Recommendations to Improve Dengue Control in the Philippines Jessica Ang MPH Capstone Project August, 2011 Capstone Advisor: Dr. Randall Packard

Agenda: Background Dengue in the Philippines Ecological Model of Dengue Disease in the Philippines Current Control Strategies in Philippines Potential Interventions Decision Matrix Conclusion

Background on Dengue Dengue is one of the fastest- emerging infections in the world 4 viruses that can cause dengue Viruses do not provide cross-immunity from one another Main Vector - Aedes mosquitoes Aedes aegypti Causes severe flu-like illness Dengue haemorrhagic fever Dengue Shock Syndrome Symptoms appear 3—14 days after the infective bite

Dengue in the Philippines Dengue is endemic in the Philippines Economic and social impact on the Philippines Dengue case rates increase one-to-two months after the onset of the rainy season in June Incidence of dengue fever in the Philippines has increased rapidly in the last ten years No vaccine and no antiviral medications to treat dengue fever. Evidence that sequential infection of dengue fever increases the risk of developing DHF(WHO, 2009) Philippines needs focus on vector management approaches to prevent transmission of the dengue virus to humans.

Dengue cases in the Philippines from 2000-2010 Data taken from http://www.wpro.who.int/health_topics/dengue/data.htm

Current Methods to Control Dengue Global Strategy for Prevention and Control of Dengue Fever and Dengue Haemorrhagic Fever Decentralization of Vector Control services Centered on community-based approaches use of internet, newspaper, radio & television Dengue cases and deaths are reported from hospitals through the National Epidemic Sentinel Surveillance System. Insecticide fogging Community participation (e.g. rotary club) From http://www.rotarymetrolipa.org/news/rcml-armed-and-dangerous/

Current Methods to Control Dengue 4-S Strategy i) Search and destroy; (ii) Self-protection measures; (iii) Seek early consultation; and (iv) Say no to indiscriminate fogging June – Dengue Awareness Month Four-o’clock Habit D.E.N.G.U.E. strategy educate the public on home treatment of mild dengue cases Ovicidal/Larvicidal (OL) Trap system No regular program monitoring and evaluation process for dengue control

Ecological Framework of Dengue Disease in the Philippines

Potential Interventions: Insecticide-treated Materials Biological control - Mesocyclops Geographical Information System Excerpt from http://www.rams-aid.org/DDSS/casasegura.php# Excerpt from (WHO, 2009)

Intervention: Decision Matrix CRITERIA APPLIED TO DECIDE PRIORITIES Biological Controls Insecticide-treated materials GIS Surveillance Do Nothing Potential impact – (x3) Reduce # of cases of dengue 3x3= 9 3x3 = 9 1x3 = 3 Administrative Feasibility 2 3 Affordability 1 Sustainability Political acceptability OVERALL PRIORITY RATING*** (Example: High = 3, Medium =2, Low =1) 18 20 13

Conclusion: The highest scoring intervention is implementing a GIS system for dengue control in the Philippines. Recommended that DOH partner with the Department of Science and Technology to perform a pilot study on the use of GIS system with dengue. Philippines needs to continuously monitor and evaluate program strategies to help assess the effectiveness of the different approaches Additional research is needed to address the broad root causes of dengue disease (e.g. solid waste disposal)

Works Cited: Capuloy, P. A. (2010, September 20). RCML – Armed and Dangerous. Retrieved June 21, 2011, from Rotary Club of Metro Lipa: http://www.rotarymetrolipa.org/news/rcml- armed-and- dangerous/ Sanika, C. (2011). Risk Assessment and Management Solutions for Arthropod-borne and Infectious Diseases. Retrieved July 20, 2011, from RAMS-AID Research - Dengue Decision Support System Project: http://www.rams- aid.org/DDSS/casasegura.php# World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva: World Health Organization. World Health Organization. (2011). Dengue Data. Retrieved June 22 from http://www.wpro.who.int/health_topics/dengue/data.htm