Prevención y Control de Dengue

Objectives

Mexico’s Specific Action Programme for Dengue Prevention and Control 2013–2018 sits within the Sectoral Health Programme and the National Development Plan’s “Inclusive Mexico” framework. It seeks to halt the sustained rise in dengue transmission, reduce incidence, severity and mortality, and improve equitable access to high-quality care through prevention, surveillance, integrated vector control and action on social and environmental determinants.[1][2][3]

• Improve access to and quality of medical care for people with dengue, including timely diagnosis, standardised care criteria, clinical-guideline adherence, specialised attention for newborns of mothers who had dengue, and a gender perspective in patient management.[4][3][5][6]
• Promote intersectoral and community action on environmental, economic and social transmission risks, including unreliable water supply, water storage, waste, housing conditions, disposable containers, public spaces and commercial settings.[7][8][9]
• Adapt integrated vector control strategically to make interventions effective and sustainable, reduce reliance on insecticides, monitor resistance, and tailor action to rural, suburban and urban transmission patterns.[10][11][12]
• Prioritise equity by addressing the needs of groups experiencing inequality through human-rights, gender and intercultural perspectives, including differentiated household responsibilities for eliminating breeding sites and monitoring possible adverse effects by sex.[13][14][15]
• Strengthen predictive risk analysis by integrating epidemiological, entomological, social, environmental, housing and population-movement information to identify priority areas before transmission intensifies.[10][11][16]
• Prepare for potential dengue-vaccine introduction through a public-private policy, alongside continued prevention, surveillance, vector control and clinical-care improvements.[17][18]

The programme sets measurable health objectives: maintain dengue haemorrhagic fever case fatality below 1% annually; reduce annual dengue incidence from the 2013 baseline of 52.7 per 100,000 population by 15% by 2018; and train all operational personnel in dengue care and clinical management with a gender perspective.[19][20][21]

Implementation

The delivery model combines coordinated action across the National Health System, state health services, municipalities, communities and non-health sectors with risk-stratified surveillance and targeted vector control. Federal coordination and institutional follow-up are led by the National Centre for Preventive Programmes and Disease Control, through its preventive-programmes and vector-borne-diseases functions, while implementation is undertaken across the 32 federal entities and health-system institutions.[22][23][24]

• Integrate epidemiological surveillance, laboratory diagnosis, entomological surveillance, health promotion, social communication, health-risk protection, clinical care, vaccination planning and vector control rather than relying on a single intervention.[13][25]
• Use the National Epidemiological Surveillance System and linked entomological and integrated vector-control platforms for real-time notification, georeferenced probable and confirmed cases, laboratory-result capture, risk stratification and operational decision-making.[24][10]
• Apply weekly ovitrap surveillance, fixed-site adult-mosquito collection, serotype identification and local insecticide-susceptibility studies to identify priority locations and adjust intervention intensity.[26][11][27]
• Assign fixed geographical areas to prevention and vector-control brigades, maintain sustained work throughout the year in risk areas, estimate local workloads and build continuing relationships with communities.[18][16]
• Conduct source reduction, larval control, household surveys and post-intervention verification, indoor residual spraying for reported probable cases, and spatial fogging in priority municipalities or during outbreaks.[28][29][30]
• Manage insecticide resistance through certified regional and state bioassay units, workforce training, continuous susceptibility monitoring and rotation of chemical groups based on local evidence.[16][31][32]
• Mobilise schools, healthy municipalities, housing, ecology, occupational health, education, tourism, social development, industry, academic institutions and communities to remove breeding containers, improve environmental conditions and reduce risks associated with packaging and tyre industries.[8][23][33]
• Strengthen clinical governance by standardising care quality across institutions, training health workers, updating the Clinical Practice Guideline and establishing a National Clinical Advisory Group.[3][34][35]

Monitoring combines process, intermediate-result and impact indicators with national and state targets. Core measures include annual case fatality and incidence, quarterly training coverage, active State Dengue Prevention and Control Committees, housing-condition assessments, ovitrap coverage, bioassay-unit operation, regular platform reporting, larval-control and fogging coverage, treatment of reported probable cases, cholinesterase testing for personnel applying organophosphate insecticides, and operational research.[14][19][22][28][30][36]

Specific operational targets include ovitrap, larval-control and spatial-fogging coverage in 100 priority municipalities; 28 functioning entomological bioassay units; 48 weeks of prevention and control activity reporting each year; 100% indoor residual spraying coverage for reported probable cases; and 32 operational research studies in the federal entities.[37][29][30][36]

Governance includes State Committees for Dengue Prevention and Control, an external advisory group involving higher-education institutions and multidisciplinary experts, and responsibility matrices for institutional follow-up. Progress information is intended to be made available to civil society through Ministry of Health, Undersecretariat for Prevention and Health Promotion and National Centre for Preventive Programmes and Disease Control websites.[8][21][23][15]

The material identifies persistent implementation constraints: delayed or insufficient resources, limited state contributions, weak cross-sector and municipal participation, uneven surveillance capacity, insecticide resistance, workforce turnover, inadequate training, insecurity and an overly reactive dependence on federal support during emergencies.[38][39][24]

Monitoring & Evaluation

The programme establishes an integrated monitoring and accountability framework linking epidemiological, laboratory, entomological, clinical-care, vector-control and health-promotion information. It uses the National Epidemiological Surveillance System (SINAVE), its Dengue Module, the entomological surveillance and integrated vector-control platform, and State Public Health Laboratories to support risk analysis, operational decisions and programme follow-up.[24][10][14][23]

• Monitor dengue haemorrhagic fever case fatality annually, with a target below 1% in each year from 2014 to 2018.[19]
• Track annual dengue incidence per 100,000 population, from a 2013 baseline of 52.7 to intermediate targets of 51.8 in 2014, 49.9 in 2015, 48.2 in 2016, 46.5 in 2017 and 44.9 in 2018, representing a planned 15% reduction over the period.[20]
• Measure quarterly the proportion of operational personnel trained in gender-sensitive dengue management, with a 100% target for 2014–2018.[21]
• Assess whether 28 State Dengue Prevention and Control Committees are active and meeting, targeting 112 meetings annually and 672 meetings over the six-year period; State Health Services report progress.[21]
• Measure housing conditions and ovitrap surveillance coverage in 100 priority municipalities, and increase functioning entomological bioassay units from one in 2013 to 28 over the programme period.[22][37]
• Record prevention and integrated vector-control activity for 48 weeks each year, with a six-year target of 288 weeks of captured information.[37]
• Monitor quarterly coverage of larval control and spatial fogging in 100 priority municipalities, and treatment of 100% of newly notified dengue cases.[28][29]
• Measure indoor residual spraying among reported probable cases, post-intervention larval surveys and verification, gender-sensitive training, cholinesterase testing among personnel applying organophosphate adulticides, and completion of 32 operational research studies.[30][40][41][36]

Risk surveillance is intended to combine georeferenced probable and confirmed cases, case residences, public gathering places, vector distribution and abundance, ovitrap readings, serotype identification, migration, housing conditions and meteorological conditions. Probable cases may be mapped before laboratory confirmation, while early-warning criteria include changes in age groups, clinical presentation, serology, hospitalisations, ovitrap positivity and egg counts.[18][42][11][16]

Laboratory surveillance uses standardised case definitions and testing algorithms. Guidance requires serological sampling of all probable cases in inter-epidemic or low-endemic periods; during outbreaks, sampling falls to 30% for dengue fever but remains at 100% for dengue haemorrhagic fever.[38]Laboratory staff enter specimen results in the national surveillance platform, and State Public Health Laboratories submit material to the Institute of Diagnostic and Epidemiological Reference for diagnostic quality control.[10]

Historical surveillance data show 55,961 confirmed cases in 2009, of which 20% involved dengue haemorrhagic fever, and 52,128 confirmed cases in 2012, when this proportion reached 36%; severe-case fatality remained at 1% or below from 2000 onwards.[25]In 2012, 105,561 ovitraps were active in 31 federal entities, with Tlaxcala joining entomological surveillance from 2013.[26]

Accountability mechanisms include federal coordination by the National Centre for Preventive Programmes and Disease Control, permanent supervision and technical support, an internal responsibility matrix, institutional reporting, programme-performance assessment, external expert review and publication of progress information for civil society through Ministry of Health, Undersecretariat for Prevention and Health Promotion and CENAPRECE websites.[23][31][15]The source does not specify a single consolidated reporting calendar, full evaluation methodology or complete set of formal accountability sanctions.[25][8][5]

Costing & Financing

Financing evidence is limited: the programme identifies past resource constraints and operational resource needs, but provides no quantified programme budget, costed implementation plan, funding envelope, unit cost, financing formula or economic assumption.[18][25][39]

• Note that dengue control initially lacked dedicated resources and was financed through the malaria programme, contributing to weak sustainability.[42]
• Recognise that insufficient resources constrained intervention coverage and timeliness during the resurgence following the 2004 Veracruz outbreak.[42]
• Record that the 2007 outbreak resulted in the first dedicated dengue-control allocation, supporting temporary staff, vehicles and insecticide-application machinery for state health services.[25]
• Address delayed release of financial resources and limited state contributions, which hindered prevention and increased local dependence on federal support during health emergencies.[24]
• Prioritise sustainable resource use through reduced dependence on insecticides, resistance monitoring, bioassay units, workforce training, surveillance platforms, vector-control equipment and operational research; no monetary valuation is provided for these inputs.[18][31][15]

Although the extracts report significant increases in dengue-prevention and control resources, these were considered insufficient for entomological surveillance and insecticide-resistance monitoring and management.[39]No explicit funding gap is quantified, and no resource-mobilisation plan or allocation by institution, federal entity or activity is specified.[39][24][43]