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The Health | august-September, 2020
| Probe |
Innovative dengue
surveillance system
When it comes to dengue vector management, Malaysia has
a good cases management database, outbreak surveillance,
and cross-agency response team.
However, the Chief Executive Officer of Artificial
Intelligence for Medical Epidemiology (AIME), Dr Helmi
Zakariah acknowledged there were limitations to its vector
management.
Previously, the only way to identify a dengue outbreak was
when healthcare facilities recorded a rise in dengue cases
admission and the patients came from the same area. As of
23rd Aug 2020, 69,412 dengue cases has been registered for
the year 2020.
“Usually, by the time an outbreak happens, it’s already too
late. You have to wait for the local city council to fog the area.
Meanwhile, the adult mosquito is already there flying and biting
people,” he said, adding
Dr Helmi
acknowledged
there were
limitations
to its vector
management.
that it is also impossible
to locate the breeding
sites.
“We need to start
investing from fogging
and control to active
surveillance. We need to
think about predictive
surveillance.”
AI Surveillance
System
This is where Artificial
Intelligence (AI) comes
into play. AIME, a
Dengue Outbreak
Prediction platform, is
an innovative dengue
dynamic surveillance system which relies on AI to predict
geo-locations and timing of the next dengue outbreak.
“The app provides a more focused, real-time notification of
dengue forecast to users - all through AI.
So what is the purpose of predictive surveillance? According
to Dr Helmi, it is to stop the life cycle of the mosquito.
“We want to identify where the larvae are and to stop its
progression because the adult mosquito can become very
resistant to insecticide. Thus, we need to divest away from
insecticide and look into a more environmentally friendly
larviciding and the practice of identifying and eradication of
breeding sites.
How does the AIME platform predict the outbreaks?
“We took more than 270 parameters, and some of the more
important ones are past cases recorded, the weather, wind
speed, humidity, dewpoint and also solar radiation.
“We also took into account the bio behaviour of the
mosquito. So, for example, we know the mosquito will not fly
further than a 400-metre radius.
“We put all of these parameters into the equation, which
cannot be counted by a human. But when you put it into an
algorithm, the algorithm will calculate and give you a real-time
prediction when outbreaks happen by identifying possible
breeding spots,” he explained.
User efficiency important
Dr Helmi said the system had been deployed in Penang, Kuala
Lumpur and Selangor. It is also used in Manila and Brazil.
Dr Helmi shared: “We can predict accurately when a place
will have a dengue outbreak within 30 days up to 84 per cent
accuracy in KL and 80.1 per cent in Selangor. In Manila, it was
82 per cent and 80 per cent in Brazil, which was during the Rio
Olympics.”
So, is the system accurate?
“Yes, the system is accurate. As for the success rate of
managing the dengue vector, it depends on how efficient the
user, which is usually the government agencies, local councils
or the Ministry of Health, react and mobilise mitigation action
based on the AIME predictions.”
AIME is a health analytics company that leverages on new
technology such as data analytics and AI. It is also part of the
Selangor government’s Task Force for Covid-19 (“STFC”),
tasked to create The SElangkah Platform.
SELangkah is more than just contact tracing. Dr Helmi
explained the platform also helped to measure human
behavioural changes when adapting and adhering to the new
norm.
The busy task of
handling twin pandemics
Health Director-General Tan Sri Dr Noor
Hisham Abdullah is undoubtedly one of
the busiest doctors in the country. Besides
fighting the Covid-19 pandemic, he and
his team are also striving to contain the
rising number of dengue fever cases in the
country.
But the trained endocrine surgeon takes
the punishing schedule in his stride. His
team has not only flattened the Covid-19
curve but also significantly reduced the
number of new infections from triple digits
in March to single digits by June, a feat few
countries in the world have achieved.
Deservingly, his contribution to the
country was appreciated and recognised
when he was awarded the “Tan Sri” title
recently by the King on the occasion of His
Majesty’s birthday.
Noor Hisham, 58, told The Health how
his ministry is fighting the dengue menace
as the number of cases reached 66,689
as at Aug 11, 2020. He also talked on how
healthcare facilities in the country will be
able to cope with the twin pandemics.
Do government hospitals have enough
capacity to admit and treat dengue
patients given the Covid-19 pandemic?
As part of Covid-19 pandemic hospital
preparedness, there are 38 MoH hospitals
designated as Covid-19 hospitals, of which
33 hospitals provide ICU facilities. As of
Aug 11, 2020, only 8.5 per cent (216) of 2,530
Covid-19 and PUI-designated beds were
occupied, which only accounts for 0.5 per
cent of MoH hospital beds.
Meanwhile, for Covid-19 and PUIdesignated
critical care beds, as of Aug 11,
2020, only 0.5 per cent (2) of 422 designated
acute care beds were occupied, accounting
for only 0.2 per cent of MoH ICU beds.
The 422 critical care beds are inclusive of
163 beds created in repurposed areas as
preparedness for any Covid-19 surge.
All frontliners in hospitals and clinics
receive annual training and Continuous
Medical Education (CME) on dengue
Dengue fever
and clinical treatment
BY KHIRTINI K KUMARAN
Although dengue fever usually heals
in three to seven days, it sometimes causes
life-threatening consequences.
Associate Professor from Universiti
Kebangsaan Malaysia, Dr Tan Toh Leong,
explained that theoretically a person might
get infected with dengue up to four times in
their lifetime as there are four serotypes of
dengue circulating in Malaysia.
He added that patients who acquire a
second dengue infection with a different
dengue serotype are at increased risk for
severe dengue.
Professor of Pediatrics from Universiti
Malaya, Dr Lucy Lum Chai See, shared
that after the first few days of high fever,
the temperature will come down because
immune systems are kicking in and it clears
the virus.
She added: “But it’s not a time to rejoice
management through sessions conducted
by hospitals, clinics and State health
departments. The ministry will also ensure
the supply of COMBO rapid test kits for
diagnosing dengue fever is adequate at all
levels at all times. Every suspected dengue
fever patient will be given a ‘Dengue Alert
Card’ and be monitored for severity by
health staff.
What can be done to reduce the high
number of dengue cases?
One uncontrolled factor is climate change,
especially with the alternating rainy and
hot season’s pattern. During the rainy
season, containers or natural breeding
places, for example, the leaf of plants
will be filled with water which provides
sites for the Aedes to breed. On the other
hand, during the hot season, the Aedes
mosquito becomes more active in its biting
behaviour.
The MoH promotes search and
destroy activities and larviciding in
the community, particularly at dengue
outbreak localities. Cleaning campaigns
activities are continuously being
implemented at the state and district
level to mobilise the community along
with relevant agencies to destroy Aedes
breeding places. The empowerment of the
community through Communication for
Behavioural Impact (COMBI) is essential to
ensure community ownership.
because this is the time when the antibody
that our body produces interacts with the
virus that has invaded us. And that reaction
might lead to collateral damage.
“One collateral damage is the leakiness
in the capillaries. This is what we call the
critical phase, where patients develop very
severe abdominal pain and severe vomiting.”
Dr Lucy stressed during the critical phase,
a patient could die within a day. This is
because the leakiness is massive, especially
in a young child.
Within a few hours of leakiness, the child
will go into severe shock. In an adult patient,
the capillaries are a bit stronger, so they
don’t leak so much. But after 24 hours of this
leakiness, they can go into severe shock as
well.
Self-Healing
According to Dr Lucy, when it comes to viral
diseases, the body’s immune system has to