44th Directing Council, September 2003 1 Pan American Health Organization . . Integrated Strategy for Dengue Prevention and Control José Luis San Mar Communicable Disease U Disease Prevention and Con
Jan 05, 2016
44th Directing Council, September 2003 1
Pan AmericanHealthOrganization
..
..
Integrated Strategy
for Dengue Prevention and
Control José Luis San MartínCommunicable Disease Unit
Disease Prevention and Control
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Pan AmericanHealthOrganization
ParadigmParadigm 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).
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Reemergence of Dengue Environmental
FactorsClimate change
Alteration of ecosystems
Alteration ofGeographical distribution
of pathogensand vectors
Increase in Increase in vector-borne diseasesvector-borne diseasesDengue Yellow
Fever
Ideal Ideal conditions for conditions for Dengue:Dengue:Latitude: 350 north 350 southAltitude: 2,200 mTemperature: 15-40 °CRelative humidity:
high-moderate
Changes in transmission
Ecological changes
Socio-economic changes
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Population Growth
Reemergence of Dengue Socio-Economic Factors
Reemergence of Dengue Socio-Economic Factors
• Unprecedented population growth.
• Urbanization neither planned nor controlled.
• Increase in poverty.
• Inadequate environmental management.
• Unprecedented population growth.
• Urbanization neither planned nor controlled.
• Increase in poverty.
• Inadequate environmental management.
0
1,000,000,000
2,000,000,000
3,000,000,000
4,000,000,000
5,000,000,000
6,000,000,000
1830 1930 2000
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Reemergence of Dengue Uncontrolled Urbanization
Reemergence of Dengue Uncontrolled 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.
• 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.
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1980:1980: 118 million people in poverty in Latin America—a third of the population.
1990:1990: 196 million people in poverty in Latin America—almost half the population. 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.
Source: Vilas, 1995.
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Reemergence of Dengue Inadequate Environmental Management
Reemergence of Dengue Inadequate Environmental Management
• Insufficient waste collection and management.
• Non-biodegradable containers.
• Improper tire disposal.
• 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.
• Insufficient and inadequate water distribution.
• Increased number of water storage containers.
• Inadequate septic system conditions.
Increase in breeding sites for the vector
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Reemergence of Dengue Population Movements
Reemergence of Dengue Population Movements
• MigrationMigration
• International International tourismtourism
• MigrationMigration
• International International tourismtourism
• 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%).
• 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%).
Source: OMT data.
Traffic of microorganisms
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0
200,000
400,000
600,000
800,000
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Dengue Cases, 1980–2002
1,000,000
1,200,000
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0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Cases of Dengue Hemorrhagic Fever (DHF)
(Region of the Americas, 1980-2002)
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Pan AmericanHealthOrganization
Cases of Dengue and DHF in the Americas
(January–August 2003, compared to same period in 2002)
2003
200
2
9,2%
84.0%
6.1%4.0%
6.0%
74.6%
2.7%
2.1%11.8%
437,283 342,061
Others
Venezuela
Colombia
Ecuador
Brazil
ll
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Integrated Strategy Integrated Strategy
SocialCommunication
EpidemiologicalSurveillance
Entomology
Patient CareLaboratory
Integrated Strategy
Components
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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).
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).
Expected Results
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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.
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.
Expected Results cont.
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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 for Integral Subregional Plans that strengthen activities in the border regions between countries.
Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors.
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 for Integral Subregional Plans that strengthen activities in the border regions between countries.
Promote and implement intersectoral activities between the Health, Environment, Education, and other sectors.
Where are we going?
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IMPACTIMPACT The reduction of the
morbi-mortality caused by
dengue outbreaks and epidemics