pan american health organization 44th directing council, september 2003 1.. integrated strategy for...

Pan AmericanHealthOrganization

44th Directing Council, September 2003

1

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Integrated Strategy

for Dengue Prevention and

Control



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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).


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 conditions Ideal conditions for Dengue:for 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


Socio-Economic Factors• Unprecedentedpopulation growth .

• Urbanization neitherplanned nor controlled.

•Increase in poverty.

•Inadequate

• environmentalmanagement.

•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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Uncontrolled Urbanization


Uncontrolled Urbanization• In 1954, 42% of Latin America’s population lived

in urban areas, while in this figure reached 1999

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.

Pan AmericanHealthOrganization 44th Directing Council,

September 2003

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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 andmanagement.

• Non-biodegradablecontainers.

•Improper tire disposal.

•Insufficient waste collection and management.

•Non-biodegradable containers.

•Improper tire disposal.

• Insufficient and inadequatewater distribution.

• Increased number of waterstorage containers .

• Inadequate septic systemconditions.

•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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Population Movements


Population Movements•MigrationMigration

• International Internationaltourismtourism

•MigrationMigration

•International International tourismtourism

• More than 750 million people annually cross international

borders.

• Increase in rural migration intourban areas.

•1.4 billion international travelersin 1999.

•697 million international tourist arrivals in 2000 and 715 million in

)up 3.1%( 2002.

•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



10

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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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 communityparticipation.

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 theintegrated strategy ,strengthening National Programs.

Incorporate theDengue Task Force in PAHO’s technical cooperation to countries.

Implement theCOMBI Plan :Communication for Behavioral Impact.

Emphasize the need for Integral SubregionalPlans that strengthen activities in the border regions between

countries.

Promote and implement intersectoralactivities between the Health, Environment, Education, and othersectors .

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

pan american health organization 44th directing council, september 2003 1.. integrated strategy for...

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