dengue fever (nepal) an emerging public health problem

7/27/2019 Dengue Fever (Nepal) an emerging public health problem.

1/13

A

Seminar Report

On

Dengue Fever, an emergingpublic health problem in Nepal

ByBijay Dhital

DEPARTMENT OF PUBLIC HEALTH

National Open College. Sanepa, Lalitpur

Date- July 28


2/13

ACKNOWLEDGEMENT


3/13

Title Page

Abstract

1. Introduction

1.1 Background

1.2 Statement of Problem

2.

Rationale

3. Objective

4. Findings

5.

Prevention

6. Recommendation

7. Conclusion

8. References


4/13

Abstract

Dengue is an acute infectious disease caused by dengue viruses and transmitted bythe Aedes species of mosquito. The rapid global spread of the dengue virus into

new areas has begun to attract more research attention. A series of dengue feveroutbreaks in several districts of Nepal has been recently observed. The evidence of

all four serotypes (DEN 1 - 4) could be a consequence of a sudden resurgence ofa more severe dengue disease in Nepal. Health care providers need to become

familiar with the disease to prevent or control the possibility of future outbreaks.The clinical features, diagnosis, treatment, epidemiological patterns and challenges

of dengue virus infection in Nepal will be discussed here.


5/13

1.Introduction

1.1

Background

Dengue is an acute infectious disease caused by dengue viruses and

transmitted by the Aedes species of mosquito. Dengue virus (DENV) is a

mosquito-borne single stranded RNA virus that belongs to the genus Flavivirus,

family Flaviviridae. The evidence of all four serotypes (DEN1 - 4) could be a

consequence of a sudden resurgence of a more severe dengue disease in

Nepal. [1]

Dengue virus (DENV) is a mosquito-borne single stranded RNA virus that

belongs to the genus Flavivirus, family Flaviviridae. It has four serotypes, DEN-1, DEN-2, DEN-3 and DEN-4, which are capable of causing dengue fever (DF).

Over the past several years, dengue epidemics have been increasing

remarkably, and have become a major public health problem, particularly in

tropical and sub-tropical countries. The World Health Organization (WHO) has

currently estimated that there may be 50 million dengue infections occurring

each year in the world, and this endemic appears in more than a total of a 100

countries. [2] In Nepal, a dengue case was _ rst reported in 2004.4 Since then,

DF has been found to be spreading rapidly across the country within a short

period of time.5,6,7 Although DENV infection is one of the emerging diseases

in Nepal, healthcare providers are sometimes found to have incomplete

knowledge of the disease. This review will discuss the clinical features,

diagnosis, treatment, epidemiological patterns and challenges of DENV

infection in Nepal.

Dengue, a mosquito-borne disease emerged in Nepal in the form of Dengue

Fever (DF), Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome

(DSS). The earliest cases were detected as early as 2005. The sporadic cases

continued and outbreaks occurred in 2006 and 2010. Initially most of the

reported cases had travel history to neighboring country (India), however

lately indigenous cases were also reported. [1]


6/13

Causes of Dengue

The dengue virus is transmitted by a bite from theAedes aegypti and Aedes

albopictus mosquito. Only the female mosquito transmits the dengue virus.

This mosquito is a daytime biter, both inside and outside homes, and ismost active in the hours after sunrise and before sunset.

Dengue fever is transmitted by the bite of an Aedes mosquito infected with

a dengue virus. The mosquito becomes infected when it bites a person with

dengue virus in their blood. It cant be spread directly fromone person to

another person.

Symptoms of Dengue

Sudden onset of high fever, pain behind the eyes, headache, backache,

joint and muscle pains. The severity of the joint pains has led it to be named break bone fever.

It is often accompanied by a rash that looks like a red flush on the chest

and abdomen.

Fever returns to normal within a week, but may leave a person feeling tired

and slightly depressed for a few weeks afterwards.


7/13

1.2

Statement of Problem

The World Health Organization (WHO) has currently estimated that there may

be 50 million dengue infections occurring each year in the world, and this

endemic appears in more than a total of a 100 countries, in Africa, theAmericas, the Eastern Mediterranean, South-East Asia and the Western Pacific.

[2].

Dengue is the most widespread vector borne virus disease in the world, and

DHF are rapidly increasing in incidence in many tropical areas. Dengue

hemorrhagic fever is a leading cause of serious illness and death among

children in some Asian countries. The disease is now endemic in over 100

countries. Approximately half-a-million people with DHF are hospitalized each

year, of which many are children. About 2.5% of these patients die. [3]

Dengue Fever in Nepal

Although DENV infections have been found in our neighboring country India

over a long period of time, there was no documented dengue case in Nepalprior to 2004. 1

st case of DF was reported in 2004 fron Chitwan district.

Dengue outbreak was first reported in 2006 with 32 confirmed cases (among

the total cases identified,94 percent were adults; male to female ratio was

4:1), followed by 27 cases in 2007, 10 cases in 2008, 30 cases in 2009.The

outbreak of 2006 was observed in 9 district of terai including Banke, Dang and

parsa. [1]

It is plausible to assume that DENV could have been introduced into Nepal

from India, due to the open border between the two countries. This

hypothesis is further supported with the _ nding of nucleotide sequences of

the Nepalese dengue strain that have been described to be very similar to the

dengue strains circulating in India. During the 2006 outbreaks, all four dengue

serotypes were found to be circulating in Nepal.6 It is clear that subsequent


8/13

infection with different strains may lead to a more severe disease among the

patients. Taken together, a sudden resurge of severe dengue disease can be,

therefore, assumed to occur in the near future [2]

Nepal experienced major outbreak of D.F in several district in 2010 particularlyin Chitwan and Rupendehi district with 917 cases and 5 reported cases. [1] A

total of 264 DF cases from across the country were admitted to Sukraraj

Tropical and Infectious Disease Hospital (STIDH), Kathmandu, between July

and December.

[2]


9/13

2.Rationale

Is an emerging disease in nepal.

Rapidly spreading into new areas across the country.

3.Objective

General

To know about the Dengue as an emerging public health problem.

Specific

To know about the Dengue cases and its situation at different time.

To understand the nature of Dengue occurrence in the country.


10/13

4.Findings

1

st

case of DF was reported in 2004 fron Chitwan district. Dengue outbreakwas first reported in 2006 with 32 confirmed cases. 917 cases in 2010 with

major outbreak in Chitwan and Rupandehi districts with five reported

deaths. During 2011, 79 confirmed cases were reported from 15 districts.

Aedes aegipti (mosquito-vector) has been identified in 5 peri-urban area of

terai region (Kailali, Dang,Chitwan, Parsa and Jhapa) during entomological

surveillance conducted by EDCD during the year 2006-2010, indicating local

transmission of dengue. [1]

Studies carried out in the year 2006 by EDCD showed all 4 sub-types (DEN-

1, DEN-2, DEN-3 and DEN-4) of Dengue virus circulation in Nepal. In 2012, a

total of 183 confirmed dengue cases were reported. [1] More than forty

percent (n=77) of these cases were from Jhapa district alone. During the FY

2069/70 total number of dengue case reported from 11 district were 184.

Year wise dengue morbidity

Source- EDCD/DoHS


11/13

5.Prevention

Currently, there are no vaccines to protect against the dengue virus and

people are advised instead to take sensible precautions to decrease the

likelihood of being bitten by the mosquito. [5]

Vector control-

The vectors of DF and DHF (e.g. A aegypti) bread in and around houses

and, in principal can be controlled by individual and community action,

using anti-adult and anti-larval measures. [4]

Personal protection and the environmental management of mosquitoes

are important in preventing illness.

increase Awareness

Prevention of mosquito bite

6.Recommendation

Increase orientation and training to doctors, health workers aboutdengue and its preventive measures.

Strategy development and planning workshop must be done.

Advocacy meetings about dengue.

Increment in district and regional budget.

Active community participation for vector control program.


12/13

7.Conclusion

Dengue infection is a relatively new disease in Nepal, hence much is not

known about its frequency among the local population. To bridge this

knowledge gap, health care providers must improve their clinical knowledgeabout dengue and DHF/DSS as well as be familiar with the geographical

distribution of DENV in order to enhance their ability to adequately respond to

a sudden and unexpected surge of patients due to DENV infection.[2]

While safe, effective and affordable vaccine for DENV is anticipated,

preventive measures that require an effective elimination of vectors and their

breeding sites remain the only options to interrupt or control DENV

transmission. The majority of the people are poorly educated; hence they

know little about newly emerging diseases. Therefore, without involving localcommunities in the planning and implementation of vector control programs

and health education, DENV transmission cannot be successfully controlled.

Hence, effective educational campaigns and community based vector control

program must be done.[5]

Dengue virus infection has now increasingly becoming an emerging disease in

Nepal. Current outbreaks of dengue fever in several districts underscore the

need for urgent and comprehensive DENV surveillance in order to identify the

current status of the disease burden and the high risk areas to be targeted for

immediate implementation of preventive measures.

Although DENV infection is a relatively new disease in Nepal, the time has

come to recognize it as a major public health problem. Therefore, the state

and stakeholders should come up with a campaign to promote public

awareness so as to prevent or respond to possible outbreaks of DENV in the

future. [5]


13/13

8.Bibliograpy

Annual report (069/70)

J Nepal Med Assoc 2011;51(184):203-8

Oxfordjournal.org.

K. PARK

World Health Organization. Dengue: Guidelines for diagnosis, treatment,

prevention, and control. New Ed.2009,Geneva, World Health

Organization, 2009.

dengue fever (nepal) an emerging public health problem

Documents