Best Practice of Dengue Fever in America

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Strategic Report 7

Best Practices for
Dengue Prevention and Control
in the Americas

by
Linda S. Lloyd
February 2003
Prepared for the USAID Bureau for Latin America and Caribbean
under EHP Project 26568/E.V.4.LACDENGUE
Environmental Health Project
Contract HRN-I-00-99-00011-00
is sponsored by the
Office of Health, Infectious Diseases and Nutrition
Bureau for Global Health
U.S. Agency for International Development
Washington, DC 20523


Contents
Acknowledgements........................................................................................................v
Abbreviations.............................................................................................................. vii
Executive Summary ..................................................................................................... ix
1. Introduction..............................................................................................................1
1.1. Rationale ......................................................................................................1
1.2.
Purpose of this Document............................................................................6
1.3.
Description of DF and DHF.........................................................................6
1.4.
Current International and Regional Efforts in Dengue Prevention and
Control .........................................................................................................8
1.5.
Organization of this Document....................................................................9
2. Conceptual Framework..........................................................................................11
2.1.
Key Elements of the Conceptual Framework ............................................12
2.2.
The 10 Essential Elements of a Dengue Prevention
and Control Program..................................................................................13
3. Examples of Best Practices....................................................................................23
3.1.
Global Dengue Surveillance--DengueNet ................................................26
3.2.
Weekly Epidemiological Report................................................................34
3.3.
Dengue Diagnostic Laboratory..................................................................39
3.4.
Social Mobilization of City Residents in Dengue Control ........................43
3.5.
Key Container and Key Premise Indices for Ae. Aegytpi Surveillance
and Control.................................................................................................51
3.6.
Management and Control of Tires .............................................................57
3.7.
Management and Control of Water Containers .........................................65
3.8.
Clinical Case Definitions for Dengue Fever, Dengue Hemorrhagic
Fever, and Dengue Shock Syndrome.........................................................72
3.9.
Case Treatment and Management..............................................................75
3.10. Primary School Curriculum for Comprehensive Vector Control ..............80
3.11. Cross-training of Ministry of Health and Municipal Government Staff
in Environmental Management for Integrated Vector Control..................86
4. Conclusions............................................................................................................93
4.1. Next
Steps ..................................................................................................94
4.2. Program
Expectations ................................................................................95
Annex 1........................................................................................................................97
International Organizations....................................................................................97
Annex 2........................................................................................................................99

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References..............................................................................................................99
Annex 3......................................................................................................................101
Use of Temephos in Water for Human Consumption .........................................101
Annex 4......................................................................................................................103
Other Resources ...................................................................................................103

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Acknowledgements
This document would not have been possible without the collaboration of many
people, first and foremost the contributors of the Best Practices. Although the
timeline was a tight one, the contributors were prompt in submitting their best
practices and responding to questions. I owe many thanks to my colleagues who
shared their technical expertise with me while I put the document together and who
served as reviewers: Jorge Arias (PAHO), Gary Clark (CDC), Mike Nathan (WHO),
Will Parks (WHO), and Jose Rigau (CDC). In addition, thanks are due to reviewers
whose comments helped strengthen the document: Alba Amaya (USAID), Jaime
Chang (USAID), Matt Lynch (USAID), Merri Weinger (USAID). Finally, it has
been a pleasure working with EHP staff, in particular Fred Rosensweig, whose
comments and suggestions have been not only perceptive but most helpful.

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Abbreviations
CDC
Centers for Disease Control and Prevention
CFR case
fatality
rates
CI confidence
interval
CVP
central venous pressure
DF dengue
fever
DHF
dengue hemorrhagic fever
DSS
dengue shock syndrome
EHT
environmental health technician
ELISA
enzyme-linked immunosorbent assay
FUNASA
Fundacao Nacional de Saude
GIS
geographic information system
HQ headquarters
KAPB
Knowledge, attitudes, practices and behavior
MOH
Ministry of Health
MSDS
Ministry of Health and Social Development
NEPRAM
Negociacion de Practicas Mejoradas (Negotiating Improved
Practices)
NGO nongovernmental
organization
PAHO
Pan American Health Organization
PCR
polymerase chain reaction
ULV ultra-low
volume
UNICEF
United Nations Children's Fund (per the UNICEF website)
USAID
United States Agency for International Development
WHO
World Health Organization

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