Kuala Muda District Office - Day 11

On 1^st ofDecember 2011, Mr. David was in charged to introduce us on topics of Diseasesurveillance Systems, Investigation of Communicable Case, Notification Methodsof a Confirmed Communicable Disease, Computerized Systems and Strategies for EpidemicInvestigation. We were gathering in themain office meeting room at 9.00am.

The day was begun with thepresentation prepared by Mr. David.

He first showed us the tasksof Hospital Surveillance Officers, which are:

• Detect and predict Outbreak / Epidemic

• Monitoring disease trends

• Evaluating effectiveness of intervention and control

• Monitor programme performance

• Monitor progress towards a control objective

• Detect changes in health practices and behaviours

• Determine disease etiology and natural history

• Generate hypotheses, stimulate research

• Determine appropriate and efficient allocation of resourcesand personnel and development of appropriate policies

Healso emphasized that surveillance of a problem does not includeactions to control the problem.

Theflow chart below is showing the steps of District Heath Office taken as adetected case found. There is always an interaction between Health care systemand surveillance centre. Both are 2 constituent systems.

Meanwhile,this is Early Warning and Response System. This shows the dissimilarity of proceduresof surveillance between an individual case found and a group of cases reportedin same area.

Ideally analysis at ALL levels districts, state andnational. However, the main responsibility is at the DISTRICT Level

The frequency of analysiscan be classified into:

• Daily: In event of outbreak

• Weekly

• Monthly

• Annually

The mandatory notifiable disease surveillance systemrequires the mandatory notification of 26 ID under the schedule 1 and 2 of thePrevention and Control of Infectious Disease Act 1988 (PCID). This list isreviewed from time to time.The present system involves manual reporting of IDusing a prescribed notification form as provided under this Act. However, anelectronic Communicable Disease Control Information System (CDCISE-Notification) was implemented nationally since 2001.

The isthe general view of Malaysia Surveillance Systems.

Notification Methods

Next, Mr. David briefed us on themethods of reporting of infectious disease.Reporting or notifying of infectious diseases is mandated by the Schedule 1 ofthe Prevention and Control of Infectious Disease Act 1988 (Act 342). ANotification Regulation was subsequently gazetted in 28 June 2011(P.U. (A) 206)whereby to date a total of 44 infectious diseases (life threatening microbialinfection) is required to be notified by law (compared with previous version iscomposed of 26 infectious diseases only). The use of these case definitionswhich provides standardized criteria for the reporting of cases will enhancethe quality of data received under the national notification of infectiousdiseases.In most instances, only confirmed cases are reported.A combination of clinical, laboratory and epidemiologic criteria is used toclassify these cases.These case definitions include a brief clinicaldescription which is intended for the purpose of notifying & classifyingcases and should not be used for making clinical diagnosis by the attendingphysicians

As mentioned before, there are 44 major diseasesrequired to be notified following Section 2 Prevention and Control of InfectiousDisease Act, 1988. The Diseases are shown below:-

• Poliomyelitis

• ViralHepatitis A

• ViralHepatitis B

• ViralHepatitis C

• ViralHepatitis(others)

• AIDS

• Chancroid

• CHOLERA

• DengueFever

• DengueHaemorrhagic Fever

• Diphtheria

• Dysentery

• Ebola

• FoodPoisoning

• Gonorrhoea

• Hand,Foot and Mouth Disease

• HumanImmunodeficiency Virus Infection

• Influenza

• Leprosy(Multibacillary)

• Leprosy(Paucibacilllary)

• Leptospirosis

• Malaria– Vivax

• Malaria– Falciparum

• Malaria– Malariae

• Malaria– others

• Measles

• Plague

• Rabies

• RelapsingFever

• Syphilis- Congenital

• Syphilis– Acquired

• TetanusNeonatorum

• Tetanus– (others)

• Typhus– Scrub

• Tuberculosis– PTB Smear Positive

• TuberculosisPTB Smear negative

• Tuberculosis– Extra Pulmonary

• Typhoid– Salmonella typhi

• Typhoid– Paratyphoid

• ViralEncephalitis – Japanese

• ViralEncephalitis – Nipah

• ViralEncephalitis – (Others)

• WhoopingCough / Pertussis

• YellowFever

• Others:please specify: _________

Notification form

Probableor suspected cases may be described in the case classification to assist localpublic health authorities in carrying out their public health mandate, such asoutbreak investigation, contact tracing and prevention and controlmeasures in a timely manner.Physicians diagnosing cases of specific (notifiable)infectious diseases should report these cases based on clinical diagnosiswith/without laboratory confirmation to the district health authorities. Theseauthorities are responsible for determining that the cases meet thesurveillance case definitions before they officially register the cases. Wherethere is uncertainty because data are missing or the results are inconclusive,it may be reported as a probable or suspected case, but the status must beconfirmed later. The district health authority registering & reporting thecase collects all necessary epidemiologic data on it.

Strategies for Epidemic Investigation & Management

Activities of Infectious Diseases Control

Firstly, they receive nofication from general hospitals,health care centres, private hospitals and private clinics through:

• telephone/ fax

• handdeliver /

• E-Notification(online)

• Noticeform post

Secondly, their task is investigation to gather thesuspected patient’s contact and personal details, food history before onset andmovement of patient before onset. Thirdly, they will carry outthe patient’s House Area Sanitation Investigation.Lastly, they will initiate the Control Response upon the case.

Objectives of Investigationof case are:

• To detect emerging pathogen strain.

• To predict and detect outbreak of disease.

• To determine and monitor the circulation of organismstrains in the country.

• To facilitate outbreak identification andinvestigation through strain identification (sero-typing, phage typing etc)

Syndromic Notification

• cluster of cases / deaths

• occurring within a short period of time

• from similar group of symptoms and signs

• to be notified

• to both State and National levels without delay

• By the A&E (deaths) and wards (admitted cases)

This is the Disease Guidelines shown by Mr. David.According to him these are the ‘Bibles of Communicable Disease Control”.

Jilid 1: Umum – FWBD/UMU/GP/001

• Jilid 2: Typhoid – FWBD/TYP/GP/001

• Jilid 3: Cholera – FWBD/CHO/GP/001

• Jilid 4: Food Poisoning – FWBD/KRM/GP/001

• Jilid 5: Hepatitis A – FWBD/HPA/GP/001

• Jilid 6: Dysentery – FWBD/DYS/GP/001

This Chart reveals the incidence of diseases in KualaMuda District 2011.

Aftera detail and good presentation taken by Mr. David, he brought us to his officeand guided us how to use the e – notification to report a confirmed case.

Thisis the e – notification website.

Mr. David also gave us atalk on Responsibilities & Functions of Environmental Health Officers.

Vision

n Towardsa safe and healthy working environment among the HCWs of MOH and clients.

n Mission

n Improvingthe working environment by identifying the hazards, taking appropriate actions to overcome themthereby making it condusive through effective health promotion via preventionand control of diseases, injuries, disabilities caused by the interaction ofman and occupation

General Objective

n Toincrease and maintain the physical, mental and social health status of HCWs of MOH to an optimumlevel.

Specific Objectives

n Maintainthe working environment through health and safety work practices and processes,causing health problems which occur between occupation and environment

n Increasethe level of knowledge and awareness regarding Occupational Safety and Health (OSH)among employers, employees and clients

n Improvethe level of health, safety and welfare of Health Care Workers (HCW) throughcontrol and prevention of diseases at workplace

n Improvethe quality and productivity through increase in the level of health, safetyand welfare of HCWs

n Tocarry out health promotion activities at work place

ACTIVITIES

n Notificationand surveillance of Occupational diseases

n QualityAssuarance Program – Incidence Rate of Needlestick Injuries

n Strengtheningof OSH committee

n OccupationalHealth Clinic

n OSHPromotion at work place

n Talks,courses and trainings

n Preparationof H.E. materials

n Carryout workplace risk asssessment

n Investigationof OSH complaints

n Organisetrainings/workshops/courses for HCWs relating to OSH

n Carryout Safety Audits at Health facilities

n Carryout Annual Medical Health Examination among HCWs

n Carryout Healthy Settings activities

n Carryout inspection PLKN/National Training Camps

OSH Programmes

1. Surveillance program

n Respiratory Disease Surveillance, skin, chemicalpoisoning, noise induced hearing loss and accidents

n data collection WEHU A1,A2&A2 cont., WEHU D1&D2, WEHU E1 & E2, WEHU L1 & L2, WEHU S1 & S2

n Notification report to MOH

2. OSH Promotion

n Carryout OSH promotion activities

3. Annual Medical Examination of HCWs

n Medicalexamination of all HCWs (incl. Hep B Immunization)

n Emphasisto high risk groups

n Carryout investigation and surveillance

n ProvideH.E. to HCWs

4. OSHCommittee Meetings

n Carryout at least 3 OSH meetings

n AccidentCase studies

n PPE

n Hazardousconditions at workplace

5. OSHAudits at Health Facilities

n Carryout OSH audits at all clinics, rural health clinics, health departments, govt.hospitals

n 7.Hazard Analysis at Workplace

n Carryout hazard anlysis at wokplace

n Identify

n Remedialmeasures

n recommendations

B. Environmental Health Program

n 1.Disease Surveillance caused by Haze (URTI,Asthma, Conjunctivitis)

n District data compilation

n Weekly report on URTI, Asthma, Conjunctivitis

n Country surveillance program

n 2.Healthy Setting

n Healthy Marketplace

n Healthy Clinic

n Healthy Work place

n Carry out healthy setting activities

n 3.Environmental Complaints

n Investigation

n Recommend relevant control measures

n Report