When dengue fever hit Yangon, Myanmar earlier this year, the government was better prepared than ever. The department of health has worked since 2014 with the Malaria Consortium, an NGO, to develop a detailed outbreak response plan.

Community health workers in four townships at high risk had been trained to recognise and treat the disease. They worked with local officials to target mosquito breeding sites in villages and homes, while stepping up chemical control of mosquitoes.



But efforts to develop similar dengue response strategies are being slowed down by the outbreak of a more headline grabbing mosquito-borne virus – Zika.

Dengue researchers and public health specialists are telling Break Dengue that Zika has soaked up a lot of attention. Our own Google Trends analysis shows the interest in Zika has been out of proportion to its real impact

Google Trends analysis of interest globally in outbreaks of several mosquito-borne diseases. Photograph: Break Dengue

The World Health Organisation declared a public health emergency in February 2016 in the wake of a significant rise in cases of the birth defect microcephaly caused by Zika. The White House sought $1.9bn (£1.5bn) in emergency funding to “prevent, detect and respond” to the threat posed by the virus. But while the media and general public focus attention on Zika, similar diseases continue to spread in the background, causing severe harm to both individuals and the public health system.

Facebook Twitter Pinterest A patient protected by a mosquito net, recovers from a bout of dengue fever at a hospital in Luque, Paraguay. Photograph: Jorge Saenz/AP

Dengue fever is just one such disease. It causes fever, headache, vomiting, joint pain and skin rashes, and has been linked to pregnancy risks. Spread by the same mosquito responsible for the Zika outbreak, it is the fastest-growing mosquito-borne viral infection in the world today, resulting in around half a million hospitalisations and an estimated 22,000 deaths each year.

Better diagnostics and disease surveillance data are required if we are to understand the true scale of the challenge

The socio-economic toll of diseases transmitted by mosquitoes is severe; the total annual cost of dengue alone has been put at $8bn (£6.5bn). What’s more, outbreaks adversely affect other health service users. Health system capacity can adapt to meet predictable demand for illnesses like malaria or diabetes, but these virulent outbreaks are sporadic, unpredictable and highly disruptive, putting enormous pressure on clinics, health workers and laboratories. Getting diseases like dengue under control would have a vast positive impact across the whole of the public health system.

Despite the risks, most cases of dengue and Zika still remain undiagnosed. Better diagnostics and disease surveillance data are required if we are to understand and measure the true scale of the challenge.

Dengue Track, for example, is an innovative crowdsourced tool which integrates new and existing data to not only track the disease worldwide but also predict and prevent future dengue outbreaks. Through an online chat system, users can report cases of dengue and this information is combined with statistics from larger national databases to create a real-time map of outbreaks and provide advice to travellers, organisations and local communities. The same tool could be just as effective in mapping other mosquito-borne diseases and turning big data into actionable information.

Once this first step in the outbreak response plan is in place, health authorities can build a system capable of springing into action once the alarm is raised. Lessons learned from three US outbreaks (pdf) highlighted the importance of detecting dengue swiftly, alerting state actors and municipal authorities, and communicating with the public. The latest dengue response plan from Queensland, Australia, also details how to target resources to hard-hit areas – suppressing the mosquito population, tracking case numbers and preparing hospitals for an imminent uptick in caseload.

This kind of painstaking planning takes time and investment. The Zika outbreak has, quite rightly, spent a long time in the spotlight. But we can’t simply move the attention away from Zika and on to the next new story.

We can’t afford to narrow our focus to one particular disease or outbreak. Innovative mosquito control measures could help to curb the number of people who become infected, while research on new treatments for one disease can often turn up leads in the fight against another.



Facebook Twitter Pinterest Removing stagnant water pools where mosquito larvae grow helps prevent dengue. Photograph: RolfAasa/Getty Images

We want to encourage cases of positive deviance where people behave differently to others in their communities and avoid local infections and illnesses.

An example would be Ma Su Lei Yee, a 25-year-old farmer who lives in Sein Pan Kone village, Hinthada, in south-west Myanmar. She and her family have never had dengue despite living in a community that has a high risk of transmission. She understands that dengue is caused by mosquitoes that bite during the day.

To prevent mosquito bites, she always wears long-sleeved clothes and sleeps under mosquito nets during the day time as well. She always covers the big water containers, changes water in small containers every 2-3 days and changes her Buddha flower vase regularly to prevent mosquito larvae from forming. She cleans the household surroundings and fills in the ditches with sand, especially in the rainy season, to avoid larvae breeding. She removes empty cans, coconut shells and turns extra containers upside down to avoid larvae growth. She recognises the signs and symptoms of dengue and goes for early diagnosis if she has a fever. “If a patient does not get an early diagnosis from a health facility, he or she can die with dengue fever,” she said.

Disease surveillance tools can prove invaluable in mapping cases worldwide and providing authorities and NGOs with valuable information to help reduce the spread of the disease.

Let’s take this opportunity to put the spotlight on all the major challenges posed by other diseases and to further develop tools such as Dengue Track that will help us overcome them as a group. We can do this if we do it together.



Gary Finnegan is editor in chief at Break Dengue.



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