Medical Journal of Malaysia

MJM, Vol 70 Supplement 1 September 2015

Influenza A outbreak among national service trainee, Melaka, Malaysia 2013

Intan Azura MD*, Noorhaida U**, Shazelin AP*, Fadzilah K***

*Melaka State Health Department, Malaysia, **Muar District Health Office, Johor, Malaysia, ***Epidemic Intelligence Program, Ministry of Health Malaysia


Introduction: Influenza Like Illness outbreak (ILI) is known to be a health problem in institutions. In Malacca, our data shows that for the past three years ILI outbreak in National Service Training Centre (NSTC) accounted for 20% of all outbreaks in Malacca. On 24th Feb 2013, Putra Puteri NSTC reported that large numbers of trainees had symptoms of ILI. Immediate investigation was carried out to verify and describe the outbreak, identify risk factors and recommend control measures.

Methods: Active case finding and case control study were conducted. Case was defined as all trainees of Putra Putri NSTC who presented with high grade fever (axilla >38 C or oral >38.5 C) within 48 hours and with any of the following symptoms: dry cough, nasal congestion/blockage, sore throat/irritation and myalgia from 9th February 2013. Controls was selected among asymptomatic trainees. Environmental assessment included inspection of dormitories and classrooms. 

Results: Thirty-nine (39) cases fulfilled the case definition. The attack rate was 8.2% (39/475). Influenza A virus was detected in 8 of the 10 collected throat swabs. Never hearing information about influenza for the past 1 year was a significant risk factor (OR 2.74; CI 1.21-6.22). Contact with ill family members during holidays and history of vaccination was not significant. On observation, beds in the dormitory were placed too close.

Conclusion: The ILI outbreak among the NSTC trainees was caused by Influenza A. The source of infection could be exposure during holidays. Good knowledge is important to enable individuals to have better attitudes and practices in influenza risk reduction. Education to trainees on cough etiquette, hand hygiene and influenza prevention is essential.

Keywords: Influenza A, Outbreak, National Service Training Center.