DENGUE FEVER &

PAKISTAN
Dr Mazhar
03066980980
 WHAT IS DENGUE ?
• Most widely spread mosquito borne infection in
humans in world
• Is an acute fever producing infectious disease by
bite of infected female mosquito ( A. egypti)
• It is also known as Dengue fever , break bone
fever or
Dengue hemorrhagic fever/or severe dengue
Causative agent is a VIRUS having four types
( DEN 1, DEN 2, DEN 3 DEN 4
• Mostly found in the tropics
POSSIBLE FACTORS RELATED TO DENGUE EPIDEMICS

1. Unplanned Urbanization
2. Climate Change( Global warming)
3. Population Movements
4. Poor Environmental Management
5. Poor Sanitation
6. Mass Mobilization
7.Lack of sustainable multi
sectorial community based
Interventions in control of Dengue
8.Lack of support from NGOs
9.Lack of Proper Legislation
10.Wide spread illiteracy
A . egypti • SPECIAL FEATURES OF MOSQ
UITO
• LONGEVITY:
8 Days ( Average)

• FLIGHT RANGE:
100 meters from site of
emergence

• ALTITUDE:
1000 meter above sea level
 CAUSATIVE AGENT OF DENGUE

Dengue is cause by a RNA virus

Dengue virus

Bauman, R., (2006). Microbiology disease by systems. San Francisco , CA: Pearson Benjamin Cumming
Publishers
 TRANSMISSION OF DENGUE
1. A mosquito is the BIOLOGICAL
VECTOR
2. This mosquito is the obligate
intermediate host for some viruses
3. Aedes albopictus/aegypti are
generally associated with the spread
of dengue fever
4. Biting around the ankles and knees
close to the ground in the daytime.
5. Preferred time is two hours after
sunrise and two hours before sunset
6. Only female mosquitoes will bite;
mostly in the daytime. Remains
infective life long.
Akram, W., (n.d.). Aedes as a vector of Dengue: a possible threat to our lives. Khwarzimig Science Society.
U ni v e rs i t y of Ag r i cu lt u r e, Fai s a la ba d . Re t r i e v e d Ap r i l 1 9 , 2 0 1 0 fr om
http://www.khwarzimic.org/takveen/dengue_kss.pdf
VECTOR MOSQUITOES

A. egypti A albopictus
 AEDES AEGYPTI
• Currently is limited to the southeastern quadrant of the
U.S., and small areas in New York and Arizona. Seen in
Pakistan
• The most competent vector of dengue virus and yellow
fever
• As A. albopictus, this mosquito depend greatly on stored
water for breeding sites.
• Male and Females adults feed on nectar of plants
• Females bloodfeed primarily on humans in order to
produce eggs
• A. aegypti bites during the day, indoor as well as
outdoors
 AEDES ALBOPICTUS
• The Asian tiger mosquito was found in Florida
at a tire dump site near Jacksonville
• The species has spread rapidly throughout the
eastern states, including all Florida’s 67
counties
• Aedes albopictus is a vector for many viruses
including dengue fever and Eastern equine
encephalitis virus
GEOGRAPHIC DISTRIBUTION OF DENGUE
• Dengue disease occurs in tropical and
subtropical areas
• Endemic in over 100 countries in the Caribbean,
South, Central and North America, Africa, the
Pacific Islands, Hawaii, Asia, (Pakistan, India)
Eastern Mediterranean and Australia
• Before 1970 only nine countries had
experience dengue hemorrhagic fever
epidemics, a number that had increased more
than four-fold by 1995
 COMMON BREEDING SITES
• Dengue cases usually increase during the rainy
season
• The spread of the mosquito is attributed to poor
environmental sanitation
• When it rains the water gets stored in any place
such as discarded tires, broken bottles, and even
shoes
• Other examples are soda cans, birdbaths, rain
gutters, toys, pool covers, tree stumps, and
garbage cans.
 AEDES AEGYPTI LIFE CYCLE

2-7 days
days

2 days
 SIGNS AND SYMPTOMS OF DENGUE FEVER
1. High fever, up to 105 F (40.6 C)
2. A rash over most of your body, can subside after a
couple of days and then reappear
3. Sever headache, backache or both
4. Pain behind eyes
5. Severe joint and muscle pain (breakbone fever)
6. Nausea and vomiting
7. Signs and symptoms usually begin about four to
seven days after being bitten by A. aegypti.
8. Mild dengue fever rarely causes death, it is usually
self-limiting
 DENGUE HEMORRHAGIC FEVER (DHF)

1. Significant damage to your blood and lymph

Mayo clinic, (2010). Dengue fever symptoms. Retrieved April 19, 2010 from
http://www.mayoclinic.com/health/dengue_fever/DS01028/DSECTION=symptoms
 TYPES OF VIRUS IN DENGUE
• There are four different types (serotypes) of the
dengue virus
• These are DEN-1, DEN-2, DEN-3 and DEN-4
• Recovery from infection by one provides lifelong
immunity against that virus, confers only partial
and transient protection against subsequent
infection by the other three viruses
• There is evidence that sequential infection
increases the risk of developing dengue
hemorrhagic fever
World Health Organization, (2009). Dengue and dengue haemorrhagic fever. Retrieved April 19,2010 from
http://www.who.int/mediacentre/factsheet/fs117/en/
 DIAGNOSIS FOR DENGUE
• Travel history and symptom profile
• Detection of antibodies against the virus
IgM & IgG
• Complete blood count/Platelet count
• Liver function test
• Occult blood in stool
 TREATMENT FOR DENGUE
• NO SPECIFIC THERAPEUTIC AGENTS EXIST FOR
DENGUE INFECTIONS
• BED REST AND HYDRATION THERAPY
• Fever control with acetaminophen. Narcotics
may be necessary if headaches are very severe
• Aspirin should be avoid because of anticoagulant
properties, children should avoid aspirin when a
viral infection is suspected
• Monitoring of signs and symptoms for warning
signs of DHF or DSS
 PREVENTION
• No vaccine or drugs are available for the
prevention of dengue
• Preventive measure should be taken to avoid the
bite of the mosquito
– Well screen accommodations or air conditioning
– Use of insecticide indoors
– Apply insect repellent to skin and clothing. The
most effective are the ones with DEET
– Empty , clean or cover any standing water that can
be a mosquito-breeding site
 PRIMARY PREVENTION
COMMUNITY LEVEL
• Since no treatment and no vaccine is
available, Health Education is the key.
1.Education of Medical Community
2.Adding a topic of “Common Public
Health Issues of Pakistan” in the
curriculum of Schools and Colleges with
special emphasis on Prevention and
Control.
3.Education of general population
–P r e v e n t m o s q u i t o b i t e s ( u s e
mosquito coils, nets, repellents,
screens, and protection of people
sick with dengue.
–Wear full sleeves cloths.
–Don’t leave the over head tanks
open & avoid using swimming pools.
– Don’t keeps water in containers for more then a
week. Instead, empty them every week, let them dry
and fill again.
– Don’t let the water stay all the time in the flower
pots. Instead water them only in the morning every
alternate day
– USED AUTOMOBILE TYRES (important breeding site
for urban Aedes) , can be recycled or filled with
earth or concrete can be used for traffic or crash
barriers Or recycled & used for making floor mats
and buckets. Truck tyres can be used for low cost
refuse containers.
 PUBLIC HEALTH PREVENTION AND
CONTROL OF DENGUE
• The importance of the activities of the Dengue
Branch can translate to:
• New technologies into real-time
• Rapid diagnosis to treat patient earlier and
effectively
• Improving surveillance that will allow an
effective and targeted public response to
dengue outbreaks
 PREVENTION AND CONTROL CONT.
• Providing training to the medical community to
improve their knowledge of the disease
• Conducting mosquito control interventions that
allow the CDC to make recommendations to vector
control program
• Improving quality of surveillance data
• Analyzing all the clinical manifestation of the disease
to conduct studies to improve the knowledge of the
dengue virus
• FUMIGATION 15% success
• Public education 85% success
• Use of electronic and print media
 ADVICE FOR TRAVELERS
• The times of higher risk of being bitten by the
female mosquito is 2 to 3 hours after daybreak
and 3 to 4 hours before nightfall
• The mosquito can feed indoors as well as
outdoors
• Precautions as mention before should be taken
especially at peak biting activity time
• The risk of exposure may be lower in modern,
air-conditioned hotels with well-kept grounds
Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews, July 1998,
p.480-496. Retrieved April 24, 2010 from http:/www.cmr.asm.org/cgi/repreint/11/3/480