RE-EMERGENCE OF DENGUE FEVER IN THE FLORIDA KEYS

Lucy Danso- Odei, MPH studentWalden University

PUBH 6165-2. Environmental Health Instructor: Dr. Howard Rubin

Summer Term, 2010

Presentation is for Residents and Visitors of

the Florida Keys

AgendaIntroduction

The Florida Keys

The Dengue Virus -serotypes -mode of transmission -re-emergence of diseasePrevalence

Dengue Fever

AgendaDengue Hemorrhagic Fever (DHF)

Dengue Shock Syndrome (DSS)

Preventive Methods

Treatment

Conclusion

References

Further reading 

I. Introduction to Dengue Fever

Affects at least 50 million people every year. (WHO, 2008).  Endemic in over 100 countries. (Teo, Ng & Lam, 2009, p.66). 2.5% of 500,000 hospitalized, die yearly. (WHO,2008).

Over 2.5 billion people worldwide at risk. (CDC, 2008).

Climate is similar to that of the Carribean Islands.

Superb weather conditions offer a tropical vacation.

Florida has an abundance of mosquitoes.

Mosquito spraying programs are not popular.Reference:

NPR NEWS (2010). Dengue Fever in Florida Portends A Growing Problem. Retrieved from http://www.npr.org/blogs/health/2010/05/20/127016467/dengue-fever-outbreak-in-florida-portends-a-growing-problem 

II. The Florida Keys

II. Cont’d: The Florida Keys

Abundance of mosquito

breeding sites .With permission from Joe Raedle, Getty ImagesLawrence Smart from Miami-Dade Mosquito Control looks for mosquito larvae in vehicle tires where water has collected so he can eradicate them on July 16 in Miami Beach, Fla. Cases of dengue fever have been found in Key West and other parts of the state. Reference:

NPR NEWS, (2010). Dengue Fever in Florida Portends A Growing Problem. Retrieved from http://www.npr.org/blogs/health/2010/05/20/127016467/dengue-fever-outbreak-in-florida-portends-a-growing-problem

III. The Dengue Virus

Definition

A Flaviviridae virus

Small and lipid-enveloped

A positive-stranded RNA virus.

 

III. Cont’d: The Dengue Virus

Serotypes

DEN-1 DEN-2 DEN-3 DEN-4

Reference:Teo, D., Ng, L., & Lam, S. (2009). Is dengue a threat to the blood supply?. Transfusion Medicine, 19(2), 66-77. doi:10.1111/j.1365-3148.2009.00916.x.

Picture, courtesy of Google Images

Mode of Transmission

Through

mosquito bites.

blood transfusion organ

transplantation.

III. Cont’d: The Dengue Virus

Re-emergence is due to:

Increased Aedes mosquito population

Expanding geographic distribution of mosquito vectors

Multiple serotypes

A viremic returning traveler

III. Cont’d: The Dengue Virus

Reference:Center for Disease Control, (2008). Retrieved September 2008 fromhttp://www.cdc.gov/NCIDOD/DVBID/DENGUE/. Accessed September 2008.

IV. Prevalence At least 50 million people affected every year.

(WHO, 2008).  Dengue hemorrhagic fever (DHF) is endemic in

over 100 countries. (Teo, Ng & Lam, 2009).  100 million cases of Dengue Fever (DF) reported

annually. (WHO, 2008).

Over 2.5 billion people worldwide live in areas potentially at risk for dengue. (CDC, 2008).

Reference:Centre for Disease Control, (2008) Retrieved September, 2008 from http://www.cdc.gov/NCIDOD/DVBID/DENGUE/.  Teo, D., Ng, L., & Lam, S. (2009). Is dengue a threat to the blood supply?. Transfusion Medicine, 19(2), 66-77. doi:10.1111/j.1365-3148.2009.00916.x. World Health Organization, (2008). Dengue and Dengue Hemorrhagic Fever. WHO Fact Sheet. WHO, Geneva. 

V. Dengue Fever

Incubation period - between 3-8 days .

Full recovery generally after 7-10 days.

Age determines clinical symptoms.

Fever ≥ 39 degrees Celsius.

Retro-orbital pain, myalgia, arthralgia, nausea, vomiting.

Reference: World Health Organization. (2004). Dengue fever in Indonesia. Accessed October 12, 2004 fromhttp://www.who.int/csr/don/2004_02_26a/en;

VI. Dengue Hemorrhagic Fever (DHF)

An acute febrile illness

Bleeding is characteristic.

Results in thrombocytopenia and plasma leakage.

Reference: World Health Organization. (2004). Dengue fever in Indonesia. Accessed October 12, 2004 from http://www.who.int/csr/don/2004_02_26a/en;

VII. Dengue Shock Syndrome (DSS)

DHF may result in DSS.

Characterized by circulatory failure. Death can occur within 12 to 24

hours

Reference:World Health Organization. (2004). Dengue fever in Indonesia. Accessed October 12, 2004 fromhttp://www.who.int/csr/don/2004_02_26a/en;

VIII. Dengue And Blood Donor Availability

Infected people cannot donate blood.

Screening tests for dengue are available.

Effective pathogen reduction processes for blood supply also available.

Reference:Teo, D., Ng, L., & Lam, S. (2009). Is dengue a threat to the blood supply? Transfusion Medicine, 19(2), 66-77. doi:10.1111/j.1365-3148.2009.00916.x.

IX. Preventive Methods

Elimination of mosquito-breeding places. Implementation of good surveillance systems.

Development of effective vaccines.

Live-attenuated tetravalent dengue vaccines also being developed.

Reference:World Health Organization. (2004). Dengue fever in Indonesia. Accessed October 12, 2004 from http://www.who.int/csr/don/2004_02_26a/en;

X. Treatment

Supportive care. Fluid volume maintenance. Electrolyte balance monitoring. Platelet transfusion.

Reference:World Health Organization. (2004). Dengue fever in Indonesia. Accessed October 12, 2004 from http://www.who.int/csr/don/2004_02_26a/en;

XI. Conclusion 

5% of Key West population infected in 2009. Florida Keys has 28 cases of dengue

fever. Absence of mosquito control program. Florida Keys has abundance of

mosquitoes. Florida – a popular vacation

destination.

Questions

References AOL News, (2010). Dengue Fever Cases Reported in Parts of Florida.

Retrieved from http://www.aolnews.com/article/florida-has-new-problem-dengue-fever/19567294

Center for Disease Control, (2008). Retrieved September 2008 fromhttp://www.cdc.gov/NCIDOD/DVBID/DENGUE/. Accessed September 2008

Gurugama, P., Garg, P., Perera, J., Wijewickrama, A., & Seneviratne, S. (2010). DENGUE VIRAL INFECTIONS. Indian Journal of Dermatology, 55(1), 68-78. doi:10.4103/0019-5154.60357.

NPR NEWS (2010). Dengue Fever in Florida Portends A Growing Problem. Retrieved from http://www.npr.org/blogs/health/2010/05/20/127016467/dengue-fever-outbreak-in-florida-portends-a-growing-problem

Ranjit, S., Kissoon, N., & Shamarao, S. (2009). Dengue viral infections and shock syndromes: An overview. Journal of Pediatric Infectious Diseases, 4(2), 107-117. doi:10.3233/JPI-2009-0164.

Reuters, (2010). More than 1,000 exposed to dengue in Florida: CDC. Retrieved from http://www.reuters.com/article/idUSTRE66C65X20100713

References Cont’d  Sung, V., O'Brien, D., Matchett, E., Brown, G., & Torresi, J. (2003).

Dengue Fever in Travelers Returning from Southeast Asia. Journal of Travel Medicine, 10(4), 208-213. Retrieved from Academic Search Complete database.

Teo, D., Ng, L., & Lam, S. (2009). Is dengue a threat to the blood supply? Transfusion Medicine, 19(2), 66-77. doi:10.1111/j.1365-3148.2009.00916.x.

  World Health Organization. (2004). Dengue fever in Indonesia.

Accessed October 12, 2004 from

http://www.who.int/csr/don/2004_02_26a/en;   World Health Organization, (2008). Dengue and Dengue

Hemorrhagic Fever. WHO Fact Sheet. WHO, Geneva.

Wilder-Smith, A., Chen, L., Massad, E., & Wilson, M. (2009). Threat of dengue to blood safety in dengue-endemic countries. Emerging Infectious Diseases, 15(1), 8-11. Retrieved from CINAHL Plus with Full Text database

 

Further ReadingFor stories about survivors: 'Indescribable, crazy pain': Surviving dengue fever. Retrieve from

http://www.cnn.com/2010/HEALTH/07/22/dengue.fever/?hpt=Sbin

For information about Prevention:  Dengue Prevention and Control Activities Receive a Boost, WHO, TDR News, No. 68, June 2002, available

online at http://www.who.int/tdr/publications/tdrnews/news68/dengue.htm

For general information Reuters. Dengue fever cases in Singapore nears record level. Accessed October 12, 2004 http://www.reuters.com/printerFriendlyPopup.jhtml?type-healthNews&storyID_6292412.  Chinaview. (2004). Vietnam reports more dengue fever cases. Accessed October 12, 2004 at http://news.xinhuanet.com/english/2004-09/21/content_2001929.htm.  World Health Organization. Dengue. Accessed October 12, 2004 at http://www.who.int/tdr/dw/dengue2004.htm.  World Health Organization. Dengue and dengue haemorrhagic fever. Accessed October 12, 2004 at http://www.who.int/mediacentre/factsheets/fs117/

Detailed advice on managing patients with DHF can be obtained at http://www.who.int/emc/diseases/ebola/Denguepublication/index.html