2009 swine flu pandemic in malaysia 2009 swine flu pandemic in malaysia the 2009 flu outbreak in malaysia was part of a larger flu pandemic involving a new type of influenza a virus subtype h1n1 (a (h1n1)) virus. as of 11 august 2009, the country had over 2,253 cases, beginning with imported cases from affected countries, including the united states and australia from 15 may 2009 onwards, and the first identified local transmission on 17 june 2009. from 12 august, the malaysian health ministry said that it had discontinue officially updating the total number of h1n1 cases within malaysia in line with guidelines issued by the world health organization. as of 21 august 2009 the unofficial number of cases reported in the media is 5,876 so far. the first death related to the a(h1n1) virus was reported on 23 july 2009 and so far there have been 78 deaths reported. on 6 july 2009 malaysia announced that it was shifting from containment to mitigation to tackle the spread of the virus. the federal government had declared a national health emergency in malaysia because of the a(h1n1) outbreak and was considering imposing a health curfew similar to the week-long shutdown of non-essential services and industries in mexico. outbreak evolution in malaysia: deaths confirmed cases total cases cases deaths laboratory confirmed estimated confirmed(suspected) malaysia 2,253(5,876) 15,000+ 78 total cases cases imported transmissions localtransmissions malaysia 574 1,679 government measures the malaysian government has started to stockpiled more than 2 million doses of tamiflu, influenza antiviral drug in case of an outbreak of the virus since the nipah virus outbreak in 1999, the malaysian health ministry have put in place processes to be better prepared to protect the malaysian population from the threat of infectious diseases. malaysia was fully prepared during the severe acute respiratory syndrome (sars) situation (malaysia was not a sars affected country) and the episode of the h5n1 (bird flu) outbreak in 2004. the malaysian government has developed a national influenza pandemic preparedness plan (nippp) which serves as a time bound guide for preparedness and response plan for influenza pandemic. it provides a policy and strategic framework for a multisectoral response and contains specific advice and actions to be undertaken by the ministry of health at the different levels, other governmental departments and agencies and non-governmental organisations to ensure that resources are mobilised and used most efficiently before, during and after a pandemic episode. according to the malaysian ministry of health, headed by liow tiong lai, health screenings were carried out on passengers travelling to and from mexico via sea, air and land beginning 17 april 2009. the health ministry's disease control division has activated its operations room to monitor the swine flu situation and informed medical practitioners who are treating cases with symptoms of influenza-like illness or severe pneumonia and persons who had visited mexico, california or texas to inform the district health office immediately for preventive and control measures. as has several asian countries, thermal scanners had been installed at entry points at the kuala lumpur international airport (klia) following the start of the global alert on the flu. screenings were imposed in pengkalan hulu, at the border with thailand, in late april. quarantine rooms had been allocated in 28 hospitals, and the country has stockpiled more than 2 million doses of tamiflu, as of may 2009. the malaysian health ministry has warned malaysians not to withhold health information to the authorities saying that those doing so could be fined rm10,000 or jailed two years or both if they are found guilty under the disease prevention act 1988. on 18 june 2009 malaysian deputy prime minister tan sri muhyiddin yassin declared that all visitors and malaysians returning from abroad will be required to fill the health declaration form following the influenza a (h1n1) pandemic around the world. mitigation of the virus on 17 august, the government said that will consider declaring a health curfew if the mortality rate of influenza a(h1n1) is above 0.4% from the current 0.1%-0.3%. health minister datuk seri liow tiong lai said that they are currently treating the flu as a "health emergency". mask use health minister datuk seri liow tiong lai urged the public to wear a mask if showing symptoms of the flu. school closures in response to the country's first case of a (h1n1), the health ministry urged calm among the populace "as the situation is under control" and "the ministry has taken all the possible precautionary measures to control and contain the disease after the who issued a level-five alert." in addition, schools were issued strict hygiene procedures on 16 may to contain any h1n1 outbreak among students and teachers. sekolah rendah kebangsaan assunta 1 in petaling jaya became the fourth school to be closed in a week. a (h1n1) cases the country had reported no suspected cases before 4 may 2009, but all cases tested negative between 4 and 15 may. the 2009 fobissea primary tournament in kuala lumpur was cancelled due to an unidentified student who was found to have contracted the virus whilst at the airport. teams from british international schools throughout south-east asia were immediately sent home and quarantined. 15 may – 10 june on 15 may, the health ministry confirmed malaysia's first case of a (h1n1) infection of a 21-year-old male student who had arrived at the klia on 13 may via a malaysia airlines flight (mh091) from newark and on transit at stockholm-arlanda airport, followed by a second case on 16 may of a female student in penang who shared the same flight as the first patient and boarded an airasia flight (ak5358) from klia to penang international airport. this makes malaysia the 36th country to detect a (h1n1) within its borders. the first patient has been hospitalised at the sungai buloh hospital, while house quarantines were undertaken on two of the second patient's friends who boarded the same flight, along with their family members. all passengers of the flights were also asked to contact the health ministry or head to any hospital, clinic or health office or further action, and crew members of mh091 and ak5358 were located and grounded. as the first patient has indicated, the use of thermal scanners is revealed not to be entirely effective as symptoms of his flu had yet to manifest; the health ministry resumes the use of the scanners nevertheless. thermal scanning for swine flu at singapore airport on 4 june, three additional inbound airline passengers were reported to be carrying the virus. the earliest of the three is a 23-year-old male student who returned from united states on 1 june via the same malaysian airlines flight (mh091) that the first cases of a (h1n1) were detected. on the same day, two german tourists and friends (aged 30 and 32) who were holidaying in southeast asia and arrived in malaysia were confirmed to be infected with the virus; both had flown into the country on 3 june via an air asia flight (ak702) after transferring from a singapore airlines flight (sq45) from germany to singapore on 1 june. the third reported victim developed symptoms on 3 june and was hospitalised in tunku jaafar hospital, while the two tourists developed symptoms while in kuala lumpur on 3 june and were given similar medical treatment. all three patients were reported to be stable. as it has been for the last two cases, passengers sharing both the malaysian airlines and air asia flights are being traced. on 5 june, sixth case were reported from a student who took the same flight with the fourth patient. on the next day, a girl from australia was confirmed to be infected with influenza a (h1n1) when the airport scanner detected severe fever making her the 7th confirmed case overall in malaysia. 10–20 june on 10 june, two new influenza a(h1n1) cases had been detected in malaysia. the eighth case involved a 17-year-old american student who accompanied her parents for a holiday in the country. the ninth case was a new zealand national who arrived in the country at 7.30am on 5 june on an air asia flight dx7 2723. malaysia recently registered two more cases of the disease, bringing the total to 11 cases. the 10th patient in the country was a 17-year-old girl who had just returned from a holiday in melbourne, australia on 9 june. the 11th patient was a 41-year-old woman who had returned from manila to penang on 6 june. a 12th case was reported on 13 june 2009 whereby a 19-year-old medical student was returning to malaysia after a 17-day holiday in melbourne. as of 15 june 2009, the total number of cases have increased to 17, with an addition of 5 new cases. the 13th case was a 12-year-old student who returned from a holiday in manila. the 14th case was a british tourist, hospitalised in kuantan after showing symptoms in pulau tioman. the 15th and 17th cases involved malaysians who recently came back from melbourne, both being currently hospitalised in sungai buloh hospital. the 16th case involved an american resident, currently hospitalised in queen elizabeth hospital in kota kinabalu, sabah. a filipino man was confirmed as the 18th victim of influenza a (h1n1) in malaysia, after being detected as having a fever and cough during the screening process when he arrived at the kl international airport from manila. malaysia recorded its first local infection of influenza a(h1n1) on 17 june 2009 involving the 19th case as that person had no history of having travelled to a country that had the flu. a 20th case was reported whereby a 23-year-old local public university male student who made a seven-day study visit together with 12 students and lecturers to melbourne, returned from melbourne aboard air asia x d7 2723 and landed at the low cost carrier terminal on 17 june. the 21st case came about with a 20-year-old medical student of a melbourne university who returned to holiday in malaysia aboard mh 128 and arrived at the klia on 16 june. the 22nd case showed that a 54-year-old man who had travelled to manila on business on 9 june and arrived at klia on 12 june. it was reported that the 23rd case was a 22-year-old female malaysian student who arrived from melbourne by air asia at the lcct on 14 june. on 18 june 2009 the crisis preparedness and response centre in malaysia reported there were four imported cases of influenza a(h1n1), bringing to total of 27 cases overall. on 19 june 2009 director-general of health tan sri dr mohd ismail merican said that eight new influenza a(h1n1) cases were detected bringing the total number of cases of the disease in malaysia to 35. the 35th case is a 20-year-old male malaysian student who is studying in a university in melbourne and has been there since january who came back to malaysia for a holiday. 20–30 june on 20 june 2009 7 new cases of a(h1n1) were reported bringing the total number of confirmed cases so far to 42. one of the new cases included a local transmission of the virus whereby an 11-year-old student of sekolah jenis kebangsaan cina (sjkc) davidson, kuala lumpur, contracted the virus from her grandmother who was 31st case confirmed. on 21 june 2009, eight more cases confirmed. three of them were students from sjk(c) jalan davidson who contracted the virus from the 31st patient, which brought the total of confirmed cases in the country soaring to 50. sjk(c) jalan davidson had also been closed and more than one thousand people in the school had been quarantined. on 22 june 2009 it was reported that there were 8 new cases of a(h1n1) in malaysia bringing the total number of confirmed cases to 58 overall. the 51st case is a three-year-old girl who returned from a week-long holiday in melbourne on 19 june with her parents on mh 148. the 52nd case is a 35-year-old mas air steward who was on duty on mh1 delta from london and arrived in klia on 18 june. the 53rd case is a 27-year-old woman who returned from a holiday in sydney with her husband on 16 june on mh 122. she is in kuala lumpur hospital. the 54th case is a 25-year-old woman who