Integrated Strategy for Dengue Prevention and Control

1. . . Integrated Strategyfor Dengue Prevention and Control José Luis San MartínCommunicable Disease Unit Disease Prevention and Control 44th Directing Council, September 2003

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). 44th Directing Council, September 2003

3. Reemergence of DengueEnvironmentalFactors 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 DengueSocio-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 44th Directing Council, September 2003

5. Reemergence of DengueUncontrolled 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. Sources:Gubler, 1998; PAHO, 1997. 44th Directing Council, September 2003

6. 1980: 118 million people in poverty in Latin America—a third of the population. • 1990: 196 million people in poverty in Latin America—almost 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. 44th Directing Council, September 2003 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 44th Directing Council, September 2003

8. Reemergence of DenguePopulation Movements • 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%). • Migration • International tourism Source: OMT data. Traffic of microorganisms 44th Directing Council, September 2003

9. Dengue Cases, 1980–2002 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 1987 1988 2001 2002 1995 1986 1993 1996 1999 1989 1991 1992 1994 1998 2000 1984 1980 1981 1982 1983 1985 1990 1997 44th Directing Council, September 2003

10. Cases of Dengue Hemorrhagic Fever (DHF) (Region of the Americas, 1980-2002) 44th Directing Council, September 2003

11. 9,2% Cases of Dengue and DHF in the Americas(January–August 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 44th Directing Council, September 2003

12. Integrated Strategy Components Epidemiological Surveillance Entomology Social Communication Integrated Strategy Laboratory Patient Care 44th Directing Council, September 2003

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). 44th Directing Council, September 2003

14. Expected Resultscont. 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. 44th Directing Council, September 2003

15. Where are we going? • 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 forIntegral Subregional Plans that strengthen activities in the border regions between countries. • Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors. 44th Directing Council, September 2003

16. IMPACT The reduction of the morbi-mortality caused by dengue outbreaks and epidemics 44th Directing Council, September 2003