Kuala Muda District - Vector Unit

Kuala Muda DHO Posting
Third Day (7th July 2009)

First Session
Venue : Vector Unit (PPKP Office)
Time : 8.00 am
Topic : Briefing on Vector Unit
Person in charge : PPKP Burke Patrick Lummuria

Organizational chart of Vector Unit Kuala Muda:

The Vector Unit of Kuala Muda is headed by PPKP(K) Nordin Omar under which there are 3 PPKP and 1 AKS (Insect Analyst). The 3 PPKPs are:
- PPKP Burke
- PPKP Zamani
- PPKP Rosli
and the only AKS in Kuala Muda (covering for Southern Kedah area) is Puan Mas.

The vector unit is equipped with 11 PKAs, 18 PRAs and 4 drivers. The unit also possesses 1 van, 2 pajeros, 2 land rovers and 2 pick-up trucks to assists in operations.

The programmes handled by vector unit include:
- Active case detection (ACD)
o House visits, take blood sample
- Passive case detection (PCD)
o Data, notifications and samples are obtained from other medical and health facilities
- Case investigations/Case follow-up
o To identify sources of infection, contact tracing
- Spraying operations
o Malaria control spraying (regular, special, focal)
o Thermal fogging, ULV
o Fumigations
- Anti-larval operations
o Abate 500 E
- Health education
o Demonstrations, exhibitions
- Records and documentations

Additional highlights:

In the DHO setting, an outbreak is defined as 2 or more cases reported in a certain locality within 14 days. This incident mobilizes multiple task force and an organized plan as well as actions are carried out. When an outbreak occurs, the medical officer from the public health department is notified and he or she decides the course of action need to be taken for containment and prevention measures. If an outbreak is declared, the PPKP officers fill the outbreak survey form with tedious details of the cases that are reported daily. This will continue daily till the outbreak ends. Meanwhile, a set of team is organized for the outbreak control. Mr. Burke Patrick, PPKP involved in the dengue prevention unit explained the task of the ‘morning team’ and the ‘evening team’. The morning team involves aedes surveillance where a thorough house to house check is carried out to identify potential aedes breeding spots within the area. Enforcement takes place when officers face problems with difficult residents who refuse to cooperate. Notices and compounds are sent out. For the evening team, the officers are mainly responsible for fogging of a designated area.

Second Session (Outdoor activity)
Venue : Taman Seri Utama (Gurun)/ Taman Kempas (Sungai Petani)
Time : 10.00 am
Topic : Aedes Survey
Person in charge : PPKP Burke Patrick Lummuria

The aedes surveillance activity was conducted from house to house. There were 10 officers from the vector unit sent to Taman Seri Utama to conduct the survey. They are separated in 5 groups (Each group consists of 1 Pegawai Kesihatan Am; PKA and 1 Pegawai Rendah Am; PRA). The teams were distributed to cover different areas of the residential neighbourhood (Each house has to be visited without exception). In regard to the visit to the houses, certain rules and regulations apply:
- Officers have to introduce themselves fully and briefly explain the purpose of the visit
- Consent has to be given verbally by the resident before entering house
- If the only resident left at home is younger than 18 years old, consent is invalid
- If the house is not occupied, officers may enter the outside compound of the house if the gate is not locked (if the gate is locked, entering is prohibited)

Upon receiving consent, officer proceeded with acquiring data as follows:
- The address of the house
- The name of the owner of the house
- The number of residents living permanently in the house
- Is there anyone living in the house suffers from fever?
- When was the house last inspected by officers from district health office?

All these data were recorded in a survey form. Upon entering the house, officers went directly to the washroom and inspected the ‘kolah’ and also the ‘flush pot’ of the toilet for any presence of mosquito larvae. Inspection was done by using a special ultra-bright flashlight. Regardless of the result of the inspection, these places are medicated with abate 1.1. Inspection was also done inside the house, looking at other possible places where mosquito larvae may breed. The next place that was inspected was the back of the house, followed the outside compound around the house. In the event of positive findings of mosquito larvae, sample are taken with pipette and kept in a small sealed container. The container is properly labelled with the date of the inspection, the address of the house, the name of the inspector and also the area where the samples are taken (i.e within the house, outside the compound of the house). Depending on the circumstances, the officers will either issue a ‘cleaning notice’ or a ‘compound notice’. If a cleaning notice is given, the resident has 7 to 14 days to properly clean the area of his/her house and make sure that there is no more breeding site found when the next visit is done. If compound is given, the resident has to pay the fine accordingly:
- residential houses : RM 100
- shop houses : RM 150
- school : RM 300
- factory : RM 500

Appeal can be made in the office of vector control units, as the main idea for the fine is not monetary but instead, to make the public realize the important of vector control. Usually, the appeal will bring about 50-70% discount from the maximum value of fine.

Health education is also another important part of the aedes survey. After the house was inspected, the resident was given pamphlets regarding the dengue fever and ways for the public to help the local health authority fight the ‘battle’.

Additional highlights:

There are priorities given for aedes surveillance to certain areas with high chances of dengue outbreak and they are graded according to their number of cases usually found. For example 16 prioritized locations 1 are areas with high number of cases in Kuala Muda district:

- Taman Sri Tanjung, SP
- Taman Keladi, SP
- Taman Permai, SP
- Taman Orkid, SP
- Taman Ria Jaya, SP
- Taman Arked, SP
- Bandar Baru Sg. Lalang, SP
- Flat Paya Nahu, SP
- Taman Murni, Gurun
- Taman Sri Utama, Gurun
- Taman Gurun Jaya, Gurun
- Taman Sri Impian, Tikam Batu
- Taman Melati, SP
- Taman Sejati Indah, SP
- Taman Ria, SP
- Pekan Bedong, SP

Prioritized locations grade 2 comprises locations with sporadic cases while grade 3 describes crowded areas such as factories, school hostels etc.

Third Session
Venue : Vector Unit (PPKP Office)
Time : 2.30 am
Topic : Briefing on Fogging
Person in charge : PPKP Burke Patrick Lummuria

All the poisons used for fogging are environmental friendly (the poison will not kill other animals or insects other than mosquitoes, therefore will not adversely affect the food chain). The types of poison used in fogging are as follows:
- aqua-resigen
o water-based
o class IV
- resigen
o water-based & oil-based
o class III
- malathion
o oil-based
o class II
- sumithion (not used in Kedah)

In fogging, officers will prefer to use the lowest class poison first. This is because, apart from the fewer side effects that it might cause, it will also allow for ‘backup’ poison if the one used does not work. Proper technique of fogging is also an issue. This is very important because ineffective fogging will cause the vector to develop resistant towards the poison.

Other poisons used by the vector unit include:
- Abate 500 Emulsion
o Used for larvaciding only

Two types of fogging used by Kuala Muda Vector Unit are Thermal Fogging and Ultra-Low Volume Fogging (ULV). For the thermal fogging, the machines used are the Agrofog 35 model with two available variants (electric starter and spark plug mechanism). Kuala Muda Vector Unit currently owns 14 of these machines with each one costing around RM 5000+. All advance maintanence of the machines is done by specialist technician sent by federal engineering unit from Kuala Lumpur. For the ULV, the main machine is mounted at a back of a 4-wheel drive vehicle. The vehicle will travel at a speed of 5-8 kilometres per hour with the nozzle of the fog machine pointed at an angle of more than 45 degrees. The poison of choice for ULV is either aqua-resigen or pure malathion. A ULV operation with 22 liters capacity (20 litres of water + 2 litres of aqua-resigen) can cover up to 400 to 500 houses.

Fogging is done 48 hours after notification of cases and the area of operation should cover about 200 meters radius from the patient’s residence & usually, vector unit will send out 4 thermal fogging to operate first before topping up with ULV after that for a wider coverage. ‘Contraindications’ for fogging operation includes:
- Funeral services
- ‘Kenduri’ or ‘majlis keramaian’

Fourth Session (Outdoor activity)
Venue : Taman Ria Jaya
Time : 5.30 am
Topic : Thermal Fogging Session
Person in charge : PPKP Burke Patrick Lummuria

The fogging session was done at Taman Ria Jaya, Sungai Petani and the coverage was targeted around a house in which a dengue case has been notified beforehand. The fogging team from the Kuala Muda Vector Unit that afternoon consists of 1 PPKP, 2 drivers and 4 PRAs. The first step was to notify all the residents of the areas concerned about the commencement of the operation. The residents were advised:
- To come out from their house and stay outside temporarily for 5 minutes while the inside of their residences were fogged.
- To cover all the consumable products within the house

Then, the agrofog machines and all the personnel involved in handling the machines were prepped. The personnel were equipped with PPE (personal protective equipments) as a protective gear. These include:
- filtered mask (nose & mouth piece with carbon-activated filter placed within retainers)
- eye goggle
- safety gloves
- whole-body protective suit
- safety boots

The fogging was done simultaneously from different directions and they also moved in parallel to each other to ensure no place was missed. The fogging operation took a little over 2 hours to be completed.