Macao’s Experience in Dengue Prevention and Control

1. Macao’s Experience in Dengue Prevention and Control Dr. Koi Kuok Ieng Department of Health, Macao SAR 2004.03.05

2. Outline • Epidemiology • Prevention • Control • Experience

3. Epidemiology

4. Reported Cases • …… • 1996– 1 (imported) • …… • 2001– 1418 • 2002– 2 (imported) • 2003– 28 (death = 0)

5. 2001 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

6. Supposed beginning Temporal distribution of reported cases of Dengue in 2001

7. Spatial distribution of reported cases of Dengue in 2001

8. Typical “Black spot” in focus

9. Interpersonal distribution of reported cases of Dengue in 2001

10. 2003 outbreak • Duration : 2003.10.09 ~ 11.02 • Total no. of reported cases : 28 • Dengue Hemorrhage Fever : 0 • Death : 0 • DEN-1

11. Spatial distribution of reported cases of Dengue in 2003

12. Prevention

13. Comprehensive 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

14. Source reduction • Two main problems encountered • More than 600 “black spots” in the city area • More than 200 thousands apartments

15. Cleaning of “black spots”

16. Community campaigns School campaigns

17. Ovitrap surveillance

18. Household larva surveillance

19. ULV spraying Fogging

20. Control

21. Detection & responses Longest IP 14 d

23. Contingency Plan • Delineation of focus of infection : 200 m • Immediate response: • Emergency community meetings • Chemical control • Door-to-door Inspection and mobilization • Examination and cleaning of abandoned houses and sites

24. Experience

25. Community 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

26. Public services Private Media Citizens Citizens Associations DOH Volunteers Special groups Schools Medical facilities Whole city mobilization

27. Residents CDC Health Center Community Entities Community Health Committee Sanitary Team Local community mobilization

28. Source reduction • Source reduction remains to be the central control strategy • Problems encountered : • Hygiene problem of private properties • Sustainability of measures • Prospect : • Legislation

29. Early 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

30. Control 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