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Junhel Dalanon, DDM, MAT

Contents
1. What is dengue fever

2. Symptoms of dengue fever

3. Characteristics of the Aedes mosquito

4. Life cycle of the Aedes mosquito

5. How the Aedes mosquito transmit diseases

6. How to prevent the spread of dengue fever

7. The 10-Mininute Mozzie Wipe-out Exercise

8. Quiz
What is dengue fever?

Dengue Fever is an illness caused by


infection with a virus transmitted by the
Aedes mosquito.
Symptoms of Dengue Fever

Example of a skin rash due


to dengue fever
Do you know

Dengue Fever (DF) and Dengue


Haemorrhagic Fever (DHF) are the
most common mosquito-borne viral
disease in the world.

It can be fatal.
Characteristics of the
Aedes Mosquito
One distinct physical
feature black and
white stripes on its
body and legs.

Bites during the day.

Lays its eggs in


Close-up of an Aedes mosquito
clean, stagnant water.
Do you know
Only the female Aedes mosquito
feeds on blood. This is because
they need the protein found in
blood to produce eggs. Male
mosquitoes feed only on plant
nectar.

On average, a female Aedes


mosquito can lay about 300 eggs
during her life span of 14 to 21
days.
Life cycle of the Aedes Mosquito

1-2 days

Pupae Larvae Eggs

4-5 days 2-3 days

Stagnant water
How Do Aedes Mosquitoes
Transmit Diseases...
Mosquito bites and sucks And passes the virus
blood containing the virus to healthy people
from an infected person. when it bites them.

Virus is carried in its


body.
This is what you
can do to help
Prevent Aedes from
Breeding!

Remove ALL sources of


stagnant water.

Deny the Aedes mosquito of any


chance to breed.
10-Minute Mozzie
Wipe-Out Exercise
Do the 10-Minute Mozzie Wipe-out
everyday.

Change water in vases on alternate days.


Do the 10-Minute Mozzie Wipe-out
everyday.

Remove water from flowerpot plates on


alternate days.
Do the 10-Minute Mozzie Wipe-out everyday.

Turn over all pails and water


storage containers.
Do the 10-Minute Mozzie Wipe-out everyday.

Cover bamboo pole holders


when not in use.
Do the 10-Minute Mozzie Wipe-out everyday.

Clear blockages and put Bti


insecticide in roof gutters monthly.
Unwanted items

Do not litter. Rubbish such as cups


and bottles can collect rain water
and breed mosquitoes.
Before you leave for holidays
Before you leave for holidays

Cover all toilet bowls in your home.

Seal off the overflow pipe of the


flushing cistern.

Cover all gully/floor traps.

Add sand granular insecticide to places


that mosquitoes could potentially breed,
such as flower vases and places where
stagnant water could not be removed.
Before you leave for
holidays(Contd)

Clear blockages and add Bti insecticide in


roof gutters.

Turn over all water storage containers.

Ask a relative or close friend to check your


home regularly for stagnant water if you are
going away for a long period of time.

Leave your contact with your neighbours or


the neighbourhood police post/ centre so that
you can be reached easily.
Spread the dengue
prevention message to
others
Let your family,
friends and
neighbours know
about the dangers
of breeding
Mozzies!!
Dengue fever

Dengue is an arthropod-borne disease caused by


any one of four closely related viruses, (Arbovirus).

Characterized by fever, severe headache, backache


joint pains nausea and vomiting, eye pain and rash

Occasionally produces shock and hemorrhage,


leading to death.

Also called breakbone fever, dandy fever or dengue


fever.
Dengue Viruses

Four closely related single-stranded RNA Dengue

viruses (DEN-1, DEN-2, DEN-3 and DEN-4)

Each serotype provides specific lifetime immunity,

and short-term cross-immunity (A person can be

infected as many as four times, once with each

serotype)

All serotypes can cause severe and fatal disease


Transmission of Dengue Virus
by Aedes aegypti

Mosquito feeds / Mosquito refeeds /


acquires virus transmits virus

Extrinsic Intrinsic
incubation incubation
period
Viremia period Viremia
0 5 8 12 16 20 24 28

Illness DAYS Illness


Human #1 Human #2
Replication and Transmission
of Dengue Virus (Part 1)
1. Virus transmitted to
human in mosquito saliva 1
2. Virus replicates
in target organs 2
3. Virus infects 4
White blood cells
3
And lymphatic
tissues

4. Virus released and


circulates in blood
Replication and Transmission
of Dengue Virus (Part 2)

5.Second mosquito 6
ingests virus with
blood

6. Virus replicates in
mosquito midgut and 7
other organs, infects
salivary glands
5
7. Virus replicates
in salivary glands
Aedes aegypti Mosquito
Aedes aegypti
Dengue transmitted by infected female Aedes
aegypti mosquito
Primarily, it is a daytime feeder
Highly domesticated tropical mosquito, lives
around human habitation
Lays eggs and produces larvae preferentially in
artificial water containers inside and around the
houses for example; plastic containers, flower
vases, buckets, used automobile tires,..
Dengue Clinical Syndromes

Undifferentiated fever (87% of


Patients are asymptomatic or mild
fever)
Classic dengue fever (DF)
Dengue hemorrhagic fever (DHF)
Dengue shock syndrome (DSS)
Clinical Characteristics
of Dengue Classic Fever

Incubation period 3-14 days (commonly 4-7


days)
Fever
Headache
Muscle and joint pain
Nausea/vomiting
Rash
Hemorrhagic manifestations
Dengue Hemorrhagic Fever
(DHF)
4 Necessary Criteria:
Fever, or recent history of acute fever
Hemorrhagic manifestations
Low platelet count (100,000/mm3 or less)
Objective evidence of leaky capillaries:
elevated hematocrit (20% or more over
baseline)
low albumin
pleural or other effusions
Dengue Shock Syndrome (DSS)

4 criteria for DHF


Evidence of circulatory failure.
Risk Factors Reported for DHF
Virus serotype
DHF risk is greatest for DEN-2, followed by DEN-3, DEN-4 and
DEN-1
Pre-existing anti-dengue antibody
previous infection
maternal antibodies in infants
Host genetics
Age (fatal cases are among children and young adult).
Higher risk in secondary infections
Higher risk in locations with two or more serotypes circulating
simultaneously at high levels (hyper-endemic transmission)
Increased Probability of DHF

Hyperendemicity

Increased circulation Increased probability


of viruses of secondary infection
Increased probability of Increased probability o
occurrence of virulent strains immune enhancement

Increased probability of DHF


Gubler & Trent, 1994
Common Misconceptions about
Dengue Hemorrhagic Fever
Dengue + bleeding = DHF
Need 4 WHO criteria & capillary permeability
DHF kills only by hemorrhage
Patient dies as a result of shock
Poor management turns dengue into DHF
Poorly managed dengue can be more severe, but DHF is a distinct
condition, which even well-treated patients may develop
DHF is a pediatric disease
All age groups are involved
DHF is a problem of low income families
All socioeconomic groups are affected
Treatment of Dengue Fever
Antipyretics (Acetaminophen) preparations to manage
the pain and fever.
Avoid Aspirin and non-steroidal anti-inflammatory.
Rest and drink plenty of fluids
Monitor blood pressure, hematocrit, platelet count,...
Keep patient in screened sickroom or under a mosquito
net
Mosquito barriers are only needed until fever subsides,
to prevent Aedes aegypti mosquitoes from biting
patients and acquiring virus.
Prognosis
Dramatic clinical response to aggressive fluids
and electrolytes.
Convalescence may be prolonged, with
weakness and mental depression
Survival is related directly to early
hospitalization and aggressive supportive care
Treated DHF is associated with a 3% mortality
rate
Un-treated DHF is associated with a 50%
mortality rate.
Prevention

Personal protection against mosquito biting by:

Screening doors and windows

Protective clothing

Application of mosquito repellents on exposed


skin

However, the best preventive measure is vector


control.
Vector Control Methods:

Biological control
Largely experimental
Option: place fish in containers to eat larvae

Environmental control
Elimination of larval habitats; Cover water holding
containers, Discard artificial containers,
It is the most likely method to be effective in the long
term.
Vector Control Methods:

Chemical Control
Larvicides may be used to kill immature aquatic stages

Ultra-low volume fumigation is ineffective against adult


mosquitoes as Aedes aegypti is fully domesticated

Mosquitoes may have resistance to commercial aerosol


sprays.
Dengue Vaccine?

No licensed vaccine at present


Effective vaccine must be tetravalent
Field testing of an attenuated tetravalent
vaccine currently underway
Effective, safe and affordable vaccine will not
be available in the immediate future.
Community Participation
Active community involvement and participation to
reduce larval breeding sources is the key for
prevention and control.
Educate the public in the basics of dengue, such as:
Where the mosquito lays her eggs
The link between larvae and adult mosquitoes
General information about dengue transmission,
symptoms and treatment
Public Education
Dengue fever is NOT contagious through person-to-
person contact
Early hospitalization is important.
Reduce A aegypti vector populations
Reduce exposure to A aegypti.
Use insect repellent.
Sleep under a mosquito net in affected areas.
Wear protective clothing.
Vaccine is NOT available.
Quiz
Why is the Aedes mosquito
dangerous to us?
ANSWER:

It can carry the dengue virus and


infect a healthy person with dengue
fever.
Name the 5 steps in the
10-Minute Mozzie Wipe-
out Exercise
ANSWER:
1. Change water in vases on alternate.

2. Remove water from flowerpot plates on alternate days.

3. Turn over all pails and water storage containers.

4. Cover bamboo pole holders when not in use.

5. Clear blockages and put in Bti insecticide in roof gutters


monthly.
What are the things that you
should do before going for a
holiday?
ANSWER:
Cover all toilet bowls in your home.

Seal off the overflow pipe of the flushing cistern.

Cover all gully/floor traps.

Add sand granular insecticide to places that mosquitoes could potentially


breed, such as flower vases and places where stagnant water could not be
removed.

Clear blockages and add Bti insecticide in roof gutters.

Turn over all pails and water storage containers.

Ask a relative or close friend to check your home regularly for stagnant
water if you are going away for a long period of time.

Leave your contact with your neighbours or the neighbourhood police post/
centre so that you can be reached easily.

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