Ugonjwa wa Homa ya Dengue Umerudi!

(AP) - Tanzanian authorities have announced an outbreak of the mosquito-borne dengue fever in the commercial capital Dar es Salaam and Tanga region along the coast.

   Deputy health minister Faustine Ndugulile said Thursday that 252 people have been hospitalized in Dar es Salaam while 55 others have been admitted at health facilities in the Tanga region.

   Dengue fever causes severe headache along with muscle and joint pain. There is no cure.

   The Tanzanian government attributes the outbreak to heavy rainfall.

What is Chikungunya Disease

From the WORLD HEALTH ORGANIZATION - WHO

Key Facts

• Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.
• The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.
• There is no cure for the disease. Treatment is focused on relieving the symptoms.
• The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.
• Since 2004, chikungunya fever has reached epidemic proportions, with considerable morbidity and suffering.
• The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in a localized outbreak in north-eastern Italy.

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Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae. The name ‘chikungunya’ derives from a word in the Kimakonde language, meaning "to become contorted" and describes the stooped appearance of sufferers with joint pain (arthralgia).

Signs and symptoms

Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain. Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash. The joint pain is often very debilitating, but usually lasts for a few days or may be prolonged to weeks.

Most patients recover fully, but in some cases joint pain may persist for several months, or even years. Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death. Often symptoms in infected individuals are mild and the infection may go unrecognized, or be misdiagnosed in areas where dengue occurs.

Transmission

Chikungunya has been identified in nearly 40 countries in Asia, Africa, Europe and also in the Americas.

WHO

The virus is transmitted from human to human by the bites of infected female mosquitoes. Most commonly, the mosquitoes involved are Aedes aegypti and Aedes albopictus, two species which can also transmit other mosquito-borne viruses, including dengue. These mosquitoes can be found biting throughout daylight hours, though there may be peaks of activity in the early morning and late afternoon. Both species are found biting outdoors, but Ae. aegypti will also readily feed indoors.

After the bite of an infected mosquito, onset of illness occurs usually between four and eight days but can range from two to 12 days.

Diagnosis

Several methods can be used for diagnosis. Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two months. Samples collected during the first week after the onset of symptoms should be tested by both serological and virological methods (RT-PCR).

The virus may be isolated from the blood during the first few days of infection. Various reverse transcriptase–polymerase chain reaction (RT–PCR) methods are available but are of variable sensitivity. Some are suited to clinical diagnosis. RT–PCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources.

Treatment

There is no specific antiviral drug treatment for Chikungunya. Treatment is directed primarily at relieving the symptoms, including the joint pain using anti-pyretics, optimal analgesics and fluids. There is no commercial chikungunya vaccine.

Prevention and control

The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes. This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.

For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting vectors is advised. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions. Repellents should contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester) or icaridin (1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-1-methylpropylester). For those who sleep during the daytime, particularly young children, or sick or older people, insecticide treated mosquito nets afford good protection. Mosquito coils or other insecticide vaporizers may also reduce indoor biting.

Basic precautions should be taken by people traveling to risk areas and these include use of repellents, wearing long sleeves and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering.

Disease outbreaks

Chikungunya occurs in Africa, Asia and the Indian subcontinent. Human infections in Africa have been at relatively low levels for a number of years, but in 1999-2000 there was a large outbreak in the Democratic Republic of the Congo, and in 2007 there was an outbreak in Gabon.

Starting in February 2005, a major outbreak of chikungunya occurred in islands of the Indian Ocean. A large number of imported cases in Europe were associated with this outbreak, mostly in 2006 when the Indian Ocean epidemic was at its peak. A large outbreak of chikungunya in India occurred in 2006 and 2007. Several other countries in South-East Asia were also affected. Since 2005, India, Indonesia, Thailand, Maldives and Myanmar have reported over 1.9 million cases. In 2007 transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy. There were 197 cases recorded during this outbreak and it confirmed that mosquito-borne outbreaks by Ae. Albopictus are plausible in Europe.

In December 2013, France reported 2 laboratory-confirmed autochthonous (native) cases of chikungunya in the French part of the Caribbean island of St Martin. Since then, local transmission has been confirmed in the Dutch part of Saint Martin [St Maarten], Anguilla, British Virgin Islands, Dominica, French Guiana, Guadeloupe, Martinique and St Barthelemy. Aruba only reported imported cases.

This is the first documented outbreak of chikungunya with autochthonous transmission in the Americas.

As of 6 March 2014, there have been over 8000 suspected cases in the region.

More about disease vectors

Both Ae. aegypti and Ae. albopictus have been implicated in large outbreaks of chikungunya. Whereas Ae. aegypti is confined within the tropics and sub-tropics, Ae. albopictus also occurs in temperate and even cold temperate regions. In recent decades Ae. albopictus has spread from Asia to become established in areas of Africa, Europe and the Americas.

The species Ae. albopictus thrives in a wider range of water-filled breeding sites than Ae. aegypti, including coconut husks, cocoa pods, bamboo stumps, tree holes and rock pools, in addition to artificial containers such as vehicle tyres and saucers beneath plant pots. This diversity of habitats explains the abundance of Ae. albopictus in rural as well as peri-urban areas and shady city parks.

Ae. aegypti is more closely associated with human habitation and uses indoor breeding sites, including flower vases, water storage vessels and concrete water tanks in bathrooms, as well as the same artificial outdoor habitats as Ae. albopictus.

In Africa several other mosquito vectors have been implicated in disease transmission, including species of the A. furcifer-taylori group and A. luteocephalus. There is evidence that some animals, including non-primates, rodents, birds and small mammals may act as reservoirs.

WHO response

WHO responds to chikungunya by:

• formulating evidence-based outbreak management plans;
• providing technical support and guidance to countries for the effective management of cases and outbreaks;
• supporting countries to improve their reporting systems;
• providing training on clinical management, diagnosis and vector control at the regional level with some of its collaborating centres;
• publishing guidelines and handbooks for case management, vector control for Member States.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

Dengue Fever Awareness

DENGUE FEVER AWARENESS Dengue is a viral infection spread by mosquitoes.  It is widespread in tropical and sub-tropical regions. In the month of February 2014, the Dar es Salaam Public Health Officials confirmed a new wave of dengue fever cropped up in the most parts of Dar es Salaam and is still continuing. The first ever recorded fever in Dar es Salaam was recorded in 2010 and in July last year. The Ministry reaffirmed that there were no confirmed death in either two past breakouts.(Tambwe M., Daily Newspaper, 8.2.2014) Although dengue symptoms, when mild, can seem flulike, there is no vaccine or treatment for the infection other than staying hydrated and taking acetaminophen to manage the pain, other pain killers of the NSAID group like Ibuprofen & Diclofenac are not recommended as they can increase bleeding due to low platelet count (blood clotting cells). Those flulike symptoms also hamper public health officials’ ability to track the disease, because official surveillance of occurrences is based on medical reports and patients may not seek care for what they assume is a bout of flu. An estimated 50 million to 100 million dengue infections occur worldwide yearly, and severe forms of the disease can be fatal, especially among children. Beyond dengue’s death toll, its impact is largely felt in economic terms because sickened people cannot work or attend school. Many people, especially children and teens, may experience no signs or symptoms during a mild case of dengue fever. When symptoms do occur, they usually begin four to 10 days after the person is bitten by an infected mosquito. SYMPTOMS The principal symptoms of dengue fever are listed below. Generally, younger children and those with their first dengue infection have a milder illness than older children and adults. High Fever, up to 41ºC Severe Headaches Muscle, bone and joint pain Pain behind your eye Patient might also experience: Widespread rash Nausea and vomiting Minor bleeding from your gums or nose Most people recover within a week or so. In some cases, however, symptoms worsen and can become life-threatening. Blood vessels often become damaged and leaky, and the number of clot-forming cells in your bloodstream falls. This can cause: Bleeding from the nose and mouth Severe abdominal pain Persistent vomiting Bleeding under the skin, which may look like bruising Problems with your lungs, liver and heart Red spots or patches on the skin Black, tarry stools (faeces, excrement) Drowsiness or irritability Pale, cold, or clammy skin Difficulty breathing PREVENTION There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Ae. aegypti is to eliminate the places where the mosquito lays her eggs, primarily areas that hold standing water to stop mosquitoes from multiplying Items that collect rainwater or to store water (for example, garbage cans, house gutters, buckets, pool covers, coolers, toys, flower pots, plastic containers, drums, buckets, any other containers, pet's water bowls, or used automobile tires) should be covered or properly discarded. Protect boats and vehicles from rain with traps that don’t accumulate water. Maintain swimming pools in good condition and appropriately chlorinated. Empty plastic swimming pools when not in use. Clothing: Wear shoes, socks, and long pants and long-sleeves. This type of protection may be necessary for people who must work in areas where mosquitoes are present. Apply mosquito repellent containing DEET Use mosquito netting to protect children younger than 2 months old. Cover doors and windows with screens to keep mosquitoes out of your house Repair broken screening on windows, doors, porches, and patios. Using air conditioning or window and door screens reduces the risk of mosquitoes coming indoors. Proper application of mosquito repellents. Mosquito Control: Use screens on doors and windows; use patio insecticides such as Permethrin (pesticide and repellent) and Allethrin (candles and lanterns. Wear long sleeve shirts, long pants, socks and closed shoes to avoid mosquito bites at dusk and dawn especial. Use repellents containing DEET (N, N-diethyl-m-toluamide) or Picaridin on your clothing and exposed skin. Follow manufacturer’s instructions and CDC recommendations. (www.cdc.gov)  TREATMENT There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use pain relievers such as acetaminophen, other pain killers of the NSAID group like Ibuprofen & Diclofenac are not recommended as they can increase bleeding due to low platelet count (blood clotting cells). They should also; Rest, Drink plenty of fluids to prevent dehydration, Avoid mosquito bites while febrile and Consult a physician. You should see your GP if you develop a fever or flu-like symptoms within two weeks of returning from an area where the dengue virus is common. If a clinical diagnosis is made early, a health care provider can effectively treat you. Kindly VISIT your nearest Health centre for advice and to test and confirm diagnosis of Dengue fever. Credit: KSIJ Central Board of Education

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