Fighting Dengue - An Integrated Management Program to Control the 2012 Dengue Epidemic in Puerto Rico

BACKGROUND: According to the World Health Organization, dengue fever ranks as the most important mosquito-borne viral disease in the world. Dengue virus is spreading around the world resulting in public health concerns, costly disruption of health services, labor force, and anxiety of individuals and their families.  Dengue is transmitted by Aedes aegypti or A. albopictus mosquitoes which have unique and complex ecological niches.  Control of mosquitoes has been difficult; it involves environmental inspections, community education, and behavioral changes among at risk individuals. In Puerto Rico, and in other dengue endemic areas of the world, dengue occurs throughout the year. The Dengue Integrated Management Program (DIMP) was designed and implemented to provide a better respond to individual and community’s health needs, reduce the social/economic impact of the condition, and increase appropriate utilization of available health resources.

METHODS: First, an assessment of work flow and procedures was conducted to join together five dengue prevention and response efforts into an integrated management program (DIMP), including epidemiologic surveillance, community health education, vector control, dengue diagnostics reference laboratory,  and Dengue Resource Center. Secondly, a framework was delineated to create  a single program with united objectives and common goals. Thirdly, a pilot project to identify surveillance barriers was implemented at Ponce Health Region.

RESULTS: Having a coordinated system, instead of "silos", allowed for strengthening surveillance capacity to be timely and action oriented; permitted the development of communication strategies to inform and advise health professionals, public officials, and communities about epidemic trends and preventive measures. Data sharing process within DIMP components, facilitated rapid identification of affected areas and interventions to eliminate mosquitoes' hot spots. Implementation of a secured electronic system for dengue test results, is a promising technology that will potentially eliminate current delays in submitting lab results to providers. Puerto Rico 2012 dengue epidemic was moderate as compared to 2010 epidemic activity.  Preliminary data for 2012 indicate a total of 11,449 reported suspected cases with 4,998 (44%) confirmed, and 6 confirmed fatal cases.

CONCLUSIONS: The DIMP has proved to be an effective tool to manage epidemic activity with less duplication of efforts and maximum utilization of available resources. The DIMP design will be available to national and international public health agencies to assist in reducing the risk of dengue fever and other conditions.