EPIDEMIOLOGICAL HEALTH RISK ASSESSMENT

DURING HEAVY FLOOD IN EAST COAST MALAYSIA

Ahmad Faudzi Yusoff, Amal Nasir Mustafa, Tharmarajah Nagalingam, Kee Chee Cheong, Zamtira Seman, Nur Farhanah Khalil

Introduction

History : ‘Bah Merah’ in Kelantan in 1926 and 1967 (38 deaths)Disaster again hits the country, several states heavily affected including

Kelantan-25 December 2014. Immediately Ministry activated Crisis Preparedness & Response Centre

(CPRC) Emergency teams mobilized to the field with a proper preparation. IMR involved doing epidemiological health risk assessment :

Leptospirosis & Melioidosis.

Risk AssessmentFramework

During and post flood

assessment The mode of transmission

PPE(Personal

Protective Equipment)

Environmental factors

Sanitation

Water and food supplies

Host factors: co-morbidity,

activity

Reservoir

Risk Assessment:

Methodology

Questionnaire preparation and discussionFormation of investigation teams.Study design : Case-control study vs Cohort

studyConfidence interval 95% , significant level 0.05,

power of study 80%, sample size estimationRisk estimate : Odds Ratio(OR) vs Relative risk

Epidemiological link Laboratory supportsEnvironmental samplingBriefing and TrainingEthical approval was not required.

Risk Assessment:

Methodology

Briefings&Training

Case definition Suspected cases vs confirmed casesConfirmation of cases : the role of IMR and MKA(KB)

for laboratory diagnosis.Coordination and management of laboratory support.Involvement of the stakeholders.

Risk Assessment:

Methodology

Risk Assessment :

Flood affected areas Health facilities : Hospitals in flood affected

districts , Reference hospitals (Kota Bharu, HUSM and Private Hospitals).

Representative of the state.Visit to the affected areas : During and Post flood.Identification and observation of high risk area of

disease transmission.

Study sites

Site Visit in Affected Area

Melioidosis

Bil District

Number of cases

Suspected

Blood Sample Taken

Confirmed

1 Kota Bharu 97 58 20

2 Kuala Krai 12 9 2

3 Machang 10 9 2

4 Tanah Merah 14 14 0

5 Gua Musang 28 23 7

6 Tumpat 6 6 0

7 Jeli 9 9 1

8 Pasir Mas 8 8 0

Total 184 136 32

Leptospirosis

Bil District

Number of cases

Suspected

Blood Sample Taken

Confirmed

1 Kota Bharu 97 77 23

2 Kuala Krai 12 9 3

3 Machang 10 10 7

4 Tanah Merah 14 14 7

5 Gua Musang 28 23 1

6 Tumpat 6 6 2

7 Jeli 9 9 1

8 Pasir Mas 8 8 3

Total 184 156 47

Lessons learned

Ideally, the investigation teams should be functioning independently during disaster. E.g. Sample collection, blood taking, interviewing patients, sample transportation and logistic preparation.

Full support, commitment and understanding from top management during disaster.

Coordination from relevant department.Sense of urgency, significant of the issues and accountability

Recommendation

Strengthening the coordination and cooperation in laboratory supports.

Risk communication : Public (Awareness )vs Medical Staff (Alertness and awareness).

Team of experts from IMR to be established for flood disaster health risk assessment.

IMR to collaborate with other expert agencies e.g. EIP

Conclusion

It was a successful risk assessment for Leptospirosis and Melioidosis which were carried out and detail results will be presented and published in peer-review journals.

Full financial support.

AcknowledgementsOfficers from:

Unit Epid IMR

Unit Biotechnology IMR

Unit Bacteriology IMR

State Health Department, Kelantan

Thank You