| Probe |
august-september, 2020 | The Health
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How effective have been the measures
such as increasing fogging?
The MoH conducts active monitoring and
surveillance of dengue cases and vectors
to ensure the effectiveness of control
interventions. As such, strategies under the
entomological surveillance are carried out
to ensure that the dosage of the insecticides
used is appropriate and sufficient to kill
the mosquitoes. Control activities such as
fogging must be done within 24 hours of
receiving the notification of dengue cases.
How can the Ministry of Health (MoH)
address the apathy of the public towards
the dengue menace?
The MoH is continuously advocating
community participation in dengue
prevention and control activities
by becoming volunteers for the
Communication for Behavioral Impact or
COMBI group.
Until July 2020, there were 2,974 COMBI
groups all over Malaysia with participation
from 25,644 volunteers. There are other
ministries and agencies involved in the
dengue prevention activities such as the
National Dengue Task Force Committee.
Do you think we are anywhere near
developing a suitable vaccine for
dengue?
Malaysia has participated in the
development of dengue vaccine previously.
DEADLY BITE ...
Prevention is better
than cure.
However, there is no valid medical evidence
on the effectiveness and safety of the
vaccine to the public.
According to the WHO, decisions
about implementing vaccine require a
careful assessment at the country level,
including sensitivity and specificity of a
dengue screening test before initiating the
vaccination, dengue hospitalisation rates,
and affordability of both the vaccine and
screening tests.
Therefore, vaccination should be
considered as part of an integrated dengue
prevention and control strategy together
with a well-executed and sustained vector
control and the best evidence-based
clinical care.
do the work.
However, people tend to focus and
worry about the fever and they would try
to control it by taking medications such as
paracetamol or ibuprofen. She stresses that
taking such medications is not advisable
because it will affect the liver in the long run.
Instead, they should rest and consume more
water.
“There are no specific antiviral agents
or medication for dengue. However, the
patient’s immune system can fight the virus.
“So, as doctors, we evaluate and provide
the necessary support, such as fluids for the
patient’s self-healing process,” she said.
Early detection of severe dengue is crucial
as it enables clinicians to make critical
decisions and initiate drastic management.
Here is where biomarkers come into play.
Dr Tan, who has published a book on
dengue biomarkers, is looking into the
potential biomarkers that associate with
severe dengue in our population.
“Liver enzymes and haematological
markers are highly researched. When the
markers rise, it usually leads to worsening
conditions.”
He said this phenomenon is not only
observed in Malaysia but also in India, Sri
Lanka and Pakistan.
Both Dr Tan and Dr Lucy urged the public
to seek immediate treatment because early
detection can reduce severe dengue and
dengue mortality.
Vaccine
The first licensed dengue vaccine is the
Dengvaxia® vaccine. However, it is not
licensed in Malaysia.
Dr Lucy explained that when a person
who is vaccinated with Dengvaxia® gets
infected for the first time, the body will
most likely not recognise it as the primary
infection.
“This is because there is already an
immunisation going on. So, the body
(Left) Liver enzymes and
haematological markers
are highly researched.
When the markers rise, it
usually leads to worsening
conditions, say Dr Tan
Dr Lucy stressed during
the critical phase, a patient
could die within a day. This
is because the leakiness
is massive, especially in a
young child.
responds severely as if this was the second
infection. The patient is most likely to be
hospitalised.”
She also revealed most of the trials were
done among children as dengue is most
common among them in Third World
countries.
“No trial was done in adults, so we can’t
expect adult patients to react the same way
as children.”
Director-General of Health Tan Sri
Dr Noor Hisham said: “Malaysia has
participated in the development of dengue
vaccine previously. However, until today
there is no valid medical evidence on the
effectiveness and safety of the vaccine for
the public.” — The Health