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How Effectively is Epidemiological Surveillance Used for Dengue Programme Planning and Epidemic Response? WHO Region/Country DF Surveillance Passive DHF Active DF/DHF Lab capability Serology Virology Epidemic prediction Panama + + - + + - Paraguay + + - - - - Peru + + - +** +** - Puerto Rico ++ ++ -** + -** - Suriname + + - - - - Trinidad + + - -** -** - United States + + - +++ +++ - Uruguay - - - - - - Venezuela ++ ++ - ++ ++ - African/Eastern Mediterranean Djibouti - - - - - - Eritrea - - - - - - Kenya - - - + + - Nigeria - - - - - - Other African Countries - - - - - - Pakistan - - - - - - Saudi Arabia + + - + + - Senegal + - - + + - Somalia - - - - - - Others Taiwan +++ +++ - +++ +++ - *The efficacy of the surveillance system and laboratory capability is rated as follows: - surveillance or capability does not exist in public health laboratory + exists ++ good +++ best **Does not include US Military, CDC or WHO laboratories There are two problems with passive surveillance for DF/DHF as it is conducted by WHO Member countries. First, there is no consistency in reporting standards. Some countries report only DHF while others report both DF and DHF. Secondly, the WHO case definitions are not strictly adhered to in reporting the cases. These problems, which lead to both underreporting and over-reporting (4) , must be corrected if we ever hope to obtain accurate incidence data on DF/DHF. Most cases of DHF are reported in Asian countries; yet only two countries Dengue Bulletin – Vol 26, 2002 99
How Effectively is Epidemiological Surveillance Used for Dengue Programme Planning and Epidemic Response? (Malaysia and Singapore) have the laboratory capacity and actually support an active, laboratory-based surveillance programme, with the aim of predicting epidemic activity in advance of peak transmission. Several Asian countries have reasonably good passive surveillance systems for DHF (Sri Lanka, Myanmar, Thailand, Indonesia, Maldives, Malaysia, Singapore and Viet Nam). Very few of these countries, with the exception of Singapore, however, have a passive surveillance system for dengue fever, which, along with mild non-specific illness, is probably responsible for most transmission. In the Americas, where DHF has emerged in the past 20 years, passive surveillance for dengue fever is better, since both DF and DHF are reported. Also, a number of countries, including the United States, Brazil, Puerto Rico and Cuba, have good laboratory capability to support active surveillance, and a number of other countries are developing that capability. Unfortunately, few countries support an active surveillance system with an early warning capability; only Puerto Rico has such a system that has accurately predicted three recent epidemics. Even in Puerto Rico, however, surveillance data from the active surveillance system have not been used effectively in emergency response to prevent the epidemics that were predicted. In the Pacific, only Australia, Tahiti and New Caledonia have good laboratory capability, but it is not used to support active surveillance. And, in the African and Eastern Mediterranean countries, surveillance for DF/DHF is generally very poor. In summary, the majority of dengue endemic countries do not have adequate laboratory-based, active surveillance systems that can provide accurate early warning predictive capability for epidemic DF/DHF. And, those few countries that do have this capability, do not use it effectively for planning and emergency response. Most countries in dengue endemic areas usually do not respond to an epidemic until it is at, or near, peak transmission (4) . By then, it is too late for mosquito control measures to have any impact on transmission, even if they were effective. What characterizes DF/DHF surveillance in most countries is under-reporting during inter-epidemic periods and over-reporting during epidemics (4,6) . This crisis mentality must be changed if we ever hope to effectively respond to such epidemics by initiating prevention and control measures before epidemic transmission begins. Country examples of DF/DHF surveillance I will use examples from some of the countries that I feel have the best surveillance systems, to illustrate what can be done, given adequate political and economic support, and some of the problems associated with these programmes. Singapore There is probably only one endemic country where surveillance is effectively used for planning, response and prevention and control; that country is Singapore (7) . Singapore uses case definitions and has mandatory reporting for both dengue fever and dengue haemorrhagic fever. Health authorities use the surveillance information to actively target specific areas of the city for 100 Dengue Bulletin – Vol 26, 2002
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Dengue Bulletin Volume 26 December
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E From the Editor’s desk pidemic
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Contents 10. Eco-epidemiological Fa
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Contents 4. Vaccines and Biological
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Sero-epidemiological Study of Dengu
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Dengue Control in North Queensland,
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Status of Dengue Control Programme
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Time-Series Analysis of Dengue Feve
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Dengue Patients at the Children’s
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Dengue in the Americas by Mary E Wi
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Dengue in the Americas through 1963
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Dengue in the Americas Year DEN-1 D
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Dengue in the Americas (xxx) Travas
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Dengue in the Americas Table 2b: In
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Dengue in the Americas Country or R
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Dengue in the Americas circulation
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Dengue in the Americas numbers of w
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Dengue in the Americas 13. Guzman M
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Dengue in the Americas by Mary E Wi
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Dengue in the Americas through 1963
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Page 87 and 88: Dengue in Latin America - A Unique
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Page 105 and 106: Dengue Viruses in Brazil Laboratory
Page 107 and 108: Dengue Viruses in Brazil Acknowledg
Page 109 and 110: Eco-epidemiological Factors Associa
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Page 143 and 144: Identification of Genetic Variation
Page 151 and 152: Rapid Detection of Dengue Viral RNA
Page 157 and 158: Detection of Dengue Viral RNA in Pa
Page 165 and 166: Intravenous Fluid Therapy in Dengue
Page 167 and 168: Intravenous Fluid Therapy in Dengue
Page 169 and 170: Inflammatory Mediators in Dengue Vi
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Inflammatory Mediators in Dengue Vi
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The Interdomain Region of Dengue NS
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Study of Dengue Fever among Israeli
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The Features of Imported Dengue Fev
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Use of Temephos for Control of Fiel
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Use of Temephos for Control of Fiel
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The Use of Ovitraps Baited with Hay
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Mechanisms of DDT and Permethrin Re
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Mechanisms of DDT and Permethrin Re
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Effect of Midgut Bacterial Flora of
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Study of Child-Invented Health Educ
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Dengue Prevention and Control Befor
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Dengue Prevention and Control new a
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Dengue Net - WHO’s Internet-based
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Dengue Net - WHO’s Internet-based
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Revision of International Health Re
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Revision of International Health Re
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Vaccines and Biologicals Recommenda
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Dengue Prevention and Control Repor
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Dengue Prevention and Control impro
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Dengue Fever and Dengue Haemorrhagi
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Instructions for Contributors Artic
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