Measles - Prevention and Control in Malaysia

Transcription

MEASLES PREVENTION & CONTROL IN MALAYSIA
Handbook for Healthcare Personnel
Contents
PAGE
Foreword
PART 1 - GENERAL
1.1 Introduction
1.2 The Disease
1.3 Complication
1.4 People At Risk
1.5 Measles Vaccination
1.6 Measles Epidemiology – Global PART 2 - MEASLES PREVENTION AND CONTROL IN MALAYSIA
2.1 Measles Epidemiology - Malaysia
2.2 Measles Elimination
2.2.1 Goal & Objectives
2.2.2 Strategies
2.3 Measles Vaccination
2.3.1 Schedule
2.3.2 Contraindication
2.4 Measles Surveillance
2.4.1 Objectives
2.4.2 Case Definition
2.4.3 Case Classification
2.4.4 Procedures Of Surveillance
2.4.5 Performance Indicators
APPENDICES
Appendix 1 : Flow Chart Of Measles Surveillance Activities
Appendix 2 : Measles Laboratory Request Form
Appendix 3 : Procedures To Collect, Store And Transport Clinical Specimens
Appendix 3a: Blood Specimen Collection For Measles Specific IgM Test
Appendix 3b: Urine Specimen Collection For Measles Virus Isolation
Appendix 3c : Nasopharyngeal Specimen Collection For Measles Virus Isolation
Appendix 3d: Throat / Nasal Swab Specimen Collection For Measles Virus Isolation
Appendix 4 : Flow Chart Of Clinical Specimen For Laboratory Confirmation
And Result
Appendix 5 : Notification Form (Malay Version)
Appendix 6 : Notification Flow
Appendix 7 : Measles Investigation Form (Malay Version)
Appendix 8 : Classification Of Measles Case
Telephone Numbers
References
Acknowledgement MEASLES PREVENTION & CONTROL IN MALAYSIA
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FOREWORD
M
easles is one of the major childhood killer before the introduction of its vaccine.
and World Health Organization (WHO) estimated that 130 million children below
6 years die due to measles annually. Since the introduction of measles vaccine in 1964, the
morbidity and mortality due to measles have been reduced drastically. Measles
vaccination was included in the Expanded Program for Immunization (EPI) in 1974.
Since then, coverage of measles vaccination climbed steadily in all regions throughout
the year 1980s. In 1980s, after the success of smallpox eradication, some scientist and public health
officials have considered of global effort to eradicate measles. Since 1990’s
strategies have been planned and implemented in many developing countries to
eliminate and eradicate measles. Three regions of the World Health Organization that
targeted elimination by 2000s are; in 1994, the American Region targeted elimination
by 2000, in 1997, the Eastern Mediterranean targeted elimination by 2010 and in 1998,
the European Region targeted elimination by 2007. In 2005, WHO for the Western
Pacific Region targeted elimination by 2012.
As we have succeeded in controlling measles occurrence at low level, the
Ministry of Health in February 2003 decided to initiate measles elimination in
Malaysia starting in 2004. Therefore, all healthcare personnel should implement the
measles prevention and control strategies and activities as required for the elimination.
This handbook is intended to serve as guiding tool in continuing to create
awareness and assisting healthcare personnel in the implementation of Measles
Elimination Programme strategies. Dato’ Dr. Hj. Ramlee Hj. Rahmat
Director of Disease Control
Ministry of Health, Malaysia
18 December 2006
PART 1
GENERAL
1.1 INTRODUCTION
Before the introduction of measles vaccine, measles is one of the major
childhood killer and the World Health Organization (WHO) estimated that
130 millions children below 6 years die due to measles annually. Since the
introduction of measles vaccine in 1964, the morbidity and mortality due
to measles have been reduced drastically.
However, despite the availability of vaccine for the past 40 years, measles
is remains a leading cause of death among young children. An estimated
454,000 people died from measles worldwide in 2004.
Measles vaccination and surveillance are two main strategies to prevent
and control the diseases.
1.2 THE DISEASE
Measles is highly infectious disease caused by a virus in the
paramyxovirus family. The disease spread by airborne droplets, close
personal contact or direct contact with nasal or throat secretion of
infected persons.
The incubation period is usually 10 to 12 days but may range up to 21 days. The first sign of infection is high fever. During this initial stage, patient
may develop coryza, cough, red and watery eyes (conjunctivitis) and
white spots inside the cheek known as Koplik’s spot. After several days
(2 – 4 days), a rash develops, usually started on the face and upper
neck. The rash proceeds downwards, reaching hands and feet and
lasted for five to sic days, then fades. The rash occurs, on average, at
day 14 after exposure to the virus with a range of seven to 18 days, rarely
as long as 19 – 21 days.
An infected individual can transmit the virus from four days prior to the
onset of rash to four days after onset. The virus remains active and
contagious in the air or on infected surfaces for up to two hours.
Figure 1: Koplik’s spot and skin rash in person with measles infection
Koplik’s spot
Maculopapular rash
Rash begins
around hairline,
on face and neck,
behind ears
Rash spreads
downward to
chest and
abdomen
Downward trend
spread of rash
Rash effects
arms and legs
last
Figure 2: Time course of clinical events in measles disease
Day of
illness
1
2
3
4
5
TEMPERATURE
104
6
7
8
9
10
Measles
103
102
101
100
99
98
Rash
Koplik’s
Conjunctivitis
Coryza
Cough
Source: Infectious Diseases of Children, 9th Edition, Figure 13-1, page
224, 1992. Editors Saul Krugman Samuel L. Katz, Anne A. Gershon,
Catherine M. Wilfert. By permission of Mosby Year Book, St. Louis
Missouri
1.3 COMPLICATION
Measles is often a mild or moderate severe illness. However, severe
measles likely occur in poorly nourished young children. The most serious
complications include, blindness, encephalitis (1 per 1,000 cases),
severe diarrhoea, ear infection (1 in every 5 – 10 cases) and pneumonia
(5 – 10 % of cases). Case fatality rate in developing countries is in the
range of 1% to 5%.
1.4 PEOPLE AT RISK
Un-immunised persons, especially young children are at highest risk.
People who have not been immunised with vaccine or who have not
acquired immunity through having experienced the disease can become
infected.
1.5 MEASLES VACCINE
Measles vaccine was available since 1963. Measles vaccine induces
long-term and probably lifelong immunity in most individuals. Natural
infection produces lifelong immunity.
Live attenuated measles virus vaccine are in use. Measles antibodies
develop in approximately 85% of children vaccinated at 9 months of
age, 95% of children vaccinated at 12 months of age and 98% of those
vaccinated at 15 months of age. Second dose vaccination is given to
children to overcome this lack detectable antibody.
Measles vaccines available in form of monovalent, bivalent
(MR – measles-rubella) and trivalent (MMR – measles-mumps-rubella).
1.6 MEASLES EPIDEMIOLOGY – GLOBAL
Worldwide, measles cases and deaths are under-reported especially in
areas with the highest burden. In 2003, 528,400 cases were reported (from 174 countries) compared
to 3,852,242 cases in 1980 (from 148 countries). Worldwide annual
deaths from measles (2002) were estimated by WHO at 610,000. About
88.5% of them (540,000) occurred among children under 5 years of age.
In Western Pacific Region, measles cases and deaths estimated of about
one million and 30,000 per year, respectively. WHO and UNICEF estimated that the measles vaccination coverage in
2003 was around 77%.
PART 2
2.1 MEASLES EPIDEMIOLOGY – MALAYSIA
In the pre vaccine era, measles was highly endemic among Malaysian
population especially among children. Measles vaccination program was
included as part of the Expanded Programme on Immunisation in 1982 and
single dose measles vaccination was given to children at 9 months of
age. Since the introduction of measles vaccination in Malaysia, the
occurrence of measles reduced with the increased of the measles
vaccination coverage.
The incidence rate of measles reported cases in 1982 was 65.62 per
100,000 populations. In 1989 – 1998, measles incidence rates in Malaysia
were ranged between 1.51 – 5.87 per 100,000 population.
However, measles cases increased drastically in 1999 and 2000 with
incidence rates 11.48 (2,608 cases) and 26.59 (6,187 cases) per 100,000
populations, respectively despite measles administrative immunization
coverage was 86.6% (1999) and 88% (2000). In these two years, the
increased of measles cases occurred in all states and outbreaks were
scattered throughout the country both in urban and rural areas. The
measles outbreak in 1999 – 2000 suggested that the outbreak was due to
primary vaccine failure and failure to vaccinate that caused accumulation of
susceptible individuals
Figure 3: Measles incidence rate of measles reported cases and
vaccination coverage, Malaysia, 1976 – 2005.
Incidence rate
Immunisation Coverage
2.2 MEASLES ELIMINATION
As we have succeeded in controlling measles occurrence at low
level, the Ministry of Health in February 2003 decided to initiate measles
elimination in Malaysia starting in 2004. Following this decision, vaccination
and surveillance strategies have been reviewed and changed to achieve
the elimination goals and objectives.
2.2.1 Goals and objectives
The main goal of this elimination initiative is to achieve sustainable
reduction of measles morbidity and mortality and to interrupt the
transmission of indigenous measles virus in Malaysia.
Specific objectives of elimination initiative are to;
1) maintain the number of susceptible individuals below the critical number required to sustain transmission of the virus;
2) eliminate measles by year 2010;
3) achieve 0 measles mortality.
2.2.2 Strategies
Sustainable reduction of measles morbidity, mortality and interruption of
the transmission of the indigenous measles virus in Malaysia are possible
by implementing the following strategies;
1) Vaccination strategies
• routine two dose MMR vaccine given to children
2) Surveillance strategies
• enhancing
measles
surveillance
with
epidemiological and laboratory information.
3) Laboratory strategies
• laboratory confirmation
measles cases
should
be
done
integration
on
all
of
suspect
4) Response to outbreak
• all measles outbreaks will be carefully investigated
5) Case management
• improving the management of every measles case
6) Training
2.3 MEASLES VACCINATION
2.3.1 Schedule
Two dose of measles vaccine are recommended as the 5 – 10 percent
who fail to be protected by the first dose will nearly all be protected by the
second. The measles vaccination schedule is as follows;
Area
10
Measles vaccination
Age vaccination given
Peninsular Malaysia First dose MMR
and Sarawak
Second dose MMR
12 months
7 year (standard one)
Sabah
First single dose measles
6 months
First dose MMR
12 months (1 year)
Second dose MMR
7 year (standard one)
2.3.2 Contraindications
Contraindications include;
• individuals with proven anaphylaxis to neomycin
• children with immune suppression
• children who have received another live vaccine in previous month
• children with HIV infection who are severely immune
compromised
• pregnant women
• women of children age, who should be advised to avoid
pregnancy for the next three months after MMR of measles
vaccine.
2.4 MEASLES SURVEILLANCE
Adequate disease surveillance data and analysis will permit
implementation of appropriate measures to control and eliminate
measles. It also will be used in the assessment of progress and in making
adjustments to programmes as required. Measles is a notifiablle disease
under the Control of Communicable Disease Act 1988.
In the elimination phase the surveillance of measles should be
case-based or known as enhanced measles surveillance (laboratory
confirmation should be done).
2.4.1 Objectives
The general objectives of measles surveillance are to immediate
detecting any suspected cases, confirming cases by laboratory
diagnosis and identifying importations and possible sources of
infection so that can be used to plan, monitor and evaluate measles
elimination programme.
The specific objectives of measles surveillance are to;
1) monitor incidence and coverage in order to assess progress;
2) identify areas at high risk or with poor programme performance;
3) identifying high-risk population;
4) describe the changing epidemiology of measles in terms of age,
immunization status and the intervals between epidemics;
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5)
6)
7)
8)
9)
predict the next outbreak that may occur because of a build-up of
susceptible persons;
detect and investigate measles outbreaks so that cause of
outbreaks can be determined
determine where measles virus is circulating;
assess the performance of surveillance system;
ensure proper case management
2.4.2 Case definition
Clinical case definition for suspect measles case that should be reported/
notify is as follows;
Any person with fever and maculopapular rash and cough,
coryza (runny nose) or conjunctivitis (red eyes)
or
Any person in whom a clinician suspects measles infection
2.4.3 Case classification
Case classification according to laboratory confirmation;
Clinically confirmed:
A case that meets the clinical case definition
Laboratory confirmed:
A case that meets the clinical case definition and is laboratory
confirmed (based on laboratory criteria for diagnosis)
Epidemiologically confirmed:
A case that meets the clinical case definition and is linked
epidemiologally to a laboratory confirmed case.
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Case classification according to source of infection
Indigenous infection:
A person becomes infected in Malaysia (no history of out from
Malaysia 21 days of rash onset), either,
• Epidemiologically linked to an international imported; or
• Not linked epidemiologically to an international imported case
Imported infection:
A person who has confirmed measles and whose rash onset was
within 21 days of arrival in Malaysia.
2.4.4 Procedures of surveillance
Flow of measles surveillance activities is as Appendix 1.
i) Case detection
•
•
•
•
take a proper history on the complaint of suspect measles cases
who fulfil measles case definition
if the onset of rash is less than 4 days, take blood/serum sample
and urine or respiratory specimens from the patient
if the onset of rash more than 4 days, take blood/serum from the
patient
send the clinical sample/s to laboratory identified by District
Health Office together with Measles – Laboratory Request From
(MSLF: 01/2004 as Appendix 2). Procedures to collect, store and
transport of samples are as in Appendix 3 and 4. The sample/s
then transported to National Public Health Laboratory (NPHL),
Sungai Buloh for confirmation. ii) Notification
All suspect measles cases must be notified to nearest District Health
Office within 48 hours of rash onset via telephone. As most of the
cases detected within few days of rash onset, it is advisable that the
case should be notified as soon as a case detected. Notification using
Notification Form should follow using current system of notification.
Notification Form and notification flow are as Appendix 5 and 6. MEASLES PREVENTION & CONTROL IN MALAYSIA
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iii) Case investigation
Identified Officer in District Health Office must investigate all
suspect measles cases within 48 hours of notification using Measles
Investigation Form. Investigation Form is as Appendix 7. iv) Case classification
After case has been investigated and laboratory result has been
available, case must be classified according the laboratory
confirmation and source of infection as following (Appendix 8);
•
•
•
clinically confirmed
epidemiologically confirmed
laboratory
confirmed
• indigenous infection
• imported infection
Laboratory confirmation
Source of infection
v) Data analysis and interpretation
Data should be analyse on weekly basis and information should be
generate.
2.4.5 Performance indicators
The following are the performance indicators that should be evaluated on
weekly basis.
•
•
•
•
•
•
•
•
% of suspected cases notified within ≤ 48 hours of onset of rash
% of suspected cases investigated
% of cases investigated within ≤ 48 hours of notification
% of cases with laboratory confirmation
% of cases with adequate specimen taken
% laboratory result (serology) within 7 days
% laboratory result (virus isolation) within 14 days
% of confirmed cases with sources of infection identified
The target of all above indicators to be ≥ 80%.
** Details on procedures of measles surveillance, refer Measles Surveillance
Manual
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APPENDICES
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Appendix 1
Flow chart of measles surveillance activities
Case detection
Health
facility
Case notification
Case investigation
Data verification & validation
District Health
Office
Case classification
Data analysis
Interpretation
Reports
Information dissemination
(feedback)
Action
Evaluation
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State Health
Department &
Disease Control
Division,
Ministry of
Health
Appendix 2
MSLF:01/2004
No. Rujukan Makmal
MEASLES - BORANG PERMOHONAN DAN KEPUTUSAN UJIAN MAKMAL
A. MAKLUMAT PESAKIT
Negeri:
Daerah:
Hospital / Klinik Kesihatan:
Nama Pesakit:
No. K/P:
Umur:
Jantina: L / P
B. MAKLUMAT IMUNISASI MEASLES
Imunisasi measles: Ada Tiada Tidak diketahui Tarikh dos terakhir diberi:
C. MAKLUMAT KLINIKAL
Gejala (Simptom)
Ada / Tiada (Tandakan √ diruang berkenaan)
Tarikh mula
Demam
Ruam (maculopapular rash)
Konjunktivitis
Batuk
“Coryza”
D. SPESIMEN KLINIKAL
Spesimen: Pertama Kedua
Spesimen (tandakan √ diruang berkenaan)
Tarikh diambil
Tarikh penghantaran
Darah / Serum
Sekresi pernafasan (Respiratory secretion)
Air kencing (urine)
E. MAKLUMAT PEMOHON
Nama dan Cop Pegawai:
No. telefon:
No. Fax:
Tandatangan:
e-mail:
F. MAKMAL (Untuk Kegunaan Makmal)
Keadaan spesimen:
Spesimen Jenis ujian Keputusan ujian Tarikh terima spesimen:
Komen
Darah / Serum
Sekresi pernafasan (Respiratory secretion)
Air kencing (Urine)
Nama dan tandatangan Pegawai Makmal:
Jawatan Pegawai Makmal dan Cop Makmal:
Tarikh:
* Nota: Spesimen klinikal (darah / sekresi pernafasan / air kencing) hendaklah diambil jika pesakit disyakki sebagai kes measles.
Defini kes (case definition) adalah seperti dinyatakan di belakang.
Jika spesimen ini adalah spesimen kedua, maklumat klinikal dan imunisasi tidak perlu diisi jika telah diisi pada borang spesimen
pertama.
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(at the back of laboratory request form)
Measles
Definisi Kes
Seseorang yang mengalami gejala berikut;
Demam dan ruam (maculopapular rash) dan; konjunktivitis atau
batuk atau “coryza”
atau
Sesiapa yang didiagnos sebagai kes campak oleh Pegawai Perubatan
Case Definition
Any person with
Fever and maculopapular rash and; conjunctivitis or cough or
coryza
or
Any person in whom a clinician suspects measles infection
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Appendix 3
PROCEDURES TO COLLECT, STORE AND TRANSPORT
CLINICAL SPECIMENS
Basic kit for specimen collection
Equipments:
1. Needles
2. Syringes
3. Tourniquet
4. Sharp bins
5. Gloves, alcohol swabs
6. Sterile urine container
7. Plain Screw-capped tube (do not use vacutainer)
8. VTM ( Viral transport medium)
9. Sterile cotton swab
10. Cold box
11. Ice packs
12. Ziplock (biohazard) plastic bag
13. Specimen Measles Surveillance Laboratory Form (MSLF-001)
14. Specimen label
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Appendix 3a
Blood Specimen collection for measles specific IgM test
Take 5ml of venous blood for adult, 2.5ml for children (< 7 y.o )
Use plain tube with screw cap (do not use vacutainer).
Blood to be taken any time, preferable 4 to 28 days after the onset of rashes
Label the container with patient identification and collection date
(name, Full new I/C No., date of specimen taken, type of test eg.
Measles Specific IgM)
Complete the request form including the last measles immunization date,
onset of rash, date specimen taken, telephone and fax numbers and name
of requesting medical officer.
Centrifuge the specimen at 1000 X g for 10 minutes to separate the serum from
the blood cells (immediately after the specimen taken)
Transfer the serum into a new plain tube
Label the new container with patient identification and collection date (name,
Full new I/C no., date of specimen taken, type of test eg.
Measles Specific IgM)
Put the specimens into their respective biohazard bag and individually packed
Store the specimen at 4 – 8oC before and during transportation
(use cold box with ice pack)
Send to National Public Health Laboratory (NPHL) Sungai Buloh
Note: Maximum period of specimen storage is seven days before transportation
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Appendix 3b
Urine specimen collection for measles virus isolation
Collect 10 – 50 ml of urine into a sterile screw-capped container. First
passed, morning specimens of urine are preferable. Urine can be collected
as soon after rash onset and at least within 5 days of rash onset
Label the container with patient identification and collection date (name, Full New I/C No., date of specimen taken, type of test eg.
Measles Virus Isolation)
Complete the request form including the last measles immunization date
given, onset of rash, date specimen taken, telephone and fax numbers
and name of requesting medical officer.
Put the specimens into their respective biohazard bag and should be
individually packed
(use cold box with ice pack) and send to National Public Health
Laboratory (NPHL) within 24 hours.
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Appendix 3c
Nasopharyngeal specimen collection for measles virus isolation Collect nasopharyngeal specimen (aspirates or lavage) and put into
a sterile screw-capped container. The specimen should be collected
as soon as possible after onset and not longer than 7 days after the
appearance of rash
(Name, Full New I/C No., date of specimen taken, type of test eg.
Complete the request form including the last measles immunization
date, onset of rash, date specimen taken, telephone and fax numbers
and name of requesting medical officer.
Put the specimen into their respective biohazard bag.
Specimen should be individually packed.
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Appendix 3d
Throat / nasal swab specimen collection for measles virus isolation
Take throat / nasal swab and put into 2.0 ml Viral Transport Medium (VTM) [VTM can be purchased / supplied by PHL]
(name, Full New I/C No., date of specimen taken, type of test eg.
Complete the request form including the last measles
immunization date, onset of rash, date specimen taken,
telephone and fax numbers and name of
requesting medical officer.
Put the specimen into their respective biohazard bag.
Specimen should be individually packed.
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Appendix 4
Flow chart of clinical specimens for laboratory confirmation
and result
Health facility
(Blood / Respiratory
secretion / Urine)
Specimen
Local laboratory at District Level
(identified by District Health Office)
Specimen
Local
laboratory can
send sample
direct to NPHL
State laboratory
Specimen
Result
National Public Health (NPHL)
Sungai Buloh
Result
Result
Result
District Health Office
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Disease Control
Division
Appendix 5
Borang: Health 1 Rev 2001
No Siri: …………….
BORANG
Subperaturan 10(2)
AKTA PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT 1988
PERATURAN-PERATURAN PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT (BORANG NOTIS) 1993
NOTIFIKASI PENYAKIT BERJANGKIT YANG PERLU DILAPORKAN
A. MAKLUMAT PESAKIT.
1. Nama Penuh(HURUF BESAR) :
Nama Ibu/Bapa/Penjaga (Jika 12 Tahun Dan Ke bawah) :
2. No. Pengenalan Diri/Dokumen Perjalanan :
Sendiri
Pengiring
3. Warganegara Malaysia:
No. Daftar Hospital/Klinik:
Ya
Keturunan : ……………
Subketurunan : ……………………
Tahun : Tidak Negara Asal : ……………
Izin
Tanpa Izin
Pemastautin Tetap
No./Nama Wad:
4. Jantina :
Lelaki
Perempuan
5. Tarikh Lahir :
-
-
6. Umur : ___Hari/___Bulan/___Tahun
7. Pekerjaan : (Jika tidak bekerja, nyatakan status diri) :
8. Alamat Kediaman: Poskod
Negeri
9. Alamat Tempat Kerja/Belajar/Pusat Asuhan Kanak-Kanak:( Nyatakan alamat tempat kejadian jika Keracunan Makanan)
Poskod
10. Nombor Telefon : Pejabat :
Ada
Negeri
Tiada Rumah
:
Tel. Bimbit :
E-Mail :
B. DIAGNOSIS PENYAKIT
11. Pilihan Diagnosis
1. Acute Flaccid Paralysis
2. AIDS.
3. Batuk Kokol.
4. Campak.
5. Chancroid.
6. Demam Denggi
7. Demam Denggi Berdarah.
8. Demam Kuning
9. Difteria. 10. Disenteri.
11. Ebola.
12. Gonorea. 13. Hand, Foot and Mouth Disease.
14. HIV 15. Keracunan Makanan.
12. Status Pesakit :
Hidup
16. Kolera.
17. Kusta (Paucibacillary).
18. Kusta (Multibacillary).
19. Malaria (Sp:……………………). 20. Plague (Jenis:………..…………).
21. Poliomielitis (Akut). 22. Rabies.
23. Relapsing Fever.
24. Sifilis – acquired.
25. Sifilis – congenital.
26. Tetanus Neonatorum.
27. Tetanus (Lain-lain).
28. Tifoid – Salmonella typhi.
29. Tifoid – Paratyphoid (Jenis:…….…).
30. Tifus – scrub.
Tarikh Mati :
Mati 14. Cara Pengesanan : Kes 31. Tuberkulosis – PTB smear positif.
32. Tuberkulosis – PTB smear negatif.
33. Tuberkulosis – Extra Pulmonary.
34. Tuberkulosis – Extra PTB dengan smear +ve.
35. Tuberkulosis – Extra PTB dengan smear –ve.
36. Viral Ensefalitis – Japanese.
37. Viral Ensefalitis – Nipah
38. Viral Ensefalitis (Lain-lain).
39. Viral Hepatitis A (Akut).
40. Viral Hepatitis B (Akut).
41. Viral Hepatitis C (Akut).
42. Viral Hepatitis – Lain-lain (Akut).
43. Lain-lain (Nyatakan):………………..………..
13. Tarikh Mula :
Kontek Kes FOMEMA Ujian Saringan ( ……………………………….)
Notifikasi melalui telefon dalam masa 24 jam perlu dilakukan bagi kes berikut selain dari notifikasi bertulis : Poliomielitis (Akut) , Kolera,
Demam Denggi, Difteria, Keracunan Makanan, Plague, Rabies dan Demam Kuning
15. Status Diagnosis (Mengikut Definisi Kes)
Sementara (Provisional/Suspected)
Disahkan (Confirmed)
- Tarikh Diagnosis :
16. Ujian Makmal/Siasatan : Ada Tiada 17. Nama Ujian Makmal/Siasatan :
18. Tarikh Sampel Diambil/
19. Keputusan Ujian Makmal/Siasatan :
Siasatan Dibuat :
Positif
Negatif
Belum Siap
- ..........................................................................
20. Maklumat Klinikal Yang Relevan:
21. Komen :
C. MAKLUMAT PEMBERITAHU
22. Nama Pengamal Perubatan(HURUF BESAR) :
23. Nama Hospital/Klinik dan Alamat :
24. Tarikh Notifikasi : - -
25. No Telefon :
- 26. No Faks:
- 27. E-Mail :
25
Appendix 6
NOTIFICATION FLOW
Health facility /
Community
Via telephone / other
communication system
Feedback
District Health Office
Case-based
investigation
Via CDCIS
State Health
Department
Disease Control
Division & IDS
Analysis
Interpretation
Response
26
Feedback
Analysis
Interpretation
Response
Appendix 7
BORANG SIASATAN CAMPAK (MEASLES)
KEMENTERIAN KESIHATAN MALALAYSIA
Nota : Semua kes yang disyaki sebagai kes campak yang dilaporkan hendaklah disiasat
dengan serta merta dan tidak lewat dari tempoh 48 jam selepas notifikasi.
FASILITI
Negeri : Daerah Kesihatan: Pejabat Kesihatan Daerah :
MAKLUMAT PESAKIT
MAKLUMAT NOTIFIKASI
Nama Pesakit :
Diagnosa : Tarikh Diagnosa : Tarikh Notifikasi :
No. K/P :
Jantina : T. Lahir : Umur :
____/____/____ ____/____/____ Punca Pengesahan Kes :
Aktif
Pasif
Warganegara :
Nama Pemberitahu :
Ya; Kumpulan Etnik : __________________
Nama Fasiliti Pemberitahu :
Tidak; Negara Asal : __________________
No. Telefon / Faks :
Status Imigrasi : ______________________
No. Rujukan Kes :
MAKLUMAT SIASATAN KES
Alamat Kediaman :
Tarikh Notifikasi Diterima : ____/____/____ Alamat
Tempat Kerja :
Tarikh Kes Didaftar : ____/____/____
No. Telefon :- Rumah: No. daftar kes:
Pejabat:
Tel. Bimbit:
E-Mel :
Tarikh Siasatan : ____/____/____
Nama Penyiasat Kes :
Jawatan :
Pekerjaan :
MAKLUMAT KLINIKAL
Demam : Ya; Tarikh mula : ____/____/____
Tidak
Tidak Diketahui
Ruam :
Ya; Tarikh mula : ____/____/____
Tidak
Tidak Diketahui
Jenis Ruam :
Maculopapular
Maculo-vesicular
Batuk :
Ya
Tidak
Tidak Diketahui
Coryza :
Ya
Tidak
Tidak Diketahui
Conjunctivitis :
Ya
Tidak
Tidak Diketahui
Jika tiada sebarang simptom campak, adakah diagnosa campak ini dibuat oleh Pegawai Perubatan/Pengamal Perubatan?
Ya
Tidak
Jika ya, catitkan ,
Nama Pegawai /Pengamal Perubatan :
Status rawatan :
Pesakit Luar
Pesakit Dalam
Jawatan:
27
(Samb.) MAKLUMAT KLINIKAL
Adakah kes mengalami komplikasi jangkitan :
Tiada
Tidak Diketahui
Diarrhea
Otitis media
Encephalitis / SSPE
Lain-lain, nyatakan :
Status kes :
Hidup
Mati; Tarikh Mati : ____/____/____
Tidak Diketahui
EPIDEMIOLOGI KES (PUNCA JANGKITAN)
Adakah kes mempunyai kontak dengan pesakit campak yang lain dalam tempoh 7 – 12 hari sebelum
mula ruam?
Ya
Tiada
Jika ada, catitkan ; Tidak Diketahui
Nama : Tarikh mula ruam : ____/____/____
No. Daftar :
Adakah terdapat kes campak yang dilaporkan di lokaliti tersebut sebelum kes ini (dalam tempoh inkubasi
yang sama)?
Ya
Tiada
Tidak Diketahui
Jika ada, catitkan ; Nama : Tarikh mula ruam : ____/____/____
No. Daftar :
Adakah kes keluar negara dalam tempoh 7 – 21 hari sebelum tarikh mula ruam?
Ya
Tiada
Tidak Diketahui
Adakah kes bekerja di dalam bidang pelancongan atau bekerja di kawasan/tempat yang terdapat ramai
pelancong antarabangsa/pendatang?
Ya
Tiada
Tidak Diketahui
Individu disyaki kes campak yang dikesan semasa penyiasatan kes :
Nama :
No. K.Pengenalan :
_______________________________________
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
Adakah terjadi wabak? Ya Tidak
Jika ya, nombor wabak :_____/______ (nombor / tahun)
MAKLUMAT UJIAN MAKMAL
Sampel darah/serum untuk ujian serologi
Ya
Tiada
Pengambilan Sampel Terima
Keputusan
Sampel
Hantar ke Sampel oleh Ujian
MKAK MKAK
dilaporkan
Sampel Darah Pertama
Sampel Darah Kedua
28
Tidak Diketahui
Tarikh
Keputusan Ujian IgM
Negatif
Equivocal
Tidak
Diketahui
Jenis Sampel
Positif
Sampel darah/serum diambil :
(Samb.) MAKLUMAT UJIAN MAKMAL
Sampel sekresi respiratori/urin untuk ujian ‘viral culture & indentification’:
Jenis Sampel
Keputusan Ujian ‘viral culture &
indentification’
Tarikh
Pengambilan Sampel Terima
Sampel
Hantar ke Sampel oleh
MKAK MKAK
Tidak Diketahui
Keputusan
Ujian
dilaporkan
Tidak
Diketahui
Tiada
Negatif
Ya
Positif &
Nama
Virus
Sampel sekresi respiratori/urin diambil :
Sekresi respiratori
Urin
STATUS IMUNISASI CAMPAK
Telah diberi imunisasi campak Sumber maklumat imunisasi :
Ya
Tiada
Kad imunisasi
Belum layak
Sejarah lisan
Tidak Diketahui
Tidak diketahui
Bilangan Dos :
Tarikh dos terakhir diberi :
KLASIFIKASI KES
Kes yang dilaporkan ini dikategori sebagai :
Status jangkitan/penularan kes ini :
‘Clinically confirmed’
Jangkitan tempatan
‘Epidemiologically-linked’
‘Imported Cases’
‘Laboratory confirmed’
Tidak dapat ditentukan
‘Discarded’
ULASAN
Nama Pegawai Kesihatan Daerah:
Tarikh :
29
Appendix 8
CLASSIFICATION OF MEASLES CASE
IgM
positive
Laboratory
confirmed
IgM
negative
Discard
Specimen
adequate
Suspect case
(Clinical case)
If the serum specimens taken
< 4 days of onset of rash &
result negative for Measles IgM
and no 2nd serum specimen or
no urine / respiratory specimens
taken
If the cases
not fulfilled
case
definition
No specimen /
no adequate
specimen
Epidemiological
linked to
laboratory
confirmed case
No
epidemiological
linked to
laboratory
confirmed case
Epidemiologically
confirmed
Clinically
confirmed
Note:
Case should be classified as clinically confirmed even though serology test result
negative with adequate specimen if the specimen taken < 4 days of rash onset and
no second serum specimen or urine / respiratory specimens taken.
Suspect case also can be classified as discard if the case is obviously not fulfilled
case definition
30
Telephone Numbers
Any questions regarding the Prevention and Control of Measles in
Malaysia, please contact the Medical Officer of Health (Epidemiology) at the
Communicable Disease Control Section, Disease Control Division, Ministry of
Health or/and the State Health Department as follows,
No.
State Health Department
Tel. No.
Fax No.
1.
Communicable Disease Control Section
Disease Control Division
Ministry of Health
03-88834506 03-88891013
2.
Perlis State Health Department
04-9773333
04-9760764
3.
Kedah State Health Department
04-7335533
04-7314936
4.
P. Pinang State Health Department
04-2625533
04-2613508
5.
Perak State Health Department
05-2533489
05-2552821
6.
Selangor State Health Department
03-51237333 03-51237329
7.
K.L.F.T. Health Department
03-26940701 03-26938742
8.
N. Sembilan State Health Department
06-7625231
06-7638543
9.
Melaka State Health Department
06-2828344
06-2864761
10. Johor State Health Department
07-2245188
07-2277577
11. Pahang State Health Department
09-5161366
09-5135528
12. Terengganu State Health Department
09-6222866
09-6245829
13. Kelantan State Health Department
09-7413300
09-7444486
14. Sabah State Health Department
088-265960
088-221477
15. Sarawak State Health Department
082-256566
082-234571
16. Labuan F.T. Health Department
087-411702
087-411298
31
REFERENCES
1.
Module on best practice for measles surveillance. Geneva, World Health
Organization, 2001.
2.
WHO Guidelines for Epidemic Preparedness and Response to Measles
Outbreaks. Geneva, World Health Organization, 1999
3.
Expanded Programme on Immunization Using Surveillance Data and
Outbreak Investigations to Strengthen Measles Immunization
Programmes. Geneva, World Health Organization, 1996.
4.
Manual for the laboratory diagnosis of measles viral infection. Geneva,
World Health Organization, 1999.
5.
Plan of action – Revised national immunisation programme for children
with a special focus on Hib and MMR immunisation. Ministry of Health,
Malaysia, 2002.
6. Rosemawati A. Measles situation in Malaysia 1999 – 2000. Ministry of
Health, Malaysia, 2003 (unpublished document)
32
ACKNOWLEDGEMENT
We would like to thanks the following persons for made this
handbook possible;
Y. Bhg. Dato’ Dr. Hj. Ramlee Hj. Rahmat
Director of Disease Control
Dr. Abdul Rasid Kasri
Deputy Director of Disease Control (Com. Disease)
Dr. Hasan Abdul Rahman
Director
Pahang State Health Department
[formerly the Deputy Director of Disease Control (Com. Disease)]
Dr. Devan Kurup
Principal Assistant Director
All Participants of the
“Operationalisation of Enhanced Measles Surveillance & Mass Campaign
Meeting”, 9 – 12 December 2003, Le Paris Hotel, Port Dickson
Prepared by
Dr. Rosemawati Ariffin
Principal Assistant Director
33
34

Measles - Prevention and Control in Malaysia

Transcription

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