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This year in Singapore, there has been close to 18,000 dengue cases reported in the first half of the year. This is three times the number of cases in 2021, according to the National Environment Agency (NEA). With the rising number of cases occurring in Singapore, it is ever more important to stay alert and protected against dengue in Singapore. To contribute to the fight against dengue, we consulted Dr. Devan Velayuthan, Deputy Medical Director of our long-time trusted partner IHP for his expert advice on all things related to dengue. 

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Overview of dengue  

Dengue is a mosquito-borne virus that is common in many tropical parts of the world, including Singapore. It is mostly transmitted to humans through the bite of the female mosquito species Aedes aegypti (known as yellow fever moquito) and, to a lesser extent, Ae. Albopictus (Asian tiger mosquito).  

There are 4 dengue strains known as DENV-1, DENV-2, DENV-3 and DENV-4, and it is possible to be infected four times. In Singapore, DENV-1 and DENV-2 have been the most common strains found among those infected. However, since the historic 2020 outbreak in Singapore, the increase in the Aedes aegypti  population has led to an increase in the less common strains of DENV-3 and DENV-4. In 2021, Singapore saw its first outbreak of DENV-3 in 40 years, with a four-fold surge in DENV-4 cases. 

“Today, DENV-2 and DENV-3 are taking over as the common dengue serotype in Singapore.” Dr. Devan informs us. “The previously uncommon dengue virus serotype 3 (DENV-3) is now widely circulating. It is now the predominant strain of dengue detected in Singapore. The "increased circulation" of the DENV-3 serotype would have meant less immunity within the community.” 

Symptoms of dengue 

The symptoms of dengue fever typically appear after 4 to 7 days after being bitten. For all 4 strains, the symptoms may be similar, but the response and immunity towards the fever for each individual may differ. Here are the following symptoms: 

  • Nausea and vomiting 
  • Sudden fever lasting for 2 to 7 days 
  • Joint and muscle pain 
  • Severe headache 
  • Skin rash 
  • Swollen glands 
  • Pain behind the eyes 
  • Mild bleeding (e.g. nose or gum bleed, or easy bruising of the skin) 

Severe dengue 

In rare cases, severe dengue normally takes place around 3 to 7 days after the virus has set in. Symptoms include: 

  • Persistent vomiting 
  • Bleeding (e.g. gum or nose bleed, black stool, blood in vomit or stool) 
  • Fatigue 
  • Quick breathing 
  • Severe abdominal pain 

During the first 24 to 48 hours of the critical phase, some patients may develop these symptoms which need to be closely monitored at treated to prevent further complications and risk of death.  

How can you distinguish between a normal fever and dengue? 

Dr. Devan answers on distinguishing between a normal fever and dengue, “Dengue fever is distinguished by its signs and symptoms which are peculiar to the disease itself. A Dengue specific antigen (NS1 – for illness days 1 – 5) or antibody (IgG and IgM – for illness day 5 and above) can be done to diagnose Dengue fever.”. 

To learn more about dengue fever and how you can protect yourself, we have asked Dr. Devan from IHP a few questions. 

How can dengue fever be diagnosed? 

Dengue fever can be diagnosed using three different tests: 

  1. Dengue Ns1 antigen: it is an antigen that is best used during the first 0 to 5 days of symptoms. Its accuracy in detection is higher for primary infection compared to secondary infection. 
  2. Dengue PCR test: like any PCR test, it requires laboratory confirmation which can take up to 2 days, making it a more expensive diagnosis test compared to the others. This test is suitable for those who exhibit symptoms within the first 7 days. 
  3. Dengue IgG/IgM antibody: this test is best done from day 5 of the illness onwards, as the test is able to identify any additional infections.  

Any advice when the first symptoms are appearing? 

If you think you have dengue fever, seek medical attention immediately. 

Treatment of dengue 

It is of utmost importance that you seek help from your healthcare provider when you have been infected as treatment for dengue fever is supportive. There is no specific treatment for dengue, but as dengue worsens when blood is more concentrated, it is extremely important to stay hydrated and to drink lots of water with added electrolytes. It is also recommended to take fever lowering medicine such as paracetamol to control the fever and relive pain. Do not take aspirin or ibuprofen as they have anticoagulant properties. Most importantly, rest well and rest plenty in order to recover from the fever.  

Is dengue contagious? 

Dengue fever does not spread from person to person. 

It is transmitted to humans via the bite of an infective Aedes mosquito. A mosquito becomes infected after it takes a blood meal from a dengue-infected person. It becomes infective after an extrinsic incubation period of 8 to 12 days. The mosquito then remains infective for the rest of its lifespan. When a person is bitten by an infective mosquito, they may develop symptoms after an intrinsic incubation period of 4 to 7 days (ranges from 3 to 14 days). Notably, up to 75% of dengue infections are asymptomatic.  

How can you protect yourself and your children against Dengue? 

Use mosquito repellent regularly if you are diagnosed with dengue or suspected to have dengue, to protect your loved ones and others living around you. Repellents containing DEET (N,N-diethyl-m-toluamide), picaridin or IR3535 as the active ingredient are the most effective in repelling mosquitoes. 

All individuals and premises owners to continue taking urgent action to break disease transmission, by removing stagnant water and potential mosquito breeding habitats by doing the Mozzie Wipeout ‘B-L-O-C-K’ steps regularly: 

  • Break up hardened soil 
  • Lift and empty flowerpot plates 
  • Overturn pails and wipe their rims 
  • Change water in vases 
  • Keep roof gutters clear and place BTI insecticide inside 

Home treatments are not recommended as this disease can be fatal if not properly treated.  

Making sure you have access to treatment 

When travelling or living in an area where you may be exposed to dengue, make sure that you have access to treatment. This may be especially important for travellers who are spending an extended period of time in a tropical region or country where the disease is endemic. 

If you are infected with dengue while on a short trip abroad, you may already be on your way back to your home country before symptoms start to appear, in which case you should be able to use your regular health insurance or national healthcare system to make sure you receive any needed treatment. Be sure to tell your doctor where you travelled to and whether you can remember any contact with mosquitoes on your trip. 

If you are on a trip where you would be staying in the country long enough to show symptoms if you contracted dengue, make sure that your travel insurance policy or international health insurance policy will be able to cover any medical expenses. If you are travelling to more remote areas, where accessing quality healthcare would be an issue, you may want to make sure that your plan covers you for any emergency medical evacuations. 

 

About IHP and Dr. Devan Velayuthan 

Founded in 1994, Integrated Health Plans Pte Ltd (IHP) provides managed healthcare services to corporate clients ranging from SMEs to MNCs.  As a neutral third -party administrator, IHP is committed to providing organisations with quality medical care at highly-competitive rates regardless of business size. IHP has been a long-time partner of APRIL, being one of APRIL International’s most trusted medical providers in our network. Dr Devan Velayuthan is a Senior Medical Advisor and Deputy Medical Director at IHP who is also an expert on dengue and its related issues. 

Learn more about IHP here 

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