IMPACT OF CLIMATE CHANGE ON DENGUE FEVER PATTERN

A CASE STUDY ON TREATING DENGUE FEVER AT

MILITARY INSTITUTE OF TRADITIONAL MEDICINE- VIETNAM 2015

Major General, Prof. PhD. Nguyen Minh Ha; Colonel, PhD. Tran Cong Truong; Colonel, PhD. Tran Ngoc Lien; Captain, MD. Nguyen Tuan Luong;

Lieutenant colonel, MD. Dinh Thanh Ha; Lieutenant, Dr. Nguyen Thi Tuyet Minh Military Institute of Traditional Medicine (MITM), Viet Nam

CONTENT

Introduction

Objectives

Methods

Results and Discussion

Conclusion

INTRODUCTION

INTRODUCTION

Climate change

Impact on the

ecosystem

Changes of infectious

disease patterns

DENGUE HEMORRHAGIC FEVER (DHF)

• Tropical areas

• Aedes aegypti

• Great affect on society and military activities

DHF

Heat

Heat clearance

Blood

• Blood nourishment

Body fluid

• Body fluid reproduction

Qi

•Qi nourishment

TVM THEORY

OBJECTIVES

OBJECTIVES

• Observe the impact of climate change on DHF pattern

• Evaluate the effectiveness of “Sinh tan chi huyet“ remedy in treatment DHF in combination with the background regimen recommended by the Ministry of Health

METHODS

1- Clinical trial to evaluate the therapeutic effect of the “Sinh tan chi huyet“ remedy on DHF at MITM

METHODS

2- Survey and statistic data of the climate pattern in 3 ending months of 2015 comparing to the mean climate pattern yearly at the same time in Hanoi, Vietnam

SELECTION CRITERIA IN CLINICAL STUDY

Dengue hemorrhagic fever (DHF) • sudden high fever continously from 2-7 days; bleeding under

the skin • headaches - pain fovea; muscle pain • heamatocrit normal or elevated; platelet count normal or

reduced ; WBC reduced • Dengue NS1 test / IgM (+).

DHF with warning signs • Struggle, lethargy, vomiting • Liver enlarge >2cm • mucosal bleeding; urination decreased • heamatocrit rising; Platelet count decreased rapidly • Dengue NS1 test / IgM (+).

• Hypovolemia shock (DHF shock) happened when plasma draining severely or major bleeding or organ failure.

DHF with severe condition

EXCLUSION CRITERIA

CLINICAL STUDY PROCEDURE

Inpatients at MITM from 01/10/2015 to

31/12/2015 199 patients

Selection criteria

Dengue hemorrhagic

fever

DHF with warning

signs

Exclusion criteria

DHF with severe

condition

TREATMENT STRATEGY

Combining traditional medicine

with morden medicine

• The therapy combining the background regimen recommended by the Ministry of Health (2011) with “Sinh tan chi huyet” remedy

OBSERVING INDICES IN STUDY

Treatment duration,cured

rates

Patients characteristics

Tests indices

RESULTS AND DISCUSSION

EVALUATING THE EFFECTIVENESS OF TREATMENT DHF USING “SINH TAN CHI HUYET” REMEDY

Epidemiological characteristics Number Percentage (%)

Age (n = 199)

≤ 17 years old 22 11.06

18 - 59 110 55.28

≥ 60 67 33.66

Average age 40,5 ± 20,6

Gender (n = 199)

Male 98 49.25

Female 101 50.75

Patients (n = 199)

Insuranced 174 87.44

Not insuranced 25 12.56

EVALUATING THE EFFECTIVENESS OF TREATMENT DHF USING “SINH TAN CHI HUYET” REMEDY

Clinical characteristics Number Percentage (%)

Amission date

(n = 199) Day 2 + day 3 119 60

Level (n = 199)

DHF 168 84.42

DHF with warning signs

31 15.58

Severe DHF 0 0

0

2

4

6

8

10

12

2 3 4 5 6 7 8 9 10

Changes of WBC count

Day

G/L

EVALUATING THE EFFECTIVENESS OF TREATMENT DHF USING “SINH TAN CHI HUYET” REMEDY

EVALUATING THE EFFECTIVENESS OF TREATMENT DHF USING “SINH TAN CHI HUYET” REMEDY

2

3

4

5

6

7

8

2 3 4 5 6 7 8 9 10

CHANGES OF RBC COUNT

Day

T/L

EVALUATING THE EFFECTIVENESS OF TREATMENT DHF USING “SINH TAN CHI HUYET” REMEDY

0.20

0.30

0.40

0.50

0.60

0.70

0.80

2 3 4 5 6 7 8 9 10

Changes of hematocrit %

Day

EVALUATING THE EFFECTIVENESS OF TREATMENT DHF USING “SINH TAN CHI HUYET” REMEDY

20.0030.0040.0050.0060.0070.0080.0090.00

100.00110.00120.00130.00140.00150.00160.00170.00180.00190.00200.00

2 3 4 5 6 7 8 9 10

Changes of platelet count

Day

G/L

OVERALL TREATMENT OUTCOME

Cured, dischargedHospital transferredDead

0.5%

99.5%

Treatment results

Average treatment days

DHF with warning signs (n = 31) 8.67 ± 2.38

In general (n = 199)

6.81 ± 1.89

OVERALL TREATMENT OUTCOME

Le Thi Luu (2011): 7,05 ± 0,6 days

ACCORDING TO TVM THEORY

• Clearing heat • Nourishing Qi and blood • Reproducing body fluid • To treat DHF was suitable to TVM theory

The remedy of “Sinh tan chi huyet” have many effects

• Shortened the duration of treatment • Increased the ratio of recovery patients • Reduced the number of patients with severe conditions

The results showed

Temperature (ºC)

Humidity (%)

Rain fall (mm)

The number of

mosquitoes/mm³

300

250

200

150

100

50

0

CLIMATE CHANGE PATTERN AND RESEARCH VECTORS OF DHF IN 7 MILITARY ZONES IN 2013 IN VIET NAM

1 2 3 4 5 6 7 8 9 10 11 12

Month

CLIMATE CHANGE PATTERN IN HANOI AND DHF PATTERN AT MITM IN 2015

050

100150200250300350400

Oct. 2015 Nov. 2015 Dec. 2015

2015 rain fall

Yearly average rain fall

0

5

10

15

20

25

30

35

Oct. 2015 Nov. 2015 Dec. 2015

2015 temperature

Yearly average temp.

Annual aver. temp. in VN: 21 - 27oC - 2014 temp. from 20 - 28oC - 2015 temp. from 20 - 32oC

(mm) (0C)

Average rain fall in 3 months 2015 Average temp. in 3 months 2015

During 3 months in 2015, monthly average temperature and rail fall increased over the normal from 0.4 - 3.10C and from 165.3 - 385.5%, respectively, making good condition for Culex species Aedes to develop.

CLIMATE CHANGE PATTERN IN HANOI AND DHF PATTERN AT MITM (IN 3 MONTHS OF 2015)

Number of patients

month

CONCLUSION

CONCLUSION

There was expression of the climate change impact on the number of patients hospitalized with DHF

“Sinh tan chi huyet” remedy combined with the background regimen has

effect on DHF treatment

RECOMMENDATION

Global solution is needed to cope with the impact of climate change on

several infectious diseases

THANK YOU FOR YOUR ATTENTION!