Epidemiology of Arboviruses
Challenge to Control
Citra Indriani
Departemen Biosta;s;k, Epidemiologi dan Kesehatan Populasi Fakultas Kedokteran, UGM
Outline
•
Arbovirus
•
Arbovirus of Public Health Importance
•
Main transmission cycle
•
Brief on Dengue, Zika, Chikungunya
•
Global Distribu;on of Arbovirus
–
Dengue, Zika and Chikungunya
Arbovirus
•
Not taxonomic indicator – describe need of vector on
their transmission
•
Viruses that are
transmi(ed
between arthropod and
vertebrates (people and mammals)
•
Arthropod
–
mosquitoes, ;cks, sandflies, midges, bugs, etc.
–
the infected one
don’t show detectable sign
of sickness an
–
virus may remain for life
Arbovirus
"
AR
thropod
Bo
rne
Virus
".
14 families
535 species
Karabatsos N. Interna;onal catalogue of arthropod-borne viruses. 3rd ed. San Antonio: American Society for Tropical Medicine and Hygiene, 1985.
Liang, G., Gao, X., & Gould, E. A. (2015). Factors responsible for the emergence of arboviruses; strategies, challenges and limita;ons for their control. Emerging Microbes & Infec1ons, 4(3), e18–. h`p://doi.org/10.1038/emi.2015.18
1985
20XX
•
Not all are pathogen
•
Highly adapted virus
•
Immense resource for emergence new pathogen in future
Arbovirus
Pathogen to Human
•
100 species
•
4 main families
–
Flaviviridae
–
Togaviridae
–
Bunyaviridae
–
Reoviridae
Disease in Human
•
wide range
–
sub clinic – fatal
haemorrhagic/encephali;s
•
oden resolve spontaneously
•
no specific treatment,
–
symptoma;c treatment, fluid
Most Arbovirus of
Public Health Importance
Transmi(ed by Flaviviridae
Flavivirus genus
Togaviridae
Alphavirus genus
Bunyaviridae
Bunyavirus genus
Mosquitoes • Dengue
• Zika
• Yellow Fever
• Japanese E
• West Nile
• Chikungunya
• Mayaro
• O nyong nyong
• Eastern equine encephali;s
• Western equine encephali;s
• Venezuela equine encephali;s
Ticks • Tick-borne Encephali;s
• Kyasanur Forest Disease
(KFD)
• Alkhurma Disease
• Omsk Hemorrhagic
Disease
• Crimean-Congo
Hemorrhagic Fever (CCHV)
US CDC, Na;onal Center for Emerging and Zoono;c Infec;ous Diseases (NCEZID) Division of High-Consequence Pathogens and Pathology (DHCPP) Viral Special Pathogens Branch (VSPB), April 2014
Dash AP1, Bha;a R, Sunyoto T, Mourya DT (2013). Emerging and Re-emerging Arboviruses in South East Asia. J Vector Borne
Examples of Arthropod Vectors
Aedes Aegyti
Assorted Ticks
Phlebotmine Sandfly
Culex Mosquito
Transmission Cycle
* Both cycle may be seen with some arbovirus such as yellow fever ** iden;fy in Indonesia
Man - arthropod - man Animal - arthropod vector – man (zoonosa)
Example
• Dengue**
• Zika**
• Chikungunya**
• Urban Yellow Fever*
• Japanese encephaliYs (JE)**
• Eastern equine encephali;s (EEE) • Western equine encephali;s (WEE) • Jungle Yellow fever*
Reservoir • Man
• Arthropod vector • Animal
Other
• Arthropod transovarial
transmission may take place
• virus is maintained in nature in a transmission
cycle involving the arthropod vector and animal
Brief on Dengue, Zika, Chikungunya
Dengue
Chikungunya
Zika
History
• Clinical descrip;on 992 China
• Batavia- joint fever • 1990: Viral e;ology
(Ashburn and Craig)
• Fever, myalgia, arthralgia, headache, rash, nausea and vomit
• 1953 in Tanzania • Severe
artralgia-persist
• Local name
Makande-bends up
• Similar to dengue and zika
• 1947 Uganda Forest • Zika forest
• Iden;fied in
Macaque monkey
• Fever, rash, non
purulent conjunc;vi;s
Fatal/
Disability • Fatal
• Rare fatal
• Chronic joint pain
• Rare fatal excl. GBS
• Pregnancy outcome
Asympto ma;c
• yes • 50%
• yes • yes
Outbreak
• First well documented outbreak 1779 -1780
• 1956 in Manila : DEN 3 & 4
• 2004 large
outbreak Africa and Southeast Asia
• 2015 rapidly
progress western
• Africa, South East
Asia un;l 2007 – Micronesia (73% of island was infected during outbreak)
Global Distribu;on Arboviruses
Geography distribu;on of Dengue
Blue dot: Geographic extension of dengue 2000-2007 Blue shaded areas: Risk of dengue transmission
Suitability for Dengue Transmission
Suitability for Dengue Transmission
High suitability
Low suitability
Zika virus
• 63 countries ac;ve transmission, 20 countries report microcephaly and other neurological abnormali;es
• 2 cases in Jambi
• 115 locally acquired cases in Singapore as of today • Previously found in Klaten among hospitalized
Global Chikungunya DistribuYon
Countries and territories where chikungunya cases have been reported* (as of April 22, 2016)
EsYmated Global DistribuYon of
Dengue, Zika, and Chikungunya, 2016
Range DistribuYon of Ae.aegypY and Ae. Albopictus
in US
Pa`erson, J., Sammon, M., & Garg, M. (2016). Dengue, Zika and Chikungunya: Emerging Arboviruses in the New World. Western Journal of Emergency Medicine, 17(6), 671–679. h`p://doi.org/10.5811/westjem.2016.9.30904
Disease Spread Globally
Global Air Travel
•
59,036 routes (2012),
Challenge in Control Strategy
Opportunity to control - Challenge
SuscepYble host
Time
IncubaYon period
Exposure Onset
Latent InfecYous Non-infecYous
Infected Non infected Clinical horizon Death Cure
natural history
Epi triangle
Host
Enviro
Agen
-
Environmental
: vector control
-
Host
: decrease suscep;bility
Global Strategy
GOAL:
TO REDUCE THE BURDEN OF DENGUE
OBJECTIVES:
UÊ /ÊÀi`ÕViÊ`i}ÕiÊÀÌ>ÌÞÊLÞÊ>ÌÊi>ÃÌÊxä¯ÊLÞÊÓäÓäI UÊ /ÊÀi`ÕViÊ`i}ÕiÊÀL`ÌÞÊLÞÊ>ÌÊi>ÃÌÊÓx¯ÊLÞÊÓäÓäI UÊ /ÊiÃÌ>ÌiÊÌ iÊÌÀÕiÊLÕÀ`iÊvÊÌ iÊ`Ãi>ÃiÊLÞÊÓä£x IÊ/ iÊÞi>ÀÊÓä£äÊÃÊÕÃi`Ê>ÃÊÌ iÊL>Ãii°
Technical element 1:
Diagnosis and case management
Technical element 2:
Integrated surveillance and outbreak preparedness
Technical element 3:
Sustainable vector control
Technical element 4:
Future vaccine implementation
Technical element 5:
Basic operational and implementation
research
ENABLING FACTORS FOR EFFECTIVE IMPLEMENTATION OF THE GLOBAL STRATEGY:
UÊ >`ÛV>VÞÊ>`ÊÀiÃÕÀViÊLâ>ÌÊ UÊ «>ÀÌiÀà «]ÊVÀ`>ÌÊ>`ÊV>LÀ>ÌÊ UÊ VÕV>ÌÊÌÊ>V iÛiÊLi >ÛÕÀ>ÊÕÌVià UÊ V>«>VÌÞLÕ`}Ê
UÊ ÌÀ}Ê>`ÊiÛ>Õ>Ì
TREATMENT, PREVENTION AND CONTROL TREATMENT, PREVENTION AND CONTROL
2O12–2O2O
GLOBAL STRATEGY
Case management - Dengue
•
Improve case management and diagnosis to prevent deaths
from dengue
–
Improve early clinical case detec;on for dengue with
warning signs and severe dengue;
–
Improve management of severe cases.
•
Improve capaci;es to facilitate a reduc;on in the burden of
the disease
–
Improve access health care services;
–
Reorganiza;on of health service for be`er managing
outbreak situa;ons;
Surveillance and outbreak preparedness
•
Improve surveillance to enhance repor;ng,
preven;on and control
–
Surveillance indicators – for clinical reasons, a minimum
set of indicators should be reported;
–
Risk indicators:
• Mosquito breeding sites (i.e. household water storage containers, poor
urban water drainage)
• Environmental control measures (i.e. ;ghtly fiung water storage lids,
presence of fish or other biological control measures, and regular cleaning containers)
–
sen;nel sites for age- stra;fied seroprevalence and burden
of disease (including economic costs).
Sustainable vector control
•
Combina;on of:
–
Environmental management
–
Biological control
Future Strategy and Research
•
Develop therapeu;c drug
•
Develop vaccines
•
Develop vector controlled – not threat to wildlife
survival but locally reduce the incidence
•
Surveillance strengthening – capacity to detect
(include lab – feasible)
•
Link academia and public health prac;ce-
research program: pathogenicity, evolu;on,
emergence, dispersal
Strengthening Public Educa;on
0 0.21 0.41 0.31 0.41 0.62 1.85
9.05 25.62 32 29.53 0 5 10 15 20 25 30 35
0 1 2 3 4 5 6 7 8 9 10
%
Skala 0 - 10
3.29 11.21 15.33 16.36 9.36 8.74 4.12 6.07 7.61 6.28 11.63 0 2 4 6 8 10 12 14 16 18
0 1 2 3 4 5 6 7 8 9 10
%
Skala 0 - 10
84.44 38.07
13.56 7.05 6.20
0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00
Menjaga kebersihan rumah
Mengendalikan jumlah
Fogging/pengasapan
Lainnya, sebutkan
Lo;on an; nyamuk
%
