introduction about dengue fever prevailing in Punjab, Pakistan.

1.  Prevention Of Dengue
An overview…
 M. Afzal Naeem (Lecturer in Botany)
 Govt. Post Graduate College of Science,
 Samanabad, Faisalabad.

2.  Dengue fever is a virus infection caused by
the dengue virus. There are 4 kinds of
dengue viruses.
Close up of Aedes aegypti Mosquito

4.  50-100 million dengue fever infections per
year globally
 500,000 cases of severe dengue, dengue
hemorrhagic fever or dengue shock syndrome
 100-200 cases annually in U.S.
 Average case fatality 5%

5.  Endemic in more than 100 tropical and
subtropical countries.
 Pandemic began in Southeast Asia after WW
II with subsequent global spread.
 Several epidemics since 1980s.
 Distribution is comparable to malaria.

7. • New infections annually: 50 million
• Deaths: 24,000 annually
• People at risk: 2.5-3 billion
• Hospitalized cases: 500 000/year
(90% of those affected are children)
• Disease burden: 465,000 Disability
Adjusted Life Years (DALY)

8. Dengue Fever In 2006
Cases Deaths
3500
3000
2500
2000
Cases
1500
1000
500
0
India Pakistan Karachi Lahore
Cases 3331 3230 1836 400
Deaths 49 50 30 4

9. 2005 Dengue Outbreak
Cases Deaths
100,000
80,000
60,000
Cases
40,000
20,000
0
India, (West
Sri Lanka Thailand Pakistan
Bengal)
Cases 90,000 3,000 31,000 4,800
Deaths 15,000 0 58 50

10. Aedes aegypti Aedes albopictus

12.  Dengue fever and dengue hemorrhagic
fever are the most common mosquito-
borne viral disease in the world.
 Only the female mosquito feeds on blood.
This is because they need the protein found
in blood to produce eggs. Male mosquitoes
feed only on plant nectar.

13.  The mosquito is attracted by the body
odors, carbon dioxide and heat emitted
from the animal or humans.
 •The female Aedes mosquito searches for
suitable places to lay their eggs.
 •Aedes are day-biters, most active during
dawn and dusk.

14. 1-2 Days
Pupae 4-5 Days Larvae 2 – 3 Days Eggs =300

15. Flavivirus family
Small enveloped viruses
containing single
stranded RNA
Four distinct viral
serotypes (Den-1, Den-
2, Den-3, Den-4)

16. Transmitted by the bite
of Aedes mosquito
(Aedes aegypti)
Incubation 3-14 days
Acute illness and
viremia 3-7 days
Recovery or progression
to leakage phase

17. ASYMPTOMATIC
Undifferentiated
Fever
Without haemorrhage
SYMPTOMATIC Dengue Fever
With unusual haemorrhage
Dengue No shock
Haemorrhagic
Fever DSS

18.  May be the most common manifestation of
dengue
 Prospective study found that 87% of students
infected were either asymptomatic or only
mildly symptomatic
 Other prospective studies including all age-
groups also demonstrate silent transmission
 DS Burke, et al. A prospective study of dengue infections
 in Bangkok. Am J Trop Med Hyg 1988; 38:172-80.

19.  Skin hemorrhages:
petechiae, purpura, ecchymoses
 Gingival bleeding
 Nasal bleeding
 Gastro-intestinal bleeding:
hematemesis, melena, hematochezia
 Hematuria
 Increased menstrual flow

20. hematemesis
purpura
petechiae
Gingival bleeding Nasal bleeding

21. 1. Fever, or recent history of acute fever
2. Hemorrhagic manifestations
3. Low platelet count (100,000/mm3 or less)
4. Objective evidence of “leaky capillaries:”
◦ elevated hematocrit (20% or more over
baseline)
◦ low albumin
◦ pleural or other effusions

22.  Abdominal pain - intense and sustained
 Persistent vomiting
 Abrupt change from fever to hypothermia,
with sweating and prostration
 Restlessness or somnolence
 Martínez Torres E. Salud Pública Mex 37 (supl):29-44, 1995.

23.  Fluids
 Rest
 Antipyretics (avoid aspirin and non-steroidal
anti-inflammatory drugs)
 Monitor blood pressure, hematocrit, platelet
count, level of consciousness

24.  All above treatment +
 – In case of severe bleeding, give fresh whole blood
20 ml/kg as a bolus
 – Give platelet rich plasma transfusion
exceptionally when platelet counts are below
5,000–10,000/ mm3 .
 – After blood transfusion, continue fluid therapy at
10 ml/kg/h and reduce it stepwise to bring it down
to 3 ml/kg/h and maintain it for 24-48 hrs

25. Papaya Juice vs. Dengue ?

 Raw papaya leaves, 2 pcs just cleaned and pound
and squeeze with filter cloth. You will only get one
tablespoon per leaf. So two tablespoon per serving
once a day.
 Do not boil or cook or rinse with hot water, it will
loose its strength. Only the leafy part and no stem
or sap.
 It is very bitter and you have to swallow it like Won
Low Kat. But it works.
 Source: from Indonesia March 2005

26. Biological:
 Target larval stage of Aedes in large water
storage containers
 Larvivorous fish (Gambusia), endotoxin
producing bacteria (Bacillus), copepod
crustaceans (mesocyclops)
Chemical:
 Insecticide treatment of water containers
 Space spraying (thermal fogs)

28. Dawn Dusk

36. A. STATE/ GOVERNMENT B. COMMUNITY LEVEL C. INDIVIDUAL MEASURES
LEVEL MEASURES MEASURES
1. ERADICATION OF MOSQUITO 1. FORMULATE A HEALTH 1. SHEILDING THE HOME ,
BREEDING SITES & MOSQUITO RELATED REPRESENTAIVE BODY OWNSELF & FAMILY FROM
ERADICATION MOSQUITOES
2. STOP FORMATION OF 2. MOSQUITO ERADICATION
MOSQUITO BREEDING SITES & DO
MOSQUITO ERADICATION
2. HEALTH EDUCATION 3. PARTICPATION IN HEALTH 3. EDUCATING MEMBERS OF
PROGRAMMES FAMILY
3. DIAGNOSIS & TREATMENT OF 4. COMMUNITY BASED 4. CONSULTING THE PHYSICIANS
DENGUE CASES MECHANISM OF REFERAL & ON SEEING SYMPTOMS AND SIGNS
TRANSPORTATION OF SUSPECTED AS EARLY AS POSSIBLE.
CASES

38.  It is the prime duty of the government to
clean up all mosquito breeding sites e.g.
 Stagnant Water Ponds
 Garbage Heaps
 Choked Sewerage and drainage system
 Regular Anti Mosquito spray in all localities
 3.Lifting the living standard of people and
bringing them out of slums

49. I. Continuous liaison with Health Department
II. To be aware of and spread the awareness about
the Health Programmes offered by the
Government and to efficiently participate in them.
III. To raise funds for the betterment of community
health
IV. To keep a vigilant eye on proper execution of
Health Related Programmes offered by
Government.

53.  This is what you can do to help…
Change water in vases on alternate days.

61. 2.Ways to keep
the Mosquitoes
away

62. Use Of Anti Mosquito Sprays

63. Use of Coils Mats Electric Devices

64. Use of Mosquito Nets and Mosquito Repellent
Oils

66.  Spread the dengue prevention message to
others…
Let your family,
friends and
neighbours know
about the dangers

69.  Itcan carry the dengue virus and
infect a healthy person with dengue
fever.

70.  Name the 5 steps in the 10-Minute
Dengue Wipe-out Exercise

71. 1. Change water in vases on alternate.
2. Remove water from flowerpot plates on alternate
days.
3. Turn over all pails and water storage containers.
4. Cover bamboo pole holders when not in use.
5. Clear blockages and put in Bti insecticide in roof
gutters monthly.

73. • Cover all toilet bowls in your home.
• Seal off the overflow pipe of the flushing cistern.
• Cover all gully/floor traps.
• Add sand granular insecticide to places that mosquitoes could potentially breed, such
as flower vases and places where stagnant water could not be removed.
• Clear blockages and add Bti insecticide in roof gutters.
 • Turn over all pails and water storage containers.
• Ask a relative or close friend to check your home regularly for stagnant water if you
are going away for a long period of time.
• Leave your contact with your neighbours or the neighbourhood police post/ centre so
that you can be reached easily.