Dengue Alert

Malaria: Why is action so slow in coming? (Straits Times, 18 June 2009)

2009-06-18T20:11:00.001+08:00

Malaria: Why is action so slow in coming?

June 18, 2009 by admin
Filed under News

By Salma Khalik, Health Correspondent from The Straits Times

DOCTORS are required by law, on pain of a fine and/or a jail term, to alert the Ministry of Health (MOH) within 24 hours of diagnosing a patient with certain infectious diseases.

This is so that the authorities can swoop in and nip the spread of these diseases - such as mosquito-borne ones like dengue, malaria and chikungunya - in the bud.

To be effective, notification must be prompt and follow-up action immediate.

The current outbreak of malaria has raised questions as to whether the notification system is imbued with enough sense of urgency.

By the time the National Environment Agency (NEA) activated its mosquito-busters, at least 17 more people had become infected.

Why did it take two to three weeks after Patient Zero surfaced for the NEA to swing into action?

An NEA spokesman said the agency was told of the Jurong cluster on May 25 - 22 days after the first patient there showed symptoms of malaria. It moved in with its search-and-destroy team the next day.

As for the Mandai cluster, it got the news on May 29, 13 days after the first patient there became ill. Fogging began the next day.

This is not the first time that a time lag between symptoms appearing in the first patient and NEA being told has resulted in more infections.

Singapore’s fight against chikungunya last year was also bugged by similar delays.

It is difficult to ascertain how many of the more than 100 locally-transmitted chikungunya cases last year, and the 250 so far this year, can be traced to the slow eradication of Aedes mosquitoes in the affected areas. But the existence of clusters of cases suggests that delay played a role in the spread of the disease.

The fact that a doctor’s failure to inform MOH of a notifiable disease like malaria within 24 hours could land him in jail for up to six months and/or a fine of up to $10,000 is indication enough that the law views the spread of such diseases seriously. Why then the delay?

The question has been posed to MOH several times, but no answer has been forthcoming.

The lapses appear to be in the reporting system. Either doctors are not reporting cases early enough, laboratories are taking too long to revert with test results, or ministry officials are not following up on tip-offs as quickly as they should.

Malaria is transmitted from patient to patient via mosquito bites. When someone is infected and symptoms appear, it means that the person has the malaria-bearing parasite in his blood.

The biting is done by the female Anopheles mosquito, which requires blood meals to go into breeding mode. A mosquito which picks up the parasites from the blood of an infected person passes them on to the next person it bites.

The only way to break the chain of transmission is to ensure that the patient is not bitten while still infectious. This means the patient either has to be kept in air-conditioned isolation and away from all insects, or all Anopheles mosquitoes in the vicinity have to be killed, and their breeding places destroyed.

In the recent outbreaks, people were getting infected and falling ill over a period of almost a month. This means several patients - and mosquitoes - were involved in spreading the disease.

The NEA is confident that it has wiped out the Anopheles mosquito in Jurong and Mandai, so there should not be any more infections there. If they had been alerted earlier, some of the victims could have been spared the fever, headache, chills and vomiting that come with malaria.

Laxity in reacting could see both malaria and chikungunya become endemic here - the way dengue already is. If they do become endemic, the fight to keep people from falling ill with these diseases will become more difficult.

Worldwide, about 240 million people are infected with malaria each year, and a million die from it.

Chikungunya rarely kills, but the illness is more severe than dengue. Its victims suffer from severe joint aches that can last weeks or even months.

Health Minister Khaw Boon Wan has warned that Singapore should not ‘belittle’ this malaria outbreak.

But perhaps Singapore’s malaria-free status for the past 27 years has bred a certain complacency, and chikungunya is relatively new. As a result, neither disease was on our radar screen, unlike dengue, which has been around for some time

But as Mr Khaw noted, it took a lot of effort for Singapore to become malaria-free. If the disease takes root here as dengue has, it will take a long time to eradicate it again.

Everyone - doctors, lab technicians and government officials - needs to take these diseases more seriously, and take action as soon as the diseases are detected.

Every citizen and resident in the country has a role to play too, since dengue, malaria and chikungunya are all spread by mosquitoes: Be assiduous in preventing this insect from breeding in the first place and none of these diseases will be able to spread.

No one is immune. The next person to be bitten by an infected mosquito could well be you.

Source: Straits Times

Use 'MP' approach to stop mosquito breeding (ST Forum, 16 Feb 2009)

2009-02-16T11:02:00.001+08:00

http://www.straitstimes.com/ST%2BForum/Story/STIStory_338838.html

February 16, 2009 Monday

Use 'MP' approach to stop mosquito breeding

SINGAPORE is perennially plagued by mosquito-borne diseases. First, it was malaria, then dengue fever, and the latest - chikungunya.

But it is possible to make Singapore essentially mosquito-free.

To illustrate the problem, I would like to describe the situation in my estate at Cluny Park, where two recent cases of chikungunya prompted me to write this letter.

Leaves falling on the road are the responsibility of the National Environment Agency (NEA). But trees on the strip of land next to the road are the concern of the National Parks Board.

The strip of land is traversed by many side drains, which direct water on the road surface into monsoon drains. The monsoon drains are under the purview of the PUB, but the side drains are 'no man's land'.

The trees shed leaves constantly and the narrow side drains are usually choked with fallen leaves. They harbour stagnant water during wet weather and so produce mosquito larvae.

Private contractors, outsourced by the NEA, remove the leaves from the road surface, but they say clearing the side drains is not their job.

As a result, my estate is seldom free of mosquitoes during the wet season. My neighbours resort to frequent chemical fogging of their compounds - a futile measure that does not affect mosquito breeding, but adds harmful pollutants to the environment.

Once, I managed to persuade the NEA contractors to clear the side drains, and we were able to enjoy a mosquito-free period until the drains became blocked again.

As felling of trees is banned, a permanent solution to these problematic side drains is to cover them and their inlets with metal grilles to keep out fallen leaves.

The authorities respond promptly to complaints. But they solve only the immediate problem, not the fundamental factors that allow mosquito breeding.

There should be a systematic and holistic approach, as disjointed ad hoc measures of mosquito control have got us nowhere.

The NEA should divide the island into districts and assign an officer to each - like a Member of Parliament (MP) looking after a constituency. Residents in each district should have access to him. He would become familiar with his district and once mosquito breeding grounds are detected, he should take effective measures to ensure no recurrence.

His primary task is to pre-empt any situation that may lead to accumulation of stagnant water, such as drains obstructed by trash and leaves, littering of containers and plastic bags, untidy construction sites, unoccupied houses with ill-maintained gardens and swimming pools.

Dr Ong Siew Chey

Breakthrough on dengue? (Straits Times, 3 Jan 2009)

2009-01-03T11:10:00.001+08:00

http://www.straitstimes.com/Breaking%2BNews/Tech%2Band%2BScience/Story/STIStory_321128.html

Jan 3, 2009

Breakthrough on dengue?

There is no known cure or vaccine for dengue fever, which is transmitted by mosquitoes and kills more than 20,000 people each year. -- ST PHOTO: ALPHONSUS CHAN

SYDNEY - AUSTRALIAN researchers funded by US billionaire Bill Gates on Friday claimed a breakthrough which could help in the fight against dengue fever by stopping the often deadly disease in its tracks.

University of Queensland researchers said they have successfully infected the mosquito which spreads the tropical disease with a bacterium which halves its 30-day lifespan, thereby reducing its ability to transmit dengue to humans.

Scientists hope their work will help halt the spread of the painful and debilitating disease which affects up to 100 million people each year.

'The key is that really only very old mosquitoes are the only ones that are able to transmit the disease,' said researcher Professor Scott O'Neill.

'What we've done is put this naturally occurring bacteria into the mosquitoes that actually halves their adult lifespan so they don't live long enough to be able to transmit the virus.'

The research published Friday in the journal Science is the result of injecting 10,000 mosquito embryos with a bacterium that occurs naturally in fruit flies but has never been detected in dengue-carrying mosquitoes.

Prof O'Neill said the test was designed to see whether the bacterium reduced the lifespan of the insects without killing them or preventing them from breeding and was able to be passed on to offspring.

He said while the laboratory tests, which involved researchers allowing the bacteria-infected mosquitoes to bite their arms because the species needs human blood to breed, had been successful, it would be several years before the technique would be tested in the wild.

'It's really a preventative strategy for preventing dengue fever outbreaks and what we've done is show that it's possible to be done in a laboratory,' he told AFP.

'The next stage is now to move it into a more realistic field setting.'

There is no known cure or vaccine for dengue fever, which is transmitted by mosquitoes and kills more than 20,000 people each year. Also known as 'breakbone fever,' symptoms include high temperatures and muscle aches.

The Bill and Melinda Gates Foundation donated US$10 million (S$14.4 million) to an international research team led by the University of Queensland into a means of defeating dengue fever in 2005. -- AFP

Today (15 Sept 2007) - 15 Town Councils fined

2007-09-15T19:54:00.000+08:00

http://www.todayonline.com/articles/211400.asp

Hot News // Weekend, September 15, 2007
15 Town Councils fined
Fifteen of the 16 Town Councils have been fined for breeding mosquitoes in the first eight months of this year – all of them repeat offenders.
.This revelation came as the National Environment Agency released the figures for the first time this year. It did not, however, name the Town Councils.
.Non-residential offenders, such as Town Councils and other public agencies, face a $200 fine for mosquito-breeding in the first three instances; further offences mean an appearance in court.
.In addition, 3,820 homes, including nine that were repeat offenders, were fined for mosquito breeding between January and August.
.Dr Yaacob Ibrahim said penalties would be stepped up if Singaporeans remained non-compliant.

Today (13 Sept 2007) - Long-term solutions needed to fight mosquito-borne diseases

2007-09-13T13:36:00.000+08:00

http://www.todayonline.com/articles/210874.asp

Voices // Thursday, September 13, 2007
Long-term solutions needed to fight mosquito-borne diseases

Letter from See Leong Kit

I refer to the report, "Woman, 53, is dengue's latest fatality" (Sept 12).
.This is the seventh death caused by dengue fever this year. To date, 6,530 people have been infected — three times more than in the same period last year. In 2005, 14,210 people were infected and 25 of them died, including a 10-year-old student.
.We now face the threat of chikungunya fever. Both viral diseases are spread by the same Aedes mosquito. Between December last year and May this year, the Health Ministry had reported eight confirmed chikungunya cases.
.While members of the public have to play their part to prevent mosquitoes breeding, public officials should also work on finding long-term solutions in tackling such mosquito-borne diseases. The National Environment Agency (NEA) should co-ordinate its efforts with other government bodies such as the Building & Construction Authority (BCA) and the Land Transport Authority (LTA).
.Have the NEA and BCA ever held a joint comprehensive review of the design and construction features of high-rise and low-rise buildings that contribute to mosquito breeding?
.Will the BCA set design rules for developers to follow?
.The NEA identified roof gutters to be a major breeding ground for mosquitoes. Yet many older bus stops still have roof gutters.
.Why don't the NEA and LTA seal off these gutters?
.Surely this would have been a quick and inexpensive solution?
.The roof gutters of houses are often difficult to reach and few home owners bother to clean them.
.Could the relevant agencies introduce new laws that ban the use of gutters in houses?
.Perhaps the NEA should also consider introducing legislation to cover these areas as well: Rooftop water tanks, lift wells, basement water-sumps, as well as drains and basement car parks.

Straits Times (4 Sept 2007) - Most people infected with dengue go undiagnosed

2007-09-04T11:13:00.000+08:00

http://www.straitstimes.com/Free/Story/STIStory_154487.html

Sep 4, 2007

Most people infected with dengue go undiagnosed

NEA finding means there are many more carriers here than originally thought

By Arti Mulchand

MOST people who are infected with dengue here are not diagnosed with the disease.
A study of blood samples collected from some 3,500 people living in six dengue hot spots has shown that only one in five victims is diagnosed with the disease.
The others either have only mild symptoms, which they brush off as a garden variety fever or cold, or show no symptoms at all, said the National Environment Agency (NEA), which conducted the study.
This is alarming, the agency added, as it means there are many more dengue carriers here than originally thought. Dengue is spread when an Aedes mosquito bites an infected person, and then transfers the virus to other people it bites.
To help combat the problem, doctors in dengue hot spots have been asked to conduct blood tests on patients who show flu-like symptoms.
People with symptoms such as fever and rash are also being encouraged to slap on mosquito repellent as a safety precaution.
VIDEO
Dengue hotspot: Bukit Batok(3:10) This year, 6,318 people here have been diagnosed with dengue.
However, the study shows this figure is only 'the tip of the iceberg', said Dr Christina Liew, a medical entomologist from the Environmental Health Institute (EHI) - the NEA's research arm - who was involved in the research.
She has a message for anyone feeling unwell: See a doctor, and use mosquito repellent as a pre-emptive measure, so the disease is not spread further.
Dr Ng Lee Ching, head of the EHI, told The Straits Times that the ongoing study, which began in May, showed that half of those who tested positive for dengue showed no symptoms, and did not know they had been infected.
Of the rest, more than half had symptoms such as fever or aches, but were not diagnosed as having dengue.
Dr Ng said that getting more people tested for dengue will help increase the reporting rate for the disease and allow the NEA to identify problem areas faster, as well as assess the population's immunity.
The revelation that most of those who have dengue go unnoticed comes just as weekly figures for the disease here dipped below 200 for the first time since mid-May.
Last week, there were 192 dengue cases, the fourth week in a row that the figure has fallen below warning levels.
However, this level is 'not comfortable', and the fight is far from over, said Mr Tai Ji Choong, head of operations of the NEA's Environmental Health Department.
In fact, in some areas, such as Bukit Batok, the situation is still worrying.
The cluster around Bukit Batok Street 31, 32 and 34, for instance, could set a new nine-year record - there have been 73 cases there in the last 57 days, and it is still active. The current record was set in 2005, with 74 cases in Yishun Street 72.
And despite the cooler weather - mosquito breeding and activity dip along with the temperature - there are other factors at play, said the EHI's Dr Ng.
This year, for example, a new type of dengue - Den 2 - is dominant, so more people are susceptible as they have no immunity to the strain.
She added that cooler weather does not always translate into lower dengue figures.
In 2004, for example, figures remained at warning levels through the year-end period, although that is not the traditional dengue season because of the cooler, wetter weather. And from July to September the following year, even through temperatures fell, the number of cases went up.
High year-end figures also have implications for next year's dengue situation: When the warmer weather sets in, the situation will likely get worse.
'The more we suppress the dengue cases now during the lull period, the more we put ourselves at an advantage when the warmer months come,' said Dr Ng.
arti@sph.com.sg
BUKIT BATOK ONE IS WORST DENGUE HOT SPOT NOW, SINGAPORE

Systemic flooding problem at Boon Lay/Jurong West

2007-08-28T11:07:00.000+08:00

Date: Mon, 27 Aug 2007 20:05:47 -0700 (PDT)

From: Jeff Ho denguealert@yahoo.com

Subject: Re: Drains along boon lay way in front of blk 517A Jurong West

To: Chuan Hoe LIM < LIM_Chuan_Hoe@pub.gov.sg >, YAP_KHENG_GUAN@PUB.GOV.SG
CC: PUBone@singnet.com.sg , Lee Yuen Hee lee_yuen_hee@nea.gov.sg, tckhoo@pub.gov.sg , Halimah halimah@ntuc.org.sg, Ibrahim Yaacob mewr_yaacob_ibrahim@mewr.gov.sg, Swarni Kaur swarnikaur@yahoo.com.sg

28 Aug 2007

To: PUB

If there is a systemic problem - fix it.

Do no insult the intelligence of Singaporeans, please!

Rgds
www.denguealert.blogspot.com
=========================================
Swarni Kaur wrote:
Thank you for your reply.
I strongly disagree with you that the hoardings (above the drain) caused the flood.
When it flooded last week, there was only a wooden ladder in the drain.

fyi There were also many occurences of flooding after the drain repairs/upgrade, just that I didnt bother to write.

To me, the entire Boon Lay/Jurong West is very flood prone and PUB has not solved the problem.
I will keep all posted when the drain flood again in the very near future.

I take the effort to tell PUB the problem but instead of solving the problem and analysing the root cause, I see that you are trying to give excuses and find scape goats.
sigh!

----- Original Message ----From: Chuan Hoe LIM To: swarnikaur@yahoo.com.sgCc: PUBone@singnet.com.sgSent: Thursday, 23 August 2007 12:32:18Subject: Drains along boon lay way in front of blk 517A Jurong West
Dear Ms Kaur Please refer to your feedback of drain overflow onto the sidetableduring the storm on 18 Aug. We have checked and found the cause to besome obstruction to flow from the hoardings erected over the drain by theTown Council. The obstruction has since been removed.2 Thank you for your feedback. Please contact my colleague Mr SiewSoon Wing at HP 92334298 directly, should you observe any obstruction todrains or occurrence of flooding.Yours faithfullyLim Chuan Hoe WilliamDeputy DirectorLim Chuan Hoe William (Embedded image moved to file: pic03970.gif) DeputyDirector (Embedded image moved to file: pic32684.gif) Catchment &Waterways Department (Embedded image moved to file: pic00246.gif) Tel :67313529 (Embedded image moved to file: pic19902.gif) Fax : 67313137 (Embedded Privileged/Confidential information may be contained in image moved to this message. If you are not the intended recipient, file: please notify the sender immediately. Visit our website at pic15726.jpg) http://www.pub.gov.sg ----- Forwarded by Irene TONG/PUB/SINGOV on 20-08-2007 01:59 PM ----- Swarni Kaur To Kheng Guan YAP/PUB/SINGOV@SINGOV, 19 Aug, 2007 PUBone@singnet.com.sg 03:28 PM cc NEA Contact/NEA/SINGOV@SINGOV, Halimah , Yuen Hee LEE/NEA/SINGOV@SINGOV, PUB Teng Chye KHOO/PUB/SINGOV@SINGOV, 75557@stomp.com.sg, Jeff Ho , MEWR Yaacob IBRAHIM/MEWR/SINGOV@SINGOV Subject Re: Drains along boon lay way in front of blk 517A JW A few weeks after I wrote the following email, PUB upgraded the drain infront of blk 517A JW.But on 18th Aug, the heavy rain flooded the bank again. So the upgrade wasnot effective.Waste public $Residents of Boon Lay have been suffering from flood every few months.9th Apr: http://singaporeseen.stomp.com.sg/viewPost2532.aspx18th Aug: http://singaporeseen.stomp.com.sg/viewPost4920.aspxPUB, pls do something effective.----- Original Message ----From: Swarni Kaur To: YAP_KHENG_GUAN@PUB.GOV.SG; PUBone@singnet.com.sgCc: Contact_NEA@nea.gov.sgSent: Monday, 9 April 2007 11:00:41Subject: Drains along boon lay way in front of blk 517A JWWish to inform that on last SAT about 3PM, the skretch of Boon Lay Way infront of Blk 517a Jurong West Str 52 was flooded. The road was flooded too.On Sat PM, the water level was about 80-100cm above the drain.Every year, this drain will flood 2-3 times.Pls look into this.thx!

AP (31 Jul 07) - WHO: Asia to be worse hit by dengue fever outbreak in decade

2007-07-31T15:05:00.000+08:00

http://news.asiaone.com/News/AsiaOne%2BNews/Asia/Story/A1Story20070731-20351.html

Margie Mason
Tue, Jul 31, 2007AP (Associated Press)

WHO: Asia to be worse hit by dengue fever outbreak in decade
HANOI, Vietnam (AP) -- Dengue fever is raging across Southeast Asia, prompting the World Health Organization to warn that the region could face the worst outbreak of the mosquito-borne virus in nearly a decade.
The disease, sometimes called the "bone breaker" illness because of the excruciating joint pain it causes, has flared across the region from ultramodern Singapore to poor Vietnam. There are four different types of dengue, and none have a cure or vaccine.
Cambodia is currently one of the most worrisome spots, where the disease has attacked about 25,000 people and killed nearly 300 children under age 15 so far this year. That's about three times more than the number of cases for all of 2005, according to WHO.
Sick children have overwhelmed ill-equipped hospitals there, forcing babies burning up with fever to wait for beds outside with IV drips attached to their arms.
The last major outbreak to hit Southeast Asia was in 1998, when about 350,000 cases were reported regionwide, including nearly 1,500 deaths. Indonesia and Thailand were not included in that tally.
John Ehrenberg, WHO's regional adviser on vector borne diseases, said it could potentially reach that level again this year.
"It looks like it might be a bad year," he said. "I think we're in the building-up stage, but it could very well peak by August or September."
Malaysia has seen a 50 percent jump in cases this year over the same period in 2006, with more than 1,000 patients admitted every week for the past month and 56 deaths recorded through June, according to Health Ministry figures.
In Indonesia, more than 100,000 infections have been reported this year, including 1,100 deaths. That compares to 114,000 cases and the same number of fatalities for all of 2006, said Nyoman Kandun, a senior Health Ministry official who predicted the number will hit 200,000 by year's end.
More than a dozen children infected with dengue filled beds in Jakarta's Tarakan Hospital. Some had IV drips in their hands while others had tubes coming from their noses.
Muhammad Wildan, 5, was hospitalized last week and remained in critical condition due to internal bleeding. Doctors said he's lucky his family did not wait any longer to bring him in.
"It did not come to us that it was dengue," said Padmi Sari, the boy's grandmother. "We thought it was just a common fever."
Singapore, known for its spotless streets and cutting-edge health facilities, has also not escaped dengue this year. The government has reported nearly 5,000 cases and at least three deaths. Early rains also caused a surge in cases in Thailand with more than 20,000 cases reported through June, including 17 deaths, officials said.
In Vietnam, which also typically logs a high number of annual cases, health officials have seen a 40 percent increase over last year reporting more than 33,000 infections this year and 32 deaths.
In addition to joint pain, rashes, nausea, severe headaches and high fever that typically accompany the disease, patients stricken with a more serious form, called dengue hemorrhagic fever, can experience internal bleeding, liver enlargement and circulatory shut down.
"You don't want to have people staying at home and starting to bleed," Ehrenberg said. "By the time they go to the hospital they're in shock and they will die."
The disease is not nearly as lethal as malaria, which kills more than 1 million people annually. But WHO estimates dengue infects up to 50 million people every year worldwide, mostly in Asia and Latin America. About a half million of those cases are severe, and some 19,000 deaths were recorded in 2002.
"We always think next year it will get better, but we always find next year it gets worse," said Kroeger Axel, a dengue research coordinator at the WHO in Geneva. "There's a very clear upward trend."
He said outbreaks run in cycles, occurring roughly every four years. Mosquitoes breed in stagnant pools of water ranging from flower pots to old tires, and residents across the region are urged to avoid letting water collect near houses.
--------
Associated Press reporters Heng Sinith in Phnom Penh, Cambodia; Sean Yoong in Kuala Lumpur, Malaysia; Tran Van Minh in Hanoi, Vietnam; and Zakki Hakim in Jakarta, Indonesia contributed to this report.

=================================================================

[QUOTE=margaret1424;68204]Why always blame the govenment when something happens? Stop complaining and play a part by helping to look out the breeding place of the mosquitoes and reporting them to the authorities. This will helps not only yourself, your loved ones but also the country. Be proud that you are a Singaporean![/QUOTE]Yes, I am proud to be a Singaporean. But if we don't blame the government first, they will blame the people ! This is what they are doing already, finding scrapgoats so that someone will appear in the papers or TV in shame breeding mozzies as 'pets'.The truth is, our eco-system is lop-sided. That is why mozzies start appearing everywhere. The Nature Society should come in and advise what natural enemies of mozzies we can introduce to balance the situation, eg. lizards, guppies, frogs, PAP MPs !
Posted by: somethingwrong at Wed Jul 25 11:27:46 SGT 2007

[quote=margaret1424;68204]Why always blame the govenment when something happens? Stop complaining and play a part by helping to look out the breeding place of the mosquitoes and reporting them to the authorities. This will helps not only yourself, your loved ones but also the country. Be proud that you are a Singaporean![/quote]The Way I See It:Do you question the government as a proud singaporeans why they forget to fog all the sewerage and drainage system as well as the lift pits and lift motor rooms in the island? These places have the most mozzie you know if you love your country and happen that you forget to complain? :D
Posted by: ILostMyBall at Tue Jul 24 17:18:15 SGT 2007

Why always blame the govenment when something happens? Stop complaining and play a part by helping to look out the breeding place of the mosquitoes and reporting them to the authorities. This will helps not only yourself, your loved ones but also the country. Be proud that you are a Singaporean!
Posted by: margaret1424 at Tue Jul 24 14:54:31 SGT 2007

Dirty drain - Jurong East Str 31

2007-07-11T14:13:00.000+08:00

Date: Tue, 10 Jul 2007 23:19:17 -0700 (PDT)

From: Jeff Ho denguealert@yahoo.com

Subject: Re: Dirty drain - Jurong East str 31

To: pub_one@pub.gov.sg , tckhoo@pub.gov.sg , pubone@singnet.com.sg

CC: halimah@ntuc.org.sg , amy_khor@mewr.gov.sg , YAP_KHENG_GUAN@PUB.GOV.SG ,Lee Yuen Hee lee_yuen_hee@nea.gov.sg, Contact_NEA@nea.gov.sg , Swarni Kaur

To: Relevant authorities
11 Jul 2007

Pls ensure the affected drains are cleaned up soon before it becomes another Aedes breeding ground (if it hasn't already become one).

Rgds
http://www.denguealert.blogspot.com/

=======================================

Swarni Kaur wrote:

see the photo of these dirty drains at the junction of jurong east str 31 and boon lay way.
They have not been swept for a month - see the grass growing on the rubbish.

cc: Ms Halimah, MP for Jurong
Ms AMy Khor, Mayor for SW CDC

Dengue experience: ministers' shortcomings and to-do list - ST (3 July 2007) - Dengue cases hit epidemic level again

2007-07-03T12:11:00.000+08:00

Date: Mon, 2 Jul 2007 21:07:59 -0700 (PDT)
From: Jeff Ho
Subject: Dengue experience: ministers' shortcomings and to-do list - ST (3 July 2007) - Dengue cases hit epidemic level again
To: mewr_yaacob_ibrahim@mewr.gov.sg, mah_bow_tan@mnd.gov.sg,
khaw_boon_wan@moh.gov.sg
CC: lee_hsien_loong@pmo.gov.sg, reach@reach.gov.sg, amy_khor@mewr.gov.sg,
"HuiChieh@ Straits Times" ,
"Letters@ Today" , tnp@sph.com.sg, arti@sph.com.sg,
taniat@sph.com.sg, dawntan@sph.com.sg, "Radha@sph Basu" ,
"Chee Kong@Today Loh" , salma@sph.com.sg,
ST Forum

To: Ministers Khaw Boon Wan (MOH)/Yaacob Ibrahim (MEWR)/Mah Bow Tan (MND)
cc: Prime Minister Lee Hsien Loong
cc: REACH
cc: Straits Times/Today/TNP

3 July 2007

Someone from my household had the misfortune to be down with dengue last week. But fortunately, she is now out of the CDC and recuperating at home. I understand from NEA there is another case across the road in my neighbourhood (Newton/Bukit Timah area) during the same period, so with these 2 cases occurring near each other, it would be updated as one of the many clusters although I note that the NEA website has yet to do so - refer link http://app.nea.gov.sg/cms/htdocs/category_sub.asp?cid=239 .

One good thing I learnt from almost first-hand experience is the observation that despite the last major outbreak in 2005, the lessons are still not learnt (or if learnt, not applied). Consequently, it is very easy for the outbreak to get out of hand again and again and again until and unless priorities are set and tackled by all concerned - households, NEA, MOH, MND, PUB, doctors, town councils, etc...

Let me share with you just 2 very basic but important observations which indicate major shortcomings that may have contributed to the recent outbreak. And since this involves inter-ministerial effort, and given the apparent ineffectiveness of the ministries working together (hence the current outbreak again), I shall set out to detail the To-do's for each minister how each should tackle the problem at his ministry:

AAA. "Preventive" measure:

In my condo, there have been many recent change of owners (due to the hot property market), as a result of which, some of the units were bought by foreigners hoping to re-sell them at a profit (just to highlight this point, one unit had barely changed hands before a "For Sale" sign was put up almost immediately. This was some 6 months ago but the unit is still vacant and unsold by the new buyer). Some months have passed but the units remain vacant - and since the owners are foreigners who do not reside here, they will remain vacant. Therefore, such vacant units are perfect for the Aedes mosquitoes - undisturbed for them to multiply manifold for many generations! And yet (despite my previous appeals for such "vacant" units to be the first to be inspected since any breeding inside these vacant units do not affect their owners (who do not stay there) or their families), the government (NEA?) is powerless as they wouldn't enter such premises without the owners' permission! (Just an example - NEA has not been able to enter one of the "identified" vacant units in my condo as they are unable to contact the owner since last week - by the time permission is granted (if ever it is granted), many generations of Aedes would have been hatched!).

Since there are confirmed cases in our estate, why isn't this a top priority?

I can foresee problems with this "missing link" where occupied houses (less likely to have breeding in the premises given the dangers posed to the occupants/loved ones) are subjected to inspection but the vacant units (more likely to have breeding since owners do not stay there) are not. This is exacerbated by the fact that more vacant units are coming up with the enbloc fever now, and the fact that many of the units are bought by foreigners (who do not stay here) for investment/speculation.

Moreover, Singapore regulations do not require these foreign owners to appoint local agents to "maintain" these units, unlike countries like Australia where I understand it is mandatory (correct me if I am wrong).

To-do's for Dr Ibrahim (MEWR) and Mr Mah (MND):

1. Make it mandatory for "vacant" units (unoccupied by owners or lessees) to be maintained by a local agent if the owner is a foreigner not residing here;
2. Mandate regulatory powers to enter households (forcibly) after 2 (or 3?) failed attempts to contact owners - especially for those in dengue clusters.
3. Thorough combing of houses and common areas in or around clusters (daily basis). I believe you have seen photos of clogged drains and filthy public areas, etc..., so I shall not belabour on this point but to add that I have always found it ridiculous that fingers have always been pointed to homeowners (be specific: homeowners of vacant units?) as the main culprits but evidence and reports have proven otherwise, with public areas like drains etc just as prone to breeding. (See my blog on dengue, www.denguealert.blogspot.com for more details).

BBB) For those infected with dengue:

1. My domestic helper first reported having fever on Saturday, 23 June while I was outstation. When the fever failed to go away, I brought her to a GP on Monday, 25 June upon my return to Singapore. GP's prognosis: unlikely to be dengue since (1) rashes only appearing on wrists and not the whole arms and legs; (2) temperature did not stay high at around 39 degree Celcius consistently throughout as her temperature fluctuated between 37 and 39 degrees. She was given anti-fever medicine. Believing the GP, I did not insist on blood test to confirm his prognosis.

2. Her condition improved intermittently but when the high fever returned on Thursday morning, I brought her to another 24-hour out-patient clinic at a nearby private hospital. The GP also said it was unlikely to be dengue as rashes appeared only on wrists and not on arms, legs and body. He however asked if I would like to have a blood test done on her to be absolutely sure, which I insisted since I suspected she might have the dengue. True enough, the blood test results an hour later confirmed my suspicion. She was later admitted to Tan Tock Seng Hospital (CDC).

3. So, for some 6 days (from Saturday, 23/6 to Thursday, 28/6) during her fever period, if any Aedes mosquito happened to have bitten her and then another person, the other person would have been infected, and the chain would go on, and on, and on....

4. The lesson learnt: Many people, including doctors, still do not know a lot about dengue, so despite all the assurances by the doctors about symptoms, the safest bet is still the blood test to confirm if dengue exists.

Given the gravity of the situation now, why isn't blood test for fever patients mandatory, or at least the first to be ordered? The blood test is pretty straight forward and fast (within an hour or so), so why not? The danger of not doing it is that someone with dengue may be missed out or wrongly disgnosed (like my maid - twice - until the blood test) and allowed to recuperate at home (most likely the source of the infection) with the high probability of her being bitten by an Aedes mosquito again for onward transmission to another healthy persson, and the transmission continues...

Despite all our painful dengue experience in 2005 and now, and the glorification of our Sars experience in 2003, such experience unfortunately is not put to good use.

To-do's for Mr Khaw, Health Minister:

1. All fever cases seen by private and public doctors must undergo a blood test to confirm dengue.
2. Report all such fever cases (potential and confirmed dengue) to a central database for tracking of clusters
3. Issue renewed advisory (with help from the local media?) about dengue symptoms since the public/doctors may have wrong ideas about such symptoms, which "may" include (extracted from Straits Times, 2 June 2007, "Dengue Strikes" - refer link, http://bp1.blogger.com/_zAPonigry-4/RmOD5A9cDiI/AAAAAAAAABM/GlEEugRozdo/s1600-h/st+(2+june+2007)+-+dengue+strikes+-+graphic.jpg :

a) Intermittent high fever (my maid had this symptom although not consistently);
b) body aches (my maid had this symptom);
c) exclude nausea (my maid did not have this symptom, so do not include this symptom, otherwise those without nausea may have the wrong impression they do not have dengue);
d) exclude diarrhoea (my maid did not have this symptom, so do not include).
e) rashes (on wrists and/or arms and/or legs and/or body but NOT ALL of these body parts as some doctors believe).

CCC. At the end of the day, minimising the spread of dengue should ideally involve both AAA and BBB above (eliminating breeding areas for the Aedes and preventing adult Aedes mosquitoes from biting an infected person), and the availability of a vaccine (still some years away), but since total elimination of all breeding areas (including forested areas and public areas) is almost impossible, what the government can zero in is to prevent adult Aedes from biting infected persons. (If you care to go through my blog www.denguealert.blogspot.com set up during the 2005 outbreak, I had proposed this too but the idea has not been taken up). How did my maid get infected? Most likely because she was unfortunate enough to be bitten by an infected mosquito after it had bitten an unsuspecting dengue patient (during the intervening "feverish" period before he/she is confirmed to be stricken with dengue via the blood test and/or while recuperating at home with fever - as in my maid's case).

MOH can easily achieve this by requiring all fever cases to see a doctor for a blood test to confirm if dengue exists, and if so, isolate them so that the chain can be broken (a valuable experience from the Sars days). At the same time, re-activate fever screening at all important points (immigration, public buildings, religious gatherings, etc... where masses are expected) to identify those with fever (another Sars invaluble experience) - such
heat-sensing machines are already in place in many areas).

Well, today's Straits Times report says it all - "Dengue cases hit epidemic level again", so do not wait for the situation to get worse (like in 2005) before taking appropriate action belatedly (reactively instead of pro-actively).

My maid remarked in disbelief, "Singapore is so clean (meaning "first world"?) when compared to her home town in Indonesia (meaning not-so-clean "third world"), but how could it happen here?"

When will the supposedly first-world Singapore government ever learn?

Rgds
www.denguealert.blogspot.com
==================================================

ST (3 July 2007) - Dengue cases hit epidemic level again

http://health.asiaone.com.sg/wellnessatwork/20070703_002.html

Dengue cases hit epidemic level again

By Arti Mulchand - Jul 3, 2007
The Straits Times
381 cases last week, crossing epidemic level for second time this year.

THE dengue situation has crossed into epidemic levels for the second time this year - the weekly number of cases here hit 381 last week.
That brings the number of people with dengue in the first 26 weeks of the year to 3,597. Three people have died.
Anything above 378 cases a week is considered an epidemic. The situation first crossed that line in the week of June 10, when it hit 401 cases.
There was a slight let-up last week, though Associate Professor Leo Yee Sin, clinical director of the Communicable Disease Centre and head of Tan Tock Seng Hospital's infectious disease department, had warned that it would be temporary.
She said: 'The number of cases is likely to fluctuate week by week, and it is likely that the level will remain high for the next few months.'
She is confident the figures will not match 2005, when there were 14,209 cases and 25 deaths, but only if 'all necessary measures' are put in place.
'All effort is needed to keep the numbers down,' she added.
The figures are expected to stay high until the usual mid-August or September peak. There were another 40 cases in the past two days alone.
There are now 78 areas where dengue is actively transmitted. In 15 of them, at least 10 people have been hit.
The situation remains bad in areas like Kim Keat, which has 31 cases, and where the dengue-spreading Aedes aegypti mosquito has been biting for close to a month.
It is also no better in the West Coast, where, between West Coast Road, West Coast Drive, West Coast Walk and Jalan Mas Puteh, there has been a combined 53 cases of dengue, and where the disease has been actively transmitted for more than 11/2 months.
Both the National Environment Agency (NEA) and the Ministry of Health (MOH) urge the public to be on even higher alert and to stay vigilant against mosquito breeding.
Those in known clusters should be extra careful, said the NEA. It advised spraying insecticide each morning in dark corners - for example, behind curtains and sofas - to get at mosquitos in hiding, and to apply mosquito repellent.
All clusters are listed on the Campaign Against Dengue website ( www.dengue.gov.sg )
MOH also reminds the public they should seek immediate medical attention if they have a fever. If diagnosed with dengue, they should use mosquito coils, nets and repellent to stop the disease being transmitted further.
'There should be no let-up in our efforts to break the chain of transmission. Continued vigilance is necessary,' said an MOH spokesman.

arti@sph.com.sg

Govt should provide evidence (photos, names..) before accusing home owners for breeding mosquitoes! - CNA (12Jun07) - Second dengue death

2007-06-13T19:23:00.001+08:00

"Name And Shame" culprits breeding mosquitoes?

Sent to the Singapore Government:

=======================================
"With more dengue cases detected at home, Dr Amy Khor, Senior Parliamentary Secretary, Ministry of the Environment and Water Resources, has urged Singaporeans not to let their guard down."

Channel News Asia (12 June 2007), "Second dengue death shows we need to be more alert: Dr Khor"

12 June 2007

Again, we hear of PAP MPs, Ministers, Parliamentary Secretaries, Senior Parliamentary Secretaries, civil servants all pointing the accusing fingers at home owners (just rhetoric but without any substantiation like photos, data, names, etc..) for breeding mosquitoes.

On the other hand, there is equally no shortage of accusing fingers from the public (all with "evidence" like photos, names of those responsible like PUB, NEA, etc..) at government agencies for their failure to maintain public areas like drains, etc.. before they are clogged, resulting in them becoming potential mosquito breeding grounds.

Based on the above, how can Dr Khor confidently claim that "more dengue cases detected at home,... " without any substantiation while the public backed their claims with evidence? Like Ms Kaur said, "..it is not fair to "push all the blame" to the people" when such accusations are not backed by evidence.

Like I suggested in my June 1st email (attached below), the government should

";Name And Shame" culprits breeding mosquitoes? (click on link for more details, or visit companion site, Name N Shame: A listing of mosquito breeders, litterbugs, etc.. ).

Is the government up to the challenge because such "naming and shaming" might well reveal the true culprits to be the government agencies themselves?

Probably that's why the government is so reluctant to implement this solution even if this solution may well work to deter those responsible for breeding mosquitoes - the source of yet another outbreak not long after the major one in 2005.

Rgds

http://denguealert.blogspot.com/

==========================================================

Swarni Kaur <> wrote:

Dear MP,

You were quoted in today's paper that "in spite of the efforts to promote the fight against dengue, Singaporeans were still complacent. People still think they are invincible. We need people to understand that it can really happen to them."

While it may be true that some singaporeans are complacent or ignorant, but it is not fair to "push all the blame" to the people. But the reality is that there are a lot of room for PUB and NEA to improve.

See the following websites and these photos that I have taken.

1) Stagnant water on grass patch along Boon Lay Way. Near Jurong East Sports complex

2) leaves, rubbish and stagnant water in drain along Jurong Town Road. Outside snow city.

http://singaporeseen.stomp.com.sg/viewPost3412.aspx

http://www.straitstimes.com/ST%2BForum/Story/STIStory_128318.html

http://www.denguealert.blogspot.com/

http://singaporeseen.stomp.com.sg/viewPost3377.aspx

http://singaporeseen.stomp.com.sg/viewPost3446.aspx

Maybe PUB and NEA too think that Singaporean are invincible to dengue.

Regards!

==============================================================

http://www.channelnewsasia.com/stories/singaporelocalnews/view/281776/1/.html

SINGAPORE: With more dengue cases detected at home, Dr Amy Khor, Senior Parliamentary Secretary, Ministry of the Environment and Water Resources, has urged Singaporeans not to let their guard down.

A second dengue related death was reported on Monday.

293 dengue cases were reported last week, up from 227 cases the week before.

The Aedes mosquitoes are increasingly adaptable and can breed even in a 20-cent coin size pool of water.

Dr Khor said everyone needs to play a part to bring down the numbers.

"We have found home breeding to have increased in the last couple of months. So we really need to make sure that everyone's involved, not just the managers, town councils... not just the pest control people, but also the residents.

"We do not hope that this will revert to what we have seen in 2005 but we really need to take precautions, put in a lot more effort to be vigilant and alert in order to... prevent this from escalating up to 2005 levels," Dr Khor added. - CNA/yy

Straits Times (12 June 2007) - Drain (outside NUS Law along Bt Timah Rd) still choked despite calling NEA, PUB

2007-06-12T10:25:00.000+08:00

"Name And Shame" culprits breeding mosquitoes?

http://www.straitstimes.com/ST%2BForum/Story/STIStory_128318.html

June 12, 2007
Drain still choked despite calling NEA, PUB
DENGUE cases have been on the rise in the past few weeks and the National Environment Agency (NEA) has been sending pamphlets to households, reminding residents to do their part in preventing mosquito breeding.
However, I have noticed a rather-alarming scene along Bukit Timah Road, where a roadside drain outside the NUS Law Faculty has been choked with weeds for the past few months, resulting in water stagnating in the drain.

I called the NEA hotline and was told that PUB Waterworks, which was responsible for maintaining the drain, would be notified. I made the call in the beginning of May, but nothing was done after a few weeks.

When I called the NEA hotline again, I was told that PUB Waterworks had been informed, and was given its telephone number so that I could remind it personally.

Upon calling the PUB, an officer told me that he would inspect the drain that day. However, a few weeks have passed, the weeds have not been cleared and the drain is still choked.

If residents have been told to do their part against mosquito breeding, shouldn't government agencies, which are responsible for taking care of public areas, set an example by doing their part as well?

Cheong Sooi Peng (Mdm)

PUB/Boon Lay Drive - TNP (6June07) - 100m of drain found clogged in dengue hotspot. PUB slaps maintenance contractor with demerit points

2007-06-07T20:24:00.000+08:00

"Name And Shame" culprits breeding mosquitoes?

To: NEA
cc: REACH

7 June 2007

I believe Ms Kaur has been highlighting this stretch of drain since months
ago but the situation does not seem to have improved, despite the heightened
dengue risk in recent months.

Rgds
============================================
Date: Mon, 15 Jan 2007 08:00:04 -0800 (PST)

From: Swarni Kaur <>Subject: drains near parc vista and boon lay driveTo: YAP_KHENG_GUAN@PUB.GOV.SG, jenlee@sph.com.sg, S_Satish_APPOO@nea.gov.sg,Contact_NEA@nea.gov.sgCC: tckhoo@pub.gov.sg, lee_yuen_hee@nea.gov.sg, denguealert@yahoo.com
see photo of choked drains outside parc vista condo and boon lay drive.
these photo are taken on 7th Jan.
========================================

http://newpaper.asia1.com.sg/news/story/0,4136,132314-1181167140,00.html?

DANGER DRAIN
100m of drain found clogged in dengue hotspot. PUB slaps maintenance contractor with demerit points
DENGUE cases are on the rise, and we have to stop the mozzies from breeding.
By Teh Jen Lee
06 June 2007
DENGUE cases are on the rise, and we have to stop the mozzies from breeding.
But last week, the drains along Boon Lay Drive were clogged and full of stagnant water.
When The New Paper went down to investigate, we found at least 100 metres of the drain along one side of the road blocked with sand, leaves and trash. There was some clogging of the drain on the other side too.
No mosquito larva could be seen, though the water was murky.
It was obvious from the stagnant water and rotting waste that the drains had not been cleared for a long time.
Local residents were jittery. Especially as there is an active dengue cluster in the area, with cases reported in five blocks along Boon Lay Drive.
Pointing at the clogged drain, housewife Lim Lay Hwa, 43, said in Mandarin: 'It's definitely possible for mosquitoes to breed in the water. I've heard of seven cases of dengue in this neighbourhood.'
She was worried about her three children aged 2 to 9, getting dengue.
She noted that the drains used to be better kept. 'Maybe it's because some blocks of flats around here have become empty recently when people moved out,' she said.
Said Madam Rosnah Mahad, 42, a housewife cycling past the clogged drains: 'Of course I am concerned. The authorities should clean it up.'
Another resident, who gave his name only as John, said: 'It seems like this area has been neglected. My mother almost died from dengue 10 years ago. I know how scary it can be. I really hope something is done.'
He said the area is home to many foreign students and workers, and more should be done to educate them on the dangers of the disease.
Ministry of Health figures have shown that roughly 30 per cent of dengue cases here involve foreigners.
The National Environment Agency (NEA) and the Public Utilities Board (PUB) are jointly responsible for ensuring that drains do not become breeding grounds for mosquitoes.
In reply to our queries, Mr Tan Nguan Sen, PUB's director for catchment and waterways, said its contractors are engaged under a performance-based contract to maintain the drains.
This rewards good performance and penalises shoddy work.
PENALISED
'Under this system, the contractors will have to clean as often as it is needed to keep the drains clean and litter-free, and they will be paid more if more cleaning is needed. However, if they fail to keep the drains clean, they will be penalised,' he said.
'The contractor in charge of Boon Lay Drive and Boon Lay Avenue failed to meet the standards and has been given demerit points, which will affect future performance evaluations.'
He added that the clogged drains have since been cleared.
'PUB welcomes all public feedback. All feedback received will help to strengthen our system, especially as Singapore has more than 7,000 km of drains and canals. The public can contact us at our 24-hour call centre PUB-One at 1800-2846600,' Mr Tan said.
A spokesman for NEA said it will apply granular insecticide to prevent mosquito-breeding whenever it comes across water stagnation in drains.
As for educating foreign workers on dengue, NEA has developed and distributed anti-dengue materials in English, Mandarin, Malay, Tamil, Bengali, Burmese, Thai, Tagalog and Sinhalese.
The number of dengue cases reported between 20 and 26 May is 259.
Weekly figures are released every Tuesday. The number of cases for the week of 27 May to 2 Jun will be released at noon today.

Jalan Besar Town Council & PUB? - Fwd: Clogged drains. Good breeding spots? (Sims Drive/Sims Place)

2007-06-06T14:30:00.000+08:00

'May I suggest that perhaps the government can adopt the "Name and Shame" (visit related site http://namenshame.blogspot.com/ to view listing of these culprits) strategy by identifying which areas that have been found to be breeding mosquitoes and under whose responsibilities (eg town councils, PUB, outsourced contractors, developers, individual household residents, etc...) with the corresponding Corrective Work Order (CWO) of "area cleaning" for culprits? 'http://denguealert.blogspot.com/2007/06/choked-and-overflowing-drain-and-sum.html

denguealert@yahoo.com

===================================================
Reply from NEA:

Subject: Clogged drains. Good breeding spots?

To: denguealert@yahoo.com
CC: Nordin SULAIMAN , PUB One ,Damian LEE , Feedback@jbtc.org.sg
From: Zulkarnain HASSAN BAKTEE Zulkarnain_HASSAN_BAKTEE@nea.gov.sg

Date: Wed, 6 Jun 2007 10:58:56 +0800Dear

Sir

I refer to your email feedback as appended below

In our recent check on 6 Jun 07 although no mosquito breeding was detected in the drain , potential habitats such as discarded containers found in the vicinity were removed immediately. We had also alerted to PUB to spruce up the road side drains and the Town Council to cleanse the HDB drains.

We are continuing our close surveillance of the estate

We will continue to work with all parties concerned to ensure a safe and clean environment and monitor the site closely.

Please contact our Managerof the area Mr Nordin Sulaiman at Tel 68546443 should you need further assistance.

Thank you for your feedback.

Sincere regards
Zulkarnain H Baktee
Manager
Customer Relations, Surveillance & Intelligence
Central Regional Office
National Environment Agency
DID +65 68546408
Fax +65 62739641

==================================================
Date: Sun, 27 May 2007 22:21:21 -0700 (PDT)

From: Moonbeam <>

Subject: Clogged drains. Good breeding spots?

To: denguealert@yahoo.com

Hi,
Attached are fotos taken of the drain in front of Blk 52 Sims Place last Thurs (24 May 07).

Sims Drive/Sims Place has been a dengue cluster for quite a number of weeks and the areas have been expanding. There's a lot of mosquitoes in the area, and from the condition of the drains there, it seems as though the drains are the cause of the presence of mosquitoes.Weird that no one has cleaned up the drains yet.

HDB & Town Councils - ST (6 June 2007) - Ltr: New methods and strategy needed to curb mosquitoes

2007-06-06T14:22:00.000+08:00

http://www.straitstimes.com/ST%2BForum/Story/STIStory_126303.html

June 6, 2007

New methods and strategy needed to curb mosquitoes

THE National Environment Agency should concentrate not only on households in its drive against mosquito breeding but also on other areas, such as drains in HDB estates and manholes along roads.
Most of the drains in HDB estates and manholes have stagnant water for long periods. They are not flushed or fogged regularly.
Unless the authorities carry out regular maintenance, these are real problems. Unlike private estates where fogging is done once a week, there are no such measures in HDB estates.
Lim Keng Hian
===============================================================

THE article, 'Dengue situation worrying, says head of CDC' (ST, June 2), is indeed worrying.
In an US experiment, it was found that less than 4 per cent of mosquitoes were killed with fogging. The most effective method is to eliminate them when they are in the larva stage in stagnant water as once they are able to fly, it is very difficult to kill them.
The uptrend in dengue cases is a cause for concern. Perhaps the National Environment Agency should look at non-traditional methods, and breeding places such as coconut trees planted in HDB areas.
Danny Chua Hock Chye

Straits Times (1 June 2007) - Ltr: NEA staff should have told him to call PUB

2007-06-05T16:01:00.000+08:00

http://www.straitstimes.com/ST+Forum/Story/STIStory_124781.html

The Straits Times
June 1, 2007

NEA staff should have told him to call PUB

ON MAY 25, I noticed that the drain along Jalan Loyang Besar (near Aloha Loyang) was again choked with overgrown weed and fallen leaves. I called the National Environment Agency (NEA) hotline to alert the staff to the problem. The officer assured me that she would pass my feedback to the relevant officer.
Three days later, I went to check on the drain. It was still choked. So I called NEA again. I was shocked when another officer told me that the choked drain comes under PUB. She asked that I call PUB instead.
I called the PUB hotline and an officer promised to have the matter looked into. Meanwhile, the drain is still choked.
It is ironic that while the CEO of NEA was making a big effort to declare war on mosquito breeding, the officer manning the NEA hotline adopted a different attitude.
It seems that whoever is responsible for the upkeep of the drain has failed in their duty. In the past five to 10 years, I had often been the one to clear the overgrown grass and debris.

Ong Kim Soon

Sunday Times (3 June 2007) - Citizen vigilantes step up fight against dengue

2007-06-04T12:07:00.000+08:00

June 3, 2007

Citizen vigilantes step up fight against dengue
Singaporeans have been taking part in the war against dengue fever, calling the NEA's hotline with tip-offs. Here, an NEA health officer is applying insecticide to the roof gutters of a house in Yishun. -- MUGILAN RAJASEGERAN
THE National Environment Agency (NEA) may have waged war on dengue fever, but it is still scant comfort to worried Singaporeans who have taken to alerting the authorities on where Aedes mosquitoes might be found.
Some write in to the newspapers. Others forward pictures of drains littered with leaves or refuse to The Straits Times' interactive online portal Stomp. But most are calling the NEA's hotline with tip-offs.
The agency got 2,502 calls last month, up from just 802 in April.
One man, at least, has taken dengue vigilance to another level. Mr Jeffrey Ho, 53, started a blog (www.denguealert.blogspot.com) during the last outbreak in 2005 to track potential breeding sites.
He has been taking pictures of drains choked with leaves, water or litter, posting them on his blog and sending them off to the NEA too.
Since about three months ago, he began getting more contributions to his blog from fellow dengue watchers, some with pictures of other clogged drains around the island.
'Most people don't know which drain falls under which agency's jurisdiction, so it can be quite frustrating sometimes.'
All public roadside drains are maintained by the Public Utilities Board's (PUB) contractors while individual land agencies or occupiers are responsible for the drains within their premises.
So town councils would take charge of those in their HDB estates, while JTC manages those in their industrial estates.

Read the full story in The Sunday Times.

"Name And Shame" culprits breeding mosquitoes?

2007-06-04T11:28:00.000+08:00

Straits Times (2 June 2007) - Dengue Strikes

2007-06-04T11:13:00.000+08:00

Straits Times - 2 June 2007:

http://www.straitstimes.com/Free/Story/STIStory_125187.html
June 2, 2007

Scientists stumped by 2 dengue findings here
Strains of disease found here and victims differ from elsewhere in region
By Tania Tan
UNDER INVESTIGATION: Health Minister Khaw Boon Wan visited Sembawang Drug Rehabilitation Centre to review the situation there. -- CHEW SENG KIM
SCIENTISTS studying dengue fever here are stumped on two fronts - that uniquely Singapore strains seem to have risen here and that young adults are most hit by the fever.
Early results from an ongoing islandwide study show that the strains of the virus circulating here could be evolving differently from those in other parts of the region.
Dr Martin Hibberd, a dengue researcher and associate director of infectious diseases at the Genome Institute of Singapore, said: 'It's possible that almost all the strains we see now are found exclusively in Singapore.'
Preliminary findings of the Early Dengue (Eden) infection and outcome study also suggest that young adults here - those over 21 - are more often victims of the disease than their counterparts in other Asian countries where the disease is endemic.
In Indonesia and India, for example, dengue victims are much younger - children.
In the region, the chance of meeting an infected Aedes mosquito carrying the virus is once every six months.
RELATED LINKS
Dengue strikes
Here - because of stringent vector control - the chance of getting bitten by an infected mosquito is about once every 10 years, what Dr Hibberd calls 'a statistical rarity'.
Adults are therefore more likely to be bitten - simply because they have been around longer.
But dengue infection in adults is not well studied here. Instead, most records are of cases of infection among children, said Dr Hibberd.
Even guidelines on treatment and management of the disease from the World Health Organisation were developed with young patients.
With so little to fall back on, doctors and scientists here have their work cut out. They have therefore pulled out all the stops in this fight against disease-bearing mosquitoes.
Eden, launched in 2005, is a collaboration between the Novartis Institute for Tropical Diseases, Tan Tock Seng Hospital and the National University of Singapore (NUS).
The study, which tracks the progress of disease development in volunteer patients with fever, hopes to shed light on how adult immune systems respond to dengue, and how best to treat the disease.
Another islandwide study by the National Environment Agency is investigating the proportion of people with immunity against different types of dengue.
Because not enough is known about the disease, vaccines are difficult to develop.
Some drugs are already in clinical trial phase, but researchers have yet to strike upon the 'perfect' vaccine, even after 20 years, said a Novartis spokesman.
A key hindrance is the fact that there are four types of dengue.
Vaccines that do not protect against all four types could do more harm than good, in that patients could end up developing more severe symptoms, said Associate Professor Paul Ananth Tambyah from NUS' Yong Loo Lin School of Medicine.
'That is a very high standard that most modern vaccines cannot meet,' he said.
taniat@sph.com.sg

Choked and overflowing drain and sum pit at jct of Gentle and Buckley Road - across from Revenue House

2007-06-01T11:07:00.000+08:00

Sent to REACH and NEA on 1 June 2007:

Date: Thu, 31 May 2007 20:05:06 -0700 (PDT)

Re: Choked and overflowing drain and sum pit at jct of Gentle and Buckley Road - across from Revenue House

To: REACH
cc: NEA CEO

1 June 2007

Please see attached photos taken at the subject junction on 31 May 2007 at around 1.34 pm.

You will note that the chokage at the sum pit and surrounding drains had caused the water to overflow. But fortunately, the overflowing water resulting from the chokage was not serious enough to cause any flooding around the area.

What is worrying is that because of the chokage (probably caused by uncleared fallen leaves, litter, etc..), it is potentially a fertile breeding ground for mosquitoes, given that the dengue is back.

Why is it that despite all the efforts that have been put in by the various government agencies (the formation of the inter-ministerial committee to tackle the menace since the major outbreak in 2005), the lessons are still not well learnt?

Well, of course, complacency is partly to blame.

And perhaps coupled with that, an attitude of "It is someone else's responsibility"? (By the way, is this affected area (public drains and sum pit) mentioned herein the responsibility of NEA? PUB? Outsouced contractors? Who else?

May I suggest that perhaps the government can adopt the "Name and Shame" (visit related site http://namenshame.blogspot.com to view listing of these culprits) strategy by identifying which areas that have been found to be breeding mosquitoes and under whose responsibilities (eg town councils, PUB, outsourced contractors, developers, individual household residents, etc...) with the corresponding Corrective Work Order (CWO) of "area cleaning" for culprits?

I can understand its reluctance (as the culprits might well be its own agencies (like NEA, PUB, MOE, HDB, etc..) or areas under its management (like PAP town councils), but in the interest of public health and accountability, the government should be transparent in identifying who the real culprits are. Otherwise, we will keep having the perennial problem again and again....

Rgds
Jeff
http://www.denguealert.blogspot.com/

Clogged drains at Blk 52, Sims Place (a dengue cluster): Good breeding spots?

2007-05-29T12:18:00.000+08:00

Sent to REACH and NEA on 29 may 2007:

Jeff Ho wrote:

Date: Mon, 28 May 2007 21:16:17 -0700 (PDT)

From: Jeff Ho denguealert@yahoo.com

Subject: Clogged drains at Blk 52, Sims Place: Good breeding spots?

To: reach@reach.gov.sg

CC: Yuen Hee LEE LEE_Yuen_Hee@nea.gov.sg , 75557@stomp.com.sg,Alias , ONN Alias_ONN@nea.gov.sg , Aminah YUNOS Aminah_YUNOS@nea.gov.sg , Ann WONG Ann_WONG@nea.gov.sg , Chin Boey CHIA CHIA_Chin_Boey@nea.gov.sg , Dalson CHUNG Dalson_CHUNG@nea.gov.sg , Fung Yin PANG PANG_Fung_Yin@nea.gov.sg , Hameed MASDI Hameed_MASDI@nea.gov.sg , Hui Tiak TAN TAN_Hui_Tiak@nea.gov.sg , Jamal MAJID Jamal_MAJID@nea.gov.sg, John GERIZIM John_GERIZIM@nea.gov.sg , Kahlik ISMAIL Kahlik_ISMAIL@nea.gov.sg , Kheng Seng LEE LEE_Kheng_Seng@nea.gov.sg , Kim Kee LIM LIM_Kim_Kee@nea.gov.sg , Kok Choy HUI HUI_Kok_Choy@nea.gov.sg , Lisa KOK Lisa_KOK@nea.gov.sg , PUB Teng Chye KHOO tckhoo@pub.gov.sg , R Chandramogan R R_Chandramogan_R@nea.gov.sg , Raja CHONNAMUTHU Raja_CHONNAMUTHU@nea.gov.sg , Ravindran NAIR Ravindran_NAIR@nea.gov.sg , S Satish APPOO S_Satish_APPOO@nea.gov.sg , Sara BOH Sara_BOH@nea.gov.sg, Selvanayagam INTHRALINGAM Selvanayagam_INTHRALINGAM@nea.gov.sg, Siti Suriani ABDUL MAJID Siti_Suriani_ABDUL_MAJID@nea.gov.sg, Song Joo LIM LIM_Song_Joo@nea.gov.sg, Subramaniam RAMASAMY Subramaniam_RAMASAMY@nea.gov.sg, Yaacob IBRAHIM Yaacob_IBRAHIM@mewr.gov.sg, Zulkarnain HASSAN BAKTEE Zulkarnain_HASSAN_BAKTEE@nea.gov.sg

To: Feedback Unit
cc: various NEA officers

29 May 2007

see attached email from concerned resident.

Moonbeam <> wrote:

Date: Sun, 27 May 2007 22:21:21 -0700 (PDT)

From: Moonbeam <>

Subject: Clogged drains. Good breeding spots?

To: denguealert@yahoo.com

Hi,

Attached are fotos taken of the drain in front of Blk 52 Sims Place last Thurs (24 May 07). Sims Drive/Sims Place has been a dengue cluster for quite a number of weeks and the areas have been expanding. There's a lot of mosquitoes in the area, and from the condition of the drains there, it seems as though the drains are the cause of the presence of mosquitoes. Weird that no one has cleaned up the drains yet.

Singapore's health minister says dengue outbreak worsened by spread of new strain

2007-05-25T14:45:00.000+08:00

http://hosted.ap.org/dynamic/stories/A/AS_MED_SINGAPORE_DENGUE_ASOL-?SITE=ASIAONE&SECTION=SOUTHEAST&TEMPLATE=DEFAULT&CTIME=2007-05-24-03-18-33

May 24, 3:18 AM EDT
Singapore's health minister says dengue outbreak worsened by spread of new strain
By GILLIAN WONG Associated Press Writer
AP Photo/Wong Maye-e
SINGAPORE (AP) -- A strain of dengue new to Singapore is impeding efforts to stem the spread of the mosquito-borne disease that has infected hundreds in the affluent city-state this year, a top health official said Thursday.
Health Minister Khaw Boon Wan said the current rise in infections, including a record 210 cases last week and one fatality, evoked memories of a 2005 epidemic that killed 25 in the tropical island-nation of 4.5 million.
"I'm quite worried about the dengue trend," Khaw told reporters on the sidelines of an infectious diseases exhibition.
Authorities said earlier this week that Singapore recorded a nearly 50 percent increase in dengue infections in the first 4-1/2 months of this year compared to the same period in 2006.
Dengue cases reported from the start of January to May 12 rose to 1,488 - up from 993 in the corresponding period last year, the Health Ministry said.
Singapore defines an epidemic as more than 378 cases a week, local media reported.
The disease, which causes joint pain, high fever, nausea and a rash, is endemic to the region. In severe cases, it leads to internal bleeding and sometimes death.
Khaw said the emergence in Singapore of a different dominant type of dengue was compounding the problem.
"What is a little against us is because of the strain, the strain type. It is ... largely new to the population here," Khaw said. "It's troublesome because many people have no current, existing immunity."
The dengue virus now predominant in Singapore is believed to be the same as in neighboring Indonesia, and is different from the main active strain in Singapore over the past few years, according to local media reports.
Those previously infected with other types of dengue are not immune, and may even face a higher risk of complications when infected with a different strain, The Straits Times newspaper said.
Health officials have been combing public housing estates in search of mosquito breeding sites. Dengue-carrying insects can breed in tiny pools of water found in flower pots, discarded bottles or cans, or old tires.
The Health Ministry said the recent spike in infections is likely due to warmer weather during this period of the year, which is conducive for breeding mosquitoes and the spread of dengue.
© 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

So many clogged drains. No wonder there's dengue.

2007-05-21T16:20:00.000+08:00

http://singaporeseen.stomp.com.sg/viewPost3052.aspx

From Yew Tee to Bukit Timah, one STOMPer has spotted potential dengue hotspots at clogged drains around Singapore.
Regular STOMP contributor, 51-year-old AG Lee, most recently emailed STOMP about his concerns about the rise in dengue cases in Singapore, and wonders if clogged drains like these might contribute to this worrying trend.
He came across these drains clogged with rubbish near a bus shelter at the Yew Tee industrial estate (main picture).
He also spotted a similar sight near the Anak Bukit flyover along Bukit Timah Road, where rubbish and overgrown grass had been clogging up the drains there (pictured)

He wondered if there could be more done by the authorities to prevent these spots from turning into dengue danger zones.
STOMP has contacted the National Environment Agency (NEA) and the PUB for comment. Watch this space.

Another dirty street near Aljunied MRT - potential dengue breeding gound

2007-05-21T15:31:00.000+08:00

See another dirty street in singapore.

http://singaporeseen.stomp.com.sg/viewPost2981.aspx

Why is this drain so dirty?

William Lim, 47, was appalled that the drain behind Aljunied MRT station was dirty and clogged up with rubbish.The production manager was on Geylang Lorong 25A, near the roundabout behind Aljunied MRT station where cars drop off and pick up passengers, yesterday evening (14 May).He was there with a friend at about 5pm to 6pm when he noticed the drain.He told STOMP, “It looked like the drain was not cleared for a long time. The water is stagnant, and there were newspapers and rubbish in there.”“I am so shocked that there is this kind of drain in Singapore.”

AP (21 May 2007) - Singapore records sharp rise in dengue cases, possibly from spread of new strain

2007-05-21T15:17:00.000+08:00

http://hosted.ap.org/dynamic/stories/A/AS_MED_SINGAPORE_DENGUE_ASOL-?SITE=ASIAONE&SECTION=SOUTHEAST&TEMPLATE=DEFAULT&CTIME=2007-05-21-01-05-18

May 21, 1:05 AM EDT
Report: Singapore records sharp rise in dengue cases, possibly from spread of new strain

SINGAPORE (AP) -- Singapore recorded a nearly 50 percent increase in dengue infections in the first 4 1/2 months of this year compared to the same period in 2006, news reports said Monday.
Dengue cases reported from the start of January to May 12 rose to 1,488 - up from 993 in the corresponding period last year, The Straits Times newspaper reported.
Singapore had 180 new cases of dengue reported last week, an all-time high, according to local TV news station Channel NewsAsia.
Health Minister Khaw Boon Wan said the sharp rise could be caused by a different strain of the virus spreading in the tropical city-state of 4.5 million, the paper reported.
One man is believed to have died this year from dengue fever, the paper said, without giving details.
The Health Ministry had no immediate comment on the reports.
Health officials have been combing public housing estates in search of mosquito breeding sites. Dengue-carrying insects can breed in tiny pools of water found in flower pots, discarded bottles or cans, or old tires.
Like several other Southeast Asian countries, Singapore reported a higher-than-usual number of dengue infections in 2005.
The disease, which causes joint pain, high fever, nausea and a rash, is endemic to the region. In severe cases, it leads to internal bleeding and sometimes death.
At least 19 out of Singapore's 4.2 million people died last year from the disease.
© 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.