The severe dengue fever is spreading in more than 50 countries all over the world. In certain part of Australia many residents are affected from dengue and it will create large burden on the health care department of the country. The major aim of this research is to offer the various suggestions to the department of Public Health to recover from this severe epidemic. This will help the government to identify various options available for prevention and effective control management techniques. It is considered as a most transmitted disease so, different aspect will be find out such as natural history, case management and diagnosis techniques and future research opportunities.
Statement of issue
This report provides detailed discussion on what is the role of Department of Health of Australia to prevent from severe Dengue fever. What are necessary steps taken by the government to implement the effective research methodology to find vaccination against severe dengue and Who should take responsibility to prevent whole country from this severe epidemic. All of the residents of Australia is waiting for when should this severe dengue fever will be eliminated from the state and when will specific treatment and immunization available to all.
Background of the Dengue fever and public health
Dengue is considered as one of the most transmitted disease which has spread due to the Aedes mosquitoes in whole world. In tropical and sub tropical regions of the world it was first recognized in 1879 in Queensland in Australia (Williams et al. 2014). Now it has affected millions of people every year worldwide and especially in northern region of Australia where tropical climates prevail. Due to this epidemic, severe illness is occurring among children and death rate is increasing in some Australian countries.
In Northern territory of Australia more than 400 cases have been identified related to dengue fever from 2003 to till now. Approximately, 3 billion people are residing in tropical areas where dengue is highly transmitted. Dengue haemorrhagic fever (DHF) is more severe illness which had same symptoms like as dengue and generally found in children below the age of 14 years. From 1995 to 2011, about 90% of the cases were related to dengue in the areas of Queensland and specially in the ‘Cairns and Hinterland’ district. From the total cases of 90% of dengue about 50% of the people were male of the average age 40 years old. 200000 cases were identified by the World Health Organization in the year 2011 which were related to the severe dengue fever. Rate of severe dengue fever is 10 times more than that other countries affected from dengue. Many health department experts estimated that dengue will rise in future in Australia as well in other geographical areas in the world. Many of the drugs were not used by the patients because it could have negative impact on the body such as non-steroidal anti-inflammatory and Asirin etc. Mainly dengue was observed in the travelers of the age groups 30-50 years old in the Australia. Dengue deaths are varying from year to year but mostly transmitted in the season of autumn and summer.
Department of Health is continuously conducting surveys for finding about the mosquito infected population present in Northern territory (Yixin et al. 2014). There is no certain vaccine or treatment found by the Health department. General treatment for this is paracetamol medicine, oral fluids for getting relief from fever and body pain. Due to the lack of proper treatment against dengue fever it is reduced to only 1 % till now. From the research it was found that dengue fever is transmitted by only female mosquito and they generally found in cool places where water is stored and outdoor places where garbage is kept mostly in daylight hours (Lindsay et al. 2015). It can develop in the old tyres, carriage of pot plant saucers and rain field vessels and can be transmitted to one place to another place. For the purpose of inventing specific vaccination against dengue, World Health Organization provides guidance and technical advice and support to countries, private institutions for research and evaluation. If proper prevention and treatment will not be available then dengue will rapidly spread in the future in whole world.
Queensland is the only area in the Australia where the dengue has prevailed. The transmission of dengue reduced to a very large extent in the season of summer or dry season. The report of World Health Organisation reveals that the burden of this disease could be increase due to the continuous change in the climatic effect of the whole environment (Hoad et al, 2015). In the areas where the probability of occurrence of dengue is high, a regular and frequent survey is required to conduct in those areas. Areas of vector where the density of population is high, the population should tries to enforce the regular conduction of surveys and reducing the sources of dengue. Drawing out programmes and photographs that shows potential day-biting can be done with the help of using social medias and promotional campaigns (Naish et al., 2014). In the annual report of NAMAC, all the information relating to the diseases borne by mosquitoes, and the activities that are taken in order to control this disease is presented.
The government has established several policies in order to prevent and control the negative effects of dengue in the country. The government has officially established taskforce and committee between different departments for the purpose of supervising the area, preventing and controlling the diseases that are spread by mosquitoes. This taskforce includes authorities relating to public health, representatives of laboratory and Medical Entomology. Activities done by human and vector supervision are coordinated using the methods of surveillance of cross-border. The capacities of laboratory and exchange of resources are also coordinated. Several types of portals are used for the purpose of communication in order to provide response to various events (Rounsevell et al., 2014). Several management plans including the assignment of roles and responsibilities, allocating funds in order to investigate and respond are designed. In order to develop coordination between different ecological research priorities, humans and vector, several methods are applied.
In the areas where dengue is highly receptive, urgent and punctual occurrences and controlling activities for mosquito disease should be done. Along with this, contact addresses should be identified by analysing travelling history. The basic purpose of this is to exterminate the disease causing virus through the measure of killing the infection causing adult females within the demographic radii of 200 metres (Musso et al., 2014). This is the extent of distance up to a female mosquito can fly. Urbanisation, blood feeding and harbouring within the premises are some of the attributes that are found in vectors of primary dengue. Therefore, synthetic pyrethroid insecticides like bifenthrin and deltamethrin should be used for the purpose of spraying at indoor residential areas can be used as a measure of control for dengue. Sometimes, the ultra low volume or thermal foggers cannot be seen effective in case of truck mounted outdoor areas. Regulators for insect growth can be used for the treatment of containers that are filled with containers. In large outbreaks, removing or tipping out the containers cannot be seen effective because these factors are not affecting in addressing the breeding sites which are mysterious or rainwater tanks. The Dengue Management Plan also focuses on the outlining of the strategies of vector control for the origination source in opposition to outbreaks of large widespread. Rapidness in spreading the dengue makes it more critical to cure. Lacking in presenting the case or diagnosing and delaying in notifications will lead in explosive out breaking. Transmitting the risk of dengue of central and southern Queensland seems difficult due to the reason of vector population has lacked in many areas.
There are various possible courses of action that could be taken by Department of Health to reduce the impact of severe dengue on the residents of Australia. Major principle behind the prevention and control measures is to develop proper case management strategy with present health system, harmonize prevention, examination or epidemiological such that they are ecologically sound, cost-effective and sustainable for future (Diamond and Pierson 2015). For successful implementation of the prevention measures allocation and mobilization of resources is also essential.
Diagnosis of Dengue and Case management:
Appropriate implementation of clinical management helps in reducing death rate caused due to severe dengue fever up to zero level. Effective implementation includes new methods of staff training, early clinical and laboratory diagnosis, and hospital restructuring and intravenous rehydration. The main advantage of this technique is helpful in reducing the death rate due to dengue up to 60%. Government should help in adopting new technology which can provide effective and fast diagnosis of cases offered by accurate differential techniques, timely response to severe disease and quick laboratory assessment. It requires fund and assistance by government to the Health department (Gubler et al. 2014). Main disadvantage is it requires huge cost to implement new methodologies in whole country. Main advantages of this are
- Effective clinical management system and well organized response of staff helps in reducing the number of avoidable hospital admissions and also saves the life of patients from severe dengue (Nguyen et al. 2015).
- Early warning of dengue infected patient is necessary to control and helps in taking prevention measures of dengue at primary stage.
- Effective management training is very important in cases of severe dengue for all medical and non-medical staff which helps to recover the patient from initial stage of disease (Sung et al. 2016).
Sustainable Vector Control of Severe Dengue:
Department of Public Heath should adopt the integrated vector management approach which is promoted by World Health Organization to vector control of dengue. Sustainable vector control means the optimum use of resources and insecticides provided by the department for vector control which is helpful in cost effectiveness and adaptable according to environment. The primary vector of dengue is Aedes aegypti mosquito. It has developed to feed, mate, and lay eggs in surroundings (Huang et al. 2016). Generally, the Aedes aegypti mosquito remains active at the time of early morning period and in the evening period. So this approached is started mainly for the abolition of containers that are favorable places for ovipositor and put covers on containers or with the help of insecticides killing all the mosquitoes. Government should help in spraying of insecticides against malaria viruses and to develop innovative vector tools such as spatial repellents, spatial repellents, genetically modified mosquitoes and lethal ovitraps (Leary, 2013). Reliable surveillance methods of vector control and techniques of virus transmission help in dengue prevention for long term (Naish et al. 2014).
The main advantage of effective vector control management is helpful in reduction of mortality rate due to dengue. The main purpose of vector control measures is to overcome the transmission of dengue and reducing the occurrence of infection and avoiding outbreaks of the disease.
Implementation of Future Vaccine:
There is no certain treatment available to recover from severe dengue fever. So, Department of Public Health should provide assistance and guidelines to manufactures and regulatory agencies on development and evaluation of vaccine for severe dengue (Cao-Lormeau et al. 2016). Guidelines should be related to the safety, quality and usefulness of dengue vaccines and issues related to manufacturing and quality control also covered. For proper implementation of vaccine, integration of various factors should be considered such as storage, financing, supplying and effective transportation for easy delivery. Vaccines should not have any side effects and should be integrated with other measures of prevention and control of dengue. Effective development strategies for vaccination should include the selection of target populations and target area which is highly infected from dengue fever (Low et al. 2014). Efficient delivery approaches, campaigns by government, routine checkup and proper schedule for vaccination and overall implementation of future vaccine should cover the whole population.
The main advantage of implementation of future vaccine is to reduce the overall mortality rate and help to reduce the severe impact of dengue (Stoler et al. 2014). It will helpful in bringing a confidence level among residence of Australia that government is implementing vaccination programs.
There are several measures which help in preventing and curing dengue. All the persons who used to travel from one place to another are required to use personal protective measures in order to reduce the risk of getting day biting mosquitoes (Webba and Hessac, 2016). It is recommended to stay in a well conditioned area or proper clothes should wear that result in reducing the extent of exposure of skin. Along with it, it is also recommended to use insect repellents on the skin that has remains uncovered. Insect repellents that comprise of diethyl-methyltoluamide can be considered as the most effective source. The extent of concentration level of DEET differs from product to product. Higher the composition of DEET signifies the higher degree of protection for a longer period of time from dengue. In some of the cases, using the sprays that are highly concentrated with DEET may negatively affect the children. So it is very much essential to apply DEET sparingly to the surface of exposure and it should be washed off after the persons indoors. Using the insecticide which has concentrated level of DEET up to 35% can prevent the mosquitoes for 4-6 hours (Leung et al., 2015). On the other hand, the insecticides having the concentration level of DEET up to 95% can protect from dengue for around 10to 12 hours. New formulas are also searching and designed which contains lower level of concentration of DEET and has a potential of preventing dengue for long time.
Still, there is no proper vaccination system has evolved for preventing dengue. Serology is the common method which is used to identify the infection of dengue virus in the body. This serology is also based on the laboratory confirmation. Diagnosing using the method of serology generally does not allow the serotyping of virus infection and is suspicious in terms of cross reactivity with different viruses. Various types of samples are required in order to do the procedure of serology. No specified viral treatment has been developed for curing the dengue. It can be cured using the method of clinical management that is also based on various supportive therapies and basically well-judged supervision of intravascular volume replacement. With the improvements in managing the case, the fatality rate of hospitalising illness of dengue has been reduced to a good extent (Walter et al., 2014).
There is only single approach present for controlling and preventing the transmission of virus of dengue was going through the intervening for targeting the vector until the proper vaccine of dengue gets developed. For this purpose, integrated vector management is recommended by World Health Organisation. Many researchers have shown that reduction in entomological indicators follows different forms of vector control (Gyawali et al., 2016). A scantiness of data has shown effect of this interference of incidences of dengue illness. There are several strategies that aim at preventing mosquitoes from lying eggs, using interferences of environment management which constitutes the disposal of solid waste, removing artificially man-made mosquitos’ habitats, removing the impurities of containers used for storing the water on regular basis. Proper pesticides should be applied to water storage containers. Participation of community should be improved and sustained vector controlling should be mobilized. Insecticides should be applied using the method of sprays can be treated as an emergency measure of vector control. Many of the dengue vaccines are ready to possess in laboratories. CYD-TDV is a name of prophylactic, tetravalent and viral vaccine (Heywood et al., 2016). It is available in both type of single and multiple of dose. It is provided in the form of pre-filled syringe for the use of single dose or in the form of multi dose presentation. It does not contain any type of preservatives or adjuvant.
On the basis of overall research, it can be analyzed that dengue is one of the major global health issues which affected approximately more than 3 billion people all over the word. This severe dengue fever is caused due the virus and mosquito’s bite which develops in the wastage and open water containers (Schwartz et al. 2015). There is no certain treatment available to recover from severe dengue fever so government is taking various steps to overcome the impact of dengue. Different measures can be taken by Government of Australia such as effective case management techniques, vector control measures and research for future vaccination.
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