December 2013 | ISSUE 9
DengueTools: Innovative Strategies and Tools for the Prevention and Control of Dengue

 

 

 

Annelies Wilder-Smith
Professor of Infectious Diseases & Lead for Global Health and Vaccinology

Dengue continues to ravage most tropical and sub-tropical countries. In Singapore, this year heralded about 19,000 cases so far, with six deaths. Although recent dengue vaccine trials conducted in Singapore showed good immunogenicity and safety, further efficacy trials in Thailand brought home the sobering reality that the current vaccines fall short in protecting against the disease.

In the absence of an effective vaccine and specific anti-viral therapy, there is still an urgent need for more research. Recognizing the threat of dengue to endemic countries, but also to currently non-endemic countries such as Europe, the European Commission launched a call for a €6 million grant specifically on dengue under the 7th European Union (EU) framework. We were successful in winning this grant and the consortium was coined “DengueTools”. DengueTools is administered by the University of Umea in Sweden, and consists of 14 partners worldwide, with the majority of the partners in Europe, and the remainder in Singapore, Thailand, Sri Lanka, Malaysia and Brazil. More information can be found under www.denguetools.net

Project Summary and Objectives

Dengue Surveillance
The first research area focuses on dengue surveillance. We lack understanding of individual or combined roles of viral, entomological, ecological, environmental and climate factors that influence dengue transmission dynamics and their respective outbreak predictive capability and the most cost-effective approach for surveillance and early warning systems. For surveillance to effectively provide early warning for epidemic transmission, it must be active, laboratory-based, and comprehensive in its coverage of the spectrum of clinical illness and the factors that influence transmission dynamics. We have set out to establish a laboratory enhanced surveillance system in Sri Lanka to study individual and combined factors including cost-effectiveness of surveillance. Furthermore, we have added research on improving entomological surveillance, and point of care diagnostic assays.

Prevention of Dengue in Children
The second research area focuses on how to prevent dengue in children in endemic countries. Effective control strategies to protect children are lacking, in particular simple, cost-effective and scalable strategies. We hypothesised that insecticide treated school uniforms may be a target for school based intervention to reduce the incidence of dengue in school children. To test the hypothesis, we have designed a school-based randomised controlled trial in Thailand.

Risk of Dengue Introduction to Non-Infected Areas
Lastly, the gaps in understanding the risk of dengue introduction to non-infected areas which include Europe hampers effective preventive strategies. We currently have insufficient data on the magnitude and trends of importation and virus evolution over time and by geographic origin. We also have a poor understanding of vector density, preferred breeding sites, and vectorial capacity of Aedes in temperate climates that are needed for predictive models under changing climate conditions. Hence, the third research area was set up to address those shortcomings and includes the development of predictive risk modelling and maps under different future climate scenarios in Europe.