Wednesday, October 7, 2009

A(H1N1) Forum Report

The forum started with YB Sim explaining the objective to organize the Sembang Sembang Forum. The first forum on Influenza A (H1N1) was attended by about 25 people.

YB Sim Tze Tzin opening the first Sembang-sembang forum

The invited speakers were Dr Chan Chee Khoon (epidemiologist, Convener of the Health and Social Policy Research Cluster at the Women’s Research Centre, USM); Dr T Jayabalan (clinical physician and advisor to Occupational Health and Safety Association, Malaysia) and YB Dr Lee Boon Chye (MP Gopeng, Perak, Consultant Cardiologist, Ipoh Specialist Centre). Below are the synopses of the talks:

Dr Chan Chee Khoon – “Coping with Infectious Disease Outbreak”

Dr Chan talked on the Risk Perception of Influenza A (H1N1) and how the public responds to this perceived risk. He also touched on the Ministry of Health’s (MOH) handling of the Influenza A (H1N1) pertaining to information management and communication.
In any spread of infectious diseases it must first be analyzed to assess how quickly the disease will spread and how deadly the disease will be. In the case of Influenza A (H1N1) even though the spread is fast and extensive, it is however, not as fatal and deadly as Nipah Virus (initially mistaken as Japanese Encephalitis (JE) Virus) or the Severe Acute Respiratory Syndrome (SARS). SARS had a fatality rate of more than 8% while the fatality rate of the current Influenza A (H1N1) is less than 2%.
The MOH has in this instance made many public announcements which were at times confusing. This has caused much public anxiety which was reflected in the indiscriminate wearing of face masks. This sudden demand resulted in the shortage of face masks in the market. Whilst in the previous two outbreaks of Nipah Virus and JE the MOH was both slow to react and kept public communication to a minimum.
Dr Chan argues that Influenza A (H1N1) is a fast spreading A (H1N1) virus and its low fatality means many people would have contracted it and in the process have built up immunity and resistance to it.
Dr Chan stressed that when communicating about outbreaks of infectious diseases, the important considerations are:
a) How candid should we be?
b) Does one speculate based on incomplete information?
He reckons that the most appropriate way to communicate is to “Make it clear what you know and what you do not know”.

Dr T Jayabalan – “Practical Aspects of Prevention in A(H1N1) Pandemic” Dr Jayabalan’s talk focused on his practical experience of working with factories dealing with the current Influenza A (H1N1) outbreak. He highlighted that the MOH, while providing much information in public announcement, was however not effective in dealing with the outbreak during the virus isolation phase. This has resulted in many workplaces not getting cohesive information and they went on to deal with this outbreak on their own.
The MOH was also not fully engaging the community and private health organizations to work in unison in countering the outbreak. Many factories then resorted to their own initiatives to control the outbreak. For example many factories implemented temperature screening of their employees and visitors by security guards who were not trained. Screening equipments were often not calibrated and gave erroneous readings. Dr Jayabalan sited a case where a thermal sensor reads a low 34.6 deg C and the person was still allowed entry into the premises.
At one point the MOH announced self quarantine without considering its impact to the industry. Such policy if not carefully controlled can lead to abuse from both employees and employer. Dr Jayabalan cautioned the use of Tami flu for treating Influenza A(H1N1) without adhering to the proper guidelines. This will not only be ineffective but will instead make the Influenza A(H1N1) virus more resistant against the medication. He is of the opinion that the MOH must be better prepared in dealing with second wave of the Influenza A (H1N1) pandemic. This is especially true in the quarantine phase i.e. to isolate and quarantine the virus and not the sick person.

Dr Lee Boon Chye – “Public Health Policy for A(H1N1) Pandemic”

Dr Lee brought up the case of an MP suspected of contracting the Influenza A (H1N1) virus who went to a private hospital for treatment. He was then referred to the University Hospital for further tests and examination. There he waited for 5 hours in a room full of sneezers and coughers. The results from the University Hospital took 3~4 weeks to be delivered to the 1st doctor that diagnosed the MP. He lamented on the inefficiencies prevalent in our public health system.
At one point schools were asked to close for 7 days when there was a reported case of a student contracting Influenza A (H1N1). In another case the headmaster asked the teachers, parents and students to take part in sterilizing the school. Dr Lee feels that while it is a good initiative on the headmaster’s part, the exercise was probably not necessary as the virus would typically not survive beyond 48 hours in the open.
Dr Lee moved an emergency motion on 30 Jun 09 in Parliament to debate on the inadequate screening at entry points. Malaysia reported the first case of confirmed Influenza A (H1N1) case on 15 May 2009. Since then visitors screening were only done at major airports with almost no screening carried out at land entry points. Dr Lee also related his personal experience with screening at the Guangzhou International Airport. Far field infra-red scanners were used to scan groups of people before being allowed to clear immigration. A factory he visited took his body temperature first on the bus and again at the factory gate.
Dr Lee also highlighted that the MOH did not deal with the virus isolation phase effectively. Whilst publicizing the virtue of personal hygiene such as frequent washing of hands may be a good thing but he noted that many public places do not have facilities for washing. Up to 27 Sep 2009 the World Health Organization (WHO) reported 340,000 cases of Influenza A (H1N1) worldwide with 4100 deaths with a fatality rate of 1.21%. Malaysia’s fatality rate of 2 % is higher so far and Dr Lee said that it is important to improve public health care services and also the training of health care personnel to cope with future outbreaks.

Q & A session:

Swee Heong (right) moderating the Q&A session

On vaccination:
Dr Chan:
According to WHO, 30% of world population will get infected with Influenza A (H1N1 virus. The world production of vaccine against Influenza A (H1N1) virus is estimated to be only able of meeting less than 10% of this need. Most of the vaccine will go to the Western countries where people can afford to pay for vaccination. In any case most of the healthy persons would have contracted the Influenza A (H1N1) in the current outbreak and would have acquired natural immunity.

Dr Lee: On another unrelated case, the MOH recently announced spending RM150M to acquire anti-HPV (Human Papilloma Virus) vaccines to vaccinate all girls of 13 years of age in Malaysia. The vaccine is supposed to offer protection against cervical cancer. Medical practitioners calculated that this vaccination program will costs the country about RM126M. However, this vaccine has not been medically proven and is still being debated by many international medical practitioners.

Dr Jaya: Many countries that are more susceptible to the Influenza A (H1N1) outbreak do not have favorable conditions to carry out mass scale vaccination program. Until and unless the “Adverse Effect Reporting System” is established to monitor the effects of the vaccination it is not advisable to administer any vaccination.

On Influenza-Like-Illness (ILI) and test for ILI:
Dr Jayabalan:
Two methods are used today to test if one has ILI. The Rapid Test which involves a throat swap and the results can be available in 1 hour. However, this test can give false negative results. When you are tested negative to the Influenza A (H1N1) virus infection, you may have other ILI. The other test is the real time test which requires 2 days to generate results and is done at the IMR (Institute of Medical Research).

Dr Chan, Dr Jayabalan and Dr Lee: Influenza A (H1N1) is only fatal to patients in the high risk group’s e.g. pregnant ladies and patients with severe asthma. Also patients who are suffering from illnesses which weaken their immunity are high risks. With normal healthy persons the best way to deal with ILI is to take normal flu relieve medication, have a lot of rest to recover over a few days.

Report compiled by: Low Swee Heong.


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