VECTOR-BORNE DISEASES

DENGUE
MALARIA

WHAT IS DENGUE?

Dengue is a viral disease

It is transmitted by the infective bite of female
Aedes Aegypti mosquito
Man develops disease after 5-6 days of being
bitten by an infective mosquito
It occurs in two forms:

Dengue Fever and Dengue HaemorrhagicFever(DHF)

Dengue Fever is a severe, flu-like illness (Influenza)
Dengue Haemorrhagic Fever (DHF) is a more severe form
of disease, which may cause death

Dengue Virus
Causes dengue and dengue hemorrhagic fever
Is an arbovirus
Transmitted by mosquitoes (vector-borne)
Composed of single-stranded RNA
Has 4 serotypes (DEN-1, 2, 3, 4)

Dengue Viruses
Each serotype provides specific lifetime
immunity, and short-term cross-immunity
All serotypes can cause severe and fatal
disease
Genetic variation within serotypes
Some genetic variants within each serotype
appear to be more virulent or have greater
epidemic potential

Transmission of Dengue Virus

by Aedes aegypti
Mosquito refeeds /
transmits virus

Mosquito feeds /
acquires virus

Viremia
0

Days

Intrinsic
incubation
period

Extrinsic
incubation
period

Illness
Human #1

12

16

Viremia
20

24

Illness
Human #2

28

Replication and Transmission

of Dengue Virus (Part 1)
1. Virus transmitted
to human in mosquito
saliva
2. Virus replicates
in target organs
3. Virus infects white
blood cells and
lymphatic tissues
4. Virus released and
circulates in blood

1
2

4
3

Replication and Transmission

of Dengue Virus (Part 2)
5. Second mosquito
ingests virus with blood
6. Virus replicates
in mosquito midgut
and other organs,
infects salivary
glands
7. Virus replicates
in salivary glands

7
5

Aedes aegypti Mosquito

Only the female Aedes

mosquito feeds on blood.
This is because they need
the protein found in blood
to produce eggs. Male
mosquitoes feed only on
plant nectar.
On average, a female
Aedes mosquito can lay
about 300 eggs during her
life span of 14 to 21 days.

Aedes aegypti
Dengue transmitted by infected female
mosquito
Primarily a daytime feeder
Lives in and around human habitation
Lays eggs and produces larvae
preferentially in artificial containers

Aedes aegypti Breeding Sites

SIGNS & SYMPTOMS OF DENGUE FEVER

Abrupt onset of high fever
Severe frontal headache
Pain behind the eyes which worsens with
eye movement
Muscle and joint pains
Loss of sense of taste and appetite
Measles-like rash over chest and upper
limbs
Nausea and vomiting

Dengue Hemorrhagic Fever

WHO classification of DHF
Usually occurs in secondary
infections after actively or
passively
Thrombocytopenia (platelet
count (maternal) acquired
immunity to a <100,000)
different viral serotype
Only 2-4% of secondary
infections
Fever 2-7 days result in severe
disease

Hemorrhagic manifestations
with a positive tourniquet
tests
Mortality is 10-20% if
untreated, but decreases to
<1% if adequately
Hemoconcentration or
evidence of treated plasma
leakage
Plasma leakage may progress
to dengue shock syndrome

LABORATORY DIAGNOSIS OF DENGUE

Haemagglutination inhibition (HI) test

Compliment Fixation Test (CFT)

Neutralization test (NT) IgM-capture

Enzyme-Linked Immunosorbent Assay (MAC-ELISA)

IgG-ELISA

Rapid Diagnostic tests (NS 1)

Management of Dengue Fever (DF)

No specific therapy, management of Dengue fever is symptomatic and

supportive.
Bed rest is advisable during the acute phase.
Use cold sponging to keep temperature below 39 C
Antipyretics may be used to lower the body temperature.
Aspirin/NSAID like Ibuprofen etc should be avoided since it may cause
gastritis, vomiting, acidosis and platelet dysfunction.
Oral fluid and electrolyte therapy are recommended for patients with
excessive sweating or vomiting
Patients should be monitored in DHF endemic area until they become a
febrile for one day without the use of antipyretics and after platelet and
haematocrit determinations are stable, platelet count is >50,000/ cumm.

Prevention

Personal:

clothing to reduce exposed skin

insect repellent especially in early morning, late afternoon.

Bed netting important

mosquito repellants(pyrethroid based)
coils, sanitation measuresEnvironmental: reduced vector
breeding sites solid waste management public
education empty water containers and cut weed/tall grass

Prevention
Biological

Target larval stage of Aedes in large water storage containers

Larvivorous fish (Gambusia), endotoxin producing bacteria
(Bacillus), copepod crustaceans (mesocyclops)

Chemical

Thermal fogging-malathion,pyrethrum
Insecticide treatment of water containers
Space spraying (thermal fogs)
Indoor space spraying(2% pyrethrum), organophosphorus
compounds

Dengue Update

The first dengue vaccine, Dengvaxia (CYD-TDV) by

Sanofi Pasteur, was first licensed in December, 2015,
in Mexico.

It has been registered for use in individuals 9-45 years

of age living in endemic areas.

CYD-TDV is a live recombinant tetravalent vaccine

based on the yellow fever 17d backbone and is
registered as a 3-dose vaccine given on a 0/6/12
month schedule.

Several other vaccine candidates are in

clinical or pre-clinical development.

Registration of a vaccine is a separate

process to public health recommendations
for use of a vaccine.

There are currently no WHO

recommendations for use of a dengue
vaccine.

The WHO Strategic Advisory Group of Experts

(SAGE) on Immunization is currently reviewing
the evidence and will advise WHO (likely in April
2016) on recommended use of a dengue vaccine.

Main considerations include vaccine safety,

vaccine efficacy, disease burden, programmatic
suitability, and cost-effectiveness.

Formal WHO guidance on public health use will

only be issued following the SAGE assessment.

Malaria

Malaria

Name is derived from Italian Mal aria or

bad air

Malaria continues to be most important

cause of fever and morbidity in the Tropical
world Malaria has been eradicated from
Europe, Most of North America, USA South
America Korea and Japan,

What causes Malaria

Malaria is caused by a parasite called
Plasmodium , which is transmitted via the
bites of infected mosquitoes. In the human
body, the parasites multiply in the liver, and
then infect red blood cells.
Transmission of Malaria do not occur
> 2000 meters altitude.

Parasites Cause of Malaria

Malaria is caused by an infection by one of

four single celled Plasmodia species, they
are: falciparum , vivax, malariae , and
ovale .

The most dangerous of the four is. P.

falciparum

Falciparum most Dangerous

Falciparum

accounts for 90% of deaths

due to malaria and vivax is the most

widely spread species because it exists in
both temperate and tropical climates.
The

malaria life cycle is a complex system

with both sexual and asexual aspects .

Malaria Kills more people than AIDS

Malaria kills in one year what AIDS kills in

15 years. For every death due to HIV/AIDS
there are about 50 deaths due to malaria.
To add to the problem is the increasing
drug resistance to the established drug.

Etiology of Malaria

Four Species known to infect Man

1. Plasmodium vivax Benign Tertian, Tertian
Malaria
2. P.ovale - Ovale tertian Malaria
3. P.malariae Quartan malaria
4. P.falciparum Falciparum malaria or
Malignant Tertian malaria.