DENGUE yellow fever

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DENGUE yellow fever Powered By Docstoc
					 Brunilda Lugo, PhD student
      Walden University
       PUBH-8165-10
Instructor: Dr. Robert Marino
      Spring term, 2010
Table of Content
    Content                              Slides
 Learning objectives                    4
 Learning outcomes                      5
 Dengue and causative agent             6-7
 Transmission and vectors               8-12
 Geographic distribution                13-15
 Breeding sites & life cycle of Aedes   16-18
 Signs and symptoms of Dengue           20-23
 Diagnostic, treatment, prevention      24-26
 Epidemiology                           27-28
 Dengue and Public Health               29-32
 Final words                            33
 References                             35-36
 Credits                                37
Learning Objectives
 The learning objectives of this presentation are to:

• Understand what is Dengue Fever, Dengue Hemorrhagic
  fever and Dengue Shock Syndrome
• Understand the modes of transmission and how to
  prevent exposure
• Understand the geographic importance of the disease
• Understand the importance of dengue from a public
  health point of view
Learning Outcomes
By the end of the presentation the audience will be able
  to:
 Define dengue fever
 Describe vectors, breeding sites and life cycles
 Recognized the signs and symptoms of the clinical
  manifestation of dengue
 Describe diagnostics, treatment and preventive
  measures of dengue
 Demonstrate knowledge about the epidemiology of
  dengue
 Discuss what public health is doing about this
  disease
What is Dengue?
 Is an acute fever producing infectious disease
 Mostly found in the tropics
 Pronounce DEN-ghee
 Complications can be fatal
 It is also known as Dengue fever , breakbone fever or
  Dengue hemorrhagic fever

Bauman, R., (2006). Microbiology disease by systems. San Francisco ,
  CA: Pearson Benjamin Cumming Publishers
Causative agent of Dengue
  Dengue is cause by a RNA virus
 This virus is a member of the viral family
  Flaviviridae.

Dengue virus



Bauman, R., (2006). Microbiology disease by systems. San Francisco , CA: Pearson Benjamin
   Cumming Publishers
Transmission of Dengue
 A mosquito is the biological vector
 This mosquito is the obligate intermediate host for
  some viruses
 Aedes albopictus/aegypti are generally associated
  with the spread of dengue fever
 Biting around the ankles and knees close to the
  ground in the daytime.
 Only female mosquitoes will bite; mostly in the
  daytime
Akram, W., (n.d.). Aedes as a vector of Dengue: a possible threat to our lives. Khwarzimig Science
   Society. University of Agriculture, Faisalabad. Retrieved April 19, 2010 from
   http://www.khwarzimic.org/takveen/dengue_kss.pdf
Aedes albopictus
 The Asian tiger mosquito was found in Florida at a
  tire dump site near Jacksonville
 The species has spread rapidly throughout the
  eastern states, including all Florida’s 67 counties
 Aedes albopictus is a vector for many viruses
  including dengue fever and Eastern equine
  encephalitis virus
 Currently this mosquito is established in 866
  counties in 26 states
Rios, L., Maruniak, J.E. (2008). Asian tiger mosquito. University of Florida Institute of
   Food and Agricultural Sciences . Retrieved April 19, 2010 from
   http://www.entemdept.ufl.edu/creatures/aqutic/asian_tiger.htm
Aedes albopictus
Aedes aegypti
 Currently is limited to the southeastern quadrant of the
    U.S., and small areas in New York and Arizona
   The most competent vector of dengue virus and yellow
    fever
   As A. albopictus, this mosquito depend greatly on stored
    water for breeding sites.
   Male and Females adults feed on nectar of plants
   Females bloodfeed primarily on humans in order to
    produce eggs
   A. aegypti bites during the day, indoor as well as outdoors
    Zettel, C., Kaufman, P. (2008). Yellow fever mosquito. University of Florida Institute of Food and
     Agricultural Sciences. Retrieved April 19, 2010 from
     http://entnemdept.ufl.edu/creatures/aqutic/aedes_aegypti.htm
Aedes aegypti
Geographic distribution of
Dengue
• Dengue disease occurs in tropical and subtropical
  areas
• Endemic in over 100 countries in the Caribbean,
  South, Central and North America, Africa, the Pacific
  Islands, Hawaii, Asia, Eastern Mediterranean and
  Australia
• Before 1970 only nine countries had experience
  dengue hemorrhagic fever epidemics, a number that
  had increased more than four-fold by 1995
•   World Health Organization, (2009). Dengue and Dengue haemorrhagic fever. Retrieved April 19, 2010 from
    http://www.who.int/mediacentre/factsheets/fs117/en/
Geography distribution of
Dengue

     BBB




     Blue dot: Geographic extension of dengue 2000-2007
     Blue shaded areas: Risk of dengue transmission
     Lines: Lines demarcate the area where the vector for dengue exists
Dengue in the United States
 Dengue reported in the U.S. were acquired elsewhere by
  travelers or immigrants
 The majority of dengue cases in U.S. citizens occur in
  Puerto Rico, the U.S. Virgin Island, Samoa and Guam
 In Puerto Rico, and most of the Caribbean Basin, the
  dengue vector is Aedes aegypti, this vector is abundant
  year-round
 Dengue transmission in Puerto Rico follows a seasonal
  pattern, high transmission begins in August until
  November
Center for Disease Control and Prevention, (2009)Dengue epidemiology. Retrieved April
  22, 2010 from http://www.cdc.gov/Dengue/epidemiology/index.html
Common breeding sites
 Dengue cases usually increase during the rainy
  season
 The spread of the mosquito is attributed to poor
  environmental sanitation
 When it rains the water gets stored in any place such
  as discarded tires, broken bottles, and even shoes
 Other examples are soda cans, birdbaths, rain
  gutters, toys, pool covers, tree stumps, and garbage
  cans.
Illinois Environmental Protection Agency, (2007). Mosquito-Borne illnesses prevention
    techniques. Retrieved April 22, 2010 from http://www.epa.st.il.us
    /land/tires/mosquito-borne-illness.html
Aedes aegypti life cycle



2-7 days



>4 days                    2 days
Signs and Symptoms of
Dengue Fever
 High fever, up to 105 F (40.6 C)
 A rash over most of your body, can subside after a couple of days and
    then reappear
   Sever headache, backache or both
   Pain behind your eyes
   Severe joint and muscle pain (breakbone fever)
   Nausea and vomiting
   Signs and symptoms usually begin about four to seven days after
    being bitten by A. aegypti.
   Mild dengue fever rarely causes death, it is usually self-limiting

Mayo clinic, (2010). Dengue fever symptoms. Retrieved April 19, 2010 from
  http://www.mayoclinic.com/health/dengue_fever/DS01028/DSECTION=symptoms
Signs and Symptoms of Dengue
Hemorrhagic fever (DHF)
 A more severe form of dengue that begins the same way
    as dengue fever but become worse after several days
   Significant damage to your blood and lymph vessels
   A decrease in the number of blood cells that help your
    blood clot (platelets)
   Bleeding from nose and mouth
   Bleeding under the skin, which gives the appearance of
    bruising
   Death
     Mayo clinic, (2010). Dengue fever symptoms. Retrieved April 19, 2010 from
    http://www.mayoclinic.com/health/dengue_fever/DS01028/DSECTION=symptoms
Signs and Symptoms of Dengue
Shock Syndrome (DSS)
 The most severe form of the disease
 It may start with the signs and symptoms of mild dengue
    plus
   Severe abdominal pain
   Frequent vomiting
   Disorientation
   Fluid (plasma) leakage from blood vessels
   Heavy bleeding
   A sudden drop in blood pressure (shock)
   Death
    Mayo clinic, (2010). Dengue fever symptoms. Retrieved April 19, 2010 from
    http://www.mayoclinic.com/health/dengue_fever/DS01028/DSECTION=symptoms
Why does different clinical
manifestations of Dengue exists?
 There are four different types (serotypes) of the
  dengue virus
 These are DEN-1, DEN-2, DEN-3 and DEN-4
 Recovery from infection by one provides lifelong
  immunity against that virus, confers only partial and
  transient protection against subsequent infection by
  the other three viruses
 There is evidence that sequential infection increases
  the risk of developing dengue hemorrhagic fever

World Health Organization, (2009). Dengue and dengue haemorrhagic fever. Retrieved April 19,2010
  from http://www.who.int/mediacentre/factsheet/fs117/en/
Diagnosis for Dengue
 Travel history and symptom profile
 Detection of antibodies against the virus
 Complete blood count
 Chemistry panel
 Liver function test
 Occult blood in stool
 DIC panel

Price, D.D., Wilson, S.R., (2009). Dengue fever: differential diagnoses and
   workout. Medscape. Retrieved April 19, 2010 from
   http://emedicine.medscape.com/article/781961-diagnosis
Treatment for Dengue
 No specific therapeutic agents exist for dengue
  infections
 Bed rest and hydration therapy
 Fever control with acetaminophen. Narcotics may be
  necessary if headaches are very severe
 Aspirin should be avoid because of anticoagulant
  properties, children should avoid aspirin when a
  viral infection is suspected
 Monitoring of signs and symptoms for warning signs
  of DHF or DSS
Price, D.D., Wilson, S.R., (2009). Dengue fever: differential diagnoses and workout. Medscape.
   Retrieved April 19, 2010 from http://emedicine.medscape.com/article/781961-diagnosis
Preventive Measure for
Travelers
 No vaccine or drugs are available for the prevention of dengue
 Preventive measure should be taken to avoid the bite of the mosquito
    Well screen accommodations or air conditioning
    Use of insecticide indoors
    Apply insect repellent to skin and clothing. The most effective are
     the ones with DEET
    Empty , clean or cover any standing water that can be a
     mosquito-breeding site

   Center for Disease Control and Prevention, (2009). Other infectious disease related to travel,
     dengue fever (DF) and dengue hemorrhagic fever (DHF). Retrieved April 19, 2010 from
     http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-
     hemorrhagic-fever.aspx
Incidence of Dengue Fever
 Global incidence of dengue has grown dramatically
 2500 million people- two fifths of the world’s population-
  are now at risk from dengue
 WHO estimates 50 million to 100 million cases of dengue
  infection worldwide every year
 In 1998,there were 616,000 cases of dengue in the
  Americas of which 11,000 cases were DHF
 In 2007, there were more than 890,000 reported cases of
  dengue in the Americas, of which 26000 were DHF
World Health Organization, (2009) Dengue and dengue haemorrhagic fever. Retrieved
  April 19, 2010 from http://www.who.int/mediacentre/factsheets/fs117/en/
More Statistics
 An estimated 500,000 people with DHF require
  hospitalization each year, a large proportion are
  children, about 2.5% of these die
 DHF fatality rates can exceed 20% without proper
  treatment
 World Health Organization, (2009) Dengue and dengue haemorrhagic fever.
 Retrieved April 19, 2010 from http://www.who.int/mediacentre/factsheets/fs117/en/
Dengue and Public Health
 Dengue fever is a major public health problem
 The reasons for the emergence of this disease are
 complex
   Effective mosquito control is virtually nonexistent in
    most dengue-endemic countries
   Major global demographic changes have occurred
         Uncontrolled urbanization
         Concurrent population growth
         Substandard housing, inadequate water, sewer, and waste
          management systems
      Gubler, D.J., Clark, G.G., (1995)Dengue/dengue hemorrhagic fever: The emergence of a
        global health problem. Retrieved April 19, 2010 from
        ftp://ftp.cdc.gov/pub/EID/vol1no2/adobe/gubler.vol1no2.pdf
Dengue Branch in Puerto Rico
 Provides global leadership in dengue risk,
  assessment, research and effective public health
  practices
 The branch has collected, analyzed and reported
  dengue cases from Puerto Rico, U.S. Virgin Island
  and the continental U.S.
 Serves as the primary reference laboratory for state
  health departments and the World Health
  Organization
Center for Disease Control and Prevention, (2009). About CDC’s dengue branch.
  Retrieved April24, 2010 from http://www.cdc.gov/Dengue/about/index.html
Public Health Prevention
and Control of Dengue
 The importance of the activities of the Dengue
  Branch can translate to:
 New technologies into real-time
 Rapid diagnosis to treat patient earlier and
  effectively
 Improving surveillance that will allow an effective
  and targeted public response to dengue outbreaks
 Clearer picture of the burden of dengue in Puerto
  Rico, the continental U.S. and internationally
Center for Disease Control and Prevention, (2009). About CDC’s dengue branch.
  Retrieved April24, 2010 from http://www.cdc.gov/Dengue/about/index.html
Prevention and Control cont.
• Providing training to the medical community to improve
  their knowledge of the disease
• Conducting mosquito control interventions that allow the
  CDC to make recommendations to vector control
  program
• Improving quality of surveillance data
• Analyzing all the clinical manifestation of the disease to
  conduct studies to improve the knowledge of the dengue
  virus
Center for Disease Control and Prevention, (2009). About CDC’s dengue branch.
  Retrieved April24, 2010 from http://www.cdc.gov/Dengue/about/index.html
Final word of advice for
travelers
 The times of higher risk of being bitten by the female
  mosquito is 2 to 3 hours after daybreak and 3 to 4
  hours before nightfall
 The mosquito can feed indoors as well as outdoors
 Precautions as mention before should be taken
  especially at peak biting activity time
 The risk of exposure may be lower in modern, air-
  conditioned hotels with well-kept grounds
Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology
  Reviews, July 1998, p.480-496. Retrieved April 24, 2010 from
  http:/www.cmr.asm.org/cgi/repreint/11/3/480
Thank you for your time
 I hope that this presentation was informative and
 useful especially when traveling to countries where
 dengue is endemic
References:
 Akram, W., (n.d.). Aedes as a vector of Dengue: a possible threat to our lives.
  Khwarzimig Science Society. University of Agriculture, Faisalabad. Retrieved April 19,
  2010 from http://www.khwarzimic.org/takveen/dengue_kss.pdf
 Bauman, R., (2006). Microbiology disease by systems. San Francisco , CA: Pearson
  Benjamin Cumming Publisher
 Center for Disease Control and Prevention, (2009)Dengue epidemiology. Retrieved
  April 22, 2010 from http://www.cdc.gov/Dengue/epidemiology/index.htm
   Center for Disease Control and Prevention, (2009). Other infectious disease related to travel,
    dengue fever (DF) and dengue hemorrhagic fever (DHF). Retrieved April 19, 2010 from
    http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-
    fever.aspx
   Center for Disease Control and Prevention, (2009). About CDC’s dengue branch. Retrieved
    April24, 2010 from http://www.cdc.gov/Dengue/about/index.html
   Gubler, D.J., Clark, G.G., (1995)Dengue/dengue hemorrhagic fever: The emergence of a global
    health problem. Retrieved April 19, 2010 from
    ftp://ftp.cdc.gov/pub/EID/vol1no2/adobe/gubler.vol1no2.pdf
   Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews, July
    1998, p.480-496. Retrieved April 24, 2010 from http:/www.cmr.asm.org/cgi/repreint/11/3/480
Reference:
   Mayo clinic, (2010). Dengue fever symptoms. Retrieved April 19, 2010 from
    http://www.mayoclinic.com/health/dengue_fever/DS01028/DSECTION=symptoms
   Price, D.D., Wilson, S.R., (2009). Dengue fever: differential diagnoses and workout. Medscape.
    Retrieved April 19, 2010 from http://emedicine.medscape.com/article/781961-diagnosis
 Rios, L., Maruniak, J.E. (2008). Asian tiger mosquito. University of Florida Institute
  of Food and Agricultural Sciences . Retrieved April 19, 2010 from
  http://www.entemdept.ufl.edu/creatures/aqutic/asian_tiger.htm
 World Health Organization, (2009). Dengue and Dengue haemorrhagic fever.
  Retrieved April 19, 2010 from http://www.who.int/mediacentre/factsheets/fs117/en/
 Zettel, C., Kaufman, P. (2008). Yellow fever mosquito. University of Florida Institute
  of Food and Agricultural Sciences. Retrieved April 19, 2010 from
  http://entnemdept.ufl.edu/creatures/aqutic/aedes_aegypti.htm
List of recommended sources:

 Dengue Fever , disease information:
  http://www.cdc.gov/ncidod/Diseases/submenus/su
  b_dengue.htm
 CDC-Dengue:
  http://www.cdc.gov/ncidod/dvbid/dengue/
 WHO/Dengue/dengue haemorrhagic fever:
  http://www.who.int/csr/disease/dengue/en/
Credits
 Slide 7: Google images dengue virus
 Slide 10: Google images-cdc-gathaway-aedes-albopictus
 Slide 12: Google images- Aedes aegypti
 Slide 14: Google images Figure 1: Dengue Transmission
 Slide 17: Google images a mosquito breeding site, mosquito breeding
            areas
 Slide 18: Google images – Aedes aegypti life cycle
 Slide 19: Google images- mosquito breeding ground
 Slide 34: Google images- beach photo

				
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