Category: Dengue Fever

Inquiry Question: How extensive is the impact of Dengue Fever (first infection) on Thalassemia Major sufferers?

Abstract:

The purpose of this report is to determine the potential impact of Dengue Fever symptoms (first infection) when presented Thalassemia Major. To determine this potential impact, a thorough research analysis was conducted into Dengue Fever (effect on body, immune response, prevention and treatment) and of Thalassemia Major (cause, prevention and current medical management). By establishing similarities and conditions induced by each disease, as well as using case studies, it was hypothesised that Thalassemia could worsen the conditions of Dengue Fever.

How does Dengue Fever affect the body?

Cause and Transmission

Dengue Fever is a non-contagious, arbovirus infectious disease caused by one of four dengue serotypes (DENV-1 to DENV-4); the path of transmission through infected Aedes aegypti, Aedes albopictus females, thus not being contagious (i.e. vector-borne). Dengue Fever impairs the haemostasis and coagulation function platelets, which leads to complications such as thrombocytopenia, uncontrolled bleeding and low blood pressure (Symptoms-Figure 1).

Human Immune Response

During extrapolation of human blood, infected mosquitoes transmit the virus past the first line of defence, immediately causing cell damage. Damaged cells subsequently release chemokines and histamines, initiating the vasodilation of blood vessels and subsequent diapedesis of responding non-specific leukocytes toward the site of infection as well as inducing fever (inflammation). In extreme cases Dengue’s infection of Langerhans Cells can exacerbate the infection, which allows virus to spread through the lymphatic system, potentially resulting in viremia. Macrophages that partially ingest virus will with MHC II [1] present the protein fragment on plasma membrane, then initiates B and T lymphocyte production.

Successfully binding immunoglobulin simultaneously hinder viral activity whilst opsonising viral material for phagocytosis, which with the MHC II complex attracts and activates antigen specific CD4+ T cells. Activated CD4+ cells subsequently undergo mitosis to produce memory and effector cells; effector cells are plasma cells that mass produce free antibodies which are able to uniquely bind externally onto the E glycoprotein. MHC I [2] complex within infected cells bind on to antigen material within the cell, present them to the surface and attract the antigen specific CD8+ T cell, thus initiating the mitosis into effector and memory cells. Cytotoxic T cells then engage in an immuno-synapse, subsequently releasing chemicals inducing death of infected cell.

Current Prevention and Medical Treatment

Currently, there is no direct cure for Dengue Virus. The best preventative measure is to reduce the human exposure to mosquitoes and reducing mosquito density. Reducing mosquito density involves measures that reduce breeding grounds within residential areas, such as concrete depressions and vases. Suggestions include wearing protective garments, well-screening homes and using insect repellent. (Figure 3). In managing Dengue once infected, fluid monitoring and balance is advised (hospitalisation). Hemoconcentration could be used as guideline for fluid replacement therapy.

Thalassemia

How does Thalassemia Major affect the human body?

Haemoglobin (Figure 4) within a healthy person is a spherical unit composed of four (4) polypeptide chains held together by noncovalent interactions. Within each of the four folded polypeptide chains hold complex porphyrin units (haems); haem’s four nitrogens bind to a charged iron molecule in the centre of the porphyrin ring, which binds to oxygen (Figure 5).

Thalassemia is an inherited autosomal recessive disorder (Figure 6) caused single gene affecting proteins making up haemoglobin within the erythrocytes. The causation of Thalassemia is dependent of both parent’s genetics. Thalassemia could also refer to the underproduction of globin protein, deformity and subsequent destruction of erythrocyte by the spleen, causing anaemia. As protein chains are coded by DNA, missing aspects of that code specifically for each of the four chains making up haemoglobin would result in a missing chain, and the attached haem, thus reducing the amount of oxygen carried. Alpha Thalassemia is the condition where alpha chains within haemoglobin are missing. Similarly, Beta Thalassemia is the condition where beta chains within haemoglobin are missing.

Current Prevention

As this disease is an inherited genetic disorder, counselling could be an alternative to prevent some cases of developing Thalassemia Major. Two available prenatal tests are Chorionic Villus Sampling [3] and Amniocentesis [4].

Current Treatment

In addition to the importance of healthy diet, avoiding infections and intake of excess iron, Thalassemia Major sufferers require frequent blood transfusion and iron management (supplements). An extreme measure to reducing frequent blood transfusion would be splenectomy, reducing anaemia level removal of erythrocyte. Alternatively, children with severe Thalassemia can also undergo bone marrow transplant that can potentially eliminate lifelong blood transfusion and iron management.

Links and Interaction

Both Thalassemia Major and Dengue Fever affect the same aspect of human body (although Thalassemia affects erythrocyte whilst Dengue Fever affects platelets and damages blood vessels), that being the circulation system. One condition of Thalassemia Major is the prevalence of anaemia complications (impaired erythrocytes such as iron deficiency) and subsequent reduction of erythrocytes, requiring blood transfusion. By adding Dengue’s modulation impairing platelet’s coagulation, the chance of someone who suffers both Dengue and Thalassemia Major simultaneously whilst left untreated could impede their chance of survival from added complications, such as iron overload and liver impairment [5]. Complications noted This is despite comparative observations [6] made that Thalassemia had no impact in the immune response to Dengue Fever.

Two studies from Thailand explicitly studied the links and interaction of Dengue and Thalassemia, where they compared clinical manifestations of non-Thalassemia sufferers with Thalassemia sufferers when clinically presented. Both studies observed unusual clinical manifestation that Thalassemia sufferers had, where close to none had hemoconcentration, but rather anaemia with low haematocrit level [7]. Hemoconcentration is the phenomenon of plasma diapedesis and blood vessel permeability due to interstitial fluid loss. Misdiagnosis of Dengue cases involving Thalassemic patients could be overlooked, due to the presence of hemoconcentration in dengue fever. Furthermore, the lack of hemoconcentration would hamper the fluid replacement therapy.

From the study results, it is imperative for Thalassemia Major sufferers to receive special treatment when managing Dengue Fever, given the likeness and seriousness of complications related to Thalassemia-induced deficiencies.

The World Health Organization (WHO, 2014) over the world every year more than 800 mothers die during pregnancy or maternity every day. Based on the Indonesian Health Demographic Survey (2017), the average maternal mortality rate (MMR) was recorded at 309 per 100 thousand live births. This death rate is higher than the results of the 2007 IDHS which reached 228 per 100 thousand live births (Ministry of Health, 2013). One of the efforts made by the government in suppressing AKI is to provide antenatal care during pregnancy provided through pregnancy care standards, including identifying pregnant women by making home visits and interacting with the community regularly for counseling and motivation for early and regular examinations (Dewi & Musfiroh, 2013).

Coverage K1 is the coverage of pregnant women who get antenatal care according to the standard for the first time during pregnancy and does not depend on gestational age (K1) consisting of pure K1 (first pregnancy visit with 0-12 weeks gestation) while K1 contact is the first visit through from 12 weeks’ gestation, while coverage of K4 pregnant women’s visits is the coverage of pregnant women who have received antenatal care according to the standard at least 4 times in one work area at a certain time period. Pregnant women are advised to carry out antenatal supervision at least 4 times, namely once in the first trimester, once in the second trimester, and twice in the third trimester (Romauli, 2011). Antenatal Care (ANC) is a pregnancy examination to optimize the physical mental health of pregnant women so that they are able to face childbirth, during puerperium, preparation for breastfeeding and the return of reproductive health naturally to reduce maternal mortality. Antenatal care services can detect complications in pregnancy and childbirth (Candra, 2013).

Data from the Ministry of Health based on the results of the National Basic Health Research (Riskesdas, 2010) coverage of K1 in 2010 was 95.26% and K4 coverage was 85.56%. The amount is still less than the national target, namely 100% K1 and 95% K4 coverage. Whereas in the National Basic Health Research (Riskesdas, 2013) data, 95.4% of pregnancy examinations (K1) and pregnancy frequency of at least 4 times during pregnancy were 83.5%. The ideal K1 coverage nationally is 81.6% with the lowest coverage in Papua (56.3%) and the highest in Bali (90.3%). National K4 coverage is 70.4%. The difference between ideal K1 coverage and K4 nationally shows that 12% of mothers who receive ideal K1 do not continue ANC according to the minimum standard (K4).

Report of the West Papua Provincial Health Office (2016), in 2014 K1 coverage was 58.1% and K4 was 33.6%, while in 2015 K1 coverage was 56% and K4 was 24%. While the 2015 Manokwari District Health Office Data K1 coverage is 111% and K4 is 49.4%. In 2016 K1 coverage was 118.3% and K4 was 45.3% and in 2017 K1 coverage was 91% and K4 was 45%. This shows that the target of ANC coverage in 2017 experienced a decline in K1 and K4 which was not reached according to the 95% standard (Manokwari District Health Office, 2017). Based on Local Area Monitoring (PWS) data in Sanggeng Health Center, Manokwari Regency in 2015 K1 coverage was 94.3% and K4 was 69.8%, in 2016 K1 coverage was 23.7% and K4 was 14.9%, in 2017 coverage K1 is 77% and K4 is 24%. Local Area Monitoring Data (PWS) declined in all three puskesmas, especially K4, and was the lowest of 23 Puskesmas in Manokwari District. So that is the reason for researchers to conduct research at the Sanggeng Health Center.

Increasing antenatal health services is affected by the use of antenatal services. With no use of antenatal care facilities can be caused by many factors such as inability in terms of costs and location of services that are too far away (Prawirohardjo, 2012).

In accordance with the above problems, the researcher was interested in conducting a study entitled ‘Factors that influence K4 visits at Sanggeng Health Center, Manokwari Regency, West Papua Province’.

Material and method

Types and Design of Research

This research is a quantitative descriptive study with a cross sectional study design. The cross sectional study is an epidemiological study design that studies variables including risk factors and variables including effects observed at the same time (Notoatmodjo, 2012).

Time and Location of Research

The study was conducted at the Sanggeng Health Center in Manokwari Regency. The reasons for choosing this Puskesmas as a place of research are:

1. Low coverage and K4 from year to year are getting lower.
2. No research has been conducted on K4 coverage at Sanggeng Community Health Center, Manokwari Regency.

Population and sample

Population

The population in this study were all pregnant women who visited in July to September 2018 in the Sanggeng Health Center as many as 606 pregnant women.

Samples

The sample is part of the number and characteristics possessed by the population (Sugiyono, 2013). The sample size in the study was 86

Physical Environmental Effects on the incidence of Dengue Hemorrhagic Fever

Physical environmental conditions such as types of containers or water reservoirs that are rarely drained, will be a breeding ground for mosquitoes. This can cause disease in humans if poor health behavior (Hidayat, 2011). Environment is everything that exists around humans that affects the development of human life both directly and indirectly. Environmental conditions have a major influence on the spread and transmission of dengue disease (Mufidah, 2012). The results of the study show that the physical environment of the respondents in Sorong City is generally 97% of the walls are made of cement cast, 62% install wire mesh on ventilation and 86% use the ceiling ceiling. The condition of the home page has 30% plant pots / flowers inundated and 32% stated that there were excavated trash cans to dispose of waste and 47% stated that there were water reservoirs outside the house, and 82% stated that there were sewerage and wastewater flowing with smoothly, so that it does not cause puddles as a breeding ground for mosquitoes. The physical condition of the respondents was 51.5% risky, that is, as much as 68.2% in the DHF case group while in the control group or not suffering from DHF as much as 38.6%. This shows that physical environmental conditions that are at risk of causing DHF.

The results of statistical tests stated that there were physical environmental influences on the incidence of Dengue Hemorrhagic Fever in Sorong City and the incidence of DHF in the physical environment of respondents who were at risk of 3,403 times compared to respondents with a non-risky physical environment.

This study is in line with Umaya (2013) who conducted research in the Talang Ubi Pendopo Health Center work area stating that poor physical environmental factors caused a risk of 4 times the incidence of DHF rather than good physical environmental factors. This is because physical environmental conditions cause mosquito nesting sites to breed. Poor physical environment conditions are very risky to the people around them because of the large number of mosquito populations so that people around them experience the bite of the Aedes aegypti mosquito.

Environmental sanitation is also one of the efforts to achieve a healthy environment through controlling physical environmental factors, especially those that have a detrimental impact on the physical development of health and human survival. Environmental sanitation business is a health effort that focuses on efforts to control physical environmental factors that might cause and cause harm in physical development, health and human survival (Notoatmodjo, 2011).

The physical environment of the house and the environment in the Sorong City area needs attention from local health agencies in controlling dengue fever, because this requires awareness of all elements of society to create healthy physical environmental conditions in preventing environmental-based diseases.

Effect of the Social Environment on the incidence of Dengue Hemorrhagic Fever

Community habits that are detrimental to health and lack pay attention to environmental cleanliness such as hanging habits clothes, the habit of taking a nap that is not safe from the bite of the Aedes aegypti mosquito, does not clean the landfill regularly, low habits cleaning the yard, and also low community participation

especially in the context of eradicating mosquito nests (PSN), it will pose a risk of transmission of dengue transmission in the community. This habit will get worse where people find it difficult to get clean water, so they tend to store water in reservoirs or tubs, because the landfill is often not washed and cleaned regularly and eventually becomes a potential breeding place for Aedes aegypti mosquitoes (Zulkoni, 2011).

The social environmental conditions for respondents in Sorong City were as much as 47% at risk. This is due to 97% of residential and adjoining homes, 59% of the habit of families hanging clothes, lack of family habits cleaning the home environment (85%), lack of community participation in cleaning the drainage channels in the environment which causes water to not flow smoothly or inundated (68 %), there are 33% of ponds around the residence and 68% of them state the dirty environment of the residence and rarely even the presence of devotion in the local environment in the Eradication of Mosquito Nests (PSN).

Respondents in the DHF case group in the risky social environment were (68.2%) and not at risk (31.8%). This shows the risk of poor social environment causing high DHF sufferers. The results of statistical tests revealed the existence of social environmental influences on the incidence of Dengue Hemorrhagic Fever in Sorong City with a large risk of dengue incidence in the respondent’s social environment by 3,750 times compared to respondents with a non-risky physical environment.

Research conducted by Purwanti (2013) revealed that the family social environment had an effect on the incidence of Dengue Fever. Socio-cultural environment conditions such as high population density will facilitate the occurrence of dengue virus infection, because densely populated areas will increase the number of incidents of dengue cases. In addition, the habit of hanging clothes made by families causes the nesting place of mosquitoes and the risk of transmitting dengue fever.

Social environmental conditions can be anticipated to prevent environmental-based diseases such as Dengue Hemorrhagic Fever with an active role in families that have a habit of maintaining environmental cleanliness and the community in the environment in maintaining cleanliness, especially at mosquito breeding sites. This needs support from health workers in overcoming social environmental problems by providing counseling regularly.

Effects of Knowledge on the incidence of Dengue Fever

Behavior based on knowledge will last more than behavior that is not based on knowledge. People will make efforts to Eradicate Mosquito Nests (PSN) to prevent DHF if they know what the goals and benefits are for health or their families and the danger of not doing the eradication (Ministry of Health, 2014). The respondent’s knowledge about Dengue Hemorrhagic Fever disease was 57.6% well-informed and 42.4% lacked knowledge. This shows that the public’s understanding of dengue fever is still low, especially in the causes of the transmission of dengue fever. In the DHF case group, there was 50% less knowledge and good knowledge (50%). The results of statistical tests stated that there was no effect of knowledge on the incidence of Dengue Hemorrhagic Fever in Sorong City and was not a risk factor for the incidence of Dengue Hemorrhagic Fever.

Research conducted by Novrita (2017) in Ogan Ilir District revealed that knowledge was not related to the incidence of Dengue Fever, because the knowledge of dengue fever mostly had good knowledge. According to the researchers’ assumption that the absence of a knowledge relationship to the incidence of dengue hemorrhagic fever is a disease that often occurs in the community and the community generally knows about dengue fever, causes and prevention, but the questions given do not know how to transmit Dengue Fever, so community knowledge must be improved … This is also expressed by Fentia (2017), that there is still an assumption in society that creates inappropriate behavior, such as; the assumption that DHF only occurs in slums and the eradication of mosquito nests (PSN) does not appear to be clear compared to fogging. This assumption is often overlooked, even though it greatly influences people’s behavior in making decisions especially in the transmission of dengue (Fentia, 2017).

Effects of Attitudes on the incidence of Dengue Hemorrhagic Fever

According to Fishbein and Ajzen in Azwar (2013), that positive or negative attitudes formed in a person depend on whether or not there is a benefit from the knowledge component, the more benefits that are known to be the more positive attitudes that are formed. Respondents’ responses to dengue hemorrhagic fever were mostly in the good category as much as 65.2% and less as much as 34.2%. The respondent’s lack of attitude about Dengue Hemorrhagic Fever is that cleaning / draining the bath once a week does not affect the spread of dengue fever including storing hanging clothes. Besides that, the attitude response is lacking because they assume that supervision of mosquito larvae is not necessary and fogging is not effective in preventing dengue fever.

Attitude response in the DHF case group in respondents who behaved less as much as 54.5% and good attitude as many as 10 people 45.5%. The results of statistical tests stated that there was an attitude effect on the incidence of Dengue Hemorrhagic Fever in Sorong City and the risk of attitude was less when viewed from OR = 3.600; CI95% (1,221 – 10,618) which is interpreted that the attitude of respondents who are less likely to be at risk with the incidence of DHF is 3,600 times compared to respondents who have a good attitude. This study is in line with what was done previously by Suyasa (2016), that the attitude influences the incidence of dengue fever because the attitude that does not support causes low enthusiasm and motivation in doing prevention of Dengue Hemorrhagic Fever. The attitude of respondents in the city of Sorong to drain water storage was not accompanied by awareness as an action to remove the larvae of Aedes aegypti mosquitoes, but more towards poor physical conditions of water. In people who lack 3 M (Drain, Close and Bury) water storage areas and do not improve sanitation and physical condition of houses in the use of wire mesh and habits not cleaning the environment have a high risk of developing Dengue Hemorrhagic Fever and presumption, which important is not the family itself who has Dengue Fever even though it is known that mosquitoes do not recognize social status and other attributes so that the attitudes and actions taken will be different in responding to the prevention of Dengue Fever.

There is still the attitude of the people who are less concerned with the disease of Dengue Hemorrhagic Fever in Sorong City, so they will be at risk of developing dengue disease which tends to cause outbreaks (extraordinary events). Attitude awareness efforts are an effort to raise awareness of the belief as the underlying aspect, so that awareness of anyone if it is not successful will have the same risk of developing Dengue Hemorrhagic Fever. When the house and the environment are clean, but family members can be bitten by mosquitoes when schooling and so on

Effect of Actions on the incidence of Dengue Hemorrhagic Fever

Every reported DHF sufferer is treated with patient care, epidemiological investigations in the field, and control efforts. The high rate of dengue morbidity is caused by an unstable climate and quite high rainfall in the rainy season which is a potential breeding tool for Aedes aegypti mosquitoes (Ministry of Health, 2014).

Dengue Hemorrhagic Fever Case, the right method to prevent DHF is the Eradication of Mosquito Nests (3M) through 3M plus (draining, closing and burying) plus other activities that can prevent or eradicate mosquitoes Aedes aegypti breed, including the use of wire netting, using mosquito repellent lotion, and using mosquito nets and this requires community participation in acting to prevent blood emam (Republic of Indonesia Ministry of Health, 2014).

The actions of respondents who were good at doing prevention of Dengue Hemorrhagic Fever as much as 60.6% and less action as much as 39.4%. The respondent’s actions were lacking, from the respondent’s answer about the habit of throwing or burying water reservoirs such as cans, jars, unused used tires as much as 74%, cleaning the sewerage channel as much as 89% and periodically preventing mosquito breeding as much as 71% . This shows that the core actions in the prevention of dengue fever are still low. Respondents whose actions were lacking in the DHF cases group were 63.6% and good actions were 27.3%. This shows that while there is less action, the higher the incidence of DHF. The results of statistical tests stated that there was an effect of action on the incidence of Dengue Hemorrhagic Fever in Sorong City and the risk of the actions of respondents who were less risky with the incidence of DHF was 3.600 times compared to respondents who had good actions.

Some family actions in Sorong City still tend to be unclean, causing the breeding of Aedes aegypti mosquitoes, where in 2016 as many as 46 cases and in 2017 as many as 37 cases this was due to family actions that many still hung clothes, there were water shelters that were not closed , and the bath is rarely drained, a habit like this must be corrected to anticipate the occurrence of dengue disease.

In this investigation, I chose warmer climate could lower Dengue risk and Mobile phone records may predict epidemics of mosquito born Dengue virus as the survey object. As time goes by, our science has been improving and never stopped, so we have many new discoveries. It can make us know more about scientific advance. It belongs to the inquiry part of science People used to choose to observe this problem, but now we will experiment to confirm Scientific progress can make people more aware of the world

Introduction

A few years ago, dengue fever was more popular in China. At that time, I was still a child. I don’t know what dengue fever is. The purpose of my research is to investigate whether climate warming can reduce the risk of dengue fever and whether cell phone records can prevent mosquito-borne dengue epidemics. I will talk about warmer climate could lower Dengue risk and Mobile phone records may predict epidemics of mosquito born Dengue virus as the survey object. According to the background information I found, global warming will reduce the risk of dengue fever in some areas, but it will increase the risk of dengue fever in areas such as Europe. And through mobile phone records, we can know in advance the arrival of dengue fever and take certain measures. And I think the second of these two advances has contributed the most to science. It is Mobile phone records may predict epidemics of mosquito born Dengue virus.

Research Methodology

I collect data by looking up the data online to verify my hypothesis by visiting the Bing website to find it. These are good academic sources. I also use this website when I finish my previous assignments. This website is very suitable for us to find information. These two scientific advances are both good and reliable, but they all have their own advantages and disadvantages. The comparison can more clearly to see their respective strengths and weaknesses, so the comparison plan between the two scientific plans is good and reliable.

Findings

The first scientific advancement began to make people more aware of what is dengue fever, and then people know that climate warming can reduce the risk of dengue fever in some places. The first scientific advancement will enable people to know in advance the arrival of dengue fever and adequate preparation to effectively reduce the risk of dengue tropical

Discussion

According to my hypothesis, I verified that my hypothesis is correct. Recorded by mobile phone, it can prevent mosquito-borne dengue epidemics, because we can make a series of preparations before the epidemic by mobile phone, which can effectively prevent dengue epidemics. The data I have looked for shows that warming can reduce the risk of dengue in some areas, but not in some areas. For example, in Europe, climate warming will bring them dengue fever. Every progress in science will bring a lot of contributions to scientific issues, and we can learn from it. Every progress in science will bring a lot of contributions to scientific issues, and we can learn from it. Every progress in science will bring a lot of contributions to scientific issues, and we can learn from it. In order to solve the progress of these two problems, I have found a lot of information from the Internet. Still quite successful, because I found the content I needed, but it is not particularly good that some of the collected content is exactly the opposite of what I found. The better part is that I should look for more specific examples to confirm my hypothesis. Whether the information I am looking for is comprehensive will affect my final result.

Conclusion and Recommendations

The most important thing for science and technology in human progress is to promote human life and other aspects, so that the quality and level of human life are constantly improving, and diseases are gradually reduced. Because we can prevent mosquito-borne dengue epidemics through science and technology, we also have more ways and techniques to treat those rare diseases.

Reference

1. Short book (2018) Climate warming will bring dengue fever to Europe,[online] Available at: https://www.jianshu.com/p/8c7b7a001046 [Accessed 31 January 2019]
2. BaiduLibrary(2017) Epidemiology of dengue fever[online] Available at: https://wenku.baidu.com/view/efb778f5c67da26925c52cc58bd63186bceb92eb.html [Accessed 31 January 2019]

Background: Dengue Hemorrhagic Fever continues to occur, including in Sorong City, which in the last three years (2016-2018) has experienced improvements that are influenced by the physical environment, social environment, knowledge, attitude, action, occupancy density and health services.

Objective: To determine the risk factors for the incidence of Dengue Hemorrhagic Fever in Sorong City, West Papua Province.

Research Method: observational with a case control study design conducted in September-October 2018. The population was DHF patients in Sorong Hospital with a total sample of 66 people with a total of 22 people and 44 people in control. Data were obtained using questionnaires and analyzed using chi square, odds ratios and logistic binary regression.

Results: The factors that influence the incidence of Dengue Hemorrhagi Fever in Sorong City are the physical environment (p-value 0.045; OR = 3.403; CI95% (1.152 – 10.053), social environment (p-value 0.029; OR = 3.750; CI95% ( 1,264-11,123) attitudes (p-value 0.036; OR = 3.600; CI95% (1,221 – 10,618), actions (p-value 0,010; OR = 4,667; CI95% (1,564 – 13,922). Factors that did not affect the incidence of fever dengue in Sorong City is knowledge (p-value 0.538; OR = 31.588; CI95% (0.565 – 4.461), occupancy density (p-value 0.477; OR = 1.815; CI95% (0.570 – 5.779), health services (p- value = 0.066; OR = 3.063; CI95% (1.057 – 8.874). The dominant factor with the incidence of Dengue Hemorrhagic Fever in Sorong City is seen from the values of action, social environment and physical environment.

Dengue fever in Southeast Asia has only begun to be known since the mid-fifties, when when Quintos Philippines in 1954 found 58 children lying sick with the same symptoms, namely high heat, acute bleeding and shock, even 28 of them died. A few years later, it turns out that in several countries in Asia, the same epidemic is reported and this is a sign that dengue fever has spread in Asia (Nasrul, 2016).

Thailand and Vietnam in 1958, in Singapore in 1960, Laos in 1962, India had one sufferer, in 1985 it appeared in 1965, and Indonesia itself only appeared on reports of the first dengue fever in Surabaya in 1968 with a number of cases 58 people and 24 of them died (Case Fatality Rate = 41.3%). Shortly thereafter followed by other cities: Jakarta in 1969, Bandung and Yogyakarta in 1972, even in the early 1973 epidemics of dengue fever attacked Semarang, Solo, Tanjung Karang (Lampung), Padang, Manado, Pekanbaru, and Ujung Pandang. Today all provinces throughout Indonesia, according to reports, have contracted dengue hemorrhagic fever (Pusdatin, 2016) The Ministry of Health of the Republic of Indonesia recorded the number of dengue sufferers in Indonesia in January-December 2016 as many as 8,487 people with DHF with 108 deaths, with a CFR of 1.3%. Most age groups who experience DHF in Indonesia at the age of 5-14 years reach 43.44% and ages 15-44 reach 33.25% (Ministry of Health, 2016).

In Papua, DHF has arisen since 1979 in Asano Village with one sufferer in Ardipura, in 1989 one sufferer in Bhayangkara Village, in 1990 there were two cases in Argapura and Mandala Village, in Jayapura City. Then the explosion in 1993 spread to five districts in the city of Jayapura with the number of cases 249 people while the dead were 3 people. Since then dengue fever has begun to appear in several districts, such as; Sorong, Manokwari, Fakfak, Nabire, Biak and Mimika (Haryono, 1999).

DHF events in Papua Province throughout 2015 with a total of 47 patients and 1 person died or with a CFR of 2.13% (Berita Satu Com, 2016). Data on dengue incidence in Sorong Regency, West Papua Province, according to the recapitulation of reports of infectious diseases throughout the years 2017-2018, with the number of patients as many as 46 children in 2016 and 39 patients in 2017 with a CFR of 2.6%. This CFR number is much higher than the national CFR which should not be> 1%, and 22 sufferers in 2018 (January-August),

Based on data obtained from the Regional General Hospital (RSUD) Sorong, in 2017 there was a decrease in the number of cases to 39 patients from the previous year which amounted to 46 incidents, as well as in the January-August period in 2018, the number of cases tended to decline. The DHF case above is data that has been separated between patients residing outside Sorong, meaning that this DHF case is truly a patient who lives in Sorong City (RSUD, 2018). The high level of CFR in Sorong City, so it becomes very important to study various risk factors, including a description of the frequency of new sufferers of a disease found at a certain time, in a community group. Determining the incidence rate of an illness, it must be known in advance about Population at Risk (David, Dullah 2016). DHF epidemiological data is estimated to occur due to various factors that accelerate its spread, which include: 1). Increased means of transportation between cities, 2). The occurrence of the rainy season, 3). There is a source of transmission, 4). The existence of vectors (Suroso, 1997).

The above risk factors are all owned by Sorong City, where the city is the gateway to all regions in West Papua Province. The habit of people who hold water allows the Aedes aegypti mosquito to breed, which is a vector of the Dengue virus. Moreover, the Eradication of Dengue Hemorrhagic Fever (PSN-DBD) and larvae monitoring (Jumantik) activities have not proceeded properly.

Community efforts to prevent the transmission of dengue hemorrhagic fever through efforts to improve the quality of the physical, social environment, increase knowledge, attitudes, and actions are still very limited, as evidenced by the high incidence of dengue which is also called ‘serious or fatal’ disease which is very dangerous and deadly (Indrawan, 2001).

Materials and methods

Types of Research

This study was an observational study with a case control study design (case control study). A case control study is a design of an epidemiological study that studies the relationship between exposure (risk factor) to a disease or health status by comparing a case group with a control group based on the status of his father. In case-control studies, effects (health status) were identified at this time, while risk factors were identified to occur in the past (retrospective) (Hasmi, 2016).

Time and Place of Research

a. Research Time

The time for conducting research for 1 (one) month, namely in September-October 2018.

b. Research Place

This research was conducted in Sorong City, West Papua Province

Research Populations and Samples

a. Population

The criteria for the research subjects that became the population in this study were all patients with Dengue Hemorrhagic Fever (DHF) who had been treated in Sorong Hospital (limited population), at least treated for 3 days, assuming that not all respondents took their children to the hospital as soon as possible when the child has a fever. It may have been two or three days of fever / illness in the new home under the hospital. The population of dengue cases in the January-August period of 2018 was 22 cases (as a sample). Control cases are diseases that have symptoms that are almost the same or similar to the initial symptoms of dengue cases, so the control is cases of pharyngitis infection, which in the same period amounted to 350 cases.

b. Samples

The sample size that was used as the object of the study was the total incidence of dengue hemorrhagic fever as of January-August 2018 as many as 22 cases that had been treated at Sorong District Hospital. Based on the number of cases above, the number of controls is a minimum with a ratio of 1: 2, so that there are 44 cases of control needed. The technique for determining case control samples used in this study was convenience sampling technique where case control samples were taken based on convenience considerations, because the addresses of respondents were spread unevenly in the Sorong City area.

Physical Environmental Effects on the incidence of Dengue Hemorrhagic Fever

Physical environmental conditions such as types of containers or water reservoirs that are rarely drained, will be a breeding ground for mosquitoes. This can cause disease in humans if poor health behavior (Hidayat, 2011). Environment is everything that exists around humans that affects the development of human life both directly and indirectly. Environmental conditions have a major influence on the spread and transmission of dengue disease (Mufidah, 2012). The results of the study show that the physical environment of the respondents in Sorong City is generally 97% of the walls are made of cement cast, 62% install wire mesh on ventilation and 86% use the ceiling ceiling. The condition of the home page has 30% plant pots / flowers inundated and 32% stated that there were excavated trash cans to dispose of waste and 47% stated that there were water reservoirs outside the house, and 82% stated that there were sewerage and wastewater flowing smoothly, so that it does not cause puddles as a breeding ground for mosquitoes.

The physical condition of the respondents was 51.5% risky, that is, as much as 68.2% in the DHF case group while in the control group or not suffering from DHF as much as 38.6%. This shows that physical environmental conditions that are at risk of causing DHF. The results of statistical tests stated that there were physical environmental influences on the incidence of Dengue Hemorrhagic Fever in Sorong City and the incidence of DHF in the physical environment of respondents who were at risk of 3,403 times compared to respondents with a non-risky physical environment.

This study is in line with Umaya (2013) who conducted research in the Talang Ubi Pendopo Health Center work area stating that poor physical environmental factors caused a risk of 4 times the incidence of DHF rather than good physical environmental factors. This is because physical environmental conditions cause mosquito nesting sites to breed. Poor physical environment conditions are very risky to the people around them because of the large number of mosquito populations so that people around them experience the bite of the Aedes aegypti mosquito.

Environmental sanitation is also one of the efforts to achieve a healthy environment through controlling physical environmental factors, especially those that have a detrimental impact on the physical development of health and human survival. Environmental sanitation business is a health effort that focuses on efforts to control physical environmental factors that might cause and cause harm in physical development, health and human survival (Notoatmodjo, 2011). The physical environment of the house and the environment in the Sorong City area needs attention from local health agencies in controlling dengue fever, because this requires awareness of all elements of society to create healthy physical environmental conditions in preventing environmental-based diseases.

Effects of the Social Environment on the incidence of Dengue Hemorrhagic Fever

Community habits that are detrimental to health and lack pay attention to environmental cleanliness such as hanging habits clothes, the habit of taking a nap that is not safe from the bite of the Aedes aegypti mosquito, does not clean the landfill regularly, low habits

cleaning the yard, and also low community participation especially in the context of eradicating mosquito nests (PSN), it will pose a risk of transmission of dengue transmission in the community. This habit will get worse where people find it difficult to get clean water, so they tend to store water in reservoirs or tubs, because the landfill is often not washed and cleaned regularly and eventually becomes a potential breeding place for Aedes aegypti mosquitoes (Zulkoni, 2011). The social environmental conditions for respondents in Sorong City were as much as 47% at risk. This is due to 97% of residential and adjoining homes, 59% of the habit of families hanging clothes, lack of family habits to clean the home environment (85%), lack of community participation in cleaning the drainage channels in the environment which causes water to not flow smoothly or inundated (68 %), there are 33% of ponds around the residence and 68% of them state the dirty environment of the residence and rarely even the presence of devotion in the local environment in the Eradication of Mosquito Nests (PSN).

Respondents in the DHF case group in the risky social environment were (68.2%) and not at risk (31.8%). This shows the risk of poor social environment causing high DHF sufferers. The results of statistical tests revealed the existence of social environmental influences on the incidence of Dengue Hemorrhagic Fever in Sorong City with a large risk of dengue incidence in the respondent’s social environment by 3,750 times compared to respondents with a non-risky physical environment. Research conducted by Purwanti (2013) revealed that the family social environment had an effect on the incidence of Dengue Fever. Socio-cultural environment conditions such as high population density will facilitate the occurrence of dengue virus infection, because densely populated areas will increase the number of incidents of dengue cases. In addition, the habit of hanging clothes made by families causes the nesting place of mosquitoes and the risk of transmitting dengue fever. Social environmental conditions can be anticipated to prevent environmental-based diseases such as Dengue Hemorrhagic Fever with an active role in families that have a habit of maintaining environmental cleanliness and the community in the environment in maintaining cleanliness, especially at mosquito breeding sites. This needs support from health workers in overcoming social environmental problems by providing counseling regularly.

Effect of Knowledge on the incidence of Dengue Fever

Behavior based on knowledge will last more than behavior that is not based on knowledge. People will make efforts to Eradicate Mosquito Nests (PSN) to prevent DHF if they know what the goals and benefits are for health or their families and the danger of not doing the eradication (Ministry of Health, 2014). The respondent’s knowledge about Dengue Hemorrhagic Fever disease was 57.6% well-informed and 42.4% lacked knowledge. This shows that the public’s understanding of dengue fever is still low, especially in the causes of the transmission of dengue fever. In the DHF case group, there was 50% less knowledge and good knowledge (50%). The results of statistical tests stated that there was no effect of knowledge on the incidence of Dengue Hemorrhagic Fever in Sorong City and was not a risk factor for the incidence of Dengue Hemorrhagic Fever. Research conducted by Novrita (2017) in Ogan Ilir District revealed that knowledge was not related to the incidence of Dengue Fever, because the knowledge of dengue fever mostly had good knowledge.

According to the researchers’ assumption that the absence of a knowledge relationship to the incidence of dengue hemorrhagic fever is a disease that often occurs in the community and the community generally knows about dengue fever, causes and prevention, but in the questions given do not know how to transmit Dengue Fever, so community knowledge must be improved … This is also expressed by Fentia (2017), that there is still an assumption in society that creates inappropriate behavior, such as; the assumption that DHF only occurs in slums and the eradication of mosquito nests (PSN) does not appear to be clear compared to fogging. This assumption is often overlooked, even though it greatly influences people’s behavior in making decisions especially in the transmission of dengue (Fentia, 2017).

Are you worried about the increasing number of dengue cases? Dengue is actually an infection and can severely affect it. ‘Dengue fever’ has become increasingly common in lots of areas and needs to be controlled. As dengue can take a serious turn in some cases, awareness of signs and symptoms of dengue is always helpful.

Dengue is a viral infection that spreads through the bite of a female Aedes mosquito and can affect almost everyone. Mosquitoes are mainly involved in the spread of dengue fever. Dengue is widely prevalent in India, but frequent travelers to other tropical countries are also at greater risk.

Fever, headache, and joint pain are common symptoms, dengue rashes also need attention. It is known as ‘Break-Bone fever’ because of extreme pain in joints. Detection of dengue on time is very important to avoid complications. It can be diagnosed by laboratory test You can seek medical attention on time and you can always go for a blood test to detect dengue. You can protect yourself only when you are aware of the warning signs of dengue, so it is necessary to understand the signs and symptoms of dengue.

Both adults and children can be affected by dengue and people with low immunity may be affected even more. Some common symptoms of dengue in adults include frequent vomiting, headaches, joint pain, body pain and high fever with nausea along with lots of pain in the eyes. It is considered stage 1 of Dengue fever. Normally these symptoms can last up o seven days, after which they abate. If the condition of patients worsens then medical supervision and attention is necessary. Children and adolescents may show no symptoms in mild dengue. However, some mild symptoms can be noticed several times between four days to two weeks after being bitten by an infected mosquito. These symptoms remain almost like adults and usually occur in 2 to 7 days.

Dengue symptoms in infants may appear within 4 to 6 days of infection. Sudden high fever occurs with eye pain, headache and body pain. Notable symptoms such as nausea, vomiting, skin rashes may appear after a few days, including bleeding from the gums and bleeding from the nose. However, even in infants, mild forms of dengue may have no symptoms or the symptoms are not well recognized. Furthermore, since children are unable to express their complaints, they should be properly evaluated.

In some cases, it can turn into a serious condition, which is potentially fatal. However, timely laboratory testing and appropriate treatment for dengue can help control complications.

Dengue Fever is a viral disease induced by Dengue virus (of the genus Flavivirus) that is pandemic-prone and is quickly emerging in many parts of the world, most notably in tropical and sub-tropical climates. The disease is created by a mosquito carried viral infection that causes intense flu-like symptoms and can sometimes progress to a potentially fatal stage known as severe dengue. Currently it is estimated that up to 50-100 million infections are estimated annually, spread over more than 100 prone countries, putting at risk close to half of the world’s population (World Health Organization, 2018).

The spread of Dengue is due mostly one species of mosquito – Aedes aegypti or ‘dengue mosquito’, which common appear in tropical locations worldwide. In Australia, towns in North Queensland hold populations of Aedes aegypti and are prone to outbreaks of the virus when the populations are infected by outside sources such as travellers. The species also reside in other locations in central and south Queensland along with the Northern Territory but there have been no recorded outbreaks in recent years. Local mosquitoes remain uninfected unless they have bitten a person who is harbouring the virus. Australia is free of dengue fever except for specific outbreaks, and regimented procedures and vigilant efforts to control the disease are needed to keep it that way (Queensland Health, 2018).

The Causative Agent of the Disease

The Dengue virus (DEN) encompasses 4 main serotypes within the genus Flavivirus, known as DEN-1, DEN-2, DEN-3 and DEN-4. The virus shows a high level of genetic variability, with several distinct genotypes within each serotype having been identified (World Health Organization, 2018).

The structure of the virus is more or less spherical and measures approximately 50nm in diameter. The most important part of the cell is the nucleocapsid, comprised of proteins and the viral genome. Surrounding this is a lipid bi-layer membrane called the viral envelope, taken from the host cell. Still enclosed by the endosome, the virus moves deeper into the cell and is released only when the pH is suitable and the endosome reaches a negative charge. At this stage the nucleocapsid is released into the cytoplasm, where the viral RNA accesses the organelles of the host cell to replicate itself. The virus’ genome within a single strand of positive-sense RNA, which is translated to a single polypeptide and directly broken down into proteins by the host cell’s ribosomes. Three of these are structural proteins, and account for the capsid, membrane and the envelope of the virus. The others are referred to as non-structural proteins and are involved in replication. One in particular, Nonstructural Protein 1 (NS1) has been found to cause adverse effects in the human body through a condition called leaky gut. Once the RNA has been replicated, the newly synthesised genetic material is enclosed in the Rough Endoplasmic Reticulum and matured in the Golgi apparatus, releasing new infectious viral cells into the body to infect more cells (Nature Education, 2014).

Symptoms and Related Issues

Dengue Virus infection can lead to a range of differing clinical symptoms across the spectrum of the disease. This can range from mild fever through to several acute, possibly fatal conditions such as dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) or severe dengue. Age and immunological tolerance both play a role in the severity of the symptoms exhibited. For individuals that develop discernable signs and symptoms, the disease’s course and acuteness can prove difficult to predict in early stages of infection (Queensland Health, 2015).

Classic dengue presents with typical symptoms such as the sudden onset of high fever up to 40 degrees celsius along with consistent headaches and pain at the back of the eyes. Muscle pains are prominent particularly in the back and limbs, as well as joint pain commonly in knees and elbows, and a rash causing skin redness with the presence of small bumps, itchiness and flaking of skin. Other notable symptoms can also be observed, such as lethargy, weakness, loss of appetite leading to weight loss, taste abnormality such as the presence of a displeasing metallic taste. Common flu-like symptoms will persist for days, such as sore throat body pains and coughing, as well as vomiting and diarrhoea.

As the disease develops in the body, abdominal pain may be experienced and minor hemorrhaging such as nosebleeds, abnormally heavy and prolonged periods for women, blood present in urine, and bleeding gums (Australian Government: Department of Health, 2015). Careful monitoring of the infected individual should be undertaken, with hospitalisation possibly being required depending on the severity of signs and symptoms. Such occasions include high level of dehydration, bleeding or the presence of additional co-occurring conditions (such as hepatitis). Dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) appear predominantly in the form of plasma leakage, the process in which the proteins and other fluid elements of blood leak from blood vessels into surrounding tissues, causing shock and can be fatal if left untreated (Australian Government: Department of Health, 2015).

Plasma leakage has been observed to occur more often in children and youths and is the most severe complication of the disease spectrum, distinguishing dengue fever from severe dengue (Centers for Disease Control and Prevention, 2019). In general, the illness commonly persits for up to a week, sometimes two, and in some instances symptoms can return for another several days, before alleviating completely (Queensland Health, 2018).

Pathology and Etiology

Dengue Fever’s life cycle involves the mosquito in the role as the transmitter (vector), with humans acting as the main source of infection (victim) (World Health Organization, 2018). In Australia, dengue mosquitoes most commonly live and breed nearby to humans and built up areas, with no large populations being observed in forests or rural areas. These mosquitoes feed throughout the day, predominantly in mornings and evenings. After feeding on the blood of their victims, females lay eggs in water sources like puddles and many artificial places it accumulates such as buckets, containers, clogged roofing gutters and other human-made structures. The eggs eventually hatch into larvae, which develop into adult mosquitoes over 1-2 weeks (Queensland Health, 2018).

The virus is spread to humans via the bites of infected female Aedes aegypti mosquitoes, which is not present in the mosquitoes when born and is most commonly received from the blood of an infected person whilst feeding. Inside the mosquito, it is the gut specifically that harbours the virus and over the course of an 8-12 day incubation period advances to the salivary glands. From here, the virus can be transmitted to humans by the transfer of saliva to body fluid during probing or feeding (World Health Organization, 2018). The time between being infected and becoming infectious is the reason that mosquitoes passing on the virus tend to be the mature females. The mosquitoes will remain infectious for life and can pass on the virus to many new hosts during that time (Queensland Health, 2018).

Humans will become sick within three to fourteen days after being bitten. The virus circulates through the person’s body via arteries and capillaries for up to seven day, at which time comes the onset of fever. Directly before fever becomes present and up to 12 days following, infected persons can infect new mosquitoes if bitten again, continuing the disease cycle and spread. Dengue fever however does not transmit directly from person to person (World Health Organization, 2018).

Recovery from an infection of the virus in humans results in immunity for life in humans, but this immunity is only for that specific virus serotype. This immunity does however provide partial and short-term protection from the additional three virus serotypes. Evidence has shown that repeated infections have been known to increase the microbial load and put the patient at risk of progressing to severe dengue. It is likely that the time intervals between infections and the sequence of particular serotype infections is also a contributing factor (World Health Organization, 2018).

Due to it’s reliance upon the mosquito as the virus transmitter, Dengue Fever is found in the tropics, where it is widespread. Risk factors pertaining to disease spread are determined by differences in rain patterns, temperature, humidity, degree of urbanisation present and the variables within the urban environment. Until the 1970s, only nine countries had been affected by severe dengue epidemics. Presently, over 100 countries have been categorised by the World Health Organisation (WHO) as being endemic of the disease, encompassing Africa, the Americas, parts of the Medditeranean, South-East Asia and Pacific regions (WHO, ‘Dengue Control’, 2018). The specific numbers of dengue cases are routinely misclassified and insufficiently reported. One 2013 study estimated 390 Dengue virus infections occur yearly, with only an average of 96 million presenting with clinical indicators of the disease. Although these figures are estimates only, they bring attention to the incredible epidemiological and economic stain that affected countries are presented with (WHO, ‘Dengue Control’, 2018).

Sample Collection and OHS Measures

Several laboratory testing methods have been implemented to facilitate patient management and disease control. All testing is conducted upon blood sample, which should be provided by the patient as soon as illness is suspected (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970). The purpose of testing, as well as the facilities available and budget considerations will all help to determine the kind of testing method used. The main determinant however is the time of the sample collection relative to the disease process, as this determined if results are viable or not (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970).

The collection and processing of blood and serum create risk of health workers and laboratory staff being exposed to potentially hazardous biological matter. In order to keep the risk of infection to a minimum, safe laboratory techniques must be practised at all times. This includes but is not limited to the use of personal protective equipment and appropriate vessels for sample collection, as well as adherence to standardised handling procedures such as correct refrigeration of samples and sample delivery timelines (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970).

Testing

1. Nucleic Acid Testing. Polymerase chain reaction (PCR) testing has grown in popularity for dengue fever diagnosis due to its ability to yield express results in up to 24hrs, as well as identifying the particular serotype of the infection. This testing method provides a high level of sensitivity of virus detection in the acute phase of the disease period. In order for the tests to be effective viral RNA must be kept intact, therefore samples should be kept refrigerated between 4-8 degrees Celsius during transport and storage. A ‘detected’ dengue PCR test indicates a recent Dengue virus infection, however a ‘non-detected’ reading must be interpreted with the addition of further testing such as antigen detection and serology tests (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970).
2. Antigen detection. Viral antigen detection is a feasible alternative to PCR testing with high sensitivity, and can be used at the beginning of the disease period as early as one day after infection, however the test is unable to detect past infections. The method is highly specific as it tests for the existence of viral antigen non-structural protein 1 (NS1). As this antigen is unique to dengue, detection can differentiate Dengue virus from alternative flavivirus infections. NS1 detection is achieved with enzyme immunoassay via plate assay or lateral flow immunoassays. Antigen detection is useful in conjunction with other testing methods as it does not distinguish between serotypes of the virus (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970).
3. Serology. Enzyme linked immunosorbent assay (ELISA) kits for use with dengue fever are able to give very fast results, but unfortunately these are not specific to the virus in question. A positive result on this test may indicate a recent infection by another flavivirus. ELISA technique is used for detecting Immunoglobulin G (IgG) antibody and is utilsed in confirming recent or former dengue infections in patients showing acute symptoms or those recovering from infection. Because the test is not positive for Dengue virus specifically, the results should be interpreted with caution and while taking into account and context patient report details (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970). Generally speaking, rapid tests tend to lose out on specificity and testing sensitivity while being easy to use and fast acting. High sensitivity and specificity testing is ideal, however more complex technology and higher level of technical aptitude is required for their use (National Center for Biotechnology Information, U.S. National Library of Medicine, 1970).
4. Laboratory diagnosis. Testing human samples for evidence of Dengue virus is completed using commercially available antibody kits. Although these kits have been seen to measure Dengue virus antibodies effectively, they are not specific and will read positive for other flavivirus infections also. These kits are well suited for use in regions that are endemic of the virus or throughout verified epidemics as the likelyihood of the illness being attributed to Dengue virus as opposed to other flavivirus is somewhat high. In locations such as Australia that are not normally affected with Dengue virus with outbreaks less common, the risk of false positive readings is increased, which can unintentionally misguide health authorities and governing bodies. Test results should always be interpreted with care and whenever possible the results should be confirmed by NS1 antigen and/or PCR positivity (Australian Government: Department of Health, 2015).

Treatment

At present, there is no particular dengue fever treatment, and medical care remains largely supportive. Patients should seek medical advice as soon as possible, rest and maintain a high level of fluid intake. Paracetamol may be used to control fever and alleviate joint and muscle pain. Although aspirin and ibuprofen should be avoided as they have the potential to increase the risk of bleeding (Australian Government: Department of Health, 2015).

In the case of severe dengue, emergency medical attention is necessary. Upkeep of the patient’s circulating fluids is achieved with intravenous rehydration and continues to be the primary component of such care, paired with close monitoring in the hospital (NSW Government, 2019).

Reporting and Validation Requirements

Effective disease monitoring depends upon general practitioners, emergency department doctors and laboratories reporting possible cases of dengue to health authorities, especially for people with recent travel history to affected countries (Queensland Health, 2015, p. 27). Under the Public Health Act 2005, it is a mandatory requirement that new cases of Dengue fever even on clinical suspicion, are immediately reported to health authorities in order to prevent the spread of further cases (Queensland Health, 2018).

In areas such as North Queensland, that are home to populations of dengue mosquito, outbreaks prompt intensive control efforts in and around affected premises, with the aim of killing infected females nearby (Australian Government: Department of Health, 2015). The dengue mosquito is known to be highly domestic, and studies suggest that most female dengue mosquitoes maintain a close distance (an average of 400m) to the houses where they emerge as adults (World Health Organization, 2018).

Control measures include indoor spraying with synthetic insecticides such as bifenthrin and deltamethrin. Water collecting vessels and other potential breeding locations are treated with pesticides, insect growth regulators or some species of naturally occurring soil-dwelling bacteria whose spores produce toxins that specifically target mosquito larvae such as Bacillus thuringiensis subspecies israelensis (Bti) (United States Environmental Protection Agency, 2017).

This report investigates the conditions that result in mosquito bourne illnesses being a threat to Far North Queensland and the steps taken to control and reduce the risks of contracting dengue fever.

Dengue fever is a disease that is very infectious and its spreading is caused by the female mosquito also known as Aedes aegypti. It’s said to usually take 3-14 days after getting bitten by a dengue infected mosquito and contracting sickness. When a person recovers from dengue fever, they develop immunity to that mosquito bourne type disease. Different dengue fever viruses that are also transmitted by mosquitos are the Dengue Shock Syndrome and the Dengue Haemorrhagic. These fevers are passed around from one person to another by the mosquitos biting an already infected person then moving along and transferring the virus by biting and uninfected person.

Symptoms and signs of dengue fever are nausea, high fever, fatigue, severe muscle and joint pains, headaches, pain behind the eyes and red rash. Other common symptoms are easy bruising, sore throat, rapid breathing or bleeding gums. If any of these symptoms or signs are being shown or present to the body you should seek medical advice and/or help. If diagnosed by a doctor or medical professional, you may be prescribed with pain relief such as the common Panadol. When recovering from this disease, symptoms such as fatigue or in worse cases prolonged depression can come along. Healing can vary in each person though, in much worse cases it can take a person many months to fully recover from the disease.

Dengue fever is primarily found in the tropics. The tropics is found between the latitude lines of the Tropic of Cancer and the Tropic of Capricorn. The tropics include the Equator and parts of North America, South America, Africa, Asia, and Australia in a band that surrounds the equator from 23º north latitude to 23º south latitude.

Mosquitos have a life-cycle with dramatic changes in shape, function, and habitat. The female mosquitoes lay their eggs on the inner, wet walls of containers with water. The larvae then hatch when water inundates the eggs as a result of rain or the result of water by people. Following on, the larvae will then feed on microorganisms and particulate organic matter, shedding their skins three times to be able to grow from first to fourth instars. When the larva has gained enough energy and size and is in the fourth instar, metamorphosis is triggered, changing the larva into a pupa Pupae. Now, the newly formed mosquito emerges from the water after breaking the pupal skin. The life cycle lasts about 8-10 days at room temperature, depending on the level of feeding. Aedes aegypti live in tropical and subtropical regions all over the world, mainly between the latitudes of 35°N and 35°S where the winter temperature is no colder than 10°C. Because Aedes aegypti require a warm climate, they typically do not live at altitudes above 1000 m, where the temperature is colder. These mosquitoes are associated with the living spaces of humans.

In Far North Queensland, Dengue viruses are carried and spread by female mosquitoes, which are sensitive to environmental conditions. Temperature, precipitation, and humidity are critical to survival, reproduction, and development of a/the mosquitos. The high temperatures reduce the time required for the virus to replicate and disseminate in the mosquito. The process “extrinsic incubation period” must occur before the virus can reach the mosquitoes salivary glands and then soon to be transmitted to humans. If the mosquito becomes infected faster because temperatures are higher/warmer, it has a greater chance of infecting a human before it dies.

Globally, the disease of dengue has been increasing. Although climate may contribute to changing dengue incidence and distribution, it is one of the many factors included. Other important factors potentially contributing to worldwide changes in dengue include population growth, urbanization, lack of sanitation, increased long-distance travel, ineffective mosquito control, and increased reporting capacity.

To reduce the spread of dengue fever across Australia, the Queensland Department of Health has created and introduced a management plan for dengue. The objective is to reduce the spread of the dengue fever disease across QLD and to support the detection and reporting of the future dengue incidences. The general public, are encouraged to help prevent the spread of the disease. The use of repellents suitable for mosquitos and wearing long sleeved shirts and long pants, also removing any mosquito breeding grounds such as small containers, pots, discarded car tyres and bird baths that are around and full of water can reduce the threat.

Dengue control aims to break the cycle of transmission by detecting and reducing populations. In North Queensland towns with established Aedes Aegypti populations, work is done to educate and support the act to remove domestic container habitats. Mosquito surveillance is required to monitor the presence and numbers of mosquitos in risk areas, ports and airports. These activities require a joint effort from local government, quarantine officers from the Australian Government Department of Agriculture, health authorities and the public. Mosquito killing traps (e.g. lethal ovitraps) and sprays may be added in high risk spots and schools. Most outbreaks occur during the summer wet season.

In dengue receptive areas, an outbreak prompts urgent and intensive mosquito control activities around the addresses where the cases may have been viraemic. Water filled containers are treated with insect growth regulators (e.g. methoprene), Bti or pesticide sprays. Tipping out or removal of containers is most effective.

Overall, in summary the dengue fever virus is known to be uncontrollably infectious. The research that I conducted, I found that the female mosquito is the only carrier that is able to make the disease spreadable and that it contains four types of viruses. It was also found that there were more cases involving dengue in QLD last year then any other time.