Materia Medica Malaysiana

Still down with dengue fever

The deadly disease still poses a major health problem although measures have been taken to combat it, writes ANNIE FREEDA CRUEZ.
DENGUE fever and dengue haemorrhagic fever are still a major public health problem in Malaysia.
It is also a global problem affecting more than 100 countries.
It is estimated that about 50 million dengue cases are reported every year in the world and of the number, some 500,000 cases were dengue haemorrhagic fever or better known as DHF.
This deadly disease kills about 12,000 people annually, with the majority being children.
As for the dengue situation in Malaysia last year, Health Ministry’s Communicable Disease Control division deputy director Dr Marzukhi Md Isa said the incidence was 132.5 for every 100,000 population which was an increase compared to the previous years.
Fatality rate for dengue fever and DHF was 0.3 while for DHF alone was 6.4
Dengue fever and DHF are caused by one of four closely related but antigenically distinct virus serotypes — DEN-1, DEN-2, DEN-3, and DEN-4 — of the genus Flavivirus.
Infection with one of these serotypes does not provide cross-protective immunity; so people living in a dengue-endemic area can have four dengue infections during their lifetime.
Dengue fever is endemic in Malaysia.
Dr Marzukhi said the total notified clinical cases was 33,895 last year and of the number, only 39.4 per cent or 13,340 were confirmed dengue cases. The disease claimed 102 lives.
Selangor was the leading state with 2,806 confirmed cases and 37 deaths.
Among other states with a high number of cases and deaths were Johor (1,942 cases and five deaths), Perak (1,886 cases and nine deaths) and Kuala Lumpur (1,542 cases and 21 deaths).
It is learnt that 197 samples were tested by the Institute for Medical Research and University of Malaya Medical Centre for virus serotyping and the outcome was DEN-1 (110), DEN-2 (11), DEN-3 (22), DEN-4 (seven) and others (47).
Dengue is primarily a disease of the tropics, and the viruses that cause it live in a cycle that involves humans and Aedes aegypti, a domestic, day-biting mosquito that prefers to feed on humans.
Infection with dengue viruses produces a spectrum of illnesses ranging from a non-specific viral syndrome to severe and fatal haemorrhagic disease.
Important risk factors for DHF include the strain and serotype of the infecting virus, as well as the age, immune status, and genetic predisposition of the patient.
According to the ministry’s surveillance report, for this year the percentage of Aedes breeding was still high at construction sites, vacant lands and lots, factories, schools, offices complexes, recreational areas and road dividers.
Other breeding sites are dumping grounds, cemeteries, and abandoned houses and projects.
As for the dengue situation this year, Dr Marzukhi said, the cases were declining.
He attributed this to the action plan focusing on the following areas:
• Relevant ministries to increase their capabilities in terms of technical capacity and human resources in the implementation of prevention control activities in their operational areas;
• Ministries, departments and agencies must emphasise knowledge and skills in prevention activities in their operational areas;
• Proper staff training to be conducted so that they would be able to help the community search and destroy Aedes breeding places and maintain a clean and healthy environment;
• Health Ministry will provide technical advice and training to the relevant agencies;
• Promoting dengue control and prevention activities in collaboration with other ministries and agencies such as community fogging, and,
• Stepping up enforcement using the Disease Bearing Insects Act (DDBIA) 1975, (Amendment 2000) and Communicable Disease Prevention Control Act (CDPCA) 1988, by personnel in the relevant ministries and agencies.
Under the DDBIA 1975, the first offence carries is a fine of up to RM10,000 or two years’ jail or both.
The second offence carries a fine of up to RM50,000 or five years’ jail or both, and a fine not exceeding RM500 for every day that the offence is continued.
To help keep dengue in check, doctors in the private sector will have to inform the authorities if they come across any cases.
Under the CDPCA 1988, every medical practitioner who treats or comes to know of the existence of any infectious diseases at any premises must immediately notify the nearest health officer through a notification form.
Failure to do so can mean being penalised under Section 24 where there is a fine or imprisonment for a term not exceeding two years or both for the first offence.
For a second offence, it can mean a fine or imprisonment not exceeding five years or both.
For a continuous offence, the penalty for the doctor is a fine not exceeding RM200 for every day that offence is continued.
Dr Marzukhi said that under the Prevention and Control of Infectious Diseases Act 1988, section 25 (compoundable offence) the director-general or any civil officer empowered by him can issue a compound fine for any offences under the Act for an amount not exceeding RM1,000.