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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.
slide3
Leishmania is a parasitic disease spread by the bite of infected

a. aedes aegypti

b. culex

c. anopheles

d. sand flies

e. aedes albopictus

aedes
Aedes

Dengue fever in Saudi Arabia

dengue 1999 ww
Dengue (1999): WW

Areas infested with Aedes aegypti

Areas with Aedes aegypti and recent epidemic dengue

slide13

Feeding. Females 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
  • Clinical Picture, diagnosis, treatment
  • Dengue virus infection
  • Dengue fever
  • Dengue hemorrhagic fever
  • Dengue shock syndrome

(Read the attached file)

malaria
Malaria
  • World Malaria Day: April 25th , 2009.
  • Malaria: plasmodium falciparum, vivax, malariae and ovale.

(Read the attached file)

malaria1
Malaria
  • 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???
slide20

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
  • What is Leishmaniasis?
  • Life cycle.
  • Mode of infection.
  • Control and Prevention.
  • Read also the attached file.
slide24

Leishmaniasis is a protozoal disease caused by Leishmania parasite, which is transmitted by the sand fly .

  • Leishmaniasis is of three types ; cutaneous leishmaniasis, muco-cutaneous and the visceral (Kala-azar )
leishmaniasis life cycle

2

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
  • Sand fly bite
  • Others (infected blood transfusion and Pregnancy in (VL), physical contact in CL)
leishmaniasis1
Leishmaniasis
  • 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.

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 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

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
  • 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
  • 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
  • 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
  • Cont.

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

leishmaniasis in ksa3
Leishmaniasis in KSA
  • 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

N

Northern

Al-jouf

Tabouk

  • A area

Medina

Riyadh

Makkah

Eastern

Baha

Najran

Aseer

Jazan

Affected area

cutaneous leishmaniasis
Cutaneous Leishmaniasis

Cutaneous leishmaniasis

has many local names

cl seasonal variations
CL: Seasonal Variations
  • 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.

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.

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

cutaneous leishmaniasis in infants
Cutaneous Leishmaniasis in Infants

1403-1424 H (Infants)

Leishmaniasis usually affects children more than other age groups .

clinical types of cl

Hyperkeratotic

Mucosal

Lymphangitis after

Pentostam treatment

Nodules

Clinical Types of CL
  • CL
clinical types of cl1

Recidivans

Plaque

Erysipeloid

Lupoid/Disseminated

Clinical Types of CL.
  • Types
vbd prevention programs
VBD Prevention Programs
  • 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
  • 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
  • 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
  • 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)
  • 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)
  • 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
  • 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
  • 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 ofAdult 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 Shortagesand Rationing
  • For locations where there are seasonal or other temporary water shortages
  • Provide information on how to properly store water
cues rainfall
Cues: Rainfall
  • 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
  • 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
  • Role of Vaccines: Are they available or under trials?
  • Regional collaboration (VBD framework, WHO-EMRO)
  • Role of Insecticide treated net ???
surveillance goals and objectives
Surveillance: Goals and Objectives
  • 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 MethodsChemical 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
  • 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
  • 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 Minimizethe Impact of Epidemics
  • Education of the medical community
  • Implementation of emergency plan
  • Education of the general population
who specifications for public health pesticides
WHO SPECIFICATIONS FOR PUBLIC HEALTH PESTICIDES

Only available on the Internet

at

WWW.WHO.INT/CTD/WHOPES

slide69

WHO Collaborating Centres for

quality control of pesticides

Station de Phytopharmacie, Gembloux

CDC, Atlanta

HEJIR Chemistry, Karachi

CIPEIN, Buenos Aires

more readings
More Readings;
  • 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
  • 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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