Caused by the dengue virus,
which is transmitted to
humans via the bite of an
infective Aedes species
(Ae. aegypti or Ae. albopictus)
of the mosquito, dengue
fever causes symptoms such as high fever,
headache, pain behind the eyes, muscle or
joint pain, nausea, vomiting, as well as rash.
“Seek medical attention as soon
as possible if you suspect that you
might have dengue,” said Dr
Alon Tan, Associate Consultant,
SingHealth Polyclinics (SHP).
“This will allow the doctor
to confirm the diagnosis via
a laboratory blood test and
determine whether you are
suitable for home recovery. In
severe cases, hospitalisation and
further treatment may be required.”
First-time dengue infections can be
severe, particularly among the elderly and
people with pre-existing medical conditions.
When these groups of people are re-infected,
there is a higher probability of severe
dengue. Dengue haemorrhagic fever can
cause patients to suffer internal bleeding,
shock and even death.
There are four different serotypes of
dengue virus (DENV1 to 4). Those who
have recovered from infection have lifelong
immunity against that particular serotype,
but remain vulnerable to infection by any of
the other three serotypes.
Dengue is endemic in Singapore. Each year,
a significant number of residents are infected
with dengue and, for a small proportion of
these patients, dengue may be fatal, said Dr
Tan. According to the National Environment
Agency (NEA), more than 32,000 dengue cases
were reported in 2022 despite extensive vector
control measures to curb mosquito breeding.
A dengue vaccine has been approved by
the Health Sciences Authority (HSA) for the
prevention of dengue in individuals aged 12 to
45 years with laboratory-confirmed evidence of
previous dengue infection. The recommended
age range is based on the epidemiological
situation in Singapore and after consideration of
the risk-benefit analysis by the local authority.
However, the vaccine is unsuitable for
those who have not been previously infected,
as it is associated with an increased risk of
severe dengue in those who contract this
naturally after vaccination. Other factors
that may preclude individuals from being
administered the dengue vaccine include allergies to any ingredient in the vaccine,
or weakened immunity, such as patients
who are receiving chemotherapy for
cancer. Individuals who have had recent
blood or plasma transfusions, treatments
with immunoglobulin (a type of antibody),
are pregnant, planning to conceive,
breastfeeding, are feeling unwell and having
a fever, are advised to discuss with their
family doctor first and it may be necessary to
reschedule their vaccination to a later date
when these factors are no longer applicable.
NEA campaigns over the years have helped
to educate and raise community awareness of
dengue vector control. To complement these
efforts, a serious game built for learning and
education has been co-created by a team in
SHP, headed by Dr Tan and mobile application
developers from AI Innovation Labs.
Available for download from the Apple
App Store and Google Play, Sam’s Mozzie
Adventure allows players, in the role of a
schoolboy named Sam, to travel through
four different scenarios. The game triggers
players to click on potential dengue breeding
sites (vases, potted plants, clogged gutters)
and take action to rectify the problem. A
player earns points for correct answers or
actions; for wrong moves, a player would lose
points or be required to repeat the task.
See this video for the gameplay:
The effectiveness of this engaging game in
educating people about dengue prevention was
evaluated in a study with over 370 volunteers
at Sengkang Polyclinic. Participants were
randomly allocated to two groups; those in the
intervention group played the game, while
those in the control group visited a website
to learn more about dengue prevention.
Participants in both groups had scores for
Knowledge, Attitude and Practice (KAP) higher
than the baseline, but the mean difference in
score was greater when assessing participants
in the intervention group.
Based on this promising outcome, the SHP
team is working on securing funding to enhance
the game. For instance, over 84 per cent of
participants in both groups expressed interest
in dengue vaccination, so future iterations of the
game may include an in-game feature to identify
suitable vaccination candidates and work with
primary care clinics to provide the vaccination.
The team is currently seeking collaborations
with NEA to promote the game to the general
public and in schools.
“Gaining knowledge about dengue is
the first step to winning the battle against
dengue,” said Dr Tan. Beyond dengue
prevention, he sees the potential of serious
games in helping the general population to
manage chronic diseases such as diabetes,
high blood pressure and high cholesterol
through bite-sized steps.
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