SRI LANKA: To prevent and control the spread of dengue fever, the Health Ministry plans to seek approval from the Parliament for “The Prevention of Mosquito Breeding Act,” which would ban the manufacture and use of polythene and plastic containers

22 February 2006

Dengue Fever 2006: New Year, New Outbreaks

Dengue fever can produce widespread epidemics characterized by high morbidity rates, but the vector-borne flavivirus generally causes much lower mortality rates unless shock and hemorrhage occur.  Four different dengue virus serotypes exist.  All four cause febrile illness in humans, which can lead to dengue hemorrhagic fever in more severe cases.  The CDC stated recently: “In 2005, dengue is the most important mosquito-borne viral disease affecting humans; its global distribution is comparable to that of malaria and an estimated 2.5 billion people live in areas at risk for epidemic transmission” [1].

Reported outbreaks of dengue fever, precautionary measures against the virus, and other dengue news occurred in the following countries last month:

BRAZIL: A dengue fever outbreak continues to spread throughout two districts of Rio de Janeiro: Barra da Tijuca and Jacarepagua. According to Reuters, a 45 year-old-woman recently succumbed to the virus and doctors suspect two more dengue-related deaths [2]. When the outbreak initially began in December, a 52-year-old man passed away from the disease, which marked the first death of the outbreak. Rio health authorities confirmed 432 new cases of dengue fever last month – a tremendous increase from the 58 cases reported in January 2005 [3].

SRI LANKA: To prevent and control the spread of dengue fever, the Health Ministry plans to seek Cabinet approval for “The Prevention of Mosquito Breeding Act,” which would ban the manufacture and use of polythene and plastic containers [4, 5]. Disposable items like plastic cups serve as ideal breeding grounds for mosquitoes and have contributed to the spread of dengue throughout the country. According to South Asian Media Net, a ministry official told the Daily Mirror that although the number of dengue cases declined from 15,463 in 2004 to 5,211 in 2005, reports from last month alone indicate 698 new cases along with one death [5].

MALAYSIA:  Health Ministry Director Ismail Merican announced an outbreak of dengue fever in the Tanah Merah district of Kelantan [6].  Officials recently learned that the two 13-year-old girls who died in the district last month tested positive for dengue, not Japanese encephalitis.  In addition, 11 other dengue cases were reported in Tanah Merah last month.  According to AsiaNews.it, Ismail stated, “We have beefed up our control measures.  Whether it is dengue or JE, the root cause is mosquitoes, so we have taken measures to ensure cleanliness” [6].

ECUADOR:  According to El Comercio, Health Minister Ivan Zambrano acknowledged a second death in Ecuador from the current outbreak of dengue fever [7].  Like the first fatality that occurred on January 13th, the 65-year-old woman who recently past away suffered from dengue hemorrhagic fever.  Zambrano reports efforts between the Crisis Committee, province directors, the Malaria Program, and local epidemiologists to control and prevent future cases.  Approximately 4,000 cases of classic dengue fever occurred in 2005 along with 75 cases of hemorrhagic dengue, as reported by El Diario [8].

PARAGUAY:  To prevent a potential outbreak of dengue fever, Public Health Ministry officials have recommended that community members in Asuncion eliminate mosquito-breeding sites that form after rainfall [9]. Because areas within Asuncion average a 4.1 percent larval infestation index, the ministry aims to reduce the index to less than one percent, which decreases the odds of virus transmission.  ABC Digital reports that prevention success also depends on increased vector surveillance and participation by the entire community to implement corrective measures [9].



Comments:  The proposed “Prevention of Mosquito Breeding Act” in Sri Lanka may prove beneficial, while recognizing that containers made from other materials like glass and aluminum can also serve as breeding grounds for mosquitoes.  As noted in reports from Paraguay, prevention success greatly depends on cooperation among all members of the entire community.  Everyone in dengue-afflicted areas must therefore work together to eliminate mosquito breeding sites by properly disposing of trash, covering buckets of water, and removing other outdoor items that collect rain.  Surveillance also plays a pivotal role in the battle against infectious disease.  Transparency remains essential to control disease outbreaks and prevent future cases; early notification enables health officials and the public to adopt precautionary measures in a timely fashion.

References

1.       CDC. Division of Vector-Borne Infectious Diseases. Dengue Fever, Current Trends.  Available at: http://www.cdc.gov/ncidod/dvbid/dengue/. Accessed on 8 February 2006.

2.       Reuters. At least two dead in Rio dengue fever outbreak. Available at: http://www.alertnet.org/thenews/newsdesk/N26376317.htm. Accessed on 12 February 2006.

3.       Agencia Brasil. Rio Physicians' Syndicate issues international dengue alert. Available at: http://internacional.radiobras.gov.br/ingles/materia_i_2004.php?materia=254853&q=1&editoria=. Accessed on 12 February 2006.

4.       South Asian Media Net. Plastic containers and bags to be banned. Available at: http://www.southasianmedia.net/Archive_full.cfm?nid=268239. Accessed on 6 February 2006.

5.       Daily News. New act on “Prevention of mosquito breeding” soon. Available at: http://www.dailynews.lk/2006/02/06/. Accessed on 6 February 2006.

6.       AsiaNews.it. Malaysia scrambles to contain dengue outbreak. Available at: http://www.asianews.it/view.php?l=en&art=5287. Accessed on 6 February 2006.

7.       El Comercio. Otra persona falleció por el dengue hemorrágico. Available at: http://www.elcomercio.com/noticia.asp?seccion=2&id=23571. Accessed on 6 February 2006.

8.       El Diario. Manabí ya supera los 20 casos de dengue. Available at:   http://www.eldiario.com.ec/?module=displaystory&story_id=59446&format=html. Accessed on 6 February 2006.

9.       ABC Digital. Story available at: http://www.abc.com.py/articulos.php?fec=2006-01-30&pid=231372&sec=3.

Deepu Alex, Carlene Gong, Chelsea Johnson, Cheryl King, Anthony Ho, Katarro Rountree, and Lisa Sani

Graduate Students, Master of Science Program in Biohazardous Threat Agents and Emerging Infectious Diseases, MICB-524 “Emerging Diseases: Past as Prologue”

 Department of Microbiology and Immunology

Georgetown University School of Medicine

www.BePast.org