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 A dengue outbreak in Madeira: From epidemiology to health education leaflets in six languages

 

The view from the Health Authority office, MadeiraBenedetto is an EPIET 2012 cohort fellow from Italy now based at Public Health England, London. He is sharing with us his experiences from his first outbreak investigation mission, on which he went directly from his first ESCAIDE conference in Edinburgh.
 
How did the opportunity arise for this mission?

Madeira faced an outbreak of dengue at the beginning of October 2012. This was the first large-scale, sustained outbreak of dengue in Europe since the 1920s. Portugal requested ECDC’s assistance with an assessment of the situation and guidance for outbreak control. The ECDC response team rapidly identified that going to the field with an EPIET fellow would provide added value. As is always the case when an outbreak arises, quick action was needed, so I was asked to get on the plane immediately. I was in Edinburgh for my first ESCAIDE conference at the time, so I just packed my bag and went to Madeira instead of heading back to London. When I arrived, with a winter coat and a scarf on, it was +20 degrees and beautifully sunny. Photo: The view from the Health Authority office, Madeira  

Hunting for larvae of Aedes aegypti in water collections
What were the most challenging aspects whilst in the field?
The first challenge was that I had only just started my EPIET training when I left. I had limited experience in outbreak investigations and we were faced with a complex situation. Despite this challenging beginning, all the people I worked with, both from Madeira and from ECDC, cooperated splendidly as a team. I learned a lot in a short time.

The other challenge was to deal with many actors and stakeholders together. Supporting the measures for mosquito control could only be achieved through close collaboration between field epidemiologists, entomologists, laboratory staff, statisticians, public health experts, engineers, technicians and national authorities. Taking any action would have been impossible if we had not generated the data needed and turned them into useful pieces of information, just like putting together a jigsaw puzzle.

Photo: Hunting for larvae of Aedes aegypti in water collections
 

My first epi curve!

Can you summarise your involvement in this field mission?
First, I supported the ECDC team in developing a new electronic surveillance system for dengue. This involved liaising with different stakeholders, developing a workflow for the transmission of data and implementing a series of post hoc adjustments to the system. Second, I was involved in the epidemiological analyses which included updating databases on a weekly basis and producing time, place and person analysis. We produced epidemic curves and rates of disease by sex, age and geographical areas. Third, I contributed to drafting the ECDC mission report, and supported the local team of biostatisticians drafting the weekly bulletins. Those were useful to the ECDC risk assessment (2). Finally, I went on several field visits around the capital, Funchal, and participated in a community health intervention in a school.
 

Photo: My first epi curve! 

Do you have any particular achievement or anecdote?
One of the initiatives of the health authorities in Madeira was to publish a multilingual flyer to inform tourists about the outbreak and to promote prevention measures. To speed up the process, I asked my EPIET colleagues and friends for help. In 48 hours we got back translations in Spanish, French, German, Italian, Russian and even in simplified Chinese!

Meeting Ana Clara Silva, vice-president of the Health Authority, MadeiraWhat have you learned from this mission/outbreak investigation?
Team work and good coordination are always mentioned in the first chapter of every epidemiology book, but a first-hand experience gave me a real vision of how important and challenging this is in real life. Another lesson has been to manage tight working schedules under stressful conditions. That requires a clear mind and logical thinking at all times.

I also learned a great deal about dengue and other vector-borne diseases. My prior knowledge was limited to what I had learnt in medical school. This might seem relatively unimportant, but vector-borne diseases like chikungunya, dengue, West Nile fever and malaria have already made a comeback in southern Europe. Chances are, with climate change and globalisation, they might become more common in the future. I feel that as an Italian, the experience in Madeira might prove to be useful in years to come.

Photo: Meeting Ana Clara Silva, vice-president of the Health Authority, Madeira

What would be your advice to future EPIET fellows, based on your experience in this mission?
At the beginning I was unsure whether to apply for this mission since I was new and relatively inexperienced. In hindsight I am very happy I did and would advise other EPIET fellows to take every chance they are offered. Aside from the great working experience, I had the chance to see an incredibly beautiful island, work outside while wearing a shirt in November, practise my Portuguese, make new friends and eat swordfish with fried bananas!

 

Read the epidemiological update from February 2013
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