Dengue in Malaysia
How serious is the problem?
The incidence of dengue in Malaysia has increased from 15.2 per 100,000 in 1973 to 361.0 per 100,000 population by the year 2014. The same trend was seen in case fatality rates that went up from 0.16% to 0.62% between 2000 to 2013. More than 60% of the cases were from the Klang Valley region. In Pahang the dengue incidence rates from 2004 to 2014 showed a similar increase from 40.9 to 193.8 per 100,000 population and an increase in case fatality rates from 0.07% to 0.3% too was observed between 2000-2014. Fortunately these figures were below the national average. Dengue epidemiology is rapidly evolving, with increase in frequency of outbreaks and involvement of new area that were previously unaffected are being observed lately. These areas are small towns, villages and land schemes. Outbreak in cities and big towns tend to be out of control and has become hotspots, a term used to identify outbreak occurring for more than 30 days. For example, during the epidemiological week 12/2015 (22 to 28 March 2015) there were 183 hotspots reported in Malaysia. In Pahang, for the year 2014, there were 100 outbreaks compared to 22 similar episodes in the previous year with 1 hotspot, showing a marked increase of more than 350%.
Dengue affects all age groups, more prevalent in developed and populated area. Rapid development and population growth, improper management of construction sites, industrial areas and poor solid waste management make these places suitable for Aedes mosquitoes to breed.
What are the challenges?
Combating dengue is always a challenging task. A lot of factors need to be considered in the prevention and control of dengue including dengue virus itself, the vector i.e.
Aedes mosquitoes, the environment and of course the human factor. Dengue virus had 4 serotypes and all four serotypes were distributed in the population. Any changes in the dominant serotypes in the population will enhance the transmission of the disease in the community. In Malaysia, changes in dominant serotypes occur every 3 years and the same serotypes were observed to be dominant up-to 10 years. Aedes mosquitoes have not change physically for the past decade. However, the rate of reproduction of Aedes mosquitoes increases with the increase in environmental temperature. It had significantly contributed to the epidemic. The density of Aedes mosquitoes in the environment is seen to increases drastically two weeks after rainy seasons due to the available places for breeding. The eggs of Aedes mosquitoes can survive in dry seasons for up to 6 months and the dengue virus can be transmitted trans-ovarian to the eggs and thus producing a new generation of Aedes mosquitoes with the virus. Source reduction, larvaciding and space spraying of insecticides are effective ways in prevention and control of the larva and adult Aedes mosquitoes. However for source reduction to be effective it needs participation and commitment from the public which at present is very poor. While space spraying is effective in controlling the adult mosquito, only 40% of the cases were done within 5 days of onset.1 This is due to the delay in patient seeking treatment and insufficient number of control teams during outbreaks. The failure will result in the spread of the disease leading to an uncontrolled outbreak. Humans had ignored the important of environmental cleanliness as a method to control Aedes mosquitoes breeding.
Based on Ministry of Health (MOH) annual report 2012, Aedes Index was persistently high in public areas such as construction sites (8.7%), factories (8.6%), empty lands (8.0%), recreational areas (7.3%) and schools (6.4%). Many studies show that despite the high level of knowledge about dengue among the public, the practice was very poor. Community as a whole need to see the dengue issue as a serious problem that affect their lives. They should not leave the responsibility to manage this problem solely to the authorities as the source of the problem is around their houses and offices.
How to fight mosquitoes?
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