Selective primary health care: strategies for control of disease in the developing world. XI. Dengue.

Since World War II, dengue viruses have progressively extended their geographic domain and have increased as causes of human morbidity and mortality. This complex of four flaviviruses is principally transmitted to humans by the bite of Aedes aegypti, the yellow fever vector. Factors that promote the indoor storage of water are congenial to the breeding of A. aegypti. These include the dislocations of wars, overpopulation , and urbanization. By the mid-20th century, A. aegypti eradication campaigns had nearly succeeded in much of the Western Hemisphere. Since then, there has been a steady degradation in ability to cope with this species despite the fact that a newly emerged, severe immunopathologic disorder, dengue hemorrhagic fever/dengue shock syndrome, endows dengue epidemics with grave consequences. Development of a vaccine against dengue is complicated by the need to develop four different live attenuated vaccines and by a justifiable caution imposed by dengue immunopathology. A wide range of proven methods have been and are available to reduce populations of A. aegypti. This paper argues that the eradication strategy adopted earlier in this century is still viable and cost effective. Critical to a successful control program is a prioritied approach, a thorough, disciplined planning effort, a commitment to assessment, adequate compensation of staff, and, above all, the will to succeed.