Dengue

Overview of Dengue Prevention and

Control

Arvin Maceda
CDW for Health and WASH
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Outline
I. Symptoms, Agent and Vector
II. Epidemiology
III. Vaccine Update
IV. Alternative Prevention and Control Measures for
Dengue
V. Recommendations

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 Symptoms, Agent and Vector

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 SYMPTOMS
Individuals should suspect dengue when a high fever (40°C/
104°F) is accompanied by two of the following symptoms:
• Severe headache
• Pain behind the eyes
• Nausea,Vomiting
• Swollen glands
• Muscle and joint pains
• Rash
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 DENGUE
• Mosquito-borne viral disease
• Caused by a virus (genus Flavivirus, family
Flaviviridae)
• It comprises four distinct serotypes
(DEN-1, DEN-2, DEN-3, DEN-4)

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 SYMPTOMS
• An infected person develops severe flu-like
symptoms.
• This is also called ‘break-bone’ fever
• This affects infants, children and adults alike could
be fatal
• There is no specific treatment for dengue fever

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 MOSQUITO
• Aedes aegypti
• Prefer to bite indoors and primarily
bite humans
• They lay eggs during the day in water
containing material or in container
with wide opening and prefer dark
colored containers in the shade
• Life span is 3 weeks
• Do not remain alive through the
winter in the egg stage in colder
climates

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 MOSQUITO
• Extremely common in areas lacking
piped water systems, and depend
greatly on water storage containers to
lay their eggs.
• Male and female adults feed on nectar
of plants
• Female mosquitoes need blood in
order to produce eggs
• Female mosquitoes are active during
daytime
• Bites primarily during the day but it can
bite at night in well lit areas

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 MOSQUITO
• Bites primarily during
the day but it can bite at
night in well lit areas

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 Epidemiology

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11
 Vaccine Update

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Vaccine
Administered in three shots. (0,6,12 mos)
Indicated for use to children and adults from 9
to 45 years old for the prevention of severe
dengue

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In late 2015 and early 2016, the first dengue
vaccine, Dengvaxia (CYD-TDV) by Sanofi
Pasteur, was registered in several countries for
use in individuals 9-45 years of age living in
endemic areas

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Vaccine
• Tetravalent soliciting – L-Arginine hydrochloride
immunity from four – Sucrose
distinct serotypes – D-Trehalose dihydrate
• Contains live-attenuated – D-sorbitol
form of the virus – Trometamol
• Also contains: – Urea
– Essential amino acids – Sodium chloride
including L-Phenylalanine – Water
– Non-essential amino acids

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Contraindications and
Precautions
Dengue tetravalent vaccine is not recommended for the following
individuals:
• Children less than 9 years of age and adults above 45 years of age.
• Anyone who is allergic or has had an allergic reaction to a prior
dose or to any component of the vaccine
• Immunocompromized individuals, due but not limited to genetic
defects, HIV infection, or therapies that affect the immune system
such as high-dose corticosteroids
• Pregnant or breastfeeding women
• Recipients of blood products for the last three months

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Contraindications and
Precautions
• Vaccination shall be deferred to a patient suffering from febrile illnesses,
cough, rashes and severe headache until the patient is well.
• Vaccination shall be postponed to a patient that is taking
immunosuppressive treatment like prednisone or equivalent until 4 weeks
after the treatment.
• Women of child bearing age, shall take necessary precautions to avoid
pregnancy for 1 month following administration of the Dengue vaccine.
• Dengue vaccines should not be co-administered with other vaccines.
• Children who received other vaccines should temporarily defer
vaccination until after 4 weeks.

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Adverse Events
• Fainting due to fear of injection
• Rare occurrence of anaphylactic shock

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Target and Administration
All eligible patients shall be vaccinated with the live
attenuated vaccine, 0.5 ml subcutaneous at the left
deltoid arm following the recommended vaccination
schedule:
• First dose: at the time of visit with the health worker
at age 9 years old and older
• Second dose: at least 6 months after the first dose
• Third dose: at least 6 months after the second dose
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Target and Administration
DOH noted that health workers must ensure
that those who received the Dengue vaccine 1st
dose shall be given the 2nd dose of Dengue
vaccine after 6 months and the 3rd dose of
Dengue vaccine 6 months after the second dose.

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Vaccine Evaluation
• Primary efficacy of the vaccine against dengue
(59.2%)
• Vaccine efficacy was higher against serotype 3
and 4
• Pooled vaccine efficacy (79.1%)

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The report concluded that there is a cumulative
benefit of the vaccine against hospitalized and
severe dengue.
There is evidence that the vaccine prevents the
occurrence of severe and lethal symptoms of
dengue but the vaccine cannot fully prevent
transmission but it can however prevent
lethal symptoms from occurring.
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 CDP Number of SC Cost PHP Cost USD
Aguinaldo Community Development Project 546 1856400 43172.09
Diaz Community Development Project 624 2121600 49339.53
Gigmoto CDP 933 3172200 73772.09
Guiuan Central CDP 333 1132200 26330.23
Guiuan North Community Development Project 449 1526600 35502.33
Guiuan South Community Development Project 317 1077800 25065.12
Kilagding Community Development Project 280 952000 22139.53
Longanapan Community Development Project 330 1122000 26093.02
Prieto Community Development Project 656 2230400 51869.77
Pugad-Tibaguin Community Development Project 416 1414400 32893.02
Sagrada Familia Community Development Project 439 1492600 34711.63
San-Isidro Community Development Project 1077 3661800 85158.14
Southville CDP 814 2767600 64362.79
Tingloy Community Development Project 782 2658800 61832.56
Total 7996 27186400 632241.9

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If GNI would distribute the vaccines to the staff
it would cost PHP 333,200 or USD 7,748.83
excluding doctor and nurse honoraria and
expenses for logistics.

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 Alternative Prevention and Control
Measures

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 Prevention and Control
• preventing mosquitoes from accessing egg-laying
habitats by environmental management and
modification;
• disposing of solid waste properly and removing artificial
man-made habitats;
• covering, emptying and cleaning of domestic water
storage containers on a weekly basis;
• applying appropriate insecticides to water storage
outdoor containers;
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 Prevention and Control
• using of personal household protection such as window
screens, long-sleeved clothes, insecticide treated materials,
coils and vaporizers;
• improving community participation and mobilization for
sustained vector control;
• applying insecticides as space spraying during outbreaks as
one of the emergency vector-control measures;
• active monitoring and surveillance of vectors should be
carried out to determine effectiveness of control
interventions.
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 OVITRAP
Effective in reducing the
population of mosquitoes and
killing 98% of the mosquito eggs
laid.

Safe and very cost effective

10 – 45 PHP per trap

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 Recommendations

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 Recommendations
1. Consider alternative and more cost-effective
measures to prevent dengue in the community.
Distribution to sponsored children might not be
the best option, for now.

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 Recommendations
2. If one of the CDPs has an expressed and
perceived need to strengthen the prevention
and control of dengue in their area further
investigation is needed to ascertain if
distribution of vaccine is warranted.

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 Recommendations
For a CDP to be considered as a priority area for
distribution of vaccines to children the following
conditions must be met:
1. High prevalence of fully immunized children
2. High reception to immunization
3. Existing vector control measures
4. High incidence rate of dengue
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 Recommendations
3. Staff vaccination is beneficial to the
organization and to the staff if ever GNI would
consider this but couple this with health
education activities to increase effectively of the
intervention

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