History

The early history of dengue is clouded by the similarity of its clinical picture to that of other febrile illnesses. Dengue-like epidemics occurred in Egypt and on Java in 1779, but these may actually have been caused by chikungunya virus.(7) Dengue or dengue-like epidemics were reported through- out the 19th and early 20th centuries in the Americas, southern Europe, North Africa, the Middle East, Asia and Australia and on various islands in the Indian Ocean, South and Central Pacific and the Caribbean.(6,7) Generally these epidemics consisted of nonfatal febrile illnesses, often associated with rash and either muscle or joint pains.(7) Deaths occurred during dengue epidemics in Australia in 1897 and in Greece in 1928, when over 1000 deaths were reported.(17) Hemorrhagic manifestations, including gastrointestinal hemorrhage, were described during dengue epidemics in Texas and Louisiana in 1922.(14,18,19) Nevertheless through the first half of the 20th century, dengue was generally described as a self-limited, nonfatal febrile illness, with occasional hemorrhagic manifestations such as petechiae, epistaxis, gingival bleeding and menorrhagia, that only rarely resulted in more severe or fatal outcomes. In 1944 two immunologically distinct but related viruses, now referred to as dengue 1 (DEN-I) and DEN-2, were isolated by Sabin (21) from patients with clinically diagnosed dengue. In 1956 Hammon et al.(22,23) and coworkers isolated two new serotypes of dengue viruses, designated DEN-3 and DEN-4, as well as the previously recognized DEN-I and DEN-2, during epidemics of severe hemorrhagic illness among children in the Philippines.(22,23) Outbreaks of what came to be known as DHF24 occurred throughout Southeast Asia during succeeding years.(23,25) The term dengue shock syndrome was coined to describe the cases of DHF with shock, which clinical studies indicated was caused by increased vascular permeability and resultant intravascular hypovolemia.(26,27) Eventually the WHO case definition of DHF was modified to make increased vascular permeability the hallmark of the disease.(28) Cases of severe hemorrhage or even deaths caused by dengue infection that do not show evidence of increased capillary permeability are not currently classified as DHF according to WHO criteria.(28,29) The emergence of DHF in the Americas(1,15,3032) is believed by some researchers to be following a similar pattern to that seen in Southeast Asia more than 30 years ago.(15,30) With the reinfestation of many countries in the American region by A. aegypti, dengue epidemics have recently struck cities and countries in the Americas that had been free of this disease for many years.(15,30,33) The worldwide distribution of endemic and epidemic dengue is shown in (Figure 1). The actual numbers of dengue and DHF cases reported are influenced by differences in surveillance and reporting systems as well as by varying and unclear applications of case definitions, making accurate assessments of global dengue incidence and trends difficult at present.

Malaria deaths higher than expected, study finds

Recent findings show the number of malaria-related deaths is nearly twice as high as previously thought. But other experts have doubts about the methods used to produce these estimates.
Malaria is often dubbed the scourge of humanity, but it would be more precise to say that it is the scourge of the poor. The mosquito-borne infectious disease does not affect wealthy industrial nations, save for a few tourists who bring it back with them from their travels. This is partly due to environmental factors. A few decades ago, mosquitoes belonging to the Anopheles genus, which can transmit the disease while feeding on the victim's blood, contributed to the spread of malaria in Europe. Then marsh draining eliminated Anopheles mosquitoes from the region. But in some developing countries environmental conditions allow the mosquitoes to thrive. The spread of the disease is exacerbated by the unavailability of products such as protective clothing, bed nets, insecticides and medication. More deaths than previously assumed? The World Health Organization collects statistics on deaths due to malaria. According to its figures, 655,000 people around the world died of the disease in 2010, a large number of them young children. But a new study, published by a team of US scientists in "The Lancet" medical journal on Friday, indicates that the number of deaths could be

much higher. According to its calculations, the actual number of malaria deaths in 2010 was nearly twice as high as the WHO estimate: around 1.2 million. The study's other major finding is that children over the age of five as well as adults die of the disease much more often than previously thought. This is surprising, as the accepted medical theory is that young children who survive the disease develop immunity to malaria and are less likely to die from it at an older age. A new calculation method

The Anopheles mosquito can transmit malaria between people According to Professor Christopher Murray from the University of Washington, the study's lead author, previous estimates were based on the total number of infected persons and the likely death rate. His study, however, used data and computer modeling to build a historical database for malaria between 1980 and 2010. It took into account the standards of medicine and hygiene in countries surveyed as well as the availability of mosquito nets, medicine and insecticides.

The scientists admit that there can be no absolute certainty that the figures are correct. But the finding that malaria deaths are more common than previously thought poses some difficult questions, Murray said. "The finding that there is more malaria death than we thought in a world were funding for global health in the coming few years may be pretty constant and not growing in the pace that we have seen means there is going to be some very difficult issues about competing priorities," said Murray. Doubts about research techniques Despite the new findings, the World Health Organization (WHO) said on Friday that it stood by its figures. "First of all, what's most important is that both WHO's estimates and the estimates from this paper in 'The Lancet' show that mortality from malaria has been declining for about the last five or seven years," said WHO spokesperson Gregory Hartl. "So the statistics are consistent, which is good." Hartl has particular doubts about the alleged high number of deaths among older children and adults. He criticized "The Lancet" study's dependence on what he called "verbal autopsies." A verbal autopsy refers to a process in which a patient has died, and his

caregiver tells the official writing down autopsy details, 'The person had a fever - it must have been malaria,' even though there is no proof that malaria was indeed the cause, Hartl explained. Stephen Lim, one of the new study's co-authors, dismissed that criticism. The scientists examined numerous cases in which malaria was the proven cause of death, together with the verbal statements accompanying them, Lim said, arguing that they showed that the effectiveness of the "verbal autopsy" method had been underestimated. Nevertheless, Lim agrees that the death rate among young children is still the highest. He also contends that survivors build up immunity to the disease, while noting that the level of immunity may not be as high as previously assumed. Praise for the new study

Horstmann believes the study's approach and findings are sound Professor Rolf Horstmann, head of the Bernhard Nocht Institute for Tropical Medicine in Hamburg, claims that while the theory about

immunity development is true, malaria survivors only develop partial immunity to the disease. He believes the findings of "The Lancet" study are credible and that its approach was more thorough than that of some other studies. "There were more individual pieces of data included in it - the research was done more carefully and over a longer period of time," said Horstmann. "It is based on 22,000 individual cases, and each of these was checked for validity." However, Horstmann noted a weak point in both the WHO and "The Lancet" estimates: the uncertain factual basis. He pointed out that both approaches involve making projections. In any case, Horstmann said that the ultimate goal is to eliminate malaria altogether. One of the world's deadliest diseases is, after all, preventable.

Malaria cases in Palawan continue to decline

July 13, 2009 9:20 am PUERTO PRINCESA, July 13 Palawan is hopeful that with the continuous decline in malaria cases due to efforts by the Kilusan Ligtas Malaria (KLM), the disease will eventually be eradicated by 2020 and a malaria-free province will be attained. Pilipinas Shell Foundation, Inc. (PSFI), the lead non-government organization in the fight and control of malaria in Palawan, and the Provincial Health Office, in charge of the provincial governments concern to stamp out malaria, are faithful that by 2011, cases would drop off to five percent, and by 2015, there would be no more to handle. Palawan health officer Dr. Ed Cruz said the status of malaria cases in this province continues to decline since the KLM was launched in 1999. Current data he provided shows that the number of recorded deaths has declined from 26 in 2007 to 11 deaths in 2008. Out of 32,598 blood

smears collected from January 2009 to July 1, 2003, only 3,311 were confirmed cases of malaria. Most of these cases were detected from Puerto Princesa City, and the municipalities of Rizal, Balabac, Bataraza and Quezon. Majority of these cases, or 2,496, are plasmodium falcifarum; and 783 are plasmodium vivax; 51 are plasmodium malariae and 41 cases are mixed. Despite Puerto Princesa being one of where most of the cases were detected, Dr. Dean Palanca of the City Health Office (CHO) explained that discovering them means actually bringing down malaria cases in the city. Compared to 2008, a total of 1,700 cases were recorded. However, this year, only 516 were reported as of January to June. Malaria cases in the city have greatly declined, and this is because of the help of the media, private companies and non-government organizations, Dr. Palanca said. In the city, the top five barangays where malaria cases have been discovered are Luzviminda, Bacungan, Sta. Lourdes, Marufinas and Napsan, which are characteristically mountainous. Malaria ranks No. 5 in the leading causes of morbidity in the province in 2008; 18 out of 23 municipalities and outlying barangays of the province are considered malarious. The municipalities of Cuyo, Agutaya, Magsaysay, Cagayancillo and Kalayaan are not malaria endemic. Dr. Cruz said that despite the declining number of cases, the PHO and the PSFI, in partnership with various agencies and local government units, continue their efforts towards the eradication of the disease in Palawan. Efforts towards malaria control In the Philippines, Palawan remains under Category A, which means recording more than 1,000 malaria cases per year. Marvi R. Trudeau, program director of the PSFI, said what shores up the fight to control malaria is the positive response of the people. The decline in the number of cases, she furthered, is owed to the people of Palawan who actively participate in the partnership. Most notable in our fight is that people have improved in their understanding of malaria, and this has already resulted in a decline, she stated. In continuing these efforts, regularly done are early case detection and treatment; distribution of mosquito nets; mosquito re-treatment; pregnancy package distribution; indoor residual spraying; and trainings; regular conduct of malaria sessions; malaria awareness days; school information dissemination and multi-media campaign activities. Under the early detection case, 278 barangay microscopists had been given a refresher course and were provided with new microscopes, laboratory supplies and anti-malaria drugs to use. The KLM considers these barangay microscopists as frontliners of the fight to control the disease as they work 24 hours in the community as volunteers, making sure deaths are avoided by early detection.

More than 118 barangay health workers (BHWs) were trained too, on malaria case management. Solar home systems (SHS) had also been installed in 278 microscopy centers and in strategic places to facilitate microscope use in poor lighting conditions. Distribution of mosquito nets Currently, the anti-malaria program of the PSFI and the provincial government is active in the distribution of bed nets, conventional and long-lasting insecticidal, as an integral part of their interventions to reduce malaria occurrences in the province. In 2005, a total of 153,993 conventional nets were dispensed all over the areas identified as malaria endemic. In 2007, more than 250,000 long-lasting insecticidal nets were again distributed. Bed nets are distributed free of charge to help save lives by protecting individuals from mosquito bites at night when they are most active. This type of bed net lasts for at least 5 years without being treated again. The bed nets are durable and imbedded with a pyrethroid insecticide that poses minimal toxic risks to humans but repels and kills mosquitoes. The PHO and the PSFI said the bed nets are free. However, they said if they are not used, they will take them back and give to other families. (PNA) LAP/CARF/utb