FOGGING ACTIVITIES & HEALTH EDUCATION ACTIVITIES

FOGGING ACTIVITIES

                   Fogging activities are carried out as soon as a suspected case of dengue is notified to the health authority. For a single case of dengue, perifocal fogging 200m around the patient's house using the portable thermal fogging is carried out. For outbreak situation, ULV fogging is used to cover the whole locality. During dengue outbreak, the first adulticidal treatment is normally followed by a second application 7-10 days later. The two treatment cycle is based on the life-cycle of the Aedes mosquitoes and the incubation period of the virus in the mosquito. The outbreak is declared as over once it has been possible to achieve a 20 day transmission-free period. The insecticide of choice for fogging is malathion in fuel oil for thermal fogging and 96% malathion technical garde for ULV. Air-borne bioassay tests are conducted regularly and to date, there is no indication of resistance developing to the insecticide by the Aedes mosquitoes.




A-numberof problems are encountered in fogging activities, including the following:


1. Some houseowners tend to close the doors and windows during fogging which will reduce the effectiveness of the spray droplets reaching the target mosquitoes.

 2. The difficulty of achieving total coverage of all houses and in carrying out second fogging within 7-10 days duration after the first round.


3. The use of newsynthetic pyrethroid insecticides for fogging which are not effective in controlling outbreaks.


 4. Private pest control operators conducting fogging without adequate supervision.






HEALTH EDUCATION ACTIVITIES



 Health education is an ongoing activity and is continuously strengthened in order to gain public support and cooperation. These activities include health talks, individual advice, demonstrations, distribution of pamphlets, etc. They are carried out during the Aedes surveys from house to house, during fogging operations and case investigations. This activity is intensified during the anti-dengue campaign months of January, April, July and October, especially in dengue-prone or sensitive areas. Demonstrations in the use of larvicides and destruction of breeding places are carried out in the premises inspected. During outbreaks, health education activities are further intensified through the use of mass media (including electronic and print) at various levels. Government agencies, local authorities, and voluntary organizations participate in source reduction activities, 307 printing of education posters and pamphlets and distribution of health education materials. In addition, special health education teams are formed to ensure quicker and fuller coverage of the affected population.

Dengue and the Aedes aegypti mosquito

                       



                   

 

                   The Aedes aegypti mosquito can transmit the viruses that cause dengue fever. The female mosquito lays eggs in containers with water and plants near the home. It bites people and animals. This species can survive year round in tropical and subtropical climates.




General information 

 Aedes aegypti is a small, dark mosquito with white lyre shaped markings and banded legs.

 They prefer to bite indoors and primarily bite humans.

 These mosquitoes can use natural locations or habitats (for example treeholes and plant axils) and artificial containers with water to lay their eggs. They lay eggs during the day in water containing organic material (e.g., decaying leaves, algae, etc.) in containers with wide openings and prefer darkcolored containers located in the shade.

  About three days after feeding on blood, the mosquito lays her eggs inside a container just above the water line. Eggs are laid over a period of several days, are resistant to desiccation and can survive for periods of six or more months. When rain floods the eggs with water, the larvae hatch.


 Generally larvae feed upon small aquatic organisms, algae and particles of plant and animal material in water-filled containers.

 The entire immature or aquatic cycle (i.e., from egg to adult) can occur in as little as 7-8 days. The life span for adult mosquitoes is around three weeks.

 Egg production sites are within or in close proximity to households.

 Aedes aegypti do not remain alive through the winter in the egg stage in colder climates.





Medical importance


Most frequently found in tropical and subtropical areas of the world, Aedes aegypti historically is considered to be a primary vector of viral diseases such as the dengue fever, chikungunya and yellow fever.



 Habitat

            Aedes aegypti is extremely common in areas lacking piped water systems, and depend greatly on water storage containers to lay their eggs. Male and female adults feed on nectar of plants; however, female mosquitoes need blood in order to produce eggs, and are active in the daytime. Eggs have the ability to survive drying for long periods of time, allowing eggs to be easily spread to new locations. Artificial or natural water containers (water storage containers, flower pots, discarded tires, plates under potted plants, cemetery vases, flower pots, buckets, tin cans, clogged rain gutters, ornamental fountains, drums, water bowls for pets, birdbaths, etc.) that are within or close to places where humans live are ideally larval habitats for this mosquito. This species has also been found in underground collections of water such as open or unsealed septic tanks, storm drains, wells, and water meters.




Biting Behavior 

          Aedes aegypti bites primarily during the day. This species is most active for approximately two hours after sunrise and several hours before sunset, but it can bite at night in well lit areas. This mosquito can bite people without being noticed because it approaches from behind and bites on the ankles and elbows. Aedes aegypti prefers biting people but it also bites dogs and other domestic animals, mostly mammals. Only females bite to obtain blood in order to lay eggs.




Mosquito Control 

 Check your yard weekly for water-filled containers.

 Throw away or recycle water-holding containers that are not needed.

 If empty containers or large objects, such as boats or old appliances must be stored, they should be covered, turned over or placed under a roof that does not allow them to fill with water.

 Clean and scrub bird baths and pet-watering dishes weekly and dump the water from overflow dishes under potted plants and flower pots. Check that gutters are not holding water and cover rain barrels with tight screening so that mosquitoes cannot enter.

  Fill tree holes and other cavities in plants with sand or soil.

  Check for hidden bodies of water such as wells, septic tanks, manholes, clogged drains, etc.

 Call the health authorities when you detect unusual numbers of mosquitoes.





Avoid mosquito bites 

   Use personal protection to avoid mosquito bites.


 Wear long sleeve shirts, long pants, socks and shoes when mosquitoes are most active.


 Apply repellents such as DEET, picaridin, oil of lemon eucalyptus or IR3535 only to exposed skin and/or clothing (as directed on the product label).

Do not use repellents under clothing. In addition to wearing repellent, you can protect yourself and your family by taking these precautions:

 Use mosquito netting over infant carriers, cribs and strollers.

 Install or repair window and door screens to keep out mosquitoes.

Strategies for dengue control

Strategies for dengue control 

                                     The strategies used in the prevention and control of dengue are contained in the Vector-borne Diseases Control Programme Sixth Malaysia Plan (1991-1995). These strategies are directed both at the larval and adult stages of the Aedes mosquitoes. For larval control, the activities carried out are source reduction measures, use of Abate larvicide, regular house inspection and enforcement of the Destruction of Disease-bearing Insects Act (DDBIA, 1975). Control measures include fogging activities when a case is notified and conducting case investigations and contact tracing. Health education activities are carried out routinely as an integrated approach for the prevention and control of dengue. The objectives of the control programme are : 1. to reduce the breeding of Aedes mosquitoes to a level below 2.5% Aedes House Index and below a Breteau Index of below 10% 2. to promote public support and community participation in the prevention and control of dengue 3. to get the full participation of the local authorities in dengue control activities. The overall control programme is very ambitious with the following targets in mind under the Sixth Malaysia Plan (1991-1995) : 1. to reduce the incidence rate to less than 6 cases per 100,000 population 2. to reduce the case fatality rate to less than 0.4%. Vector control against the Aedes adult and larval mosquitoes is given emphasis and the following activities are promoted.

(a) Source reduction The objective of this exercise is the elimination of Aedes mosquito breeding grounds in and around the home environment, state lands, public parks, construction sites, factories, government premises, schools and cemeteries. This is carried out with community involvement together with various other agencies as well as the local health authority. One of the problems encountered in source reduction is illegal dumping of household refuse by the roadside. This creates favourable breeding sites for the Aedes mosquitoes. To overcome this problem, the local health authority has stepped up scavenging services and provided additional bins at designated areas. Surveys carried out recently have identified neglected and unusual breeding sites which hamper source reduction efforts. Some of these breeding sites are cocoa pods, septic tanks, abandoned housing projects, roof gutters, refrigerator trays and Chinese cemeteries.





(b) Use of Abate Larvicide The use of a suitable larvicide such as Abate is given emphasis in the dengue control programsedrgbhbik o
me. It is safe, effective and convenient to use, especially in water holding 305 containers. The householders are encouraged to put Abate sand granules into water storage containers so that Aedes larvae will not breed. Its effectiveness will last for about 3 months. Abate is easily available in many outlets in Malaysia and priced so that it is within the means of all. Bacillus thuringiensis H-14 was found to be effective in suppressing Aedes albopictus breeding in outdoor artificial containers (Lee and Cheong, 1987) and the use of spraying machines to disperse this agent is under investigation.




(c) House inspection for Aedes Breeding House inspection for Aedes breeding is carried out daily by the health authority. The purpose of house inspection is to impart health education to the people on ways and meansto prevent Aedes breeding including the use of Abate larvicide and to look for Aedes breeding in individual household. Another purpose of the house visit is to ensure that the people carry out source reduction measures. The results of the Aedes larval surveys can be used to assess regularly the Aedes situation and density and to pin-point high risk areas as priority areas for prevention. House inspection to assess risk of dengue outbreak is based on Aedes surveillance and the larval density is expressed as House Index and Breteau Index. Although these indices were useful indicators in the past (Cheong, 1986), recent studies have indicated that dengue continues to occur despite very low larval populations. A more sensitive surveillance method is sequential sampling using ovitrap (Jakob and Bevier, 1969). Lee (1991) used a similar technique and reported that an ovitrap larval index of 10% was crucial for the initiation of vector control to suppress a possible outbreak. The major setback to the wider use of ovitrap is that it is labour-intensive. For the past five years, an average of 3.5 million houses were inspected for Aedes breeding. Out of this total, 12,111 (0.34%) houses were positive for Aedes aegypti and 29,768 (0.84%) houses were positive for Aedes albopictus. One of the problems encountered in house inspection is the coverage and frequency of visits to houses not being up to expectation due to shortage of manpower. For effective surveillance and control, each house should be visited at least once a month but this is seldom, if ever, achieved.

(d) Enforcement of the DDBIA, 1975 The enforcement of the DDBIA, 1975, against anyone found having Aedes larvae breeding in and around his house is an effective but unpopular strategy. However, it must be emphasized that the basis of enforcing this Act is not entirely to elicit public acceptance of legislation but to highlight the role of the public in supportive activities and the importance of their participation especially in source reduction measures. Towards this end, the implementation of legislation will be supported by health education and viewed as a constant reminder and driving force behind the Ministry's 306 objective of seeking spontaneous and full community participation in the prevention of Aedes breeding.

Information for Health Care Practitioners

Dengue Fever

                      Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such asheadache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the “dengue triad”) of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles. Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed. Dengue goes by other names, including “breakbone” or “dandy fever.” Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.

                      Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.

How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease.

The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway.

Dengue fever facts

• Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.
• Symptoms include severe joint and muscle pain, swollen lymph nodes,headache, fever, exhaustion, and rash. The presence of fever, rash, and headache (the "dengue triad") is characteristic of dengue fever.
• Dengue is prevalent throughout the tropics and subtropics.
• Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms (symptomatic treatment).
• The acute phase of the illness with fever and muscle pain lasts about one to two weeks.
• Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
• The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.
• There is currently no vaccine to prevent dengue fever.

What is dengue and how is it treated?

 What is dengue and how is it treated?

                     Dengue is a viral infection transmitted by the bite of an infected female Aedes mosquito. There are four distinct serotypes of the dengue virus (DEN 1, DEN 2, DEN 3 and DEN 4). Symptoms appear in 3–14 days (average 4–7 days) after the infective bite. Dengue fever is a flu-like illness that affects infants, young children and adults. There is no specific treatment for dengue fever. Severe dengue is a potentially lethal complication but early clinical diagnosis and careful clinical management by experienced physicians and nurses often save lives.

                     More than 70% of the disease burden is in South-East Asia and the Western Pacific. In Latin America and the Caribbean, the incidence and severity of disease have increased rapidly in recent years. The African and Eastern Mediterranean regions have also recorded more outbreaks of the disease in the last ten years. In 2010 indigenous transmission of dengue was also reported in two countries of Europe. Urbanization, rapid movement of people and goods, favorable climatic conditions and lack of trained staff have all contributed to the global increase of dengue.

Programme Dengue Patrol Nationwide

           

           The Dengue Patrol Programme goes Nationwide Sanofi Pasteur together with the Ministry of Education and the Ministry of Health launches a dengue education initiative to address the rising dengue epidemic in Malaysia. Putrajaya, Malaysia - 5 March 2014 – Sanofi Pasteur, the vaccines division of Sanofi (EURONEXT: SAN and NYSE: SNY) together with the joint effort of the Ministry of Education and Ministry of Health have launched the Dengue Patrol (DP) Programme – which is set to go nationwide this year. 

              The DP programme which was launched initially in 2011 as a pilot programme is part of Sanofi Pasteur’s ongoing commitment to take proactive measures to intensify awareness on dengue and involve public participation, especially from the younger generation. In line with the government’s aim to educate and create public awareness on various health matters, the DP programme is aimed at advocating prevention against this disease and spearheading dengue prevention activities in the respective school’s immediate communities. This year, the DP programme is set to expand its reach nationwide to all schools in Malaysia. The launch ceremony was officiated by Yang Berhormat Tuan P. Kamalanathan A/L P. Panchanathan, the Deputy Minister of Education II from the Ministry of Education, who spoke on the urgency and timeliness of the DP programme, “The Dengue epidemic in Malaysia is a serious and pressing matter to the nation. Dengue is an infection that does not recognize national or provincial boundaries and is spreading with an amplified frequency of outbreaks. Everyone is aware that dengue is serious, but yet people continue to be apathetic about prevention methods. 

                We need a multi-stakeholder approach to address the situation – effort comes not only from the government – but also from individuals and communities.” The objectives of DP Programme are to intensify awareness on dengue and improve public education. This programme aims to recruit students nationwide to form Dengue Patrols in their respective schools to initiate activities that encourage the prevention of dengue and protection against Aedes mosquitoes. The DP programme features a six-week long campaign with activities relating to dengue health awareness and dengue health education that will be supervised by the selected teacher advisor. The programme consists of six compulsory elements that need to be incorporated by the students into their schools and respective communities – these elements range from community outreach programmes, the creation of a mosquito cartoon series and a dance movement. As part of the programme, each school will receive a RM1, 000 grant from Sanofi Pasteur to carry out the activities. A total of seven winners will be chosen at the end of the campaign while consolation prizes will be awarded to all participants of the programme. “The Dengue Patrol Programme initiated by Sanofi Pasteur is an excellent initiative that is aimed at cultivating strong civic consciousness amongst children. It will inculcate the values of caring and taking action while educating them about ways they can protect their community against this disease. We are very happy with the outcome of this campaign over the past years, it has yielded tremendous results towards addressing this health challenge – we are excited for this programme to go nationwide.” added Yang Berhormat P. Kamalanathan. Deaths from dengue fever have nearly tripled in Malaysia this year, compared to the same period in 2013. Recent data has shown the gravity of this disease escalating quickly, with this year being at its peak with over a whopping 302.2% of increase in the number of cases as compared to 20131. According to recent statistics, the dengue fever cases have currently reached up to 13,915 cases and 25 fatalities over the past eight weeks of 20141. “We at Sanofi Pasteur strongly believe it is important for children to be aware of health issues affecting their community. 

                    We are happy to be able to contribute to this important initiative together with the support of the Ministry of Education and Ministry of Health,” said Baptiste de Clarens, Vaccine Head Malaysia / Singapore / Brunei, Sanofi Pasteur. The DP Programme has proved to be an enriching experience for participating students and overwhelming requests have led to the expansion of this programme on a national scale. The DP Programme is part of a long-term initiative for schools in Malaysia and is set to continue for the years to come. With the continuous support from the Ministry of Education and the Ministry of Health, this meaningful initiative is set for 2014 and beyond to ensure widespread efforts in all parts of the country. About Dengue Dengue is a threat to nearly half of the world’s population. Currently, there is no specific treatment available for dengue. It is a health priority in many countries of Latin America and Asia where epidemics occur regularly. The WHO estimates up to 100 millions infections per year but the overall number of people infected with dengue globally is not fully known. The WHO has set the target to estimate the true burden of dengue by 2015. Dengue is underreported because it is often misdiagnosed due to the limitations of the surveillance system and the large spectrum of clinical symptoms from mild non-specific illness to life threatening complications. Each year, 500,000 people, mostly children, are affected with dengue hemorrhagic fever (DHF), the severe form of the disease. DHF is a leading cause of 1 “Govt going all out against dengue Menace” The Star, 21 February 2014. hospitalization, placing tremendous pressure on health system and strained medical resources with a heavy economic and social impact. Timely access to appropriate health care is critical to reduce the risk of mortality in case of severe dengue. The WHO has set the target to reduce dengue mortality by 50% and reduce morbidity by 25% by 2020. About Sanofi Pasteur’s Dengue Vaccine Clinical Program Sanofi Pasteur has been working on a dengue vaccine for more than 20 years. 

                   Sanofi Pasteur dengue vaccine is the world’s most clinically, and industrially, advanced candidate vaccine. Sanofi Pasteur’s dengue vaccine candidate has been evaluated in clinical studies (Phase I, II) in adults and children in the U.S., Asia and Latin America. Results of the first efficacy clinical study published in The Lancet show evidence of the vaccine candidate to protect against dengue fever caused by three dengue virus types. The results confirm the good safety profile of Sanofi Pasteur’s dengue vaccine candidate.2 Large-scale phase III clinical studies with 31,000 children and adolescents are ongoing in Latin America (Mexico, Colombia, Honduras, Puerto Rico and Brazil) and in Asia (the Philippines, Vietnam, Malaysia, Indonesia, and Thailand). These studies follow the highest standards from the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). Additional information, photos and videos about Sanofi Pasteur dengue vaccine candidate are available on the web at http://www.dengue.info. About Sanofi Sanofi, a global and diversified healthcare leader, discovers, develops and distributes therapeutic solutions focused on patients’ needs. Sanofi has core strengths in the field of healthcare with seven growth platforms: diabetes solutions, human vaccines, innovative drugs, rare diseases, consumer healthcare, emerging markets and animal health.

             Sanofi is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY). Sanofi Pasteur, the vaccines division of Sanofi Group, provided more than 1.6 billion doses of vaccine in 2009, making it possible to immunize more than 500 million people across the globe. A world leader in the vaccine industry, Sanofi Pasteur offers the broadest range of vaccines protecting against 20 infectious diseases. The company's heritage, to create vaccines that protect life, dates back more than a century. Sanofi Pasteur is the largest company entirely dedicated to vaccines. Every day, the company invests more than EUR 1 million in research and development. For more information, please visit: www.sanofipasteur.com.