Dengue in Western Pacific Region A need for urgent action

Dr Mark Jacobs Director, Control of Communicable Diseases, Regional Office for the Western Pacific
Disclaimer: The views expressed in this paper/presentation do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

In just the past decade, the significance of dengue as a threat to health and a burden on health services and economies has increased substantially. Compared with the situation 50 years ago, the worldwide incidence of dengue has risen 30-fold. More countries are reporting their first outbreaks. More outbreaks are explosive in ways that severely disrupt societies and drain economies. Today, dengue ranks as the most important mosquito-borne viral disease in the world. Everywhere, the human and economic costs are staggering. - Dr Margaret Chan, Director-General, World Health Organization.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Dengue factors contributing to present critical situation

Five fold increase in disease burden over last 5 decades globally and increasing mortality Presence of four sero-types with no cross protection -i.e. people can get infected more than once Vectors are well adapted to human environments in both urban and rural Climate change possibly contributing to increasing geographic distribution and abundance of vectors Absence of specific treatment (only supportive) or a vaccine
Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Increasing dengue burden in region

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Increasing number of annual deaths

1400

1200

1000

800

600

400

200

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Increasing number of WPR countries reporting dengue cases

Countries reporting dengue in year 2000 (17 out of 37 = 46%) Countries reporting dengue in year 2011 (24 out of 37 = 65%)

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Expansion of countries/territories reporting dengue

Countries/territories that reported dengue in Year 2011 (but not in year 2000) Marshall Islands Federated States of Micronesia New Zealand Brunei Darussalam Macao (China) Papua New Guinea Vanuatu

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Countries/territories with highest burden of disease

Asia subregion
Cambodia Lao PDR Malaysia Philippines Singapore Vietnam

Pacific subregion
Cook Islands French Polynesia Micronesia New Caledonia Solomon Islands

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Economic impact of dengue

Asia-Pacific bears 75% of current global disease burden from dengue, estimated at 50 -100 million cases annually. ASEAN region has highest number of dengue infections in Asia-Pacific. Significant impact on socio-economic status of Member States. In Cambodia, out of pocket expenditure on dengue patients left up to 1/3 of affected households with continued debt burden even one year after an outbreak.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Distribution of global dengue risk

Suitability for Dengue Transmission High suitability

Low suitability Unsuitable or nonendemic

Determination of risk status based on combined reports from WHO, the United States Centers for Disease Control and Prevention, Gideon online,ProMED, DengueMap, Eurosurveillance and published literature (Simmons CP et al, 2012).

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

New Global Strategy for Dengue Control 2012 - 2020

Goal of global strategy is to reduce burden of dengue.
Specific objectives are to reduce mortality and morbidity from dengue by 2020 by at least 50% and 25% respectively (using 2010 as the baseline). Objectives can be achieved by applying existing knowledge.

Global strategy provides both technical elements and enabling factors for implementation that are necessary to reverse growing trend in number of dengue cases. Applying existing knowledge for dengue prevention and control will require collaboration among partners, organizations and countries, leadership by WHO and increased funding.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Strategies for reducing morbidity

Implementing improved outbreak prediction and detection through coordinated epidemiological and entomological surveillance; Promoting principles of integrated vector management;

Deploying locally-adapted vector control measures, including effective urban and household water management;
Communication to encourage behavioural outcomes in prevention programmes.
Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Strategies for reducing mortality

Implementing early case detection and referral systems for patients; Managing severe cases with appropriate treatment; Reorienting health services to cope with dengue outbreaks; Training health personnel at all levels of health system.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Enabling factors for implementation of Global Strategy

1) Advocacy and resource mobilization;

2) Partnership, coordination and collaboration; 3) Communication to encourage behavioural outcomes; 4) Capacity building; 5) Monitoring and evaluation.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Key messages
We need to act together at regional level focusing on high-priority countries. We need to strengthen existing partnerships and forge new partnerships. We need to mobilize sustainable resources at regional and country level. Countries need to be proactive rather than reactive. Dengue will be with us for foreseeable future, but action can and should be taken to reduce its impact
Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines

Thank you.

Managing Regional Public Goods for Health Community Based Dengue Control 12 September 2013, Manila, Philippines