Dengue in Southeast Asia: Epidemiological characteristics and strategic challenges in disease prevention

DSO National Laboratories, Singapore.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública (Impact Factor: 0.98). 02/2009; 25 Suppl 1(Suppl. 1):S115-24. DOI: 10.1590/S0102-311X2009001300011
Source: PubMed


Dengue emerged as a public health burden in Southeast Asia during and following the Second World War and has become increasingly important, with progressively longer and more frequent cyclical epidemics of dengue fever/dengue hemorrhagic fever. Despite this trend, surveillance for this vector-borne viral disease remains largely passive in most Southeast Asian countries, without adequate laboratory support. We review here the factors that may have contributed to the changing epidemiology of dengue in Southeast Asia as well as challenges of disease prevention. We also discuss a regional approach to active dengue virus surveillance, focusing on urban areas where the viruses are maintained, which may be a solution to limited financial resources since most of the countries in the region have developing economies. A regional approach would also result in a greater likelihood of success in disease prevention since the large volume of human travel is a major factor contributing to the geographical spread of dengue viruses.

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    • "The mosquito vector has an anthrophilic nature, wherein its reproductive development is achieved in sustaining a human blood meal. According Gubler and Ooi (2008), an increase in population has an inevitable effect on the citizens that may lead to an increase in the need of good housing, clean water, sewage and waste management creating ideal conditions for the vector. The impact of economic expansion and urbanization indicates increased movement of people in between cities and regions (Gubler, 1997). "
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    ABSTRACT: Dengue fever is considered as a rapidly emerging arthropod-borne viral disease all over the world especially in the Philippines resulting in severe illness, possibly death, and economic burden to society and disruption of quality of life. In the absence of an available vaccine and specific treatment for use by the general population, dengue prevention is largely focused in controlling its main principal vector, Aedes aegypti and implicated secondary vector, Ae. albopictus. The biology and distribution of these mosquito vectors are greatly affected by several environmental determinants namely; (1) type of household (2) vegetation (3) climatic conditions (4) artificial water-holding containers (5) population density and (6) affected flood prone areas. Here we discuss the roles of each environmental or condition and its impact towards the spread and epidemiology of Dengue in Metro Manila. It also highlights modifiable measures of the environmental determinants that may be utilized in the prevention and control of Dengue.
    7th ASEAN Environmental Engineering Conference, Puerto Princesa, Palawan, Philippines; 10/2014
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    • "Infection may be clinically asymptomatic or give rise to an undifferentiated fever, dengue fever (DF), dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS) [2]. One third of the world population is at risk and with outbreaks occurring in cyclical epidemics in Asia, Sri Lanka is at a greater risk as it is a country naturally endemic to dengue [2–4]. An increasing number of patients whom present with the clinical picture of fever, myalgia and arthralgia, can evolve into dengue hemorrhagic fever with plasma leakage, which if not properly managed could very well progress to worsening organ involvement with dengue shock. "
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    ABSTRACT: Background Dengue fever is a common mosquito borne viral fever in South Asia, which causes significant morbidity and mortality. Dengue fever is well known to involve the liver, especially in dengue hemorrhagic fever. The hepatic involvement is usually that of a mild hepatitis with transaminase derangement without jaundice. In cases of dengue hemorrhagic fever where shock has ensued, a severe hepatitis with gross derangements of transaminases and bilirubin may occur. These are two rare cases of adult patients with dengue hemorrhagic fever presenting with a cholestatic type of jaundice. Case presentation This case report describes two female patients aged 30 and 46 years who presented with fever, icterus and biochemical analysis revealed cholestatic jaundice. Evolution of the clinical picture and dropping platelets prompted serological investigations in the form of dengue non-structural protein 1 antigen and dengue immunoglobulin M which confirmed acute dengue infection. Conclusion These cases highlight the importance of considering dengue fever as a differential diagnosis even in the presence of a cholestatic jaundice, especially in countries where dengue fever is endemic, and in travelers returning from dengue endemic countries. The early diagnosis of dengue fever and timely institution of supportive fluid management is essential to prevent morbidity and mortality.
    BMC Research Notes 08/2014; 7(1):568. DOI:10.1186/1756-0500-7-568
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    • "No licensed vaccine or treatment for dengue disease currently exists. Prevention relies on individual protection and vector control measures, which have limited effectiveness [1]. The Asia-Pacific region is considered the global epicentre of the disease, with ∼1.8 billion people at risk [4]. "
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    ABSTRACT: Dengue disease is a major public health problem across the Asia-Pacific region for which there is no licensed vaccine or treatment. We evaluated the safety and immunogenicity of Phase III lots of a candidate vaccine (CYD-TDV) in children in Malaysia. In this observer-blind, placebo-controlled, Phase III study, children aged 2-11 years were randomized (4:1) to receive CYD-TDV or placebo at 0, 6 and 12 months. Primary endpoints included assessment of reactogenicity following each dose, adverse events (AEs) and serious AEs (SAEs) reported throughout the study, and immunogenicity expressed as geometric mean titres (GMTs) and distribution of dengue virus (DENV) neutralizing antibody titres. 250 participants enrolled in the study (CYD-TDV: n=199; placebo: n=51). There was a trend for reactogenicity to be higher with CYD-TDV than with placebo post-dose 1 (75.4% versus 68.6%) and post-dose 2 (71.6% versus 62.0%) and slightly lower post-dose 3 (57.9% versus 64.0%). Unsolicited AEs declined in frequency with each subsequent dose and were similar overall between groups (CYD-TDV: 53.8%; placebo: 49.0%). Most AEs were of Grade 1 intensity and were transient. SAEs were reported by 5.5% and 11.8% of participants in the CYD-TDV and placebo groups, respectively. No deaths were reported. Baseline seropositivity against each of the four DENV serotypes was similar between groups, ranging from 24.0% (DENV-4) to 36.7% (DENV-3). In the CYD-TDV group, GMTs increased post-dose 2 for all serotypes compared with baseline, ranging from 4.8 (DENV-1) to 8.1-fold (DENV-3). GMTs further increased post-dose 3 for DENV-1 and DENV-2. Compared with baseline, individual titre increases ranged from 6.1-fold (DENV-1) to 7.96-fold (DENV-3). This study demonstrated a satisfactory safety profile and a balanced humoral immune response against all four DENV serotypes for CYD-TDV administered via a three-dose regimen to children in Malaysia.
    Vaccine 10/2013; 31(49). DOI:10.1016/j.vaccine.2013.10.013 · 3.62 Impact Factor
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