Dengue fever (DF) also called as yellow fever or backbone fever is one of the most important disease which are spread by arthropods .It is very old and major public health problem .It is cause by a virus family called Flaviviridae and its vector is a female mosquito called Aedes aegypti. Dengue fever is first spread by ship trading between different countries in which water containers on ships are used by the vector mosquitos.1 The world war 2 and the army movement from west to east also produce this condition.1 In Asia and America dengue fever is very common specially in East Asian countries like Sri Lanka and Pakistan.2 Its prevalence is high as compared to past years especially from 1950s to onward. It is now spread very fast and its rate is increased in recent years. For the period 2000-2004,The number of cases per year is 925,896 cases, almost double of cases in period from 1990-1999 which are 479,848 (WHO).Also according to World Health Organization every year about fifty million people affect by this fever and 2.5 billion are at risk. The wide spread of the disease is due to increase population, global trading, bad cleanliness and poor management .3
DF is very important in case of health care because firstly it is widely spread in the whole world and its transmission is very easy. There primary host is human and they give there eggs in fresh water which is very strange. Their single bite is enough to produce virus in the body of any human.4 and this mosquito usually bite in early morning and early evening when people are normally not active (WHO) .Also as the virus is in blood so it can be transmit from blood donation and infected blood tools and products. Then It comes mostly without any symptoms in most of the patients, Its spread rate is also very fast. The virus takes about 10-14 days to show its symptoms.5 Its symptoms are not tolerable to healthy human like headache, joint pains, muscle pains and high fever.1 It is also very dangerous to life as it can be transfer to serious conditions like dengue hemorrhage fever(DHF) in which whole body shows hemorrhage under skin in form of patches. In DHF the platelet count is decrease to high levels and is the main cause of death about 25% in dengue patients(WHO)DF and DHF is also result into life killing situation called dengue shock syndrome (DSS).Children and elderly patients are at more risk. Dengue fever is also linked with other conditions and affect other body system also. The disability adjusted life years (DALY) for dengue is 1300 per million of population. DF is also can result into brain infections and liver failure (WHO). Dengue virus is now show variety of types which also result into its widespread and further problem to its prevention.6 It is also one of neglected tropical disease according to WHO.
These all things show serious effect on health of public ,society and economics of any region. If we talk about its effect on public health ,it is very big and harmful. As we know that its rate is increasing with years and that it is now a major public health problem. It is almost present in 100 countries in which DHF is in more than 60 percent patients.7 It is present widely in America and Asian countries. The main problem which make it problem that during early period the patient shows no symptoms but as times passes the patient start showing symptoms but at this time it is difficult to control this disease. It is the reason that this disease is widespread in areas where there is no planning to prevent this before the patient shows symptoms. No strategies and planning from government and health sector is the biggest cause in increasing its rate. The major population affected is children and older people. once the disease progress it becomes burden on hospitals and for the public.
Social impact of DF is also very important. During early years like in 1950s ,little program was used to fight this disease and was successful but as DF start spreading it becomes difficult to control this condition. It become really difficult to remove it from society. Because of no monitoring of DF and especially DHF at that time no good strategies can be developed to fight this condition.8 Because of the poor planning to control this fever, it results into social burden. The public ,clinics and hospitals can be confused. The hospitals become overcrowded and this also further increase the social problems. Families of the patients are also disturbed .In such cases government sometimes plan strategies to control mosquito spread but due to cost of such sprays ,it is not very useful. For example use of ultra low volume insecticide space sprays is tested but it is not very useful.9 In such cases then public try to find other cheap alternatives which further increase the rate of DF and DHF and end up in the situation that such fever cannot be control.10
It is very clear that such a condition is also a burden for the economic for any region. Some studies shows this burden like in Thailand it is estimated that about 40 million dollar was spent in a single year to control DF.11 Similarly in Cuba it was about 100 million dollar in which half of the cost is for mosquito control only. Not only this but the cost is increased as the time passes for example in America ,a study shows the cost for control of DF is about 10 million dollar in 1977 which increase to 12 million dollar in 1994.This shows that the rate and spread of this fever is increasing with time .Also during epidemics of DF other economic burdens due to absences from office, schools and social problems takes place. These all things make dengue fever similar to malaria ,tuberculosis and other infectious diseases 12 so bad financial management fails to remove the epidemic on one side but also disturbed the economics of other sectors within the region.
These are major impacts of dengue fever and its related complications. DF is an epidemic which should be control by best planning and strategies .In the past many countries show planning strategies which are also successful to some bases. So it is need that a program is produced with many of such strategies to control the spread of dengue fever in small time. Not single strategy is useable in controlling dengue fever but a plan or program is needed. On the large level World health Organization gave a standard program for the control of dengue fever which is used by several countries. But as different regions have different environment and difference in system so every region should produce a plan which suit it mostly. Management and prevention of any disease should involve three basic parts of public health which are disease prevention, disease education and disease treatment .So for dengue fever these public health parts can be used in solving different public health problems. Dengue fever can be managed by fighting with original cause and vector of this disease .The original cause is virus which is not easy to remove from community but mosquitoes and their larvae can be control and removed from the community. This can be done if we start from individual to community level. For example start from home level ,then manage communities ,then the whole region. In this all management the normal public health persons and government should help each other. It can not be done by single team or person. Also new and good methods and strategies are produced which are successful to prevent this fever. It is not job of single month but it takes years .Epidemiology studies are very important in these conditions because these studies tells us about the environment of that area where dengue fever and its complications are present. Also epidemiology studies tells us what type of population lives in that area. How many children, adults are there. What is the history of disease there. What is the prevalence of disease in that area. Is the rate of disease high in recent years or not. What is the number of women and men in that area. How is the quality of life in that area and how many other diseases are present in that area. These all thing tells us very useful information about the area .By use of such information we can make a very good program which suits that area and helpful in treating dengue fever.
The removal and prevention of this DF can be started from individual level. As we talk before that most easy and good way is to prevent or remove from vector of this disease which is female mosquito .If we control it from individual and home level then it will not spread in the community and it will not become epidemic. This mosquito normally lives on fresh water where it give eggs which again produce adult mosquitoes . Also we can prevent the mosquito from biting so that the virus from mosquito not reaches the blood of individual and do not get dengue fever. For this first thing is public education .All the individual in the community should get education from media, newspapers, health person that how to do such things and what is the benefit of doing these things. What will the damage if the persons will not do such things. There are number of things which a person can do to avoid the mosquito. Firstly try to remove all the fresh water places in the home. For example if there is plants in the home try to avoid over water them .Also in containers like pots where water is present .try to cover these containers. The tires of vehicles and toys of children [resent in the backyard of home is usually filled with water and should be monitored Also try to not drop water in the different areas of home so that no mosquito can be produce. This problem is mostly present in the countries and areas where there is not good system of sanitation and water is not easily removed from the houses especially after raining. In such area care should be there to remove the water early. Also it is important that in countries within Asia ,there are four weathers in the years and this mosquito develops from eggs before summers and winters because it cannot live in such conditions. These are also the time o year when there is more raining in such areas which increase the chance of this mosquito production. So extreme care should be there. The best solution is to maintain the sanitation from home level. The fish containers like aquarium are also become source for this mosquito production. The areas where water can not be removed such as in aquarium and places of drinking water, here a person can use chemicals like organophosphate which is not very useful but is better than nothing.13 These chemicals should be of quality and their amount should be in limits so that they do not disturb the health of a person. This is called chemical control for this vector. In chemical control also other things come like room and home sprays to fight this mosquito, use of mosquito nets and use of repellants. Repellants are very good in this sense. Because they prevent mosquito from bite. The best repellent is now a days is N,N-Diethyl-meta-toluamide, abbreviated as DEET, which is slightly yellow oil and is present in market products .14 Also the time and way of application of repellent is very important. As this mosquito bite in early day and early evening ,this is the best time to apply these repellants. Application is important and should apply to all the body parts which are not covered with clothes usually like hands, arms , feet, neck and face area. Check also for any reaction or redness of skin because some people can not tolerate the chemicals in these repellents. Also the type of clothes use is very important. Try to wear the clothes which cover the body so mosquito cannot bite. Try to not wear clothes which are thin or made of net so mosquito can not bite. The hydration status of individual should be very good to fight against this disease, so the individuals should drink plenty of water to keep their body hydrated all the time. It is very important and strange that this mosquito produce from fresh water and not from dirty water so do not waste time in removing dirty water. It is also very important that the family
Individual can do all these preventions if he can manage but children and elder people are not very active to do such things. In this case the other people in the family take care of them. For example parents of the children should take care of their children when they go to school. The school uniform should be make of clothes in which no body part is uncovered. Also the container for water or water bottles should be covered properly. The repellent is applied to children at proper time and take care of the place where they sleep. Also the elder people are at risk of the bite of mosquito as their immune system is not very good. Care also should provide to them in case of their sleeping place and repellent application. Moreover the care taker of home or all the adults members of any home should help each other to remove fresh water places not only in the home but also near to neighbor of home especially in rainy season. The refrigerator is very common place for the production of Aedes aegypti. In terms of education they should teach their children and neighbors how to fight with this mosquito or prevent it to bite. They should teach the children not to drink from open space when ever they are away from home or in the study centers or in the playing areas. Also it is the duty of parents that if they find any symptom of dengue or any signs of dengue like symptom like flue, high fever, they should immediately consult doctors because the dengue fever is spread very quickly within the family members and then to the neighborhood areas. It is seen and is important that money should not be spend in low quality products and non necessary things which affect the budget of family.15 It is also very important that if treat fever, give only paracetamol and not the aspirin because it increases the chances of bleeding in such fever.
Then comes the role of whole community. Community is made up of number of homes ,living areas ,markets ,schools, offices ,roads and other populated places. As dengue fever is spread by mosquito whose host is human so it can be spread anywhere where people are present .Now it is the duty of people living in the communities and the government to help each other to apply all the possible strategies to prevent mosquito spread and to control the eggs production of these mosquitoes. What people can do here is to accept government policies, help the government persons, recommend the government person about any better plans, educate the people live around them and try to make stronger minds in preventing this fever. The students from university can help in a good manner. They can work with spray teams to speed up the whole program and decrease the burden on the government. The role of health sector is very important. Dengue prevention is very effective to avoid patient from having this disease but if patient get this disease ,it is not easy to control. About 5 % of patient reaches to risky stage which is DHF and most of them died. 13 Doctors and health care staff should be educated about the epidemiology of the area where they are practicing. They should also up to date to new and successful policies in case of treatment their should be proper management system in hospitals to treat dengue patients especially in outbreak conditions. The environment of the hospital should be clear of any chance of mosquito production. The working of hospital laboratories is very important. Because dengue is diagnosed with blood samples, so laboratories should be very active in taking blood samples fast and get the right result to have knowledge of how many patient in that area. This also help the government in policy management. The team for the sprays at community level should be guided by the hospital staff. Care should be take during transfusion of blood because dengue virus is present in blood of the patient. Beside all this treatment the patients also motivate to increase there immunity against this fever. The pharmacies of that area can also counsel the patients to fight with this disease
Now if we talk about government role, its role is equal to public role in fight dengue fever and is very much important .Without Government help nothing can achieved. Government policies are not only apply to societies like different councils where people live but also to the schools ,offices, commercial places and most important to health care place like hospitals, clinics where dengue patient is treated. The most important policy of government is to educate people how to prevent from this fever by messaging from newspapers, T.V channels, advertisements, door to door leaflets. This is the most important thing to make stronger mind from home level to fight against dengue fever. Also government education program is used at school level, universities, collages and offices to make people and children aware of this disease. At community level ,government can take care of places where always there is fresh water present like ponds in parks, streams, wells and can preserve these places by thin application of mosquito repellent films .Also the areas where people spend time in drinking and bathing like public toilets should be monitor that no water should be stand there for long. Also the construction of areas and their sewerage system should be good. Roof gutters are very important in favor of production of larva for Aedes aegypti .They are difficult to maintain and should be removed .16 This is done in Singapore where new buildings are made with no roof gutter at all.(WHO)The chemical control of the vector is very important and government with the help of health trust of every area should start campaigns to spray that area, homes, schools and commercial places at regular periods in risky seasons. For this few holidays can be give to people to carry out this spray. The quality of spray should be very good and finance department should involve in purchasing that chemicals. Moreover the team selected for the spray should educate the people about the scheme so that there is more awareness in people about this epidemic. In these years after chemical control, biological control is very effective. A lot of research is done to use biological control and not the chemical control because it is more safer than chemical control. Biological control involves use living organisms to eat mosquito larvae from fresh water places like streams, ponds, aquariums. These fishes eat these larvae and then no mosquito is produce from this. This is very speedy method but when time and how it is used is very important. Government can produce a policy that which organism like fish or crustaceans are good in which area ,what time they can be used and how much the amount. If government wants to use in school and home like in aquariums then the normal public should help them. Biological control is very successful. In northern Viet Nam ,government use copepods to remove larvae of the mosquitoes in large water tanks .Similarly in Sri Lanka ,Australia and Pakistan they use small carnivorous fish like guppies and gold fish and it is successful . 17,18 When we talk about policies of government in health sectors, they should include proper wards for dengue patients in risky areas. The laboratory is up to date. The diagnosis should be right and policies are there to control the hospital transmitted virus. The environment of hospital should be cleaned and staff should be educated. As dengue treatment is quite expensive when it is at the end stage. In the end stage patient requires white blood cells. For this new technology and donors are needed. So it is the duty of government that it provide hospitals with that technology before the risky season and people should be aware of donation. It can be done only when people support the government and government is serious towards dengue prevention program. These all things should be there before time in order to fight any dengue outbreak.
The most important thing for these policies is check whether they are working or not. This is called surveillance. In this it is checked that how many new patients are produced from dengue fever. Is the service in the favor of normal public or not. Are the population support these policies or not. Are they aware of this program. The new cases of dengue fever can be checked through laboratory data where blood sample is taken from these patient. Also the death rate for the dengue patients can be check from hospital data. The removal of larvae from fresh water sources can be check through taking samples from these places regularly. This help in telling the usefulness of chemical control or biological control in the strategy use so it can be improved. After all this surveillance more and more betterment can be use for further studies and research.Dengue.net is database used by WHO to collect surveillance data from several countries so that better plans can be produced. The expanses in developing all the policies should not disturb the other areas of any region like education sector, transport and tourism.
Dengue become now big threat especially to tropical countries in terms of economics, public health but also to the tourism and beauty of any region. The good thing is that all of the policies which are currently used are very good and very successful in many regions. They are very helpful in terms of future research and policies to fight with dengue fever and its complications .The future of dengue prevention is vaccine development for dengue virus ,antiviral drugs against this virus and new tools to make these policies better and better. The vaccine development is very good in terms of complete removal of this disease from the globe but it is facing many challenges because of the resistance cause by virus and number of implementation problems .19 Similarly the antiviral drug development is not easy thing and is under process for the final product .Now a days the antiviral drugs are in their starting levels.20 But if we see the different controlling methods and tools in managing this dengue epidemic ,they are now better than the past. The application of these all methods especially in the health sector and especially community regions is improves. People are now more aware of this epidemic. World health organization role is very active in this as a global supporter. Because the vaccine development and antiviral drugs are there in start so need is to improve further such policies and make them more effective .This can done by take help form the experts and researches from other countries and apply the successful strategies in risky areas .This help can be in shape of research ideas new strategies, findings ,communication and help from scientists. By the import and export of research ideas not only the communication will be good but also the new knowledge of health sector such as treatment of dengue will be share among different countries. In this case work is done between Bill Gates company and Asia-Pacific Dengue Prevention Partnership and the European union's DENFRAME(WHO). Also the research funds should be increased and proper budget should be give to the control of such epidemics. Such a better thinking, policies and future planning will not only free people from this big public health issue but also to give help in search of producing new scientific ideas which can help the society in good way.
