Vector-borne

disease management Health

2012
programmes
A guide for managers and supervisors
in the oil and gas industry
The global oil and gas industry association for environmental and social issues

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International Association of Oil & Gas Producers

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OGP Report Number 481

© OGP/IPIECA 2012 All rights reserved.

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Vector-borne
disease management
programmes
A guide for managers and supervisors
in the oil and gas industry

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US Centers for Disease Control and Prevention; page 3 (inset): Wikimedia Commons—US Centers for Disease
Control and Prevention/Dr Myron G. Schultz; page 4: BP; page 6: ©Asianet-Pakistan/Shutterstock.com;
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(licensed under a Creative Commons Generic Licence).
 IPIECA • OGP VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Contents

Purpose of this guide 1 Management and prevention 13

Primary management—vector control 13
Introduction 1
Elimination of breeding sites 13
Use of larvicide or insecticide 13
Vector-borne diseases 2
Secondary management 15
Definitions 2
Education 15
Human, business and financial impact 2
Avoidance 15
Clothing and behaviour 16
Key factors to promote success:
Repellants 16
the role of senior management 5
Room precautions 17
Benefits of a vector-borne disease Immunization 17
management programme (VBDMP) 6
Chemoprophylaxis 17
When to develop and implement a VBDMP 6 Malaria management in the local workforce
and community 18
Integrating a VBDMP with other impact
assessment and outreach programmes 6 Returning travellers 19
Point of care (POC) testing 19
National and international stakeholder
consultation 7 Standby treatment 20

Putting it all together: Appendix 1:

the VBDMP process 8 Understanding the need for
chemoprophylaxis 21
Screening 8
Scoping 8 Appendix 2:
Planning, including resourcing, cost and Some specific vector-borne diseases 23
time management 9 Malaria 23
Stakeholder consultation 9 Yellow fever 24
Risk assessment 10 Dengue 25
Decision making 11 Japanese encephalitis 26
Mitigation 11 American trypanosomiasis (Chagas disease) 27
Implementation and monitoring 11 Human African trypanosomiasis (HAT) 29
Implementation 11 Tick-borne encephalitis 30
Monitoring 12
Rickettsial infections 31
Evaluation 12
Leishmaniasis 32

Appendix 3:
Neglected tropical diseases 33

Glossary 34

References and further reading 37

ii

Purpose of this guide
This guide is aimed at health, safety and
environment practitioners, as well as medical
personnel and health risks managers working for
the oil and gas industry. It is especially relevant for
managers and supervisors located in, or
responsible for, personnel working in areas where
vector-borne diseases (VBDs) are endemic. It
outlines the importance of vector-borne diseases,
including malaria, and their potential impact on
operations, and provides guidance on the design
of appropriate vector-borne disease management
programmes (VBDMPs).
This document is not intended to be a textbook of
VBDs or tropical medicine; rather, it describes the
importance and rationale underpinning the
development of a VBDMP. While the broad
principles described apply to many vector-borne
diseases, examples of more specific requirements of
particular diseases are covered in the Appendices.
Significant emphasis is placed on malaria because
of its substantial impact, but this does not detract
Introduction
The oil and gas industry is committed to
safeguarding the health of its workforce as well as
improving health standards in host countries. The
potential impact of VBDs is high because of the
complex interaction between biological,
geographical, social and political factors.
Regardless of geographical location, the industry
operates in an atmosphere of heightened
expectations, particularly with regard to its health,
social and environmental practices. Vector-borne
diseases can present a major health management
problem that can transcend traditional company
health support systems, placing significant pressure
on an organization’s health, safety and
environmental (HSE) management resources. The
effective control of vector-borne diseases is
therefore a potential concern throughout the range
of oil and gas industry activities.
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
The importance of
vector-borne
diseases and their
potential impact on
oil and gas industry
operations should
not be
underestimated.
from the importance of other VBDs, and the
principles outlined in this document may be
adapted for other conditions where appropriate.
The following support material is available:
● Primary prevention of transmissible vector-
borne diseases:
www.iogp.org/pubs/382/Appendix_B.pdf
● Example malaria case investigation form:
www.iogp.org/pubs/382/Appendix_E.pdf
● Sample implementation checklist to assist with
a company malaria control programme:
www.iogp.org/pubs/382/Appendix_D.xls
This guide attempts to build on successful industry
practices. Experience at both the international
health level, and within the private sector,
indicates that vector-borne disease management is
both complex and difficult. There is no unique set
of strategies or programmes that will work in all
situations or geographical locations. However,
there are some reasonably well-understood
principles that can be utilized in virtually all
situations that are likely to be encountered by the
oil and gas industry. This document presents and
analyses these principles, and illustrates how they
can be applied systematically within the context of
worldwide oil and gas operations. Links are
provided to additional resources on the internet
for readers who require greater scientific
explanation and technical back-up, and a
glossary is also included.
1
 IPIECA • OGP

Vector-borne diseases

Definitions The US Centers for Disease Control and Prevention

Vector-borne diseases are those that involve the
interaction of a disease-causing agent (e.g.
bacteria, virus, protozoan or fungus), a vector and
a host. A vector is defined as an organism that
carries and transfers a microorganism from one
host to another. The two hosts may be of the same
species (e.g. human-to-human transmission of
malaria by mosquito) or different species (e.g. from
bird to human via mosquito, as with Japanese
encephalitis). Different diseases may have a very
limited, or very broad range of hosts. The range of
vectors for disease is vast, and includes mosquitoes,
flies, mites, ticks, fleas and reduviid bugs (see
Table 1). This guide does not attempt to provide a
comprehensive or in-depth account of the topic of
vector biology; instead, the objective is to address
those conditions that are most common and/or
have potential for greatest impact in the oil and
gas industry.
(CDC) provides additional information on a range
of vector-borne diseases at:
www.cdc.gov/ncezid/dvbd/about.html
Human, business and financial impact
VBDs are considered to be amongst the most
complex of all infectious diseases in terms of their
prevention and control. They are also some of the
world’s most damaging diseases, due not only to
their effect on the individual, but also because of
their impact on the population as a whole. Some
diseases also have significant effects on cattle and
agriculture, which may lead to poverty,
malnutrition and ill health.
These diseases are the most common infections of
the poorest billion people in the world—those living
on the equivalent of US$1.25 or less per day—and

Table 1 Vectors and associated diseases

Vector Disease
Mosquito Malaria; yellow fever; dengue; chikungunya;
Japanese encephalitis; filariasis; West Nile
virus; and many others

Sand fly Leishmaniasis

Black fly Onchocerciasis (river blindness)

Tse-tse fly African trypanosomiasis (sleeping sickness)

Triatomine bugs American trypanosomiasis (Chagas disease)

Soft ticks Tick-borne relapsing fever

Hard ticks Tick-borne encephalitis; Congo-Crimean

haemorrhagic fever; African tick bite fever;
Q fever; and many others

Fleas Murine typhus; plague

Lice Louse-borne epidemic typhus and epidemic Triatoma infestans, a type of reduviid bug, is well
relapsing fever adapted to living with humans, and is considered an
important vector of the Chagas disease parasite. It is
Mites Scrub typhus
commonly known as the ‘assassin bug’.

2
 VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Table 2 Impact of selected VBDs

Disease Disability adjusted life years (DALYS) Annual incidence (millions) Annual deaths
Malaria 39 million 243 800,000

Yellow fever 18-842,000 0.2 30,000

Dengue 700,000 50 19,000

Japanese
107-755,000 0.05 10,000
encephalitis

Leishmaniasis 2.1 million 12 51,000

Human African
trypanosomiasis 1.5 million <0.1 48,000
(HAT)

Chagas disease 700,000 8-9 15,000

Modified from Hotez et al. with additions from the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC).

cause chronic, debilitating, disabling and A lymph node smear

disfiguring effects. This serves to exacerbate shows the presence
poverty and destabilize communities through the of the parasite
inability to work productively or to care for the Trypanosoma cruzi,
young and old. The long-term and elevated costs of which is transmitted

treatment can equal, or exceed, a family’s yearly to animals and

people by vectors,
earnings. Almost every one of the ‘poorest billion’
and is a recognized
will have at least one VBD, and often more than
cause of Chagas
one. The economic burden of these diseases can be
disease—an illness
assessed by adding the direct costs of expenditure responsible for some
on prevention and treatment to the indirect costs of 750,000 working
productive labour time lost because of the days lost per year
morbidity and mortality of VBDs. due to premature
deaths in South
In 2008, there were an estimated 243 million America.

malaria cases with 863,000 deaths globally; 89%

of the reported deaths were in Africa. The annual
economic costs of malaria in Africa because of lost
production have been estimated to be about same condition and, in Brazil alone, absenteeism
US$12 billion. Indeed, a recent review has due to Chagas disease is estimated to cost
indicated that global deaths from malaria may US$5.6 million per year. Dengue fever in India
have been significantly underestimated, and well in accounts for a loss of US$29.3 million annually,
excess of the previously accepted values. while, according to one estimate, the economy in
India loses almost US$1 billion annually as a
In South America, some 750,000 working days result of reduced agricultural productivity caused
per year are lost due to premature deaths caused by the side effects of chronic and disabling
by Chagas disease. Approximately US$1.2 billion diseases in general. Lymphatic filariasis, a
per year is lost in productivity in the seven chronic, disabling condition affecting some 120
southernmost countries in Latin America due to the million people in the developing world, is

3
 IPIECA • OGP
Many oil and gas
operations take
place in areas
where VBDs are
endemic, such as
the Casanare
foothills in
Colombia (right),
presenting a risk for
local employees
and expatriates.
responsible for almost US$1.3 billion in lost
productivity every year.
With the exception of malaria, VBDs command
only a small portion of the global investment in
research and development. While approximately
US$2.2 billion are spent in research and
development for the ‘big three’ infectious diseases
(HIV/AIDS; tuberculosis; and malaria), only
US$840 million have been invested in research
and support of the remaining infectious diseases,
including the vector-borne ones.
It is easy to understand that interventions to control
vector-borne diseases promise large economic pay-
offs in productivity and educational benefits outside
the health sector, and hence are an investment
towards human capital and poverty reduction.
The oil and gas industry is not excluded from the
impact of vector-borne diseases. Not only do many
oil and gas operations take place in areas where
VBDs are endemic, presenting a risk for both local
employees and expatriates, but there is also a huge
number of employees being mobilized from the
4
affected areas and assigned to work overseas—
taking local endemic diseases with them. In
addition, climate change has been suggested as a
factor in the change of distribution of some of these
diseases. The yellow fever mosquito, Aedes aegypti
has reestablished itself in parts of the Americas
where it had been presumed to have been
eradicated; the Asian tiger mosquito, Aedes
albopictus, was introduced into the Americas in the
1980s and has spread to Central and South
America; and the blacklegged tick, Ixodes
scapularis, an important transmitter of Lyme
disease and other pathogens, has gradually
expanded its range in parts of eastern and central
North America.
It has been shown that the best strategy to tackle
and control vector-borne diseases is through
‘integrated vector management’—an approach
that reinforces the linkages between health and
the environment, optimizing the benefits to both.
Through this approach, the public and private
sectors have a joint interest in working together
to control or manage the diseases in a cost-
effective way.
 VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Key factors to promote success:

the role of senior management

For industry, one of the most important insights in Use of fogging at

vector-borne disease management is simply
recognizing that these diseases are a key
business issue that cuts across multiple staff and
line functions. Because vector-borne disease
management potentially requires a large effort, it
is essential that senior management play a
prominent leadership role. While the
development of an effective VBDMP is a highly
technical undertaking, the articulation of a
‘vision’ involving the importance of vector-borne
diseases and their control becomes one of the
most important first steps. VBDMPs are
multidimensional, affecting numerous
stakeholders both inside and outside the
company. The impact of these programmes,
either positive or negative, is potentially visible at
the in-country staff level and even at national
and international levels. VBDs can also have an
impact on sustainable development efforts and
on company reputation. Hence, VBDMPs offer a
significant opportunity for a ‘win-win’ scenario
for the company and the host country: an
effective programme can significantly enhance
operating efficiency and reputation while
providing a clear positive benefit for the host
country at multiple levels.
sunset to control
dengue: many
vector-borne
diseases demonstrate
remarkable
resilience in human
populations despite
enormous efforts to
eradicate it.
VBDMPs are multidisciplinary, integrated efforts
that combine expertise and strategies in human
and vector biology, environmental management,
clinical medicine and community-level interactions
to protect people from disease. The long history of
efforts to manage, for example, malaria, illustrates
that this disease demonstrates remarkable resilience
in human populations despite enormous efforts to
eradicate it, and this picture is mirrored by some
other vector-borne diseases. In order to develop
and implement an effective VBDMP, it is necessary
to construct a basic scientific framework that

Table 3 Features of a vector-borne disease management programme

• Protecting the health of the workforce

• Demonstrating the commitment of senior management to key health issues

• Defining roles and responsibilities between companies, contractors and host governments

• Establishing an accurate and appropriate baseline of a key disease for future comparison during the
development, operation and eventual closure of a project/operation

• Demonstrating the potential improvement in the VBD burden in the surrounding communities

• Identifying and documenting key environmental features that relate to vector habitat and subsequent control

• Documenting baseline environmental conditions relevant to vector control

• Developing and enhancing local, provincial and national capacity for VBD control

• Providing a positive framework/opportunity for stakeholder input, involvement and trust building

• Enhancing the company’s profile amongst NGOs

• Potentially contributing to the host community’s health systems capacity

5
 IPIECA • OGP
captures the underlying biology, pathophysiology
(how humans respond to infection) and
epidemiology of the disease. This fundamental
framework is generally built around the principles
of primary, secondary and tertiary prevention.
Benefits of a vector-borne disease
management programme
A well-executed VBDMP can reduce morbidity and
mortality in the workforce. VBDMPs send an
important and positive message to the entire
workforce (including nationals and expatriates),
surrounding communities and other national and
international stakeholders.
When to develop and implement a
VBDMP
If a company is considering business
opportunities in locations where VBDs exist, it is
essential to consider the development of an
appropriate VBDMP for all phases of the business
activity. Programme development and complexity
Increasingly, the oil
and gas industry
faces the need to
understand
community level
health, social and
environmental
concerns in order to
receive and
maintain a ‘licence
to operate’.
6
should reflect an accurate understanding of the
VBD risks for company personnel and the
surrounding communities. Many companies may
wish to develop a standardized set of prevention
practices and procedures for any work in VBD
areas. As well as applying to their own
workforces, these standard practices and
procedures may cover a variety of contractors
and suppliers. Overall, an integrated approach,
using primary, secondary and tertiary
prevention, is likely to be the most successful.
Integrating a VBDMP with other
impact assessment and outreach
programmes
VBDs are a multi-dimensional range of diseases;
therefore, a complex skill set is essential for the
programme development and management.
Construction of each level of the wall of prevention
requires a diverse team of specialized professionals.
For example, if a proposed business activity is in a
malarious area, then an accurate and detailed
assessment of malaria risk is required. Experience
indicates that environmental scientists, sociologists,

medical professionals, vector biologists, education
trainers and community development specialists may
be necessary when delivering a VBDMP. VBD risks
and impacts should also be considered when
conducting health, social and environmental impact
assessments. Because of both the importance and
complexity of VBDMP issues, some companies in the
oil and gas industry have developed multi-
disciplinary integrated teams of specialists for
programme development and implementation.
The OGP-IPIECA guidance document on health
impact assessment (OGP-IPIECA, 2005) specifically
discusses the need to consider vector-related
diseases like malaria as part of the impact
assessment process. Integration with company HSE
management and health risk assessment processes
is also important.
National and international stakeholder
consultation
VBD-related issues are the focus of a large number
of international stakeholders. These include WHO,
non-governmental organizations (NGOs),
academic institutions, multilateral development and
funding agencies, and institutions dedicated to
VBD prevention, management and control. In
addition, some level of local, provincial and
national VBD control efforts may be encountered
at the host country level. In many situations,
coordination and communication with all of these
international and national stakeholders is a
daunting task. Nevertheless, because of the
potential for other significant benefits, or
inadvertent adverse impacts such as duplication of
efforts and unmet or unanticipated community-
level expectations, it is important to consider
carefully the multi-level social and community
ramifications of any proposed VBDMP.
It has become apparent that significant advances
in the control of VBDs at the medical and
environmental levels have not necessarily
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
translated into success at the individual, population Consultation
or health systems levels. There may be significant between
gaps between the intervention efficacy of the oil international
stakeholders is vital
and gas company and the effectiveness of these
interventions at the community level in a
in the prevention,
management and
developing country setting. Increasingly, the oil
control of VBD-
and gas industry faces the need to understand related issues.
community-level health, social and environmental
concerns in order to receive and maintain a
‘licence to operate’. VBDMPs face a particularly
difficult set of issues because the biology of the
disease is not easily confined within the
boundaries of a proposed project and, invariably
in a large project, overlaps into the adjacent
communities. The oil and gas industry is
increasingly asked to address problems that are
‘outside the fence line’ and, historically, considered
to be the responsibilities of the host government. In
a given project, comprehensive secondary and
tertiary prevention strategies may be adequate;
however, it is likely that some international and
national stakeholders will request a more active
outreach role in all levels of prevention
management and control, particularly with regard
to vector control efforts. In order to fully appreciate
these expectations, careful, close and early
consultation with key national and international
stakeholders during project formation and
development stages is advisable.
7
 IPIECA • OGP
Putting it all together: the VBDMP process
No single VBDMP process will necessarily be
appropriate for use throughout the diverse range of
situations that may confront the oil and gas industry.
However, there is a series of systematic steps that
can be used in order to determine what type of
VBDMP is appropriate in a particular situation.
Many companies in the oil and gas industry already
have a general approach for developing VBDMPs.
Similarly, many international agencies and national
governments have published detailed guidelines
covering aspects of VBD diagnosis and treatment at
both an individual and community level. Because
both diagnostic testing and available medications
and treatment protocols are constantly evolving, the
most currently available guidelines should always
be consulted. While the science of some VBDs such
as malaria is constantly changing, an overall
management framework is reasonably well
established and can be used in almost all situations
confronting the oil and gas industry. This structure
consists of a sequence of common elements that
frames the VBDMP process, and is illustrated in
Table 4. The process is modelled after the general
framework used in environmental, social and health
impact assessments.
Table 4 Framework for a typical VBDMP process
• Screening—determine whether a proposed business activity is going to
take place within a VBD environment.
• Scoping—outline the range and types of vector-borne disease
problems that could be encountered.
• Planning including resourcing, cost and time management—consider
the types of resources, activities, costs and level of effort that may be
required.
• Stakeholder consultation—coordinate, communicate and exchange
information at the local, provincial, national and international level.
• Risk assessment—investigate, appraise and qualitatively or
quantitatively rank the impacts, positive or negative, that could be
produced.
• Decision making—establish priorities.
• Mitigation strategy—develop a written mitigation action plan (vector-
borne disease management programme).
• Implementation and monitoring—define roles and responsibilities.
8
Screening
The geographical settings where VBD transmission
may exist are reasonably well known. Therefore, if
a business activity is likely to involve a VBD area,
these diseases should be considered as a potential
health concern. A detailed scoping of the proposed
business activity, covering location, size, workforce,
surrounding communities and operations, is
essential. This initial review will help to determine
the extent of the VBDMP that may be required. In
many situations, companies have developed
specific VBDMPs, such as the ‘malaria visa’
programme which is based on secondary and
tertiary prevention strategies incorporated in the
‘ABCD’ (Awareness, Bite prevention,
Chemoprophylaxis and Diagnosis) approach to
malaria prevention. The implementation of a simple
programme such as this may be sufficient for the
workforce. However, it is important to understand
that this particular programme is focused on the
internal workforce and is not fully transferable to
the large number of individuals who may be
living in communities adjacent to the proposed
business activity.
Scoping
Scoping is a term that is generally used to describe
the process of outlining the range and types of
hazards to be addressed, together with the
potential impacts of any action being considered.
The scoping stage enables early identification of
the types and categories of issues that will need to
be addressed, such as: defining the type and
endemicity of VBDs, e.g. dominant diseases;
considering whether different strategies will be
required depending upon the phase of the business
activity, i.e. construction, operation,
decommissioning; and defining the at-risk
population including construction workers,
contractors, nationals and community residents. If
primary prevention vector control strategies are
deemed critical, then a general series of sequential
 VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Figure 1 Decision-making process oil and gas companies have large and
sophisticated medical, environmental and safety
Stratify area according to the disease burden
departments, it is quite likely that some level of
and epidemiology of transmission
outside expertise will still need to be considered,
particularly related to the implementation of
Determine whether there is a role for primary vector control strategies. For large
vector control in each epidemiological stratum
business activities, even secondary prevention
and in current local circumstances
strategies require significant levels of on-site
clinical medical support for accurate diagnosis
If there is a role for vector control, determine and treatment. If the proposed business activity
the vector(s) in each stratum
does not require an on-site medical function, it
may still be advisable to identify appropriate local
For each vector implicated determine: resources, including medical practitioners and
• breeding sites hospitals with appropriate expertise in dealing
• adult resting sites
• blood feeding behaviour
with VBDs, diagnostic equipment and treatment
• ecology facilities. Implementing a VBDMP is a potentially
• history of insecticide resistance
expensive undertaking and may require a
significant level of staffing. The level of staffing is a
Adapted from Najera and Zaim, 2002

Determine which method(s) of function of the goals that the programme aims to
vector control is (are) suitable achieve and the underlying level of VBD
transmission. Many programmes have overall
worldwide objectives that include achieving a zero
Where the use of insecticides is essential,
select the method of application fatality rate while minimizing the risk of
contracting a VBD to the lowest practicable level.
Potentially, these goals can be achieved, but an
intense, integrated and sustained effort using a
questions should be considered. The overall process variety of primary, secondary and tertiary
for this effort is shown in Figure 1, above. strategies is likely to be needed.

The output of the scoping exercise can also be

used as a basis for formally developing a set of
terms of reference (TOR). Either internal or
external consultants, or a combination of both, can
use the TOR.
Planning, including resourcing, cost
and time management
After the general scope has been determined, the
planning process can begin. It is essential to identify
at the outset the types and amounts of resources
that may be required. Resourcing requires careful
consideration since multilevel, integrated VBDMPs
draw expertise from many disciplines. While many
Stakeholder consultation
Stakeholder communication and consultation is a
process of dialogue and information exchange
between the business activity and the key
stakeholders. Stakeholders should be systematically
defined and identified since it is likely that there
will be multiple levels of groups and organizations
that will be interested, active and operating within
the overall sphere of the business activity. Some
VBDs, such as malaria, have attracted worldwide
attention in virtually all areas where transmission is
found. Therefore, it is highly likely that any
proposed project in a known VBD area will already
be subject to some level of NGO, national or

9
 IPIECA • OGP
international intervention control effort.
Consequently, the potential for miscommunication
and duplication of effort is significant. A VBD
stakeholder communication programme is therefore
important, and should be considered as early as
possible in the overall business development cycle.
This effort should be carefully planned and
coordinated in a fashion that is consistent with, and
responsive to, overall business objectives.
Risk assessment
Risk assessment is the process that investigates,
appraises and (qualitatively or quantitatively) ranks
the impacts (positive or negative) that could be
produced by a given activity. Many oil and gas
companies have internal risk assessment
procedures and protocols covering the health,
Many oil and gas environmental, social and safety aspects of
companies have proposed new activities. These processes can also
internal risk be applied to VBDMP efforts. In a given
assessment
geographical location, it is important to understand
procedures and
the specific biology, pathophysiology and
protocols covering
epidemiology of the VBD that may be encountered.
the health,
environmental, The level of the VBD risk will vary substantially,
social and safety both by geographical location and complexity of
aspects of proposed proposed business activity. An oil field development
new activities. and pipeline in a VBD area is likely to require
10
substantially more investigation and programme
development than opening a small marketing office
or retail store. The risk assessment process can
capture these differences and provide an
appropriate way to rank impacts so that they can
be addressed in a priority fashion.
Two important considerations in the risk assessment
process are the evaluation of existing data and
determination of the need for new baseline
information. Existing sources of information must
be carefully reviewed for accuracy, relevance and
completeness. For example, all fevers are actually
not malaria even though in rural malarious areas
fever is frequently ‘assumed’ to be malaria and
treated accordingly. Many studies have
documented that malaria is over-diagnosed, often
on clinical symptoms and signs alone.
If there is a concern that the project will have an
impact on the existing transmission pattern or
burden of a VBD, careful consideration should be
given to determine whether a new data collection
effort is indicated. The profile of a VBD in urban
and peri-urban settings is quite different from that
usually seen in a rural environment. If new data are
deemed necessary, a series of carefully defined
study questions and collection methods should be
developed. These study questions are likely to cover
vector species, habitat and density, in addition to
objective burden of the disease.
The ranking of potential impacts can be considered
from an individual environmental, medical or
sociological perspective, or as an integrated
exercise. Since VBDs can operate at many levels, it
may be more efficient and meaningful to develop
an integrated impacts ranking that considers not
only health but also social and environmental
effects. The degree of detail and sophistication of
the ranking exercise will be specific to the business
activity. The literature on community level impacts
of VBDs is vast and varies significantly across
different global locations, and it should not
necessarily be assumed that impacts and effects

observed, for example, in sub-Saharan Africa will
necessarily apply to Asia or South America. For a
large business activity that is expected to last for
many years, risk assessments frequently consider
both the workforce and the surrounding community.
Decision making
Decision making establishes priorities and begins
the process of developing and dedicating
appropriate resources. For episodic or small-scale
business activities the implementation of existing
standard practices (e.g. a ‘VBD visa’ programme)
may be entirely sufficient. For large, long-term
operations, many companies have established
dedicated multidisciplinary VBD management
teams to simultaneously manage both company
and community VBD issues. Senior management
support, both at the project and corporate level, is
essential because sustainable VBDMPs are neither
simple nor inexpensive.
Mitigation
The VBDMP is the mitigation plan. This plan
specifies how high and how thick the ‘wall of
prevention’ is constructed. The VBDMP is not
static, but a ‘living document’ that will evolve and
change over time. The programme is likely to be a
combination of internal workforce and external
community needs. Many of the most important
concerns and controversies surround the key
vector control strategies of insecticide application,
internal residual spraying (IRS), space spraying,
insecticide treated nets (ITNs) and larviciding.
Finally, emergency response preparation should
also be undertaken because no VBDMP is 100%
effective, and in some situations, immediate
treatment and/or the evacuation of persons taken
ill may be indicated.
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Implementation and monitoring No single VBDMP
can be guaranteed
to be completely
Implementation effective, and in
some situations, the
Two of the most critical aspects of an effective treatment or
VBDMP are the division of responsibilities between evacuation of
the project and the host government at local, persons taken ill
regional and national levels, and agreement on may be necessary.
timescales. Roles and responsibilities should be
defined and clearly understood, particularly if the
VBDMP efforts are going to extend outside the
business activity boundaries. Therefore, an analysis
of local, regional and national health systems
infrastructure and VBD management capacity is
critical. Building the environmental, medical and
social capacity and sustainability required for an
integrated approach to VBD management is neither
simple nor cheap. Many VBDMPs initially succeed,
only to fail at a later date because primary
prevention vector control strategies are not properly
maintained. Long-term planning and commitment is
essential since sustainable capacity development is
a long and slow process. The roles and
responsibilities of contractors are also important,
because much of the day–to-day activity is
performed by rotating contractors, e.g. during the
construction phase of a project. Contractor roles
and responsibilities can be specified and assigned
when defining the initial scope of work and during
the contracting process.
11
 IPIECA • OGP
Staffing levels will also require attention and
consideration on an ongoing basis because a
VBDMP is not a static process. It should be
reasonably anticipated that unexpected changes in
weather and human migration patterns and
activities will occur. These events can have
profound impacts on VBD transmission within and
between the workforce and external communities.
Monitoring
Development of a monitoring system for the overall
VBDMP effort is a critical component. A monitoring
system is designed to document how the
programme is affecting VBD transmission. A variety
of indicators can be developed for this purpose.
Standard medical outcome indicators can be
developed covering diagnosis and treatment, e.g.
suspected, probable, confirmed and fatal VBD
cases. These medical data are important because
they provide an early detection system for changes
in VBD transmission. A sample malaria case
investigation form is available at:
www.iogp.org/pubs/382/Appendix_E.pdf.
Finally, the early detection of a VBD is not the same
thing as early warning. For example, the Malaria
Early Warning Systems (MEWS) requires a different
level of monitoring, planning and development and
is usually considered to be a national government
initiative. However, because of the high levels of
technological expertise present in many oil and gas
companies, particularly regarding remote sensing
(RS) and graphic information systems (GIS)
techniques, collaboration or technology transfer
between the oil and gas company and the host
government may be entirely appropriate.
Evaluation
Evaluation of performance and effectiveness is one
of the most important steps in a VBDMP. A system
for determining that implementation has been
accomplished and is achieving the desired results
12
should be considered. Within the implementation
and monitoring plan, a system of outcome
indicators is typically specified. Auditing against
these indicators can be readily performed.
Contractor performance should also be verified
and assessed for effectiveness and compliance. If
the VBDMP is actively cooperating with host
country programmes, these efforts should also be
independently assessed against previously
established outcome indicators.
A variety of audit systems for health programmes
have been developed. General audits often cover:
● medical records and reports;
● facility inspections for vector control evaluation;
● knowledge, attitude and practices (KAP)
assessments;
● training records—topics, attendances and
feedback;
● health-care programme reviews and audits;
● emergency drills; and
● incident investigations.
Audits should be considered at regular intervals
because business activities may change, for
example due to:
● new company activities (e.g. work near swamps,
jungles, etc.);
● new projects in potentially exposed geographic
locations;
● modifications in work schedule (e.g. night shifts);
● changing contractual requirements;
● new scientific discoveries (e.g. medications,
resistance to control measures); and
● international and government advisory
recommendations concerning malaria resistance
to medication.
A suggested audit form for a malaria management
programme is available at:
www.iogp.org/pubs/382/Appendix_F.xls

Management and prevention
As with all health-related issues, any procedures
should be appropriate, proportionate and effective.
While some processes are relatively
straightforward, such as personal exposure control,
others are much more complex and will require
expert input or extensive stakeholder engagement.
This document serves only to give an indication of
what is available. Care should be taken to ensure
that any action is compatible with local best
practice and the management schemes of local
authorities.
Primary management—vector control
Vector control aims to manage a disease by
eliminating or significantly reducing the population
of the vector responsible for transmitting the
disease of interest. The process may seek to
interfere with the reproductive cycle of the vector at
some point or to destroy adult vectors. Broadly,
control may be through density reduction (through
removal of breeding sites or killing larvae) or
longevity reduction (through killing adult vectors).
Often, a combination of these is required.
Elimination of breeding sites
The simplest example of this involves removal or
enclosure of bodies of water that serve as the
repository for eggs and larval development in
mosquitoes. Insect breeding requirements vary.
Some, such as Anopheles, require relatively small
pools of clean, stagnant water. Others, such as the
Aedes vectors of yellow fever and dengue, prefer
water in containers such as jars, tanks or even used
tyres. Large open bodies of water, such as lakes
and reservoirs are not usually suitable sites for
mosquito breeding. Actions may include:
● draining and filling in ditches, ponds or
swamps, and keeping them dry;
● removing unused containers;
● covering water tanks and other bodies of water
that are in use;
● removing small-scale sources of water;
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Small pools of
standing water
provide the perfect
breeding ground for
some species, such
as Anopheles,
whilst others, e.g.
Aedes, prefer
stagnant water in
containers, such as
discarded jars, tanks
or even old tyres.
● removing plants such as bromeliads (which
collect water in which eggs are laid) from the
work or living area; and
● storing used tyres under cover.
As mosquitoes often fly only a short distance from
their breeding sites to feed, eliminating discarded
motor tyres, pots or tanks may make an appreciable
difference. Before any irrevocable action is taken on
substantial bodies of water, checks should be made
to ensure that they are not protected under a habitat
conservation programme or similar.
Managing the potential breeding environment in
this way has a number of possible advantages:
● there is no risk of accidental environmental
contamination or human intoxication;
● there is no risk of the development of resistance
to chemicals; and
● the effects may actually be longer lasting for the
whole community.
The major disadvantage of taking action to
eliminate breeding sites is that it is usually an
expensive option.
Use of larvicide or insecticide
These methods rely on the use of chemicals to kill
insect larvae or adult insects. The following
important questions should be borne in mind when
considering these operations:
13
 IPIECA • OGP
● Has the vector been clearly identified?
● How susceptible are the different vector stages
to chemical agents?
● Have the habits and resting places of the adult
vector been identified?
● Which bodies of water are used for breeding,
and when?
● How is the water used, and is it safe to apply
larvicides to it?
● What chemicals are appropriate, permitted
and available? Some effective larvicides and
insecticides may be forbidden in some
jurisdictions. Local mosquito larvae may exhibit
resistance to the proposed chemical. The
proposed chemical may not be readily
available from local sources, and this could
lead to difficulty in maintaining control (e.g.
after an international oil and gas company
has departed).
● Are trained and properly equipped personnel
available?
● Is the correct equipment for application
available?
● Is the treatment scheme sustainable? How often
will treatment be required? Can the company
commit to this frequency? When the company
leaves, can the local community continue the
treatment (if relevant)?
● Does the proposed treatment fit with local and
international schemes? Will it have the support
of the local authorities and communities?
Any such proposal to use chemicals for vector
control should be formulated by experienced
practitioners and take full account of local
stakeholders.
Avoiding water contamination
Where bodies of water cannot be readily
eliminated, application of chemical larvicides may
be appropriate. These are chemicals that, when
applied to the water, kill the larvae of mosquitoes.
This can be effective, but expert advice must be
taken to ensure that contamination of drinking
water or water used for irrigation does not occur.
14
Wide area spraying
Wide area spraying or fogging with an insecticide
can be used to kill adult insects, especially in
emergencies or after a major catastrophe. For a
variety of reasons (e.g. its temporary nature, high
cost of application, potential traffic hazard, etc.), this
method is not employed unless absolutely essential.
Residual spraying
This refers to the process of applying insecticide to
the interior walls of living and working quarters in
order to leave a long-term residue of insecticide that
kills adult insects over a prolonged period. A typical
residual spraying schedule might be as infrequently
as six-monthly to yearly. Although there have been
some concerns over the persistent exposure of
pregnant women and nursing mothers to insecticide
residue, the practice appears to be generally safe
and can be very effective. The primary issue is the
choice of insecticide, with regard to insect resistance,
possible effects on humans and the cost or availability
of alternatives. A prolonged debate has taken place
regarding the use of dichlorodiphenyltrichloroethane
(DDT) and alternatives, involving environmental,
health, resistance and other issues. Although
cheap, safer alternatives may be available, it has
been recognized by the WHO that the use of DDT
for residual spraying may still be the most
appropriate method in some situations.
Access
Important, but simple, control can be achieved by
preventing access of vectors to dwellings and
offices, e.g. through the use of well fitting doors
and windows. Door and window screens are
effective, but must be maintained with no holes or
gaps at the edges.
Search and destroy
Active searching for mosquitoes that have eluded
other controls, and killing them with a ‘knock
down’ spray is useful. Searches should be actively
carried out for insects inside cupboards, in
curtains, in lampshades, and even within the folds
of mosquito nets!

Building maintenance and renovation
Reduviid bugs—including the triatomine bug, a
vector of Chagas disease—typically live in cracks
in mud or plaster walls, or in thatched roofs.
Replacing such buildings with modern buildings,
renewing thatched roofs, or carrying out regular
maintenance to eliminate cracks and holes can be
effective. Elimination of crevices and dark corners
to allow open access for spraying and to reduce
the number of hiding places for mosquitos is useful.
Ground clearance
Local ground clearance to eliminate breeding or
resting sites of insects around compounds, camps
or other buildings may be appropriate. Ticks may
thrive in scrub and grass, while rodents may be
hosts for the diseases of concern.
Secondary management
Education
Educating the workforce about VBDs is essential.
Compliance with preventive measures is likely to
be much greater when the serious nature of a
disease and the effectiveness of such measures
are understood.
Personnel who are on international assignment or
rotation should receive thorough awareness
training as part of their predeployment
preparation. There is good evidence that verbal
communication alone may be ineffective in
individuals who are anxious or coping with a high
information load (e.g. an individual preparing to
move and live abroad). Provision of written
guidance, including details of additional sources of
information and advice, is important. Because of
the likely information load for a new assignee,
advice on VBDs should be succinct and engaging.
Local employees or long-term expatriates may
have established beliefs and practices which, if
inappropriate, need to be tactfully challenged.
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Again, it is important to engage individuals in a
cooperative effort in order to achieve compliance.
Language and cultural issues may need to be
addressed and the use of clear, pictorial messages
may be useful.
Avoidance
Local insect vectors should be avoided. Young
children may be kept indoors from early dusk
onwards to avoid night-flying insects, but they will
still be exposed during the daytime. Although
adults will inevitably need to go out after dark,
exposure time can still be minimized by avoiding
unnecessary time outside at night.
As mentioned previously, door and window
screens can be effective in controlling access to
dwellings and offices. Impregnated bed nets are
extremely effective at preventing mosquito bites
while resting or sleeping. Impregnation with
Permethrin can remain effective for up to six
months or longer. When impregnated, nets not
Hotel rooms are not
only operate as a physical barrier, but also as a
impervious to
residual insecticide. However, it is important that
mosquitos—always
bed nets are used appropriately. They must be
ensure mosquito nets
properly tucked in around the bed and inspected are intact, and take
for holes, and any mosquitoes already within the care not to let any
net must be killed. When inside, it is important that mosquitos inside the
no part of the body actually touches the net net when getting into
because mosquitoes can bite through the fabric and out of bed.
15
 IPIECA • OGP
and into the adjacent skin. Various styles of net
are available, including freestanding nets and
those that are suspended by hooks on the wall or
ceiling. In general, the larger the space inside the
net the less likely one is to come into contact with
the inside of the net whilst sleeping. The extra
volume of air inside larger nets may also provide
greater comfort because air movement (ventilation)
through the net is likely to be restricted.
Avoiding mud-walled or thatched buildings at
night can reduce exposure to assassin (triatomine)
bugs (vectors of Trypanosoma cruzi—a parasite
which causes Chagas disease). In Africa, tsetse
fly habitats are often well recognized by local
people and, again, should be avoided when
possible. Ticks will often be associated with scrub
and grassland.
Clothing and behaviour
Long-sleeved shirts and long trousers will reduce
the likelihood of bites from mosquitos and other
vectors, as well as providing sun protection. The
fabric has to be of reasonably tight weave to
prevent penetration by insect mouthparts, and this
can cause compliance issues in hot or humid
climates. Tucking trouser leg bottoms into socks
can be effective.
Mosquitoes are sometimes reported to be attracted
to dark clothing; however, movement, heat and
body chemistry are known to be sources of
attraction, so simply wearing light-coloured clothes
is not an adequate means of protection. On the
other hand, tsetse flies appear to be attracted to
clothing that contrasts with the surroundings (which
in most cases means light shaded clothes). Tsetse
flies are also attracted to movement.
A hat with a neck shield, designed for sun
protection, may also help to deter insects.
Shoes with socks will discourage insect bites and
can be particularly important as many insects bite
16
on the lower limbs. Footwear also provides
protection against sand flies (responsible for
transmission of leishmaniasis) and chiggers (the
larvae of mites) as well as physical injuries.
The use of permethrin-impregnated clothing,
especially coveralls, should be actively encouraged
(provided no individual allergic skin reaction is
noticed) and distributed to the workforce. Their use
is proven to be an efficient tool in minimizing the
probability of insect bites. Washing will gradually
remove the insecticide, so the clothes will
eventually need to be either replaced or
reimpregnated with permethrin, according to the
manufacturers’ recommendations.
Repellents
The ideal personal insect repellent should be
effective, safe, long-lasting, comfortable and
convenient. No single agent meets all these criteria,
but some effective agents are available.
Reviews indicate that diethyltoluamide (DEET) at a
strength of 50% is probably the most effective and
that higher concentrations are not needed. DEET is
available in lower concentrations, but with reduced
duration of action (see Table 5). DEET is safe for
young children older than two months.
Good practices for using personal insect repellants
include:
● apply as directed;
● apply liberally and thoroughly, as mosquitoes
will readily bite untreated skin adjacent to
treated areas;
● re-apply after washing, swimming or heavy
sweating;
● apply sun protection creams before applying
repellents; and
● consider applying DEET to socks and cuffs.
Alternatives to DEET are available, but tend to be
less effective or of shorter duration. Picaridin and
oil of lemon eucalyptus are examples. Citronella-
 VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Table 5 Duration of protection of DEET by concentration Chemoprophylaxis

Malaria is one of very few conditions in which
DEET concentration Duration of action
preventive drugs are routinely given as a
20% 1–3 hours prophylactic. Excellent advice is now available on
chemoprophylaxis for malaria from a variety of
30% Up to 6 hours
national and international sources. When
50% Up to 12 hours considering this topic, it is important that up-to-date
and destination-specific guidance is obtained and
followed. A doctor should be consulted to evaluate
its use and restrictions, and to give specific
recommendations.
based repellents probably have too short a
duration of activity to be of practical use. It should
In principle, a number of issues need to be
be noted that DEET can soften some plastics, such
addressed:
as watch straps.
● Is malaria present in the country and in the
region concerned?
Room precautions ● If so, is the risk seasonal or is it present all
year round?
Mosquitoes may get into all sorts of unlikely
● Is chemoprophylaxis indicated?
locations, including cars and aeroplanes. Rooms or
● If chemoprophylaxis is indicated, is it suitable
apartments may be air-conditioned, but this does
and available?
not make it inaccessible or inhospitable to
● How will special groups, children, pregnant
mosquitoes. The following precautions are
women, those with underlying medical
recommended:
conditions, be managed?
● Always ensure mosquito screens are intact and
● Chemoprophylaxis may not be indicated in
kept shut.
every situation, usually because the risk of
● Before going to bed, search the room for
malaria transmission is very low. In this
mosquitoes and kill them with a knock down
situation, rigorous precautions against insect
spray; it is important to inspect dark areas such
bites and rapid accessibility to a medical
as behind curtains, upholstery, lamp shades and
practitioner competent to diagnose and treat
room corners.
malaria are essential.
● Consider using chemical mosquito mats or liquid
● Are standby malaria treatment kits a sensible
in a vaporizer overnight; burning mosquito coils
precaution? These kits allow rapid diagnosis of
is less effective and the smoke can be hazardous
malaria by on-site testing, and contain
to humans in the long term.
medication for emergency treatment of malaria.
● Electric buzzers DO NOT work and should not
Their use is discussed on page 20.
be used.
● When getting into bed, ensure that you do not
Currently available chemoprophylaxis for malaria
allow any mosquitoes inside your impregnated
includes the following:
bed net! If you have to get up in the night, take
● Chloroquine with or without proguanil: because
care to avoid letting mosquitoes within the net.
of widespread resistance, this regimen is now
only indicated in a very limited number of
Immunization locations (e.g. some areas of Central America).
Some VBDs are preventable through immunization. Experience in the use of both drugs is extensive
For the specific conditions see Appendix 2. and, as prophylactics, their safety profile is good.

17
 IPIECA • OGP
● Doxycycline: this is effective in most areas
against Plasmodium falciparum and other
strains of malaria. It is not suitable for pregnant
women or young children, and may cause
photosensitivity of the skin and oesophageal
irritation.
● Mefloquine: this is an effective drug that has the
advantage of being taken once weekly. It is
contraindicated in anyone with a previous
history of psychiatric illness or convulsions.
There is some evidence of resistance in South-
East Asia. It is considered safe in the second
and third trimesters of pregnancy. It has been
used without untoward incident in the first
trimester when the risk of malaria was
considered significant and exposure otherwise
unavoidable.
● Atovaquone and proguanil (e.g. Malarone®):
this combination is effective and, because of its
mode of action, needs only to be taken for two
days before exposure and for one week after
leaving the malarious zone. It is expensive,
however and, because of insufficient data, its
use is not currently recommended in pregnancy.
The duration of use will depend on local licensing
regulations (e.g. the licence for Malarone® is
significantly different in the UK compared to the
USA), although there appears to be no positive
contraindication to the prolonged use of any of the
malaria chemoprophylaxis drugs.
No chemoprophylaxis is 100% effective. Therefore,
those who have been in a malarious zone should
be warned that they may develop malaria despite
these precautions, and instructed to seek medical
assistance immediately should they develop fever,
sweating or other indications for up to 12 months
after leaving the malarious area. It is prudent to
ensure that persons who are about to travel to a
malarious area are issued with a letter addressed
to their doctor emphasizing the risk of malaria. In
high risk zones, employers may consider providing
emergency diagnostic and treatment kits for use by
the traveller’s doctor.
18
For further information on the need for
chemoprophylaxis see Appendix 1 on page 21.
Malaria management in the local
workforce and community
In areas that are holo- or hyperendemic for
malaria, people are affected throughout their lives.
There is generally a very high level of illness and
death in children. In some areas, 25% of deaths in
children between 1 and 4 years of age may be
due to malaria, but for those children who survive
multiple infections, a state of ‘premunition’ is
achieved where infection causes little or no
problem to the host. This is sometimes termed
semi-immunity, and is sufficient to control but not
prevent infection. Acquisition of premunition is
much more rapid for adults than for children.
Adults in areas of high endemicity rarely develop
severe or even symptomatic disease, despite being
infected. However, in areas where transmission is
low, erratic or markedly seasonal, i.e. where the
rate of re-infection is low or variable, all ages
may develop symptomatic malaria and even
cerebral malaria. This phenomenon is termed
unstable malaria.
Oil and gas companies may wish, or need, to
intervene either as part of a social welfare
programme or to reduce infection in the local
workforce. In holoendemic and hyperendemic areas,
there may be no need to take special measures to
protect local adults (with certain exceptions). In areas
of unstable malaria, protective measures for local
adults will also be required. The major difference
between measures aimed at local people and those
directed at expatriates or business travellers is that,
in the former case, chemoprophylaxis is rarely used.
The exceptions to this may be pregnant women and
local adults returning to an endemic zone after a
year or more away. The use of chemoprophylaxis is
limited by safety and effectiveness issues.
Chloroquine and proguanil have, for many years,
proven to be safe for use during pregnancy (with

folate supplementation for proguanil), but are no
longer effective in most areas of malaria risk.
Tetracyclines are contraindicated in pregnancy and
childhood and, for Malarone®, there is no definitive
evidence either way. Presently, this leaves mefloquine
which is considered safe during the second and third
trimesters, and probably safe in the first (but again
with limited evidence).
Those nationals returning to a highly endemic
zone after a year or so will have lost their
premunition and will be vulnerable to potentially
severe infection. Management of this situation is
difficult because, if chemoprophylaxis is started, a
decision must be made as to when to stop it, since
it is unreasonable to assume that the individual will
take the drug for the rest of his or her life. One
course of action has been to continue
chemoprophylaxis for about three months in the
hope that exposure to parasites will re-induce
premunition, even though overt infection is aborted
by chemoprophylaxis.
Any programmes for managing malaria should be
cheap, simple, sustainable and readily
communicated through education. Simple
measures such as covering up bare skin with long
sleeves and trousers or staying indoors during
peak biting times will help to reduce infection.
Regular use of a personal protective repellent such
as DEET may not be wholly realistic, but can help
especially with mosquitoes biting in the early
evening or morning.
However, the single most effective measure to date
has been the use of bed nets treated with an
insecticide such as permethrin. These insecticide
treated nets (ITNs) can remain effective because of
the insecticide, despite small holes or minor errors
in use. Indeed, in a village in which most people
use ITNs, there may be a communal protective effect
through reduction in overall mosquito density. The
use of ITNs has been shown to reduce childhood
deaths by up to 60% (indicating that the effect of
malaria may have been grossly underestimated).
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
The use of insecticide to treat clothing, household
curtains and even cattle has been demonstrated to
have some effect in reducing transmission.
Returning travellers
Routine screening of all travellers and expatriates
returning from international travel or assignments
can be expensive and unproductive. A risk
assessment process should guide the approach
taken because many factors, e.g. location, duration
of visit, nature of accommodation and activity in
country, will affect the likelihood of a disease being
contracted. The most cost-effective method is
probably to target longer-term or repeat visitors to,
and expatriates from, VBD-prone locations with a
specific health questionnaire designed to elicit
symptoms or activities possibly associated with
disease, and to follow up on positive responses. At
the same time, all travellers should be advised to
contact their health provider if they develop specific
symptoms during or after travel or assignment. In
addition, some travellers may be offered a face-to-
face consultation and limited examination/testing if
they have been exposed for a long period in a
high risk area, e.g. in the case of longer-term
assignees to remote areas of sub-Saharan Africa.
Point-of–care (POC) testing
POC testing refers to methods of disease diagnosis
that are sufficiently simple and mobile that they can
be performed by a clinician, either in the clinic or
in the field at the point where the patient is being
managed. POC tests should be distinguished from
the more generic rapid diagnostic tests (RDTs), the
majority of which are designed to be performed in
a laboratory; although some RDTs may be simple
and compact enough to be performed in the field,
this will not always be the case. POC testing for
infectious diseases has developed rapidly in recent
years and will probably continue to do so. However,
a number of questions should be addressed before
a POC test, where available, is deployed:
19
 IPIECA • OGP
● Will a POC test make an important difference
in outcome, or influence the treatment?
● Is the test suitably sensitive and specific?
● Is it simple enough for reliable use by those
required to use it?
● Will its use be restricted by storage temperature
requirements (e.g. ‘cold chain’) or short shelf
life?
The UK Medicines and Healthcare products
Regulatory Agency (MHRA) suggest that certain
criteria be met before instituting POC testing.
These include:
● adequate training and assessment of end users;
● clear instructions on use, that should be
followed precisely;
● adequate quality control;
● a system of review or laboratory overview; and
● adequate safety precautions, e.g. the safe
disposal of used tests, lancets, swabs etc., and
appropriate caution when handling reagents.
POC testing is available for a growing number of
infectious diseases. Among VBDs, tests for malaria
and dengue are well established and a POC test
for Chagas disease (American trypanosomiasis) is
available. At the time of publication, POC tests for
human African trypanosomiasis and Japanese
encephalitis are under development. Of all these,
the POC tests for malaria diagnosis are the most
important. POC tests (and standby treatment) can
be valuable when an individual leaves the endemic
zone and returns home, where malaria is unknown
and likely to be ‘missed’ by the home doctor.
POC tests for malaria usually rely upon identifying
histidine-rich protein or parasite lactate
dehydrogenase in a patient’s blood, and have
reached a level of specificity and sensitivity such
that they can be reliably used in the field after
minimal training.
20
Standby treatment
Standby treatment refers to treatment carried for
emergency use by an individual. In relation to
VBDs, this is only of importance with regard to
malaria, and has been greatly facilitated by the
development of POC testing for malaria. Use of
standby treatment is usually only recommended:
● when access to medical expertise of appropriate
quality for diagnosis and treatment is not readily
available (even when chemoprophylaxis is taken);
● in areas where transmission is very high, but
protection by chemoprophylaxis is so poor or
unreliable due to drug resistance (e.g. some
parts of Thailand and Cambodia) that the
benefits of taking it are outweighed by the
disadvantages; and
● in areas where transmission is so low that taking
regular chemoprophylaxis is unwarranted, but a
risk of exposure remains.
The preferred option is to have a health practitioner
confirm the diagnosis and then to take the
medication with medical follow-up. However, if
there is likely to be a delay in reaching medical
support in excess of 12 hours after symptom
development, the patient may use standby
medication to initiate drug treatment of the infection.
Combined POC tests and a course of standby
treatment for malaria are now available in small,
easily carried kits. A combination of lumefantrine
and artemether (e.g. Riamet®, Coartem®) is one of
the most common standby treatments for malaria.
Occasionally, atovaquone with proguanil (e.g.
Malarone®) is used, but this is not appropriate if the
same drug has been used as chemoprophylaxis.
It is important that those issued with such kits are
thoroughly trained in the circumstances and method
of their use. There must be no contraindications to
the drug contained in the kit, and full instructions
should be included. Irrespective of any response to
standby treatment, the patient must be aware that it is
still essential to obtain medical assistance for accurate
diagnosis and treatment as soon as possible.

Appendix 1:
Understanding the need for chemoprophylaxis
Failure to appreciate the need for
chemoprophylaxis is a common problem,
particularly among long-term expatriates. The
reasons for this may include:
● concern about possible side-effects, especially in
relation to long-term use, and the perception
that the risk presented by chemoprophylaxis is
greater than the risk of malaria;
● the belief expressed by other expatriates that
‘we don’t need to use it here, the risk is less than
they say’;
● advice given by local medical practitioners
which contradicts or confuses the advice given
by company health departments (e.g. by telling
people they need chemoprophylaxis in rural
areas but not in the city, etc.);
● a genuine lack of awareness of the risk or
possible consequences of malaria;
● the false belief that malaria is ‘easily treated’
and that there is no need to worry; and
● the occasional, deeply held personal conviction
that ‘orthodox medications’ are unacceptable.
Misconceptions may be fostered by the press or
other expatriates, but the limitations of a drug’s
technical licence can also cause alarm. For
example, Malarone® carried a 28-day licence in
the UK long after most authorities and physicians
were happy to prescribe it for much longer.
Management of this issue can be complex. Some
options are given below:
● Education—this is essential, regardless of any
other strategy that may be adopted.
• The risk of catching malaria and the possible
consequences must be made patently clear
using a variety of media, and the message
reiterated frequently.
• The safety of chemoprophylaxis, particularly
in relation to the effects of malaria, must be
emphasized.
• The ‘licence restriction’ conundrum must be
confronted. Obtaining a drug licence is
expensive and time-consuming, and a drug
company may not see any major benefit in
formally extending a previous licence, despite
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Failure to appreciate
the need for
chemoprophylaxis is a
common problem:
assignees must be
informed that malaria
is a serious and
debilitating illness, if
not fatal, and that
they have a duty to
take reasonable
precautions to avoid
becoming ill while
working.
no evidence of harm. This may require use
‘off licence’ under physician control, and
individuals should understand that this is
neither ‘illegal’ nor unsafe.
• The attitude of ‘if I catch it I can just get
treated’ must be confronted. Assignees must
understand that malaria is a serious and
debilitating illness, if not fatal, and that they
have a duty to take reasonable precautions
to avoid becoming ill while working. They
must also be made aware that resistance to
treatment is always a possibility and can be
fatal. (However, in some situations, e.g.
where there is low risk, high resistance and
ready access to treatment, insect
precautions and treatment of affected
personnel may be appropriate, as in some
areas of South-East Asia.)
● A clear process must be established with
management, so that the issue becomes a
company one, rather than simply an
occupational health requirement. Once agreed,
all parties must faithfully follow the procedure
and support one another. Employees and
contractors are much more likely to subscribe to
requirements which are fully endorsed by
management.
21
 IPIECA • OGP

• Potential overseas assignees or travellers

should be informed well in advance about
chemoprophylaxis requirements.
• A policy of voluntary disclosure may be
encouraged, where individuals give early
notice of their intention to avoid
chemoprophylaxis and can be assigned to an
alternative location in good time.
• A formal testing procedure may be put in
place, such that individuals in risk locations
are subject to urine testing to detect the
presence of an approved chemoprophylactic.
Testing negative may result in a formal
warning and repeated failure may result in
removal from location.
● All doctors with whom overseas assignees are
likely to come into contact should be
encouraged (if independent) or required (if
employed by the company) to support the
company policy on use of chemoprophylactics.
● It may be possible to engage with other
companies working in the location to attempt to
agree a common policy, especially when
engaged on common projects.
● As ever, ensuring that contractors are fully in
line with process can be daunting, but may be
achieved through rigorous contract procedures.

22

Appendix 2:
Some specific vector-borne diseases
Malaria
Malaria affects around 200 million people each
year, and causes some 1 million deaths of which
90% involve children under 5 years old in sub-
Saharan Africa. The social and economic losses
each year due to death from malaria and the
debility caused by repeat infections is huge in
regions of the world that are least able to withstand
it. The initial manifestation is usually a severe flu-
like illness with high fever, prostration and aching.
Anaemia and jaundice may occur, the kidneys may
be affected and, in the most serious cases, fatal
cerebral malaria may develop.
Causative agent
Four kinds of malaria parasites have long been
known to infect humans: Plasmodium falciparum,
P. vivax, P. ovale, and P. malariae. Recently,
P. knowlesii, a malaria parasite that previously only
infected monkeys in Southeast Asia, has been
recognized as infectious to humans when transmitted
from animal to human (‘zoonotic’ malaria).
P. falciparum malaria usually results in the most
severe and life-threatening malaria and is
responsible for the majority of deaths. However,
P. vivax can also be fatal, especially in those who
are already malnourished or ill. People who have
little or no immunity to malaria, such as young
children and pregnant women or travellers coming
from areas with no malaria, are more likely to
become very sick and die.
Vectors and transmission
Human malaria is transmitted through the bite of
blood-feeding female mosquitoes of the genus
Anopheles. When a mosquito takes a blood meal
form a person who is already infected with
malaria, it may ingest reproductive forms of the
malaria parasite. These then mature to infective
forms within the mosquito and are subsequently
transmitted to another human at a later blood
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
The Anopheles
mosquito plays a
prominent role in
the transmission of
malaria to humans.
meal. The cycle of infection was exclusively thought
to be human-mosquito-human, until the discovery
of the P. knowlesii infection (see above). However,
this exception contributes only a very limited
proportion of cases in a limited area.
Rarely, malaria may be transmitted through blood
transfusion, organ transplant, or the shared use of
needles or syringes contaminated with blood. A
pregnant woman may also transmit her infection to
the unborn child.
Incubation period
The incubation period varies according to the type
of parasite. In general, this period is around 10
days but can extend to 8 weeks after infection,
although a person may feel ill as early as 7 days
or as late as 1 year after infection.
Two kinds of malaria, P. vivax and P. ovale, can recur
again without further infection (relapsing malaria),
despite being cleared form the blood, when parasites
that have remained dormant in the liver reactivate
and begin invading red blood cells (‘relapse’).
Diagnosis
Rapid and accurate diagnosis of malaria is
fundamental to the appropriate and effective
treatment of affected individuals and is vital to
prevent the infection spreading through the
community.
Microscopic diagnosis by smear slide examination
remains the gold standard where carried out
23
 IPIECA • OGP
correctly. It carries the advantage of both identifying
the specific parasite and the degree of parasitaemia
(measure of parasites in the blood and thus a
measure of severity of infection). Rapid diagnostic
kits are available, and some are of acceptable
sensitivity and specificity. However, while some can
differentiate Plasmodium species, not all do, and
they cannot give an indication of parasite load.
Differential diagnosis
The early symptoms of malaria resemble a ‘flu-like’
illness and can mimic a large variety of conditions,
especially in someone who has resided in the
tropics. A traveller who becomes ill with a fever
while travelling, or up to a year after returning
from an area that is endemic for malaria, should
immediately seek professional medical care and
should emphasize the potential for malaria infection.
Treatment
Malaria can be cured if treated with appropriate
drugs soon enough. The exact drug choice may be
influenced by: the type of malaria; the location
where the disease was contracted (parasite
sensitivity to treatment drugs varies geographically);
the age of the patient; pregnancy; and the type of
drug used for chemoprophylaxis (if any).
The hypnozoite liver forms of P. vivax and P. ovale
need to be eradicated by special treatment (usually
primaquine at present) otherwise the disease may
relapse at a later stage. Use of primaquine should be
preceded by a blood test to exclude G6PD deficiency.
If not adequately treated P. malariae may simply be
suppressed and can relapse repeatedly over many
years.
Prevention
A simple reminder of the key steps needed for
personal prevention is the ‘ABCD’ model:
Awareness, Bite prevention, Chemoprophylaxis and
24
Diagnosis. For further details on personal prevention,
see the section on Chemoprophylaxis on page 17).
Eradication of mosquitoes and their breeding sites
is an important element of long-term control, and is
discussed in the section on Management and
prevention on pages 13–14.
Distribution
Malaria is present throughout the tropics. A global
map of confirmed malaria cases in 2010 can be
found courtesy of the WHO at:
http://gamapserver.who.int/mapLibrary/Files/
Maps/Global_Malaria_ReportedCases_2010.png
Yellow fever
The majority of people infected have an
asymptomatic or very mild infection. For those who
become symptomatic, the incubation period is
about three to six days. The illness presents as a
flu-like condition with sudden onset of fever, chills,
muscle aches, nausea and headache. Most people
then recover, but about 15% may progress to the
more serious second stage with jaundice,
haemorrhagic symptoms, shock and multiple organ
failure. At this stage, the mortality is very high (up
to 50%). Diagnosis is by clinical picture and
circumstances, together with the identification of
virus-specific antibodies.
Infective agent
Yellow fever is caused by an RNA virus of the
Flavivirus genus. It is related to the viruses causing
dengue fever, chikengunya and Japanese
encephalitis.
Vector
The disease is transmitted by the bite of infected
female mosquitoes—mainly the Aedes and
Haemogogus species. It occurs in non-human

primates as well as humans, and may be
transmitted either from human to human via
mosquito, or from monkey to human via mosquito.
There are three transmission cycles for the disease:
● Sylvatic (jungle) cycle: non-human primates act
as the main reservoir in forested areas. Canopy-
dwelling mosquitoes transmit the disease from
monkey to monkey. When the forest environment
is disturbed, mosquitoes may transmit yellow
fever from monkeys to humans (e.g. loggers,
farmers). If these infected humans subsequently
return to an urban environment, the disease may
be further transmitted to other humans, usually
by a different mosquito, and an urban cycle may
be initiated (sometimes of epidemic proportions).
● Savannah cycle: this occurs in Africa, where
Aedes mosquitoes living in lower tree levels (e.g.
in water filled trunk holes) transmit the disease
indiscriminately between local monkeys and
humans, and between humans working at the
forest border areas.
● The urban cycle: involves the transmission of
disease by Aedes mosquitoes between humans
in the urban setting. This may be the norm in
some parts of Africa or may be occasional
when the forest worker returns after having been
infected in the sylvatic cycle.
In some areas, there may have been no human
yellow fever for many years. Yet, through regular
surveillance or the examination of dead monkeys, it
may be evident that jungle monkeys remain as
reservoirs. In this situation, great care must be taken
to ensure that oil and gas companies working in
the jungle do not initiate an active sylvatic cycle for
the workers or even lead to an urban outbreak.
Distribution
Yellow fever occurs in sub-Saharan Africa and
tropical Central and South America. Typically it is
endemic with periodic epidemics. The greatest
human burden is in Africa where infants and
children are at greatest risk (older adults will have
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
some immunity). In South America, young forest
workers are the main victims, when they are
exposed to the sylvatic cycle during forest clearance.
Prevention
General precautions as described for mosquito
bites (pages 15–17) are appropriate. It should be
noted that mosquitoes transmitting yellow fever are
diurnal (active during the daytime) and it is
therefore appropriate to take precautions by
wearing long sleeves and trousers and using insect
repellent during the day. An effective live-attenuated
vaccine is available. Older people (generally 60
years or older) receiving the vaccine for the first
time are at greater risk of two serious vaccine side
effects—vaccine-associated neurotropic disease
(VND) and vaccine-associated viscerotropic disease
(VVD). In view of the changing epidemiology of
yellow fever, it is important that the decision to
vaccinate is risk based. The WHO issues lists of
countries in which yellow fever is endemic and for
which an official yellow fever vaccine certificate is
mandatory for entry. In addition, many other
countries will demand vaccination certificates for
those coming from certain countries even if not on
the official WHO list.
Dengue
This mosquito-borne disease causes high fever,
severe headache, muscle pains and general
malaise. There may be retro-orbital pain (pain
behind the eye) and a body rash (sparing the
face). After an incubation period of approximately
three to four days, the symptoms develop and the
fever lasts for around seven days. Most people
recover, but for some, the recovery may be slow or
intermittent with prolonged fatigue. A proportion of
those infected may go on to develop dengue
haemorrhagic fever (DHF) or dengue shock
syndrome (DSS) if they have previously had a
dengue infection of a different strain (see below).
These conditions are much more serious and carry
25
 IPIECA • OGP
a mortality rate of up to 20%, although the best
hospital care may reduce this to as low as 1%.
There is currently a move to change the
nomenclature so that dengue is seen as a spectrum
of disease, with DHF and DSS at one end as
‘severe dengue’. The disease often occurs in
outbreaks superimposed on a background of
sporadic cases. Some of these outbreaks can be
enormous (hundreds of thousands of cases).
Diagnosis is clinical, especially during an epidemic.
Reduced platelet count is typical, and antibody tests
can be performed for confirmatory purposes.
Infective agent
The dengue virus is an RNA virus of the Flaviviridae
family. It exists in four serotypes—DEN-1, DEN-2,
DEN-3 and DEN-4. One or all four types may
circulate in a given region at the same time. Infection
with one type gives long-term immunity to that type
and temporary (about eight weeks) immunity to the
other types. The increased susceptibility to DHF and
DSS is manifest in those who have had a previous
infection with one type and then develop infection
with another type at a later date.
Vector
The virus is transmitted by female mosquitoes of the
genus Aedes when seeking a blood meal. The
principal vector species is Ae. aegypti, which is
widespread and tends to be urban and semi-urban.
Once infected, the mosquito carries and transmits
the virus for life. Other species, e.g. Ae. albopictus,
may also transmit the infection, but are generally
not as efficient in doing so as Ae. aegypti.
Distribution
The range and intensity of dengue infection have
grown markedly in the past few decades. Before
1970, only nine countries had significant problems.
Now, it is present in more than 100 countries in
Asia, Africa, the Americas, the Pacific and eastern
26
Mediterranean. Two-fifths of the world’s population
is now at risk of the disease, and DHF and DSS are
a major cause of child deaths in Southeast Asia.
Prevention
No vaccine is available, although research efforts
continue to towards developing one. Personal bite
avoidance is important, but vector management
through the elimination of breeding sites and
insecticide spraying is the mainstay of control. The
main difficulty remains the presence of four
serotypes, as well as the complex interaction
between infection, immunity and the severe forms
of dengue. The basis of disease control is to manage
and eliminate mosquito breeding. As the mosquito’s
life-cycle from egg to adult phase is 7 to 10 days,
breeding control measures must be carried out every
week using various procedures as described in the
section on Elimination of breeding sites on page 13.
Some work is under way on interference with
breeding by genetic manipulation of mosquito
populations. Joint efforts with health authorities,
other companies and communities to identify and
eliminate potential breeding grounds for
mosquitoes (inside and outside workplaces),
increased awareness by means of lectures, and
corporate campaigns may significantly improve
overall levels of management success, as well as
enhance the company’s social performance profile.
An example of coordinated practice is the Dengue
Awareness Day celebration organized by the
Association of Southeast Asian Nations (ASEAN)
and held for first time on 15 June 2011.
Japanese encephalitis
The majority of human infections are completely
asymptomatic or very mild. Less than 1% of infected
persons develop recognizable overt disease. In
these cases, after an incubation period of between
5 and 25 days, there is a sudden onset of fever,
headache and vomiting. Encephalitis is usually

severe, with a Parkinson-like syndrome, paralysis
and seizures. Of those who become clinically ill, up
to 30% may die and 30–50% may be left with
permanent neurological or psychiatric sequelae.
Causative agent
The disease is caused by an RNA virus of the
flavivirus group.
Vector and transmission
The disease is spread by the bite of infected female
mosquitoes, generally the Culex species. Humans
are incidental hosts, i.e. they are not normally sick
for long enough, or with high enough viral loads to
transmit the virus to mosquitoes (and onwards to
humans). The main hosts are pigs or wading birds,
which act as very good amplifying hosts. The main
foci of transmission are thus pig farms and the
surrounding areas, or flooded paddy fields
(wading birds), but this does not restrict the disease
to rural areas because, in Asia, such farms and
fields may be near to, or in, urban locations.
Japanese encephalitis is confined to Asia and the
western pacific and has not been transmitted in
Africa, Europe or the Americas. It is diagnosed by
clinical picture and the identification of a specific
antibody. Although the Japanese encephalitis virus
is the most common vaccine-preventable
encephalitis in Asia, and is extremely serious when
not sub-clinical, it is a rare disease amongst short-
term travellers. Also, in many areas, no
confirmatory laboratory testing facilities will be
available, so diagnosis may be on the basis of
symptoms alone, and other causes of encephalitis
cannot be excluded.
Prevention
Mosquito avoidance measures are appropriate.
The distancing of urban settings from piggeries
and paddy fields would be helpful. Vaccines are
available, and in some countries with endemic
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Japanese
encephalitis is most
commonly spread
by the Culex genus
of mosquito.
disease are used as a routine childhood vaccine.
The use of a vaccine for short-term travellers has
been somewhat controversial, as some vaccines
were reputed to have significant side-effects.
profile. A new vaccine is available which has a
much better side-effect profile, and it is reasonable
to offer this to anyone staying in a high-risk area
for more than four weeks.
American trypanosomiasis
(Chagas disease)
This parasitic disease of the Americas (almost
exclusively Central and South America) presents
with a biphasic picture (acute and chronic phases)
and either phase may be clinically silent or life
threatening. The acute phase, occurring shortly
after infection, lasts for weeks or months and is
characterized by parasites circulating in the blood.
In symptomatic cases, there may be fever, fatigue,
headache, malaise, loss of appetite, diarrhoea and
vomiting. A characteristic feature of infection near
the eye is a swelling of the eyelids, known as
Romana’s sign. In the very young, the very old and
those with compromised immune systems, the acute
phase may be severe and occasionally fatal.
Most patients recover from the acute phase, but
continue to harbour the parasite. Most remain
asymptomatic for life, but a minority (20–30%) may
develop symptomatic chronic disease which
manifests many years after the acute infection. The
most common manifestation of chronic disease is
infection of the heart with disorders of heart
27
 IPIECA • OGP
conduction, damage to ventricular muscle function
and even aneurysms. In the more southerly range
of the disease (especially the Southern Cone of
America), megasyndromes affecting the
gastrointestinal tract may also occur due to damage
to the nerve plexuses in the smooth muscle. The most
common are megaoesophagus and megacolon.
Diagnosis
In the acute phase, parasites may be identified in
blood, or xenodiagnosis may be used.
Immunological tests such as IFAT and ELISA are
available for chronic disease.
Treatment
Traditionally, only the acute disease was treated
with anti-parasitic medication, while the chronic
phase, when parasites are rarely detectable in the
blood, was treated solely on the basis of the
damaged organs. However, a case has been made
more recently to use anti-parasite drugs in the
chronic phase also, particularly in children, who
tolerate the side-effects better.
Causative organism
The infection is caused by a species of parasite
known as Trypanosome cruzi. The Trypanosoma
genus is distributed worldwide but different species
tend to be host-species specific and cause
remarkably different diseases. T. cruzi, however, is
confined to the Americas. Within its range, there
Rhodnius prolixus is
an important
triatomine vector of
the Chagas
parasite due to its
efficient adaptation
to the human
domicile in northern
South America.
28
appear to be a number of variants, or subspecies,
and differences in the disease spectrum are
probably related to this. For example, the
trypanosomes in the northerly part of the range do
not cause megasyndromes.
Vector
The parasite is spread through contact with the
faeces of triatomine bugs. A number of species are
involved, and they go by a variety of popular and
local names (assassin bugs, kissing bugs,
benchucha, vinchuca, chinche, barbeiro), some of
which reflect the tendency of the infection to
originate around the face (which, being uncovered,
is the main target of the night-biting insect). The
triatomine bug does not carry the parasite in its
saliva, so does not inoculate the infection with its
bite. Instead, the individual is believed to rub the
infected faeces into the bite wound. However,
infection through direct contact between insect
faeces and mucous membranes of the eye or mouth
is also important. These are probably the most
important routes for the majority of infections in
South America and many such infections are
initiated in childhood. Infection may also occur via
blood transfusion, organ donation, transplacental
transmission and even through food or drink
contaminated with triatomine faeces (usually via
bugs crushed inadvertently during processing).
The important triatomine bugs (with regard to
infection) are peri-domestic and live in the thatch,
adobe, straw or other materials of basic housing.

They may also infect farm buildings such as sheds
and chicken coops as well as rodent burrows.
Distribution
Chagas disease is found throughout the Americas
from Mexico to Argentina. Cases have also been
reported in the southern USA. Different variants in
the type of trypanosome cause differences in the
disease, and differences in the dominant insect
vector cause differences in epidemiology
(depending on the habitat preferences). Prevalence
and incidence have both dropped significantly in
the past two decades due to vector control. However,
a large burden of chronic disease still remains. In
addition, cases of chronic Chagas disease are now
appearing more prominently in other non-endemic
countries, such as Spain, due to immigration.
Prevention
No vaccine is available. Management of the
disease rests principally on the control of vector
breeding and resting sites. Foremost in this area
has been the replacement of basic housing and
animal accommodation (i.e. which often contain
numerous cracks and crevices) with buildings
constructed using more solid material. This has led
to a marked reduction in cases of the disease in
areas where the vector has little other habitat.
Eradication in other areas (such as forested areas
of the Amazon) has been harder, as the bugs have
numerous burrows or other areas to hide in during
the day and can readily reinvade homes.
In some countries, testing of potential blood donors
for infection is now routine, as blood transfusion
does transmit the disease.
Human African trypanosomiasis
Human African trypanosomiasis (HAT) presents as
two different conditions, in west and east sub-
Saharan Africa. Each condition is caused by a
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
different subspecies of the parasite Trypanosoma
brucei, and each is associated with different
habitats and spread by different fly species. Both
have an early and a late phase. The western form,
T.b. gambiense, has an early phase characterized
by irregular fever and enlarged lymph nodes
before progressing, after many months or years, to
a severe neurological and psycho-neurological
condition. The eastern variety, T.b. rhodesiense,
often presents with a chancre (a painless ulcer) at
the site of the fly bite, with cellulitis, enlarged lymph
nodes and fever. It tends to progress to the second
phase much more rapidly than T.b. gambiense,
with fatal heart and neurological disease
appearing within six to nine months.
Diagnosis
Acute phase T.b. gambiense may be diagnosed by
lymph node aspiration, while acute phase
T.b. rhodesiense will usually reveal parasites in the
blood. The chronic phase of both varieties is
diagnosed on CSF (cerebral spinal fluid)
examination and, for T.b. gambiense, serological
testing using CATT (card agglutination test for
trypanosomiasis) will also yield useful information
for screening.
Treatment
Drug treatment depends on the type of HAT and the
development stage of the disease (early or late).
Most have significant toxicity, and treatment is
highly specialized.
Causative organism
HAT is caused by two subspecies of the parasite
Trypanosoma brucei—T.b. gambiense and
T.b. rhodesiense, each with different ranges,
disease manifestations and hosts. T.b. gambiense
occurs principally in west and central sub-Saharan
Africa and is spread from human to human
(although dogs and pigs may also act as hosts).
T.b. rhodesiense occurs in the eastern sub-Saharan
29
 IPIECA • OGP
region and is a zoonosis maintained in wild and
domestic animals (such as antelope, cattle and
goats); humans are an incidental host.
Vector
Trypanosoma brucei is transmitted by the bite of
the tsetse fly, Glossina, of which a variety of
species are important. These are large flies, active
by day, and tend to be localized in distribution;
local nationals will often know the risk areas. The
fly is said to be attracted to moving objects and
dark silhouettes.
Distribution
T. brucei is present in sub-Saharan Africa, but
usually in localized areas and with variations in
prevalence. T.b. gambiense is mainly found in the
Democratic Republic of Congo, Angola, southern
Sudan and northern Uganda, and is associated
with water, particularly rivers with dense
vegetation. T.b. rhodesiense is most important in
Tanzania and south-east Uganda, and is
associated with savannah and bush.
Prevention
No vaccine is available. Prevention depends on the
subspecies of the parasite. For T.b. gambiense, with
no animal host, early identification of human cases
by active surveillance, together with treatment and
prevention of further transmission, is important.
With T.b. rhodesiense, patients tend to report quite
rapidly for treatment and active surveillance is less
important. Habitat management to reduce fly
populations may also be feasible, and trapping of
tsetse flies is sometimes used for both forms.
Tick-borne encephalitis
Tick-borne encephalitis (TBE) may present as a
biphasic condition. After an initial incubation
period of eight days (but with a wide range), a
non-specific flu-like illness develops. Up to two-
30
thirds of people may recover at this stage. One-
third may progress to disease involving the central
nervous system, e.g. meningitis, encephalitis,
myelitis or paralysis. The outcome depends on
which of three subtypes of the disease is involved:
● The Far-Eastern subtype has the highest case
fatality ratio (20–40%) with high rates of
neurological sequelae.
● The Siberian subtype often involves a chronic or
progressive condition and has a case fatality
ratio of 3%.
● The European subtype is generally milder, with a
case fatality ratio of less than 2%. However,
neurological sequelae can occur in 30% of
patients.
Causative organism
The disease is caused by an RNA flavivirus.
Vector and transmission
The virus is spread primarily by the bite of a hard-
bodied tick of the ixodidae family. The European
sub-type is spread by Ixodes ricinus, and the Siberia
and Far-Eastern subtypes by I. persulcatus. Drinking
the unpasteurized milk of infected cows or goats can
also infect humans. The tick itself is both host and
vector, although rodents can act as amplifying
hosts. The disease is limited by the distribution and
behaviour of the host ticks. Its distribution extends
from mid-Europe to the Far East in the temperate
zone and up to 1,500 m altitude. Siberia has by far
the greatest burden of disease. The ticks are most
active from early to late summer, although cases do
occur outside these limits. The disease has been
spreading significantly, particularly westward, and
is now present in Sweden. The precise reasons for
this increased distribution are not known.
Prevention
The ticks and their larvae seek out hosts on which to
feed by climbing to the tops of stalks of grass and
actively waving their legs to gain a hold on a

passing animal (‘questing’). They bite to get a blood
meal and pass on the virus in the process. It is
believed that the tick must be actively attached for at
least half a day for a significant chance of
transmission. Therefore, wearing thick trousers and
socks and using an insect repellent while exposed to
grass and scrub, followed by active searching for
ticks afterwards, can be very effective. Avoidance of
unpasteurized dairy products is also important.
Vaccines are available and are believed to have an
efficacy greater than 95%, although people over 50
years of age may be less responsive. Estimates of
risk for an unvaccinated visitor to a TBE area are
1 case per 10,000 person-months of exposure.
However, vaccination may be worthwhile for those
working in forested areas over the longer term.
Some countries (e.g. Austria) vaccinate against TBE
as part of their national programme.
Rickettsial infections
These diseases are caused by various species of
obligate intracellular bacteria (i.e. parasites which
can only grow and reproduce within the living cells
of the host). The most important conditions are the
spotted fevers and typhus fevers. The causative
organisms, reservoir hosts, vectors and clinical
syndromes are varied and somewhat complicated
(see Table A1), but a common clinical picture is of
Table A1 Rickettsial infections—causative organisms and vectors
Disease Agent
Rocky Mountain spotted fever Rickettsia rickettsiae
Mediterranean spotted fever Rickettsia coroni
African tick bite fever Rickettsia africae
Scrub typhus Orientia* tsutsugamushi
Epidemic typhus Rickettsia prowazekii
Murine (endemic) typhus Rickettsia typhi
* Orientia was formerly classified as Rickettsia
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
headache, fever, malaise and nausea coming on
within two or so weeks of exposure. The tick-borne
disease is often accompanied by a rash, and
sometimes by an eschar (a scab-like scar) at the
site of the bite.
Relevance
These diseases are a chronic burden for the
indigenous populations of endemic countries, but
may also be a significant problem for travellers to
affected areas. It has been estimated that African
tick bite fever probably affects more travellers to
Southern Africa than malaria (CDC, 2012).
Many of the associated conditions are relatively
mild or transitory, but Rocky Mountain spotted
fever and epidemic typhus can have mortality rates
of 50% or more.
Prevention
Appropriate clothing covering the arms, legs,
head and neck, and the use of insect repellent is
indicated in all cases. Examination of oneself and
colleagues for ticks is important, as rapid removal
may prevent disease transmission. Ticks must be
removed whole, with head intact. Avoidance of
areas reputed to carry high populations of the
vector may be helpful.
Vector Distribution
tick North America
tick Mediterranean, Africa, Middle East, India
tick Sub-Saharan Africa
mite larva Far East
louse West and East Africa, Mexico, Peru, Bolivia, Ecuador
flea Prominent in SE Asia, south and east USA, Mexico and
West Africa, with patchy distribution elsewhere worldwide
31
 IPIECA • OGP
Epidemic typhus is only found in areas of
considerable poverty and in situations such as post
disaster, wars and refugee camps. Delousing of body
and clothes is an important control. Doxycycline may
be an appropriate prophylaxis for workers travelling
to the affected areas (e.g. aid workers, etc.), but
should not be taken during pregnancy or when
breast feeding (see Chemoprophylaxis on page 17).
Reduction of rodent numbers around habitations
may reduce exposure to the fleas responsible for
murine typhus.
Leishmaniasis
This condition occurs from the tropics of the Old
and New World to southern Europe and is caused
by an obligate intracellular protozoon. There are
two broad varieties—cutaneous and visceral,
caused by different organisms—with a
mucocutaneous form also occurring in areas of
high cutaneous disease in South America.
Cutaneous leishmaniasis
This is characterized by the development of
painless skin lesions which progress form nodules
to indolent ulcers, sometimes with enlarged
regional lymph nodes. The lesions usually appear
weeks or months after a bite by a sand fly, and can
occasionally be reactivated years later by trauma
or surgery to the affected area of skin. Eventually,
the ulcers heal, but this can take months or years
and can leave disfiguring scars. In South America,
a variation called mucocutaneous leishmaniasis
(MCL) can affect mucous membranes and be much
more destructive.
Visceral leishmaniasis
In visceral leishmaniasis, the protozoon parasites
invade the body systemically, and fever, weight
loss, hepatosplenomegaly and pancytopaenia may
occur. It may be fatal if not treated. Recovered
32
cases may undergo reactivation if an individual’s
immunity decreases due to disease or age. While
cutaneous leishmaniasis may be found in both rural
and urban environments, visceral leishmaniasis
tends to be more rural in distribution and occurs in
more limited foci.
Vector
The infecting protozoon is spread by female sand
flies of the phlebotomine family. Despite the
common name, they are not restricted to sandy
areas and are found in a wide environment. At
2–3 mm long, they are much smaller than most
mosquitoes and are easily overlooked. They bite
mainly from dusk to dawn, but may also bite
during the daytime if disturbed.
Distribution
Leishmaniasis is found throughout tropical Africa,
North Africa, the Middle East, Southern Europe,
Mexico, and Central and South America.
Approximately 90% of cases occur in Afghanistan,
Algeria, Iran, Iraq, Saudi Arabia, Bolivia, Brazil,
Columbia and Peru.
Prevention
Standard anti-mosquito precautions, i.e. wearing
long sleeves and trousers and frequent use of insect
repellent, are important, together with avoidance of
outdoor activities after dark if possible. Sand flies
also bite indoors, however, and it should be noted
that the mesh size of standard mosquito nets and
door/window screens is usually too large to
prevent the entry of the much smaller sand flies.
Bed nets with a very small mesh are available, but
air movement (ventilation) through this type of net
is considerably restricted and, consequently, such
nets are reputed to be very uncomfortable to sleep
under. If only a standard mosquito bed net is
available or tolerable, thorough impregnation with
permethrin will help.
 VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Appendix 3:
Neglected tropical diseases

Often neglected is a group of disabling, and
frequently chronic, diseases that affect the poorest
of the world’s population living in remote rural
areas or urban slums. Because of the population
affected, and a lack of awareness of the true
impact of these diseases, their control or
elimination has tended to be overlooked by
government and international funding bodies. In
October 2012, the WHO launched a campaign to
address these conditions and, ironically, estimated
that most of them can be controlled by safe, simple
and effective treatments and interventions that are
already available. Furthermore, it is thought that,
90% of these diseases are probably treatable by
medication given just once or twice a year. Major
scientific advances and drug developments are not
required—just a willingness to engage with time
and money.
Although many of these neglected tropical diseases
(NTDs) do not appear to have a direct impact on
the typical operations of oil and gas producers, the
social exclusion, suffering, mortality and negative
effect on general economic productivity in the
countries affected will undoubtedly affect major
corporations, even if indirectly. Furthermore, there
is an increasing imperative for resource-exploiting
companies to ‘give back’ to host countries through
corporate and social responsibility programmes,
and in this respect, the control or elimination of
NTDs—which may be easily achieved in many
cases—is a particularly worthy consideration. The
WHO has identified 17 diseases or disease groups
that fall into the category of neglected tropical
diseases. Whilst not all of these are vector-borne
diseases, their impact on the communities affected
is still significant.

Table A2 Neglected tropical diseases identified by the World Health Organization

Disease Transmission
Chagas * Parasite via triatomine bug

Dengue * Virus via mosquito

Rabies Animal bite

Trachoma Chlamydia via flies

Buruli ulcer Mycobacterium via plant wounds or insects

Leprosy Mycobacterium human to human

HAT * Parasite via tsetse fly

Dracunculiasis Nematode worm via water flea

Lymphatic filariasis Parasitic worm via mosquito

Onchocerciasis Parasitic worm via black fly

Schistosomiasis Freshwater snail vector

Soil-transmitted helminths† Nematodes via contaminated soil or self infection

Endemic treponematoses Spirochaete infections by direct contact

Cysticercosis Pig tapeworm ova and larva via ingestion of meat

Echinococcosis Tapeworm via ingestion

Leishmaniasis * Parasitic worm via sand fly

Fascioliasis Flukes via ingestion (and water snails)

* discussed in more detail in Appendix A † Ascariasis, hookworm and trichiniasis Vector-borne diseases are shown in red.

33
 IPIECA • OGP
Glossary
ABCD: a simple way to remember the key steps
needed to protect people from malaria: Awareness,
Bite prevention, Chemoprophylaxis, Diagnosis.
Anopheles: a genus of mosquito—some female
species of Anopheles are capable of transmitting
malaria to humans and animals.
Asymptomatic malaria: the presence of malaria
parasites in the blood in the absence of symptoms: in
certain immune states it is possible for an individual to
carry a high parasite load but not show symptoms
typically associated with the disease. (See also
Symptomatic malaria.)
Burden: the size of a health problem in an area,
measured by cost, mortality, morbidity or other
indicators.
Cerebral malaria: a state of unrousable coma
associated with severe falciparum malaria, although
any state of altered consciousness should be managed
as severe malaria. It may come on rapidly or slowly
and, in untreated cases, carries a 100% case fatality
risk. Even when treated, case fatality is probably
between 20–50% and is especially high in pregnant
women.
Chemoprophylaxis: a method of attempting to prevent
disease by taking various drugs prior to, during,
and/or after exposure.
Coartem®: a malaria treatment (artemether/
lumefantrine); sometimes used in ‘standby treatment’
kits. (See Standby treatment.)
CATT: card agglutination test for trypanosomiasis—a
test used to detect trypanosome-specific antibodies in
blood, serum or plasma.
CSF: cerebrospinal fluid analysis—examination of the
fluid that surrounds the brain and spinal cord.
DALYS: disability adjusted life years—the sum of years
of potential life lost due to premature mortality plus
the years of productive life lost due to disability.
Designed to give a more realistic idea of the burden
of a disease beyond simple infection or death rates.
DDT: dichlorodiphenyltrichloroethane—an insecticide
widely used for many years, but associated with
significant environmental concerns. It is a cheap and
effective insecticide for the management of mosquitos
in many areas.
DEET: an insect repellent (N,N,-diethyl-3-
methylbenzamide) for use on exposed skin to repel
mosquitoes and other insects.
34
Disability: a physical or mental impairment that
substantially limits one or more major life activities.
Diurnal: of or during the day.
E&P: exploration and production.
ELISA: enzyme-linked immunosorbent assay—
laboratory procedure used for detection of biological
chemicals including antibodies to disease.
Encephalitis: inflammation of the brain—can be
caused by a variety of infective organisms.
Endemic: describes a disease that is localized to a
particular geographical region.
Endemicity: the probable presence of disease
transmission.
Entomologist: an expert on insects.
Epidemic: a sudden increase in the frequency of a
disease that significantly exceeds the seasonal
variation normally observed in a given area.
Epidemiology: the study of the incidence, distribution
and control of disease in a population.
Eschar: a scab-like scar forming at the site of the bite
of certain insects (e.g. the tsetse fly Glossina
transmitting human African trypanosomiasis via the
parasite T.b. rhodesiense; sand fly transmitting
leishmaniasis).
FAT: fluorescent antibody test. Two varieties of test exist:
direct FAT (dFAT) in which antibodies to an antigen of
interest are labelled with fluorescent molecules to allow
identification of antibody-antigen fixation; and indirect
FAT (IFAT) in which the primary antibody attached to
the antigen is not labelled, but antibodies raised
against the primary antibody are labelled. The IFAT is
more complicated, but is more sensitive because
labelling at each antigen molecule is greater.
Fatality ratio: the fatality ratio is the proportion of
people with a disease who actually die from it (for
example ‘about 60% of people infected with the ebola
virus die’. (Contrast with Mortality rate, below.) It is
sometimes called a ‘fatality rate’, although, technically
this is not correct if a time period is not specified.
G6PD deficiency: an inherited condition in which the
body does not have enough of the enzyme glucose-6-
phosphate dehydrogenase, or G6PD, which helps red
blood cells to function normally.

HAT: human African trypanosomiasis—sleeping
sickness of sub-Saharan Africa.
Hepatosplenomegaly: the simultaneous enlargement
of both the liver and spleen, often due to infection.
Holoendemic: a disease is holoendemic when it is
present at such a high level that essentially all
individuals are, or have been, infected, and where the
greater bulk of pathological disease affects children,
with older individuals being asymptomatic or mildly
affected because of adaptive immunity.
Host: the human or animal in which an infective
parasite lives outside of the transmitting vector.
Hyperendemic: a disease present at very high
incidence and/or prevalence rates, and affecting all
ages equally (contrast holoendemic).
IFAT: indirect fluorescent antibody test. (See FAT.)
Immunity: protection generated by the body’s immune
system in response to a previous infection, resulting in
the ability to prevent or reduce the severity of a future
infection by the same organism.
Incidence: the number of new cases of a disease
arising in a given time interval, e.g. 20,000 cases per
annum. Useful for acute conditions such as infective
diseases.
Incubation period: the interval of time between
infection by an organism and the onset of the first
symptoms of the illness.
Infective bite: an insect bite that introduces infective
organisms into the bitten host.
Insecticide: a chemical substance that is designed to
kill insects.
IRS: indoor residual spraying—the treatment of houses
where people spend night-time hours, by spraying
insecticides that have a residual efficacy, i.e. they
continue to affect mosquitoes for several months.
ITNs: insecticide-treated bed nets.
Ixodid: a form of hard tick that can transmit a number
of diseases.
Larvicide: a chemical used to kill insect larvae, e.g.
one applied to water where mosquitoes are breeding.
Malaria: parasitic disease that kills two million people
per year around the world.
VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Malaria visa programme: see VBD visa programme.
Malarone®: the brand name of the drug combination
atovaquone/proguanil, which is used to prevent and
treat malaria.
Mefloquine: a drug used to prevent malaria; it goes
under the brand name of Lariam®.
Megasyndrome: enlargement of internal organs due
to infection.
MEWS: Malaria Early Warning System—a system for
predicting malaria epidemics based on satellite date.
MHRA: Medicines and Healthcare products Regulatory
Agency—the UK body responsible for licensing drugs
and medical products.
MMP: malaria management programme.
Morbidity: proportion of a population who have a
particular disease.
Mortality rate: proportion of a population who die
from a particular disease in a given time (for example
‘two people per thousand in a population die each
year from malaria’). (See also Fatality ratio.)
NGO: non-governmental organization.
Nocturnal: term describing insects or other animals
that are active at night.
Non-immune: a person with no immunity to a
specified disease.
Pancytopaenia: a situation where the numbers of all
three elements of the blood, i.e. red cells, white cells
and platelets, are reduced.
Parasite: microorganism, such as Plasmodium, that
lives, grows and feeds in a different organism while
contributing nothing to the survival of its host.
Pathogen: parasites, bacteria, viruses or fungi that
can cause disease.
Pathophysiology: the functional changes in humans
resulting from infection.
Peri-urban: the area immediately surrounding an
urban or city area.
Permethrin: a chemical that is especially useful as a
persistent insecticide on clothing and bed nets.
35
 IPIECA • OGP
Phlebotamine: group of sandflies in which female
takes a blood meal from mammals.
Point-of-care (POC) test: a test that may be used to
diagnose a disease without resource to a laboratory. It
may be used by medical personnel in the field, or
even by non-medical personnel if suitably trained. A
POC test kit may be included in a combined kit with
standby treatment, so that diagnosis and emergency
treatment may be carried out in a remote location.
(See Point-of-care testing on page 19.)
Prevalence: a measure of the disease burden at any
one time, taking account of new and chronic cases.
More useful for long-term conditions rather than
acute, short lived infections.
Repellent: a chemical substance that discourages
biting by insect vectors (and nuisance vectors). It may
or may not also act as an insecticide.
Residual spraying: see IRS—indoor residual spraying.
Retro-orbital pain: pain or pressure behind the eyes.
RNA: ribonucleic acid—a complex chemical which is
present as the main genetic material in some forms of
virus.
Rickettsia: a large group of bacteria that cause
spotted fevers and typhus.
Sequelae: a pathological condition that is the
consequence of a previous disease or injury.
Sylvatic (literally ‘related to woods’): diseases that
occur predominantly in, or affect, wild animals
especially in forested areas, in contrast to urban or
semi-urban disease. Sylvatic infection may be
transmitted to humans that visit, work or live in sylvatic
areas.
Standby treatment: treatment for a disease that is
used in an emergency when normal treatment facilities
are unavailable or unsuitable. A POC test (see Point-
of-care test) kit may be included in a combined kit, so
that diagnosis and emergency treatment may be
carried out in a remote location.
Subclinical: relating to, or denoting, a disease that is
not severe enough to present definite or readily
observable symptoms.
Symptomatic malaria: a malaria infection in an
individual who has no immunity to malaria and who
therefore displays symptoms typically associated with
the disease. (See also Asymptomatic malaria.)
36
Tick: a form of small insect that can transmit a number
of diseases through the bite of both immature and
mature forms. Usually associated with vegetation.
Tsetse fly: a large fly of the genus Glossina, which
transmits human African trypanosomiasis in sub-
Saharan Africa.
VBD visa programme: a procedure which requires an
individual to perform specific educational, behavioural
(e.g. spraying clothing with insecticide, obtaining
repellants, spraying bednets with insecticide) and
chemoprophylaxis activities before being given
permission to enter a VBD-infected area on company
business.
Vector: an organism that does not cause disease itself,
but which spreads infection by conveying pathogens
from one host to another.
VND: vaccine-associated neurotropic disease; a side-
effect of yellow fever vaccine manifesting in
neurological disturbance of various forms (e.g.
meningoencephalitis). Incidence is between 0.13 to
0.8 per 100,000 vaccines administered, but is
significantly higher in those older than 60 years. Most
victims make a complete recovery.
VVD: vaccine-associated viscerotropic disease. A side-
effect of yellow fever vaccine, causing severe multi-
organ failure. The incidence is about 0.8 per 100,000
vaccines administered but, like VND (above), it is
greater in those over 60 years of age. The risk
increases with age and reaches 2.4 cases per
100,000 vaccines in those older than 70 years of
age. Unlike VND, it carries a high fatality ratio of
about 60%.
WHO: World Health Organization—the main health
body of the United Nations. It coordinates and advises
upon international health programmes.
Xenodiagnosis: method of diagnosis in which a
presumed or suspected infected animal or human is
exposed to a laboratory bred, non-infected vector
capable of transmitting the infection. The vector is
later examined for evidence of the infective organisms
which have had a chance to multiply in the vector. The
most common application is in diagnosis of early
cases of Chagas disease, where laboratory bred
triatomine bugs are allowed to bite suspected patients.
Zoonosis: a disease which is transmitted to man from
another animal which is the usual host for the disease.
Transmission may or may not involve a vector.
 VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

References and further reading

References

CDC (2012). The Yellow Book: CDC Health Information for International Travel 2012. Centers for Disease
Control and Prevention. (Chapter 3: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-
diseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-and-related-infections-anaplasmosis-and-
ehrlichiosis.htm)

Hotez, P.J., Fenwick, A., Savioli, L. and Molyneux, D.H. (2009). Rescuing the bottom billion through control
of neglected tropical diseases. Lancet, 2009; 373: 1570–75.

Najera, J.A. and Zaim, M. (2002). Malaria Vector Control: Decision making criteria and procedures for
judicious use of insecticides. World Health Organization, Geneva. WHO/CDS/WHOPES/2002.5.

OGP-IPIECA (2005). A guide to health impact assessments in the oil and gas industry. OGP-IPIECA, London.

Websites and resources

World Health Organization: international body with extensive material on disease distribution and control.
www.who.int/ith

Centers for Disease Control and Prevention (CDC): US governmental authority in disease, with a major
section on international health and travel. www.cdc.gov. Produces the US Yellow Book: CDC Health
Information for International Travel. In addition, the CDC’s Division of Vector-Borne Diseases (DVBD)
provides information on a range of vector-borne diseases: the DVBD’s information pamphlet can be
downloaded from: www.cdc.gov/ncezid/dvbd/pdf/dvbd-pamphlet-2011.pdf

European Centre for Disease Control: collects, coordinates and disseminates information on infectious
disease in Europe or that may impact Europe. Publishes a newsletter and updates.
www.ecdc.europa.eu/en/healthtopics

Health Protection Agency: UK agency responsible for general health advice and guidance. Incorporates the
Malaria Reference Laboratory. www.hpa.org.uk

NaTHNaC: National Travel Health Network and Centre. Main UK body for advice on travel health in the
UK. Provides extensive information online, and publishes the UK ‘Yellow Book’, Health Information for
Overseas Travel: Prevention of Illness in Travellers from the UK. It administers the yellow fever vaccination
programme for the UK. www.nathnac.org

International Society for Infectious Diseases: produces the internet service ‘ProMed-mail’ which provides
regular and frequent mails on disease outbreaks worldwide, including animal and plant diseases.
www.promedmail.org

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of health, safety, the environment and social responsibility.

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