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Dengue virus infection--the Malaysian experience
Abstract:
Since dengue was first documented in Malaysia in 1902 and made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of increasing trend yearly. The largest outbreak was seen in 1996 with 14,255 dengue cases reported and 32 deaths. The case fatality rate varied from a high of 10.43% in 1985 when dengue type 3 was the predominant type to a low of 1.29% when dengue type 1 predominated. Severe disease patterns have been observed with dengue 2 and 3 serotypes in the country. The clinical spectrum has also been changing and multisystem involvement with more severe manifestations are being seen. Liver involvement has been documented since 1987. Fulminant hepatitis with encephalopathy can resemble Reye's syndrome. Dengue type 3 has been isolated from liver biopsy specimens. Neurological manifestations can very from irritability, convulsions, coma to peripheral neuritis. The isolation of dengue viruses from cerebrospinal fluids recently strongly suggests that dengue viruses can be neurovirulent. Adult respiratory distress syndrome was seen in three children admitted with shock. Deaths were more frequent in children in the early period but since 1982, over 50% of deaths have occurred in patients over the age of 15 years.
Insights
Dengue cases in Malaysia show a yearly increasing trend, with severe disease patterns observed, particularly involving the liver and nervous system. Case fatality rates fluctuate based on dengue serotypes, with a shift in mortality towards older age groups.
Area of Science:
- Epidemiology
- Infectious Diseases
- Virology
Background:
- Dengue fever has been a notifiable disease in Malaysia since 1973.
- The disease pattern has shifted from biennial outbreaks to a yearly increasing trend.
- The largest outbreak occurred in 1996, with 14,255 cases and 32 deaths.
Purpose of the Study:
- To analyze the changing patterns of dengue disease in Malaysia.
- To investigate the trends in case fatality rates and serotype predominance.
- To document the evolving clinical spectrum and multisystem involvement in dengue.
Main Methods:
- Retrospective analysis of dengue case data in Malaysia.
- Review of case fatality rates correlated with predominant dengue serotypes.
- Documentation of clinical manifestations, including liver and neurological involvement.
Main Results:
- Dengue cases show a yearly increasing trend, with a significant outbreak in 1996.
- Case fatality rates varied significantly (1.29% to 10.43%) depending on the predominant serotype (Dengue type 1 vs. Dengue type 3).
- Severe manifestations, including liver involvement (fulminant hepatitis) and neurological complications (neurovirulence), are increasingly observed, with Dengue type 3 implicated.
Conclusions:
- Dengue epidemiology in Malaysia is evolving, with an increasing yearly incidence.
- Dengue serotypes 2 and 3 are associated with severe disease patterns and multisystem involvement.
- There is a notable shift in mortality, with over 50% of deaths occurring in patients over 15 years since 1982.