. Environmental factors • Aedes aegypti fluctuates with rain fall & water storage • Survives best between temp. 16 0 c -30 0 c & Humidity - 60 – 80 % • Even with 20 c increase in temp., Extrinsic Incubation Period of DENV will be shortened. • More infected mosquitos are available for longer duration. • Because of dehydration mosquito will bite more frequently & increases man - mosquito contact.
- 8. Transmission of dengue by Aedes aegypti Illness Mosquito feeds Acquires virus Mosquito re-feeds Transmits virus Extrinsic Incubation period Intrinsic Incubation periodViremia Viremia Days 0 1612 20 24 285 8 Susceptible HostInfected Host Illness
- 10. Diagnostic Markers of Dengue Dengue NS 1 antigen Day 1 to 9 Dengue Ig M Day 5 to 21 Dengue Ig G Day 30 +
- 11. NVBDCP – Dengue control • Early case detection and treatment • Strengthening referral services • Epidemic preparedness and rapid response Disease management • Entomological surveillance • Chemical methods • Personal protection • Legislative measures Integrated vector management • Behavior change communication • Inter-sectoral convergence • Capacity building Supportive interventions • Source reduction
- 12. Dengue case definition Probable DF/DHF • A case compatible with clinical description of dengue fever during outbreak or • Non ELISA based NS 1antigen/ IgM positive* Confirmed dengue fever • A case compatible with the clinical description of dengue with at least one of the following • Isolation of dengue virus (Virus culture+ VE) from serum, plasma, leucocyte • Demonstration of IgM antibody by ELISA positive in single serum sample • Demonstration of dengue virus antigen in serum sample by NS-1 ELISA • IgG serocnversion in paired sera after 2 weeks with four fiold increase in IgG titer • Detection of viral nucleic acid by polymerase chain reaction (PCR) * A positive test by RDT will be considered as probable due to poor sensitivity specificity of currently available RDTs
- 13. Treatment of Dengue • Supportive measures –Antipyretics, oxygen as per need • Plenty of water and salt are required • Monitor BP, haematocrit, platelet count, RFT, LFT • Watch level of consciousness, signs of bleeding • Avoid Aspirin and pain killers • Steroids should not be used • Children below 12 require careful watch for dangerous form • No antibiotics are of proven value
- 14. Key Elements of IVMIntegrated vector control Intersectoral coordination Environmental Manipulation & Modification Biological control IEC activities Personal Protection measures Chemical control
- 15. Environmental modification Removal of natural breeding sites Turn pails and watering cans over and store them under shelter. Remove water in plant pot plates. Clean and scrub the plate thoroughly to remove mosquito eggs. Avoid the use of plant pot plates, if possible. Loosen soil from potted plants to prevent the accumulation of stagnant water on the surface of the hardened soil. Cover rarely used gully traps. Replace the gully trap with non-perforated ones and install anti-mosquito valves.
- 16. Entomological surveillance Larval Surveys House index (HI) • Percentage of houses infected with larvae or pupae Container Index (CI) • Percentage of water holding container infected with larvae or pupae Breteau Index (BI) • No. of positive containers per 100 houses inspected Pupae Index (PI) • No. of pupae per 100 houses inspected • AnHI>5%&/or a BI>20for anylocality isan indication that the locality isdengue sensitive and therefore adequate preventive measures should betaken
- 17. Entomological surveillance Adult Surveys Landing/biting collection • Presence of aedes aegypti mosquito can be reliable indicator of clear proximity to hidden larvae habitats • It is expressed as landing/ biting counts per man hour. Resting collection • Mosquitoes typically rest indoors, especially in bedrooms and mostly in dark places, such as cloth closets and other sheltered sites • Mosquito searched with the aid of flashlight & Recorded as number of adults per house per man hour of human efforts Oviposition traps • Ovitraps are devices used to detect presence of Aedes aegypti where population density is low (BI < 5) (urban areas) • Used to evaluate impact of adulticidal space spraying on female adult mosquito population
- 18. Vector control Chemical control Larvicide • Temephos - (50 EC) 1ppm (1mg per lit. of water) Adulticide • e.g. Malathion fogging or ULV spray • Pyrethrum spray ( 0.1%-o.2%) – Indoor spray (30-60 ml /1000 cu. ft.) • Commercial spray – 2% pyrethrum is diluted by kerosene into 20 lit. to make o.1% formulation. Repellents • DEET, indalone, diethyl benzamide, dimethyl phathalate.
- 19. Larvivorous Fish Gambusia affinis Lebister reticulatus Aphanius dispar Mosquito larvae are typically good source of food for organisms such as the Larvae-eating fish(e.g. Gambusia “mosquito fish”), Immature dragonflies and damselflies, Aquatic beetles, and Certain aquatic organisms such as planaria Endotoxin producing bacteria Bacillus thuringiensis iserailensis (Bti) Biological control
- 20. Vector control Genetic control Methods such as 1. Sterile male technique 2. Cytoplasmic incompatability 3. Chromosomal translocations 4. Sex distortion 5. Gene replacement Limitations: 1. Lack ofmating competitiveness released males. 2. Immigration of fertile females from regions close to the release sites.
- 21. Repellants Personal protection a) Mosquito net: ITBN treated with Deltamethrin b) Screening: of windows, not >0.0475 inch in any diameter. c) Repellants : DEET, indalone, diethyl benzamide, dimethyl phathalate. Bednet hole size : Not bigger than 1.2 to 1.5 mm. diameter. i.e. 6 to 8 holes to 10 mm. linear length. Dosage : 25 mg Deltamethrin / sq. mt. OR 50 mg Cyfluthrin / sq. mt.
- 22. Behavioral change communication campaign Massive, Repetative, Intense and Persistent Educate public on – Transmission of disease, mosquito breeding sites, symptoms of Dengue, vector control measures. Mass media - T.V., Radio, Newspapers, cable etc. Outdoor publicity – Hoardings, miking, rallies Health education material distributed –pamphlets, handbills. Interpersonal communication – group meetings, folk media Involvement of VHSC, ASHA Inter-sectoral Collaboration & community participationis the key components for prevention and control of Dengue
- 23. Mosquito abatement Weekly scheduleof socialmobilization- Satara No. Activity Periodicity Responsibility 1 Gramsabha, Fever Surveillance Monday THO/BDO/MO/ 2 Dry day, Container surveillance, distribution of pamphlets Tuesday Gramsevak, HA, MPW (M/F), Aanganwadi sevika 3 Removal of tires and mesh for ventpipe Wednesday Headmasters, 4 Application of Temephos , Introduction of guppy fish in cementcontainers Thursday Teachers, ASHA 5 Sanitization, miking Friday 6 Student march Saturday
- 24. Model civic by-laws : • Fine / punishment is imparted, if breeding is detected. Strictly imposed by Mumbai, Navi Mumbai, Chandigarh and Delhi Municipal Corporations. Building construction regulation act : • For overhead / underground tanks etc In Mumbai, builders deposit a fee for controlling mosquitogenic conditions at site Environmental Health Act : • By-laws for proper disposal / storage of junk, discarded tins old tyres and other debris Health Impact Assessments : • Prior to any development projects/major constructions Legislative measures
- 25. The World Mosquito Program’s Wolbachiamethod Release of either all mosquitoes or male only mosquitoes with Wolbachia WMP and ICMR partnership is researching at Puducherry through VRC(2016-17) Modified Vector density and vector competence
- 26. Dengue vaccine CYD-TDV developed by Sanofi Pasteur is a recombinant tetravalent (four-serotype) live attenuated virus vaccine that was first licensed in Mexico in December 2015. It took Sanofi-Pasteur about 20 years to design and improve the Dengvaxia. Useful in individuals 9–45 years of age living in endemic areas. It is given as a three-dose series on a 0-, 6-, 12-month schedule. Additional dengue vaccine candidates are in clinical development.
- 27. Dengue vaccines in development Vaccine type Component Dose Frequency Country NIH vaccine TV003/TV005 Live attenuated tetravalent One component is a chimeric virus Single dose 74-92% (TV003) and 90% (TV005) of flavivirus-naïve licensed to Instituto Butantan (Brazil), Vabiotech (Viet Nam), Panacea Biotech & Serum Institute (India) TDV - Takeda Based on Den 2 Chimeric virus Two doses 3 months Takeda Japan GSK - PIDV Purified inactivated tetravalent Two doses 28 days U.S. and Puerto Rico Merck-Vaccine Sub-unit protein truncated envelope protein (E) Three doses 1 month apart Australia
- 28. Global strategy for Dengue prevention & control ( 2012 - 2020) Dengue has global threat that require global response. Coordination & collaboration among multi-sectoral partners on Integrated vector management approach Goals – 1) To reduce mortality by at least 50 % by 2020 2) To reduce morbidity by at least 25 % by 2020 3) To estimate true burden of the disease by 2015
- 29. Take home message…. DHF as a serious Public Health Problem Early diagnosis and treatment of cases Stop spread of disease • Passive surveillance • Active surveillance Elimination of breeding places of mosquito. • Used tyres, bottles and containers should be disposed of properly. Personal protection: • Use of mosquito nets, repellant creams, mosquito coils, mats and aerosols. Health education
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