Introduction

Dengue fever and malaria - the two most common arthropod-borne diseases - are major public health concerns in tropical settings. The dengue viruses (family Flaviridae, genus Flavivirus) and the Plasmodium parasites are widespread in American and Asian intertropical regions, where their endemic areas greatly overlap. Although their pathogeneses differ, their clinical and biological presentations are unspecific and it is difficult to distinguish the two infections. Dengue fever, also known as breakbone fever, is a mosquito-borne infection that causes a severe flu-like illness. There are four different viruses that can cause dengue fever, all of which spread by a certain type of mosquito. Dengue can vary from mild to severe; the more severe forms include dengue shock syndrome and dengue hemorrhagic fever (DHF). Patients who develop the more serious forms of dengue fever usually need to be hospitalized. There are currently no vaccines for Dengue fever. The best way to prevent the disease is to avoid being bitten by mosquitoes altogether. Although there is no certain treatment for Dengue, it can be treated as long as it is caught before developing into dengue shock syndrome or dengue hemorrhagic fever. A study published in Nature (April 2013 issue) showed that there are approximately 390 million people worldwide infected with the dengue virus each year, over three times as many as the World Health Organization's estimate of up to 100 million. Dengue fever can be commonly found in urban parts of subtropical and tropical areas, such as Central and South America, parts of Africa, parts of Asia, the Caribbean and the Pacific. Dengue is just as prevalent in urban districts of its range as in rural areas (unlike malaria). However, researchers from the Nagasaki Institute of Tropical Medicine in Japan reported in PLoS Medicine (August 2011 issue) that people living in rural areas have a higher risk of dengue virus infection than city dwellers.

Difference Between Malaria And Dengue Fever Both malaria and dengue is transmitted by mosquitoes and both have some of the symptoms which are very common. Based on these symptoms one may confuse between malaria and dengue. Only through proper examination and proper tests from the physician can identify if it is malaria or dengue. People should be aware of the basic differences between malaria and dengue so as to protect them in the right way. Dengue and malaria are endemic and is common in tropical and subtropical countries. Malaria on the other has destinations like parts of Africa, Asia, South and Central America.

Dengue is caused by one of the four types of closely related viruses. And to be specific it is caused by viruses while in malaria the parasites are responsible for the malarial fever. The four types of viruses

are closely related but immunity acquired for one type of virus will not have significant effect in other virus types. In malaria the disease is caused by a unicellular parasite. Four species of parasites are plasmodium falciparum, plasmodium vivax, plasmodium malariae, plasmodium ovale. The different plasmodium types appear at different places and sometimes more than one species can occur in the same place.

Even though both dengue and malaria are mosquito borne diseases the type of carrier differs. Dengue is transmitted from an infected Aedes aegypti species of mosquito. When mosquito bites an infected person becomes carriers and starts developing that virus inside the blood. When it bites a person it gets transmitted. In malaria, the infection is transmitted via female anopheles mosquito. In general only female mosquitoes can transmit the disease by biting. Another difference is Aedes aegypti will bite only during day time while anopheles bites in the evening or in dark conditions.

In dengue the incubation period that is time gap between the mosquito bite and exposure varies between 3 to 14 days. But in malaria since the transmitters are parasites the incubation vary from one 7 to 16 days. This may be even extending to several months when the parasite's maturity increases. Even though some of the symptoms like rashes, headache, muscle pain and joint pain are common. There occurs a huge difference in fever. In dengue high fever will start after 4-7 days whereas in malaria, the fever varies in temperature. This change in temperature from chillness to high temperature, then again to sweating will make the patient feel tired.

Coming to prevention, dengue can only be prevented by protecting from mosquito bites but in malaria we have some prophylactic drugs available to develop partial immunity. For treating malarial infections, quinine was used at the earlier stage but nowadays this drug has been replaced by quinacrine, chloroquinine etc... Using repellents and medications while traveling to vulnerable areas is must in both the cases. Additionally keeping our surroundings clean by clearing all water stagnant containers, sewage tanks, and plastic materials will certainly help in multiplication of mosquitoes. Creating basic awareness including early identification of symptoms and prompt treatment can reduce the fatality rate in both the cases.

What are the signs and symptoms of Dengue Fever? A symptom is something the patient feels or reports, while a sign is something that other people, including the doctor detects. A headache may be an example of a symptom, while a rash may be an example of a sign. Dengue fever symptoms

As there are different severities of dengue fever, the symptoms can vary. Mild Dengue Fever symptoms can appear up to seven days after the mosquito carrying the virus bites, and usually disappear after a week. This form of the disease hardly ever results in serious or fatal complications. The symptoms of mild dengue fever are: Aching muscles and joints Body rash that can disappear and then reappear High fever Intense headache Pain behind the eyes Vomiting and feeling nauseous Dengue hemorrhagic fever (DHF) - symptoms during onset may be mild, but gradually worsen after a number of days. DHF can result in death if not treated in time. Mild dengue fever symptoms may occur in DHF, as well as the ones listed below: Bleeding from your mouth/gums Nosebleeds Clammy skin Considerably damaged lymph and blood vessels Internal bleeding, which can result in black vomit and feces (stools) Lower number of platelets in blood - these are the cells that help clot your blood Sensitive stomach Small blood spots under your skin Weak pulse Dengue shock syndrome - This is the worst form of dengue which can also result in death, again mild dengue fever symptoms may appear, but others likely to appear are: Intense stomach pain Disorientation Sudden hypotension (fast drop in blood pressure) Heavy bleeding Regular vomiting Blood vessels leaking fluid

Death Diagnosis of Dengue fever The signs symptoms of Dengue fever are similar to some other diseases, such as typhoid fever or malaria, which can sometimes complicate the chances of a prompt and accurate diagnosis. In order for a doctor to properly diagnose dengue fever they will: Assess the symptoms - the doctor will take into account all your symptoms to properly diagnose whether you have dengue. Some tests may be ordered to determine whether it is a dengue infection, or some other. Blood sample - this sample can be tested in a laboratory in a number of ways to find signs of the dengue virus. If the dengue virus is detected diagnosis is straightforward; if this fails there are other blood tests which can identify antibodies, antigens and nucleic acids, including:

-ELISA (enzyme-linked immunosorbent assay) -HI assay (hemagglutination inhibition assay) -RT-PCR (reverse transcriptase-polymerase chain reaction) Assess your medical history - The doctor will need to know your travel history and medical history, especially if it involves mosquito exposure.

What are the treatment options for dengue fever? Because dengue is a virus there is no specific treatment or cure, however there are things the patient or the doctor can do to help, depending on the severity of the disease.

For milder forms of dengue the treatment methods are: Prevent dehydration - high fever and vomiting can dehydrate the body. Make sure you drink clean (ideally bottled) water rather than tap water. Rehydration salts can also help replace fluids and minerals. Painkillers - this can help lower fever and ease pain. As some NSAIDs (non-steroidal antiinflammatory drugs), such as aspirin or ibuprofen can increase the risk of internal bleeding, patients are advised to use Tylenol (paracetamol) instead. The following treatment options are designed for the more severe forms of dengue fever: Intravenous fluid supplementation (IV drip) - in some harsher cases of dengue the patient is unable to take fluids orally (via the mouth) and will need to receive an IV drip.

Bloood transfusion - a blood transfusion may be recommended for patients with severe dehydration. Hospital care - it is important that you be treated by medical professionals, this way you can be properly monitored (e.g. fluid levels, blood pressure) in case your symptoms worsen. If the patient is cared for by physicians and nurses experienced with the effects and complications of hemorrhagic fever, lives can be saved.

Prevention of dengue fever At present there is no dengue vaccine; one is currently in development. Even so, developing a vaccine to protect against four closely related viruses that can cause the disease will not be easy.

The best method of prevention is to avoid being bitten by mosquitoes. If you live or travel to an area where dengue exists, there a number of ways to avoid being bitten: Clothing - your chances of being bitten are significantly reduced if you expose as little skin as possible. When in an area with mosquitoes, be sure to wear long trousers/pants, long sleeved shirts, and socks. For further protection, tuck your pant legs into your shoes or socks. Wear a hat. Mosquito repellants - be sure to use one with at least 10% concentration of DEET, you will need a higher concentration the longer you need the protection, avoid using DEET on young children. Use mosquito traps and nets - studies have shown that the risk of being bitten by mosquitoes is considerably reduced if you use a mosquito net when you go to sleep. Untreated nets are significantly less effective because the mosquito can bite the host through the net if the person is standing next to it. Also, even tiny holes in the netting are usually enough for the mosquito to find a way in. Nets that have been treated with insecticide are much more protective. Not only does the insecticide kill the mosquito and other insects, it is also a repellent - fewer mosquitoes are likely to enter the room(s). Smell - Avoid wearing heavily scented soaps and perfumes. Windows - use structural barriers, such as window screens or netting. Camping - if you are camping, treat clothes, shoes and camping gear with permethrin. There are clothes which have been treated with permethrin. Certain times of day - try to avoid being outside at dawn, dusk and early evening.

Stagnant water - the Aedes mosquito prefers to breed in clean, stagnant water. It is important to frequently check and remove stagnant water in your home/premises.

Turn pails (buckets) and watering cans over; store them under shelter so water cannot accumulate in them. Remove the water from plant pot plates. To remove mosquito eggs, clean and scrub them thoroughly. Ideally, do not use plant pot plates. Loosen soil from potted plants. This will prevent puddles from developing on the surface of hard soil. Make sure scupper drains are not blocked; do not place potted plants and other objects over the scupper drains. Gully traps that are rarely used should be covered; replace gully traps with non-perforated ones, and install anti-mosquito valves. Do not place receptacles under or on top of any air-conditioning unit. Flower vases - change the water every other day. When you do so, scrub the inside of the vase thoroughly and rinse it out. Leaves - make sure leaves are not blocking anything which may result in the accumulation of puddles or stagnant water. Prevention of Malaria
Methods used to prevent the spread of disease, or to protect individuals in areas where malaria is endemic, includeprophylactic drugs, mosquito eradication, and the prevention of mosquito bites. The continued existence of malaria in an area requires a combination of high human population density, high mosquito population density, and high rates of transmission from humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite will sooner or later disappear from that area, as happened in North America, Europe and much of Middle East. However, unless the parasite is eliminated from the whole world, it could become re-established if conditions revert to a combination that favors the parasite's reproduction. Many countries are seeing an increasing number of imported malaria cases due to extensive travel and migration. There is currently no vaccine that will prevent malaria, but this is an active field of research. Vector control Before DDT, malaria was successfully eradicated or controlled also in several tropical areas by removing or poisoning the breeding grounds of the mosquitoes or the aquatic habitats of the larva stages, for example by filling or applying oil to places with standing water. These methods have seen little application in Africa for more than half a century.

Prophylactic drugs Several drugs, most of which are also used for treatment of malaria, can be taken preventively. Generally, these drugs are taken daily or weekly, at a lower dose than would be used for treatment of a person who had actually contracted the disease. Use of prophylactic drugs is seldom practical for full-time residents of malaria-endemic areas, and their use is usually restricted to short-term visitors and travelers to malarial regions. This is due to the cost of purchasing the drugs, negative side effects from long-term use, and because some effective anti-malarial drugs are difficult to obtain outside of wealthy nations. Quinine was used starting in the seventeenth century as a prophylactic against malaria. The development of more effective alternatives such as quinacrine, chloroquine, and primaquine in the twentieth century reduced the reliance on quinine. Today, quinine is still used to treat chloroquine resistant Plasmodium falciparum, as well as severe and cerebral stages of malaria, but is not generally used for prophylaxis. Modern drugs used preventively include mefloquine (Lariam), doxycycline (available generically), and the combination ofatovaquone and proguanil hydrochloride (Malarone). The choice of which drug to use depends on which drugs the parasites in the area are resistant to, as well as sideeffects and other considerations. The prophylactic effect does not begin immediately upon starting taking the drugs, so people temporarily visiting malaria-endemic areas usually begin taking the drugs one to two weeks before arriving and must continue taking them for 4 weeks after leaving (with the exception of atovaquone proguanil that only needs be started 2 days prior and continued for 7 days afterwards). Indoor residual spraying Indoor residual spraying (IRS) is the practice of spraying insecticides on the interior walls of homes in malaria affected areas. After feeding, many mosquito species rest on a nearby surface while digesting the bloodmeal, so if the walls of dwellings have been coated with insecticides, the resting mosquitos will be killed before they can bite another victim, transferring the malaria parasite. The first and historically the most popular insecticide used for IRS is DDT. While it was initially used exclusively to combat malaria, its use quickly spread to agriculture. In time, pest-control, rather than disease-control, came to dominate DDT use, and this large-scale agricultural use led to the evolution of resistant mosquitoes in many regions. If the use of DDT was limited agriculturally, DDT may be more effective now as a method of disease-control. The DDT resistance shown by Anopheles mosquitoes can be compared to antibiotic resistance shown by bacteria. The overuse of antibacterial soaps and antibiotics have led to antibiotic resistance in bacteria, similar to how overspraying of DDT on crops have led to DDT resistance in Anopheles mosquitoes. During the 1960s, awareness of the negative consequences of its indiscriminate use increased ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s. Though DDT has never been banned for use in malaria control and there are several other insecticides suitable for IRS, some advocates have claimed that bans are responsible for tens of millions of deaths in tropical countries where DDT had once been effective in controlling malaria. Furthermore, most of the problems associated with DDT use stem specifically from its industrialscale application in agriculture, rather than its use in public health. The World Health Organization (WHO) currently advises the use of 12 different insecticides in IRS operations. These include DDT and a series of alternative insecticides (such as the pyrethroids permethrin and deltamethrin) to both, combat malaria in areas where mosquitoes are DDTresistant, and to slow the evolution of resistance. This public health use of small amounts of DDT is

permitted under the Stockholm Convention on Persistent Organic Pollutants (POPs), which prohibits the agricultural use of DDT. However, because of its legacy, many developed countries discourage DDT use even in small quantities. One problem with all forms of Indoor Residual Spraying is insecticide resistance via evolution of mosquitos. Mosquito nets and bedclothes Mosquito nets help keep mosquitoes away from people, and thus greatly reduce the infection and transmission of malaria. The nets are not a perfect barrier, so they are often treated with an insecticide designed to kill the mosquito before it has time to search for a way past the net. Insecticide-treated nets (ITN) are estimated to be twice as effective as untreated nets, and offer greater than 70% protection compared with no net. Although ITN are proven to be very effective against malaria, less than 2% of children in urban areas in Sub-Saharan Africa are protected by ITNs. Since the Anopheles mosquitoes feed at night, the preferred method is to hang a large "bed net" above the center of a bed such that it drapes down and covers the bed completely. The extensive distribution of mosquito nets impregnated with insecticide (often permethrin or deltamethrin) has shown to be an extremely effective method of malaria prevention, and also one of the most cost-effective methods of prevention in East Africa. For maximum effectiveness, the nets should be re-impregnated with insecticide every six months. This process poses a significant logistical problem in rural areas. New technologies like Olyset or DawaPlus allow for production of long-lasting insecticidal mosquito nets (LLINs), which release insecticide for approximately 5 years. ITNs have the advantage of protecting people sleeping under the net and simultaneously killing mosquitoes that contact the net. This has the effect of killing the most dangerous mosquitoes. Some protection is also provided to others, including people sleeping in the same room but not under the net. Vaccination Vaccines for malaria are under development, with no completely effective vaccine yet available. Presently, there is a huge variety of vaccine candidates on the table. Pre-erythrocytic vaccines (vaccines that target the parasite before it reaches the blood), in particular vaccines based on circumsporozoite protein (CSP), make up the largest group of research for the malaria vaccine. Other vaccine candidates include: those that seek to induce immunity to the blood stages of the infection; those that seek to avoid more severe pathologies of malaria by preventing adherence of the parasite to blood venules and placenta; and transmission-blocking vaccines that would stop the development of the parasite in the mosquito right after the mosquito has taken a bloodmeal from an infected person. It is hoped that the sequencing of the P. falciparum genome will provide targets for new drugs or vaccines. Other methods Education in recognizing the symptoms of malaria has reduced the number of cases in some areas of the East Africa by as much as 20%. Recognizing the disease in the early stages can also stop the disease from becoming a killer. Education can also inform people to cover over areas of stagnant, still water e.g. Water Tanks which are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is most put in practice in urban

areas where there are large centers of population in a confined space and transmission would be most likely in these areas. The Malaria Control Project is currently using downtime computing power donated by individual volunteers around the to simulate models of the health effects and transmission dynamics in order to find the best method or combination of methods for malaria control. This modeling is extremely computer intensive due to the simulations of large human populations with a vast range of parameters related to biological and social factors that influence the spread of the disease. It is expected to take a few months using volunteered computing power compared to the 40 years it would have taken with the current resources available to the scientists who developed the program.

WHOs efforts on Dengue

Currently vector control is the available method for the dengue and DHF prevention and control but research on dengue vaccines for public health use is in process. The global strategy for dengue /DHF prevention and control developed by WHO and the regional strategy formulation in the Americas, South-East Asia and the Western Pacific during the 1990s have facilitated identification of the main priorities: strengthening epidemiological surveillance through the implementation ofDengueNet; accelerated training and the adoption of WHO standard clinical management guidelines for DHF; promoting behavioral change at individual, household and community levels to improve prevention and control; and accelerating research on vaccine development, host-pathogen interactions, and development of tools/interventions by including dengue in the disease portfolio ofTDR (UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases) and IVR (WHO Initiative for Vaccine Research). WHOs efforts on Malaria Around the world, 3.3 billion people are at risk of contracting malaria. In 2012, an estimated 207 million cases occurred, and the disease killed approx. 627 000 people most of them children under five in Africa. On average, malaria kills a child every minute. WHO-recommended strategies to tackle malaria include: prevention with long-lasting insecticidal nets and indoor residual spraying; diagnostic testing and treatment with quality-assured anti-malarial medicines; preventive therapies for infants, children and pregnant women; tracking every malaria case in a surveillance system; scaling up the fight against emerging drug and insecticide resistance. In a 2007 resolution, the World Health Assembly called for a 75% reduction in the global malaria burden by 2015.

Questions a Draft Resolution must answer: Discuss the causes for malaria and dengue.

What responsibilities do countries have in controlling the spread of malaria and dengue? What steps can be taken to spread awareness? Should preventive measures be forced or advised? Why arent the methods already being employed working? How can existing laws be improved?

Bibliography
http://www.who.int/mediacentre/factsheets/fs094/en/ http://www.unicef.org/health/index_malaria.html http://www.who.int/mediacentre/factsheets/fs117/en/ http://www.healthmap.org/dengue/en/