Introduction
Dengue is a mosquito-borne viral disease that has rapidly spread in many countries worldwide in recent years.
In Nepal, dengue is a rapidly emerging disease. Endemic across most provinces, dengue incidence has increased in recent years largely due to expansion of the vector Aedes aegypti and Aedes albopictus, as well as the movement of people and the introduction of imported cases. All 4 dengue serotypes exist in Nepal, with DENV-1 historically contributing the highest burden.
Prevention, clinical case management, surveillance, vector control and management and outbreak response are ongoing in Nepal, however there is a need to strengthen these especially at a time of national decentralization towards a federalized system. National dengue guidelines was first developed in Nepal in 2008 based on the World Health Organization (WHO) guidelines 1997 which was revised in 2011. This revised national guidelines on dengue prevention, management and control, 2019 aims to
provide a technical ‘gold-standard’ advice on all aspects of dengue using the latest internationally adopted definitions, protocols and guidelines. It also provides simple, and easy to reference content, which can be printed and displayed on the walls of doctors rooms, wards or simply held in the hands of health workers who are spreading awareness on dengue within their local communities.
Aim of the guidelines
- To provide current and robust guidelines for each of the core areas of seasonal and epidemic dengue prevention, management and control in Nepal.
Objectives
- To support dengue control and prevention activities.
- To provide pragmatic country-specific guidelines with reference to international gold standards.
- To provide guidance and new standards to all stakeholders.
- To provide country case studies for dengue prevention, management and control.
- To align and build collaboration between stakeholders.
- To provide a number of annexes that can be used as quick reference tools.
Epidemiology
Dengue is believed to have originated as a mammalian disease in non-human primates and emerged in the human population roughly 500-1,000 years ago. The disease is widespread throughout the tropics with risk factors influenced by local spatial variations of rainfall, temperature, relative humidity, degree of urbanization and quality of vector control services in urban areas. It is estimated to infect 390 million people annually of which 96 million manifest clinically. One study on prevalence of dengue estimates
that 3.9 billion people in 128 countries are at risk of infection with dengue viruses. Before 1970, only 9 countries had experienced severe dengue epidemics, today the disease is endemic in more than 100 countries.
Dengue is caused by a flavivirus of 4 virus serotypes (DENV1, DENV2, DENV3, DENV4). Over the past 20 years, these serotypes have spread worldwide from South East Asia and are now found throughout Asia, Africa and the Americas. International travel, trade, migration, decreased access to health care and urbanization are considered among the main drivers behind the rapid dissemination of all four dengue serotypes. Compounding the problem has been the global spread of the dengue mosquito vectors, Ae. aegypti and Ae. albopictus, throughout the last century.
Disease Burden
Global and regional
The incidence of dengue has increased dramatically around the world in recent decades. Vast majority of cases are asymptomatic and hence actual numbers of dengue cases are under reported and many cases are misclassified. The disease is now endemic in more than 100 countries in the regions of Africa, Americas, Eastern Mediterranean, South East Asia and Western Pacific. The region of Americas, South East Asia and Western Pacific are the most seriously affected. Not only the number of cases are increasing and spreading to new areas but many outbreaks are occurring in recent years. However, many countries have reduced the case fatality rate to less than 1 % and globally, 28 % decline in case fatality have been recorded between the period of 2010-2106, largely due to improvement in case management through capacity building in countries. The number of dengue cases notified to the WHO by the member countries in South East Asia region (SEAR) has also increased substantially in recent years. The number of dengue cases has increased dramatically in the countries like India, Srilanka and Indonesia in this region.
Nepal
Dengue has been identified as one of the youngest emerging infectious diseases in Nepal. The first case of dengue was reported in 2004. In 2006, large number of probable cases and 32 laboratory-confirmed cases were reported across hospitals in central and western Terai, as well as Kathmandu during the post monsoon season. Most cases were indigenous and confirmed the presence of all 4 serotypes in Nepal. From the years 2007 to 2009, sporadic clinical cases and outbreaks were recorded. Since 2010, dengue epidemics have continued to affect lowland districts as well as mid-hill areas. This trend for increased magnitude has since continued with number of outbreaks reported each year in many districts- Chitwan, Jhapa, Parsa (2012-2013), Jhapa, Chitwan (2015-2016), Rupandehi, Jhapa, Mahottari (2017), Kaski (2018) and Sunsari (2019).
Source:
National Guidelines on Prevention, Management and Control of Dengue in Nepal
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