1. 1 Macao’s Experience in Dengue Prevention and Control Dr. Koi Kuok Ieng Department of Health, Macao SAR 2004.03.05

2. 2 Outline Epidemiology Prevention Control Experience

3. 3 Epidemiology

4. 4 Reported Cases …… 1996 – 1 (imported) …… 2001 – 1418 2002 – 2 (imported) 2003 – 28 (death = 0)

5. 5 2001 epidemic Duration : August to December Total no. of reported cases : 1418 Attack rate : 3.2/1000 Dengue Hemorrhage Fever : 0 Death : 0 DEN-2 (a few DEN-1) Vector : Aedes albopictus

6. 6 Temporal distribution of reported cases of Dengue in 2001 Supposed beginning

7. 7 Spatial distribution of reported cases of Dengue in 2001

8. 8 Typical “Black spot” in focus

9. 9 Interpersonal distribution of reported cases of Dengue in 2001

10. 10 2003 outbreak Duration : 2003.10.09 ~ 11.02 Total no. of reported cases : 28 Dengue Hemorrhage Fever : 0 Death : 0 DEN-1

11. 11 Spatial distribution of reported cases of Dengue in 2003

12. 12 Prevention

13. 13 Comprehensive strategies Central strategy: SOURCE REDUCTION Supplementary strategies: Health education and community mobilization Early detection, isolation and treatment of case Vector surveillance and study Chemical control Legislation Communication

14. 14 Source reduction Two main problems encountered More than 600 “black spots” in the city area More than 200 thousands apartments

15. 15 Cleaning of “black spots”

16. 16 Community campaigns School campaigns

17. 17 Ovitrap surveillance

18. 18 Household larva surveillance

19. 19 ULV spraying Fogging

20. 20 Control

21. 21 Detection & responses Longest IP 14 d

22. 22

23. 23 Contingency Plan Delineation of focus of infection : 200 m Immediate response: 1. Emergency community meetings 2. Chemical control 3. Door-to-door Inspection and mobilization 4. Examination and cleaning of abandoned houses and sites

24. 24 Experience

25. 25 Community participation Effective community participation is the key to Disease management Problems encountered : Ineffectiveness of traditional health education activities in community involvement Behavioral change of population against Dengue not sustain Prospect : Healthy City Project

26. 26 Whole city mobilization DOH Public services Media Associations Schools Special groups Medical facilities Volunteers Private Citizens

27. 27 Local community mobilization Community Health Committee Community Entities Health Center Sanitary Team CDC Residents

28. 28 Source reduction Source reduction remains to be the central control strategy Problems encountered : Hygiene problem of private properties Sustainability of measures Prospect : Legislation

29. 29 Early detection of epidemic Early detection is crucial to stop a potential epidemic Problems encountered : Delay in diagnosis and reporting In 2003 outbreak, onset to consultation was 2 days ; and from onset to case report was 6.4 days Prospect : Education for citizens Guideline for clinicians Accessibility of laboratory analysis

30. 30 Control measures If adopted early, planned and sufficient control measures can stop a potential epidemic Problems encountered : “safety coefficient” insufficient Prospect : Review extent, method adopted and frequency of chemical control