Monday, June 15, 2009

Pandemic Influenza A (H1N1)

Finally, WHO has declared an Influenza A (H1N1) pandemic. It is obvious that it is difficult to contain a virus that spread through droplet infection and close contact. Now that it has affected more than 30,000 people in more than 75 countries, it is inevitable that the WHO has to announce a pandemic. Now the whole world is on the alert.

It is obvious that the Influenza A H1N1 has been very mild. We hope that it will not mutate into a more virulent virus. We should not panic and overreact since the common influenza affects millions of people every year with more death than the H1N1. Having said that, it does not mean that we should let our guards down. The necessary precaution still needs to be taken. H1N1 causes more morbidity and fear rather than mortality.

In Malaysia, all cases are now imported. There is yet any confirmed case of human-to-human transmission within the local community. Hence, stringent measures should be undertaken at all entry points. Students returning from overseas, especially from Australia, USA and UK should be advised to postpone their trip home if they have flu-like symptoms. At the entry point, these countries, which are regarded as the epicentre of the H1N1 virus should be targeted for more stringent screening before entering the country. There is no fullproof screening since there is often an incubation period where at the early stages, there is no symptoms at all. If they develop H1N1 at a later stage and if they are not isolated early, then the likelihood of a local transmission is increased. Hence, people should be exercising more self-responsibility by seeking treatment early for any flu-like symptoms. Healthcare providers should be on high alert. Doctors should always keep in mind that any patient with flu-like symptoms and coming into contact with people who have travelled to any of the 75 affected countries could be an H1N1 patient.

In a disease where close contact is the mode of transmission, personal cleanliness and avoiding crowded and congested place will be the best form of precaution. Hence, it is wise to avoid the cinema, crowded restaurants and shopping centres. Travelling should be on the need basis. It is not a good time to go oversea for family holiday.

When I was in Beijing, I discovered that all big international gatherings have been postponed. This action can be regarded as quite drastic. Probably China has the SARS phobia and has been extremely stringent at its point of entry. When we arrived in Beijing, we were not allowed to disembark and health personnel came on board to do a quick temperature screening. If there are people with fever on board, then all the passengers may be quarantined until a diagnosis is made of the suspect. This is to prevent the problem of contact tracing after the disembarkation in the event that one of the passengers with fever is diagnosed with H1N1.

Since the disease is mild, doctors should be more conservative in the usage of Tamiflu. If Tamiflu is used routinely to treat all H1N1 cases, the danger is that they may develop resistant to Tamiflu. If a patient is down with H1N1 and also has underlying disease, at the same time, the patient’s H1N1 is resistant to Tamiflu, then it is likely that the patient will succumb to the illness.

Meanwhile, Malaysians should relax and do not panic. It is personal hygiene and common sense that will prevent us from being infected.









Anonymous said...

Dear Dr Chua,
The way this disease is reported is misleading. If you watch the t.v. news, it will go something like so and so have been to some western country, come back and have fever or flu like symptoms. Then from an interview, this disease is reported. Don't the doctors run some tests before confirming that it is a diagnosed disease and not just an unconfirmed case ? One thing about viruses is that there is no antibiotic because they can actually manipulate the gene of the cell. That is why it is important to have a very healthy body because it is the body itself that can stop the viruses from attacking.

Unknown said...

if we need to make a choice, i think dengue is more dangerous and shld gain more attention from the health ministry and the public.

Should organize more gotong-royong, or find a way to make it a monthly event to local community.

Unknown said...

Dear Dr Chua,

It is indeed very shameful to read two difference reports from World Health Organisation and our Malaysian Health Ministry regarding the number of victims in this pandemic influenza A (H1N1) today.

As per WHO reported in their latest update 49 on 15 June 2009., As of 17:00 GMT, 15June 2009, 76 countries have officially reported 35,928 cases of influenza A(H1N1) infection, including 163 deaths. The breakdown of the number of laboratory-confirmed cases by country is given in the following table and map. Malaysia scored 5 victims confirmed with H1N1.

Unfortunately, a Filipino man is the latest confirmed victim of influenza A (H1N1) in Malaysia, bringing the total number of patients infected with the virus to 18 in Malaysia today as announced by Health Ministry director-general Tan Sri Dr Ismail Merican.

We are puzzled why the Health Ministry has failed to update or inform WHO on the actual numbers of H1N1 victims in Malaysia. Both reports showed that Malaysian Health Ministry is less tranparent and negligence in their accuracy reporting to the WHO body. Maybe the new Health Minister is sleeping in his jobs?

Well, Malaysians still missed and salute the past Health Minister, Dr Chua SL to lead this Ministry with an open mind and tranparent policy. It is indeed a big mistake for MCA Taiko Ong TK to exclude a capable Dr Chua in Najib's cabinet line-up. What a loss ?

Franking speaking, Malaysians careless about the serious of pandemic H1N1 since the political turmoil and illegal power grab in Perak is more important agenda than pandemic H1N1. It is an atomic influenza time bomb in Malaysia today.


TT said...

Does Malaysia overreact to A/H1N1? It seems that Malaysia is quarantining herself from the world, as people will postpone coming to Malaysia to avoid the risk of being quarantined

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