MBBS 13 Group 1 - All Is Well

Epidemiology of Vector Borne Diseases

   Objectives of the Vector Borne Disease Control Programme (VBDCP)

Ø  Prevent the occurrence of dengue cases

Ø  To control dengue outbreaks

Ø  Prevent reoccurrence of Dengue Fever in priority localities

Ø  Improve Malaria prevention and control activities, especially foreigners

Ø  Prevent the spread of Malaria to the local population

   Strategies of this programme

Ø  Formulations of new policies besides reviewing and updating existing policies from time to time.

Ø  Planning, specifying targets and identifying resources that are needed.

Ø  Setting standards, determining indicators and preparation of guidelines.

Ø  Coordinating vector control activities throughout the country related to approaches and implementation methods.

Ø  Identifying and obtaining resources such as spraying equipment, insecticides and entomological equipments.

Ø  Monitoring activities carried out by the state and other agencies.

Ø  Evaluation of vector control activities.

Ø  Providing technical advice pertaining to vector control strategies and activities.

Ø  Obtaining co-operation from agencies involved in vector control activities.

Ø  Identifying training needs, planning and coordinating training courses with relevant institutions.

Ø  Planning, coordinating and co-operating with relevant authorities in carrying out operational research.

   Organization chart of VBDCP

   Flow of information from peripheral to ministry level

Case notification methods:

ü  E-notificasi

ü  E-denggue

ü  Vecpro

ü  Phone notification

ü  Notification form

  Statistics Data in Kota Setar DHO

Dengue (2006-2010)                  Malaria (2008-2010)           

2006- 610 cases                            2008- 4 cases

2007- 856 cases                            2009- 4 cases

2008- 286 cases                            2010- 4 cases

2009- 179 cases                            2011(7^th ew)- 1 case

2010- 192 cases

2011(5^th ew)- 32 cases

Filariasis no outbreak for the pass 5 years.

  Dengue control activity 

                a) AEDES SURVEY

                b) ABATING                      early morning activity

                c) LARVACIDING

                d) LAW ENFORCEMENT

                e) FOGGING

                f) ULV                                late evening activity

   Malaria control activity

Ø   Monitoring areas abundant with foreign workers- especially Depot Tahanan Imigresen Belantik

Ø  BFMP slides for case detection

Ø  ACD/ PCD

Ø  Focal spraying- Poison is K- Othrine and is available in 2 forms ; the powder form and the liquid form( commonest).

Ø  Medicated Nettings- soaked with K-Othrine and dried up

   Filariasis control activity

Ø  The strategies for controlling Filariasis are the same as for Malaria except that the fogging done for Filariasis is usually done at 5 something in the evening.

Ø  The blood smears for Filariasis can only be taken from 9pm- 12 pm as the antigen only appears in the bloodstream during that time.

   Law enforcement

Regarding the vector control there has been a law which is enacted, Destruction of  Disease-Bearing Insects Act 1975 (Act 154) Akta Pemusnah Serangga Pembawa  Penyakit 1975 (Pindaan 2000).

1.  If there is breeding of Aedes mosquitoes, the premise owner can be compounded immediately not more than RM 500- Seksyen 23 Akta Pemusnah Serangga Pembawa Penyakit 1975 (Pindaan 2000).

2.  If the premise owner fails to pay the compound then the person can be charged as the following:-

          - For the 1^st offence, fine not more than RM 10,000 or imprisonment not more than 2 years or   

            both (Seksyen 23 (a)).

         - For the 2^nd offence, fine not more than RM 50,000 or imprisonment not more than 5 years or  

            both (Seksyen 23 (b)).

  Supervision, monitoring and evaluation

Ø  Data on vector control activities collected were shared through weekly, monthly, quarterly and half yearly returns( Districts          State            National)

Ø  Operation room are operational during outbreak

Ø  Data on control activities are monitored, analyzed and evaluated daily at the operation room at all levels until the outbreak is over

Ø  Officers of VBDCP were required to supervise outbreak control activities in the field to ensure these activities were carried effectively and efficiently.

 by Gomalaa Devee Rajaram

Epidemiology of HIV / AIDS

1.       Objectives & Need of Programmes

q  To prevent HIV/AIDS transmission and to control its spread

q  To minimize the morbidity and suffering associated with the infection

q  To mobilize the government and NGOs’ resources in the fight against HIV/AIDS

q  To promote and enhance international collaboration and cooperation.

2.       Programme strategies

·         Screening for HIV

1. Inmates of rehabilitation centre (1989)
2. Prisoners (at risk)
3. Antenatal mothers (1997)
4. TB cases
5. STI cases
6. Donated blood (1986) /blood products
7. Foreign workers - FOMEMA
8. Blood dependent patients
9. Contact of HIV infected person
10. All occupational sectors
11. Sex workers
12. premarital

·         Notification of HIV/AIDS/AIDS Death

·         Partner Notification

·         Contact Tracing

·         Provision pf Medical Care and Counselling services

·         Treatment For HIV/AIDS

·         Standard Precaution (Universal Precaution)

·         Health Education (PLKN trainees, women, youth, children, sex workers, IDU & partner, school counselors)

·         Voluntary HIV Testing

·         HARM REDUCTION

·         Death Management Programme (Program Pengendalian Jenazah) – for muslim & non-muslim

·         HIV education to religious leader

3.       Implementation of act from district to peripheral level

a.       PPHIV ( Pengendalian Pesakit HIV)

HAART treatment given only in clinics with FMS (Fly Medicine Specialist).  @ Pusat Rawatan 1 (PR1)

Team in PR1 consist of

·         FMS (Pakar Perubatan Keluarga)

·         MO (Pegawai Perubatan dan Kesihatan)

·         MA (Pembantu Perubatan)

·         Nurses (Jururawat Kesihatan / Jururawat Masyarakat)

·         Pharmacist (Pegawai atau Pembantu Farmasi)

·         Caunsellor

Services offered

·         Risk analysis

·         Counseling

o   Pre-test

o   Post-test

o   Pre-treatment , Issues to be covered:

§  Basic knowledge of HIV infection

§  Initial difficulty in determining HIV status of the baby and the necessity of repeating blood testing (PMTCT)

§  CD4/ Viral load

§  Modes of transmission

§  Potential risk of HIV transmission to the neonate

§  Natural history of HIV infection in children.

§  Abstinence from breastfeeding

§  Safe sex / Harm reduction

§   Counseling and HIV testing for the spouse

§  Spouse/ Partner notification

§  Counseling family members

§  Addressing patient’s concerns

§  Need for compliance if starting on ARVT

§  Benefits of HAART for patient

§  Importance of HAART and clinical follow-up .

§  Possible HAART side-effect to patient.

o   Supportive

o   Crisis Intervention

o   Bereavement

·         Lab investigation

o   CD4, Viral load & Serum lactase done in Hosp A.Star

·         Clinical assessment

·         Treatment & follow up

·         Partner notification & contacts screening

·         Reference to hospital and other agencies

·         Home visit

b.      PLWHAS (People Living With HIV/AIDS)

·         Society  for wife of HIV/ AIDS patient

·         In Kuala Kedah

·         Under UNICEF

·         Not active

c.       HARM REDUCTION (Components) – community based project, done by trained NGOs through drop in centers.

·         Health education ( methods of reducing HIV/AIDS, Hep and STD infections)

·         Counselling

·         Screening for HIV, STD, TB

·         Treatment

·         NSEP

                                                                           i.      1 for 1 exchange

                                                                         ii.      Collect and destroy used needles

                                                                        iii.      Reduce HIV incidence among IDUs

·         Drugs Exchange Programme (methadone)

                                                                           i.      Started in OCT 2005 in 4 zones

                                                                         ii.      Under MO supervision

                                                                        iii.      1.7 million spent on methadone (2.3million given)

·         Condom

NSEP : Activities in Drop In Centers (DIC)

IEC – Information, Education, Communication         VCT – Voluntary counseling & testing

Records maintenance

Results will be repeated and in cases involving pregnant mothers, confirmation done as the blood sample is sent to IMR (Institute for Medical Research) and western blot is done. Only results obtained from government lab are valid.

Notification is done when

·         HIV case detected

·         AIDS case detected

·         Death encountered among HIV/ AIDS patient.

~ Difference between hospital and primary care ~

by Mohanajothi Samasuvam

Epidemiology of Tuberculosis

•       Case

–      TB confirmed by bacteriology OR clinician

•       Sputum smear exam:

–      Positive: 2 +ve smears OR 1 +ve smear with either culture +ve/radiological abnormalities of active pulmonary TB

–      Negative: 3 –ve smears but with TB symptoms and X-ray abnormalities/culture +ve

•       3 Sputum sample to be taken. (At least 1 early morning sample- overnight accumulation of secretions which has highest yield of AFB) 

•       For outpatients, collect 1 sample at the time of presentation (known as spot specimen). Suspect given 2^nd sputum container for collection on the following morning and it is being sent to the laboratory. When the patient returns the morning specimen, another spot specimen is collected. (spot…. Smear… spot)

•       For hospitalized patients, early morning sputum taken for 3 consecutive days.

A.      DOTS Strategies

o   Government commitment to a national TB Control Programme

o   Case detection through sputum smear microscopy examination of TB suspects in general health services.

o   A standardized short course TB treatment regimen of 6 months under direct supervision of trained supervisor to ensure the patient takes every dose of medication.

o   A regular uninterrupted supply of quality anti-TB drugs

o   A monitoring and reporting system to evaluate treatment outcome to each and every patient with proper documentation.

B.      First line drugs

o   Isoniazid (H)

o   Rifampicin (R)

o   Streptomycin (S)

o   Pyrazinamide(Z)

o   Ethambutol (E)

C.      * 2^nd line drugs not being used in Malaysia

D.      Treatment regimens

·         Intensive phase – daily doses for 2 months

·         Maintenance phase – thrice weekly doses for 4 months.

1.       Implementation of activities

                    I.            Home visit done weekly with specialist permission in cases involving bed ridden and old age patient.

                  II.            2 weeks after initiating treatment

a.       review result

b.      Look for any allergic reactions

                III.            Referral to hospital done only when the problems related to treatment is not overcome.

Kota Star District has a total of 10 KK. Out of these, KK Bandar Kota Star functions as Pusat Rawatan 1 (PR1)/ Treatment Centre 1 and there are 6 KK functions as Pusat Rawatan 2 (PR2).

Activities in PR1 (Personnel involved in PR1 are MO/Specialist, Nurses)

·         Diagnose TB

·         Initiate treatment

·         DOTS

Activities in PR2 (Personnel involved in PR2 are Nurses, MA)

1.       Maintenance of records and reports

·         TBIS (done manually)

·         Borang 101D (record patient’s compliance)/ Buku rawatan (separate for infectious and non-infectious TB)

·         Borang 10A-1, 10A-3,10A-4, 10C-1, 10C-2

Buku rawatan TB (Yellow for infectious cases - sputum smear +ve and white for non infectious – extrapulmonary TB, sputum –ve smear)

 Programme monitoring & evaluation

DOTS under supervision of Nurses, MA, trained family members.

A.      Investigation done by IK (Inspektor Kesihatan)

                                I.            Call patient

                              II.            Visit to patient’s house (done about 2 weeks after reporting/ as soon as patient is on treatment)

Default in Treatment (Pt missed >25% treatment doses in a month : > 6 doses of daily treatment, >2 doses of biweekly treatment) 

by Mohanajothi Samasuvam