Dengue is the fastest growing mosquito-borne infectious disease today and health organizations around the world are trying to find ways to prevent its occurrence. While most people will recover from an infection without any lasting problems, children and the elderly are susceptible to developing the more deadly form of the disease called dengue hemorrhagic fever. This essay reviews current global and U.S. strategies to combat this emerging health threat.
Repost: Dengue in Africa
The incidence of dengue infections has risen 30-fold over the past 50 years and most of this increase is not due to advances in detection or awareness (WHO, 2012). The relatively rapid increase is due primarily to uncontrolled urban development, which leads to the accumulation of human refuse capable of trapping and storing rainwater. Discarded tires, soda cans, and plastic bottles can trap water, even in arid climates, and provide an excellent habitat for egg laying by the primary dengue vector, Aedes aegypti. The overall result is that dengue has emerged as the fastest growing mosquito-borne disease in the world today and causes between 50 and 100 million dengue infections every year globally. Nearly half the global population lives in regions where dengue is considered endemic, including 22 countries in sub-Saharan Africa (Amarasinghe, Kuritsky, Letson, and Margolis, 2011). This essay will examine the resources, both human and financial, that are being used to tackle dengue in Africa.
Dengue in Africa
The primary tools being used to combat dengue today are adequate medical care for infected individuals (diagnosis and treatment), infection surveillance, and vector control (Nathan, Dayal-Drager, and Guzman, 2009). A viable vaccine is anticipated within the next few years (WHO, 2012) and the success of antiviral drugs for treating HIV has encouraged similar research and development efforts for treating dengue infections (Nathan, Dayal-Drager, and Guzman, 2009). However, the implementation of these control and treatment strategies in Africa, a region with minimal health infrastructure, dengue surveillance, or vector control programs, will likely be in the distant future.
The World Health Organization (WHO) has identified three goals related to combating dengue in the foreseeable future (WHO, 2012). These are reducing mortality by >50%, reducing morbidity by >25%, and estimate the true burden of the disease by 2015. The last goal is very revealing, because the data for estimating the true prevalence of dengue in Africa is nonexistent and by extension, the financial and human resources needed to combat dengue in Africa are also almost nonexistent.
The WHO has also outlined the most important strategies for achieving these goals in regions where the disease is endemic (WHO, 2012). These are recruiting and training medical personnel for diagnosing and managing dengue infections, establishing the laboratory resources needed to diagnose dengue, create a surveillance and outbreak response infrastructure, develop sustainable vector control programs, develop effective and cheap vaccines, and engage in research. Very little of this exists in sub-Saharan Africa. A visit to the Health Ministry websites of Kenya, Nigeria, Liberia, and the Democratic Republic of the Congo, countries where dengue is considered endemic, reveals an almost complete absence of such programs or concern.
The U.S. And its Fight Against Dengue Globally
The primary agency responsible for global disease surveillance in the United States is the Centers for Disease Control and Prevention (CDC). Although dengue is not endemic to the U.S. except for the southern tip of Texas (Brunkard et al., 2007), there is still considerable concern about imported cases. For example, between 2001 and 2007, 796 dengue cases were imported into the United States (Nathan, Dayal-Drager, and Guzman, 2009). Despite the increasing threat of dengue to the U.S., budget constrains have led to proposed budget cuts within the CDC, including programs addressing emerging and zoonotic infectious diseases (ASTMH, 2013). However, between 2000 and 2010 the National Institute of Allergy and Infectious Diseases increased funding for domestic and foreign dengue researchers from $5.2 to $44.4 million (NIAID, 2011).
The President's proposed 2013 budget also shifts funding around to effectively increase contributions to the Global Fund to Fight AIDs, Tuberculosis and Malaria by 60%, which should indirectly help dengue vector control programs and improve health system infrastructures in developing countries (ASTMH, 2013). Importantly, the Bill and Melinda Gates Foundation contributed $1.5 billion dollars to this fund (Gates, 2013) and Germany is contributing another billion Euros (Niebel, 2013).
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