Dengue cases are sky-rocketing in Malaysia this year. As of May 21, 2015, 44,524 cases had been reported, an average in excess of 300 cases each day. What’s more there have been an unprecedented 136 deaths, with the most recent reported on May 16. When you consider numbers from previous years, 2015 numbers are a real cause for concern.

Data taken from WHO Dengue Situation Updates. *2015 figures are extrapolated.

Nearby, Vietnam’s Ministry of Health has also reported a surge in dengue cases. A total of 9,727 cases and eight deaths had been reported as of April 19. Cases have increased by 23% and deaths have doubled compared to the same period in 2014.

Prevention is more cost effective than cure

Back in February, the World Health Organization (WHO) sent a press release urging governments to increase investment in tackling neglected tropical diseases. In it, they highlight how “increased investments by national governments can alleviate human misery, distribute economic gains more evenly, and free masses of people long trapped in poverty.”

Malaysia is one such country increasing investment in dengue prevention. In February this year, Prime Minister Najib Raza told the Bangkok Post that the government was intensifying its efforts to deal with the mosquito-borne disease. Efforts include sanitation awareness campaigns and taking actions against contractors who neglect cleaning up their work sites. Earlier in the year, the Ministry of Health had also announced that homeowners who failed to remove mosquito breeding grounds in their premises within 14 days would be fined RM500 (approximately $135).  

“There is public education on dengue and the Ministry of Health has run nationwide campaigns aimed at removing blockages and cleaning up potential dengue breeding sites,” Dr. H. Krishna Kumar, president of the Malaysian Medical Association (MMA), told us. “Dengue management has been standardized through a fixed protocol. Whenever there is a positive test, for example, the whole housing area is fumigated.”

A cooperative approach

The number of hospital beds available in Malaysia is still relatively low. This means that whenever there’s an outbreak in a specific region, hospitals get filled up quickly and some of the most serious cases don’t get admitted.

The state of Selangor is Malaysia’s biggest dengue hotspot, with more than half the total number of cases: 27,777 cases as of June 2. The state government is cooperating with Malaysia’s national Ministry of Health to contain the spread of dengue and find the best ways to fight the disease. In February, Selangor Mentri Besar (Great Minister) Mohamed Azmin Ali told The Sun Daily how the collaboration was key to combating the steep increase in cases seen across the state despite the prevention measures in place.

Across the state local authorities carry out weekly drainage maintenance work to ensure the system is free from Aedes mosquito breeding grounds. And, since the most common breeding grounds used to be found inside houses, it fines both tenants and property owners if their buildings are deemed to be breeding grounds.

Communities remain key

Dr. Kumar believes Malaysia has reached a stage where it can’t ask its politicians to do anything more. It’s now up to local authorities to ensure they are doing all they can and to the general public to realize that work together to combat dengue is in their best interest.

“Some local councils are not monitoring and clearing up potential breeding areas as efficiently as they’re supposed to,” he reveals. “In this country, we are very good at building things but very poor at maintaining them and enforcing laws.” The MMA president feels there are still a lot of opportunities for people to flaunt the law, suggesting there aren’t as many enforcement officers as needed simply because fining people is politically unpopular.

Despite dengue being rampant in urban areas, apathy among the general public is still apparent and Dr. Kumar is concerned. “People leave lots of empty containers around, which quickly become breeding grounds for dengue. They just don’t care. Everybody thinks the disease is not going to affect them until it affects them, and then, after that, they start reacting. We need to change how the public looks at dengue and make it a personal responsibility for every individual to contribute to preventing this disease.”

“People need to take responsibility for their own health,” adds Dr. Kumar who is using the media to tell the public to be more involved rather than depending on other people.
New hope

A portable dengue test kit has brought Malaysia some hope. However, even though it gives results from just one drop of blood, it still has its limitations. “The kit only gives a positive result after 72 hours,” reveals Dr. Kumar. “When patients present with atypical or severe dengue symptoms, even if you test them there and then, the result won’t be positive. You have to wait for a few days before you know.”

But there is another new prospect on the horizon. In February, Malaysia’s Deputy Health Minister YB Dato’ Seri Dr. Hilmi Bin Haji Yahaya told reporters that a French-made dengue vaccine was expected to be available across the ASEAN region by mid-2015 – and announced that the vaccine would be available to the public for free in Malaysia.

“We hope that by vaccinating the population we can prevent people from actually developing the disease,” notes Dr. Kumar. “That would help us.”

But with Malaysians tending to be reactive rather than proactive, the vaccine’s effectiveness will depend on the cooperation of the general public. With uptake of vaccines historically low in Malaysia, a very persuasive campaign will be needed to motivate the population to actually get the shot.