Dengue Fever And Public Health – Discussion And Recommendations

Problems / Statement of Issues

Discuss about the Dengue Fever and Public Health.

Dengue is a viral disease caused by a mosquito. It is a major health concern in tropical and subtropical regions. The rising incidence of this disease may be due to the common factors like growing population, increasing urbanization, global warming and due to  the limited success of vector control measures by the public or by the Government. The World Health Organization (WHO) considers dengue as a major global health challenge. Roughly 100 million infections cases occur every year in different regions of the countries. It causes severe flu-like symptoms, such as high fever, headache, muscle and joint pains, vomiting, skin rash. The full life cycle of dengue involves the mosquito as a transmitter and the humans as the victim and the source of infection.

Urbanization and the global warming have led to the significant rise in the percentage of the cases reported of this severe disease. The mortality rate is 1-5% without treatment and less than 1% with treatment. It is an alarming stage now for the entire Australian Government and the people, to control this disease before this becomes an epidemic spread. Prevention and safety steps should be followed strictly by the public to cut down the rising ratio.  Although major cases are shown in northern Australia, slowly and slowly it is becoming a public health issue in south part as well.

To cut down this ratio of the cases reported each year question arises, what steps should be taken by the Government and the individuals to make themselves aware to control dengue fever? What role can World Health Organization (WHO) play in controlling this viral disease?

Dengue is a severe flu-like infection that can attack individual of all age groups, i.e. infants, children, and adults. It is transmitted by the mosquito and occurs mainly during the rainy season as it is the time when mosquitoes breed the most. This fever does not spread from one person to another but transmits through the bite of infected mosquito. Common symptoms are sudden fever, headache, joint and muscle pain and skin rashes. This disease lasts about a week or more. Any carelessness in this type of viral infection can result in severe dengue known as dengue hemorrhagic the complications in this can lead to collapse and sudden death. Dengue is a global health issue as it is endemic in around many countries mainly tropical and sub-tropical areas. Over the last decades, number has rapidly increased.

Background

The history of Dengue fever in Australia is more than 120 years old. The first case was reported in New South Wales in 1898.By the end of 19^th century, it was spread in many coastal areas of Australia mainly due to movement of people from one place to another and other reasons like conservation of water in water tanks and the stagnant water around homes and offices. Over the last ten years, 70-80 cases per year reported that has been diagnosed serologically. Between the years 1995-2012, there were 42 outbreaks of dengue that includes approx 3000 confirmed dengue fever cases.              In the past few years, data also shows some cases of dengue fever are reported in South Australia also. As per the data from Health department more than 2000 cases of mosquito-borne diseases were confirmed in Australia in last year.

The main problem lies in this; no specific treatment is available for this type of fever. There are four types of viruses known to cause this fever in humans, and the person immune to one of the virus can be infected by other three types of viruses. In Australia as on date, there is no vaccine or any type of preventive medicine available to control this fever at the early stage only best option is to prevent oneself from the mosquito bites.

Health department under Government of Australia has been playing a crucial role so that epidemics of dengue can be controlled for coming future. Various laboratories in Australia are specially design for study for these viruses and what prevention can be done so that this threat get controlled, as this is becoming a public health problem is south parts as well. Various safety measures are passed by the health department and local government to make the people aware of this threat and what steps have to be taken to minimize the mosquito breeding process.

The purpose of the policies laid down by health department in this is to provide strategic guidelines to the public on prevention and control of dengue viruses.Many guidelines have been developed in consultation with the Communicable Diseases Network Australia (CDNA) to provide consistent guidance and knowledge to public health units (PHUs) to further acknowledge the public at large about the safety measures to control this virus and disease. Series of national guidelines are ruled out by Government and below are some of the legislation used in disease surveillance and mosquito management:-

• Public Health Act 2005.
• Public Health regulation 2005.
• Pest Management Act 2001.
• Pest Management Regulation 2003.

Pre-Existing policies/Activity

Under these Public Act and Regulations, Local governments and health departments educate the residents about how they can control mosquito breeding on their properties and maintain the check on the water tanks and follow the compliance for maintaining water in the water tanks. Under Pest Act and Regulations, the public is made aware of the control activities involving knowledge on the importance of pesticide in agriculture fields and at residential areas. It also states that pesticides and chemical activities should be conducted by the licensed pest management team. 

At International level also on timely basis guidelines and handbooks are published for further study for case management, diagnosis step, prevention and control of dengue for the member states. Some of them are:-

• Global Strategy for dengue prevention and control, 2012-2020.
• American Mosquito Control Association.
• Centers for Disease Control and Prevention, USA.
• World Health Organization (WHO).

WHO and International policies respond to the dengue in the following ways:-

1. Whenever any country confirms the outbreak, they support through collaborating the networks of laboratories.
2. Provide proper guidance and technical support whenever needed.
3. They also help in controlling the outbreak by providing the clinical training, and training on vector control at the regional level with the help of some of its collaborating laboratory centers.
4. These centers and policies help the countries in developing new methods and tools, including the pesticides products and its technologies.

Some policies are incorporated at the region level also according to the density of population and other environmental factors to prevent and control the dengue. These are approved under the Local government and regional health centers. These include:-

• Mosquito control Association of Australia.
• Dengue and Zika mosquito prevention.
• Guidelines to minimize mosquito and biting midge problems in new development areas.
• Treatment advise for Pest Management Technicians: For control of Dengue virus.
• Aedes aegypti, the dengue virus Surveillance Toolkit.

These policies are executed to control the larvae of this Dengue mosquito, at the early stage. These guidelines state the background information on biology and public health importance. These policies also assist the developers and local government in the use of land planning for agriculture or development.

Avoiding this virus spread or mosquito bite is the only best option to prevent from dengue fever. Many measures are taken as Prevention and Control measures to fight this virus at different area and state and country level. But prevention starts from the home itself. Some prevention steps that can be taken at home to protect oneself from this virus include the following:-

• Bed nets should be used at home while sleeping.
• Use air conditioners to stay and sleep to keep away the mosquitoes.
• Long-sleeved shirts and long pants should be used to cover exposed skin.
• Pesticide should be done after a fixed interval of time; water tanks should be cleaned on a timely basis.
• Disposing the house-waste properly and not allowing water to accumulate in any open holes.
• Using mosquito coils and plug-in mosquito repellent devices.

The virus of Dengue fever transmits commonly from the individual travelling from one place to another, from one part of the world to the other. Therefore, travellers to endemic countries are advised to take the following precautions to prevent from the mosquito:-

• Be ensured that the hotel or the accommodations rooms are free from mosquitoes by closing the window, using sprays and using bed nets.
• Seeking medical advice without any delay, if the person becomes unwell or has symptoms of fever during or soon after the travel.
• Traveler should try to avoid the visit to the places that are prone to stagnant water and polluted areas.

Some Dengue management plans and action steps to control and prevent the outbreak in different areas are:-

• If the dengue is diagnosed in a person traveling or living in the region, health authorities respond rapidly to prevent a local spread.
• Restrictions are imposed to the travelers from overseas areas coming for blood donation in those regions.
• Assisting and supporting local government with the implementation of mosquito surveillance and control activities.
• Conducting public awareness activities to educate and promote among the public self-protective measures to be taken around their homes and businesses areas.
• Supporting local government by providing the provision of expert medical advice.
• Monitoring and spraying of pesticide resistance in the relevant areas.
• Using insect repellent containing small portions of DEET, which prevent a mosquito to breed.

Mosquito control is the only way out till now to control this virus to break into the epidemic. Potential course of action that can be taken by the Government to control this dengue fever in my opinion:-

Encouraging and monitoring the cases overseas, i.e., outside Australia and studying the pattern of disease occurrence.

Studying the cases of epidemics worldwide can help the Government to prepare and secure themselves before such happens in Australia. Experts should be provided with adequate training and equipments to help in these. Government or health departments at international level should conduct training and meet for their member state and country on the periodical basis to keep them update.

Considerations and Recommendation

Advantages of this are:-

• Before the virus spread in that pattern, as attacked in some other area or country, Australia will be prepared to fight that situation and can control the situation.
• It can be controlled at a early stage.

Disadvantages are:-

• It requires a huge cost to set up the equipment and laboratory for research.
• Specialized doctors and physicians are needed to participate in the training and meetings.

With the help of local government and with the support of the Hospital and health departments a simple generic text message can be circulated to the public at large on their mobile phones in the language that is easily understood by the public at large. This text message has to be circulated at the time before the mosquito breeding starts, i.e., before the rainy season, so that the people can become aware and keep a check on their surroundings. Advantages of this are:-

• This is the one of the simple methods to make the public aware and communicate any information in today’s time.
• Sending a text message is convenient for people of all age groups.
• A text message is also helpful to communicate to the people who are deaf and hearing-impaired people.
• It is not a compulsory, that person mobile phone has to be in range for sending the message. If the Mobile phone is switched off or is in not reachable area, message gets delivered once it is in reachable area or is switched on.

Disadvantages are:-

• Sometimes the message is delivered at the non-preferable time, as one might be busy in some important meeting or may be out to some doctor or for some important piece of work a where simple text message can distract anyone.
• The message has to be short and crisp, people might don’t have much space to get the message across.
• Some people respond negatively to unwanted text messages. Make sure message is sent with the required privacy and permission and data protection rules.

1. Conducting the public awareness activities time to time.

Local government with health department should conduct public awareness programs on the periodic basis to make the people aware about this dengue fever and about all the prevention and control measures that can be taken. Public awareness can be created through various means which includes media awareness, using the social media and broadcasting awareness on television and internet. Communities can be used as a public awareness in small areas and region.  Campaigning strategies can be used to make public at large aware of the dengue fever. The monthly or weekly meeting can be held in residential and businesses areas to communicate the important message and to communicate people about the prevention and control of this virus. 

Advantages are:-

• People of all categories can be part of these activities i.e. high standard and middle- class person.
• Social media is used by most of the public in one way or the other, through which awareness can be easily spread.
• Old age people like to be participating in the society meeting and all communities meeting, through which other family members can be communicated.

Disadvantages are:-

• This is one of the time- consuming activities, which requires people to take some time out and be part of the campaigns and meetings.
• It is an expensive task that requires proper setup and places.

Hence, recommendation would be conducting the public awareness on time to time basis to make the public aware of this viral disease. The more awareness is created, the more the people will take steps to make them protect against the infection and protect from the mosquito bites.

For this, a cross-sectional pilot study was conducted among the people visiting one of the famous hospitals in some small region of Australia. Through the method of convenience sampling, a pre-tested questionnaire was asked face- to- face as an interview with four hundred visitors in a span of time. This was done to access the knowledge level and awareness among the people about the dengue virus and the practices they follow in their daily routine to prevent this growing viral infection. And the score of knowledge at the last was recorded on a scale 1-3.

Result was, about 90% of the individuals interviewed had heard about the dengue fever. While the sufficient knowledge about this virus with early symptoms details and types was found in only 38.5% of the individuals, who appeared for the interview. Result also showed that the knowledge that was based upon preventive measures was found to be focused towards the preventive measures rather than eradication of mosquito population. Use of mosquito coils and sprays was the only best most preventive measure known among the set of people interviewed. As a public awareness tool, television was considered as the most important and useful source of information about any disease.

Therefore it clarifies that public awareness activities and campaign plays an important role to educate the public at mass level. Short documentary movie, shown on Television or any social media can play a vital role to educate the people. Types of public awareness programs are rolled out from time to time by health government and local government for literate and illiterate class of people in the language commonly known among the people.

Future Actions that can be taken:-

• With the aim to prevent and treat dengue infection in the future, Control of mosquito transmission, development of dengue virus vaccine and antiviral medicine constitute the main action to be taken to prevent this outbreak at higher level.
• Control of mosquitoes (vector) transmission can be done by keeping species like guppies or copepods in standing water, and infecting the mosquito population with these bacteria.
• There should be proper techniques to deal with the water waste and stagnant water mainly during the peak rainy seasons and the deep holes if any in the near buy areas, i.e. in home gardens and public places should be completely filled so that we can minimize the chances of mosquitoes breeding.
• Mosquitoes also breeds in the useless tyres and empty drums kept in the houses and garages and industries, if kept in open. Proper check should be done so that water does not become stagnant in any case.

            Due to increasing cases of epidemics and cases of enhancing severity of dengue infection, the necessity to develop a dengue vaccine and antiviral drug has gained a considerable importance. Several laboratory test and several researches are done and carried on in many parts of the world under the International Organization to achieve success in preparation of antiviral drug and the vaccine. World Health organization (WHO) is constantly performing research and is issuing guidelines on timely basis to fight this virus.

Conclusion

Dengue has become a global life- threatening public health concern, affecting around 2.5 billion individuals in more than 100 countries. The doctors and the physician should be up to date and aware about the clinical manifestations of the prevailing condition and ensure an adequate early treatment is available to the patient, as the dengue fever can progress to life-threatening dengue hemorrhagic fever, which is fatal and can even cause the death of the victim. Future directions to this combat dreadful disease aim at the methods to control the breeding of mosquito, development of a vaccine to fight all the types of viruses of dengue and antiviral drug regimen.

References

Annamalai, R. and Suresh, K. (2015). Panuveitis with disc edema after dengue fever: A rare presentation. International Journal of Medicine and Public Health, 5(4), p.393.

Azil, A., Long, S., Ritchie, S. and Williams, C. (2010). The development of predictive tools for pre-emptive dengue vector control: a study of Aedes aegypti abundance and meteorological variables in North Queensland, Australia. Tropical Medicine & International Health, 15(10), pp.1190-1197.

Chaudhary, S., Mohanty, D., Sonkar, S., Gupta, A., Singla, P. and Arya, R. (2013). Acute hypokalemic quadriparesis in dengue fever. Annals of Tropical Medicine and Public Health, 6(3), p.365.

HO, S., SPELDEWINDE, P. and COOK, A. (2016). Predicting arboviral disease emergence using Bayesian networks: a case study of dengue virus in Western Australia. Epidemiology and Infection, 145(01), pp.54-66.

Huang, X., Clements, A., Williams, G., Milinovich, G. and Hu, W. (2013). A threshold analysis of dengue transmission in terms of weather variables and imported dengue cases in Australia. Emerging Microbes & Infections, 2(12), p.e87.

Joy, J. (2016). Dengue Fever. Indian Journal of Communicable Diseases, 2(2), pp.81-85.

Lye, D. (2017). Dengue and travellers: implications for doctors in Australia. The Medical Journal of Australia, 206(7), pp.293-294.

Manokaran, G., McPherson, K. and Simmons, C. (2016). Stopping dengue: recent advances and new challenges. Microbiology Australia.

Ndii, M., Allingham, D., Hickson, R. and Glass, K. (2016). The effect of Wolbachia on dengue outbreaks when dengue is repeatedly introduced. Theoretical Population Biology, 111, pp.9-15.

Pozzetto, B. (2015). Is transfusion-transmitted dengue fever a potential public health threat?. World Journal of Virology, 4(2), p.113.

Sriwijitralai, W. and Wiwanitkit, V. (2017). Rebound thrombocytosis and persistence of clinical symptoms after recovery from dengue hemorrhagic fever. Annals of Tropical Medicine and Public Health, 10(1), p.286.

Sungchasit, R., Pongsumpun, P. and Tang, I. (2016). ENVIRONMENTAL IMPACT ON THE SPREAD OF DENGUE VIRUS WHEN TWO MOSQUITO SPECIES CIRCULATE. Far East Journal of Mathematical Sciences (FJMS), 101(1), pp.137-170.

Tai, A., Robosa, R., Padiglione, A., Dalpatadu, C. and Korman, T. (2016). Dengue fever in travellers: are we missing warning signs of severe dengue in a non-endemic setting?. The Medical Journal of Australia, 204(7), p.267.

Tennakone, K. (2014). Analysis and mathematical modelling of possible inter-larval spread of the dengue virus. Journal of the National Science Foundation of Sri Lanka, 42(3).

Tittarelli, E., Mistchenko, A. and Barrero, P. (2014). Dengue Virus 1 in Buenos Aires from 1999 to 2010: Towards Local Spread. PLoS ONE, 9(10), p.e111017.

van den Hurk, A. (2016). Dengue and the introduction of mosquito-transmitted viruses into Australia. Microbiology Australia.

Villabona-Arenas, C. and Zanotto, P. (2013). Worldwide Spread of Dengue Virus Type 1. PLoS ONE, 8(5), p.e62649.

VILLAMOR, E., VILLAR, L., LOZANO, A., HERRERA, V. and HERRÁN, O. (2017). Vitamin D serostatus and dengue fever progression to dengue hemorrhagic fever/dengue shock syndrome. Epidemiology and Infection, pp.1-10.

VILLAMOR, E., VILLAR, L., LOZANO, A., HERRERA, V. and HERRÁN, O. (2017). Vitamin D serostatus and dengue fever progression to dengue hemorrhagic fever/dengue shock syndrome. Epidemiology and Infection, pp.1-10.

WILLIAMS, C., JOHNSON, P., BALL, T. and RITCHIE, S. (2012). Productivity and population density estimates of the dengue vector mosquitoAedes aegypti(Stegomyia aegypti) in Australia. Medical and Veterinary Entomology, 27(3), pp.313-322.

Tuiskunen, A., Monteil, V., Plumet, S., Boubis, L., Wahlström, M., Duong, V., Buchy, P., Lundkvist, Å., Tolou, H. and Leparc-Goffart, I. (2011). Phenotypic and genotypic characterization of dengue virus isolates differentiates dengue fever and dengue hemorrhagic fever from dengue shock syndrome. Archives of Virology, 156(11), pp.2023-2032.