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Any measure for Taiwan's dengue control and surveillance? 07/10/17

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Outline 96.6 96.7.18 Dengue Prevention and 35 Years of Vector Control in Singapore Eng-Eong Ooi,* Kee-Tai Goh, and Duane J. Gubler

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(Dengue fever) ( 38 ) ( ) (hemorrhagic manifestations) (leucopenia)

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Aedes aegypti Aedes albopictus

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Temperature, Virus Positivity and Anti- Dengue IgM, by Fever Day Dengue IgMMean Max. TemperatureVirus Adapted from Figure 1 in Vaughn et al., J Infect Dis, 1997; 176:322-30. Fever Day 0 20 40 60 80 100 Percent Virus Positive -4-3-2 0123456 39.5 39.0 38.5 38.0 37.5 37.0 Temperature (degrees Celsius) Dengue IgM (EIA units) 300 150 0 75 225

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1987 2006

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1987-2006

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96.6

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1. ( ) ( ) 2. ( ) ( ) ( ) / ( ) /

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( ) 24 24 ( ) ( ) 92 7 17 92 1 1

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( ) ( ) 5000 ( ) ( ) ( ) ( ) ( )

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American Journal of Tropical Medicine & Hygiene 5-July-2007

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2006 11 23 11 20 11 23 (PCR) PCR 2006 96 5 25 23 5 236

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( ) ( ) ( )IgM IgG IgM IgG IgM

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96/7/18

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95/9/9

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96-99 95.2 96-99

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97-98

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Dengue Prevention and 35 Years of Vector Control in Singapore Eng-Eong Ooi,* Kee-Tai Goh, and Duane J. Gubler Emerging Infectious Diseases www.cdc.gov/eid Vol. 12, No. 6, June 2006

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Annual incidence dengue fever (DF) and dengue hemorrhagic fever (DHF) and the premises index, Singapore,19662005.

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Vector Control in Singapore The vector control program thus has 2 elements in addition to source reduction: Public education and Law enforcement. The Destruction of Disease Bearing Insects Act of 1968 was enacted to discourage persons from intentionally or unintentionally propagating mosquitoes.

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Singapore have identified several factors that may have contributed to this resurgence: lowered herd immunity, children6.7%< adult42% Increasing virus transmission outside the home, More clinically overt infection as a consequence of adult infection, and A shift in the surveillance emphasis of the vector control program.

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Transmission Outside the Home In Singapore,however, the incidence of DF/DHF is lower in children than in adults School-age children were therefore 9 more likely to have antibodies to dengue than were preschool children Women, who are more likely than men to care for children at home, have a lower incidence of dengue, as indicated by the male-to female disease ratio of 1.6:1

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Proportion of indigenous dengue fever cases in patients 25 years of age, Singapore, 19772004.

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Dengue in Adults As a consequence of lowered herd immunity and transmission outside the home, cases in adults predominate in Singapore. While most dengue infections, particularly primary infections in young children, are mild or silent, infections in adults are more likely to be clinically overt.

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Shift in Surveillance Emphasis Responding to dengue cases and clusters, however, has limited effectiveness in preventing virus transmission, since such an approach ignores virus transmission from persons with subclinical infection or mild undifferentiated fever to uninfected mosquitoes. Only 30% of cases can be mapped to a cluster. Most reported dengue cases occur outside known clusters. No evidence shows that emergency control measures, particularly the use of chemical insecticides, are effective after cases have already been detected

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Strengthening Regional Vector Control The Singapore experience also underscores the fact that dengue control must be a regional effort. Barring eradication of the mosquito vector, countries that control dengue transmission are doomed to failure if neighboring countries do nothing to prevent continued epidemic transmission

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Thank you for your attention