1. Pan American Health Organization 44th Directing Council, September 2003 1.. Integrated Strategy for Dengue Prevention and Control

2. Pan American Health Organization 44th Directing Council, September 2003 2 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).

3. Pan American Health Organization Reemergence of Dengue Environmental Factors Climate change Alteration of ecosystems Alteration of Geographical distribution of pathogens and vectors Increase in vector-borne diseases Dengue Yellow Fever Ideal conditions for Dengue: Latitude: 35 0 north 35 0 south Altitude: 2,200 m Temperature: 15-40 °C Relative humidity: high-moderate Changes in transmission Ecological changes Socio-economic changes 44th Directing Council, September 2003

4. Pan American Health Organization 44th Directing Council, September 2003 4 Population Growth Reemergence of Dengue Socio-Economic Factors Unprecedented population growth. Urbanization neither planned nor controlled. Increase in poverty. Inadequate environmental management. Unprecedented population growth. Urbanization neither planned nor controlled. Increase in poverty. Inadequate environmental management. 0 1,000,000,000 2,000,000,000 3,000,000,000 4,000,000,000 5,000,000,000 6,000,000,000 183019302000

5. Pan American Health Organization 44th Directing Council, September 2003 5 Reemergence of Dengue Uncontrolled 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. 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.

6. Pan American Health Organization 44th Directing Council, September 2003 6  1980:  1980: 118 million people in poverty in Latin America—a third of the population.  1990:  1990: 196 million people in poverty in Latin America—almost half the population.  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. Source: Vilas, 1995.

7. Pan American Health Organization 44th Directing Council, September 2003 7 Reemergence of Dengue Inadequate Environmental Management Insufficient waste collection and management. Non-biodegradable containers. Improper tire disposal. 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. Insufficient and inadequate water distribution. Increased number of water storage containers. Inadequate septic system conditions. Increase in breeding sites for the vector

8. Pan American Health Organization 44th Directing Council, September 2003 8 Reemergence of Dengue Population Movements MigrationMigration International tourismInternational tourism MigrationMigration International tourismInternational tourism 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%). 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%). Source: OMT data. Traffic of microorganisms

9. Pan American Health Organization 44th Directing Council, September 2003 9 0 200,000 400,000 600,000 800,000 1980198119821983 1984 1985 1986 19871988 1989 1990 19911992 1993 1994 1995 1996 1997 1998 1999 2000 20012002 Dengue Cases, 1980–2002 1,000,000 1,200,000

10. Pan American Health Organization 44th Directing Council, September 2003 10 Cases of Dengue Hemorrhagic Fever (DHF) (Region of the Americas, 1980-2002)

11. Pan American Health Organization 44th Directing Council, September 2003 11 Cases of Dengue and DHF in the Americas (January–August 2003, compared to same period in 2002) 2003 2002 9,2% 84.0% 6.1% 4.0% 6.0% 74.6% 2.7% 2.1% 11.8% 437,283342,061 Others Venezuela Colombia Ecuador Brazil ll

12. Pan American Health Organization 44th Directing Council, September 2003 12 Integrated Strategy Social Communication Epidemiological Surveillance Entomology Patient Care Laboratory Integrated Strategy Components

13. Pan American Health Organization 44th Directing Council, September 2003 13 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). 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). Expected Results

14. Pan American Health Organization 44th Directing Council, September 2003 14 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. 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. Expected Results cont.

15. Pan American Health Organization 44th Directing Council, September 2003 15  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 for Integral Subregional Plans that strengthen activities in the border regions between countries.  Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors.  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 for Integral Subregional Plans that strengthen activities in the border regions between countries.  Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors. Where are we going?

16. Pan American Health Organization 44th Directing Council, September 2003 16 IMPACT The reduction of the morbi-mortality caused by dengue outbreaks and epidemics