H1N1 in Malaysia Getting Worse

A month ago, I posted in my blog that the H1N1 would spread rapidly in Malaysia. It started off with imported cases. It is now local infection that accounts for more than 50% of the total 1200 cases reported. This is to be expected since the local infected cases become the source of local transmission. I have always felt that we are not stringent enough in picking up imported cases at the point of entry.

Since it has a low mortality rate, there is a tendency by healthcare providers and also patients to treat it like common flu. Out of the 1200 cases, we have 4 reported cases of death. So far, the mortality rate is 0.5 percent. With such low mortality, there’s a tendency to let our guards down and throw cautions to the wind. However, I am glad to note that the Director General of Health seems to be very committed in this battle against the H1N1. However, like all infectious disease control, it involves many healthcare providers, what we call the chain of command from the nurses, doctors, lab technologists and etc. The lack of sensitivity and commitment by any of the healthcare providers would render the whole effort to contain the transmission a failure.

What was puzzling is that the Minister of Health one and a half months ago said that the Ministry has ordered H1N1 vaccine to be given to healthcare providers who are front liners. In fact, the H1N1 vaccine is now on trial. So I wonder how he ordered one and a half months ago! Maybe the healthcare providers in Malaysia are part of the H1N1 vaccine trial on human being.

Most of the patients who succumbed to the H1N1 infection seem to have underlying illness, which rendered them more prone to death. The pregnant, the elderly, the very young age group and those with underlying illness seems to be the high risk group. Pregnant ladies are four times more prone to infections.

I am surprised about the death involving a 42 years old man reported in the papers yesterday. This is a classical case of lack of awareness by the attending doctors. This patient falls sick on 6^th July. After a series of visits to clinics and finally private hospital, the diagnosis was made only on 22^nd July. By then, it was too late. We lost a middle-aged man in his prime of life. One can speculate that if the diagnosis was made much earlier, he could be saved. A total of 16 days were wasted and all we need was the patient’s throat swab. I wonder why after seeing so many doctors, none of them even give a thought to the H1N1 despite batteries of test and a declared pandemic by WHO. Doctors can only make a diagnosis if they keep in mind diseases which becomes the current epidemic. Hence, many doctors also failed to make a diagnosis for dengue until it is too late. There should be no excuse since there is enough publicity to alert doctors that the H1N1 and dengue fever is staring at us everyday. Maybe practicing doctors should attend a refresher course to remind them to think of these 2 diseases. A late diagnosis would be fatal for both dengue and H1N1.

While the H1N1 is highly infectious, one should not lose track of dengue fever which is endemic in this country. With the epidemic going on, I will not be surprised that the number of death this year may be more than 120 cases. The number of dengue cases recorded could also be more than 50,000. Both the figures are the highest ever recorded in this country. It is an achievement of which we are not proud of.

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大约一个月前，我在布落格写道国内的H1N1流感疫情将迅速蔓延。我国的疫情始于外国传入病例，但目前，本土感染病例与日俱增，已占了H1N1流感总数的一半。本土感染是集体感染的源头，所以本土病例增长是可预见的。但我始终认为，我们在入境处检证外国传入病例不够严格迅速。 由于死亡率偏低，医疗人员以及病患本身往往视发病为普通流感来进行治疗。我国目前有1千200宗确诊病例，4宗死亡，死亡率为0.5%。以如此低的死亡率来看，国人容易松懈防范。但我欣慰卫生总监非常尽责致力与H1N1流感抗战。然而，像其他传染疾病控管程式一样，这场疫战需要各医药单位的紧密配合，既我们所谓的指挥链：从护士、医生到化验技术人员等，缺一不可。任何一方缺乏敏感度或责任心，都将导致抗疫努力失败。

让人费解的是，卫生部长月前声称，卫生部已经为前线的医护人员订购H1N1流感疫苗。但事实上，该流感的疫苗还在试验阶段。我奇怪他何以能在一个月半前订购疫苗？也许我国的医务人员接受试验

目前的病例看来，大多数不幸染上 H1N1流感的病患几乎同时都患有其他潜在疾病，而增加死亡的风险。孕妇、老、幼以及潜在疾病患者都属于高风险群体群体，孕妇感染的机率比一般人高出4倍！
我对42岁患者死亡的病例感到惊讶。那是一宗主诊医生疏忽的典型个案。病人在7月6日病倒，并数度到私人诊所求诊，最终在22日送往一家私人医院时才被诊出病因，但为时已晚，失去性命的男子正直壮年。人们纷纷推测若及早诊断，该男子或能保命。浪费了16天，医生需要的不过是病人咽喉的拭样。我不能理解，世界卫生组织既已宣布H1N1大流行，多名曾为死者诊治的医生，难道没有一名医生想过从此病着手？

医生必须对当前流行的疫症有足够认知，才会有确诊结果。在一些时候，许多医生也因同样态度，而没有及时诊出骨痛热症，发现时已束手无策。医生们没有任何借口开脱，因为我们有足够和广泛的宣传提醒他们，H1N1流感以及骨痛热症肆虐我国。也许，他们应该参加进修课程，提醒自己对这两项疾病的认知，因为延诊H1N1流感及骨痛热症随时可以致命！

虽然H1N1病毒的传染性很强，但我们也不能停止追踪骨痛热症疫情。由于骨痛热症持续流行蔓延，我对今年的死亡人数或会超过120例不感到惊讶，而骨痛热症病例也可能破5万宗，成为例年来最高的骨痛热症记录，惟并不值得我们感到自豪。