UNCLAS SECTION 01 OF 03 KUALA LUMPUR 000555

SENSITIVE
SIPDIS

STATE FOR CA/OCS/EAP
STATE FOR M/PRI FOR RMORRITZ
STATE FOR S/ES-O/CMS FOR EPARRA
STATE FOR EAP/MTS FOR DBISCHOF
STATE FOR OES/AIAG FOR AMBASSSADOR LOFTIS, DWINN AND
CPATTERSON
STATE FOR REO/BKK FOR HHOWARD
STATE FOR OES/IHB, AAIT, MED
HHS FOR OGHA STEIGER AND HICKEY
CDC ATLANTA FOR CCID AND COGH
USDA FOR APHIS

E.O. 12958: N/A
TAGS: KFLU AEMR ASEC AMED CASC KFLO TBIO KSAF KPAO PREL
PINR, AMGT, TF, MY
SUBJECT: MALAYSIA H1N1 UPDATE - July 9, 2009


1. (SBU) SUMMARY: Influenza A (H1N1) cases continue to grow in
Malaysia with over 300 new cases in the last week. Most cases
continue to be imported but about one-third involve local
transmission. The Ministry of Health (MOH) reported the first case
of second-generation local transmission on July 5. The MOH is
gradually transitioning from containment to mitigation and its
current measures involve aspects of both approaches. MOH expects to
move toward more mitigation activities as local transmission
increases compared to imported cases. While Malaysia's transition
from containment to mitigation has created some unclear messages and
observed inconsistent implementation, the local WHO representative
is satisfied that Malaysia's overall approach is appropriate and
generally effective. END SUMMARY.

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Growing Case Load
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2. (U) MOH has confirmed a total of 513 cases of H1N1 with 317 new
cases occurring in the last week. Most cases continue to be
individuals who were infected abroad and then traveled to Malaysia.
However, there are a growing number of local transmissions. MOH
also reported the first instance of second-generation local
transmission on July 5. All cases continue to show improvement with
Tamiflu treatment and there have been no deaths. In fact, 430 of
the 513 confirmed cases have already fully recovered and been

released from quarantine.

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Containment Transitioning to Mitigation
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3. (SBU) MOH has been pursuing a strict containment strategy with
regard to H1N1. Border screening including thermal scanning was
required for all travelers entering Malaysia. Immediate in-hospital
quarantine for one week was mandatory for all H1N1 positive
individuals. Close contacts of infected individuals also faced a
week-long quarantine period; however, this could take place at home.
With the increased caseload and limited lethality of H1N1, MOH has
shown signs of relaxing this containment policy and moving more
toward a mitigation approach. However, health minister Liow Tiong
Lai has stated that MOH will only adopt a complete mitigation
strategy "when there is sustained local transmission and the sources
of the flu cannot be traced." The inter-ministerial pandemic
response committee met on July 8 to discuss the next steps for
moving away from containment but a formal policy change is still
forthcoming.

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Surveillance
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4. (SBU) As part of the gradual shift toward a mitigation approach,
screening, testing, and quarantining protocols have been adjusted.
MOH border surveillance will continue for the time being, including
a mandatory health declaration card and thermal scanning. MOH
policy instructs that all passengers, local and foreign, submit to
this screening. As an example of the shift away from strict
containment, Dr. Devan Kurup, MOH Principal Assistant Director for
Infectious Disease Surveillance, informed ESTHoff that only
foreigners are being screened at the Singapore land crossing due to
logistical considerations. However, ConGen observed on July 5 at
the Singapore-Malaysia land crossing that only those individuals who
obviously appeared to be Western were put through any H1N1
screening.

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Testing
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5. (SBU) MOH policy dictates testing of symptomatic individuals at
MOH hospitals and ports of entry to be done by a throat swab.

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Individuals with relevant health complications and risk factors
(including pregnant women, those with respiratory illness, obese
individuals, and children) and passengers who have traveled to the
United States, Melbourne, or Manila will have their samples sent to
the Institute of Medical Research (IMR) with results available
within a few hours. They are also given two days of antivirals and
released to home quarantine until the test result is returned. For
most other individuals, the sample is sent to the National Public
Health Laboratory with results available approximately 24 hours
later. These individuals are released to home without antivirals
and asked to call MOH to obtain the results of the test.

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Quarantine
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6. (SBU) Confirmed positive cases are still required to be brought
to a MOH hospital for quarantine and treatment. Individuals may now
be released from quarantine if they have had no further
complications, had at least three days of antiviral treatment, and
no fever in the last 24 hours. This has resulted in most patients
being released from quarantine in three or four days, down from the
previously mandated seven day quarantine period. Children are
required to quarantine for a minimum of five treatment days.
However, MOH continues to publicly state that the quarantine period
is seven days and Post has observed inconsistencies in the
implementation of MOH's policy.


7. (SBU) While most patients are now released prior to the seven day
quarantine period, one AmCit family experienced a longer period. A
young AmCit girl was confirmed positive for H1N1 on July 4 after
reporting to MOH with symptoms on July 2. The girl and both parents
were placed under quarantine on July 4 and remained in quarantine
until July 8 with no complications or further symptoms, thus
fulfilling four days of treatment. However, MOH ordered the family
to complete three more days of quarantine in their hotel, which was
inconsistent with MOH protocol. ESTHoff and ConOff were able to
intercede with MOH to obtain the release of the family on July 9.

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Close Contacts
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8. (SBU) MOH is still attempting to trace all close contacts of
confirmed cases but has reduced the amount of resources spent on
this tactic. "Close contacts" has now been defined as those who
live in the same house or those who have sustained close contact of
less than three feet for more than four hours. These individuals
will be given prophylaxis antiviral treatment assuming contact was
within the last 48 hours.


9. (SBU) Close contacts are asked now to "self-quarantine" rather
than "home-quarantine" as before. This distinction is to indicate
that there will be no MOH enforcement of the quarantine.
Previously, MOH had made several public statements reminding
individuals that they must undergo the quarantine subject to the
Prevention and Control of Infectious Diseases Act 1988. As another
example of unclear messages from MOH, the mother of the
abovementioned AmCit child who tested positive for H1N1 was asked on
July 4 to quarantine in her hotel room. This mother reported to
ConOff that, contrary to MOH's stated softer approach, she was told
she faced two years imprisonment if she left her hotel room.

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Policy and Implementation
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10. (SBU) Dr. Harpal Singh of WHO's Malaysia office told ESTHoff on
July 7 that WHO is generally pleased with Malaysia's policy
approach, notwithstanding the abovementioned inconsistencies in
policy implementation. He pointed to the relatively slow rate of
local infection in Malaysia as a sign that the containment measures

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were actually working, mentioning neighboring Brunei as an example
of containment measures that did not work. He also said that
Malaysia's gradual movement toward mitigation was appropriate at
this juncture.


KEITH