DR. ZUHAIDA BINTI A. JALIL KETUA PENOLONG PENAGARAH KANAN SEKTOR SURVELAN PENYAKIT, BKP 1 APRIL 2018

Transcription

1 DR. ZUHAIDA BINTI A. JALIL KETUA PENOLONG PENAGARAH KANAN SEKTOR SURVELAN PENYAKIT, BKP 1 APRIL 2018

2 MOH Malaysia: The Organizational Structure National Level: For Surveillance Disease Control Division Responsible for legislation, policy, norms and standards for surveillance State Level: The State Health Department District Level: The District Health Office

3 Surveillance Systems in Malaysia

4 The Components of PH Surveillance Systematic data framework development Evaluation of public health actions Data collection Timely information dissemination Data analysis & interpretation

5 The Operational Framework: Surveillance, Risk Assessment & Response EBS IBS

6 THE ESTABLISHMENT OF PUBLIC HEALTH SURVEILLANCE IN MALAYSIA

7 Nipah Virus Outbreak Among pig-handlers September 1998 May 1999 Outcome: 265 cases of acute encephalitis with 105 deaths Mortality rate 40% 1.1 million pigs culled Direct economic impact (Loss of USD625 million) Causative agent: A novel paramyxovirus i.e. Nipah virus

8 Lesson Learnt Way Forward Preparedness capacities and capabilities Rapid response Proper management of the livestock industry Early & accurate surveillance crucial Early identification of pathogen would have resulted in earlier control of outbreak Multi-sectoral cooperation 1999: Inter Ministry Committee on the Control of Zoonotic Diseases 2001: Infectious Disease Surveillance Section, Disease Control Division 2002: Epidemic Intelligence Programme (EIP) Malaysia

9 Malaysia: Indicator-Based Surveillance Mandatory Notification Prevention and Control of Infectious Diseases Act 1988 (Act 342) 28 notifiable infectious diseases Health facility based reporting Notify within 24 hours (9 diseases: cholera, dengue fever, diphtheria, ebola-marburg disease, food poisoning, plague, poliomyelitis, rabies, yellow fever) Laboratory-Based Surveillance Introduced in year 2005 Coordinated by the National Public Health Laboratory (NPHL) Sg. Buloh Pathogens prioritised: S. Typhi, S. Paratyphi, Salmonella spp., N. Meningitidis, H. Influenza Type B and V. Cholerae Sentinel Surveillance e.g. Influenza-like Illness; ILI and Severe Acute Respiratory Infection; sari

10 Case Definitions Infectious Diseases What is a case definition? (time, place & person) Clinically Compatible Case compatible syndrome Suspected Case common clinical presentation Probable Case epidemiological link Confirmed Case laboratory result

11 Objectives: Laboratory-Based Surveillance To detect emerging pathogen strain. To predict and detect outbreak of disease. To determine and monitor the circulation of organism strains in the country. To monitor the trend of anti-microbial resistance. To facilitate outbreak identification and investigation through strain identification (serotyping, phage typing etc.)

12 Pathogens Identified For National Laboratory Surveillance Sentinel Surveillance Dengue Influenza Enterovirus Viral National Surveillance Japenese encephalitis Mumps, Measles and Rubella Non Viral Pathogens H. influenzae type B Neisseriae meningitides Salmonella typhi Salmonella paratyphi Salmonella spp. Vibrio cholerae 12

13 Sentinel Surveillance: Malaysia Influenza Surveillance Programme Sentinel surveillance involves systematically collecting data on a routine basis from a limited number of surveillance sites Started in January major components: Disease-based surveillance: 14 sentinel health clinics - for ILI surveillance 9 sentinel hospitals for SARI Surveillance Laboratory-based surveillance: 1 National Influenza Centres (NIC) & 1 National Influenza Lab (NIL) sentinel sites per state for clinical specimen collection 5 specimens from ILI / SARI cases per clinic per week should be collected

14 Flow of Data/Information Related To Influenza Surveillance Sentinel Sites: ILI / SARI Cases Make a diagnosis Treat accordingly Referral to hospital (if necessary) Recorded in return form 5 specimens /week Send clinical specimens for viral isolation to NPHL Sungai Buloh (NIL) DISTRICT STATE Inst. Med. Research (NIC) Surveillance Section, Ministry of Health Malaysia

15 SYNDROMIC SURVEILLANCE Case definition based on a syndrome, not on a specific disease Rely on immediate reporting of event to the system rapid risk assessment and immediate response Designed to detect rare yet highimpact outbreaks Type of specimens to be collected will depend on the syndrome encountered Health facility based reporting

16 Syndromic Surveillance: The Objectives To facilitate & expedite notification & response using clinical syndromes to define & capture all diseases that potentially cause outbreaks To alert attention to a problem at the earliest possible time and to promote rapid investigation & containment of the outbreak To complement other existing specific disease notification & is especially useful for rapid response to newly emerging and reemerging diseases & the deliberate release of biological agents

17 THE SYNDROMES 1) Acute neurological syndrome 2) Acute respiratory syndrome 3) Acute dermatological syndrome 4) Acute haemorrhagic syndrome 5) Acute jaundice syndrome 6) Acute diarrhoeal syndrome

18 Syndromic Surveillance: The Common Features ACUTE: Defined as a period of 3 weeks or less SEVERE ILLNESS: Characterized by at least one of the following: hospital admission major organ failure altered stated of consciousness circulatory collapse death ABSENCE OF KNOWN PREDISPOSING FACTORS: is the absence of known underlying diseases or other factors e.g. drugs which can explain the occurrence of the syndrome

19 RUMOUR SURVEILLANCE This system relies on information gather from many sources General Objectives: to provide an early warning sign in detecting potential outbreak within and outside Malaysia Specific Objectives: to collate rumours on infectious diseases within the country and internationally to verify the rumours through investigation for decision on further action or to dismiss it to disseminate information about the verified rumours to appropriate parties so that appropriate public health action is taken

20 Source Of Information For Rumour Surveillance Printed media e.g. local newspapers Internet Television & radio Phone calls s from public discussion group e.g. ProMed-mail Word-of-mouth of public or health staff from different levels

21 EVENT-BASED SURVEILLANCE

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23 EVENT NOTIFICATION EXAMPLES OF EVENTS REPORTED : FLOOD / LANDSLIDE EXPLOSION AND FIRE GAS LEAKAGE AMMONIA /CHLORINE CARBON MONOXIDE POISONING CLUSTER OF ARI

24 Overview of All Hazard Public Health Surveillance & Response Functions Source: WHO Early detection, assessment and response to acute public health events: Implementation of Early Warning and Response with a Focus on Event-Based Surveillance (Interim Version). Geneva, Switzerland.

25 WHAT IS EVENT-BASED SURVEILLANCE Event-Based Surveillance (EBS) is defined as; - The organized and rapid capture of information about events that are a potential risk / concern to public health. Information can include rumours and other ad-hoc reports obtained through either; formal channel (established routine reporting systems) or informal channel. (media, health workers and non-governmental organisation reports) Source : A Guide to Establishing Event-based Surveillance, WHO Western Pacific Region

26 Objectives of Event-Based Surveillance To rapidly detect and appropriately respond to acute public health events of any origin, ensuring timely implementation of effective control measures. To facilitate early detection and early response towards reported public health events. To reduce the public health risk and impact of the events To complement the indicator-based surveillance and other surveillance systems.

27 PUBLIC HEALTH EVENTS DEFINITION Any public health event that raises concern, fear and alarm in the community. Events which may have a known, suspected or possible impact on human health and require immediate action to reduce the consequences e.g. highly potential for spread and / or high case fatality rates Events with unusual disease pattern; events arising outside their usual pattern of occurrence. Events where the underlying agent, disease, mode of transmission is new, newly-discovered or as yet unknown at the time of detection. Events that constitute a public health threat; i.e. with severe consequences on trade / travel and related to the intentional release of biological or chemical agents

28 Achievements: Disaster Preparedness Plan General Plan Plans for disaster due to - Communicable diseases - Mass casualty incident - Environmental-linked event - CBRNe - Stockpile Preparing / finalization of Preparing plan for human resources mobilization Preparing crisis, violence, terrorism management plan

29 Number of Outbreaks Notification Notification to e-wabak Year Total Notification Outbreaks Notification Events Notification

30 Number of Outbreaks Notification Total Notification Year Outbreaks Notification Events Notification Total Notification 500 0

31 Number of Outbreaks Notification Outbreaks Notification Year Outbreaks Notification

32 Notification of Events Event Notification

33 Activities for Malaysian Field Hospital, Cox Bazar

34 International Health Sector Disease Control Division

35 FUNCTIONS OF INTERNATIONAL HEALTH SECTOR (IHS) 1 To - Plan - Implement - Monitor & - Evaluate - International Health Regulation (IHR) International Point of Entry - Foreign workers Programme - Travel Health Programme 2 To be a FOCAL POINT and act as a technical adviser to other agencies, internationally or nationally, with regards to issues related to International Health. 3 To coordinate any activities or collaboration between Disease Control Division and International level.

36 MALAYSIA STRATEGIC WORKPLAN FOR EMERGING DISEASES AND PUBLIC HEALTH EMERGENCIES (MYSED II) MySED / MySED 1 MySED II

37 Reference document for MySED

38 JOINT EXTERNAL EVALUATION (JEE) JEE is a method developed by the World Health Organization (WHO) to enable a participating country to evaluate its capacity in implementing International Health Regulations (IHR) Through it, a country may identify its gaps and further strengthen its capacity accordingly in preventing, detecting and responding fast against any threat to public health in their respective countries. Until November 2017, 35 countries have implemented JEE ratings involving their respective countries. In the assessment of JEE, these WHO experts will be invited to make an assessment of the identified 19 focus areas. Malaysia is planning to invite the WHO experts for JEE in 2nd or 3rd quarter MOH Malaysia will call for a meeting with all related ministries / agencies / stakeholders to discuss further on this evaluation.

39 POINT OF ENTRY : CORE CAPACITY Capacity Strengthening REQUIREMENTS at Points (ROUTINE) of Entry (a) Assessment and Medical care, staff & equipment (b) Equipment & personnel for transport ill travellers (e) Trained staff and programme for vector control (c) Trained personnel for inspection of conveyances (d) ensure save environment: water, food, waste, wash rooms & other potential risk areas - inspection programmes

40 As of December 2015, the training and hands-on sessions for the permission to Import and Export Permit of Human Remain, Human Tissues, Micro- Organism and Pathogenic Substances through the Business Licensing Electronic Support System (BLESS) has been conducted in all states. For 2016, all states need to actively carry out training to importing / exporting agents and must encouraged that these agents apply for their import and export permits through BLESS (manual application is still accepted). In 2017, all states were obliged to carry out all activities of Import and Export of of Human Remain, Human Tissues, Micro-Organism and Pathogenic Substances permits through BLESS fully (no more manual application).

41 FOREIGN WORKERS MEDICAL EXAMINATION SYSTEM (FWMES) IN MALAYSIA 1 The New Concession Agreement between Ministry of Health (MOH), Ministry of Home Affairs (MOHA) and FOMEMA was signed on 16th December The 17 th Cabinet Committee Meeting on Foreign Workers and Unauthorized workers (JKKPA-PATI) on 17th August 2017 had agreed that all foreign workers need to undergo few health screenings, namely : before departing from their country of origin one month after arrival in Malaysia at the end of the first year at the end of the second year and at intervals of every two years as long as they are employed in Malaysia 3 MOH will continue to monitor all clauses in the agreement to ensure the concession agreement will be followed through and implemented by FOMEMA Sdn Bhd. This is done through Project Monitoring Committee (PMC) Meeting held every 4 months, co-chaired by DG of MOH and DG of JIM. 4 At least 4 meetings will be held to ensure that the quality of medical examination is maintained Committee on Quality of Laboratory Services Committee on Quality of X-ray Services Technical Committee on Foreign Workers Examination chair by PKP Interagency Meeting on Foreign Workers Examination chair by

42 Travel health IHS, Surveillance Section monitors the health status of international travellers with the focus on Pilgrim Hajj Programme Yellow Fever Surveillance

43 ACHIEVEMENTS OF IHS HAJJ PILGRIMS Top 5 Common Causes For Outpatient Attendance Top 5 Common Causes For Inpatient Admission No. Common Cause 2014 Number of Patients (Percentage) 1 Chest Diseases 37,299 (80.6%) 2 Musculoskeletal Diseases 2,994 (6.5%) 3 Skin Diseases 2,375 (5.1%) 4 Ear, Nose and Throat Diseases 2,119 (4.6%) 5 Gastrointestinal Diseases 1,511 (3.3%) Chest Diseases 39,817 (88.5%) 2 Musculoskeletal Diseases 2,269 (5.0) 3 Gastointestinal Diseases 1,154 (2.6%) 4 Skin Diseases 899 (2.0) 5 Cardiovascular Diseases 844 (1.9%) Chest Diseases 37,311(67.8%) 2 Ear, Nose and Throat Diseases 2505(4.6%) 3 Musculoskeletal Diseases 2242(4.1%) 4 Skin Diseases 1696(3.1%) 5 Cardiovascular Diseases 1081(2.0%) Chest Diseases (59.9%) 2 Musculoskeletal Diseases 3908 (4.4%) 3 Ear, Nose and Throat Diseases 3890 (4.4%) 4 Gastro-intestinal Diseases 2892 (3.3%) 5 Cardiovasular Diseases 2826 (3.2%) No. Common Cause 2014 Number of Patients (Percentage) 1 Chest Diseases 188 (45.3%) 2 Cardiovascular Diseases 88 (21.2%) 3 Metabolic Disorders 58 (14.0%) 4 Gastrointestinal Diseases 51 (12.3%) 5 Psychiatric Disorders 30 (7.2%) Chest Diseases 292 (40.7%) 2 Cardiovascular Diseases 162 (22.6%) 3 Metabolic Disorders 110 (15.3%) 4 Gastrointestinal Diseases 94 (13.1%) 5 Psychiatric Disorders 59 (8.2%) Chest Diseases 353 (40.0%) 2 Cardiovascular Diseases 79 (9.0%) 3 Nuerological Diseases 72 (8.1%) 4 Gastrointestinal Diseases 57 (6.5%) 5 Kidney and Urinary Diseases 53 (6.0%) Chest Diseases 625 (43%) 2 Cardiovascular Diseases %) 3 Metabolic Disorders 147 (10%) 4 Gastrointestinal Diseases 103 (7%) 5 Skin Diseases 68 (4.7%)

44 ACHIEVEMENTS OF IHS YELLOW FEVER SCREENING AT THE INTERNATIONAL ENTRY POINTS YEAR TOTAL VISITORS SCREENED VISITORS WITH VALID CERTIFICATE VISITORS QUARANTINED VISITORS UNDER HEALTH SURVEILLANCE ,180 30,963 (99.3%) 175 (0.56%) 42(0.1%) ,183 30,961 (99.3%) 91 (0.29%) 12 (0.04%) ,909 27,868 (99.9%) 20 (0.07%) 9 (0.03%) ,235 30,088 (99.5%) 122 (0.40%) 14 (0.05%) ,808 27,705 (99.6%) 84 (0.30%) 4 (0.01%) ,090 31,923 (99.5%) 135 (0.42%) 26 (0.07%) (99.6%) 72 (0.23%) 6 (0.02%) Monitoring of Yellow Fever Vaccination Centre, Number of Application Number of approved

45 THANK YOU