Everyone must do their part as the number of dengue cases this year projected to break a new record

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PETALING JAYA: With the number of dengue cases this year projected to break a new record, health experts say a whole of society approach is what it takes to contain the surge.

They said piecemeal strategies such as fogging or mosquitoes with Wolbachia are not enough to stem an outbreak, and that it is the combination of methods that will save lives.

Time is also of the essence as there are already 59 deaths due to dengue logged this year from January to Sept 9, compared with 56 deaths for the whole of 2022.

There were also 82,485 cases from January to Sept 9, 2023, compared with the 66,102 cases in 2022.

Asia Dengue Voice and Action Group international adviser Prof Dr Tikki Pangestu (pic) said integrated efforts are needed to fight dengue not just by deploying mosquitoes infected with Wolbachia, or vaccines.

Countries at the recent 6th Asia Dengue Summit in Bangkok, Thailand, agreed that what is needed is an integrated holistic set of strategies and initiatives that has five key components, he added.

“The first one is straightforward – surveillance. That’s basically tracking and keeping tabs on viruses, on a number of cases, on the number of mosquitoes,” he said in an interview.

“Secondly, the health system must be ready to manage those who actually get sick with dengue and end up in hospital.

“About 90% of people who get dengue do not need to go to hospital. They can maybe go and see a GP (general practitioner), rest at home and that’s fine.”

“But for the serious cases, hospitals need to be ready to manage and take care of them,” said Prof Pangestu, who is a visiting professor at the Yong Loo Lin School of Medicine, National University of Singapore.

It is only then that vector control measures and vaccines can play a role, he added.

“But the fifth and final one, which is perhaps the most important in terms of a foundational stone behind all the other strategies, is community involvement.

“Community engagement, community buy-in, and community awareness of the dangers of dengue – that is the fifth column.

“It involves community education and community awareness so that in their everyday lives, they make sure that their immediate environment does not encourage mosquito breeding,” said Prof Pangestu.

Another expert, Dr Rahmat Dapari, said the projected outbreak later this year or next year could potentially surpass the historic number of cases in the 2019 outbreak.

Over 130,000 dengue cases were recorded in 2019, beating the previous historic high of 120,836 cases reported for the whole of 2015, said Dr Rahmat of Universiti Putra Malaysia.

But there were fewer deaths in 2019 at 182, compared with 336 in 2015, said the senior medical lecturer and public health medicine specialist.

Dr Rahmat said while various vector control measures have been implemented to reduce disease transmission, including the destruction of mosquito breeding places, fogging, community clean-ups and health education, these methods alone were not sufficient.

Innovations such as Wolbachia-infected mosquitoes and dengue vaccination are promising but there is still a need for communities to do their part, he added.

Wolbachia is a bacterium and a form of biological control that is naturally occurring in 60%-70% of insects, spiders and nematodes.

Selected strains of Wolbachia have been introduced into Aedes aegypti populations to prevent transmission of dengue viruses by the vector.

Currently, the Health Ministry has deployed Wolbachia-carrying Aedes in 28 localities in Malaysia.

“To this end, there needs to be a holistic approach using varied strategies so that dengue can be tackled from every angle.

“This involves collaboration between multiple agencies and different fields of expertise, as well as community engagement and education, together with diverse strategies that address breeding and transmission, and preventive methods,” said Dr Rahmat.

He added that the newly established Dengue Prevention Advocacy Malaysia (DPAM) also plays a crucial role in supporting the government to foster holistic dengue management strategies and reduce resource burdens.

“As a community, we must be well informed of these novel approaches and be more disciplined and proactive in doing our part to support the government in combating dengue.

“By working together, we can make a significant impact and create a safer and healthier environment for all Malaysians,” he said.

Tropical Infectious Diseases Research and Education Centre director Prof Dr Sazaly Abu Bakar said while the number of dengue cases in 2023 may seem high, it is not even half of the cases during pre-pandemic times such as in 2019.

“There must be a full and total commitment by the government to tackle dengue and not just leave it to the Health Ministry,” he said.

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It’s almost always flu season

Fighting off infection: Patients waiting to see a doctor amid the rise in influenza cases at a clinic in Wangsa Maju. — AZMAN GHANI/The Star

PETALING JAYA: Although there is a sharp drop in reported influenza cases this year, the highly contagious respiratory illness occurs all year round, says the Health Ministry, while reminding the public to take safety measures against it.

From January to July this year, the ministry logged 158 influenza clusters – compared with 255 clusters during the same period last year.

Of the 158 clusters reported this year, 54% were in schools, followed by kindergartens at 20%.

Health Minister Dr Zaliha Mustafa said the total number of cases reported from the 158 clusters was 4,606, whereas in 2022 the cases were three times higher or 12,876 cases from 255 clusters.

“The ministry still monitors influenza outbreaks and clusters that occur, although individual cases are not required to be notified by clinics and hospitals,” she said in an interview.

This is because influenza, or the flu, is not subject to mandatory notifications under the Prevention and Control of Infectious Diseases Act 1988 (Act 342).

Dr Zaliha said influenza tends to occur all year round and has the potential to attack all ages.

While most people recover within a week without requiring medical attention, some may require admission for close monitoring, she said.

Influenza and the common cold are both contagious respiratory illnesses but caused by different viruses, she added.

“The flu is caused by influenza viruses only whereas the common cold can be caused by a number of different viruses, including rhinoviruses and (human) parainfluenza (viruses),” she said.

Dr Zaliha said the best way to avoid infection is to get the influenza vaccine every year.

She also advised those with symptoms to avoid close contact with others and keep a distance to protect other people from getting sick too.

“Stay home when you are sick. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick,” she said.

Flu viruses, she noted, spread mainly by droplets made when people cough, sneeze or talk.

Dr Zaliha said practising good hand hygiene is also important to curb the spread of the flu.

Germs can also be spread when a person touches something that is contaminated with germs and then touches their eyes, nose or mouth, she said.

Other good health habits – such as cleaning and disinfecting frequently touched surfaces at home, work or school, especially when someone is ill – should also be practised, she added.

“Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food. Also seek immediate treatment if symptoms worsen,” she said.

Federation of Private Medical Practitioners’ Associations Malaysia president Dr Shanmuganathan TV Ganeson said the flu season peaks in May to July and November to January.“For the first 24 weeks of 2023 in Malaysia, there was 18.45% positivity for influenza of the specimens sent. The figures for Singapore were quite similar at 20%,” he said.

Dr Shanmuganathan said that as there are pockets of spread, the prevalence would vary from area to area and from time to time.

For example, he said that in May, Klang doctors commented on increased influenza A and B cases, but doctors in Kuala Lumpur did not seem to corroborate that increase.

Symptoms of influenza are fever, flu, cough and chest discomfort, sore throat, lethargy, headache and body aches, respiratory distress, and even vomiting and diarrhoea.

Meanwhile, the symptoms of the common cold are sneezing, stuffy nose, runny nose, sore throat, coughing, mucus dripping down your throat (post-nasal drip), watery eyes and fever.

“However, most people with colds do not have fever,” said Dr Shanmuganathan.

The at-risk groups include children below five years old, the elderly above 65 years old, those with chronic conditions like asthma, diabetes, heart disease or chronic bronchitis, persons with poor immunity like HIV, cancer and chemotherapy patients, healthcare workers and caregivers, he added.

Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh said Covid-19 has taught the world how to curb the spread of upper respiratory infections, and that the same principles could be applied to flu infections.

“The precautions are pretty similar to Covid-19, such as masking up, social distancing and hand washing – as well as isolation for those infected to control the spread,” he said.

Dr Kuljit also said that in July, private hospitals saw a rise in bed occupancy due to many factors, most notably influenza.

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Three months for booster shots for all after second dose of Pfizer, AZ, Sinovac, in view of high Omicron variant

 

` PETALING JAYA: Booster jabs for all Covid-19 vaccine recipients will now take place three months after they get their second shot following a decision by the Health Ministry to shorten the waiting period.

` More vaccination centres and clinics will also be opened to increase capacity.

` Previously, only Sinovac recipients got their booster shots 90 days after receiving their second dose while those on Pfizer and AstraZeneca had to wait 180 days.

` Health Minister Khairy Jamaluddin said the Covid-19 booster shots for Pfizer and AstraZeneca recipients could now be shortened to three months.

` He said recent data showed that the Omicron variant of the Covid-19 virus could cause increased transmission of infections and had higher viral binding affinity and higher antibody escape than vaccine-induced immunity or natural infections.

` “Strong evidence has accumulated over the past three weeks indicating that a Covid-19 booster vaccine is possible to increase protection against Omicron variant infections,” he told reporters here yesterday.

` A technical working group, he added, had also evaluated the existing evidence and provided new recommendations on the administration of Covid-19 booster doses.

` “All seniors aged 60 and above, and all adults who have received both doses of their vaccines (from Pfizer, AstraZeneca and Sinovac) are highly recommended to get their booster vaccine at least three months after receiving the primary vaccine.

` “Individuals with comorbidities, and residents and staff at healthcare centres will be given priority to receive the booster shots.

` “We will be using the age de-escalation approach for adults who have received two doses of their jabs, starting from 50 years and above, 40 years and above, and subsequently, 18 years and above.

 ` “Adults are expected to receive their booster shots in January and February and we will increase the capacity by opening more vaccination centres and private clinics,” he said.

` He added that heterologous vaccination – mixing vaccine types – was found to be safe and effective.

` “We will give priority to Pfizer and AstraZeneca as booster shots. However, we will look at an individual’s safety profile.

` “Sinovac will only be given to those who are contraindicated against Pfizer or AstraZeneca,” he said.

` The government, announced Khairy, would also lift the temporary travel restrictions against eight countries – South Africa, Botswana, Eswatini, Lesotho, Mozambique, Namibia, Zimbabwe and Malawi.

` “We will shift them from total ban to high-risk countries. However, we urge people to avoid any unnecessary travel to high-risk countries as the Omicron situation there is dangerous,” he said.

` Khairy said the Health Ministry was also considering taking action against the 1.4% of Covid-19 positive cases who violated the quarantine granted to them under the Surveillance and Observation Order between Dec 1 and 28.

` On another matter, he said the MySejahtera Trace (MySJ Trace) would use Bluetooth technology to allow easier close contact tracing with those who tested positive for Covid-19 in public areas.

` “It is highly recommended the public use this feature for their own safety.

` “To ensure the effectiveness of the feature, users are required to activate the Bluetooth on their devices when they are outside.

` “When a person is confirmed to be positive for Covid-19, a notification will appear through MySejahtera to request approval for the sharing of any close contact information that was detected.

` “Upon approval, MySejahtera will provide access to the Health Ministry to conduct a risk assessment on all the close contact data traced via Bluetooth before carrying out close contact tracing activities on identified individuals.

` “However, this will not take place if no approval is given by the individual and any close contact tracing will be done manually,” he said.

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Pfizer, AZ booster shots can be given at least three months after second dose, says Khairy 

 

 ` Reduce the risks: Khairy, seen at the Health Ministry in Putrajaya, says the government urges people to avoid any unnecessary travel to high-risk countries as theOmicron situation there is dangerous. — BernamaReduce the risks: Khairy, seen at the Health Ministry in Putrajaya, says the government urges people to avoid any unnecessary travel to high-risk countries as theOmicron situation there is dangerous. — Bernama

 

PETALING JAYA: Pfizer and AstraZeneca vaccine booster shots can be given at least three months after the second dose, says Khairy Jamaluddin (pic).

` The Health Minister made the announcement on the shorter interval for Covid-19 booster shots during a press conference on Tuesday (Dec 28).

` The move to shorten the interval is similar to measures taken by other countries such as Germany and Australia, which are recommending shorter booster intervals in an attempt to stop the spread of new variants.

` Khairy added that following the discovery of a confirmed Omicron case in a man in Sarawak who has no history of recent travel abroad, it is very likely that Omicron is now in the community.

` He said recent data showed that Omicron variants could cause increased transmission of infection, higher viral binding affinity and higher antibody escape than vaccine-induced immunity or natural infections.

` "Strong evidence accumulated over the past three weeks indicate that a Covid-19 booster vaccine is possible to increase protection against Omicron variant infections.

` "Results initially involving 21 million booster doses administered in the United Kingdom have shown very convincing security data.

` "In line with that, regulatory bodies such as in the United Kingdom, Canada and Australia, as well as a panel of health experts are now recommending an interval for booster dose vaccination can be given as early as three months after receiving the primer vaccine," he said at a press conference on Tuesday (Dec 28).

` Khairy added that the technical working group has also evaluated the existing evidence and provided new recommendations on the administration of Covid-19 booster doses.

` "All seniors aged 60 and above and all adults who have received both doses of their vaccines (Pfizer, AZ and CoronaVac) are highly recommended to receive their booster vaccine at least three months after receiving the primary vaccine.

` "Individuals with comorbidities, residents and staff at health care centres will be given priority to receive the booster shots.

` "We will be using the age de-escalation approach for those who are 18 years old and above and have received two doses of their jabs, starting from 50 years and above, 40 years and above, and subsequently 18 years and above.

` "Adults will receive their booster shots in January and February next year and we will increase the capacity by opening more PPV and private clinics," he said, adding that Sinovac booster shots would only be given to those who were contraindicated against Pfizer or AZ.

` Furthermore, Khairy said the government would lift the temporary travel restrictions to eight countries namely South Africa, Botswana, Eswatini, Lesotho, Mozambique, Namibia, Zimbabwe and Malawi.

` "We will shift them from total ban to high risk countries.

` "However, we urge people to avoid any unnecessary travel to the high risk countries, as the Omicron situation in these countries are dangerous," he said.

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Vital to control blood pressure now

  

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 MALAYSIA recorded 6,976 new Covid-19 cases on May 23, the highest number of daily cases reported since the start of the pandemic in March 2020. The number of Covid-19 deaths and severe cases that require intensive care has also increased tremendously.

According to Health Ministry statistics, from May 1 to 21, Malaysia lost 643 people, close to one-third of all Covid-19 deaths in the country since the pandemic started. Within the same period, patients admitted to ICUs increased by 91% (from 337 to 643) and patients requiring ventilation support doubled from 176 to 363.

Covid-19 has negatively impacted the care of patients with noncommunicable diseases such as hypertension and diabetes. Hypertension (high blood pressure) is the most common pre-existing medical condition among Covid-19 patients globally as well as in Malaysia. Patients with hypertension are 95% more likely to require ICU admission and 160% more likely to succumb to the disease. A local study reported that 49% of patients with the severe form of Covid-19 had hypertension, compared with 13% among mild cases. The high prevalence of hypertension in Malaysia – three in every 10 adults have it – means that a substantial proportion of our adult population is at risk.

Adherence to and compliance with medication is crucial. Stop-ping antihypertensive medications could lead to poor blood pressure control, which in turn can result in adverse cardiovascular events such as heart attack, stroke, or kidney failure. All these are linked to poor Covid-19 outcomes.

In addition, once the virus enters the body, it could lead to overactivation of the immune system resulting in a cytokine storm, further burdening a cardiovascular and respiratory system that is already in a suboptimal state. This probably explains why hypertension is the most common comorbidity among Covid-19 patients, especially among those who experience the severe version of the disease.

Maintaining a healthy blood pressure (below 140/90mmHg for systolic and diastolic respectively) is important. Take these steps to control your blood pressure:

> Know your blood pressure levels. Monitor them regularly. This is important to see whether efforts to control the pressure are sufficient or should be improved.

> Limit salt intake in your diet according to daily recommendations. This can be achieved by carefully inspecting food labels for salt and sodium content, avoiding preserved and processed foods, and replacing salt with herbs and spices in cooking.

> Keep your body weight within the normal range. For overweight people, weight loss of 3% to 9% from current body weight has been shown to reduce blood pressure readings by 3mmHg to 6mmHg.

> Exercise consistently. Regular aerobic exercise, such as brisk walking and jogging, for at least 150 minutes a week is recommended as it is beneficial for the cardiovascular system and can help lower blood pressure.

> Quit smoking and avoid alcohol intake as both activities have been shown to increase blood pressure.

> Keep taking your current medications and continue to go for follow-up appointments if you are hypertensive. Be assured that the medications are safe. Do not hesitate to contact your doctor if you are in doubt about your blood pressure control or medications.

Apart from all this, hypertensive patients must seriously follow the current Covid-19 SOP and make every effort to protect yourselves from contracting the disease.

DR NOR AFIQAH NORDIN, DR ANG SWEE HUNG, PROF DR MOY FOONG MING & PROF DR NORAN NAQIAH HAIRI Public Health Department, Universiti Malaya Medical Centre (UMMC)

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