Integrated Strategy for Dengue Prevention and Control

44th Directing Council, September 2003 1

Pan AmericanHealthOrganization

..

..

Integrated Strategy

for Dengue Prevention and

Control José Luis San MartínCommunicable Disease Unit

Disease Prevention and Control



ParadigmParadigm Large-scale factors are strongly acting upon the

issue of dengue.

The dimensions of Dengue go beyond the scope of

the health sector.

The health sector is not solely responsible for

dengue prevention and control.

To limit its effects, it is necessary to join the efforts

of all sectors (public, private, and communities).



Reemergence of Dengue Environmental

FactorsClimate change

Alteration of ecosystems

Alteration ofGeographical distribution

of pathogensand vectors

Increase in Increase in vector-borne diseasesvector-borne diseasesDengue Yellow

Fever

Ideal Ideal conditions for conditions for Dengue:Dengue:Latitude: 350 north 350 southAltitude: 2,200 mTemperature: 15-40 °CRelative humidity:

high-moderate

Changes in transmission

Ecological changes

Socio-economic changes



Population Growth

Reemergence of Dengue Socio-Economic Factors

Reemergence of Dengue Socio-Economic Factors

• Unprecedented population growth.

• Urbanization neither planned nor controlled.

• Increase in poverty.

• Inadequate environmental management.

• Unprecedented population growth.

• Urbanization neither planned nor controlled.

• Increase in poverty.

• Inadequate environmental management.

0

1,000,000,000

2,000,000,000

3,000,000,000

4,000,000,000

5,000,000,000

6,000,000,000

1830 1930 2000



Reemergence of Dengue Uncontrolled Urbanization

Reemergence of Dengue Uncontrolled Urbanization

• In 1954, 42% of Latin America’s population lived in urban areas, while in 1999 this figure reached 75%.

• Informal settlements proliferate due to poverty.

• Absence of basic services: electricity, running water, sewer systems, garbage collection.

• High population density.

• In 1954, 42% of Latin America’s population lived in urban areas, while in 1999 this figure reached 75%.

• Informal settlements proliferate due to poverty.

• Absence of basic services: electricity, running water, sewer systems, garbage collection.

• High population density.

Sources: Gubler, 1998; PAHO, 1997.



1980:1980: 118 million people in poverty in Latin America—a third of the population.

1990:1990: 196 million people in poverty in Latin America—almost half the population. This is equivalent to a

42% increase in poverty in the 1980s, compared to a 22% increase in population.

Of the 78 million new people in poverty in Latin America in the 1980s, 80% are urban.

Source: Vilas, 1995.



Reemergence of Dengue Inadequate Environmental Management

Reemergence of Dengue Inadequate Environmental Management

• Insufficient waste collection and management.

• Non-biodegradable containers.

• Improper tire disposal.

• Insufficient waste collection and management.

• Non-biodegradable containers.

• Improper tire disposal.

• Insufficient and inadequate water distribution.

• Increased number of water storage containers.

• Inadequate septic system conditions.

• Insufficient and inadequate water distribution.

• Increased number of water storage containers.

• Inadequate septic system conditions.

Increase in breeding sites for the vector



Reemergence of Dengue Population Movements

Reemergence of Dengue Population Movements

• MigrationMigration

• International International tourismtourism

• MigrationMigration

• International International tourismtourism

• More than 750 million people annually cross international borders.

• Increase in rural migration into urban areas.

• 1.4 billion international travelers in 1999.

• 697 million international tourist arrivals in 2000 and 715 million in 2002 (up 3.1%).

• More than 750 million people annually cross international borders.

• Increase in rural migration into urban areas.

• 1.4 billion international travelers in 1999.

• 697 million international tourist arrivals in 2000 and 715 million in 2002 (up 3.1%).

Source: OMT data.

Traffic of microorganisms



0

200,000

400,000

600,000

800,000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Dengue Cases, 1980–2002

1,000,000

1,200,000



0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Cases of Dengue Hemorrhagic Fever (DHF)

(Region of the Americas, 1980-2002)



Cases of Dengue and DHF in the Americas

(January–August 2003, compared to same period in 2002)

2003

200

2

9,2%

84.0%

6.1%4.0%

6.0%

74.6%

2.7%

2.1%11.8%

437,283 342,061

Others

Venezuela

Colombia

Ecuador

Brazil

ll



Integrated Strategy Integrated Strategy

SocialCommunication

EpidemiologicalSurveillance

Entomology

Patient CareLaboratory

Integrated Strategy

Components



Social Communication • Strengthen the effectiveness and sustainability of

national strategies through social communication and community participation.

Epidemiologic Surveillance• Ensure that public health policies have a

multisectorial, intersectorial, and interdisciplinary focus.

Entomology• Establish a system of entomologic surveillance

for integrated vector management (intersectoral, involving the education, environment, academic, public-works, local/regional government, NGO and private sector).

Social Communication • Strengthen the effectiveness and sustainability of

national strategies through social communication and community participation.

Epidemiologic Surveillance• Ensure that public health policies have a

multisectorial, intersectorial, and interdisciplinary focus.

Entomology• Establish a system of entomologic surveillance

for integrated vector management (intersectoral, involving the education, environment, academic, public-works, local/regional government, NGO and private sector).

Expected Results



Patient Care• Ensuring that health workers are trained in the

diagnosis and treatment of the disease, that the network of institutions be prepared to treat the ill, and that the community is well informed as to warning signs.

Laboratory• Ensuring that the surveillance system has a

laboratory or an integrated network of laboratories available, that is capable of generating reliable and timely information for clinical diagnosis and the design of interventions.

Patient Care• Ensuring that health workers are trained in the

diagnosis and treatment of the disease, that the network of institutions be prepared to treat the ill, and that the community is well informed as to warning signs.

Laboratory• Ensuring that the surveillance system has a

laboratory or an integrated network of laboratories available, that is capable of generating reliable and timely information for clinical diagnosis and the design of interventions.

Expected Results cont.



Promote the methodology of the integrated strategy, strengthening National Programs.

Incorporate the Dengue Task Force in PAHO’s technical cooperation to countries.

Implement the COMBI Plan: Communication for Behavioral Impact.

Emphasize the need for Integral Subregional Plans that strengthen activities in the border regions between countries.

Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors.

Promote the methodology of the integrated strategy, strengthening National Programs.

Incorporate the Dengue Task Force in PAHO’s technical cooperation to countries.

Implement the COMBI Plan: Communication for Behavioral Impact.

Emphasize the need for Integral Subregional Plans that strengthen activities in the border regions between countries.

Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors.

Where are we going?



IMPACTIMPACT The reduction of the

morbi-mortality caused by

dengue outbreaks and epidemics

Documents

Integrated Strategy for Dengue Prevention and Control