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 26th 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

CASES
MONTH LOCAL IMPORT DEATH TOTAL CASES
April - - -
May - 2 - 2
June 25 133 - 158
July 797 574 4 1371
August 854 601 67 1522
FIGURE1

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 CASES

April - - -
May - - -
June - - -
July 3 1 4
August 38 29 67
FIGURE 3
 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.