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Dengue: Bracing for Another Wave

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Dengue is a viral disease transmitted by female mosquitoes (especially Aedes aegypti) and is widely distributed throughout the tropics and subtropics region in the world. The virus responsible for causing dengue is dengue virus (DENV), which comes in four different types and can infect the same person four times. Recently, there has been a surge in cases in South East Asia countries, including Singapore, where more than 8,000 cases have been reported so far this year, surpassing the total number of cases in 2021. This article will bring to you all the latest information we have on dengue. 

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Prevalence of Dengue

Dengue is the fastest spreading mosquito-borne viral disease globally, affecting more than 100 million people annually. It also causes up to 36,000 deaths each year, primarily in children, and is found in more than 100 countries. 70% of the global cases and death comes from Asia. Specifically, from 2015-2019, dengue cases in South East Asia region increased by 46%, with 2% decrease in total death number. Scientific study has revealed that the best temperature for transmission of dengue is between 21.6 °C and 32.9 °C, which is the usual temperature across the South East Asia and South America region, likely explaining the numbers behind the dengue statistics.

Taking a closer look at the situation in South East Asia right now, the Malaysia Ministry of Health reported nearly 13,000 cases in early May, compared to around 9,000 cases for the same period in 2021, an increase of nearly 40%. In Thailand, though the case number has reduced in the past two years, 200 cases have been reported in January this year, with 2 people died. In Singapore, more than 8,000 cases with 280 active clusters have been reported so far this year, surpassing the total number of cases in 2021. The numbers across the region are expected to rise in the second half of the year, partially due to relaxed COVID restrictions. 

Symptoms of Dengue

Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of the following symptoms during the febrile phase (2-7 days):

  • Severe headache
  • Pain behind the eyes
  • Muscle and joint ache
  • Nausea and vomiting
  • Loss of appetite 
  • Swollen lymph nodes in arm pits and neck 
  • Rash 

In severe cases of dengue, people can develop dengue haemorrhagic fever, presented with:

  • Multiple organ failures 
  • Bleeding from nose and under the skin 
  • Blood vessel damage 
  • Liver failure
  • Acute kidney injury

If you have any of the above symptoms and live in area with known dengue cases, go to a local hospital immediately, where doctors can offer serological test to confirm a current or recent infection. Even if dengue does not sound as scary as COVID-19, it can certainly kill people by causing complications such as multiple organ failures and systemic shock. DO NOT delay consulting your doctors. 

Treatment

Unfortunately, there is no specific anti-viral treatment developed for dengue virus. Symptomatic treatment including fluid administration to avoid dehydration, and paracetamol to relieve the fever and headache. 

In people with severe dengue, blood transfusion with ICU admission should be considered in case of significant internal bleeding. Nasal gastric tube feeding, and/or dialysis could also be utilised in organ failure. 

Preventative measures 

One of the key preventative options may be the use of vaccination. Since the development of dengue vaccine started in 1920s, only one vaccine – Dengvaxia, has been made commercially available, and was approved by US Food and Drug Administration in 2019. So far, it has only been approved in a few countries, such as the US, Singapore, Brazil, Thailand, Indonesia, due to its very limited use – it is only available to be used for people aged 6-45 years who have had previous dengue infection. Dramatically, in 2019 the Philippines had to ban the use of Dengvaxia due to the death of several children after receiving this vaccine. 

There are no current medical or pharmaceutical prevention measure in place. However, here are some handy lifestyle advice to prevent yourself from getting exposed to mosquitoes and subsequently the dengue virus: 

  • Wear long sleeves and pants tucked into socks: that’s the single most effective way to avoid mosquito bite. Mosquito bite is the only possible way this virus can transmit. 
  • Use mosquito repellent 
  • Avoid heavily populated residential areas
  • Close window and room door at night
  • Keep your room dry: do not allow water to collect. Water is where mosquitoes breed.

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