Dengue Outbreak Response and Control in Khyber Pakhtunkhwa, Pakistan: A Mixed Methods Study.

BACKGROUND: Since 2008, dengue fever outbreaks had occurred repeatedly in various districts of Khyber Pakhtunkhwa (KP) province of Pakistan. Most importantly the outbreak of 2017 caused 70 deaths, about 121,083 suspected and 24,938 confirmed cases in 23 districts of KP. In 2018, an abrupt decline in suspected and confirmed dengue cases was observed and 2018 was declared as dengue outbreak free. This study characterizes and explores the control and response measure activities of the outbreak. In addition, we explored the challenges faced and lessons learned for control of future dengue outbreaks from the perspectives of health authorities and dengue response staff in the KP province of Pakistan. METHODS: This was a mixed methods study with quantitative data on dengue outbreaks obtained from health department in KP followed by qualitative study to explore activities and responses that enabled the Dengue Response Unit (DRU) for a successful dengue outbreak control in 2018. In-depth interviews were conducted with the key informants from the department of health and the dengue response unit. RESULTS: The quantitative data analysis revealed a huge decline of suspected and confirmed dengue cases in comparison with the previous year in most of the KP districts. A similar decline in dengue reported cases was also observed from previously high dengue burden 14 union counsels of Peshawar district. Among the 70 verified deaths in 2017, 44 (63%) were males and 26 (37%) were females. The cases were about 20% each from age groups of 21-30, 41-50, and 51-60 years. The qualitative study findings showed four prominent major themes for successful control: (1) control and response strategy; (2) organizing specific dengue control and response intervention activities; (3) addressing dengue control and response challenges; and (4) generating lesson for future dengue control and response.

30 years of fatal dengue cases in Brazil: a review.

BACKGROUND: Over the last 30 years, extensive dengue epidemics have occurred in Brazil, characterized by emergences and re-emergences of different serotypes, a change in the epidemiological profile and an increase in the number of severe and fatal cases. Here, we present a review on the dengue fatal cases that occurred in Brazil in 30 years (1986-2015). METHODS: We performed an ecological study by using secondary data on dengue fatal cases obtained in the National System of Reported Diseases (Sistema de Informação de Agravos de Notificação -SINAN) and in the Mortality Information System (SIM), both maintained by the Brazilian Ministry of Health. Cases were analyzed by region, demographic variables, clinical classification and complications based on the data available. RESULTS: In 30 years (1986-2015), the Southeast region reported 43% (n = 2225) of all dengue deaths in the country. The Midwest region was responsible for 18% of the fatal cases. After 2000, deaths occurred in almost all states, with the exception of Santa Catarina and Rio Grande do Sul, South region. From 2006 to 2010, the number of deaths increased, with higher rates of mortality, especially in Goiás and Mato Grosso. From 2011 to 2015, Goiás became the state with the highest mortality rate in the country, and Rio Grande do Sul reported its first dengue deaths. In 30 years, a total of 2682 dengue deaths occurred in males and 2455 in females, and an equal distribution between the sexes was observed. From 1986 to 2006, dengue deaths occurred predominantly in individuals over 15 years old, but this scenario changed in 2007-2008. After 2009, fatal cases on individuals above 15 years old became more frequent, with peaks in the years of 2010, 2013 and 2015. CONCLUSIONS: The Brazil is experiencing a hyperendemic scenario, which has resulted in the co-circulation of the four DENV serotypes and with the increasing occurrence of severe and fatal cases. The disease surveillance and studies characterizing what has been reported overtime, are still important tools to better understand the factors involved in the disease outcome.

Dengue mortality in Colombia, 1985-2012.

INTRODUCTION: Dengue in Colombia is an important public health problem due to the huge economic and social costs it has caused, especially during the disease outbreaks.  OBJECTIVE: To describe the behavior of dengue mortality in Colombia between 1985 and 2012.  MATERIALS AND METHODS: We conducted a descriptive study. Information was obtained from mortality and population projection databases provided by the Departamento Administrativo Nacional de Estadística (DANE) for the 1985-2012 period. Mortality rates, rate ratios, and case fatality rates were estimated.  RESULTS: A total of 1,990 dengue deaths were registered during this period in Colombia. Dengue mortality rates presented an increasing trend with statistical significance between 1985 and 1998. Higher mortality rates were reported in men both younger than 5 years and older than 65 years. Between 1995 and 2012, category 1 to 4 municipalities reported the highest mortality rates. Case fatality rates varied during the period between 0.01% and 0.39%.  CONCLUSION: Dengue is an avoidable disease that should disappear from mortality statistics as a cause of death. The event is avoidable if the proposed activities from the Estrategia de Gestión Integrada (EGI)-Dengue are implemented and evaluated. We recommend encouraging the development of an informational culture to contribute to decision making and prioritizing resource allocation.