VECCON digital surveillance system for the control of Dengue Hemorrhagic Fever

Dengue Hemorrhagic Fever (DHF) cases are still a public health problem in Indonesia. DHF cases are recorded to tend to increase. Since the beginning of the occurrence of dengue fever in Surabaya in 1968, the reported cases of DHF were only 0.05 per 100,000 population then continued to increase to reach 86 per 100,000 population (Kemenkes, 2020).

            Dengue hemorrhagic fever (DHF) is caused by the dengue virus. This dengue virus has 4 serotypes, namely Den-1, Den-2, Den-3 and Den-4. Serotypes that are often found are Den-2 and Den-3. The Aedes sp mosquito is the vector of this virus, this mosquito, Aedes aegypti, is usually indoors and Aedes albopictus, which breed outside (Mulyatno et al., 2018).

            Mosquitoes can lay 100-200 eggs and within one week can grow into adult mosquitoes. This condition causes the vector density level to be high if the mosquito breeding grounds are not controlled (WHO, 2016). Aedes sp. Mosquitoes usually bite during the day at 10 o'clock and usually repeatedly. For this reason, water reservoirs inside and outside the house must be drained frequently so that they do not become breeding places for mosquitoes (WHO, 2012).

            Efforts to control dengue fever have been carried out by using the fogging method with chemicals for adult mosquitoes and also larvicides. The use of chemical methods can cause resistance to mosquitoes and damage the environment (Morales et al., 2019), (Marcombe et al., 2018), (Francis et al., 2017). So far, control measures using physical approaches such as draining, closing water reservoirs and selling used goods are recommended, however, their implementation is still not optimal.

            The surveillance system that has been developed using manual methods is still finding biased and replicated data. Manual systems take time to implement and are not reported in an integrated manner. Not all of the data collected were reported nor analyzed properly. Based on these problems, an integrated and real-time surveillance system is needed to collect data on the incidence of DHF.

The development of the Veccon application using a web-based and mobile-based digital approach is made by integrating the system from the initial entry data, namely hospitals, reports from the health department and puskesmas. Data from the hospital will be sent to the District Health Office and then reported to the Puskesmas. The Puskesmas will send a surveillance team to the field. The surveillance team uses a digital reporting system to record the patient's house and 20 surrounding houses. The data will be directly integrated into the Puskesmas and the Health Office. The data includes case coordinate data, larva density maps and case maps. The data will continue to be collected for a certain period of time. Based on the data entered, it can be analyzed the level of case density in the area, the density of larvae and population density. This data can be used by the puskesmas to make further policies on DHF control by creating programs that focus more on vulnerable areas in the work area of the local puskesmas.

            Reporting using web and mobile-based digital technology is currently needed to support smart cities, where people can play an active role in using technology in accessing government data and information. The existing information technology can assist in implementing the program more quickly and precisely, especially in controlling the incidence of DHF.

            The strategy for developing digital surveillance systems has also been used in several countries. Integrated dengue control efforts are recommended by WHO (WHO, 2012). Brazil developed a web-based digital system to speed up the reporting process and the work of laboratory technicians, reduce time and reduce errors. This helps accelerate the decision-making process (Brasil et al., 2015). Sri Lanka has also developed a DHF surveillance system called Epihack, surveillance using a mobile phone which is then analyzed into data and maps of vulnerable areas for intervention (Lwin et al., 2019).  

Mapping of dengue-prone areas based on cases and larva density

              The development of digital surveillance for dengue hemorrhagic fever is needed. The development of web and mobile based Veccon (vector control) technology is a necessity for programs and public health. This technology makes it easier for the public and health workers to report the incidence of dengue fever and the density of larvae and this data can be quickly received by officers. This can speed up work and reduce the risk of data bias.

              Based on the results of data collection using the Veccon application, a mapping of dengue-prone areas and the level of mosquito density in an area was obtained. Following are the results of the analysis and geographic mapping of DHF incidence in South Denpasar. The following is a map of dengue-prone areas based on larva density. This map shows that the Sesetan area has a high risk as an area that has a high larva density above 1,250 larva positive containers. Then followed by the Sidakarya area which has a positive larva density of 850-1250 containers. Areas that have a high rate of cases and a high density of larvae are prone areas that need serious attention for DHF control efforts.

Figure 1. Mapping of dengue-prone areas based on larva density

Mapping of dengue-prone areas based on cases and population density

The following is a mapping of dengue-prone areas based on dengue cases and population density. This map shows that the Sidakarya area has a high population density of over 6,500 people / km2. This is followed by the Sesetan Village Area which has a density of 4,500-6500 people / km2. Furthermore, Panjer Village is <4500 people / km2. The high level of population density is one of the risk factors for the spread of DHF cases. The denser the area, the more susceptible to mosquito bite transmission.

Figure 2. Mapping of DHF cases with population density

Based on the analysis of the prone areas, policy makers can make priority programs in areas prone to dengue. Quick and precise decisions are needed to carry out DHF control in the area. Carry out simultaneous eradication of mosquito nests in vulnerable areas as well as education to the surrounding community.

References

Brasil, L. M. et al. (2015) ‘Web platform using digital image processing and geographic information system tools: A Brazilian case study on dengue’, BioMedical Engineering Online, 14(1), pp. 1–15. doi: 10.1186/s12938-015-0052-2.

Francis, S. et al. (2017) ‘Insecticide resistance to permethrin and malathion and associated mechanisms in Aedes aegypti mosquitoes from St. Andrew Jamaica’, PLoS ONE, 12(6), pp. 1–13. doi: 10.1371/journal.pone.0179673.

Kemenkes (2020) Laporan Kejadian DBD. Jakarta.

Lwin, M. O. et al. (2019) ‘Epihack Sri Lanka: Development of a mobile surveillance tool for dengue fever’, BMC Medical Informatics and Decision Making, 19(1), pp. 1–10. doi: 10.1186/s12911-019-0829-5.

Marcombe, S. et al. (2018) ‘Alternative insecticides for larval control of the dengue vector Aedes aegypti in Lao PDR: Insecticide resistance and semi-field trial study’, Parasites and Vectors. Parasites & Vectors, 11(1), pp. 1–8. doi: 10.1186/s13071-018-3187-8.

Morales, D. et al. (2019) ‘Resistance Status of Aedes aegypti to Deltamethrin, Malathion, and Temephos in Ecuador’, Journal of the American Mosquito Control Association, 35(2), pp. 113–122. doi: 10.2987/19-6831.1.

Mulyatno, K. C. et al. (2018) ‘Detection and serotyping of dengue viruses in aedes aegypti and aedes albopictus (Diptera: Culicidae) collected in Surabaya, Indonesia from 2008 to 2015’, Japanese Journal of Infectious Diseases, 71(1), pp. 58–61. doi: 10.7883/yoken.JJID.2017.117.

WHO (2012) ‘Treatment, prevention and control global strategy for dengue prevention and control 2’, WHO geneva.

WHO (2016) ‘Vector Surveillance and Control at Ports, Airports, and Ground Crossings’, International Health Regulations, p. 92. Available at: http://apps.who.int/iris/bitstream/10665/204660/1/9789241549592_eng.pdf.