Zahedan University of Medical Sciences

Report from: ZAUMS Communicable Diseases Control Department

Published on: 17 June 2019

Dengue fever poses as a global public health threat. Climate and socioeconomic changes, globalization, an increase in the international trade and travel, lack of surveillance and efficient control, are expressed as major causes for the rapid expansion of this Aedes-borne disease (1, 2). Special behaviors like preference of small man-made water containers as larval habitats can increase the risk of dengue vectors breeding and the possibility of their establishment even in arid areas (3).

The global expansion of Ae.albopictus, especially, its presence in neighboring countries, especially Pakistan, concurrent with recent dengue outbreaks has increased the possibility of the introduction of the disease in Sistan & Balouchestan Province and has put the Iranian health system on high alert.

The Islamic Republic of Iran is under threat of potential outbreak of Aedes borne diseases and in 2008, the first imported case of dengue was reported in the country. In a study published in 2013, presence of dengue infection was reported in six cases were from the Sistan and Baluchistan province in southeast Iran (Travel Med Infect Dis. 2013 May-Jun; 11(3):166-9). Active mosquito surveillance has been established in the province since 2015. And larva and adult mosquitoes have been collected from 34 sentinel sites and 4 of them belonged to genus Aedes. But no confirmed cases of local transmission of Aedes borne diseases has been reported in Sistan & Balouchetsan Province.

It seems like that the threat of dengue fever is closer than before. Based on the sitrep#5 reported from Kech and Gwadar district Health Offices to WHO, EMRO Office  on 7^th of May 2019, a total of 1052 confirmed dengue cases and 3 deaths have been reported from Kech district , which is located about 100 Km to the Iran border.

Following the alert issued by the Iranian Center for Communicable Diseases Control, an emergency meeting was held in the Vice Chancellery for Health of Zahedan University of Medical Sciences (ZAUMS) on 30^th of May 2019. Previous to this another emergency meeting was held on 9^th April 2019, based on scattered and unofficial warnings issued by various news agencies (4).

Although, vector monitoring, GIS-based modelling (5) and case finding (6) had been previously conducted by the Provincial Health Center of ZAUMS, the following measures have also been taken in response to the recent dengue fever outbreaks in neighboring areas of Pakistan:

- Strengthening of dengue vectors surveillance and monitoring especially in border areas, costumes office, international airports and railways. 

 - Setting up the data bank for dengue cases

 - Training of entomological surveillance staff / Aedes entomological collectors

 - Updating the previous GIS-based model for the risk of Adedes-vector borne diseases  

 - Increasing the field visits and  supervision by the entomological focal point for Adedes-vector borne diseases  

 -  Scaling up International Health Regulations (IHR) activities in Sistan & Balouchestan   Province

 - Training of physicians on dengue diagnosis and management  by an infectious disease specialist(Dr. Kouhpayeh)  who is the focal point of Adedes-vector borne diseases  

 - Training of healthcare  workers by the entomological focal point on the vector biology, monitoring and control methods

 -  Holding joint meetings with relevant organizations and agencies to receive further support in the vectors monitoring activities

Based on the risk assessment and decisions taken, the number of ovitraps as well as sampling sites was increased to 40 foci.

 A joint meeting was held between Vice Chancellor for Health of ZAUMS and the Director General of the Southeast Railway Station to establish monitoring of dengue fever vector, including the installation ovitrap in train stations.

The provincial field was visited and supervised by Dr. A. Miroliyaei, the National technical Officer in the Management of Aedes borne diseases along with Dr. J.Nejati, the Entomological focal point for Adedes-vector borne diseases in Sistan & Balouchestan  Province, and Eng. A.Hasanzehi, Dengue Program Manager in Vice Chancellery for Health, ZAUMS. As part of this field visit, the vector surveillance activities in Kohak Border Market and Pasabandar seaport, the two important entry points were visited.

During this visit, six workshops were held in the districts bordering Pakistan. Fifty seven physicians and 114 healthcare workers attendee the workshops and were briefed on various related issues including:  the vectors behavior, monitoring and control methods, dengue clinical sign and symptoms, diagnosis and treatment.

In these workshops, integrated and intelligent surveillance system, case finding along with vector monitoring, considering the diagnosis of dengue fever in febrile patients were highlighted. In addition, an emphasis was put on holding regular training sessions to put the urban and rural health care systems on high alert regarding the preparedness and response to the Adedes-vector borne diseases.

Copyright © 2019 Zahedan University of Medical Sciences. All rights reserved. Date updated: 17/06/2019.
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References

1. Marchi S, Trombetta CM, Montomoli E. Emerging and Re-emerging Arboviral Diseases as a Global Health Problem.  Public Health-Emerging and Re-emerging Issues: IntechOpen; 2018.

 2. Murray NEA, Quam MB, Wilder-Smith A. Epidemiology of dengue: past, present and future prospects. Clinical epidemiology. 2013;5:299.

 3. Kumawat R, Singh KV, Bansal S, Singh H. Use of different coloured ovitraps in the surveillance of Aedes mosquitoes in an arid-urban area of western Rajasthan, India. Journal of vector borne diseases. 2014;51(4):320.

 4. Post F. Dengue outbreak: 93 new cases reported in Balochistan’s Kech 2019 [Available from: https://reliefweb.int/report/pakistan/dengue-outbreak-93-new-cases-reported-balochistan-s-kech.

 5. Nejati J, Bueno-Marí R, Collantes F, Hanafi-Bojd AA, Vatandoost H, Charrahy Z, et al. Potential risk areas of Aedes albopictus in South-Eastern Iran: a vector of Dengue Fever, Zika, and Chikungunya. Frontiers in microbiology. 2017;8:1660.

 6. Heydari M, Metanat M, Rouzbeh-Far M-A, Tabatabaei SM, Rakhshani M, Sepehri-Rad N, et al. Dengue Fever as an Emerging Infection in Southeast Iran. The American journal of tropical medicine and hygiene. 2018;98(5):1469-71.