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PUBLIC HEALTH INFORMATION

DENGUE FEVER
Although dengue fever is mostly found in the tropics, it is beginning to be known as a significant disease
in other areas. Dengue fever is not a newcomer to our planet. In Asia, Africa and North America, the first
reported epidemics of DF were in 1779-1780. Often there were long periods of time, several decades,
between outbreaks, because mosquitoes could only be carried on slow sailing ships.
Around 1950, a global pandemic occurred, beginning in Southeast Asia and by 1975, dengue haemorrhagic
fever (DHF) had become the leading cause of death in children in the region. Spread of the disease has
expanded rapidly in the last 15 years, including increasing reports of cases in the Americas. In fact, the
Center for Disease Control (CDC) calls the emergence of DF and DHF in the Americas a "major public
health problem." Spraying efforts by public health organizations in the 1950's and 1960's significantly
reduced Aedes egypti populations, and the spread of this disease, but were abandoned in the United States in
the 1970's. Now the populations of this mosquito are higher than before spraying was conducted.
By 1997, DF/DHF were considered to pose the greatest threat of mosquito borne diseases, rivalling
malaria, worldwide. Serious mosquito eradication efforts are imperative, on both a global and community
level.
Even the "milder" form of dengue fever is anything but mild. The symptoms are muscular and joint pain,
high fever, severe headaches and backaches, vomiting, nausea and eye pain. DHF involves a high fever of
extended duration, about 2-7 days. The initial symptoms are like those of many types of flu: headache,
nausea, vomiting and abdominal pain. Then small capillaries begin to leak, and haemorrhaging can occur
through the skin, nose, gums and even internally. Without proper medical management, the haemorrhagic
phase may lead to shock, failure of the circulatory system and possibly death.
There is no specific treatment for this fever, other than pain relievers, but aspirin should be avoided because
it impairs blood clotting. In DHF, hospitalization is often required to insure proper fluid replacement.
Although dengue fever occurs mostly in tropical area infested with the Aedes
aegypti or Aedes albopictus mosquitoes, it may be spread to other areas by
travellers carrying the infection. In fact, one strain was found in Central
America in 1994 and has spread into several countries in that region.
Unfortunately, because the strain had not been present in the area for two
decades, immunity in the area is low, and the disease is expected to spread
quickly. All the strains are found the Americas at this time.
No vaccines exist for any of the strains, and prevention is the best cure.
Keep standing water clean or eliminate it. And, avoid being bitten. Be sure all portals in buildings, such as
houses, and offices are screened.
In terms of frequency of reported cases, the CDC reports there are approximately 50 to 100 million cases
per year of DF. DHF infects approximately several hundred thousand people each year. The average rate
of fatality for dengue haemorrhagic fever is about 5%. In the Americas in the late 1990's there were
approximately 250,000 cases of dengue fever, and about 7,000 reported cases of dengue haemorrhagic fever.
By CDC estimates, between 100-200 cases of this virus are introduced into the United States each year by
travellers.
Unfortunately, epidemics of the disease are occurring with increasing frequency and are more widespread
than in the past. The CDC draws a parallel in dengue fever's evolution in the Americas, calling it similar to
the pattern of its spread to what occurred in South East Asia in the 1950's and 1960's
As our global community becomes more urban, and we continue to become more mobile, the disease is
expected to spread rapidly. And, education of medical personnel in the Americas is critical. At the present
time the haemorrhagic disease is often poorly understood because it has not been a common ailment.

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ENCEPHALITIS
While the West Nile virus can result in cases of encephalitis, it is not the only mosquito borne type of
encephalic disease; there are several others, some of which are more severe. The more common ones are:

EASTERN EQUINE ENCEPHALITIS As its name implies, this viral infection is found primarily in
the Eastern United States. It is a disease that affects both horses and humans. It is transmitted through the
bite of a mosquito that has fed on an infected bird. The most frequent species that transmits the disease is
the Culiseta melanura.
Far more than West Nile virus, it is one of the more serious of the mosquito borne encephalitic diseases.
The symptoms, in their mild form, are like a mild case of the flu. At the other end of the spectrum, it
produces encephalitis, or inflammation of the brain, coma and death. It has an alarmingly high mortality
rate: 35% of those who contract it die. Of those who survive an infection, about 35% have some residual
neurological damage, ranging from mild to severe.
These precautions are not to be taken lightly, even though the disease is not common, it is one of the most
serious of mosquito borne diseases.
Luckily, it is quite rare. From 1964 to the present, only 200 cases have been confirmed in the United States.
The states with the highest rates of cases are on the Eastern seaboard, ranging from Florida to
Massachusetts. Part of the reason for its rare occurrence is that carrier mosquitoes that inhabit swamps,
which humans do not frequent often.
The greatest risk of danger is among those over 50 and less than 15 years of age who visit, live or work in
areas where the mosquitoes are prevalent. The best way to avoid infection is to avoid being bitten. So, stay
away from swampy, marshy areas, if you live on or visit the East coast. And, follow the usual precautions
about wearing protective clothing, staying inside during feeding times, and always wear a good repellant.
Unfortunately, there is no vaccine for humans, although there is one available for horses.

JAPANESE ENCEPHALITIS This viral infection is transmitted by

mosquitoes breeding in rice paddies in Asia, mostly from one of the Culex
species. It is closely related to the virus that causes St. Louis encephalitis. In
this case, the mosquitoes feed on infected domestic pigs and birds, which
then feed on human hosts. Like the West Nile virus, many people have no
symptoms. The milder forms of infection can produce some fever and
headaches. The more severe symptoms include high fever, headache,
disorientation, coma, neck stiffness, convulsions, stupor, and paralysis.
The symptoms usually manifest in one to two weeks after the bite. Its
reported mortality rate is very broad, somewhere between .3% to 60%.
This is the leading cause of viral based encephalitis in Asia, but rarely occurs
outside of that area.
Like the other forms of mosquito borne viral encephalitis, there is no treatment, except to alleviate the
symptoms. It is much more common in rural areas of Asia and is rarely found in urban areas.
Again, the best precaution is to avoid being bitten, and to take action to avoid areas of exposure.

LACROSSE ENCEPHALITIS This is one of the rarer forms of mosquito viral encephalitis diseases.
And, fatalities are very rare. More often, mild symptoms are the norm. There are only about 70 cases
reported each year, and
less than 1% of those result in fatality. It is transmitted mostly by one of the Aedes triseriatus, the treehole
mosquito, that is found primarily in wooded habitats. The animal hosts for Lacrosse encephalitis are mostly

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chipmunks and squirrels. Treehole mosquitoes breed in small collections of water, like crevices in trees,
discarded cans and low-lying puddles.
As with all other types of encephalitis diseases, prevention is the best cure. Avoid going into the mosquito's
natural habitat, wear protective clothing, and use a good repellant.

ST. LOUIS ENCEPHALITIS This virus is very closely related to Japanese encephalitis, but far less
prevalent. Mostly, its victims have only a mild illness, although it can produce the more severe symptoms.
It occurs with varying frequency, often rarely, but sometimes up to 3000 cases per year. It is spread by
various members of the Culex species.

WESTERN EQUINE ENCEPHALITIS This version of mosquito borne virus is not at all common.
There have been only about 600 reported cases since 1964, and its symptoms are like most encephalitic
disorders, mild flu like symptoms to a few, rare deaths. It can be epidemic, but its occurrence is hard to
predict. While related to the Eastern equine encephalitis virus, it is simply not as prevalent. There is no
known treatment, except addressing symptoms, and the best precaution is avoidance.
As you can see, mosquito borne encephalitic diseases encompass far more than just West Nile virus. And,
the best means of combating them is to avoid the bites. The best way to avoid these types of illnesses comes
from a double approach. Learn all you can about them, and then be smart about staying out of harm's way.
It is important to take a balanced view, too.
Sure, these are serious diseases, and not to be ignored, but at the same time, recognize that they are not
really than common in urban dwelling environments.

MALARIA
Malaria is not a newcomer on the disease forefront. It was reported as far back as 4000 BC. In the 1700's,
Spanish missionaries in South America learned of a treatment for the disease they called Peruvian bark. The
tree that produced this bark was named after the Peruvian countess, Cinchona, and is now known as
quinine. Even today, quinine, along with artemisinin, it is one of the most effective drugs available.
Artemisinin comes from the sweet wormwood plant, found to be effective for treatment of this disease by
Chinese herbalists as early as 340 BC.
Still, even today, public health experts consider it to be one of the most serious and severe mosquitoes
borne diseases. About 700,000 to 2,700,000 people die each year from it. While most of the fatalities are in
Africa, the disease is a world-wide problem. Most cases involve bites from one of the Anophelese species. To
date, malaria is the leading cause of death and disease, world-wide. In the United States, where it is
considered to have been eradicated, more than 1300 cases were reported in 2002, of which 8 resulted in
fatalities. Most of the cases came from bites acquired in other countries, but since 1957, after eradication
was considered complete, there have been 63 outbreaks of malaria from domestic transmission.
Consider this, about 41% of the world's population lives in areas where it is actively transmitted. And,
consider that geographic isolation is no longer feasible, and you get an idea of the danger malaria presents
to the human community, planet wide. And, more frightening, these numbers are probably lower than the
reality of the situation. Most deaths from malaria occur in Africa, where patients have no access to adequate
medical care and die at home. In this instance, under reporting is a real issue. One reason that malaria has
been mostly eliminated in the United States and Europe is simply a matter of climate. In areas where freezes
occur, the mosquitoes die out. Most of the areas of significant malaria outbreaks are in tropical climates.
The cycle of transmission follows a set pattern. A mosquito bites an infected host and ingests malaria
parasites. While the mosquito is unharmed by the parasites, they thrive in the body of the mosquito, and
then migrate back to the mosquito's salivary glands. Once the mosquito bites again, the parasites are injected

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into the victim. First, the parasites migrate to the host's liver, where they incubate for about 7-30 days. This
is the incubation period and the victim have no symptoms. Then, the parasites enter the bloodstream and
infect the red blood cells, causing them to burst. This causes the classic symptoms of malaria.
First, the victim feels cold and often shivers. This is followed by fever, headaches, and vomiting. In young
children, seizures can also occur. Last, the victim begins sweating, and normal temperatures resume.
Depending on which parasite is involved, the victim will experience these attacks every second day or in
three-day intervals.
The red blood rupture is what ultimately causes fatality. Particularly in children, insurmountable anaemia
results.
And, of course, if the victim is bitten by another mosquito, the parasite goes on to find a new host, which
spreads the disease.
The World Health Organization has attempted to launch efforts to eradicate the disease, but lack of funding
and manpower has forced it to focus on control.
For now, the best course would appear to be what is true for all mosquito borne diseases: get rid of the
vector. Mosquito eradication and avoiding bites is far better than trying to combat the diseases they cause

MOSQUITO FACTS
1. Mosquitoes are responsible for more human death than any other living creature.
2. Male mosquitoes do not bite. The real risk is from female mosquitoes which bite when in search of a
blood meal to provide protein for their eggs.
3. Most adult mosquitoes live for about two weeks.
4. There are over 2,500 species of mosquitoes in the world.
5. The welts that appear after a mosquito leaves aren’t from the bite - it's an allergic reaction to saliva the
mosquito injected under the skin to prevent the blood from clotting
6. Mosquitoes like dark areas and will suck the juice out of plants in order to live - including tree leaves,
grass, shrubs, etc.
7. Mosquitoes are "born" in standing water, mud, ponds, tin cans, under decks, puddles and old tires, etc.
8. Hundreds of thousands are "born" each day in your area during infestations.
9. Mosquitoes rarely travel farther than 300 feet from their birthplace.
10. Studies have shown that while bats devour a huge number of insects, mosquitoes are only a small part
of their diet.
11. Mosquitoes are found all over the world, even in the Arctic

Life cycle of the house fly, Musca domestica Linnaeus.

Clockwise from upper left: eggs, larva, pupa, adult.

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CONTROL OF INSECTS AND RODENTS

1. German cockroaches
• 5/8 in. (16mm) long, flattened light brown insects with two dark longitudinal stripes on
the thoracic shield behind the head
• Secretive habits: 80% of time spent in harborages during the day. 20% of time spent
foraging
• High reproductive rate: female produces 200-300 offspring in her lifetime. One egg case
(ootheca) every 60 days. Female will carry egg case until it is ready to hatch
• Immatures and adults may be located in the same harborages
• German cockroaches are most common in food preparation areas but travel great
distances from harborages and can even be found in berthing

2. American cockroaches
• 1.5in.(38mm) long, dark brown with no stripes
• Remain secluded in harborages during the day and forage at night
• Female produces 100-200 offspring in her lifetime. Egg cases are carried up to 4 days and
are hidden in crevices
• Immature nymphs look similar to adults but are wingless. Immatures and adults will be
found in the same harborages
• American cockroaches prefer damp dark areas and do not travel far from their harbourage

Prevention
1. The first step in preventing a cockroach infestation is conducting pier side or loading dock
inspections:
 Inspect a random selection of boxes or cartons, especially those holding fresh fruits
and vegetables. Look for cockroach eggs, nymphs, and adults
 Can enhance the survey results using a contact pyrethroid (PT 565) to inspect
oncoming stores (do not spray directly onto fresh fruits and vegetables)
2. The second step involves eliminating or reducing the following four essential requirements
for cockroach survival:
 Harborages: cockroaches need hiding spaces to harbor and breed (3/16" (5mm)
opening or smaller space) such as cracks and crevices, unsealed space between
equipment, torn lagging, voids, wire bundles, electrical boxes, and deck drains
 Food: cockroaches require very little for growth and development and can eat
almost any organic matter including cockroach faeces or cast skins
 Moisture: cockroaches will die in 7-10 days without water
 Warmth: cockroaches do not produce their own body heat and require an outside
source to grow and reproduce
3. Eighty-five percent of all insect control is a result of a strong food service sanitation
program by denying the insect population sources of food and water
 Conduct a thorough field day after every meal
 Remove standing water
 Remove food spills and torn packages in storerooms as soon as they occur
 Food should only be consumed in the dining facility. Discourage the presence of
food in other areas (workspace, etc.)
 Eliminate excess cardboard as it provides harborages and a food source from
starch in glue

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Structure
1. Eliminate harborages to prevent cockroaches from hiding, feeding, and breeding in these
protected areas
2. Seal cracks and crevices with silicone or vinyl caulking
3. Repair or replace all torn or damaged lagging

Pesticides
4. Pesticides are to be applied only when all other prevention efforts fail.
5. Emphasize safer/more stable chemicals. Combat bait stations, gel baits, and Permadust
can be used as part of the control program
6. Only crack and crevice treatments are recommended as a pesticide application. Space
treatments are not authorized
 Emphasize the importance of preparing a space for treatment which involves
removal of all food items, covering all equipment, opening drawers and doors,
covering utensils, plates, and glassware
 Emphasize the importance of sweeping the surfaces after treatment. Pesticides do
not penetrate or kill egg cases and they must be removed to eliminate the next
generation
 Emphasize the importance of staying out of the area for at least 30 minutes after
application. Then, thoroughly clean all food service areas with water and detergent

3. The most common stored product pests include saw-toothed grain beetle, flour beetles, and
dermestid beetles. Dermestid beetle larvae are the only stored products pests of significant
medical importance as they have hairs which can cause gastroenteritis if ingested

Prevention
1. Pier side or loading dock inspections
 Use flashlight and look for signs of infestation (live or dead insects, pin holes where
insects have entered or exited packaging, grass-insect excrement, cast skins, webbing)
 Examine most commonly infested products: grain products, pasta, beans, cake mix,
flour. These products are basically processed grain, the preferred food choice for these
insects
2. Stock rotation: first in, first out
3. Storeroom sanitation: immediately clean-up all spills, and discard or secure broken
packages. Spills are similar to unrotated stock, permitting the development of infestation
4. If facilities permit, place commonly infested stored food items in refrigerator or freezer to
prevent infestation from developing

Description of the most common stored products pests:

1. Saw-toothed grain beetle: most common insect in stored products. Adult is slender, flat,
brown, 2.5mm long with six saw-tooth projections on each side
2. Red and confused flour beetles: adult is shiny, flattened, reddish brown, 3.5mm long with small
pits on the head and ridges on the wing covers
3. Dermestid beetles: adults are dark with colorful patterns on their wings. Larvae are pale white,
6.25 mm. long, with numerous hairs. Hairs can break off into food products and cause
gastroenteritis if ingested
4. Indian meal moths: adults dark colored with silver patches on forewings. Larvae are yellowish
and spin silk (webbing) which can be found in food items
5. Weevils: many species, but rice weevil is the most common. Adults have 4 pale spots on wing
covers and a short proboscis, which is used to chew into containers

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The allowable number of pests per product is as follows:

1. One Dermestid beetle per package
2. 3 flour beetles per pound
3. 7 or more sawtooth grain beetles or other insects not listed above per pound

Sanitation
1. Promptly clean up spills in storerooms. Dedicate a vacuum for this purpose. A strong
sanitation program will eliminate readily available food sources for pests
2. Discard or seal broken packages

Rodent Management
a. Most common types of rodents and their capabilities
1. Norway rat, roof rat, and house mouse are historically the most common medically
important rodents.
2. Rodent physical capabilities:
 Rodents can jump several feet and are agile climbers
 They can pass through 1-inch (25mm) openings
 They can walk across wires
 They can climb vertical pipes and walls
 They can swim up to 1 mile (1.6km)
3. Generally, litter sizes are 6-12 young with a range of 3-12 litters per year. Life span: 1
year for mice, 2-3 years for rats

b. Medical and economic importance

1. Rodents and parasites on rodents can spread plague, murine typhus, salmonellosis, Lyme
disease, Hantavirus, and leptospirosis
2. Rodents destroy a tremendous amount of food through consumption, gnawing, or
contamination with urine and faeces

c. Prevention
1. Rat guards: rat guards must be constructed of galvanized sheet steel or sheet aluminum
alloy
2. Conduct inspections of all incoming subsistence items. Look for damaged boxes and faecal
pellets
3. Gangways and loading docks should be well lit. Most rodents travel along dark paths,
bulkheads, and under pallets and shelving
4. Position dumpsters 100 feet (328m) from facility. Keep garbage containers tightly sealed
or closed
5. Barrier materials should be used to prevent rodent access to food stocks. Screen or seal all
rodent entries

d. Surveillance
1. For ships, requires a valid deratization certificate for all ships and submarines every 6
months. Ship must be certified rodent free to visit any foreign port. Deratization
inspections are performed by a certified quarantine inspector
2. Signs of rodent infestation include droppings, urine, rub marks, footprints, and gnaw
marks. Fresh droppings will be black and shiny in appearance. Old droppings will be gray
and dull and powdery when crushed. Rodent urine fluoresces in UV light

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e. Sanitation
1. Proper storage/disposal of garbage is extremely important. Garbage cans should be
positioned away from food service areas in approved containers with tight fitting lids
2. A strong sanitation program will eliminate readily available food sources for rodents and
mice by performing prompt clean-up of spilled food
3. Proper disposal of damaged goods that may also attract rodents or be contaminated with
urine and faeces must also occur

f. Control measures
1. Glue boards are recommended as a control measure. Lay glue boards flat or rodents may
walk off with unsecured glue boards stuck to their backs
2. Wooden snap traps are also recommended for light rodent infestations. Placement of trap
is as follows:
 Place trap on deck flush against wall or bulkhead
 Bait with a mixture of oatmeal, bread, etc. and peanut butter, or another suitable
attractant
 Check daily
 Wash snap trap with soap and water
3. Anticoagulant baits are only recommended for very heavy rodent infestations

4. Flies
a. Description and importance
1. The housefly is the most common fly in food service areas. Smaller, black fruit flies
may also be present, especially near or in fruits and vegetables. Drain flies are also
nuisance pests in sinks and heads
2. Fly larvae (maggots) are pale white, legless, with a dark head containing two mouth
hooks. Fly pupae resemble cockroach egg cases but do not have ridges. Each pupa
contains one adult fly

b. Prevention
1. Sanitation is main method of prevention. Spilled food items (particularly blood and
other meat juices) and broken packaging attract flies. Rotten vegetables can also
support fly maggots.
2. Inspection of stores for pupae or larvae help prevent flies
3. Place fruits and vegetables in a cool storage area

c. Sanitation
1. Proper storage/disposal of garbage is extremely important. Garbage and refuse should
be stored in tightly covered containers. Trash cans should be maintained in a clean
condition
2. Promptly clean up any liquid or food spills

e. Control measures
1. Ensure all food items are covered
2. Screen doors and windows to prevent fly entry
3. Air curtains over doors will also prevent fly entry
 Adequate for size of door
 Properly installed and operated
4. Good old-fashioned fly swatter
5. Fly paper or bug zappers are not authorized
6. Contact local medical entomologist for assistance with fly control

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