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Dengue: How are we doing?

Dengue: How are we doing?. Celebrating 100 Years of PAHO. Pan American Health Organization 1902–2002. Jorge R. Arias, Ph.D. Aedes aegypti: Distribution throughout the world. 2002. 1930s. 1970. Reinfestation of Aedes aegypti. The first eradication campaigns were successful.

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Dengue: How are we doing?

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  1. Dengue:How are we doing? Celebrating 100 Years of PAHO Pan American Health Organization 1902–2002 Jorge R. Arias, Ph.D.

  2. Aedes aegypti: Distribution throughout the world

  3. 2002 1930s 1970 Reinfestation of Aedes aegypti

  4. The first eradication campaigns were successful • Internal and external financing for personnel, equipment, and materials. • Emphasis on source reduction. • Efficient residual insecticide. • Centralized vertical programs, with military-style organization, strict supervision, and a high level of discipline.

  5. Reasons Why the Eradication Failed • Not all countries were willing to eradicate Aedes aegypti. • The program lost political importance in the majority of the countries that achieved eradication. • Once re-infestation was observed reaction was too late. • High cost of materials, equipment, salaries and social benefits. • Aedes aegypti Resistance to organochloride insecticides. • Rapid and uncontrolled growth of urban centers.

  6. Hemispheric erradication of Aedes aegypti is no longer realistic. • The problem is larger than it was prior to the previous campaigns. • Lack of resources. • Resistance to vertical programs and the use of insecticides. • Lack of effective insecticides. • Low priority and lack of sustainability.

  7. Complicating Factors • Intrinsic factors of the vector Aedes aegypti • Reproductive capacity • Domestic breeding sites • Disorganized urbanization of urban centers. • Industrialization of disposable packaging. • Persistence of tires and plastics. • Deterioration or lack of basic services.

  8. The Problem: Dengue • It is a growing problem. • The number of cases in the Americas has gone from 66,011 in 1980, to over 700,000 en 2000. • The control activities that are being carried out are not working.

  9. Hawaii D.R.. Grenada Antigua & Barbuda Grenada British Virgin Islands Monserrat Incidence of Dengue* 2001 St. Lucia St. Kitts & Nevis Anguilla P.R. Aruba Bahamas Bermuda Cayman Islands Curação Guadaloupe Turkas & Caicos Islands Barbados Jamaica Trinidad & Tobago Dominica St.Vincent & the Grenadines >100 or more (14 countries) 10 to 99 (14 countries) 1 to 9 (5 countries) <1 (2 countries) 0 cases (9 countries) * per 100,000 population

  10. Central America & Mexico 1995–2001

  11. Caribbean Islands 1995–2001

  12. Andean Countries 1995–2001

  13. Southern Cone Countries 1995–2001

  14. Cases of Dengue, 1980–2001

  15. Cases of Dengue 1980–2001without Brasil or Cuba

  16. Dengue Epidemics in the Americas Hawaii 2001 2000 9 countries 11 countries

  17. Dengue Epidemics 2000–2002 Hawaii

  18. Dengue Epidemics 2002 2002  DEN-3   DEN-?    DEN-1 >250,000 cases DEN-3 DEN-1 DEN-3

  19. The Problem: DHF • The tendency of DHF in the Americas is increasing. • The situation is going to get worse before it improves.

  20. 1981–2001*28 Countries >93,000 Cases 1968–19805 Countries: 60 Cases * to 01/01/2002 Dengue Hemorrhagic Fever (DHF)

  21. Cases of DHF, <1980 to 2001

  22. Number of Cases of DHF, 1981–2001 ** all other countries

  23. Cases of DHF in Asia, 1955–1998

  24. Cases of DHF in Asia and in the Americas

  25. If we take the first 18 years that DHF was reported in Asia (1955–1973) and the first 18 years that it occurred in the Americas (1984–2001) after the Cuban epidemic of 1981, and we compare the data, what we get is:

  26. First 18 Years of DHF in Asia and in the Americas (1984-2001) (1955-1973) First years DHF wasreported

  27. 1984 1998 1981 1988 1978 1975 1995 1977 1968 1987 1982 1991 1995 1985 1986 2000 2001 The Evolution of DHF

  28. 1% Case Fatality Rate (CFR) of DHFvs. Case Frequency CFR Cases

  29. -2000 -1999 1998 2001 Antigua and Barbuda Dominica Martinique Puerto Rico Santa Lucia Trinidad & Tobago 1977 Martinique Barbados 2002 Circulation of DEN-1

  30. - 1999 Circulation of DEN-2 - 2000 1998 British Vírgin Islands Granada St. Kits & Nevis Barbados Martinique Puerto Rico St. Vincent & Grenadines Trinidad & Tobago 1981 2001

  31. 1998 Anguilla Aruba Barbados Puerto Rico St. Kits & Nevis Martinique 1994 2002 2001–2002 Circulation of DEN-3 - 2000 - 1999 British Vírgin Islands Curação Dominica Guadeloupe Martinique

  32. - 2000 - 1999 1998 DHF Circulation of DEN-4 Bahamas Barbados British Virgin Islands Puerto Rico Antigua & Barbuda Trinidad & Tobago 1981

  33. Countries at Risk of Yellow Fever and Outbreaks, 1985–2001 At Risk Outbreaks reported

  34. Yellow Fever (YF) 1999 2000 Municipalities with epizootics & YF cases Municipalities with epizootics Municipalities with YF cases Municipalities with Aedes aegypti

  35. The majority of the obstacles for dengue control continue to be the same as they were in the past.

  36. Obstacles for Dengue Control Present-day dengue programs are not progressing because: • Community participation in dengue prevention and control is limited to official demands and never attains community ownership;

  37. Obstacles for Dengue Control • Local health services, now politically and administratively responsible for the prevention and control programs are not sufficiently established;

  38. Obstacles for Dengue Control • Individual and community behavioral change strategies are weak and are not incorporated into the programs;

  39. Obstacles for Dengue Control • Water supply and solid waste management are limited in high-risk areas;

  40. Obstacles for Dengue Control • Sustainability and continuity of control actions are constantly compromised by other health demands and policies that compete with them;

  41. Obstacles for Dengue Control • Little capacity for intersectoral coordination The dengue problem is not the sole responsibility of the Ministry of Health.

  42. Obstacles for Dengue Control • Operational research on individual or community-based strategies have not been sufficient.

  43. A Dengue Vaccine? • There is no licensed vaccine at present. • An efficient vaccine has to be tetravalent. • Several vaccines are in the pipeline. • An effective, safe, low-cost vaccine will not be available in the near future.

  44. Opportunities for Dengue Control Intersectoral Actions Community Participation

  45. Intersectoral actions Health education Compromise Formal education Behavioral change Healthy houses Environment Ecoclubs Healthy schools

  46. Social Communication Component Dengue and DHF Prevention and Control Program Pan American Health Organization

  47. Where are we coming from? The Hemispheric Plan (1997) establishes the role of community participation and of social communication as components of the national programs. It also refers to 10% of the budget for this component.

  48. Where are we coming from? (2) The Blueprint for Action for the Next Generation: Dengue Prevention and Control (1999) reinforces the Directive that was established for community participation and social communication as specified in the Hemispheric Plan of Action.

  49. Surveillance for planning and response Behavioral change Reduction of disease burden Where are we coming from?(3) The Global Strategy for Dengue Fever and DHF Control (2000)

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