Dengue... coming to a town near you. Amanda Hutchings Senior Environmental Health Officer Darling Downs Public Health Unit

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1 Dengue... coming to a town near you Amanda Hutchings Senior Environmental Health Officer Darling Downs Public Health Unit

Queensland Joint Strategic Framework for Mosquito Management 2010-2015 To adequately manage mosquitoes & prevent mosquito-borne diseases in Queensland.

2 Queensland Joint Strategic Framework for Mosquito Management To adequately manage mosquitoes & prevent mosquito-borne diseases in Queensland. Four Objectives: Surveillance, prevention & control Detecting & identifying mosquito problems in an area Evaluating mosquito-borne disease risk Communication & marketing Education and Training Research

4 Dengue response in Charleville

Charleville 758km west of Brisbane Population 3,278 Previous survey results March 2003-54 premises

5 Charleville 758km west of Brisbane Population 3,278 Previous survey results March premises surveyed, 8 positive for Aedes aegypti September premises surveyed, 1 positive for Aedes aegypti

6 Case Investigation Case visited the Medical Centre on 02/02/2012 complaining of the symptoms associated with Dengue (rash, fever, lethargy, nausea, itchiness). Testing was ordered by local doctor. Public Health Nurse from DDPHU received a dengue notification (Dengue IgM Reactive) on 07/02/2012 and conducted enhanced surveillance. The following information was obtained: Travelled to Bali on 16/01/2012 & returned to Australia (Brisbane Airport) on 26/01/2012 Travelled to Gold Coast on 27/01/2012 & returned home (Charleville) on 01/02/2012 Due to possible flooding, the case evacuated to friend s house on 02/02/2012 and returned home on 06/02/2012.

7 Case was confirmed as Dengue via PCR on the 08/02/2012 and typed as Dengue 2 on 10/02/2012. Exposure period 16/01/2012 to 26/01/2012. Viraemic period 29/01/2012 to 10/02/2012.

8 Assessment of Risk Aim of the DMP: to minimise the number of locally acquired cases in Queensland Three components of dengue management: Mosquito surveillance and control Disease surveillance Public awareness and community awareness

9 Vector surveillance / public awareness (QH & LG partnership) Larval and adult surveillance/control in risk areas and/or hot spots Consider use of Breteau Index Dengue zone: larval survey during peak breeding season annually Non-dengue zones: larval survey at least bi annually Conduct/support training in surveillance and control methods Public role in mosquito control emphasised via public awareness and engagement Dengue Activity Levels and Responses Level 1: No current cases Level 2: Sporadic cases Disease surveillance Clinical and Lab surveillance Public encouraged via public awareness raising to report symptoms early if unwell with fever PHN/PHMO investigates notified cases; determines if imported or locally acquired Conduct risk assessment & if necessary escalate to Level 2 Enhanced vector surveillance & control / public awareness Coordination between QH & LG Med Ent conducts risk assessment & maps response areas Larval control in all premises within 200m of case contact points (QH & LG) where vector is present Adult mosquito control by QH in all premises within 200m of case contact points where vector is present Continue to emphasise public s role in mosquito control & personal protection via public awareness and engagement Disease surveillance & control PHN case investigation using case report form Identifies case movements in relation to high risk areas for transmission PHMO/PHN, Med Ent, EH and LG, consult re mosquito control response If case confirmed as locally acquired escalate to Level 3, outbreak declared Public encouraged via public awareness raising to report symptoms early if unwell with fever Level 3: Dengue outbreak Case is confirmed as locally-acquired Consider activation of the HPPIMS at the local level, PHUs work together: To inform District Manager (activate core funding), Senior Director CDB, LG and local GPs, Emergency Depts and local laboratories to enhance awareness and prompt early case reporting PHN/PHMO staff implement contact tracing and active case finding Med Ent staff assess, coordinate and manage vector control in collaboration with Local Govt Enhanced mosquito surveillance and control undertaken as above in current and new dengue activity areas Develop media communications plan Enhanced public awareness activities encouraging residents to reduce domestic mosquito breeding sites, use personal protection & present if unwell with fever Level 4: Large or Multiple outbreaks Establish HPPIMS: Public Health Incident Controller appointed Establish Public Health Emergency Operations Centre Consider activation of the Health Protection Sub Plan to QLD Health Disaster Plan Implement the dengue management plan for large or multiple outbreaks Establish Incident Management Team to plan and coordinate response Commence enhanced mosquito and disease surveillance and control measures as above Enhanced media and public awareness campaign

Information for residents were delivered to all

10 AIM- To prevent local transmission of Dengue in Charleville Dengue case contact points were mapped. Information for residents were delivered to all letter boxes within 200m of the dengue case contact points.

11 Community Engagement Media releases were issued by Queensland Health and Murweh Shire Council. Regular communication with Murweh Shire Council, Hospital, Medical Centre, School and Police occurred. Dengue information and fact sheets were distributed to Murweh Shire Council, South West Public Health Unit, Medical Centre and Hospital.

12 Resources No vector control team/equipment in Charleville. Recent floods (Majority of town had been evacuated). Level 1 Public Health Incident declared (Health Protection Program Incident Management Protocol).

13 Surveillance and control Commenced on 13/02/2012 Larval Surveillance and control Larval samples were taken for identification Consisted of the removal and/or insecticide treatment of actual and potential breeding containers ProLink Pellets & Prolink XR-Briquets (contains the insect growth regulator (S)-methoprene) was used Surface spray Adult Surveillance and control BioGents (BG traps) Interior and external residual spraying

14 Results

15 Results A total of 172 premises were inspected 575 wet containers 775 dry containers Resulting in an average of 8 potential breeding sites per premises. Mosquito breeding was identified in approximately 30% of premises and 17% of wet containers. Aedes aegypti was recorded at approximately 16% of premises.

16 Results Adult surveillance BGs traps were set at Dengue case contact points and at high risk premises. The Breteau Index was 23.3 for Aedes aegypti in Charleville, indicating the risk of dengue transmission at the time of overseas-acquired case was high.

17 Outcome Local transmission of dengue was avoided Aedes aegypti has been shown to be prevalent in Charleville. The profile of dengue and the dengue vector has been raised within the Charleville community as a result of the activities undertaken. Demonstrates the importance of surveillance, prevention and control program.

18 Acknowledgements Murweh Shire Council Queensland Health Darling Downs Public Health Unit South West Public Health Unit Gold Coast Public Health Unit West Moreton Public Health Unit Communicable Diseases Branch

Queensland. Dengue Management Plan (DMP)

Queensland. Dengue Management Plan (DMP) Queensland Dengue Management Plan (DMP) 2010 > 2015 Title This plan shall be titled and known as the: Queensland Dengue Management Plan Authorisation The queensland Dengue Management Plan is issued under