Sik District

DAY 4
Date: 9th July 2009
Venue: Meeting room, Pejabat Kesihatn Daerah Sik
Topic: Investigation of an Outbreak
Person Incharge: Mr. Jamil Osman ( Penolong Pegawai Kesihatan Persekitaran)

1.1 Definition
1.1.1 Outbreak of Dengue - Occurrence of 2 cases in a specific location within 14 days.
1.1.2 Outbreak of Malaria
a) Malaria Endemic Area - Occurrence of 2 or more local cases, or Occurrence of cases over 3 months.
b) Malaria Prone Area - Occurrence of one local case, or one introduced case, or 5 cases in a month.
c) Malaria Free Area - Occurrence of one local case, or one introduced case, or 5 cases in a month.
1.1.3 Outbreak of Cholera - Occurrence of one or more cases in a specific location.
1.1.4 Outbreak of Food Poisoning - Occurrence of 2 or more cases which share the same source of food and exposure.
1.1.5 End of Outbreak
a) Dengue – No new case within 14 days.
b) Malaria - No new case in 1 month.
c) Cholera – No new case in 10 days from the date of onset of the last case in the specific location.





2.1     The organization of the management team of outbreak disease.
2.1.1 There is no District Epidemiologist in Sik.
2.1.2   This is ad-hoc committee.
2.1.3   The members of the Rapid Assessment Team includes :
           1 Health Officer
           1 Family Medicine Specialist
           1 Medical Officer
           3 PPKP – Penolong Pegawai Kebersihan Persekitaran
2.1.4   ACD - Active Case Detector (Pasukan Pengesanan) is a team to detect cases which are not reported to the hospital or clinic.

2.2 The Strategy of an outbreak of disease


3. There are control measures which are being carried out after the end of the outbreak of disease. 
a. Aedes Survey which is a daily routine under the control of Vector Borne Disease Control Unit.
b. Fogging in Potential / Dengue Sensitive Area 
c. Hunting for foreign workers to detect possible Malaria case by peripheral blood smear.
d. Night trapping activities to catch the vector for Malaria.
e. Banners/brochures/posters/ flyers being distributed to raise the awareness among the community. ( Health Promotion Unit)
f. Talks for the public to educate them about the importance of keeping clean of their housing area.
g. Training programs for staffs such as seminars are carried out by the DHO or JKN.

4. Funding
a. Extra funding for the management of the outbreak can be applied from JKN if the operating budget allocated is insufficient.

5．Specific Strategy for Outbreak of diseases.
5.1 There is a guideline for outbreak of diseases such as Food and Water borne diseases, Typhoid, Vector borne diseases. Circulars are given by the JKN to all the District Health Office.
5.2 In the Sik district, strategies for all the outbreak of diseases is basically the same as the above (column 2.2).
5.3 As for the Food Poisoning cases, there is an additional team which is called ACD – Active Case Detector. The members of this team include those from the nursing unit (nurses who go for home visit). This team will go to the specific / targeted villages which there are cases reported or complaints received from that village. The members of this team will need to identify the number of cases of food poisoning in every house, by doing survey about the number of times of diarrhea episodes of each of the household members. The job of this team is to collect the data of unreported cases of food poisoning and to find out the causes and risk factors of the food poisoning. This team will only be formed when there is a suspected outbreak of food poisoning.
5.4 Weekly report will be received from all the Health Clinics for any food poisoning case. Interpretation of the collected data will be done and graph will be plotted. If the graph shows an abnormal maximum curve which indicate a suspected outbreak, investigation will need to be done.
5.5 There is no typhoid nor H1N1 cases in Sik District. The Disease Control department will follow the guideline which is given in the circulars by the JKN, for any new cases.