Download presentation
Published byRalf Barton Modified over 9 years ago
1
DENGUE EPIDEMIOLOGY AND CONTROL PROGRAM IN MALAYSIA
DR ROSE NANI MUDIN DISEASE CONTROL DIVISION MINISTRY OF HEALTH 13 JAN 2009
2
OUTLINES OF PRESENTATION
Epidemiology of Dengue in Malaysia Dengue Mortality Control Activities Strategies Conclusion
3
INCIDENCE RATE OF REPORTED DENGUE CASES IN MALAYSIA (1981 - 2008)
3
4
NUMBER OF REPORTED DENGUE FEVER AND DENGUE HAEMORRHAGIC FEVER CASES IN MALAYSIA, 1995 – 2007
5
DISTRIBUTION OF REPORTED DENGUE CASES IN MALAYSIA BY EPIDEMIOLOGY WEEK (2006–2008)
Epid. Week 5
6
COMPARISION OF DENGUE CASES BY STATE (2007 & 2008)
NO. OF CASES 2008 6 2007 6
7
THE DENGUE INCIDENCE RATE BY STATE (2008)
78 86 80 150 33 LABUAN 150 179 157 62 88 408 141 WPKL 334 110 MALAYSIA 178 cases/100,000population 118
8
PATTERN OF DENGUE CASES
9
RATIO OF DHF : DF IN MALAYSIA
1998 – 2008 DHF : DF RATIO 9 9
10
PERCENTAGE DISTRIBUTION OF DENGUE CASES BY LOCALITY IN MALAYSIA (1998 – 2008)
10 10
11
% 11 11 11
12
DHF AND DF FATALITY RATES FOR MALAYSIA (1990-2008)
13
DISTRIBUTION OF DENGUE DEATH CASES BY AGE GROUP (1997 – 2007)
NO. OF CASES YEAR 13
14
FINDINGS OF DENGUE CASES ANALYSIS FOR 2008
14
15
DISTRIBUTION OF DENGUE CASES BY GENDER
15
16
DISTIRBUTION OF DENGUE CASES BY AGE GROUP
16 16
17
FINDINGS OF VEKPRO ANALYSIS FOR 2008 (Epid wk 1- 49)
State % of Cases Fulfilling ClinicalCriteria % of Positive Serology from All Cases with Results % Cases Notified by Primary Care Clinics Diagnosed ≤ 3 d from Onset % Premises of Cases Fogged < 5 d from Onset Perlis 81.8 63.0 8.5 37.4 39.2 Kedah 65.9 55.2 1.1 46.5 31.5 P. Pinang 33.0 75.7 50.4 36.5 Perak 64.0 97.5 1.3 38.9 30.1 Selangor 95.8 91.7 5.7 31.7 13.5 WPKL 8.0 84.7 0.9 34.4 7.8 N. Sembilan 78.0 99.1 0.6 30.9 21.9 Melaka 65.7 99.5 0.2 35.9 29.9 Johor 93.7 84.3 32.7 19.6 Pahang 85.5 84.5 1.4 34.1 24.3 Terengganu 81.1 51.5 36.9 35.6 Kelantan 88.1 75.4 3.6 28.1 17.8 Sabah 45.5 79.1 3.3 35.2 18.2 WP Labuan 28.6 62.9 55.7 Putrajaya 56.8 100.0 14.5 25.5 Sarawak 37.1 90.3 10.9 42.0 MALAYSIA 74.2 85.4 3.4 34.5 18.8 17
18
DENGUE MORTALITY ANALYSIS 2008
18
19
DENGUE MORTALITY 112 dengue deaths reported for 2008 (98 cases in 2007
Only 62 cases were reviewed by the state mortality review committee 19
20
DISTRIBUTION OF DENGUE MORTALITY BY AGEGROUP
20
21
DURATION BETWEEN TIME OF ONSET AND ADMISSION
21
22
DURATION BETWEEN TIME OF ADMISSION AND DEATH
22
23
DIAGNOSIS OF MORTALITY CASES Immediate Cause of death
Fulfillment of WHO Case Definition (WHO 1997) Percentage of Cases DF DHF 11 DSS 89 CAUSE OF DEATH Immediate Cause of death Percentage of Cases Shock Syndrome 61.8 End/Multi organ failure 40.0 Severe bleeding from GIT/DIVC/Thrombocytopenia 32.7 ARDS 10.9 Sepsis (including Nosocomial infection) Others (specify) Hyperkalemia with ARF 12.7 23
24
36.4 CONTRIBUTING FACTORS FOR DENGUE MORTALITY N0.
% 1. PATIENT CAME IN ALREADY TOO ILL 47.3 2. DELAY IN DIAGNOSIS/ ASSESSMENT OF SEVERITY Low index of suspicion 36.4 Delay in review by doctor 14.5 Late referral 9.1 Results delayed/not traced/not reviewed 7.3 Infrequent investigation ordered Others 16.4 24
25
CONTRIBUTING FACTORS FOR DENGUE MORTALITY
% 3. INADEQUATE MONITORING/TREATMENT Inadequate fluid resuscitation 21.8 Failure to recognize DSS 20.0 Insufficient blood products given 18.2 Inadequate monitoring of vital signs 16.4 Overloading/pulmonary oedema Delay in seeking ICU care 14.5 Inadequate monitoring of FBC 10.9 DIVC not suspected/recognized 1.8 4. CO MORBID CONDITIONS Obesity Extremes of age (<1yr / >60yrs) 9.1 Others – Uncontrolled DM/HPT; Hepatitis, Fits 53% of the death were preventable 25
26
Key Components of Dengue Control Strategy
Early diagnosis and treatment Training of frontliners Health education to public on importance of early diagnosis and treatment Active case detection in outbreak localities Prompt notification Within 24 hours By phone Nearest District Health Office Case Investigation within 24 hours Prompt vector control response Within 24 hours of notification Fogging within 200 m radius 400 m if outbreak locality Quality Assurance Program -Dengue Outbreak Control Index (DOCI): 100% outbreak controlled within 14 days
27
Key Components of Dengue Control Strategy
Proper Case Management CPG- The Management Of Dengue Infection In Adult/Children (2nd Edition) All dengue death are audited immediately. Appropriate remedial actions are taken by the relevant parties and report to be sent to the Disease Control Division within 2 weeks Health Education And Community Mobilization Production of health materials/ mass media Guidelines on health education and community mobilization activities in outbreak localities Guidelines on COMBI For Dengue Prevention and Control
28
CHALLENGES IN THE DENGUE PREVENTION ACTIVITIES
Health seeking behavior of the dengue patient: Only 4% of cases were from the clinic and majority from hospital 50% of the dengue mortality cases were admitted on day 4 or 5 after onset - delay in seeking treatment 47% of dengue mortality cases came in already ill Difficult to break the dengue virus transmission: Only 35% of patient diagnosed within 3 days from the onset of illness Only 19% of dengue cases’ residence were fogged within 5 days of onset of illness Thus other patients infected with the dengue virus may still transmit the disease 28
29
CHALLENGES IN THE DENGUE PREVENTION ACTIVITIES
Low index of suspicion of dengue cases by the attending doctors: Delayed notification Delay in giving appropriate treatment Lack in community cooperation and participation in the dengue prevention and control activities 29
30
CONCLUSION-1 To strengthen the implementation of dengue prevention and control measure (to be alert and responsive) Ensure effective and efficient performance of the control activities through: Monitoring & supervision Analysis of data at district, state, and MOH level
31
CONCLUSION-2 Strengthen the prevention and control activities at district and state level Facilitate training for healthcare workers to increase knowledge and skills on the dengue management and vector control Continuous monitoring of dengue status and mortality at all levels, as to address uncontrolled situation of the disease
32
THANK YOU FOR YOUR ATTENTION
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.