Identifier
Created
Classification
Origin
09KUALALUMPUR621
2009-07-30 01:09:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Kuala Lumpur
Cable title:  

MALAYSIA H1N1 UPDATE - July 29, 2009

Tags:  KFLU AEMR ASEC AMED CASC KFLO TBIO KSAF KPAO PREL 
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VZCZCXRO9771
RR RUEHAST RUEHCHI RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHKL #0621/01 2110109
ZNR UUUUU ZZH
R 300109Z JUL 09
FM AMEMBASSY KUALA LUMPUR
TO RUEHC/SECSTATE WASHDC 3034
INFO RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHGV/USMISSION GENEVA 1754
RUEKJCS/SECDEF WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
UNCLAS SECTION 01 OF 02 KUALA LUMPUR 000621 

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 29, 2009

UNCLAS SECTION 01 OF 02 KUALA LUMPUR 000621

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 29, 2009


1. (SBU) SUMMARY: The Malaysian Ministry of Health reported the
third and fourth Influenza A (H1N1) related deaths on July 29.
These deaths both involve local transmission of H1N1. The total
number of locally transmitted cases now exceeds the number of
imported cases. In the first three cases, the individuals were
treated at private hospitals and clinics and were not tested or
treated for H1N1 for at least several days after showing some
symptoms. In the fourth and most recent death, a 20 year old woman
was treated at a MOH hospital but she did not report any symptoms
until 11 days after onset. Minister of Health Liow Tiong Lai has
expressed his concern and "discomfort" with the worsening situation
and has called on private hospital to be more vigilant with regard
to H1N1 surveillance and treatment. Malaysia continues to define
its mitigation approach and MOH has announced they will preorder the
H1N1 vaccine. END SUMMARY.

--------------
H1N1 Deaths
--------------


2. (SBU) The fourth and most recent H1N1 related death in Malaysia
was reported on July 29. A 20 year old woman sought treatment at a
MOH hospital in Malacca on July 26, reportedly 11 days after she
began experiencing symptoms. Her condition worsened on July 27 and
she was tested for H1N1. She passed away on July 28 before the
results of the test were known. MOH reported that the individual
was obese.


3. (SBU) MOH reported on July 29 that a 42 year old Malaysian man

had died from H1N1 related causes on July 27. He reported to a
private clinic on July 6 with flu-like symptoms but was not referred
to the hospital until July 18. The man was treated for 10 days in a
private hospital and developed pneumonia. The hospital did not
perform a throat swab to test for H1N1 until July 22. The
individual reportedly was infected locally and not overseas, making
this the first death involving local transmission. Health Minister
Liow Tiong Lai expressed concern that the individual was not treated
for H1N1 early enough; like the prior two deaths, he was not treated
at a MOH designated hospital and flu-like symptoms were reported
several days before any H1N1 tests or treatments were performed. He
urged private clinics and hospitals to be more vigilant.


4. (SBU) Malaysia's second H1N1 related death involves a 46 year old
Malaysian man who passed away on July 26 after testing positive for
H1N1. He reportedly traveled to Langkawi with his family on July 13
where he developed flu-like symptoms, although MOH suspects he may
have encountered the disease while traveling in Europe. The man
went to a private hospital in the Kuala Lumpur area on July 16 and
was given a chest x-ray, which showed pneumonia. He was admitted to
the ICU of a different private hospital on July 19. MOH confirmed
he was positive for H1N1 on July 22 and he died four days later. It
is unclear why he was not tested sooner and at what point, if ever,
he received antiviral treatment. MOH did not disclose any
complicating preconditions about the victim, something they were
quick to do with the first death case.


5. (SBU) Malaysia's first H1N1-related death was reported on July

24. A 30 year old Indonesian student entered Malaysia on July 5
with flu-like symptoms. He reportedly fainted at a private medical
facility while waiting for medication on July 21 and died that same
day. Minister of Health Liow Tiong Lai stated, "Influenza A (H1N1)
was not a direct cause of his death" and described the individual as
obese with a heart condition.

--------------
Clusters of H1N1
--------------


6. (SBU) Malaysia reported a total of 1219 confirmed cases from the
start of the pandemic until July 28. MOH has not estimated how many
H1N1 cases may be positive but not reported. MOH reports that
approximately 53% of these cases were locally transmitted. Local

KUALA LUMP 00000621 002 OF 002


transmission has far outpaced imported cases in the last two weeks.
Liow had previously stated on July 27 that the situation in Malaysia
was confined mostly to clusters of infection with a few isolated
cases with limited community transmission. The latest death
prompted a much more grim assessment from Liow. He stated that
there were 95 new cases of local transmission in the last 24 hours
with 19 new clusters of infection. However, MOH has reported that
almost 98% of all confirmed cases have already fully recovered.


7. (SBU) MOH has publicly adopted a mitigation approach after slowly
transitioning from a strict containment policy. This means that
some surveillance measures have relaxed. Airport screening has
loosened with health declaration cards still being distributed but
ESTHoff observed that the cards are often not collected. The cards
primarily served to help health screeners identify if passengers had
traveled to countries with local transmission of H1N1. This
information is no longer helpful now that Malaysia and all of its
major transit points meet that criterion.


8. (SBU) While MOH has shifted away from a containment strategy,
this message still has not completely filtered down, leaving some
inconsistent implementation. The Ministry of Education (MOE) issued
guidance on July 17 requiring all schools to form a special unit for
H1N1 monitoring. This MOE circular asked all schools to require
students traveling back to Malaysia from overseas to receive a
medical certificate of good health before returning to class. This
requirement does not apply to students already in Malaysia. This
guidance supersedes the previous instruction that all students
returning from overseas must undergo seven days of home quarantine
prior to returning to class regardless of whether or not they
exhibit any symptoms. However, MOH Principal Assistant Director for
Infectious Disease Control Dr. Devan Ramu has stated this policy is
outdated even though MOE has not said so. Until MOE clarification
is received the International School of Kuala Lumpur (ISKL) will
follow the July 17 protocol and the Embassy will set up additional
hours in the medical unit to examine Embassy children returning from
summer vacation or other travel.

--------------
Flu Vaccine
--------------


9. (SBU) MOH confirmed on July 15 that it would place orders for the
H1N1 vaccine. Once the vaccine is available, MOH plans to vaccinate
the 200,000 "frontliners" first, including police, health, and
immigration officers.

KEITH