Wednesday, July 29, 2009

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 6th July. After a series of visits to clinics and finally private hospital, the diagnosis was made only on 22nd 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.


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。


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!




northborneo said...

Dear Dr, do you think the ministry of health should closed all school for 1 to 2 week to prevent H1N1 spreading among the student? thanks.

Vince said...

Dr Chua,

If this is an issue so serious. Where is the containment plan, corrective action and preventive action plan? We have so many Phd around us, why is it still so slow action?
Are we in DENIAL to prevent lost of tourist? We can not fool ourselves, i believe many more poor people have suffered from H1N1 due to lack of awareness. Most probably their death is recorded as 'sudden death' or others.
The poor won't buy news paper and they don't have time to watch TV. So Please put up those bloody BANNERS and EFFECTIVE posters for awareness. Why so many banner and poster can be put up by BN during election but we don't see any on H1N1 awareness.
The only way to fight this H1N1 is to make public aware and know how to react.

hexhar said...

You mention that health staff like doctors, nurses, lab technologist are of importance ini combating H1N1, what about Health Inspectors at entry point and Health Offices who are the backbone of control. No mention about them. These are the officers who worker 24/7 to control H1N1. But gratitude is always given to doctors, wonder H1N1 is out of control

阿土伯 said...


Mike said...

Your statement only confirms what we suspected all along. This Liaw TL guy is totally not qualified to be Health Minister. How can he announced publicly the ministry already ordered H1N1 vaccine whereas it is still on trial and not available in the market yet? He really makes a mockery out of his ministry.

The way he handles this H1N1 case is a total failure and disaster. How can his ministry simply order closure of colleges and send the thousands and thousands of college students cross country to spread all the virus to their hometown etc? When he decided the school closure policy, there must be proper mechanism in-place to monitor and supervise the compliance of home quarantine. Otherwise with the colleges closure, all the students will happily go shopping, sight seeing, vacations, … This will worse the spread of virus to other none affected communities.

Why this virus spread so fast in Malaysia, the answer also lie in two of the questions post to the Director General at Putrajaya press conference yesterday. Two patients went to hospital with obvious symptom of H1N1 whereas they were not properly diagnosis and simply given medication without any follow up. This kind of medical treatment attitude – how not to spread the virus.

Now that the virus already mutated to H3N2 and is spreading crazy in other countries, are we ready / prepare for the 2nd wave of flu virus attack?

As a start, let’s get rid of the current Health Minister and appoint someone who is more qualify like you. At least you can spell out all the medical term and treatment properly.

michael said...

If I remember correctly, the vaccines ordered earlier were not for health care workers but for the swine ie. the prevent swine flu from from spreading among the pigs.

Some idiot tried to link that with the A(H1N1) swine fever which, of course,is a different thing all together.

KACAK5 said...

I arrived at the Klinik Kesihatan Ulu Tiram recently at about 10:00am and was given directly from the machine Q-number 2106 and printed current number as 2043. OK, I was late so I had to wait about 63 patients away. A sign board says KPI max 90 minutes/ patient, so I was relieved so I thought. But I do not see 63 patients waiting! Estimated about less 20 waiting.
I notice many of a particular race coming later than me went to newly register at the registration counter are having smaller Q-numbers. These numbers are already reserved in the drawer, so what is the purpose of having the Q-machine? I do not mind if these are much elderly(older than 70 years) or newly leass than 6 months babies that jump Q. No, there are between 20~40 years old of a particular race. By 12:30pm, I noticed only the other races balance was waiting and so my turn comes at about 12:50pm. Next we went to the phamacy, only the other race was waiting.

Low C. W. said...

We are not the first country to place order in advance, country like US and Britain already placed huge amount of order knowing that the vaccine is to availble soon. In fact WHO has interfered so that priority can be given to those needed country which are poor and critical situation. So place order in advance should not be a issue.
BUT I like the idea where why so little banner can put up compare to what was put up for election and agree that renumeration should be improved for those front liner others than doctor.

kenny said...

Dear Datuk Seri

We have system failures in the country. In every field, the people working there are becoming incompetent.

1. New buildings that leaks
2. Stadium collapsed before use

So, now with this crisis, we see doctors that cannot cure.

There is something serious wrong with the way the govt is working.

Anonymous said...

So the H1N1 disease has hit Malaysia. What can anyone do about it ? The doctors will tell you to go home, get a sick leave, drink bottles and bottles of plain water, eat fruits, eat vegetables, eat nourishing foods, quarantine yourself, wear mask, get plenty of rest, stay indoors. They would not tell you to get the Tamiflu jab. So the treatment is simple and not intensive for a potentially life threatening disease. So why does anyone want to make such a big deal out of it if nobody is doing anything that big a deal ? What about a drip ? What about being admitted ? It is dangerous to be staying at home if one is confirmed with the disease, unless the people at home know how to give emergency treatment if one suddenly gets into a shock. This is becoming like a legal issue.

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