Address by Dr Poonam Khetrapal Singh Regional Director, WHO South-East Asia Symposium on Dengue Prevention and Control

New Delhi, 29 September 2014

Address by Dr Poonam Khetrapal Singh Regional Director, WHO South-East Asia Symposium on Dengue Prevention and Control New Delhi, 29 September 2014 Dr K Vijay Raghavan, Secretary, Department of Biotechnology, Government of India; Dr VM Katoch, Secretary, Department of Health Research & DG, ICMR, Prof NK Ganguly, Prof Duane Gubler, distinguished guests, ladies and gentlemen.

I am indeed very pleased to be with you all at this Symposium on Dengue Prevention and Control. It is timely and topical. Dengue has established itself as the world’s fastest growing vector-borne disease. Ever since its detection in early 1950s, a 30-fold increase has been seen in its incidence. Globally, an estimated 50–100 million dengue infections occur annually in over 100 endemic countries. Almost half of the world’s population is currently considered at risk of contracting dengue.

Dengue is still an emerging infection and the overall trend in the WHO South-East Asia Region is increasing. Our Region contributes to more than half of the global burden of dengue. About 52% of the global population at risk resides in this Region. The disease is endemic in 10 of the 11 Member States.

Dengue cases have been regularly reported in this Region since 2000. The Region was severely hit in 2010 with more than 350,000 cases and around 2000 deaths. 2013 surpassed even this number of cases with Member States reporting almost 400,000 cases. Five of our Member States viz. India, Indonesia, Myanmar, Sri Lanka and Thailand are among the 30 most highly endemic countries in the world. Let me share some good news now. In spite of the increasing number of cases, the deaths due to dengue have been very low in our Region. With concerted efforts by all Member States, and technical assistance from WHO, good case management capacity has been established in all countries during the past decade. The Region has been able to sustain CFR of less than 0.5% and is striving to prevent any death from dengue.

Ladies and gentlemen,

Outbreaks of dengue are now occurring with greater frequency. As is obvious from currently available evidence, dengue is a disease with which we have to fight a long battle.  

How do we move forward ?

In this context I wish to share with four strategic directions to guide our collective efforts to mitigate the impact of this disease.

First, we need to understand and keep pace with the changing epidemiology of dengue especially the multiple ecological factors that influence spread of this disease. Being a vector-borne disease, an ever increasing numbers and varieties of mosquito breeding habitats are being created with rapid and poorly planned urbanization, globalization, consumerisms, poor solid waste and water management and increasing population movement without adequate measures to prevent vector breeding.

Climate change is also influencing ecology that benefits vectors.

The accumulation of modern non-biodegradable products such as automobile tyres, plastic containers and tin products provide a conducive environment for prolific breeding of Aedes aegypti and Aedes albopictus vectors of dengue. Most of these factors are because of actions –or inactions of sectors other than health. Hence, effective and sustainable prevention and control of dengue requires interventions that address these factors in an integrated and multisectoral approach.

Recognizing the importance of multisectoral approach and to advocate utmost need for “Health in All Policies”, the Health Ministers of the South-East Asia Region, in their recent meeting held a few weeks back, have given a call for Dhaka Declaration on Vector-borne Diseases. The Declaration encourages a “whole of government” approach against diseases such as dengue. We are very optimistic that this declaration shall act as a strong catalyst to stimulate comprehensive multisectoral action against vector-borne diseases in our Region.

Second, I would like to reinforce the efficient use of WHO recommended integrated vector management as the approach for controlling vectors of public health importance. While integrated vector management is recognized universally as the back-bone of the vector control programmes, entomologists and vector experts are either non-existent or this expertise is rapidly declining in the Region. Urgent steps are needed to maintain and augment vector control capacity in all developing countries. Technical assistance from WHO and its Collaborating Centres to enhance national capacity is available and we encourage Member States to utilize it to meet their national needs.

Third, despite non-availability of any specific antiviral drugs against dengue, rational and effective case management has been extremely useful in bringing down mortality due to dengue. While these must be sustained, another pillar of prevention ie development of an efficacious, safe and affordable vaccine that provides long term protection against all serotypes of dengue virus is swiftly needed. WHO has been supporting these R & D efforts and we understand that a few candidate vaccines are now in advanced stages of clinical trials. We look forward to their early availability to public health systems in developing countries. We shall also urge the researchers and pharmaceutical industry to accelerate their efforts in developing and making available safe and efficacious vaccines to our communities.

Lastly, and perhaps most importantly, I am convinced that control of dengue can never be achieved or sustained without the community empowerment and ownership. Unfortunately, there is lack of community awareness on role played by vectors and vital contributions that they can make in mitigating vector breeding to prevent dengue. Even the best of the public health systems in the world will not accomplish the desired task of containing dengue unless communities actively participate in this endeavor. We need to make special efforts to educate and galvanize communities so that their critical cooperation in anti-dengue activities is obtained and sustained.

Ladies and gentlemen

WHO has been assiduously working through advocacy, normative functions and provision of technical support to Member States against dengue. We continue to advocate to the governments on the public health importance of vector-borne diseases, especially dengue and its control, strengthening of public health systems in Member States including capacity building and allocation of appropriate resources. Acknowledging their public health importance, the theme of 2014 World Health Day was on vector-borne diseases to raise global awareness and increase commitment on controlling these diseases.

A Dengue Strategic Plan for the Asia Pacific Region, 2008–2015 has been developed and endorsed by the Regional Committees of the South-East Asia and Western Pacific Regions. The Comprehensive Guidelines for the Prevention and Control of Dengue and Dengue Haemorrhagic Fever – a publication of WHO Regional Office for South-East Asia is being extensively used as a valuable treatise on public health and case management aspects of dengue. In addition to these a number of guidelines and technical documents have been developed by WHO, and several training activities organized. We shall continue to do so to meet the needs of our Member States in control of dengue.

Ladies and gentlemen,

Let me conclude by expressing my gratitude to the organizers for giving me an opportunity to share a few of my thoughts with you all.

I am pleased to see that this symposium will address many of the strategic directions that I have enunciated just now including IVM, case management and vaccines against dengue. I wish you all the success and very keenly look forward to the outcome of your deliberations.

Thank you very much.