UPDATES IN VECTOR

CONTROL IN MALAYSIA:
What is new?
Vector Borne Disease Sector
Disease Control Division
Ministry of Health Malaysia
12th February 2022
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.
Outline of Presentation 3

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
Dengue Situation in Malaysia

4
DENGUE SITUATION IN MALAYSIA 2021 & 2022
Dengue Cases
Cumulative cases in 2021: 26,365 70.8%
VS (63,939 cases)
Cumulative cases in 2020: 90,304
Dengue deaths
Dengue deaths 2021: 20 86.2%
VS
(125 deaths)
Dengue deaths 2020: 145
Case Fatality Rate (CFR)
2021: 0.08% 2020: 0.16%
DENGUE SITUATION IN MALAYSIA (EW 5/2022)

Dengue Cases
Cumulative cases in 2022: 3,573 7.3 %
VS (244 cases)
Cumulative cases in 2021: 3,329

Dengue Deaths
Dengue death in 2022: 0
VS
Dengue death in 2021: 0
 Weekly Dengue Cases in Malaysia
Year 2021, 2020 & 5 years median (2016-2020)
3500
2021 2020 5 yr median

3000

2500

2000
Cases

1500

1000

500

Epid Week 7
 DENGUE TRENDS IN MALAYSIA 2013 –2021
4000

3500

3000

2500

2000

1500

1000

500

0
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
 Number Of Dengue Cases & Deaths
(Year 2000 – 2021)
140,000 350

120,000 300

100,000 250
Number of Cases

Number of Death
80,000 200

60,000 150

40,000 100

20,000 50

0 0
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

Year
 Number Of Dengue Cases & Incidence rate
(Year 2000 – 2021)
140,000 450.0

400.0
120,000

Incidence rate per 100,000 population

350.0

100,000
300.0
Number of case

80,000
250.0

200.0
60,000

150.0
40,000

100.0

20,000
50.0

0 0.0
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

10
 Number Of Deaths & Case Fatality Rate
(Year 2000 – 2021)
400 0.70%

350
0.60%

300
0.50%

250

Case Mortality rate

0.40%
Number of death

200

0.30%
150

0.20%
100

0.10%
50

0 0.00%
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%

Year 11
DENGUE INCIDENCE RATE BY STATES IN 2021
8.2

29.4

22.9
11.6 3.8
5.0
22.2 46.0

25.4

240.1

57.5
164.7
65.2 15.1
46.8

> 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 Incidence Rate Malaysia = 78.0 per 100,000 population
12
< 100 per 100,000 population
DENGUE CASES & DENGUE SEROTYPE 2013-2021
4000

3500

3000

2500

2000

1500

1000

500

0
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

70%

60%

50%

40%

30%

20%

10%

0%
MAR
MAY

MAR
MAY

MAR
MAY

MAR
MAY

MAR
MAY

MAR
MAY

MAR
MAY

MAR
MAY

MAR
MAY
JAN

JUL

JAN

JUL

JAN

JUL

JAN

JUL

JAN

JUL

JAN

JUL

JAN

JUL

JAN

JUL

JAN

JUL
SPT

SPT

SPT

SPT
NOV

NOV

NOV

NOV

SEP
NOV

SEP
NOV

SEP
NOV

SEP
NOV

SEP
NOV
2013 2014 2015 2016 2017 2018 2019 2020 2021
13
DENV1 DENV2 DENV3 DENV4
 Vector Control Approaches in
Dengue Prevention & Control in
Malaysia

14
 Objective of vector control

•reducing abundance of vector

population/density to the level that it may
not allow transmission

15
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
Vector Control Approaches in Dengue Prevention & Control

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)
Search & destroy activities
Vector Control Approaches in Dengue Prevention & Control

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’
 Spray can
Spray can Mist Blower

Abating using sand granule

Vector Control Approaches in Dengue Prevention & Control
By COMBI volunteers (Communication for Behavioural Impact) :-

21
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
Preparation of fogging machine before space spray at the field
Space spraying/fogging
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
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
Vector Control Approaches in Dengue Prevention & Control

Announcements

TV/radios interviews Posters/banners 27

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)
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

28
Source: Bahagian Perkembangan Kesihatan Awam, KKM
New Innovative Approaches in Dengue Control

1. Wolbachia Mosquito
2. Sterile Insect Technique (SIT)
3. Dengue Forecasting

29
1. Wolbachia mosquito release
Intracellular bacteria

Wolbachia inside an insect cell 31

How is Wolbachia transferred to Aedes aegypti mosquito?

32
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
➢ 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
 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;
CRITERIA FOR ▪ river
▪ Highways
LOCALITY ▪ Park/open space
▪ Fields
SELECTION 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
2 Wolbachia based strategies

The hallmark of replacement

strategy: to REPLACE wild
Aedes aegypti populations with
Wolbachia infected Aedes (WIA)
aegypti populations .

Malaysia adopts
Replacement Strategy

Courtesy from IMR

States Involved In Wolbachia mosquito release

COHORT 1 2 localities COHORT 3

7 July 2019 2021 - 2022
11 localities 11 localities
3 localities
▪ Selangor : 8 localities ▪ WPKL & Putrajaya : 1
▪ WPKL & Putrajaya: 3 locality
localities ▪ Kelantan : 2 localities
▪ Pulau Pinang : 2 localities
COHORT 2 ▪ Selangor : 2 localities
November 2019 ▪ Johor : 1 locality
▪ Melaka: 1 locality
8 localities ▪ N. Sembilan: 1 locality
10 localities
▪ WPKL & Putrajaya : 3 ▪ Pahang : 1 locality
localities
▪ Pulau Pinang : 3 7 localities
localities
▪ Selangor : 2 localities

• All these 22 sites: recalcitrant dengue hotspots

• High rise building 37
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
Dengue cases 6 months before & after 2 years of Wolbachia mosquito release

Time frame
Code Locality Dengue cases 6 Dengue cases 24
Differences (%)
month pre- release months post- release
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 39
DENGUE CASES 6 MONTHS BEFORE & 24 MONTHS AFTER
WOLBACHIA MOSQUITO RELEASE

200
200 100.0
180 90.0
160 80.0
140 70.0
No. of dengue case

Case reduction (%)

120 60.0
100 92 50.0
79 84
78 77
80 40.0
60 47 30.0
40 20.0
23
20 12 13 10.0
1 0 1 4 1 3 0 2 2 4 2 1
0 0.0

6 MTH PRE 6 MTH POST2YR REDUCTION (%)

Dengue Cases at Wolbachia mosquito released locality

BIL KES APARTMENT PERDANA - SEKSYEN 13

20 20

18
19.5
16

14 19

12
18.5

10

18
8

6 17.5

4
17
2

0 16.5
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
EPID WEEK
Daftar Pelepasan Telur Pelepasan Nyamuk Dewasa
41
Dengue Cases at Wolbachia mosquito released locality

BIL KES PELANGI DAMANSARA (BLOK D-K)

12 12

10 10

8 8

6 6

4 4

2 2

0 0
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
MINGGU EPID 42
Daftar Pelepasan Nyamuk Dewasa Pelepasan Telur
Dengue Cases at Wolbachia mosquito released locality

43
PREPARATION BEFORE RELEASE OF WOLBACHIA MOSQUITO (EGGS)
STAGE)
PREPARATION BEFORE RELEASE OF ADULT WOLBACHIA MOSQUITOES
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

Sterile Insect Technique
✓ “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
(Dyck et al, 2005; Alphey et al, 2010)

Dr. R. Bushland Dr. E. Knipling

(www.worldfoodprize.org)
Nazni wt al., 2021
WHAT IS SIT?

BIRTH CONTROL (BC)

Eggs do not
hatch=population
crashed
Sterile Insect Technique

Radiation

+
Sterile Male Female
Insect

Pupae No Offspring

Nazni wt al., 2021

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

Prior to field release

• 100 sterile males per cup (by scooping)

• Daily sucrose feeding ( 1-2 days) until release day

Nazni wt al., 2021

 Larval Density
B
as

0
10
20
30
40
el
B ine
as
el 1
B ine
as 2
11 elin
Ja e 3
18 n 2
Ja 021
25 n 2
Ja 021
n
2 20
Fe 21
b
8 20
Fe 21
15 b 2
Fe 02
1
22 b 2
Fe 021
1 b
M 2
ar 02
8 ch 1
M 2
a 0
compared to control site after 16th release.

15 rc 21
h
M 2
a 0
22 rc 21
h
M 2
a 0
29 rc 21
h
M 2
ar 02
c 1
5 h2
Overall Ae. aegypti Larval Density

A 02
p
12 ril 1
A 202
p
19 ril 1
96.74% suppression of Ae. aegypti larvae in the release site

A 202
p
26 ril 1
A 202
pr
il 1
20
21
Kota Laksamana (Control site)
Taman Tasik Utama (Release site)

Nazni wt al., 2021

Dengue Cases Reported at TTU
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
❖ 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

55
Dashboard

56
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

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
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
Thank you