DENGUE FEVER IN MALAYSIA Prepared by : Fadhila Binti Mohd Hanapiah Nadiah Binti Suffian

INTRODUCTION  Dengue is a viral infection transmitted by mosquitoes, mainly the Aedes aegypti species.  The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. One mosquito bite can inflict the disease.  There are four strains or serotypes of dengue virus namely DEN-1, DEN-2, DEN-3 and DEN-4.  The mosquito flourishes during rainy seasons but can breed in water-filled containers, year-round.  The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito- to-another-person pathway.  Dengue haemorrhagic fever  severe form of dengue. A second attack by dengue virus of a different serotype from the first infection.  Approximately 1% of patients with dengue infection progress to dengue haemorrhagic fever.

WORLD-WIDE DENGUE DISTRIBUTION

EPIDEMIOLOGY  The earliest recorded case of dengue fever in Malaysia  Penang  1962 – The first major dengue outbreak in Malaysia  Penang  1973 – A nationwide outbreak  Kuala Lumpur  Since then dengue has become a major public health problem in the country.  Dengue cases/deaths mounts parallel with the rapid development, expansion of urban areas & population density (as of Sept 2008 = 27,730,000 inhabitants).

INCIDENCE OF DENGUE CASES IN MALAYSIA FROM YearCaseDeath P/S : – , 1157 cases were reported with 4 deaths so far…

DIAGNOSIS  Classic symptoms : high fever, a petechial rash with thrombocytopenia & relative leukopenia (decrease in the number of circulating WBC in the blood).  WHO definition of DHF :  Fever  Haemorrhagic tendency [positive tourniquet test (> than 20 petechiae per square inch), spontaneous bruising, bleeding from mucosa, gingiva, injection sites, vomiting blood or bloody diarrhea].  Thrombocytopaenia [<100,000 platelets per mm³].  Evidence of plasma leakage [rise in hematocrit level > than 20%].  Serology (identification of antibodies in the blood serum) & polymerase chain reaction (PCR)  to confirm the diagnosis of dengue if clinically indicated.

SYMPTOMS  Sudden high fever ( °C) for 2 to 7 days  Headache  Pain behind the eyes  Muscle pain, joint pain, bone pain (break-bone fever)  After 1 to 2 days of fever, the patient develops initial rash with discoloured spots, often described as “Isles of white in a sea of red”  Second rash may develop to palms and soles, and skin may peel off (desquamate) & body temperature drops

TREATMENTS  No specific antiviral treatment, only supportive treatment is given to such patients.  If the patient is dehydrating, adequate fluids are to be taken.  Intravenous fluid is administered if the patient is unable to maintain oral intake.  For severe body ache, painkillers may be needed.  For severe headache and for joint and muscle pain, acetaminophen/paracetamol and codeine may be given.  If there is significant bleeding, blood or platelet transfusion will be carried out. Note : Aspirin should be avoided as this drug may worsen the bleeding tendency (because of its anticoagulant effects & the increased risk of developing Reye syndrome).

PREVENTIONS STRATEGIES  Individual roles. People are urged to empty stagnant water from old tires, trash cans & flower pots.  Mosquito control. Place larvicide e.g. Abate® or any other suitable insecticides into any exposed water container. Use mosquito repellant sprays that contain NNDB or DEET.  Enforcement. Local authorities from Ministry of Health conduct on-site check & destroy larvae at residential premises & construction sites. Fines may be imposed on the owner of properties. There is currently no vaccine available for the dengue fever.

PREVENTIONS  Fogging with insecticide. Fogging would be carried out by local authorities in housing area where 2 or more cases of dengue fever are reported within one week.  Information. In Nov 2007, the Ministry of Health carried out a major campaign against Aedes. During the campaign free packages of Abate® were distributed. Leaflets & brochures to inform the public on ways to prevent & curb Aedes breeding are distributed.  Awareness campaign. Schools & local communities are encouraged to carry out communal cleaning activities. Public awareness campaigns through strategically placed posters & television advertisements are also done.

REFERENCES    ealth/HealthPersonal/CommonDiseases ealth/HealthPersonal/CommonDiseases  malaysia.html malaysia.html    ?showMe=28&storyid= ?showMe=28&storyid=  asp asp 