A

Seminar Report
On
Dengue Fever, an emerging
public health problem in Nepal

By
Bijay Dhital


DEPARTMENT OF PUBLIC HEALTH
National Open College. Sanepa, Lalitpur
Date- July 28

ACKNOWLEDGEMENT












Title Page

Abstract
1. Introduction
1.1 Background
1.2 Statement of Problem
2. Rationale

3. Objective

4. Findings

5. Prevention

6. Recommendation

7. Conclusion

8. References


Abstract

Dengue is an acute infectious disease caused by dengue viruses and transmitted by
the Aedes species of mosquito. The rapid global spread of the dengue virus into
new areas has begun to attract more research attention. A series of dengue fever
outbreaks in several districts of Nepal has been recently observed. The evidence of
all four serotypes (DEN 1 - 4) could be a consequence of a sudden resurgence of
a more severe dengue disease in Nepal. Health care providers need to become
familiar with the disease to prevent or control the possibility of future outbreaks.
The clinical features, diagnosis, treatment, epidemiological patterns and challenges
of dengue virus infection in Nepal will be discussed here.











1. Introduction

1.1 Background
Dengue is an acute infectious disease caused by dengue viruses and
transmitted by the Aedes species of mosquito. Dengue virus (DENV) is a
mosquito-borne single stranded RNA virus that belongs to the genus Flavivirus,
family Flaviviridae. The evidence of all four serotypes (DEN 1 - 4) could be a
consequence of a sudden resurgence of a more severe dengue disease in
Nepal. [1]

Dengue virus (DENV) is a mosquito-borne single stranded RNA virus that
belongs to the genus Flavivirus, family Flaviviridae. It has four serotypes, DEN-
1, DEN-2, DEN-3 and DEN-4, which are capable of causing dengue fever (DF).
Over the past several years, dengue epidemics have been increasing
remarkably, and have become a major public health problem, particularly in
tropical and sub-tropical countries. The World Health Organization (WHO) has
currently estimated that there may be 50 million dengue infections occurring
each year in the world, and this endemic appears in more than a total of a 100
countries. [2] In Nepal, a dengue case was _ rst reported in 2004.4 Since then,
DF has been found to be spreading rapidly across the country within a short
period of time.5,6,7 Although DENV infection is one of the emerging diseases
in Nepal, healthcare providers are sometimes found to have incomplete
knowledge of the disease. This review will discuss the clinical features,
diagnosis, treatment, epidemiological patterns and challenges of DENV
infection in Nepal.

Dengue, a mosquito-borne disease emerged in Nepal in the form of Dengue
Fever (DF), Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome
(DSS). The earliest cases were detected as early as 2005. The sporadic cases
continued and outbreaks occurred in 2006 and 2010. Initially most of the
reported cases had travel history to neighboring country (India), however
lately indigenous cases were also reported. [1]



Causes of Dengue

The dengue virus is transmitted by a bite from the Aedes aegypti and Aedes
albopictus mosquito. Only the female mosquito transmits the dengue virus.
This mosquito is a daytime biter, both inside and outside homes, and is
most active in the hours after sunrise and before sunset.
Dengue fever is transmitted by the bite of an Aedes mosquito infected with
a dengue virus. The mosquito becomes infected when it bites a person with
dengue virus in their blood. It cant be spread directly from one person to
another person.

Symptoms of Dengue
Sudden onset of high fever, pain behind the eyes, headache, backache,
joint and muscle pains.
The severity of the joint pains has led it to be named break bone fever.
It is often accompanied by a rash that looks like a red flush on the chest
and abdomen.
Fever returns to normal within a week, but may leave a person feeling tired
and slightly depressed for a few weeks afterwards.












1.2 Statement of Problem
The World Health Organization (WHO) has currently estimated that there may
be 50 million dengue infections occurring each year in the world, and this
endemic appears in more than a total of a 100 countries, in Africa, the
Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific.
[2].
Dengue is the most widespread vector borne virus disease in the world, and
DHF are rapidly increasing in incidence in many tropical areas. Dengue
hemorrhagic fever is a leading cause of serious illness and death among
children in some Asian countries. The disease is now endemic in over 100
countries. Approximately half-a-million people with DHF are hospitalized each
year, of which many are children. About 2.5% of these patients die. [3]


Dengue Fever in Nepal
Although DENV infections have been found in our neighboring country India
over a long period of time, there was no documented dengue case in Nepal
prior to 2004. 1
st
case of DF was reported in 2004 fron Chitwan district.
Dengue outbreak was first reported in 2006 with 32 confirmed cases (among
the total cases identified,94 percent were adults; male to female ratio was
4:1), followed by 27 cases in 2007, 10 cases in 2008, 30 cases in 2009.The
outbreak of 2006 was observed in 9 district of terai including Banke, Dang and
parsa. [1]
It is plausible to assume that DENV could have been introduced into Nepal
from India, due to the open border between the two countries. This
hypothesis is further supported with the _ nding of nucleotide sequences of
the Nepalese dengue strain that have been described to be very similar to the
dengue strains circulating in India. During the 2006 outbreaks, all four dengue
serotypes were found to be circulating in Nepal.6 It is clear that subsequent
infection with different strains may lead to a more severe disease among the
patients. Taken together, a sudden resurge of severe dengue disease can be,
therefore, assumed to occur in the near future [2]
Nepal experienced major outbreak of D.F in several district in 2010 particularly
in Chitwan and Rupendehi district with 917 cases and 5 reported cases. [1] A
total of 264 DF cases from across the country were admitted to Sukraraj
Tropical and Infectious Disease Hospital (STIDH), Kathmandu, between July
and December.

[2]






2. Rationale
Is an emerging disease in nepal.
Rapidly spreading into new areas across the country.

3. Objective
General
To know about the Dengue as an emerging public health problem.
Specific
To know about the Dengue cases and its situation at different time.
To understand the nature of Dengue occurrence in the country.












4. Findings

1
st
case of DF was reported in 2004 fron Chitwan district. Dengue outbreak
was first reported in 2006 with 32 confirmed cases. 917 cases in 2010 with
major outbreak in Chitwan and Rupandehi districts with five reported
deaths. During 2011, 79 confirmed cases were reported from 15 districts.
Aedes aegipti (mosquito-vector) has been identified in 5 peri-urban area of
terai region (Kailali, Dang,Chitwan, Parsa and Jhapa) during entomological
surveillance conducted by EDCD during the year 2006-2010, indicating local
transmission of dengue. [1]
Studies carried out in the year 2006 by EDCD showed all 4 sub-types (DEN-
1, DEN-2, DEN-3 and DEN-4) of Dengue virus circulation in Nepal. In 2012, a
total of 183 confirmed dengue cases were reported. [1] More than forty
percent (n=77) of these cases were from Jhapa district alone. During the FY
2069/70 total number of dengue case reported from 11 district were 184.

Year wise dengue morbidity
Source- EDCD/DoHS

5. Prevention

Currently, there are no vaccines to protect against the dengue virus and
people are advised instead to take sensible precautions to decrease the
likelihood of being bitten by the mosquito. [5]
Vector control-
The vectors of DF and DHF (e.g. A aegypti) bread in and around houses
and, in principal can be controlled by individual and community action,
using anti-adult and anti-larval measures. [4]
Personal protection and the environmental management of mosquitoes
are important in preventing illness.
increase Awareness
Prevention of mosquito bite

6. Recommendation

Increase orientation and training to doctors, health workers about
dengue and its preventive measures.
Strategy development and planning workshop must be done.
Advocacy meetings about dengue.
Increment in district and regional budget.
Active community participation for vector control program.






7. Conclusion
Dengue infection is a relatively new disease in Nepal, hence much is not
known about its frequency among the local population. To bridge this
knowledge gap, health care providers must improve their clinical knowledge
about dengue and DHF/DSS as well as be familiar with the geographical
distribution of DENV in order to enhance their ability to adequately respond to
a sudden and unexpected surge of patients due to DENV infection.[2]

While safe, effective and affordable vaccine for DENV is anticipated,
preventive measures that require an effective elimination of vectors and their
breeding sites remain the only options to interrupt or control DENV
transmission. The majority of the people are poorly educated; hence they
know little about newly emerging diseases. Therefore, without involving local
communities in the planning and implementation of vector control programs
and health education, DENV transmission cannot be successfully controlled.
Hence, effective educational campaigns and community based vector control
program must be done.[5]
Dengue virus infection has now increasingly becoming an emerging disease in
Nepal. Current outbreaks of dengue fever in several districts underscore the
need for urgent and comprehensive DENV surveillance in order to identify the
current status of the disease burden and the high risk areas to be targeted for
immediate implementation of preventive measures.

Although DENV infection is a relatively new disease in Nepal, the time has
come to recognize it as a major public health problem. Therefore, the state
and stakeholders should come up with a campaign to promote public
awareness so as to prevent or respond to possible outbreaks of DENV in the
future. [5]





8. Bibliograpy

Annual report (069/70)
J Nepal Med Assoc 2011;51(184):203-8
Oxfordjournal.org.
K. PARK
World Health Organization. Dengue: Guidelines for diagnosis, treatment,
prevention, and control. New Ed.2009,Geneva, World Health
Organization, 2009.