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Analysis finds gaps in dengue preparedness for 2020 Tokyo Olympics
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Although the system to detect dengue virus in Tokyo is “robust,” researchers said they identified gaps in current controls that should be addressed before the Japanese capital hosts the 2020 Summer Olympics and Paralympics.
Writing in PLoS Neglected Tropical Diseases, Naoki Yanagisawa, MD, MPH, PhD, FACP, FIDSA, visiting scientist in the department of environmental health at the Harvard T. H. Chan School of Public Health, and colleagues noted that an unexpected dengue outbreak occurred in Tokyo in the summer of 2014 — the first time in 70 years Japan experienced local transmission of the mosquito-borne disease.
“Although Tokyo is located in a temperate climate zone, vector-borne disease will continue to be a major concern, as it was in previous games,” they wrote. “[The 2014] outbreak implies that Tokyo possesses a suitable ecoclimatic condition, has a population that is immunologically naive to the virus, with a high probability of introduction of the virus by travelers, and the existence of the Aedes mosquito, which is the competent vector.”
They noted that dengue is the most prevalent emerging arbovirus, with up to 96 million clinically significant cases occurring each year, and can carry a high mortality rate if left untreated in a small proportion of patients who develop severe dengue.
Some experts worried there may be widespread exposure to Zika and other common mosquito-borne diseases during the 2016 Summer Olympics in Rio de Janeiro. However, WHO declared that there was no public health justification for postponing or canceling the games, and no confirmed cases were reported among participants.
In the current study, Yanagisawa and colleagues examined strategies for early detection and prevention of dengue during the Tokyo games. They used failure mode and effect analysis (FMEA) methodology to study current controls for dengue detection and assessment, and gathered information on existing controls from publicly available resources.
The researchers reported that “the national infectious disease control system to detect dengue in Japan is robust,” with a comprehensive guideline on mosquito-borne infection and a list of medical institutions capable of taking care of travelers with suspected dengue available and written in Japanese.
However, they reported identifying 20 failure modes for detecting and assessing disease and communicating with patients. These included five specific failure modes with calculated risk priority numbers higher than 150 — one of the criteria used to decide if action needs to be taken — including missed cases at vacation rentals, physician failure to diagnose cases at noninfectious designated hospitals or clinics, physician failure to diagnose cases at hospitals or clinics at night, communication failure at hospitals or clinics and communication failure at vacation rentals.
“In the case of large assemblies of international visitors for special events when the spread of communicable and vector-borne diseases increases, these gaps need to be especially taken into consideration for reinforcement,” Yanagisawa and colleagues wrote.
They noted how three main gaps could be addressed to improve detection and prevention of dengue, including instituting cyclical training or a certification program on tropical disease management for physicians, providing translators or telephone services in multiple languages and conducting formal disease training programs for staff members working at accommodations for tourists, with a contingency plan in place for travelers with a suspected infectious disease.
“To the best of our knowledge, this is the first study to utilize FMEA analysis to identify opportunities for improving detection and mitigation of a particular infectious disease,” Yanagisawa and colleagues wrote. “Application of FMEA [to] public health protection in [association] with [a] large international event is also novel.”
They noted that the tourism and hospitality sector needs to know how to respond when travelers seek assistance outside of the medical setting.
“Although FMEA analysis described [above] has been applied to [the] health preparedness plan for the potential outbreak of dengue at the 2020 Summer Olympic and Paralympic games in Tokyo, it certainly could be extended to other infectious diseases,” they concluded. “We focused on dengue because of a prior outbreak in Japan and the fact that dengue mortality is increasing. The trend is expected to continue due to factors such as urbanization and climate variability.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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