Improving the monitoring of disease emergence and progression related to changes in human demographics and transportation
Phnom Penh – The ECOMORE Project’s Final Symposium, held last 5th of December 2016 at the Le Royale Raffles Hotel, highlights the project’s component in Cambodia, which aims to alert public health authorities on possible dengue outbreaks through its early warning system.
Head of Epidemiology and Public Health Unit of Institut Pasteur du Cambodge Dr. Arnaud Tarantola emphasized that the ECOnomic development, ECOsystem MOdifications, and emerging infectious diseases Risk Evaluation, commonly known as ECOMORE, places high importance on borders and roads where prevalent exchanges in diseases occur. “If people travel, so do viruses,” he attested.
By providing an early warning system to predict the epidemic, the ECOMORE model enables local healthcare providers to anticipate better management of the disease. Dengue, especially in developing countries, is a year-round public health threat and the number of dengue cases in the Southeast Asia region is expected to increase especially during wet season.
Dr. Didier Fontenille, Director of Institut Pasteur du Cambodge, stated that dengue has always been a major public health concern and that a better knowledge and understanding of the disease should be clearly met.
“Dengue is a major public concern in Cambodia. We believe that we can do something about it. We do not talk about drugs yet as there is no available vaccine in Cambodia as of the moment. However, a vaccine is not efficient enough. Hence, we need to have a better knowledge and understanding of the disease. We need to know how many dengue cases we have, how many vectors are prevailing, and where we can find these cases. The ECOMORE model, then, offers the early warning system that anticipates and predicts dengue outbreak in the country. [By] having this knowledge, we will have a better control of the disease at the health center level, at the hospital level and in vector control,” Dr. Fontenille said.
Entomology Supervisor Mr. Didot Prasetyo also presented in the symposium the different vector collection techniques used during the ECOMORE campaign such as CDC Light Traps, Double Nets, Mechanical Aspirators, BG-Sentinel Traps and Backpack Aspirators for both Culex and Aedes mosquito genera. This collection aims to improve vector control in both hospitals and communities. It is considered that both mosquito genera thrive on different seasons—Culex during the dry season and Aedes during the wet season (June and July). Though the country’s dengue rate is lower in 2016 compared to previous years, there has been a recorded increase in cases for the months of July and August most specifically among children 5 to 10 years of age.
The improved surveillance in sentinel hospitals also allowed the creation of an algorithm that detects irregularities in surveillance data to anticipate major outbreaks few weeks in advance. For instance, Phnom Penh’s early warning surveillance for 2008 till 2015 lead to two accurately predicted outbreaks and four accurately predicted non-major outbreaks. Remarkably, the surveillance showed major outbreak predictive capability of 8.8 weeks in advance. Further differences in data from specific Cambodian provinces were also presented during the symposium by Ms. Julia Ledien, a freelance statistical epidemiologist in France.
Every knowledge and data encountered during the project could also be transferrable and usable to manage chikungunya and zika viruses.
“The ECOMORE project is a success for many reasons. We managed to attain a better understanding of the emergence and occurrence of dengue as well as the relationship between dengue and mosquitoes."
"It has also helped improve alerts and warning systems for the management of the disease. Moreover, it is also a useful not only for dengue but also for other viruses with dengue-like symptoms such Chikungunya and Zika. We may make a phase in the future for these two,” Dr. Fontenille added.
The ECOMORE project also offered a training component towards local government units where nurses and doctors were trained for the project. Likewise, proponents of the project are positive that it could decrease cases once policies concerning national dengue control are established. “The objective for such program is not only research and data. It is also knowledge translation. The objective is to transfer the information obtained into policies and action in controlling the disease.” he concluded.
Major beneficiaries of the project include healthcare providers who will be able to clearly identify different categories of suspected cases of dengue, the National Center for Parasitology Entomology and Malaria Control who will receive the data, medical practitioners who will participate in the monitoring to improve their awareness of dengue circulation, as well as the Cambodian public who will be informed beforehand regarding risks of dengue outbreaks.
The ECOMORE, which started in March 2013 and was funded by the AFD (French Agency of Development), was spearheaded by four institutes namely Institut Pasteur du Cambodge (Cambodia), Institut Pasteur du Laos (Laos PDR), National Health Laboratory (Myanmar), and National Institute of Hygiene and Epidemiology (Vietnam). The project hopes to launch the second ECOMORE soon with Philippines as its new member through the Research Institute for Tropical Medicine.