Dengue fever in Singapore - are you at risk?

Posted on Dec 29, 2015 by rob.mcbroom

When moving to Singapore from another country, many expats will take the time to visit their local travel clinic in order to get necessary vaccines and learn about potential diseases they will face while living in the city-state. Because of Singapore's location close to the equator you can expect to be exposed to various tropical diseases, and while the government has gone to great lengths to minimize disease in the city, there is one that has proven hard to manage, meaning all expats moving to the city should be aware of it: Dengue fever.

A brief history of dengue fever in Singapore

Dengue fever is no stranger in Singapore, with the city-state having seen its first major outbreak in 1960. With the adoption of the DDIBA (Destruction of Disease-bearing Insects Act) in 1968 the government was largely able to keep dengue and other mosquito born illnesses in check. As the National Library Board points out however, "In the 1990s, the number of dengue cases began to rise." This rise has continued in a somewhat cyclical fashion with major outbreaks happening in 2005 and 2013 which saw around 14,000 cases and 27 deaths in 2005, and 22,000 cases in 2013.

In the few years since the 2013 high-watermark, the number of dengue cases has dropped thanks largely to efforts made by the National Environmental Agency. According to facts and figures from the Ministry of Health, there has been a total of 10,458 recorded cases of dengue in Singapore as of the end of week 50 (December 19, 2015), down from the 17,000+ cases seen by the same time period in 2014.

While overall this is good news, the weekly figure for week 50 (December 13-19) show that 333 new cases of dengue were recorded that week, almost double the number of cases seen over the same time period in 2014. This is interesting because historically, dengue cases peak in the months of June-August, and fall off closer to the end of the year.

According to an article published in the Straits Times, "While the number of dengue cases in the first 10 months of this year fell by about half compared with the same period last year, the Aedes mosquito population has doubled. The NEA said warmer than usual year-end weather caused by the El Nino phenomenon could result in shorter mosquito breeding periods and shorter incubation times for the dengue virus."  

Because of this year-end surge in cases, it would be a good time to ensure that you are aware of what exactly the symptoms of dengue fever are, how you can prevent it, and how your health insurance will cover the costs incurred if you need treatment.

Signs and symptoms of dengue

Dengue is a mosquito born viral infection commonly found in tropical and subtropical countries which causes a flu-like illness and can develop into severe dengue (commonly referred to as dengue hemorrhagic fever) which can be lethal. As such, it would be beneficial to know the main symptoms of dengue which include:

• sudden high fever which lasts up to 7 days
• severe headache
• intense pain usually behind the eyes
• joint, muscle, and bone pain
• mild bleeding of the nose or gums, or increased bruising
• skin rash
• loss of appetite
• nausea and vomiting

These symptoms will last from between two to seven days, and will usually occur from between 4 and 10 days of being bitten by a mosquito carrying the virus.

Dengue Hemorrhagic Fever shows all of the same symptoms but symptoms will be exacerbated. As the CDC points out, "Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. This marks the beginning of a 24- to 48-hour period when the smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels." If this is not corrected, it often leads to failure of the circulatory system and death.

The CDC also notes that if you start to suffer from the following symptoms 3-7 days after symptoms begin you should go to the emergency room as soon as possible:

• Severe abdominal pain or persistent vomiting
• Red spots or patches on the skin
• Bleeding from nose or gums
• Vomiting blood
• Black, tarry stools (feces, excrement)
• Drowsiness or irritability
• Pale, cold, or clammy skin
• Difficulty breathing

Prevention and treatment

With evidence pointing to the fact that dengue fever is generally more present in urban areas there is always a chance that you can contract it while living in Singapore. Because the symptoms are close to those of the flu it can be hard to determine when, or if, you should see a doctor. Most medical experts will recommend visiting your doctor if you have a high fever (above 40°C) and two or more of the symptoms above.

This is especially important if you are living in a recognized "dengue cluster", which is an area in Singapore that has a high population count of Aedes Mosquitos - the mosquito largely responsible for transmitting the virus. Thankfully, the Singapore Government, more specifically the National Environment Agency, keeps an up-to-date public record of current dengue clusters - areas where more than a set number of cases have been recorded - which are designated by color - red being a high risk area with more than 10 recent cases through to green with no new cases in the past 21 days. You can view the clusters here.

Knowing if you are living in a high risk area can be beneficial as you can then take more stringent prevention measures to reduce the risk of contracting the virus. These measures include:

• Knowing how to spot the Aedes Mosquito - These mosquitoes are black with white bands on their bodies.
• Removing all sources of standing/stagnant water in and around your house/apartment - This has long been a rule in Singapore, yet people still have standing water which can quickly become a breeding area for mosquitoes so, be sure to regularly check for, and remove standing water.   
• Using repellent - While it is not necessary to use repellent all of the time, if you are going to be exposed to mosquitoes for an extended period of time e.g., outside playing sports, or dining outside, then it would be a good idea to use repellent with DEET in it. Visit the Dengue.gov site to learn more about using inscet repellent in Singapore.
• Following the recommended preventive measures from the National Environment Agency - If you are living in one of the recognized dengue clusters, it is recommended that you follow the preventative measures related to the alert level for your area. They can be found here.  

Should you get sick, and decide to see a doctor, you should be aware that there are currently no drugs that will cure dengue. Doctors will prescribe medicine based on your symptoms, and with more severe cases you will likely be hospitalized. As an expat in Singapore this is not going to be cheap, especially if you go to a non-public facility. Therefore, it would be a good idea to ensure that you have a robust health insurance plan in place.

Talk to the experts at Pacific Prime Singapore today. They can help you secure a health insurance plan with coverage in Singapore and worldwide, that can ensure you and your family are covered for any health emergency including treatment for dengue fever.