6 Nov 2024
Towards Zero Dengue Deaths
Musa Mohd Nordin
There has been 106,773 cases of dengue reported up until the 41st Epidemiology Week (EW) in 2024. This is 12,592 more than the cases reported for the same period in 2023. (Diagram I)
The number of dengue associated deaths has increased from 67 in 2023 to 96 in 2024, as at the 41st EW. (1)
Diagram I
Selangor bears the highest dengue burden, accounting for 50% of the total cases. The Unity Government states of Selangor, Johor, Wilayah Persekutuan, Perak, Negeri Sembilan and Penang is responsible for 85% of dengue cases in the country. (2) (Diagram II)
Diagram II
For the 41st EW, Selangor was home to 22 of 38 (57.9%) dengue hotspots in Malaysia. (Diagram III)
Diagram III
Selangor has the largest economy in Malaysia contributing 25.9% of Malaysia’s GDP of RM450 Billion (USD$100 Billion) in 2023. (3)
It is the most developed state in Malaysia.
It is undisputable that dengue is a significant public health issue in Selangor.
Addressing and reducing the dengue burden in Selangor will be crucial not only to the state but also to the nation.
The adolescents, young and mature adults between 11-40 years old are the most susceptible groups for contracting dengue infection in Selangor.
These age groups, who are also the most economically productive, account for 50.2% of the total estimated population in Selangor in 2023
This will impact patients; or caregivers’ productivity and eventually affect the economic growth of Selangor. (Diagram IV)
Diagram IV
DENGUE INTEGRATED MANAGEMENT STRATEGY
An Integrated Management Strategy (IMS) for the prevention and control of dengue has been operational since 2012. (Diagram V)
Diagram V: Integrated Management Strategy
One of the pillars of IMS is Integrated Vector Management (IVM). The total cost of vector control nationwide in 2018 is reported to be MYR260 million.
While there is no data on the total cost by state, it is safe to assume that a significant amount was spent on Selangor – as the state with the highest number of cases annually. The Selangor state government allocated MYR4 million annually for dengue prevention and control activities
One of the key performance indicators (KPI) of Integrated Vector Management (IVM) activities against dengue in Malaysia is100% controlled outbreaks. This is defined as zero new case reports in a specific locality within 14 days after the second dengue case is reported
Selangor recorded the lowest percentage of controlled outbreak when compared to other states between 2019-2024. In 2023, Selangor recorded only 84.1% of controlled outbreaks. As of epidemiology week 24, 2024, it was 83.9%, well below the target. (Diagram VI)
Diagram VI
The impact of these IVM activities in reducing dengue cases remain unclear. Vector control has achieved only limited success in reducing Dengue transmission.
The existing IMS with a public focus on IVM has not been effective in reducing the burden of dengue in Selangor within the context of the national dengue burden. (Diagram VII)
Diagram VII
Dengue imposes a considerable economic burden in Malayisa. The estimated cost of dengue illness in Malaysia in 2009 was MYR196 million per year, which is MYR7.14 per capita. (4)
The total cost of dengue would be even higher if costs associated with dengue prevention and control, dengue surveillance, and long-term sequelae of dengue were included in the equation.
Therefore, health policies aimed at preventing and controlling dengue effectively and efficiently would be economically invaluable. Enhancing the immunity of the host through vaccination is another viable public health iniative to be seriously considered. The dengue vaccine should be incorporated as part of an integrated approach to dengue prevention and control.
THE DENGUE VACCINE.
The dengue vaccine efficacy study (DEN-301) was undertaken in 4 Latin American countries and 3 countries in Asia. There were 20,071 children and adolescents aged 4-16 years, who were investigated over a period of 54 months.
The results are very encouraging. The vaccine efficacy (VE) against symptomatic dengue at 4.5 years was 61.2%. The efficacy of 60~% was maintained from the 3rd year onwards, thus we may not even need a booster. Nonetheless, trials are underway to investigate the need for a booster dose. (4)
The overall VE against hospitalisation at 54 months was 84.1%. This would most certainly reduce the severity of dengue experienced by the vaccinee and reduce the burden on hospital admissions.
The total rates of unsolicited Serious Adverse Events (SAE) were similar in the dengue vaccine and the placebo groups.
CONCLUSIONS
The dengue burden in Malaysia, notably in Selangor is a major public health challenge. The economic burden of dengue is high. There are gaps in the current public health initiatives. The dengue vaccine is another tool in the prevention and control of dengue. The dengue vaccine shows sustained long -term protection against dengue disease and hospitalizations and there are no major safety risks.
The Ministry of Health and in particular the state of Selangor must urgently and seriously consider the incorporation of the dengue vaccine as a major pillar in their IMS for the prevention and control of dengue.
REFERENCES:
1.file:///Users/musamohdnordin/Downloads/KENYATAAN%20AKHBAR%20ME%2041-2024.pdf
2. https://idengue.mysa.gov.my/ide_v3/index.php
3. https://www.malaymail.com/news/malaysia/2024/07/02/dosm-selangor-top-contributor-to-malaysias-2023-gdp/142535
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3516253/
5. Tricou V, et al. Lancet Glob Health 2024;12:e257-70
