Dengue outbreak response: documented effective interventions and evidence gap

Background 2.5 billion people, two-fifths of the world’s population, are at risk from dengue with 50 million cases of dengue infection worldwide every year. Objectives To review the effectiveness of interventions employed during dengue outbreaks, to recommend an evidence-based strategy for the management of dengue outbreak response programmes, and to identify areas for further research. Methods We searched for literature containing different terms for dengue (including dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS)) combined with the terms “outbreak”, “epidemic” and “intervention”, “response”, “control”, “management” and “treatment” in the Cochrane Database of Systematic Reviews, PubMed, EMBASE, LILACS, WHO library database, grey literature, and through manual reference searching. Studies were included that measured the outcome of interventions implemented during outbreaks by entomological and/or human disease epidemiological parameters. Results A total of 24 (out of 1134) studies met all the inclusion criteria. Different strategies in the organization of outbreak response were identified that clearly emphasized an intersectoral approach. Studies that managed the outbreak response by creating multidisciplinary response teams, including vector control teams working on a door-to-door basis, and studies that monitored and evaluated their activities, showed successful outbreak control. Combining interventions that use 1) vector control (elimination of larval habitats with community involvement; appropriate use of insecticides in and around houses) and 2) capacity training of medical personnel in combination with laboratory support, were crucial for the successful control of outbreaks. Spatial spraying of insecticides alone proved ineffective in achieving outbreak control and its usefulness in combination with other interventions remains doubtful. Conclusion Further research is needed that links the effectiveness of interventions used during the outbreak response to human disease epidemiology. However, available evidence indicates that, in order to achieve rapid control, the outbreak response must employ a multidisciplinary approach combined with monitoring and evaluation.