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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!