Climate Change and Dengue Fever

This assignment delves into the relationship between climate change and the spread of dengue fever. It requires students to analyze research papers outlining how rising temperatures and altered rainfall patterns influence the proliferation of Aedes mosquitoes, the primary vector for dengue. Students will examine the impact of these changes on disease outbreaks and evaluate strategies for controlling dengue in a changing climate.

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Assessment Task 3: Ministerial Briefing Paper

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Table of Contents
Subject.............................................................................................................................................3
Executive Summary.........................................................................................................................3
Introduction......................................................................................................................................4
Statement of issue............................................................................................................................5
Background of the Dengue fever and public health........................................................................5
Pre-existing policies/activity...........................................................................................................6
Considerations.................................................................................................................................8
Diagnosis of Dengue and Case management:.................................................................................9
Sustainable Vector Control of Severe Dengue:.............................................................................10
Implementation of Future Vaccine:...............................................................................................10
Recommendations..........................................................................................................................11
Conclusion:....................................................................................................................................14
References:....................................................................................................................................15

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Subject: This paper is presented on the overview of the dengue fever that severely affected the
residents in northern and southern Australia.
Executive Summary
Throughout the whole world dengue fever is considered as a major public health issue. It is a
viral disease transmitted through the bite of a mosquito. Every year about 100 million people are
infected from dengue fever in all over world. The main purpose of conducting this research is to
find out the effects of dengue in the northern Australia where tropical climates prevail.
Department of Public Health is taking various measures for controlling the effect of severe
dengue (Leung et al. 2015). This paper presents the overview of different actions taken by the
Government of Australia in dealing with the issues of severe epidemic. For the purpose of
effective control and prevention measures there are various options available for health
department such as effective diagnosis of dengue and case management, sustainable vector
control of severe dengue and implementation of future vaccine. Effective research methodology
will be helpful in reducing the death rate and implementing new techniques for the prevention,
control and surveillance of severe dengue fever.

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Introduction
The severe dengue fever is spreading in more than 50 countries all over the world. In certain part
of Australia many residents are affected from dengue and it will create large burden on the health
care department of the country. The major aim of this research is to offer the various suggestions
to the department of Public Health to recover from this severe epidemic. This will help the
government to identify various options available for prevention and effective control
management techniques. It is considered as a most transmitted disease so, different aspect will be
find out such as natural history, case management and diagnosis techniques and future research
opportunities.

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Statement of issue
This report provides detailed discussion on what is the role of Department of Health of Australia
to prevent from severe Dengue fever. What are necessary steps taken by the government to
implement the effective research methodology to find vaccination against severe dengue and
Who should take responsibility to prevent whole country from this severe epidemic. All of the
residents of Australia is waiting for when should this severe dengue fever will be eliminated
from the state and when will specific treatment and immunization available to all.
Background of the Dengue fever and public health
Dengue is considered as one of the most transmitted disease which has spread due to the Aedes
mosquitoes in whole world. In tropical and sub tropical regions of the world it was first
recognized in 1879 in Queensland in Australia (Williams et al. 2014). Now it has affected
millions of people every year worldwide and especially in northern region of Australia where
tropical climates prevail. Due to this epidemic, severe illness is occurring among children and
death rate is increasing in some Australian countries.
In Northern territory of Australia more than 400 cases have been identified related to dengue
fever from 2003 to till now. Approximately, 3 billion people are residing in tropical areas where
dengue is highly transmitted. Dengue haemorrhagic fever (DHF) is more severe illness which
had same symptoms like as dengue and generally found in children below the age of 14 years.
From 1995 to 2011, about 90% of the cases were related to dengue in the areas of Queensland
and specially in the ‘Cairns and Hinterland’ district. From the total cases of 90% of dengue about
50% of the people were male of the average age 40 years old. 200000 cases were identified by
the World Health Organization in the year 2011 which were related to the severe dengue fever.
Rate of severe dengue fever is 10 times more than that other countries affected from dengue.

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Many health department experts estimated that dengue will rise in future in Australia as well in
other geographical areas in the world. Many of the drugs were not used by the patients because it
could have negative impact on the body such as non-steroidal anti-inflammatory and Asirin etc.
Mainly dengue was observed in the travelers of the age groups 30-50 years old in the Australia.
Dengue deaths are varying from year to year but mostly transmitted in the season of autumn and
summer.
Department of Health is continuously conducting surveys for finding about the mosquito infected
population present in Northern territory (Yixin et al. 2014). There is no certain vaccine or
treatment found by the Health department. General treatment for this is paracetamol medicine,
oral fluids for getting relief from fever and body pain. Due to the lack of proper treatment against
dengue fever it is reduced to only 1 % till now. From the research it was found that dengue fever
is transmitted by only female mosquito and they generally found in cool places where water is
stored and outdoor places where garbage is kept mostly in daylight hours (Lindsay et al. 2015). It
can develop in the old tyres, carriage of pot plant saucers and rain field vessels and can be
transmitted to one place to another place. For the purpose of inventing specific vaccination
against dengue, World Health Organization provides guidance and technical advice and support
to countries, private institutions for research and evaluation. If proper prevention and treatment
will not be available then dengue will rapidly spread in the future in whole world.
Pre-existing policies/activity
Queensland is the only area in the Australia where the dengue has prevailed. The transmission of
dengue reduced to a very large extent in the season of summer or dry season. The report of
World Health Organisation reveals that the burden of this disease could be increase due to the
continuous change in the climatic effect of the whole environment (Hoad et al, 2015). In the

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areas where the probability of occurrence of dengue is high, a regular and frequent survey is
required to conduct in those areas. Areas of vector where the density of population is high, the
population should tries to enforce the regular conduction of surveys and reducing the sources of
dengue. Drawing out programmes and photographs that shows potential day-biting can be done
with the help of using social medias and promotional campaigns (Naish et al., 2014). In the
annual report of NAMAC, all the information relating to the diseases borne by mosquitoes, and
the activities that are taken in order to control this disease is presented.
The government has established several policies in order to prevent and control the negative
effects of dengue in the country. The government has officially established taskforce and
committee between different departments for the purpose of supervising the area, preventing and
controlling the diseases that are spread by mosquitoes. This taskforce includes authorities
relating to public health, representatives of laboratory and Medical Entomology. Activities done
by human and vector supervision are coordinated using the methods of surveillance of cross-
border. The capacities of laboratory and exchange of resources are also coordinated. Several
types of portals are used for the purpose of communication in order to provide response to
various events (Rounsevell et al., 2014). Several management plans including the assignment of
roles and responsibilities, allocating funds in order to investigate and respond are designed. In
order to develop coordination between different ecological research priorities, humans and
vector, several methods are applied.

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(Source: Phoenix Rising)
In the areas where dengue is highly receptive, urgent and punctual occurrences and controlling
activities for mosquito disease should be done. Along with this, contact addresses should be
identified by analysing travelling history. The basic purpose of this is to exterminate the disease
causing virus through the measure of killing the infection causing adult females within the
demographic radii of 200 metres (Musso et al., 2014). This is the extent of distance up to a
female mosquito can fly. Urbanisation, blood feeding and harbouring within the premises are
some of the attributes that are found in vectors of primary dengue. Therefore, synthetic
pyrethroid insecticides like bifenthrin and deltamethrin should be used for the purpose of
spraying at indoor residential areas can be used as a measure of control for dengue. Sometimes,
the ultra low volume or thermal foggers cannot be seen effective in case of truck mounted
outdoor areas. Regulators for insect growth can be used for the treatment of containers that are
filled with containers. In large outbreaks, removing or tipping out the containers cannot be seen
effective because these factors are not affecting in addressing the breeding sites which are
mysterious or rainwater tanks. The Dengue Management Plan also focuses on the outlining of

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the strategies of vector control for the origination source in opposition to outbreaks of large
widespread. Rapidness in spreading the dengue makes it more critical to cure. Lacking in
presenting the case or diagnosing and delaying in notifications will lead in explosive out
breaking. Transmitting the risk of dengue of central and southern Queensland seems difficult due
to the reason of vector population has lacked in many areas.
Considerations
There are various possible courses of action that could be taken by Department of Health to
reduce the impact of severe dengue on the residents of Australia. Major principle behind the
prevention and control measures is to develop proper case management strategy with present
health system, harmonize prevention, examination or epidemiological such that they are
ecologically sound, cost-effective and sustainable for future (Diamond and Pierson 2015). For
successful implementation of the prevention measures allocation and mobilization of resources is
also essential.
Diagnosis of Dengue and Case management:
Appropriate implementation of clinical management helps in reducing death rate caused due to
severe dengue fever up to zero level. Effective implementation includes new methods of staff
training, early clinical and laboratory diagnosis, and hospital restructuring and intravenous
rehydration. The main advantage of this technique is helpful in reducing the death rate due to
dengue up to 60%. Government should help in adopting new technology which can provide
effective and fast diagnosis of cases offered by accurate differential techniques, timely response
to severe disease and quick laboratory assessment. It requires fund and assistance by government

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to the Health department (Gubler et al. 2014). Main disadvantage is it requires huge cost to
implement new methodologies in whole country. Main advantages of this are
 Effective clinical management system and well organized response of staff helps in
reducing the number of avoidable hospital admissions and also saves the life of patients from
severe dengue (Nguyen et al. 2015).
 Early warning of dengue infected patient is necessary to control and helps in taking
prevention measures of dengue at primary stage.
 Effective management training is very important in cases of severe dengue for all medical
and non-medical staff which helps to recover the patient from initial stage of disease (Sung et al.
2016).
Sustainable Vector Control of Severe Dengue:
Department of Public Heath should adopt the integrated vector management approach which is
promoted by World Health Organization to vector control of dengue. Sustainable vector control
means the optimum use of resources and insecticides provided by the department for vector
control which is helpful in cost effectiveness and adaptable according to environment. The
primary vector of dengue is Aedes aegypti mosquito. It has developed to feed, mate, and lay eggs
in surroundings (Huang et al. 2016). Generally, the Aedes aegypti mosquito remains active at the
time of early morning period and in the evening period. So this approached is started mainly for
the abolition of containers that are favorable places for ovipositor and put covers on containers or
with the help of insecticides killing all the mosquitoes. Government should help in spraying of
insecticides against malaria viruses and to develop innovative vector tools such as spatial
repellents, spatial repellents, genetically modified mosquitoes and lethal ovitraps (Leary, 2013).

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Reliable surveillance methods of vector control and techniques of virus transmission help in
dengue prevention for long term (Naish et al. 2014).
The main advantage of effective vector control management is helpful in reduction of mortality
rate due to dengue. The main purpose of vector control measures is to overcome the transmission
of dengue and reducing the occurrence of infection and avoiding outbreaks of the disease.
Implementation of Future Vaccine:
There is no certain treatment available to recover from severe dengue fever. So, Department of
Public Health should provide assistance and guidelines to manufactures and regulatory agencies
on development and evaluation of vaccine for severe dengue (Cao-Lormeau et al. 2016).
Guidelines should be related to the safety, quality and usefulness of dengue vaccines and issues
related to manufacturing and quality control also covered. For proper implementation of vaccine,
integration of various factors should be considered such as storage, financing, supplying and
effective transportation for easy delivery. Vaccines should not have any side effects and should
be integrated with other measures of prevention and control of dengue. Effective development
strategies for vaccination should include the selection of target populations and target area which
is highly infected from dengue fever (Low et al. 2014). Efficient delivery approaches, campaigns
by government, routine checkup and proper schedule for vaccination and overall implementation
of future vaccine should cover the whole population.
The main advantage of implementation of future vaccine is to reduce the overall mortality rate
and help to reduce the severe impact of dengue (Stoler et al. 2014). It will helpful in bringing a
confidence level among residence of Australia that government is implementing vaccination
programs.

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Recommendations
There are several measures which help in preventing and curing dengue. All the persons who
used to travel from one place to another are required to use personal protective measures in order
to reduce the risk of getting day biting mosquitoes (Webba and Hessac, 2016). It is
recommended to stay in a well conditioned area or proper clothes should wear that result in
reducing the extent of exposure of skin. Along with it, it is also recommended to use insect
repellents on the skin that has remains uncovered. Insect repellents that comprise of diethyl-
methyltoluamide can be considered as the most effective source. The extent of concentration
level of DEET differs from product to product. Higher the composition of DEET signifies the
higher degree of protection for a longer period of time from dengue. In some of the cases, using
the sprays that are highly concentrated with DEET may negatively affect the children. So it is
very much essential to apply DEET sparingly to the surface of exposure and it should be washed
off after the persons indoors. Using the insecticide which has concentrated level of DEET up to
35% can prevent the mosquitoes for 4-6 hours (Leung et al., 2015). On the other hand, the
insecticides having the concentration level of DEET up to 95% can protect from dengue for
around 10to 12 hours. New formulas are also searching and designed which contains lower level
of concentration of DEET and has a potential of preventing dengue for long time.
Still, there is no proper vaccination system has evolved for preventing dengue. Serology is the
common method which is used to identify the infection of dengue virus in the body. This
serology is also based on the laboratory confirmation. Diagnosing using the method of serology
generally does not allow the serotyping of virus infection and is suspicious in terms of cross
reactivity with different viruses. Various types of samples are required in order to do the
procedure of serology. No specified viral treatment has been developed for curing the dengue. It

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can be cured using the method of clinical management that is also based on various supportive
therapies and basically well-judged supervision of intravascular volume replacement. With the
improvements in managing the case, the fatality rate of hospitalising illness of dengue has been
reduced to a good extent (Walter et al., 2014).
There is only single approach present for controlling and preventing the transmission of virus of
dengue was going through the intervening for targeting the vector until the proper vaccine of
dengue gets developed. For this purpose, integrated vector management is recommended by
World Health Organisation. Many researchers have shown that reduction in entomological
indicators follows different forms of vector control (Gyawali et al., 2016). A scantiness of data
has shown effect of this interference of incidences of dengue illness. There are several strategies
that aim at preventing mosquitoes from lying eggs, using interferences of environment
management which constitutes the disposal of solid waste, removing artificially man-made
mosquitos’ habitats, removing the impurities of containers used for storing the water on regular
basis. Proper pesticides should be applied to water storage containers. Participation of
community should be improved and sustained vector controlling should be mobilized.
Insecticides should be applied using the method of sprays can be treated as an emergency
measure of vector control. Many of the dengue vaccines are ready to possess in laboratories.
CYD-TDV is a name of prophylactic, tetravalent and viral vaccine (Heywood et al., 2016). It is
available in both type of single and multiple of dose. It is provided in the form of pre-filled
syringe for the use of single dose or in the form of multi dose presentation. It does not contain
any type of preservatives or adjuvant.

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Conclusion:
On the basis of overall research, it can be analyzed that dengue is one of the major global health
issues which affected approximately more than 3 billion people all over the word. This severe
dengue fever is caused due the virus and mosquito’s bite which develops in the wastage and open
water containers (Schwartz et al. 2015). There is no certain treatment available to recover from
severe dengue fever so government is taking various steps to overcome the impact of dengue.
Different measures can be taken by Government of Australia such as effective case management
techniques, vector control measures and research for future vaccination.

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References:
Cao-Lormeau, V.M., Blake, A., Mons, S., Lastère, S., Roche, C., Vanhomwegen, J., Dub, T.,
Baudouin, L., Teissier, A., Larre, P. and Vial, A.L., 2016, ‘Guillain-Barré Syndrome outbreak
associated with Zika virus infection in French Polynesia: a case-control study’, The
Lancet, 387(10027), pp. 1531-1539, doi: 0140673616005626
Diamond, M.S. and Pierson, T.C., 2015, ‘Molecular insight into dengue virus pathogenesis and
its implications for disease control’, Cell, 162(3), pp. 488-492, doi: 0092867415008429
Gubler, D.J., Ooi, E.E., Vasudevan, S. and Farrar, J. eds., 2014, Dengue and dengue hemorrhagic
fever, CABI, UK.
Gyawali, N., Bradbury, R.S. and Taylor-Robinson, A.W., 2016, ‘The epidemiology of dengue
infection: Harnessing past experience and current knowledge to support implementation of future
control strategies’. Journal of vector borne diseases, 53(4), p.293,
www.nimr.org.in/assets/534293.pdf
Heywood, A.E., Zwar, N., Forssman, B.L., Seale, H., Stephens, N., Musto, J., Lane, C.,
Polkinghorne, B., Sheikh, M., Smith, M. and Worth, H., 2016, ‘The contribution of travellers
visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced
surveillance’. Epidemiology & Infection, 144(16), pp.3554-3563,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111124/
Hoad, V.C., Speers, D.J., Keller, A.J., Dowse, G.K., Seed, C.R., Lindsay, M.D., Faddy, H.M.
and Pink, J., 2015, ‘First reported case of transfusion-transmitted Ross River virus
infection’. Med J Aust, 202(5), pp.267-70, https://www.ncbi.nlm.nih.gov/pubmed/25758699

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Huang, X., Yakob, L., Devine, G., Frentiu, F.D., Fu, S.Y. and Hu, W., 2016, ‘Dynamic
spatiotemporal trends of imported dengue fever in Australia’, Scientific reports, 6, p.30360,
retrieved 3 September 2017, <>
Leary, N 2013, Climate Change and Vulnerability and Adaptation: Two Volume Set, Routledge,
UK.
Leung, G.H., Baird, R.W., Druce, J. and Anstey, N.M., 2015, ‘Zika virus infection in Australia
following a monkey bite in Indonesia’, Southeast Asian Journal of Tropical Medicine and Public
Health, 46(3), p. 460, retrieved 4 September 2017, <>
Leung, G.H., Baird, R.W., Druce, J. and Anstey, N.M., 2015, ‘Zika virus infection in Australia
following a monkey bite in Indonesia’. Southeast Asian Journal of Tropical Medicine and Public
Health, 46(3), p.460, https://www.ncbi.nlm.nih.gov/pubmed/26521519
Lindsay, M.D., Jardine, A., Giele, C., Armstrong, P., McCarthy, S., Whittle, A., Pal, N., Lyttle,
H., Harrington, S., Nicholson, J. and Smith, D., 2015, ‘Investigation of the first case of dengue
virus infection acquired in Western Australia in seven decades: evidence of importation of
infected mosquitoes?’, PLoS neglected tropical diseases, 9(9), p.e0004114, doi:
10.1371/0004114
Low, J.G., Sung, C., Wijaya, L., Wei, Y., Rathore, A.P., Watanabe, S., Tan, B.H., Toh, L., Chua,
L.T., Hou, Y.A. and Chow, A., 2014, ‘Efficacy and safety of celgosivir in patients with dengue
fever (CELADEN): a phase 1b, randomised, double-blind, placebo-controlled, proof-of-concept
trial’, The Lancet infectious diseases, 14(8), pp. 706-715, doi: 1473309914707303
Musso, D., Nhan, T., Robin, E., Roche, C., Bierlaire, D., Zisou, K., Shan Yan, A., Cao-Lormeau,
V.M. and Broult, J., 2014, ‘Potential for Zika virus transmission through blood transfusion

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demonstrated during an outbreak in French Polynesia’, November 2013 to February 2014. Euro
Surveill, 19(14), p.20761, https://www.ncbi.nlm.nih.gov/pubmed/24739982
Naish, S., Dale, P., Mackenzie, J.S., McBride, J. and Mengersen, K., 2014, ‘Spatial and
Temporal Patterns of Locally-Acquired Dengue Transmission in Northern’,
journals.plos.org/plosone/article?id=10.1371/journal.pone.0092524
Naish, S., Dale, P., Mackenzie, J.S., McBride, J., Mengersen, K. and Tong, S., 2014, ‘Spatial and
temporal patterns of locally-acquired dengue transmission in northern Queensland’, Australia,
1993–2012. PloS one, 9(4), p. e92524, doi: 10.1371/0092524
Nguyen, T.H., Le Nguyen, H., Nguyen, T.Y., Vu, S.N., Tran, N.D., Le, T.N., Vien, Q.M., Bui,
T.C., Le, H.T., Kutcher, S. and Hurst, T.P., 2015, ‘Field evaluation of the establishment potential
of w MelPop Wolbachia in Australia and Vietnam for dengue control’, Parasites & vectors, 8(1),
p.563, doi: 10.1186/s13071-015-1174-x
Rounsevell, M.D.A., Arneth, A., Alexander, P., Brown, D.G., de Noblet-Ducoudré, N., Ellis, E.,
Finnigan, J., Galvin, K., Grigg, N., Harman, I. and Lennox, J., 2014, ‘Towards decision-based
global land use models for improved understanding of the Earth system’. Earth System
Dynamics, 5(1), p.117, https://www.earth-syst-dynam.net/5/117/2014/
Schwartz, L.M., Halloran, M.E., Durbin, A.P. and Longini, I.M., 2015, ‘The dengue vaccine
pipeline: Implications for the future of dengue control’, Vaccine, 33(29), pp. 3293-3298, doi:
0264410X15006313
Simon, 2014, Phoenix Rising. [Online] Available at: http://forums.phoenixrising.me/index.php?
threads/cfs-me-starts-most-often-age-10-19-30-39-norwegian-population-study.32890/page-2
(Accessed at: 13 September, 2017)

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Stoler, J., al Dashti, R., Anto, F., Fobil, J.N. and Awandare, G.A., 2014, ‘Deconstructing
“malaria”: West Africa as the next front for dengue fever surveillance and control’, Acta
tropica, 134, pp. 58-65, doi: 0001706X14000631
Sung, C., Wei, Y., Watanabe, S., Lee, H.S., Khoo, Y.M., Fan, L., Rathore, A.P., Chan, K.W.K.,
Choy, M.M., Kamaraj, U.S. and Sessions, O.M., 2016, ‘Extended evaluation of virological,
immunological and pharmacokinetic endpoints of CELADEN: a randomized, placebo-controlled
trial of celgosivir in dengue fever patients’, PLoS neglected tropical diseases, 10(8), p.e
0004851, doi: 10.1371/0004851
Walter, T., Stevens, P., Verhoeven, A. and Boxall, A.M., 2014, ‘title Impacts of climate change
on public health in Australia: Recommendations for new policies and practices for adaptation
within the public health sector’,
https://ahha.asn.au/.../publications/deeble_issues_brief_no_7_walter_t_et_al_impacts_...
Webba, C.E. and Hessc, I.M., 2016. ‘A review of recommendations on the safe and effective use
of topical mosquito repellents’. Public health research & practice, 26(5),
https://cameronwebb.wordpress.com/publications/
Williams, C.R., Mincham, G., Ritchie, S.A., Viennet, E. and Harley, D., 2014, ‘Bionomic
response of Aedes aegypti to two future climate change scenarios in far north Queensland,
Australia: implications for dengue outbreak’, Parasites & vectors, 7(1), p. 447, doi:
10.1186/1756-3305-7-447
Yixin, H.Y., Ng, T.S., Frentiu, F.D., Walker, T., van den Hurk, A.F., O'Neill, S.L., Beebe, N.W.
and McGraw, E.A., 2014, ‘Comparative susceptibility of mosquito populations in North
Queensland, Australia to oral infection with dengue virus’, The American journal of tropical
medicine and hygiene, 90(3), pp. 422-430, doi: 10.4269/13-0186.