Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

Abstract

Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans.

Dengue disease surveillance: an updated systematic literature review

“…Surveillance for dengue can include different indicators and systems (Harrington et al . ; Henning ; Stroup et al . ) to detect outbreaks and monitor trends.…”

“…Emergency vector control operations in response to dengue outbreaks 1116 are more typically applied, even though the efficacy of the most widespread method used, insecticide fogging or space-spraying, is dubious (Esu et al 2010). Surveillance for dengue can include different indicators and systems (Harrington et al 2013;Henning 2004;Stroup et al 1989) to detect outbreaks and monitor trends. The authors' earlier systematic literature review (Runge Ranzinger et al 2008) analysed 'the evidence on the structure, purpose and usefulness of dengue disease surveillance in dengue endemic countries' and described a general lack of evidence for the usefulness of dengue disease surveillance for early outbreak detection, especially the lack of indicators/alert signals available to trigger response.…”

Evaluation of Dengue Prevention and Control Programs in Banyumas Health Office, Central Java, Indonesia

“…Dengue prevention and control programneed to be multisectoral, multidisciplinary, and multilevel. This is required environmental, political, social, and medical inputs to be coordinated so that effective activities of one sector are not negated by the lack of commitment from another [13].…”

Dengue disease outbreak definitions are implicitly variable

“…The inappropriateness of some outbreak response plans to the original case data-based outbreak definitions for dengue has led many to adapt the endemic channel plus two standard deviations method to increase or decrease sensitivity and specificity, for example by requiring two successive weeks above the threshold before response activity is triggered ( Harrington et al, 2013 ). This has led to many different dengue outbreak definitions being employed in different countries and regions ( Harrington et al, 2013; Badurdeen et al, 2013 ). These individual definitions are at odds with international efforts to produce standardised, evidence-based outbreak response strategies ( WHO, 2009; Pilger et al, 2010; Farrar et al, 2007; Hutwagner et al, 2003 ).…”