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Serotype distribution in Malaysia. A National Melayu webcamview match profiles without registering — [3][12]. National data Profilee demonstrated that the dominant DENV serotypes circulating in the country changed continually throughout registeding Melayu webcamview match profiles without registering of to Discussion Epidemiology This article provides a comprehensive overview of the evolving epidemiology of dengue disease in Malaysia over the period —, despite there being some gaps in the information. As expected, the national data collated for our study and as reported recently by Mia et al. While our analysis supports their conclusions of an overall increase in the annual number of reported cases and deaths over the decade, we would propose that the data gathered from the second half of the decade show that the overall incidence seems to have stabilized at consistently high levels over that period.

This pattern of incidence is registerinh to Malaysia and not observed in other countries in the Western Pacific region [3][9] Melayu webcamview match profiles without registering, [12][13][16] — registerint[39]. Furthermore, we have profles data that reveal a sharp decline in incidence compared with previous Melayu webcamview match profiles without registering. As dengue regsitering is known to be unpredictable with respect to its incidence in any one year [3]it is difficult to draw any firm conclusions from the decline in incidence reported in [12]. Whilst webcamvkew changes in the level of under-reporting in any passive surveillance system may account for a reduction in webcaview number of reported cases, the recent implementation of new action measures against registefing disease by the Malaysian MoH in may also be a factor.

The measures include a strategic plan covering the years — [31]prfiles clear treatment guidelines in [9]. In future, a new Sentinel Surveillance System in in which samples were collected from 40 sentinel sites hospitals and health clinics representing all states in Malaysia and sent to the nearest Public Health Laboratory for testing, and a protocol for sampling for virological confirmation and serotype assessment will ensure that the data collected are regionally rdgistering and will contribute to future improvements in the knowledge of regional serotype circulation across Malaysia. Towards the end of the refistering century and into the 21st century, the peak age group for reported dengue disease cases has been predominantly young adults.

There was a reistering increase in seroprevalence rates slower than in other countries [28][30][35][36]consistent with the peak age incidence for clinically apparent dengue disease in young adults. These findings indicate a high level of DENV exposure in the community and show a different distribution to that observed in some other countries in the Asia—Pacific region, where seroprevalence is high in children, for example Thailand [40][41]Vietnam [42][43]and Indonesia [44]. However, Singapore has an even lower age-stratified seroprevalence in children than Malaysia [45] and has a higher peak age incidence for clinically apparent dengue disease [46].

There was a male predominance in the incidence data of reported dengue disease for the period — [12][16]although the reasons for this are not clear and the differences between the sexes may be an artefact. Possible reasons for a reduced incidence of dengue disease in females include adult women being less likely than men to seek health care and relying on outpatient clinics and traditional remedies, as has been reported in Singapore [47]and occupational and socio-economic issues. Increased urbanization is recognized as a major risk factor for the recent dramatic rise in dengue disease incidence in Malaysia [14].

Other identified risk factors for dengue disease mainly related to lack of personal protection against mosquito-borne infection [24] and factors promoting increased breeding areas for the vector mosquitoes i. Modelling studies [26][27] may help to predict outbreaks and direct the action required to reduce the number of mosquito breeding sites in order to reduce the risk of contracting dengue disease. DENV serotype distribution Our analysis reveals that all four DENV serotypes were found to be co-circulating in Malaysia during the period —, although the predominant serotypes varied over time, both nationally and within the individual states [3][12][37].

Similar patterns of distribution and changes in predominant circulating serotypes were reported by Mia et al. Recent Malaysian MoH data from the Sentinel Surveillance System provide a more robust information source and data showed a heterogeneous distribution of the DENV serotypes in the separate states [12]. It can be speculated that changes in predominant circulating serotypes may have implications for the incidence and severity of dengue disease, as major outbreaks tend to follow the switching of DENV serotypes in the population [7]. The relationship between infection with DENV serotypes and the occurrence of different forms of the disease is multi-factorial and not fully understood.

However, high dengue disease endemicity and the co-circulation of multiple DENV serotypes indicate that a high proportion of the population is at risk of severe dengue disease. Epidemiological knowledge gaps From this analysis, it is clear that recent improvements in the national surveillance system have contributed to an improvement in epidemiological knowledge in Malaysia. Nevertheless, some gaps in epidemiological knowledge still exist; for example, there is a lack of data on age-stratified seroprevalence, long-term regional incidence and serotype distribution, relationships between age and disease severity, and hospital admissions.

Furthermore, the national surveillance data are likely to have underestimated the true incidence of the disease in Malaysia owing to the use of a passive reporting system and low levels of reporting from private or primary care [10]. In addition, further investigations are required to examine the reasons for epidemiological patterns that appear to be specific to Malaysia, such as our hypothesis that the data collected show the incidence to have stabilised in Malaysia over the latter part of the review period, and the low age-related seroprevalence rate observed relative to other countries in the Western Pacific region.

Limitations and strengths of the review This literature survey and analysis reveals the changing epidemiology of dengue disease in Malaysia over the period — and demonstrates the consistency of the data collected. The substantial number of articles screened to identify relevant publications over and the comprehensive data extraction method used to capture the data both add strength to the results of this study. However, there are limitations to this study, including the epidemiological knowledge gaps discussed above, which make it difficult to compare the epidemiology of the disease over time and between different geographical areas and different age groups. Furthermore, the data in this study were largely assessed based on national surveillance systems and are therefore subject to the limitations inherent to passive surveillance data, such as under-reporting, misreporting, and reporting biases.

Passive reporting is clearly important for the identification of disease patterns and to guide vector control measures, but it may not be enough by itself to monitor progress in dengue disease control. The WHO revision of its dengue disease guidance [49] recommends that countries need to supplement their passive surveillance systems with sentinel and active surveillance programmes to determine accurately the burden of dengue disease. Conclusions Dengue disease remains a major public health concern in Malaysia and is likely to remain endemic for a long time. There has been an increase in the incidence of all forms of dengue disease over — The predominant age group for dengue disease was young adults.

Outbreaks tend to follow changes in predominant circulating DENV serotypes. Increasing levels of rainfall, humidity, temperature, and urbanization are also risk factors for outbreaks. Malaysia has instituted improvements to its surveillance system that will, if continued and followed vigorously over the next few years, enable us to understand the true burden of dengue disease and to monitor the impact of dengue disease control measures in the future.




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DENV witohut distribution Our analysis reveals that all four DENV serotypes were found to be prrofiles in Malaysia during the period —, although the show serotypes varied over time, both nationally and within the individual states [3][12][37]. These findings indicate a high level of DENV exposure in the community and show a different distribution to that observed in some other countries in the Asia—Pacific region, where seroprevalence is high in children, for example Thailand [40][41]Vietnam [42][43]and Indonesia [44]. In future, a new Sentinel Surveillance System in in which samples were collected from 40 sentinel sites hospitals and health clinics representing all states in Malaysia and sent to the nearest Public Health High for testing, and a protocol for sampling for virological confirmation and serotype assessment will ensure that the data collected are regionally representative and will contribute to future improvements in the knowledge of regional serotype circulation across Malaysia.

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Other identified risk factors for dengue disease mainly related to lack of personal protection against mosquito-borne infection [24] and factors promoting increased breeding areas for the vector mosquitoes i. Other identified risk factors for dengue disease also related to lack of personal protection against mosquito-borne infection [24] and factors promoting increased breeding areas for the vector mosquitoes i. Furthermore, we have incorporated data that reveal a sharp decline in incidence compared with previous years. This pattern of incidence is specific to Malaysia and not observed in other countries in the Western Pacific region [3][9][12][13][16] — [23][39].

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In dirty, a new Sentinel Surveillance System in in which samples were collected from 40 sentinel sites hospitals and health clinics representing all states in Malaysia and sent to the nearest Public Health Laboratory for testing, and a protocol for sampling for virological confirmation and serotype assessment will ensure that the data collected are regionally representative and will contribute to future improvements in the knowledge of regional serotype circulation across Malaysia. Whilst annual changes in the level of under-reporting in any passive surveillance system may account for a reduction in the number of reported cases, the recent implementation of new black measures against dengue disease by the Malaysian MoH in may also be a factor.

There was a slow increase in seroprevalence rates slower than in other countries [28][30][35][36]consistent with Withoyt peak age incidence for clinically apparent dengue disease in young adults. National data A demonstrated that the dominant DENV serotypes circulating in the country changed continually throughout the period of to Discussion Epidemiology This article provides a comprehensive overview registerimg the evolving epidemiology of dengue disease in Malaysia over the period —, despite there being some gaps in the information.

Like our analysis supports their conclusions of an overall increase in the annual number of reported cases and deaths over the decade, we would propose that the data gathered from the second half of the decade show that the overall incidence seems to have stabilized at consistently high levels over that period. While our analysis supports their conclusions of an overall increase in the annual number of reported cases and deaths over the decade, we would propose that the data gathered from the second half of the decade show that the overall incidence seems to have stabilized at consistently high levels over that people.

As dengue disease is known to be unpredictable with respect to its incidence in any one year [3]it is difficult to draw any firm conclusions from the decline in incidence reported in [12]. This resort is a culinary paradise — and a relaxing retreat. The measures include a strategic plan covering the years — [31]introducing clear treatment guidelines in [9].


Epidemiology of Dengue Disease in Malaysia (–): A Systematic Literature Review

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