5 Popular Dengue Myths Debunked by a Family Medicine Specialist

WORDS LIM TECK CHOON

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.

Expert Coalition to Educate Malaysians & Prevent Another COVID-19 Surge

PRESS RELEASE
COVID-19 IS STILL A THREAT

As we welcomed 2023, China reported a huge spike in daily COVID-19 cases during the end of year holiday seasons 2022.

After a period of pandemic fatigue and indifference, the event sparked sudden and short-lived fear and caution among the global as well as Malaysian community.

The news triggered some Malaysians to be up in arms, calling for a ban on travellers from China and reinforcement of pandemic SOPs such as the mandatory wearing of mask in public areas.

Nonetheless, the interest soon died down as other headlines made their way in the news.

It appears that it is only when crises are about to hit our shores that we react.

In fact, as highlighted by the World Health Organisation (WHO), we need to always be prepared and cannot afford to be reactive.

On January 27, 2023, it announced and reminded member countries that COVID-19 remains a public health emergency of international concern.

WHO compared 28-days data between Dec 5, 2022 to Jan 1, 2023 and Jan 2 to Jan 29, 2023.

It found that although the number of cases reported decreased by 78%, the number of deaths increased steeply by 65%.

This result is mainly due to the large wave of cases and deaths in the Western Pacific Region, especially in China.

WHO further states that the numbers may be an underestimation due to the reduction in testing and delay in reporting in many countries.

STAY VIGILANT & PROTECT THE VULNERABLE

3 years into the pandemic, Malaysia has reported more than 5 million cases and over 36,000 deaths.

In 2021, it became the main cause of death in Malaysia, overtaking heart disease.

The risk of death is higher among:

  • Those above 60 years
  • Individuals with underlying health conditions
  • Unvaccinated individuals

According to MOH data between Jan 1, 2022 to July 31, 2022, 75% of COVID-19 deaths were among individuals 60 years and above, and 86% of deaths were among those with at least one underlying health condition .

Compared to the first year of pandemic, we are now more prepared to curb COVID-19 due to advancement in preventive measures, rapid diagnoses, and management tools such as vaccination, rapid test kits (RTK) as well as early treatment with antivirals.

These tools are important particularly to prevent severe COVID-19, keeping individuals especially those with risk factors away from hospitalization, intensive care unit (ICU) admissions and ultimately death.

Nonetheless, these tools will only be useful if they are being utilized optimally.

While Malaysians were quick on the uptake of primary COVID-19 vaccination doses, the uptake of booster doses are very poor with only 49.7% uptake of the 1st booster and a mere 1.6% of the 2nd booster (as of Feb 7, 2023) .

While no concrete data is available, there are good reasons to believe that due to pandemic fatigue, people are now less likely to test and seek treatment for COVID-19.

It is also important to note that antiviral treatment needs to be taken within the first 5 days of symptom onset. Thus, speed is of the essence.

We cannot risk another surge of COVID-19 globally or locally as it would put a toll on our healthcare system and risk overwhelming it.

In addition to COVID-19, we are also facing the threat of other respiratory illnesses such as influenza and respiratory syncytial virus (RSV).

As it stands, we are currently experiencing overcrowding in Emergency Departments.

Hence, it is crucial that we answer the calls of WHO and the Ministry of Health Malaysia to continue urging the public especially those who are in the high-risk groups (older persons, individuals with underlying medical conditions) to take precautions against COVID-19.

OUR CAMPAIGN

The Malaysian Society of Infection Control and Infectious Diseases (MyICID) in collaboration with the Family Medicine Association Malaysia (FMSA) and Malaysian Medical Association (MMA) are organising an educational campaign themed COVID-19: QUICKLY TEST & TREAT.

Our objectives

This campaign aims to urge the public especially individuals who are at high-risk as well as their family members to continue protecting themselves and others from severe COVID-19 by:

  • Getting primary and booster doses
  • Testing immediately upon onset of symptoms
  • Seeking early treatment, within the first five days of symptoms

Our campaign’s panel of experts

  • Dr Alif Adlan Mohd Thabit Infectious disease physician
  • Dr Ang Peng Peng Infectious disease physician
  • Dr Suriani Sulaiman Family medicine specialist
  • Dr Balachandran S Krishnan General practitioner
THIS IS A PUBLIC COMMUNITY MESSAGE BROUGHT TO YOU BY

Should We Be Worried About COVID-19 in Our Wastewater?

WORDS DR SAPNA SHRIDHAR PATIL & ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN

Recently, our Ministry of Health detected SARS-CoV-2, the virus responsible for COVID-19, during wastewater surveillance at airports in the country. It was also reported that China has begun SARS-CoV-2 wastewater surveillance for selected cities after the cessation of the country’s zero COVID policy.

WASTEWATER SURVEILLANCE EXPLAINED

In wastewater surveillance, samples of untreated sewage from selected communities and institutions are routinely collected and sent to laboratories for identification and quantification of virus content and testing for different or new virus variants.

Benefits of wastewater surveillance
  • It provides a rapid real-time ‘snapshot’ of the disease prevalence in the community where the wastewater was sampled from.
  • Wastewater surveillance also addresses challenges of disease under-reporting due to asymptomatic infections, self-home treatment, and delayed or absent notifications from medical practitioners.
  • Information from wastewater surveillance can be used to monitor disease burden patterns, reintroduction or emergence of a new pathogen/variant, and even evaluate the impact of community behavioural campaigns such as masking and physical distancing.

An example of the importance of wastewater surveillance is the detection, in 2022, of wild polio virus in sewage samples during routine testing in London and New York before any clinical cases were reported. This prompted the local health authorities to implement immediate measures to enhance the coverage of primary polio vaccination together with polio boosters in at-risk communities.

Limitations of wastewater surveillance

However, wastewater surveillance cannot replace the existing disease notification system and clinical testing as the wastewater comes from pooled community sewage samples and cannot be used for individual diagnosis.

Apart from this, technical and logistic challenges can also affect the accuracy of the results of wastewater surveillance.

Nonetheless, the information from an effective wastewater surveillance system can greatly complement existing notification system, as it provides an early warning alert for local health authorities to implement prompt targeted interventions in the communities at risk.

WASTEWATER SURVEILLANCE & COVID-19 DETECTION

Since the emergence of the COVID-19 pandemic in 2020, there has been ongoing research into the transmission dynamics and ways to curb the disease spread.

It is known that the SARS-CoV-2 virus spreads mainly through oral and nasal secretions. However, the virus is also shed in stools for prolonged periods of time. Individuals infected with the virus can shed the virus in their stools, irrespective of whether they have symptoms of COVID-19.

Wastewater surveillance has been implemented in many countries as an environmental monitoring tool to rapidly detect the presence of the SARS-CoV-2 virus in a community and enable local health authorities to be aware of the transmission risk factors, emergence of new variants, and the impact of community preventive measures.

Hong Kong

Hong Kong detected the delta variant in the sewage samples since the end of December 2020 and strengthened public health interventions by informing the public about the common symptoms, and the importance of continuing physical distancing and masking, in addition to hand hygiene and respiratory etiquette.

United States

In July 2022, California researchers reported that sampling of community wastewater in San Diego detected the presence of the alpha, delta, epsilon, and omicron COVID-19 variants up to 14 days before they started appearing on nasal swabs. This implies that wastewater surveillance applied to transportation-based sanitation systems can serve as an early indicator of possible community transmission.

SO, SHOULD WE BE WORRIED ABOUT COVID-19 IN OUR WASTEWATER?

The general public need not be alarmed by the news regarding the detection of the SARS-CoV-2 virus in human waste.

As COVID-19 has now become endemic across most countries around the world, the detection of the SARS-CoV-2 virus in sewage samples is not an unusual finding.

From the Ministry of Health’s initial reports, the variants isolated are already in circulation in Malaysia and the risk posed to human health and the environment is minimal.

However, being aware of such a system enables all of us to be better receptive of updated information shared by the Ministry of Health from time to time.

Is Antimicrobial Resistance the Next Global Threat After COVID-19? Let’s Find Out

WORDS PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR

PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
Infectious Disease Professor
University Malaya Medical Centre (UMMC)

As Malaysia and most of the world transitioned to the endemic phase of COVID-19, it’s easy to forget that just two years ago, the pandemic had led to millions of lives lost, rise in unemployment rates, and the near-collapse of healthcare systems due to the tsunami of cases. Today, thanks to the quick development of medical innovations such as COVID-19 vaccines, we are now able to continue living our lives in the new normal, resuming productivity, and building towards economic recovery and growth.

Now that we have seen the long-lasting and devastating impact that a pandemic can leave, it is vital that we draw our attention to tackling another urgent public health crisis—antimicrobial resistance, which continues to rise to alarming levels across the world .

A SILENT PANDEMIC

Over the years, antimicrobial resistance has become an urgent health challenge on a global scale. This is because microbes such as bacteria, fungi, and viruses no longer respond to commonly used medicines, resulting in infections becoming harder to treat.

How antibiotic resistance happens. Click the image above for a larger, clearer version.

Antimicrobial treatment no longer serves their desired effect, which in turn will increase the risk of poor outcomes in patients with an infection caused by antimicrobial resistance.

During the COVID-19 pandemic, there was a significant increase in antibiotic prescriptions despite a relatively low bacterial co-infection rate.

The misuse of antibiotics in these patients can result in increased selective pressure for antimicrobial resistance leading to a lasting consequence of the COVID-19 pandemic .

Apart from overprescribing of antibiotics unnecessarily, the increased risk of antimicrobial resistance is compounded by the lack of awareness of appropriate antibiotic use and a poor understanding on the consequences of misusing antibiotics among the public .

It is estimated that drug resistance claims 700,000 lives every year, and this toll is projected to increase exponentially to 10 million a year by 2050 without immediate action.

CONCERNING IMPACTS OF ANTIMICROBIAL RESISTANCE

Development of new antibiotics may not be fast enough to replace those that have become less effective due to antimicrobial resistance

The discovery of antibiotics was a turning point in human history, revolutionizing medicine and increasing the survival rates of infected patients over time.

However, the growing burden of antimicrobial resistance threatens the return to a world with a scarcity of effective treatments for even common bacterial infections such as urinary tract infection, pneumonia, skin infection, and surgical site infections.

As the effects of antimicrobial resistance continue to increase today, the discovery and development of new antimicrobials is not able to keep up against the emergence of AMR.

There is an urgent need for new antibacterial drugs in the market, but with this, comes the importance of ensuring that these antibiotics are used wisely.

Patients should be prescribed antibiotics only when needed, at the right dose, frequency, and duration. Otherwise the new antibiotics will also suffer the same fate as its predecessors and eventually lose effectiveness .

Antimicrobial resistance can also result in productivity loss caused by sickness and premature death, as well as rise of healthcare cost that stems from prolonged hospital stays and care

Without effective tools for the prevention and adequate treatment of drug-resistant infections, treatment may fail for an increasing number of patients. There will also be an increased risk in major medical procedures such as surgery, chemotherapy, and organ transplants .

WHAT CAN WE DO TO REDUCE & PREVENT ANTIMICROBIAL RESISTANCE?
  1. We should only take antibiotics when prescribed by a doctor and correctly follow the prescription directions.
  2. Don’t demand for antibiotics and buy medication without a prescription, or share or take leftover antibiotics.
  3. Maintain strict infection prevention measures such as hand hygiene to reduce the spread of antimicrobial resistance organisms.
  4. There is now increasing evidence that certain vaccines currently available for infectious diseases can decrease the risks of AMR by preventing bacterial and viral infections. Keeping up to date on vaccination schedules. particularly for children and elderlies, may be able to reduce the use of antibiotics, and thus prevent antibiotic-resistant infections.
A CALL TO STAKEHOLDERS TO RISE UP & REDUCE THE SPREAD OF ANTIMICROBIAL RESISTANCE

Besides creating awareness among consumers and healthcare professionals, combatting antimicrobial resistance also requires action from governments, policymakers, and industry players to really address the crux of the issue.

Investment is required in antibiotic research and development, both as a tool to control novel disease outbreaks, and to treat known pathogens developing resistance to currently available treatments.

We must learn from the COVID-19 pandemic to address the next global and public health threat. We have seen that it is indeed possible for all parties to work together to reduce the spread of COVID-19—from citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the creation of vaccines and COVID-19 treatment, and governments who put in place and enforced guidelines for the people, while also supporting the R&D of these innovations.

The same urgency is needed so that we can prevent the next public health crisis.

Thinking of Traveling? Get These Tips to Keep Yourself Flu-free!

DATUK DR CHRISTOPHER LEE
Consultant Infectious Diseases Physician
Member of the Malaysian Influenza Working Group
FLU FACTS THAT ARE NOTHING TO SNEEZE AT
  1. On board the plane, you have an 80% chance of getting the flu if there is an infected person–who may or may not have symptoms–sitting one row in front or behind you, within 2 seats to either side.
  2. Flu viruses can survive for up to 48 hours on certain surfaces, including your overhead compartment handle, seat-belt buckle, video screen, food tray, arm-rest, and control panel.
  3. You can try disinfecting the items mentioned in the above point, but it would be impractical to disinfect everything you will touch when you land, such as your luggage bag, trolley, the toilet flush, car door handle and so on.
TRAVELING SOON? HERE ARE 2 SIMPLE TIPS

Tip 1: Follow the COVID-19 SOPs when possible
Masking, although no longer promoted in most countries, may help reduce the chances of catching the flu.

However, it is less effective when those around you are not masked. This is where the next tip comes in.

Tip 2: Get the flu shot
The additional protection conferred by the annual flu vaccination is therefore recommended to prevent the disease.

When injected, the vaccine introduces inactivated flu viruses into the body. These have been killed and are unable to cause disease.

Instead, they stimulate your body to produce antibodies that will spring to your defense if you happen to be exposed to the flu.

Allow 2 weeks to reach the desired level of immunity before flying off.

MORE ABOUT THE FLU VACCINE
It gives you a better shot at beating the flu and reducing your risks of heart problems 

Flu vaccination helps prevent severe flu-related infection, hospitalization, and death . It is also associated with a 34% lower risk of major adverse cardiovascular events . There was also an 18% reduced risk of death reported in patients with heart failure .

In people with type 2 diabetes, flu vaccination has been associated with a reduced risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15% .

With the COVID-19, flu, & RSV triple threat in the northern hemisphere, the flu shot is a good bet 

Noting that flu viruses mutate constantly, Datuk Dr Christopher Lee explains that currently available flu vaccines have been updated to effectively fight virus sub-types that are circulating in the northern hemisphere at this time.

“This will help reduce your risk of contracting the disease. The flu vaccination is recommended for those travelling abroad, especially high-risk groups as the importation of flu cases through air travel can result in the spread of flu within the community,” he adds. “So, if you have not been vaccinated against the flu, now is a good time to get it done. The annual flu vaccination is your passport to healthy holidays. Don’t leave home without it.”

This article was contributed by the Flu Prevention is An Act of Love campaign under Immunise4Life, a major initiative to promote life course vaccination by the Ministry of Health, Malaysian Paediatric Association, and the Malaysian Society of Infectious Diseases & Chemotherapy. Learn more at actoflove.ifl.my (link opens in a new tab).

Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!

DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

HOW THE FLU AFFECTS YOUR HEART

When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.

 

An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.

OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.

FLU VACCINATION CAN PROTECT YOUR HEART

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).

References:

  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351

Invasive Mold Infections: A Rare but Deadly Fungal Disease

WORDS DR LOW LEE LEE

DR LOW LEE LEE
Infectious Disease Physician
Sultanah Bahiyah Hospital
FUNGI: OUR FRIENDS & FOES (IT’S COMPLICATED)

Fungi are found naturally in our environment. There are many different types of fungi, over 2 million species however about 600 fungi have caused diseases.

Invasive fungal infections typically manifest as a severe and aggressive form of the disease, leading to corresponding to high prevalence and death rates if left untreated.

These infections include invasive mold infections.

INVASIVE MOLD INFECTIONS AT A GLANCE
  • Usually caused by Aspergillus (giving rise to invasive aspergillosis) but can also be caused by other rarer molds such as Mucormycetes (giving rise to mucormycosis).
  • These molds produce spores; most of us encounter these spores every day without getting ill, but people with compromised immune systems may develop complications as a result of these spores.
  • Despite invasive aspergillosis and mucormycosis being relatively uncommon, invasive mold infections are often life threatening. If left untreated, the mortality rates can reach 100%!
  • Various parts of the world reported superinfections of invasive aspergillosis and mucormycosis in patients with COVID-19, which are associated with increased risk of death. COVID-19 likely increases the risk for fungal infections because it weakens the immune system or due to certain therapies used for treatment such as steroids.
  • There are no specific symptoms, as symptoms can vary depending on the type of infection. This makes diagnosis an infection a challenging and sometimes complicated task!
Invasive Aspergillosis
Aspergillosis and how it affects our lungs. Click on the image for a larger, more detailed version.
  • Invasive aspergillosis is uncommon and occurs primarily in immunocompromised people.
  • Commonly seen in people that have undergone stem cell and other organ transplants (especially lung transplant), as well as in patients with blood-related cancers such as acute leukemia.
  • Typically affects the lungs, but it can also spread to other parts of the body.
Mucormycosis
  • Mucormycosis is rare and estimated to affect approximately 10,000 cases worldwide, barring India. If India is included the numbers rise to 910,000 cases annually!
  • Typically occurs in the sinuses of the nose or lungs; however it can spread to the brain and other organs as well.
COMMON SYMPTOMS OF A POSSIBLE INVASIVE MOLD INFECTION
  • Typical pneumonia symptoms including fever, chest pain, cough, coughing up blood, and shortness of breath
  • Sinus infection, which may be painful
  • Pain, tenderness, swelling and pressure around the eyes, cheeks, nose or forehead
  • One-sided facial swelling
  • Headaches
  • Nasal or sinus congestion
  • Black lesions on nasal bridge
HOW TO REDUCE YOUR RISK OF AN INVASIVE MOLD INFECTION
  • When performing activities that involve close contact with soil and dust, such as yard work or gardening, take care to wear shoes, long pants, and long-sleeved shirts
  • Whenever possible, avoid dusty areas like construction or excavation sites; wear a N95 mask when you have to visit these areas
  • Keep your house dry and mold-free
  • Avoid staying in a moldy home (even while it is being cleaned)

Children More Vulnerable to Infections During These Post-Pandemic Times?

WORDS DR LIM YIN SEAR & DR MAHFUZAH MOHAMED

DR LIM YIN SEAR
Senior Lecturer of Paediatrics
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University		 DR MAHFUZAH MOHAMED
Guest Lecturer of Paediatrics
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
NEW NORMAL LEADS TO  NEW ‘CULTURE SHOCK’ FOR A CHILD’S IMMUNE SYSTEM

For the duration of the COVID-19 pandemic, children were predominantly confined to their home and as a result, were less exposed to common bacteria and viruses. This will render younger children’s immune system to develop poorly.

From March 2022 onwards, as life seemed to make its way back to normality, children started to attend school, enrichment classes, and sports activities again.

This has led to many young kids falling ill with diseases such as influenza, hand-foot-and-mouth disease, and lung infections. An elevated frequency of visits to the doctor has worried many parents that their children may have weakened immune system (we say that these children are then immunocompromised).

ARE CHILDREN REALLY MORE PRONE TO INFECTIONS POST-PANDEMIC?

Currently, there is no scientific data to show that children are more prone to infections after the pandemic.

HOWEVER, THERE ARE CERTAIN FACTORS THAT CAN INDIRECTLY UP THE RISK OF INFECTIONS IN CHILDREN

A briefing by UNICEF on the impact of COVID-19 on children has shown that the prevalence of unhealthy diets such as snacking has increased. This may be due to a lack of easy access to fresh food and financial constraints, possibly leading to childhood obesity and malnourishment.

Additionally, a sedentary lifestyle and the lack of exercise could contribute to childhood obesity, escalating vulnerability to infections.

Another major issue that arose during the MCO period was the disruption of essential health services including childhood immunisations. In a recent WHO pulse survey, 90% of countries reported disruptions to routine immunisations. Immunisations are of utmost importance for preventing certain infectious diseases.

Another important issue that needs to be taken seriously is the mental health of children and their caretakers. The Adverse Childhood experience (ACE) study showed that adverse childhood experiences in categories of abuse, household challenges, and neglect are not only associated with worse mental health outcomes, but also with chronic health conditions such as diabetes, heart disease, chronic obstructive pulmonary disease, liver disease, and cancer.

POSSIBLE SIGNS THAT YOUR CHILD MAY HAVE A WEAK IMMUNE SYSTEM 
  • Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis, or skin infections
  • Inflammation and infection of internal organs
  • Blood disorders, such as low platelet count or anaemia
  • Digestive problems, such as cramping, loss of appetite, nausea, and diarrhoea
  • Delayed growth and development
  • Autoimmune disorders, such as lupus, rheumatoid arthritis, or type 1 diabetes
TOO CLEAN ISN’T ALWAYS GOOD

Some parents go to the extreme to create a “super clean” environment to protect their children and forbid the children to play or touch anything or anyone that has not been sanitised. This isn’t necessarily a good thing, and here’s why.

In the early years, our immune system is a blank canvas. Although infectious disease is a legitimate cause for concern, and a certain level of cleanliness is necessary, children need to develop an immunity to common pathogens.

Overprotecting children from germs is detrimental to their development. Therefore, parents need to balance between a clean environment rather than a sterile environment.

HOW ABOUT HAND-WASHING AND SANITISING?

Studies have shown that soap and water are better equipped to remove more germs from one’s hand than hand sanitiser does.

However, it is still recommended to use hand sanitisers when washing with soap is not an option.

LET’S TALK ABOUT VITAMIN D

Generally speaking, children with a balanced diet and outdoor activities would attain the daily requirement of nutrients.

A minimum of 400 IU (10 µg/day) of vitamin D is recommended for children and adolescents, especially among exclusively breastfed infants and all children and adolescents who are not routinely exposed to sunlight.

Vitamin D supplementation is only recommended to those who are unable to obtain an adequate amount of vitamin D from their diet or have inadequate exposure to sunlight.

Care should be taken while consuming vitamin D supplementation. A daily vitamin D intake of 2,000 IU or more puts one at risk of vitamin D toxicity. The signs and symptoms of toxicity include headache, a metallic taste in one’s mouth, pancreatitis, nausea, and vomiting.

Minister of Health Officiates New Child Health, Safety, and Well-being Programme

WORDS LIM TECK CHOON

On September 15 2022, our Minister of Health YB Tuan Khairy Jamaluddin officiated the launch of Healthy Little Bloomers programme and the roll-out of its maiden campaign Junior Germ Busters. 

The Healthy Little Bloomers programme aims to promote child health, safety and well-being through a network more than 30,000 early childhood care and education centres nationwide, potentially benefiting more than 800,000 children.

This is an initiative led by the Malaysian Paediatric Association (MPA) in collaboration with 10 prominent early childhood care and education organisations from both private and government sectors. These organisations are Jabatan Kemajuan Masyarakat (KEMAS), ECCE Council, Malaysian Association of Professional Early Childhood Educators (MAPECE), Persatuan Tadika Malaysia (PTM), Jabatan Kebajikan Masyarakat (JKM), Persatuan Pengasuh Berdaftar Malaysia (PPBM), National Association of Special Education, Malaysia (PPKK), Majlis Kebajikan Kanak-Kanak Malaysia (MKKM), Persatuan Tadika Sabah (PTS) and Association of Kindergarten Operators Sarawak (AKO).

In his speech during the launch, YB Tuan Khairy highlighted the following:
  • Young children, especially those under the age of 5, are vulnerable to health and safety threats, such as infectious diseases, injuries, abuse and neglect
  • Children who are overweight or obese are 5 times more likely to become overweight and obese adults
  • Child abuse survivors are at higher risk of becoming abusers or getting involved in abusive relationship during adulthood
  • Unmet emotional and mental health needs during childhood will lead to difficulties and problems during adolescence and adulthood
PROGRAMME IN STEP & LINE WITH MALAYSIAN GOVERNMENT DEVELOPMENT GOALS

YB Tuan Khairy is pleased with the launch of Healthy Little Bloomers because, as he puts it: “Children are the nation’s future. Therefore, addressing their health, safety and well-being needs holistically is one of the government’s key priorities. It has been part of the Malaysian government development goals since the 1960s and outlined in our latest Child Health 2021-2023 national framework”.

He applauds the campaign as an initiative that brings together MPA and partner organisations for bringing together medical professionals and early childhood care and education experts in a systematic and potentially long-term collaboration to help bring to fruition the goals of the government.

This is a vital programme as many young children spend most of their waking hours in kindergartens and children centres every week, abd studies have shown that health promotion intervention in kindergarten and childcare centres can be effective, especially if parental engagement is involved.

THE PROGRAMME IN MORE DETAIL

Professor Datuk Dr Zulkifli Ismail, Chairman of Healthy Little Bloomers, shares that the programme is meant to be cover all key domains and aspects of child health, safety and well-being in a holistic manner.

He further elaborates that the programme will take an annual thematic approach.

WHAT THE HEALTHY LITTLE BLOOMERS PROGRAMME OFFERS
  • Training for early childhood care and education operators and personnel
  • Fun, exciting, and interactive lessons for children; the programme is inclusive and will cater to children from various population segments, including those that are underprivileged and with special needs
  • Information and educational materials for parents and primary caregivers; available in Bahasa Malaysia and English
  • Roadshows to cater to less advantaged children, featuring activities that will consider the needs of those with hearing or vision impairments.

Visit healthylittlebloomers.my to get more information as well as free educational materials.

Rise of the Superbugs

WORDS LIM TECK CHOON

PROFESSOR CHIN BEEK YOKE
Associate Dean
School of Health Sciences
International Medical University

Superbug is a term coined to describe multi-drug resistant bacteria.

Medications that are usually effective on them, such as antibiotics, just don’t work as effectively anymore. “These are bacteria that circumvent the effects of antibiotics and proliferate or multiply uncontrollably in the host,” explains Professor Chin Beek Yoke.

EVERY BACTERIAL SPECIES CAN BE A SUPERBUG

Any species of bacteria can develop a resistance to antibiotics and become a superbug.

“Bacteria are very smart. They will mutate to overcome antibiotics. Once bacteria has the resistance gene in them, they can duplicate and combine with different species of bacteria. That’s how bacteria propagate their multi-drug resistance in nature,” Prof Chin shares.

WE HAVE A ROLE IN CREATING SUPERBUGS

According to Prof Chin, a key reason why superbugs are prevalent is the unnecessary and over-prescription of antibiotics.

GOOD HABITS TO ADOPT
  • Take antibiotics only when necessary. Diseases that are not caused by bacteria do not require antibiotics!
  • Complete your full course of antibiotics—finish all the antibiotics your doctor gave you. Don’t stop just because you think you are feeling better.
  • Avoid using unapproved or black market antibiotics that are not at full strength and do not work as effectively as genuine ones
IMPROPER DISPOSAL OF ANTIBIOTICS MAY ALSO PLAY A ROLE

People tend to dispose of antibiotics incorrectly, and this can be a problem.

“We pour it down the drain, or throw it into the trash. The excess antibiotics then get into our ecosystem, in the soil, or may end up in rivers and water bodies,” says Prof Chin.

GOOD HABIT TO ADOPT
The correct way to dispose of the extra antibiotics is to bring them to your nearest pharmacy. Many pharmacies are equipped to dispose of extra medicines in the appropriate manner.
THEN THERE’S THE ISSUE OF ANTIBIOTICS IN ANIMAL AND FISH FEED…

Another cause is the use of antibiotics in feed for domestic animals or fish. When humans consume the meat from these animals and fish, they also consume the residual antibiotics present in these products.

This unintended consumption of antibiotics may modify the bacterial environment in our bodies and render us susceptible to future bacterial infections.

GOOD HABIT TO ADOPT
Purchase foods that are obtained from sources that are free of antibiotics.
HOW TO MINIMIZE POSSIBLE CONTACT WITH SUPERBUGS

Multidrug resistant bacteria are everywhere, but we can do a few things to reduce coming in contact with them.

PRACTICE GOOD HYGIENE
  • Wipe surfaces and clean items that come into our household
  • Wash all fruits and vegetables after purchase, before storage, and before cooking. This will prevent the bacteria from propagating
  • If you wish to try fruits from stalls and supermarkets in order to ‘test before buying’, wipe them first with a wet wipe
  • Wear shoes and socks when travelling in areas where contaminated soil or water is prevalent
DON’T PANIC TOO MUCH ABOUT COMING IN CONTACT WITH SUPERBUGS, HOWEVER!

Prof Chin explains that having them on your skin alone doesn’t mean that you will become infected and suffer.

“Your skin is a very good protective organ,” she says. “Bacteria or pathogens can only enter when there is a cut. So, if you don’t have a cut or laceration, you will be fine. Just make sure to wash your hands and feet or any exposed areas.”

The same goes for the times when you ingest bacteria. “You will usually have enough stomach acid to kill these superbugs, and most of the time you have enough innate immune cells in your body to fight them off,” she explains.

However, people with health conditions that weaken their immune system should take precautions to reduce their odds of contracting bacterial infections; they should consult their doctor on the best ways to do this.