PETALING JAYA, March 31 — For Datuk Borhanuddin Osman, there was no way in his mind that he ever thought he would be third time unlucky.
After all, who would guess that one could get dengue for the third time?
The Themed Attractions Resorts and Hotels director said his most recent “misadventure” with dengue was in late February when he returned from a golfing trip in Jakarta.
He thought he had caught the flu from a fellow golfer despite necessary precautions to make sure he did not get it.
“But I felt cold and was shivering when I came back. So, I took Panadol every six hours but the fever would return,” he said.
Borhanuddin is among Malaysians who have been infected with dengue more than once — an occurrence that experts say can happen when there is a change in dengue serotype at different periods of time.
The 63-year-old headed to Tropicana Medical Centre and got a blood test done.
“Then my cardiologist, Dr Haizal came in and said ‘the little fella got you again.’ So, I was admitted for monitoring,” he added.
“It was mild dengue. My platelet level was 189. But I just couldn’t sleep properly and I had a massive headache the whole time.”
Having other health problems, Borhanuddin’s liver enzymes were also elevated this time around.
“I am a pro when it comes to hospitals. I have had 14 surgeries,” he said adding that this included for a road accident, spine, liver and heart.
He remembered that the first time he was infected with dengue was in 2014 that saw him admitted to Hospital Kuala Lumpur for 10 days.
That first time saw him running a fever of about 40 degrees Celcius, shivers and bone ache.
It was almost the same in 2017 when he was admitted to Universiti Malaya Medical Centre although he did not run a fever.
His hospital stay was about six days.
The avid golfer and motorcyclist has never let any illness get him down.
He is always raring to go — case in point: he went biking in Morocco a week after his fourth stent procedure for his heart.
Borhanuddin added that it has been slightly difficult for him to be his old active self after the third attack.
“It is taking longer. Maybe it’s also because I am older,” he said.
“I have no idea why I keep getting it. My family and maid have never gotten it. And my friends just laugh because they just cannot believe that I got it a third time.”
Never a medical leave until dengue
Cardiologist Dr Haizal Haron Kamar is proud of the fact that he had never taken an MC. That is until 2013 when he was hit by dengue for the first time.
He had a fever, body aches and eventually there was water in his lungs which brought down the oxygen content in his lungs.
“I was still being ‘macho’ and went on my rounds for the first two to three days until it got so bad. I had to take my first ever MC,” he added.
He took about 10 days to recover and suffered from fever, lethargy, headaches, breathlessness and dehydration.
“It was quite scary,” he said.
In fact, Dr Haizal found out that his platelet levels were already low at 38 but did not inform his wife and family about it.
“I drove them to Lembah Beringin and it was only on the way back that I told my wife because I was feeling exhausted,” he said.
“She forced me to get admitted.”
The second he was diagnosed with dengue was in early February after returning from a working trip to Bangkok.
“The cab had a lot of mosquitoes until the driver himself was swatting them,” he said.
Dr Haizal added that this time around although he was admitted, he did not close his clinics and still went on his hospital rounds.
“No MCs this time. I had a drip attached to me. I had to keep busy,” he said.
“You know what they say about doctors making the worst patients.”
Phobia of Klang
Nurul Shafira Amimie Zaizul Sharham has never returned to Klang after getting dengue in 2011.
The nurse remembers suffering from intermittent fever and chills.
Although she initially did not test positive for dengue, a blood test at Hospital Tengku Ampuan Rahimah eventually confirmed that she had it.
She was duly admitted and stayed there for three days.
Besides fever and body aches, she also had rashes.
“I felt weak for the next two weeks,” she said.
She suspects that it was the indiscriminate throwing of rubbish by college students who stayed at the same apartment complex as her that led to her having dengue.
“They never threw the rubbish in bins although these were available. Many people got dengue,” she said.
She subsequently moved out of Klang and fears returning to the area to this day.
“I just went back to pack my things and returned to Kelantan. I was going to back to get married anyway,” she added.
The second time Nurul got dengue was in 2016 when she was living and working in Kota Damansara.
“I could not sleep and was popping Panadol. I went to work as usual but felt worse by the afternoon,” she said.
The aches returned and she took a blood test that tested positive for dengue.
She also had fever and was admitted to Tropicana Medical Centre, where she worked.
This time she suspects that it was construction work that caused water to be stagnated near her home.
“I am afraid of getting it again,” she said.
It can happen
Health Ministry disease control division director Datuk Dr Chong Chee Kheong said a reason someone can get dengue multiple times is because the dengue fever virus has four serotypes, DEN 1, 2, 3 and 4.
“The dominant circulating virus serotype may change in the community at different period of time,” he said.
Simply put, a person who has been infected by an Aedes mosquito which has one serotype can be infected when bitten by a mosquito that has a different serotype.
He cited as an example that at the end of last year, there was a switch from DEN3 to DEN2.
“For those who have never been exposed to DEN2, they would not be immune and that could lead to an increase in dengue cases and deaths,” he said.
He added that based on a study published by Malaysia and Singapore in 2015, DEN virus serotype surveillance revealed that outbreaks in both countries were associated with a switch in predominant serotypes.
Dr Chong also reminded that poor environmental cleanliness provides places for the Aedes mosquito to breed and increase their population.
This, in turns, helps the dengue virus to spread in the community.
“Environmental cleanliness is crucial to ensure that Aedes mosquito does not leave with human and spread the virus,” he said.
He added that clinical manifestations can be more severe if a previously infected person becomes infected months or years later with a different serotype.
“The virus causing dengue fever comes in four different serotypes, and immunity to one seems to make infection by another serotype more dangerous,” he added.
Overall, about 10 per cent of those infected, regardless of the number of times, suffer from severe symptoms.
Multi-organ failures still happen and represented about 51 per cent of 58 per cent of dengue deaths in Malaysia in 2016 and 2017.
Among the preparedness plans implemented by the ministry in view of the change in serotype is enacting the state level dengue special task force meeting with various agencies while the dengue outbreak meeting should be implemented according to existing terms of reference at district level.
It will also ensure that control and prevention activities are done by district health officers and local authorities besides mobilising members from other districts to dengue areas when necessary.
Others include implementing enforcement activities and ensuring medical practitioners in primary clinics and hospitals conduct early detection by identifying dengue warning signs and conducting dengue confirmation tests.
The ministry will also improve health education activities by focusing on environmental and eliminating breeding sites, and setting up Communication for Behavioural Impact projects primarily at hotspots.
