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Macao’s Experience in Macao’s Experience in Dengue Prevention and ControlDengue Prevention and Control

Dr. Koi Kuok Ieng

Department of Health, Macao SAR

2004.03.05

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OutlineOutline

Epidemiology Prevention Control Experience

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EpidemiologyEpidemiology

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Reported CasesReported Cases ……

1996 – 1 (imported)

……

2001 – 1418

2002 – 2 (imported)

2003 – 28

(death = 0)

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2001 epidemic2001 epidemic Duration : August to December Total no. of reported cases : 1418 Attack rate : 3.2/1000 Dengue Hemorrhage Fever : 0 Death : 0 DEN-2 (a few DEN-1)

Vector : Aedes albopictus

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Temporal distribution of reported cases of Dengue in 2001Temporal distribution of reported cases of Dengue in 2001

（ Total = 1418）

0

100

200

300

400

500

600

700

800

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

Month

Case

Supposed beginning

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Spatial distribution of reported cases of Dengue in 2001

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Typical “Black spot” in focus

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Interpersonal distribution of reported cases of Dengue in 2001Interpersonal distribution of reported cases of Dengue in 2001

0

2

4

6

8

0-14 15-24 25-34 35-44 45-54 55-64 >=65

Age groups

Attack rate (1/1000)

Male

Female

Total

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2003 outbreak2003 outbreak Duration : 2003.10.09 ~ 11.02

Total no. of reported cases : 28

Dengue Hemorrhage Fever : 0

Death : 0

DEN-1

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Spatial distribution of reported cases of Dengue in 2003

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PreventionPrevention

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Comprehensive strategiesComprehensive strategies Central strategy:

SOURCE REDUCTION

Supplementary strategies: Health education and community mobilization Early detection, isolation and treatment of case Vector surveillance and study Chemical control Legislation Communication

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Source reductionSource reduction Two main problems encountered

More than 600 “black spots” in the city area

More than 200 thousands apartments

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Cleaning of “black spots”Cleaning of “black spots”

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Community campaignsCommunity campaigns

School campaignsSchool campaigns

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Ovitrap surveillanceOvitrap surveillance

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

Month

Positive rate

20022003

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Household larva surveillanceHousehold larva surveillance

0

2

4

6

8

10

12

2002.06 2002.09 2003.06 2003.09

Breateau Index

House In d e x

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ULV sprayingULV spraying

FoggingFogging

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ControlControl

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0

1

2

3

4

5

6

7

8

9

10

Case

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

Date of onset

2003 limited outbreak

Detection& responses

Longest IP 14 d

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Contingency PlanContingency Plan Delineation of focus of infection : 200 m

Immediate response:

1. Emergency community meetings

2. Chemical control

3. Door-to-door Inspection and mobilization

4. Examination and cleaning of abandoned houses and sites

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ExperienceExperience

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Community participationCommunity participation Effective community participation is the key to

Disease management Problems encountered :

Ineffectiveness of traditional health education activities in community involvement

Behavioral change of population against Dengue not sustain

Prospect :

Healthy City Project

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Whole city mobilizationWhole city mobilization

DOH

Publicservices

Media

Associations

SchoolsSpecialgroups

Medical facilities

Volunteers

Private

CitizensCitizens

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Local community mobilizationLocal community mobilization

Community Health

Committee

CommunityEntities

HealthCenter

SanitaryTeam

CDCResidents

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Source reductionSource reduction Source reduction remains to be the

central control strategy Problems encountered :

Hygiene problem of private properties

Sustainability of measures

Prospect : Legislation

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Early detection of epidemicEarly detection of epidemic Early detection is crucial to stop a potential epidemic

Problems encountered : Delay in diagnosis and reporting In 2003 outbreak, onset to consultation was 2

days ; and from onset to case report was 6.4 days Prospect :

Education for citizens Guideline for clinicians Accessibility of laboratory analysis

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Control measuresControl measures If adopted early, planned and sufficient

control measures can stop a potential epidemic

Problems encountered : “safety coefficient” insufficient

Prospect :

Review extent, method adopted and frequency of chemical control