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Dengue
1. MODERATOR DR. RAUF –UR-RASHID KAUL
ADDITIONAL PROFESSOR
S.R. INCHARGE DR. FEROZ AH. WANI
SENIOR RESIDENT
PRESENTED BY DR. UROOSA FAROOQ
POST GRADUATE STUDENT
2. Table of contents
1. INTRODUCTION
2. HISTORY
3. MAGNITUDE :GLOBALLY , SEAR AND INDIA
4. EPIDEMIOLOGY
5. MANIFESTATIONS OF DENGUE VIRUS INFECTION
6. WHO CLASSIFICATION OF DENGUE
7. CLINICAL SIGN/SYMPTOMS AND TREATMENT
8. GLOBAL STRATEGY FOR PREVENTION AND CONTROL 2012-2020
3. Introduction - What is Dengue?
• Dengue is a mosquito-borne, viral
infection.
• The infection causes flu-like illness, and
occasionally develops into a potentially
lethal complication called severe dengue.
• Common name of the disease is ‘break-
bone fever’
4. (WHO 2011)
History
• The first epidemic of dengue was recorded in
1635 in the French West Indies, although a disease
outbreak compatible with dengue had been
reported in China as early as 992 AD.
5. • Epidemics of an illness resembling dengue occurred in
1779, 1780 in three continents-Asia, Africa and North
America.
• First epidemic of DHF occurred in Manila, Philippines
1950.
• In India dengue virus was first isolated in Calcutta in
1945.
• Epidemic of DHF first occurred in Calcutta in 1963.
(WHO 2011)
8. GLOBALLY:
The global incidence of dengue has grown dramatically in recent decades.
–The incidence of dengue has increased 30-fold over the last 50 years.
–Up to 50-100 million infections are now estimated to occur annually in
over 100 (only 9 counties in 1955) endemic countries.
–Almost half of the world’s population at risk.
10. Average number of dengue and severe dengue cases reported to WHO annually
in 1955–2007 and number of cases reported in recent years, 2008–2010
11. SEAR:
• Some 2.5 billion people – two fifths of the world's population in
tropical and subtropical countries – are at risk.
• An estimated 50 million dengue infections occur worldwide
annually.
• About 500 000 people with DHF require hospitalization each
year. A very large proportion (approximately 90%) of them are
children aged less than five years, and about 2.5% of those
affected die.
( W H O 2 0 1 1 )
12. Variable endemicity for DF/DHF in countries
of the SEA Region
Category
A
• Bangladesh, India, Indonesia, Maldives, Myanmar, SriLanka, Thailand and Timor-Leste
• Major public health problem.
• Leading cause of hospitalization and death among children.
• Hyperendemicity with all four serotypes circulating in urban
• areas.
• Spreading to rural areas.
Category
B
• Bhutan, Nepal
• Endemicity uncertain.
• Bhutan: First outbreak reported in 2004.
• Nepal: Reported first indigenous dengue case in 2004.
Category
C
• DPR Korea
• No evidence of endemicity.
13. STATE CASES DEATHS
Andhra pradesh 990 1
Assam 4526 2
Delhi 5574 6
Chandigarh 7132 6
Goa 1255 9
Gujarat 6170 15
Haryana 1751 4
Karnataka 6408 12
Kerela 7911 25
Maharashtra 5432 48
Punjab 4114 11
Rajhasthan 3160 8
Tamil nadu 6122 0
Uttar pradesh 1409 5
West bengal 5920 6
TOTAL 74168 168
( N A T I O N A L H E A L T H P R O F I L E 2 0 1 3 )
INDIA
17. Dengue Virus
1.Causes dengue and dengue hemorrhagic fever
2. It is an arbovirus
3.Transmitted by mosquitoes
4.Composed of single-stranded RNA
5.Has 4 serotypes (DEN-1, 2, 3, 4)
18. • Each serotype provides specific lifetime immunity, and
short-term cross-immunity
• All serotypes can cause severe and fatal disease
• Genetic variation within serotypes
• Some genetic variants within each serotype appear to
be more virulent or have greater epidemic potential
19. AEDES AEGYPTI
• Dengue transmitted by infected female mosquito
• Primarily a daytime feeder
• Lives around human habitation
• Lays eggs and produces larvae preferentially in artificial
containers
20. The most common epidemic vector of dengue in the world is the
Aedes aegypti mosquito. It can be identified by the white bands or
scale patterns on its legs and thorax.
21.
22. AEDES ALBOPICTUS: is second most
important vector of dengue
• AEDES AEGYPTI:
• HIGHLY DOMESTICATED
• NERVOUS FEEDER
• DISCORDANT SPECIES
• AEDES ALBOPICTUS:
• BREEDS IN PEREPHERAL
AREAS OF URBAN CITIES
• AGGRESSIVE FEEDER
• CONCORDANT SPECIES
24. ENVIRONMENTAL CONDITIONS
HELP IN TRANSMISION
• Dengue transmission usually occurs during the rainy season when
the temperature and humidity are conducive for build-up of the
vector population breeding in secondary habitats as well as for
longer mosquito survival.
• In arid zones where rainfall is scanty during the dry season, high
vector population builds up in man-made storage containers.
THEY GROW WELL AT A TEMP. OF 16 TO 30 DEGREE
AND HUMIDITY OF 60-80%
25.
26. 1. The virus is inoculated into
humans with the mosquito saliva.
2. The virus localizes and replicates
in various target organs, for
example, local lymph nodes and
the liver.
3. The virus is then released from
these tissues and spreads
through the blood to infect white
blood cells and other lymphatic
tissues.
4. The virus is then released from
these tissues and circulates in the
blood.
27. 5. The mosquito ingests blood
containing the virus.
6. The virus replicates in the
mosquito midgut, the ovaries,
nerve tissue and fat body. It then
escapes into the body cavity, and
later infects the salivary glands.
7. The virus replicates in the salivary
glands and when the mosquito
bites another human, the cycle
continues.
28.
29. HIGH RISK GROUP INCLUDES:
• 1 INFANTS AND ELDERLY
• 2 OBESITY
• 3 PREGNANCY
• 4 PEPTIC ULCER DISEASE
• 5 MENSTRUATING WOMEN
• 6 HAEMOLYTIC DISEASE
• 7 CHD
• 8 DIABETES, RENAL FAILURE, LIVER CIRRHOSIS AND ASTHMA
• 9 PATIENTS ON STEROIDS OR NSAID TREATMENT
38. Signs and Symptoms of
Encephalitis/Encephalopathy Associated with
Acute Dengue Infection
• Decreased level of consciousness:
lethargy, confusion, coma
• Seizures
• Nuchal rigidity
• Paresis
39. LABORATORY DIAGNOSIS:
• 1 VIRUS ISOLATION WITHIN FIRST 6 DAYS
• 2 VIRAL NUCLEIC ACID DETECTION BY RT-PCR
• 3 IMMUNOLOGICAL : NT, CFT, HIA AND IgM/IgG RATIO
• 4 VIRAL ANTIGEN DETECTION BY ELISA
• 5 RDT FOR IgM AND IgG ANTIBODY DETECTION
• 6 PLATELET COUNT AND HAEMATOCRIT MUST BE CLOSLY
• MONITORED
40. Treatment of Dengue fever:
• Fluids
• Rest
• Antipyretics (avoid aspirin and non-steroidal anti-
inflammatory drugs)
• Monitor blood pressure, hematocrit, platelet count, level
of consciousness
41. Rx of DHF I & II
Hemorrhagic tendencies ,
thrombocytopenia
Initiate IV therapy-6ml/kg/hr
crystalloid solution for 1-2 hrs
Improvement
IV therapy by
crystalloid
successively
reducing frm 6 to 3
ml/kg/hr
Further
improvement
Discontinue IV after
24hrs
NO IMPROVEMENT
Increase IV-10 ml/kg/hr -
2hrs
Improvement
Reduce IV to 6 ml/kg/hr crystalloid
with further reduction to 3ml/kg/hr
discontinue after 24-48hrs
No improvement
Unstable vital signs
Hematocrit rises
IV colloid dextran 10ml/kg/hr
duration 1hr
Improvement
IV therapy by crystalloid
successively reducing the flow
frm 10 to 6 and 6 to 3 ml/kg/hr
discontinue after 24-48hrs
Hematocrit falls
Blood transfusion 10ml/kg/hr
duration 1hr
42. Rx of DHF III & IV
UNSTABLE VITAL SIGNS
URINE OUT PUT FALLS, SIGNS OF SHOCK
IMMEDIATE RAPID VOLUME
REPLACEMENT: INITIATE IV THERAPY
10-20ML/KG/HR CRYSTALLOID SOLN FOR
1HR
IMPROVEMENT
IV THERAPY BY
CRYSTALLOID
SUCCESSIVELY
REDUCING FROM 20
to 10, 10 to 6 AND 6 to 3
FURTHER
IMPROVEMENT
DISCONTINUE IV
AFTER 24HRS
NO IMPROVEMENT
OXYGEN
HAEMATOCRIT RISES
IV COLLOID DEXTRAN OR
PLASMA 10ML/KG/HR AS
INTRAVENOUS
BOLUS(REPEAT IF
NECESSARY)
IMPROVEMENT
IV THERAPY BY CRYSTALLOID
SUCCESSIVELY REDUCING THE
FLOW FROM 10 to 6 and 6 to
3ml/kg/hr
DISCONTINUE AFTER 24-48HRS
HAEMATOCRIT FALLS
BLOOD
TRANSFUSION
10ML/KG/HR
43. Dengue vaccine
• No licensed vaccine at present
• Recently Tetravalent Dengue Vaccine phase 3 trial completed in
Asia.
45. Global strategy for dengue prevention &
control 2012- 20
• To reduce dengue mortality by at least 50% by 2020
• To reduce dengue morbidity by at least 25 % by 2020
• To estimate the true burden of disease by 2015
( W H O 2 0 1 2 )
47. National Vector Born Disease Control Program
• Surveillance
• Case management
• Vector management
• Outbreak response
• Behavioral change communication
• Inter-sectoral coordination
• Monitoring & supervision
48. Disease Surveillance:
Epidemiological and Entomological
Epidemiological surveillance
Epidemiological surveillance is an ongoing systematic collection, recording, analysis, interpretation and
dissemination of data for initiating suitable public health interventions for prevention and control.
Objectives of surveillance
The objectives of public health surveillance applicable to dengue are to detect
epidemics early for timely intervention;
• measure the disease burden;
• monitor trends in the distribution and spread of dengue over time;
• assess the social and economic impact of dengue on the affected community;
• evaluate the effectiveness of prevention and control programmes; and
• facilitate planning and resource allocation based on the lessons learnt from programme evaluation.
49. Components of a surveillance system
The surveillance system comprises passive surveillance, active surveillance
and event-based surveillance.
All three surveillance components require a good public health laboratory
to provide diagnostic support in virology, bacteriology and parasitology .
The laboratory need not be able to test for all agents but should know
where to refer specimens for testing, for example, select samples for the
WHO collaborating centers for reference and research.
Individually, the three components are not sensitive enough to provide
effective early warning. But when used collectively they can often
accurately predict epidemic activity.
50. Indices used to assess the levels of Ae.
aegypti infestations
51. Pupal Index: Number of pupae per house
Pupal Index (PI) = Number of pupae/Number of houses inspected X 100
In order to compare the relative importance of larval habitats, the Pupal Index
can be disaggregated by “useful”, “non-essential” and “natural” containers, or
by specific habitat types such as tyres , flower vases, drums, clay pots, etc.
55. •Don’t allow water to remain stagnant in and around your house. Fill the ditches.
•Clean the blocked drains.
•Empty the room air coolers and flower vases completely at least once in seven
days and then refill them.
•Tray below the fridge also to be cleaned.
Anti-larval measures-Environmental Control
56. • Dispose off old containers tins and
tyres etc. Properly.
•Keep the water
tanks and water
containers tightly covered so that the
mosquitoes can not enter them and
start breeding.
57. •Keep the surroundings of your house clean.
•Don’t litter garbage.
•Don’t allow wild herbs etc.to grow around your house.
Do inform and take help from your local health Centre ,panchayat or municipality incase you
notice abnormal density of mosquitoes or too many cases of fever are occurring in your area.
58. Anti-larval measures-chemical control
•TEMEPHOS an insecticide can be used
to kill larva in water.
or
•Put about two tablespoons (30 ml)
of petrol or kerosene
oil into 100 liters of water.
59. Anti-larval measures-Biological control
•Some types of small fish (Gambusia, Lebister) which
eat mosquito larva, can be
obtained from local
administrative bodies.
•These fish can be used in
burrow pits , sewage
oxidation pounds,
ornamental pounds,
Cisterns and farm ponds.
61. Don’t turn away spray workers
whenever they come to spray your
house.
62. Protection Against Mosquito Bites
•Wear clothes which cover the body as much as
possible.
•Use Wire mesh on windows and doors.
•Usemosquitorepellentsprays,creams,coils,matso
rliquidstodriveaway/kill the mosquitoes..
63. It is advisable to always keep the patient of Dengue fever under a
mosquito net in the first 5-6 days of the illness so that mosquitoes don’t
have an access to him/her . The characteristics of net are it should be
rectangular, the size of opening should not exceed 0.0475 inch and the
no. of holes in 1sq inch is usually 150.
64. RECENT OUTBREAK OF DENGUE IN
INDIA
IN THE YEAR 2014 NEAR ABOUT TEN THOUSAND CASES
WHERE REPORTED AND 37 DEATHS HAD OCCURRED.
WHILE IN YEAR 2015 THE CASE LOAD UPTO NOVEMBER IS
NINTEEN THOUSAND AND 41 DEATHS. AMOUNG THESE
HIGHEST NO. OF CASES WHERE REPORTED FROM DELHI 1259
AND 25 DEATHS.
65. DENGUE FEVER CAN BE
EASILY PREVENTED
ITS YOUR ,MINE AND
OUR RESPONSIBILITY
