Medical Journal of Malaysia

MJM, Vol 70 Supplement 1 September 2015

National collaborative approach in investigating influenza outbreak amongst police staff, Malaysia, 2013

Noor Aizam Mohd Said, Noorhaida U, Intan Azura MD, Rosmawati A, Bina Rai S

Malaysia EIP, Ministry of Health Malaysia


Introduction: Influenza A has been under surveillance in Malaysia since influenza A (H1N1) pandemic in 2009. On 5th December 2013, we were notified of a police staff that died from H1N1 after attending a National Assembly for police staff at Hotel MH Melaka. The rapid assessment team verified the death and learnt that about 400 police staff from all over the country had attended the event, some with similar symptoms, but all had returned. This study aims to describe the outbreak, determine extent and whether all patients were adequately managed.

Methods: Case finding was conducted through screening of all contacts who attended the assembly. The list of participants was obtained from the assembly’s secretariat and sent to the epidemiology officers of all states with structured questionnaire. A case control study using multivariate logistic regression analysis was conducted. Cases were defined as those with influenza-like-illness symptoms. Controls were those with similar exposure without symptoms (1:2). Throat swabs from patients were sent for culture. We reviewed the movements of the index case in the bus, hotel and assembly hall.

Results: A totally of 154 cases were identified. Influenza A (H1N1) was identified in 19 cases (31%). Main symptoms were cough (31.2%), sore throat (21.1%) and fever (13.5%). All had fixed seats in assembly hall.  Proximity to index cases in both assembly hall and room level in hotel as well as state origin was significantly associated with Influenza A.

Conclusion: This Influenza A (H1N1) outbreak amongst police staff spread through close proximity from the index case probably through poor cough etiquette. All symptomatic cases were monitored and treated at respective states. Education on cough etiquette and personal hygiene were given. Cough etiquette important to contain spread of influenza and should be strengthened.

Keywords: H1N1 outbreak, police