Dengue is a virus that is transmitted by an infected female Aedes mosquito. The virus has 4 stereotypes – DEN1, DEN2, DEN3 and DEN4. Dengue symptoms usually appear 4 to 7 days after the person is bitten by the mosquito. It is an illness that affects people regardless of age.
While there is no cure for this potentially fatal disease, early medical attention will help in saving lives. Dengue is common in South-East Asian and Western Pacific countries.
According to the Centers for Disease Control and Prevention, dengue infects up to 400 million people annually, with 22,000 cases ending in death. The number of reported dengue cases globally has continuously risen in the past decade.
Dengue in Malaysia
The very first case of dengue in Malaysia was reported in 1902. The number of cases has continued to rise over the years even with the efforts taken by Malaysia’s Ministry of Health to stop the spread of this disease.
According to the World Health Organization, the number of cases in Malaysia from 1 Jan to 2 March in 2019 was 157% higher than the number of cases in the same period in 2018. In 2019, Selangor contributed over 50% of Malaysia’s total dengue cases. Of the 4 strains, DEN1 and DEN2 are most common in this country.
Vector control is still the main dengue prevention strategy in Malaysia as there is no cure for the illness and the dengue vaccine has not yet been approved by the Malaysian government.
While initiatives such as Communications for Behavioral Changes (COMBI) have had an effect in reducing the number of dengue cases, there is still much to be done in fighting dengue.
A nationwide study on dengue found that 91.6% of the adults in their sample to be dengue igG positive. The prevalence of this illness in Malaysia should be taken seriously.
The number of dengue cases peaks during the late monsoon seasons in Malaysia – July to August in the West of peninsular Malaysia and October to February in the East of peninsular Malaysia, Sabah and Sarawak.
Cases spike during these months due to weather conditions that are just right for mosquito breeding. However, the lack of proper sanitization and rapid development has also contributed to this problem.
As such, there is a constant need to provide the community with basic knowledge of the diseases as well as the preventive methods that Malaysian citizens can take to help combat dengue. Studies do show that health education plays a vital role in the prevention of dengue.
Additionally, there is also a need to understand the community’s baseline knowledge, attitudes and practices of dengue to increase the effectiveness of vector control in this country.
With the number of cases increasing yearly, it seems that dengue is not an easy battle for Malaysia even with the tremendous effort that has been put into it.
Preventing dengue in Malaysia
Malaysia’s Department of Occupational Safety and Health aims to stop dengue by preventing Aedes mosquitoes from breeding and by keeping adult mosquitoes away.
Mosquitoes love areas with standing water such as water tanks, water containers and puddles. Thus, Aedes mosquitoes can be prevented from breeding by:
- Disposing of unwanted containers in a correct manner so that it does not collect water. For example, recycling plastic bottles so that rainwater does not collect in it.
- Change water in flower vases at least once a week.
- Clean potted plants to remove mosquito larva once a week.
- Cover all water containers
- Add insecticide to water containers according to the recommended dosage
- Make sure the environment is clean
Some practical ways to keep adult mosquitoes away include:
- Destroy adult mosquitoes with aerosol insect repellent. Do take precautions when using them, especially when there are young children around.
- Wear long-sleeved clothing, long pants or long dresses to cover your body as much as possible.
- Use mosquito coils or electric vapour mats.
- Use mosquito nets or put up mosquito netting on all doors and windows.
For more information, read our article on “How to prevent dengue?”
Signs and Symptoms of Dengue Fever
The following are signs and symptoms of dengue:
- High fever
- Rash on the body that may disappear and reappear
- Headaches
- Muscle aches and joint pain
- Eye pain, especially behind the eyes
- Nausea and vomiting
Signs of dengue hemorrhagic fever
Severe dengue, also known as dengue hemorrhagic fever have the following signs and symptoms:
- Abdominal pain.
- Bleeding from nose, gums and/or mouth.
- Black vomit and/or blood stools which is a sign of internal bleeding.
- Small but noticeable blood spots under the skin.
- Weak pulse.
If you suspect that you or a family member has dengue, seek immediate medical attention as early intervention helps save lives. Take all the precautionary measures mentioned above to stem the spread of the illness to others who are in the same household. Also, take note that signs of severe dengue can occur 2 days after mild symptoms have subsided.
Dengue vaccine conditionally approved in Malaysia
In 2017, Dengvaxia was approved for post-registration, or Phase IV clinical studies which were carried out on volunteers between 9 and 45 years.
These studies were planned for a two year period and consist of three injections scheduled 6 months apart. Only the participants of this study have access to the vaccine.
Jointly conducted by Malaysia’s Health Ministry and the French pharmaceutical company that produces the vaccine, Sanofi Pasteur, the study aims to review the safety and efficacy of Dengvaxia before it is fully approved.
According to The Star newspaper, the New England Journal of Medicine reported that this vaccine is 66% effective in protecting those who are between 9 and 16 against dengue. Protection from severe dengue is 93% and 80% from hospitalization due to dengue.
Malaysia’s Drug Control Authority has mentioned that one of the concerns with this vaccine is that it is more effective for dengue caused by the DEN3 (73.6%) and DEN4 (83.2%) strains as compared to the DEN1 (58.4%) and DEN2 (47.1%) strains. This is because the DEN1 and DEN2 strains are the most widely spread in this nation.
If these studies are not able to substantiate the clinical benefit of Dengvaxia and/or not carried out with utmost diligence in the two years, the vaccine would not be approved, conditionally or fully.
This vaccine is being used in 14 other countries including Singapore, Philippines, Thailand and Indonesia. Mexico was the first country to approve the use of Dengvaxia in December 2015.
As of 2020, the Malaysian government has not yet fully approved the use of Dengvaxia in this country.
Dengue in the midst of Covid-19
As the global Covid-19 health pandemic hits Malaysia, many have forgotten about the dengue situation in the country.
There were over 130,000 reported cases of dengue in 2019, 147 of which resulted in death. As of mid-April 2020, there have been over 38,000 dengue cases reported in Malaysia. 63 of the above-mentioned cases resulted in death.
While there have been more deaths due to the coronavirus, the number of dengue cases continue to rise and Malaysia should remember not to take dengue any less seriously.
Dengue in Malaysian news 2020
As one of the major health epidemics in this nation, dengue is quite a common topic in Malaysian newspapers.
In the Malay Mail, Malaysia’s Health Director-General Datuk Dr Noor Hisham Abdullah warns that there would be a spike in dengue cases occurring from June to September. The increased risk is due to the reopening of businesses that have not been used since Malaysia went into the Movement Control Order (MCO) to battle the spread of Covid-19.
The News Straits Times reported that there were a total of 50,511 cases and 88 deaths from 1 January to 13 June 2020. While these numbers are lower when compared to the same period in 2019, efforts to fight dengue need to continue as numbers are still high.
An article in The Star talks about the Intervention for Dengue Epidemiology in Malaysia (iDEM) program which is a brand new initiative led by the Health Ministry to combat dengue. This collaborative program enables the pooling of knowledge, expertise and tools to produce an integrated vector management (IVM) system.
IVM has three major components:
- Outdoor residual spraying of insecticide for covered and partly covered walls of high rise buildings. This targeted action will be carried out three times a year
- User-friendly auto dissemination devices that will be used for hard to reach areas
- Active community engagement
While it is hoped that this initiative will reduce the spread of dengue by preventing it before it occurs, its real effectiveness will only be known in the next few years.
Conclusion
Dengue continues to be a serious health problem in Malaysia even with the continuous efforts to combat it. While terminating the vector will prevent the spread of this virus, a dengue vaccine is still very much needed to ensure the safety of the people. As such, more studies on the vaccine should be conducted in order to make it available for all Malaysians.
