Home' Australian Pharmacist : Australian Pharmacist February 2011 Contents Vol.30–February#02
• fallen palm fronds
As A. aegypti is commonly found
indoors, the use of a residual insecticide
on surfaces on which they like to rest
may provide some additional benefit.
The female mosquito is also more likely
to bite during the day so it is important
to use control measures during the day
to avoid infection.
Personal protection measures are
also important. Using a suitable insect
repellent is one of the simplest and
most effective ways of avoiding biting
insects. Products containing DEET are
the most widely used and appear to
be the ones with the most acceptable
side effect and toxicity profile. Care
should, however, be taken in their use
in pregnant women and very young
15 Advising on the correct use
of repellents is also important. General
counselling points include:
• Apply to exposed areas
• For use on the face, first apply to
the palms of the hands then the
face avoiding the eyes and mouth
• Apply carefully to children and avoid
applying to their hands
• Avoid use in broken or inflamed skin
• Always follow the manufacturers’
Using mosquito coils and burning
citronella candles has been shown
to provide a level of protection from
mosquitoes. There is also some
anecdotal evidence for the use of
thiamine in doses of 50 mg/day
to protect against mosquito bites.
However, given the scant evidence
for this indication it is not advisable to
rely solely on this method.
Other measures that can be
employed include wearing long,
loose fitting clothing made from
close woven material. Light colours
are preferred to dark ones as the
latter may attract mosquitoes. These
are simple measures, but have been
shown to dramatically reduce the
likelihood of contact with mosquitoes
and hence significantly reduce the
likelihood of infection.8,15
The impact of climate change on the
geographic distribution of dengue fever
is still not clear. While studies have
shown that an increase in temperature
could potentially increase the
distribution of the vector mosquito, it is
complicated by the urbanisation of this
species. Therefore while climate change
may have an impact, environmental
issues such as the increase in water
storage tanks in southern Australia may
also provide a means for A. aegypti to
increase its range.
The pharmacist’s role in managing
DF is an important one. What was
once considered a disease of the
tropics is increasingly being seen in
It is therefore imperative that the
profession understands the risk
that diseases such as DF present
and assumes a much greater role
in identifying and referring potential
cases, as well as being a reliable
source of factual and timely public
1. World Health Organisation. Dengue: Guidelines for
diagnosis, treatment, prevention and control [online].
2009 [accessed 12 Aug 2010]. At: www.who.int/csr/
2. Kyle JL, Harris E. Global spread and persistence of
dengue. Ann Rev Microbiol. 2008; 62:71–92.
3. Gibbons RV. Dengue conundrums. Int J Antimicrob
Agents. 2010 [published online 11 Aug 2010].
4. Department of Health and Ageing. Arboviral diseases
and malaria in Australia, 2007/08: Annual report of the
National Arbovirus and Malaria Advisory Committee.
Communicable Diseases Intelligence [online]. 33(2) –
Jun 2009 [accessed 30 Sep 2010]. At: www.health.
5. Martina BEE, et al. Dengue virus pathogenesis: an
integrated view. Clin Microbiol Rev. 2009; 22 (4):
6. Rodenhuis-Zybert IA, et al. Dengue virus life cycle: viral
and host factors modulating infectivity. Cell Mol Life
Sci. 2010; 67:2773–86.
7. Halstead SB. Dengue virus-mosquito interactions. Ann
Rev Entomol. 2008; 53:273–91.
8. Cook GC, Zumla AI. Manson’s Tropical Diseases. 21st
ed. Saunders Elsevier Philadelphia; 2009;753–61.
9. Halstead SB. Dengue. Lancet. 2007; 370:1644–52.
10. Potts JA, Rothman AL. Clinical and laboratory
features that distinguish dengue from other febrile
illnesses in endemic populations. Trop Med Int Health
11. Rajapakse S. Corticosteroids in the treatment of
dengue illness. Trans R Soc Trop Med Hyg. 2009;
12. Carver S, et al. Influence of hosts on the ecology
of arboviral transmission: potential mechanisms
influencing dengue, Murray Valley encephalitis and
Ross River virus in Australia. Vector-Borne and Zoonotic
Dis. 2009; 9(1):51–64.
13. Swaminathan S, et al. Dengue vaccines: state of the
art. Expert Opin Ther Patents. 2010; 20(6):819–35.
14. Qld Health. Dengue Fever [online]. [Accessed 30 Aug
2010]. At: www.health.qld.gov.au/dengue/dengue_
15. Goodyear LI. Travel Medicine for Health Professionals.
1st ed. Pharmaceutical Press; UK, 2004. p 139–69.
16. Beebe NW, et al. Australia’s dengue risk driven by
human adaptation to climate change. PloS Negl Trop
Dis. 2009; 3(5): e429.
17. Russell RC, et al. Dengue and climate change in
Australia: predictions for the future should incorporate
knowledge from the past. MJA. 2009; 190(5):265–8.
18. Tabachnick WJ. Challenges in predicting climate
and environmental effects on vector-borne disease
episystems in a changing world. J Exp Biol. 2010;
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