Tropical Vector Borne Disease: Dengue Fever Good Afternoon. My name is Kerry-Ann Nelson and today I will be talking about dengue fever; a tropical vector borne disease which has had an effect on individuals on a global level for many years. Kerry-Ann Nelson Walden University Graduate Student February 3rd, 2013

Stakeholders World Health Organization Citizens of affected countries Government health care officials of affected countries Non Governmental Organizations (NGO). Non Profit Organizations Environmental Officials of affected countries The purpose of this presentation is to educate affected individuals and other relevant stakeholders on what dengue fever is, its causes, symptoms, how it is transmitted, treatment options and ways which infections can be prevented. The stakeholders for this presentation includes but is not limited to the World Health Organization, citizens of the affected countries, government health care officials of the affected countries, non governmental organizations, non profit organizations and environmental officials of affected countries.

Overview Leading cause of illness and death in the tropics and subtropics 100 million infected yearly Infectious disease Prevalent for over 200 years Dengue fever is an infectious disease which is the main cause of death and illness in the subtropics and tropics. These areas include India, Southeast Asia, the Caribbean, China, Africa, the Middle East, Australia, Central and South America and South and Central Pacific Islands. Over 100 million individuals are affected yearly, mostly during and after the rainy seasons. This disease is well known by individuals and researchers as it has been around for over 200 years (Centers for Disease and Prevention, 2012), (National Institute of Allergy and Infectious Disease, 2007). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html National Institute of Allergy and Infectious Diseases. (2007). Dengue fever. Retrieved from http://www.niaid.nih.gov/topics/DengueFever/Understanding/Pages/Treatment.aspx

History of Dengue Origination of dengue Spread to humans between 100 and 800 years ago Minor, geographically restricted disease First documentation of dengue hemorrhagic fever Occurrence in Caribbean and Latin America Dengue is said to have started within monkeys in Southeast Asia and Africa and spread to humans between 100 and 800 years ago. Up until the 20th century it was considered a minor geographically restricted disease. In 1981, dengue hemorrhagic fever, a more severe case of dengue fever was first documented in Latin America and the Caribbean (Centers for Disease Control and Prevention, 2012). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html

Causes Virus based disease caused by mosquitoes Commonly Aedes Aegypti Four types of viruses: DEN-1 DEN-2 DEN-3 DEN-4 Dengue fever is a virus based disease which is caused by mosquitoes, particularly the Aedes Aegypti species. Four types of viruses can cause infection, these include DEN-1, DEN-2, DEN-3 and DEN-4 all which can affect individuals during their lifetime (Pubmed Health, 2011), (National Institute of Allergy and Infectious Disease, 2007). Pubmed Health. (2011). Dengue Fever. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002350/ National Institute of Allergy and Infectious Diseases. (2007). Dengue fever. Retrieved from http://www.niaid.nih.gov/topics/DengueFever/Understanding/Pages/Treatment.aspx

Aedes Mosquito Identification of the Aedes mosquito Cycle of development Incubation period Lifespan The Aedes mosquito can be easily identified by the white and black stripes on their bodies. Eggs are lain by the female mosquito after biting an individual, it takes in blood and hatches into larva in less than one day. The larva is then developed into a pupa in approximately four days, then an adult mosquito in two days. So as you can see the developmental cycle occurs fairly quickly. Seven days after biting an individual who is infected with the virus, the mosquito can become infective as the virus is replicated within the body. The Aedes can survive for up to two weeks in nature, but the eggs can last up to nine months if they stay dormant in cool dry areas (National Environmental Agency, 2005). National Environmental Agency. (2005). Dengue. Retrieved from http://www.dengue.gov.sg/subject.asp?id=12

Symptoms Appears 4 to 10 days after infection Fever Headaches Muscle, bone and joint pain Rash Nausea Vomiting Pain Symptoms can last from 2 to 7 days Symptoms can occur from 4 to 10 days after infection and can include muscle, bone and joint pain, pain behind the eyes, fever, vomiting and headaches. These symptoms can last anywhere from 2 to 7 days. Approximately 3 to 4 days after the fever, a rash may develop over most of the body, subside after 1 to 2 days and return a few days later. These symptoms can persist from 2 to 7 days (Mayo Clinic, 2012). Dengue rarely causes death but severe dengue can create deadly complications with the occurrence of plasma leaking, respiratory distress, fluid retention, organ impairment and severe bleeding. There is also the occurrence of bleeding gums, blood in the vomit and severe abdominal pains. At this stage, medical care should be seeked so as more health problems could be avoided which can ultimately lead to death (World Health Organization, 2012). Mayo Clinic. (2012). Dengue Fever. Retrieved from http://www.mayoclinic.com/health/dengue-fever/DS01028/DSECTION=treatments-and-drugs World Health Organization. (2012). Dengue and severe dengue. Retrieved from http://www.who.int/mediacentre/factsheets/fs117/en/

Transmission Transmittal via female mosquitoes Can infect individuals during entire life span Humans identified as main carrier sources for uninfected mosquitoes Mosquitoes more prevalent in the daytime Breeding grounds Adaptations Spread of infection As the earlier stated, the Aedes aegypti mosquito is responsible for the transmission of dengue fever between individuals. Uninfected mosquitoes can get infected by using the individual as a source of attaining the infection. After infection of the mosquito, it can transmit the virus to individuals for its entire lifespan. This particular type of mosquito is more prevalent during the daytime hours, and tend to attack mainly in the early morning and evening before dusk, at which time multiple people are fed on. It lives and breeds in urban habitats and containers which may be man made. Due to international trade of items such as bamboo and used tires, this mosquito has managed to spread to parts of North America and Europe. Their highly adaptive nature, along with hibernation, allows them to survive during relatively cold temperatures (World Health Organization, 2012). World Health Organization. (2012). Dengue and severe dengue. Retrieved from http://www.who.int/mediacentre/factsheets/fs117/en/

Transmission Population at risk Dengue hemorrhagic fever Occurrence Estimated infections Dengue hemorrhagic fever Adolescent deaths 2.5 billion people or roughly 40% of the world’s population reside in areas where they are at risk for transmitting dengue. It is estimated by the World Health Organization that yearly, an average of 50 to 100 million infections occur. Of those infections, over 500,000 are classified as dengue hemorrhagic fever cases and 22,000 result in death. These infections which results in death mainly occur among children and adolescents (Centers for Disease Control and Prevention, 2012). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html

Transmission Transmission during pregnancy Effects of dengue on Effects of dengue on baby The dengue infection can also affect pregnant women negatively, as the virus can infect not only her, but her unborn and or newborn baby. The dengue virus infection can cause premature birth, low birth weight and even death. At the time of delivery, if a woman is infected with dengue, there is a chance that the baby can also develop the infection within the first two weeks of their life (Centers for Disease Control and Prevention, 2012). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html

Diagnosis Complete Blood Count (CBC) Antibody Titer Polymerase Chain Reaction (PCR) In order to diagnose dengue, a few tests can be done by a physician. An antibody titer or a polymerase chain reaction can be done, to identify virus types within an individual. A complete blood count is another test, which can be performed by a physician to aid in diagnosis (National Institute of Allergy and Infectious Disease, 2007). National Institute of Allergy and Infectious Diseases. (2007). Dengue fever. Retrieved from http://www.niaid.nih.gov/topics/DengueFever/Understanding/Pages/Treatment.aspx

Treatment No treatments currently available for the dengue fever infection. Immunizations Treatment for dengue fever symptoms Acetaminophen Fluids Rest Medications to avoid Aspirin, Ibuprofen, naproxen sodium There are currently no vaccines, immunizations or treatments available for dengue fever. In the event of infection, it is advised that acetaminophen should be taken to reduce pain and fever which may occur. Fluids and lots of rest are also recommended to aid in recovery. There are some medications however, which should be avoided, due to them increasing bleeding complications such as aspirin, ibuprofen (motrin, advil etc) and naproxen sodium (aleve) (Mayo Clinic, 2012). Mayo Clinic. (2012). Dengue Fever. Retrieved from http://www.mayoclinic.com/health/dengue-fever/DS01028/DSECTION=treatments-and-drugs

Incidence 50 to 100 million cases globally 10% case fatality rate 100 to 200 cases in the U.S each year introduced by travelers 2007: Outbreaks reported in 11 countries 900,782 cases reported in the Americas There are over 50 to 100 million cases of dengue fever worldwide with a fatality rate as high as 10%; a fatality rate which can be decreased to 1% with early detection and treatment. Travelers are said to be responsible for the 100 to 200 suspected cases, which has been introduced into the United States yearly, and of the 11 countries where there has been reported outbreaks in 2007. Of those outbreaks, 900,782 were in the Americas (Centers for Disease Control and Prevention, 2012). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html

Prevention Protective clothing Mosquito repellant containing: DEET Picaridin Oil of Eucalyptus Window and door screens Reduce mosquito habitat Avoiding outdoor activities during specific times of the day Because a vaccine for the dengue fever is currently being developed with years ahead before its availability, standard precautions should be taken to aid in prevention. Protective clothing should be worn, which can include long shirts and pants, shoes and socks; basically clothing which would restrict access to the mosquitoes. Mosquito repellant should be used which has a high concentration of DEET, Picaridin or oil of eucalyptus. These ingredients are deemed most effective in repelling mosquitoes as well as other insects (National Institute of Allergy and Infectious Disease, 2007). Screening on doors and windows are also ways to decrease the risk of being bitten by mosquitoes. This helps to prevent them from entering the home. Reducing mosquito habitats can be a very important preventative measure, as this action will attempt to eliminate the presence of the mosquitoes all together. Standing water in containers should be emptied, covered or cleaned on a weekly basis, insecticides which are appropriate should be applied to outside water storage, and any type of activities which occur during specific times of the day, where the mosquitoes are more prevalent, should be avoided (World Health Organization, 2012). National Institute of Allergy and Infectious Diseases. (2007). Dengue fever. Retrieved from http://www.niaid.nih.gov/topics/DengueFever/Understanding/Pages/Treatment.aspx World Health Organization. (2012). Dengue and severe dengue. Retrieved from http://www.who.int/mediacentre/factsheets/fs117/en/

Prevention Prevention steps for babies Covering Use of repellant Clothing In regards to babies, preventionary measures should be a priority. Cribs and strollers should be covered at all times with mosquito netting regardless of the time of day. Repellant can also be used on babies 2 months of age and older. Like adults, in order to prevent being bitten by mosquitoes babies should be dressed in loose clothing which provides coverage to the arms and legs (Centers for Disease Control and Prevention, 2012). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html

Public Health Interventions Vaccine Development Insecticide application Vector control Community participation Active monitoring and surveillance There are currently multiple trial phases for dengue vaccines which has been fully supported with their research and evaluations. There has also been active interventions in increasing participation within the community for sustained vector control, along with the application of insecticides as control measures during outbreaks. The use of surveillance and active monitoring is another intervention, which is typically implemented, to evaluate just how effective the control measures are (World Health Organization, 2012). World Health Organization. (2012). Dengue and severe dengue. Retrieved from http://www.who.int/mediacentre/factsheets/fs117/en/

Public Health Interventions U.S dengue surveillance US areas more prevalent to infection Statistical compilation Passive Dengue Surveillance System (PDSS) As of 2009 dengue has been listed as a reportable infection to the CDC in 26 states within the US. Most of the dengue cases which occur in the US affect citizens of Puerto Rico, Samoa and Guam along with the U.S Virgin Islands. Puerto Rico especially has been reporting cases of dengue from as early as 1915 with rampant endemics ever since. The passive dengue surveillance system, is an island wide partnership in the Puerto Rico Department of Health. It confirms dengue endemics and transmissions. It was also extremely instrumental in identifying the first cases of severe dengue, along with dengue related deaths (Centers for Disease Control and Prevention, 2012). Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html

Public Health Interventions WHO Interventions Technical support and guidance Training Formulation of evidence based strategies and policies Development of new tools and products Gathers official records Publishes guidelines and handbooks The World Health Organization specifically, has responded to the dengue fever issue in many different ways. Technical support and guidance is given to countries along with clinical management training, diagnosis and vector control for effective management of dengue outbreaks. Evidence based strategies along with policies are formulated, in addition to new tools and products which aids in product application. WHO is responsible for gathering official records of dengue from over 100 states so in conjunction with this they publish guidelines and handbooks to aid in case management, control and prevention of dengue (World Health Organization, 2012). World Health Organization. (2012). Dengue and severe dengue. Retrieved from http://www.who.int/mediacentre/factsheets/fs117/en/

Questions All the points addressed within this presentation, will not only aid in the education of the dengue infection, but it will also educate on the multiple prevention measures which can be taken, in order to avoid being afflicted with dengue fever. If these measures are followed then the dengue fever incidence rate can be decreased until a vaccine is finally developed which can eradicate the infection all together. Thank You. Any questions?

References Centers for Disease Control and Prevention. (2012). Dengue Fact Sheet. Retrieved from http://www.cdc.gov/Dengue/faqFacts/fact.html Mayo Clinic. (2012). Dengue Fever. Retrieved from http://www.mayoclinic.com/health/denguefever/DS01028/DSECTION=treatments-and-drugs Medline Plus. (2012) Dengue fever. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001374.htm National Environmental Agency. (2005). Dengue. Retrieved from http://www.dengue.gov.sg/subject.asp?id=12

References National Institute of Allergy and Infectious Diseases. (2007). Dengue fever. Retrieved from http://www.niaid.nih.gov/topics/DengueFever/Understanding/Pages/Treatment.aspx Pubmed Health. (2011). Dengue Fever. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002350/ World Health Organization. (2012). Dengue and severe dengue. Retrieved from http://www.who.int/mediacentre/factsheets/fs117/en/