Maldives can defeat dengue with coordinated action from all

By Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia

5 March 2014: Since it was first reported in 1979, Maldives has experienced sporadic outbreaks of dengue, till the disease became endemic in 2004. Since then there has been large number of cases reported every year. With a high incidence rate, the disease has been reported from every atoll of the country. The country has launched a systematic and determined fight against the virus. But victory over dengue is not possible without coordinated action by different sections of the society- the community, health practitioners, different sectors of the Government and the media.

Maldives is not alone in its fight against dengue. The disease has shown a 30-fold increase globally over the past five decades. Some 50 to 100 million new infections are estimated to occur annually in more than 100 endemic countries. Every year, hundreds of thousands of severe cases arise resulting in 20 000 deaths. On 7 April 2014, World Health Day, WHO is bringing global attention to vector-borne diseases like dengue which are putting our health at risk, at home and when we travel.

Dengue is a complex disease, with multiple viruses and an extremely versatile and efficient vector- the mosquito. Dengue vector dynamics is strongly influenced by environmental factors, population dynamics and climate change. Despite these challenges, dengue is a preventable disease. The solution lies in a united and sustained effort from all. Ministries of health alone cannot control dengue. A lot of factors that lead to favorable conditions for the spread of dengue and emergence of outbreaks lies beyond the scope and mandate of health sector. Therefore dengue control and prevention require a truly committed multisectoral engagement, with strong political support, where every partner takes full ownership and responsibility of their domain of work.

Vector control is the backbone of dengue prevention. Good environmental management, effective solid waste management and better management of water and water resources are key elements of vector control. No single approach could work on the mosquitoes and hence an integrated vector management approach needs to be practiced. Educating and empowering communities, to take ownership of mosquito control in their individual houses and communities is the cornerstone of a sustainable mosquito control programme.

As of now there is no vaccine available to prevent dengue. However, there is optimism on the vaccine development, with several candidate vaccines in various advanced stages of clinical trial. In the meantime we must focus on strengthening dengue prevention and control efforts, more specifically on vector control. We must continue to sustain the gains made on reducing case fatality and continue educating and re-educating the doctors, nurses and health workers on clinical management of dengue cases. We need to strengthen the referral systems, ensuring timely referral of patients to appropriate levels of healthcare to ensure that no child dies of dengue.

Maldives also have done much to strengthen its disease surveillance, response and case management capacity. Despite many challenges, including the high turnover rate of doctors in the islands, and difficulty in retaining the experience and expertise, Maldives has maintained a low case fatality rate. However, much needs to be done, and Maldives needs to build on from the gains made so far. Maldives is developing a national strategic plan which will be an important guiding document for all stakeholders, converging individual efforts towards a national objective.

This is a country whose collective efforts and strong determination have successfully eliminated malaria, and has sustained that remarkable achievement. Maldives is the only country in WHO’s South-East Asia Region to achieve this goal. The country must reflect on that experience and use their expertise to control dengue- a major public health threat to its citizens. The World Health Organization remains committed to support Maldives in their fight against dengue.