Plans to curb dengue epidemic outdated, says expert (17.7.15)

(Photo: FMT)

(Photo: FMT)

While the incidents of dengue cases has reached unprecedented levels, plans to combat the epidemic are still very much outdated, claimed S Veeramohan, the vice president of the Malaysian Association of Environmental Health (MAEH).

Speaking to FMT in a recent interview, Veeramohan, using field studies and statistical and spatial analysis done by MAEH, said that the Ministry of Health’s (MOH) plan of action to curb dengue was rigidly based on World Health Organisation methods, which did not take into account new data available and was still too focused on residential areas as the source of infection.

New findings however suggested that the spread of dengue had more to do with mobile populations, where the infection was picked up while people who were out of their homes, according to Veeramohan.

“The mobile population is getting infected while getting to work or during some recreational activity, in the early hours of the morning, and adding on to these cases (in residential areas).

“You need to identify and eliminate transmission areas, so that they don’t add on to the numbers,” he said.

Transmission in residential areas, Veeramohan claimed was more or less under control, due to WHO methods that the MOH had been subscribing to but the focus now should be on identifying transmission areas, away from homes and to act upon these.

He added, “They are (transmission areas outside homes) virtually untouched. They are not being identified and eliminated.”

MAEH’s proposed approach, however, is based on a case study in Thailand, where cases originated in the capital, Bangkok, radiated to the peripherals i.e. other districts and eventually settled in the rural areas.

A similar trend was observed in Malaysia, where infections often picked up in Kuala Lumpur and Petaling Jaya, being the two major epicentres of dengue, were then spread to outer residential areas, according to Veeramohan.

“It’s due to the movement of people, not mosquitoes. We have to find out where people move and find out the common place the people move to, in order to identify the actual transmission hub.

“As long as it is not identified, these infected mosquitoes remain there, and bite whoever passes through that area,” he said.

MAEH has proposed that upon identifying the hot-spots in cities or urban areas, which mostly consist of vacant lots with vegetation blanketing the ground, the local city council’s landscaping crew must be deployed to clear the plants and remove any thrash or receptacles that may serve as mosquitoe breeding sites.

Veeramohan said his association had shared their findings and methods with the MOH, which proved to work at their pilot sites in Setiawan, Perak, and a Kuala Lumpur City Council (DBKL) district, where the reported cases and hot spots were reduced drastically.

The Ministry was receptive to the new methods initially and even issued a support letter to MAEH, but eventually announced it would go with the “outdoor residual spraying” method at four districts in Selangor, the state with the most reported cases, using the pesticide, deltamethrin, which Veeramohan argues is not as effective against Aedes if used in open areas.

He added deltamethrin was recommended only to be used if it was “infused” in textiles such as dog collars, or mosquitoes nets, not sprayed outside in the open air.

“It will kill other useful insects, as it is an ecotoxin. It will kill the bees and others that contribute to the ecosystem,” Veeramohan said.

MAEH monitored the development, and after three months, found that not only were the old hotspots not eliminated, newer sites popped up in Selangor, showing that the spraying was not working as intended.

“The Ministry of Health is the de-facto agency that is in charge of dengue control, but if they go by the WHO guidelines, they will not progress any further,” he lamented.

Source: FMT

Comments

  1. Despite our briefing to the State EXCO for Health, our once absolutely cost-free proposal was ignored for reasons only known to those concerned. We did not even claim travelling costs!

    After securing DBKL cooperation, we went on to ensure that all eleven (11) parliamentary constituencies in Wilayah Persekutuan Kuala Lumpur remained hotspot-free for at least 53 consecutive weeks (one year).

    It would be interesting to note that this “secondary dengue transmission-free” status was achieved despite the fact that the DBKL operational area covering Wilayah Persekutuan, shared a common boundary with Selangor’s heavily dengue-afflicted districts with hotspots lingering for many months, thousands of cases and hundreds of deaths.

    The above results were exactly as we had guaranteed, based on nearly 15 years of operational field research experience….and sustainable for many years to come.

    To date, WPKL remains “relatively” hotspot free despite the inclusion of unconfirmed cases into certain constituencies which occasionally give rise to short-lived “hotspot-like” conditions.

    The Selangor State Government is welcome to call us again, but the MAEH Executive Council has decided that we charge a reasonable consultation fee for our proven and guaranteed services.

    The rates can be negotiated although the Government spends an estimated USD13 million per 10,000 reported cases in control work according to a study jointly conducted in 2013 by the Ministry of Health, University Malaya and Brandeis University funded by vaccine researchers Sanofi.

    Like

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