Top Dengue-Related Highlights from the Dengue Prevention Advocacy Malaysia Launch

WORDS LIM TECK CHOON

ABOUT THE DENGUE PREVENTION ADVOCACY MALAYSIA (DPAM) GROUP
  • DPAM is an independent advocacy group co-jointly led by the Malaysian Paediatric Association (MPA), the Malaysian Society of Infection Control and Infectious Disease (MyICID), the Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC), and the Malaysian Public Health Physicians Association (PPPKAM).
  • DPAM collaborates with the Malaysian Society of Parasitology and Tropical Medicine (MSPTM), the Malaysian Medical Association (MMA), Asia-Pacific Academic Consortium for Public Health Kuala Lumpur (APACPH-KL) and Rotary International District 3300.
  • DPAM is established to support the efforts of the Ministry of Health in strengthening dengue prevention, management, and control in Malaysia.
WHY DPAM IS NECESSARY: A POTENTIAL EMERGING DENGUE EMERGENCY
FEATURED EXPERT
DR HUSNINA IBRAHIM
Deputy Director of Disease Control Division (Communicable Diseases)
Ministry of Health Malaysia
  • Malaysia had its worst dengue outbreak in 2019, over 130,000 cases and 182 deaths.
  • The numbers declined during the MCO a few years ago. During this new normal, however, dengue numbers are once again on the rise.
  • From January to epidemiology week-22 this year, there has been a 158% rise in dengue cases and 183% increase in the deaths compared with the same period last year.

Dr Husnina Ibrahim, the Deputy Director of Disease Control Division (Communicable Diseases), said: “As Malaysia typically experiences a surge in dengue cases every 4 to 5 years, it was projected that an outbreak is due around this or next year, with an estimated number of cases potentially surpassing the historic 2019 outbreak.

RECENT ADVANCES YIELD POSITIVE RESULTS IN THE PREVENTION & CONTROL OF DENGUE
Wolbachia-infected mosquitoes
  • The introduction of Wolbachia-infected mosquitoes has significantly reduced dengue cases in 16 out of 19 localities, by 33% to 100%.
  • Wolbachia is a type of bacteria that can infect many species of invertebrates—organism with no backbone—including mosquitoes such as Aedes aegypti, the mosquito that carries and spreads the dengue viruses.
  • Male Aedes aegypti infected with Wolbachia will mate with female mosquitoes, but the resulting eggs will not hatch.
  • This reduces the number of Aedes aegypti mosquitoes.
Implementation of comprehensive guidelines, proper training, and a critical review of dengue mortality

These efforts have reduced the case-fatality rate by 87.3% from 2000 to 2022.

SETTING TARGETS FOR FUTURE DENGUE PREVENTION & CONTROL EFFORTS
  • The Ministry of Health has in place the National Dengue Prevention and Control Strategic Plan 2022-2026, which aims to annually reduce the number of dengue cases by 5% while maintaining the proportion of deaths compared to the number of cases (case fatality rate or CFR) below 0.2%.
  • The Ministry aims to reduce the CFR to 0% by 2030—which is to say, there should be no deaths due to dengue by that year.
DPAM TO PLAY AN ACTIVE ROLE IN SUPPORTING THE EFFORTS OF THE MINISTRY OF HEALTH TO ACHIEVE THESE TARGETS
FEATURED EXPERT
PROFESSOR DATUK DR ZULKIFLI ISMAIL
Consultant Paediatrician and Paediatric Cardiologist
Chairman of the Dengue Prevention Advocacy Malaysia (DPAM)

Professor Datuk Dr. Zulkifli Ismail expresses his optimism that the Ministry of Health’s aforementioned targets are achievable with the active involvement of key stakeholders such as the government, civil society, academia, private sector, media, and the community.

DPAM aims to synergize efforts by various of these stakeholders in assisting the Ministry of Health to achieve its national and global dengue targets through the strengthening of dengue prevention, management, and control in Malaysia.

He said, “DPAM will focus its efforts on healthcare professional and public education and communication, local research, guideline recommendations, as well as policy recommendations.”

To foster and strengthen regional collaborations, DPAM will work closely with the Asian Dengue Voice & Action (ADVA), a regional advocacy group. Their first collaborative initiative is the hosting of the 7th Asia Dengue Summit in Malaysia next year.

DPAM also released a Resolution Paper that contained key strategies for all relevant stakeholders to create a “whole of society” approach.

5 Popular Dengue Myths Debunked by a Family Medicine Specialist

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN
Family Medicine Specialist
International Medical University (IMU)
Myth 1
YOU ONLY CATCH DENGUE ONCE IN YOUR LIFETIME 

Unfortunately, no.

“There are 4 dengue serotypes,” says Associate Professor Dr Verna Lee Kar Mun.

Serotype is a word used to describe a strain of microorganism, which means that there are 4 different types of the dengue virus that can infect us.

This means that each of us can get infected up to 4 times, once with each serotype, and achieve total immunity to dengue only after being infected with all 4 serotypes!

“However, before you start thinking it’s a good idea to get infected four times, bear in mind that subsequent infections are likely to be more serious than the first,” warns Assoc Prof Dr Verna, “and each infection only increases your chances of getting severe dengue.”

Myth 2
YOU’RE GETTING BETTER WHEN YOUR FEVER GOES AWAY

Well, things are not so simple.

You see, according to Assoc Prof Dr Verna, there are 3 different stages of dengue fever.

  • Febrile phase: 1 to 2 days of high fever that begins suddenly. During this time, we’re likely to have experience aches, headache with pain behind the eyes, flushed faces, and sometimes blotchy skin or rashes.
  • Critical phase: the fever subsides, and we may feel that we are getting better. However, these 1 to 2 days are also a period when our blood capillaries may leak plasma, leading to a sudden drop in blood pressure and sending us into shock.
  • The next phase will depend on the outcome of the critical phase. We may get better after receiving proper medical treatment and proceed to the recovery phase, or we may get worse and experience severe dengue instead.

“Many viral illnesses such as dengue are self-limiting, which means they will naturally subside,” Assoc Prof Dr Verna shares. “In most cases, patients only need self-care at home, and the most important thing to remember is to take plenty of fluids to prevent the dehydration that comes with plasma leakage.”

“Anyone who gets dengue fever should aim to drink at least 3 litres of water daily for the first 3 days,” she adds.

Myth 3
DENGUE IS ONLY A SMALL CONCERN; AFTER ALL, YOU CAN GET BETTER FROM PRACTICING SELF CARE AT HOME

Not necessarily true.

“An estimated 1% of patients will experience severe dengue, also known as haemorrhagic dengue, which will require hospitalization,” says Assoc Prof Dr Verna.

She goes on to explain that one may begin to experience bleeding during the febrile phase, usually in the skin or gums. If the bleeding weren’t managed well, the dengue will worsen during the critical phase, forcing us to be admitted into the hospital.

“Those with a healthy immune system usually recover in 2 days, but if there is inflammation affecting the organs such as the heart, liver or brain, it can take up to a week, longer if there are other complications,” she goes on to say.

Myth 4
YOU SHOULD ONLY TEST FOR DENGUE AFTER 3 DAYS 

“It is true that the initial symptoms are vague, as a fever can be a sign of many different illnesses,” says Assoc Prof Dr Verna.

However, with dengue, the high fever usually comes suddenly.

“The S1 dengue rapid antigen test can detect dengue from the first day, so don’t delay seeking medical advice if you suddenly develop a high fever,” she advises.

Delay in getting tested may lead to severe consequences, as we will enter the critical phase 1 to 2 days after catching dengue—a time when our condition can suddenly take a turn for the worse!

Myth 5
ONCE YOUR NEIGHBOURHOOD HAS BEEN FOGGED, THERE IS NO NEED TO DO ANYTHING ELSE TO PREVENT DENGUE

Not true.

Assoc Prof Dr Verna reveals that while fogging helps to kill adult mosquitoes and getting rid of stagnant water in public drains and other places helps to prevent breeding sites, this method are only partially effective.

To illustrate, millions are spent on fogging efforts every year—an estimated RM777 million was spent on fogging efforts in the 2009 to 2010 period—but dengue remains prevalent to this day. There is even evidence that mosquitoes have grown resistant to the common insecticides used in fogging!

“On a personal level, all of us can do something at home to help prevent mosquito bites and breeding sites. We need to make a bigger effort to protect ourselves and our loved ones by making sure our home environment is clear of any breeding sites, covering up exposed skin and using mosquito repellents, especially during sunrise and sundown,” she advises.