2009 swine flu pandemic in Malaysia

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Outbreak evolution in Malaysia

  Deaths

  Confirmed cases

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 updating the total number of H1N1 cases within Malaysia in line with guidelines issued by the World Health Organisation. The first death related to the A(H1N1) virus was reported on 23 July, 2009 and so far there have been 59 deaths reported. On July 6, 2009 Malaysia announced that it was shifting from containment to mitigation to tackle the spread of the virus.

Government measures

The Malaysian government has started to stockpiled more than 2 million doses of Tamiflu, influenza antiviral drug in case of an outbreak of the virus

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 government has also responded to the increase in the H1N1 infection, by doubling the antiviral drug Tamiflu stockpile from 10 per cent of the Malaysian population to 20 per cent.

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 June 25, 2009 the Health Ministry announced that all leave of 100,000 staff nationwide until further notice to contain the Influenza A(H1N1) outbreak. This applied to all officers in government hospitals, public health departments and laboratories. The World Health Organisation wants Malaysia to move from containment mode to mitigation mode in its battle against influenza A (H1N1). But the Malaysian Health Ministry says it is not necessary as yet. Once a country goes into mitigation mode, the focus will be on lessening the severity of casualties. The Health Ministry has said that it is just matter of time before they decide to raise its level of seriousness in dealing with Influenza A H1N1 from the containment to the mitigation stage as more cases of local transmission are being reported.

Quarantine measures

Health Ministry director-general Tan Sri Dr Ismail Merican has advised students returning for holidays from the United States, United Kingdom, Australia and the Philippines must quarantine themselves at home for seven days. The Health Ministry has said most imported cases of the Influenza A (H1N1) reported in the country involved people who returned from these countries. School authorities have been told to monitor students and staff members for symptoms of influenza A(H1N1) such as fever and flu to avoid locally transmitted cases. The Education Ministry said that such cases must be sent to the nearest hospital for quarantine of both the victim and family if there were any such signs.

On June 25, 2009 the Health Ministry issued a statement to all employers to allow seven days’ unrecorded leave for staff placed under quarantine for A(H1N1) or going into self-quarantine after visiting Australia, Mexico, the Philippines or the United States. Minister Liow Tiong Lai said the ministry had prepared documents for those placed under home quarantine or volunteering for self-quarantine so employers could identify genuine cases.

Mitigation of the Virus

The Health Ministry has introduced the containment stage since the outbreak of the disease, while the mitigation phase involved three measures. Health Minister Liow Tiong Lai explained that the main measure of mitigation phase involved the people in prevention and control of the disease, including social distancing, reduced public interaction and practiced self-hygiene. The second measure was for mild cases of cough and fever, the patients would undergo home quarantine. The third measure involved the hospitalization for the high risk groups with the virus, who were, at the same time, diagnosed with asthma, chronic respiratory illness, diabetes, organ failure, obesity and pregnant women. These high-risk groups, including children and pregnant women, will be given anti-viral treatment if they go to hospitals with influenza-like symptoms even if they are waiting to be tested or waiting for their results to return.

A(H1N1) Testing

On July 1, 2009 Health Minister Datuk Seri Liow Tiong Lai announced that five private hospitals in the Klang Valley as well as 29 government health clinics were now equipped with facilities to conduct throat swab sample tests to check for H1N1. The five private hospitals are Sunway Medical Centre, Pantai Hospital, KL, Sime Darby Medical Centre, Prince Court Medical Centre and Gleneagles Intan Medical Centre. He mentioned that rapid test kits were inaccurate in their A(H1N1) testing as they were meant to test for other types of flu. It is understood that the rapid test kits are widely available at private clinics, which hope to cash in on the H1N1 scare.

Mask use

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The Malaysian authorities have advised the public to wear face masks like the N95 in public areas such as airports, train stations, bus stations and general public areas.

Health Minister Datuk Seri Liow Tiong Lai urged the public to wear a mask if showing symptoms of the flu. State Tourism, Domestic Trade and Consumer Affairs Committee chairman Hoo Seong Chang urged frontliners in the tourism sector to increase their precautionary measures such as wearing mask when dealing with clients. These professions include taxi drivers, tourist guides and those working in the hotels that usually deal with foreigners.

Medical Leave

The Malaysian cabinet decided on June 26, 2009 that any employee on self-quarantine on suspicion of having the Influenza A(H1N1) will be given a seven day medical leave with full pay. These employees will have to get an authorisation letter from any government hospitals or clinics to certify that they had to be home quarantined for a week. Malaysian Employers Federation previously had announced that employees were worried that their annual leave or salary will be affected if they are quarantined, and said that paid leave would should only be given to people who are quarantined after returning on work-related trips from an affected countries.

School closures

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.

SJK (C) Jalan Davidson in Kuala Lumpur, where one of the students had infected two classmates with the virus, has been ordered to be shut down for a week and all the teachers, students and their parents have been ordered to be quarantined at home. SRK Assunta 2 in Petaling Jaya became the second school to be closed for a week from following a locally transmitted case of Influenza A (H1N1) being detected in the school. In was reported on June 22, 2009 that Seri Cempaka International School in Batu 9 Cheras, SMK Seksyen 9 Shah Alam and SMK Damansara Utama in Petaling Jaya and SM Wangsa Maju was also asked to stop classes for a week.

The Chempaka International School was ordered closed on June 23 after two pupils tested positive for A(H1N1) influenza. Sekolah Rendah Kebangsaan Assunta 1 in Petaling Jaya became the fourth school to be closed in a week.

Sekolah Menengah Kebangsaan Abdul Rahim 2, Kudat in Sabah were ordered by the Health Ministry to close temporarily two classes after infection was detected on a 24-year-old teacher who went on a 17-day vacation in Istanbul. On June 28, Sekolah Tinggi Chung Hwa in Negeri Sembilan was ordered by the Health Ministry to be closed for one week after a female student was confirmed positive with A(H1N1) virus. Sekolah Menengah Tsun Jin, Kuala Lumpur became the next school to be closed until Friday July 3 by the Health Ministry.

The Health Ministry has also ordered closures of class 6A in SK Setapak Indah and eight Aqua Sri Cempaka International classes, in Kuala Lumpur, until July 9 after one student was infected each. It was announced on July 10 that the Alice Smith International School in Seri Kembangan, closed after two of its students contracted the virus following a school trip to New York. Also the kindergarten Tadika Gospel Chapel Kerokop in Miri, Sarawak has closed due a student being infected by the virus.

It was announced on July 12, 2009 that Sekolah Kebangsaan Sulaiman 1 was the first school in Kuala Terengganu to be closed after two of its students tested positive for the A (H1N1) virus.

College and University Closures

Universiti Teknologi Mara has imposed a temporary prohibition on travel abroad by its staff and students in view of the influenza A(H1N1) pandemic.

The Ministry of Health has ordered the Universiti Teknologi Mara campus in Lendu, Alor Gajah to temporarily stop classes after several more students contracted Influenza A(H1N1). On July 22, two more Universiti Teknologi Mara campuses in Permatang Pauh and Seri Iskandar were ordered to be close for a week after students there tested positive for the influenza A(H1N1) virus.

In Malacca, three colleges were ordered to be closed for a week from July 24. They are Maktab Perguruan Perempuan Melayu in Durian Daun, Kolej Professional Mara in Jalan Hang Tuah and Kolej Yayasan Melaka in Bukit Sebukor.

It was announced on July 29, that Universiti Pendidikan Sultan Idris in Tanjung Malim in Perak had been closed for seven days after an unconfirmed number of students showed flu-like symptoms.

National Service Camps

It was announced on July 30, that 11 National Service camps in the peninsula Malaysia were ordered to close for a week as some trainees had shown signs of A(H1N1) virus. The camps involved were in Mersing, Johor; Tangkas Kendiri, Kuala Kangsar, Perak; Sri Impian, Penang; Merang Suria, Terengganu; Lagenda Gunung Ledang, Asahan, Melaka.

A (H1N1) cases

The country had reported no suspected cases before May 4, 2009, but all cases tested negative between May 4 and May 15.

May 15 — June 10

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 Penang 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 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.

June 10 — June 20

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.

Malaysia recorded its first local infection of influenza A(H1N1) on June 17, 2009 involving the 19th case as that person had no history of having traveled to a country that had the flu.

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 18 June, 2009 the Crisis Preparedness and Response Centre in Malaysia reported there were four imported cases of Influenza A(H1N1), bringing to total of 27 cases overall.

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.

June 20 - June 30

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.

The 55th case is an 18-year-old woman who was also infected by the 48th cases and is hospitalised in Alor Star. She is the 6th local transmission. The 56th case is a businessman who had returned from Manila on MH 705 on June 15 and is now warded in Hospital Sungai Buloh. The 57th case is a Malaysian man who had holidayed in Phuket and returned on June 21 in AirAsia AK837. The 58th case is an 11-year-old female student who had contact with the 43rd case.

The 59th case was a Malaysian girl who had returned to the country from San Francisco, arriving at the KL International Airport on June 19 and was admitted to Sungai Buloh Hospital are developing fever, sore throat and cough. The 60th and 61st cases involved Malaysians, one of them a 14-year-old female student who had returned to Malaysia from Melbourne on June 18, developed the symptoms on June 20 and received treatment at the Sime Darby Medical Centre in Subang Jaya and the other a 23-year-old man who had returned to Malaysia on June 19 and travelled to Kuching the same day, developed symptoms of the disease the following day and was admitting to the Sarawak General Hospital on June 21.

The 63rd case involved a 24-year-old Yemeni national, who arrived in Malaysia from Bangkok on June 19 and developed fever and cough the following day and was receiving treatment at the Damansara Specialist Hospital on June 21 and was admitted to the Sungai Buloh Hospital the following day. The 64th case was a 54-year-old Swiss national who had arrived in Malaysia with his wife on June 21 and developed fever and cough on June 18 and was admitted to the Tuanku Jaafar Hospital in Seremban.

The 65th case was a 19-year-old Italian national who had completed a three-month study in Melbourne and arrived in Malaysia on June 21. The 66th case was a 11-year-old Malaysian male pupil who had contracted the disease from the 36th case, a pupil of the SRJK (C) Jalan Davidson, Kuala Lumpur, on June 20 and was admitted to the Sungai Buloh Hospital yesterday. The 67th and 68th cases were a five-year-old girl who lived in Manila and who had returned to Malaysia and a 42-year-old man who had gone to Manila, he said.

On June 24, twelve more cases of the influenza A(H1N1)were reported, bringing the total number of cases in the country to 80. The Health Ministry has instructed 11 more government hospitals to take throat swab of patients suspected to be infected with the virus. Three of the cases identified involved two from Yemen and one from Indonesia while the rest were Malaysians who had visited Singapore, the United Kingdom, Thailand, Philippines, Australia and the United States.

On June 25, it was reported by the Malaysian Health Ministry that there were eleven Influenza A(H1N1) cases of which there were eight imported cases and three local transmissions. Of the eight imported cases, five were Malaysians while the rest were Irish, Australian and Philippine citizens. Of the three local transmission, two were Malaysians and the other a Yemeni national.

Malaysia's Health Ministry confirmed 14 more A(H1N1) flu cases on June 26, bringing the country's total number of cases to 105. Of the 14 new cases reported, 13 were imported cases and one was a local transmission.

On June 27, 2009 the Health Ministry announced another 7 cases of A(H1N1) cases raising the total number of confirmed cases to 112. Six of the cases were imported, with the remaining case a local transmission. Twelve newly confirmed cases of influenza A(H1N1), including 11 imported cases, were reported on June 28, bringing the total to 124 cases. A 15-month-old boy, who is the son of an influenza A (H1N1) patient, was the only local infection and his condition was stable after being given an antiviral medication.

Another 20 Influenza A (H1N1) cases were reported in Malaysia on June 29, 2009 of which 16 are imported cases while four are local transmitted. The 20 new cases involved 13 Malaysians and seven foreigners - one Vietnamese, one German, one Australian, one Japanese, one American and two Indonesians.

On June 30, 2009 Director-General of Health Tan Sri Dr Mohd Ismail Merican reported 14 new cases of influenza A(H1N1) of which 11 were imported cases while the remaining three were locally infected, raising the total number of cases so far to 158. Out of the 14 new cases, 11 were Malaysians while the other three were an Australian, a New Zealander and an Indonesian.

July 1 - July 10

On July 1, 2009 the Malaysian Health Ministry confirmed 38 new A/H1N1 cases, raising the total number of the cases in the country to 196. Of the new cases 33 were imported, while 5 were locally transmitted. The imported cases involved those who had visited Australia, Indonesia, Britain, Singapore, Thailand, the United States, the Philippines, Argentina and Cambodia.

On July 2, 2009 the Health Ministry said confirmed a record new 48 cases of A(H1N1, of which 40 of the newly confirmed cases were imported while the remaining eight locally transmitted. The latest victims consisted of 36 Malaysians, 4 Indonesians, 2 Singaporeans, 2 Filipinos, 2 Australians, 1 Chinese and 1 Italian. Another 47 new cases of influenza A(H1N1) cases recorded on July 3, including 41 imported and six local transmissions. This has brought the total number of confirmed cases to 291.

The total number of flu A/H1N1cases in Malaysia rose to 326 on July 4 as the authorities reported 35 new confirmed cases on the day. 11 of the 35 new cases were local transmitted cases, the highest number of such cases reported in a single day in the Malaysia.

On July 5, Malaysian Health Ministry recorded 12 locally-transmitted Influenza A (H1N1) cases among 33 new cases, bringing the total number of infected people to 359. On July 6, 2009 Health Minister Datuk Seri Liow Tiong Lai announced 75 new cases of H1N1, with 41 imported cases and 34 local transmission, bringing the total number of cases so far to 431.

A further 34 new cases of Influenza A(H1N1) recorded on July 7, consisting of 22 imported cases while 12 others were locally transmitted. The new cases involved 24 Malaysians and five Indonesians, three Australians, one American and one Danish. 45 new cases of influenza A(H1N1), 22 local transmissions and the rest imported, were detected on July 8 bringing to the total number of cases confirmed since the outbreak in May to 513. Of the latest cases, 38 are Malaysians, four Indonesians, one New Zealander, one Yemenese and one Indian.

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.

Another 53 new cases of A(H1N1) were detected on July 10, 2009 consisting of 41 imported and 12 local transmissions, including a student of SBP Integrasi Gopeng and two cases from a private company in Cyberjaya, bringing the country's total to 627.

July 11 - July 31

On 11 July another forty-four new influenza A(H1N1) cases were reported. Health Minister Datuk Seri Liow Tiong Lai said 29 of these cases were imported while 15 were local transmission cases. A further 39 new cases of A(H1N1) were reported on July 12, 2009 consisting of 22 imported cases and 17 local infections. This has raised the accumulated total of H1N1 cases in the country to 710 comprising 507 imported cases and 203 local infections.

Malaysia recorded 34 local transmissions of Influenza A(H1N1) in a single day exceeding the 28 imported cases detected on July 13, bringing the country's total to 772. Of the latest cases, 53 are Malaysians, four Indonesians and one each from Pakistan, South Africa, Oman, Saudi Arabia and Russia. On July 14, the number of total cases increased to 804 with 32 cases reported. Of the cases reported, 20 were imported and 12 locally transmitted.

The Malaysian Health Ministry on June 15 reported 21 new cases of A(H1N1) flu, bringing the total number of such cases to 825. Malaysian Health Ministry said that among the new cases, seven were imported and 14 were locally infected. 10 new cases of the Influenza A (H1N1) virus infection were detected on July 16 involving students of Universiti Teknologi Mara Melaka and one patient at the Sungai Buloh Hospital in Selangor.

On July 17, the Health Ministry reported 13 new cases of A(H1N1), of which 12 were local cases and 1 was imported. 23 new cases were reported on July 18, one of them an imported one while the rest were local infections, bringing the total to 871 cases. Three new Influenza A(H1N1) cases were reported over the past 24 hours on July 19, bringing the total number of cases to 874. Another 3 cases of A(H1N1) flu cases were reported on July 21, bringing the number of total cases in the country to 877.

The Malaysian Health Ministry reported 44 new A(H1N1) flu cases on July 22, bringing the number of total cases in the country to 921.

On July 23, 18 new cases were confirmed in Malaysia consisting 17 local transmission and 1 imported case.

A further 39 new cases of A(H1N1) flu were reported nationwide on July 24, all of which were local transmissions bringing the total number of cases to 978. The ministry on July 25 recorded 43 new infections nationwide, of which 36 were in six new clusters, four in Sarawak and two in Kedah. This has brought the total number of cases diagnosed to 1,021 nationwide.

There were 54 new influenza A (H1N1) cases reported on July 26, bringing the total number in the country to 1,075. Out of the 54 cases, 53 were local transmissions and 1 was a foreign transmission.

Another 49 new cases were reported on the 27th July, all involving locals bringing the total number of cases to 1,124. A further 95 new cases of Influenza A(H1N1) were detected on that 28 July, all of them being local cases among Malaysian citizens.

A further 47 new cases of A(H1N1) were reported nationwide on July 29 and all these cases were locally transmitted.

Another 36 new local transmissions of influenza A(H1N1) cases in the country were reported on July 30. 69 new locally-transmitted Influenza A(H1N1) cases were reported on July 31, bringing the total number of cases in the country to 1,371 with four deaths so far.

August 1 onwards

Nineteen new Influenza A(H1N1) cases were reported on August 1, bringing the total number of cases in the country to 1,390. According to the Health Ministry another 39 cases of A(H1N1) were reported on August 2.

On August 3, 18 new cases of A(H1N1) were detected bringing the total number of cases to date 1,447. 14 new cases were detected on August 4, 2009 bringing the total accumulated number of Influenza A (H1N1) in Malaysia to 1,460. 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 a 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. From 12 August onwards, the Health Ministry has announced that it would discontinue updating the total number of H1N1 cases in line with guidelines issued by the World health Organisation.

Deaths

Reported death as of 17 August 2009

July

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.

Malaysia recorded its second death related to influenza A(H1N1) when a 46-year-old man, who was confirmed positive with the virus, died in a private hospital here on July 27, 2009. A third death related to A(H1N1) was confirmed as 42-year-old Malaysian man who died of pneumonia and organ failure by the Ministry of Health on July 28, 2009.

It was reported on July 29 that a 20-year-old Malaysian woman died from A(H1N1), bringing the number of deaths since outbreak in Malaysia to four. The victim died at the Melaka Hospital due to severe community-acquired pneumonia, and samples taken from her throat showed that she had A(H1N1).

August

It was announced on August 2, that a post-mortem report of a 10-year-old who died in Perak showed that she was influenza A(H1N1) positive. The latest case brought the number of deaths due to influenza A (H1N1) to five. Malaysia also recorded its sixth death related to the Influenza A(H1N1) on the same day with when a 11-year-old boy who died from lung and heart inflammation in Johor Baru.

On August 3, the Health Ministry says a woman who gave birth two weeks ago has become the seventh person to die of swine flu-related causes in this country. On the same day it was announced that a lady teacher, from a Selangor school which closed on July 27 passed away, making her the eighth Influenza A(H1N1) death in the country.

On August 5, 2009, 4 more deaths were confirmed. The ninth case was a 3-year-old girl who had records of underlying medical condition. She was admitted to the hospital on 31 July 2009 when she started to show symptoms on June 25, 2009. The tenth death involved a 12-year-old boy with a kidney failure and was undergoing dialysis. The eleventh death involved a 20-year-old male who had asthma. The twelfth death involved a 6-year-old boy who was suffering from pneumonia. The thirteen death was a 6-year-old boy. All of the five victims that died on August 5 were suffering from chronic respiratory problems when they contracted the virus.

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 sixteen 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, lethagy and altered consiousness 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 a 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 a 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 diarrhea. 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 diarrhea 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.

Terminology

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. However according to the Director General of the Health Ministry they would continue sticking to the term influenza A(H1N1) based on three reasons, namely the virus that causes the spread of the disease is a mixture of human beings, avian and swine, as identified by the World Health Organisation. He said Malaysia must also comply with the directive of the WHO because if it were to use another term, it would mean that other countries too would use different terms that could lead to a chaotic situation and using the term 'swine flu' could lead to a misunderstanding as the people would have the wrong perception that only those who consumed pork would be infected by the virus.

See also

• 2009 flu pandemic by country
• 2009 flu pandemic timeline

External link

Ministry of Health, Malaysia

• Official A(H1N1) Portal Template:Ms icon