The 2009 flu outbreak in Malaysia is part of a larger flu pandemic involving a new type of influenza A virus subtype H1N1 (A (H1N1)) virus. As of 11 August 2009, the country has over 2,253 cases, beginning with "imported" cases from affected countries, including the United States and Australia from May 15, 2009 onwards, and the first local transmission on June 17, 2009. From August 12, the Malaysian Health Ministry said that it had discontinue officially updating the total number of H1N1 cases within Malaysia in line with guidelines issued by the World Health Organisation. As of August 21, 2009 the unofficial number of cases reported in the media is 5,876 so far. The first death related to the A(H1N1) virus was reported on 23 July 2009 and so far there have been 78 deaths reported. On July 6, 2009 Malaysia announced that it was shifting from containment to mitigation to tackle the spread of the virus. The federal government has declared a national health emergency in Malaysia due to the A(H1N1) outbreak and is considering imposing a health curfew similar to the week-long shutdown of non-essential services and industries in Mexico.
Since the Nipah virus outbreak in 1999, the Malaysian Health Ministry have put in place processes to be better prepared to protect the Malaysian population from the threat of infectious diseases. Malaysia was fully prepared during the Severe Acute Respiratory Syndrome (SARS) situation (Malaysia was not a SARS affected country) and the episode of the H5N1 (bird flu) outbreak in 2004.
The Malaysian government has developed a National Influenza Pandemic Preparedness Plan (NIPPP) which serves as a time bound guide for preparedness and response plan for influenza pandemic. It provides a policy and strategic framework for a multisectoral response and contains specific advice and actions to be undertaken by the Ministry of Health at the different levels, other governmental departments and agencies and non governmental organizations to ensure that resources are mobilized and used most efficiently before, during and after a pandemic episode.
According to the Malaysian Ministry of Health, headed by Liow Tiong Lai, health screenings were carried out on passengers traveling to and from Mexico via sea, air and land beginning April 17, 2009. The Health Ministry's disease control division has activated its operations room to monitor the swine flu situation and informed medical practitioners who are treating cases with symptoms of influenza-like illness or severe pneumonia and persons who had visited Mexico, California or Texas to inform the district health office immediately for preventive and control measures. As has several Asian countries, thermal scanners had been installed at entry points at the Kuala Lumpur International Airport (KLIA) following the start of the global alert on the flu. Screenings were imposed in Pengkalan Hulu, at the border with Thailand, in late April. Quarantine rooms had been allocated in 28 hospitals, and the country has stockpiled more than 2 million doses of Tamiflu, as of May 2009.
The Malaysian Health Ministry has warned Malaysians not to withhold health information to the authorities saying that those doing so could be fined RM10,000 or jailed two years or both if they are found guilty under the Disease Prevention Act 1988. On June 18, 2009 Malaysian Deputy Prime Minister Tan Sri Muhyiddin Yassin declared that all visitors and Malaysians returning from abroad will be required to fill the health declaration form following the influenza A (H1N1) pandemic around the world.
On August 17, The Government said that will consider declaring a health curfew if the mortality rate of Influenza A(H1N1) is above 0.4% from the current 0.1%-0.3%. Health Minister Datuk Seri Liow Tiong Lai said that they'are currently treating the flu as a "health emergency".
Health Minister Datuk Seri Liow Tiong Lai urged the public to wear a mask if showing symptoms of the flu.
In response to the country's first case of A (H1N1), the health ministry urged calm among the populace "as the situation is under control" and "the ministry has taken all the possible precautionary measures to control and contain the disease after the WHO issued a level-five alert." In addition, schools were issued strict hygiene procedures on May 16 to contain any H1N1 outbreak among students and teachers.
The country had reported no suspected cases before May 4, 2009, but all cases tested negative between May 4 and May 15.
On May 15, the Health Ministry confirmed Malaysia's first case of A (H1N1) infection of a 21 year-old male student who had arrived at the KLIA on May 13 via a Malaysia Airlines flight (MH091) from Newark and on transit at Stockholm-Arlanda Airport, followed by a second case on May 16 of a female student in Johor who shared the same flight as the first patient and boarded an AirAsia flight (AK5358) from KLIA to Penang International Airport. This makes Malaysia the 36th country to detect A (H1N1) within its borders.
The first patient has been warded at the Sungai Buloh Hospital, while house quarantines were undertaken on two of the second patient's friends who boarded the same flight, along with their family members. All passengers of the flights were also asked to contact the Health Ministry or head to any hospital, clinic or health office or further action, and crew members of MH091 and AK5358 were located and grounded. As the first patient has indicated, the use of thermal scanners is revealed not to be entirely effective as symptoms of his flu had yet to manifest; the Health Ministry resumes the use of the scanners nevertheless.
On June 4, three additional inbound airline passengers were reported to be carrying the virus. The earliest of the three is a 23-year-old male student who returned from United States on June 1 via the same Malaysian Airlines flight (MH091) that the first cases of A (H1N1) were detected. On the same day, two German tourists and friends (aged 30 and 32) who were holidaying in Southeast Asia and arrived in Malaysia were confirmed to be infected with the virus; both had flown into the country on June 3 via an Air Asia flight (AK702) after transferring from a Singapore Airlines flight (SQ45) from Germany to Singapore on June 1. The third reported victim developed symptoms on June 3 and was warded in Tunku Jaafar Hospital, while the two tourists developed symptoms while in Kuala Lumpur on June 3 and were given similar medical treatment. All three victims were reported to be stable. As is has been for the last two cases, passengers sharing both the Malaysian Airlines and Air Asia flights are being traced. On June 5, sixth case were reported from a student who took the same flight with the fourth patient. On the next day, a girl from Australia was confirmed to be infected with Influenza A (H1N1) when the airport scanner detected severe fever making her the 7th confirmed case overall in Malaysia.
On June 10, two new Influenza A(H1N1) cases had been detected in Malaysia. The eighth case involved a 17-year-old American student who accompanied her parents for a holiday in the country. The ninth case was a New Zealand national who arrived in the country at 7.30am on June 5 on an Air Asia flight DX7 2723. Malaysia recently registered two more cases of the disease, bringing the total to 11 cases. The 10th patient in the country was a 17-year-old girl who had just returned from a holiday in Melbourne, Australia on June 9. The 11th patient was a 41-year-old woman who had returned from Manila to Penang on June 6.
A 12th case was reported on June 13, 2009 whereby a 19-year-old medical student was returning to Malaysia after a 17-day holiday in Melbourne.
As of June 15, 2009, the total number of cases have increase to 17, with an addition of 5 new cases. The 13th case was a 12-year-old student who returned from a holiday in Manila. The 14th case was a British tourist, hospitalized in Kuantan after showing symptoms in Pulau Tioman. The 15th and 17th cases involved Malaysians who recently came back from Melbourne, both being currently warded in Sungai Buloh Hospital. The 16th case involved an American resident, currently warded in Queen Elizabeth Hospital in Kota Kinabalu, Sabah. A Filipino man was confirmed as the 18th victim of influenza A (H1N1) in Malaysia, after being detected as having a fever and cough during the screening process when he arrived at the KL International Airport from Manila.
A 20th case was reported whereby a 23-year-old local public university male student who made a seven-day study visit together with 12 students and lecturers to Melbourne, returned from Melbourne aboard Air Asia X D7 2723 and landed at the Low Cost Carrier Terminal on June 17. The 21st case came about with a 20-year-old medical student of a Melbourne university who returned to holiday in Malaysia aboard MH 128 and arrived at the KLIA on June 16. The 22nd case showed that a 54-year-old man who had travelled to Manila on business on June 9 and arrived at KLIA on June 12. It was reported that the 23rd case was a 22-year-old female Malaysian student who arrived from Melbourne by Air Asia at the LCCT on June 14.
On 19 June 2009 Director-General of Health Tan Sri Dr Mohd Ismail Merican said that eight new Influenza A(H1N1) cases were detected bringing the total number of cases of the disease in Malaysia to 35. The 35th case is a 20-year-old male Malaysian student who is studying in a university in Melbourne and has been there since January who came back to Malaysia for a holiday.
On June 20, 2009 7 new cases of A(H1N1) were reported bringing the total number of confirmed cases so far to 42. One of the new cases included a local transmission of the virus whereby a 11-year-old student of Sekolah Jenis Kebangsaan Cina (SJKC) Davidson, Kuala Lumpur, contracted the virus from her grandmother who was 31st case confirmed.
On June 21, 2009, eight more cases confirmed. Three of them were students from SJK(C) Jalan Davidson who contracted the virus from the 31st patient, which brought the total of confirmed cases in the country soaring to 50. SJK(C) Jalan Davidson had also been closed and more than one thousand people in the school had been quarantined.
On June 22, 2009 it was reported that there were 8 new cases of A(H1N1) in Malaysia bringing the total number of confirmed cases to 58 overall. The 51st case is a three-year-old girl who returned from a week-long holiday in Melbourne on June 19 with her parents on MH 148. The 52nd case is a 35-year-old MAS air steward who was on duty on MH1 Delta from London and arrived in KLIA on June 18. The 53rd case is a 27-year-old woman who returned from a holiday in Sydney with her husband on June 16 on MH 122. She is in Kuala Lumpur Hospital. The 54th case is a 25-year-old woman who had contact with the 48th case and was confirmed with the flu June 21 in Hospital Sultanah Bahiyah, Alor Star. She is the 5th local transmission.
On July 9, 61 new cases of Influenza A(H1N1) were confirmed, consisting of 37 imported cases and 24 locally transmitted which makes the number of cases in Malaysia soared to 574. Among the 574 cases, 415 cases were reported to have been imported while 159 cases were locally transmitted. One of the visitors who visited a company in Cyberjaya were confirmed to have contracted the virus, which caused 12 workers to be put under home quarantine.
On July 23, 18 new cases were confirmed in Malaysia consisting 17 local transmission and 1 imported case.
According to the Health Ministry another 39 cases of A(H1N1) were reported on August 2.
16 new cases of H1N1 were discovered on August 5, 2009 bringing the total number of cases to 1,492.
33 new cases were reported on August 6, 2009, bringing the total cases in Malaysia to 1525. It was reported on the same day that an immigration detainee from Togo was found dead at the Sepang detention centre. According to the guard, the prisoner did not complain of fever or cough. Autopsy were conducted on August 4, 2009 in Selayang Hospital and discovered that the patient was suffering from Influenza A(H1N1). However, they were still unable to determine if the flu was the direct cause of the patient's fatality.
On August 8, 2009, 53 more cases were confirmed and brought the number of cases in Malaysia to 1578. Among the 1578 cases, 574(36%) were imported cases and 1004(64%) were local transmission.
A record of more than 200 cases were confirmed on August 9, 2009. 202 new local transmitted cases were confirmed which brought the number of flu cases soared to 1780. 13 patients were still in ICU, and four of them were still in critical condition. 270 new local cases were confirmed on August 11, 2009, bringing the total cases in Malaysia to 2,253.
On July 23, 2009 first A(H1N1) related death was confirmed. The patient is a 30-year-old Indonesian man who suffered from multiple medical condition, including obesity and enlarged heart. However, Health Minister Datuk Liow Tiong Lai revealed that the flu was not the direct cause of the patient's fatality.
On August 6, 2009, in Putrajaya another death was confirmed involving a 57-year-old pensioner who was a diabetic and suffered from hypertension. On August 7, 2009, a 40-year-old obese man who was admitted to Kuala Lumpur Hospital died of acute coronary syndrome and cardiogenic shock. The man was suffering from fever and had been coughing since July 28, 2009. Autopsy result came back and confirmed the man as the nation's fifteen death due to Influenza A(H1N1).
On August 8, 2009, three more deaths were recorded, which brought the death cases in Malaysia to 18. The sixteenth death was a 5-year-old boy who had upper respiratory tract infection and sought treatment in a private clinic on August 3. He was then had a seizure and was sent to Tengku Ampuan Afzan Hospital and confirmed to have the H1N1 virus. He died on August 7, 2009 due to acute encephalitis secondary to Influenza A(H1N1). The seventeenth death was a one-year-old toddler who had history of hyperthyroidism and was under treatment for it. He had symptoms of the flu but did not seek for treatment. He was then sent to Sultanah Amanah Hospital, Johor Bahru. He was confirmed to have the flu on August 4, 2009. However, after five days of treatment, his condition deteriorate with symptoms of drowsiness, lethargy and altered consciousness and was sent to ICU. On August 7, 2009, he died due to pneumonia with underlying H1N1 infection. The eighteenth death was a 63-year-old man who was suffering from asthma and tuberculosis. He was admitted to Selayang Hospital and died on August 6 due to severe pneumonia with positive Influenza A(H1N1) and underlying pulmonary tuberculosis.
Eight more deaths were confirmed on August 9, 2009. Among the eight patient who died, three died on August 3, two on August 5, four on August 7 and one on August 8. All of them were in the high-risk group except a 20-year-old college student who was found dead at her hostel about a week after obtaining outpatient treatment. Among the dead were two Sabahans, one of them was a 24-year-old obese woman from Ranau who died of pulmonary oedema after a bout of flu while the other one was a 74-year-old man who had a history of heart problem who died of pneumonia and pulmonary oedema. The other deaths were a 47-year-old patient with asthma in Sarawak and a 37-year-old obese man who died of broncho-pneumonia at the hospital in Johor Bahru.
Six more deaths were confirmed on August 10, 2009, bringing the total death cases in Malaysia skyrocketed to 32. Of the six cases, four of them had underlying medical cases. Another six deaths were recorded on August 11, 2009. Among the six death cases, four of them had been diagnosed with asthma, hypertension and diabetes.
As at August 12, 2009 the total of deaths reported raised to 44 with six more cases confirmed. A 60-year-old man who had histories of diabetes, hypertension and heart problems was warded on August 6 after showing symptoms of the flu. Throat swab and antiviral drugs were prescribed. However, he died on the next day due to severe pneumonia. Lab result confirmed the man as an Influenza A(H1N1) patient on August 9. A 62-year-old man who was a diabetic was hospitalized on August 6. He was then later dehydrated and given antiviral drug for precaution against the flu. Throat swab was taken on August 7. However, he died on the same day due to pneumonia and possible cancer. A 20-year-old whom didn't have any history of underlying medical condition suffered from fever, coughing and sore throat. He sought for treatment at a hospital on August 6 and was later hospitalized due to suffocation. Antiviral drugs were later prescribed by the doctor. On the next day, he died due to severe pneumonia and septicemia. A 10-year-old baby was among the death cases confirmed on August 12. She showed symptoms but was warded six days later due to suffocation. Antiviral drugs were not given. On the next day, she died due to bronchopneumonia. A 18-year-old woman who was 26 weeks pregnant, and was also obese, showed symptoms on August 3. Her condition deteriorate and was then later sent to ICU. Throat swab was done. She died due to severe pneumonia. A 1-year-old toddler who had congenital heart disease had a seizure and fever on August 7. Antiviral drugs were not given to the toddler and he died on August 9, 2009 while undergoing a surgery.
Seven more deaths were confirmed on August 13, 2009, bringing the total number of death cases in Malaysia rose to 51. All of the seven fatalities were in high-risk group. A 4-month-old baby who had an extremely low immunity was hospitalized on August 8, 2009 after he showed symptoms of fever, breathing difficulty, vomiting, coughing and diarrhea. Throat swab was conducted, but he died on August 10 due to severe pneumonia. Lab result confirmed he had Influenza A(H1N1) on the next day, making him one of the victims of the flu. A 37-year-old diabetic woman was hospitalized after showing symptoms. She was later given antiviral drugs but died on August 10. A 69-year-old woman who had history of hypertension was found to have been coughing. Throat swab was conducted after she was transferred to ICU due to suffocation. On August 11, 2009, she died due to acute myocarditis. A woman in her 20s, who also had a history of congenital disease, started to have fever and coughing on August 6. She was later admitted and given antiviral drugs on August 8. However, she died on August 10 due to severe bronchopneumonia. A 4-year-old boy who had congenital disease was treated on August 2 after exhibiting symptoms of the flu. He was later confirmed to have the flu after throat swab was taken, however, he died before the confirmation. A 92-year-old lady who had asthma and a 43-year-old man who had diabetes, hypertension and heart diseases died on August 11, 2009 due to severe pneumonia.
Five more cases were confirmed on August 14. A two-month-old baby who was born prematurely was admitted to the hospital after suffering from fever, coughing, sneezing and difficulty in breathing. His condition deteriorate and was later put on mechanical ventilation. Antiviral drugs were given but he died on August 12 due to pneumonia. Another two-month-old baby was rushed to the hospital when he was found unconscious. His condition was critical and was sent to ICU. He tested positive for the flu on August 8, bue died on August 10 due to myocarditis, hepatitis and renal impairment due to H1N1. A 49-year-old diabetic woman, who was also obese and having tuberculosis was confirmed to have the virus on August 11. A 57-year-old diabetic man sought for treatment on August 2 after showing symptoms of the flu. On August 3, he returned to the clinic after experiencing fever, vomiting and diarrhoea. He was then sent to hospital and given antiviral drugs. Despite given antiviral drugs, he died on August 12 due to sepsis. A 19-year-old teenager was admitted to the hospital after complaining having fever and coughing. He was then suffocated and died on August 11 due to pneumonia.
3 more deaths were confirmed on August 15. A 22-year-old obese man was hospitalized on August 9 but died on August 12 due to viral pneumonia. A 29-year-old man who had valvular heart disease was admitted to the hospital after flu symptoms persisted for 2 days. Antiviral drugs were given on August 10 but he died 2 days later due to bronchopneumonia. A 44-year-old woman who had asthma was tested positive for the flu on August 10 but died on August 13 due to pneumonia.
Another three deaths were confirmed on August 16, total death cases tally now stands at 62. The 59th death is a 6-year-old kid with Down's syndrome. He had the flu for 3 days and confirmed as a H1N1 patient. He died on August 13 due to pneumonia with underlying Down's syndrome with AVSD and pulmonary hypertension. A 3-year-old child was hospitalized on August 1 after having symptoms for 5 days. Confirmed to have contracted the virus on August 3 and antiviral drugs were given on the same day. However, he died on August 14 due to severe pneumonia. A man in his 50s who had symptoms on July 28 was hospitalized. He was also suffering from vomiting and diarrhoea two days before he was admitted. On August 13, he was confirmed dead due to septicemia with severe pneumonia.
On August 17, it was announced that 2 more deaths were confirmed. A 7-month-old boy who had asthma was transferred to ICU after having fever and coughing for 2 days. Antiviral drugs were given and was confirmed to have the virus on August 12. However, he was confirmed dead three days later due to severe pneumonia and acute respiratory failure. A 74-year-old diabetic woman, who also had CCF was admitted to the hospital after she was found unconscious in her house. She died on August 11 due to severe pneumonia. Her test results came back on August 12 and confirmed her as a H1N1 patient.
On August 18, three more death cases were confirmed and brought the number of death cases in Malaysia to 67. A 33-year-old woman was transferred to ICU after her lungs disease began to deteriorate after 4 days of treatment in a private hospital. She showed symptoms on July 31 and antiviral drugs were started on August 7. On August 12, she died due to bronchopneumonia. Her result later came back and was positive for the flu. A 10-year-old school girl, who was diagnosed with Systemic lupus erythematosus was sent to ICU after she had breathing difficulty, chest pain and stomach ache. Antiviral drugs were given since July 8. Despite on medicine, she died on August 13 due to Systemic lupus erythematous with severe pneumonia with renal impairment. A 71-year-old woman with Chronic obstructive pulmonary disease, hypertension, Ischaemic heart disease and Diabetes mellitus type 2, showed symptoms of the flu and was hospitalized on August 12. However, on August 14, she died due to Ischaemic dilated cardiomyopathy precipitated by pneumonia.
On August 20, 2009 one new death was confirmed. The victim was a 34-year-old woman who was in the 34th week of pregnancy. The patient was treated and admitted into a private hospital in Johor Baru on Aug 8 after developing fever and cough for a day. She was subsequently, referred and admitted to the intensive care unit of the Sultanah Aminah Hospital in Johor Baru for breathing difficulties five days later. Tamiflu was administered. However, she died on next day due to severe pneumonia and respiratory failure.
Another death was confirmed on August 24, 2009. Death toll now increased to 69. The patient, a 38-year-old teacher, who was also obese, tested positive for H1N1 by a private clinic. Tamiflu was not administered but only gave her symptomatic treatment. Five days later, on August 18, she was admitted to the hospital after suffering from breathing difficulties and cyanosis. She was referred to KL Hospital and Tamiflu was administered. However, the woman died on August 19 due to pneumonia with AVDS. One more death was confirmed on August 25, 2009. Confirmed by the Mortality Review Committee, the 3-year-old boy who had febrile convulsion and cough was hospitalized on August 12. The boy was then transferred to ICU after his condition deteriorate and tamiflu was administered. He tested positive for the flu on August 17. However, he died on the next day due to H1N1 encephalitis with Cerebral oedema and multiorgan failure.
The death of a 24-year-old woman brought the number of cases in Malaysia to 71. The patient, having fever, cough and headache was admitted to a private hospital in Kuantan on August 10 and received viral pneumonitis treatment. She was then referred to a government hospital after her condition worsened and placed in ICU. Her condition still deteriorate, albeit Tamiflu was administered. On August 19, she was confirmed dead due to H1N1 secondary to ARDS.
One more death was confirmed on August 30. The 49-year-old patient with heart problems was brought to Melaka Hospital after suffering from fever, cough and vomiting which persisted for 2 days. He was given antiviral drugs and antibiotics and he was also tested for tuberculosis, typhoid, dengue, Leptospirosis and H1N1 but all of the tests came back negative. The patient's condition deteriorate and was confirmed dead on August 19 due to severe pneumonia with septic shock and H1N1. The post-mortem biopsy report based on lung samples tested positive for Influenza A(H1N1) on Aug 24.
On September 3, 2009 the death of a 25-year-old woman was confirmed bringing the total number of deaths related to A(H1N1) to 73. The woman received outpatient treatment after developing flu symptoms. She was then subsequently brought to Sibu Hospital and administered antiviral drugs. However, she died on September 1 due to severe pneumonia with H1N1 infection.
It was announced that on September 11, the death of the 19-year-old man brought the total number of death cases to 74. The patient was brought to Gerik Hospital after flu symptoms persisted for 4 days. On August 20, he was transferred to Ipoh Hospital where he was administered Tamiflu. Despite given antiviral drugs, he died on August 23 due to Acute Pulmonary Oedema with Underlying Influenza A(H1N1) infection.
Another two death cases were confirmed on September 15, bringing the total number of cases to 76 in total. The first death, a 45-year-old woman who had hypertension was referred to Tambunan Hospital on August 17 after flu symptoms persisted. She was then sent to Keningau Hospital and antiviral was administered. After 10 days in ICU, she died due to severe bronchopneumonia and Acute respiratory distress syndrome. The second death registered was a 19-year-old teenage girl. She was sent to Kuala Lumpur Hospital and antiviral was administered. Despite given antiviral drugs, she died on 31 August due to severe pneumonia with H1N1 infection.
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The flu virus is officially designated by the WHO as "Influenza A (H1N1)", following a name change from "swine flu" to avoid suggestions that eating pork products carried a risk of infection, and is referred as such by Malaysia's Health Minister. However, Information Communication and Culture Minister Rais Yatim suggested on June 25 that the local media use "swine flu" (Malay: selsema babi) instead, justifying that the dangers of the flu would be better understood by the public, and that the flu would be easily described in Malay, a language which is officially used in news programmers of government-owned television and radio channels.
Ministry of Health, Malaysia