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Cablegate: Dengue Fever Epidemic: Not yet Peaked?

VZCZCXRO8090
PP RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHGP #1241 1790916
ZNR UUUUU ZZH
P 280916Z JUN 07
FM AMEMBASSY SINGAPORE
TO RUEHC/SECSTATE WASHDC PRIORITY 3488
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHPH/CDC ATLANTA GA

UNCLAS SINGAPORE 001241

SIPDIS

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: SENV TBIO ECON SN
SUBJECT: DENGUE FEVER EPIDEMIC: NOT YET PEAKED?

REF: 04 SINGAPORE 2984

NOT FOR INTERNET DISTRIBUTION

1. (SBU) The number of Singapore's dengue fever cases
decreased recently after briefly crossing the Ministry of
Health's (MOH) "epidemic threshold" of 378 cases per week in
mid-June, according to press reports. However, there are
concerns that the current outbreak is far from over.
Hospitals reported a total of 349 cases from June 17-23,
significantly lower that the 401 cases reported from June
10-16. Three dengue-related deaths have occurred in 2007.
The National Environmental Agency (NEA) has responded with
both mosquito eradication and public outreach campaigns,
including mailing information kits to all of Singapore's 1.2
million households. RMO and CONS have had no reports that
the outbreak has directly affected the American community,
but we have heard anecdotal accounts of cases at Singapore
American School. We are including a reference to dengue
fever in a revised Consular Information Sheet for Singapore.

2. (SBU) Dr. Annelies Wilder-Smith, Associate Professor at
the National University of Singapore and the Director of the
Traveler's Health and Vaccination Center, told Econoff that
recent rain and the unusual prevalence of serotype-2 dengue
(more common in Malaysia) may be to blame for the increased
number of cases this year. Unlike malarial mosquitoes,
dengue mosquitoes (Aedes egypti) prefer to breed in clear,
standing water. A wet May and June has provided ample
opportunity for water to collect in various containers around
the island, Wilder-Smith explained. Serotype-1 dengue is
typically the more prevalent strain in Singapore, so many
Singaporeans, especially children, have not built up an
immunity to serotype-2, resulting in more hospital visits.
Wilder-Smith praised Singapore's prompt and widespread
reaction to the outbreak. However, in the absence of a
vaccine, dengue is a very difficult disease to control, she
said. Agri-Food and Veterinary Authority (AVA) officials
told us that outsourcing to private companies of previously
government-run control efforts might have accounted for some
of the increase in dengue-carrying mosquitoes. They cited
what they claimed were the less rigorous methods of these
companies as a problem.

3. (SBU) There is no treatment for common dengue "fever",
but physicians monitor certain patients for possible dengue
hemorrhagic fever or dengue shock syndrome, which can be
fatal. MOH uses a platelet count to identify at-risk
patients. A low count automatically triggers a hospital
stay, Wilder-Smith said. However, such monitoring efforts
can strain the healthcare system. For example, MOH had to
lower its trigger level after being inundated with cases
during an outbreak in 2004, during which hospitals were
forced to remove other patients in order to make room for
dengue cases.

Comment
-------

4. (SBU) Singapore's impressive media blitz and full-scale
deployment of eradication teams are typical of the
government's reaction to domestic emergencies. In the case
of dengue, the response may have as much to do with the
bottom line as with health concerns. While dengue's
mortality rate is low, its morbidity costs are very high and
can impose a heavy burden on the healthcare system, as
evidenced by GOS willingness to modify its "at-risk"
definition. Additionally, Singapore clearly would prefer to
avoid any negative impact on its important tourism sector.
We will continue to monitor the situation and report as
events warrant.

Visit Embassy Singapore's Classified website:
http://www.state.sgov.gov/p/eap/singapore/ind ex.cfm
HERBOLD

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