INFLUENZA A(H1N1) - SRATEGIES AND ACTIVITIES DURING PHASE 6

ORGANISATIONAL RESPONSE
1. Activation of National Inter-Ministerial Influenza Pandemic Committee ? chaired by Hon. Health Minister, to be held every fortnightly
2. Continuation of National Influenza Pandemic Planning Committee (Technical Committee) ? chaired by Director General of Health Malaysia, to be held every week
3. Continuation of Influenza Pandemic Committee ? at National, State & District level ? chaired by Deputy Director General of Health (PH).
4. Activation of National Security Council to coordinate all preventive and control measures taken by all agencies. Will be done if there are local transmission in Malaysia, multiple states involved, increase number of severe cases/deaths and to get resources or if hospitals? bed not enough for influenza A(H1N1) cases.

PUBLIC HEALTH RESPONSE
Surveillance
1. Enhance of Malaysia Influenza Surveillance System (MISS) including identifying and investigating unusual cases, clusters or outbreaks, therefore important changes in the epidemiology and severity are identified. Also will include event-based surveillance and monitoring of flu medicine dispensed over counter at pharmacy.
2. Enhance Notification of all suspected and confirmed cases immediately (within 24 hours).
a. Characterizing in detail the epidemiology features in the first 100 or more cases of pandemic to ensure the critical information is collected and made available.
3. Monitor absenteeism data among health care workers
4. Encourage reporting of unusual absenteeism from work places, institution & schools
5. Continue reporting to WHO according to IHR 2005
6. Monitor global situation through WHO Country Office / Regional Office

Control Measures
1. Optimise functioning of operation room at national, state & district level
2. Continue the usage and distribution of health alert card to all travelers who visit Malaysia
3. Continuation and enhancement of Health Declaration Form to be filled by travelers
4. Exit screening should be performed for all travelers leaving Malaysia ? to consult WHO if necessary
5. Continue implementation of isolation procedures and infection control for all suspected cases (as in Medical Plan)
6. Enhanced control and prevention activities
a. National efforts should focus on primarily mitigating the health and social impact of the virus through care of ill persons rather than on attempts to contain transmission of the disease. For example to admit cases with severe symptoms, cases with mild symptoms can stay at home and place under home surveillance
b. PPE usage by relevant HCW
c. Barrier nursing and infection control at hospitals and clinics
d. General infection control measures for general public and those under surveillance at home
e. Implementation of immunization if vaccine is available especially to the front-liners
f. Practice universal precaution while handling dead bodies
g. Closure of schools/institution/ cancellation of event or public gathering
7. Enhanced risk communication to the public
8. Antiviral ? implement prophylaxis and treatment guideline to those identified
9. Stockpile of PPE/antiviral/vaccine ? to monitor weekly. Apply budget to purchase PPE/antiviral/vaccine for stockpile.

MEDICAL RESPONSE
Surveillance and Control
1. Consider alternate treatment centre in the event of hospital bed shortage ? hostel/ schools/ community facilities
2. Reallocate staffs and duties
3. Collate data and cases and effectiveness of vaccine and drug treatment

Clinical Management
1. Develop criteria for hospital admission
2. Monitor HCW handling cases

LABORATORY RESPONSE
1. Laboratory based surveillance
a. Enhanced surveillance to monitor extent of spread of the virus and its effects on different subgroups of population
2. Diagnostic capabilities
a. Ensure laboratory has adequate supply of diagnostic reagent capable of identification of novel influenza virus(primer/antibodies/reagents)
3. Manpower
a. Mobilize cross trained staffs to meet the increase workload of the laboratories
4. Virus characteristics
a. Monitor the emergence of drug resistance virus isolate in collaboration with WHO Influenza Collaborative Centre
5. Strengthened networking as necessary with the other laboratories in the Universities and other institutions
6. Research and development
a. Undertaking research and development in various sectors pertaining to the novel influenza virus
7. Budget will be prioritized to contain to the outbreak/pandemic

RISK COMMUNICATION
1. Revise existing health education materials and incorporate new preventive measures
2. Produce new health education materials or advisories and distribute quickly to the target group
3. Intensify communication to the public of the latest development and also caution on preventive measures
4. Continue daily press release or conference by credible spokesperson
5. Encourage and educate general public to seek information from reliable sources i.e. MOH and WHO websites

WIDE SPREAD COMMUNITY TRANSMISSION
Surveillance
1. Monitor and track of the following:
a. The pattern of spread of cases, death and outbreaks associated with the pandemic virus
b. Functioning of the health care system
c. Any changes in viruses
2. Collection of clinical samples for viral testing should be limited, only selected samples are being tested during the pandemic

Control Measures
1. Primary focus should be on appropriate management of patient either at home or at health care facilities
2. Continue the existing strategies

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