Dr. Khin Nan Lon, Program

Manager(DHF/Filaria)

7th November,2015

Population(2014)Census

Yangon 7360703

Mandalay 6165723

Ayeyarwaddy 6184829

Sagaing 5325347

Tanintharyi 1408401

Mon 2054393

Rakhine 3188807

Naypyitaw 1160242

Magwe 3917055

Bago 4867373

Kayin 1574079

Shan 5824432

Kachin 1689441

Kayah 286627

Chin 478801

51,486253

total land

area 676,578

square kilometer

Capital Naypyidaw

First level 2nd Level Third

7 Regions

(White)&

7 states

(Red) 1 Union

Territory

6 -self-

administe

red

zones

69

Districts

330

Townshi

ps

82

sub-

townshi

ps

3045

wards

13,267

village

tracts

67,285

Villages

Neighbour

Countries

Thailand, China,

India, Laos

Country Name Myanmar (Burma)

Dengue endemicity of Myanmar in SEA Region is category A.

Sporadic cases of dengue have been reported since 1960

It was notification of disease since 1964

First outbreak was occurred in Yangon in 1970 (1654 /91)

Firstly spread to other States & Regions since 1974 .

The highest number of cases and deaths recorded were 24285

cases in 2009 and 444 deaths in 1994 respectively.

But DF/DHF cases in 2015 is twice more than 2009.

43845 – cases (From 1.1.2015 to 30.11.2015 )

444

204

161

050100150200250300350400450500

05000

100001500020000250003000035000400004500050000

Cases Deaths

1970-2015 (30-11-15) DF/DHF Cases & Death (Absolute Number)

24285

43845

5.5

3.2

4.3

6.4

5.3

3.1

4.4

3.4 3.9

5.9

2.9

1.7

5.0

3.1

5.4

2.9

4.2

2.2

3.8

2.2

1.0

2.0 1.6 1.3 1.1

0.3 0.6

0.4 0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0

10000

20000

30000

40000

50000

Cases Deaths

1970-2015 (30-11-15) DF/DHF Cases & CFR

61491

43845

1266

938

1406

537

777

332 161

0

200

400

600

800

1000

1200

1400

1600

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

Cases Deaths

11

mo

nth

s

5 y

rs

5 y

rs

5 y

ears

10

yrs

10

yrs

10

yrs

13376

0

2000

4000

6000

8000

10000

12000

14000

16000

Januar

y

Mar

ch

May

July

Sep

tem

ber

Nov

ember

Jan

uar

y

Mar

ch

May

July

Sep

tem

ber

Nov

ember

Januar

y

Mar

ch

May

July

Sep

tem

ber

Nov

ember

Januar

y

Mar

ch

May

July

Sep

tem

ber

Nov

ember

Januar

y

Mar

ch

May

July

Sep

tem

ber

Nov

ember

Januar

y

Mar

ch

May

July

Sep

tem

ber

Nov

ember

2010 2011 2012 2013 2014 2015

0

5

10

15

20

25

30

35

0

1000

2000

3000

4000

5000

6000

7000

Case Death

0

1000

2000

3000

4000

5000

6000

7000

0.0

50.0

100.0

150.0

200.0

250.0

300.0 Cases/100,000 Population

DHF cases in Urban /Rural

(2010-2014)

DHF cases in

Urban /Rural

(2015)

0

5000

10000

15000

20000

25000

Urban Rural

Urban Rural

Age Group wise Dengue cases (2007-2015)

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

2007 2008 2009 2010 2011 2012 2013 2014 2015

<1 1..4 5..9 10..14 15above

DHF Cases in Grading and Sex, 2015 (upto 30.11.15)

Dengue Virus Serotpye (1999-2010)

Year Total DENV 1 DENV 2 DENV 3 DENV 4 Mixed

1999 11 2 5 3 1 0

2000 8 6 1 1 0 0

2001 121 115 1 3 0 2(D1+2)

2002 72 28 24 3 12 4(D1+2)

2003 11 3 6 0 0 2(D1+2)

2004 5 0 1 2 0 2(D3+1)

2005 12 3 1 5 1 2(D1+3)

2006 5 0 1 2 0 2(D1+3)

2007 12 2 0 9 0 1(D1+3)

2008 16 6 3 4 2 1(D1+3)

2009 17 11 1 3 1 1(D1+3)

2010 31 14 5 0 12 1 (D2+4)

Source- DMR

Dengue Laboratory report (PCR)

Year Total Tested

Sero

type

1

Sero

type

2

Sero

type

3

Sero

type

4

2009 100 (Research at NOGH) 16 - 3 -

2010 15 (from Monywa Hospital) 12 - - -

2011 5 (from Ma-U Bin Hospital) - - - -

2012 4 (From NPT 1000bedded

Hospital)

2 - - -

2013

3 (Mawlamyine Hospital) +

5 (Zeyar Thiri Township,

Ywa Thit Kone Village,

NPT)+

44 (Research at Yangon

Children Hospital) =52

12 2 6 8

2014 5 (Mon state) - - 1 -

DHF Control Program In Myanmar

Goal To reduce the burden of dengue

Objectives To reduce dengue mortality by at least 50 %

To reduce morbidity by at least 25% by 2020

(Base Line data of 2010 are 16259 cases/119 deaths)

(25% is 4000 cases /50 % is 60 deaths)

To estimate the true burden of disease by 2016

Strategies Activities

1 To establish effective disease and

vector surveillance systems

based on reliable laboratory &

Health Information System

Public Hospital based disease

surveillance by VBDC staff

(15 % of private hospital report

in 2015)

2 To undertake disease prevention

through selective, stratified and

integrated vector control with

community

Vector Control

Larval Control with

community participation

Adult (Mosquito) control

Strategies Activities

3 To establish emergency

preparedness capacity to

prevent & control

outbreaks with appropriate

contingency plans

Epidemic preparedness and response

Capacity building

Training of Medical Officers and

BHS staffs on

effective disease and vector

surveillance

Epidemic preparedness

Dengue case management

Dengue workshop –(Sept,Nov 2015)

Updating Guidelines(P&C; Rx)

4 To ensure prompt case

management of DF/DHF

including early recognition

of signs and symptoms to

prevent mortality

Strategies Activities

5 To increase awareness of the

community regarding DF/DHF

prevention control and

management, through IEC

Advocacy meetings &

Community awareness session

on DHF prevention & control

6 To improve management and

technical support system and

strengthen the health facilities for

health sector development

Supervision & monitoring

Intra and Inter-sectoral co-

operation

Operational research - KAP

Study

Strength

• Initiating School Based DHF control plan including

Government schools, private schools and monastery

based education school

• Coordination and collaboration with other sectors in

some extent (Local Authorities, Ministry of Health,

Ministry of Education, Minister of Home Affair,

fishery department, NGOs, INGOs and Media. etc.)

• Better reporting data from Public Hospital and some

Private Hospital

Strength

• Improvement in Early Diagnostics, Effective

Treatment care and early referral system, there is

reduction in Mortality even though cases are

increasing.

• Political commitment of the government , have

more technical and material supports (Abate,

Fogging Machine, diagnostic tools, drugs and even

some INGOs support IEC materials, vector control

materials )

Weakness Shortage of Manpower in Vector Borne Disease Control Unit ,into which, DHF/ LF

section is integrated .

Weakness in Surveillance system- passive surveillance system from public hospitals

Weakness in Prevention and control

Weak integrated approach in control measures between different organizations

(VBDC, NGOs, City Development Council, Environmental Ministry)doing

separately

Local authorities & the community take more interest in fogging than larva control

Limited budgets for operational cost

Limited knowledge on prevention and control of Dengue Fever in the community

Existing vector control methods (Abate, fogging) have several limitations in terms

of cost and long term sustainability

Threats

• Climate Change (Global Warming & greenhouse gas )

• Uncontrolled mobile & migrants in peri-urban areas ( Poor sanitation

including solid waste disposal like as non-biodegradable products

(plastic, paper cups, used tyres)i ncrease vector breeding sites)

• Uncontrolled urbanization with under developed infrastructure

(unplanned settlements with inadequate potable water as increased in

improper water storage system, temporary containers without covers)

• High workload burden on Basic Health Staffs

Opportunities

• Political commitment by local authority and support

by Local government, NGO, Social Welfare

• Role of NGOs –

- promote community mobilization for

implementing environmental management

- correct health seeking behavior

• INGOs – more interest in Dengue Control Activities

The Ways Forward

• DF is an notifiable disease and government need to revitalize it‘s

law enforcement

• To follow the updated National Guideline for Prevention, Control

and treatment for DF/DHF .( National DHF control Program and

Malaria consortium is developing it )

• Program need to find out more funding.

• Need to scale up School and Institutional based DHF prevention

and Control activities( Program is plan and find funding)

• .

The Ways Forward

• To do serological surveillance in selected sentinel hospitals in each

and every State and Region by VBDC,NHL&DMR (Need Budget)

(VBDC, NHL, DMR)

• To initiate mobile/web-based reporting system

• To strengthen of E-reporting system(M-health)and to develop

Dengue Webpage and train IT person

• To use WHO IVM training manual for implementation

• Strengthen social network (using viber or facebook for community

awareness as well as supporting surveillance activities.