Threat of dengue in Europe and strategic measures to control its spread
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Transcript of Threat of dengue in Europe and strategic measures to control its spread
Threat of dengue in Europe and strategic measures to control its spread
© Francis Schaffner/IPZ
Dr Raman VelayudhanCoordinator, Vector Ecology and Management unitControl of Neglected Tropical DiseasesWorld Health OrganizationGeneva
Average /number of Dengue cases reported to WHO per year
2010 2011 2012 20131995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
0
500000
1000000
1500000
2000000
2500000
3000000
Number of cases recorded from four WHO regions
EMR
AMR
WPR
SEAR
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
500
1000
1500
2000
2500
3000
3500
4000
4500
995
1747 16541820 1786
2453
1828
3267
2292
3484
4248
2798
YEAR
Num
ber o
f dea
ths
repo
rted
Number of Dengue deaths reported to WHO per year
Malaria 1 DengueWHO RECENT 2
Population at risk 3.2 billion 2.5 billion
3.9 billion
Endemic countries 97 >100 128
Infections /year 219 million 50-100 million
390 million
Severe Cases 3 million 2.1 million
Deaths/ year 627,000 20,000 21,000
1) Global Malaria Report 20132) http://www.pdvi.org/about_dengue/GBD.asp and Brady et.al. PLoS Negl Trop Dis 2012; 6: e1760
Some historical reports of large outbreaks in
Europe, with Aedes spp. as vector.
► Dengue epidemic, Greece, 1927–1931*
The total number of deaths from the epidemic ranged from 1 in cities like
Giannitsa or Tripolis to 631 in Athens.
► 19th century yellow fever epidemics (Spain, France,
UK) **
Barcelona, Spain, 1821: estimated 20,000 deaths
* Louis C. Daily newspaper view of dengue fever epidemic, Athens, Greece, 1927–1931. EID Journal, 2012, 18 (1). ** Morillon M. et al. Yellow Fever in Europe during the19th Century. In Ecological Aspects of Past Settlement in Europe, European Anthropological Association, 2002 Biennal Yearbook. Eötvös University Press, Budapest. p 211-222
Increased activity of mosquito-borne diseases (Aedes spp.) in Europe
► Chikungunya virus outbreak, Ravenna, Emilia-Romagna region, Italy, July–September 2007 (257 cases)
► First 2 autochthonous dengue virus infections, Nice, France, September 2010
► First autochthonous dengue virus infection, Pelješac, Croatia, August 2010
► First dengue fever outbreak, Madeira, Portugal, September 2012 – February 2013 (2164 cases)
►Dengue in France, Montpellier (October 2014)
Sharp increase in number of imported dengue cases in UK and Switzerland
The history of dengue and yellow fever in Europe is evidence that
conditions are already suitable for transmission. The establishment of
Ae. albopictus has made this possible, and the possibility will increase
as the species expands northwards, or if Ae. aegypti is re-established.
In Europe, dengue cases are second only to malaria in causing
hospitalizations of travellers (imported cases)
Source: Reiter P. Yellow fever and dengue: a threat to Europe? Eurosurveillance, 2010, 15(10) (http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19509).
Return of old foes
Public Health Response
► Global strategy for dengue prevention and
control, 2012–2020
► WHO meetings on invasive mosquito species,
The Hague, Netherlands (June 2012) and Copenhagen, Denmark
(November 2012 and May 2013)
► Technical support (e.g. European Centre for Disease Prevention and
Control (ECDC) mission, Madeira, 2012)
► WHO Regional Office for Europe framework for surveillance and control
of invasive mosquito vectors and re-emerging vector-borne diseases
(reviewed by Standing Committee of the Regional Committee, March 2013)
Global/Regional response
Goal: To reduce the burden of dengue
Objectives:• To reduce dengue mortality by at least 50% by 2020*• To reduce dengue morbidity by at least 25% by 2020*• To estimate the true burden of the disease by 2015
Technical element 1: Diagnosis and case management
Technical element 2:
Integrated surveillance and
outbreak preparedness
Technical element 3:
Sustainable vector control
Technical element 4:
Future vaccine
implementation
Technical element 5:
Basic operational and
implementation research
Enabling factors for effective implementation of the global strategy: Advocacy and resource mobilization; Partnership, coordination and collaboration; Communication to achieve behavioral outcomes; Capacity building; and Monitoring and evaluation
The global strategy for dengue prevention and control (2012- 2020)
► Framework for action, in line with Health 2020
► Intersectoral, building on partnerships (e.g. ECDC, European Mosquito Control
Association (EMCA), the Netherlands); EURO/EMRO collaboration.
► Aims
Raising awareness
Integrating surveillance
Preventing introduction
Preventing disease transmission
Capacity building: regional networks and human
resource development (e.g. entomologists!)
Regional framework
WHO response
European and global commitments
• Regional framework for surveillance and
control of invasive mosquito vectors and
re-emerging vector-borne diseases, 2014–
2020• Executive board of WHO Jan 2015
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Dengue, avenues for advocacy
● A growing threat to public health
● Generates distress among citizens
● High economic costs for governments and citizens
● Disrupts national health systems
● Impacts tourism & overall economy
● Contributes to human suffering & poverty on a global scale
● High medical need remains unaddressed
● Negative impact on health authorities performance
● Increases media, civil society & international community pressure on government's performance
● Public discontent
High Political impact
Disastrous Disease consequences
Source: internal disease ladder exercise conducted in Q4 2010 by Sanofi Pasteur Dengue teams
Factors contributing to a high sense of priority
• Broad geographic distribution & spread
• Frequent occurrence of outbreaks
• Recurrent risk of infection each transmission season
• Disease severity & difficulty of diagnosis & management
• Urban outbreaks
• Burden on hospitals & public health infrastructure
• Economic toll on governments & families
Dengue, advocacy
Public health action
3 phases of vector and disease prevention and control
• Control the vector
• Prevent the disease
• Limit the spread
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Phase 1. Control the vector (1)
• Integrated vector control to prevent the introduction, establishment and spread of the vector
• Measures for early detection and containment• Robust methods for monitoring and evaluation • Social mobilization for vector control• Information for the public on how to
reduce vectors in the environment through risk communication and community mobilization
• Increased capacity for vector control
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Phase 1. Control the vector (2)
Advice on:•long-lasting insecticide-treated bed nets (where necessary)•indoor residual spraying•outdoor spraying•environmental management (reduction of breeding habitats, biological control, genetic control and waste management)•housing modifications
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Phase 2. Prevent the disease
Action needed where the introduction of vectors could not be avoided
• Coordination of disease surveillance in the population at risk is with vector surveillance, to prevent outbreaks
• Advice on personal protection measures (clothing, insect repellents, etc.), prevention, and source reduction• Blood and body fluid safety
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Phase 3. Limit the spread
Measures to avoid large outbreaks, particularly in newly affected areas
• Inform and educate the public• Raise awareness among health professionals• Ensure laboratories are equipped
for early diagnosis • Ensure early detection and case
management
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Individuals and families can contribute
•Know which vectors carry disease•Use proven vector-control tools•Cooperate with local authorities in vector control•Take part in health education in the community•Ensure environmental management
around and in homes
© Francis Schaffner/IPZ
World Health Day 2014Vector-borne diseases19
Current challenges
• Emerging insecticide resistance
• Lack of expertise in vector control
• Integrated surveillance
• Sanitation
• Pesticide safety
• Environmental change
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WHO Regional Office for Europe response• Working with partners including the European
Commission, the European Centre for Disease Prevention and Control (ECDC) and the European Mosquito Control Association (EMCA)
• Assisting countries in disease surveillance, prevention and control, following the International Health Regulations
• Providing training and guidelines on case management and vector control
• Advocacy for surveillance of mosquitoes (ECDC)
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