Incidence and Prevalence of the

disease in Malaysia and the World

• Dengue Fever / Dengue Haemorrhagic Fever
• Malaria
• Chikungunya
• Japanese Encephalitis
• Leptospirosis
Trend of DF/ DHF in the World
Distribution of DF/DHF cases in Malaysia
Trend of DF/ DHF in Malaysia
Malaria
Distribution of Malaria Cases Worldwide
Trend of Malaria in the World
Distribution of Malaria cases in Malaysia
Trend of Malaria in Malaysia
Chikungunya
Global Distribution of Chikungunya in 2016
Trend of Chikungunya Worldwide & in
Malaysia
Distribution of Chikungunya in Malaysia
Japanese Encephalitis
Global Distribution of Japanese Encephalitis
Trend of Japanese Encephalitis in the World
(China)
Trend of Japanese Encephalitis
in Malaysia
Leptospirosis
Global Distribution of Leptospirosis
Trend of Leptospirosis in the World
(Denmark)
Trend of Leptospirosis in Malaysia
Leptospirosis case fatality rate in different
Malaysian state from 2004 to 2009
Causative Organisms, the types and
their modes of transmission
• Dengue Fever / Dengue Haemorrhagic Fever
• Malaria
• Chikungunya
• Japanese Encephalitis
• Leptospirosis
 Dengue Fever/
Dengue Haemorrhagic Fever
• Causative organism:
Dengue Virus (DEN-1, DEN-2, DEN-3 & DEN-4)
• Modes of transmission:
Vector-borne viral infection via mosquito bite
i. Aedes aegypti
ii. Aedes albopictus
Mode of Transmission of Dengue Virus
 Malaria
• Causative organisms:
Intracellular Plasmodium Protozoa
-Plasmodium falciparum
-Plasmodium malariae
-Plasmodium ovale
-Plasmodium vivax
-Plasmodium knowlesi

• Modes of transmission:
Vector-borne parasite infection via
female Anopheles mosquito
 Chikungunya
• Causative organisms:
Chikungunya Virus of Togaviridae Family
• Modes of transmission:
Vector-borne viral infection via mosquito bite:
-Aedes albopictus
 Japanese Encephalitis
• Causative organisms:
Japenese Encephalitis Virus
• Modes of transmission:
Vector-borne viral infection via mosquito bite:
-Culex tritaeniorhynchus
 Leptospirosis
• Causative organisms:
Leptospira Interrogans
• Modes of transmission:
i. Direct contact with urine or tissue of infected animal
-Through skin abrasions, intact mucus membrane
ii. Indirect contact
-Broken skin infected soil, water or vegetation
-Ingestion of contaminated food & water
iii. Droplet infection
-Inhalation of droplets of infected urine.
Mode of Transmission of Leptospirosis
 Disease, Causative Organisms and Mode of Transmission

Disease Causative Organisms Mode of Transmission

1. Dengue Fever/ Dengue • DEN Virus (DEN-1, DEN-2, Mosquito-borne Viral Infection:
Haemorrhagic Fever DEN-3 & DEN-4) of • Aedes aegypti
Flaviviridae Family • Aedes albopictus
2. Malaria • Intracellular plasmodium Mosquito-borne Infection:
protozoa • Female Anopheles Mosquito
3. Chikungunya • Chikungunya Virus of Mosquito-borne Viral Infection:
Togaviridae Family • Aedes albopictus
4. Japanese Encephalitis • Japanese Encephalitis Mosquito-borne Viral Infection:
Virus • Culex tritaeniorhynchus
5. Leptospirosis • Leptospira interrogans • Direct Contact with Urine of
tissue of infected animal
• Indirect Contact
• Droplet Infection
 o Dengue Fever / Dengue Hemorrhagic Fever
o Malaria
o Chikugunya
o Japanese Encephalitis
o Leptospirosis

How would you diagnose each of the above? (

What laboratory tests and clinical sign)
8/1/2018 COMMED 41
 Dengue Fever /
Dengue Hemorrhagic Fever
o Athropod-Borne Infections
o May be asymptomatic or may lead to
a) "classical" dengue fever
b) dengue haemorrhagic fever without shock
c) dengue haemorrhagic fever with shock

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CLINICAL SIGNS

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CLINICAL SIGNS

8/1/2018 COMMED 44
HOW DO WE DIAGNOSE?
I. DENGUE FEVER
Probable diagnosis
Acute febrile illness with two or more of the following;
o headache,
o retro-orbital pain,
o myalgia,
o arthralgia/bone pain,
o rash,
o haemorrhagic manifestations,
o leucopenia (wbc s 5000 cells/mm3),
o thrombocytopenia (platelet count <150,000 cells/mm3),
o rising haematocrit (5-10%);
o and at least one of following :
o supportive serology on single serum sample: titre :2: 1280 with
haemagglutination inhibition test, comparable IgG titre with enzyme-linked
immunosorbent assay, or testing positive in lgM antibody test, and
occurrence at the same locationCOMMED
8/1/2018 and time as · confirmed cases of dengue
45
Confirmed diagnosis
Probable case with at least one of the following :
o isolation of dengue virus from serum, CSF or autopsy samples.
o fourfold or greater increase in serum lgG (by
haemagglutination inhibition test) or increase in lgM antibody
specific to dengue virus.
o detection of dengue virus or antigen in tissue, serum or
cerebrospinal fluid by immunohistochemistry,
immunofluorescence or enzyme-linked immunosorbent assay.
o detection of dengue virus genomic sequences by reverse
transcription-polymerase chain reaction.

8/1/2018 COMMED 46
II. DENGUE HAEMORRHAGIC FEVER

All of following :
o acute onset of fever of two to seven days duration.
o haemorrhagic manifestations, shown by any of the
following;
o positive tourniquet test
o petechiae
o ecchymoses or purpura
o bleeding from mucosa,
o gastrointestinal tract
o injection sites
o platelet count S: 100,000 cells/mm3 ·vascular permeability
shown by any of the following :
o Rising haematocrit/haemoconcentration ~ 20% from baseline
or evidence of plasma leakage such as pleural effusion, ascites
or hypoproteinaemia/ albuminaemia.

8/1/2018 COMMED 47
 III. DENGUE SHOCK SYNDROME

Criteria for dengue haemorrhagic fever as above with

signs of shock including :
o Tachycardia
o cool extremities
o delayed capillary refill
o weak pulse
o lethargy or restlessness (which may be a sign of
reduced brain perfusion )
o pulse pressure ~ 20 mmHg with increased diastolic
pressure, e.g. 100/80 mmHg.
o hypotension by age, defined as systolic pressure <80
mmHg for those aged <5 years, or SO to 90 mmHg for
older children and adults.

8/1/2018 COMMED 48
LAB DIAGNOSIS
I. Virus isolation :
o Isolation of dengue virus from clinical specimens is possible
provided the specimen is taken during the first six days of illness
and processed without delay.
o Specimen that are suitable for virus isolation are acute phase
serum, plasma or washed b\lffY coat from the patient,autopsy
tissue from fatal case (especially liver, spleen, lymph nodes and
thymus), and mosquitoes collected from the affected areas.
II. Viral nucleic acid detection :
o Dengue viral genome, which consists of RNA, can be detected by
reverse transcriptase polymerase chain reaction (RT -PCR) assay
and real time RT-PCR. In recent years, a number of RT
o PCR assays have been reported for detecting dengue virus.
o They offer better specificity and sensitivity compared to virus
isolation with a much more rapid turnaround time.
8/1/2018 COMMED 49
III. Immunological response and serological tests
Following tests are available for diagnosis of dengue infection:

a. Haemagglutination inhibition assay (HIA)

b. Complement Fixation (CF)

c. Neutralization test (NT)

d. IgM capture enzyme-linked immunosorbent assay (MAC-

ELISA)

e. Indirect lgG- ELISA

f. IgM/IgG ratio

8/1/2018 COMMED 50
IV. Viral antigen detection : ELISA and dot blot assays
o directed against the envelop/membrane (EM) antigens and

o nonstructural protein 1 (NSl) can be detected in both

o patients with primary and secondary dengue infection up to 6

days after the onset of the illness. Commercial kits for the
detection of NSl antigens are now available; however, these kits
do not differentiate between the serotypes. Besides providing an
early diagnostic marker for clinical management, it may also
facilitate the improvement of epidemiological surveys of dengue
infection.

8/1/2018 COMMED 51
V. Rapid diagnostic test (RDT)
o A number of commercial rapid format serological test-kits for
anti-dengue IgM and IgG antibodies have become available in
the past few years
o some of these producing results within 15 minutes.
o Unfortunately, the accuracy of most of these tests is uncertain
since they have not yet been properly validated.

VI. Analysis of haematological parameters : Standard

o haematological parameters such as platelet count and
o haematocrit are important and are part of the diagnosis of
o dengue infection. They should be closely monitored.

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8/1/2018 COMMED 53
 MALARIA

8/1/2018 COMMED 54
Clinical Signs
Clinical symptoms include the following:
o Headache (noted in virtually all patients with malaria)
o Cough
o Fatigue
o Malaise
o Shaking chills
o Arthralgia
o Myalgia
o Paroxysm of fever, shaking chills, and sweats (every 48 or 72
hours, depending on species)
Less common symptoms include the following:
o Anorexia and lethargy
o Nausea and vomiting
o Diarrhea
o Jaundice
8/1/2018 COMMED 55
Most patients with malaria have no specific physical findings,
but splenomegaly may be present. Severe malaria manifests as
the following:
o Cerebral malaria (sometimes with coma)
o Severe anemia
o Respiratory abnormalities: Include metabolic acidosis,
associated respiratory distress, and pulmonary edema; signs
of malarial hyperpneic syndrome include alar flaring, chest
retraction, use of accessory muscles for respiration, and
abnormally deep breathing
o Renal failure (typically reversible)
8/1/2018 COMMED 56
Clinical Signs
The typical attack comprises three distinct stages, i.e. the cold stage, the hot stage
and the sweating stage. These are followed by an afebrile period in which the
patient feels greately relieved.

COLD STAGE :
• Onset: lassitude, headache, nausea, chilly sensation followed in an hour or so by
rigors.
• Temperature rises rapidly to 39-41°C.
• Severe headache and vomiting. In early part of this stage, skin feels cold; later it
becomes hot.
• Parasites are usually demonstrable in the blood. Pulse is rapid and may be weak.
This stage lasts for 1/4-1 hour.

HOT STAGE :
• Patient feels burning hot and casts off his clothes. Skin is hot and dry to touch.
• Headache is intense but nausea commonly diminishes.
• The pulse is full and respiration rapid. This stage lasts for 2 to 6 hours.

8/1/2018 COMMED 57
SWEATING STAGE :
• Fever comes down with profuse sweating. The temperature
drops rapidly to normal & skin is cool and moist. The pulse rate
becomes slower, patient feels relieved and often falls asleep.
• This stage lasts for 2-4 hours. The febrile paroxysms occur
intermittent periodicity repeating every third or fourth day
depends the species of the parasite involved.
• The classical 3 stages (cold, hot and sweating) may not always
be observed due to maturation of generations of parasite at
different times. Periods of latency may last several weeks or
months (8, 19).
• The disease has a tendency to relapse and is characterized by
splenomegaly and secondary anemia. Febrile herpes is
common in all malarial patients.
Lab Diagnosis
1. Microscopy
• Two types of blood films.
• The "thin film" and the "thick film". It is recommended that both types of film be
prepared on a single microscope glass slide. The thick film is more reliable in
searching for parasite, as large volume of blood is examined under each
microscope field. When scanty, parasite may be found about 20 times more rapidly
in thick slide than in thin slide. The thin slide is more valuable for identifying the
species of the parasite present. In it they are seen more clearly. The advantage of
microscopy are : The sensitivity is high. It is possible to detect malarial parasite
at low densities. It also helps to quantify the parasite load; It is possible to
distinguish the various species of malaria parasite and their different stages.

8/1/2018 COMMED 59
Specific tests for malaria infection should be carried out, as follows:
o Microhematocrit centrifugation (sensitive but incapable of speciation)
o Fluorescent dyes/ultraviolet indicator tests (may not yield speciation
information)
o Thin (qualitative) or thick (quantitative) blood smears (standard): Note that
1 negative smear does not exclude malaria as a diagnosis; several more
smears should be examined over a 36-hour period
o Include rapid diagnostic tests, polymerase chain reaction assay, nucleic acid
sequence-based amplification, and quantitative buffy coat

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 CHIKUGUNYA

8/1/2018 COMMED 64
Clinical Signs
Clinical examination reveals
o high-grade fevers (up to 105°F), pharyngitis, conjunctival
suffusion
o Conjunctivitis
o Photophobia
o Other frequent manifestations include severe arthralgias,
myalgias, and rash.

8/1/2018 COMMED 65
Lab Diagnosis
Several methods can be used for diagnosis.
Confirmation Test
o Serological tests – ELISA = may confirm the presence of
IgM and IgG anti-chikungunya antibodies. IgM antibody
levels are highest 3 to 5 weeks after the onset of illness and
persist for about 2 months.
o Samples collected during the first week after the onset of
symptoms should be tested by both serological and
virological methods (RT-PCR).
o The virus may be isolated from the blood during the first
few days of infection. Various reverse transcriptase–
polymerase chain reaction (RT–PCR) methods are available
but are of variable sensitivity.

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 JAPANESE ENCEPHALITIS

8/1/2018 COMMED 67
Lab Diagnosis
o The virus can be isolated from the blood of febrile patients
by the intracerebral inoculation in suckling mice or on
VERO cells.
o In serologic diagnosis, which is the approach most
commonly used, sero-conversion is demonstrated by
comparing acute and convalescent - phase sera in the
haemagglutination inhibition, serum neutralization, or
complement fixation test.
o The enzyme-linked immunosorbent assay (ELISA) is used
to detect lgM. A reverse-transcription polymerase chain
reaction (RT-PCR) I nested PCR technique has also been
shown to be useful in rapidly diagnosing the disease.
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 LEPTOSPIROSIS

8/1/2018 COMMED 69
Clinical Signs
It is characterized by sudden onset of the following:
o Fever (38-40°C)
o Rigors
o Headache, retro-orbital pain, photophobia
o Conjunctival suffusion
o Dry cough
o Nausea and vomiting, diarrhea
o Muscle pain localized to the calf and lumbar areas
More severe disease manifests as icteric leptospirosis, also known as
Weil disease, with the following features:
o Icterus or frank jaundice
o Renal failure with oliguria
o Hemorrhagic features
o Systemic inflammatory syndrome or shock
8/1/2018 COMMED 70
Lab Diagnosis
I. Leptospira immunoglobulin M (IgM) ELISA or
IgM/immunoglobulin G (IgG) enzyme-linked immunoabsorbent
assay (ELISA), including rapid diagnostic kits usable in the field
Real-time DNA polymerase chain reaction (PCR) of blood, urine,
and cerebrospinal fluid (CSF)
Confirmation Test
o Microscopic agglutination testing (MAT; criterion standard for
serologic identification of leptospires, available at reference
laboratories)
o Single titer ≥1:200 or 4-fold rise in serum drawn between the
first and fourth week of illness is considered diagnostic
o DNA PCR of blood, urine, CSF, tissue
o Culture of leptospires from body fluids or tissue (criterion
standard, but requires specific media and several weeks’
incubation, thus usually limited
8/1/2018 to reference laboratory)
COMMED 71
Lab Diagnosis
o Early in the disease, the organism may be identified by dark-
field examination of the patient's blood or by culture on a
semisolid medium. Culture takes 1-6 weeks to become positive.
The organism may also be grown from the urine from 10th day
to 6 weeks.
o Diagnosis is usually made by means of serological tests, of
which several are available. Agglutination tests (microscopic
using live organism, and macroscopic using killed antigen)
become positive after 7-10 days of illness and peak at 3-4
weeks and may persist at high level for many years. Indirect
haemagglutination, immunoflourescent antibody and ELISA
tests are also available. The IgM ELISA is particularly useful in
making an early diagnosis, as it is positive as early as 2 days
into illness. Now Leptodipstick test is also available.

8/1/2018 COMMED 72
8/1/2018 COMMED 73
3. PREVENTION , PROMOTION AND CONTROL
Prevention and control of Dengue
• Secondary prevention:
– Construct system for monitoring number of infections.
– Mechanism for responding to epidemic promptly.
– To upgrade the effectiveness of laboratory diagnosis.
Prevention and control of Dengue
• Tertiary prevention:
– Prevent advanced cases that cause death:
• Target: reduce death rate of dengue hemorrhagic fever to <
5%.
– Train medical treatment personnel of dengue hemorrhagic fever.
– Amend standards for designated hospitals in treating fatal dengue
hemorrhagic fever in an emergency.
– Select hospitals for treating dengue hemorrhagic fever in an
emergency.
– Create mechanism for allocating hospital beds in an emergency.
Prevention and control of Malaria

Primary prevention :
1.Awareness and Education of the risk of malaria:
1.Recognizing the disease in the early stages can stop
the disease from becoming a killer.

2.Education can also inform people to cover over areas

of stagnant, still water e.g. Water Tanks which are ideal
breeding grounds for the parasite and mosquito, thus
cutting down the risk of the transmission between
people.
2. Personal protection measures:

1. Use personal protection measures

2. Understand anopheles behavior—feeding and
resting
3. Wear proper clothing—long sleeved shirts, long
pants, socks and shoes
4. Use appropriate repellents—especially at twilight
and on neck, face and ankles
5. Use permethrin (insect repellant) on clothes and
use of bed nets
Secondary prevention :
1.Use of prophylactic drugs
Generally, these drugs are taken daily or weekly, at a
lower dose than would be used for treatment of a
person who had actually contracted the disease.

Modern drugs used preventively

include mefloquine (Lariam), doxycycline (available
generically), and the combination
ofatovaquone and proguanil hydrochloride (Malarone
). The choice of which drug to use depends on which
drugs the parasites in the area are resistant to, as well
as side-effects and other considerations.
2. Indoor residual spraying
Indoor residual spraying (IRS) is the practice of
spraying insecticides on the interior walls of
homes in malaria affected areas.
After feeding, many mosquito species rest on a
nearby surface while digesting the bloodmeal, so
if the walls of dwellings have been coated with
insecticides, the resting mosquitos will be killed
before they can bite another victim, transferring
the malaria parasite.
Tertiary prevention
1.Diagnosis and treatment

Malaria is diagnosed with microscopy: specifically, a

thick and thin blood smear. The results should be made
available on the same day, because malaria is considered
an emergency and can quickly progress if not diagnosed
and treated promptly.

To treat severe malaria, intravenous (IV) antimalarials

are used (e.g: Quinidine).Uncomplicated malaria can be
treated with oral antimalarials.
 Prevention and control of
Chikungunya
• Protect Yourself from Mosquito Bites
• Use air conditioning or window/door screens to keep mosquitoes outside.
sleep under a mosquito bed net.
• emptying standing water from containers such as flowerpots or buckets.
• When weather permits, wear long-sleeved shirts and long pants.
• Use insect repellents
– Repellents containing DEET, picaridin, IR3535, and oil of lemon
eucalyptus or para-menthane-diol provide long-lasting protection.
– If you use both sunscreen and insect repellent, apply the sunscreen
first and then the repellent.
– Do not spray repellent on the skin under your clothing.
– Treat clothing with permethrin or purchase permethrin-treated
clothing.
– Always follow the label instructions when using insect repellent or
sunscreen.
 Prevention and control Japanese
Encephalitis
• JE vaccine
• Japanese encephalitis vaccine is approved for people 2 months of age and older. It
is recommended for travellers to Asia who:
• 1.plan to spend at least a month in areas where JE occurs,
• 2.plan to travel for less than a month, but will visit rural areas and spend a lot of
time outdoors,
• 3.travel to areas where there is a JE outbreak, or
• are not sure of their travel plans.
• 4.Laboratory workers at risk for exposure to JE virus should also be vaccinated.
• The vaccine is given as a 2-dose series, with the doses spaced 28 days apart.
• The second dose should be given at least a week before travel. Children younger
than 3 years of age get a smaller dose than patients who are 3 or older.
• A booster dose might be recommended for anyone 17 or older who was
vaccinated more than a year ago and is still at risk of exposure.
• .There is no information yet on the need for a booster dose for children.
• Is not recommended to anyone that have severe allergic effect.
 Prevention and control of
Leptospirosis
• The risk of acquiring leptospirosis can be
greatly reduced by not swimming or wading in
water that might be contaminated with animal
urine, or eliminating contact with potentially
infected animals
• Protective clothing or footwear should be
worn by those exposed to contaminated water
or soil because of their job or recreational
activities
• Prevention and control should be targeted at :
a) the infection source (e.g. rodent control, animal
vaccination)
b)the route of transmission between the infection
source and the human host (e.g. wearing
protective clothing, refrain from contact with
infected animals and from swimming in
contaminated water)
c) infection or disease in human host（e.g.
vaccination, antibiotic prophylaxis)
References
• http://malaysia.kurnia.com/Lifestyle/Health/17/Def
ault.aspx
• file:///C:/Users/Asus/Downloads/Four-
yearDengueFeverPlan-
StrategiesforPrevention_ImplementationandOragan
izationalOperation(pdffile).pdf
• Before the Swarm: Guidelines for the Emergency Management of
Vector-Borne Disease Outbreaks
http://www.astho.org/Programs/Environmental-Health/Natural-
Environment/Before-the-Swarm/
 1.Criteria for diagnosis of probable
dengue:
• Dengue fever (DF):
• Defined by the presence of fever (few hours – 2 days) and 2
or more of the following (but not meeting the case
definition of dengue haemorrhagic fever):
– Retro-orbital or ocular pain
– Headache
– Rash
– Myalgia (muscle pain)
– Arthralgia (joint pain)
– Leukopenia (WBC )
– Haemorrhagic manifestations (e.g., positive tourniquet test,
petechiae, purpura/ecchymosis, epistaxis, gum bleeding, blood
in vomit/urine/stool, vaginal bleeding).
 2.Warning signs of dengue:
• Dengue with warning signs:
– Abdominal pain or tenderness
– Persistent vomiting
– Clinical fluid accumulation (e.g., ascites, pleural effusion)
– Mucosal bleeding
– Lethargy/restlessness
– Liver enlargement >2 cm
– Laboratory: increase in haematocrit concurrent with rapid
decrease in platelet count.
• Warning signs require strict observation and medical
intervention.
The criteria of hospital admission
/ referral for dengue
Hospital referral and admission criteria
• The clinical course of DHF (Dengue Haemorrhagic Fever) can be
modified by early diagnosis and prompt correction of plasma loss.
Early and appropriate referral is important. The admission criteria
recommended by the MOH’s committee of experts are as follows:

Presence of any ONE of the following justifies referral to hospital :

 Significant bleeding
 Fall in blood pressure
 Dehydration and postural hypotension
 A rise in hematocrit > 20% above baseline
 Platelet count < 80,000 cells per cubic mm
 Severe vomiting or diarrhea
 Severe abdominal pain
 Elderly patients with co-morbidities who are unwell

Sources :
https://www.moh.gov.sg/content/dam/moh_web/PressRoom/Current_Issues/2005/DengueAdvisory.pdf
i. White cell count (WCC) and Platelet count:
• In the early febrile phase WCC and platelet count are usually normal but will
decrease rapidly as the disease progresses. The decrease in WCC is
accompanied by platelet reduction. There is no correlation between
disease severity and platelet count and it is not predictive of bleeding in
recovery phase, the WCC normalises followed by platelet.

ii. Haematocrit (HTC)

• A rising HCT is a marker of plasma leakage in dengue infection. The median
values of normal HCT level among Malaysian populations are:
a) male < 60 years – 46%
b) male > 60 years – 42%
c) female (all age groups) – 40%

Sources :
http://www.moh.gov.my/penerbitan/CPG/CPG%20Dengue%20Infection%20PDF%20Final.pdf
 QUES 4
CHALLENGES IN THE
DENGUE PREVENTION
ACTIVITIES IN MALAYSIA
• A) Low index of suspicion of dengue cases by
attending doctors
> delayed notification
>delay in giving appropriate treatment
• B)Lack in comunity cooperation and participation in
the dengue prevention and control activities
*stagnant and clogged drains
• C) Health seeking behavior of dengue patient
• a)only 4 % of cases were frm the clinic and
majority from hospital
b)50% of the dengue mortality cases admitted on
day 4 or 5 after onset-delay seeking treatment
c)47% of dengue mortality cases came in already ill
• D)Difficult to break the dengue virus transmission
• *only 35%of patient diagnosed within 3 days from
onset of illness
• *only 19% of dengue cases residence were fogged
within 5 days of onset of illness
5.What is the definition for 'outbreak locality ' and 'hotspot 'in
reference to dengue and chickungunya?

Outbreak locality

An outbreak defined as a situation where a sudden occurrence

of a disease (Dengue fever / Chickungunya ) in a community,
which has never experienced the disease before or when cases
of that disease (dengue/chickungunya)occur in numbers greater
than expected in a defined area.
 On Malaria
1. What is the national strategic plan for elimination of malaria
(2011-2020) and what are the strategies outlined there.
• In 2011, the Malaria Control Programme was reoriented from
control to elimination, and MOH formulated the National
Strategic Plan for the Elimination of Malaria (NSPEM) (2011 –
2020) with the objective of eliminating locally acquired
human-only malaria by 2020.
Seven strategies outlined in the NSPEM (2011 – 2020) :
• strengthen Malaria Surveillance System
• intensify control activities using Integrated Vector
Management approach
• ensure early detection of cases and prompt treatment
• heighten preparedness and early response to outbreak
• enhance awareness and knowledge on malaria towards social
mobilisation and empowerment
• strengthen human resource capacity and
• conduct relevant researches.

One of the seven main strategies is early detection of cases and

prompt treatment which advocate for the use of Artemisinin-
based Combination Therapy (ACT) as first line treatment for all
species
• Algaecides to kill and/or
slowing the growth of algae.
• Antimicrobials to control
germs and microbes such as
bacteria and viruses.
• Disinfectants to control germs
and microbes such as bacteria
and viruses.
• Fungicides to control fungal
problems like molds, mildew,
and rust.
• Herbicides to kill or inhibit the
growth of unwanted plants,
also known as weeds.
 Space spray
• A liquid insecticide dispersed into the air in the form
of hundreds of millionsof tiny droplets less than 50
μm in diameter.
• It is only effective while the droplets remain
airborne.
• Space sprays are applied mainly as thermal fogs or
cold fogs.
 Thermal fog
Advantages
• Easily visible fog so dispersal
and penetration can be
readily observed and
monitored
• Good public relations in some
circumstances as people can
see something being done
about the problem
• Low concentration of active
ingredient in the spray
mixture and reduced operator
exposure
 Cold fog
Advantages
• The amount of diluent is kept
to a minimum, resulting in
lower application cost and
increased acceptability. Some
formulations are ready to use,
thereby reducing operator
exposure
• May use water-based and
water-diluted formulations,
which pose a low fire hazard
and are more environmentally
friendly
• Because a lower volume of
liquid is applied, application is
more efficient
• No traffic hazard as the spray
cloud is nearly invisible.
 3. Control methods used for rats
• 1. The First Step for Rat Control is Sanitation, Inspection
and Exclusion
• Inspection - Once you know the location of the rats, you can
set traps or place bait.
• Exclusion - rodent control technique. It will get rid of the rats
by making it difficult for them to enter the home or structure.
Rats are easier to exclude than mice because rats a typically
larger.
 Exclusion and sanitation
• Stuf-fit Copper Mesh
• Use Stuf-fit Copper Mesh around pipes and utility lines
stuffing into the openings such as openings where pipes and
wires enter the foundation and siding.
• e.g., around outdoor faucets, receptacles, gas meters, clothes
dryer vents, and telephone/cable TV wires.
• Check to see that shingles are tight.
 PUR Black Gun Foam
• will expand into voids and cracks and crevices. PUR Black Gun
Foam is a polyurethane and moisture curing foam. It is very
handy to seal the entry points where rodents, bats, birds,
squirrels or insects may enter structures. It also bonds on
surfaces as a cured foam and will not decompose under direct
sunlight.
• It will also seal and stop the passage of air, gases, water, dust
fibers, sound and odors.
 2. The Second Step for Rat Control is Trapping or Baiting
The most effective methods to get rid of rats is trapping them
and placing rodent baits.

• Reducing Rat Populations By Trapping

• Trapping does have some advantages over baiting. It provides
an alternative for those who do not want to place
rodenticides.
• If the rat population is small enough, trapping can yield quick
results when done properly.
• Finally, trapping ensures that you can dispose of the dead rats
before their odor becomes a problem in an inaccessible area.
 Get Rid Of Rats With Rodent Bait

• Rodenticides - poison baits

- used in areas where domestic animals
and children can't access them.
• protection against accidental poisoning, use tamper-resistant
bait stations that hold the baits in place and keep children and
pets out.
• It is a national law and guideline to use tamper-resistant bait
stations in areas where children or pets can access.
• We carry single feed bait (requires just one feeding for a lethal
dose.)
• Rat Baits come in pellets, meal, and block forms.
 Control methods for flies
• Fly Control: Prevention, Using the Right Products at the Right
Time

• **The first step to fly control is preventing flies from

becoming a problem in the barn and pasture areas, which is
best done by targeting the species most common to your
environment and most harmful to your horse.
• Reduce the number of flies by starting fly control early in the
season.
• Prevent flies from breeding – interrupt the life cycle.
• Use products that will target all the species in your area.
• Practice routine sanitation and take housekeeping – lower
down the flies population.
 Fly Control: Management, Maintaining and
Minimizing Throughout the Season

• Keep your pastures healthy and pick up manure daily. Cover

stored manure piles with clear plastic / hire a commercial
service for pick up and removal. Use a feed-thru fly control
product inhibit the development of adult houseflies and
stable flies in the manure of treated horses.
• Use good fly wear, such as Farnam's SuperMask® II Horse Fly
Mask, to help protect your horse's face, eyes and ears.
• Use equine fly control products on your horse, especially
around sensitive areas, which varies depending upon the fly
species.
• Available products include roll-ons, sprays and lotions; always
be sure to follow the product label’s directions for use.
 5 Steps for Indoor House Fly Control
• 1. House Fly Inspection
• have to know where they are and why they are there.
• inspect to find the areas and materials that are attracting the
flies and to identify the flies.
• 2. Sanitation Reduces Flies
• House flies are called filth flies because they are attracted to
filth. keeping things & cleaning the areas where they are
feeding and breeding.
• Keep trash closed in lidded containers and take out often.
• Clean spills quickly and cover any non-refrigerated foods.
• Keep pet feeding and litter areas clean.
• Fix drips and eliminate any areas of excess moisture.
• 3. Exclusion
• eliminating the ways that flies can get into the home,
"excluding" them from entry. These include:
• Keep window and door screens in good repair.
• Keep doors, windows and vents closed when not in use. Use
automatic door closing devices where possible.
• Caulk or cover other possible fly entry areas, such as around
vents, cracks and holes in the house siding, and windows or
doors. Screen vent openings.
• Plug weep holes with pieces of nylon, plastic scouring pads or
window screening.
• 4. Mechanical Control
• Fly swatters can kill small numbers of flies, but be careful to not
swat flies near food areas prevent flying body parts get into food.
• Trap flies with sticky fly papers or ribbons that include an odor
attractant. (Many are white because house flies are attracted to
white surfaces.)
• You can bait flies traps with molasses, sugar, fruit or meat. Pre-
baited traps often use fly pheromones (sex attractants).
• Ultraviolet light traps can be useful, but must be properly placed:
- where it cannot be seen from outside, so it doesn't attract flies
indoors;
- no more than 5 feet above the floor – where most flies fly;
- away from competing light sources (including sunlight) and food
preparation areas;
• 5. Chemical Control
• flies have become resistant to many insecticides making them even
more difficult to control. So, only when and where needed:
• Place pesticide-releasing fly strips in attics and small, unoccupied
rooms, such as closets and storage rooms.
• Use non-residual, contact aerosols that are labeled for flies to kill
adults. this does not get rid of the source, only temporary relief.
• Spray a residual insecticide, labeled for flies, around door and
window casings, onto screens, under eaves or around other fly
entry points.
• When using any pesticide, always read the product label and follow
all directions.
 Control methods for cockroaches
• HOW TO ELIMINATE COCKROACHES
1. IDENTIFY PROBLEM AREAS WITH FLASHLIGHT
• first examine your home for possible roach infestation sites.
• Using a flashlight to search popular roach hiding spots,
including behind the refrigerator, under the sink, crevices in
cabinets and shelves, closet door corners, bathroom cabinets
and closets.
2.PLACE GLUE STRIPS
• Use roach glue strips to locate large infestations. Based on your
flashlight inspection, decide on the most strategic areas to place
strips.
• Surveillance for a few days to a week. Strips in high-traffic areas
will catch the most roaches, and these areas will need the most
treatment.
 3.USE CAULK TO CLOSE GAPS
• won’t get rid of roaches on the outside trying to break in.
• use caulk to fill possible entry points, including gaps between
walls or tile, small crevices and entry holes. It will also help to use
weather stripping on doors and window seals.
4.GEL BAIT
• effective roach killer. Gel bait usually in the form of a tube and can
be applied under baseboards, in cracks and crevices, and near areas
that are most likely to attract roaches. Result in a number of dead
roaches lying around your home.
7.PEST MANAGEMENT PROFESSIONAL
• Hiring a Terminix specialist to treat a roach infestation can increase
safety, ongoing solution to cockroach control. It also eliminates the
need to have traps scattered around your home.
 5.ROACH HOTELS
• Bait stations - attracting roaches into stations to feed on poison.
The poisoned roach then travels back to its home location, dies and
is eaten by the other roaches, further passing on the poison.
• work partially to get rid of roaches, but do not target all roaches in
a home. they contain poison and look unappealing when scattered
around your home. Some roach hotels only contain glue to trap the
roaches, not bait and poison them.
6.BORIC ACID POWDER
• a substance found in products like clothing detergent and
toothpaste, can be one of the best roach killers.
• easily misapplied and subject to displacement by air currents,
sending the material into areas where children and pets can come
into contact with it. Boric acid is low in toxicity to people and pets
but deadly to cockroaches. When used incorrectly, boric acid will
lose effectiveness if misuse. not
• recommended as the sole method for getting rid of cockroaches.