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. Integrated Strategy for Dengue Prevention and Control. José Luis San Martín Communicable Disease Unit Disease Prevention and Control. Paradigm. Large-scale factors are strongly acting upon the issue of dengue. The dimensions of Dengue go beyond the scope of the health sector.

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Integrated Strategyfor

Dengue Prevention and Control

José Luis San MartínCommunicable Disease Unit

Disease Prevention and Control

44th Directing Council, September 2003

slide2

Paradigm

  • Large-scale factors are strongly acting upon the issue of dengue.
  • The dimensions of Dengue go beyond the scope of the health sector.
  • The health sector is not solely responsible for dengue prevention and control.
  • To limit its effects, it is necessary to join the efforts of all sectors (public, private, and communities).

44th Directing Council, September 2003

slide3

Reemergence of DengueEnvironmentalFactors

Changes in transmission

Climate change

Ideal conditions for Dengue:

Latitude: 350 north

350 south

Altitude: 2,200 m

Temperature: 15-40 °C

Relative humidity: high-moderate

Ecological changes

Alteration

of ecosystems

Socio-economic changes

Alteration of

Geographical distribution

of pathogens

and vectors

Increase in vector-borne diseases

Yellow Fever

Dengue

44th Directing Council, September 2003

slide4

Reemergence of DengueSocio-Economic Factors

Population Growth

  • Unprecedented population growth.
  • Urbanization neither planned nor controlled.
  • Increase in poverty.
  • Inadequate environmental management.

6,000,000,000

5,000,000,000

4,000,000,000

3,000,000,000

2,000,000,000

1,000,000,000

0

1830

1930

2000

44th Directing Council, September 2003

slide5

Reemergence of DengueUncontrolled Urbanization

  • In 1954, 42% of Latin America’s population lived in urban areas, while in 1999 this figure reached 75%.
  • Informal settlements proliferate due to poverty.
  • Absence of basic services: electricity, running water, sewer systems, garbage collection.
  • High population density.

Sources:Gubler, 1998; PAHO, 1997.

44th Directing Council, September 2003

slide6

1980: 118 million people in poverty in Latin America—a third of the population.

  • 1990: 196 million people in poverty in Latin America—almost half the population.

Poverty

  • This is equivalent to a 42% increase in poverty in the 1980s, compared to a 22% increase in population.
  • Of the 78 million new people in poverty in Latin America in the 1980s, 80% are urban.

44th Directing Council, September 2003

Source: Vilas, 1995.

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Reemergence of Dengue Inadequate Environmental Management

  • Insufficient waste collection and management.
  • Non-biodegradable containers.
  • Improper tire disposal.
  • Insufficient and inadequate water distribution.
  • Increased number of water storage containers.
  • Inadequate septic system conditions.

Increase in breeding sites for the vector

44th Directing Council, September 2003

slide8

Reemergence of DenguePopulation Movements

  • More than 750 million people annually cross international borders.
  • Increase in rural migration into urban areas.
  • 1.4 billion international travelers in 1999.
  • 697 million international tourist arrivals in 2000 and 715 million in 2002 (up 3.1%).
  • Migration
  • International tourism

Source: OMT data.

Traffic of microorganisms

44th Directing Council, September 2003

slide9

Dengue Cases, 1980–2002

1,200,000

1,000,000

800,000

600,000

400,000

200,000

0

1987

1988

2001

2002

1995

1986

1993

1996

1999

1989

1991

1992

1994

1998

2000

1984

1980

1981

1982

1983

1985

1990

1997

44th Directing Council, September 2003

slide10

Cases of Dengue Hemorrhagic Fever (DHF)

(Region of the Americas, 1980-2002)

44th Directing Council, September 2003

slide11

9,2%

Cases of Dengue and DHF in the Americas(January–August 2003, compared to same period in 2002)

2002

2003

6.0%

4.0%

Others

6.1%

11.8%

Venezuela

2.1%

Colombia

2.7%

ll

84.0%

Ecuador

74.6%

Brazil

437,283

342,061

44th Directing Council, September 2003

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Integrated Strategy

Components

Epidemiological

Surveillance

Entomology

Social

Communication

Integrated

Strategy

Laboratory

Patient Care

44th Directing Council, September 2003

slide13

Expected Results

Social Communication

  • Strengthen the effectiveness and sustainability of national strategies through social communication and community participation.

Epidemiologic Surveillance

  • Ensure that public health policies have a multisectorial, intersectorial, and interdisciplinary focus.

Entomology

  • Establish a system of entomologic surveillance for integrated vector management (intersectoral, involving the education, environment, academic, public-works, local/regional government, NGO and private sector).

44th Directing Council, September 2003

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Expected Resultscont.

Patient Care

  • Ensuring that health workers are trained in the diagnosis and treatment of the disease, that the network of institutions be prepared to treat the ill, and that the community is well informed as to warning signs.

Laboratory

  • Ensuring that the surveillance system has a laboratory or an integrated network of laboratories available, that is capable of generating reliable and timely information for clinical diagnosis and the design of interventions.

44th Directing Council, September 2003

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Where are we going?

  • Promote the methodology of the integrated strategy, strengthening National Programs.
  • Incorporate the Dengue Task Force in PAHO’s technical cooperation to countries.
  • Implement the COMBI Plan: Communication for Behavioral Impact.
  • Emphasize the need forIntegral Subregional Plans that strengthen activities in the border regions between countries.
  • Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors.

44th Directing Council, September 2003

slide16

IMPACT

The reduction of the morbi-mortality caused by dengue outbreaks and epidemics

44th Directing Council, September 2003