INTERMEDIATE VECTOR-BORNE DISEASES

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 Outline

 Learning objectives

 Introduction to Vector Borne Diseases

 Factors that affect the distribution of VBD

 Definition, causative agent, mode of transmission, reservoir, treatment and method of

prevention and control method of common vector borne diseases like:

 Filariasis

 Yellow Fever (Jungle fever)

 Trypanosomiasis (Haemo-Flagellates)

 Leishmaniasis

 Rickettsial Diseases

 Relapsing Fever
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 Plague
 Learning objectives

After completion of this chapter the student will be able to:

 Define vector borne diseases

 Identify common vector borne diseases in our country

 Describe the basic principles of vector control.

 Describe the mechanisms of transmissions of common vector

borne diseases in our country;

 Diagnose and describe the management of vector borne diseases;

 Describe prevention and control of common vector borne

diseases in our country

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 Introduction to Vector Borne Diseases
• A vector is an organism that transmits or carries a
disease from one human to another or from animal to
another and in some cases from an animal to a human
being.
• Therefore a vector simply is a carrier of disease.
• Many parasites, from viruses to nematodes, are
transmitted to humans by arthropod vectors, usually by
blood-feeding ticks and insects.
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 Introduction to Vector Borne Diseases

•The organism that causes the disease is carried

within the vector, without causing any harm to it.

•These disease causing organisms may undergo

some physiological development of their life cycle
while they are within the vector.

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 Introduction to Vector Borne Diseases
•The developmental changes that the organism undergoes
while within the host are called extrinsic incubation
period.

•This is a time taken for the parasite to complete the life

cycle within its vector.

•The intrinsic incubation period is the time in the

vertebrate from infection to the first appearance of
symptoms.
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 Distribution of Vector Borne Diseases

•Vector borne diseases are mainly concentrated in

areas where there are suitable conditions for the
vectors to thrive.

•Most of the vectors breed, feed and thrive well in

certain environmental conditions and, therefore, most
vector borne diseases are common in certain
environmental and ecological conditions.
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 Distribution of Vector Borne Diseases...

In Africa many vector borne diseases such as:

– Malaria

– Schistosomiasis Endemic.

– Filariasis
– Trypanosomiasis
Serious epidemics of yellow fever have been experienced
in Nigeria, Sudan, Ethiopia and Ghana.

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Factors that affect the distribution of VBD

 Meteorological factors

 Human factors

 Socio economic factors

 Vulnerability factors

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 Principles of Vector Control
• Vector-borne diseases have an extrinsic cycle where the
organism exists outside the human being.
• This offers a good opportunity to control the disease
without necessarily interfering with the behaviour of human
beings.
We need to have a good understanding of the vectors:
Breeding places
Nesting places
Feeding patterns
Flying distances
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 Principles of Vector Control...

The main principles of vector control are:

Reducing the reservoir host

Controlling the vector population

Protecting the susceptible host

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 Principles of Vector Control...

There are four main ways of vector control:

Targeting the adult vector using Insecticides
Targeting the larvae stage using larvicides
Preventing the breeding of the vector through
environmental interventions;
Protecting the susceptible hosts.

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 Common vector borne diseases
Filariasis
Yellow Fever (Jungle fever)
Trypanosomiasis (Haemo-Flagellates)
Leishmaniasis
Rickettsial Diseases
Relapsing Fever
Plague

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 Malaria

Malaria is an acute infection of blood caused by protozoa of

the genus plasmodium.
It is a common & most important of the parasitic diseases of
humans and the most significant vector born disease in Africa,
it is transmitted in 108 countries containing 3 billion people
and causes nearly 1 million deaths each year.

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 Epidemiology

Malaria is an important cause of death and illness in

children and adults, especially in tropical countries.
Malaria occurs throughout most of the tropical region
of the world.
P. falciparum predominate in Africa, New Guinea, and
Hispaniola (i.e., the Dominican Republic and Haiti)

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 Epidemiology...
P. Vivax is more common in Central America and Indian sub

continent.

P. Malariae – is found in most endemic areas, especially

throughout sub –Saharan Africa much less common.

P. Ovale is relatively unusual outside of Africa

Children <5 years pregnant women and travellers to endemic areas

are risk group.

Case fatality rate for P. falciparum may exceed 10% among

untreated
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children and non immune adult.
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 Epidemiology...

Endemicity is classified into

Hypoendemic (an area with little transmission )< 10%

Mesoendemic (an area with some transmission) 11 to 50%

Hyperendemic (a disease that is constantly present at a high

incidence and/or prevalence rate and affects all age

groups equally) 51 to 75% People infected repeatedly throughout

their lives

Haloendemic (endemic in the entire population of a given area) >

75% People infected repeatedly throughout their lives

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 Epidemiology...
 Approximately 52 million people (68%) live in malaria risk
areas in Ethiopia, primarily at altitudes below 2,000 meters.
 Malaria is mainly seasonal with unstable transmission in the
highland fringe areas and of relatively longer transmission
duration in lowland areas, river basins and valleys.
 Historically, there have been an estimated 10 million clinical
malaria cases annually. Since 2006, however, cases have
reduced substantially.

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 Epidemiology...
 On average, 60%-70% of malaria cases have been due to P.
Falciparum
• Rates of morbidity and mortality increase dramatically (i.e.
3-5 fold) during epidemics.
• Since 2005, Ethiopia has scaled-up one of the largest and
most ambitious malaria control programs in Africa,
designed to support the country‘s Health Sector
Development Plan (HSDP)
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 Epidemiology...
• Ethiopia‘s malaria control program is currently shifting
from the SUFI phase to consolidating and refining malaria
reduction interventions, through integrated programming
for impact.
• This will involve gradually moving from scaling-up for
impact to programming (integrated within the overall health
system) for sustainable and equitable long-term impact.
• The challenge now is maintaining the existing high LLIN
coverage
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and increasing utilization rates.
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 Epidemiology...
Malaria has been reported as the major cause of mortality and
morbidity accounting for
15.5% of Outpatient consultation
20.4% of admission
27% of Inpatient death

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 Infectious agent

There are approximately 156 named species of Plasmodium which

infect various species of vertebrates.

Four are known to infect humans:

 P. falciparum

 P. Vivax

 P. ovale

 P. malariae.
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 Infectious agent...

The four species of plasmodium

A.Plasmodium falciparum /malignant tertian
 Almost all death caused by it
 Invades all age of RBC
 RBC cycle is 48hours
B.Plasmodium Vivax /Benign tertian
 Invade Reticulocyte only
 RBC cycle is 48 hours
• Has possible relapse
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 Infectious agent...

C. Plasmodium Ovale (has the same characteristics with

Vivax)

D. Plasmodium Malariae / Quartan malaria

 Invade only Reticulocyte

 RBC cycle is 72 hours

 Mixed infections are not infrequent in endemic areas.

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 Risk Factors

Visiting or living in an endemic area

Exposure to mosquitoes in outdoor areas from dusk to
dawn
Exposure to infected blood
Transplacental infection
Blood transfusion
Needle-stick injury
Sharing of needles by infected drug addicts
Organ transplantation
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 Method of Transmission

1. Bite of infective female anopheles mosquito (sucks blood

for egg maturation)
2. Blood transfusion
3. Organ donation
4. Hypodermic needle prick
5. Trans-placental

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 Method of Transmission...

The vector
• The main vector in Ethiopia is anopheles arabiensis which
breeds in small water collections & usually indoor resting.
• Anopheles pharoensis – is 2nd vector
• Anopheles funestus and anopheles nini are also found in
Ethiopia
• Behavioural pattern of vectors
– Peak time of bite depends on the species and environmental
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condition.
 Method of Transmission...
Different nomenclatures are given for different behaviour of vector
• Feed on domestic animals: zoophilic
• Feed on human blood: anthropophilic
• Indoor biting: endophagic
• Outdoor biting: exophagic
• Resting place is house: endophilic
• Resting place out of house: exophilic
• Flight range
– Usually 2-3 kilometres from breeding site.
– Up to 30 kilometres by
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Vector wind.
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Incubation period
P. Falciparum: 7-14 days
P. Vivax: 8-14 days
P. Ovale: 8-14 days
P. Malariae: 7-30 days

Period of communicability
Mosquitoes are infective as long as infective gametocyte
is present in blood of patient.
 Once infected, mosquito
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remain infective for life
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Susceptibility and resistance
• Susceptibility is universal except in some host resistant factors.

Non specific factors

• Increased spleenic clearance reaction
• Hyperpyrexia which said to be schizonticidal
• Sickle cell traits are resistant to P. Falciparum
• Observation suggests that genetic disorders such as G6PD deficiency,
thalasemia, sickle cell disease confer protection against P. falciparum.
• Duffy blood group deficiency (Duffy antigen –ve RBC, Lacks
receptors for P. vivax.
• Passive
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immunity in infancy resistant in early life.
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 Specific factors

• Humoral and cell mediated immunity that is species and strain

specific
• Hard won after repeated infection

• Specific immune response to malaria confers protection from

high level of parasitemia and disease but not from infection
• State of infection with out is known as premonition, leading to
asymptomatic parasitemia (in halo or hyper endemic areas)

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 Life cycle

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