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Tropical Vector Borne Disease: Dengue Fever

Tropical Vector Borne Disease: Dengue Fever. Judith Pinkham (Ph.D. Student) Walden University PUBH 8165 Instructor: Dr. Fredric Grant Summer 2013. Stakeholders. Government: Federal and State Ministries of Health Local Health Departments Primary Healthcare Departments

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Tropical Vector Borne Disease: Dengue Fever

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  1. Tropical Vector Borne Disease: Dengue Fever Judith Pinkham (Ph.D. Student) Walden University PUBH 8165 Instructor: Dr. Fredric Grant Summer 2013 World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

  2. Stakeholders • Government: • Federal and State Ministries of Health • Local Health Departments • Primary Healthcare Departments • Environmental officials • Citizens of the affected countries • Non-Governmental Organizations (NGOs) • Community based organizations • Community groups and coalitions • Major Donor Agencies • World Health Organization (WHO) • USAID • US Public • International travelers who may or plan to travel to the affected countries.

  3. What is Dengue Fever? • Mosquito-borne infection found in tropical and sub-tropical regions around the world • Alternative names for Dengue Fever • Break –bone fever • Victims often have contortions due to the intense joint and muscle pain • Dandy fever World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

  4. History • History • Originated from monkeys and spread to humans between 100-800 years ago. • First documented in the 1950s in Philippines and Thailand • Re-emerged in 1981 in Caribbean and Latin America Center for Disease Control and Prevention (2012). Dengue Homepage. Retrieved from: http://www.cdc.gov/Dengue/epidemiology/index.html

  5. Causes • RNA virus of the family Flaviviridae; genus Flavivirus is responsible • There are four strains or serotypes of the virus that cause dengue; • DEN-1 • DEN-2 • DEN-3 • DEN -4 Gould EA, Solomon T (February 2008). "Pathogenic flaviviruses". The Lancet 371 (9611): 500–9. Retrieved from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60238-X/fulltext World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

  6. Signs and Symptoms • Acute febrile infection of sudden onset with manifestation of 3 stages • Febrile phase (1st-4th ) • Sudden-onset fever • Muscle and joint pains • Rash • diarrhea • Critical phase (4th -7th day) • Hypertension • Gastrointestinal bleeding • Recovery phase (7th – 10th ) • Seizures • Itching • Fatigue • Peeling of skin Chen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20581669 Wolff K, Johnson RA (eds.) (2009). "Viral infections of skin and mucosa". Fitzpatrick's color atlas and synopsis of clinical dermatology (6th ed.). New York: McGraw-Hill Medical. pp. 810–2. Rodenhuis-Zybert IA, Wilschut J, Smit JM (August 2010). "Dengue virus life cycle: viral and host factors modulating infectivity". Cell. Mol. Life Sci. 67 (16): 2773–86. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/20372965 Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue". N Engl J Med 366 (15): 1423–32.Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMra1110265

  7. Transmission • Transmitted by Aedes mosquitoes • Aedes albopictus/Aegypti are generally associated with the spread of dengue fever • Biting around the ankles and knees close to the ground in the daytime • Only female mosquitoes will bite; mostly in the daytime. • Humans act as carriers to uninfected mosquitoes during blood meal World Health Organization. (2012). Dengue and severe dengue. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en

  8. Advice to Travelers • Mosquito feeding time • 2-3 hours after day break • 3-4 hours before night fall • Mosquitoes feed indoors and outdoors • Always take preventative measure Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews, July 1998, p.480-496. Retrieved from: http://cmr.asm.org/content/11/3/480.full World Health Organization (2013). Global Alert and Response. “Impact of Dengue". Retrieved from: http://www.who.int/neglected_diseases/diseases/en/

  9. Diagnosis • Difficult to differentiate from other viral infections • Develop fever within two weeks of being in the tropics or sub tropics • Low white blood cell count • Confirmation by laboratory testing • Polymerase Chain Reaction (PCR) • Antibody titer • Complete blood count (CBC) Ranjit S, Kissoon N (January 2011). "Dengue hemorrhagic fever and shock syndromes". Pediatr. Crit. Care Med. 12 (1): 90–100. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20639791 World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf Halstead, edited by Scott B. (2008). Dengue. London: Imperial College Press. p. 180 Halstead, Scott (2008). Volume 5 of Tropical medicine. Imperial College Press. p. 429.

  10. Treatment • No approved treatments available • Immunizations • Treatments for fever symptoms • Fluids • Rest • Acetaminophen • Avoid certain medications • Aspirin • Ibuprofen • Naproxen sodium Mayo Clinic. (2012). Dengue Fever. Retrieved from : http://www.mayoclinic.com/health/dengue-fever/DS01028/DSECTION=treatments-and-drugs

  11. Prevention • No approved vaccine or drugs available • Preventive measures should be taken • Application of mosquito repellants • DEET • Oil of Eucalyptus • Protective clothing • Mosquito bed nets • Empty, clean or cover any standing water that can be a mosquito- breeding site Center for Disease Control and Prevention, (2009). Travelers’ Health: Dengue fever & Dengue hemorrhaging fever. Retrieved from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx

  12. Epidemiological background of Dengue • One of seventeen neglected tropical diseases • Disease burden estimated 1600 disability –adjusted life years (DALY) per million population • Mortality rate • Without treatment is 1-5% • Severe illness is 26% • Endemic in over 110 countries • 50-390 cases globally per year • Half million hospitalizations • 25000 deaths Guzman MG, Halstead SB, Artsob H, et al. (December 2010). "Dengue: a continuing global threat". Nat. Rev. Microbiol. 8 (12 Suppl): S7–S16. Retrieved from: http://www.nature.com/nrmicro/journal/v8/n12_supp/full/nrmicro2460.html

  13. Incidence • Increased by 30 folds between 1960-2010 • Geographical distribution • Around equator • 2.5 billion people at risk • In the US 3-8% of those who travel in endemic areas have illness • 2nd most common next to malaria to be diagnosed in US travelers to endemic areas Chen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20581669 Center for Disease Control and Prevention, (2009). Travelers’ Health: Dengue fever & Dengue hemorrhaging fever. Retrieved from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx

  14. Public Health Interventions • Vector Control • Insecticide application • Community participation • Vaccine development • Active monitoring and surveillance • Integration of evidence based strategies and policies • Creating awareness and education World Health Organization. (2012). Dengue and severe dengue. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en

  15. Questions

  16. References Bhatt S, Gething PW, Brady OJ, et al. (April 2013). "The global distribution and burden of dengue". Nature 496 (7446): 504–7. Retrieved from: http://www.nature.com/nature/journal/v496/n7446/full/nature12060.html Center for Disease Control and Prevention (2012). Dengue Homepage. Retrieved from: http://www.cdc.gov/Dengue/epidemiology/index.html Centers for Disease Control and Prevention (2012) New CDC test for dengue approved". Retrieved from: http://www.cdc.gov/media/releases/2012/p0620_dengue_test.html Center for Disease Control and Prevention, (2009). Travelers’ Health: Dengue fever & Dengue hemorrhaging fever. Retrieved from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx Center for Disease Control and Prevention. (2012) "Chapter 5 – dengue fever (DF) and dengue hemorrhagic fever (DHF)". 2010 Yellow Book.Retrieved from: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/dengue-fever-and-dengue-hemorrhagic-fever Chen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20581669 Gould EA, Solomon T (February 2008). "Pathogenic flaviviruses". The Lancet 371 (9611): 500–9. Retrieved from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60238-X/fulltext Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews, July 1998, p.480-496. Retrieved from: http://cmr.asm.org/content/11/3/480.full Guzman MG, Halstead SB, Artsob H, et al. (December 2010). "Dengue: a continuing global threat". Nat. Rev. Microbiol. 8 (12 Suppl): S7–S16. Retrieved from: http://www.nature.com/nrmicro/journal/v8/n12_supp/full/nrmicro2460.html Halstead, edited by Scott B. (2008). Dengue. London: Imperial College Press. p. 180 Halstead, Scott (2008). Volume 5 of Tropical medicine. Imperial College Press. p. 429. Mayo Clinic. (2012). Dengue Fever. Retrieved from : http://www.mayoclinic.com/health/dengue-fever/DS01028/DSECTION=treatments-and-drugs Ranjit S, Kissoon N (January 2011). "Dengue hemorrhagic fever and shock syndromes". Pediatr. Crit. Care Med. 12 (1): 90–100. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20639791 Rodenhuis-Zybert IA, Wilschut J, Smit JM (August 2010). "Dengue virus life cycle: viral and host factors modulating infectivity". Cell. Mol. Life Sci. 67 (16): 2773–86. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/20372965 Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue". N Engl J Med 366 (15): 1423–32.Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMra1110265 Varatharaj A (2010). "Encephalitis in the clinical spectrum of dengue infection". Neurol. India 58 (4): 585–91. Retrieved from: http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2010;volume=58;issue=4;spage=585;epage=591;aulast=Varatharaj Wolff K, Johnson RA (eds.) (2009). "Viral infections of skin and mucosa". Fitzpatrick's color atlas and synopsis of clinical dermatology (6th ed.). New York: McGraw-Hill Medical. pp. 810–2. World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf World Health Organization. (2012). Dengue and severe dengue. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en World Health Organization (2013). Neglected Tropical Diseases. "The 17 neglected tropical diseases". Retrieved from: http://www.who.int/neglected_diseases/diseases/en/ World Health Organization (2013). Global Alert and Response. “Impact of Dengue". Retrieved from: http://www.who.int/neglected_diseases/diseases/en/

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