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Stopping the spread of dengue,

chikungunya and zika viruses in Timor-


Leste - is it possible?
Hapara dengue, chikungunya no zika virus iha Timor-Leste- bele?
Dengue, Chikungunya, Zika viruses
Cause fever and aching joints
Cause disease that can be either mild or serious, sometimes
causing death, particularly in young children
Zika can cause serious defects in unborn babies
Can be hard to diagnose without laboratory tests, because
many diseases cause fever and aching
Dengue, chikungunya and zika viruses are carried by
mosquitoes and transmitted to humans when an infected
mosquito bites
Mosquitoes in Timor-Leste
100s of mosquito species world-wide
>20 species in Timor-Leste
Only some species are known to transmit diseases to humans
and animals

Species in the genus Aedes transmit dengue, chikungunya,


zika and yellow fever

Species in genus Anopheles transmit malaria


Species in genus Culex transmit Japanese encephalitis
Dengue, Chikungunya, Zika vectors: Aedes mosquitoes
Aedes aegypti
Responsible for most severe Aedes albopictus
dengue outbreaks Vector of dengue, chikungunya
Vector of epidemic Asian and zika viruses
genotype of Chikungunya More tolerant of cool climates
than Aedes aegypti
Dengue and chikungunya
Dengue now endemic in over 100 D
countries1 E
Under-diagnosed, under-reported- - N
hard to estimate global burden1 V
ChikV reported Mar 2015
Major health problem in SE Asia +
Western Pacific region, incl Timor-
Leste
Annual DENV cases 2010 (all ages)
Bhatt et al. Nature. 2013

C
H
I
Since 2004, Chikungunya spread to
K
previously non-endemic regions:
V
America, Europe, Oceania. Recorded
in Timor-Leste
Associated w mutation that
Countries where CHIKV reported as of
transmission by Aedes albopictus Mar 2015
http://www.cdc.gov/chikungunya/geo
Sam et al. Vector Borne Zoonotic Dis. 2015
Not yet recorded in
Timor-Leste
Why have Aedes mosquitoes spread so
far?
Lay eggs on the insides of containers, so if containers, are
sent overseas, the eggs are spread

Eggs can survive without water and hatch when rain comes
Adult mosquito flight can be assisted by wind,
Aedes albopictus more tolerant of
cool temperature than Aedes aegypti
Aedes mosquitoes lay eggs in small containers of water - tree holes, rock
holes coconut shells, old tyres, rubbish, potplant holders, blocked drains,
bamboo stumps, splits in bamboo fences, animal drinking troughs,
mandis etc.
Larval surveys detect presence of
potential vector mosquitoes
.
Aedes aegypti + Aedes albopictus in TL
Ae. albopictus (Asian tiger mosquito) recorded in TL in
19741. Ae. aegypti first recorded in Dili in 19912

4 years of larval sampling in rural area in Manufahi Ae.


albopictus more common than Ae. aegypti

Dili

Same

1. Pinhao 1974, 2. Whelan 1999


Welala R .
CONTROL AT EACH STAGE OF LIFE CYCLE
Infection - prevent with
vaccines- when available
Wolbachia can restrict
transmission
Female makes
eggs Female bites human
Insectides or animal Mating
adult traps Prevent bites with nets, Mass release sterile
screened windows + males
doors, clothes, repellent Insectides
adult traps

Adults
Female lays eggs on Prevent emergence by
side of container of water or on screen/lethal ovitrap
or on water surface
Prevent by covering,
emptying, or lethal Larvae Pupae
ovitraps Larvicide, Predator (e.g.fish, copepod)
HOW VIRUS SPREADS IN MOSQUITOES AND HUMANS

Mosquito 1 carrying virus

Mosquito 1 bites Esther

3-12 days

Esther develops fever


Mosquito 2 has no virus

Mosquito 2 bites Esther


Helen develops fever
3-12 days
8-10 days
Mosquito 2 bites Helen Mosquito 2 now has virus
STOPPING SPREAD OF VIRUS TO OTHER MOSQUITOS

Mosquito 1 carrying virus

Mosquito 1 bites Esther

3-12 days

Esther develops fever

Mosquito 2 has no virus

Esther guards against


more mosquito bites with nets, repellents,
screens until infection passed, so virus
does not spread
Large-scale control methods:
Spray adulticide or larvicide over large areas as fog/aerosol mist
by plane, helicopter, land vehicle 1

Chemical: pyrethroids, organophosphates (malathion,


temephos (Abate)

Biological: Bacillus thuringiensis israelensis (Bti)


sprayed/misted onto larval habitats 2

May not be applicable/cost effective in rural areas of Timor-


Leste with lack of vehicle access and widely scattered houses in
dense vegetation

WHO 2009, Tan et al 20012


Large-scale control methods
Decreasing vector populations by mass release of modified adults in a
wide area
Infected w Wolbachia strains that stop DENV transmission (trials with
Ae aegypti in Australia, Vietnam, Thailand, Indonesia, Brazil,
Colombia)1
Genetically modified: release of insects w dominant lethal gene (RIDL)
OX3604C, female-specific flightless phenotype 2
OX513A causes sterility in males (Malaysia Ae aegypti) 3
Male mosquitoes, offspring fail to develop (Brazil, Ae. aegypti)
Sterile insect technique (SIT)4
Males sterilised by irradiation (Italy, Reunion Is, Ae albopictus)
Sex switching early research on transforming females to males5
Not known when any of these methods will be used in Timor-Leste

1.www.eliminagedengue.com 2. Wise de Valdez 2011, 3. Lacroix et al 2012 4. Oliva 2012,Hall et al


2015.
Small-scale larval control methods
Intervention Disadvantage
Source reduction -cover, remove, Usually not possible to eliminate all potential
clean, drain habitats

Add predators/parasites to larval Need to restock if habitat dries out


habitats (copepods, fish)
fish, nematodes)
Add organophosphates- temephos, Resistance, expense, effect on other
pirimiphos-methyl organisms
Add insect growth regulators Expense, need to replace
(methoprene, pyriproxyfen)
Chitin synth inhibitors (novaluron,
diflubenzuron, triflumuron, buprofezin)
Add bacillus thuringiensis israelensis Expense, Bti low residual activity in field,
(Bti), spinosad needs frequent re-application, esp in
polluted habitats

Lethal ovitraps Must monitor to check kill factor still working


Lethal ovitrap design

3 4 5

+glue +Bti + mesh


To stop the spread of mosquito-borne
diseases
Anyone who has a fever should be protected from mosquito bites - even if you
dont know the cause of the fever - in case the fever is caused by a mosquito
borne disease . This will help reduce the spread of disease

Vaccinate when vaccine available


Mosquito-screen all windows and keep doors shut or screened
Empty/cover/drain/ to stop mosquitoes laying eggs in water containers
Add larvicide/predators (e.g.fish) to water containers to stop larvae developing
or screen to stop adults flying out

Lethal ovitraps
Health departments consider mass programs (e.g. release of sterile males or
Wolbachia infected mosquitoes
Para daet moras dengue, chikunguya, zika katak susuk mak lori

Sei ema isin manas, labele husuk susuk tata/sona.


Simu vaccine bainhira doutour bele fo vaccine. Agora iha vaccine
para dengue
Proteje usa moskiteiru haleu kama, moskiteiru proteje janela,
Fakar bee ou taka , entaun susuk labele tau tolun
Tau ikan ou larvicide iha bee lihun, ou taka
Ovitraps katak hamate susuk
Governmentu Departmentu Saude bele usa programa boot
konaba susuk,
Transmission of Zika
Mosquitos become infected by biting an infected human
Also virus can be transmitted from infected female to her eggs
Humans become infected mainly via bite from infected mosquito
Also:
by sexual intercourse with infected mosquito
from infected mother to child -rare
blood transfusion
Habitats for Mosquito Larvae
Broken coconut shells often fill with rainwater.
In the wet season, shells became habitats for
mosquito larvae. In the dry season, shells usually
dry out too quickly
What properties of oviposition sites
attract Aedes females?
Visual, olfactory, gustatory and tactile cues include 1-12
Light/dark contrast, reflectance, colour, depth, surface area
Tactile properties of container sides
Humidity
Eggs or larvae of mosquitoes of the same or different species
Predators
Organic material e.g. decaying endosperm in coconut shells,
Dissolved salts

Hoel et al. 2011, Reiskind and Zarrabi 2012, Chadee et al. 1993, Harrington et al. 2008, Dieng et al.
2012, Harrington, et al. 2008, Allan and Kline 1998, Wong et al. 2011, Blaustein et al. 2004, Clements
2006, Darriet and Corbel 2008, Darriet et al. 2010).
Incubation periods
Time after bite for person to develop Zika - 3-12 days
Time after biting an infected person for mosquito to be able
to transmit Zika: 8-10 days
Thank you/Obrigada

Questions?
Pergunta?

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