Knowledge and Practice Regarding Dengue Fever and Acceptance Towards Wolbachia Among Universiti Kebangsaan Malaysia Medical Centre Healthcare Staff

Background

Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world, with its incidence increasing dramatically over recent decades. Malaysia is highly endemic for dengue, with annual case numbers frequently exceeding 100,000 and periodic outbreaks causing significant morbidity, mortality, and strain on healthcare resources. The Aedes aegypti mosquito, the primary vector for dengue virus transmission, thrives in Malaysia’s tropical climate and urban environments, making sustained vector control a central pillar of the national dengue prevention strategy.

Traditional dengue control approaches — primarily insecticide-based fogging, larviciding, and source reduction — have achieved limited and often unsustainable success. Insecticide resistance among Aedes mosquito populations is increasing, and the operational challenges of maintaining effective vector control across large urban areas have proven formidable. Against this backdrop, innovative biological control strategies have emerged as promising complements to conventional approaches.

One of the most scientifically exciting of these innovations involves the bacterium Wolbachia pipientis. When certain strains of Wolbachia (particularly wMel) are deliberately introduced into Aedes aegypti mosquitoes, the infected mosquitoes show markedly reduced capacity to transmit dengue virus. Moreover, Wolbachia is maternally transmitted, meaning that once established in a mosquito population, the bacterium can spread and maintain itself without ongoing human intervention. Landmark clinical trials in Yogyakarta, Indonesia, demonstrated that deployment of Wolbachia-infected mosquitoes resulted in a substantial reduction in dengue incidence in treated areas.

Malaysia has been among the countries exploring Wolbachia deployment as a dengue control strategy, with field trials conducted in selected areas. For such novel approaches to succeed, public acceptance and healthcare worker understanding are essential. This study investigated the knowledge and practices of healthcare staff at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) regarding dengue fever, as well as their acceptance of Wolbachia-based control strategies.

Study Design

A cross-sectional survey was conducted among healthcare staff at UKMMC, a major tertiary care and academic medical centre in Kuala Lumpur. The study population included doctors, nurses, laboratory staff, and other healthcare professionals who may encounter dengue patients in their clinical practice or who serve as health information resources for patients and the community.

The survey instrument assessed three key domains: knowledge about dengue fever (including transmission, clinical features, prevention, and management), current practices related to dengue prevention, and attitudes toward and acceptance of Wolbachia-based biological control as a dengue prevention strategy. Data were analysed to identify knowledge gaps, practice deficiencies, and factors associated with Wolbachia acceptance.

Knowledge Assessment

The assessment of dengue knowledge among healthcare staff revealed a mixed picture. Most respondents demonstrated adequate basic knowledge of dengue transmission — correctly identifying Aedes mosquitoes as the vector and recognising key clinical features of dengue infection. However, knowledge gaps were identified in several important areas, including the specific breeding habitat preferences of Aedes mosquitoes, the timing of peak biting activity, the distinction between dengue fever and dengue haemorrhagic fever, and current clinical management protocols.

These knowledge gaps among healthcare workers are concerning for several reasons. First, healthcare workers are frontline practitioners responsible for timely diagnosis and appropriate management of dengue cases; knowledge deficiencies can translate into diagnostic delays and suboptimal clinical care. Second, healthcare workers serve as trusted sources of health information for patients, families, and communities; inaccurate or incomplete knowledge can undermine public health messaging about dengue prevention.

Prevention Practices

The survey assessed personal and household dengue prevention practices among healthcare staff. While most respondents reported awareness of basic prevention measures such as eliminating standing water, using mosquito repellents, and wearing protective clothing, the consistency of actual practice implementation was variable. The gap between knowledge of prevention measures and consistent application of those measures reflects a common pattern in health behaviour research and suggests that knowledge alone is insufficient to drive sustained behavioural change.

Wolbachia Acceptance

The assessment of acceptance toward Wolbachia-based dengue control revealed important insights into the factors that influence receptivity to this innovative biological strategy. While many respondents expressed support for novel approaches to dengue control, particularly given the limitations of existing strategies, concerns were also identified. These included uncertainties about the safety of releasing modified mosquitoes into the environment, questions about the potential for unintended ecological consequences, and a desire for more comprehensive information about the science underlying the Wolbachia approach.

Understanding these acceptance patterns among healthcare workers is strategically important because healthcare professionals serve as opinion leaders within their communities. Their endorsement or scepticism regarding Wolbachia deployment can significantly influence broader public acceptance. Addressing their information needs and concerns is therefore a priority for communication strategies supporting Wolbachia programme implementation.

The Wolbachia Approach: Scientific Context

Wolbachia is a naturally occurring intracellular bacterium found in approximately 60% of all insect species. When transfected into Aedes aegypti — which does not naturally carry Wolbachia — the bacterium activates the mosquito’s innate immune system and competes with dengue virus for intracellular resources, dramatically reducing the mosquito’s ability to become infected with and transmit the virus. The wMel strain used in most current programmes also induces cytoplasmic incompatibility, a reproductive manipulation that gives Wolbachia-carrying females a mating advantage over uninfected females, enabling the bacterium to spread through the mosquito population.

The evidence base for Wolbachia’s effectiveness has strengthened considerably. A cluster-randomised trial in Yogyakarta, Indonesia, demonstrated that areas receiving Wolbachia-infected mosquito deployments experienced a 77% reduction in dengue incidence compared to control areas. This landmark result, published in the New England Journal of Medicine, established Wolbachia deployment as one of the most promising new tools for dengue control in decades.

Implications

The study’s findings support targeted educational interventions for healthcare workers that address identified knowledge gaps about dengue while simultaneously building understanding of and confidence in innovative control strategies like Wolbachia. Such interventions should go beyond didactic knowledge transfer to address the concerns and questions that healthcare workers have about novel biological approaches, providing the scientific evidence and practical context that will enable them to serve as informed advocates within their communities.

For Malaysia’s dengue control programme, ensuring that healthcare workers are well-informed about both traditional and innovative prevention strategies is essential for maintaining a cohesive, evidence-based approach to reducing the burden of this important infectious disease.

Limitations

The study was conducted at a single institution and may not be representative of healthcare workers across all Malaysian healthcare settings. The cross-sectional design provides a snapshot of knowledge and attitudes at one point in time. Self-reported practices may overestimate actual prevention behaviours due to social desirability bias. The rapidly evolving evidence base for Wolbachia means that acceptance patterns may change as more information becomes available from ongoing field trials and implementation programmes.

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