New, more fatal dengue strain leaves Health Ministry searching for answers

Dengue cases increased to some 50,000 this year, a 74% from last year, but the Health Ministry is still in the dark as to the actual factors leading to the spike which has doubled the number of deaths. – AFP pic, June 26, 2015.

A new strain of dengue that attacks vital human organs and has resulted in 158 deaths so far this year is cause for concern to the Health Ministry, as Putrajaya looks for ways to tackle the problem.

With symptoms and seriousness of the cases differing drastically from last year, dengue has to date resulted in a 100% increase in deaths over the corresponding period in 2014.

Despite speculations on the possible cause, the ministry is still in the dark as to the actual factors leading to the spike in dengue deaths, as well as dengue infections, in the country.

The number of cases reported this year is close to 50,000, a 74% increase over the corresponding period last year.

But the spike in cases did not occur overnight – statistics from 2013 to 2014 showed that the increase was already stark.

In the first 6 months of 2013, only 38 people died of dengue. This jumped to 72 deaths, a 189% increase, in 2014, before rising to 158, in the first 6 months of this year.

The number of dengue cases reported in the same period last year was also more than 200% higher than the figures reported in 2013.

The increase is said to be because the fever has now begun attacking vital organs and causing acute organ failure, which cannot be reversed by doctors if reported or detected late.

This has led to DAP's Klang MP, Charles Santiago, to urge the government to declare an emergency and rope in the aid of the World Health Organisation (WHO) before the situation gets any worse.

But Putrajaya believes they will be able to tackle the issue once the cause of this new strain, which has proved to be more fatal over time, is uncovered.

Health Ministry deputy director-general, Datuk Dr Jeyaindran Sinnadurai, told The Malaysian Insider that the government wanted to find answers within a couple of months by studying patients seriously affected by dengue infection.

Previously, those with dengue fever were affected by disruption in liver enzymes, which was reversible. But patients were now turning up with "acute liver failure" and inflammation of the liver.

Worse, the new strain is also causing inflammation to the brain, said Jeyaindran.

One possible answer is the change in the level of prior exposure to dengue among the Malaysian populace.

"Now, you have a large pool of Malaysians who have had exposure to dengue over the years, and our immune system had reacted in a certain way. But if you get dengue from a different serotype, the amplification of the virus in your body might be very different," he said.

Jeyaindran pointed out that there are four different serotypes in dengue, and this might be a case of a new serotype affecting Malaysians.

"Also, there is a possibility that the virus has become more virulent. This happens with viruses all the time," he said.

Another possibility is genetic predisposition.

"It might just be a case of how one person can feel cold in a room, and another person can't. It might be genetic predisposition," he said.

Fogging is routinely carried out to kill mosquitoes, but its effectiveness has come under question amid a rise in cases over the past two years. – The Malaysian Insider file pic, June 26, 2015.

But one factor he was quick to rule out was that there is a new breed of dengue mosquitoes that are carrying an entirely new virus.

"So far, in our fogging exercises, we have not seen extra resistance from the mosquitoes. There is no indication of such a thing," he added.

Charles, however, said that fogging exercises by the government are ineffective given the rise in cases over the past two years.

Instead, he suggested releasing dragonflies to target mosquitoes at the breeding grounds.

"The fogging is not working because there are still so many breeding grounds and the cases are just increasing over time," he said.

The ministry, however, maintained that the rate of death in proportion to the cases reported was still low, as the percentage of deaths to cases reported was about 0.3% so far this year.

"We are still doing a good job in treating patients," Jeyaindran said.

"The number of cases reported, in proportion, is also still below WHO guidelines. If it goes beyond the mark, then we are required to report it to WHO and alert neighbouring countries. But at the moment, we have enough contingency plans to deal with this problem," he added.

Charles last week brought an emergency motion in the Dewan Rakyat to discuss the endemic disease but it was shot down by Speaker, Tan Sri Pandikar Amin Mulia.

Health Minister Datuk Seri S. Subramaniam had admitted that the current trend was "worrying", but insisted that the government was searching for answers to tackle the problem.

"We really hope to make some headway in a couple of months," Jeyaindran said.