1. Dengue Fever in the Philippines
Good day to everyone. I would like to introduce myself. I am Camille Sana , a Masters in Public Health student. Today, I will be giving you an educational presentation on Dengue Fever in the Philippines.
Dengue fever has resulted to a significant burden to the Philippines. For many years , it has affected a substantial amount of the population falling ill and even causing death. With this presentation I want to provide you with information to better understand the disease and promote the implementation of measures to control this problem. Dengue is a threat to health and everyone is at risk .
Photo Reference:
Picture retrieved from:
Camille Sana
MPH Student
Walden University
PUBH :Environmental Health
Dr. Howard Rubin
February 2012
Source: Centers for Disease Control and Prevention

2. Goals/Objectives Audience Expected Learning outcome
Objective of Presentation
I would like to provide a brief over view of what to expect from my presentation for today. I will define Dengue and provide you the common signs and symptoms of the disease and information on the impact of this illness in the Philippines . I will discuss Dengue transmission and prevention . I will provide you examples of anti-Dengue efforts. For those who would like to do further research, I will provide you additional information and the list references and sources I have used for this presentation . We can open the floor for any questions at the end.
I expect that you will have a better understanding of the negative consequences of Dengue, recognize the routes of infection and apply the different effective vector control methods after my presentation.
The disease burden of dengue in the Philippine community has been pervasive and nationwide. This presentation is to encourage and promote among rural health workers and the general public to importance in taking a positive action in fighting dengue that has plagued the Philippines for many years. The objective of this presentation is to raise public awareness of the current problem , to encourage everyone to actively participate and utilize effective control measures that would eradicate the mosquito and the disease .

3. What is Dengue Fever? Mosquito: Aedes Aegypti
Common in tropical countries
like Philippines
Symptoms : mild to high grade fever, headache, joint and muscle pain, rash
Complication: Dengue Hemorrhagic Fever --Lethal !
Source: Bepast.org
Dengue Fever is transmitted by a bite from an infected aedes aegypti mosquito. The Aedes mosquito gets infected through biting a Dengue-infected person. Dengue is common in tropical countries like the Philippines. Dengue has also been reported in other regions like America and Africa.
Signs of illnesses vary from person to person and may present as flu-like symptoms. It can lead to a complication called Dengue Hemorrhagic fever that can be lethal. (CDC, 2009)
Reference:
Centers for Disease Control and Prevention (2009). Dengue frequently asked questions. Retrieved from
Photo reference:
Mosquito Photo: Retrieved from

4. Clinical Manifestations
Clinical presentations of dengue illness are non specific. They can present as fever, abdominal pain, vomiting, nose or gum bleeding, lethargy and restlessness . For patients presenting with fever, Dengue should be always be considered .Medical management of the illness is simple and inexpensive. And if identified early can lead to a favorable outcome for the patient.
There are 3 phases: The Febrile phase is characterized by development of high grade fever usually 2-7 days. Petecchial rashes appear on the different parts of the body. Patient complains of headache and joint and muscle aches. Gum bleeding or nose bleeding can also occur. The Critical phase happens when the fever goes down. This when the platelet count also goes down causing internal bleeding. Without the proper blood work , a patient might feel that they are getting better but is actually going to the second phase of the illness. This phase happens in 2 to 3 days. It is fast and the patient’s condition worsen within this time. The next phase is the Recovery phase. With proper hydration and supportive treatment, the patient recovers. ( WHO, 2009)
Reference:
World Health Education ( 2009).Dengue guidelines for diagnosis treatment prevention and control. Retrieved from
Reference: WHO, 2009

5. Clinical Manifestations cont.
Dengue Fever Symptoms: Fever headache muscle and joint aches Skin rash Dengue Hemorrhagic Fever: High fever, hemorrhage, has 4 grades: Petecchial rash Grade 1: Fever, non specific Source: Denquefever.co.in Grade 2: Grade 1 manifestation + spontaneous bleeding Grade 3: Signs of circulatory failure Grade 4: Profound shock,death Reference: WHO, 2009
The Dengue Hemorrhagic Fever is divided into 4 grades.
Grade 1 is non specific. A simple test using Tourniquet test. This is done by inflating the BP cuff half way between the diastolic and systolic pressure. Leave it inflated for 5 minutes. If more than 10 small red rashes appear in 1 square inch. This is considered a positive tourniquet test ( WHO ,2006). Grade 2 presents bleeding such as nose and gum bleeding. Grade 3 involves internal bleeding resulting to circulation failure. Grade 4 presents severe internal bleeding, the patient can go into hypovolemic shock.( WHO, 2006)
Reference:
World Health Organization (2006). Dengue hemorrhagic fever early recognition diagnosis and hospital management an audiovisual guide for health care workers responding to outbreaks. retrieved from
Photo Reference:
Skin rash picture retrieved from

6. Impact of Dengue in the Philippines 1996-2005
Dengue Incidence Manila, Philippines
Here is a graph of incidence of Dengue in Manila from 1996 to As you can see Dengue is reported to occur year round but peaks on increased incidence can be seen in July 1996 , July 1998 and July The Philippines being a tropical country experiences sporadic rainfalls. Higher reported cases coincide with the months considered the rainy season, which is typically around the months June to September ( Sia, 2008). Incidences of Dengue increase during rainy season because the mosquitoes breed in the water.
Reference; Sia Su, G. L. (2008). Correlation of Climatic Factors and Dengue Incidence in Metro Manila, Philippines. AMBIO - A Journal Of The Human Environment, 37(4), Retrieved from
Source : Sia, S.(2008)AMBIO - A Journal of the Human Environment, Jun2008, Vol. 37 Issue 4, p , 3p, 1 Chart, 2 Graphs, 1 Map Graph; found on p293

7. Impact of Dengue in the Philippines 2010-2011
Here is a graphical report from the latest Department of Health Dengue Surveillance. This graph shows comparison of cases by month of 2010 to In 2010, cases have been reported for the entire year with increased incidence in months of July to September. Although the incidence in 2011 has shown a decrease (DOH, 2011).
Reference:
Department of Health (2011) Dengue cases disease surveillance report morbidity week 36. Retrieved from
Source: Department of Health Philippines Disease Surveillance Report Morbidity Week 36 ,figure 1 page 1

8. Impact of Dengue in the Philippines 2010-2011(cont.)
Here is a graphical report from the latest Department of Health Dengue Surveillance. Looking at the distribution affected by age group, Dengue can affect equally both male and female genders and all types of ages. However, majority of cases ( 40.9%) belonged to the 1 to 10 age groups ( DOH, 2011). The children are particularly vulnerable because they have weak and undeveloped immune system. They are also less likely to be able to recover from the internal bleeding and has increased risk of dying from the disease ( WHO, 2009).
Reference: DOH Disease Surveillance Week 36. Retrieved from
Source: Department of Health Philippines Disease Surveillance Report Morbidity Week 36 ,Figure 2 page 2

9. Transmission of Dengue
VECTOR: Transmitted to humans by bite of female aedes aegypti mosquito. Dengue mosquitos lay eggs in areas with water (see left)
HOST: Humans become host of virus. Virus incubation is 4-10 days then produce dengue symptoms
Source:
The figure on the top shows the life cycle of the aedes aegypti mosquito. It is important to note that the egg to pupa stage is spent on water. The mosquito lays its eggs on water and grow in the water from a larvae to pupae.
Humans are the hosts of the dengue virus. After being bitten by an infected mosquito, 4-10 days later symptoms of the illness start to show. Each individual host reacts differently to dengue. This varies on age and presence of chronic illnesses like asthma or diabetes. Children are a greater risk than adults because they are unable to recover from the bleeding during the shock phase.
Transmission is through a bite of an infected aedes mosquito. (CDC,2010; WHO, 2009,p 15)
Reference :
World Health Education ( 2009).Dengue guidelines for diagnosis treatment prevention and control. Retrieved from
Centers for Disease and Control Prevention ( 2010) . Transmission of dengue virus. retrieved from
Centers for Disease and Control Prevention ( n.d.) how to prevent the spread of mosquito that causes dengue. Retrieved from
Photo Reference:
Life Cycle picture retrieved from (2012)
Photo of Mosquito Bite: Retrieved from (2012)
TRANSMISSION: Humans get infected from bite of infected aedes mosquito. Mosquitos get infected when they bite infected humans.
Source: Everyday health.com
Reference: CDC, n.d.

10. Prevention Environmental Management Biological Control
Chemical Control
There are different methods of preventing Dengue Fever : Environmental management, Biological Control and Chemical control. I will now discuss each method in more detail in the succeeding slides.

11. Prevention (cont.) ENVIRONMENTAL MANAGEMENT Modification Manipulation
Changes in Human Behavior
Source: CDC,n.d.
Source: CDC,n.d.
One way of prevention is through Environmental management . There are 3 different ways environmental management for Dengue. Environmental modification is permanently changing the physical environment that affect the mosquito habitat. Examples of environmental modification is improving water supply and storage systems, provision of piped in water can eliminate the need to store water in containers. Environmental manipulation is a temporary change in physical environment of the mosquito habitat. An example of environmental manipulation is covering water containers prevents the vessels from becoming a breeding ground , disposing old tires that accumulate water from the rain that can also become a breeding ground for mosquitoes . Changes in human behavior can be any actions done by the human to reduce contact with the mosquito. Examples include use of mosquito nets, screening doors and windows and wearing of clothing that cover the skin . (WHO, 2009, p 61)
Reference:
World Health Education ( 2009).Dengue guidelines for diagnosis treatment prevention and control. Retrieved from
Photos Reference:
Water bucket, water storage and photo tire Retrieved from
Mosquito Net: Retrieved from
Source: CDC,n.d.)
Source:travelpod)

12. Prevention (cont.) CHEMICAL CONTROL Use of insecticides Fogging
Use of mosquito coils
Repellents
Another way is through Chemical control. This is the use of chemical such as insecticides that are sprayed in the area to kill mosquitoes are also effective. Fogging is a type of application of insecticide. Application of mosquito repellents and use of mosquito coils can also drive away the disease causing mosquitoes. ( CDC, 2010)
Reference:
Centers for disease control and prevention (2010). Larval control and other vector control preventions. Retrieved from
Photo Reference:
Fogging retrieved from
Source: mosquitoes and more.com

13. Prevention (cont.) BIOLOGICAL CONTROL Fish (poecilia reticulata)
Predatory copepods (copepoda cyclopoidea)
Lethal ovitraps
Source: US Geological Survey
Source: US Geological Survey
Biological control of Dengue includes use of organisms that prey or interrupt the life cycle of the mosquitoes resulting to reducing the mosquito population. Examples of predatory organisms are the fish Poecilia reticulata and the copepoda cyclopoidea that kill by eating the eggs, larvae and pupa of the mosquitoes ( Elias et al, 1995).
The ovicidal and larvicidal traps interrupt the life cycle of the mosquitoes by attracting the female mosquito to lay eggs on the trap. The trap contains substances that kills the eggs. ( WHO, 2009, p 72)
Reference:
Elias, M. Islam, M. Kabir, M & Rahman,M. ( 1995, August). Biological control of mosquito larvae by guppy fish. Bangladesh medical research council bulletin.21(2):81-6. Department of medical entomology. Institute of preventative and social medicine Mohakhali, Dhaka.Retrieved from
World Health Organization ( 2009). Dengue guidelines for diagnosis and treatment. Vector management and delivery of vector control services. Chapter 3.
Retrieved from
Photos Reference:
Poecilia Reticulata Retrieved from
Cyclopoidea Retried from nas.er.usgs.gov/queries/factsheet.aspx?Specie...
Ovitrap: Retrieved from
Source: DOH

14. Anti-Dengue Programs in the Philippines
June 2011: Dengue Prevention Month
Massive anti-dengue campaign
Source:
Due to the alarming increase of Dengue illness in the Philippines, the Department of Health along with different sectors such as media, local government, private sectors have worked together to fight Dengue. In June 2011, the Department of health announces it as the Dengue prevention month. Massive anti-dengue campaigns using media campaigns in such flyers and posters were distributed.
Flyers and education materials show how to help eradicate the mosquitoes by removing water sources that can be a breeding ground for mosquitoes. These campaigns are geared towards raising awareness to the communities about the threat of Dengue, to call the public to action and do their share in eliminating the mosquitoes.
Photos Reference:
Flier: Retrieved from
Anti dengue poster retrieved from
Source:
Source:DOH

15. Anti-Dengue Programs in the Philippines
Distribution and training on use of mosquito OL trap (ovicidal-larvicidal trap)
Source : DOH
The Philippine Department of Science and Technology partnered with the Department of Health in supplying local schools and communities with the Ovicidal-Larvicidal trap. The OL trap was invented by the scientists at the Department of Science and Technology to control the aedes mosquito vector. This was simple to use, inexpensive and is proven to kill the eggs of the mosquito causing dengue. ( DOST, n.d.)
Reference:
Department of science and technology (n.d.).Mosquioto OL trap. Retrieved from
Photo Reference:
Retrieved from
Retrieved from DOH
Source: DOH

16. Anti-Dengue Programs in the Philippines ( cont.)
Multi-sectoral mosquito “search and destroy” cleanup campaign
“Search and destroy” and clean up campaigns are held in various areas of the Philippines. These were participated by local government, churches , public and private schools in different communities. These include cleaning of the streets, picking up trash, emptying old tires and containers that contain water. Removing any possible breeding grounds for mosquitoes.( DOH, 2011)
Reference:
Department of health ( 2011). Dengue surge in Luzon. Retrieved from
Photo Reference:
Community health development 2011.University of Makati , College of Nursing 2011
Source: College of Nursing, University of Makati

17. Conclusion Dengue is a health threat Dengue is Preventable
Plan for action
Dengue fever is endemic in all regions of the Philippines with epidemics occuring every 3 to 4 years. Since 2001 , the cases of dengue has remained high ( WHO,2012). Dengue illness can lead to a severe negative health outcomes including death. There are tremendous challenges in a developing country such as the Philippines. There are still many individuals who do not understand dengue and how this can be prevented, frequent monsoon rains and flooding in certain areas of the country increases the breeding grounds for the mosquitoes, increasing population growth, urbanization, problems with waste management in the various areas of the Philippines all make vector control a challenge.
Dengue is a threat to everybody’s health ,everyone is all at risk and should be everybody’s concern.
The key is to winning the fight against Dengue is to increase public awareness through educational campaigns and use effective community partnership programs to work together to apply an effective method to eliminate the vector (DOH, 2011), otherwise the Philippines will continue to be attacked by Dengue causing mosquitoes. Dengue is preventable. It is evident that there are many available opportunities that can be utilized by individuals and communities to eradicate the dengue virus.
Reference:
World Health Organization (2012) Dengue epidemiology philippines. World health organization Western pacific region Retrieved from
Department of health ( 2011). Dengue surge in Luzon. Retrieved from
Photos Reference:
Retrieved from
Source:ADRA

18. Thank you
Thank you very much. We can open the floor for any questions you may have.

19. Additional Information/Resources
WEBSITES:
World Health Organization
Centers for Disease Control and Prevention
WHO. Dengue Haemorrhagic fever ealy recognition diagnosis and hospital management. An audiovisual guide for healthcrae workers responding to outbreaks.
WHO. Global Alert and response.
World Heath Organization. Guidelines for treatment of demgue fever/dengue hemorrhagic fever in small hospitals.
CDC, Clinicians Reference card.
CDC. Information for health care practitioners.
CDC. Basic facts on Dengue
There are additional information and resources if you would like to do further readings and research.

20. Additional Information/Resources ( cont.)
JOURNALS/ARTICLES:
Bernardo, E. C. (2008). Solid-Waste Management Practices of Households in Manila, Philippines. Annals Of The New York Academy Of Sciences, doi: /annals
Johansson, MA, F Dominici, & GE Glass. Local and global effects of climate on dengue transmission in Puerto Rico. PLoS Neglected Tropical Diseases. 3(2): e382 (2009).
Barrera R Simplified Aedes aegypti’s pupal-surveys for entomological surveillance and dengue control. American Journal of Tropical Medicine and Hygiene 81:
Barrera R, Amador M, Díaz A. Joshua Smith, Muñoz-Jordán JL, Rosario Y Unusual productivity of Aedes aegypti in septic tanks and its implications for dengue control. Medical and Veterinary Entomology 22:
Group on Dengue Meeting 1-5 October 2006, Special Programme for Research and Training in Tropical Diseases UNICEF/UNDP/World Bank and WHO.

21. References
World Health Education ( 2009).Dengue guidelines for diagnosis treatment prevention and control. Retrieved from
Centers for Disease Control and Prevention (2009). Dengue frequently asked questions. Retrieved from
World Health Organization (2006). Dengue hemorrhagic fever early recognition
diagnosis and hospital management an audiovisual guide for health care
workers responding to outbreaks. retrieved from
Department of Health (2011) Disease surveillance report morbidity week 36. Retrieved from
Sia Su, G. L. (2008). Correlation of Climatic Factors and Dengue Incidence in Metro Manila, Philippines. AMBIO - A Journal Of The Human Environment, 37(4), Retrieved from
Here are the references and sources I used in preparing this presentation.

22. References ( cont.)
Centers for Disease and Control Prevention ( 2010) . Transmission of dengue virus retrieved from
Centers for Disease and Control Prevention ( n.d.) how to prevent the spread of mosquito that causes dengue. Retrieved from
Centers for disease control and prevention (2010). Larval control and other vector control preventions. Retrieved from
Elias, M. Islam, M. Kabir, M & Rahman,M. ( 1995, August). Biological control of mosquito larvae by guppy fish. Bangladesh medical research council bulletin.21(2):81-6. Department of medical entomology. Institute of preventative and social medicine Mohakhali, Dhaka.Retrieved from
Department of health ( 2011). Dengue surge in Luzon. Retrieved from

23. References ( cont.)
Department of science and technology (n.d.).Mosquioto OL trap. Retrieved from
Department of Health (2011) . National dengue prevention and control program. Retrieved form
World Health Organization (2012) Dengue epidemiology philippines. World health organization Western pacific region Retrieved from