8/4/2019 Dengue Control Strategy in Pakistan
1/49
1
Dengue FeverA situation analysis in PakistanDENGUE CONTROL STRATEGY INPAKISTAN
Shahid YusufMD, MPH (Student) Walden University
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
2/49
2
Purpose of this presentationBarely able to recuperate after the devastating earthquake of2006 the worlds most populous region went into another
crisis of dengue fever. In 2006 alone Pakistan had over 4000cases of dengue fever and more than 50 deaths.
Later years are being more daunting as the number of denguefever cases are increasing each year. The dengue scare isgripping the public while little or no efforts are being done bythe government to ameliorate the situation.
This presentation walks-through the perils of dengue fever,its burden, causes of failure and methods to ameliorate the
situation.
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
3/49
3
The audience for this presentation are intendedbut not limited to:
Public Health Professionals atthe federal and provincial levels of Pakistan.
Public Health Nursing community at the federaland provincial levels.
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
4/49
4
AGENDAAgenda of this presentation is aimed at:
Profile of Pakistan.
Clinical manifestation of Dengue fever.
Burden of the disease in Pakistani population.
Measures adopted by governmental and public healthagencies to reduce the incidence and prevalence of the
disease.
Tracing the causes of failure and discussing options toadopt an effective strategy for controlling dengue fever inPakistan
4/17/20124
8/4/2019 Dengue Control Strategy in Pakistan
5/49
5GOVERNMENT SECRETARIAT ISLAMABADTHE FEDERAL CAPITAL
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
6/49
6
SHAHLAMAR GARDENSPUNJAB PROVINCE4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
7/49
7Karachi's Mazar-e-Quaid MausoleumSINDH PROVINCE
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
8/49
8MOUNTAINOUS NWFP
KHYBER PROVINCE4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
9/49
9BLAUCHISTAN PROVINCE4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
10/49
10
OFFICIAL INSIGNIA OFMINISTRY OF HEALTH
PAKISTAN
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
11/49
11WHO Maps http://www.who.int/countries/en
MAP OF PAKISTAN
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
12/49
12
PROFILE OF PAKISTAN Situated in South Asia Pakistan borders India
on its East, Afghanistan and Iran on its West,and China in the North.
Total area of the country is 796,095 sq km
Total population of the country as in July 2011is estimated at 187,342,721.
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
13/49
13
HEALTH DEVELOPMENT INPAKISTAN Poor maternal and child health profile High maternal mortality rate 276/100,000 live births Low ante-natal coverage (61%) High under five, infant, and neonatal mortality
( 94, 78, and 54/1000 live births respectively).
Double burden of diseaseThe burden of disease is heavily dominated bycommunicable diseases, reproductive healthproblems, and malnutrition which together account forabout 50% of the total.
world health organization, May 2011
http://www.who.int/country focus
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
14/49
14
HEALTH DEVELOPMENT .. Cont. Low health expenditures and low public investment
in health sector; low focus on prevention; mainexpenditures for salaries an inequity in allocation ofresources.
Insufficient health district mapping and planning,Inadequately planned human resources for health.
Transfer of critical responsibilities from federal toprovincial level.
Health referral pyramid not respected.
World health organization, May 2011
http://www.who.int/country focus
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
15/49
15
DENGUE FEVER :entomology Dengue fever is causedby an arthropod-borne viruswhich is transmitted tohumans through a mosquito
Aedes Aegypti.
Dengue is the most commonmosquito-borne viral disease of humans that is recentlybecoming a major international public health concern.
Globally 2.5 billion people live in areas where dengueviruses can be transmitted (WHO Dengue/dengue hemorrhagic fever, 2011)
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
16/49
16
Aedes Mosquito
Aedes Aegypti Aedes Albopictus
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
17/49
17A mosquito sucking blood courtesy of National Geographic
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
18/49
18
DENGUE FEVER: world distribution
2006Red: Epidemic dengue (wikipedia, www.wikipedia.org)
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
19/49
19
DENGUE FEVER: endemicity Dengue is endemic in more than 100 countries. It
infects 50-110 million people worldwide a year,leading to a half a million hospitalizations, andapproximately 12,500 to 25,000 deaths.
This disease has a burden estimated to be 1600disability-adjusted life years per million population,similar to tropical diseases like Tuberculosis.
WHO counts dengue as one of the sixteen neglectedtropical diseases.
(WHO Dengue/dengue hemorrhagic fever, 2011).(Wikipedia, Dengue).
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
20/49
20
DENGUE FEVER : Clinical manifestations Dengue fever is also known as break bone fever or dengue hemorrhagic
fever.
Majority of the cases (80%) with dengue remain asymptomatic havingmild fever, a small proportion develop life threatening illness termed as
dengue hemorrhagic fever.
Occurs when a mosquito carrying an arbovirus bites a human, passingthe virus to the new host. The virus travels to various glands in the bodywhere it multiplies. Acute viremia is manifested by bleeding, low levels ofblood platelets, and blood plasma leakage resulting in dengue shocksyndrome, where dangerously low blood pressure occurs.
Wikipedia, dengue, http://en.wikipedia.org/wiki/Dengue_fever
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
21/49
21
Clinical manifestationscont. Incubation of the diseases ranges from 4-7
days.
The course of infection is divided into threephases: febrile, critical and recovery.
Febrile phased is spanned by a fever over 40C (104 F), associated with generalized pains andheadache, flushed skin, measles like rash, andsmall petechiae. The fever is classically biphasicin nature, breaking than returning for one or twodays.
Critical phase of the disease is manifested byhigh grade fever which lasts for one or two days,fluid accumulation in chest and abdominal cavitydue to capillary permeability. Shock (dengueshock syndrome) and hemorrhage (denguehemorrhagic fever) may occur in less than 5% ofcases.
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
22/49
22
Clinical manifestations.. cont. The recovery phaseis
heralded by resorption of theleaked fluid into the bloodstream. This lasts for two-three
days.
A typical rash seen in dengue fever
Hemorrhages in the eyes4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
23/49
23
DENGUE FEVER : with mild form of disease High fever , up to 105 F (40.6 C)
A rash over most of the body, which maysubside after a couple of days, thenreappear.
Severe headache, backache or both.
Pain behind the eyes
Severe joint and muscle pain
Nausea and vomiting
Mild bleeding manifestations (e.g. nose orgum bleed, petechiae, or easy bruising).
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
24/49
24
DENGUE FEVER with severe form of disease Severe abdominal pain or persistent
vomiting
Red spots or patches on the skin
Bleeding from nose or gums
Vomiting blood
Black tarry stools ( feces,excrement)
Drowsiness or irritability
Pale, cold or clammy skin
Breathing difficulty
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
25/49
25
LABORATORY CRITERIAFOR DIAGNOSIS Isolation of dengue virus from serum,
plasma, leukocytes, or autopsy samples
Demonstration of a 4-fold or greaterchange in reciprocal immunoglobulin G(IgG) or immunoglobulin M (IgM) antibodytiters to one or more dengue virusantigens in paired serum samples.
Demonstration of dengue virus in tissuevia immunohistochemistry orimmunofluorescence or in serum samplesvia enzyme immunoassay (EIA) .
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
26/49
26
CLASSIFICATIONOF DENGUE CASES Cases are classified as suspectedif they are
compatible with the clinical description.
Cases are classified as probable if they arecompatible with the clinical definition and satisfy one or
more of the following criteria:
Occurrence at the same location and time as otherconfirmed cases of dengue fever
Supportive serology: antibody titer greater than 1280,comparable IgG EIA titers, or positive IgM antibody testin late acute or convalescent-phase serum specimen.
A confirmed case is one that is compatible with theclinical definition and is confirmed by the laboratory.
Shepherd, S. M. & Cunha, B. A. 2009emedicine.medscape.com
4/17/2012
8/4/2019 Dengue Control Strategy in Pakistan
27/49
27
DIAGNOSIS CRITERIADENGUE HEMORRHAGIC FEVER
A positive result from the tourniquet test
Petechiae, ecchymoses, or purpura
Bleeding from the mucosa, gastrointestinal tract,injection sites, or other sites
Hematemesis or melena, thrombocytopenia (