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Control and Prevention of. Dengue fever Malaria and Leishmania. Objectives: You students will be capable to. identify the epidemiology of above arthropods transmissible infectious diseases

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Control and prevention of
Control and Prevention of

  • Dengue fever

  • Malaria and

  • Leishmania


Objectives you students will be capable to
Objectives: You students will be capable to

  • identify the epidemiology of above arthropods transmissible infectious diseases

  • assist the community in the prevention and control programs of the above mentioned infectious diseases.



Dengue the vectors aedes aegypti and a albopictus
Dengue: The vectors infectedAedes aegypti and A. albopictus


Aedes
Aedes infected

Dengue fever in Saudi Arabia


The world distribution of aedes aegypti
The world distribution of infectedAedes aegypti


Dengue 1999 ww
Dengue (1999): WW infected

Areas infested with Aedes aegypti

Areas with Aedes aegypti and recent epidemic dengue


Dengue ww 2008
Dengue WW, 2008 infected

  • Dengue



Aedes aegypti adult male
Aedes aegypti infectedadult male


Aedes albopictus adult male
Aedes albopictus infectedadult male



Feeding. infectedFemales feed on any vertebrate host, but prefer humans. They fly upwind following odors. The first step can be to enter a house. Blood feeding and oviposition occur mostly in the morning and in the late afternoon.


Dengue fever
Dengue fever infected

  • Clinical Picture, diagnosis, treatment

  • Dengue virus infection

  • Dengue fever

  • Dengue hemorrhagic fever

  • Dengue shock syndrome

    (Read the attached file)


Malaria
Malaria infected

  • World Malaria Day: April 25th , 2009.

  • Malaria: plasmodium falciparum, vivax, malariae and ovale.

    (Read the attached file)



Malaria patient infected


Malaria1
Malaria infected

  • In 104 countries

  • 300-500 million cases/year

  • World 1.1 to 2.7 million deaths/year

  • Africa deaths 961000

  • SEAR countries 53000

  • India 20000

  • KSA???



Group 1: 10 countries interrupted transmission: Bah, Cyp, Jor, Kuw, Leb, Lib, Pal, Tun, UAE

Group 2: 4 countries targeting elimination: Egy, Mor, Oma, SyrGroup 3: 4 countries low- moderate endemicity: Ira, Iraq, Pak, KSAGroup 4: 5 countries high burden: Afghanistan, Dji, Som, Sud, Yem


Leishmaniasis
Leishmaniasis Jor, Kuw, Leb, Lib, Pal, Tun, UAE

  • What is Leishmaniasis?

  • Life cycle.

  • Mode of infection.

  • Control and Prevention.

  • Read also the attached file.



Leishmaniasis life cycle

2 parasite, which is transmitted by the sand fly .

1

8

3

7

4

6

i

5

i

d

d

Leishmaniasis Life Cycle

Sand fly Stages

Human Stages

Sand fly takes a blood meal

Promastigotes are

Phagocytized by

macrophages

Divide in midgut and

migrate to proboscis

(Injects promastigote

stage into the tissue)

Promastigotes transfer

into amastigotes inside

macrophages

Amastigotes transform

Into promastigote

stage in midgut

Ingestion of

Parasitized cell

Amastigotes multiply in cells

(Including macrophages) of

Various tissues

Sand fly takes

a blood meal

Infective stage

(ingest macrophages

Infected with amastigotes )

Diagnostic stage


Leishmaniasis mode of infection
Leishmaniasis: Mode of infection parasite, which is transmitted by the sand fly .

  • Sand fly bite

  • Others (infected blood transfusion and Pregnancy in (VL), physical contact in CL)


Sand fly
Sand fly parasite, which is transmitted by the sand fly .


Leishmaniasis1
Leishmaniasis parasite, which is transmitted by the sand fly .

  • Sand Flies are vector of the disease. More than 500 species and subspecies in the world. of which, only 35 types are known to transmit the disease, Phlebotomus in OCL, and Lutzomia in NCL.

  • There are more than 21 Leishmanial species .


Leishmaniasis2

Clinical features. parasite, which is transmitted by the sand fly .

Smear from the base of the ulcer stained with Wright‘s stain detects round or ovoid parasite in the cytoplasm of macrophages.

Leishman test: Intradermal injection of leishmanial antigen causes a delayed

tuberculin type of reaction.

Leishmaniasis

Diagnosis:


Leishmaniasis reservoirs

The parasite, which is transmitted by the sand fly .dogs in the Mediterranean countries

The man in the Middle East

The wild rodents in Asia and Africa

Leishmaniasis Reservoirs

Reservoirs


Leishmaniasis ww
Leishmaniasis WW parasite, which is transmitted by the sand fly .

W

  • Leishmaniasis

O

R

L

> 12 Million people infected in 88 countries

> 350 Million people are risk

D

Annually,0.5M (VL)80,000 Deaths,1.5M(CL)

Visceral Leishmaniasis

Cutaneous Leishmaniasis

Mucocutaneous Leishmaniasis


Leishmaniasis3
Leishmaniasis parasite, which is transmitted by the sand fly .

  • Types

Visceral

* Fever

* Hepatosplenomegaly

* Weight loss

  • Death, 90% in

  • Bangladesh, Brazil, India, Nepal,and in Sudan

Cutaneous

  • Skin ulceration,

  • 90%Afghanistan

  • ,Syria,Iran,Iraq,Brazil,Peru,

  • and Saudi Arabia

Mucocutaneous

* Skin and mucus

membranes affection

  • Might be fatal. 90%

  • in Bolivia,

  • Brazil and Peru


Leishmaniasis in ksa
Leishmaniasis in KSA parasite, which is transmitted by the sand fly .

  • Leishmaniasis:

It is known in the Kingdom back to 1950.

Ministry of Health has established the leishmaniasis unit in the 1980 Under The precautionary medicine to follow-up the diseasein the Saudi cities


Leishmaniasis in ksa1
Leishmaniasis in KSA parasite, which is transmitted by the sand fly .

  • Types

There are VL and CL.

VL caused by L.Donovani LON 42, and the Rattus rattus is the reservoir.

2 types of CL(ZCL and ACL)

In the Riyadh and Eastern province, ZCL transmitted by P.Papatasi and caused by L.Major LON4


Leishmaniasis in ksa2
Leishmaniasis in KSA parasite, which is transmitted by the sand fly .

  • Cont.

CL in Southern region is ACL transmitted by P.Sergenti and caused by L.Tropica LON 72


Leishmaniasis in ksa3
Leishmaniasis in KSA parasite, which is transmitted by the sand fly .

  • Sand flies:

There are 20 types of Sand Flies in the KSA. 7 are Phlebotomous and 13 are of Sergentomyia type.


Visceral leishmaniasis
Visceral Leishmaniasis parasite, which is transmitted by the sand fly .

N

Northern

Al-jouf

Tabouk

  • A area

Medina

Riyadh

Makkah

Eastern

Baha

Najran

Aseer

Jazan

Affected area


Reported cases of vl
Reported Cases of VL parasite, which is transmitted by the sand fly .

1984-2004

  • RCVL


Cutaneous leishmaniasis
Cutaneous Leishmaniasis parasite, which is transmitted by the sand fly .

Cutaneous leishmaniasis

has many local names


Cl seasonal variations
CL: Seasonal Variations parasite, which is transmitted by the sand fly .

  • CL:

The peak of cutaneous leishmaniasis is in August, October, December, Januaryand February. The least number of cases are reported in May and June.


Cl geographical dist
CL: Geographical Dist parasite, which is transmitted by the sand fly ..

Northern

8.4 %

Al-jouf

2001

Tabouk

18.2 %

  • CLGD

7.6 %

Hail

Qaseem

Alhsa only 41.2 %

Medina

Riyadh

9.6 %

Makkah

Eastern

Baha

Najran

Aseer

N

Jazan


Cl cont
CL: cont. parasite, which is transmitted by the sand fly .

Northern

9.1 %

Al-jouf

2004

Tabouk

26.6%

  • GD

18.5 %

Hail

4.1 %

Qaseem

Alhsa 20.9%

Medina

Riyadh

4.1 %

Makkah

Eastern

Baha

Najran

Aseer

N

Jazan


Reported cases of cutaneous l
Reported Cases of Cutaneous L. parasite, which is transmitted by the sand fly .

1983-2004

  • CL


Reported cases of cl
Reported Cases of CL parasite, which is transmitted by the sand fly .

1983-2004

  • CL


Cutaneous leishmaniasis in infants
Cutaneous Leishmaniasis in Infants parasite, which is transmitted by the sand fly .

1403-1424 H (Infants)

Leishmaniasis usually affects children more than other age groups .


Clinical types of cl

Hyperkeratotic parasite, which is transmitted by the sand fly .

Mucosal

Lymphangitis after

Pentostam treatment

Nodules

Clinical Types of CL

  • CL


Clinical types of cl1

Recidivans parasite, which is transmitted by the sand fly .

Plaque

Erysipeloid

Lupoid/Disseminated

Clinical Types of CL.

  • Types


Vbd prevention programs
VBD Prevention Programs parasite, which is transmitted by the sand fly .

  • Efforts should focus on sustainable environmental control rather than eradication

  • Control programs should be community-based and -integrated. They cannot rely solely on insecticides nor require large budgets

  • Need to promote VBD as a priority among health officials and the general public


Community approaches
Community Approaches parasite, which is transmitted by the sand fly .

  • Define communities geographically

  • More likely to be sustainable

  • Advantages: built-in manpower, help develop resources and empower community organizations

  • Disadvantages: more difficult to organize, take longer to get off the ground


Community participation
Community Participation parasite, which is transmitted by the sand fly .

  • First must educate the public in the basics of VBD, such as:

    • Where the mosquito lays her eggs

    • The link between larvae and adult mosquitoes

    • General information about VBD transmission, symptoms and TTT.


Skills deficit
Skills Deficit parasite, which is transmitted by the sand fly .

  • Knowledge is not sufficient to produce behavior change

  • People may lack the skills necessary to carry out the recommended behaviors

  • Need to address this skills deficit


Barriers and motivation part 1
Barriers and Motivation (Part 1) parasite, which is transmitted by the sand fly .

  • Knowledge combined with skills still may not be sufficient to change behavior

  • Need to understand what barriers may prevent the behavior, and what factors may motivate people to take the desired action

  • Barriers and motivating factors vary in different regions


Barriers and motivation part 2
Barriers and Motivation (Part 2) parasite, which is transmitted by the sand fly .

  • Structural factors

    • laws regarding Aedes aegypti habitats

  • Environmental factors

    • lack of potable water, need to store water

    • inadequate solid waste disposal

  • Attitudinal factors

    • beliefs: causes, treatment, prevention of febrile illnesses

  • Community factors

    • community history and structure

    • other priority problems in the community


Cues for vbd like dengue preventive behaviors
Cues for VBD like Dengue Preventive Behaviors parasite, which is transmitted by the sand fly .

  • People need reminders when they are learning a new behavior

  • Behavioral cues are prompts or signals to remind the person to engage in the desired behavior


Cues feedback
Cues: Feedback parasite, which is transmitted by the sand fly .

  • Use regular feedback of entomologic and epidemiologic data

  • Every time someone receives the information, it can serve as a reminder to act

  • If the data indicate control activities are successful, they serve as positive reinforcement


Cues presence of adult mosquitoes
Cues: Presence of parasite, which is transmitted by the sand fly .Adult Mosquitoes

  • Idea to promote:

    • Person sees adult mosquito

    • Asks him/herself, “Where did it come from?”

    • Immediately searches for larval habitats

    • Eliminates or controls all potential habitats found


Cues water shortages and rationing
Cues: Water Shortages parasite, which is transmitted by the sand fly .and Rationing

  • For locations where there are seasonal or other temporary water shortages

  • Provide information on how to properly store water


Cues rainfall
Cues: Rainfall parasite, which is transmitted by the sand fly .

  • Link rainfall to the creation of larval habitats

  • This mental link can remind people to look for and eliminate larval habitats after it rains

  • Eliminates larval habitats influenced by rainfall, and perhaps others as well


The challenge
The Challenge parasite, which is transmitted by the sand fly .

  • Achieve active community involvement

  • Solicit input from the earliest program planning stages

  • Encourage community ownership

  • Programs that emphasize telling communities what to do, without involving them or taking their views into account, are not likely to be effective

  • True community participation is the key


Vbd prevention
VBD Prevention parasite, which is transmitted by the sand fly .

  • Role of Vaccines: Are they available or under trials?

  • Regional collaboration (VBD framework, WHO-EMRO)

  • Role of Insecticide treated net ???


Vbd surveillance and control

VBD Surveillance and Control parasite, which is transmitted by the sand fly .


Surveillance goals and objectives
Surveillance: Goals and Objectives parasite, which is transmitted by the sand fly .

  • Provide early and precise information

  • disease severity

  • Predict VBD like dengue and malaria transmission and guide implementation of control measures

  • Link clinical and entomologic surveillance


Vector control methods chemical control
Vector Control Methods parasite, which is transmitted by the sand fly .Chemical Control

  • Larvicides may be used to kill immature aquatic stages

  • Ultra-low volume fumigation ineffective against adult mosquitoes

  • Mosquitoes may have resistance to commercial aerosol sprays


Vector control methods
Vector Control Methods parasite, which is transmitted by the sand fly .

  • Biological control

    • Largely experimental

    • Option: place fish in containers to eat larvae

  • Environmental control

    • Elimination of larval habitats

    • Most likely method to be effective in the long term


Purpose of control
Purpose of Control parasite, which is transmitted by the sand fly .

  • Reduce female vector density to a level below which epidemic vector transmission will not occur

  • Based on the assumption that eliminating or reducing the number of larval habitats in the domestic environment will control the vector

  • The minimum vector density to prevent epidemic transmission is unknown


Programs to minimize the impact of epidemics
Programs to Minimize parasite, which is transmitted by the sand fly .the Impact of Epidemics

  • Education of the medical community

  • Implementation of emergency plan

  • Education of the general population


Insecticide use for vector control emro
INSECTICIDE USE FOR VECTOR CONTROL parasite, which is transmitted by the sand fly .- EMRO -


Who specifications for public health pesticides
WHO SPECIFICATIONS FOR parasite, which is transmitted by the sand fly .PUBLIC HEALTH PESTICIDES

Only available on the Internet

at

WWW.WHO.INT/CTD/WHOPES


WHO Collaborating Centres for parasite, which is transmitted by the sand fly .

quality control of pesticides

Station de Phytopharmacie, Gembloux

CDC, Atlanta

HEJIR Chemistry, Karachi

CIPEIN, Buenos Aires


More readings
More Readings; parasite, which is transmitted by the sand fly .

  • WHO-EMRO: Country Profile: Saudi Arabia. EMRO website

  • CDC materials and publications

  • CDC: VBD fact sheets.

  • Read the attached files.


Objectives you students will be capable to1
Objectives: You students will be capable to parasite, which is transmitted by the sand fly .

  • identify the epidemiology of above arthropods transmissible infectious diseases

  • assist the community in the prevention and control programs of the above mentioned infectious diseases.


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