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Globally every one minute someone is admitted to hospital with dengue and every 25 minutes a life is lost to dengue fever.

Kym

World's most dangerous animal

Special guests:

Kym Blechynden, Australian Aid worker 

Host:

Marie Bout, Australian Red Cross

 

Marie Bout

It’s a silent or not so silent killer, and it affects people in almost every country in the world.

I’m Marie Bout from Australian Red Cross and you’ve tuned in to How Aid Works.

Kym Blechynden is an Australian Aid worker who works as the Regional Emergency Health Coordinator for Asia and Pacific with the International Federation of the Red Cross. She’s going to start by telling us about the deadliest animal in the world…

Kym Blechynden

Yeah look it's a really good question. When we're doing trainings we have pictures of a range of different animals and we ask people to put them in order of which is the most deadliest or that causes the most deaths per year.  And we've got pictures of crocodiles, snakes, sharks, elephants, lions, all of these sexy type animals that you hear lots about in the media or in movies, thinking like Jaws or things like that.  And no-one ever picks up the picture of the humble mosquito that's sitting there, it's always left on the pile by itself, and everyone's always having these big discussions about it's elephants, it's lions, it's sharks, it's crocodiles, and when we put it into the right order and we show actually which causes the most deaths, it is the mosquito, and it's about three quarters of a million or 750,000 deaths per years.

Marie

I'm guessing the way that they kill is obviously by the diseases they carry?

Kym

Exactly. Half of those deaths are caused by malaria and then the rest are due to a range of other diseases including dengue which is a really big problem in Asia and Pacific, and we also have dengue in Australia, in North Queensland as well.  Some of the other mosquito diseases are ones which people may not hear much about, ones like chikungunya, Ross River virus or yellow fever as well.  But the main two that people know most about are probably malaria and dengue.

Marie

So tell us a little bit about dengue, I think everyone's really aware of malaria precautions, but dengue is kind of a little less known. 

Kym

Yeah it is.  So dengue is caused by a mosquito that lives in most of Asia and a large number of Pacific countries as well.  It hangs out in countries in the tropics or the subtropical areas where it's nice and warm.  And it breeds in containers filled with water, so it could be outside your home or your workplace, in coconut shells or palm fronds that are turned upside down and collect water.  And it's the female mosquito that bites and does all the damage and that transmits or that causes the diseases. 

Dengue itself has really severe like ‘flu symptoms, really strong aches and pains in your muscles and joints, pain behind your eyes and about 2.5% of people that get dengue unfortunately die and this number could be as little as 1% if we had better early detection and people getting to hospital or health centres quicker for the dengue to be managed.

Marie

So all the usual kind of precautions like repellent and mozzie nets and that kind of thing, is that enough to ward against dengue or what's the difference with the typical malaria precautions?

Kym

So malaria is usually at night time or at the dawn and dusk where the mosquitoes are most I guess bitey or cause the most damage, whereas dengue is more a daytime biter.  So still the first thing in the morning or late in the afternoon evening but a lot of people forget that it can bite throughout the day.  And then it's a pretty shy mosquito, it hangs out in the little dark corners in your house, under your curtains, under your bed, in the shade, underneath tables or different areas, and then when you disturb it it can bite you on those areas that you may not have covered up, like your feet, your hands, your legs or other things as well.

It also, as I said, hangs out near people's houses.  So it only goes about 400m flight from where it breeds and from where it lays its eggs in the water containers, and so predominantly around people's houses, workplaces, shops, urban areas like that is where you're going to be more, more inclined to have a run-in with a dengue mosquito.

Marie

Now I got told by a colleague when I was overseas once that the first time you get dengue you're very sick, the second time you get dengue you're even more sick and the third time you get dengue you die; is that true?

Kym

Not in every case, no, I mean people can die the first time they get dengue, so I wouldn't want people to think they've got three chances before that happens.  It depends on the type of dengue you get.  So there's four different strains or stereotypes of dengue which vary between different countries, and it also depends on how quickly you may get to the health centre to have the symptoms managed and detected as well.  So it can really vary.  But the major thing we want people to know is to try and prevent getting bitten by a mosquito in the first place, but secondly if you do think you have dengue then go and have a chat with your health professional or your doctor, particularly if you've just come back from a country which has really high rates of dengue, just to check and make sure you don't have it, and that way you don't spread it to someone else as well, or if the mosquito bites you it can then bite someone else and transmit the dengue.

Marie

And are there a lot of countries that have really high rates of dengue?

Kym

Yeah there is, absolutely, and unfortunately Asia Pacific has about 75% of the world's at risk population of dengue in the world, which is huge.  And countries where I live unfortunately, Malaysia, Philippines, Thailand, Vietnam, some countries in the Pacific, Sri Lanka, all have really high rates and at the moment in Sri Lanka we've had over 160,000 cases of Dengue this year alone and it's only October, so there's still a few months to go which is huge.  So we're not just talking about a few thousand cases here and there, we're talking in the hundreds of thousands.

Marie

Wow.  And I mean and those are countries you know obviously it's really devastating for local populations, but those are countries that Australians often travel to as tourists - are they just as susceptible or is this really a problem for the local population?

Kym

I think it's a problem for anyone that's in those countries and that's near the breeding sites.  So I mean we have huge numbers of people go to Thailand and Indonesia each year for holidays because of the close proximity and the nice climate from Australia, but they're also countries with really high rates of dengue and if you're sleeping outdoors, if you're in areas where there are large amounts of dengue breeding sites with the palm fronds or the coconut shells, the buckets of water or so forth, then yes you certainly can be at risk, particularly on holidays.  We get a bit blasé sometimes, we're there to relax and enjoy and have fun or have our downtime and we quite often forget, I know I do, to put our repellent on or to make sure that we prevent our mosquito bites.  So it's really simple things like that can make sure that we still have a good holiday or a good break and not get sick and not transmit the dengue to other people as well.

Marie

Yep, so mosquitoes just don't discriminate; they'll bite anyone really.

Kym

Pretty much, yeah.

Marie

I read an article recently that was talking about some of the many recent large disasters caused by storms and hurricanes, and it was talking about some of the flood waters lying around and it being a perfect breeding ground for mosquitoes, and I was wondering will mosquito-borne disease or the prevalence of mosquito-borne disease become a bigger problem as we see, more of the effects of climate change?

Kym

Yeah look I think so and unfortunately in Asia Pacific we have a huge impact from climate change, not only with increasing severity and frequency of disasters, but also we're seeing different types of disasters with droughts or super-storms, super-typhoons which are creating a large amount of destruction and then leaving really ripe conditions for mosquito breeding afterwards with the rubble, with the construction, with people perhaps moving from other parts of the country due to the disaster or due to climate change.

We've also got really high rates of urbanisation happening; people moving from the countries or the rural areas to the cities, and it could be to places that are a bit haphazard, so with poor water or sanitation, not great drainage or water drainage and lots of people living in close proximity in unplanned parts of the city, and again that's leading to higher rates of dengue and other disease as well in most settings.  So climate change and disasters certainly go hand in hand unfortunately with dengue and we need to do a lot more to try and counter that.

Marie

I wanted to ask you about another mosquito-borne virus that got a lot of media hype recently because of some of the outbreaks in South America, the Zika virus, and I was really surprised to learn that the Zika virus has been around for quite a long time and is all over the world and particularly in our region, in the Asia Pacific region.  Can you tell me a little bit more about the virus because it's quite an alarming one?

Kym

Yeah it is.  So Zika has been, as you've said, globally and also in Asia Pacific for a number of years and there was some outbreaks back in the 1970s in the Pacific which affected really high numbers of the population in a number of countries.  But it wasn't until 2015/16 and in the lead‑up to the Olympics that we had this sudden increase in cases, but also a very large I guess prominence in the media with the outbreaks as you said largely in the Americas.  And we saw the impact on the children with microcephaly as well from that, which also got a lot of media attention. 

Marie

Can you explain what microcephaly is?

Kym

Sorry, microcephaly is when the Zika virus may be passed from the mother to the child and impacts on the brain development and the size of the brain of young children or the unborn child.

Marie

So those are those really kind of, really heartbreaking and disturbing images I guess the world saw of mothers delivering children with kind of smaller heads and of course the brain development had been affected.

Kym

Exactly.

Marie

So it's really an alarming, alarming illness.

Kym

Absolutely and we also had cases like that in Asia as well and we're still seeing some reported cases of microcephaly in some of our countries, but not nearly in the same numbers as in the Americas.  We've still, in the last week, we've had 60 cases of Zika reported in Bangkok which obviously a lot of people transit through or go there for holidays as well from Australia and from a number of other countries, but also in Singapore, Vietnam and we had sporadic cases in Malaysia and countries in the Pacific as well.  We've had Zika cases ongoing or being reported pretty much each week in a number of these countries.  Nowhere near in the same numbers as the Americas or as the dengue numbers that we report, but it's absolutely a concern and it's the same mosquito that transmits Zika as well as dengue and chikungunya and we know we have that mosquito everywhere in our region, so of course we're still on high alert to make sure it doesn't spread further.

Marie

 What's chikungunya?

Kym

Chikungunya is a really hard to pronounce mosquito-borne disease which causes horrible symptoms of really pain in your limbs, really strong pain; quite often called breakbone fever, the same as dengue as well, so quite similar symptoms.  It doesn't kill you but it can cause - it's really debilitating and it can be for quite some time.

Marie

Well I find it incredible that these mosquito-borne diseases are all, I mean people are susceptible to them in really large cities and capitals like Bangkok or countries like Singapore, where people from all over the world are going through and it's pretty - I  mean when you look at Bangkok it's a really developed place; it looks like a western city now, but it amazes me that this is still there and I've never even heard of that, and particularly as a traveller, I'm never told about that.  Do you think more needs to be done around education or?

Kym

I think absolutely and globally every one minute someone is admitted to hospital with dengue or every 25 minutes a life is lost to dengue, and this is huge as you said but it goes largely unreported in the mainstream media or in the news.  We don't hear about it as much; it's not as sexy as some of the other, the diseases or outbreaks that we see and there's been a lot of research that has shown that lots of different disasters get more media attention than others and unfortunately dengue is down there on the lowest of the list of getting attention.  We certainly do need to increase the awareness more on how to prevent it, but also just how prevalent it is across Asia and Pacific and globally, and also how it can impact more on our most vulnerable communities because of the cost of going to see the doctor or get to the doctor for healthcare, and to have it detected, can be double or sometimes triple someone's monthly salary.  It means a lot of the time people aren't going to seek health advice or maybe they're living in a poorer area of the community where there is poor water or sanitation, and so they're more susceptible or have a higher impact if they do contract dengue than some of the other population who may be more affluent.  And so again it's, with Red Cross we work with those most vulnerable, we're trying to reach those most vulnerable in the community and work with the community to come up with ways to prevent a spread of this and to be able to respond to the outbreaks that we're seeing.

Marie

And of course those people can't afford things like repellents which you know we travellers can afford.

Kym

Quite possibly yeah or people may be living in outdoor areas.  A lot of people, if we've just had a disaster, people may be living in tents or in areas where they don't have protection or where they don't have a mosquito net to protect them against mosquito bites or other diseases as well.  So a lot of those basic things that we take for granted are not always available for large areas of our population.

Marie

So let's talk about solutions - what needs to be done?  I guess we should break it down into categories because it's, obviously there's a series of different, you know there are different ways this could be helped on an individual level but also for people that are living rurally and don't have as much of an income or as much resources at hand, and then also just kind of you know in Australia or in our region what could be done at a bigger level from you know government and that kind of stuff?  What things can be done?

Kym

Sure, so for individuals we can try and prevent mosquito bites when we're travelling or when we're living and working overseas.  So take your own personal precautions; as you said cover up, sleep in a mosquito net, use repellent and be aware of the signs and symptoms.  If you returned from a country with high dengue rates and you think you've got dengue, go see your doctor to make sure that you're not spreading it to other people in the community if you get bitten by a mosquito and then it bites someone else. 

From a wider level I guess we've got responsibilities as the media, as organisations to advocate for more funding and for more media attention for dengue and other mosquito-borne diseases, particularly for the communities that are most vulnerable and they're our neighbouring countries a lot of the time.  Making sure that people are aware, not only of how to prevent mosquito bites and why we should prevent mosquito bites, but also destroying mosquito breeding sites.  Tipping out containers of water.  Making sure that communities and schools are doing regular surveillance and checking where there could be mosquito breeding sites and destroying or preventing those where possible.

A large part of my role is doing things like this, it's advocating, it's trying to make mosquitoes and dengue sexy in the media attention, but also in the donor or funding attention, so we can get some greater investment on programmes, long‑term programmes that are working with the communities, that are working with our millions of Red Cross volunteers and staff across the world in the communities looking at community education, behaviour change, making sure our community health volunteers have the right skills and knowledge to be able to detect and refer people that have suspected dengue, and to be able to do that surveillance and look out for dengue cases or outbreaks when they occur straight away.  And also making sure that our teams are equipped to be able to respond if dengue outbreaks do occur and we've got five responses occurring at the moment in countries across Asia and Pacific where we've got funding that we've released for our volunteers and staff to be doing these community education activities to try and stem the flow of the dengue outbreak.

The outbreaks sort of start and finish with the communities, so we need to make sure that the communities have these skills and also the resources to be able to detect and respond accordingly.

Marie

So if listeners want to support people, particularly in you know rural or developing communities, that need extra support to ward against mosquito-borne viruses, what should they do?

Kym

The best thing always is to donate to an organisation that is working and that's locally based for that country.  So the Red Cross has a presence in 190 countries around the world and has volunteers and community members in those countries, in those communities where the outbreaks are occurring.  And the Australian Red Cross has the Disaster Response Fund that people can donate to which helped contribute to a staff member being involved in the Vanuatu dengue response earlier this year, and also I'm funded by the Australian Red Cross as well and work a lot on dengue outbreaks across the region. 

Marie

And is there anything else you'd like to say Kym on the issue mosquito‑borne virus or these silent little - well not so silent - buzzing little killers?

Kym

I guess just for people to be aware and let's make mosquitoes a bit sexier in the media and in the donor area.  It's a huge problem; we need to do more and there's lots more that we can do.  We've got the community volunteers and staff across the Asia and Pacific that are responding to these activities already and let's support them to continue to do a fabulous job in averting these outbreaks and saving lives.

Marie

That was Kym Blechynden, an Australian Aid worker who works as the Regional Emergency Health Coordinator for Asia and Pacific with the International Federation of the Red Cross talking about the perils of mosquito born viruses… and you’ve been listening to How Aid Works.

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