Breaking dengue – together

World Health Organisation report on eHealth highlights Break Dengue’s impact as an example of how technology and collaboration can help fight infectious disease

Screen Shot 2017-03-08 at 09.56.29BRUSSELS, 06 March, 2017 – A new WHO report highlights the Break Dengue project as a shining example of how to address the growing global threat of dengue fever. Break Dengue is an open initiative bringing together scientists, healthcare providers, patients, journalist and industry to meet this shared challenge. Together, this broad coalition of stakeholders is helping to track dengue outbreaks, connect experts around the world, and provides a platform for integrating approaches to dengue control.

The report – Global diffusion of eHealth: making universal health coverage achievablewas produced by the WHO’s Global Observatory for eHealth. It looks at how governments and organisations around the world are embracing eHealth, big data and information communications technologies to advance global health.

The authors note that, since its creation in 2013, Break Dengue has encouraged stakeholders to look at the bigger picture – rather than focusing on single aspects of the challenge such as vector control or vaccine development.

Latest innovation – Dengue Track

Harnessing the latest technological tools is essential to beating dengue fever. Break Dengue’s Dengue Track initiative seeks to capture data from internet users to fill epidemiological surveillance information gaps. In the future, these data sets will also include social media monitoring (Twitter microblogs or Facebook posts), tracking of Google search patterns, monitoring mobile phone use and crowd-sourced participatory disease surveillance tools. Break Dengue is partnering with the HealthMap team at Boston Children’s Hospital to create an innovative internet-based surveillance platform for dengue.

“Due to the complex nature of dengue fever transmission, efforts to decrease its spread require both effective collaborative models to bring together diverse stakeholders, and approaches that leverage the power and scalability that our connected world offers,” says Dr Mauricio Santillana Mauricio Santillana, PhD, a physicist and applied mathematician, at Boston Children’s Hospital. “By combining both of these aspects, Break Dengue is ideally positioned to catalyse the conception and implementation of innovative solutions to curb dengue.”

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Diana Zaharia, Communications Manager
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diana@thesynergist.org

World Health Organization report on eHealth cites Break Dengue

World Health Organisation report on eHealth cites Break Dengue as an example of how technology and collaboration can help fight infectious disease.

The new report – Global diffusion of eHealth: making universal health coverage achievablewas produced by the WHO’s Global Observatory for eHealth. It looks at how governments and organizations around the world are embracing eHealth, big data and information communications technologies to advance global health.

The report explains how Break Dengue has built a coalition of stakeholders to meet the considerable challenge posed by dengue fever. In particular, the authors note that, since its creation in 2013, we have encouraged stakeholders to look at the bigger picture – rather than focusing on single aspects of the challenge such as vector control or vaccine development.

The breadth of the network we have built is also highlighted, along with our use of digital channels and social media tools to connect patients, doctors, industry, NGOs, R&D organizations and associated. Whether it’s reaching out to people at risk via Twitter and Facebook or bringing together specialists on our Dengue Lab platform for experts, Break Dengue has built links between all those on a mission to beat dengue fever – wherever they may be.

That’s why we launched our Give Dengue the Red Card campaign during the World Cup in Brazil; sent our travel blogger to dengue-affected areas; and reported from dengue hotspots in Asia and Latin America.

We even took our message to New York for the Millennium Campus Conference at the United Nations.

Innovating together

For us, these partnerships are essential to understanding and tackling the problem. But it is about more than just awareness. Connecting experts – and ordinary citizens – can lead to concrete actions, enabled by new technology.

“Due to the complex nature of dengue fever transmission, efforts to decrease its spread require both effective collaborative models to bring together diverse stakeholders, and approaches that leverage the power and scalability that our connected world offers,” says Dr Mauricio Santillana Mauricio Santillana, PhD, a physicist and applied mathematician, at Boston Children’s Hospital. “By combining both of these aspects, Break Dengue is ideally positioned to catalyse the conception and implementation of innovative solutions to curb dengue.”

This quote, featured in the WHO report, sums up our philosophy and links neatly with our new Dengue Track initiative that seeks to capture data from internet users to fill epidemiological surveillance information gaps.

These data sets include social media monitoring (Twitter microblogs or Facebook posts), tracking of Google search patterns, monitoring mobile phone use and crowd-sourced participatory disease surveillance tools. Break Dengue is partnering with the HealthMap team at Boston Children’s Hospital to create an innovative internet-based surveillance platform for dengue.

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We were delighted to see our project showcased in this way. But rather than rest on our laurels, this honor only encourages us to do more, to shout louder and to fight harder against dengue.

Because we know there is still so much work to be done.

Dengue alert: scientists find natural warning system

Researchers in Sweden have identified a strong link between El Niño conditions in the Pacific and dengue fever epidemics in South Asia. The finding could help to improve epidemic warning lead times – giving health authorities time to prepare for major dengue outbreaks.

El Niño is associated with a band of warm ocean water that develops in the central and east-central equatorial Pacific. The new study looked at how this natural phenomenon influences rainfall and temperatures in Sri Lanka.

The El Niño, dengue connection

Weather is already known to influence the spread of mosquito-borne diseases so if El Niño works like an advance weather forecast, it could essentially serve as a long-range epidemic predictor.

“Dengue is the major public health burden in Sri Lanka and the Kalutara district is one of the most affected areas. So understanding how reoccurring weather patterns drive dengue is vital in controlling and preventing the disease spread,” says Joacim Rocklöv, a researcher at the Unit for Epidemiology and Global Health at Umeå University in Sweden and co-author of the article published in the International Journal of Environmental Research and Public Health.

“These new findings allow disease early warning systems to provide warnings for upcoming epidemics with much longer lead time than before,” says Prasad Liyanage, a doctoral student at Umeå University and Medical Officer for dengue control in Kalutara district at the Sri Lankan Ministry of Health.

Graph, showing the effect El Nino has on the rise in dengue outbreaks based on research at Umea University.

A three-dimensional plot showing the exposure-lag-response association between Oceanic Niño index (ONI) and relative risk of dengue (RR) in Kalutara, Sri Lanka. When ONI increases to more than 0.5, the relative risk of dengue dramatically increases at a lag period of six months (see upper right corner). Image via Umeå University

In the study, researchers used the Oceanic Niño Index, which is a measure indicating el Niño activity by sea surface temperature in the Pacific Ocean, along with local weather and epidemiological data to quantify data associations in 10 healthcare divisions of Kalutara in southwestern Sri Lanka. Weekly weather variables and data on dengue notifications, gathered by Prasad Liyanage for the Ministry of Health between 2009 and 2013, were analyzed to estimate locally specific and overall relationships between weather and dengue.

The results showed an increasing relative risk of dengue with increasing rainfall starting at above 50 mm per week. The strongest association between rainfall and dengue was found around 6 to 10 weeks following rainfalls of more than 300 mm per week, which amounts to very wet conditions and floods. With increasing temperatures of 30 degrees Celsius or higher, the overall relative risk of dengue increased steadily starting from a lag of 4 weeks.

“Looking at weather and dengue incidents over longer periods, we found a similar strong link between how increased rainfall and warmer temperatures resulting from the reoccurring el Niño phenomenon are associated with elevated risks of dengue epidemics. In the longer perspective, our data further confirms this association and suggests that dengue fever thrives whenever el Niño visits our island,” says Prasad Liyanage.

Learn more: Understanding the impact of global warming on the spread of dengue

According to the researchers, the findings can be used to improve predictive surveillance models with lead times of up to six months. This would give health officials longer time to increase preparedness and mount control effort responses prior to the epidemics. Today, such control efforts usually have limited effects as they start when signs of an epidemic can be seen within the hospital and primary care surveillance system.

Help control dengue outbreaks. Report dengue activity from your smartphone using Dengue Track.

 

Dengue vaccination toolkit hopes to boost introduction

A new dengue vaccination toolkit offers a guide to introducing the dengue vaccine, tackling everything from vaccine delivery to ‘rumor management’

Introducing a new vaccine is a complex task. Not only must health authorities consider how they will reach the target population and who will administer the vaccine, new systems must be developed to monitor impact and track any safety issues. Add to that the need to communicate about the value of an immunization program – and counter the misinformation that might be circulated online by anti-vaccine activists – and this is clearly a major challenge.

image of a vaccination against dengue. Now a dengue vaccination toolkit is available

Credit: Sanofi Pasteur / Industria Fotográfica Estudio Base

For new childhood vaccines that fit into an established pediatric immunization schedule, some of these hurdles are more easily cleared. Key infrastructure is already in place: doctors and nurses are used to inviting parents to bring their children for their shots, and most parents are happy to protect their kids against killer viruses and bacteria.

The first dengue vaccine to be licensed – known as DENGVAXIA® – is not indicated for infants. In fact, the youngest target group begins at nine years of age.

These unique characteristics make introducing the vaccine more complex and may even discourage some governments from rolling out the jab. New solutions needed

New solutions needed

Step forward, Agence de Médecine Préventive (AMP), a Paris-based NGO with scientific and technical expertise in vaccination. Vaccinology specialists at AMP Services have developed a dengue vaccination program toolkit which includes a series of training modules, a case study library and interactive tools to help health authorities to add the vaccine to their anti-dengue arsenal.

Currently available in English, Spanish and Portuguese, the toolkit will be of use to the 13 countries in which the vaccine is licensed – Mexico, the Philippines, Brazil, El Salvador, Costa Rica, Guatemala, Paraguay, Indonesia, Peru, Cambodia, Thailand, Singapore, and Bolivia – and in others where the vaccine is being considered.

Dr. Isabelle Delrieu, Scientist and Project Leader at AMP Services, says her team has been working on the toolkit for one year with support from Sanofi Pasteur, the company that developed Dengvaxia®.

“Given the increasing burden of dengue infection and disease worldwide, the dengue vaccine has great potential to have a significant impact in terms of disease reduction and prevention of dengue outbreak,” she said. However, she noted that technical aspects of the vaccine such as the three-dose schedule given six months apart over a 12-month period in the teenage and adult population – require a unique approach.

Dr. Delrieu said that the toolkit is not an advocacy tool but an operational handbook for countries that have decided to embrace vaccination. “Each country has its own epidemiological and organizational context. Rather than promoting a ‘one size fits all’ solution, the toolkit is linked to a case study library aimed at reflecting the range and diversity of thoughts and solutions.”

National decision-makers and immunization program stakeholders are the target audience for the resources developed by AMP Services: “This includes staff from the Ministry of Health, NITAG members, but also – for some specific modules – Ministries of Education, Economics, and so on.”

The toolkit already includes seven modules and an interactive tool providing information on several topics:

  • information on the dengue vaccine
  • implementation strategies
  • organization of vaccination sessions
  • impact evaluation
  • pharmacovigilance
  • dengue outbreak and evaluation
  • diagnosis strategies in the context of vaccination

Modules on dengue vaccine communication, rumor management, and social mobilization are currently under development. An interactive companion Excel tool has been developed with the objective to help decision makers in summarizing their country data and evaluating possible introduction areas, implementation, and evaluation strategies.

The case study library is regularly updated based on country experiences, according to Dr. Delrieu. “The toolkit is regularly enhanced and updated with feedback from country consultations, international meetings and experts’ insights, World Health Organization (WHO) recommendations, international organizations’ reports, and scientific literature,” she said.

Image for the dengue vaccination toolkit by AMP Services

Rumor has it

Communication issues and rumor management are becoming a major concern when implementing new health interventions. This is particularly true for new vaccines, which are given to a healthy population.

“Together with a pharmacovigilance system, it is also important to summarize and explain the scientific data from the trials, and emphasize the necessity to prepare accurate communication plans regarding dengue vaccine and its use in the context of routine immunization and outbreak response,” says Dr. Delrieu. “Communication, including COMBI – Communication for Behavioral Impact – and social mobilization are compulsory components of a vaccine introduction strategy.”

She said communication programs should be implemented at various levels, including in the community, with healthcare workers, clinicians, NGOs members, but also other staff and stakeholders involved in vaccine implementation such as teachers.

In addition to practical information on vaccine implementation, communication should also address and disseminate technical topics such as the real public health impact of the vaccine.

Paving the way

Dengvaxia® is the first and, currently, the only vaccine against dengue. Its implementation will be crucial to how dengue vaccination is viewed in general. The Dengue Vaccine Program Toolkit is essential to overcoming the many logistical and public perception issues that come with rolling out a new vaccine.

The good news is that monitoring and evaluation systems, as well as public communication and professional training programs, that are introduced now will make it easier to combat dengue and other arboviruses such as Zika, chikungunya, yellow fever, and Japanese encephalitis.

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Malaria campaigners take on dengue fight

Image showing the vast spread of dengue on a world map, produced by Malaria Consortium.

Dengue is one of the fastest growing infectious diseases in the world. The disease burden has grown from 15,000 cases per year in the 1960s to over 390 million today

Commitment of veteran malaria campaigners to tackle dengue is a sign of how serious global public health advocates take the disease

Leading global health organization Malaria Consortium is hosting a roundtable in London this week and launching a new report in an effort to put dengue fever on the political agenda. The move marks the latest initiative by the not-for-profit group to raise awareness of dengue among Westminster politicians and the influential global health policy community in London.

Malaria Consortium has deep experience in disease surveillance, prevention and treatment of mosquito-related diseases, and has a network of staff running programs in 12 African and Southeast Asian countries. As both malaria and dengue are spread by mosquitoes, the group starts from a position of strength.

However, there are some significant differences between the two diseases. For a start, the geographical spread of the mosquitoes that spread malaria are limited to warm and humid climates. The dengue mosquito, in contrast, has the potential to invade new areas and are spreading fast around the world. Their eggs can withstand dry conditions and the diseases are even extending into temperate regions, including Europe.

Did Cristiano Ronaldo start a dengue outbreak?

The time of transmission is different too. Mosquitoes transmitting dengue usually bite during the daytime, while malaria vectors bite during the night. This means that insecticide-treated nets (ITNs) which are used to fight malaria would have limited effect for a large proportion of the population who have daytime activities.

There are also habitat differences: dengue vectors, especially Aedes aegypti, are widespread in urban areas and breed mainly in water containers and discarded items. Another invasive dengue mosquito, Ae. albopictus (the so-called Asian tiger mosquito) that breeds in natural habitats such as tree holes, was previously considered a rural vector; it is now adapted well to urban environments with larvae breeding in artificial containers and has become an important and sometimes sole vector in urban areas.

Urbanization boosts dengue

Urban areas are unsuitable for breeding of the Anopheles vector in most African countries, although in Asia some malaria vectors are adapted to urban environments. In contrast, urban areas usually create suitable breeding conditions for mosquitoes that transmit dengue.

Increasing community awareness to participate in vector control and prevention of mosquito breeding would help in tackling both diseases.

While the dengue problem is growing, Malaria Consortium experts see great scope for improvement. In the field of diagnostics, for example, malaria diagnostic tools are well developed and in widespread use, including rapid diagnostic tests (RDTs) that can be used even at community levels.

In contrast, while there is a range of laboratory-based diagnostic techniques for dengue diagnosis, the lack of standardization and quality control measures for these techniques is a major concern. Some tests (e.g. nucleic acid detection) are very important but are often not feasible because of their cost and complexity, according to Malaria Consortium. Some antigen detection assays are credible candidates, but further improvement and evaluation is required.

Image and quote from Dr Jeffrey Hii. The quote reads, “It is essential that an accurate, rapid and affordable diagnostic test that covers the first seven days of dengue infection..." -Dr. Jeffrey Hii

Dr. Jeffrey Hii, Senior Malaria Consortium Vector Control Specialist

“It is essential that an accurate, rapid and affordable diagnostic test that covers the first seven days of dengue infection, and that can be used in peripheral and remote settings on a single acute sample, be developed,” says Dr. Jeffrey Hii, Senior Malaria Consortium Vector Control Specialist. “Due to high costs, a high range of false positivity from 0% to 31% with dengue RDTs, and the need for a quality-assured laboratory and strong health system support, diagnostic tools for dengue are still not widely available for use especially at peripheral levels.”

As a result, the disease is under-reported and it is not as easy to detect and respond to outbreaks. The distribution of dengue, especially in Africa, is still poorly understood making appropriate targeting of interventions challenging.

Treatment and vaccines

“When we compare treatment for both diseases, it is yet another story. Artemisinin-based combination therapy is available and widely recommended for malaria; there are currently no approved or registered anti-viral drugs for dengue,” Dr. Hii says.

Malaria vaccines are in an advanced stage of clinical testing; a Phase 3 trial of malaria vaccine RTS,S/ASO1 enrolled 15,460 infants and young children in seven countries in sub-Saharan Africa achieved vaccine efficacy of 27 percent in infants (who received four doses) and 35 percent among children aged 5-17 months who received four doses.

The first dengue vaccine, Dengvaxia (CYD-TDV) by Sanofi Pasteur, was first registered in Mexico in December 2015, followed by the Philippines in 2016. CYD-TDV is a live recombinant tetravalent dengue vaccine that has been evaluated as a 3-dose series on a 0/6/12 month schedule in Phase III clinical studies with an overall vaccine efficacy of 65.5 percent participants aged nine years and over (Hadinegoro SR et al. 2015). It has been since been registered for use in individuals 9-45 years living in endemic areas.

Neglected disease

Malaria Consortium is stepping up its work in this area but has, in fact, been active for several years. “Dengue is and has been a focus area for Malaria Consortium for some time,” says Dr. Giuseppina Ortu. “Our organization supports integrated vector control activities for insect vector-borne diseases in its core areas of work, depending on needs and disease burden. Although Malaria Consortium has a strong record on malaria, interest in dengue has been growing not only as part of our integrated vector management approach but also as part of Malaria Consortium’s neglected tropical diseases (NTDs) agenda.”

Dengue is one of the 17 recognized neglected tropical diseases but even within NTD circles, it has been one of the least prominent. Yet it has been one of the major causes of recent disease outbreaks not only in Asia but even in Europe. National Institutes of Health (NIH) has even included dengue as one of the current bioterrorism threats. “There is an urgency to address this disease now, understand these outbreaks and implement differential diagnosis for non-malaria cases, especially in Africa where the dengue burden is still not completely understood,” Dr Ortu adds.

“We are committed to extending our work on dengue and possibly to integrate future malaria projects with dengue prevention, control and management…”

So what is Malaria Consortium doing on the ground to tackle dengue? The NGO has been working with governments in assessing dengue surveillance systems as a first step to evaluate needs and challenges in the management of the disease. In Cambodia, Malaria Consortium is currently evaluating alternative methods of vector control such as the use of guppy fish (released in water containers to eat mosquito larvae) in reducing dengue transmission.

Increasing resistance to temephos (an organophosphate larvicide) and the high cost of Bacillus thuringiensis serotype israelensis (a group of bacteria used as biological control agents for larvae stages) to kill mosquitos in standing water in Cambodia, have raised the need to pilot new affordable vector control strategies, such as the one Malaria Consortium is currently testing. Alongside this study, Malaria Consortium is surveying knowledge, attitudes, and practices to determine the feasibility of such interventions in Cambodia.

“We are committed to extending our work on dengue and possibly to integrate future malaria projects with dengue prevention, control, and management,” says Dr. Ortu.

Advocacy work

Overall, while the malaria distribution map is shrinking, dengue is a rapidly expanding disease. Despite an estimated 390 million cases and roughly 12,500 deaths every year, dengue has not received the enough attention given its public health significance. Disease advocacy is a big part of fighting dengue, according to Malaria Consortium.

Great progress has been made in tackling other diseases, including malaria, following the increased attention and mobilization of resources unleashed by the Millennium Development Goals. Tackling dengue poses different challenges. To be successful, we need a similar global mobilizing of resources. Malaria Consortium is working to raise awareness of dengue among policymakers, both in the UK and in endemic countries.

At its policy roundtable event in London this week, it will launch a new report which it hopes will put dengue on the radar of policymakers and aid agencies.

“We hope that our latest report, and this roundtable discussion, will help to stimulate debate around the key issues involved in the fight against dengue, and raise awareness of the huge impact it is having around the world,” says Dr. James Tibenderana, Malaria Consortium Technical Director. “The UK is already a world leader in the fight against infectious diseases, including a range of NTDs, but even as one of those diseases classified as ‘neglected’, dengue receives little funding or attention.”

The new report will highlight areas where action can be taken to reduce the spread of dengue and control outbreaks when they occur. “Globally there needs to be a shift from responding to isolated outbreaks of dengue on an ad-hoc basis to a focus on developing long-term, integrated programming, including community-level initiatives leading to sustainable behavior change,” Dr. Tibenderana says. “This can be done by empowering communities with the essential knowledge and skills concerning hygiene and environmental sanitation, and training and engaging community health volunteers to better identify and refer suspected dengue cases, and improving community-based disease surveillance.”

Paint a true picture of dengue and predict future outbreaks. Report dengue cases near you to Dengue Track.

Dengue Track

Parana dengue vaccine program ‘an investment’, says Health Chief

Image of Aedes mosquito. The target for the Parana dengue vaccine program in Brazil fighting dengue outbreaks.

The Aedes mosquito is spreading dengue and other diseases, but Brazil is fighting back

The Paraná dengue vaccine program, introduced earlier this year, will pay off by reducing spending on hospital care as well as keeping people in work and protecting the tourist industry. That’s the view of Health Secretary Michele Caputo, the official responsible for running the ground-breaking initiative.

Interview: Michele Caputo Neto, Health Secretary in Paraná, says the prevention plan is designed to protect the population

Are you proud that Paraná is the first Brazilian State to introduce the vaccine?

Yes, we are very proud and we know that Paraná has the technical capacity and appropriate infrastructure to incorporate a new vaccine in the public system. We have one of the best health public systems in this country, and our vaccination campaigns obtain the best coverage. All this gives us the credentials to innovate and go forward in the control of the disease in the State.

Why have you decided to lead the way? Is the burden of dengue higher in your state than all the others in Brazil?

The decision to vaccinate the population is an additional strategy to control dengue in Paraná and will not replace the necessary measures to control the mosquito Aedes aegypti.

We have taken solid initiatives to attend the interests of our population. We have invested R$ 50 million to purchase such doses, but it is important to highlight the direct and indirect losses caused by dengue. We spent more than R$ 330 million dealing with the epidemics – through the mobilization of the State to help the families affected, caring for people in hospitals and purchasing equipment. This is in addition to the indirect impact on the economy: keeping away tourists and also people who stopped working. This is a public health investment we are making to protect our population.

Where will the vaccine be delivered and will it be free to the public?

The vaccine will be free and shall be made available to 500,000 people in 30 municipalities of the State.

How did you decide on the age ranges to target? Are you concerned that the inconsistency will cause confusion or resentment among the general public?

In 28 of the Paraná municipalities that were given priority for the campaign, the population to be vaccinated is in the age range of 15 to 27 years. This age group concentrates about 30% of the dengue cases in Paraná. In the municipalities of Paranaguá and Assai, the vaccine will target the age group between 9 and 44 years, because both municipalities have an incidence greater than 8,000 cases per 100,000 inhabitants.

The selection of the municipalities was based on the disease epidemiology in Paraná. The municipalities that suffered three epidemics or more in the last five periods, between 2010 and 2015 were taken into consideration. Another parameter is the current incidence with a cut above 500 cases/100,000 inhabitants; the number of hospitalizations for serious dengue; the number of dengue cases with hospitalization and age group of the dengue cases during the period from August 2015 to July 2016.

Are there awareness-raising measures or other initiatives planned to ensure high uptake of all doses of the vaccine?

The objective is to vaccinate at least 80% of the target public. At launch, we organized a great event in Paranaguá, where the local population and the press from throughout Brazil participated. We also plan to make a big effort of disclosure via press office throughout the period before we initiate the campaign.

On the vaccination, D-Day, August 13 (Saturday), health units remained open during the whole day. The campaign continued for three weeks, until August 31, in the Basic Health Units of the selected municipalities.

What other major anti-dengue measures are in place in Paraná? Is the vaccine program using funds diverted from other dengue programs or is it ‘new’ money?

The whole Government structure has been mobilized to control the dengue mosquito and several initiatives have been taken to contain the advance of the disease throughout Paraná.

The transfer of funds for the control of the mosquito that spreads dengue has already reached over R$ 120 million, without, however, being able to avoid new disease epidemics. The investments have been used in the temporary hiring of health agents, spraying insecticides, purchase of vehicles, acquisition of PPEs, consumption material, besides other expenses such as training of professionals, payment of fuel, maintenance of the fleet and production of education material.

“…we should obtain a reduction of 93% of serious dengue cases…”

The funds to purchase the vaccines represent an additional investment using the State Treasury’s own funds, which should be added up to the investments already made towards controlling dengue.

How and when will you measure the impact of the dengue vaccine program? Will you look at reported dengue cases, hospitalization or other factors?

This year vaccination should have an effective impact already next summer, since the first dose already provides protection against the disease, thus hopefully minimizing the number and intensity of new epidemics.

According to the studies, we should obtain a reduction of 93% of serious dengue cases, which should cause a reduction of 80% in hospitalizations for dengue. We plan to monitor the number and the seriousness of all confirmed cases in the municipalities where the population received the vaccine.

How do you collect information from the public about dengue cases?

In Brazil, all dengue cases must be notified to the health public authorities. They are notified to SINAN – Sistema de Informação de Agravos de Notificação, which is a national database. Here in Paraná we also have the dengue situation room that monitors the cases of the disease and the current situation in the 399 municipalities in the State on a daily basis.

The professionals working in that room maintain contacts with the municipalities’ technicians and with the health regional staff. With such information at hand, we issue a weekly bulletin with all the cases of dengue grouped by municipalities and health regions.

We also have the State Central Laboratory that uses a pioneering technology in this country, the Multiplex methodology for the simultaneous diagnostic of arbovirosis (viral diseases transmitted by insects). With the use of the Multiplex system, we are able to perform 1,400 tests per week.

 

Zika outbreaks must be tackled in tandem with dengue

As well as causing thousands of serious birth defects, Zika outbreaks threaten to distract us from other public health crises

The Zika virus is spread by the Aedes aegypti mosquito – a bug that is also responsible for spreading dengue fever, yellow fever, and chikungunya. The attention given to Zika is an opportunity to shine a spotlight on the major challenges posed by other vector-borne diseases, and to develop tools that can help us overcome them as a group.

Zika outbreaks have been linked to serious neurological conditions such as microcephaly and Guillain-Barré syndrome and sparked global concern. The symptoms of the disease itself are usually mild but the sudden surge in cases – coupled with distressing images of babies born with smaller than normal heads – have triggered a strong reaction.

The WHO declared a public health emergency in February 2016 in the wake of a significant rise in cases of microcephaly. The White House sought $1.9 in emergency funding to ‘prevent, detect and respond’ to the threat posed by the virus.

Then a degree of panic set in. The outbreak continued to make headlines around the world, athletes began withdrawing from the Rio Olympics due to infection fears, and cases were reported across Latin America and in the US.

With the Ebola epidemic under control, Zika has taken on the role the world’s most feared virus. The worry stems from its novelty, apparently rapid spread, and a visceral reaction to images of birth defects.

All of this is entirely understandable. Similar phenomena have been seen with SARS, H1N1, and Ebola. But what about the major public health challenges that continue in the background?

Infographic comparing the interest vs incidence for zika, dengue, malaria and yellow fever in recent years.

Interest vs incidence: Zika, dengue, malaria, yellow fever

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Permanent emergency

There were 214 million malaria cases last year, which normally kills around 30,000 people per year but the figure may be higher this year due to outbreaks in Angola and the Democratic Republic of Congo.

Dengue fever is of particular interest given its geographic spread, public health impact and capacity for disrupting health systems. It causes fever, headache, vomiting, joint pain and a skin rash, and has been linked to pregnancy risks. Spread by the same mosquito responsible for the Zika outbreak, it is the fastest-growing mosquito-borne viral infection in the world today.

In the 1970s, fewer than 10 countries reported severe dengue epidemics. Today, dengue is present in over 150 countries.

The rise in cases numbers may not be quite as dramatic as Zika, but take a step back and the growth in cases is steady and steep.

Around 40% of the world’s population live in countries where dengue is a daily risk. There are between 50 million and 400 million infections per year. A study of 10 countries in Latin America and South East Asia shows the disease is responsible for 10% of all fever episodes.

Like Zika, many cases are mild or not recorded, but it is estimated that around half a million hospitalizations result from dengue infections annually. The disease causes an estimated 20,000 deaths per annum. The economic toll of dengue fever and its impact on health systems are enormous. The total annual cost of dengue has been put at $8 billion. Hospital care of non-fatal cases accounts for half of this.

The burden of dengue on families in Latin America, Asia, and Africa can also be profound. The emotional and economic cost of losing a family member is devastating. Even non-fatal cases that require hospital treatment can cost $70 in countries where this can be the weekly income.

Add to this the lost productivity associated with missing work or education for several days or weeks and the costs quickly mount.

Dengue outbreaks have indirect effects on other health service users. Health system capacity can adapt to meet a predictable demand for malaria or diabetes care. But dengue outbreaks are sporadic, unpredictable and highly disruptive.

In this respect, the disease can be likened to the Ebola epidemic which put enormous and unexpected pressure on clinics, health workers, and laboratory infrastructure. The true public health value of controlling dengue would have system-wide positive effects.

So what can be done to stop ZIka and other vector-borne diseases?

To start with, most cases of dengue and Zika infection are not diagnosed today. Better diagnostics and disease surveillance data are required to get a handle on the true scale of the challenge – and to measure the real-world impact of preventative measures such as vector control and immunization.

To tackle this, our team at Break Dengue has launched an innovative initiative that turns big data into actionable information. ‘Dengue Track’ is a crowdsourced disease surveillance tool. Through a user-friendly online chat system, we are mapping dengue cases worldwide and giving the public free access to toolkits that help reduce their risk of infection.

By pairing this information with official data sources, a more comprehensive picture of real-time dengue outbreaks can be built. This will provide authorities and non-governmental organizations with a valuable resource on which they can make informed decisions.

In parallel, vector control, vaccination, rapid diagnostics and effective treatment for severe cases can combine to turn the tide against dengue. Zika is a serious public health challenge about which much can be learned by studying other vector-borne illnesses. By tracking the epidemiology of all of these diseases, it is clear that there is a real risk that Zika will reach regions where mosquito control has failed.

We should not view it as straight competition between dengue, chikungunya, yellow fever and Zika. There are, in fact, huge synergies in the global effort to tackle these arboviruses and other vector-borne diseases. Innovation mosquito control measures could help to curb the number of vectors while research on new treatments for one disease may turn up leads in the fight against the other.

Our Dengue Track tool can be used to map Zika – or malaria, yellow fever, chikungunya and others – just as we are doing for dengue fever.

Investment and attention are required to harness the power of the tools we have – and develop new ones – in an integrated approach to breaking dengue and other vector-borne diseases. We can do this if we do it together.

Click below to report dengue outbreaks near you using Dengue Track 

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Mosquito-borne diseases: experts unite to fight dengue and Zika

Image of the Aedes moqsuito. Public health organizations are uniting to stop the disease it spreads.

Integrating vector control and vaccination key to beating viruses spread by Aedes mosquitoes

Public health organizations are uniting in a stance against the world’s deadliest creature. Four leading institutions working on dengue prevention and control have joined forces to take on one of the world’s most dangerous creatures – the dreaded Aedes mosquito.

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The International Vaccine Institute (IVI), the International Vaccine Access Center (IVAC) at the Johns Hopkins University, the Partnership for Dengue Control Foundation (PDC) and the Sabin Vaccine Institute have announced a new global alliance.

Their mission: to integrate approaches to fighting dengue and other diseases spread by the Aedes mosquito, including Zika, chikungunya, and yellow fever. Named the Global Dengue and Aedes-transmitted Diseases Consortium (GDAC), is designed to improve coordination of the currently fragmented efforts to control mosquito-borne illnesses.

Uniting fragmented leadership

“Dengue has emerged as one of the most important infectious diseases over the past 40 years, today infecting 400 million people worldwide each year in over 100 countries,” said Dr. In-Kyu Yoon, Deputy Director General of Science at the International Vaccine Institute and now Director of GDAC. “Efforts to reverse this trend have fallen short for many reasons, but limited funding, lack of effective tools, and fragmented leadership have been among the most important.”

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The rapid spread of Zika and chikungunya have proven to be a timely reminder that Aedes-transmitted diseases will continue to spread as irreversible global trends such as population growth, urbanization and globalization continue to provide the ideal conditions to promote the spread of these diseases.

“We need a global, unified strategy to prevent and control known and as yet unknown Aedes-transmitted diseases,” Dr. Yoon said.

New tools

While dengue and other mosquito-borne illnesses pose a serious public health risk, there are reasons to be optimistic. New tools are emerging fast, including the first dengue vaccine, new innovations in dengue control and advances in diagnostics. One of the goals of GDAC will be to devise an integrated approach that gets the most out of new technologies.

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“We propose to provide the leadership for integrated program implementation under one umbrella, working closely with the WHO and international funders, to reverse the trend of expanding epidemic dengue and other Aedes-transmitted viruses as public health problems,” said Prof. Duane J Gubler, Chairperson of GDAC and Prof. Emeritus of the Program in Emerging Infectious Diseases, Duke-NUS Medical School.

“While much has been achieved in the past decade in developing new tools, it is unlikely that any of these new tools will be successful in controlling these diseases when used alone,” Prof Gubler said.

Dengue prevention funding: €10,000 prize

New prize for initiatives to combat dengue fever

Dengue prevention funding is key to controlling outbreaks, and discovering innovative solutions to meet today’s public health challenges.  image of an Aedes mosquito

Do you have an initiative or campaign that could help to combat dengue fever in your community through behavioural change?

We are looking for pilot initiatives or simply ideas to design and test new approaches to integrating a dengue vaccine as part of a holistic plan to combat dengue. These ideas or initiatives should ideally identify, understand and address community-level drivers and barriers for dengue vaccine integration, its sustained uptake and/or compliance.

Perhaps you are an expert in vector control, prevention, surveillance, or other relevant fields. You might be a healthcare professional in a country impacted by dengue. Or perhaps an active member of a community involved in the fight against dengue.

The Break Dengue Community Action Prize offers €10,000 for projects that maximise the impact of public health interventions by integrating the new vaccine into the anti-dengue arsenal.

Image of health care professional for dengue prevention funding promo.

The winning project should:

  • Have SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound)
  • Show scalability potential
  • Demonstrate potential sustainability
  • Arise from understanding and insights to community’s needs, drivers, barriers, priorities and strengths
  • Consider monitoring & ongoing evaluation

Why we need you

Dengue causes nearly 400 million infections annually, impacting half of the world’s population. It is an enormous public health challenge that demands a collective effort.

“The Break Dengue Prize is our way to shine a light on the work of communities, and directly support and nurture their promising ideas and solutions, so that they can become a reality,” said. Nicholas Brooke, Executive Director of The Synergist.

To enter, simply fill out the form and tell us more about your work. You can check the terms and conditions here. Contact us if you have any questions. 

 

 

 

 

Dengue vaccine launch in Mexico

Image of dengue patrol. prevention gets a boost with the dengue vaccine launch in Mexico.

Dengue prevention gets a boost as the dengue vaccine becomes available in Mexico.

The dengue vaccine launch in Mexico could be the missing link to successfully combating the dengue virus in the country home to over 122 million people. Doctors in Mexico’s private clinics are offering vaccination against dengue fever. The country is among nine other countries to approve the dengue vaccine. The vaccine’s most recent registrations come from Paraguay, Peru, Indonesia and Guatemala.

The vaccine has been recommended by a WHO expert group for people living in areas with a high burden of dengue fever, prompting national experts in several Latin American and Asia countries to consider its introduction for people aged 9 to 45. In Mexico, 90% of dengue cases in Mexico are in people aged nine years and older.

The Brazilian state of Parána has introduced an active public vaccination campaign in recent weeks, private clinics in El Salvador are now offering the jab, and Paraguay has also recently approved the vaccine for use.

In Mexico, a public vaccination program may be in the offing as the national vaccination council – CONAVA – has recommended introducing the vaccine in endemic areas. Data from 2013 show that 231,400 suspected dengue cases were reported. This led to 34,100 reported hospitalizations at an average cost of $ $1,327 (USD) each.

Click here to learn more about the costs of dengue

Doctors in Mexico have welcomed the advent of the dengue vaccination era in their country. “Dengue is a major public health risk in parts of Mexico with no specific treatment available to healthcare professionals to manage outcomes with this disease,” says Dr. José Ramos Castañeda, Professor of Virology and Researcher at the Center for Population Health Research of the National Institute of Public Health (INSP).

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He said the disease remains a serious threat to public health in the central American nation.  “The Mexican medical community welcomes the ability to vaccinate people against dengue with the first clinical preventive tool for this often debilitating disease which continues to be a growing health issue in our country,” he said.