AN INVESTIGATION INTO DISEASE OF INFLUENZA A( H1N1) IN MALAYSIA

2.0 INTRODUCTION

This section will discuss the background of the study, the statement of the problem, the

objectives of the study, method use and the limitations of the study.

2.1 BACKGROUND OF THE STUDY

In mid of March, news broke that a new strain of flu virus similar to one seen in pigs was

infecting humans in Mexico. By mid of April, confirmed cases started popping up in the US

and slowly but surely, the virus spread around the world. Then eventually, after much

speculation, the World Health Organization (WHO) officially declared the flu pandemic on

June 11th. It was the first to be classified as such in 41 years, by which point around 70

countries, including Ireland had reported new cases of the virus and the infection was

spreading within communities. As the virus started to spread, the WHO named Influenza

Type A (H1N1) and now refers to it as Pandemic (H1N1) 2009. (Source: World Health Organization,

July 2009)

In Malaysia, based on Ministry of Health the total cases of Influenza A( H1N1) are 1460

cases with 8 death. From 1460 cases that have been reported 574 (39.4%) are imported

cases and 886 (60.6%) are local cases. From this number, 1410(96.5%) cases have been

recovered and only 27 cases or 1.8% is having the antiviral treatment at hospital whereas 10

of them are charged at Intensive Care Unit. 23 individual or 1% is having the antiviral

treatment at home. (Source: Ministry of Health, Malaysia, August 2009)

Influenza A(H1N1) virus is a subtype of influenza virus A and the most common cause of

influenza flu in humans. Some strains of H1N1 are endemic in humans and cause a small

fraction of all influenza-like illness and a large fraction of all seasonal influenza. H1N1 strains

caused roughly half of all human flu infections in 2006. Other strains of H1N1 are endemic in

pigs (swine influenza) and in birds (avian influenza). Influenza A virus strains are categorized

according to two proteins found on the surface of the virus: hemagglutinin (H) and

neuraminidase (N). All influenza A viruses contain hemagglutinin and neuraminidase, but the

structures of these proteins differ from strain to strain, due to rapid genetic mutation in the

viral genome. (Source: Wikipedia, Swine Flu, July 2009)

2.2 STATEMENT OF THE PROBLEM

Malaysia’s position in the worldwide Influenza A(H1N1) has worsened so much, so that The

Ministry Health of Malaysia has forced to call for a shutdown of many schools, education

institutions, colleges as the effect of this dangerous disease. The latest numbers of cases

until 4th August 2009 are 1460 including 8 cases of death which is taken by the research of

The Ministry Health of Malaysia. It shows how serious is this problem in Malaysia. We

investigated the seriousness of H1N1, the causes, symptoms and the potential victims of this

disease.

2.3 OBJECTIVES OF THE REPORT

1) To investigate the seriousness of current disease, H1N1 in Malaysia.

2) To describe the symptoms of H1N1.

3) To find out the causes of H1N1.

4) To find out the potential victims of the H1N1 disease.

2.4 RESEARCH QUESTIONS

1) How serious is H1N1 in Malaysia?

2) What are the symptoms of H1N1?

3) What are the causes of H1N1?

4) Who are the potential victims of the H1N1 disease?

3.0 FINDINGS

3.1 SERIOUSNESS OF H1N1 IN MALAYSIA

Malaysia’s position in the worldwide Influenza A (H1N1) has worsened. Everyday there are

increasing of the H1N1 cases and deaths in our country. The aim of our research is to

investigate the seriousness of H1N1 in Malaysia. The suspected victims “like Influenza

illnesses (ILI) are also increasing from day to day. Even though the number of discharged

victims is occurred every time, the rate of H1N1 victims is still increasing. The Health

Ministry’s estimation that the current mortality rate of those infected is below 0.4% maybe

flawed as the total number of conformed cases reported on August 26 th was 1522 cases and

the total death than was 71 people. Based on that, the mortality has reached 1.5%. (Ministry

of Health, Malaysia, August 2009)

THE TOTAL CASES OF H1N1 FROM APRIL TO AUGUST 2009

MONTHCASES

TOTAL CASESLOCAL IMPORT DEATH

April - - -May - 2 - 2June 25 133 - 158July 797 574 4 1371

August 854 601 67 1522FIGURE1

April May June July August0

100

200

300

400

500

600

700

800

900

Local Case

Import case

Death

FIFIGURE 2

The figure 2 shows the total cases of H1N1 from April to August 2009. In April, there are no cases was recorded. However in May, only two cases were revealed which they are

imported cases. The number of imported cases rapidly increased in June at 133 cases. In July, the number of imported cases rose drastically to 574 cases. For the next month, the cases increased gradually to 601 cases. Despite of that, these cases was the highest registered in five month.

For the local cases, it started with no cases recorded in April and May. However in June, they are slightly increased of local cases which 25 was reported. For the next month, the reported cases were dramatically increased to 754 cases. In August, the cases rose slightly to 854 cases. This figure was the highest cases among the five month. The total cases in August are 1522 which cumulative cases for the five months.

THE TOTAL CASES OF H1N1 AMONG MALE AND FEMALE IN APRIL TO AUGUST 2009

MONTH MALE FEMALE TOTAL CASESApril - - -May - - -June - - -July 3 1 4

August 38 29 67FIGURE 3

April May June July August0

10

20

30

40

50

60

70

80

Female

Male

FIGURE 4

The figure 4 shows the total cases of H1N1 among male and female in April to August 2009. There are no cases reported in April, May and June for both male and female. For male, the number of cases started in July which three cases indicated. The number increased dramatically to 38 cases in August 2009.

In comparison to the total cases of H1N1 for female, there is only one case registered. However this rate of uniformity was not constant and the number increased rapidly to 29 cases in August 2009. The total cases for male almost tripled than female in July.The total cases for both gender are 71 cases which male is higher that female.

3.3 CAUSES AND THE WAYS H1N1 VIRUS IS SPREAD.

3.3.1 Causes of H1N1

Influenza A, H1N1 is a new influenza virus causing illness in people. This new virus was first

detected in people in the United States in April 2009. This virus is spreading from person-to-

person worldwide, probably in much the same way that regular seasonal influenza viruses

spread.

Influenza A, H1N1 caused particular strain of the influenza virus. This particular strain A-

H1N1/09 originated in pigs (swine) but has changed itself to be infective to humans. This

originally infected only pigs and they spread it from one infected hog to other hogs the same

way it spreads in people, by direct contact or by droplets holding the virus in the air after a

pig coughed or sneezed. Because pigs are physiologically very similar to humans, when

they have been living closely with humans, some microbes that can infect them are able to

be changed or mutated into strains that people can catch.

( Wikipedia , 2009 pandemic flu, July 2009)

FIGURE 7

How the Swine Flu evolves.

3.3.2 The ways H1N1 virus is spread.

3.3.2.1 Cough and Sneeze

The main way that influenza viruses are thought to spread is from person to person in

respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or

sneeze of an infected person are propelled through the air and deposited on the mouth or

nose of people nearby. When people who are infected with swine flu cough or sneeze, they

release tiny droplets containing the virus into the air. (Centre of Disease

Control, H1N1 Flu, August 2009)

3.3.2.2 Touching the infected object

Influenza viruses may also be spread when a person touches respiratory droplets on another

person or an object and then touches their own mouth or nose (or someone else’s mouth or

nose) before washing their hands. Anyone who comes in contact with these droplets or

touches a surface (such as a doorknob or sink) that an infected person has recently touched

can catch H1N1 swine flu. Influenza A, H1N1 is infectious in 24 hours before any symptoms

show in the victims.

A person who has swine flu can be contagious from one day before they show symptoms to

seven days after they get sick. Children can be contagious for as long as 10 days. But, the

H1N1 cannot spread by eating bacon, ham, or any other pork product.

(Web MD, H1N1 Swine Flu, September 2009)

3.4The potential victims of H1N1 in Malaysia

People at high-risk for complications of novel influenza (H1N1) virus infection include:

3.4.1. Children younger than 5 years old.

The risk for severe complications from seasonal influenza is highest among children younger than 2 years old. Children are afflicted by many respiratory illnesses and it may be very difficult to distinguish more common acute respiratory tract infections from the Novel Influenza A infection. Besides, children are less likely to present with the classical symptoms of Influenza A infection, namely high grade fever, sore throat, cough, difficulty breathing, headache and myalgia.

Infants may present to the health care worker (HCW) with fever and lethargy, maybe poor feeding and diarrhea and vomiting (acute gastroenteritis being a more common explanation) and no other symptoms or signs related to the respiratory tract. A high index of suspicion is required to make the diagnosis especially if there is a travel history or contact with a case.

Unless early diagnosis is made, the child may deteriorate with symptoms and signs of severe disease which includes; cessation of

breathing, rapid breathing, difficulty breathing, turning blue, dehydration, altered consciousness and irritability.

3.4.2. Pregnant women.

Pregnant women are in the high risk group because of altered immunity, so they are more prone to succumbing to viruses, not just A(H1N1), but any virus. A lot about the virus it is unknown, so we are not sure why it seems to be attacking some people more than others. Then there is the foetus that is another reason why the pregnant woman is at higher risk. Among the many symptoms, fever is one of those that can be potentially disastrous for pregnant women. High fevers can pose problems to mothers and they could have a miscarriage, they can go into premature labour, or have a poor outcome at birth; to babies, it can result in deformities, or cause cerebral palsy.

The first priority is to control the fever when they are pregnant because babies can go into distress.

As for the mother, the complications are very similar to somebody who is not pregnant, which is chest congestion, pneumonia, and acute respiratory distress syndrome.

(Clove two, total woman online,August 2009)

3.4.3. Persons aged 65 years old and above

Persons aged 65 years old and above have higher risk of potential of getting H1N1 because the antibodies in older people are usually decreasing as they getting old. This will cause them less protection from any bacteria or virus because of the less immunity in their body.

3.4.4. Adults and children with asthma, chronic obstructive pulmonary disease, organ failure, cardiovascular disease , hepatic, heamatological, neurologic, neuromuscular or metabolic disorders such as Diabetes Mellitus

Patients with chronic cardiovascular disease and cerebrovascular disease (CVD) are at increased risk of experiencing an acute exacerbation of disease during influenza epidemics. Patients with CVD risk factors such as hypertension, smoking, obesity, and family history of premature heart disease might be considered for priority care over healthy individuals but not before health care providers, the very

young, elderly people, and the ill. Health care providers should be aware that influenza might produce increased numbers of cardiovascular events, leading to increased hospitalizations and use of resources to treat acute coronary events, heart failure, and stroke. Consideration should be given for having adequate supplies of commonly used cardiovascular medications for prevention and treatment of cardiovascular events.

3.4.5. Adults and children who have immunosuppressant (including caused by medications OR HIV infected persons)

In the past, people with HIV/AIDS have not appeared to be at any greater risk than the general population for infection with routine seasonal influenza. However, HIV-infected adults and adolescents, and especially persons with low CD4 cell counts or AIDS, can experience more severe complications of seasonal influenza. It is therefore possible that HIV-infected adults and adolescents are also at higher risk for complications from infection with the H1N1 flu virus.

HIV-infected persons should maintain a healthy lifestyle; eat right, get enough sleep, and reduce stress as much as possible.  Staying healthy reduces your risk of getting infected by influenza and other infections.  Staying health also helps your immune system fight off a flu infection should it occur.

3.4.6. Residents of nursing homes and other chronic care facilities

The residents of nursing homes and other chronic care facilities are also facing of H1N1 because these flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something such as a surface or object with flu viruses on it and then touching their mouth or nose.