r.measles-Prevention and Control in Malaysia

MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �

� MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �MEASLES PREVENTION & CONTROL IN MALAYSIA

Handbook for Healthcare PersonnelMEASLES PREVENTION & CONTROL IN MALAYSIA

Handbook for Healthcare Personnel �

Contents

Foreword �PART�-GENERAL 4 1.1 Introduction 4 1.2 TheDisease 4 1.3 Complication 6 1.4 PeopleAtRisk 6 1.5 MeaslesVaccination 7 1.6 MeaslesEpidemiology–Global 7 PART�-MEASLESPREVENTIONANDCONTROLINMALAYSIA 8 2.1 MeaslesEpidemiology-Malaysia 8 2.2 MeaslesElimination 9 2.2.1 Goal&Objectives 9 2.2.2 Strategies 10 2.3 MeaslesVaccination 10 2.3.1 Schedule 10 2.3.2 Contraindication 11 2.4 MeaslesSurveillance 11 2.4.1 Objectives 11 2.4.2 CaseDefinition 12 2.4.3 CaseClassification 12 2.4.4 ProceduresOfSurveillance 13 2.4.5 PerformanceIndicators 14APPENDICESAppendix1 : FlowChartOfMeaslesSurveillanceActivities 16Appendix2 : MeaslesLaboratoryRequestForm 17Appendix3 : ProceduresToCollect,StoreAndTransportClinicalSpecimens 19Appendix3a: BloodSpecimenCollectionForMeaslesSpecificIgMTest 20Appendix3b: UrineSpecimenCollectionForMeaslesVirusIsolation 21Appendix3c : NasopharyngealSpecimenCollectionForMeaslesVirusIsolation 22Appendix3d: Throat/NasalSwabSpecimenCollectionForMeaslesVirus 23 IsolationAppendix4 : FlowChartOfClinicalSpecimenForLaboratoryConfirmation 24 AndResultAppendix5 : NotificationForm(MalayVersion) 25Appendix6 : NotificationFlow 26Appendix7 : MeaslesInvestigationForm(MalayVersion) 27Appendix8 : ClassificationOfMeaslesCase 30 TelephoneNumbers 31References 32Acknowledgement 33

PAGE

MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �

FOREWORD

Measlesisoneof themajorchildhoodkillerbeforetheintroductionof itsvaccine.andWorldHealthOrganization(WHO)estimatedthat130millionchildrenbelow

6yearsdieduetomeaslesannually.Sincetheintroductionofmeaslesvaccinein1964,themorbidity and mortality due to measles have been reduced drastically. Measlesvaccinationwas included in theExpandedProgram for Immunization (EPI) in 1974.Sincethen,coverageofmeaslesvaccinationclimbedsteadilyinallregionsthroughouttheyear1980s.

In1980s,after thesuccessofsmallpoxeradication,somescientistandpublichealthofficials have considered of global effort to eradicate measles. Since 1990’sstrategies have been planned and implemented in many developing countries toeliminateanderadicatemeasles.ThreeregionsoftheWorldHealthOrganizationthattargetedeliminationby2000sare; in1994,theAmericanRegiontargetedeliminationby2000,in1997,theEasternMediterraneantargetedeliminationby2010andin1998,the European Region targeted elimination by 2007. In 2005, WHO for the WesternPacificRegiontargetedeliminationby2012.

As we have succeeded in controlling measles occurrence at low level, theMinistry of Health in February 2003 decided to initiate measles elimination inMalaysia starting in 2004.Therefore, all healthcare personnel should implement themeaslespreventionandcontrolstrategiesandactivitiesasrequiredfortheelimination.

This handbook is intended to serve as guiding tool in continuing to createawareness and assisting healthcare personnel in the implementation of MeaslesEliminationProgrammestrategies.

Dato’Dr.Hj.RamleeHj.RahmatDirectorofDiseaseControlMinistryofHealth,Malaysia

18December2006

4 MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �MEASLES PREVENTION & CONTROL IN MALAYSIA



�.� INTRODUCTION

Beforetheintroductionofmeaslesvaccine,measlesisoneofthemajorchildhoodkillerandtheWorldHealthOrganization(WHO)estimatedthat130millionschildrenbelow6yearsdieduetomeaslesannually.Sincetheintroductionofmeaslesvaccinein1964,themorbidityandmortalityduetomeasleshavebeenreduceddrastically.

However,despitetheavailabilityofvaccineforthepast40years,measlesisremainsaleadingcauseofdeathamongyoungchildren.Anestimated454,000peoplediedfrommeaslesworldwidein2004.

Measlesvaccinationandsurveillancearetwomainstrategiestopreventandcontrolthediseases.

�.� THEDISEASE

Measles is highly infectious disease caused by a virus in theparamyxovirus family. The disease spread by airborne droplets, closepersonal contact or direct contact with nasal or throat secretion ofinfectedpersons.

Theincubationperiodisusually10to12daysbutmayrangeupto21days.Thefirst signof infection ishigh fever.During this initial stage,patientmay develop coryza, cough, red and watery eyes (conjunctivitis) andwhitespotsinsidethecheekknownasKoplik’sspot.Afterseveraldays(2 – 4 days), a rash develops, usually started on the face and upperneck. The rash proceeds downwards, reaching hands and feet andlastedforfivetosicdays,thenfades.Therashoccurs,onaverage,atday14afterexposuretotheviruswitharangeofsevento18days,rarelyaslongas19–21days.

An infected individualcan transmit thevirus fromfourdaysprior to theonset of rash to four days after onset. The virus remains active andcontagiousintheairoroninfectedsurfacesforuptotwohours.

PART 1

GENERAL


Figure�:Koplik’sspotandskinrashinpersonwithmeaslesinfection

Koplik’sspot Maculopapularrash

Downwardtrendspreadofrash

Rashbeginsaroundhairline,onfaceandneck,behindears

Rashspreadsdownwardtochestandabdomen

Rasheffectsarmsandlegslast

� MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �MEASLES PREVENTION & CONTROL IN MALAYSIA



�.� COMPLICATION

Measles is often a mild or moderate severe illness. However, severemeasleslikelyoccurinpoorlynourishedyoungchildren.Themostseriouscomplications include, blindness, encephalitis (1 per 1,000 cases),severediarrhoea,earinfection(1inevery5–10cases)andpneumonia(5–10%ofcases).Casefatalityrate indevelopingcountries is in therangeof1%to5%.

�.4 PEOPLEATRISK

Un-immunised persons, especially young children are at highest risk.People who have not been immunised with vaccine or who have notacquiredimmunitythroughhavingexperiencedthediseasecanbecomeinfected.

Figure�:Timecourseofclinicaleventsinmeaslesdisease

Dayofillness � � � 4 � � � 8 9 �0

Measles

Rash

Koplik’s

Conjunctivitis

Coryza

Cough

TEM

PE

RAT

UR

E104

103

102

101

100

99

98

Source:InfectiousDiseasesofChildren,9thEdition,Figure13-1,page224,1992.EditorsSaulKrugmanSamuelL.Katz,AnneA.Gershon,Catherine M. Wilfert. By permission of Mosby Year Book, St. LouisMissouri


�.� MEASLESVACCINE

Measles vaccine was available since 1963. Measles vaccine induceslong-term and probably lifelong immunity in most individuals. Naturalinfectionproduceslifelongimmunity.

Live attenuated measles virus vaccine are in use. Measles antibodiesdevelop in approximately 85% of children vaccinated at 9 months ofage,95%ofchildrenvaccinatedat12monthsofageand98%ofthosevaccinated at 15 months of age. Second dose vaccination is given tochildrentoovercomethislackdetectableantibody.

Measles vaccines available in form of monovalent, bivalent(MR–measles-rubella)andtrivalent(MMR–measles-mumps-rubella).

�.� MEASLESEPIDEMIOLOGY–GLOBAL

Worldwide,measlescasesanddeathsareunder-reportedespecially inareaswiththehighestburden.

In 2003, 528,400 cases were reported (from 174 countries) comparedto 3,852,242 cases in 1980 (from 148 countries). Worldwide annualdeathsfrommeasles(2002)wereestimatedbyWHOat610,000.About88.5%ofthem(540,000)occurredamongchildrenunder5yearsofage.InWesternPacificRegion,measlescasesanddeathsestimatedofaboutonemillionand30,000peryear,respectively.

WHOandUNICEFestimated that themeaslesvaccinationcoverage in2003wasaround77%.

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Handbook for Healthcare Personnel 9

�.� MEASLESEPIDEMIOLOGY–MALAYSIA

In theprevaccineera,measleswashighlyendemicamongMalaysianpopulationespeciallyamongchildren.MeaslesvaccinationprogramwasincludedaspartoftheExpandedProgrammeonImmunisationin1982andsingle dose measles vaccination was given to children at 9 months ofage. Since the introduction of measles vaccination in Malaysia, theoccurrence of measles reduced with the increased of the measlesvaccinationcoverage.

The incidence rate of measles reported cases in 1982 was 65.62 per100,000populations.In1989–1998,measlesincidenceratesinMalaysiawererangedbetween1.51–5.87per100,000population.

However, measles cases increased drastically in 1999 and 2000 withincidencerates11.48(2,608cases)and26.59(6,187cases)per100,000populations, respectively despite measles administrative immunizationcoveragewas 86.6% (1999) and 88% (2000). In these two years, theincreased of measles cases occurred in all states and outbreaks werescattered throughout the country both in urban and rural areas. Themeaslesoutbreakin1999–2000suggestedthattheoutbreakwasduetoprimaryvaccinefailureandfailuretovaccinatethatcausedaccumulationofsusceptibleindividuals

PART 2

MEASLES PREVENTION & CONTROL IN MALAYSIA

MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel 9MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel 9

Figure�:Measles incidence rate of measles reported cases andvaccinationcoverage,Malaysia,�9��–�00�.

Incidencerate ImmunisationCoverage

�.� MEASLESELIMINATION

As we have succeeded in controlling measles occurrence at lowlevel,theMinistryofHealthinFebruary2003decidedtoinitiatemeasleseliminationinMalaysiastartingin2004.Followingthisdecision,vaccinationandsurveillancestrategieshavebeenreviewedandchangedtoachievetheeliminationgoalsandobjectives.

�.�.� Goalsandobjectives

The main goal of this elimination initiative is to achieve sustainablereduction of measles morbidity and mortality and to interrupt thetransmissionofindigenousmeaslesvirusinMalaysia.

Specificobjectivesofeliminationinitiativeareto;1) maintain thenumberofsusceptible individualsbelow thecritical

numberrequiredtosustaintransmissionofthevirus;2) eliminatemeaslesbyyear2010;3) achieve0measlesmortality.

�0 MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel ��MEASLES PREVENTION & CONTROL IN MALAYSIA


Handbook for Healthcare Personnel ��

�.�.� Strategies

Sustainablereductionofmeaslesmorbidity,mortalityandinterruptionofthetransmissionoftheindigenousmeaslesvirusinMalaysiaarepossiblebyimplementingthefollowingstrategies;

1) Vaccinationstrategies • routinetwodoseMMRvaccinegiventochildren

2) Surveillancestrategies • enhancing measles surveillance with integration of

epidemiologicalandlaboratoryinformation.

3) Laboratorystrategies • laboratory confirmation should be done on all suspect

measlescases

4) Responsetooutbreak • allmeaslesoutbreakswillbecarefullyinvestigated

5) Casemanagement • improvingthemanagementofeverymeaslescase

6) Training

�.� MEASLESVACCINATION

�.�.� Schedule

Twodoseofmeaslesvaccinearerecommendedasthe5–10percentwhofailtobeprotectedbythefirstdosewillnearlyallbeprotectedbythesecond.Themeaslesvaccinationscheduleisasfollows;

PeninsularMalaysia FirstdoseMMR 12monthsandSarawak SeconddoseMMR 7year(standardone)

Sabah Firstsingledose 6months measles FirstdoseMMR 12months(1year)

SeconddoseMMR 7year(standardone)

Area Measlesvaccination Agevaccinationgiven

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�.�.� Contraindications

Contraindicationsinclude; • individualswithprovenanaphylaxistoneomycin • childrenwithimmunesuppression • childrenwhohavereceivedanotherlivevaccineinpreviousmonth • children with HIV infection who are severely immune compromised • pregnantwomen • women of children age, who should be advised to avoid pregnancy for the next three months after MMR of measles vaccine.

�.4 MEASLESSURVEILLANCE

Adequate disease surveillance data and analysis will permitimplementation of appropriate measures to control and eliminatemeasles.Italsowillbeusedintheassessmentofprogressandinmakingadjustmentstoprogrammesasrequired.MeaslesisanotifiabllediseaseundertheControlofCommunicableDiseaseAct1988.

In the elimination phase the surveillance of measles should becase-based or known as enhanced measles surveillance (laboratoryconfirmationshouldbedone).

�.4.� Objectives

The general objectives of measles surveillance are to immediatedetecting any suspected cases, confirming cases by laboratorydiagnosis and identifying importations and possible sources ofinfection so that can be used to plan, monitor and evaluate measleseliminationprogramme.

Thespecificobjectivesofmeaslessurveillanceareto;1) monitorincidenceandcoverageinordertoassessprogress;2) identifyareasathighriskorwithpoorprogrammeperformance;3) identifyinghigh-riskpopulation;4) describe the changing epidemiology ofmeasles in terms of age,

immunizationstatusandtheintervalsbetweenepidemics;

�� MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel ��MEASLES PREVENTION & CONTROL IN MALAYSIA



5) predictthenextoutbreakthatmayoccurbecauseofabuild-upofsusceptiblepersons;

6) detect and investigate measles outbreaks so that cause ofoutbreakscanbedetermined

7) determinewheremeaslesvirusiscirculating;8) assesstheperformanceofsurveillancesystem;9) ensurepropercasemanagement

2.4.2 Casedefinition

Clinicalcasedefinitionforsuspectmeaslescasethatshouldbereported/notifyisasfollows;

2.4.3 Caseclassification

Caseclassificationaccordingtolaboratoryconfirmation;

Any person with fever and maculopapular rash and cough,coryza(runnynose)orconjunctivitis(redeyes)

or

Anypersoninwhomacliniciansuspectsmeaslesinfection

Clinicallyconfirmed:Acasethatmeetstheclinicalcasedefinition

Laboratoryconfirmed:A case that meets the clinical case definition and is laboratoryconfirmed(basedonlaboratorycriteriafordiagnosis)

Epidemiologicallyconfirmed:A case that meets the clinical case definition and is linkedepidemiologallytoalaboratoryconfirmedcase.


�.4.4 Proceduresofsurveillance

FlowofmeaslessurveillanceactivitiesisasAppendix1.

i) Casedetection

• takeaproperhistoryonthecomplaintofsuspectmeaslescaseswhofulfilmeaslescasedefinition

• iftheonsetofrashislessthan4days,takeblood/serumsampleandurineorrespiratoryspecimensfromthepatient

• iftheonsetofrashmorethan4days,takeblood/serumfromthepatient

• send the clinical sample/s to laboratory identified by DistrictHealthOfficetogetherwithMeasles–LaboratoryRequestFrom(MSLF:01/2004asAppendix2).Procedurestocollect,storeandtransportofsamplesareas inAppendix3and4.Thesample/sthen transported to National Public Health Laboratory (NPHL),SungaiBulohforconfirmation.

ii) Notification

AllsuspectmeaslescasesmustbenotifiedtonearestDistrictHealthOfficewithin48hoursofrashonsetviatelephone.Asmostofthecasesdetectedwithinfewdaysofrashonset,itisadvisablethatthecaseshouldbenotifiedassoonasacasedetected.NotificationusingNotification Form should follow using current systemof notification.NotificationFormandnotificationflowareasAppendix5and6.

Caseclassificationaccordingtosourceofinfection

Indigenousinfection:

A person becomes infected in Malaysia (no history of out fromMalaysia21daysofrashonset),either,• Epidemiologicallylinkedtoaninternationalimported;or• Notlinkedepidemiologicallytoaninternationalimportedcase

Importedinfection:

Apersonwhohasconfirmedmeaslesandwhoserashonsetwaswithin21daysofarrivalinMalaysia.




iii) Caseinvestigation

Identified Officer in District Health Office must investigate allsuspectmeaslescaseswithin48hoursofnotificationusingMeaslesInvestigationForm.InvestigationFormisasAppendix7.

iv) Caseclassification

After case has been investigated and laboratory result has beenavailable, case must be classified according the laboratoryconfirmationandsourceofinfectionasfollowing(Appendix8);

• clinicallyconfirmed• epidemiologicallyconfirmed• laboratoryconfirmed • indigenousinfection• importedinfection

v) Dataanalysisandinterpretation

Datashouldbeanalyseonweeklybasisand informationshouldbegenerate.

�.4.� Performanceindicators

Thefollowingaretheperformanceindicatorsthatshouldbeevaluatedonweeklybasis.

• %ofsuspectedcasesnotifiedwithin≤48hoursofonsetofrash• %ofsuspectedcasesinvestigated• %ofcasesinvestigatedwithin≤48hoursofnotification• %ofcaseswithlaboratoryconfirmation• %ofcaseswithadequatespecimentaken• %laboratoryresult(serology)within7days• %laboratoryresult(virusisolation)within14days• %ofconfirmedcaseswithsourcesofinfectionidentified

Thetargetofallaboveindicatorstobe≥80%.

** Details on procedures of measles surveillance, refer Measles Surveillance Manual

Laboratoryconfirmation

Sourceofinfection


APPENDICES




Appendix1

Flowchartofmeaslessurveillanceactivities

Casedetection

Casenotification

Caseinvestigation

Dataanalysis

Caseclassification

Dataverification&validation

Evaluation

Action

Informationdissemination(feedback)

Reports

Interpretation

Healthfacility

StateHealthDepartment&

DiseaseControlDivision,

MinistryofHealth

DistrictHealthOffice


A.MAKLUMATPESAKITNegeri: Daerah:Hospital/KlinikKesihatan:NamaPesakit:No.K/P: Umur: Jantina:L/P

B.MAKLUMATIMUNISASIMEASLESImunisasimeasles:AdaTiada Tidakdiketahui Tarikhdosterakhirdiberi:

C.MAKLUMATKLINIKALGejala (Simptom) Ada / Tiada (Tandakan √ diruang berkenaan) Tarikh mulaDemamRuam(maculopapularrash)KonjunktivitisBatuk“Coryza”

D.SPESIMENKLINIKALSpesimen: Pertama KeduaSpesimen (tandakan √ diruang berkenaan) Tarikh diambil Tarikh penghantaranDarah/SerumSekresipernafasan(Respiratorysecretion)Airkencing(urine)E.MAKLUMATPEMOHONNamadanCopPegawai: No.telefon: No.Fax:Tandatangan: e-mail:

F.MAKMAL(UntukKegunaanMakmal)Keadaanspesimen: Tarikhterimaspesimen:

Spesimen Jenis ujian Keputusan ujian KomenDarah/SerumSekresipernafasan(Respiratorysecretion)Airkencing(Urine)NamadantandatanganPegawaiMakmal:JawatanPegawaiMakmaldanCopMakmal: Tarikh:

Appendix2

MSLF:01/2004

No.RujukanMakmal

MEASLES-BORANGPERMOHONANDANKEPUTUSANUJIANMAKMAL

*Nota:Spesimenklinikal(darah/sekresipernafasan/airkencing)hendaklahdiambiljikapesakitdisyakkisebagaikesmeasles.Definikes(casedefinition)adalahsepertidinyatakandibelakang.

Jikaspesimeniniadalahspesimenkedua,maklumatklinikaldanimunisasitidakperludiisijikatelahdiisipadaborangspesimenpertama.

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Handbook for Healthcare Personnel �9

(atthebackoflaboratoryrequestform)

Measles

DefinisiKes

Seseorangyangmengalamigejalaberikut;Demamdanruam(maculopapularrash)dan;konjunktivitisataubatukatau“coryza”

atauSesiapayangdidiagnossebagaikescampakolehPegawaiPerubatan

Case Definition

Any person withFever and maculopapular rash and; conjunctivitis or cough or coryza

orAny person in whom a clinician suspects measles infection

MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �9MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �9

Appendix3

PROCEDURESTOCOLLECT,STOREANDTRANSPORTCLINICALSPECIMENS

Basickitforspecimencollection

Equipments:

1. Needles2. Syringes3. Tourniquet4. Sharpbins5. Gloves,alcoholswabs6. Sterileurinecontainer7. PlainScrew-cappedtube(donotusevacutainer)8. VTM(Viraltransportmedium)9. Sterilecottonswab10. Coldbox11. Icepacks12. Ziplock(biohazard)plasticbag13. SpecimenMeaslesSurveillanceLaboratoryForm(MSLF-001)14. Specimenlabel




Appendix3a

BloodSpecimencollectionformeaslesspecificIgMtest

Transfertheserumintoanewplaintube

Centrifugethespecimenat1000Xgfor10minutestoseparatetheserumfromthebloodcells(immediatelyafterthespecimentaken)

Labelthenewcontainerwithpatientidentificationandcollectiondate(name,FullnewI/Cno.,dateofspecimentaken,typeoftesteg.

MeaslesSpecificIgM)

Completetherequestformincludingthelastmeaslesimmunizationdate,onsetofrash,datespecimentaken,telephoneandfaxnumbersandname

ofrequestingmedicalofficer.

Labelthecontainerwithpatientidentificationandcollectiondate(name,FullnewI/CNo.,dateofspecimentaken,typeoftesteg.

MeaslesSpecificIgM)

SendtoNationalPublicHealthLaboratory(NPHL)SungaiBuloh

Storethespecimenat4–8oCbeforeandduringtransportation(usecoldboxwithicepack)

Putthespecimensintotheirrespectivebiohazardbagandindividuallypacked

Note:Maximumperiodofspecimenstorageissevendaysbeforetransportation

Take5mlofvenousbloodforadult,2.5mlforchildren(<7y.o)Useplaintubewithscrewcap(donotusevacutainer).

Bloodtobetakenanytime,preferable4to28daysaftertheonsetofrashes


Appendix3b

Urinespecimencollectionformeaslesvirusisolation

Collect10–50mlofurineintoasterilescrew-cappedcontainer.Firstpassed,morningspecimensofurinearepreferable.Urinecanbecollected

assoonafterrashonsetandatleastwithin5daysofrashonset

Labelthecontainerwithpatientidentificationandcollectiondate(name,FullNewI/CNo.,dateofspecimentaken,typeoftesteg.

MeaslesVirusIsolation)

Completetherequestformincludingthelastmeaslesimmunizationdategiven,onsetofrash,datespecimentaken,telephoneandfaxnumbers

andnameofrequestingmedicalofficer.

Putthespecimensintotheirrespectivebiohazardbagandshouldbeindividuallypacked

Storethespecimenat4–8oCbeforeandduringtransportation(usecoldboxwithicepack)andsendtoNationalPublicHealth

Laboratory(NPHL)within24hours.






Appendix3c

Nasopharyngealspecimencollectionformeaslesvirusisolation

Collectnasopharyngealspecimen(aspiratesorlavage)andputintoasterilescrew-cappedcontainer.Thespecimenshouldbecollectedassoonaspossibleafteronsetandnotlongerthan7daysafterthe

appearanceofrash

Labelthecontainerwithpatientidentificationandcollectiondate(Name,FullNewI/CNo.,dateofspecimentaken,typeoftesteg.


Completetherequestformincludingthelastmeaslesimmunizationdate,onsetofrash,datespecimentaken,telephoneandfaxnumbers

andnameofrequestingmedicalofficer.

Putthespecimenintotheirrespectivebiohazardbag.Specimenshouldbeindividuallypacked.


Appendix3d

Throat/nasalswabspecimencollectionformeaslesvirusisolation

Takethroat/nasalswabandputinto2.0mlViralTransportMedium(VTM)[VTMcanbepurchased/suppliedbyPHL]

Labelthecontainerwithpatientidentificationandcollectiondate(name,FullNewI/CNo.,dateofspecimentaken,typeoftesteg.




Putthespecimenintotheirrespectivebiohazardbag.Specimenshouldbeindividuallypacked.

Completetherequestformincludingthelastmeaslesimmunizationdate,onsetofrash,datespecimentaken,

telephoneandfaxnumbersandnameofrequestingmedicalofficer.




Appendix4

Flowchartofclinicalspecimensforlaboratoryconfirmationandresult

LocallaboratoryatDistrictLevel(identifiedbyDistrictHealthOffice)

NationalPublicHealth(NPHL)SungaiBuloh

Locallaboratory can send sample

direct to NPHL

Healthfacility(Blood/Respiratorysecretion/Urine)

Statelaboratory

DiseaseControlDivisionDistrictHealthOffice

Specimen

Specimen

Specimen

Result

Result

Result

Result


A. MAKLUMAT PESAKIT.1. Nama Penuh(HURUF BESAR) :

Nama Ibu/Bapa/Penjaga (Jika 12 Tahun Dan Ke bawah) :

2. No. Pengenalan Diri/Dokumen Perjalanan : Sendiri Pengiring 3. Warganegara Malaysia: No. Daftar Hospital/Klinik: Ya Keturunan : …………… Subketurunan : …………………… Tahun : Tidak Negara Asal : …………… Izin Tanpa Izin Pemastautin Tetap No./Nama Wad: 4. Jantina : Lelaki Perempuan

5. Tarikh Lahir : - - 6. Umur : ___Hari/___Bulan/___Tahun

7. Pekerjaan : (Jika tidak bekerja, nyatakan status diri) :

8. Alamat Kediaman:

9. Alamat Tempat Kerja/Belajar/Pusat Asuhan Kanak-Kanak:( Nyatakan alamat tempat kejadian jika Keracunan Makanan)

10. Nombor Telefon : Ada Tiada Rumah : Pejabat : Tel. Bimbit : E-Mail :

B. DIAGNOSIS PENYAKIT

11. Pilihan Diagnosis 1. Acute Flaccid Paralysis 16. Kolera. 31. Tuberkulosis – PTB smear positif. 2. AIDS. 17. Kusta (Paucibacillary). 32. Tuberkulosis – PTB smear negatif. 3. Batuk Kokol. 18. Kusta (Multibacillary). 33. Tuberkulosis – Extra Pulmonary. 4. Campak. 19. Malaria (Sp:……………………). 34. Tuberkulosis – Extra PTB dengan smear +ve. 5. Chancroid. 20. Plague (Jenis:………..…………). 35. Tuberkulosis – Extra PTB dengan smear –ve. 6. Demam Denggi 21. Poliomielitis (Akut). 36. Viral Ensefalitis – Japanese. 7. Demam Denggi Berdarah. 22. Rabies. 37. Viral Ensefalitis – Nipah 8. Demam Kuning 23. Relapsing Fever. 38. Viral Ensefalitis (Lain-lain). 9.Difteria. 24.Sifilis–acquired. 39.ViralHepatitisA(Akut). 10.Disenteri. 25.Sifilis–congenital. 40.ViralHepatitisB(Akut). 11. Ebola. 26. Tetanus Neonatorum. 41. Viral Hepatitis C (Akut). 12. Gonorea. 27. Tetanus (Lain-lain). 42. Viral Hepatitis – Lain-lain (Akut). 13. Hand, Foot and Mouth Disease. 28. Tifoid – Salmonella typhi. 43. Lain-lain (Nyatakan):………………..……….. 14. HIV 29. Tifoid – Paratyphoid (Jenis:…….…). 15. Keracunan Makanan. 30. Tifus – scrub.

12. Status Pesakit : Tarikh Mati : 13. Tarikh Mula :

Hidup Mati 14. Cara Pengesanan : Kes Kontek Kes FOMEMA Ujian Saringan ( ……………………………….)

Notifikasi melalui telefon dalam masa 24 jam perlu dilakukan bagi kes berikut selain dari notifikasi bertulis : Poliomielitis (Akut) , Kolera, Demam Denggi, Difteria, Keracunan Makanan, Plague, Rabies dan Demam Kuning

15.StatusDiagnosis(MengikutDefinisiKes) 16.UjianMakmal/Siasatan: AdaTiada Sementara (Provisional/Suspected) 17. Nama Ujian Makmal/Siasatan : Disahkan(Confirmed) 18.TarikhSampelDiambil/ 19.KeputusanUjianMakmal/Siasatan: Siasatan Dibuat : Positif Negatif Belum SiapTarikh Diagnosis : ..........................................................................

20. Maklumat Klinikal Yang Relevan: 21. Komen :

C. MAKLUMAT PEMBERITAHU

22. Nama Pengamal Perubatan(HURUF BESAR) :

23. Nama Hospital/Klinik dan Alamat :

24.TarikhNotifikasi: 25.NoTelefon: 26.NoFaks: 27.E-Mail:

Borang: Health 1 Rev 2001No Siri: …………….BORANG

Subperaturan 10(2)AKTA PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT 1988

PERATURAN-PERATURAN PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT (BORANG NOTIS) 1993 NOTIFIKASI PENYAKIT BERJANGKIT YANG PERLU DILAPORKAN

Appendix�

Poskod Negeri

Poskod Negeri

-- - -

-- --




Appendix6

NOTIFICATIONFLOW

DistrictHealthOffice

Healthfacility/Community

Case-basedinvestigation

StateHealthDepartment

ViaCDCIS

DiseaseControlDivision&IDS

AnalysisInterpretation

Response

Feedback

Feedback

AnalysisInterpretation

Response

Viatelephone/othercommunicationsystem


BORANGSIASATANCAMPAK(MEASLES)KEMENTERIANKESIHATANMALALAYSIA

Nota :Semuakesyangdisyakisebagaikescampakyangdilaporkanhendaklahdisiasatdengansertamertadantidaklewatdaritempoh48jamselepasnotifikasi.

FASILITINegeri:DaerahKesihatan: PejabatKesihatanDaerah:

MAKLUMATPESAKIT MAKLUMATNOTIFIKASINamaPesakit: Diagnosa:

TarikhDiagnosa:TarikhNotifikasi:

____/____/________/____/____No.K/P: Jantina: T.Lahir: Umur: PuncaPengesahanKes: Aktif Pasif

Warganegara: NamaPemberitahu:

Ya;KumpulanEtnik:__________________ NamaFasilitiPemberitahu:

Tidak;NegaraAsal:__________________ No.Telefon/Faks:

StatusImigrasi:______________________ No.RujukanKes:

AlamatKediaman: MAKLUMATSIASATANKES

TarikhNotifikasiDiterima:____/____/____

AlamatTempatKerja: TarikhKesDidaftar:____/____/____ No.daftarkes:

No.Telefon:-Rumah: Pejabat: TarikhSiasatan:____/____/____

Tel.Bimbit: NamaPenyiasatKes:

E-Mel: Jawatan:Pekerjaan:

MAKLUMATKLINIKALDemam: Ruam: JenisRuam: Ya;Tarikhmula:____/____/____ Ya;Tarikhmula:____/____/____ Maculopapular Tidak Tidak Maculo-vesicular TidakDiketahui TidakDiketahui

Batuk: Coryza: Conjunctivitis: Ya Ya Ya Tidak Tidak Tidak TidakDiketahui TidakDiketahui TidakDiketahui

Jikatiadasebarangsimptomcampak,adakahdiagnosacampakinidibuatolehPegawaiPerubatan/PengamalPerubatan?

Ya Tidak Statusrawatan: PesakitLuarJikaya,catitkan, PesakitDalamNamaPegawai/PengamalPerubatan:

Jawatan:

Appendix7

�8 MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �9MEASLES PREVENTION & CONTROL IN MALAYSIA


Handbook for Healthcare Personnel �9

(Samb.)MAKLUMATKLINIKALAdakahkesmengalamikomplikasijangkitan: Tiada TidakDiketahui Diarrhea Otitismedia Encephalitis/SSPE Lain-lain,nyatakan:

Statuskes: Hidup Mati;TarikhMati:____/____/____ TidakDiketahui

EPIDEMIOLOGIKES(PUNCAJANGKITAN)Adakahkesmempunyaikontakdenganpesakitcampakyanglaindalamtempoh7–12harisebelummularuam? Ya Tiada TidakDiketahui

Jikaada,catitkan; Nama: No.Daftar: Tarikhmularuam:____/____/____

Adakahterdapatkescampakyangdilaporkandilokalititersebutsebelumkesini(dalamtempohinkubasiyangsama)? Ya Tiada TidakDiketahui

Jikaada,catitkan; Nama: No.Daftar: Tarikhmularuam:____/____/____

Adakahkeskeluarnegaradalamtempoh7–21harisebelumtarikhmularuam? Ya Tiada TidakDiketahui

Adakahkesbekerjadidalambidangpelanconganataubekerjadikawasan/tempatyangterdapatramaipelancongantarabangsa/pendatang? Ya Tiada TidakDiketahui

Individudisyakikescampakyangdikesansemasapenyiasatankes: Nama: No.K.Pengenalan:_______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _____________________________________

Adakahterjadiwabak?YaTidakJikaya,nomborwabak:_____/______(nombor/tahun)

MAKLUMATUJIANMAKMALSampeldarah/serumuntukujianserologi

Sampeldarah/serumdiambil: Ya Tiada TidakDiketahui

TarikhJenisSampel Pengambilan Sampel Terima Keputusan Sampel Hantarke Sampeloleh Ujian MKAK MKAK dilaporkan

SampelDarahPertama

SampelDarahKedua

Pos

itif

Neg

atif

Equ

ivoc

al Ti

dak

Dik

etah

ui

KeputusanUjianIgM

MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �9MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel �9

(Samb.)MAKLUMATUJIANMAKMAL

Sampelsekresirespiratori/urinuntukujian‘viralculture&indentification’:

Sampelsekresirespiratori/urindiambil: Ya Tiada TidakDiketahui

Tarikh

JenisSampel Pengambilan Sampel Terima Keputusan Sampel Hantarke Sampeloleh Ujian MKAK MKAK dilaporkan

Sekresirespiratori

Urin

KeputusanUjian‘viralculture&indentification’

STATUSIMUNISASICAMPAK

Telahdiberiimunisasicampak Ya Tiada Belumlayak TidakDiketahui

Sumbermaklumatimunisasi: Kadimunisasi Sejarahlisan Tidakdiketahui

BilanganDos:

Tarikhdosterakhirdiberi:

KLASIFIKASIKES

Kesyangdilaporkaninidikategorisebagai: Statusjangkitan/penularankesini:

‘Clinicallyconfirmed’ Jangkitantempatan

‘Epidemiologically-linked’ ‘ImportedCases’

‘Laboratoryconfirmed’ Tidakdapatditentukan

‘Discarded’

ULASAN

NamaPegawaiKesihatanDaerah:

Tarikh:

Pos

itif&

Nam

aVi

rus

Neg

atif

Tida

kD

iket

ahui




Appendix8

CLASSIFICATIONOFMEASLESCASE

If the serum specimens taken < 4 days of onset of rash & result negative for Measles IgM and no 2nd serum specimen or no urine / respiratory specimens taken

If the cases not fulfilled

case definition

Note:Caseshouldbeclassifiedasclinicallyconfirmedeventhoughserologytestresultnegativewithadequatespecimenifthespecimentaken<4daysofrashonsetandnosecondserumspecimenorurine/respiratoryspecimenstaken.Suspectcasealsocanbeclassifiedasdiscardifthecaseisobviouslynotfulfilledcasedefinition

Discard

Specimenadequate

Laboratoryconfirmed

Suspectcase(Clinicalcase)

Epidemiologicallyconfirmed

Noepidemiological

linkedtolaboratory

confirmedcase

Epidemiologicallinkedto

laboratoryconfirmedcase

Clinicallyconfirmed

IgMnegative

IgMpositive

Nospecimen/noadequate

specimen


No. StateHealthDepartment Tel.No. FaxNo.

1. CommunicableDiseaseControlSection DiseaseControlDivision MinistryofHealth 03-88834506 03-88891013

2. PerlisStateHealthDepartment 04-9773333 04-9760764

3. KedahStateHealthDepartment 04-7335533 04-7314936

4. P.PinangStateHealthDepartment 04-2625533 04-2613508

5. PerakStateHealthDepartment 05-2533489 05-2552821

6. SelangorStateHealthDepartment 03-51237333 03-51237329

7. K.L.F.T.HealthDepartment 03-26940701 03-26938742

8. N.SembilanStateHealthDepartment 06-7625231 06-7638543

9. MelakaStateHealthDepartment 06-2828344 06-2864761

10. JohorStateHealthDepartment 07-2245188 07-2277577

11. PahangStateHealthDepartment 09-5161366 09-5135528

12. TerengganuStateHealthDepartment 09-6222866 09-6245829

13. KelantanStateHealthDepartment 09-7413300 09-7444486

14. SabahStateHealthDepartment 088-265960 088-221477

15. SarawakStateHealthDepartment 082-256566 082-234571

16. LabuanF.T.HealthDepartment 087-411702 087-411298

TelephoneNumbers

Any questions regarding the Prevention and Control of Measles inMalaysia,pleasecontact theMedicalOfficerofHealth(Epidemiology)at theCommunicableDiseaseControlSection,DiseaseControlDivision,MinistryofHealthor/andtheStateHealthDepartmentasfollows,




REFERENCES

1. Module on best practice for measles surveillance.Geneva,WorldHealthOrganization,2001.

2. WHO Guidelines for Epidemic Preparedness and Response to Measles Outbreaks.Geneva,WorldHealthOrganization,1999

3. Expanded Programme on Immunization Using Surveillance Data and Outbreak Investigations to Strengthen Measles Immunization Programmes.Geneva,WorldHealthOrganization,1996.

4. Manual for the laboratory diagnosis of measles viral infection.Geneva,WorldHealthOrganization,1999.

5. Plan of action – Revised national immunisation programme for children with a special focus on Hib and MMR immunisation.MinistryofHealth,Malaysia,2002.

6. RosemawatiA. Measles situation in Malaysia 1999 – 2000. Ministry ofHealth,Malaysia,2003(unpublisheddocument)


ACKNOWLEDGEMENT

Wewouldliketothanksthefollowingpersonsformadethishandbookpossible;

Y.Bhg.Dato’Dr.Hj.RamleeHj.RahmatDirectorofDiseaseControl

Dr.AbdulRasidKasriDeputyDirectorofDiseaseControl(Com.Disease)

Dr.HasanAbdulRahmanDirector

PahangStateHealthDepartment[formerlytheDeputyDirectorofDiseaseControl(Com.Disease)]

Dr.DevanKurupPrincipalAssistantDirector

CommunicableDiseaseControlSection

AllParticipantsofthe“OperationalisationofEnhancedMeaslesSurveillance&MassCampaign

Meeting”,9–12December2003,LeParisHotel,PortDickson

Preparedby

Dr.RosemawatiAriffinPrincipalAssistantDirector

CommunicableDiseaseControlSection

�4 MEASLES PREVENTION & CONTROL IN MALAYSIAHandbook for Healthcare Personnel PBMEASLES PREVENTION & CONTROL IN MALAYSIA

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Documents

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