Guidelines needed to predict, detect and manage dengue outbreaks

Comprehensive review of research evidence shows significant gaps

TDR news item
13 August 2013

There is no universally accepted or proven set of indicators to detect dengue outbreaks, or proven methods for controlling the Aedes aegypti mosquito that carries the disease, or agreed-upon guidelines for clinical health systems management of outbreaks. There is also scarce information on the costs of outbreaks, as well as the understanding of climate factors. These are the findings of a TDR team working with a worldwide panel of experts and national dengue experts to develop new models and practical guidelines for dengue detection and management.

The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5 billion people – over 40% of the world's population – are now at risk from the disease. It is a leading cause of serious illness and sometimes death among children and increasingly adults in many Asian and Latin American countries. There is no specific treatment, but early detection and access to proper medical care lowers fatality rates below 1%.

“It is very rewarding to be working with other countries facing the same challenges, and to learn from them. We know there is no one-size-fits-all, but through this careful analysis of past research and testing new models with our own cases, we should find what works best in each of our countries.”

Dr Lokman Hakim
Deputy Director General of Health
Ministry of Health in Malaysia

The work from the International Consortium on Dengue Risk Assessment, Management, and Surveillance (IDAMS) is going on in 5 Latin American (Brazil, Colombia, Dominican Republic, Mexico, Peru) and 5 Asian countries (Indonesia, Malaysia, Maldives, Sri Lanka, Vietnam). The work on dengue outbreak detection and response is being managed by TDR, with funding from the European Union. National control programme officers in each country are working together with international research experts to develop a textbook that each country can use to adapt for their own needs. They have found considerable variations among their countries, and are sharing their data in this international consortium.

New models being developed

The textbook will include a model contingency plan to predict, detect and respond to the disease. Work is focusing on the weakest areas identified ̶ outbreak management and stakeholder collaborations, surveillance strategies that include alert thresholds for when action should be initiated, and the ‘who, when, how and why’ of outbreak response activities as opposed to just the ‘what’.

“It is very rewarding to be working with other countries facing the same challenges, and to learn from them,” said Dr Lokman Hakim, Deputy Director General of Health at the Ministry of Health in Malaysia. “We know there is no one -size-fits-all , but through this careful analysis of past research and testing new models with our own cases, we should find what works best in each of our countries.”

The costs of dengue outbreaks are also being examined through a systematic literature review and country case studies (involving Peru, Dominican Republic, Vietnam and Indonesia). It was found that there is growing evidence on the burden of disease of dengue but very little information on the costs of outbreaks.

“This is the kind of information that is so important for our country. If we can compare costs for different models, then we can find the most efficient one and not waste scarce funds and time.”

Dr Giovanini Coelho
Dengue Control Programme Manager
Ministry of Health in Brazil

“This is the kind of information that is so important for our country,” said Dr Giovanini Coelho, Dengue Control Programme Manager in the Ministry of Health in Brazil. “If we can compare costs for different models, then we can find the most efficient one and not waste scarce funds and time.”

Journal papers on the core areas of work are being submitted and published as the work is completed. The first paper on the process was published in Biomed Central Public Health (see right hand column link). The consortium is publishing papers on each of the topics as the work is completed. In June, 2014 the group will finalize the retrospective study that looks at factors proven to be useful predictors in past outbreaks. Members will then make recommendations for how to test an early warning system and its costs. The complete textbook is expected to be published in 2015.

The work is part of an ongoing effort at TDR to provide research evidence to help prevent and control dengue. Working with the World Health Organization, a handbook for clinical management of dengue was produced in 2012.

For more information, please contact

Piero Olliaro
E-mail: olliarop@who.int

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