pencegahan dan kawalan denggi - ministry of housing and

Pencegahan dan Kawalan Denggimelalui pengurusan persekitaran bandar

secara mampan dan lestari

Veeramohan Supramaniam, FRSH

Malaysian Association of Environmental Health

Pengenalan

• Kejadian dan (Kematian) akibat denggi kian meningkatselepas wabak teruk pada tahun 2010:

• 46,171 (134) @ 2010,

• 19,884 (34) @ 2011,

• 21,900 (35) @ 2012,

• 43,346 (92) @ 2013

• 100,661* (190) @ 13 Dis 2014

* Unit Vektor KKM hingga minggu ke-50 berakhir 13 Dis 2014

Source: http://idengue.remotesensing.gov.my/idengue/index.php

4+ dekad Denggi di Malaysia*

12,077 20,973

143,262

372,224

43,346

100,661

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

1973-

1982

1983-

1992

1993-

2002

2003-

2012

2013 2014

Jumlah kes

173.7%

683.1%

* Geraf dihasilkan oleh MAEH daripada data asas dari KKM

259.8%

Hasil perlaksanaan kaedah alternatifMajlis Daerah Manjung Ref: 2001: 497 cases27.3 percent reduction in 2002 (361 cases) - 3rd quarter intervention. Sitiawan and TLDM Lumut - epidemic free until today. (Trf 01.04.04)

Majlis Daerah Perak Tengah Ref: 2008 : 250 cases52.00 percent drop in 2009 (120 cases); 35.00 percent drop in 2010 (78 cases); 44.87 in 2011 (43 cases); 18.60 in 2012 (35 cases);14.29 in 2013 (30 cases); 4 cases up to 05 April 2014 (Rtd 29.03.14)

Setapak, DBKL Ref: 2006 : 2431 cases 11.35 percent reduction in 2007 (2155 cases);46.36 percent reduction in 2008 (1156 cases); 14.01 percent reduction in 2009 ( 994 cases);16.60 percent increase in 2010 (1159 cases); 65.31 percent reduction in 2011 ( 402 cases);22.14 percent increase in 2012 ( 491 cases);79.02 percent reduction in 2013 ( 103 cases);

0

20000

40000

60000

80000

100000

120000

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

-62.3%

Nationwide Intensive Campaign

Nationwide Intensive Campaign

Bersih & Indah Campaign II

National Cleanliness and Anti-mosquito Campaign

Bersih & Indah Campaign I

Keberkesanan Kempen Kebersihan Nasional

-73.7% -53%

-63%-30%

-18%

Worst epidemic before the new millennium

Nationwide Cleanup CampaignIntensive Cleanup Campaign

-15.9%

-56.9%

10 min Search & DestroyCampaign

100,661 (190) 13/12/14

Garispanduan Kawalan DenggiKementerian Kesihatan Malaysia

• Pemeriksaan premis dari rumah ke rumah

• Penggunaan racun kimia (fogging, ULV, Abate SG-1) dll

• Penguatkuasaan – perintah berhenti kerja, pendakwaan

• Penubuhan dan penglibatan pasukan COMBI

• Gotong royong di kawasan perumahan dankediaman

Malaysia mengkritik WHO keranagagal menangani wabak denggi*

Malaysia criticized the WHO for failing to tackle the spread of

dengue in the region, which saw 242,000 cases of the mosquito-

borne disease in 2009 and 831 deaths so far this year.

Health Minister Liow Tiong Lai, who is chairing a World Health

Organization regional conference this week, said the UN body needed

to push countries to adopt a more comprehensive strategy to deal

with the threat.

"We want them to do a lot more. We want the WHO to do more on

dengue, we think they are not doing enough," he told reporters on the

sidelines of the meeting of the organization's Asia Pacific member

states.

* Romen Bose, Agence France-Presse – Wednesday 10/13/2010, 16:47:00

Garispanduan Kawalan Denggi WHO*

* WHO Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever - Revised and expanded edition, 2011 - Chapter 7 (Page 60)

Pusingan hidup nyamuk Aedes

Beberapa saat –

bertahun-tahun

Telur kering

2 – 3 hari

3 – 4 hari (kalau

makanan wujud)

2 – 3 hari

X

Tiada Makanan

Telur nyamuk diletak pada dindinglembab/kering, BUKAN ATAS AIR

Penetasan telur S. albopicta yang matang

Stegomyia aegypti• Nyamuk rimau (Egyptian Tiger)

• Nyamuk vektor berasal dari Egypt

• Membiak dalam rumah dan halaman

• Menggigit di bawah paras pinggang

• Tidak efisyen meminda jangkitan melalui telur(menjangkiti 5 generasi)

• Tahan kekeringan dan menetas dalam 3 hariapabila ditenggelami air.

Stegomyia albopicta• Nyamuk rimau (Asian Tiger)

• Nyamuk vektor tempatan

• Membiak di celah tumbuh-tumbuhan

• Mengejar dan menggigit

• Sangat efisyen meminda jangkitan melaluitelur (semua generasi terjangkit)

• Tahan kekeringan dan menetas serta mertaapabila ditenggelami air hujan panas.

Hasil Kajian Vektor di Malaysia

TOT - S. albopicta berbanding S. aegypti

Kenapa Denggi harus dicegah?

• Kejadian kes = Produktiviti Negara terjejas

• Kematian kes = Kehilangan Modal Insan

• Beban Ekonomi = +/- 20 % GDP

• Kesan kepada Pelancongan

Beban Ekonomi kepada negara

Kos kawalan denggi di Malaysia (2013)

Kos rawatan & kawalan untuk 12 bulan RM196,000,000

Kos setiap kes yang dilapurkan RM5,441.27

Kos setiap rawatan pesakit luar RM680.78

Kos harian rawatan kes di wad RM163.54

Kos pengurusan setiap penduduk negara RM7.14 /warga

Shepard2, et al. (2013) - Use of Multiple Data Sources to Estimate the

Economic Cost of Dengue Illness in Malaysia

Beban ekonomi akibat denggi di Malaysia (Oxitech)

Kos setiap 10,000 kes = US$13 juta* RM 44,460,000*

Kos untuk 100,661* (190) kes denggi

(setakat 13/12/14)

RM 436,277,088

Kehilangan hari kerja / 10,000 kes 940,000 hari

Kos rawatan wad / kes / hari = US$718 RM 2,283.24

Kehilangan pengeluaran ekonomi / kes 56 hari

Oxitech - http://www.oxitec.com/health/dengue-information-centre/the-economic-burden/

* Bersamaan 20% the Pengeluaran Kasar dalam negara.

* Berdasarkan pertukaran matawang = RM 3.42 / USD

Dry spell, diseases spoil Visit Malaysia Year by G Vinod *Dengue cases rise dramatically, TB makes a comeback and the haze makes an early appearance.

PETALING JAYA: It’s been a bad start for Visit Malaysia Year 2014, but neither the Tourism Ministry nor the tourism industry is to blame.Rather, the culprits are disease and bad weather.

According to the Health Ministry, more than 20,000 cases of dengue were recorded between the beginning of the year and the end of last week. This was a huge jump from the 4,760 cases recorded in the same period last year. Forty-five of this year’s dengue victims have died.

To make matters worse, a disease thought to be long gone—tuberculosis (TB)–has made a comeback to the Malaysian health hazard list.The Health Ministry said 1,520 people lost their lives to TB in 2012 alone. They were among 22,710 people infected with the disease.No one is sure how TB has resurfaced in the country, but some quarters blame illegal immigrants, pointing out that they entered the country without health screening.

The weather is also discouraging tourists from coming to the country. Malaysia has been facing an unseasonal dry spell since early February. Water levels at several dams in Selangor, Negeri Sembilan and Johor are reaching critical points. The Meteorological Department says the rains will start coming at the end of March or in early April. Meanwhile the National Water Services Commission (SPAN) is rationing water distribution in Negeri Sembilan, Johor and Selangor.Selangor is the most industrialised state in Malaysia, and the water rationing has affected many businesses, especially restaurants and agriculture based enterprises. Rice and palm oil production are also affected.

If the dry spell goes on for another month, oil palm yields will keep dropping for six months to two years down line, according to people in the industry. This concern pushed up palm oil prices by 8% in February.

With the dry spell creating bush fires in Sumatra, coupled with illegal burning by farmers there, the notorious “haze season” has made an unwelcome return to Malaysia. Air Pollutant Index (API) readings on Friday breached the hazardous level at Port Klang (358) and Banting(311), prompting authorities to order a temporary closure of 202 schools. Readings have also shown a deterioration in air quality in Petaling Jaya, where the API is 185, and in Shah Alam, where it is 164.

Cloud seeding has induced some rain, but not enough to clear the haze or even improve dam levels. No one knows for sure when theweather will improve. In the meantime, health facilities will be busy treating increasing numbers of people complaining of respiratory problems and other maladies brought on by heat and polluted air.

*Free Malaysia Today - March 15, 2014

Bagaimana Denggi berlaku?

• Manusia/mawas pembawa virus

• Nyamuk Aedes peminda virus.

• Persekitaran / kediaman = tempat membiak

Mana satu mampu kita kawal?

Punca Virus – Pembiakan Nyamuk – Manusia

Siapa mangsa denggi - 2013

Jangkitan berlaku di luar*

* Dengue Bulletin – Volume 25, 2001.

Jangkitan di kawasan lapangan

Denggi di kalangan murid sekolah

Statistik Pembiakan Vektor* Malaysia 1992 - 2001

0

1000000

2000000

3000000

4000000

5000000

6000000

Houses Insp 4306403 4822081 4724210 4555906 4397754 4239489 5071478 3915499 3956344 4249307

Houses +ve 46440 48649 33378 43773 41612 42902 36203 27961 21117 26856

Aedes Index 1.1 1 0.7 1 0.9 1 0.7 0.7 0.5 0.6

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

*Source: Vector HQ MOH

Status Pembiakan Nyamuk di kawasan lapangan Bandaran

• 99 peratus nyamuk membiak di persekitaran

• 1 peratus masuk ke premis yang didiami orang

Bagaimana virus berjangkit?

• Ae. albopictus membiak liar di kawasan tanahlapangan/tanah terbiar dalam semak samun

• Ae. albopictus lebih berpeluang menemuipembawa virus denggi 2 hari sebelum “onset”

• Ae. albopictus yang terjangkit memindahkanjangkitan kepada penduduk tempatan yang lalu lalang berhampiran tanah lapangan yang menjadi “epicentre” jangkitan.

Cara nyamuk vektor terjangkit*

*Frontiers in Immunology Journal, 17 June 2014.

Pergerakan manusia pembawa virus

Source: Control of Vector-Borne Diseases Unit, Ministry of Health, Malaysia

Cases radiating from epicentres

Status Orang Asing di Malaysia 2014

Negara berbeban tertinggi 2013

Ketibaan pelancong 2012

Ministry of Tourism

Kawasan kediaman pekerja asing di Lembah Kelang

Langkah terbaik kawalan nyamuk

• Pastikan “epicenter” jangkitan

• Bersihkan kawasan sekitar dari semak samun

• Jadikan kawasan lapangan tidak sesuai untukpembiakan nyamuk

• Jangan guna semburan racun kecuali ada kes

• Galakkan tumbuhan berbunga yang memikatnyamuk dan pemangsanya.

• Gunakan racun jejentik jenis EC bukan SG

Pemetaan Pergerakan Tempatan

Epicentre – Laluan pejalan kaki

Epicentre – Laluan tepi Taman

Masa yang sesuai untuk semburan

Source: Bebas Denggi - Unit Kawalan Penyakit Bawaan Vektor JKWP KL dan Putrajaya

“Urban Heat Island Effect”

“Temperature Inversion”

Masa terbaik – “thermal fogging”

Asap tidak lesap dengan cepat

Tanah terbiar di Taman Rakyat Kg. Koh, Manjung (projek perintis)

Reproduced with permission from A Pictorial Report (MPM) - Operations Anti-Aedes

Tanah selepas dibersihkan

Reproduced with permission from A Pictorial Report (MPM) - Operations Anti-Aedes

Tanah terbiar di Taman Maju, Seri Iskandar

Tanah dibersihkan dan dilakukanlandscaping di Seri Iskandar

Sebelum tanah terbiar dibersihkan, Setapak

Selepas pembersihan tanah terbiar, Setapak

Akta Kerajaan Tempatan 1976

Pekerja menyembur racun serangga di Yoyogi Park, Jepun, yang dipercayai punca wabak denggi pada 28 Ogos, 2014.

Semburan kabus ULV

Kawalan VektorSemulajadi

Nyamuk terperangkap di sawanglabah-labah

Peranan utama nyamuk

Bukti nyamuk menghisap madu

Nyamuk adalah pemindahdebunga

Pemangsa nyamuk paling berkesan

Mentadak

Kekatak

Cecicak

Telur diletak pada kelopak bunga

Sesemut – pemangsa telur nyamuk

Mamalia terbang

Burung

Penghijauan and Biodiversifikasi bandar

Cuba : Contoh Pertanian di Bandar

Pertanian Organik di Havana, Cuba

MAEH VP signs MOU* with DBKL

* Partners and Stakeholders in LA21 since 16 Dec 2013

Kesan nyata dan positif

• Pengurusan kawasan lapangan merupakankaedah yang terbaik untuk mencegahjangkitan virus bawaan nyamuk secara terusdan transovarial oleh Stegomyia sepertiDenggi, Chikungunya serta Zika fever di kawasan bercorak bandar.

• Penurunan kes dapat dilihat dalam 2 atau 3 minggu selepas diputuskan jangkitantempatan (Batu and Lembah Pantai, WPKL May 2014)

Surat sokongan dari KKM

Sokongan YBMK terhadap kawalan kawasan lapangan

Cadangan MAEH diterimapakai

Kelebihan sampingan

• Kawalan semulajadi dalam rantaian makanan.

• Penghijauan dan pengindahan bandar

amalan pertanian di bandar

perseimbangan ekosistem tempatan

perkayaan biodiversiti

Penjimatan Kos.Kesudahan Kempen Kebersihan dan Anti Nyamuk Kebangsaan 1998 (inisiatif KPKT)

1998 = 27,381 kes

1999 = 10,146 kes

Pengurangan = 17,235 kes

penurunan 63 %

Kos @ RM 4,000 setiap kes

17,235 kes = RM 68,940,000 (penjimatan)

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Intensive Campaign

Intensive Campaign

National Cleanliness and Anti Mosquito Campaign

Bersih & Indah Campaign

@10 % reduction in cases per annum

Actual Cases for 2012

Kesudahan kempen kebersihan kawasan terbuka

(ramalan @ 10% pengurangan kes tahunan)

? lives & cost savings

Actual Cases for 2003

Actual Cases in 2013

Predicted 2014 cases (381 cases)

100,661 (190) @ 13/12/14

289,827,708

4+dekad kejadian denggi

12,077 20,973

143,262

372,224

43,346

100,661

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

1973-

1982

1983-

1992

1993-

2002

2003-

2012

2013 2014

Total cases

173.7%

683.1%

Source: MOH Malaysia

220.6%

Kesudahan kempen kebersihan kawasan terbuka(ramalan @ 10% pengurangan kes tahunan)

12077

20973

25807

7905

0

5000

10000

15000

20000

25000

30000

1973-1982 1983-1992 1993-2002 2003-1012

Total cases

173.7%

123%

69.4%

Keberkesanan Kos Pencegahan darisegi pengurangan Keuzuran, Kematian

• Kos minima @ pengurangan 10 % setiap tahun

Pengurusan Kawasan Lapangan melalui

Intervensi Kesihatan Persekitaran

Jumlah kes bagi Dekad ke-3 (2003 - 2012)

dianggarkan menghasilkan hanya 7,905 kes

Berbanding jumlah sebenar 372,224 kes

Pencegahan 364,319 kes = RM 1,457,276,000

Keuzuran = Kehilangan Productiviti

Kematian = Kehilangan Modal Insan

Mengapa “semburan” racunserangga berbahaya dan

kurang berkesan.

Pendedahan kepada karsinogen..Polycyclic Aromatic Hydrocarbons (PAH)

Penggunaan racunkimia selepas 2000.

Actellic EC Sumithion

Fogging membunuh mahkluk lain yang tidak disasarkan.

Kesan sampingan kepada ekosistem

Black arrows indicate live Aedes larvae.

Red arrow indicates dead spider and an unidentified insect.

A pair of dead butterflies

Chua, et al.3 2003

Kesan sampingan kepada ekosistem

A dead frog found in an ovitrap48 hours after application of ULV

A dead centipete and various other spiders and insects found in another ovitrap after application of ULV

Tanpa pemangsa…

• Se ekor nyamuk betina Stegomyia mampumenghasilkan 1,000 biji telur dalam jangkahayat30 hari.

• 500 ekor nyamuk betina = 500,000 biji telur.

• 250,000 ekor = 250,000,000 biji telur.

• 125,000,000 ekor = 125,000,000,000 telur.

Mengurangkan pendedahan kepadagigitan nyamuk

Penggunaan penghalau nyamuk ketika Piala Dunia*

The soccer World Cup, which runs through July 13, has brought thousands of visitors to a country with

the world’s largest incidence of dengue. A heatwave has extended the mosquito season and fans have

been urged to use repellent and wear long-sleeved clothing in the early morning and late afternoon.

* Makiko Kitamura and Natasha Khan – Bloomberg News Jul 1, 2014 4:54 PM

Terima kasih atas

perhatian anda.

Veeramohan Supramaniam, FRSH

HP: 013-3335361, 018-5711371

vmosram@gmail.com