Singapore Breaks Into Homes to Stem Dengue Fever: Southeast Asia

Singapore’s dengue cases are set to surge to a record this year, prompting the government to break into homes that could be breeding grounds for mosquitoes that transmit the disease.

Inspectors have broken into three homes suspected of housing mosquitoes since the start of the year, the National Environment Agency said today. They cut the delay before forcing entry into locked premises to one week from two this month, it said. Dengue infections may rise to 23,000 this year, exceeding the record 14,000 in 2005, Leo Yee Sin, director of Tan Tock Seng Hospital’s communicable disease center, said yesterday.

Singapore, one of the five places most affected by the Severe Acute Respiratory Syndrome or SARS outbreak in 2003, is seeking to prevent the spread of dengue, a tropical disease that has affected the city-state and other Southeast Asian nations for decades.

“There is a slightly more heightened sense of awareness of the risks associated with a supervirus or something that can spread very quickly,” Vishnu Varathan, a Singapore-based economist at Mizuho Corporate Bank Ltd., said in an interview yesterday. “The fact that SARS has actually hit the economy means that the coordination between ministries and the kind of airtime that such warnings get has become better over time.”

SARS killed about 33 in the city-state at the height of the outbreak. Tourist arrivals plunged to a two-decade low and the government shut schools and isolated more than 4,000 people.

The Ministry of Health said in an e-mailed statement today that no deaths have been reported from dengue this year. The estimate on dengue cases for 2013 is based on the trend of a fivefold increase from last year’s cases, Leo said.

‘Challenging Mosquito’

“This mosquito is a very challenging mosquito -- it’s adapting very well to our environment,” she said in an interview. “They will lay their eggs in many, many different places. If we humans destroy their breeding site in one place, they still have other eggs in some other areas.”

The government revised the latest daily dengue infections to 66 as of 6 p.m. Singapore time, bringing the number this year to 6,123. That’s more than the full-year total of 4,632 in 2012. Environment Minister Vivian Balakrishnan said last week the outbreak “may be our worst dengue epidemic ever.”

The National Environment Agency or NEA, which Balakrishnan’s ministry oversees, will make multiple visits to homes in affected areas before placing a legal notice to enter the premises. The break ins follow if homeowners or residents fail to respond after one week, the agency said in an e-mailed response to queries. Almost 1.5 million homes were inspected between January and mid-April, it said.

Active Transmission

“In areas where dengue is actively transmitting, NEA will shorten the time required to make the first inspection of all premises,” he said on his Facebook page on April 28, adding that residents will “understand the need for urgency.”

Dengue symptoms include high fever, headaches, joint pains and rash, according to the World Health Organization’s website. It may lead to complications and dengue hemorrhagic fever, a life-threatening form of the disease with symptoms that include abdominal pain, vomiting and bleeding.

The nation could have 1,000 infections a week at the peak of the outbreak, the Straits Times reported last week, citing Balakrishnan. The newspaper first reported the shorter period before inspectors break into homes.

Dengue, typically a childhood disease internationally, is infecting more adults in Singapore, the National Environment Agency, which Balakrishnan’s ministry oversees, said in an e-mailed response to queries.

Fitter Viruses

“Because of our intensive vector control over the years our population has had low herd immunity, making the population vulnerable to outbreaks,” it said, adding that the mosquito population has risen and viruses have become “fitter.”

Shares of hospital operators have risen this year. Raffles Medical Group Ltd. climbed 27 percent since the start of the year, and Parkway Life REIT jumped 28 percent, outpacing the benchmark Straits Times Index’s 7.3 percent advance.

The dengue outbreak also comes as an outbreak of H7N9 bird flu has killed 26 people in China since March.

In Singapore, a surge in the number of immigrants may have added to the outbreak, according to Ooi Eng Eong, an associate professor of emerging infectious diseases at Duke-NUS Graduate Medical School in the city-state.

‘Immunologically Naive’

“A significant proportion of our population’s made up of people who may not have been born in dengue-endemic regions so they are immunologically naive and therefore susceptible to infection,” Ooi said. The rise in population adds to “the pool of the people who are susceptible to the infection,” he said.

The number of people in Singapore has jumped by more than 1.1 million to 5.3 million since mid-2004 as the government used immigration to make up for a low birth rate.

The surge in infections this year could also be due to a switch in the type of dengue being transmitted, according to Tan Tock Seng’s Leo. People on the island may not have built up immunity to the type of dengue that is now dominant and are more vulnerable to it, she said.

“Dengue will be here to stay,” Leo said. “These mosquitoes are not mosquitoes we can easily get rid off.”

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