1. Control and Prevention of
Dengue fever
Malaria and
Leishmania

2. Objectives: You students will be capable to
identify the epidemiology of above arthropods transmissible infectious diseases
assist the community in the prevention and control programs of the above mentioned infectious diseases.

3. Leishmania is a parasitic disease spread by the bite of infected
a. aedes aegypti
b. culex
c. anopheles
d. sand flies
e. aedes albopictus

4. Dengue: The vectors Aedes aegypti and A. albopictus

5. Aedes
Dengue fever in Saudi Arabia

6. The world distribution of Aedes aegypti
The center of origin of A. aegypti seems to be southeastern Asia. A. a. aegypti, A. a. queenslandensis and the small dark forest type A. a. formosus like A. albopictus are all Asian. A. aegypti is distributed from northeastern US almost through Argentina. It occurs worldwise within 35 north and 35 south latitude, although in summertime A. aegypti can invade to 45 north.
The world distribution of Aedes aegypti

7. Dengue (1999): WW Areas infested with Aedes aegypti
Areas with Aedes aegypti and recent epidemic dengue

8. Dengue WW, 2008
Dengue

9. Aedes Aegypti: most common breeding places
Tin cans, bottles, vases, buckets, milk cans, roof gutters, animal drinking bowls and unused toilets fairly represent containers attractive for oviposition. Tree holes, rock holes and wells are other sites. One crucial site is the standard 200-liter drum containing water for households without piped water, and these drums are often treated with a larvicide. See the sketch by José Moquillaza. Although common, bottles are not important like tires, because female mosquitoes do not prefer them. Containers can be observed directly or with ovitraps used for appropriate estimates of container preference and the size of the mosquito population.
Of course, mosquito populations respond directly to rain.
Aedes Aegypti: most common breeding places

10. Aedes aegypti adult male
This mosquito is rarely found more than 100 m from its source and thus proven controllable. Perhaps the newcomer A. albopictus will also adapt so that it too will become a household mosquito, depending much on artificial breeding sites not on sylvan ones.
A. albopictus, more rural than urban A. aegypti, is known through southeastern US since 1985 and through northeastern Mexico since A. albopictus carries many similar viruses like Eastern Equine Encephalitis virus, Cache Valley, Keystone, Tensaw and Potosi viruses.
Aedes aegypti adult male

11. Aedes albopictus adult male
A. ALBOPICTUS HAS WHITE MIDLINE STRIPES ON THE MESONOTUM, WHEREAS A. AEGYPTI HAS A RHOMBOIDشبه المعين OF WHITE LINES.
Aedes albopictus adult male

12. Life cycle of Aedes Aegypti
After a little rain in a few days adults may emerge. This brief emergence of perhaps a week can be from old eggs rather than from new matings.
Life cycle of Aedes Aegypti

13. Feeding. Females feed on any vertebrate host, but prefer humans
Feeding. Females feed on any vertebrate host, but prefer humans. They fly upwind following odors. The first step can be to enter a house. Blood feeding and oviposition occur mostly in the morning and in the late afternoon.

14. Dengue fever Clinical Picture, diagnosis, treatment
Dengue virus infection
Dengue fever
Dengue hemorrhagic fever
Dengue shock syndrome
(Read the attached file)

15. Malaria World Malaria Day: April 25th , 2009.
Malaria: plasmodium falciparum, vivax, malariae and ovale.
(Read the attached file)

16. Map

17. Malaria patient

18. Malaria In 104 countries 300-500 million cases/year
World 1.1 to 2.7 million deaths/year
Africa deaths
SEAR countries 53000
India 20000
KSA???

19. Anopheles mosquito

20. Group 1: 10 countries interrupted transmission: Bah, Cyp, Jor, Kuw, Leb, Lib, Pal, Tun, UAE
Group 2: 4 countries targeting elimination: Egy, Mor, Oma, Syr Group 3: 4 countries low- moderate endemicity: Ira, Iraq, Pak, KSA Group 4: 5 countries high burden: Afghanistan, Dji, Som, Sud, Yem

23. Leishmaniasis What is Leishmaniasis? Life cycle. Mode of infection.
Control and Prevention.
Read also the attached file.

24. Leishmaniasis is a protozoal disease caused by Leishmania parasite, which is transmitted by the sand fly .
Leishmaniasis is of three types ; cutaneous leishmaniasis, muco-cutaneous and the visceral (Kala-azar )

25. Leishmaniasis Life Cycle
Sand fly Stages
Human Stages 1
Sand fly takes a blood meal 8
Divide in midgut and
migrate to proboscis
(Injects promastigote
stage into the tissue) 2
Promastigotes are
Phagocytized by
macrophages i 3
Promastigotes transfer
into amastigotes inside
macrophages 7
Amastigotes transform
Into promastigote
stage in midgut d
Leishmaniasis life cycle 6
Ingestion of
Parasitized cell 4
Amastigotes multiply in cells
(Including macrophages) of
Various tissues 5
Sand fly takes
a blood meal i
Infective stage
(ingest macrophages
Infected with amastigotes ) d
Diagnostic stage

26. Leishmaniasis: Mode of infection
Sand fly bite
Others (infected blood transfusion and Pregnancy in (VL), physical contact in CL)

27. Sand fly
The sand fly causes leishmaniasis.

28. Leishmaniasis
Sand Flies are vector of the disease. More than 500 species and subspecies in the world. of which, only 35 types are known to transmit the disease, Phlebotomus in OCL, and Lutzomia in NCL.
There are more than 21 Leishmanial species .

29. Leishmaniasis Diagnosis: Clinical features.
Smear from the base of the ulcer stained with Wright‘s stain detects round or ovoid parasite in the cytoplasm of macrophages.
Leishman test: Intradermal injection of leishmanial antigen causes a delayed
tuberculin type of reaction.

30. Leishmaniasis Reservoirs
The dogs in the Mediterranean countries
The man in the Middle East
The wild rodents in Asia and Africa

31. Leishmaniasis WW W O R L D Leishmaniasis Cutaneous Leishmaniasis
> 12 Million people infected in 88 countries
> 350 Million people are risk
Annually,0.5M (VL)80,000 Deaths,1.5M(CL) D
Cutaneous Leishmaniasis
Visceral Leishmaniasis
Mucocutaneous Leishmaniasis

32. Leishmaniasis Types Visceral Cutaneous Mucocutaneous * Fever
* Hepatosplenomegaly
* Weight loss
Death, 90% in
Bangladesh, Brazil, India, Nepal,and in Sudan
Cutaneous
Skin ulceration,
90%Afghanistan
,Syria,Iran,Iraq,Brazil,Peru,
and Saudi Arabia
Mucocutaneous
* Skin and mucus
membranes affection
Might be fatal. 90%
in Bolivia,
Brazil and Peru

33. Leishmaniasis in KSA Leishmaniasis:
It is known in the Kingdom back to 1950.
Ministry of Health has established the leishmaniasis unit in the 1980 Under The precautionary medicine to follow-up the disease in the Saudi cities

34. Leishmaniasis in KSA There are VL and CL.
Types
There are VL and CL.
VL caused by L.Donovani LON 42, and the Rattus rattus is the reservoir.
2 types of CL(ZCL and ACL)
In the Riyadh and Eastern province, ZCL transmitted by P.Papatasi and caused by L.Major LON4

35. Leishmaniasis in KSA
Cont.
CL in Southern region is ACL transmitted by P.Sergenti and caused by L.Tropica LON 72

36. Leishmaniasis in KSA
Sand flies:
There are 20 types of Sand Flies in the KSA. 7 are Phlebotomous and 13 are of Sergentomyia type.

37. Visceral Leishmaniasis
A area
Northern
Al-jouf
Tabouk
Medina
Riyadh
Makkah
Eastern
Baha
Najran
Aseer
Jazan
Affected area

38. Reported Cases of VL
RCVL

39. Cutaneous Leishmaniasis
has many local names

40. CL: Seasonal Variations
The peak of cutaneous leishmaniasis is in August, October, December, January and February. The least number of cases are reported in May and June.

41. CL: Geographical Dist. 2001 N CLGD Northern Al-jouf Tabouk Hail Qaseem
8.4 %
2001
Tabouk
18.2 %
7.6 %
Hail
Qaseem
Alhsa only 41.2 %
Medina
Riyadh
9.6 %
Makkah
Eastern
Baha
Najran
Aseer N
Jazan

42. CL: cont. 2004 N GD Northern Al-jouf Tabouk Hail Qaseem Medina Riyadh
9.1 %
2004
Tabouk
26.6%
18.5 %
Hail
4.1 %
Qaseem
Alhsa 20.9%
Medina
Riyadh
4.1 %
Makkah
Eastern
Baha
Najran
Aseer N
Jazan

43. Reported Cases of Cutaneous L.CL

44. Reported Cases of CL CL

45. Cutaneous Leishmaniasis in Infants
H (Infants)
Leishmaniasis usually affects children more than other age groups .

46. Clinical Types of CL CL Hyperkeratotic Mucosal Lymphangitis after
Pentostam treatment
Nodules

47. Clinical Types of CL. Types Recidivans Plaque Erysipeloid
Lupoid/Disseminated

48. VBD Prevention Programs
Efforts should focus on sustainable environmental control rather than eradication
Control programs should be community-based and -integrated. They cannot rely solely on insecticides nor require large budgets
Need to promote VBD as a priority among health officials and the general public

49. Community Approaches
Define communities geographically
More likely to be sustainable
Advantages: built-in manpower, help develop resources and empower community organizations
Disadvantages: more difficult to organize, take longer to get off the ground

50. Community Participation
First must educate the public in the basics of VBD, such as:
Where the mosquito lays her eggs
The link between larvae and adult mosquitoes
General information about VBD transmission, symptoms and TTT.

51. Skills Deficit
Knowledge is not sufficient to produce behavior change
People may lack the skills necessary to carry out the recommended behaviors
Need to address this skills deficit

52. Barriers and Motivation (Part 1)
Knowledge combined with skills still may not be sufficient to change behavior
Need to understand what barriers may prevent the behavior, and what factors may motivate people to take the desired action
Barriers and motivating factors vary in different regions

53. Barriers and Motivation (Part 2)
Structural factors
laws regarding Aedes aegypti habitats
Environmental factors
lack of potable water, need to store water
inadequate solid waste disposal
Attitudinal factors
beliefs: causes, treatment, prevention of febrile illnesses
Community factors
community history and structure
other priority problems in the community

54. Cues for VBD like Dengue Preventive Behaviors
People need reminders when they are learning a new behavior
Behavioral cues are prompts or signals to remind the person to engage in the desired behavior

55. Cues: Feedback
Use regular feedback of entomologic and epidemiologic data
Every time someone receives the information, it can serve as a reminder to act
If the data indicate control activities are successful, they serve as positive reinforcement

56. Cues: Presence of Adult Mosquitoes
Idea to promote:
Person sees adult mosquito
Asks him/herself, “Where did it come from?”
Immediately searches for larval habitats
Eliminates or controls all potential habitats found

57. Cues: Water Shortages and Rationing
For locations where there are seasonal or other temporary water shortages
Provide information on how to properly store water

58. Cues: Rainfall Link rainfall to the creation of larval habitats
This mental link can remind people to look for and eliminate larval habitats after it rains
Eliminates larval habitats influenced by rainfall, and perhaps others as well

59. The Challenge Achieve active community involvement
Solicit input from the earliest program planning stages
Encourage community ownership
Programs that emphasize telling communities what to do, without involving them or taking their views into account, are not likely to be effective
True community participation is the key

60. VBD Prevention
Role of Vaccines: Are they available or under trials?
Regional collaboration (VBD framework, WHO-EMRO)
Role of Insecticide treated net ???

61. VBD Surveillance and Control10

62. Surveillance: Goals and Objectives
Provide early and precise information
disease severity
Predict VBD like dengue and malaria transmission and guide implementation of control measures
Link clinical and entomologic surveillance 11

63. Vector Control Methods Chemical Control
Larvicides may be used to kill immature aquatic stages
Ultra-low volume fumigation ineffective against adult mosquitoes
Mosquitoes may have resistance to commercial aerosol sprays 13

64. Vector Control Methods
Biological control
Largely experimental
Option: place fish in containers to eat larvae
Environmental control
Elimination of larval habitats
Most likely method to be effective in the long term

65. Purpose of Control
Reduce female vector density to a level below which epidemic vector transmission will not occur
Based on the assumption that eliminating or reducing the number of larval habitats in the domestic environment will control the vector
The minimum vector density to prevent epidemic transmission is unknown 14

66. Programs to Minimize the Impact of Epidemics
Education of the medical community
Implementation of emergency plan
Education of the general population 15

67. INSECTICIDE USE FOR VECTOR CONTROL - EMRO -

68. WHO SPECIFICATIONS FOR PUBLIC HEALTH PESTICIDES
Only available on the Internet at

69. WHO Collaborating Centres for quality control of pesticides
Station de Phytopharmacie, Gembloux
CDC, Atlanta
HEJIR Chemistry, Karachi
CIPEIN, Buenos Aires

70. More Readings; WHO-EMRO: Country Profile: Saudi Arabia. EMRO website
CDC materials and publications
CDC: VBD fact sheets.
Read the attached files.

71. Objectives: You students will be capable to
identify the epidemiology of above arthropods transmissible infectious diseases
assist the community in the prevention and control programs of the above mentioned infectious diseases.