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05NTD 2022 - UPDATES IN VECTOR CONTROL IN MALAYSIA: What is new?

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05NTD 2022 - UPDATES IN VECTOR CONTROL IN MALAYSIA: What is new?

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This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.

Presenter: Dr Norhayati Mokhtar, Public Health Physician at the Vector Borne Disease Sector, Disease Control Division, Ministry of Health Malaysia
#dengue #WorldNTDDay #BeatNTDs

This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.

Presenter: Dr Norhayati Mokhtar, Public Health Physician at the Vector Borne Disease Sector, Disease Control Division, Ministry of Health Malaysia
#dengue #WorldNTDDay #BeatNTDs

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05NTD 2022 - UPDATES IN VECTOR CONTROL IN MALAYSIA: What is new?

  1. 1. UPDATES IN VECTOR CONTROL IN MALAYSIA: What is new? Vector Borne Disease Sector Disease Control Division Ministry of Health Malaysia 12th February 2022
  2. 2. Disclaimer • This slide was prepared for the Webinar Series on COVID-19 session on 3rd March 2021, by Dr Norhayati Mokhtar, Public Health Physician at the Vector Borne Disease Sector, Disease Control Division, Ministry of Health Malaysia. • This is intended to share within healthcare professionals, not for public. • This webinar is organised by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH in conjunction of World NTD Day 2022.
  3. 3. Outline of Presentation 1. Dengue situational analysis in Malaysia 2. Vector Control Approaches in dengue prevention & control in Malaysia 3. Innovations in dengue prevention & control :- • Wolbachia mosquito • Sterile Insect Technique (SIT) • Dengue Forecasting System 4. Summary 3
  4. 4. Dengue Situation in Malaysia 4
  5. 5. DENGUE SITUATION IN MALAYSIA 2021 & 2022 Dengue Cases 70.8% (63,939 cases) Cumulative cases in 2021: 26,365 Cumulative cases in 2020: 90,304 VS Dengue deaths Dengue deaths 2021: 20 Dengue deaths 2020: 145 86.2% (125 deaths) VS Case Fatality Rate (CFR) 2021: 0.08% 2020: 0.16%
  6. 6. DENGUE SITUATION IN MALAYSIA (EW 5/2022) Dengue Cases 7.3 % (244 cases) Cumulative cases in 2022: 3,573 Cumulative cases in 2021: 3,329 VS Dengue Deaths Dengue death in 2022: 0 Dengue death in 2021: 0 VS
  7. 7. 7 0 500 1000 1500 2000 2500 3000 3500 2021 2020 5 yr median Cases Epid Week Weekly Dengue Cases in Malaysia Year 2021, 2020 & 5 years median (2016-2020)
  8. 8. DENGUE TRENDS IN MALAYSIA 2013 –2021 0 500 1000 1500 2000 2500 3000 3500 4000 1 7 13 19 25 31 37 43 49 3 9 15 21 27 33 39 45 51 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 2013 2014 2015 2016 2017 2018 2019 2020 2021
  9. 9. Number Of Dengue Cases & Deaths (Year 2000 – 2021) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Number of Cases 7,103 16,368 32,767 31,545 33,895 39,686 38,556 48,846 49,335 41,486 46,171 19,884 21,900 43,346 108,698 120,836 101,357 83,849 80,615 130,101 90,304 26,365 Number of death 45 50 99 72 102 107 92 98 112 88 134 36 35 92 215 336 237 177 147 182 145 20 0 50 100 150 200 250 300 350 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 Number of Death Number of Cases Year
  10. 10. Number Of Dengue Cases & Incidence rate (Year 2000 – 2021) 10 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Number of case 7,103 16,368 32,767 31,545 33,895 39,686 38,556 48,846 49,335 41,486 46,171 19,884 21,900 43,346 108,69 120,83 101,35 83,849 80,615 130,10 90,304 26,365 Incidence rate 30.5 68.8 133.6 125.9 132.5 151.9 144.7 179.8 177.9 146.6 163.4 69.6 74.7 145.9 361.1 396.4 328.3 258.9 245.3 390.4 276.5 78.0 0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 450.0 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 Incidence rate per 100,000 population Number of case
  11. 11. 11 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Number of death 45 50 99 72 102 107 92 98 112 88 134 36 35 92 215 336 237 177 147 182 145 20 Case Mortality rate 0.63% 0.31% 0.30% 0.23% 0.30% 0.27% 0.24% 0.20% 0.23% 0.21% 0.29% 0.18% 0.16% 0.21% 0.20% 0.28% 0.23% 0.21% 0.18% 0.14% 0.16% 0.08% 0.00% 0.10% 0.20% 0.30% 0.40% 0.50% 0.60% 0.70% 0 50 100 150 200 250 300 350 400 Case Mortality rate Number of death Year Number Of Deaths & Case Fatality Rate (Year 2000 – 2021)
  12. 12. DENGUE INCIDENCE RATE BY STATES IN 2021 > 400 per 100,000 population 300 – 399.9 per 100,000 population 200 – 299.9 per 100,000 population 100- 199.9 per 100,000 population < 100 per 100,000 population 46.0 15.1 5.0 25.4 65.2 3.8 57.5 22.2 46.8 29.4 240.1 22.9 8.2 11.6 164.7 Incidence Rate Malaysia = 78.0 per 100,000 population 12
  13. 13. 13 DENGUE CASES & DENGUE SEROTYPE 2013-2021 0 500 1000 1500 2000 2500 3000 3500 4000 1 7 13 19 25 31 37 43 49 3 9 15 21 27 33 39 45 51 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 2013 2014 2015 2016 2017 2018 2019 2020 2021 0% 10% 20% 30% 40% 50% 60% 70% JAN MAR MAY JUL SPT NOV JAN MAR MAY JUL SPT NOV JAN MAR MAY JUL SPT NOV JAN MAR MAY JUL SPT NOV JAN MAR MAY JUL SEP NOV JAN MAR MAY JUL SEP NOV JAN MAR MAY JUL SEP NOV JAN MAR MAY JUL SEP NOV JAN MAR MAY JUL SEP NOV 2013 2014 2015 2016 2017 2018 2019 2020 2021 DENV1 DENV2 DENV3 DENV4
  14. 14. Vector Control Approaches in Dengue Prevention & Control in Malaysia 14
  15. 15. •reducing abundance of vector population/density to the level that it may not allow transmission 15 Objective of vector control
  16. 16. Vector Control Approaches in Dengue Prevention & Control 1. Source reduction (Penghapusan Tempat Pembiakan, PTP) 2. Larvaciding 3. Space Spraying (Semburan Ruang Termal, SRT) 4. Targeted Outdoor Residual Spray (ORS) 5. Health promotion 6. Law Enforcement
  17. 17. 1. Source reduction of Aedes larvae • Search & destroy of Aedes breeding places • Done in 24 hours after case notified in the eDengue system • Premise coverage in the affected locality must be 100% within 3 days • 200 meters for single case and 400 meters in outbreak • Health Inspectorates (PPKP/ PKA/ PA) ➢ District Health Office (Pejabat Kesihatan Daerah,PKD) ➢ Local Council (Pihak Berkuasa Tempatan, PBT eg: MBSA, MBPJ) • Pest Control Operator (PCO) Vector Control Approaches in Dengue Prevention & Control
  18. 18. Search & destroy activities
  19. 19. 2. Larvaciding ▪ Sand granule/ capsule/ solutions ▪ Using Temephos or Bacillus Thuringiensis Israelensis (Bti) ▪ Done at any site that has potential breeding containers eg: back lane /empty lots/ bushes/ building structure ▪ ‘Community larvaciding’ Vector Control Approaches in Dengue Prevention & Control
  20. 20. Abating using sand granule Mist Blower Spray can Spray can
  21. 21. Vector Control Approaches in Dengue Prevention & Control 21 By COMBI volunteers (Communication for Behavioural Impact) :-
  22. 22. Vector Control Approaches in Dengue Prevention & Control 3. Space Spray of adult Aedes ▪ Done within 24 hours after case notified in eDengue system ▪ Premise coverage in the affected locality must be 80% ▪ 200 meters for single case and 400 meters in outbreak ▪ Indoor and outdoor ▪ Dawn (5 am-7 am) & dusk (5 pm-7 pm); peak biting hours ▪ Encourage use of aerosol spray for closed premises ▪ Thermal fogging must be complimented with ULV in outbreak situation
  23. 23. Preparation of fogging machine before space spray at the field
  24. 24. Space spraying/fogging
  25. 25. Vector Control Approaches in Dengue Prevention & Control 4. Targeted Outdoor Residual Spray (ORS) ▪ New approach initiated by IMR Malaysia ▪ Applying of low dose pyrethroid onto the outer surfaces where mosquito suspected to hide/rest ▪ The residual activity of the insecticide lasts between 2-3 months ▪ Preventive method in dengue hotspot localities or areas with recurring dengue ▪ Done at least for 2 cycles of spray; every 3 months ▪ Disadvantage: laborious
  26. 26. HEALTH PROMOTION • Depending on type of dengue cases reported (single case/controlled outbreak/uncontrolled outbreak/ hotspots) :- ✓Announcement (Siaraya/Hebahan) ✓Hebahan; Mass (TV, radios) & Social Media (Whatsapp, Facebook, Instagram etc) ✓Banner/ Posters/ Flyers ✓Community mobilization ✓Health Education Kiosk at hotspots area ✓Dialogues 26
  27. 27. Vector Control Approaches in Dengue Prevention & Control 27 TV/radios interviews Posters/banners Announcements
  28. 28. LAW ENFORCEMENT • According to Destruction of Disease-Bearing Insects Act 1975 (DDBIA 1975) : “ The Director General, a medical Officer of Health, an inspector or a public officer authorized in writing in that behalf by the Director General may compound any offence committed by any person under this act or any regulations made under this act……….of an amount not exceeding five hundred ringgit within the time specified in the offer” • Operasi Gempur Aedes (OGA) 28 Year Premises Inspected Premises Positive Breeding Compounds issued Premises closed 2018 4,688,302 119,418 21,370 120 2019 4,877,369 161,506 24,869 117 2020 4,685,063 175,642 21,748 71 2020 3,953,480 140,415 21,976 52 Source: Bahagian Perkembangan Kesihatan Awam, KKM
  29. 29. New Innovative Approaches in Dengue Control 1. Wolbachia Mosquito 2. Sterile Insect Technique (SIT) 3. Dengue Forecasting 29
  30. 30. 1. Wolbachia mosquito release
  31. 31. Wolbachia inside an insect cell 31 Intracellular bacteria
  32. 32. How is Wolbachia transferred to Aedes aegypti mosquito? 32
  33. 33. Wolbachia have been proven to block the virus replication in mosquito HOW? i. Boost the natural immune systems of the mosquito ii. Consume cholesterol inside the mosquito Make the dengue virus harder to grow 33
  34. 34. ➢ Field trial phase by IMR in 2017: all localities shows reduction in cases • Operational phase: starts in 7 July 2019 at 11 localities with high dengue burden • Operating Budget (staffs, equipments, Wolbachia insectariums) : Ministry of Health Malaysia (District Health Offices & State Health Offices) • Involves multidisciplinary team; Epidemiologists/ Entomologists/ Health Inspectors/ Health Education Officers/ COMBI team/ community leaders/ residential building management body/ local municipal. • Prevention & control activities at Wolbachia mosquito release site: NO fogging • Dengue Enforcement as usual 34
  35. 35. CRITERIA FOR LOCALITY SELECTION a. High burden Dengue cases/ recalcitrant dengue hotspots b. Type of premises (high rise building): reduction of dengue cases in Wolbachia mosquitoes release sites best seen in the clustered high rise or flats c. Natural boundaries; ▪ river ▪ Highways ▪ Park/open space ▪ Fields d. No industrial sites e. Area of at least 0.6 km square f. Number of households g. Good public co-operation & support • Score (1-5) 1= the most inappropriate, 5= the most appropriate
  36. 36. 2 Wolbachia based strategies Malaysia adopts Replacement Strategy The hallmark of replacement strategy: to REPLACE wild Aedes aegypti populations with Wolbachia infected Aedes (WIA) aegypti populations . Courtesy from IMR
  37. 37. States Involved In Wolbachia mosquito release 37 • All these 22 sites: recalcitrant dengue hotspots • High rise building COHORT 1 7 July 2019 11 localities ▪ Selangor : 8 localities ▪ WPKL & Putrajaya: 3 localities 2 localities COHORT 2 November 2019 8 localities ▪ WPKL & Putrajaya : 3 localities ▪ Pulau Pinang : 3 localities ▪ Selangor : 2 localities COHORT 3 2021 - 2022 11 localities ▪ WPKL & Putrajaya : 1 locality ▪ Kelantan : 2 localities ▪ Pulau Pinang : 2 localities ▪ Selangor : 2 localities ▪ Johor : 1 locality ▪ Melaka: 1 locality ▪ N. Sembilan: 1 locality ▪ Pahang : 1 locality 3 localities 10 localities 7 localities
  38. 38. Outcome indicators :- 2 important endpoints:- 1. Epidemiological Endpoints ❖Weekly confirmed dengue cases reported in the area 2. 2. Entomological Endpoints ❖Wolbachia frequency (%) in the environment 38
  39. 39. Dengue cases 6 months before & after 2 years of Wolbachia mosquito release 39 Code Locality Time frame Dengue cases 6 month pre- release Dengue cases 24 months post- release Differences (%) W01. Kelana 23 1 95.7 W02. Baiduri 79 0 100 W03. Damansara 47 1 97.9 W04. Lavendar 4 1 75 W05. Perdana 78 3 96.2 W06. D.Mentari 92 0 100 W07. Otomobil 200 2 99 W08. Subang Suria 84 2 97 W09. Penara 77 4 94.8 W10. Razak 12 2 83.3 W11. Sri Rakyat 13 1 92.3 TOTAL 709 17 97.6
  40. 40. 23 79 47 4 78 92 200 84 77 12 13 1 0 1 1 3 0 2 2 4 2 1 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 0 20 40 60 80 100 120 140 160 180 200 Case reduction (%) No. of dengue case 6 MTH PRE 6 MTH POST2YR REDUCTION (%) DENGUE CASES 6 MONTHS BEFORE & 24 MONTHS AFTER WOLBACHIA MOSQUITO RELEASE
  41. 41. Dengue Cases at Wolbachia mosquito released locality 41 16.5 17 17.5 18 18.5 19 19.5 20 0 2 4 6 8 10 12 14 16 18 20 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 03 06 09 12 15 18 21 24 27 30 33 36 39 42 45 48 51 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Daftar Pelepasan Telur Pelepasan Nyamuk Dewasa APARTMENT PERDANA - SEKSYEN 13 BIL KES EPID WEEK
  42. 42. Dengue Cases at Wolbachia mosquito released locality 42 0 2 4 6 8 10 12 0 2 4 6 8 10 12 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 03 06 09 12 15 18 21 24 27 30 33 36 39 42 45 48 51 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Daftar Pelepasan Nyamuk Dewasa Pelepasan Telur PELANGI DAMANSARA (BLOK D-K) BIL KES MINGGU EPID
  43. 43. Dengue Cases at Wolbachia mosquito released locality 43
  44. 44. PREPARATION BEFORE RELEASE OF WOLBACHIA MOSQUITO (EGGS) STAGE)
  45. 45. PREPARATION BEFORE RELEASE OF ADULT WOLBACHIA MOSQUITOES
  46. 46. 2. STERILE INSECT TECHNIQUE (SIT) • The SIT was among the first biological insect control methods designed for area wide application (AW-A) • Insect control methods in the first 70 years of the 20th century were based largely on chemical insecticides and it has unsolved resistance and environmental problem • IMR conducted trial phase study since 2019 • Radiation process done at Malaysian Nuclear Agency Nazni wt al., 2021
  47. 47. ✓ “Birth control of insects”, for suppression or elimination of target pest population (Dyck et al, 2005) ✓ It is an environment-friendly, species-specific, cost-effective, sustainable biological pest control method ✓ Radiation sterilised insects are considered radioactivity free, because no residual radioactivity remains on them (Whitten & Mahon, 2005) ✓ Developed in 1950 by Dr. R. Bushland Dr. E. Knipling (www.worldfoodprize.org) (Dyck et al, 2005; Alphey et al, 2010) Nazni wt al., 2021 Sterile Insect Technique
  48. 48. Eggs do not hatch=population crashed BIRTH CONTROL (BC) WHAT IS SIT?
  49. 49. Sterile Insect Technique + Radiation Pupae Sterile Male Female Insect No Offspring Nazni wt al., 2021
  50. 50. 2 Phases of study: PHASE 1: Laboratory experiments Optimal dosage, Life-cycle - longevity, Sterility status, susceptibility to dengue virus, TEM on salivary gland PHASE 2: Open Field Release ( a ) Mass rearing ( b ) Site selection – Hot spot ( c ) Community engagement ( d ) Surveillance of Aedes aegypti population Nazni wt al., 2021
  51. 51. Prior to field release • 100 sterile males per cup (by scooping) • Daily sucrose feeding ( 1-2 days) until release day Nazni wt al., 2021
  52. 52. Overall Ae. aegypti Larval Density B a s e l i n e 1 B a s e l i n e 2 B a s e l i n e 3 1 1 J a n 2 0 2 1 1 8 J a n 2 0 2 1 2 5 J a n 2 0 2 1 2 F e b 2 0 2 1 8 F e b 2 0 2 1 1 5 F e b 2 0 2 1 2 2 F e b 2 0 2 1 1 M a r c h 2 0 2 1 8 M a r c h 2 0 2 1 1 5 M a r c h 2 0 2 1 2 2 M a r c h 2 0 2 1 2 9 M a r c h 2 0 2 1 5 A p r i l 2 0 2 1 1 2 A p r i l 2 0 2 1 1 9 A p r i l 2 0 2 1 2 6 A p r i l 2 0 2 1 0 10 20 30 40 Kota Laksamana (Control site) Taman Tasik Utama (Release site) Larval Density 96.74% suppression of Ae. aegypti larvae in the release site compared to control site after 16th release. Nazni wt al., 2021
  53. 53. Dengue Cases Reported at TTU
  54. 54. 3. DENGUE FORECASTING • System that forecasts dengue outbreaks, with sufficient lead time to allow for effective interventions to be implemented using seasonal climate data • UK Space Agency International Partnership Programme (IPP): Dengue Forecasting Model Satellite-Based System (D-MOSS); pilot project since November 2021 • Decision support tools • Predicts outbreak 6 months in advance 54
  55. 55. 55 ❖ 20 years of historical Earth Observation data from satellites:- • Temperature • Humidity • Rainfall • Soil moisture • Land cover • Wind Speed and direction ❖ 10 years Epidemiological data:- dengue cases
  56. 56. 56 Dashboard
  57. 57. STRATIFICATION OF DENGUE LOCALITY ➢Priority localities (lokaliti keutamaan): 4 categories ❖Priority 1 : uncontrolled outbreak/ hotspots in previous year ❖Priority 2 : controlled outbreak in previous year ❖Priority 3 : 1 case in previous year ❖Priority 4 : no case reported in previous year ➢Priority premises (premis keutamaan): vary with states / districts
  58. 58. Summary 1. Dengue prevention & control is everyone’s responsibility. Continuous efforts are required to sustain cooperation from communities in maintaining search & destroy activities. 2. During Covid-19 pandemic : competing priorities for financial support, attention & synergistic collaboration from all stakeholders; need for re- focus for essential duty 3. Paradigm shift : from control mode to preventive mode by using dengue forecasting system 4. Wolbachia mosquito operationalization will be expanded to other high dengue burden localities 5. No ‘magic bullet’ & stand-alone tool to combat dengue; Integrated Vector Control Management
  59. 59. 59
  60. 60. ACKNOWLEDGEMENTS • Director General of Health, Tan Abdullah • Dr Nazni WA, Institute for Medical Research (IMR) • Dr Nurul Husna AH, Institute for Medical Research (IMR) • PKD Petaling Vector Unit • COMBI Negeri Pulau Pinang
  61. 61. Thank you

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