Preventing disease Promoting and protecting health

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Clarissa Hardy
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1 Preventing disease Promoting and protecting health

2 STRENGTHENING VECTOR CONTROL FOR CHIKUNGUNYA AND DENGUE : CARPHA S ROLE Dr Christian Frederickson

3 The problem Dengue continues to be a major public health problem in the Caribbean and now Chikungunya a second vector borne viral disease has arrived which is being transmitted by the same mosquito vectors. The need for effective and efficient vector control has been highlighted by this new viral public health threat.

4 Dengue and Chikungunya

5 Number and case fatality rate (CFR) of Dengue in the Americas, *

6 Suspected Dengue Cases Reported up to Sept 12, ,552 8,136

7 Chikungunya (CHIK) In early December 2013 CARPHA received reports of local transmission of Chikungunya in Saint Martin. This signalled the start of the first major outbreak in the Americas and its focus has been in the Caribbean. As of September 12, 2014 there have been 706,093 suspected cases and 8,651 confirmed cases in the region 98% of which are in the Caribbean. Dominican Republic has been most affected. As always this is an underestimate of the number of cases as not everyone go to get registered.

8 What is the Regional Response to the Dengue and Chikungunya threat In the Americas the regional response to dengue and now Chikungunya is with the Integrated Management Strategy for Dengue or IMS Dengue This programme consists of 4 or 5 core areas. (depending upon how they are grouped.)

10 Importance of Vector Control No vaccines or treatment available for these diseases Most effective tool for prevention and control of these diseases is vector control through Integrated Vector Management (IVM)

14 The features of IVM include: The selection of proven vector control methods based on knowledge of local vector biology and ecology, disease transmission and morbidity. The continuous monitoring and evaluation of control activities to ensure that they are effective and appropriate. The use best management practices. Close coordination with epidemiology to focus control efforts.

15 So why has IVM not been more effective in the Americas?

16 Challenges for Vector Control Programmes in the Americas. Vector control Programmes are often working with too little interaction with other departments such as epidemiology. In order to be effective epidemiology needs to produce actionable information ie where are the cases being reported. When were these cases reported In what areas have cases historically been reported. Neighbourhoods and locations that have reported cases often present problems year after year.

17 Challenges for Vector Control Programmes in the Americas. To effectively access and review the risk of transmission Epidemiological information and entomological information needs to be entered into a geo-referenced database and linked to rainfall information in order to predict and prepare for a rapid and effective response. Vector-borne diseases are not going away so we need to prepare a response based upon actionable information and be able to predict where and when possible outbreaks may occur.

19 Challenges for Vector Control Programmes in the Americas. Vector control programmes often have human resource difficulties Programmes often lack a Medical Entomologist and few technicians are trained in medical entomology to provide technical assistance in the national control programmes. Some exceptions are BRA, MEX, COL, VEN, JAM Entomological surveillance is often inadequate and does not produce actionable information. Insecticide resistance monitoring is not performed and control activities are not evaluated. So it is difficult to determine how effective control programmes.

20 Challenges for Vector Control Programmes in the Americas. Control activities especially insecticide applications are not evaluated to confirm their effectiveness. Lack of field supervision at the local level and reporting of results and fidings Lack of training and updating of personnel in the new methods of vector control. Personnel are often inadequately trained in the safe use of and calibration of equipment. There is a need to certify the training of the insecticide applicators to ensure safe and effective applications. (Ideally this could be conducted together with a local agricultural college and needs to be mandated by law. )

21 Challenges for Vector Control Programmes in the Americas. Inefficient use of personnel especially field inspectors. ie do inspectors conduct entomological surveillance and inform the public of the risks? Do all houses need to be sampled? How long does it take to get the information of an area. What is done with this information? Is it computerized in a database or paper based? Are weekly summary risk assessment and reports produced? The focus of vector surveillance and control is often mainly on epidemic response and not to respond to high infestation indices. In summary vector control programmes are often operating very ineffectively and are incapable of responding to epidemics.

22 CARPHA S Role in Vector Control includes the following CARPHA s challenge is to support the improvement of the effectiveness and efficiency of National vector control programmes Provide technical advice and assistance to countries in preparedness for and response to outbreaks of vector-borne diseases Build capacity in countries through training of Environmental Health and Vector Control Officers in: Vector control methods and evaluation Vector surveillance

23 CARPHA S Role in Vector Control Provide assistance to countries in the development and implementation of National IVM plans as part of the Integrated Management Strategy for Dengue (IMS- Dengue) prevention and control (together with partnership with PAHO) Conduct needs assessments and evaluations of vector control programmes and provide guidance to countries in monitoring and evaluation of vector control programmes Provide supporting information and training material to CMC Provide assistance to countries in the development of research protocols and execution of research projects

24 CARPHA S Role in Vector Control Conduct evaluations of new vector control tools Provide services such as: Microscopic identification of arthropods of public health importance Provide assistance in establishing field assessment of effectiveness of control efforts. Insecticide Resistance Testing (Aedes aegypti) Tests conducted using WHO Bioassay methods

25 Thank you for your attention

Chikungunya: Perspectives and Trends Global and in the Americas. Presenter: Dr. Eldonna Boisson PAHO/WHO

Chikungunya: Perspectives and Trends Global and in the Americas Presenter: Dr. Eldonna Boisson PAHO/WHO Outline What is chikungunya Where did chikungunya start? Chikungunya spread - Africa, Asia, Europe,