Dr.

Khin Nan Lon, Program

Manager(DHF/Filaria)

7th November,2015
Country Name Myanmar (Burma) total land 676,578
area square kilometer
Population(2014)Census
Yangon 7360703 Capital Naypyidaw
Mandalay 6165723 First level 2nd Level Third
Ayeyarwaddy 6184829 7 Regions 69 3045
(White)& Districts wards
Sagaing 5325347 7 states
Tanintharyi 1408401 (Red) 330 13,267
Mon 2054393 Townshi village
ps tracts
Rakhine 3188807
Naypyitaw 1160242 82 67,285
Magwe 3917055 sub- Villages
townshi
Bago 4867373 1 Union ps
Kayin 1574079 Territory
Shan 5824432 6 -self-
administe
Kachin 1689441 red
Kayah 286627 zones
Chin 478801 Neighbour Thailand, China,
Countries India, Laos
51,486253
Dengue endemicity of Myanmar in SEA Region is category A.

Sporadic cases of dengue have been reported since 1960

It was notification of disease since 1964

First outbreak was occurred in Yangon in 1970 (1654 /91)

Firstly spread to other States & Regions since 1974 .

The highest number of cases and deaths recorded were 24285

cases in 2009 and 444 deaths in 1994 respectively.

But DF/DHF cases in 2015 is twice more than 2009.

43845 cases (From 1.1.2015 to 30.11.2015 )

 1970-2015 (30-11-15) DF/DHF Cases & CFR
50000 438457.0
6.4
5.9 Cases Deaths 6.0
40000 5.5 5.3 5.0 5.4
5.0
30000 4.3 4.4 4.2
3.9 3.8 24285 4.0
3.2 3.1 3.4 3.1 3.0
20000 2.9 2.9
2.2 2.2 2.0 2.0
10000 1.7 1.6
1.0 1.3
1.1 1.0
0 0.3 0.4
0.6 0.0

1970-2015 (30-11-15) DF/DHF Cases & Death (Absolute Number)

50000 500
45000 Cases Deaths 444 450
40000 400
35000 350
30000 300
25000 204 250
20000 200
15000 150
10000 161 100
5000 50
0 0
 11 months
100000 1600

5 yrs
1406

5 years
90000
1266 1400
80000
1200

yrs

5 yrs
70000
938 61491
1000

10
60000

50000 800
10 yrs

yrs

43845
40000 777 600
10

30000
537 400
20000
332 161
200
10000

0 0

Cases Deaths
 0
4000
6000
8000
10000
12000
14000
16000

2000
January
March
May
July

2010
September
November
January
March
May
July

2011
September
November
January
March
May
July

2012
September
November
January
March
May
July

2013
September
November
January
March
May
July
2014

September
November
January
March
May
July
2015

September
November
13376
7000 35

6000 30

5000 25

4000 20

3000 15

2000 10

1000 5

0 0

Case Death
7000
6000
5000
4000
3000
2000
1000
0

300.0 Cases/100,000 Population

250.0
200.0
150.0
100.0
50.0
0.0
DHF cases in Urban /Rural DHF cases in
Urban /Rural
(2010-2014) (2015)
Urban Rural
25000

20000

15000

10000

5000

0
Urban Rural
 Age Group wise Dengue cases (2007-2015)
70.00
<1 1..4 5..9 10..14 15above
60.00

50.00

40.00

30.00

20.00

10.00

0.00
2007 2008 2009 2010 2011 2012 2013 2014 2015
DHF Cases in Grading and Sex, 2015 (upto 30.11.15)
 Dengue Virus Serotpye (1999-2010)
Year Total DENV 1 DENV 2 DENV 3 DENV 4 Mixed
1999 11 2 5 3 1 0
2000 8 6 1 1 0 0
2001 121 115 1 3 0 2(D1+2)
2002 72 28 24 3 12 4(D1+2)
2003 11 3 6 0 0 2(D1+2)
2004 5 0 1 2 0 2(D3+1)
2005 12 3 1 5 1 2(D1+3)
2006 5 0 1 2 0 2(D1+3)
2007 12 2 0 9 0 1(D1+3)
2008 16 6 3 4 2 1(D1+3)
2009 17 11 1 3 1 1(D1+3)
2010 31 14 5 0 12 1 (D2+4)
Source- DMR
 Dengue Laboratory report (PCR)
Sero Sero Sero Sero
Year Total Tested type type type type
1 2 3 4
2009 100 (Research at NOGH) 16 - 3 -
2010 15 (from Monywa Hospital) 12 - - -

2011 5 (from Ma-U Bin Hospital) - - - -

2012 4 (From NPT 1000bedded 2 - - -
Hospital)
3 (Mawlamyine Hospital) +
5 (Zeyar Thiri Township,
Ywa Thit Kone Village,
2013 12 2 6 8
NPT)+
44 (Research at Yangon
Children Hospital) =52
2014 5 (Mon state) - - 1 -
 DHF Control Program In Myanmar

Goal To reduce the burden of dengue

Objectives To reduce dengue mortality by at least 50 %
To reduce morbidity by at least 25% by 2020
(Base Line data of 2010 are 16259 cases/119 deaths)
(25% is 4000 cases /50 % is 60 deaths)
To estimate the true burden of disease by 2016
 Strategies Activities
1 To establish effective disease and Public Hospital based disease
vector surveillance systems surveillance by VBDC staff
based on reliable laboratory & (15 % of private hospital report
Health Information System in 2015)
2 To undertake disease prevention Vector Control
through selective, stratified and Larval Control with
integrated vector control with community participation
community Adult (Mosquito) control
 Strategies Activities
3 To establish emergency Epidemic preparedness and response
preparedness capacity to Capacity building
prevent & control Training of Medical Officers and
outbreaks with appropriate BHS staffs on
contingency plans effective disease and vector
4 To ensure prompt case surveillance

management of DF/DHF Epidemic preparedness

including early recognition Dengue case management

of signs and symptoms to Dengue workshop (Sept,Nov 2015)
prevent mortality Updating Guidelines(P&C; Rx)
 Strategies Activities
5 To increase awareness of the Advocacy meetings &
community regarding DF/DHF Community awareness session
prevention control and on DHF prevention & control
management, through IEC
6 To improve management and Supervision & monitoring
technical support system and Intra and Inter-sectoral co-
strengthen the health facilities for operation
health sector development Operational research - KAP
Study
 Strength
Initiating School Based DHF control plan including
Government schools, private schools and monastery
based education school
Coordination and collaboration with other sectors in
some extent (Local Authorities, Ministry of Health,
Ministry of Education, Minister of Home Affair,
fishery department, NGOs, INGOs and Media. etc.)
Better reporting data from Public Hospital and some
Private Hospital
 Strength
Improvement in Early Diagnostics, Effective
Treatment care and early referral system, there is
reduction in Mortality even though cases are
increasing.
Political commitment of the government , have
more technical and material supports (Abate,
Fogging Machine, diagnostic tools, drugs and even
some INGOs support IEC materials, vector control
materials )
 Weakness
Shortage of Manpower in Vector Borne Disease Control Unit ,into which, DHF/ LF
section is integrated .

Weakness in Surveillance system- passive surveillance system from public hospitals

Weakness in Prevention and control

Weak integrated approach in control measures between different organizations

(VBDC, NGOs, City Development Council, Environmental Ministry)doing
separately

Local authorities & the community take more interest in fogging than larva control

Limited budgets for operational cost

Limited knowledge on prevention and control of Dengue Fever in the community

Existing vector control methods (Abate, fogging) have several limitations in terms
of cost and long term sustainability
 Threats
Climate Change (Global Warming & greenhouse gas )

Uncontrolled mobile & migrants in peri-urban areas ( Poor sanitation

including solid waste disposal like as non-biodegradable products
(plastic, paper cups, used tyres)i ncrease vector breeding sites)

Uncontrolled urbanization with under developed infrastructure

(unplanned settlements with inadequate potable water as increased in
improper water storage system, temporary containers without covers)

High workload burden on Basic Health Staffs

 Opportunities
Political commitment by local authority and support
by Local government, NGO, Social Welfare

Role of NGOs

- promote community mobilization for

implementing environmental management

- correct health seeking behavior

INGOs more interest in Dengue Control Activities

 The Ways Forward
DF is an notifiable disease and government need to revitalize its

law enforcement

To follow the updated National Guideline for Prevention, Control

and treatment for DF/DHF .( National DHF control Program and

Malaria consortium is developing it )

Program need to find out more funding.

Need to scale up School and Institutional based DHF prevention

and Control activities( Program is plan and find funding)

.
 The Ways Forward
To do serological surveillance in selected sentinel hospitals in each

and every State and Region by VBDC,NHL&DMR (Need Budget)

(VBDC, NHL, DMR)

To initiate mobile/web-based reporting system

To strengthen of E-reporting system(M-health)and to develop

Dengue Webpage and train IT person

To use WHO IVM training manual for implementation

Strengthen social network (using viber or facebook for community

awareness as well as supporting surveillance activities.