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Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India
G Model JIPH-873; No. of Pages 3
ARTICLE IN PRESS Journal of Infection and Public Health xxx (2018) xxx–xxx
Contents lists available at ScienceDirect
Journal of Infection and Public Health journal homepage: http://www.elsevier.com/locate/jiph
Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India Pradip V. Barde a,∗ , Neeta Mishra b , Neeru Singh a a b
ICMR-National Institute for Research in Tribal Health, Nagpur Road, Garha, Jabalpur 482003, India Indira Market Compound, Jabalpur 482001, India
a r t i c l e
i n f o
Article history: Received 12 July 2017 Accepted 13 March 2018 Keywords: Dengue Diagnosis Mosquito control Outbreak prevention
a b s t r a c t Background: Dengue is most important arboviral disease spreading to newer areas. Timely diagnosis and mosquito control are only ways to prevent outbreaks; however there are very few studies demonstrating this hypothesis. Methods: During this study laboratory diagnosis for Dengue was provided to patient and the programme manager on the same day of receipt of the sample. The mobile number of the patient/kin of patient was used to contact patient and reach their address to conduct vector control within 24 h of case detection. Results: Eighty three present cases were diagnosed within 24 h and 82% houses were surveyed within 24 h of reporting of the positive cases. The prompt diagnosis proactive vector control model helped keeping dengue outbreaks at bay. Conclusion: Timely diagnosis and prompt vector control activities can prevent dengue outbreaks. It is suggested to enhance diagnostic capabilities at local level and use new technologies such as mobile phones and internet to strengthen health systems to curb DEN. © 2018 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction Dengue (DEN) is the most important vector borne viral disease. Almost half of the world population residing mostly in tropical and subtropical regions is at risk of DEN [1]. It is estimated that around 390 million dengue virus (DENV) infections occur every year of which about 100 million are apparent clinically [2]. DEN endemicity is on rise in India and in 2016 more than 200 outbreaks of the diseases were recorded [3,4]. Although, WHO has recently licensed vaccine, it has limitations for use in routine vaccination and in absence of specific treatment, early detection of sporadic cases and efficient vector control are the only tool to reduce the mortality and avoid outbreaks [1]. However, there are limited “evidence” backed studies done in this regard. Mobile phones are the modern tool of communication. The rapid spread of network and affordability of mobile phones have increased the mobile users over the years in India and more than 87% population and 53.2% of households in India have mobiles [5]. Further, virtually all the programme offices are connected by internet enabling rapid communication. We demonstrate how timely
∗ Corresponding author. E-mail address: pradip [email protected] (P.V. Barde).
diagnosis and mosquito control activities along with use of mobile phone and internet can be used to avoid DEN outbreaks as “proof of concept”. Material and methods The virology laboratory of National Institute for Research in Tribal Health, Jabalpur is designated as Apex Referral Laboratory by National vector borne disease control programme (NVBDCP). Samples from central part of India are referred for DEN and Chikungunya diagnosis to this laboratory, the laboratory also investigate outbreak of these diseases. The present observation from the field is from city of Jabalpur (Coordinates: 23◦ 10 N 79◦ 56 E, Population: 1,081,677) situated in centre of India in Madhya Pradesh. The clinical and demographic information of the patients was collected in predesigned formats wherein mobile number is mandatory. The diagnosis was provided within 24 h of drawing of blood sample following national guidelines [6,7]. The information such as name, address and most importantly contact mobile number of the positive cases was shared with district unit of state vector borne disease control program on the same day by email. All the positive cases were contacted by the vector survey and eradication team using available mobile number/s and were requested to present at home. The survey team conducted fever and entomological surveys in and
https://doi.org/10.1016/j.jiph.2018.03.002 1876-0341/© 2018 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Barde PV, et al. Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India. J Infect Public Health (2018), https://doi.org/10.1016/j.jiph.2018.03.002
G Model
ARTICLE IN PRESS
JIPH-873; No. of Pages 3
P.V. Barde et al. / Journal of Infection and Public Health xxx (2018) xxx–xxx
2
Table 1 Showing samples tested, positive cases, houses served within 24 and 48 h in the study area. Year
Positive/suspected cases (%)
Diagnosed positive within 24 h [positive/tested (%)]
Number of Phone numbers available
Household visited (%) and vector control activities done within 24 h of diagnosis
House hold visited (%) and vector control activities done after 24 h but before 48 of diagnosis
2015 2016
35/568 (6.16) 61/515 (11.84)
30/35 (86) 54/61 (89)
34 61
28 (82.3) 56 (91.8%)b
4 (11.4)a 5 (8.2)
a b
Homes and surrounding area of two cases were visited after 48 h of reporting. Two cases diagnosed after 24 h of receipt of sample were visited within 24 h of diagnosis.
around patient’s home in 500 m periphery following guidelines. The larvae and pupa were destroyed by emptying water containers or by adding larvicide (Temephos: 1 ppm), adults were destroyed by ultra low volume fogging of 95% technical grade Malathion or space spraying with 2% Pyrethrum. Fever cases (if any) were examined for DEN symptoms [6].
Results and discussion We observed 6.16% (35/568) and 11.84% (61/515) DEN positivity in 2015 and 2016 respectively which was significantly low in comparison to 20% positivity recorded in 2010 among sporadic cases [7]. About 86% of the cases in 2015 and 82% cases in 2016 were diagnosed and reported within 24 h of receipt of sample remaining were reported within 48 h. The survey teams were provided with mobile numbers of almost all the cases (Table 1) and the cases could be immediately contacted using mobiles. More than 82% of the houses were surveyed within 24 h of reporting of the positive cases. On average 150 houses (Range: 27–225) were surveyed by the team in the periphery of the positive case. The average Breteau Index (BI) of 5.6 (Range: 0–6.4) was recorded by the team. Larval destruction was insured by decanting the containers or by treatment with larvicide. Epidemiologically connected cases were not detected from the same area within week of detection of the case. Our analysis demonstrates that timely diagnosis and vector control can prevent sporadic DEN cases in to outbreaks. DENV needs 8–12 days to multiply in mosquito before infecting another person and this period is known as extrinsic incubation period [8], indicating that, if mosquito control is done prior to this period the transmission cycle can be blocked. Outbreak, clustered cases and high incidence was recorded from Jabalpur and adjoining districts in past [7,9,10]. However, the establishment of diagnostic laboratory in 2012 providing prompt diagnosis coupled with vector control program has helped keeping DEN outbreaks at bay in the city. The laboratory diagnosis at local level on same day of receipt of sample and reporting positive cases to vector control teams by E mail with adequate contact information of the case with mobile number helped tracking the patients. The initiation of vector control activity within 24 h of diagnosis helped in breaking down the transmission cycle in extrinsic incubation period and thus prevented spread of disease resulting in avoiding the outbreaks. Mobile phone is now part and parcel of common man’s life, and its use is increasing by leaps and bounce, we used mobile numbers to track the cases, this helped us reaching the exact address in time further this also enabled us to take feedback regarding mosquito control activities. Recent study from ® Gujarat, India has demonstrated utility of WhatsApp for sharing information for outbreaks mitigation [11]. However, potential of information technology and social media in avoiding and intervening outbreaks is not fully explored [12]. The use of mobile phones should be increased in vector borne disease control program. Developing and using applications such as “India Fights Dengue” [13] and popularizing those applications among health works and general public will also help reduce disease burden by situation monitor-
ing and prompt actions. This will also help in proper and timely resource allocation to the most needed areas. Conclusion Our study demonstrates how timely diagnosis and prompt vector control activities can prevent dengue outbreaks. We suggest enhancing diagnostic capabilities at grass root level and use of new technologies such as mobile phones and internet which will be helpful to fasten and strengthen health systems to curb DEN. Acknowledgements Authors are thankful to the Director General and Secretary Department of Health Research Indian Council of Medical Research (http://www.icmr.nic.in) DHR, MoH&FW, Govt. of India for providing grant under the project “Establishment of Virology Laboratory” (Grant No. VIR/43/2011-ECD-I) and Directorate National Vector borne disease control programme for funds for procurement of reagents kits etc for diagnosis. The assistance by staff of Virology laboratory of in diagnosis and reporting is also acknowledged. The funders had no role in study design, data collection and analysis, preparation of the manuscript or decision to publish. Ethical approval This work was supported by the Indian Council of Medical Research DHR, MoH&FW, Govt. of India (Grant No. VIR/43/2011ECD-I). None declared. The study was done as a part of project “Establishment of Grade II Virologylaboratory” and this has clearance of Institutionalethical committee (approval no:RMRCT/Ethics committee/ 2715/2011). References [1] Dengue and severe dengue, WHO Fact sheet, Updated April; 2017. Available at: http://www.who.int/mediacentre/factsheets/fs117/en/. [Accessed 9 June 2017]. [2] Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature 2013;496:504–7. [3] VRDL database about Dengue and Chikungunya; 2016. Available at: http://www.dhr.gov.in/importantlinks/vrdl-database-about-dengue-andchikungunya. [Accessed 9 June 2017]. [4] IDSP Disease alerts/outbreaks reported and responded to by State/UTs through integrated disease surveillance programme (IDSP); 2016. Available at: idsp.nic. in/WriteReadData/l892s/89800766661487223603. pdf [Accessed 9 June 2017]. [5] TRAI Information Note to the Press (Press Release No. 117/2016), Telecom Regulatory authority of India New Delhi, 9th December, 2016; 2016. Available at: www.trai.gov.in. [Accessed 9 June 2017]. [6] NVBDCP, Guidelines for Integrated vector management for control of dengue haemorrhagic fever; 2015. Available at: http://nvbdcp.gov.in/iec.html. [Accessed 9 June 2017]. [7] Barde PV, Godbole S, Bharti PK, Chand G, Agarwal M, Singh N. Detection of dengue virus 4 from central India. Indian J Med Res 2012;136(3):491–4. [8] CDC, Mosquito-borne Transmission Centre for Disease Control; 2015. Available at: https://www.cdc.gov/dengue/training/cme/ccm/page45915.html. [Accessed 9 June 2017]. [9] Barde PV, Kori BK, Shukla MK, Bharti PK, Chand G, Kumar G, et al. Maiden outbreaks of dengue virus 1 genotype III in rural
Please cite this article in press as: Barde PV, et al. Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India. J Infect Public Health (2018), https://doi.org/10.1016/j.jiph.2018.03.002
G Model JIPH-873; No. of Pages 3
ARTICLE IN PRESS P.V. Barde et al. / Journal of Infection and Public Health xxx (2018) xxx–xxx
central India. Epidemiol Infect 2015;143(January (2)):412–8, http://dx.doi.org/10.1017/S0950268814000612. Epub 2014 Mar 25. [10] Barde PV, Shukla MK, Kori BK, Chand G, Jain L, Varun BM, et al. Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India. Indian J Med Res 2015;141(5):584–90. [11] Shah B, Kaushik S. Innovative use of social media platform WhatsApp during influenza outbreak in Gujarat India. WHO South East Asia J Public Health 2015;4(2):213–4, http://dx.doi.org/10.4103/2224-3151.206692.
3
[12] Charles-Smith LE, Reynolds TL, Cameron MA, Conway M, Lau E, Olsen JM, et al. Using social media for actionable disease surveillance and outbreak management: a systematic literature review. PLos One 2015;10(10):e0139701, http://dx.doi.org/10.1371/journal.pone.0139701. [13] India Fights Dengue mobile application Government of India; 2015. Available at: https://www.nhp.gov.in/mobile-app-dengue. [Accessed 9 June 2017].
Please cite this article in press as: Barde PV, et al. Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India. J Infect Public Health (2018), https://doi.org/10.1016/j.jiph.2018.03.002
ARTICLE IN PRESS Journal of Infection and Public Health xxx (2018) xxx–xxx
Contents lists available at ScienceDirect
Journal of Infection and Public Health journal homepage: http://www.elsevier.com/locate/jiph
Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India Pradip V. Barde a,∗ , Neeta Mishra b , Neeru Singh a a b
ICMR-National Institute for Research in Tribal Health, Nagpur Road, Garha, Jabalpur 482003, India Indira Market Compound, Jabalpur 482001, India
a r t i c l e
i n f o
Article history: Received 12 July 2017 Accepted 13 March 2018 Keywords: Dengue Diagnosis Mosquito control Outbreak prevention
a b s t r a c t Background: Dengue is most important arboviral disease spreading to newer areas. Timely diagnosis and mosquito control are only ways to prevent outbreaks; however there are very few studies demonstrating this hypothesis. Methods: During this study laboratory diagnosis for Dengue was provided to patient and the programme manager on the same day of receipt of the sample. The mobile number of the patient/kin of patient was used to contact patient and reach their address to conduct vector control within 24 h of case detection. Results: Eighty three present cases were diagnosed within 24 h and 82% houses were surveyed within 24 h of reporting of the positive cases. The prompt diagnosis proactive vector control model helped keeping dengue outbreaks at bay. Conclusion: Timely diagnosis and prompt vector control activities can prevent dengue outbreaks. It is suggested to enhance diagnostic capabilities at local level and use new technologies such as mobile phones and internet to strengthen health systems to curb DEN. © 2018 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction Dengue (DEN) is the most important vector borne viral disease. Almost half of the world population residing mostly in tropical and subtropical regions is at risk of DEN [1]. It is estimated that around 390 million dengue virus (DENV) infections occur every year of which about 100 million are apparent clinically [2]. DEN endemicity is on rise in India and in 2016 more than 200 outbreaks of the diseases were recorded [3,4]. Although, WHO has recently licensed vaccine, it has limitations for use in routine vaccination and in absence of specific treatment, early detection of sporadic cases and efficient vector control are the only tool to reduce the mortality and avoid outbreaks [1]. However, there are limited “evidence” backed studies done in this regard. Mobile phones are the modern tool of communication. The rapid spread of network and affordability of mobile phones have increased the mobile users over the years in India and more than 87% population and 53.2% of households in India have mobiles [5]. Further, virtually all the programme offices are connected by internet enabling rapid communication. We demonstrate how timely
∗ Corresponding author. E-mail address: pradip [email protected] (P.V. Barde).
diagnosis and mosquito control activities along with use of mobile phone and internet can be used to avoid DEN outbreaks as “proof of concept”. Material and methods The virology laboratory of National Institute for Research in Tribal Health, Jabalpur is designated as Apex Referral Laboratory by National vector borne disease control programme (NVBDCP). Samples from central part of India are referred for DEN and Chikungunya diagnosis to this laboratory, the laboratory also investigate outbreak of these diseases. The present observation from the field is from city of Jabalpur (Coordinates: 23◦ 10 N 79◦ 56 E, Population: 1,081,677) situated in centre of India in Madhya Pradesh. The clinical and demographic information of the patients was collected in predesigned formats wherein mobile number is mandatory. The diagnosis was provided within 24 h of drawing of blood sample following national guidelines [6,7]. The information such as name, address and most importantly contact mobile number of the positive cases was shared with district unit of state vector borne disease control program on the same day by email. All the positive cases were contacted by the vector survey and eradication team using available mobile number/s and were requested to present at home. The survey team conducted fever and entomological surveys in and
https://doi.org/10.1016/j.jiph.2018.03.002 1876-0341/© 2018 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Barde PV, et al. Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India. J Infect Public Health (2018), https://doi.org/10.1016/j.jiph.2018.03.002
G Model
ARTICLE IN PRESS
JIPH-873; No. of Pages 3
P.V. Barde et al. / Journal of Infection and Public Health xxx (2018) xxx–xxx
2
Table 1 Showing samples tested, positive cases, houses served within 24 and 48 h in the study area. Year
Positive/suspected cases (%)
Diagnosed positive within 24 h [positive/tested (%)]
Number of Phone numbers available
Household visited (%) and vector control activities done within 24 h of diagnosis
House hold visited (%) and vector control activities done after 24 h but before 48 of diagnosis
2015 2016
35/568 (6.16) 61/515 (11.84)
30/35 (86) 54/61 (89)
34 61
28 (82.3) 56 (91.8%)b
4 (11.4)a 5 (8.2)
a b
Homes and surrounding area of two cases were visited after 48 h of reporting. Two cases diagnosed after 24 h of receipt of sample were visited within 24 h of diagnosis.
around patient’s home in 500 m periphery following guidelines. The larvae and pupa were destroyed by emptying water containers or by adding larvicide (Temephos: 1 ppm), adults were destroyed by ultra low volume fogging of 95% technical grade Malathion or space spraying with 2% Pyrethrum. Fever cases (if any) were examined for DEN symptoms [6].
Results and discussion We observed 6.16% (35/568) and 11.84% (61/515) DEN positivity in 2015 and 2016 respectively which was significantly low in comparison to 20% positivity recorded in 2010 among sporadic cases [7]. About 86% of the cases in 2015 and 82% cases in 2016 were diagnosed and reported within 24 h of receipt of sample remaining were reported within 48 h. The survey teams were provided with mobile numbers of almost all the cases (Table 1) and the cases could be immediately contacted using mobiles. More than 82% of the houses were surveyed within 24 h of reporting of the positive cases. On average 150 houses (Range: 27–225) were surveyed by the team in the periphery of the positive case. The average Breteau Index (BI) of 5.6 (Range: 0–6.4) was recorded by the team. Larval destruction was insured by decanting the containers or by treatment with larvicide. Epidemiologically connected cases were not detected from the same area within week of detection of the case. Our analysis demonstrates that timely diagnosis and vector control can prevent sporadic DEN cases in to outbreaks. DENV needs 8–12 days to multiply in mosquito before infecting another person and this period is known as extrinsic incubation period [8], indicating that, if mosquito control is done prior to this period the transmission cycle can be blocked. Outbreak, clustered cases and high incidence was recorded from Jabalpur and adjoining districts in past [7,9,10]. However, the establishment of diagnostic laboratory in 2012 providing prompt diagnosis coupled with vector control program has helped keeping DEN outbreaks at bay in the city. The laboratory diagnosis at local level on same day of receipt of sample and reporting positive cases to vector control teams by E mail with adequate contact information of the case with mobile number helped tracking the patients. The initiation of vector control activity within 24 h of diagnosis helped in breaking down the transmission cycle in extrinsic incubation period and thus prevented spread of disease resulting in avoiding the outbreaks. Mobile phone is now part and parcel of common man’s life, and its use is increasing by leaps and bounce, we used mobile numbers to track the cases, this helped us reaching the exact address in time further this also enabled us to take feedback regarding mosquito control activities. Recent study from ® Gujarat, India has demonstrated utility of WhatsApp for sharing information for outbreaks mitigation [11]. However, potential of information technology and social media in avoiding and intervening outbreaks is not fully explored [12]. The use of mobile phones should be increased in vector borne disease control program. Developing and using applications such as “India Fights Dengue” [13] and popularizing those applications among health works and general public will also help reduce disease burden by situation monitor-
ing and prompt actions. This will also help in proper and timely resource allocation to the most needed areas. Conclusion Our study demonstrates how timely diagnosis and prompt vector control activities can prevent dengue outbreaks. We suggest enhancing diagnostic capabilities at grass root level and use of new technologies such as mobile phones and internet which will be helpful to fasten and strengthen health systems to curb DEN. Acknowledgements Authors are thankful to the Director General and Secretary Department of Health Research Indian Council of Medical Research (http://www.icmr.nic.in) DHR, MoH&FW, Govt. of India for providing grant under the project “Establishment of Virology Laboratory” (Grant No. VIR/43/2011-ECD-I) and Directorate National Vector borne disease control programme for funds for procurement of reagents kits etc for diagnosis. The assistance by staff of Virology laboratory of in diagnosis and reporting is also acknowledged. The funders had no role in study design, data collection and analysis, preparation of the manuscript or decision to publish. Ethical approval This work was supported by the Indian Council of Medical Research DHR, MoH&FW, Govt. of India (Grant No. VIR/43/2011ECD-I). None declared. The study was done as a part of project “Establishment of Grade II Virologylaboratory” and this has clearance of Institutionalethical committee (approval no:RMRCT/Ethics committee/ 2715/2011). References [1] Dengue and severe dengue, WHO Fact sheet, Updated April; 2017. Available at: http://www.who.int/mediacentre/factsheets/fs117/en/. [Accessed 9 June 2017]. [2] Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature 2013;496:504–7. [3] VRDL database about Dengue and Chikungunya; 2016. Available at: http://www.dhr.gov.in/importantlinks/vrdl-database-about-dengue-andchikungunya. [Accessed 9 June 2017]. [4] IDSP Disease alerts/outbreaks reported and responded to by State/UTs through integrated disease surveillance programme (IDSP); 2016. Available at: idsp.nic. in/WriteReadData/l892s/89800766661487223603. pdf [Accessed 9 June 2017]. [5] TRAI Information Note to the Press (Press Release No. 117/2016), Telecom Regulatory authority of India New Delhi, 9th December, 2016; 2016. Available at: www.trai.gov.in. [Accessed 9 June 2017]. [6] NVBDCP, Guidelines for Integrated vector management for control of dengue haemorrhagic fever; 2015. Available at: http://nvbdcp.gov.in/iec.html. [Accessed 9 June 2017]. [7] Barde PV, Godbole S, Bharti PK, Chand G, Agarwal M, Singh N. Detection of dengue virus 4 from central India. Indian J Med Res 2012;136(3):491–4. [8] CDC, Mosquito-borne Transmission Centre for Disease Control; 2015. Available at: https://www.cdc.gov/dengue/training/cme/ccm/page45915.html. [Accessed 9 June 2017]. [9] Barde PV, Kori BK, Shukla MK, Bharti PK, Chand G, Kumar G, et al. Maiden outbreaks of dengue virus 1 genotype III in rural
Please cite this article in press as: Barde PV, et al. Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India. J Infect Public Health (2018), https://doi.org/10.1016/j.jiph.2018.03.002
G Model JIPH-873; No. of Pages 3
ARTICLE IN PRESS P.V. Barde et al. / Journal of Infection and Public Health xxx (2018) xxx–xxx
central India. Epidemiol Infect 2015;143(January (2)):412–8, http://dx.doi.org/10.1017/S0950268814000612. Epub 2014 Mar 25. [10] Barde PV, Shukla MK, Kori BK, Chand G, Jain L, Varun BM, et al. Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India. Indian J Med Res 2015;141(5):584–90. [11] Shah B, Kaushik S. Innovative use of social media platform WhatsApp during influenza outbreak in Gujarat India. WHO South East Asia J Public Health 2015;4(2):213–4, http://dx.doi.org/10.4103/2224-3151.206692.
3
[12] Charles-Smith LE, Reynolds TL, Cameron MA, Conway M, Lau E, Olsen JM, et al. Using social media for actionable disease surveillance and outbreak management: a systematic literature review. PLos One 2015;10(10):e0139701, http://dx.doi.org/10.1371/journal.pone.0139701. [13] India Fights Dengue mobile application Government of India; 2015. Available at: https://www.nhp.gov.in/mobile-app-dengue. [Accessed 9 June 2017].
Please cite this article in press as: Barde PV, et al. Timely diagnosis, use of information technology and mosquito control prevents dengue outbreaks: Experience from central India. J Infect Public Health (2018), https://doi.org/10.1016/j.jiph.2018.03.002