Wednesday, March 11, 2009

Dengue Fever

Extracted from ST Online 11 March 2009

Dengue threat growing in Asia-Pacific
It caused more than 3,000 deaths in S-E Asia last year
By Jessica Jaganathan

DENGUE fever, an old enemy to the region, is gathering strength, with almost three times as many people in South-east Asia dying of the haemorrhagic form last year, compared with five years ago.
Far from defeated, it is fast spreading to newer areas in the Asia-Pacific region, and with more frequent outbreaks. Altogether, 1.8 billion people in the region are at risk of being infected.

The disease has also become more severe. According to latest statistics from the World Health Organisation (WHO), cases of dengue haemorrhagic fever - in which uncontrollable bleeding occurs - have increased by more than 70 per cent since 2003.

Last year, 3,255 people died of it in South-east Asian countries, compared with 1,202 in 2003.

The deaths are a concern, as they reflect the medical community's inability to manage the cases, said WHO South-east Asia Region's Communicable Diseases Control coordinator Chusak Prasittisuk.

'The medical community may need more training because the younger generation of practitioners may not be aware of early detection and proper case management. This is our big concern.'

In Singapore, dengue cases were up in the first nine weeks of the year, with 1,205 people infected, compared with 951 during the same period last year. The authorities are studying if the increase is part of the normal cycle.

Last year, Singapore recorded 7,032 cases, a 20 per cent dip over the 8,826 in 2007. It bucked the trend, as the rest of the region saw an upswing in cases.

Dr Prasittisuk said dengue fever was spreading to countries that were unaffected before, such as Nepal, Bhutan and Timor Leste. Within countries, it is moving from urban to rural areas, where malaria is usually the main scourge.

A regional and international approach is essential to tackle the disease, which is spread by the Aedes aegypti mosquito, he said.

Dr Prasittisuk was speaking at the opening yesterday of the first Asia-Pacific dengue workshop in Singapore, organised by the WHO, Ministry of Foreign Affairs and National Environment Agency (NEA). Forty-two participants from 29 countries are taking part in the workshop, which runs till next Thursday.

It is part of the Asia-Pacific Dengue Strategic Plan, by the WHO and its member states, to eradicate the disease in the region. This trip to Singapore will comprise site visits and field experience to study Singapore's dengue programme.

NEA chief executive officer Andrew Tan said Singapore took a proactive and pre-emptive approach to reduce mosquito breeding and 'deal with the problem before it hits us'.

'The long-term goal through a workshop like this and through future workshops is to develop a regional surveillance network that will allow us to share information, such as the different genotypes of dengue and best practices not only from the laboratory, but also in the field,' he said.

The head of Duke-NUS Graduate Medical School's emerging infectious diseases research programme, Professor Duane Gubler, said dengue's resurgence in the region could be due to the lack of effective mosquito controls in most countries, the movement of virus vectors around the world by air travel, and a continuous importation of new viruses to which people are not immune in the cities.

Dengue cases usually follow a six- to seven-year cyclical trend, with each year surpassing the one before. Singapore is now in the third year of a cycle that began in 2007. Mr Tan said Singapore should remain prepared for the year ahead. He said the NEA would work with the community to ensure simple measures to eradicate mosquito breeding in homes and offices are followed.

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