Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans. 1. Introduction Dengue, a mosquito-borne viral disease, is emerging as one of the world’s most rapidly spreading and important infectious diseases of the twenty first century [1] A somewhat different disease scenario exists today, with all four viral serotypes circulating in Asia, Africa, and the Americas, an estimated 3.6 billion people living in dengue endemic countries, and over 50 million dengue infections occurring annually [2]. The increasing global threat of dengue outbreaks in both endemic and nonendemic regions has led to a focus on establishing an effective outbreak response. A dengue outbreak response has been defined as the sum of measures specifically addressing a dengue outbreak, with the aim of reducing case fatality rates, case number, and entomological parameters [3]. In addition to this, in order to detect the outbreak, systematic surveillance needs to be in place. Emergency preparedness and anticipated response planning are an integral part of dengue control, yet this is often neglected in dengue endemic countries [1]. Different measures need to be implemented depending on the context of dengue in the area. Thus, in endemic areas, the ability to
References
[1]
WHO & TDR, Dengue Guidelines for Diagnosis, Treatment, Prevention and Control, World Health Organisation (WHO) & Special Programme for the Research and Training in Tropical Diseases (TDR), Geneva, Switzerland, 2009.
[2]
D. J. Gubler, “The economic burden of Dengue,” The American Journal of Tropical Medicine and Hygiene, vol. 86, no. 5, pp. 743–744, 2012.
[3]
D. Pilger, M. de Maesschalck, O. Horstick, and J. L. San Martin, “Dengue outbreak response: documented effective interventions and evidence gaps,” TropIKA, vol. 1, no. 1, 2010.
[4]
J. Farrar, D. Focks, D. Gubler et al., “Towards a global dengue research agenda,” Tropical Medicine and International Health, vol. 12, no. 6, pp. 695–699, 2007.
[5]
C. Pope, S. Ziebland, and N. Mays, “Analysing qualitative data,” British Medical Journal, vol. 320, no. 7227, pp. 114–116, 2000.
[6]
WHO, Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever, WHO Regional Office for South East Asia, New Dehli, India, 2011.
[7]
WHO, Asia Pacific Strategy for Emerging Diseases, World Health Organisation, Geneva, Switzerland, 2010.
[8]
R. Krumkamp, S. Mounier-Jack, A. Ahmad, R. Reintjes, and R. Coker, “Evaluating health systems' preparedness for emerging infectious diseases: A novel conceptual and analytic framework,” Health Policy, vol. 98, no. 2-3, pp. 91–97, 2010.
[9]
Queensland Health, Queensland Dengue Management Plan 2010–2015, 2011.
[10]
M. I. González Fernández, E. Orozco Nú？ez, and E. Cifuentes, “Policy analysis of the dengue control program in Mexico,” Revista de Saúde Pública, vol. 44, pp. 1079–1086, 2010.
[11]
J. Barbosa da Silva Jr., J. B. Siqueira Jr., G. E. Coelho, P. T. R. Vilarinhos, and F. G. Pimenta Jr., “Dengue in Brazil: current situation and prevention and control activities,” Epidemiological bulletin, vol. 23, no. 1, pp. 3–6, 2002.
[12]
O. Horstick, S. Runge-Ranzinger, M. B. Nathan, and A. Kroeger, “Dengue vector-control services: How do they work? A systematic literature review and country case studies,” Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 104, no. 6, pp. 379–386, 2010.
[13]
K. Griffiths, M. R. Banjara, O'Dempsey T, B. Munslow, and A. Kroeger, “Public health responses to a Dengue outbreak in a Fragile state: a case study of Nepal,” Journal of Tropical Medicine, vol. 2013, Article ID 158462, 8 pages, 2013.
[14]
C. Heintze, M. V. Garrido, and A. Kroeger, “What do community-based dengue control programmes achieve? A systematic review of published evaluations,” Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 101, no. 4, pp. 317–325, 2007.
[15]
D. J. Gubler, “Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century,” Trends in Microbiology, vol. 10, no. 2, pp. 100–103, 2002.
[16]
D. J. Gubler, “How effectively is epidemiological surveillance used for dengue programme planning and epidemic response?” Dengue Bulletin, vol. 26, pp. 96–106, 2002.
[17]
O. Wichmann, I.-K. Yoon, S. Vong et al., “Dengue in Thailand and Cambodia: an assessment of the degree of underrecognized disease burden based on reported cases,” PLoS Neglected Tropical Diseases, vol. 5, no. 3, article e996, 2011.
[18]
M. E. Beatty, A. Stone, D. W. Fitzsimons et al., “Best practices in dengue surveillance: a report from the asia-pacific and americas dengue prevention boards,” PLoS Neglected Tropical Diseases, vol. 4, no. 11, article e890, 2010.
[19]
R. L. Malcolm, J. N. Hanna, and D. A. Phillips, “The timeliness of notification of clinically suspected cases of dengue imported into north Queensland,” Australian and New Zealand Journal of Public Health, vol. 23, no. 4, pp. 414–417, 1999.
[20]
M. Barry and B. G. Blackburn, “Dengue outbreak in Kenya: sign of a larger issue in this region?” Travel Medicine Advisor, vol. 21, pp. 69–71, 2011.
[21]
S. Runge-Ranzinger, O. Horstick, M. Marx, and A. Kroeger, “What does dengue disease surveillance contribute to predicting and detecting outbreaks and describing trends?” Tropical Medicine and International Health, vol. 13, no. 8, pp. 1022–1041, 2008.
[22]
C. Bruckner and F. Checchi, “Detection of infectious disease outbreaks in twenty-two fragile states, 2000–2010: a systematic review,” Conflict and Health, vol. 5, no. 1, article 13, 2011.
[23]
A. S. Bin Ghouth, A. Amarasinghe, and G. W. Letson, “Dengue outbreak in Hadramout, Yemen, 2010: an epidemiological perspective,” The American Journal of Tropical Medicine and Hygiene, vol. 86, pp. 1072–1076, 2012.
[24]
T. W. Scott and A. C. Morrison, “Vector dynamics and transmission of dengue virus: implications for dengue surveillance and prevention strategies: vector dynamics and dengue prevention,” Current Topics in Microbiology and Immunology, vol. 338, no. 1, pp. 115–128, 2010.
[25]
S. Badurdeen, D. Benitez Valladares, J. Farrar, et al., “Sharing experiences: towards an evidence based model of dengue surveillance and outbreak response in Latin America and Asia,” BMC Public Health, vol. 13, article 607, 2013.
[26]
E. Esu, A. Lenhart, L. Smith, and O. Horstick, “Effectiveness of peridomestic space spraying with insecticide on dengue transmission; systematic review,” Tropical Medicine and International Health, vol. 15, no. 5, pp. 619–631, 2010.
[27]
D. Pérez, P. Levèvre, L. Sánchez et al., “Community participation in Aedes aegypti control: a sociological perspective on five years of research in the health area “26 de Julio”, Havana, Cuba,” Tropical Medicine and International Health, vol. 12, no. 5, pp. 664–672, 2007.
[28]
W. Parks and L. Lloyd, “Planning social mobilization and communication for dengue fever prevention and control: a step-by-step guide,” TDR/STR/SEB/DEN/04.1, WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland, 2004.
[29]
K. M. Tomashek, C. J. Gregory, A. Rivera Sánchez, et al., “Dengue deaths in Puerto Rico: lessons learned from the 2007 epidemic,” PLOS Neglected Tropical Diseases, vol. 6, no. 4, article e1614, 2012.
