Vector-Borne Disease Management Programmes

Vector-borne
disease management
programmes
A guide for managers and supervisors
in the oil and gas industry
Health
2012
The global oil and gas industry association for environmental and social issues
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OGP Report Number 481

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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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IPIECA
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VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES
Contents
Purpose of this guide
Introduction
Vector-borne diseases
Definitions
Human, business and financial impact
Key factors to promote success:

the role of senior management
Benefits of a vector-borne disease

management programme (VBDMP)
When to develop and implement a VBDMP
Integrating a VBDMP with other impact

assessment and outreach programmes
Management and prevention
13
Primary managementvector control
13
Elimination of breeding sites
13
Use of larvicide or insecticide
13
Secondary management
15
Education
15
Avoidance
15
Clothing and behaviour
16
Repellants
16
Room precautions
17
Immunization
17
Chemoprophylaxis
17
Malaria management in the local workforce

and community
18
Returning travellers
19
Point of care (POC) testing
19
Standby treatment
20
Putting it all together:

the VBDMP process
Screening
Appendix 1:
Understanding the need for
chemoprophylaxis
21
Scoping
Appendix 2:
Some specific vector-borne diseases
23
National and international stakeholder

consultation
Planning, including resourcing, cost and

time management
Malaria
23
Stakeholder consultation
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
Monitoring
12
Tick-borne encephalitis
30
Rickettsial infections
31
Leishmaniasis
32
Appendix 3:
Neglected tropical diseases
33
Glossary
34
References and further reading
37
Evaluation
ii
12
Purpose of this guide

This guide is aimed at health, safety and
The importance of
environment practitioners, as well as medical
vector-borne
personnel and health risks managers working for
diseases and their

potential impact on
the oil and gas industry. It is especially relevant for
oil and gas industry
managers and supervisors located in, or
operations should
responsible for, personnel working in areas where
not be
vector-borne diseases (VBDs) are endemic. It
underestimated.
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
from the importance of other VBDs, and the
programmes (VBDMPs).
principles outlined in this document may be

adapted for other conditions where appropriate.
This document is not intended to be a textbook of
The following support material is available:
VBDs or tropical medicine; rather, it describes the
www.iogp.org/pubs/382/Appendix_B.pdf
development of a VBDMP. While the broad

principles described apply to many vector-borne
Example malaria case investigation form:

www.iogp.org/pubs/382/Appendix_E.pdf
diseases, examples of more specific requirements of

particular diseases are covered in the Appendices.
Primary prevention of transmissible vectorborne diseases:
importance and rationale underpinning the
Sample implementation checklist to assist with
Significant emphasis is placed on malaria because
a company malaria control programme:
of its substantial impact, but this does not detract
www.iogp.org/pubs/382/Appendix_D.xls
Introduction
The oil and gas industry is committed to
This guide attempts to build on successful industry
safeguarding the health of its workforce as well as
practices. Experience at both the international
improving health standards in host countries. The
health level, and within the private sector,
potential impact of VBDs is high because of the
indicates that vector-borne disease management is
complex interaction between biological,
both complex and difficult. There is no unique set
geographical, social and political factors.
of strategies or programmes that will work in all
Regardless of geographical location, the industry
situations or geographical locations. However,
operates in an atmosphere of heightened
there are some reasonably well-understood
expectations, particularly with regard to its health,
principles that can be utilized in virtually all
social and environmental practices. Vector-borne
situations that are likely to be encountered by the
diseases can present a major health management
oil and gas industry. This document presents and
problem that can transcend traditional company
analyses these principles, and illustrates how they
health support systems, placing significant pressure
can be applied systematically within the context of
on an organizations health, safety and
worldwide oil and gas operations. Links are
environmental (HSE) management resources. The
provided to additional resources on the internet
effective control of vector-borne diseases is
for readers who require greater scientific
therefore a potential concern throughout the range
explanation and technical back-up, and a
of oil and gas industry activities.
glossary is also included.

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Vector-borne diseases
Definitions
The US Centers for Disease Control and Prevention

(CDC) provides additional information on a range
Vector-borne diseases are those that involve the
of vector-borne diseases at:
interaction of a disease-causing agent (e.g.
www.cdc.gov/ncezid/dvbd/about.html
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
Human, business and financial impact
host to another. The two hosts may be of the same

species (e.g. human-to-human transmission of
VBDs are considered to be amongst the most
malaria by mosquito) or different species (e.g. from
complex of all infectious diseases in terms of their
bird to human via mosquito, as with Japanese
prevention and control. They are also some of the
encephalitis). Different diseases may have a very
worlds most damaging diseases, due not only to
limited, or very broad range of hosts. The range of
their effect on the individual, but also because of
vectors for disease is vast, and includes mosquitoes,
their impact on the population as a whole. Some
flies, mites, ticks, fleas and reduviid bugs (see
diseases also have significant effects on cattle and
Table 1). This guide does not attempt to provide a
agriculture, which may lead to poverty,
comprehensive or in-depth account of the topic of
malnutrition and ill health.
vector biology; instead, the objective is to address

those conditions that are most common and/or
These diseases are the most common infections of
have potential for greatest impact in the oil and
the poorest billion people in the worldthose living
gas industry.
on the equivalent of US$1.25 or less per dayand
Table 1 Vectors and associated diseases

Vector
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

relapsing fever
Mites
Disease
Scrub typhus
Triatoma infestans, a type of reduviid bug, is well
adapted to living with humans, and is considered an

important vector of the Chagas disease parasite. It is
commonly known as the assassin bug.
Table 2 Impact of selected VBDs

Disease
Disability adjusted life years (DALYS)
Annual incidence (millions)
Annual deaths
39 million
243
800,000
18-842,000
0.2
30,000
700,000
50
19,000
107-755,000
0.05
10,000
Leishmaniasis
2.1 million
12
51,000
Human African
trypanosomiasis
(HAT)
1.5 million
<0.1
48,000
Chagas disease
700,000
8-9
15,000
Malaria
Yellow fever
Dengue
Japanese
encephalitis
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 familys 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
diseasean 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
America.
In 2008, there were an estimated 243 million

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

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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
affected areas and assigned to work overseas
productivity every year.
taking local endemic diseases with them. In

addition, climate change has been suggested as a
With the exception of malaria, VBDs command
factor in the change of distribution of some of these
only a small portion of the global investment in
diseases. The yellow fever mosquito, Aedes aegypti
research and development. While approximately
has reestablished itself in parts of the Americas
US$2.2 billion are spent in research and
where it had been presumed to have been
development for the big three infectious diseases
eradicated; the Asian tiger mosquito, Aedes
(HIV/AIDS; tuberculosis; and malaria), only
albopictus, was introduced into the Americas in the
US$840 million have been invested in research
1980s and has spread to Central and South
and support of the remaining infectious diseases,
America; and the blacklegged tick, Ixodes
including the vector-borne ones.
scapularis, an important transmitter of Lyme

disease and other pathogens, has gradually
It is easy to understand that interventions to control
expanded its range in parts of eastern and central
vector-borne diseases promise large economic pay-
North America.
offs in productivity and educational benefits outside

the health sector, and hence are an investment
It has been shown that the best strategy to tackle
towards human capital and poverty reduction.
and control vector-borne diseases is through

integrated vector managementan approach
The oil and gas industry is not excluded from the
that reinforces the linkages between health and
impact of vector-borne diseases. Not only do many
the environment, optimizing the benefits to both.
oil and gas operations take place in areas where
Through this approach, the public and private
VBDs are endemic, presenting a risk for both local
sectors have a joint interest in working together
employees and expatriates, but there is also a huge
to control or manage the diseases in a cost-
number of employees being mobilized from the
effective way.
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
sunset to control
recognizing that these diseases are a key
dengue: many
vector-borne
business issue that cuts across multiple staff and
diseases demonstrate
line functions. Because vector-borne disease
remarkable
management potentially requires a large effort, it
resilience in human
is essential that senior management play a
populations despite
prominent leadership role. While the
enormous efforts to
development of an effective VBDMP is a highly
eradicate it.
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,
VBDMPs are multidisciplinary, integrated efforts
either positive or negative, is potentially visible at
that combine expertise and strategies in human
the in-country staff level and even at national
and vector biology, environmental management,
and international levels. VBDs can also have an
clinical medicine and community-level interactions
impact on sustainable development efforts and
to protect people from disease. The long history of
on company reputation. Hence, VBDMPs offer a
efforts to manage, for example, malaria, illustrates
significant opportunity for a win-win scenario
that this disease demonstrates remarkable resilience
for the company and the host country: an
in human populations despite enormous efforts to
effective programme can significantly enhance
eradicate it, and this picture is mirrored by some
operating efficiency and reputation while
other vector-borne diseases. In order to develop
providing a clear positive benefit for the host
and implement an effective VBDMP, it is necessary
country at multiple levels.
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 companys profile amongst NGOs
Potentially contributing to the host communitys health systems capacity
IPIECA
OGP
captures the underlying biology, pathophysiology
should reflect an accurate understanding of the
(how humans respond to infection) and
VBD risks for company personnel and the
epidemiology of the disease. This fundamental
surrounding communities. Many companies may
framework is generally built around the principles
wish to develop a standardized set of prevention
of primary, secondary and tertiary prevention.
practices and procedures for any work in VBD

areas. As well as applying to their own
workforces, these standard practices and
Benefits of a vector-borne disease

management programme
procedures may cover a variety of contractors

and suppliers. Overall, an integrated approach,
using primary, secondary and tertiary
A well-executed VBDMP can reduce morbidity and
prevention, is likely to be the most successful.
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
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
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.
If a company is considering business
requires a diverse team of specialized professionals.
opportunities in locations where VBDs exist, it is
For example, if a proposed business activity is in a
essential to consider the development of an
malarious area, then an accurate and detailed
appropriate VBDMP for all phases of the business
assessment of malaria risk is required. Experience
activity. Programme development and complexity
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 multidisciplinary 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
translated into success at the individual, population
Consultation
is also important.
or health systems levels. There may be significant
between
gaps between the intervention efficacy of the oil
international
National and international stakeholder

consultation
and gas company and the effectiveness of these

interventions at the community level in a
developing country setting. Increasingly, the oil
and gas industry faces the need to understand
VBD-related issues are the focus of a large number
community-level health, social and environmental
of international stakeholders. These include WHO,
concerns in order to receive and maintain a
non-governmental organizations (NGOs),
licence to operate. VBDMPs face a particularly
academic institutions, multilateral development and
difficult set of issues because the biology of the
funding agencies, and institutions dedicated to
disease is not easily confined within the
VBD prevention, management and control. In
boundaries of a proposed project and, invariably
addition, some level of local, provincial and
in a large project, overlaps into the adjacent
national VBD control efforts may be encountered
communities. The oil and gas industry is
at the host country level. In many situations,
increasingly asked to address problems that are
coordination and communication with all of these
outside the fence line and, historically, considered
international and national stakeholders is a
to be the responsibilities of the host government. In
daunting task. Nevertheless, because of the
a given project, comprehensive secondary and
potential for other significant benefits, or
tertiary prevention strategies may be adequate;
inadvertent adverse impacts such as duplication of
however, it is likely that some international and
efforts and unmet or unanticipated community-
national stakeholders will request a more active
level expectations, it is important to consider
outreach role in all levels of prevention
carefully the multi-level social and community
management and control, particularly with regard
ramifications of any proposed VBDMP.
to vector control efforts. In order to fully appreciate
stakeholders is vital
in the prevention,
management and
control of VBDrelated issues.
these expectations, careful, close and early

It has become apparent that significant advances
consultation with key national and international
in the control of VBDs at the medical and
stakeholders during project formation and
environmental levels have not necessarily
development stages is advisable.

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Putting it all together: the VBDMP process

No single VBDMP process will necessarily be
Screening
appropriate for use throughout the diverse range of

situations that may confront the oil and gas industry.
The geographical settings where VBD transmission
However, there is a series of systematic steps that
may exist are reasonably well known. Therefore, if
can be used in order to determine what type of
a business activity is likely to involve a VBD area,
VBDMP is appropriate in a particular situation.
these diseases should be considered as a potential
Many companies in the oil and gas industry already
health concern. A detailed scoping of the proposed
have a general approach for developing VBDMPs.
business activity, covering location, size, workforce,
Similarly, many international agencies and national
surrounding communities and operations, is
governments have published detailed guidelines
essential. This initial review will help to determine
covering aspects of VBD diagnosis and treatment at
the extent of the VBDMP that may be required. In
both an individual and community level. Because
many situations, companies have developed
both diagnostic testing and available medications
specific VBDMPs, such as the malaria visa
and treatment protocols are constantly evolving, the
programme which is based on secondary and
most currently available guidelines should always
tertiary prevention strategies incorporated in the
be consulted. While the science of some VBDs such
ABCD (Awareness, Bite prevention,
as malaria is constantly changing, an overall
Chemoprophylaxis and Diagnosis) approach to
management framework is reasonably well
malaria prevention. The implementation of a simple
established and can be used in almost all situations
programme such as this may be sufficient for the
confronting the oil and gas industry. This structure
workforce. However, it is important to understand
consists of a sequence of common elements that
that this particular programme is focused on the
frames the VBDMP process, and is illustrated in
internal workforce and is not fully transferable to
Table 4. The process is modelled after the general
the large number of individuals who may be
framework used in environmental, social and health
living in communities adjacent to the proposed
impact assessments.
business activity.
Table 4 Framework for a typical VBDMP process

Screeningdetermine whether a proposed business activity is going to
take place within a VBD environment.
Scoping
Scoping is a term that is generally used to describe
Scopingoutline the range and types of vector-borne disease

problems that could be encountered.
the process of outlining the range and types of
Planning including resourcing, cost and time managementconsider

the types of resources, activities, costs and level of effort that may be
required.
potential impacts of any action being considered.
Stakeholder consultationcoordinate, communicate and exchange

information at the local, provincial, national and international level.
be addressed, such as: defining the type and
Risk assessmentinvestigate, appraise and qualitatively or

quantitatively rank the impacts, positive or negative, that could be
produced.
considering whether different strategies will be
Decision makingestablish priorities.
decommissioning; and defining the at-risk
Mitigation strategydevelop a written mitigation action plan (vectorborne disease management programme).
population including construction workers,
Implementation and monitoringdefine roles and responsibilities.
primary prevention vector control strategies are
hazards to be addressed, together with the

The scoping stage enables early identification of
the types and categories of issues that will need to
endemicity of VBDs, e.g. dominant diseases;
required depending upon the phase of the business
activity, i.e. construction, operation,
contractors, nationals and community residents. If

deemed critical, then a general series of sequential
Figure 1 Decision-making process
oil and gas companies have large and

sophisticated medical, environmental and safety
Stratify area according to the disease burden

and epidemiology of transmission
departments, it is quite likely that some level of

outside expertise will still need to be considered,
particularly related to the implementation of
primary vector control strategies. For large
Determine whether there is a role for

vector control in each epidemiological stratum
and in current local circumstances
business activities, even secondary prevention

strategies require significant levels of on-site
clinical medical support for accurate diagnosis
and treatment. If the proposed business activity
If there is a role for vector control, determine

the vector(s) in each stratum
does not require an on-site medical function, it

may still be advisable to identify appropriate local
resources, including medical practitioners and
each vector implicated determine:

breeding sites
adult resting sites
blood feeding behaviour
ecology
history of insecticide resistance
Determine which method(s) of

vector control is (are) suitable
Where the use of insecticides is essential,

select the method of application
hospitals with appropriate expertise in dealing

with VBDs, diagnostic equipment and treatment
facilities. Implementing a VBDMP is a potentially
expensive undertaking and may require a
Adapted from Najera and Zaim, 2002
For
significant level of staffing. The level of staffing is a

function of the goals that the programme aims to
achieve and the underlying level of VBD
transmission. Many programmes have overall
worldwide objectives that include achieving a zero
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
Stakeholder consultation
external consultants, or a combination of both, can
Stakeholder communication and consultation is a
use the TOR.
process of dialogue and information exchange

between the business activity and the key
Planning, including resourcing, cost

and time management
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
After the general scope has been determined, the
the overall sphere of the business activity. Some
planning process can begin. It is essential to identify
VBDs, such as malaria, have attracted worldwide
at the outset the types and amounts of resources
attention in virtually all areas where transmission is
that may be required. Resourcing requires careful
found. Therefore, it is highly likely that any
consideration since multilevel, integrated VBDMPs
proposed project in a known VBD area will already
draw expertise from many disciplines. While many
be subject to some level of NGO, national or

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international intervention control effort.
substantially more investigation and programme
Consequently, the potential for miscommunication
development than opening a small marketing office
and duplication of effort is significant. A VBD
or retail store. The risk assessment process can
stakeholder communication programme is therefore
capture these differences and provide an
important, and should be considered as early as
appropriate way to rank impacts so that they can
possible in the overall business development cycle.
be addressed in a priority fashion.
This effort should be carefully planned and

coordinated in a fashion that is consistent with, and
Two important considerations in the risk assessment
responsive to, overall business objectives.
process are the evaluation of existing data and

determination of the need for new baseline
information. Existing sources of information must
Risk assessment
be carefully reviewed for accuracy, relevance and

completeness. For example, all fevers are actually
Risk assessment is the process that investigates,
not malaria even though in rural malarious areas
appraises and (qualitatively or quantitatively) ranks
fever is frequently assumed to be malaria and
the impacts (positive or negative) that could be
treated accordingly. Many studies have
produced by a given activity. Many oil and gas
documented that malaria is over-diagnosed, often
companies have internal risk assessment
on clinical symptoms and signs alone.
procedures and protocols covering the health,

Many oil and gas
environmental, social and safety aspects of
If there is a concern that the project will have an
companies have
proposed new activities. These processes can also
impact on the existing transmission pattern or
internal risk
be applied to VBDMP efforts. In a given
burden of a VBD, careful consideration should be
geographical location, it is important to understand
given to determine whether a new data collection
the specific biology, pathophysiology and
effort is indicated. The profile of a VBD in urban
epidemiology of the VBD that may be encountered.
and peri-urban settings is quite different from that
environmental,
The level of the VBD risk will vary substantially,
usually seen in a rural environment. If new data are
social and safety
both by geographical location and complexity of
deemed necessary, a series of carefully defined
aspects of proposed
proposed business activity. An oil field development
study questions and collection methods should be
new activities.
and pipeline in a VBD area is likely to require
developed. These study questions are likely to cover
assessment
procedures and
protocols covering
the health,
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
10
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
Implementation and monitoring
dedicated multidisciplinary VBD management

teams to simultaneously manage both company
and community VBD issues. Senior management
No single VBDMP
can be guaranteed
to be completely
Implementation
effective, and in
some situations, the
support, both at the project and corporate level, is
Two of the most critical aspects of an effective
essential because sustainable VBDMPs are neither
VBDMP are the division of responsibilities between
simple nor inexpensive.
the project and the host government at local,
persons taken ill
regional and national levels, and agreement on
may be necessary.
treatment or
evacuation of
timescales. Roles and responsibilities should be
Mitigation
defined and clearly understood, particularly if the

VBDMP efforts are going to extend outside the
The VBDMP is the mitigation plan. This plan
business activity boundaries. Therefore, an analysis
specifies how high and how thick the wall of
of local, regional and national health systems
prevention is constructed. The VBDMP is not
infrastructure and VBD management capacity is
static, but a living document that will evolve and
critical. Building the environmental, medical and
change over time. The programme is likely to be a
social capacity and sustainability required for an
combination of internal workforce and external
integrated approach to VBD management is neither
community needs. Many of the most important
simple nor cheap. Many VBDMPs initially succeed,
concerns and controversies surround the key
only to fail at a later date because primary
vector control strategies of insecticide application,
prevention vector control strategies are not properly
internal residual spraying (IRS), space spraying,
maintained. Long-term planning and commitment is
insecticide treated nets (ITNs) and larviciding.
essential since sustainable capacity development is
Finally, emergency response preparation should
a long and slow process. The roles and
also be undertaken because no VBDMP is 100%
responsibilities of contractors are also important,
effective, and in some situations, immediate
because much of the dayto-day activity is
treatment and/or the evacuation of persons taken
performed by rotating contractors, e.g. during the
ill may be indicated.
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.
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Staffing levels will also require attention and
should be considered. Within the implementation
consideration on an ongoing basis because a
and monitoring plan, a system of outcome
VBDMP is not a static process. It should be
indicators is typically specified. Auditing against
reasonably anticipated that unexpected changes in
these indicators can be readily performed.
weather and human migration patterns and
Contractor performance should also be verified
activities will occur. These events can have
and assessed for effectiveness and compliance. If
profound impacts on VBD transmission within and
the VBDMP is actively cooperating with host
between the workforce and external communities.
country programmes, these efforts should also be

independently assessed against previously
Monitoring
established outcome indicators.
Development of a monitoring system for the overall
A variety of audit systems for health programmes
VBDMP effort is a critical component. A monitoring
have been developed. General audits often cover:
system is designed to document how the
medical records and reports;
programme is affecting VBD transmission. A variety
facility inspections for vector control evaluation;
of indicators can be developed for this purpose.
knowledge, attitude and practices (KAP)

assessments;
Standard medical outcome indicators can be

developed covering diagnosis and treatment, e.g.
training recordstopics, attendances and

feedback;
suspected, probable, confirmed and fatal VBD

cases. These medical data are important because
health-care programme reviews and audits;
they provide an early detection system for changes
emergency drills; and
in VBD transmission. A sample malaria case
incident investigations.
investigation form is available at:

www.iogp.org/pubs/382/Appendix_E.pdf.
Audits should be considered at regular intervals

because business activities may change, for
Finally, the early detection of a VBD is not the same
example due to:
thing as early warning. For example, the Malaria
jungles, etc.);
Early Warning Systems (MEWS) requires a different

level of monitoring, planning and development and
new company activities (e.g. work near swamps,
new projects in potentially exposed geographic

locations;
is usually considered to be a national government

initiative. However, because of the high levels of
modifications in work schedule (e.g. night shifts);
technological expertise present in many oil and gas
changing contractual requirements;
companies, particularly regarding remote sensing
new scientific discoveries (e.g. medications,

resistance to control measures); and
(RS) and graphic information systems (GIS)

techniques, collaboration or technology transfer
international and government advisory
between the oil and gas company and the host
recommendations concerning malaria resistance
government may be entirely appropriate.
to medication.
A suggested audit form for a malaria management
Evaluation
programme is available at:

www.iogp.org/pubs/382/Appendix_F.xls
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
Management and prevention

As with all health-related issues, any procedures
Small pools of
should be appropriate, proportionate and effective.
standing water
While some processes are relatively
provide the perfect

breeding ground for
straightforward, such as personal exposure control,
some species, such
others are much more complex and will require
as Anopheles,
expert input or extensive stakeholder engagement.
whilst others, e.g.
This document serves only to give an indication of
Aedes, prefer
what is available. Care should be taken to ensure
stagnant water in
that any action is compatible with local best
containers, such as
practice and the management schemes of local
discarded jars, tanks
authorities.
or even old tyres.
Primary managementvector control
removing plants such as bromeliads (which

collect water in which eggs are laid) from the
work or living area; and
Vector control aims to manage a disease by

eliminating or significantly reducing the population
storing used tyres under cover.
of the vector responsible for transmitting the

disease of interest. The process may seek to
As mosquitoes often fly only a short distance from
interfere with the reproductive cycle of the vector at
their breeding sites to feed, eliminating discarded
some point or to destroy adult vectors. Broadly,
motor tyres, pots or tanks may make an appreciable
control may be through density reduction (through
difference. Before any irrevocable action is taken on
removal of breeding sites or killing larvae) or
substantial bodies of water, checks should be made
longevity reduction (through killing adult vectors).
to ensure that they are not protected under a habitat
Often, a combination of these is required.
conservation programme or similar.
Elimination of breeding sites

The simplest example of this involves removal or
Managing the potential breeding environment in

this way has a number of possible advantages:
contamination or human intoxication;
enclosure of bodies of water that serve as the

repository for eggs and larval development in
pools of clean, stagnant water. Others, such as the
there is no risk of the development of resistance

to chemicals; and
mosquitoes. Insect breeding requirements vary.

Some, such as Anopheles, require relatively small
there is no risk of accidental environmental
the effects may actually be longer lasting for the

whole community.
Aedes vectors of yellow fever and dengue, prefer

water in containers such as jars, tanks or even used
The major disadvantage of taking action to
tyres. Large open bodies of water, such as lakes
eliminate breeding sites is that it is usually an
and reservoirs are not usually suitable sites for
expensive option.
mosquito breeding. Actions may include:
draining and filling in ditches, ponds or

swamps, and keeping them dry;
Use of larvicide or insecticide
removing unused containers;
These methods rely on the use of chemicals to kill
covering water tanks and other bodies of water
insect larvae or adult insects. The following
that are in use;
important questions should be borne in mind when
removing small-scale sources of water;
considering these operations:
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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)?
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.
Does the proposed treatment fit with local and
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.
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
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 bugsincluding the triatomine bug, a
vector of Chagas diseasetypically 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.
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
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.
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
Secondary management
extremely effective at preventing mosquito bites

while resting or sleeping. Impregnation with
Education
Permethrin can remain effective for up to six

months or longer. When impregnated, nets not
Educating the workforce about VBDs is essential.
only operate as a physical barrier, but also as a
Compliance with preventive measures is likely to
residual insecticide. However, it is important that
be much greater when the serious nature of a
bed nets are used appropriately. They must be
disease and the effectiveness of such measures
properly tucked in around the bed and inspected
are understood.
for holes, and any mosquitoes already within the
Hotel rooms are not

impervious to
mosquitosalways
ensure mosquito nets
are intact, and take
care not to let any
net must be killed. When inside, it is important that
mosquitos inside the
Personnel who are on international assignment or
no part of the body actually touches the net
net when getting into
rotation should receive thorough awareness
because mosquitoes can bite through the fabric
and out of bed.
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.
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and into the adjacent skin. Various styles of net
on the lower limbs. Footwear also provides
are available, including freestanding nets and
protection against sand flies (responsible for
those that are suspended by hooks on the wall or
transmission of leishmaniasis) and chiggers (the
ceiling. In general, the larger the space inside the
larvae of mites) as well as physical injuries.
net the less likely one is to come into contact with

the inside of the net whilst sleeping. The extra
The use of permethrin-impregnated clothing,
volume of air inside larger nets may also provide
especially coveralls, should be actively encouraged
greater comfort because air movement (ventilation)
(provided no individual allergic skin reaction is
through the net is likely to be restricted.
noticed) and distributed to the workforce. Their use

is proven to be an efficient tool in minimizing the
Avoiding mud-walled or thatched buildings at
probability of insect bites. Washing will gradually
night can reduce exposure to assassin (triatomine)
remove the insecticide, so the clothes will
bugs (vectors of Trypanosoma cruzia parasite
eventually need to be either replaced or
which causes Chagas disease). In Africa, tsetse
reimpregnated with permethrin, according to the
fly habitats are often well recognized by local
manufacturers recommendations.
people and, again, should be avoided when

possible. Ticks will often be associated with scrub
and grassland.
Repellents
The ideal personal insect repellent should be
Clothing and behaviour

Long-sleeved shirts and long trousers will reduce
effective, safe, long-lasting, comfortable and

convenient. No single agent meets all these criteria,
but some effective agents are available.
the likelihood of bites from mosquitos and other

vectors, as well as providing sun protection. The
Reviews indicate that diethyltoluamide (DEET) at a
fabric has to be of reasonably tight weave to
strength of 50% is probably the most effective and
prevent penetration by insect mouthparts, and this
that higher concentrations are not needed. DEET is
can cause compliance issues in hot or humid
available in lower concentrations, but with reduced
climates. Tucking trouser leg bottoms into socks
duration of action (see Table 5). DEET is safe for
can be effective.
young children older than two months.
Mosquitoes are sometimes reported to be attracted
Good practices for using personal insect repellants
to dark clothing; however, movement, heat and
include:
body chemistry are known to be sources of
apply as directed;
attraction, so simply wearing light-coloured clothes
apply liberally and thoroughly, as mosquitoes
is not an adequate means of protection. On the
will readily bite untreated skin adjacent to
other hand, tsetse flies appear to be attracted to
treated areas;
clothing that contrasts with the surroundings (which
re-apply after washing, swimming or heavy

sweating;
in most cases means light shaded clothes). Tsetse

flies are also attracted to movement.
A hat with a neck shield, designed for sun
apply sun protection creams before applying

repellents; and
consider applying DEET to socks and cuffs.
protection, may also help to deter insects.

Alternatives to DEET are available, but tend to be
16
Shoes with socks will discourage insect bites and
less effective or of shorter duration. Picaridin and
can be particularly important as many insects bite
oil of lemon eucalyptus are examples. Citronella-
Table 5 Duration of protection of DEET by concentration

DEET concentration
Duration of action
20%
13 hours
30%
Up to 6 hours
50%
Up to 12 hours
Chemoprophylaxis
Malaria is one of very few conditions in which
preventive drugs are routinely given as a
prophylactic. Excellent advice is now available on
chemoprophylaxis for malaria from a variety of
national and international sources. When
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
based repellents probably have too short a

duration of activity to be of practical use. It should
be noted that DEET can soften some plastics, such
as watch straps.
recommendations.
In principle, a number of issues need to be
addressed:
Is malaria present in the country and in the

region concerned?
Room precautions
Mosquitoes may get into all sorts of unlikely
locations, including cars and aeroplanes. Rooms or
apartments may be air-conditioned, but this does
not make it inaccessible or inhospitable to
mosquitoes. The following precautions are
year round?
Is chemoprophylaxis indicated?
If chemoprophylaxis is indicated, is it suitable

and available?
Always ensure mosquito screens are intact and

kept shut.
conditions, be managed?
malaria transmission is very low. In this

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.
Consider using chemical mosquito mats or liquid
in a vaporizer overnight; burning mosquito coils
malaria are essential.
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

allow any mosquitoes inside your impregnated
bed net! If you have to get up in the night, take
care to avoid letting mosquitoes within the net.
Are standby malaria treatment kits a sensible

precaution? These kits allow rapid diagnosis of
is less effective and the smoke can be hazardous
Chemoprophylaxis may not be indicated in

every situation, usually because the risk of
Before going to bed, search the room for

mosquitoes and kill them with a knock down
How will special groups, children, pregnant

women, those with underlying medical
recommended:
If so, is the risk seasonal or is it present all
Currently available chemoprophylaxis for malaria

includes the following:
Chloroquine with or without proguanil: because

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.

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Doxycycline: this is effective in most areas
For further information on the need for
against Plasmodium falciparum and other
chemoprophylaxis see Appendix 1 on page 21.
strains of malaria. It is not suitable for pregnant

women or young children, and may cause
photosensitivity of the skin and oesophageal
irritation.
Malaria management in the local

workforce and community
Mefloquine: this is an effective drug that has the
In areas that are holo- or hyperendemic for
advantage of being taken once weekly. It is
malaria, people are affected throughout their lives.
contraindicated in anyone with a previous
There is generally a very high level of illness and
history of psychiatric illness or convulsions.
death in children. In some areas, 25% of deaths in
There is some evidence of resistance in South-
children between 1 and 4 years of age may be
East Asia. It is considered safe in the second
due to malaria, but for those children who survive
and third trimesters of pregnancy. It has been
multiple infections, a state of premunition is
used without untoward incident in the first
achieved where infection causes little or no
trimester when the risk of malaria was
problem to the host. This is sometimes termed
considered significant and exposure otherwise
semi-immunity, and is sufficient to control but not
unavoidable.
prevent infection. Acquisition of premunition is
Atovaquone and proguanil (e.g. Malarone):
much more rapid for adults than for children.
this combination is effective and, because of its

mode of action, needs only to be taken for two
Adults in areas of high endemicity rarely develop
days before exposure and for one week after
severe or even symptomatic disease, despite being
leaving the malarious zone. It is expensive,
infected. However, in areas where transmission is
however and, because of insufficient data, its
low, erratic or markedly seasonal, i.e. where the
use is not currently recommended in pregnancy.
rate of re-infection is low or variable, all ages

may develop symptomatic malaria and even
The duration of use will depend on local licensing
cerebral malaria. This phenomenon is termed
regulations (e.g. the licence for Malarone is
unstable malaria.
significantly different in the UK compared to the

USA), although there appears to be no positive
Oil and gas companies may wish, or need, to
contraindication to the prolonged use of any of the
intervene either as part of a social welfare
malaria chemoprophylaxis drugs.
programme or to reduce infection in the local

workforce. In holoendemic and hyperendemic areas,
18
No chemoprophylaxis is 100% effective. Therefore,
there may be no need to take special measures to
those who have been in a malarious zone should
protect local adults (with certain exceptions). In areas
be warned that they may develop malaria despite
of unstable malaria, protective measures for local
these precautions, and instructed to seek medical
adults will also be required. The major difference
assistance immediately should they develop fever,
between measures aimed at local people and those
sweating or other indications for up to 12 months
directed at expatriates or business travellers is that,
after leaving the malarious area. It is prudent to
in the former case, chemoprophylaxis is rarely used.
ensure that persons who are about to travel to a
The exceptions to this may be pregnant women and
malarious area are issued with a letter addressed
local adults returning to an endemic zone after a
to their doctor emphasizing the risk of malaria. In
year or more away. The use of chemoprophylaxis is
high risk zones, employers may consider providing
limited by safety and effectiveness issues.
emergency diagnostic and treatment kits for use by
Chloroquine and proguanil have, for many years,
the travellers doctor.
proven to be safe for use during pregnancy (with
folate supplementation for proguanil), but are no
The use of insecticide to treat clothing, household
longer effective in most areas of malaria risk.
curtains and even cattle has been demonstrated to
Tetracyclines are contraindicated in pregnancy and
have some effect in reducing transmission.
childhood and, for Malarone, there is no definitive

evidence either way. Presently, this leaves mefloquine
which is considered safe during the second and third
Returning travellers
trimesters, and probably safe in the first (but again
Routine screening of all travellers and expatriates
with limited evidence).
returning from international travel or assignments

can be expensive and unproductive. A risk
Those nationals returning to a highly endemic
assessment process should guide the approach
zone after a year or so will have lost their
taken because many factors, e.g. location, duration
premunition and will be vulnerable to potentially
of visit, nature of accommodation and activity in
severe infection. Management of this situation is
country, will affect the likelihood of a disease being
difficult because, if chemoprophylaxis is started, a
contracted. The most cost-effective method is
decision must be made as to when to stop it, since
probably to target longer-term or repeat visitors to,
it is unreasonable to assume that the individual will
and expatriates from, VBD-prone locations with a
take the drug for the rest of his or her life. One
specific health questionnaire designed to elicit
course of action has been to continue
symptoms or activities possibly associated with
chemoprophylaxis for about three months in the
disease, and to follow up on positive responses. At
hope that exposure to parasites will re-induce
the same time, all travellers should be advised to
premunition, even though overt infection is aborted
contact their health provider if they develop specific
by chemoprophylaxis.
symptoms during or after travel or assignment. In

addition, some travellers may be offered a face-to-
Any programmes for managing malaria should be
face consultation and limited examination/testing if
cheap, simple, sustainable and readily
they have been exposed for a long period in a
communicated through education. Simple
high risk area, e.g. in the case of longer-term
measures such as covering up bare skin with long
assignees to remote areas of sub-Saharan Africa.
sleeves and trousers or staying indoors during

peak biting times will help to reduce infection.
Regular use of a personal protective repellent such
Point-ofcare (POC) testing
as DEET may not be wholly realistic, but can help

especially with mosquitoes biting in the early
POC testing refers to methods of disease diagnosis
evening or morning.
that are sufficiently simple and mobile that they can

be performed by a clinician, either in the clinic or
However, the single most effective measure to date
in the field at the point where the patient is being
has been the use of bed nets treated with an
managed. POC tests should be distinguished from
insecticide such as permethrin. These insecticide
the more generic rapid diagnostic tests (RDTs), the
treated nets (ITNs) can remain effective because of
majority of which are designed to be performed in
the insecticide, despite small holes or minor errors
a laboratory; although some RDTs may be simple
in use. Indeed, in a village in which most people
and compact enough to be performed in the field,
use ITNs, there may be a communal protective effect
this will not always be the case. POC testing for
through reduction in overall mosquito density. The
infectious diseases has developed rapidly in recent
use of ITNs has been shown to reduce childhood
years and will probably continue to do so. However,
deaths by up to 60% (indicating that the effect of
a number of questions should be addressed before
malaria may have been grossly underestimated).
a POC test, where available, is deployed:

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Will a POC test make an important difference
Standby treatment
in outcome, or influence the treatment?
Is the test suitably sensitive and specific?
Standby treatment refers to treatment carried for
Is it simple enough for reliable use by those
emergency use by an individual. In relation to
required to use it?
VBDs, this is only of importance with regard to
Will its use be restricted by storage temperature
malaria, and has been greatly facilitated by the
requirements (e.g. cold chain) or short shelf
development of POC testing for malaria. Use of
life?
standby treatment is usually only recommended:
when access to medical expertise of appropriate
The UK Medicines and Healthcare products
quality for diagnosis and treatment is not readily
Regulatory Agency (MHRA) suggest that certain
available (even when chemoprophylaxis is taken);
criteria be met before instituting POC testing.
These include:
in areas where transmission is very high, but

protection by chemoprophylaxis is so poor or
adequate training and assessment of end users;
unreliable due to drug resistance (e.g. some
clear instructions on use, that should be
parts of Thailand and Cambodia) that the
followed precisely;
benefits of taking it are outweighed by the
adequate quality control;
a system of review or laboratory overview; and
adequate safety precautions, e.g. the safe
regular chemoprophylaxis is unwarranted, but a
disposal of used tests, lancets, swabs etc., and
risk of exposure remains.
disadvantages; and
in areas where transmission is so low that taking
appropriate caution when handling reagents.

The preferred option is to have a health practitioner
POC testing is available for a growing number of
confirm the diagnosis and then to take the
infectious diseases. Among VBDs, tests for malaria
medication with medical follow-up. However, if
and dengue are well established and a POC test
there is likely to be a delay in reaching medical
for Chagas disease (American trypanosomiasis) is
support in excess of 12 hours after symptom
available. At the time of publication, POC tests for
development, the patient may use standby
human African trypanosomiasis and Japanese
medication to initiate drug treatment of the infection.
encephalitis are under development. Of all these,
Combined POC tests and a course of standby
the POC tests for malaria diagnosis are the most
treatment for malaria are now available in small,
important. POC tests (and standby treatment) can
easily carried kits. A combination of lumefantrine
be valuable when an individual leaves the endemic
and artemether (e.g. Riamet, Coartem) is one of
zone and returns home, where malaria is unknown
the most common standby treatments for malaria.
and likely to be missed by the home doctor.
Occasionally, atovaquone with proguanil (e.g.

Malarone) is used, but this is not appropriate if the
POC tests for malaria usually rely upon identifying
same drug has been used as chemoprophylaxis.
histidine-rich protein or parasite lactate

dehydrogenase in a patients blood, and have
It is important that those issued with such kits are
reached a level of specificity and sensitivity such
thoroughly trained in the circumstances and method
that they can be reliably used in the field after
of their use. There must be no contraindications to
minimal training.
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.
20
Appendix 1:
Understanding the need for chemoprophylaxis
Failure to appreciate the need for
Failure to appreciate
chemoprophylaxis is a common problem,
the need for
particularly among long-term expatriates. The
chemoprophylaxis is a
common problem:
reasons for this may include:
assignees must be
concern about possible side-effects, especially in
informed that malaria
relation to long-term use, and the perception
is a serious and
that the risk presented by chemoprophylaxis is
debilitating illness, if
greater than the risk of malaria;
not fatal, and that
the belief expressed by other expatriates that
they have a duty to
we dont need to use it here, the risk is less than
take reasonable
they say;
precautions to avoid
advice given by local medical practitioners
becoming ill while
which contradicts or confuses the advice given
working.
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
no evidence of harm. This may require use
and that there is no need to worry; and
off licence under physician control, and
the occasional, deeply held personal conviction
individuals should understand that this is
that orthodox medications are unacceptable.
neither illegal nor unsafe.
Misconceptions may be fostered by the press or
The attitude of if I catch it I can just get

treated must be confronted. Assignees must
other expatriates, but the limitations of a drugs
understand that malaria is a serious and
technical licence can also cause alarm. For
debilitating illness, if not fatal, and that they
example, Malarone carried a 28-day licence in
have a duty to take reasonable precautions
the UK long after most authorities and physicians
to avoid becoming ill while working. They
were happy to prescribe it for much longer.
must also be made aware that resistance to
Management of this issue can be complex. Some
treatment is always a possibility and can be
options are given below:
fatal. (However, in some situations, e.g.
Educationthis is essential, regardless of any
where there is low risk, high resistance and
other strategy that may be adopted.
ready access to treatment, insect
The risk of catching malaria and the possible

consequences must be made patently clear
precautions and treatment of affected

personnel may be appropriate, as in some
areas of South-East Asia.)
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
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
expensive and time-consuming, and a drug
contractors are much more likely to subscribe to
company may not see any major benefit in
requirements which are fully endorsed by
formally extending a previous licence, despite
management.
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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
The Anopheles
Malaria
mosquito plays a
prominent role in
Malaria affects around 200 million people each
the transmission of
year, and causes some 1 million deaths of which
malaria to humans.
90% involve children under 5 years old in subSaharan 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-
meal. The cycle of infection was exclusively thought
like illness with high fever, prostration and aching.
to be human-mosquito-human, until the discovery
Anaemia and jaundice may occur, the kidneys may
of the P. knowlesii infection (see above). However,
be affected and, in the most serious cases, fatal
this exception contributes only a very limited
cerebral malaria may develop.
proportion of cases in a limited area.
Causative agent
Rarely, malaria may be transmitted through blood

transfusion, organ transplant, or the shared use of
Four kinds of malaria parasites have long been
needles or syringes contaminated with blood. A
known to infect humans: Plasmodium falciparum,
pregnant woman may also transmit her infection to
P. vivax, P. ovale, and P. malariae. Recently,
the unborn child.
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).
Incubation period
The incubation period varies according to the type
of parasite. In general, this period is around 10
P. falciparum malaria usually results in the most
days but can extend to 8 weeks after infection,
severe and life-threatening malaria and is
although a person may feel ill as early as 7 days
responsible for the majority of deaths. However,
or as late as 1 year after infection.
P. vivax can also be fatal, especially in those who

are already malnourished or ill. People who have
Two kinds of malaria, P. vivax and P. ovale, can recur
little or no immunity to malaria, such as young
again without further infection (relapsing malaria),
children and pregnant women or travellers coming
despite being cleared form the blood, when parasites
from areas with no malaria, are more likely to
that have remained dormant in the liver reactivate
become very sick and die.
and begin invading red blood cells (relapse).
Vectors and transmission
Diagnosis
Human malaria is transmitted through the bite of
Rapid and accurate diagnosis of malaria is
blood-feeding female mosquitoes of the genus
fundamental to the appropriate and effective
Anopheles. When a mosquito takes a blood meal
treatment of affected individuals and is vital to
form a person who is already infected with
prevent the infection spreading through the
malaria, it may ingest reproductive forms of the
community.
malaria parasite. These then mature to infective

forms within the mosquito and are subsequently
Microscopic diagnosis by smear slide examination
transmitted to another human at a later blood
remains the gold standard where carried out

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correctly. It carries the advantage of both identifying
Diagnosis. For further details on personal prevention,
the specific parasite and the degree of parasitaemia
see the section on Chemoprophylaxis on page 17).
(measure of parasites in the blood and thus a

measure of severity of infection). Rapid diagnostic
Eradication of mosquitoes and their breeding sites
kits are available, and some are of acceptable
is an important element of long-term control, and is
sensitivity and specificity. However, while some can
discussed in the section on Management and
differentiate Plasmodium species, not all do, and
prevention on pages 1314.
they cannot give an indication of parasite load.
Distribution
Differential diagnosis
Malaria is present throughout the tropics. A global
The early symptoms of malaria resemble a flu-like
map of confirmed malaria cases in 2010 can be
illness and can mimic a large variety of conditions,
found courtesy of the WHO at:
especially in someone who has resided in the
http://gamapserver.who.int/mapLibrary/Files/
tropics. A traveller who becomes ill with a fever
Maps/Global_Malaria_ReportedCases_2010.png
while travelling, or up to a year after returning

from an area that is endemic for malaria, should
immediately seek professional medical care and
Yellow fever
should emphasize the potential for malaria infection.

The majority of people infected have an
Treatment
asymptomatic or very mild infection. For those who

become symptomatic, the incubation period is
Malaria can be cured if treated with appropriate
about three to six days. The illness presents as a
drugs soon enough. The exact drug choice may be
flu-like condition with sudden onset of fever, chills,
influenced by: the type of malaria; the location
muscle aches, nausea and headache. Most people
where the disease was contracted (parasite
then recover, but about 15% may progress to the
sensitivity to treatment drugs varies geographically);
more serious second stage with jaundice,
the age of the patient; pregnancy; and the type of
haemorrhagic symptoms, shock and multiple organ
drug used for chemoprophylaxis (if any).
failure. At this stage, the mortality is very high (up

to 50%). Diagnosis is by clinical picture and
The hypnozoite liver forms of P. vivax and P. ovale
circumstances, together with the identification of
need to be eradicated by special treatment (usually
virus-specific antibodies.
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.
Infective agent
Yellow fever is caused by an RNA virus of the
24
If not adequately treated P. malariae may simply be
Flavivirus genus. It is related to the viruses causing
suppressed and can relapse repeatedly over many
dengue fever, chikengunya and Japanese
years.
encephalitis.
Prevention
Vector
A simple reminder of the key steps needed for
The disease is transmitted by the bite of infected
personal prevention is the ABCD model:
female mosquitoesmainly the Aedes and
Awareness, Bite prevention, Chemoprophylaxis and
Haemogogus species. It occurs in non-human
primates as well as humans, and may be
some immunity). In South America, young forest
transmitted either from human to human via
workers are the main victims, when they are
mosquito, or from monkey to human via mosquito.
exposed to the sylvatic cycle during forest clearance.
There are three transmission cycles for the disease:
Sylvatic (jungle) cycle: non-human primates act
Prevention
as the main reservoir in forested areas. Canopy-
General precautions as described for mosquito
dwelling mosquitoes transmit the disease from
bites (pages 1517) are appropriate. It should be
monkey to monkey. When the forest environment
noted that mosquitoes transmitting yellow fever are
is disturbed, mosquitoes may transmit yellow
diurnal (active during the daytime) and it is
fever from monkeys to humans (e.g. loggers,
therefore appropriate to take precautions by
farmers). If these infected humans subsequently
wearing long sleeves and trousers and using insect
return to an urban environment, the disease may
repellent during the day. An effective live-attenuated
be further transmitted to other humans, usually
vaccine is available. Older people (generally 60
by a different mosquito, and an urban cycle may
years or older) receiving the vaccine for the first
be initiated (sometimes of epidemic proportions).
time are at greater risk of two serious vaccine side
Savannah cycle: this occurs in Africa, where
effectsvaccine-associated neurotropic disease
Aedes mosquitoes living in lower tree levels (e.g.
(VND) and vaccine-associated viscerotropic disease
in water filled trunk holes) transmit the disease
(VVD). In view of the changing epidemiology of
indiscriminately between local monkeys and
yellow fever, it is important that the decision to
humans, and between humans working at the
vaccinate is risk based. The WHO issues lists of
forest border areas.
countries in which yellow fever is endemic and for
The urban cycle: involves the transmission of
which an official yellow fever vaccine certificate is
disease by Aedes mosquitoes between humans
mandatory for entry. In addition, many other
in the urban setting. This may be the norm in
countries will demand vaccination certificates for
some parts of Africa or may be occasional
those coming from certain countries even if not on
when the forest worker returns after having been
the official WHO list.
infected in the sylvatic cycle.

In some areas, there may have been no human
Dengue
yellow fever for many years. Yet, through regular

surveillance or the examination of dead monkeys, it
This mosquito-borne disease causes high fever,
may be evident that jungle monkeys remain as
severe headache, muscle pains and general
reservoirs. In this situation, great care must be taken
malaise. There may be retro-orbital pain (pain
to ensure that oil and gas companies working in
behind the eye) and a body rash (sparing the
the jungle do not initiate an active sylvatic cycle for
face). After an incubation period of approximately
the workers or even lead to an urban outbreak.
three to four days, the symptoms develop and the

fever lasts for around seven days. Most people
Distribution
recover, but for some, the recovery may be slow or

intermittent with prolonged fatigue. A proportion of
Yellow fever occurs in sub-Saharan Africa and
those infected may go on to develop dengue
tropical Central and South America. Typically it is
haemorrhagic fever (DHF) or dengue shock
endemic with periodic epidemics. The greatest
syndrome (DSS) if they have previously had a
human burden is in Africa where infants and
dengue infection of a different strain (see below).
children are at greatest risk (older adults will have
These conditions are much more serious and carry

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a mortality rate of up to 20%, although the best
Mediterranean. Two-fifths of the worlds population
hospital care may reduce this to as low as 1%.
is now at risk of the disease, and DHF and DSS are
There is currently a move to change the
a major cause of child deaths in Southeast Asia.
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
Prevention
outbreaks superimposed on a background of
No vaccine is available, although research efforts
sporadic cases. Some of these outbreaks can be
continue to towards developing one. Personal bite
enormous (hundreds of thousands of cases).
avoidance is important, but vector management

through the elimination of breeding sites and
Diagnosis is clinical, especially during an epidemic.
insecticide spraying is the mainstay of control. The
Reduced platelet count is typical, and antibody tests
main difficulty remains the presence of four
can be performed for confirmatory purposes.
serotypes, as well as the complex interaction

between infection, immunity and the severe forms
Infective agent
of dengue. The basis of disease control is to manage

and eliminate mosquito breeding. As the mosquitos
The dengue virus is an RNA virus of the Flaviviridae
life-cycle from egg to adult phase is 7 to 10 days,
family. It exists in four serotypesDEN-1, DEN-2,
breeding control measures must be carried out every
DEN-3 and DEN-4. One or all four types may
week using various procedures as described in the
circulate in a given region at the same time. Infection
section on Elimination of breeding sites on page 13.
with one type gives long-term immunity to that type

and temporary (about eight weeks) immunity to the
Some work is under way on interference with
other types. The increased susceptibility to DHF and
breeding by genetic manipulation of mosquito
DSS is manifest in those who have had a previous
populations. Joint efforts with health authorities,
infection with one type and then develop infection
other companies and communities to identify and
with another type at a later date.
eliminate potential breeding grounds for

mosquitoes (inside and outside workplaces),
Vector
increased awareness by means of lectures, and

corporate campaigns may significantly improve
The virus is transmitted by female mosquitoes of the
overall levels of management success, as well as
genus Aedes when seeking a blood meal. The
enhance the companys social performance profile.
principal vector species is Ae. aegypti, which is
An example of coordinated practice is the Dengue
widespread and tends to be urban and semi-urban.
Awareness Day celebration organized by the
Once infected, the mosquito carries and transmits
Association of Southeast Asian Nations (ASEAN)
the virus for life. Other species, e.g. Ae. albopictus,
and held for first time on 15 June 2011.
may also transmit the infection, but are generally

not as efficient in doing so as Ae. aegypti.
Japanese encephalitis
Distribution
26
The majority of human infections are completely
The range and intensity of dengue infection have
asymptomatic or very mild. Less than 1% of infected
grown markedly in the past few decades. Before
persons develop recognizable overt disease. In
1970, only nine countries had significant problems.
these cases, after an incubation period of between
Now, it is present in more than 100 countries in
5 and 25 days, there is a sudden onset of fever,
Asia, Africa, the Americas, the Pacific and eastern
headache and vomiting. Encephalitis is usually
severe, with a Parkinson-like syndrome, paralysis
Japanese
and seizures. Of those who become clinically ill, up
encephalitis is most
to 30% may die and 3050% may be left with
commonly spread
by the Culex genus
permanent neurological or psychiatric sequelae.
of mosquito.
Causative agent
The disease is caused by an RNA virus of the
flavivirus group.
disease are used as a routine childhood vaccine.
Vector and transmission
The use of a vaccine for short-term travellers has
The disease is spread by the bite of infected female
been somewhat controversial, as some vaccines
mosquitoes, generally the Culex species. Humans
were reputed to have significant side-effects.
are incidental hosts, i.e. they are not normally sick
profile. A new vaccine is available which has a
for long enough, or with high enough viral loads to
much better side-effect profile, and it is reasonable
transmit the virus to mosquitoes (and onwards to
to offer this to anyone staying in a high-risk area
humans). The main hosts are pigs or wading birds,
for more than four weeks.
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
American trypanosomiasis
(Chagas disease)
to rural areas because, in Asia, such farms and

fields may be near to, or in, urban locations.
This parasitic disease of the Americas (almost

exclusively Central and South America) presents
Japanese encephalitis is confined to Asia and the
with a biphasic picture (acute and chronic phases)
western pacific and has not been transmitted in
and either phase may be clinically silent or life
Africa, Europe or the Americas. It is diagnosed by
threatening. The acute phase, occurring shortly
clinical picture and the identification of a specific
after infection, lasts for weeks or months and is
antibody. Although the Japanese encephalitis virus
characterized by parasites circulating in the blood.
is the most common vaccine-preventable
In symptomatic cases, there may be fever, fatigue,
encephalitis in Asia, and is extremely serious when
headache, malaise, loss of appetite, diarrhoea and
not sub-clinical, it is a rare disease amongst short-
vomiting. A characteristic feature of infection near
term travellers. Also, in many areas, no
the eye is a swelling of the eyelids, known as
confirmatory laboratory testing facilities will be
Romanas sign. In the very young, the very old and
available, so diagnosis may be on the basis of
those with compromised immune systems, the acute
symptoms alone, and other causes of encephalitis
phase may be severe and occasionally fatal.
cannot be excluded.
Most patients recover from the acute phase, but
Prevention
continue to harbour the parasite. Most remain

asymptomatic for life, but a minority (2030%) may
Mosquito avoidance measures are appropriate.
develop symptomatic chronic disease which
The distancing of urban settings from piggeries
manifests many years after the acute infection. The
and paddy fields would be helpful. Vaccines are
most common manifestation of chronic disease is
available, and in some countries with endemic
infection of the heart with disorders of heart

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conduction, damage to ventricular muscle function
appear to be a number of variants, or subspecies,
and even aneurysms. In the more southerly range
and differences in the disease spectrum are
of the disease (especially the Southern Cone of
probably related to this. For example, the
America), megasyndromes affecting the
trypanosomes in the northerly part of the range do
gastrointestinal tract may also occur due to damage
not cause megasyndromes.
to the nerve plexuses in the smooth muscle. The most

common are megaoesophagus and megacolon.
Diagnosis
Vector
The parasite is spread through contact with the
faeces of triatomine bugs. A number of species are
In the acute phase, parasites may be identified in
involved, and they go by a variety of popular and
blood, or xenodiagnosis may be used.
local names (assassin bugs, kissing bugs,
Immunological tests such as IFAT and ELISA are
benchucha, vinchuca, chinche, barbeiro), some of
available for chronic disease.
which reflect the tendency of the infection to

originate around the face (which, being uncovered,
Treatment
is the main target of the night-biting insect). The

triatomine bug does not carry the parasite in its
Traditionally, only the acute disease was treated
saliva, so does not inoculate the infection with its
with anti-parasitic medication, while the chronic
bite. Instead, the individual is believed to rub the
phase, when parasites are rarely detectable in the
infected faeces into the bite wound. However,
blood, was treated solely on the basis of the
infection through direct contact between insect
damaged organs. However, a case has been made
faeces and mucous membranes of the eye or mouth
more recently to use anti-parasite drugs in the
is also important. These are probably the most
chronic phase also, particularly in children, who
important routes for the majority of infections in
tolerate the side-effects better.
South America and many such infections are

initiated in childhood. Infection may also occur via
Causative organism
blood transfusion, organ donation, transplacental

transmission and even through food or drink
The infection is caused by a species of parasite
contaminated with triatomine faeces (usually via
known as Trypanosome cruzi. The Trypanosoma
bugs crushed inadvertently during processing).
genus is distributed worldwide but different species
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
tend to be host-species specific and cause
The important triatomine bugs (with regard to
remarkably different diseases. T. cruzi, however, is
infection) are peri-domestic and live in the thatch,
confined to the Americas. Within its range, there
adobe, straw or other materials of basic housing.
They may also infect farm buildings such as sheds
different subspecies of the parasite Trypanosoma
and chicken coops as well as rodent burrows.
brucei, and each is associated with different

habitats and spread by different fly species. Both
Distribution
have an early and a late phase. The western form,
T.b. gambiense, has an early phase characterized
Chagas disease is found throughout the Americas
by irregular fever and enlarged lymph nodes
from Mexico to Argentina. Cases have also been
before progressing, after many months or years, to
reported in the southern USA. Different variants in
a severe neurological and psycho-neurological
the type of trypanosome cause differences in the
condition. The eastern variety, T.b. rhodesiense,
disease, and differences in the dominant insect
often presents with a chancre (a painless ulcer) at
vector cause differences in epidemiology
the site of the fly bite, with cellulitis, enlarged lymph
(depending on the habitat preferences). Prevalence
nodes and fever. It tends to progress to the second
and incidence have both dropped significantly in
phase much more rapidly than T.b. gambiense,
the past two decades due to vector control. However,
with fatal heart and neurological disease
a large burden of chronic disease still remains. In
appearing within six to nine months.
addition, cases of chronic Chagas disease are now

appearing more prominently in other non-endemic
countries, such as Spain, due to immigration.
Diagnosis
Acute phase T.b. gambiense may be diagnosed by
Prevention
lymph node aspiration, while acute phase
T.b. rhodesiense will usually reveal parasites in the
No vaccine is available. Management of the
blood. The chronic phase of both varieties is
disease rests principally on the control of vector
diagnosed on CSF (cerebral spinal fluid)
breeding and resting sites. Foremost in this area
examination and, for T.b. gambiense, serological
has been the replacement of basic housing and
testing using CATT (card agglutination test for
animal accommodation (i.e. which often contain
trypanosomiasis) will also yield useful information
numerous cracks and crevices) with buildings
for screening.
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.
Treatment
Eradication in other areas (such as forested areas
Drug treatment depends on the type of HAT and the
of the Amazon) has been harder, as the bugs have
development stage of the disease (early or late).
numerous burrows or other areas to hide in during
Most have significant toxicity, and treatment is
the day and can readily reinvade homes.
highly specialized.
In some countries, testing of potential blood donors

for infection is now routine, as blood transfusion
does transmit the disease.
Causative organism
HAT is caused by two subspecies of the parasite
Trypanosoma bruceiT.b. gambiense and
Human African trypanosomiasis
T.b. rhodesiense, each with different ranges,

disease manifestations and hosts. T.b. gambiense
occurs principally in west and central sub-Saharan
Human African trypanosomiasis (HAT) presents as
Africa and is spread from human to human
two different conditions, in west and east sub-
(although dogs and pigs may also act as hosts).
Saharan Africa. Each condition is caused by a
T.b. rhodesiense occurs in the eastern sub-Saharan

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region and is a zoonosis maintained in wild and
thirds of people may recover at this stage. One-
domestic animals (such as antelope, cattle and
third may progress to disease involving the central
goats); humans are an incidental host.
nervous system, e.g. meningitis, encephalitis,

myelitis or paralysis. The outcome depends on
Vector
which of three subtypes of the disease is involved:
Trypanosoma brucei is transmitted by the bite of
fatality ratio (2040%) with high rates of
the tsetse fly, Glossina, of which a variety of

species are important. These are large flies, active
The Far-Eastern subtype has the highest case

neurological sequelae.
The Siberian subtype often involves a chronic or
by day, and tend to be localized in distribution;
progressive condition and has a case fatality
local nationals will often know the risk areas. The
ratio of 3%.
fly is said to be attracted to moving objects and

dark silhouettes.
The European subtype is generally milder, with a

case fatality ratio of less than 2%. However,
neurological sequelae can occur in 30% of
Distribution
patients.
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
Causative organism
The disease is caused by an RNA flavivirus.
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.
Vector and transmission

The virus is spread primarily by the bite of a hardbodied 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
Prevention
the unpasteurized milk of infected cows or goats can
No vaccine is available. Prevention depends on the
also infect humans. The tick itself is both host and
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.
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.
Tick-borne encephalitis
Tick-borne encephalitis (TBE) may present as a
30
Prevention
biphasic condition. After an initial incubation
The ticks and their larvae seek out hosts on which to
period of eight days (but with a wide range), a
feed by climbing to the tops of stalks of grass and
non-specific flu-like illness develops. Up to two-
actively waving their legs to gain a hold on a
passing animal (questing). They bite to get a blood
headache, fever, malaise and nausea coming on
meal and pass on the virus in the process. It is
within two or so weeks of exposure. The tick-borne
believed that the tick must be actively attached for at
disease is often accompanied by a rash, and
least half a day for a significant chance of
sometimes by an eschar (a scab-like scar) at the
transmission. Therefore, wearing thick trousers and
site of the bite.
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
Relevance
unpasteurized dairy products is also important.
These diseases are a chronic burden for the
Vaccines are available and are believed to have an
indigenous populations of endemic countries, but
efficacy greater than 95%, although people over 50
may also be a significant problem for travellers to
years of age may be less responsive. Estimates of
affected areas. It has been estimated that African
risk for an unvaccinated visitor to a TBE area are
tick bite fever probably affects more travellers to
1 case per 10,000 person-months of exposure.
Southern Africa than malaria (CDC, 2012).
However, vaccination may be worthwhile for those

working in forested areas over the longer term.
Many of the associated conditions are relatively
Some countries (e.g. Austria) vaccinate against TBE
mild or transitory, but Rocky Mountain spotted
as part of their national programme.
fever and epidemic typhus can have mortality rates

of 50% or more.
Rickettsial infections
Prevention
These diseases are caused by various species of
Appropriate clothing covering the arms, legs,
obligate intracellular bacteria (i.e. parasites which
head and neck, and the use of insect repellent is
can only grow and reproduce within the living cells
indicated in all cases. Examination of oneself and
of the host). The most important conditions are the
colleagues for ticks is important, as rapid removal
spotted fevers and typhus fevers. The causative
may prevent disease transmission. Ticks must be
organisms, reservoir hosts, vectors and clinical
removed whole, with head intact. Avoidance of
syndromes are varied and somewhat complicated
areas reputed to carry high populations of the
(see Table A1), but a common clinical picture is of
vector may be helpful.
Table A1 Rickettsial infectionscausative organisms and vectors
Disease
Agent
Vector
Distribution
Rocky Mountain spotted fever
Rickettsia rickettsiae
tick
North America
Mediterranean spotted fever
Rickettsia coroni
tick
Mediterranean, Africa, Middle East, India
African tick bite fever
Rickettsia africae
tick
Sub-Saharan Africa
Orientia* tsutsugamushi
mite larva
Far East
Rickettsia prowazekii
louse
West and East Africa, Mexico, Peru, Bolivia, Ecuador
Rickettsia typhi
flea
Prominent in SE Asia, south and east USA, Mexico and

West Africa, with patchy distribution elsewhere worldwide
Scrub typhus
Epidemic typhus
Murine (endemic) typhus
* Orientia was formerly classified as Rickettsia
31
IPIECA
OGP
Epidemic typhus is only found in areas of
cases may undergo reactivation if an individuals
considerable poverty and in situations such as post
immunity decreases due to disease or age. While
disaster, wars and refugee camps. Delousing of body
cutaneous leishmaniasis may be found in both rural
and clothes is an important control. Doxycycline may
and urban environments, visceral leishmaniasis
be an appropriate prophylaxis for workers travelling
tends to be more rural in distribution and occurs in
to the affected areas (e.g. aid workers, etc.), but
more limited foci.
should not be taken during pregnancy or when

breast feeding (see Chemoprophylaxis on page 17).
Vector
Reduction of rodent numbers around habitations
The infecting protozoon is spread by female sand
may reduce exposure to the fleas responsible for
flies of the phlebotomine family. Despite the
murine typhus.
common name, they are not restricted to sandy

areas and are found in a wide environment. At
23 mm long, they are much smaller than most
Leishmaniasis
mosquitoes and are easily overlooked. They bite

mainly from dusk to dawn, but may also bite
This condition occurs from the tropics of the Old
during the daytime if disturbed.
and New World to southern Europe and is caused

by an obligate intracellular protozoon. There are
two broad varietiescutaneous and visceral,
Distribution
caused by different organismswith a
Leishmaniasis is found throughout tropical Africa,
mucocutaneous form also occurring in areas of
North Africa, the Middle East, Southern Europe,
high cutaneous disease in South America.
Mexico, and Central and South America.
Cutaneous leishmaniasis
This is characterized by the development of
Approximately 90% of cases occur in Afghanistan,

Algeria, Iran, Iraq, Saudi Arabia, Bolivia, Brazil,
Columbia and Peru.
painless skin lesions which progress form nodules

to indolent ulcers, sometimes with enlarged
regional lymph nodes. The lesions usually appear
Prevention
weeks or months after a bite by a sand fly, and can
Standard anti-mosquito precautions, i.e. wearing
occasionally be reactivated years later by trauma
long sleeves and trousers and frequent use of insect
or surgery to the affected area of skin. Eventually,
repellent, are important, together with avoidance of
the ulcers heal, but this can take months or years
outdoor activities after dark if possible. Sand flies
and can leave disfiguring scars. In South America,
also bite indoors, however, and it should be noted
a variation called mucocutaneous leishmaniasis
that the mesh size of standard mosquito nets and
(MCL) can affect mucous membranes and be much
door/window screens is usually too large to
more destructive.
prevent the entry of the much smaller sand flies.

Bed nets with a very small mesh are available, but
Visceral leishmaniasis
32
air movement (ventilation) through this type of net

is considerably restricted and, consequently, such
In visceral leishmaniasis, the protozoon parasites
nets are reputed to be very uncomfortable to sleep
invade the body systemically, and fever, weight
under. If only a standard mosquito bed net is
loss, hepatosplenomegaly and pancytopaenia may
available or tolerable, thorough impregnation with
occur. It may be fatal if not treated. Recovered
permethrin will help.
Appendix 3:
Neglected tropical diseases
Often neglected is a group of disabling, and
Although many of these neglected tropical diseases
frequently chronic, diseases that affect the poorest
(NTDs) do not appear to have a direct impact on
of the worlds population living in remote rural
the typical operations of oil and gas producers, the
areas or urban slums. Because of the population
social exclusion, suffering, mortality and negative
affected, and a lack of awareness of the true
effect on general economic productivity in the
impact of these diseases, their control or
countries affected will undoubtedly affect major
elimination has tended to be overlooked by
corporations, even if indirectly. Furthermore, there
government and international funding bodies. In
is an increasing imperative for resource-exploiting
October 2012, the WHO launched a campaign to
companies to give back to host countries through
address these conditions and, ironically, estimated
corporate and social responsibility programmes,
that most of them can be controlled by safe, simple
and in this respect, the control or elimination of
and effective treatments and interventions that are
NTDswhich may be easily achieved in many
already available. Furthermore, it is thought that,
casesis a particularly worthy consideration. The
90% of these diseases are probably treatable by
WHO has identified 17 diseases or disease groups
medication given just once or twice a year. Major
that fall into the category of neglected tropical
scientific advances and drug developments are not
diseases. Whilst not all of these are vector-borne
requiredjust a willingness to engage with time
diseases, their impact on the communities affected
and money.
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
Soil-transmitted
Freshwater snail vector

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.
Disability: a physical or mental impairment that

substantially limits one or more major life activities.
Diurnal: of or during the day.
Anopheles: a genus of mosquitosome 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 2050% 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 trypanosomiasisa
test used to detect trypanosome-specific antibodies in
blood, serum or plasma.
CSF: cerebrospinal fluid analysisexamination of the
fluid that surrounds the brain and spinal cord.
DALYS: disability adjusted life yearsthe 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: dichlorodiphenyltrichloroethanean 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-3methylbenzamide) for use on exposed skin to repel
mosquitoes and other insects.
34
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 braincan 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-6phosphate dehydrogenase, or G6PD, which helps red
blood cells to function normally.
HAT: human African trypanosomiasissleeping

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 bodys 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 sprayingthe 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.
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 Systema system for
predicting malaria epidemics based on satellite date.
MHRA: Medicines and Healthcare products Regulatory
Agencythe 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.
ITNs: insecticide-treated bed nets.
Pathogen: parasites, bacteria, viruses or fungi that

can cause disease.
Ixodid: a form of hard tick that can transmit a number

of diseases.
Pathophysiology: the functional changes in humans

resulting from infection.
Larvicide: a chemical used to kill insect larvae, e.g.

one applied to water where mosquitoes are breeding.
Peri-urban: the area immediately surrounding an

urban or city area.
Malaria: parasitic disease that kills two million people

per year around the world.
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 IRSindoor residual spraying.
Retro-orbital pain: pain or pressure behind the eyes.
RNA: ribonucleic acida 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 Pointof-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 subSaharan 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 sideeffect 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 sideeffect of yellow fever vaccine, causing severe multiorgan 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 Organizationthe 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.
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-infectiousdiseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-and-related-infections-anaplasmosis-andehrlichiosis.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: 157075.
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 CDCs Division of Vector-Borne Diseases (DVBD)
provides information on a range of vector-borne diseases: the DVBDs 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
37
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IPIECA is the global oil and gas industry association for environmental and social issues. It develops,
shares and promotes good practices and knowledge to help the industry improve its environmental and
social performance, and is the industrys principal channel of communication with the United Nations.
Through its member-led working groups and executive leadership, IPIECA brings together the collective
expertise of oil and gas companies and associations. Its unique position within the industry enables its
members to respond effectively to key environmental and social issues.
E-mail: info@ipieca.org Internet: www.ipieca.org
OGP represents the upstream oil and gas industry before international organizations including the
International Maritime Organization, the United Nations Environment Programme (UNEP) Regional
Seas Conventions and other groups under the UN umbrella. At the regional level, OGP is the industry
representative to the European Commission and Parliament and the OSPAR Commission for the North
East Atlantic. Equally important is OGPs role in promulgating best practices, particularly in the areas
of health, safety, the environment and social responsibility.
London office
Brussels office
Boulevard du Souverain 165, 4th Floor, B-1160 Brussels, Belgium
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Vector-Borne Disease Management Programmes

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Vector-borne

International Association of Oil & Gas Producers

OGP Report Number 481

VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Human, business and financial impact

Key factors to promote success:

Benefits of a vector-borne disease

When to develop and implement a VBDMP

Integrating a VBDMP with other impact

Management and prevention

Primary managementvector control

Elimination of breeding sites

Use of larvicide or insecticide

Clothing and behaviour

Malaria management in the local workforce

Point of care (POC) testing

Putting it all together:

National and international stakeholder

Planning, including resourcing, cost and

American trypanosomiasis (Chagas disease)

Implementation and monitoring

Human African trypanosomiasis (HAT)

References and further reading

VECTOR-BORNE DISEASE MANAGEMENT PROGRAMMES

Purpose of this guide

environment practitioners, as well as medical

personnel and health risks managers working for

diseases and their

the oil and gas industry. It is especially relevant for

oil and gas industry

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,

from the importance of other VBDs, and the

principles outlined in this document may be

This document is not intended to be a textbook of

The following support material is available:

VBDs or tropical medicine; rather, it describes the

development of a VBDMP. While the broad

Example malaria case investigation form:

diseases, examples of more specific requirements of

Primary prevention of transmissible vectorborne diseases:

importance and rationale underpinning the

Sample implementation checklist to assist with

Significant emphasis is placed on malaria because

a company malaria control programme:

of its substantial impact, but this does not detract

This guide attempts to build on successful industry

safeguarding the health of its workforce as well as

practices. Experience at both the international

improving health standards in host countries. The

health level, and within the private sector,

potential impact of VBDs is high because of the

indicates that vector-borne disease management is

complex interaction between biological,

both complex and difficult. There is no unique set

geographical, social and political factors.

of strategies or programmes that will work in all

Regardless of geographical location, the industry

situations or geographical locations. However,

operates in an atmosphere of heightened

there are some reasonably well-understood