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La dengue dans les départements français d’Amérique

 | 
Raymond Corriveau
, 
Bernard Philippon
, 
André Yébakima

Synopsis and Recommendations

Conclusions

Texte intégral

1The risk of a dengue epidemic with severe and potentially fatal forms is henceforth a fact of life in the French départements of America, one of the "ordinary risks" of everyday life.

2There is still no specific drug treatment and no vaccine to prevent or reduce the risk of transmission, however promising the current progress in vaccine research.

3No method for predicting the timing, extent and severity of epidemics has so far proved insufficiently effective or convincing to be validated, generalized and brought into operational use.

4Prediction, and hence prevention, therefore depend on entomological methods. However, good tools are lacking to guide vector control and containment and to assess their impact on virus transmission and clinical manifestations of the disease. So far, moreover, vector control operations by specialist teams have received very little backup from the community: residents do not carry out mosquito control measures in and around their homes.

5All in all, until a vaccine is discovered, there seems to be very few ways open to us to improve dengue control.

6Efforts to mobilize community involvement must of course be increased, since it is in and around the home that the virus is transmitted. Residents must be given the theoretical capacity to break the transmission chain at that point. However, the authorities should not place too much hope on the results: raising awareness and fostering conviction and community ownership of concepts until individuals and communities make a real, practical commitment to vector control is obviously a long-term process. Furthermore, it is open to question what proportion of vector breeding sites outside of people's homes can be covered by individual and community initiatives.

7Vector control is still no doubt a major strand of dengue prevention. It must be made responsive and accurate, and must cover as much geographical ground as possible, even though little is known of the correlation between vector breeding sites, transmission and clinical manifestations. In particular, we do not know whether vector control is capable of reducing vector density below the (presumably very low) thresholds that would halt transmission. Nonetheless, appropriate vector control operations should, if not prevent an epidemic, at least attenuate it and probably spread it over time, which is a definite advantage as it will help to prevent saturation of the healthcare services and maintain patient care quality. It must also be borne in mind that, despite its advantages, a dengue vaccine would not be a panacea, and even after a vaccine is found, it will be important to continue mosquito control measures and related research.

8Well-organised epidemiological monitoring, especially the gathering, transmission and integrated analysis of data, and the dissemination of validated information, is undoubtedly a priority field, and a promising one, for improving the responsiveness, reliability and coherence of surveillance and intervention systems.

9In the present situation, improving medical management of patients must be the foremost preoccupation, and research into the physiopathology of severe cases should be a high priority in the FDAs.

© IRD Éditions, 2003

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