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
1902 - 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 1998-2008

Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Case 27381 10146 7103 16386 15493 31545 33895 39654 34386 48846 49355 Death 82 37 45 50 54 72 102 107 70 98 112
120 100 80 82 50 54 72 45 102 107 98 70
50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

R eported D engu C e ases inM alaysia

Y ear

Reported Dengue Deaths in Malaysia

112

P/S : 28.12.2008 03.01.2009, 1157 cases were reported with 4 deaths so

60 40 20 0 1998 1999 2000 2001 37

2002

2003

2004

2005

2006

2007

2008

Year

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 mm]. Evidence of plasma leakage [rise in hematocrit level > than 20%]. Serology (identification of antibodies in the blood serum) & polymerase chain reaction (PCR)

SYMPTOMS
Sudden high fever (39-41.5C)

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

PREVENTIONS
There is currently no vaccine STRATEGIES available for the dengue fever. 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.

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

http://ms.wikipedia.org/wiki/Demam_Denggi http://en.wikipedia.org/wiki/Dengue_fever http://www.gov.my/MyGov/BI/Directory/Citizen/CitizenHe http://library.thinkquest.org/07aug/01614/dengue-malays http://www.dph.gov.my/vektor/eng/kes_dd_tahunan.htm http://www.infosihat.gov.my/isusemasa.php?id=17 http://www.myhealth.gov.my/myhealth/bm/template.jsp? http://wonder.cdc.gov/wonder/prevguid/p0000373/p0000 http:// www.who.int/csr/disease/dengue/en/index.html