H1N1 situation in Malaysia (Part 2)
August 17th, 2009Ministry of Health Hotline (8am – 9pm): 03-88810200 / 0300, 03-88834414 / 4415. Email: cprc@moh.gov.my. Website.
11th September 2009: Malaysia on 74 deaths: a disabled 19-year-old boy from Gerik, Perak, who was admitted to Gerik Hospital on 19th August for fever, cough, sore throat and vomiting over 4 days. The next day, he was referred to Ipoh Hospital for specialist treatment and anti-viral treatment was started. However, on 23rd August he died of complications arising from acute pulmonary oedema with underlying Influenza A(H1N1) infection. Lab tests confirmed this to be caused A(H1N1) on 28th August.
On the same day, US trials of Sanofi-Pasteur SA’s and CSL Ltd’s H1N1 swine flu vaccines confirm that only one dose is needed for it to work.
4th September 2009: Malaysia on 73 deaths, and the first death of a person not in a high-risk group: a 25-year-old woman from Betong, Sarawak. She was admitted to the district hospital on 30th August for fever, cough and sore throat. The next day, she was referred to Sibu Hospital for further treatment where anti-viral treatment was given. She died the next day due to severe pneumonia with H1N1 infection.
2nd September 2009: a top WHO expert, Marie-Paule Kieny, director of the WHO’s vaccine research programme said the vaccine will definitely work, even if the virus mutates, and that:
(i) it will be available as early as this month;
(ii) health workers should get immunised first;
(iii) cost: rich countries USD10-USD20 per dose, middle-income countries half that, & low-income countries quarter that;
(iv) a complete clinical evaluation of the vaccine is not necessary;
(v) a third of the world’s population will eventually be infected with the virus.
30th August 2009: Malaysia on 72 deaths: a 49-year-old man who died at Malacca Hospital. He was admitted 13th August, immediately given anti-viral drugs and antibiotics after having fever, cough and vomiting for two days. His condition worsened due to lung disorders, although he tested negative for tuberculosis, typhoid, dengue, leptospira infection and even H1N1 on 18th Aug 18. He was moved to the ICU the next day, and died the same day due to “severe pneumonia with septicaemic shock”. It was only on 24th August that he was confirmed to have the virus, after the post-mortem biopsy report based on lung samples tested positive.
29th August 2009: the World Health Organisation (WHO) says Malaysians have low understanding and poor knowledge on the spread of the A(H1N1). The public did not take H1N1 seriously. 4 awareness campaigns have been held since May, but only the wearing of masks had given the public the most awareness. The others: personal hygiene, use of sanitisers and hand cleaning had not sunk in.
26th August 2009: Malaysia on 71 deaths: 24-year-old woman who died of “H1N1 with Acute Respiratory Distress Syndrome (ARDS)”.
25th August 2009: Malaysia on 70 deaths: 3-year-old boy who died 18th August of H1N1 Encephalitis with Celebral Odema and Multiorgan Failure. He suffered high fever and fits for 2 days before receiving treatment on 12th August; condition deteriorated, admitted to ICU, given Tamiflu, tested positive for the virus 5 days later.
24th August 2009: Malaysia on 69 deaths: latest is the 38-year-old female teacher at SMK USJ 12 who died on 19th August.
21th August 2009: The World Health Organisation stated that: for every confirmed case, there are 20 other undetected cases. That means, there are actually almost 110,000 cases in Malaysia now.
20th August 2009: Malaysia on 68 deaths: a 33-year old woman who’s 34 weeks pregnant. The unborn child also died. She was treated and admitted into a private hospital in Johor Baru on 8th August after developing fever and cough for one day. 5 days later, she was admitted to the ICU of Sultanah Aminah Hospital in Johor Baru for breathing difficulties. Tamiflu was administered, but she died the next day due to “severe pneumonia and respiratory failure.” A(H1N1) infection was confirmed 14th August.
The country recorded its highest number of cases in one day: 569. Total number of confirmed cases: 5,496.
Difference between normal flu and H1N1
A(H1N1): fever exceeding 38 degrees Celsius for 3-4 days, headache, severe body ache, sore throat and dry cough (in the early stages), excessive tiredness.
Normal flu: rarely have fever or have only mild fever (of less than 38 degrees Celsius), runny nose and sneeze often.
Professor of Medicine and Infectious Diseases Dr Adeeba Kamarulzaman of Universiti Malaya Medical Centre (UMMC) was quoted to have said:
The rapid test kit, as advocated by the Health Ministry, is not a good idea as it gives a “false sense of security”: it’s only at best 25% accurate. Health Minister Datuk Seri Liow Tiong Lai had earlier approved the use of these kits as he claimed it could diagnose patients in 15 minutes and was 70 – 90% accurate.
A report by the Centre for Disease Control in Atlanta says mask-use by either infected patients or health-care personnel does not prevent the transmission of viruses. While the mask is effective in preventing those already infected with the virus from spreading it, it actually does nothing to prevent healthy people from getting the disease. If this true, the recent exercise by the authorities to make face masks a controlled item, seems useless and redundant.
18th August 2009: Malaysia on 67 deaths: additional 3 deaths from the day before, all in high risk group:
(i) a 33-year-old woman of severe bronchopneumonia; admitted to ICU on 7th August, tested positive for the virus on 12th August.
(ii) a 10-year-old girl of “Systematic Lupus Erythematous (SLE) with severe pneumonia with renal impairment”, admitted 17th July, died 13th August.
(iii) a 71-year-old man of “Ischaemic Dilated Cardiomyopathy precipitated by pneumonia”, admitted to hospital after having fever, cough and breathing difficulties for two days, died 14th August.
Number of patients in wards: 276
Number of patients in ICU: 36 [21 with risk factors]
Malaysia now ranked 8th in the world, behind the USA (477), Argentina, Brazil, Mexico, Australia, Chile and Thailand; we have even more deaths than vastly more populous or more densely populated countries like Japan, India, Indonesia, the Philippines, China (zero deaths!) and Hong Kong.
Note: antiviral treatment WITHOUT first testing for the virus will ONLY be given to 3 high risk groups and those with influenza (any flu).
Dr Ismail: fatalities could be avoided if health practitioners take appropriate actions immediately. Of the 56 recorded deaths, 40 percent involved delays in receiving early treatment and 13 percent was because of late detection by medical practitioners.
Dr Adeeba: although treatment can be given very quickly, patients with underlying diseases could succumb before the medication can take effect. I cannot speak for other cases of death but from what I see here, the cause is not late detection. Lung infection takes off very fast and not much can be done. This is a delicate situation and we do not want to over-treat people. 64 deaths (to date) is a lot. Although there is sufficient supply of Tamilflu, healthcare practitioners need to be prudent in dispensing the anti-viral drug. If not, those who really do need medical attention will fall thru the cracks. The number of people down with the flu is certainly very big. It is a very unusual situation in Malaysia due to the extent of the infection.
The Health Ministry should send a clear and consistent message on the outbreak so that Malaysians know exactly what to do. We want people to be aware but we do not want them to panic. Do not tell people to do a throat swab one minute and then say ‘don’t’ the next minute. That was really confusing for the public.
If ever a medical emergency is declared, people could be rushing out of the country, I sure hope the exit signs are well placed…
Part 1 of the chronology.
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