Author: breakdengue

Joko Murdianto contracted dengue hemorrhagic fever in 1996 and after going through the illness, he decided to make a commitment to the battle against dengue so that other people didn’t have to suffer the way he did. Here’s his story.

I contracted dengue in 1996 in Indonesia, and it was first misdiagnosed as pharyngitis as dengue was so uncommon at that time. After one week, I was in hospital with stomach bleeding and I was so weak that I felt like I was in a coma.
Now as a survivor of this illness, I am working with communities to minimize the incidence of dengue hemorrhagic fever through educating people.
I talk to people to ensure they know how to keep their communities clean and deter dengue larvae from growing. I tell them how the amount of time spent in hospital leads to a drop in productivity. I also advocate the use of larvacide and fumigation to help reduce the numbers of mosquitos that are carrying the disease, and I have joined the national blood committee.
In my opinion Break Dengue is a great tool to help in the fight against dengue.
Will you take a stand?
If just one person can make a stand against dengue and work towards minimizing its impacts, imagine what would happen if all of us decided to stand together against this illness.
Will you join us as we try to put a stop to the suffering dengue causes around the world? Share your pledge with us on Facebook and Twitter!

According to the recent Dengue Epidemiology Forecast, laboratory-confirmed cases of dengue reported by the national surveillance systems across Brazil, India, Mexico, Singapore and Thailand (the 5MM) will rise on average 1.13% each year for the next decade. The report also notes that long-dormant or new dengue serotypes are a significant driver in disease transmission. We decided to investigate their impact.

Long-dormant serotypes

Highlighting the reemergence of the DENV-3 serotype in South Pacific after nearly 20 years, the World Health Organization explains how infection from one of the four different dengue serotypes provides protection from that particular serotype for life. This means that an outbreak could eventually reach a level where a significant proportion of the population is immune and the serotype then simply lies dormant.

However, infection with one serotype only provides protection from the other three for a very short period – at most, months. So, while one serotype takes a backseat, one of the other three may instead take hold. Worse still, it would seem that immunity to one serotype could make you more susceptible to infection with severe dengue from another.

Dengue serotypes can reemerge in a region after an absence of 15 to 20 years, having slept while the next generation is born. The proportion of the population with no immunity will eventually increase above a certain threshold and the serotype can take hold again – with the potential to cause a major outbreak.

This tendency to lie dormant has contributed to dengue’s neglect by public health experts, asserts an article in the Nature online journal. It suggests that health authorities may mistakenly give dengue a low priority while the region’s endemic serotypes are just awaiting the next opportunity to explode into a severe outbreak.

New serotypes

The forecast also refers to the impact of new serotypes on disease transmission. Fortunately, the only new dengue serotype identified in the last 50 years is one that circulates primarily in non-human primates. Science Magazine reports how the DENV-5 serotype was discovered within samples from an outbreak in Malaysia in 2007, but this is the only human outbreak ever recorded.

Currently, it is not certain what impact this new finding may have, though it may assist us in understanding the origins of dengue and how it is evolving.

One thing is clear, however: even when the battle seems to be won, we should not let our guard down against dengue. Those combatting dengue today must fight to increase the focus on dengue and help turn the forecast into reduced cases.

As reported in our previous blog on the Asian study exploring the impact of eco-bio-social factors in Aedes aegypti breeding, phase one identified appropriate interventions. These amounted to targeting periodic checking on key water-holding containers backed by continuous improvements such as putting on lids and disposing of trash. Phase one identified 1,200 households within Masagana* City, a rapidly-developing area of metropolitan Manila, to participate in the study. Households were grouped into 12 clusters, identified by low/high dengue incidence and by low/high crowding. The low-crowding – and more affluent – clusters were in an area labelled as Village A, while the higher-crowding clusters, where the settlers lived, were known as Village B. In Village A, the intervention was first introduced to households through meetings and workshops. Attendance was extremely low, so instead health workers were dispatched to teach households how to inspect containers for pupa and clean them if any were found. Each household was given a guide and a checklist. Following this experience, though meetings were better attended in Village B, health worker home visits were planned there from the outset. In Village A, household awareness increased and more containers were covered despite considerable reluctance and communication difficulties, largely unrelated to the study. In Village B, however, the residents were happy to participate in discussions. They described how they felt safer and had become more aware of dengue control while the number of cases had fallen. Dr. Fe Espino, from the Research Institute for Tropical Medicine (RITM), explained the importance of support from the local administration: “When we started, the mayor helped by delivering an ordinance for the creation of a Dengue Task Force and for water container management. But local authorities have to get buy-in from communities to enforce it properly. They need to find a way to penetrate the community and its mindset – to understand what is going on.” Inevitably, local politics can be another factor, as Dr. Fe describes: “There was a change of government before we started phase two and the Dengue Task Force became less active. We were dealing with a whole new administration and had a hard time getting an audience with the mayor because our project was identified with the previous administration. We had the evidence, we knew it would work, but we had to deal with a new set of stakeholders.” The study and its findings have since led to a change in the way dengue vector control is approached, not just in the city of Masagana*, but across the whole of the Philippines. “We presented our findings – around community health workers training and supervising households in inspecting key containers – during national forums and I was told that the National Dengue Prevention and Control Program is planning to use this approach.” *Name of city has been anonymized for privacy reasons

How can a growing city’s planners and builders best join the fight against dengue?

The way urbanization impacts the spread of dengue is well understood. As Dr. Humne of the Indian Medical Association (IMA) said in an article in The Times of India, “Rise in population has given a fillip to construction activities whose sites have become breeding ground for mosquitoes.”

Dengue never stands still 

Like many other diseases, dengue is a moving target. A study from Jalna District in western India highlighted how the growing resistance of pathogens to drugs and of mosquitoes to insecticides was a significant factor in the re-emergence of vector-borne diseases.

Another study, this time in Brazil’s Boa Vista districts, recorded a rapid increase in resistance following intense use of a pyrethroid insecticide, though it only achieved a slight reduction in levels of infestation.

Working together and staying informed

Just as healthcare professionals must keep up-to-date on diseases developing drug resistance, those caring for our cities – civic authorities, town planners and builders – need to stay on top of developments. “People from these professions must also update themselves about these diseases like doctors do," said city IMA secretary Dr. Kush Jhunjhunwala.

They must use this knowledge to develop alternative strategies within their dengue control programs. The Brazilian study suggests insecticide rotations and mixtures could delay the evolution of resistance, letting dengue control programs keep on track.

By working together and staying informed, professionals from many different disciplines can help halt the spread of dengue.