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