Dengue

Dengue
 Dengue is a viral infection transmitted to humans
through the bite of infected Aedes mosquitoes.
 Dengue is widespread throughout the tropics, with
local variations in risk influenced by climate
parameters as well as social and environmental
factors.
 Dengue is caused by a virus of the Flaviviridae family
and there are four distinct, but closely related,
serotypes of the virus that cause dengue (DENV-1,
DENV-2, DENV-3 and DENV-4).
 Dengue
 In Nepal, dengue is a rapidly emerging disease.
 A vector surveillance conducted in three
districts: Dang, Lalitpur and Kathmandu has
demonstrated presence of the vector Aedes
aegypti and Aedes albopictus.
 All 4 dengue serotypes exist in Nepal, with
DENV-1 and 2 historically contributing the
highest burden (EDCD, 2019).
 Dengue situation
 First reported in the country in 2060/61 (2004),
cases have steadily risen, including Kathmandu.
 Multiple outbreaks occurred between 2062/63
(2006) and 2078/79 (2022),
 The A. aegypti was identified in five peri-urban
areas of the Terai (Kailali, Dang, Chitwan, Parsa and
Jhapa) during entomological surveillance
conducted by EDCD from 2062/63 - 2066/67
(2006–2010), suggesting the local transmission of
dengue
 Dengue situation
 From 2068/69 to 2071/72 (2012 to 2015), cases
continued variably.
 Subsequent years saw annual outbreaks in
different districts, notably in 2075/76 (2019)
when 68 out of 77 districts were affected with
17,992 reported cases.
 The COVID-19 pandemic 2076/77-2077/78
(2020-2021) resulted in fewer cases,
Trend
Trend
 Present Situation
 The 2079 (2022) outbreak was larger, with
56,338 cases and 88 deaths, marking it as the
largest outbreak in Nepal to date.
 Dengue has emerged as a significant concern
nationwide, with cases reported in all 77
districts throughout the year.
 The implementation of the program is guided
with the goal to reduced dengue related
mortality
 Nepal’s Dengue Control
Programme
Goal — To reduce the morbidity and mortality due
to dengue fever, dengue haemorrhagic fever (DHF)
and dengue shock syndrome (DSS).
 Nepal’s Dengue Control
Programme
Objectives:
1. To develop an integrated vector management
(IVM) approach for prevention and control.
2. To develop capacity on diagnosis and case
management of dengue fever, DHF and DSS.
3. To intensify health education and IEC activities.
4. To strengthen the surveillance system for
prediction, early detection, preparedness and
early response to dengue outbreaks.
 Strategies:
1. Early case detection, diagnosis, management
and reporting of dengue fever
2. Regular monitoring of dengue fever
surveillance through the EWARS
3. Mosquito vector surveillance in municipalities
4. The integrated vector control approach where
a combination of several approaches are
directed towards containment and source
reduction
 Major activities
1. Training to physicians, nurses, paramedics and
laboratory technicians on dengue case detection,
diagnosis, management and reporting.
2. Orientation to municipality stakeholders
3. Supplied rapid diagnostic test kits (IgM).
4. Dengue case monitoring and vector surveillance.
5. Search and destruction of dengue vector larvae (A.
aegypti)
6. Developed and disseminated health education
messages
• यो लामखुट्टेले सामान्त्यत: जमेको सफा पानीमा अण्डा पाने
गर्दछ
जीवन वयश्क

चक्र

१-२ दिन

प्यप लाभा अण्

ा द डा

४-५ दिन २-३ दिन

पानी
 Ornamental or Recreational Containers:
Plant pots and dishes, plastic pools, rooting plants in water.
 Ornamental or Recreational Containers:
Plant pots and dishes, plastic pools, rooting plants in water.
 Aedes Breeding Sites
• Plastic Containers

Slide courtesy : Dr. B. Nagpal,

WHO
 Aedes Breeding Sites
• Tyre Dumps

Slide courtesy : Dr. B. Nagpal,

WHO
 Aedes Breeding
Sites

• Solid Waste

Slide courtesy : Dr. B. Nagpal,

WHO
 Aedes Breeding
• Plants Sites

Slide courtesy : Dr. B. Nagpal,

Significance of environmental modification
and personal protection
• Destroy the mosquito habitats. This is the
first and most effective way to Prevent dengue.
• Use mosquito repellents. Mosquito repellents are
available in different forms.
• Maintain cleanliness in and around your house;
Search and destroy water containing container,
bottle, plastics, tyres, tubes, broken glass, water
tank.
• Use nets on the doors and windows.
• Wear full sleeved clothes, and shoes at work places
 Major activities in 2079/80
 Routine Dengue surveillance through EWARS across118 sentinel
sites,
 Vector surveillance activities in Bagmati province (Bhaktapur,
Chitwan, Kathmandu, Lalitpur, Makwanpur) & some selected sites
at Sudurpaschim province.
 Genome sequencing study for type of dengue virus circulating
 Procurement and supply of rapid diagnostic test kits (IgM) to
provincial and local government.
 Regular advocacy & coordination meetings with institutions like
Rotary Club, Institute of Engineering, Armed Police Forces, etc.
 Preparation of daily situation updates of dengue &dissemination.
 Development of SOPs for integrated vector surveillance and
disseminated to concerned stakeholders.
 Major activities in 2079/80
 Consultative review and planning meeting on Dengue
preparedness and response: Stakeholders from diverse sectors
collaborated to enhance the country’s capabilities in managing
Dengue outbreaks.
 MOHP circular for “Every Friday 10 Minute” cleanliness
campaign: MoHP issued a circular promoting a nation wide
breeding sites ‘Search & Destroy’ campaign, encouraging citizens
to dedicate 10 minutes every Friday to eliminate potential
breeding grounds for mosquitoes in their homes, offices and public
places
 EDCD circular to local levels requesting Dengue prevention and
control activities: EDCD circulated request letter to LLGs, urging
them to implement Dengue prevention and control activities.
 Major activities in 2079/80
 DCD circular to local levels regarding Dengue prevention and
control action plan EDCD issued another circular to LLGs, detailing
a comprehensive Dengue Prevention and Control Action Plan as a
roadmap.
 Nepal’s participation in meeting of the programme managers and
RTAG on Dengue: Nepal actively participated in meeting of
program managers and regional technical advisory group (RTAG)
on Dengue in South-East Asia region.
 Clinical seminar on Dengue: It, supported by WHO, was organized
to enhance healthcare professionals’ understanding of diagnosis
and treatment. International clinical experts were invited for
orientation on effective triage and case management, focusing on
fluid management in Dengue with warning signs.
 .
 Major activities in 2079/80
Sensitization meetings on Dengue prevention and control with:
 Nepal Auto-mechanics Association: A focused sensitization
meeting was held to educate and involve auto service providers in
Dengue prevention. The emphasis was on proper disposal and
Storage of tires.
 Nepal Recollectors’ and Recyclers’ Association: Similar
sensitization meeting was held to engage the waste management
sector in Dengue prevention activities and acknowledging their
vital role in eliminating mosquito breeding sites.
 Journalists: Media professionals and journalists were sensitized on
Dengue prevention and control strategies, leveraging their
influence to disseminate accurate information and raise public
awareness about preventive measures.
 Strengths
 Availability of National Guidelines on Prevention, Management
and Control of Dengue in Nepal.
 Comprehensive month wise action plan for dengue control and
prevention is in place.
 Establishment of online reporting system through EWARS on
DHIS2
 Availability of dengue register for better recording and reporting.
 Development of National Guidelines on IVM Development of
SOPs for Integrated Vector Surveillance.
 SOPs for complimentary vector control intervention like, targeted
Indoor Residual Spray, BTI Use has been developed and
disseminated
 Strengths
 Availability of National Guidelines on Prevention, Management
and Control of Dengue in Nepal.
 Comprehensive month wise action plan for dengue control and
prevention is in place.
 Establishment of online reporting system through EWARS on
DHIS2
 Availability of dengue register for better recording and reporting.
 Development of National Guidelines on IVM Development of
SOPs for Integrated Vector Surveillance.
 SOPs for complimentary vector control intervention like, targeted
Indoor Residual Spray, BTI Use has been developed and
disseminated
 Weakness
• Low priority for the dengue control program at sub-national
level.
• Inadequate training and orientation for newly recruited health
workers and refresher trainings.
• Under/over reporting of dengue cases leading
• Inconsistent, incomplete, and untimely reporting
• EWARS system is unable to capture a substantial number of
dengue cases that are tested outside the designated sentinel
sites
• Limited capacity for early detection and response to outbreaks
• Limited entomological capacity and vector surveillance due to
unavailability of resources (trained human resources and budget
 Opportunity
 Local governments have authority and capacity to
plan and implement response activities as per the
local need.
 Collaboration with regional and international
organizations for dengue control efforts.
 Prospects for integration of technology in
surveillance and response systems, such as Epidemic
Intelligence from Open Sources (EIOS).
 Increased collaboration and coordination among all
three tiers of government.
 Threats
 Climate change and its impact on mosquito populations and
dengue transmission with shifting of disease from low land regions
to higher elevations.
 Rapid and unplanned urbanization have created favorable
breeding environments for mosquitoes
 Limited engagement of other concerned ministries besides the
Ministry of Health and Population in the prevention and control of
mosquitoes.
 Lack of community compliance and multi stake holders’
engagement in dengue control measures at local levels.
 Sudden and unpredictable outbreaks overwhelm healthcare
systems and strain available resources
 Lack of reporting on Dengue from private clinics, polyclinics, and
other health institutions