1. Judith Pinkham (Ph.D. Student) Walden University PUBH 8165 Instructor: Dr. Fredric Grant Summer 2013

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

4. 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

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

6. Signs and Symptoms Acute febrile infection of sudden onset with manifestation of 3 stages Febrile phase (1 st -4 th ) Sudden-onset fever Muscle and joint pains Rash diarrhea Critical phase (4 th -7 th day) Hypertension Gastrointestinal bleeding Recovery phase (7 th – 10 th ) Seizures Itching Fatigue Peeling of skin

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

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

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)

10. Treatment No approved treatments available Immunizations Treatments for fever symptoms Fluids Rest Acetaminophen Avoid certain medications Aspirin Ibuprofen Naproxen sodium

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

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

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 2 nd most common next to malaria to be diagnosed in US travelers to endemic areas

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

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