There have been 106,773 cases of dengue reported up until Epidemiology Week (EW) 41 in 2024. This is 12,592 more than the cases reported for the same period in 2023. (Diagram 1)
The number of dengue-associated deaths has increased from 67 in 2023 to 96 in 2024, as at EW 41.
Diagram 1
Selangor bears the highest dengue burden, accounting for 50 per cent of the total cases. The states of Selangor, Johor, Perak, Negeri Sembilan, Penang, and the Federal Territory are responsible for 85 per cent of dengue cases in the country. (Diagram 2)
Diagram 2
For EW 41, Selangor was home to 22 of 38 (57.9 per cent) dengue hotspots in Malaysia. (Diagram 3)
Diagram 3
Selangor has the largest economy in Malaysia, contributing 25.9 per cent of Malaysia’s GDP of RM450 billion in 2023. It is the most developed state in Malaysia.
However, it is also indisputable 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.
Adolescents and adults between 11 and 40 years old comprise the most susceptible groups for contracting dengue infection in Selangor.
This age group, which is also the most economically productive, account for 50.2 per cent of the total estimated population in Selangor in 2023
This will impact patients and caregivers’ productivity, and eventually affect the economic growth of Selangor. (Diagram 4)
Diagram 4
An Integrated Management Strategy (IMS) for the prevention and control of dengue has been operational since 2012. (Diagram 5)
Diagram 5
One of the pillars of IMS is Integrated Vector Management (IVM). The total cost of vector control nationwide in 2018 is reported to be RM260 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, since it is the state with the highest number of cases annually.
The Selangor state government has allocated RM4 million annually for dengue prevention and control activities
One of the key performance indicators (KPI) of IVM activities against dengue in Malaysia is controlled outbreaks. This is defined as zero new case reports in a specific locality within 14 days after the second dengue case has been reported
Selangor recorded the lowest percentage of controlled outbreaks when compared to other states between 2019 and 2024. In 2023, Selangor recorded only 84.1 per cent of controlled outbreaks.
As of EW 24, 2024, it was 83.9 per cent, well below the target. (Diagram 6)
Diagram 6
The impact of 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 7)
Diagram 7
Dengue imposes a considerable economic burden on Malaysia. The estimated cost of dengue illness in Malaysia in 2009 was RM196 million per year, which translates to RM7.14 per capita.
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 initiative that should be seriously considered. The dengue vaccine should be incorporated as part of an integrated approach to dengue prevention and control.
A dengue vaccine efficacy study (DEN-301) has been undertaken in four Latin American countries and three countries in Asia. There were 20,071 children and adolescents aged between 4 and 16 years old 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 per cent. The efficacy of ~60 per cent was maintained from the third year onwards, thus eliminating the need for a booster. Nonetheless, trials are underway to investigate the need for a booster dose.
The overall VE against hospitalisation at 54 months was 84.1 per cent. 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.
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 an important tool in the prevention and control of dengue. The dengue vaccine has shown to have sustained long-term protection against dengue disease and hospitalisations, and there are no major safety risks.
The Ministry of Health (MOH), and in particular the Selangor state government, 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.
Dr Musa Mohd Nordin is a paediatrician at KPJ Damansara Specialist Hospital.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
