Climate Change and its Effects on Blood Supply - Research Proposal Example

Climate Change and its Effects on Blood Supply: an Australian case study Introduction Climate change is expected to lead to unprecented outbreaks of vector-borne diseases as well as increasing geographical bounderies of transmission. This adversely affects the supply of fresh blood products across the globe. A recent outbreak of dengue fever has resulted in shortages of blood supply in Australia. Dengue is a potentially dangerous disease transmitted by a bite of an infected Aedes aegypi mosquito.Dengue can cause serious health complications such as dengue hemorrhage, shock and death among children. Aedes aegypti is an important vector of several aboviruses. The vector has expanded its range from its geographic origin of Africa and spread allover the world through urbanization, transportation, as well as, changes in human movement and behavior. Climatic change affect the survival of Aedes aegypti mosquitoes, habitat, maturation, as well as, infective period. Increase in temperature shortens the incubation and the development of the dengue virus. Aedes aegypti inhabits natural water bodies, stagnant pools and accumulated water in trash. Aedes aegypti thrives well indoors and feeds on human blood, hence, the mosquitoes adapts well to urban environments with high population densities (Bergquist, 2001). In Australia, dengue outbreaks have been reported to in populated urban areas such as northern part of Queensland. Infected individuals becomes infective at the viraemic phase of the ailment which is 1-2 days before the appearance of the symptoms, followed by 4-5 days after the onset of the symptoms before the appearance of the antibody titre. The symptoms of dengue fever occur abruptly after some days of infection and subside after six days and reoccur days later and then disappear completely (Bergquist, 2001). Dengue fever can be prevented through prevention and eradication of the vector, and protection against mosquito bites. In addition, Aedes aegypti spreads other diseases such as yellow fever. Therefore it is important to improve public healthcare since there is no available cure or vaccine effective enough for the treatment of dengue. Literature Review Climate change is a factor that has led to the spread of dengue fever. The vector borne disease has clear related pattern because rainfall and temperature leads to the spread of mosquito vectors with the likelihood that they will transmit the dengue virus from one person to another (IPCC, 2007). Climate models indicates that increases in temperature have implications to the increases to the latitudinal range of the spread and transmission intensity in dengue pandemic areas. Transmission patterns of dengue would become an established epidemic in Australia if no measure put in place to curb the spread of Aedes aegypti mosquito (Gibbons & Vaughn, 2002). A study undertaken by Bulto et al (2006) concludes that Aedes aegypti is found between latitudes 35o N and 35o S and it is very susceptible to dengue virus, through feeding on human blood, and thriving to a close proximity to man has made the vector to have the ability of transmitting the virus to many people. According to Wu et al (2009) dengue transmission occurs mainly in the warm, humid, and rainy seasons which favor the breeding of the mosquitoes. Human population increase in tropical countries combined with increased urbanization lead to poor management of water resources and solid wastes creating more habitats for the mosquito larvae. A great obstacle to the control of the disease includes few mosquito control programs which are ineffective. Many cases of dengue infections have been reported to increase in many regions outside the tropics, despite the proliferation of the reported cases, it is generally accepted that disease incidence of infection is largely underreported (Beebe et al, 2009). The outbreak of dengue fever result into long and unexpected shortage of fresh blood products. The areas that favor transmission of dengue fever are predicted to spread out to several states and include new populations. Climate change is likely to affect supply of blood by altering the movement of vector-borne diseases. The global changes in climate that are being observed currently are predicted to have adverse effects on the health of people (Reiter, 2008). In Australia, these effects comprises of increased occurrences of vector-borne diseases as well as the geographical areas affected (Wu et al, 2009). Gibbons & Vaughn (2002) posit that several outbreaks of dengue would greatly reduce the supply of blood in Australia . People who were living in town and cities and who were not exposed to dengue fever before would suffer most during an outbreak. Australia is potentially vulnerable to increased occurrence of dengue fever; however, the virus is not yet endemic in the country (Bulto et al, 2006).There has been a sporadic outbreak of dengue fever in northern Queensland. Several incidences of dengue have been reported in international travelers who return in dengue endemic countries then transmit the viral infection to other people. Currently, dengue outbreaks in Australia follow a cycle starting with an infected traveler from a dengue endemic country and enter into the country (Wu et al, 2009). This has contributed to cases of dengue infections and the introduction dengue hemorrhagic disease (Liumbruno et al, 2008).The disease is very common among children because older patients especially in the northern part of Queensland have a long period for dengue serotypes, meaning that the older people or those previously infected, for example international travelers, are very susceptible to the disease. The occurrence of dengue serotypes may frequently occur in the coming years due to increased virus activity, random chance, and increased tourism activities across the globe (McBride, 2000). According to Beebe et al, (2009) climate models are used to indicate that the supply of blood and dengue are climatic problems, hence, there is a correlation between dengue fever and climatic variables. Climate change has been recorded in various parts of the world with incidences of dengue fever predicted to increase in many countries. Climate change is likely to affect supply of blood by altering the movement of vector-borne disease . Data and methods Modeling of suitable areas for dengue transmission in Australia in the coming years were analyzed under various climate change scenarios to estimate the implications to the populations at risk and effects of the blood supply. Based on global distribution of dengue, empirical models used, determine the effect of climate on the transmission of dengue in various regions in Australia (Beebe et al, 2009). Climatologically, factors such as high intensity of rainfall predict the outbreak of dengue more precisely. Thus, the long-term average humidity in the atmosphere expressed as an average annual vapor pressure determines both humidity and temperature. The climatic factors are important for the survival of the female Aedes aegypti mosquito. The vector depend on humidity and temperature changes for its survival (Kuno, 1995). Favorable climatic conditions increase the mosquito lifespan of and increased blood feed hence, increasing transmission levels of dengue virus (Kuno, 1995). High temperature increases the replication rates of dengue virus and reduces the incubation interval and the period of infectivity. The modelsa were used to determine the probability that the introduction of one or more outbreak of dengue fever could occur. Relative humidity was ascertained by use of a standard meteorological conversion formula. The model provided a description of regions at risk of dengue infection to surpass 50% likelihood of dengue transmission. Climatic scenarios used in the study indicated no action taken to reduce atmospheric pollution. Hence, there is the projection of an increase in the global temperatures by 4.5 oC by 2100. There are differences in the climatic scenarios used because of variations in relative humidity and rainfall intensity. Use of the climatic model was based on assumption that strong measures were adopted to reduce atmospheric emissions in the coming years. According to historical data, CO2will be stable in the atmosphere at 420 ppm and the increase in the global temperature would increase by 2oC Table 1: Climate scenarios Scenario No action taken Strong action taken Hot and dry Hot, median humidity Hot and wet warm Global temperature increase (oC) 4.5 4.5 4.5 2 Humidity low median high median Data obtained determine the population at risk in cities and urban areas between 2011 and 2100. Data from major cities were modeled to project the standard deviation. A minimum occurrence of dengue was used to estimate prevalence of annual dengue transmissions, and figures derived from the existing data using national meteorological records between 2001 and 2009. A higher incidence for dengue infections in future were projected from the total number of dengue infections during the most current dengue outbreak. The effect of dengue on blood supply was ascertained by use of blood samples from donors from different regions, to determine the reduction in blood supply and focusing on the modeled dengue prone areas. The economic and public health implications of dengue fever include increased healthcare costs which are estimated at approximately $3.0 per individual residing in dengue endemic areas. Surveillance and mosquito control costs are estimated at approximately $3.0, for surveillance and vector control, education programs, and training of health personnel. Diagnostic tests conducted for dengue and other vector-borne viruses’ accounts for more than 20 cts per person. Other costs include treatment costs and hospital costs. Results Regions with climate that are conducive to Aedes aegypti mosquito could expand to densely populated areas in a number of the present dengue marginal reagions and lead to a reduction of blood. Transmission of the virus is expected to spread to southern and western parts of Australia. Areas at high risk of dengue infection include; Queensland, New South Wales, northern and western parts of Australia, as well as, the Northern Territory. Table 2. Percentage change in numbers of people living in transmission-risk areas Year Hot (dry) Hot (median) Hot (wet) Warm (strong mitigation) 2020 +57 +57 +57 +57 2050 +116 +116 +116 +116 2070 +312 +334 +334 +126 2011 +1,600 +1,780 +2700 +138 Table 2 illustrates the annual rates of confirmed infections which are given estimates in the dengue susceptible areas. Table 3. Estimated annual numbers of new dengue transmissions under the four climatic scenarios Year Hot (dry) Hot (median) Hot (wet) Warm (strong mitigation) 2020 370-1,877 370-1,877 370-1,877 370-1,877 2050 520-2,631 520-2,631 520-2,631 520-2,631 2070 980-4,890 1,030-5,020 985-4,986 635-2,864 2100 4,320-19,354 5,640-24,443 6,120-30,123 560-2,960 The table above indicates an estimate of a number of people at risk of dengue infection based on the population exposed and the current trends of dengue transmission. The population at risk projections is necessary in the calculation of lower estimates from the average annual incidence rate 1993-2009. Upper estimates can be ascertained by calculation from a much widespread outbreak in 2008-2009. The population at risk is predicted to increase in the next coming decades as observed in the data above due to population growth in dengue endemic regions rather than the transmission in areas that have favorable climatic conditions for dengue transmission. Increase in urban populations due to geographic expansions will require strong mitigation measures to reduce the population of those residing in dengue prone areas by approximately 85% based on the regional climatic patterns and the response to increased atmospheric emissions. Dengue fever will have implications to the distribution of fresh blood supply and blood supplements. Table 4. Australia’s blood donors by territory/state and population distribution State/territory Australia’s regular donors (%) Australia’s population (%) New South Wales Victoria Queensland Western Australia South Australia Tasmania Australian capital territory 36.6 22.4 19.3 7.8 11.6 2.3 3.1 2.0 33.9 24.2 19.3 7.8 10.1 3.8 2.0 3.4 Discussion As explained earlier, research findings indicate that dengue transmission will continue to expand geographically in Australia. This expansion will affect several states as well as new populations if strong measures are not taken by concerned parties to control the transimission rate. Measures should be taken to reduce climate change through reduction of global carbondioxide emissions. Climate change has numerous implications in the spread of dengue in Autralia. The increased rates are as aresult of lack of adequate vector control in areas that require urgent attention (McBride, 2000). The ratio of dengue hemorrhage fever and dengue shock syndrome cases to classical dengue fever have increased dramatically over the last decades. Dengue infections have become the leading cause of hospitalization and death in children in several endemic countries. During rainy seasons the epidemic increase from Western Australia towards the Northern Territory and the New South Wales (Beebe et al, 2009). These areas significantly need the eradication programs to reduce the spread of dengue virus. Lack of appropriate measures leads to many infections with dengue. Hence, severe occurrence of dengue in various places and the spread to new areas would greatly reduce the collection and supply of fresh blood products. Populations in urban areas are more susceptible to dengue infections during outbreaks. According to demographic studies, many people would be at risk of infection, leading to bimagnification of the virus through increased incidence of occurrence of dengue. For instance, in early 1990’s more than 25% of Queensland’s population in the town of Charter Towers were infected with the virus during a recent outbreak outbreak (McBride, 2000). The increased rates of dengue transmission is a result of inadequate vector control measures. There is a widespread expansion of geographic range for Aedes aegypti and the dengue virus. Historical epidemiological data on the global transmission of dengue virus indicate an estimated prevalence of 90% of dengue outbreaks with more attention on endemic areas having occurrence of more than 50% of the population (Beebe et al, 2009)The models indicate that regions recording low than 50% of transmission rates could be prone to dengue infection. Predictive models project the future activity of dengue and carefully considers data on the distribution of dengue. According to historical data on the global prevalence of the virus, there is an estimated prevalence of 90% of dengue outbreaks with more attention on endemic areas with an estimated value of occurrence of more than 50% of the population (Gould et al, 2006). Regions recording low than 50% of transmission rates could be prone to dengue infection. There is prediction that the occurrence of dengue will spread in most parts of Australia, for instance, the recent occurrence of dengue outbreak in Townsville (Beebe et al, 2009). Predictive models are important in the identification of areas that dengue outbreaks are likely to occur, based on the data obtained from regions currently infected. The occurrence of dengue had been reported before in many parts of Australia (Beebe et al, 2009). The models have been used to predict the occurrence of dengue through surveillance programs which have enabled the health officers to employ methods to reduce the transmission rates. The models are important in the identification of areas that dengue outbreaks are likely to occur, based on the data obtained from regions currently infected. The occurrence of dengue had been reported in many parts of Australia (Beebe et al, 2009). Hence, the predictive models have implications on the anthropogenic activites. The models have been used to predict the occurrence of dengue through surveillance programs which have enabled health officers to employ methods to reduce the transmission rates. Reduced installation of domestic water storage in the urban areas has reduced mosquito breeding sites, particularly near water reticulation areas. This has placed Southeastern part of Australia on increased water shortages. There is need to install large domestic water storage facilities and infrastructure (Beebe et al, 2009). Reduced installation of domestic water storage in the urban areas has reduced mosquito breeding sites, particularly near water reticulation areas. This has placed Southeastern part of Australia on increased water shortages. There is need to install large domestic water storage facilities and infrastructure (Beebe et al, 2009). However, this may increase the reoccurrence of the mosquito to other regions such as populated centres in Austaralia and New South Wales because the water collection tanks may act as breeding sites of the vectors. The distribution of fresh blood would reduce significantly between 60% and 90%. Appropriate measure should be implemented to curb the outbreak of the disease. The models emphasize on the effects of climate change in regions that receive high amounts of rainfall, and favourable temperatures to be more susceptible to the virus. The occurrence of dengue, particularly in the Nothern parts of Australia could reduce the supply of fresh blood, causing a significant loss in the country’s blood supply to approximately 20%. Northern part of Queensland state would experience large reductions in blood supply because of an earlier occurrence of the disease indicated by the epidemiological data (Gould et al, 2006). Dengue transmission has increased the cost of medicare throughout Australia, the healthcare costs are estimated at approximately $ 23 million. Control measures should be adopted to control the vectors and to cut on the increased costs of medication. Despite strong mitigation measures to curb the spread of the virus, other vector borne diseases such as malaria may emerge due to climatic changes (Beebe et al, 2009). Health cost per individual would be constant in future if the pattern of dengue transmission in the country stabilizes. However, if the transmission rates change in future, and the disease becomes endemic, there would be adverse implications in the healthcare costs. The increase in the occurence of the virus would tremendously increase the healthcare costs above the estimated expenditure per individual. The prevailing scenario of dengue transmission shows that no records are available to show the transmission rates of dengue (McBride, 2000). There is need for a strong campain measure for to reduce dengue transmission such as habitat destruction. Mosquito eradication programs would be very necessary in urban areas where the virus is endemic. International travel have increased the pattern of dengue transmission with a direct link to the occurrence of the virus from a country with a population infectecd with the virus. Increase in global tourism has direct effects in the increase of dengue transmissions throughout the world. Health official in Australia have reported cases of dengue transmission to be directly related to the increase in international travelers and residents who return to Autralia from foreign countries which are endemic to dengue (McBride, 2000). The introduction of different serotypes of dengue have increased the occurrence of a more serious and life threatening complication of dengue haemorrhagic disease. Therefore, the severity of dengue symptoms have marked differences in many regions. Factors that are responsible for the spread of the virus includes higherpopulation growth rates, poorly planned urban demographies, inadequate public health facility and infrastructure, lack of vector control programmes, poor stagnat pools, the evolution of dengue virus, increased trourism, and travel to endemic countries (Bulto et al, 2006). The severity of dengue is attributed to; ethnicity, nutritional status, occurrence of different serotypes of dengue, age, and the efficierncy and competence of health facilities. In Australia, future health systems, population growth, and climatic influences the severity of dengue transmission. Recent healthcare data in Australia have recorded few death cases to approximately 0.3% of the population yearly. The increase in dengue transmission, which may be intensified, makesw the virus to become endemic as an outcome of increased infections (Gould et al, 2006). Dengue haemorrhagic is prevalent in children in countries such as Southeast Asia. In older people, the occurrence of dengue haemorrhagic fever takes a longer period between the different serotypes of dengue, particularly in northern parts of Queensland. Older people and those who have have been infected by dengue while visiting countries where the virus is endemic are highly at risk of dengue haemorrhagic fever infections. The frequent occurrence of different serotypes of dengue, or local establishment of the virus in a region has implications on the age profile of dengue haemorrhagic fever towards children. Climate change is likely to increase the prevalence of dengue transmission in areas that are exposed to the virus and increase its spread to new regions (Gould et al, 2006). Using scenario-based modelling that uses the climatic models and temperature changes has led to the prediction of an increased latitudinal range of dengue outbreaks and a higher intensity in areas already exposed to the virus. Therefore, dengue transmission will get established in newer areas. In future, it is predicted that dengue may spread into South America, parts of Africa and several parts in Australia (Balmford et al, 2005), there is likelihood of the occurrence of the virus in USA . Countries like India, Southeastern Asia, and some parts of the middle east are regarded as low risk areas. Low risk zones countries will become high risk if mitigation measures are not put in place. Using models, dengue fever is predicted to intensify in the northern parts of Australia especially in the Queensland area, and may spread to other regions such as India and Thailand, some parts of Africa, as well as, South and Central America. The climatic changes such as rainfall causes wetness, hence making vectors to multiply and the situation gets worsened with increase in the global temperatures (Wu PCet al,2009). There is likelihood of new patterns of infection emerging round the globe as dengue transmission increases in other parts of Australia . Dengue has implications in blood supply in Australia and the situation is increased by climatic changes resulting into induced shortages in the distribution of fresh blood. Dengue has significant and long-term implications on human life, particularly, in regions struggling to implement strategies to curb the spread of the virus and those that are potentially at risk of transmissions. The same applies to countries working towards replenishing the blood supply needs (Balmford et al, 2005). However, changes of dengue transmission taking place in many regions in the world, the potential for climate change to alter blood supply will advance to other vectore born diseases such as dengue haemorrhagic fever. Cases of other important vector borne viruses may occur in other parts of Australia including Ross River virus, Barmah Forest virus and Murray Valley Encephalitis (Rigau-Perez, 1998). There is likelihood that the virus may get widespread and intensity may increase in many regions as conditions get favourable to mosquitoes and the replication of dengue virus. This would further increase the negative impacts in blood supply in Australia. Climate change causes the reduction to blood supply globally due to its implications in the spread of the disease vectors, a situation similar to other important vector borne diseases (Wilder-Smith & Schwartz, 2005). Climatic Modells have been used to predicte the occurrence of a single virus. Surveillance of Aedes aegypti in Australia depends on the distributive models to project the global distribution of Aedes aegypti under climatic change scenarios. Synthesis of dengue distribution data indicate that climatic limits for dengue transmission is derived from historical data of dengue transmission, suggesting that he proliferation of water collection tanks in most regions in Australia would lead to the the widespread distribution of dengue hence, exposing a larger population to dengue transmission. Thus, the increased risk of dengue transmission does not depend solely on climatic changes but rather to the adaptation of the impacts of climate change through installation of water collection tanks. Measures should be implementd by the government to ensure that the expansion of dengue vector does not pose an emerging and re-emerging risk to Australia (Rigau-Perez, 1998). However, research evidence shows that there is an increase in the intensification of the vector borne diseases in various geographic locations. Tourism has led to an increase in the global movement of blood and fresh blood suppliments from dengue endemic areas, hence having serious implications to the future blood safety. However, transfusion and transmission risk does not depend on the geographic locations but could lead to exposure of the disease to previously marginalized regions to the virus with a lot of difficulty to trace infected blood supplies (Adger, 2005). According to Wilder-Smith & Schwartz ( 2005), they observed that changes would occur in the use of blood products not considered in the modeling of future blood supply reductions. In Australia, the yearly rate of IVIg use increased to approximately over 56% in the year 2003, and the platelet use increased to an estimated value of 13%. The results indicated a decline in the plasma derived factor VIII and IX which reduced to give way for a recombinant technology during the same time (Rigau-Perez, 1998).. The effect observed is the impossibility to deduce whether the urgency of therapeutic requirements will increase or reduce in the near future. Australian health officials reports indicate that increased intensity of dengue outbreaks in endemic regions is the result of climatic changes that have increased the incidences of dengue in most parts of Australia (Beebe et al, 2009). This will need health practitioners to reduce overreliance on donated blood supplies. On the other hand, dengue will is not considered an easily curable infection because there will be no accurate and reliable and available screening devices. Having an effective dengue vaccine and the need to adopt the application of sound technologies to help in the reduction of the pathogen to blood supplies and supplements, would reduce the potential risks of dengue (Wilder-Smith & Schwartz, 2005). Climate change has been a major cause of other vector-borne pathogens, therefore overreliance on screening and vaccination for blood products as a means of blood collection can jeopardize the availability of blood supplies if adequate measures are not taken into consideration, particularly in marginal areas. Australia’s national blood component inventory is sufficiently prepared to transfer blood components in regions with urgent need. Having safety measures that can address urgent situations when an outbreak occurs should be a priority in addressing a nation’s healthcare (Adger, 2005). Many countries have not adopted such measures hence making ineffective the efforts to eradicate the spread dengue. Situations may grow worse with the unpredictable changes in climate which may cause an increased rate of vector-borne infections globally. To cope with the increasing demands of blood, proper surveillance should be undertaken to determine the intensity of the shortfalls in blood supply to allow for proper planning. The concentration of carbon dioxide gas in the atmosphere causes global warming. Reduction of atmospheric emissions would drastically minimize climatic change due to reduction of the green-house-gasses in the atmosphere. A reduction of more than half of carbondioxide emission in the atmosphere is an important strategy to alter the current trend of global warming. An optimal range of CO2 concentration should be below 450 ppm at 2C (Gould et al, 2006). international standards would govern the acceptable levels that would not significantly affect climate change, hence would ensure that the future of blood supplies is safeguarded globally. The dengue virus and Aedes aegypti mosquito are very sensitive to climatic variations; a minimal increase in the global temperature has implications to the transmission rate of vector borne diseases (Boserup, 1981). The occurence of dengue in Australia indicates that with the changes in the global temperature and weather patterns, the vector borne diseases will be challenging to control. However, through surveillance, actions can be taken to reduce the breeding sites. Preventive measures such as screening of water collection tanks to prevent oviposition of the mosquitoes should be done well in advance (Beebe et al, 2009). These measures should be undertaken regardless of measures to reduce atmospheric pollution . The occurrence and distribution of climate change and its implications on human health and the environment is not easy to ascertain. This may be more complicated in circumstances when different components of the environment are affected, as well as, human and ecological health problems (Rigau-Perez, 1998). Thus, climate change is an issue that has serious implications to the supply of blood in Australia, because it causes favorable environments for the occurrence and transmission of dengue virus (Wu PC et al, 2009). Conclusions and Implications By reduction of greenhouse gases significantly, the spread of dengue fever southwards of Australia’s dengue transmission zones could be limited and reduce the population at risk from dengue. The climate of north Queensland is currently suitable for the establishment of dengue; however, the virus is not yet endemic in Australia. Locally, dengue transmissions, mostly spread through international travel, have been observed through many years in northeastern Queensland. In order to divert the future health risks, health official in Australia should take adaptive measures to control the spread of the virus. However, little research has been undertaken in Australia to estimate the cost of the current climate sensitivity burden of diseases.Analyses indicate that reductions in green house gases would provide health benefits from a reduction in dengue transmission rates. Some adaptations are necessary to respond to the projected increases in the atmospheric temperature and in the expanded zones of dengue fever transmission (Rigau-Perez, 1998). Mitigation measures could reduce the rate of increase in the number of dengue transmissions which is expected to increase further south to Sidney and north to Brisbane. In summary, the emission policies adapted by governments will mitigate the green house gas emissions and reduce the rate and extent of severity of the impacts of climate change on dengue transmission. The reduction of climatic influences may reduce the number of people residing in dengue endemic regions in Australia in the coming years. Dengue fever has economic impacts on the people when the epidemic affects thousands of people. It increases Medicare costs through creating an overload to the community and the medical facilities. The growth of urban centers in the tropical countries and the developing world has led to the expansion of Aedes aegypti. In most cities in Australia, the constant transmission makes dengue acute with lack of effective control measures. When combined with the current trend of international transportation and tourism, the prevalence of dengue may cause a disaster. According to World Health Organization (2011), appropriate measure to curb the health implications of dengue includes effective public health system, control of mosquito populations, and reduction of human populations in dengue endemic areas. Currently, the mitigation measures should focus on the mosquito. The mosquito inhabits storage water tanks, and domestic trash. Mitigation measures to control the spread of the virus include water supplies management and storage, solid waste management, and the modification of the breeding sites by man. The bites from vectors can be reduced through removal of stagnant waters, use of protective clothing, use of mosquito repellants, and larvicides. The development of a vaccine has been hampered by lack of dengue animal model. There are new approaches to the development of a vaccine including use of infectious clone DNA and naked DNA vaccines that may lead to simpler and cheap ways with a higher likelihood of safety and stability. However, the development of dengue vaccine may take many years; therefore, there has been intensification of incidences of dengue and emergence of dengue hemorrhagic fever. 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