New guidelines can help health officials better predict and control dengue epidemics

Dengue fever, once under control in many tropical areas of the Americas, has now re-emerged. Globally, some 2.5 to 3.0 billion people live in regions where the disease is endemic. In developing countries, the lack of a closed water system and adequate refuse disposal has encouraged the proliferation of water containers that are ideal larval habitats for Aedes aegypti, the mosquito responsible for epidemic dengue transmission. Efforts to avoid large-scale epidemics have focused on engaging communities in reducing the mosquito's density by emptying, cleaning, treating, and removing containers and other sites where eggs are laid.

Yet, as various studies have pointed out, such interventions do not guarantee that an epidemic will not occur. At the same time, while many types of larval control campaigns have been carried out in a variety of locales, there is little reliable information about what such campaigns cost, and to what degree, if any, the resources expended will have a positive effect on the final result. The possibility of a lack of "success" in health interventions can be particularly unsettling for local authorities faced with the decision of whether or not to carry out larval control efforts.

However, new dengue-control guidelines, described in a scientific-journal article, hold the potential to remove some of the guesswork from this process by enabling decisionmakers to more accurately assess the cost-effectiveness of larval control measures. On the one hand, the methods employed provide data regarding the costs of carrying out a rapid-response, emergency intervention and the expected reduction in the number of reported dengue cases. At the same time, the guidelines provide insight into the value of having an early warning system that yields information on a possible outbreak of dengue--even when that system is not 100% accurate.

The guidelines are described in an English-language article in the July 2003 issue of the "Revista Pana

Contact: Mara Luisa Clark
Pan American Health Organization

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