Infection and Drug Resistance (Feb 2023)
Singapore’s Dengue Outbreak Amidst the COVID-19 Pandemic: Challenges, Responses, and Lessons
Abstract
Huzaifa Ahmad Cheema,1 Rustam Shariq Mujtaba,2 Amna Siddiqui,3 Laiba Imran Vohra,4 Abia Shahid,1 Jaffer Shah,5 Abdulqadir J Nashwan,6 Natasha Howard7– 9 1Division of Infectious Diseases, Department of Medicine, King Edward Medical University, Lahore, Pakistan; 2Department of Pharmacy, National University of Singapore, Singapore, Singapore; 3Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan; 4Department of Medicine, Ziauddin University, Karachi, Pakistan; 5New York State Department of Health, Albany, NY, USA; 6Hamad Medical Corporation, Doha, Qatar; 7Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; 8Free Aleppo University, Aleppo, Syria; 9Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKCorrespondence: Abdulqadir J Nashwan, Department of Nursing, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar, Email [email protected]: Dengue outbreaks have been documented in Singapore since 1901, occurring almost annually in the 1960s and disproportionately affecting the paediatric population. In January 2020, virological surveillance detected a shift from DENV-2, which was the previous dominant strain, to DENV-3. As of 20 September 2022, 27,283 cases have been reported in 2022. Singapore is currently also responding to the COVID-19 pandemic, overcoming another wave of infections with 281,977 cases recorded in the past two months as of 19 September 2022. While Singapore has adopted several policies and interventions to combat dengue, primarily through environmental control but also innovations such as the Wolbachia mosquito programme, there is a need for further efforts to deal with the dual threat of dengue and COVID-19. Drawing lessons from Singapore’s experience, countries facing such dual epidemics should enact clear policy responses, including establishing a multisectoral dengue action committee and action plan prior to potential outbreaks. Key indicators should be agreed upon and tracked at all healthcare levels as part of dengue surveillance and incorporated into the national health information system. Digitizing dengue monitoring systems and implementing telemedicine solutions are innovative measures that would facilitate the response to dengue in the context of restrictions during the COVID-19 pandemic that hinder the detection and response to new cases. There is a need for greater international collaboration in reducing or eradicating dengue in endemic countries. Further research is also required on how best to establish integrated early warning systems and extend our knowledge of the effects of COVID-19 on dengue transmission in affected countries.Keywords: DENV-3, SARS-CoV-2, infectious disease control, Singapore
