Dengue is a mosquito-borne diseases.

It is a disease caused by a virus that is spread

through the bite of a female mosquito of Aedes aegypti and Aedes albopictus. Humans are
the primary host of the virus. There are 4 types of this virus (Serotype 1-4), namely DENV-
1, DENV-2, DENV-3 and DENV-4. The dengue virus is an RNA virus from the genus
Flavivirus (Rogers, 2019).

According to World Health Organization (WHO), the occurrence of dengue has grown
dramatically around the world in recent decades. About 2.5 billions people (2/5 of the
world’s population) are now at risk from dengue. WHO has been reported that there maybe
50 million cases of dengue infections worldwide every year (Chia et al., 2018). In Malaysia,
in the year of 2019, there were approximately 153.37 dengue fever cases per 100 thousand
inhabitants reported in Selangor. In comparison, there were a total of around 860 dengue
fever cases reported in W.P Kuala Lumpur and W.P. Putrajaya combined (Hirschmann,
2021). Figure 2 shows the incident rate of dengue fever cases in Malaysia in 2019, by
region.

Figure 1 : Incident rate of dengue fever cases in Malaysia in 2019, by region.

 Transmission of Dengue through Mosquitoes

Dengue is caused by the virus DEN-1, DEN-2, DEN-3 and DEN-4 which comes from
the genus Flaviviridae sp. (Duane & Gary, 1995). While being closely related, they are
antigenically different however transmitted using the same vector, which is through the bite
of the female Aedes aegypti and Aedes albopictus. Dengue does not spread directly from a
person to person; it does not spread through air or sharing of personal belonging and food.
It only spread through the bite of the mentioned mosquitoes when they feast on an infected
person’s blood (Chia et al., 2018). When a female Aedes aegypti or Aedes albopictus takes
an infected person's blood for meal, the cells that line the intestines become infected. Then,
after 8 to 10 days infected by the virus, this virus spreads to other tissues and its salivary
gland, which is then released into its saliva. Figure 5 shows the anatomy of a female Aedes
aegypti which is a vector of dengue transmittance.

Figure 5: Anatomy of female Aedes aegypti

Proboscis is the part of the mosquito which it used to feast on a person’s blood,
when the infected Aedes mosquito bites a person with its proboscis, the dengue virus is
transmitted and enters the human skin along with the saliva. After being bitten with the
Aedes mosquito, the virus enters and binds to the white blood cell (site of action) and
reproduces in the cell as it travels all over the body. During a serious infection, the
production of virus in the body increased considerably. Thus, the liver and bone marrow are
also affected by the viruses (Chia et al., 2018).
 Symptom of Dengue

Dengue were a very lethal disease, especially to one that had weak immune system.
Thus, an early precaution should be taken by noticing Dengue symptoms. Dengue
symptoms usually appear after a period ranging from two to seven days because this was
the incubation period of Dengue. The symptoms may vary and depend on the form this
disease which can either be dengue fever and dengue haemorrhagic fever that had more
severe symptoms.

Dengue fever symptoms usually include severe joint and muscle pain, swollen lymph
nodes, headache, sudden high fever, exhaustion and rash. Other symptoms of these disease
include bleeding of gums, severe pains behind the arms, and red palm and soles (Feigin &
Barnett, 2020). This symptom was caused by the virus attacking various glands in the
human body system and continue travelling to other body parts where it multiplied and
grow. These symptoms can be illustrated as shown in Figure 1 and Figure 2.

Figure 1: Muscle and joint pain. Figure 2: Swollen lymph nodes.

Dengue haemorrhagic fever were more severe compared to dengue fever and it tend
to affect children under 15 years old. This fever occurred when a person undergoes dengue
shock syndrome (DSS). The symptom of this disease includes high fever (39 - 41℃), loss of
appetite, nausea and vomiting, abdominal pain, haemorrhage, bleeding of nose and gums,
and circulatory collapse. Other than that, the symptoms may include sore throat,
pneumonia, inflammation of heart, blood in stool, and headache (Feigin & Barnett, 2020).
These symptoms can be illustrated as in Figure 3 and Figure 4.
 Figure 3: Small purplish spit (Petechiae). Figure 4: High fever.

 Treatment of Dengue

According to Renganathan et al., dengue still does not have any specific medication
which is given to patients with dengue (Renganathan et al., 2003). Only supportive measure
was given to patients such as supportive medication and judicious fluid therapy. Doctors
make some initiative by using pain reliever such as acetaminophen and paracetamol to
reduce the pain (Rajapakse et al., 2012). Medications which contain aspirins and ibuprofen
must be avoided as it could worsen the bleeding. Moreover, the patients also need to have
plenty of rest and drink a lot of water to avoid dehydration and prevent them from vomiting
and got a high fever of a sudden. The danger period, or the critical period where the
patients’ condition suddenly worsen only last 2-3 days, if the patient’s is well managed,
fatality can be avoided but still need close monitoring on their condition (Rajapakse et al.,
2012).

The development of vaccine toward all type of dengue is still incomplete and yet to
be completed. A vaccine which have been commercially distributed is one of the versions of
the vaccine was being introduced in 2019 known as CYD-TDV and commercially sold under
the name of Dengvaxia (World Health Organization, 2018). However, this vaccine is only
recommended for those who have a previous record of being infected with dengue fever. In
addition, the vaccine may worsen the condition of the patient who never suffered from
dengue fever before. Moreover, the vaccine have side effects such as headache, nausea,
fever and reaction at site injection such as redness and swelling. Unfortunately, the vaccine
is only available on limited country such as Indonesia, Philippines and 9 other countries
(East, 2016). But, there is no doubt that this vaccine has been proven effective in tests
conducted.

To sum up, the vaccine against dengue is still in development and may require years before
finishing. In the future, new technology against dengue will be completed such as the
production of chimera where inserting the structural protein of dengue viruses into the
infectious clones of the 17D yellow fever and the SA14-14-2 Japanese encephalitis vaccine
viruses; The development of naked DNA vaccines is in its infancy but shows great promise
(Duane, 1998). Another studies by Ahmad et al. regarding the use of papaya leaves extract
to fight dengue is also in development. The team use extract of the leaves and feed them to
dengue patients as they believed that papaya contains two active ingredients, chymopapain
and papain which suppress the activity of dengue viruses in the body (Ahmad et al., 2011).

 Prevention of Dengue

Dengue is still prevalent in some countries and the treatment for dengue are still not
reachable for some people. Preventive measure proved to work best against battling dengue
because it is considerably easier to prevent the transmittance through vector than treating
already infected persons. Using insect repellent is one of the ways to prevent mosquito
bites. However, the type of insect repellent used should be chosen carefully because some
of it were harmful to the environment and also to those who were pregnant. In order to
prevent this, one must buy insect repellent that were registered under the Environmental
Protection Agency (EPA). These insect repellents that were registered under EPA were
proven safe and effective (Nicole et al., 2015). It includes picaridin, IR3535, oil of lemon
eucalyptus, 2-undecanone, and so on. Babies were also advised to wear insect repellent as
they were more prone to mosquito bites. But, dressing them in clothing that cover their
arms and legs were much better since mosquitoes cannot penetrate their proboscis through
the clothes. It is advisable to treat cloth with permethrin to repel mosquitoes (Nicole et al.,
2015). Permethrin is an insecticide which repel or kills mosquitoes and its can be used as
addition to laundry detergent, direct exposure to skin is hazardous to health. The product
will repel mosquitoes for a period specified on its label.

The environment indoors and outdoors should be controlled to prevent any mosquito
from entering or breeding. Screen and windows should be improvised and any holes on
them should be repaired so that mosquitoes will not have any chances of entering. Stagnant
water, such as in drain or plant pots should be regularly cleaned as it is the breeding place
of mosquitoes (World Health Organisation, 2009). For individual who were travelling
overseas, it was advised for them to choose a hotel or lodging that was well equipped with
air conditioning, and screen on windows and doors. This will prevent mosquitoes from
entering the room and transmitting dengue fever. The individual should also sleep under a
bed net for extra precaution as there might be chance for mosquitoes to slip through any
opening in the room (World Health Organisation, 2009). If one wanted to be safer, it is
advised for them to buy and bring their own bed with them. The bed that they have bought
should have been treated with permethrin as this will repel all the mosquitoes that were
trying to get close to that individual. To preserve the permethrin inside the bed, it was
advised for the bed to not be washed and exposed to sunlight as this will break down the
insecticide more quickly.

From the discussion, it was concluded that the disease that outbreak in that
particular area was Dengue. This disease was caused by a virus that came from genus
Flaviviridae sp. and was transmitted by the female Aedes aegyptii mosquito. The symptom
of this disease may varies and depend on its form which can either be dengue fever and
dengue haemorrhagic fever which had a more severe symptoms. There have already been
several treatments to this disease including vaccine. However, prevention must be taken as
the saying goes “prevention was better than curing”.
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