Barrera R, Amador M, Daz A.

Joshua
Smith, Muoz-Jordn JL, Rosario Y. 2008.
Unusual productivity of Aedes aegypti in
septic tanks and its implications for
dengue control. Medical and Veterinary
Entomology 22:62-69.
http://www3.interscience.wiley.com/cgi-bi
n/fulltext/119401311/PDFSTART

Dengue

Aedes aegypti
Dengue viruses are mainly transmitted by
the bite of infectedAedes
aegyptimosquitoes; an invasive, domestic
species with tropical and subtropical
worldwide distribution that originated in

1
1

Madhya Pradesh Tribal situation

Results:

Of the 648 samples collected from 18

villages of Mandla, 321 (49.53%) were
found to be positive for dengue. The
nRT-PCR and sequencing confirmed
the aetiology as dengue virus type 2.
Eighteen per cent of patients needed
hospitalization and five deaths were
attributed to dengue. The virus was
also detected fromAedes
aegyptimosquito, which was
incriminated as a vector. Phylogenetic
analysis revealed that the dengue
virus 2 detected belonged to
cosmopolitan genotype of the virus.

Interpretation & conclusions:

Dengue virus serotype 2 was
detected as the aetiological
agent in the outbreak in tribal
villages of Mandla district of
Madhya Pradesh. Conducive
man-made environment
favouring mosquitogenic
conditions and seeding of virus
could be the probable reasons for
this outbreak. Urgent attention is
needed to control this new threat
to tribal population, which is
already overburdened with other
vector borne diseases.
2

Rural areas of Kanyakumari district, Tamil

Nadu
Results:
Interpretation & conclusion:
Of the 76 samples tested, 15 (20%)
were found positive for dengue virus
specific IgM antibodies. Dengue virus
serotype-3 was detected from a
plasma sample by Toxo-IFA test using
virus specific monoclonal antibodies.
Entomological survey revealed the
abundance of Aedes albopictus
(Skuse) mosquitoes in the study area.
One pool consisting of 12 Ae.
albopictus males were found positive
for dengue virus infection.

Based on the IgM antibody capture ELISA

results, it was evident that the current
infection was caused by dengue virus in
the affected areas. All the age groups were
affected during this outbreak. Detection of
dengue virus serotype-3 in plasma
samples further confirmed the aetiology of
this outbreak.
The high prevalence of the mosquito
vector Ae. albopictus (Skuse) was
observed. Detection of dengue virus
antigen in the male mosquitoes confirms
that the virus is maintained in wild
populations of Ae. albopictus in these
areas.

World Map

Mosquito Control
identifying the most productive mosquito breeding sites
1- The government has vacated houses in large numbers in and around
new market.
They are now the TOP sites for breeding
2- bad economic situation has lead to slow movement and unfinished
construction projects---- Reason NO-2
In Viet Nam, biological control has been used with particular success in community
participation programmes involving applications of a small
crustacean,Mesocyclops(Copepoda), which feeds on the newly-hatched larvae ofAedes
aegypti. Scientists, in collaboration with health workers, introducedMesocyclopsinto
household water tanks and water jars in rural provinces of northern and central Viet Nam, and
monitored results. Local leaders, together with schoolchildren, conducted clean-up campaigns
and awareness events. The strategy, which was gradually expanded by health authorities,
eliminated the dengue fever vector in 40 of 45 communes in northern and central Viet Nam
(more than 380 000 people) where the programme has been implemented so far. There have

Cont
In Cambodia, the World Health Organization, together with national and local
authorities, is testing a new long-lasting insecticide-treated netting cover for
household water storage containers using an insecticide treatment
technology that has been developed for bednets in malaria prevention and
control. The cover, fitted over concrete rainwater storage tanks, is designed
both to prevent mosquito breeding in these key containers and to reduce adult
vector densities and longevity

KNOW

DO

GOAL

The Mozzies
3,500
mosquito
species

Culex

West Nile
Virus

Anopheles

Malaria

Aedes

Yellow Fever
Dengue
Chikunguny
a
8

Question

What does aedes mean?

Unpleasant (Greek) by Meigen in 1818

Life Cycle
All in all, it takes 8-10
days.
Two phases: terrestrial and
aquatic
Eggs are resistant to
environmental stress.
Eggs larva (feeder) in
presence of water
Larva pupa (non-feeder)
Pupa young adult (still
water)

The Mosquito Life-cycle, Centers for Disease Control and Prevention

10

Feeding
Mosquitoes sense the
presence of:
Genetics 85%
Chemicals (respiratory, skin)
Carbon dioxide (activity, using
candle)
Lactic acid (exercise, after eating
salty foods, high-potassium)
Steroids
Uric acid
Cholesterol

Pregnancy
Body temperature
Dark-colored materials
clothings, garbage cans

Movement
Floral/fruity fragrances
Moisture

11

Lets understand the Killer

Habitat
Aedes aegypti is extremely common in areas lacking piped water
systems, and depend greatly on water storage containers to lay their
eggs.
Male and female adults feed on nectar of plants; however, female
mosquitoes need blood in order to produce eggs, and are active in the
daytime.
Eggs have the ability to survive drying for long periods of time, allowing
eggs to be easily spread to new locations.
Artificial or natural water containers (water storage containers, flower
pots, discarded tires, plates under potted plants, cemetery vases, flower
pots, buckets, tin cans, clogged rain gutters, ornamental fountains,
drums, water bowls for pets, birdbaths, etc.) that are within or close to
places where humans live are ideally larval habitats for this mosquito.
This species has also been found in underground collections of 12

Biting Behavior
1. Aedes aegypti bites primarily during the day.
2. This species is most active for approximately
two hours after sunrise and several hours
before sunset, but it can bite at night

in well lit areas.

3. This mosquito can bite people without being
noticed because it approaches from behind and
bites on the ankles and elbows.
4. Aedes aegypti prefers biting people but it also
bites dogs and other domestic animals, mostly

13

Question

Why do female mosquitoes need

blood?
For egg development. The amino acid
isoleucine is important.

10/12/2010

14

Breeding
Mosquitoes will practically breed anywhere
where there is a collection of water that stands
longer than five to seven days. Some prefer
lighted areas and some shady areas. Some
prefer fresh water and some stagnant water.

15

Ponds
Streams

Common natural
breeding grounds

Swamps

Rock holes

Ditches

Tree holes

16

Rain barrel
Cans

Wells

Common man-made
breeding grounds

Vases

Roof gutter
Old tires

Road gutter
17

Comparison
Aedes aegypti

Aedes albopictus

Invasion biology of Aedes albopictus, University of Florida.

18

Aedes aegypti
Egyptian tiger mosquito
Origin: Africa
Primary vector for:
Yellow fever
Dengue fever
Chikungunya fever

Prefers to breed in water storage

containers (in and out)
Day biter humans

Aedes albopictus
Asian Tiger mosquito
Origin: Africa/S.E. Asia
Vector for:
Same as aegypti

Prefers to breed in trash (out)

Outdoor day biter humans,
livestock, amphibians,
reptiles, and birds

Larval habitats and distribution patterns of Aedes aegypti and Aedes albopictus in Thailand,
Chareonviriyaphap, et al., 2003. PDF
Aedes albopictus, Global Invasive Species Database.
19

Dengue and the Aedes albopictus mosquito

Aedes albopictusalso called the
Asian tiger mosquito-- is a mosquito
that can transmit the viruses that
cause dengue fever.
The female mosquito lays eggs in
water holding containers around or
further away from homes, treeholes
and bamboo internodes. It bites
people, pets and wild animals.
This species can survive year round
in tropical and subtropical climates.

Medical importance Aedes

albopictus is most well known
for transmitting dengue and
chikungunya viruses but it has
also been found infected in
nature with the following
viruses
West Nile, Eastern equine
encephalitis, Japanese
encephalitis. It can also transmit
dog heartworm parasites.
20

Dengue and the Aedes aegypti mosquito

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

Medical importance Most

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

21

Question
In India, which of the two is the
predominant mosquito species?
Aedes aegypti

22

Dengue Virus

THE CAUSATIVE AGENT

23

The Dengue Virus

Flavivirus (Yellow virus)
Only transmitted by
mosquito bites
It takes 8 days for a
mosquito to be a
vector but remains
infected for life.
Dengue 1 Virus and Dengue Hemorrhagic Fever, French Polynesia, 2001,
Hubert and Halstead, Emerging Infectious Diseases, August 2009

24

Historical
Dengue viruses
originally came from
monkeys.
It jumped to humans
100 to 800 years ago.
It was a minor disease
until World War 2
25

Question
Why has dengue became a
significant health problem after World
War 2?
Due to increased travel and active
transport industry

26

The Four Types

Dengue has four closely related
types or serotypes: DENV-1 to 4
Each serotype gives specific
lifetime immunity and short-term
cross-immunity.
A second, third or fourth infection
results in a worse infection than
the first.
Infants can have a severe first
infection if the mother has
previous dengue infection.

Dengue virus and its serotypes DV-1 was

isolated in 1956 at Vellore.
All the Indian DV-1 isolates belong to the
American African (AMAF) genotype.
The Indian DV-1 isolates are distributed
into four lineages, India I, II, III and the
Africa lineage. Of these, India III is the
oldest and extinct lineage; the Afro-India is
a transient lineage while India I is
imported from Singapore and India II,
evolving in situ, are the circulating
lineages

27
Molecular Evolutionary Pathogenesis of Dengue Virus Infection, Shannon Bennett

Why is the next infection worse?

When Good Antibodies Go Bad
Antibody-dependent Enhancement
In ADE, two things will happen:
1. The virus is still active and will
continue infecting cells and
replicating in them.
2. The dengue virus will initiate a
complement cascade
activation that leads to blood
vessel breakdown bleeding
and shock
ADE can be found in:
. Dengue patients with previous
dengue infections.
. Infants and toddlers of mothers
with previous dengue infection.
28

Dengue Spread
Possible factors
Inadequate housing and
public health systems
(water, sewage, waste
management)
Poor vector control
Climate change
Increased international
travel
29

Dengue Fever, Dengue Hemorrhagic Fever

THE DISEASE
30

Question
Where did the word dengue come
from?
Spanish, dengue for fever
Swahili, Ka-dinga pepo for sudden
cramp-like illness caused by an evil
spirit.

31

Historical Reports
Chronology
265-420 AD in China; called water
poison
Slaves in Caribbean, Dandy fever
1780 in Madras, India and
Philadelphia, USA
1789, Benjamin Rush coined the term
breakbone fever
1799 in Cairo and Alexandria, Egypt;
Jakarta, Indonesia1943: Japanese
scientists first identified the virus
1953: First report of Dengue
Hemorrhagic Fever in Manila
1956: Four types of dengue

Number of cases vs. number of countries

1955-2007
32

Dengue virus
infection
No
symptoms
No different
from other
fever
Without
hemorrhage

With
symptoms
Dengue Fever
(DF) Syndrome

Dengue
Hemorrhage Fever
(DHF) (plasma
leakage)

With unusual
hemorrhage
Symptoms: high fever;
severe headache; pain
behind the eyes;
muscle, bone and joint
pains; nausea, vomiting,
and rash. Skin
hemorrhage (tiny
purplish-red spots on
skin) sometimes seen

No
shock

Symptoms: Sudden rise

in temperature, facial
flush, DF symptoms like
vomiting, headache,
etc., sore throat, gum
bleeding,
breathlessness,
elevated
Dengue Shock
blood
hematocrit
Syndrome
Symptoms: Occurs at
the end of fever on 3rd to
7th day, skin becomes
cool and blotchy, pulse
weak and rapid,
lethargy, restlessness,
acute abdominal pain
frequently felt just
before onset of shock

Dengue
Dengue
Fever
Hemorrhage Fever
http://thestar.com.my/archives/2008/9/14/health/sf_pg06manifestation.jpg

33

Dengue or not?
Diagnosis:
Medical history
Physical examination
Tourniquet test

Lab:
Low platelet count (<150,000)
Complete blood
count/hematocrit
Blood test for antibodies

34

Managing Dengue
What to do
Bring the fever down.
Sponge bath and
paracetamol.
Maintain hydration using
oral fluids.
Keep mosquitoes away.
Use mosquito nets.

What Not to do
Avoid certain drugs like
aspirin, NSAIDs
(ibuprofen, mefenamic
acid)
Avoid IV fluids. Use oral
fluids if child is able to
drink.
Fluids in the lungs
Water retention
35

Warning Signs of DHF

Critical Period: Risk for DHF is high 1-2 days after fever subsides.

Refuse fluids or vomiting.

Sleepy or restless child.
Gastrointestinal bleeding
Abdominal pain
Skin mottling, cold sweaty
skin, cold hands and feet
No urine for the past 6
hours.

Mottled skin

dehydration

Abdominal pain

GI bleeding

36

Dengue Hemorrhagic Fever

(DHF)
Odds of getting DHF?
DHF is a second infection.
90% of DHF patients has previous
infection.
Getting a second infection does
not mean youre going to get DHF

Risk of dying from DHF with

inadequate treatment is 10%15%
Risk of dying from DHF with
adequate treatment is < 1%

Causes of death

Shock due to dehydration

Severe hemorrhage
Encephalitis
Liver failure

Advice to former dengue patients

Dont get bitten again!

37

Barriers Against Mosquito Bites and Infection

PREVENTING DENGUE
38

Mosquito Repellents
DEET
Apply insect repellent
DEET (20-30%)
If repellent is aerosol,
open air
If child, dont apply to
hands

Apply on clothing.
Mosquito net if room is
non-air-conditioned or
screened

Natural
Need frequent
application
Citronella, lemon
eucalyptus, castor oil,
peppermint oil.
Multiple repellents tend
to be more effective
due to mosquito
differences.
39

Prevent Breeding
1

Keep drains free from

blockage

Cover water
containers, wells, and
water tanks tightly

Dispose of unwanted
containers where water
may collect such as
lunch boxes and soft
drink cans into covered
bins

Change the water in

vases and for aquatic
plants at least once a
week and leave no
water in the saucers
underneath the plants

Repair uneven surfaces

of the ground to
prevent water from
collecting

Cover up tires before

disposal to prevent
water from collecting.

Check whether there is

water collecting on the
tray under an airconditioner and in the
drainage system, and
remove stagnant water

Lets Act to Prevent Dengue, Hong Kong Housing Authority

40

Prevent Bites
3

Use mosquito nets or

screens when the room
is not air-conditioned

Wear light-coloured
and long-sleeved
clothing and pants

Apply mosquito
repellents containing
DEET to exposed parts
of the body

Avoid visiting
scrubby areas

Install screens on
windows and doors, or
place mosquito coils
/electric mosquito mats
/anti-mosquito liquid
near the windows

41

Vaccines?
At present, there are no approved
vaccines.
At the US National Institute of
Health, 11 vaccines are undergoing
testing.
Difficulties with vaccine
development:
Four serotypes with no crossimmunity.
No good animal model for testing.

Vaccines should be tetravalent

against the DENV-1 to 4
42

Websites of Interest

DENGUE REFERENCES
10/12/2010

43

Centers for Disease Control and Prevention

http://www.cdc.gov/Dengue/

44

Dengue Map
http://www.healthmap.org/dengue/index.php

45

This Week in Virology

46