STATUS OF PREPAREDNESS AND RESPONSE BY THE MINISTRY OF HEALTH IN AN EVENT OF AN OUTBREAK OF EBOLA (EVD) IN MALAYSIA
The Ministry of Health Malaysia (MOH) wishes to inform that the World Health Organization (WHO) has reported an outbreak of Ebola (Ebola virus disease; EVD) involving three (3) West African countries of Guinea, Liberia and Sierra Leone. Until 12 October 2014, WHO have reported a total of 8,973 cases of EVD (including suspected, probable and confirmed cases) with 4,484 deaths in countries with widespread and persistent transmission.
Countries with localized transmission, namely Nigeria, Senegal, the United States and Spain have reported a total of 24 cases of EVD (including suspected, probable and confirmed cases) with 9 deaths. Ongoing active surveillance being conducted in Nigeria and Senegal have shown all contacts having completed the 21 days of monitoring and WHO have announced that no new cases have been reported. WHO also informs that if no new cases are reported over a period of 42 days (two incubation periods), WHO will declare the outbreak over at these two countries. This welcoming news would indicate that the Ebola outbreak will only be limited to three (3) West African countries of Guinea, Liberia and Sierra Leone.
It should be noted that, until now the WHO does not recommend any travel or trade restrictions to be applied by countries except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD.
Therefore, MOH has placed several preparedness and response measures at various levels of public and private health facilities. It is important that all public and private health facilities involved in the management of EVD cases clearly understand the current definition of a case of PUI (Person Under Investigation) EVD or a suspected case of EVD. This is to ensure that medical practitioners are able to identify cases of PUI EVD and to refer these cases to hospital for examination, confirmation and further treatment.
In addition, it is extremely important that health personnel handling cases of PUI EVD at all levels of public and private health facilities practice proper infection prevention and control measures to avoid infection and further transmission of the disease.
MOH is has put into place several preparedness and response measures in an event of the spread of EVD into Malaysia;
i. The National Crisis Preparedness and Response Centre (CPRC), continuously enhances the disease surveillance and monitoring of the status of EVD events in West Africa and coordinates MOH preparedness and response measures to prevent the spread of the disease.
ii. EVD is a notifiable disease under the Prevention and Control of Infectious Diseases Act 1988 (Act 342). EVD Notifications should also be sent to the National CPRC, in addition to notifying the nearest District Health Office and State Health Department. As of 15 October, nine (9) cases of PUI EVD were reported to the National CPRC. Diagnostic tests conducted on clinical samples of these patients found all cases were negative for EVD.
iii. MOH personnel at all levels, including at the international entry points are continuously briefed on the guidelines for the management of cases suspected of being infected. These would include the process of immediate reporting / notification to the nearest District Health Office, State Health Department and the National CPRC. The latest updated guidelines have been distributed on 29 September 2014 via a circular by the Director General of Health. This was followed by a national level briefing on 9 October 2014.
Representatives who attended this briefing from each State / Federal Territory Health Departments are required to provide a similar briefing at their respective departments to disseminate the latest information at all levels.
iiii. Improvements to the EVD case management guidelines in hospitals have been made especially relating to the aspect of reducing the risk of infection to medical personnel handling cases of EVD.
v. Health screening at entry points of the country has been strengthened to detect Malaysians and visitors who have visited, worked or studied in countries with EVD infections. The cooperation with the Immigration Department (JIM) is essential for those detected to be referred to the health authorities at the entry points.
vi. Information and health advice about EVD is being updated to the public on an ongoing basis through the mass media that includes, regular press releases by the Minister of Health, the Director General of Health, television and radio interviews, MOH website, CPRC Facebook and by the distribution of information through the relevant ministries and agencies such as the Ministry Foreign Affairs, Immigration Department, Ministry of Transport, Ministry of Education and others to assist the Ministry of Health to prevent the spread of the disease into the country.
vii. MOH has identified a total of 21 hospitals nationwide to receive referred cases of PUI-EVD for early case detection and management. Laboratory confirmed EVD cases would be treated in three (3) dedicated hospitals, which are Hospital Sungai Buloh for Peninsular Malaysia, Hospital Queen Elizabeth Kota Kinabalu, Sabah and Kuching General Hospital in Sarawak.
viii. A total of 20 laboratories in hospitals around the country have been identified to carry out routine tests for PUI-EVD case management. The three (3) laboratories that have been identified to perform laboratory confirmation of EVD are, Institute for Medical Research (IMR), National Public Health Laboratory (NPHL) Sungai Buloh and Public Health Laboratory Kota Kinabalu.
ix. District Rapid Response Teams (RRT) and Rapid Assessment Teams (RAT) are on standby to be activated if there is a notification of a suspected case of EVD.
x. Personal Protective Equipment (PPE) stockpiles has been enhanced to accommodate the needs of all health facilities in an event of an epidemic, and continuous training is provided to health personnel in the proper use of PPE.
xi. Currently, a total of six (6) field simulation exercises related to the handling of EVD cases have been conducted at various levels of MOH to evaluate and strengthen the status of preparedness and response of a potential spread of EVD in Malaysia. In addition, Malaysia is also involved with the EVD simulation exercises organized by WHO Western Pacific Regional Office on 8 October, 2014.
xii. MOH is with close cooperation with various ministries and agencies (multi-sectoral collaboration) in an effort to prevent the spread of EVD into the country. An interagency meeting was held on 8 October 2014, which was chaired by the Minister of Health Malaysia to explain the current situation of the EVD epidemic and the roles of each of the relevant agencies to assist the Ministry of Health to prevent the possibility of the spread of EVD into Malaysia.
MOH will continuously monitor the disease situation and will regularly update the latest developments from WHO. Additional information and the current situation on EVD can be obtained by visiting the MOH website at http://www.moh.gov.my and the CPRC Facebook.
Thank you.
DATUK SERI DR. S. SUBRAMANIAM
MINISTER OF HEALTH MALAYSIA