Category Archives: ARTICLES

Cyclone Dengue

Cyclone Dengue

Written By: Website Administrator

31/03/2014

Authors: Dr Devina Nand and Dr Eric Rafai

 

Global

Approximately 40% of the world is at risk of Dengue (≈2.5 billion people). There are 50 – 100 million cases of Dengue every year. Almost 500 000 require hospitalization and 25 000 cases die annually.

Dengue fever has been reported in over 100 countries in Africa, the America’s, the Caribbean, Eastern Mediterranean, South East Asia and the Western Pacific regions.

Dengue fever outbreaks commonly occur in populated urban and residential areas of tropical nations. The disease is distributed along the distribution of the vector (agent that carries the disease). In this case, the vector is the mosquito (in particular the Aedesaegypti). The distribution remains 40˚North to 40˚South latitude.

 

map

Figure 1: Map of distribution of Dengue Cases Globally (source WHO Dengue training ppt)

 

The yellow areas are where there is known risk of transmission of Dengue Fever. The red dots denote areas such as Hawaii, Galapagos Islands, Sudan, Nepal, Bhutan and Madagascar where Dengue re-emerged in 2000-2006 after many years of being in remission.

 

Regional

The region has been experiencing Dengue outbreaks before the 1950’s in countries like American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, New Caledonia, PNG, Solomon Islands, Tonga, Tuvalu and Vanuatu. Resurgence in outbreaks was documented from the 1970’s.

Fiji is vulnerable to dengue fever outbreaks that occur at neighbouring Pacific Island countries. Our vulnerability is related to travel through our country and hub for trade in the Pacific. The same dengue 3 & Dengue virus serotype 3) outbreak in Fiji occurred in the Solomons, Vanuatu in 2012 and Kiribati early this year

French Polynesia, Queensland (Australia) and possibly Tonga are currently reporting DEN 3 outbreaks..

mapii

Figure 2: Map of distribution of endemic and non-endemic countries for Dengue in the Western Pacific Region. (source: WHO)

 

map3

Figure 3: Map of distribution of outbreaks as at 10/03/14 in the Western Pacific Region. (source: http://www.spc.int/phs/PPHSN/)

 

 

The Republic of Fiji

Fiji declared an outbreak in December 2013 and commenced immediately on its outbreak response that is not limited to enhancing clinical management of cases, monitoring the disease in affected and unaffected areas, increasing public awareness, prevention strategies, targeting clinical interventions, mobilizing community groups, government and stakeholders. Currently there is over 15, 446 suspected cases of Dengue notified to the Ministry of Health. There have been 12 confirmed deaths.  About   10% of these cases in Fiji are hospitalized. The initial outbreak was centered in the Central division in December; it has peaked in the Western division with the Northern division showing an increase in numbers.

 

Other Diseases in Fiji may mimic to Dengue Fever

The symptoms of Dengue fever include fever with:

  • Nausea or vomiting
  • Muscle or joint pains
  • Severe headache or pain behind the eyes (retro-orbital pain)
  • Rash

 

The Warning signs include:

  • Any bleeding (gums, nose, blood in stool, vomiting blood, vaginal bleeds, bruising or bleeding under the skin)
  • Persistent vomiting
  • Abdominal pain
  • Restlessness or lethargy

 

However, it is important to understand that the symptoms and signs are similar to other infectious diseases in the region. These include:

 

  • Leptospirosis ( endemic in Fiji)
  • Typhoid fever (endemic in Fiji)
  • Influenza ( seasonal in Fiji)
  • Zika virus (New Caledonia, Cook Is., French Polynesia)
  • Chikungunya virus (New Caledonia, PNG)
  • Other viral illnesses such as West Nile virus.

 

Leptospirosis and Dengue fever can be fatal if the person remains untreated at home and comes to the hospital very late in the course of the disease

It is very important to consult a doctor if you are having any of the symptoms mentioned above so treatment can be received early and precautions taken to prevent others from falling sick.

It is also important to protect oneself and family from the bite of mosquitoes.

 

Conclusion

The Republic of Fiji is not alone in experiencing dengue outbreaks. Other countries in the Western Pacific Region are experiencing the same challenges including the more developed nations such as Queensland, Australia. Globally, the Americas, South East Asia and Africa continue to experience dengue outbreaks.

The only effective responses are to work together, every individual, community and institution to reduce the breeding of mosquitoes by destroying man-made containers that breed mosquitoes, protecting ourselves from getting bitten by mosquitoes, protecting people suffering from Dengue from being bitten by mosquitoes and transferring the disease, and educating everyone around us in the importance of consulting a doctor when someone falls sick.

 

References

  1. Bhatt et al. (2013). The Global Distribution of Dengue. WHO database
  2. http://www.spc.int/phs/PPHSN/
  3. Singh N., Kiedrzynski T., Lepers C., Benyon E. S. (2005). Dengue in the Pacific –  an update of the current situation Retrieved from https://www.spc.int/phs/pphsn/Publications/PHDSurveillance/Surveillance-pages111-119.pdf.
  4. World Health organization Dengue Training Slides

 

POLHN Boosts Continuing Professional Development for Medical Professional

POLHN Boosts Continuing Professional Development for Medical Professional

Written By: Website Administrator

11/03/2013

 

Health professional across Fiji have begun taking Pacific Open Learning Health Net (POLHN) seriously to establish Continuing Professional development.

 

POLHN was created in 2003 in partnership with Pacific Health Ministries and the World Health Organisation to ensure the availability of high quality training and education resources for health professionals, in order to improve health and health services in the region through online learning.

 

POLHN now has 16 learning centres around Fiji Islands and operates in 12 countries, providing access to online Continuing Professional Development (CPD) courses through an expanding network of learning centres, managed by a team of POLHN Country Coordinators supported by focal points. The majority of the centres are equipped with computers connected to the Internet, printers, scanners and projectors.

Early this year 10 Ministry of Health staff in Nabouwalu, on the coastline of Vanua Levu, graduated from POLHN’s basic computer course. Staff Nurse TavaitaLomani and husband IfeiremiDau of Wainunu Nursing Station each attained more than 15 short course certificates: “The good thing about POLHN is that I can access courses anytime and from anywhere. The courses are free, so I do not have to worry about cost” said Ifeiremi.

 

Inspired by the couples’ story, Staff Nurse Krishneel Kumar of Lautoka Hospital followed their footsteps and completed several self paced courses from Lippincott Nursing Centre and Global Health eLearning Center. After finishing numerous courses during his night shifts; “I feel more confident in dealing with patients,” Krishneel says.

 

POLHN’s aim is to ensure health professionals have access to a variety of courses and digital health resources available through the Internet. POLHN believes that continuous health education is essential in order to improve the quality of health care provided to the people of Fiji and the Pacific. Many of POLHN’s courses can be completed entirely online, and for health workers who have yet to build their confidence using computers, POLHN offers basic and intermediate computer literacy training

 

There are more than 1000 short courses, available through the POLHN website. There are also postgraduate courses in health services management and public health, through the Fiji National University as well as a variety of specialized public health courses designed for health professionals. All POLHN courses are offered at no cost to Ministry of Health workers.

 

Currently, POLHN is running a Poster Competition open to everyone, to design a poster promoting POLHN and lifelong learning. The poster competition ends on 31 March, 2013 and there are 100s of free giveaways. The winner will get chance to be in the 10th year POLHN retreat, so get your creative ideas flowing and send your poster designs to yasinm@wpro.who.int / sarkisn@wpro.who.int

 

Stay tuned for more news from POLHN and keep learning!

 

 

Dengue Interventions By A Small Mosquito Control Unit

According to World Health Organization, preventing or reducing dengue virus transmission depends entirely the control of the mosquito vectors or interruption of human–vector contact.

In essence, the prevention and control activity for dengue fever is centred on the control of the transmitting vector or agent i.e. the mosquito. Past research in Fiji and various published report identified Aedes aegypti mosquitoes as the most effective vector for dengue fever. The mosquito prefers to inhabit close to household and immediate vicinity of its food source (blood meal), as well as other settings (such as schools, hospitals and workplaces). Therefore, the dengue, fever Interventions are focused on eliminating or at least reducing the population of mosquitoes around areas where humans habitat.

The World Health Organization recommends an integrated vector management (IVM) as the strategic approach for vector control. IVM is defined as “a rational decision-making process for the optimal use of resources for vector control”. The Integrated Vector Management (IVM) considers five key elements in the management process, namely:

  • Advocacy, social mobilization and legislation
  • Collaboration within the health sector and with other sectors
  • Integrated approach to disease control
  • Evidence-based decision-making
  • Capacity-building

According to a recent review on the Vector Control initiatives by a WHO Consultant (Unpublished 2014), Fiji has a long history of dealing with dengue (since 1885) and has a leading dengue vector control program in the Melanesia and Pacific region. Whilst the consultant noted that there is a high level of knowledge and awareness of dengue amongst the health leadership and staff, there is scope to provide additional resources to increase mobility and technical capacity of the teams.

Despite limitations, the overall aim for vector control has been to eliminate all potential breeding habits of mosquitoes through effective vector reduction campaign in the high risk urban and rural areas within the operational health division’s placing greater emphasis on source reduction through basic environmental health approaches and community mobilization. This is implemented through:

  • Vector reduction campaign via clean-up of compounds / backyard , overgrowth in vacant lots and blocked drains
  • Cartage of refuse in dengue sensitive and high risk areas within the rural areas
  • Mobilization of community to sustain clean and vector free environment

Intersectoral collaboration through a National Dengue Clean-Up Initiative which is places emphasis on destroying mosquito breeding in tyres, drums and other receptacles that can retain water.

Apart from source reduction, vector control can be achieved through good water supply and storage measures (mosquito proofing water storage containers), good solid waste management practices (ensuring that potential water retaining receptacles are properly disposed), and through the use of chemical controls. Chemical controls are usually done through spraying which ideally targets adult mosquitoes and through larviciding which targets immature mosquito larvae. In addition, entomological monitoring and surveillance through the monitoring of vector populations through larval and adult mosquito monitoring coupled with timely feedbacks are essential for dengue prevention and control.

A final tool that is available for effective dengue control is through the use of legislative advocacy and implementation of legislative authority. Simply put, imposing of fines to persons who harbour or breed mosquitoes. The limitations to such an approach are the long awaited court processes and associated court costs to resolve an eminent threat.

Finally, dengue Fever is preventable, but no prevention is 100% effective. Some of the best means of prevention starts with an individual mindset towards self-protection. Some of these prevention measures include minimizing mosquito bites, avoiding mosquito-prone areas and using of repellents. Apart from these, source reduction through elimination of mosquito breeding sites is the best course in prevention dengue.

It is only through the combination of these efforts successful dengue control can be achieved.

Reference:
1. Dengue: guidelines for diagnosis, treatment, prevention and control — New edition (2009), World Health Organization.