Malaysia - Malaysia Registers 25,000 Cases of Dengue Fever in Three Months

Kuala Lumpur, Malaysia, Apr 25 (Prensa Latina) Malaysia has registered nationally almost 25,000 cases of dengue fever, the Malaysian Public Health Vice Minister, Hilmi Yahaya has confirmed

Hilmi Yahaya stated that from January until April 24th, 42,683 cases have been reported, a rise of almost 5,000 in comparison with the same quarter last year.

Ninety-four people have died in the same period, which is a reduction on the 120 victims who succumbed to the disease in same quarter in 2015.

According to official data, during January and February this year, the authorities inspected almost 1,000 areas, imposed 3,260 fines and took 353 cases to court.

Yahaya thanked other ministries and governmental agencies for their help in the national operation, which started on April 11th, against the Aedes Aefypti mosquito - the transmitter of the disease.

Analysts have said that the country's initiatives against dengue fever are ineffective, despite being regional pioneers in research on the transmitting agent.

In 2011, Malaysia sterilized 6,000 male mosquitoes and released them to mate with females with the aim of reducing the mosquito population.

The experiment was the first of its type in Asia and although the population of mosquitoes has been reduced, this has not led to a drastic reduction in the incidence of dengue fever.

According to the World Health Organization, in 2015, the hospitals in Malaysia treated 111,000 suspects dengue fever cases, an increase of 16 percent in comparison to 2014.

The WHO also reports that in 2015, 390 million cases of dengue in at least 128 countries were reported.

Dengue fever is transmitted by the bite of the female of the Aedes Aegypti that nests in stagnated waters.

The symptoms are fever, headache, and pains in the joints and muscles.

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Singapore - Evolution of dengue epidemic "at a critical juncture"

Environment and Water Resources Minister Dr Vivian Balakrishnan said Singapore has "reached a critical juncture" in the evolution of the dengue epidemic.

820 cases were reported last week, bringing the total number to 9,421. That is the highest ever in Singapore's history, surpassing even the previous peak during the 2005 epidemic.

The minister said it is going to get worse before it gets any better.

Apart from the rising numbers, there is evidence that dengue clusters are spreading across Singapore from the east, west to the northern regions.

There are four contributing factors to the current epidemic. Firstly, the Aedes mosquito is now predominant across the island. Secondly, the currently circulating dengue virus - Dengue Serotype 1 - has higher epidemic potential. Thirdly, the low immunity amongst the population makes people more vulnerable. Lastly, the hot and wet weather accelerates the life cycle of the Aedes mosquito and increases the likelihood of stagnant water accumulating.

Dr Balakrishnan said: "Our numbers are still rising and we are going into a peak dengue season so we cannot afford to lose control at this stage."

The National Environment Agency (NEA) will step up surveillance and inspection.

It will recruit another 300 officers over the next two months so that all premises in dengue clusters can be checked within a week.

Officers will be equipped with a new aerosol spray and it will be applied to dark corners of homes. The spray is said to last in the air longer and is more deadly to mosquitoes.

1.2 million insect repellents will also be distributed for free to households in dengue clusters.

Homes remain the top culprit for breeding spots.

Mr Balakrishnan said: "Infectious diseases are a test of special cohesion as a society and we need everyone to understand that our own health depends on the health of our neighbours and we need to exercise personal and collective responsibility for each other."

The Health Ministry has sent circulars to hospitals reminding them to be on heightened alert and give priority to returning A & E patients.

It has also released an additional 160 beds since March 2013, of which only 10 per cent are in use. By the end of the year, there will be another 90 beds added.

Dr Amy Khor, Minister of State for Health, said: “We have been working with every hospital, right down to the restructured hospitals to see where the added capacity can come from. And as the minister has said, the total absolute number of additional beds is there to cater to any surge in demand for beds due to dengue cases."

So far, only about 1.8 per cent of beds in public hospitals are occupied by dengue patients. Less than 30 per cent of dengue cases are admitted to hospital.

On the management of suspected dengue patients, authorities stressed that proper procedures are in place.

They added that most patients do recover from the disease.

So far, there have been two dengue-related deaths here this year.

The victims died after being discharged from A & E and re-admitted to hospital due to worsening conditions.

This has led some to raise concerns over the way suspected dengue cases are managed.

"Our doctors are working very hard on the ground... We can all sit down here and pontificate but there is no substitute for clinical judgement and one-on-one interaction for doctors. Our duty at the ministry level and administrative level is to make sure all the resources that are needed are available, so that whether you need beds, whether you need drugs, whether you need drips, whether you need any diagnostic tools, all those things are available, so that doctors can do what they do best," said Dr Balakrishnan. 

- CNA/xq/ir

Singapore - Dengue fever surges in Singapore 9,000 sickened

Singapore is telling doctors to be more vigilant against dengue fever as the mosquito-borne disease surges this year. The Southeast Asian city-state has had more than 9,000 cases and two deaths since January.

The illnesses counted so far in 2013 are already twice the total for all of last year. Singapore's health ministry said in a statement late yesterday that it has alerted clinics in neighborhoods where dengue cases have spiked and has advised all medical practitioners about the early diagnosis and close monitoring of patients.

Dengue fever, spread by the Aedes aegypti mosquito, is common in Asia and Latin America. Symptoms include high fever, joint pains and nausea, but in severe cases, it can lead to internal bleeding, liver enlargement, circulatory shutdown and death. Part of the reason for this year's increase is that the dengue virus seems to be showing more strength and resistance, said Asok Kurup, a doctor at Mount Elizabeth Hospital's infectious diseases care center, who has treated dozens of dengue cases this year.

Officials have urged Singaporeans to take precautions and clear stagnant water where mosquitoes breed, but some residents say the main responsibility lies with the health care system. "With so many cases occurring, shouldn't the vigilance fall on our doctors instead?" said homemaker Audrey Quek, whose teenage son had dengue two years ago. She said doctor initially mistook his fever and joint pains for flu symptoms, but he survived.

Authorities say they're taking other measures such as increasing insecticide fumigation and sending officers to inspect locations where mosquitoes might breed. Public awareness campaigns are also being planned, including an online reality show focusing on environmental officers on anti-dengue patrols.

Singapore imposes tough penalties on residents whose homes are found to be mosquito breeding areas. Offenders can be fined and jailed three months. Singapore's worst dengue outbreak in recent years was in 2005, when nearly 14,000 cases and 25 deaths were reported.

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Malaysia - Dengue fever claims second victim

A SECOND person has died after being infected by the dengue virus in the current epidemic, which has affected more than 9,200 people here so far.

The 60-year-old man was admitted on his second visit to Tan Tock Seng Hospital’s (TTSH) emergency department.

A joint statement from the Ministry of Health and the National Environment Agency (NEA) said he had gone to the hospital last Wednesday “with fever, shortness of breath, vomiting and a rash on his left leg”.

The man, who lived in Ang Mo Kio Avenue 3, was diagnosed with skin inflammation of the left leg. He was given antibiotics and told to go to a polyclinic for a blood test at a later date.

But he returned to TTSH late last Friday night when his leg got so weak that he could hardly stand on it.

He was still having fever and had no appetite.

He was sent to a general ward the next day and diagnosed with dengue. Within hours, his condition worsened, and he was transferred to the intensive care unit.

He died of dengue shock syndrome yesterday morning.

Last month, Mr Ang Yong Han, 20, became the first casualty in this year’s dengue epidemic, expected to be the biggest Singapore has ever experienced.

He had gone to TTSH’s emergency department, but was given some Panadol and told to see a doctor three days later if he still felt sick. But he was feeling so ill that he returned to TTSH three days later and was warded. He died two days after that.

A TTSH spokesman said the latest victim had “multi-organ failure and complications associated with abnormal heart rhythm”. At the time of admission, he also had blood poisoning and suffered from diabetes and high blood pressure.

During the 2005 epidemic – when 14,000 people were infected and 25 died – half the dengue sufferers were warded. In the current one, about one in four is being warded. Hospitals are being more stringent in who they admit, largely because experts feel most do not need such care, and possibly due to the bed crunch at public hospitals.

TTSH, for example, has occupancy rates of over 90%.

Health Minister Gan Kim Yong has said that should the need arise, hospitals will postpone non-urgent surgery to find beds for dengue patients.

Dr Lam Pin Min, chairman of the Government Parliamentary Committee for Health, said: “It is imperative that all health-care givers stay vigilant and take all febrile cases seriously.

“Early cases may be deceptive and passed off as a viral fever or influenza. The full-blown symptoms and signs may not appear till later stages.”

His advice is to return to hospital should their fever persist.

Although there is no existing dengue cluster near the dead man’s home, NEA said it is stepping up its control of mosquitoes in that area.

The Straits Times / Asia News Network

Singapore - Immunology: Vaccine hope for virile virus

A*STAR researchers have shown that the antibody produced in the initial immune response to CHIKV recognizes the protein E2 and binds to a specific site called E2EP3, seen here in red. This site projects from the surface of the virus, making it easily accessible to the antibody.

Exploiting the early immune response in Chikungunya fever promises to provide protection

Chikungunya fever is a viral disease that has re-emerged to cause epidemics in the Pacific region within the last decade. It is caused by the Chikungunya virus (CHIKV), which is transmitted by mosquitoes and causes symptoms including fever, rash and joint pain. It can be incapacitating, with some patients developing severe chronic symptoms, and it is sometimes fatal. The main current control measure is to prevent exposure to mosquitoes; a vaccine would reduce the threat of CHIKV.

Lisa Ng of the A*STAR Singapore Immunology Network and co-workers1 have now provided insight into the natural immune response that may help in developing a vaccine. Ng’s group showed previously that the initial immune response to CHIKV is spearheaded by a specific class of antibody that disables the virus when bound to it. Their latest research reveals a way to exploit this clinically.

Working with clinicians at the Tan Tock Seng Hospital, Ng and her team took blood samples from CHIKV-infected patients and tested them to see if they contained any antibodies that recognize proteins from the surface of the virus. They found that at early stages of recovery, patients’ blood contained large amounts of an antibody that targets a protein known as E2, which projects from the surface of CHIKV (see image). The same antibody was found in different groups of patients, showing that it is a reliable indicator of early infection.

The team confirmed that this antibody neutralizes CHIKV by adding blood samples to virus which was then used to infect susceptible human cells. If the blood samples contained the antibody, infection rates were reduced, whereas removing the antibody from the samples beforehand left infection rates high.

Having identified that the antibody recognizes E2, the researchers then tested its ability to recognize fragments of the protein. This allowed identification of the epitope, or the exact site on the protein, that the antibody binds to, which they called E2EP3.

When they vaccinated mice with a protein fragment equivalent to this epitope, the mice produced the same antibody in response. On subsequent infection with CHIKV, the vaccinated mice also showed milder symptoms, making the epitope a promising basis for a future vaccine in humans.

“[This study is] highly relevant for the rational design of CHIKV vaccines and for the development of diagnostics for optimal clinical management of patients,” says Ng. “It may also inspire similar studies with other arthritic arboviruses that in many parts of the world cause severe morbidity with extensive incapacitation.”

The A*STAR-affiliated researchers contributing to this research are from the Singapore Immunology Network and the Institute for Infocomm Research

References

1. Kam, Y-W et al. Early neutralizing IgG response to Chikungunya virus in infected patients targets a dominant linear epitope on the E2 glycoprotein. EMBO Molecular Medicine 4, 1–14 (2012). | article

USA - Allergy misconceptions: Why hay fever may be a good sign

If you're one of the millions of people coughing, sneezing, sputtering, and cursing your body's hypersensitivity to ragweed, trees, and grass this spring, researchers at Yale have what could be considered positive news: Seasonal allergies may be a sign that your immune system is doing what nature intended it to do -- protect you against environmental toxins that are far more harmful than pollen.

The paper appears in Nature.

The body’s defense arsenal consists of different types of immune responses to deal with various classes of pathogens. Type 1 immunity — which battles viruses, bacteria, fungi, and protozoa — relies primarily on directly killing pathogens or infected host cells.

Type 2 immunity, the focus of this Perspectives piece, protects against external environmental challenges by spurring the body’s T cells and antibodies into action to fight the irritant. The problem is, type 2 immunity can go into overdrive when inadvertently activated by environmental antigens such as pollen.

Hay fever sufferers know the consequences all too well: The allergens such as pollen trigger an over-production of histamine, resulting in the coughing, sneezing, runny noses, and all-round misery that afflict them most severely in the spring and fall.

Nonetheless, the Yale authors argue that, despite the occasional misfiring, type 2 immunity is beneficial to humans. They write that this particular response of the host defense system evolved over time to protect us from at least four different classes of environmental challenges: helminthes (parasites), noxious chemicals, animal venoms, and environmental irritants.

But if type 2 immunity evolved over time to protect us, what is the purpose of sensing such small amounts of allergen when the levels are far too low to really harm us, and when a misfiring can cause such suffering?

Lead author Ruslan Medzhitov, professor of immunobiology at Yale School of Medicine and a Howard Hughes Medical Institute investigator, said, “We believe that allergic hypersensitivity evolved to survey the environment for the presence of noxious substances.

After the first exposure, the immune system gains a memory, and subsequent exposure to even minute amounts will induce an anticipatory response that helps minimize potentially harmful effects.” He added that such responses also encourage avoidance of the environment that contains the noxious substance. “According to this view, hypersensitivity to allergens triggers avoidance of a sub-optimal environment,” Medzhitov explained.

More information: http://www.nature. … re11047.html

Provided by Yale University (news : web)

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