DENGUE FEVER CASES

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DENGUE FEVER CASES: 7.

Mr Leong Horn Kee asked the Minister for the Environment and Water Resources, in view of the recent sharp increase of dengue fever cases, what concerted actions have been taken or are being planned nationwide to fight against this health hazard.

The Minister for the Environment and Water Resources (Assoc. Prof. Dr Yaacob Ibrahim): Mr Speaker, Sir, Singapore, like the rest of the region, experienced a resurgence of dengue fever over the past few years. In 2003, there were 4,788 dengue fever cases and, in 2004, the number of cases increased to 9,459. Although we saw a significant drop in the number of cases from an average of 294 per week in January to 125 per week in April this year, the number has risen as we entered the period of warmer weather and intermittent rain. The number of dengue fever cases has exceeded 300 cases per week in July. We, therefore, have to be extra vigilant and step up efforts to tackle this problem.

Let me briefly explain what NEA does. NEA has a pre-emptive surveillance system to keep a check on dengue-prone areas. They have worked with the construction industry, schools and condominium management to put in place mosquito control programmes. These programmes have thus far been effective in controlling mosquito breedings in these premises.

Today, whenever a dengue case is reported, NEA will immediately move in to search for all mosquito-breeding sources and destroy the mosquito larvae in the vicinity of the patient's home. NEA will also fog the area when there is an upsurge of adult mosquitoes. The purpose is to reduce the population of mosquitoes so as to prevent further dengue trans

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missions. In addition, should there be more than one dengue case detected in the same area within two weeks, NEA will classify the area as a dengue cluster, and deploy additional manpower to intensify the search-and-destroy operations. Today, it is an SOP on the ground for NEA to alert the MPs, CCC and RC chairmen as soon as a cluster is found. NEA will also proceed to mobilise the grassroots volunteers to help spread the dengue prevention message to households in the neighbourhood affected. This is a tested approach and, by engaging the community, NEA has been able to keep most of the clusters small and close them within the targeted 14 days.

Sir, NEA will deploy more manpower to step up checks on mosquito breeding in residential areas, particularly in areas prone to dengue. However, these efforts by NEA alone are not sufficient to tackle the resurgence of dengue fever. Our greatest challenge is with individual households. We need the active involvement of the community to reduce and keep the number of dengue cases to the lowest level possible. Today, with all the publicity given to dengue fever, most householders are aware of how to prevent mosquito breeding. Unfortunately, many of us have yet to put our knowledge into action. We need the cooperation of each and every household to check for and remove stagnant water. We need to do this at least once a week in order to deny the Aedes mosquito a place to breed in our homes.

Sir, in April last year, we launched the Mozzie Attack programme. We have since been receiving good support from the grassroots organisations and volunteers. In fact, I am happy to say that, as of now, all the 84 CCCs have put in place their own Mozzie Attack Programmes. What is even more encouraging is that the number of dengue prevention volunteers has also doubled from 2,000 last year to 4,000 this year.

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In the past four months, NEA and the various grassroots organisations and CDCs have been working on various new approaches in dealing with dengue. For some CDCs, our Mayors have come out personally to declare war against dengue. Let me cite a few examples: North East CDC's plan to 'smoke out' dengue from North-East district by supporting a series of outreach programmes in 2005, South West CDC's launch of 'My Environment Shines' Campaign in April 2005, which included efforts to reach out to residents with tips to prevent mosquito breeding in their neighbourhoods, and the use of specially designed "dengue alert tags" by the South East CDC grassroots leaders and volunteers to warn households of potential breeding habitats.

We are very encouraged by the efforts of the CDCs and grassroots organisations and will work even more closely with all our CCCs. NEA has set aside $5,000 for each CCC and $50,000 for each CDC per year to fund part of their community outreach programmes. I hope that grassroots organisations will find this funding timely and helpful in their ongoing dengue prevention programmes.

This year, besides providing funding to grassroots organisations, NEA has also intensified its public awareness and outreach efforts. Since May this year, pamphlets to raise awareness of dengue fever are made available at all GP clinics in Singapore. A new series of posters are being displayed at lift lobbies of every HDB block and condominium. And since March, NEA started putting up dengue prevention posters at more than 400 bus-stops to reach out to residents in dengue-prone areas.

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Over the last few weeks, NEA has further extended this publicity effort to reach out to more commuters. These included dengue advertisements at some 200 bus shelters, inside MRT trains and Bukit Panjang LRT trains, as well as at MRT stations where there is high human traffic.

Over the last two weeks, NEA also proceeded to conduct briefings to 84 CCCs and 16 Town Councils to provide detailed updates on local dengue situation, urging them to step up on preventive measures and help spread the dengue message to their residents. In fact, next month, NEA plans to distribute a new set of dengue educational kit specifically designed for the 70,000 families living in landed homes, to remind them on what they can do to reduce mosquito breeding sources, such as roof-gutters, within their premises.

Sir, my Ministry will do all that is within our means to ensure that dengue fever remains under control. However, the success of dengue prevention programmes hinges heavily on community participation. Only with the active participation of every householder will we be able to reduce the number of dengue cases to the minimum.

Mr Leong Horn Kee: Sir, I am pleased to hear that the Minister is making a very concerted effort. I am afraid I still feel that more can be done. In my view, instead of a Mozzie Attack, it is currently more like a Mozzie Defence. So we should go into an attack. For example, contrast against the way we treat SARS, I do not know how much we spent on the whole SARS programme. But let me ask the Minister, in the case of this dengue programme, how much of the total budget has been devoted for the programme and can more be allocated for us to actually eradicate this particular nuisance? First, is the budget. Second, can more teeth be given to the inspectors and the Ministry because a lot of these problems are coming from, like what the Minister said, the fault of the residents? In my constituency, for example, I am hearing about more dengue fever cases than before. So I think it really needs an all-out attack to solve this problem. Could we

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give more teeth to things like the building control practices, whereby maybe gutters should not be allowed in certain cases, so that there is no room for mosquitoes to breed? We know that palm trees, for example, collect water and, therefore, are prone to dengue spreading. Also, ---

Mr Speaker: Mr Leong, that is a very long supplementary.

Mr Leong Horn Kee: I have two more supplementary questions. I have just asked two questions. One is on funding and the other is on teeth. The third question is whether we could have more prevention, like the Minister needs more money for fogging and oiling of the stagnant water, maybe more can be done in that area. And, finally, more money for education. As the Minister has said, education is a very important factor. Perhaps, he can do more on that aspect.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, the short answer is yes to all the queries. We have increased the budget this year. As I have mentioned in my reply, $5,000 to each CCC and $50,000 to each CDC. We will evaluate whether or not more money will be needed to do the programmes on the ground.

On more teeth, yes, we are giving our officers a bit more resources and, in fact, we do come down hard on people who have been caught the first time. In the past, we gave them a warning. Now, we are relooking at whether we should penalise them.

On more prevention programmes, I agree entirely with him. But the example he cited in the case of gutters, we found this to be the problem in some of the older landed properties and we do encourage the owners to either remove it or do periodic checks because gutters are one of those structures that attract mosquitoes, unless they design them properly. We have seen some design

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whereby there is a filter on top of the gutter that will catch debris and only allow water to flow through. So there are ways in which you can improve this, and this is something which we would like householders to consider.

Public education is a campaign that we step up this year. You have seen some of the posters at the bus shelters and MRT stations. So the bottomline is that we are prepared to spend more and tackle this problem. But, ultimately, as I mentioned in my reply, there are two important variables. One, of course, is the weather, which we cannot control; secondly, is the behaviour of the householders. Ultimately, he or she would have to do his or her best to inspect the possibility of water being trapped. We cannot ask Singaporeans not to plant plants in their homes. But if they want to do that, they should be more responsible. So the public education campaign is very important, to ask Singaporeans to do their part, especially when there is a heavy rain and after which, there is a dry weather. These are conditions which are very suitable for the Aedes mosquitoes to breed and to increase their population.

Mr Alexander Chan Meng Wah (Nominated Member): Sir, with regard to this particular species of mosquitoes, since all our efforts are directed at urban breeding areas, do these mosquitoes, for example, breed in green areas near urban centres and, if so, do they peregrinate into the urban centres and, if they do, do we have any programmes to deal with that? Because we may succeed fighting the urban war but we may not succeed in actually preventing this particular problem.

Assoc. Prof. Dr Yaacob Ibrahim: I am not familiar with the science behind all these things. What I know is that the mosquitoes need human blood in order for them to procreate. It feeds on, for example, sugar just for its own energy, but it needs the human blood in order for

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it to procreate. So it has to go into where there is human population in order for it to procreate. As to whether we have found instances of mosquitoes breeding in our parks, we are in close contact with NParks and the authorities responsible for managing our parks, to work closely to ensure that there are no natural habitats for the mosquitoes to breed. But as to whether they migrate from our green parks of the country to urban areas, I am not able to answer that question. But I am most happy to check and reply to him on that.

Mdm Cynthia Phua: Mr Speaker, Sir, two supplementary questions. Would the Minister give us a better idea on the causes, areas and locations? Is he able to give us statistics on how many of these cases are from HDB flats and how many are from the landed properties and, within the landed properties, how many are actually due to the containers within their households or within their compound itself, or how many are due to the building structures, like gutters?

Assoc. Prof. Dr Yaacob Ibrahim: Sir, I do not have the exact breakdown. But the figures that we have show that we have clusters within HDB estates and we do have clusters among landed properties. But in the case of HDB estates, we work very closely with the Town Councils who had been very helpful in making sure that in the public areas where Town Councils are responsible, they will check diligently. It is within the HDB flats where we need to work with the local constituents, the MPs and RC chairmen to educate the households to make sure that they check. For landed properties, it is a challenge. We also work with the local MPs, but we go house-to-house whenever there is a need to check. What is more important is for the public to be aware that they have a role to play, whether or not you are living in a landed property or HDB flat, if you have a puddle of water which is

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neglected, that will be attractive to Aedes mosquitoes and, therefore, they will start to procreate and then it will become a problem.

The second question she asked is whether the instances of the breeding are basically from the containers. Most of them tend to be from the containers. For example, we have found in the flower pots, gutters, in the common areas managed by the Town Councils, even in places where you have installation, such as the pump room, where there was a water leakage in one instance and the water puddle was small or large enough, depends on how you look at it, for the mosquitoes to breed. So our message to all households and property owners is that they have to check constantly, especially during this time of the year when you have a warm weather, with intermittent rain. These are ideal conditions for the mosquitoes to breed.