xcxcxcxc

1
.

• .

Integrated Strategy for Dengue Prevention and
Control
2
Paradigm

• 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).

3
Reemergence of Dengue Environmental Factors
Changes in transmission
Climate change
Ideal conditions for Dengue Latitude 350
north 350 south Altitude
2,200 m Temperature 15-40 C Relative
humidity high-moderate
Ecological changes
Alteration of ecosystems
Socio-economic changes
Alteration of Geographical distribution of
pathogens and vectors
Increase in vector-borne diseases
Yellow Fever
Dengue
44th Directing Council, September 2003
4
Reemergence of Dengue Socio-Economic Factors
Population Growth

• Unprecedented population growth.
• Urbanization neither planned nor controlled.
• Increase in poverty.
• Inadequate
• environmental management.

6,000,000,000
5,000,000,000
4,000,000,000
3,000,000,000
2,000,000,000
1,000,000,000
0
1830
1930
2000
5
Reemergence of Dengue Uncontrolled Urbanization

• In 1954, 42 of Latin Americas 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.

6

• 1980 118 million people in poverty in Latin
  Americaa third of the population.
• 1990 196 million people in poverty in Latin
  Americaalmost half the population.

Poverty

• 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.

7
Reemergence of Dengue Inadequate Environmental
Management

• 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.

Increase in breeding sites for the vector
8
Reemergence of Dengue Population Movements

• Migration
• International tourism

• 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
9
Dengue Cases, 19802002
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
10
Cases of Dengue Hemorrhagic Fever (DHF) (Region
of the Americas, 1980-2002)
11
Cases of Dengue and DHF in the Americas
(JanuaryAugust 2003, compared to same period in
2002)
2002
2003
6.0
4.0
Others
6.1
11.8
Venezuela
2.1
Colombia
2.7
ll
84.0
Ecuador
74.6
Brazil
437,283
342,061
12
Integrated Strategy
Components
Epidemiological Surveillance
Entomology
Social Communication
Integrated Strategy
Patient Care
Laboratory
13
Expected Results

• 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).

14
Expected Results cont.

• 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.

15
Where are we going?

• Promote the methodology of the integrated
  strategy, strengthening National Programs.
• Incorporate the Dengue Task Force in PAHOs
  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.

16
IMPACT
The reduction of the morbi-mortality caused by
dengue outbreaks and epidemics