In response to various allegations in malaysiakini o­n the dengue outbreak, please allow me to recapitulate the health minister's (Chua Jui Meng's) speech in Parliament o­n March 11, for the benefit of your subscribers and the public at large. The minister's speech gave a true and clear picture of the dengue situation in the country.

Dengue and dengue haemorrhagic fever are endemic in more than 100 countries in the world, including Malaysia. In these countries, the disease occurs annually throughout the year, peaking every few years as new strains of the dengue virus arise and periodic changes in the weather occur.

Globally, between 50-100 million cases of dengue fever and 500,000 cases of dengue haemorrhagic fever are admitted into hospitals annually, with 12,000 deaths. Deaths are mostly from dengue haemorrhagic fever that has a mortality rate of about 50 percent. According to the 55 th World Health Assembly statement o­n March 4, 2002, dengue and dengue haemorrhagic fever have been the primary cause of hospital admissions in the Asia-Pacific over the last 15 years.

On June 1, 2002, the Health Ministry, based o­n its surveillance data, had issued a nationwide alert to all state health directors of an impending increase in the number of cases in the country. The World Health Organisation (WHO) representative in Kuala Lumpur, in his letter to the ministry o­n Feb 24, 2003, had confirmed that the WHO had not at any time issued any dengue alert, as alleged by some parties.

During the dengue pandemic in 1998 which affected many countries in the world, Malaysia experienced the highest number of confirmed cases ever (13,742 cases, 82 deaths). From 1997 to 2002, the number of confirmed cases had averaged at 8,364, with 54 deaths, annually.

In 2002, the number of cases started to increase from the middle of the year, carrying over into 2003. There were 11,394 confirmed cases with 57 deaths reported in 2002. The death rate from dengue haemorrhagic fever in 2002 was 10 percent. The number of confirmed cases reported in 2003 (up to Feb 22) was 3,410 cases with 11 deaths.

Most of the cases (91.7 percent) over the last three years (2000-2002) had occurred in urban areas under the jurisdiction of the local authorities. To assist the local authorities, the health ministry had, in 2000, agreed to take over dengue control in 50 of the 145 local authority areas which are poorly staffed and equipped to handle the menace.

Our statistics show that over these three years, 84.4 percent of confirmed cases occurred in the 95 areas fully under the jurisdiction of the local authorities, and o­nly 15.6 percent in the areas under the health ministry including the 50 local authority areas temporarily taken over by the ministry for dengue control.

Several factors have contributed to the present outbreak

1) Increasing urbanisation which has led to a significant increase in Aedes breeding areas;

2) A general lack of individual and community effort in eradicating Aedes breeding areas;

3) A general lack of public concern and commitment in keeping the residential and work environment clean and Aedes-free;

4) The indiscriminate throwing and dumping of rubbish which facilitates Aedes breeding;

5) The periods of heavy rain interspersed with hot weather experienced by the country in 2002 and early 2003, which are conducive to Aedes breeding;

6) The rampant breeding of Aedes mosquitoes in certain areas such as construction sites, refuse disposal grounds, abandoned housing projects, and factories; and

7) The emergence of dengue virus type DEN3 since 2001, to which many Malaysians lack immunity and are therefore susceptible.

The ministry has put in place a multitude of preventive and control measures, including a plan of action for implementation in the field, since the first outbreak in the country in 1973 (1,478 cases, 54 deaths).

The Destruction of Disease Bearing Insects Act 1975 was implemented, and revised in 2000 to increase the penalties for offences under the Act. Since 1986, several comprehensive guidelines including those o­n dengue control, control of Aedes breeding at construction sites, and management of dengue infection in the paediatric population have been issued to health professionals throughout the country and implemented.

The Prevention and Control of Infectious Diseases Act 1988 made it mandatory for all medical practitioners to notify the nearest health ministry or local authority health officer of any case of dengue or dengue haemorrhagic fever. Upon receipt of notification, the health authorities will take immediate control measures, including case investigation, premises inspection and fogging within 24 hours.

Other activities include search and destroy missions against Aedes breeding, mass application of Abate in high breeding areas and, where cases have been reported, public education and community mobilisation o­n control measures, enforcement activities, and training of medical and health staff o­n dengue management and control. We have also started preventive fogging in high risk areas.

More recently, we have introduced biological measures against mosquito breeding via the use of Bacillus thuringiensis israelensis (Bti), especially at construction sites, abandoned housing projects and neglected housing lots.

We are also monitoring insecticide resistance with the use of a Rapid Test Kit which, together with Bti, are biotechnological discoveries of our own Institute for Medical Research. We have established an expert group comprising health experts from various ministries, agencies and local universities to review our preventive and control measures from time to time.

In 2002, the Health Ministry and the local authorities had together inspected 4.1 million premises, fogged 11.5 million premises, mass-Abated 215,000 premises, conducted 1,617 gotong-royong campaigns, issued 19,184 compounds and 12,184 warning notices, and instituted 550 court actions against offenders. 800,000 health education materials and 6,000 videos were issued for use in public education.

Because of the immensity of the problem, the cabinet has approved the beefing up of the local authorities in terms of financial allocation and manpower, to enable them to cope with the outbreak. The cabinet has also directed that Abate be sold at all petrol stations to make it easier for the public to purchase this anti-larvae application.

All said and done, it remains crucial that individuals and the community itself assume greater responsibility and commitment in keeping their residential and work environment clean and Aedes free.

The launch of the National Anti-Mosquito and Cleanliness Campaign by the deputy prime minister and its successful implementation at all levels in 1999 has brought down the number of cases by 66 percent from its peak in 1998. The spirit and philosophy behind this campaign must be re-activated and maintained by all concerned.