exudates and Influenza--Human

Epidemiological and evolutionary dynamics of influenza B Victoria and Yamagata lineages remained poorly understood in the tropical Southeast Asia region, despite causing seasonal outbreaks worldwide. From 2012-2014, nasopharyngeal swab samples collected from outpatients experiencing acute upper respiratory tract infection symptoms in Kuala Lumpur, Malaysia, were screened for influenza viruses using a multiplex RT-PCR assay. Among 2,010/3,935 (51.1%) patients infected with at least one respiratory virus, 287 (14.3%) and 183 (9.1%) samples were tested positive for influenza A and B viruses, respectively. Influenza-positive cases correlate significantly with meteorological factors-total amount of rainfall, relative humidity, number of rain days, ground temperature and particulate matter (PM10). Phylogenetic reconstruction of haemagglutinin (HA) gene from 168 influenza B viruses grouped them into Yamagata Clade 3 (65, 38.7%), Yamagata Clade 2 (48, 28.6%) and Victoria Clade 1 (55, 32.7%). With neuraminidase (NA) phylogeny, 30 intra-clade (29 within Yamagata Clade 3, 1 within Victoria Clade 1) and 1 inter-clade (Yamagata Clade 2-HA/Yamagata Clade 3-NA) reassortants were identified. Study of virus temporal dynamics revealed a lineage shift from Victoria to Yamagata (2012-2013), and a clade shift from Yamagata Clade 2 to Clade 3 (2013-2014). Yamagata Clade 3 predominating in 2014 consisted of intra-clade reassortants that were closely related to a recent WHO vaccine candidate strain (B/Phuket/3073/2013), with the reassortment event occurred approximately 2 years ago based on Bayesian molecular clock estimation. Malaysian Victoria Clade 1 viruses carried H274Y substitution in the active site of neuraminidase, which confers resistance to oseltamivir. Statistical analyses on clinical and demographic data showed Yamagata-infected patients were older and more likely to experience headache while Victoria-infected patients were more likely to experience nasal congestion and sore throat. This study describes the evolution of influenza B viruses in Malaysia and highlights the importance of continuous surveillance for better vaccination policy in this region.

Topics: Adolescent; Adult; Amino Acid Substitution; Evolution, Molecular; Female; Hemagglutinin Glycoproteins, Influenza Virus; Humans; Influenza B virus; Influenza, Human; Malaysia; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Mutation, Missense; Neuraminidase; Phylogeny; Reverse Transcriptase Polymerase Chain Reaction

The aims of the study were to determine the attack rate of influenza-like illness among inhabitants of five old folk homes nationwide using influenza vaccine as a probe and the effectiveness of influenza vaccination in prevention of influenza-like illness. We conducted a nonrandomized, single-blind placebo control study from June 2003 to February 2004. VAXIGRIP(R) 2003 Southern hemisphere formulation was used. Among 527 subjects, the attack rates of influenza-like illness in the influenza vaccine group were 6.4, 4.6 and 2.4% during the first, second and third 2-month periods, respectively. The attack rates of influenza-like illness in the placebo group were 17.7, 13.8 and 10.1%. Influenza vaccination reduced the risk of contracting influenza-like illness by between 14, and 45%. The vaccine effectiveness in reducing the occurrence of influenza-like illness ranged from 55 to 76%, during the 6-month study followup. The presence of cerebrovascular diseases significantly increased the risk of influenza-like illness (p < 0.005). Vaccine recipients had fewer episodes of fever, cough, muscle aches, runny nose (p < 0.001) and experience fewer sick days due to respiratory illness. Subjects who received influenza vaccination had clinically and statistically significant reductions in the attack rate of influenza-like illness. Our data support influenza vaccination of persons with chronic diseases and >50 year olds living in institutions.

Topics: Aged; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza A Virus, H3N2 Subtype; Influenza B virus; Influenza Vaccines; Influenza, Human; Malaysia; Male; Nursing Homes; Prospective Studies; Single-Blind Method

Adult immunization remains to be a neglected issue in developing countries including Malaysia. This nationwide study determined the vaccination coverage of hepatitis B and influenza among Malaysia's healthcare workers (HCWs), the elderly (aged 60 y and above) and patients with diabetes, who are the participants of The Malaysia Cohort Program. The participants were categorized based on their occupation, age and medical history. Self-reported questionnaire was used to assess the participant's hepatitis B and influenza vaccination status. A Chi-square test and logistic regression analyses were performed to determine the risk factors associated with vaccination behavior. The hepatitis B vaccination coverage for healthcare workers, elderly, and patients with diabetes were 34.6%, 10.1% and 9.8%, respectively. The influenza vaccination coverage rates for healthcare workers, the elderly and patients with diabetes were 26.3%, 5.5% and 6.4%, respectively. The Chinese were more likely to be vaccinated against hepatitis B, while Malay was more likely to be vaccinated against influenza. Individuals with higher education and living in urban areas were more likely vaccinated than those with low education levels and who lived in rural areas. The low vaccination coverage for healthcare workers was alarming because hepatitis B and influenza were subsidized for the healthcare workers. The hepatitis B and influenza vaccination coverage among healthcare workers, elderly and patients with diabetes in Malaysia were low. Specific interventions such as educational and awareness programs should be conducted to increase the vaccination rate among adults, especially those at high risk.

Topics: Adult; Aged; Cross-Sectional Studies; Diabetes Mellitus; Health Personnel; Hepatitis B; Humans; Influenza Vaccines; Influenza, Human; Malaysia; Surveys and Questionnaires; Vaccination; Vaccination Coverage

Topics: COVID-19; COVID-19 Vaccines; Cross-Sectional Studies; Humans; Indonesia; Influenza Vaccines; Influenza, Human; Malaysia; United States; Vaccination

The economic burden of influenza is a significant issue within healthcare system, related to higher medical costs particularly among the elderly. Yet, influenza vaccination rates in the elderly in Malaysia were considerably low as it is not part of Malaysia's national immunization program, with substantial mortality and morbidity consequences. Therefore, we conducted a cost-effectiveness analysis of quadrivalent influenza vaccine (QIV) for the elderly in Malaysia compared with the current no-vaccination policy. A static cost-utility model, with a lifetime horizon based on age, was used for the analysis to assess the cost-effectiveness and health outcomes associated with QIV. Univariate and probabilistic sensitivity analyses were performed to test the effects of variations in the parameters. The use of QIV in Malaysia's elderly population would prevent 66,326 potential influenza cases and 888 potential deaths among the elderly, leading to 10,048 potential quality-adjusted life years (QALYs) gained. The QIV would also save over USD 4.4 million currently spent on influenza-related hospitalizations and reduce productivity losses by approximately USD 21.6 million. The ICER per QALY gained from a third-party payer's perspective would be USD 2216, which is lower than the country's gross domestic product per capita. A QIV-based vaccination program in the elderly was found to be highly cost-effective, therefore would reduce the financial burden of managing influenza and reduce pre-mature death related to this disease.

Topics: Aged; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Humans; Influenza Vaccines; Influenza, Human; Malaysia; Vaccination

Influenza is a contagious respiratory illness that can cause life-threatening complications among high-risk groups. Estimating the economic burden of influenza is essential to guide policy-making on influenza vaccination programmes, especially in resource-limited settings. This study aimed to estimate the economic burden of influenza on older adults (those aged ≥60 years) in Malaysia from the provider's perspective.. The main data source in this study was the MY-DRG Casemix database of a teaching hospital in Malaysia. Cases with principal and secondary diagnoses coded in the International Classification of Diseases version 10 (ICD-10) as J09, J10.0, J10.1, J10.8, J11.0, J11.1, J11.8, J12.8, and J12.9, which represent influenza and its complications, were included in the study. The direct cost of influenza at all severity levels was calculated from the casemix data and guided by a clinical pathway developed by experts. The effect of the variations in costs and incidence rate of influenza for both the casemix and clinical pathway costing approaches was assessed with sensitivity analysis.. A total of 1,599 inpatient and 407 outpatient influenza cases were identified from the MY-DRG Casemix database. Most hospitalised cases were aged <18 years (90.6%), while 77 cases (4.8%) involved older people. Mild, moderate, and severe cases comprised 56.5%, 35.1%, and 8.4% of cases, respectively. The estimated average annual direct costs for managing mild, moderate, and severe influenza were RM2,435 (USD579), RM6,504 (USD1,549), and RM13,282 (USD3,163), respectively. The estimated total annual economic burden of influenza on older adults in Malaysia was RM3.28 billion (USD782 million), which was equivalent to 10.7% of the Ministry of Health Malaysia budget for 2020. The sensitivity analysis indicated that the influenza incidence rate and cost of managing severe influenza were the most important factors influencing the total economic burden.. Overall, our results demonstrated that influenza imposes a substantial economic burden on the older Malaysian population. The high cost of influenza suggested that further efforts are required to implement a preventive programme, such as immunisation for older people, to reduce the disease and economic burdens.

Topics: Aged; Cost of Illness; Financial Stress; Hospitals, Teaching; Humans; Influenza, Human; Malaysia

Children are at higher risk of influenza virus infection, and it is difficult to diagnose. They are also responsible for the transmission of influenza because of their longer viral shedding compared to adults. In Malaysia, studies on influenza in children are scarce, and as a result, policy decisions cannot be formulated to control the infection. Hence, the objective of this study is to determine the prevalence and epidemiological characteristics of influenza among children with upper respiratory symptoms in the Sabah state of Malaysia.. A cross-sectional study with a simple random sampling was conducted among children with upper respiratory symptoms in Sabah from 1 March 2019 to 29 February 2020. Patients admitted to a pediatric ward of Sabah Women and Children's Hospital who presented with a fever >38 °C and cough within 48 h of admission were enrolled in this study. A nasopharyngeal swab was taken, and influenza was diagnosed by lateral flow test. Clinical features of influenza-positive children were compared with children whose results were negative.. A total of 323 nasopharyngeal samples were collected, and 66 (20.4%) of them were positive for influenza. Fifty-six (85%) were infected by influenza A whereas ten (15%) were by influenza B virus. Higher temperature (aOR 2.03, 95% CI 1.296-3.181), less activity (aOR 2.07, 95% CI 1.158-3.693), and seizure (aOR 4.2, 95% CI 1.614-10.978) on admission were significant risk factors associated with influenza in children. Meteorology parameters such as humidity and rainfall amount were statistically significant at 95% CI [1.133 (1.024-1.255)] and 95% CI [0.946 (0.907-0.986)].. The prevalence of influenza was high among children with upper respiratory symptoms, and they were infected predominantly with the influenza A virus. Children presented with seizures, less activity, and fever were the significant risk factors for influenza. Influenza vaccination should be prioritized as preventive measures for children.

Topics: Adult; Child; Child, Hospitalized; Cross-Sectional Studies; Female; Humans; Influenza, Human; Malaysia; Risk Factors

Older persons are at high-risk of developing severe complications from influenza. This consensus statement was developed to provide guidance on appropriate influenza prevention strategies relevant to the Malaysian healthcare setting.. Under the initiative of the Malaysian Influenza Working Group (MIWG), a panel comprising 11 multi-speciality physicians was convened to develop a consensus statement. Using a modified Delphi process, the panellists reviewed published evidence on various influenza management interventions and synthesised 10 recommendations for the prevention of influenza among the aged population via group discussions and a blinded rating exercise.. Overall, annual influenza vaccination is recommended for individuals aged ≥ 60 years, particularly those with specific medical conditions or residing in aged care facilities (ACFs). There is no preference for a particular vaccine type in this target population. Antiviral agents can be given for post-exposure chemoprophylaxis or when vaccine contraindication exists. Infection control measures should serve as adjuncts to prevent the spread of influenza, especially during Hajj.. This consensus statement presents 10 evidence-based recommendations that can be adopted by healthcare providers to prevent influenza among the aged population in Malaysia. It could also serve as a basis for health policy planning in other lower- and middle-income countries.

Topics: Aged; Aged, 80 and over; Antiviral Agents; Humans; Influenza Vaccines; Influenza, Human; Malaysia; Vaccination

The Western Pacific Region (WPR) is exposed each year to seasonal influenza and is often the source of new influenza virus variants and novel pathogen emergence. National influenza surveillance systems play a critical role in detecting emerging viruses, monitoring influenza epidemics, improving public disease awareness and promoting pandemic preparedness, but vary widely across WPR countries. The aim of this study is to improve existing influenza surveillance systems by systematically comparing selected WPR influenza surveillance systems.. Three national influenza surveillance systems with different levels of development (Australia, China and Malaysia) were compared and their adherence to World Health Organization (WHO) guidance was evaluated using a structured framework previously tested in several European countries consisting of seven surveillance sub-systems, 19 comparable outcomes and five evaluation criteria. Based on the results, experts from the Asia-Pacific Alliance for the Control of Influenza (APACI) issued recommendations for the improvement of existing surveillance systems.. Australia demonstrated the broadest scope of influenza surveillance followed by China and Malaysia. In Australia, surveillance tools covered all sub-systems. In China, surveillance did not cover non-medically attended respiratory events, primary care consultations, and excess mortality modelling. In Malaysia, surveillance consisted of primary care and hospital sentinel schemes. There were disparities between the countries across the 5 evaluation criteria, particularly regarding data granularity from health authorities, information on data representativeness, and data communication, especially the absence of publicly available influenza epidemiological reports in Malaysia. This dual approach describing the scope of surveillance and evaluating the adherence to WHO guidance enabled APACI experts to make a number of recommendations for each country that included but were not limited to introducing new surveillance tools, broadening the use of specific existing surveillance tools, collecting and sharing data on virus characteristics, developing immunization status registries, and improving public health communication.. Influenza monitoring in Australia, China, and Malaysia could benefit from the expansion of existing surveillance sentinel schemes, the broadened use of laboratory confirmation and the introduction of excess-mortality modelling. The results from the evaluation can be used as a basis to support expert recommendations and to enhance influenza surveillance capabilities.

Topics: Australia; China; Humans; Influenza, Human; Malaysia; Orthomyxoviridae

Influenza is an infectious disease that leads to an estimated 5 million cases of severe illness and 650,000 respiratory deaths worldwide each year. The early detection and prediction of influenza outbreaks are crucial for efficient resource planning to save patient's lives and healthcare costs. We propose a new data-driven methodology for influenza outbreak detection and prediction at very local levels. A doctor's diagnostic dataset of influenza-like illness from more than 3000 clinics in Malaysia is used in this study because these diagnostic data are reliable and can be captured promptly. A new region index (RI) of the influenza outbreak is proposed based on the diagnostic dataset. By analysing the anomalies in the weekly RI value, potential outbreaks are identified using statistical methods. An ensemble learning method is developed to predict potential influenza outbreaks. Cross-validation is conducted to optimize the hyperparameters of the ensemble model. A testing data set is used to provide an unbiased evaluation of the model. The proposed methodology is shown to be sensitive and accurate at influenza outbreak prediction, with average of 75% recall, 74% precision, and 83% accuracy scores across five regions in Malaysia. The results are also validated by Google Flu Trends data, news reports, and surveillance data released by World Health Organization.

Topics: Datasets as Topic; Disease Outbreaks; Epidemiologic Methods; Humans; Influenza, Human; Malaysia; Models, Statistical; Population Surveillance; Statistics as Topic

The increasing trend in the number new cases of influenza every year as reported by WHO is concerning, especially in Malaysia. To date, there is no local research under healthcare sector that implements the time series forecasting methods to predict future disease outbreak in Malaysia, specifically influenza. Addressing the problem could increase awareness of the disease and could help healthcare workers to be more prepared in preventing the widespread of the disease. This paper intends to perform a hybrid ARIMA-SVR approach in forecasting monthly influenza cases in Malaysia. Autoregressive Integrated Moving Average (ARIMA) model (using Box-Jenkins method) and Support Vector Regression (SVR) model were used to capture the linear and nonlinear components in the monthly influenza cases, respectively. It was forecasted that the performance of the hybrid model would improve. The data from World Health Organization (WHO) websites consisting of weekly Influenza Serology A cases in Malaysia from the year 2006 until 2019 have been used for this study. The data were recategorized into monthly data. The findings of the study showed that the monthly influenza cases could be efficiently forecasted using three comparator models as all models outperformed the benchmark model (Naïve model). However, SVR with linear kernel produced the lowest values of RMSE and MAE for the test dataset suggesting the best performance out of the other comparators. This suggested that SVR has the potential to produce more consistent results in forecasting future values when compared with ARIMA and the ARIMA-SVR hybrid model.

Topics: Disease Outbreaks; Forecasting; Humans; Influenza, Human; Malaysia; Models, Theoretical; Morbidity; Seasons; Support Vector Machine

The transmission of COVID-19 has sent Malaysia into cycles of tightening and relaxation of movement control, which are still continuing currently in line with local fluctuations of new COVID-19 cases. During movement control, measures comprising physical distancing, hand cleaning or sanitizing, and sanitization of premises are consistently implemented while self-isolation and travel restrictions are adaptively enforced. This study aims to examine if the control of COVID-19 transmission has an effect on the national influenza occurrences as some measures for COVID-19 control are similar to those for influenza.. For this study, data of weekly new cases of influenza and COVID-19 were obtained from official platforms for non-parametric statistical analysis.. This study compared the influenza occurrences before and after the onset of COVID-19 using the Mann-Whitney U-test and explored Spearman's correlations between COVID-19 and influenza incidences after the onset of COVID-19.. It shows that influenza incidences before and after the onset of COVID-19 were significantly different and that influenza cases have significantly reduced after the onset of COVID-19. The weekly cases of influenza and COVID-19 were significantly and negatively correlated.. This study underscores the co-benefits of COVID-19 control measures and alleviates the concern for the risk of COVID-19 and influenza co-infection.

Topics: COVID-19; Humans; Influenza, Human; Malaysia; SARS-CoV-2; Travel

Age is an established risk factor for poor outcomes in individuals with influenza-related illness, and data on its influence on clinical presentations and outcomes in the South-East Asian settings are scarce. The aim of this study was to determine the above among adults with influenza-related upper respiratory tract infection at a teaching hospital in Malaysia.. A retrospective case-note analysis was conducted on a cohort of 3935 patients attending primary care at the University Malaya Medical Centre, Malaysia from February 2012 till May 2014 with URTI symptoms. Demographics, clinical characteristics, medical and vaccination history were obtained from electronic medical records, and mortality data from the National Registration Department. Comparisons were made between those aged <25, ≥25 to <65 and ≥65 years.. 470 (11.9%) had PCR-confirmed influenza virus infection. Six (1.3%) received prior influenza vaccination. Those aged ≥65 years were more likely to have ≥2 comorbidities (P < .001) and were less likely to present with fever (P = .004). One-third of those aged ≥65 years experienced hospitalization, intensive care admission or death within a year compared to 10% in the ≥25 to <65 years. Age ≥65 years was an independent predictor of hospitalization and death (OR = 9.97; 95% CI = 3.11-31.93) compared to those aged <25 years.. Older patients in our cohort were more likely to have comorbidities and present with atypical features, with older age being an independent predictor of poor health outcomes. Our findings will now inform future health policies on older persons and economic modelling of adult vaccination programmes.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Hospitalization; Humans; Influenza, Human; Malaysia; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Young Adult

Influenza seasonality in equatorial countries is little understood. Seasonal and alert influenza thresholds were determined for Malaysia, using laboratory-based data obtained from the Malaysia Influenza Surveillance System and a major teaching hospital, from 2011 to 2016. Influenza was present year-round, with no clear annual seasons. Variable periods of higher transmission occurred inconsistently, in November to December, January to March, July to September, or a combination of these. These coincide with seasons in the nearby southeast Asian countries or winter seasons of the northern and southern hemispheres. Changes in the predominant circulating influenza type were only sometimes associated with increased transmission. The data can provide public health interventions such as vaccines.

Topics: Humans; Influenza A virus; Influenza B virus; Influenza, Human; Malaysia; Public Health Surveillance; Tropical Climate

Rapid diagnosis of influenza is important for early treatment and institution of control measures. In developing tropical countries such as Malaysia, influenza occurs all year round, but molecular assays and conventional techniques (such as immunofluorescence and culture) for diagnosis are not widely available. Rapid influenza diagnostic tests (RIDTs) may be useful in this setting. A total of 552 fresh respiratory specimens were assessed from patients with respiratory symptoms at a teaching hospital in Kuala Lumpur, Malaysia from November 2017 to March 2018. Two digital immunoassays (DIAs), STANDARD F Influenza A/B Fluorescence Immunoassay (STANDARD F) and Sofia Influenza A + B Fluorescence Immunoassay (Sofia) and one conventional RIDT (immunochromatographic assay), SD Bioline Influenza Ag A/B/A(H1N1) Pandemic rapid test kit (SD Bioline) were evaluated in comparison with a WHO-recommended reverse transcription quantitative PCR (RT-qPCR). Of the 552 samples, influenza A virus was detected in 47 (8.5%) and influenza B virus in 7 (1.3%). The digital immunoassays STANDARD F and Sofia had significantly higher overall sensitivity rates (71.7% and 70.6%, respectively) than the conventional RIDT SD Bioline and immunofluorescence/viral culture (55.8% and 52.8%, respectively). Sensitivity rates were higher for influenza A than influenza B, and specificity rates were uniformly high, ranging from 98% to 100%. Digital readout RIDTs can be used in tropical settings with year-round influenza if PCR is unavailable.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Diagnostic Tests, Routine; Female; Hospitals, Teaching; Humans; Immunoassay; Infant; Infant, Newborn; Influenza A virus; Influenza B virus; Influenza, Human; Malaysia; Male; Middle Aged; Sensitivity and Specificity; Time Factors; Young Adult

Influenza outbreaks in tropical countries are rarely reported. This article reports four cases of influenza within a psychiatric ward of a tertiary hospital in Malaysia. These were patients with severe mental illness who were involuntarily admitted and did not show the classical triad of influenza-like-illness (ILI) at the beginning. However, severe respiratory complications developed requiring intubation. Referral and cooperation with the infectious disease team was initiated to help manage the outbreak while continuing psychiatric treatment. Incidences of influenza among hospitalised psychiatric patients should be treated seriously with immediate multidisciplinary approach to prevent severe unwanted complications.

Topics: Cross Infection; Disease Outbreaks; Female; Humans; Influenza B virus; Influenza, Human; Malaysia; Mental Disorders; Middle Aged; Psychiatric Department, Hospital

Reassortment of genetic segments between and within influenza B lineages (Victoria and Yamagata) has been shown to generate novel reassortants with unique genetic characteristics. Based on hemagglutinin (HA) and neuraminidase (NA) genes, recent surveillance study has identified reassortment properties in B/Phuket/3073/2013-like virus, which is currently used in the WHO-recommended influenza vaccine. To understand the potential reassortment patterns for all gene segments, four B/Phuket/3073/2013-like viruses and two unique reassortants (one each from Yamagata and Victoria) detected in Malaysia from 2012-2014 were subjected to whole-genome sequencing. Each gene was phylogenetically classified into lineages, clades and sub-clades. Three B/Phuket/3073/2013-like viruses from Yamagata lineage were found to be intra-clade reassortants, possessing PA and NA genes derived from Stockholm/12-like sub-clade, while the remaining genes from Wisconsin/01-like sub-clade (both sub-clades were within Yamagata Clade 3/Yam-3). However, the other B/Phuket/3073/2013-like virus had NS gene that derived from Stockholm/12-like sub-clade instead of Wisconsin/01-like sub-clade. One inter-clade reassortant had Yamagata Clade 2/Yam-2-derived HA and NP, and its remaining genes were Yam-3-derived. Within Victoria Clade 1/Vic-1 in Victoria lineage, one virus had intra-clade reassortment properties: HA and PB2 from Vic-1B sub-clade, MP and NS from a unique sub-clade "Vic-1C", and the remaining genes from Vic-1A sub-clade. Although random reassortment event may generate unique reassortants, detailed phylogenetic classification of gene segments showed possible genetic linkage between PA and NA genes in B/Phuket/3073/2013-like viruses, which requires further investigation. Understanding on reassortment patterns in influenza B evolution may contribute to future vaccine design.

Topics: Evolution, Molecular; Genome, Viral; Hemagglutinin Glycoproteins, Influenza Virus; Humans; Influenza B virus; Influenza Vaccines; Influenza, Human; Malaysia; Neuraminidase; Phylogeny; Reassortant Viruses

The pandemic caused by the H1N1 influenza virus in 2009 resulted in extensive morbidity and mortality worldwide. As the virus was a novel virus, there was limited data available on the clinical effects of the virus on children in Malaysia. Herein, we describe the clinical characteristics of children hospitalised with H1N1 influenza in a tertiary care centre; we also attempted to identify the risk factors associated with disease severity.. In this retrospective study, we compared the characteristics of the children who were admitted into the University of Malaya Medical Centre, Malaysia, for H1N1 influenza during the pandemic with those who were admitted for seasonal influenza in 2002-2007.. Among the 77 children (aged ≤ 12 years) admitted to the centre due to H1N1 influenza from 1 July 2009-30 June 2010, nearly 60% were aged < 6 years and 40.3% had an underlying medical condition. The top three underlying medical conditions were bronchial asthma (14.3%), cardiac disease (10.4%) and neurological disorder (11.7%). The risk factors for severe disease were age < 2 years, underlying bronchial asthma and chronic lung disease. The three patients who died had a comorbid medical condition. The underlying cause of the deaths was acute respiratory distress syndrome or shock.. The clinical presentation of the children infected with the pandemic (H1N1) 2009 influenza virus did not differ significantly from that of children infected with seasonal influenza. However, there were more complaints of fever, cough and vomiting in the former group.

Topics: Adolescent; Child; Child, Hospitalized; Child, Preschool; Disease Outbreaks; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Retrospective Studies; Risk Factors; Seasons; Tertiary Care Centers

Respiratory illness continues to exert a burden on hajj pilgrims in Makkah. The purpose of this study is to determine the prevalence of respiratory illness and its associated factors among Malaysian hajj pilgrims in 2013 and to describe its preventive measures.. A cross-sectional study was conducted in Makkah and Malaysia during the 2013 hajj season. A self-administered proforma on social demographics, previous experience of hajj or umrah, smoking habits, co-morbid illness and practices of preventive measures against respiratory illness were obtained.. A total of 468 proforma were analysed. The prevalence of the respiratory illness was 93.4% with a subset of 78.2% fulfilled the criteria for influenza-like illness (ILI). Most of them (77.8%) had a respiratory illness of <2 weeks duration. Approximately 61.8% were administered antibiotics but only 2.1% of them had been hospitalized. Most of them acquired the infection after a brief stay at Arafat (81.2%). Vaccination coverages for influenza virus and pneumococcal disease were quite high, 65.2% and 59.4%, respectively. For other preventive measures practices, only 31.8% of them practiced good hand hygiene, ∼82.9% of pilgrims used surgical face masks, N95 face masks, dry towels, wet towels or veils as their face masks. Nearly one-half of the respondents (44.4%) took vitamins as their food supplement. Malaysian hajj pilgrims with previous experience of hajj (OR 0.24; 95% CI 0.10-0.56) or umrah (OR 0.19; 95% CI 0.07-0.52) and those who have practiced good hand hygiene (OR 0.35; 95% CI 0.16-0.79) were found to be significantly associated with lower risk of having respiratory illness. Otherwise, pilgrims who had contact with those with respiratory illness (OR 2.61; 95% CI 1.12-6.09) was associated with higher risk.. The prevalence of respiratory illness remains high among Malaysian hajj pilgrims despite having some practices of preventive measures. All preventive measures which include hand hygiene, wearing face masks and influenza vaccination must be practiced together as bundle of care to reduce respiratory illness effectively.

Topics: Adolescent; Adult; Aged; Communicable Disease Control; Cross-Sectional Studies; Female; Hand Disinfection; Humans; Influenza Vaccines; Influenza, Human; Islam; Malaysia; Male; Middle Aged; Prevalence; Travel Medicine; Young Adult

Topics: Child, Preschool; Hospitalization; Humans; Infant; Infant, Newborn; Influenza A Virus, H1N1 Subtype; Influenza, Human; Inpatients; Malaysia; Risk Factors

Healthcare workers (HCWs) are at increased risk of getting influenza than the general population, therefore putting patients at risk of nosocomial infection. Influenza vaccination coverage among HCWs is low despite the availability of a safe and effective vaccine. However, the reasons for such a poor uptake are not well reported in Malaysia. This study aimed at assessing the rate of influenza vaccination uptake, knowledge and attitude of healthcare workers regarding influenza, and employers' policy on influenza vaccination.. A cross-sectional questionnaire survey was conducted in three hospitals in the Klang Valley. Mann-Whitney test was used to assess possible differences in knowledge and attitude towards flu vaccination and the χ. A total of 690 questionnaires were distributed; 527 were returned (giving a response rate of 76.4%. The vaccine uptake was 51.4% with the majority (83.5%) of those believing they were vaccinated to protect themselves. Higher proportion of vaccinated HCWs (p <0.05) agreeing to the fact that influenza is a serious threat to their health, however, 10% were not sure of its safety. Eighty-three (15.7%) claimed their employers did not have a vaccination policy, while 43.3% were not sure if their employers have vaccination policy.. This study has demonstrated more than half of the healthcare workers were vaccinated, with a significant proportion of the healthcare workers believed they were vaccinated to protect themselves, while most of those that were not vaccinated claimed they are worried about the safety of the vaccine. Most employers did not have a flu vaccination policy in place. Hence, the need for government to enforce such policy and make annual flu vaccination free and compulsory for all healthcare workers.

Topics: Attitude of Health Personnel; Cross Infection; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Influenza Vaccines; Influenza, Human; Malaysia; Surveys and Questionnaires; Vaccination

In 2009, pandemic influenza A H1N1 emerged in Mexico and subsequently spread worldwide. In Malaysia, there were more than a thousand of confirmed cases among children. The general clinical characteristics of these children have been well-published. However, the description of neurologic complications is scarce.. This study aims to describe the characteristics of neurologic manifestations and complications in a national paediatric cohort with pandemic influenza A H1N1.. During the pandemic, children (12 years or less) admitted for novel influenza A H1N1 in 68 Malaysian public hospitals, were prospectively enrolled into national database. The clinical, laboratory and neuro-imaging data for children with neurologic manifestations, hospitalized from 15th June 2009 till 30th November 2009, was reviewed.. Of 1244 children with influenza A H1N1 during the study period, 103 (8.3%) presented with influenza-related neurological manifestations. The mean age of our study cohort was 4.2 years (SD: 3.3 years). Sixty percent of them were males. Sixty-nine (66.9%) were diagnosed as febrile seizures, 16 (15.5%) as breakthrough seizures with underlying epilepsy, 14 (13.6%) as influenza-associated encephalopathy or encephalitis (IAE) and 4 (3.9%) as acute necrotizing encephalopathy of childhood (ANEC). All 4 available CSF specimens were negative for influenza viral PCR. Among 14 children with brain-imaging done, 9 were abnormal (2: cerebral oedema, 4: ANEC and 3: other findings). There were four deaths and three cases with permanent neurological sequelae.. About one-tenth of children with pandemic influenza A H1N1 presented with neurologic complications. The most common diagnosis was febrile seizures. One-fifth of those children with neurologic presentation had IAE or ANEC, which carried higher mortality and morbidity. This large national study provides us useful data to better manage children with neurologic complications in the future pandemic influenza outbreaks.

Topics: Brain Diseases; Child; Child, Preschool; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Pandemics

Respiratory illness were a major problem and caused high hospital admission during hajj seasons. One of the contributing cause to this illness is infection. Various measures had been implemented to reduce respiratory infections. The aim on the study is to determine the effect of influenza vaccination against acute respiratory illness among Malaysian Hajj pilgrims. This is an observational cohort study. Influenza vaccination was given to pilgrims at least 2 weeks prior to departure. The occurrence of symptoms for respiratory illness such as cough, fever, sore throat and runny nose was monitored daily for 6 weeks during pilgrimage using a health diary. A total of 65 vaccinated hajj pilgrims and 41 controls were analyzed. There was no significant difference in pattern of occurrence of symptoms of respiratory illness by duration of pilgrimage as well as the number of symptoms between both groups. Hajj pilgrims have frequent respiratory symptoms. We were unable to document benefit from influenza vaccination, but our study was limited by a small sample size and lack of laboratory testing for influenza.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Influenza Vaccines; Influenza, Human; Islam; Malaysia; Male; Middle Aged; Respiratory Tract Diseases; Saudi Arabia; Travel; Young Adult

Of the ≈400 cases of avian influenza (H7N9) diagnosed in China since 2003, the only travel-related cases have been in Hong Kong and Taiwan. Detection of a case in a Chinese tourist in Sabah, Malaysia, highlights the ease with which emerging viral respiratory infections can travel globally.

Topics: Aged; China; Epidemiological Monitoring; Female; Humans; Influenza A Virus, H7N9 Subtype; Influenza, Human; Malaysia; Multilocus Sequence Typing; Travel

Recent outbreaks of highly pathogenic and occasional drug-resistant influenza strains have highlighted the need to develop novel anti-influenza therapeutics. Here, we report computational and experimental efforts to identify influenza neuraminidase inhibitors from among the 3000 natural compounds in the Malaysian-Plants Natural-Product (NADI) database. These 3000 compounds were first docked into the neuraminidase active site. The five plants with the largest number of top predicted ligands were selected for experimental evaluation. Twelve specific compounds isolated from these five plants were shown to inhibit neuraminidase, including two compounds with IC50 values less than 92 μM. Furthermore, four of the 12 isolated compounds had also been identified in the top 100 compounds from the virtual screen. Together, these results suggest an effective new approach for identifying bioactive plant species that will further the identification of new pharmacologically active compounds from diverse natural-product resources.

Topics: Databases, Chemical; Enzyme Inhibitors; False Positive Reactions; Fruit; High-Throughput Screening Assays; Humans; Influenza A Virus, H5N1 Subtype; Influenza, Human; Malaysia; Neuraminidase; Plants, Medicinal; Xanthones

Influenza B virus causes significant disease but remains understudied in tropical regions. We sequenced 72 influenza B viruses collected in Kuala Lumpur, Malaysia, from 1995 to 2008. The predominant circulating lineage (Victoria or Yamagata) changed every 1 to 3 years, and these shifts were associated with increased incidence of influenza B. We also found poor lineage matches with recommended influenza virus vaccine strains. While most influenza B virus lineages in Malaysia were short-lived, one circulated for 3 to 4 years.

Topics: Base Sequence; Evolution, Molecular; Female; Humans; Influenza B virus; Influenza, Human; Malaysia; Male; Molecular Sequence Data

The Canadian Acute Respiratory Illness and Flu Scale (CARIFS) is a parent-proxy questionnaire that assesses severity of acute respiratory infections in children. The aim was to (a) perform a cross-cultural adaptation and (b) prove that the Malay CARIFS is a reliable tool.. The CARIFS underwent forward and backward translations as recommended by international guidelines. A pilot study was performed on the harmonised version and the final version of the Malay version of CARIFS was produced. A test-retest, 1 h apart, was then performed on parents with children less than 13 years old, admitted with a respiratory tract infection. Parents of children with asthma and who were not eloquent in Malay, were excluded. The data was analysed for consistency (Cronbach's alpha) and reliability (test-retest co-efficient). Thirty-three parents were recruited. Children were aged median (IQR) 6 (2.8, 13.3) months with a male: female ratio of 22:11 and 88% were Malays. Parents were interviewed at median (IQR) 6 (3, 11.5) days of admission. The Cronbach's α coefficient was 0.70 for all items. The test-retest reliability analysis had a minimum and maximum intraclass correlation coefficient of 0.63 and 0.97 respectively. Clinically, the longer patients were admitted, the lower the severity score (r = -0.35, p < 0.05), indicating that they were getting better.. The Malay version of CARIFS is a valid and reliable tool to determine severity of respiratory illness in children. Parent-centred questionnaires are useful and should be an adjunct to other methods, in monitoring response to treatment.

Topics: Adolescent; Child; Child Welfare; Child, Preschool; Cross-Cultural Comparison; Female; Humans; Influenza, Human; Malaysia; Male; Pilot Projects; Psychometrics; Quality of Life; Reproducibility of Results; Respiratory Tract Diseases; Severity of Illness Index; Surveys and Questionnaires; Translating

Annual influenza vaccination is the most important preventive strategy against influenza illness in healthcare workers (HCWs), who could acquire influenza from and transmit influenza to patients and other HCWs. Despite the well established benefits and strong recommendations for influenza vaccination for all HCWs, influenza vaccination uptake at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for the past 3 years has been low and is decreasing. We aimed to determine the factors associated with influenza vaccination uptake among HCWs at UKMMC. We conducted a cross sectional study via questionnaire among 211 randomly selected HCWs, consisting of 106 HCWs who were vaccinated in 2011 and 105 HCWs who were not vaccinated in 2010 or 2011. We had a 100% response rate. Influenza vaccination uptake was significantly associated with age and previous vaccination history, with older HCWs being more likely to be vaccinated (adjusted OR = 12.494; 95% CI:6.278-24.863; p < 0.001) and HCWs with previous vaccination history being more likely to be vaccinated (adjusted OR = 1.038; 95% CI:1.001-1.077; p = 0.045). Influenza vaccination uptake was not associated with gender (p = 0.926) or job category (p = 0.220). Publicity at the workplace was the main source of information about the vaccine (51.2% of respondents), followed by colleagues (29.9%). Despite the low uptake, 85.3% of respondents believed influenza vaccination was important for disease prevention. The most common reason given for vaccination was protection against influenza infection (73.6%). The most common reason for not having the vaccine was time constraints (56.2%). An evidenced-based strategy needs to be developed to improve vaccine uptake or having mandatory vaccination.

Topics: Adult; Age Factors; Cross-Sectional Studies; Female; Health Personnel; Hospitals, Teaching; Humans; Infectious Disease Transmission, Professional-to-Patient; Influenza Vaccines; Influenza, Human; Malaysia; Male; Middle Aged; Patient Compliance; Sex Factors; Surveys and Questionnaires; Vaccination; Young Adult

Relatively little is known about the burden of influenza in tropical countries. The seroprevalence of pandemic influenza A (H1N1) 2009, seasonal H1N1 and H3N2 was determined in Kuala Lumpur, Malaysia. Pre- and post-pandemic residual laboratory sera were tested by hemagglutination-inhibition. The seroprevalence of A(H1N1)pdm09 increased from 3.7% pre-pandemic to 21.9% post-pandemic, giving an overall cumulative incidence of 18.1% (95% CI, 13.8-22.5%), mainly due to increases in those <5, 5-17, and 18-29 years old. In contrast with findings from USA, Europe, and Australia, pre-existing seroprevalence to A(H1N1)pdm09 was low at 5.6% in the elderly age group of >55 years. A(H1N1)pdm09 affected almost a third of those <30 years in Kuala Lumpur. Pre-pandemic seroprevalence was 14.7% for seasonal H1N1 and 21.0% for H3N2, and these rates did not change significantly after the pandemic. Seasonal and pandemic influenza cause a considerable burden in tropical Malaysia, particularly in children and young adults.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Child; Child, Preschool; Female; Hemagglutination Inhibition Tests; Humans; Incidence; Infant; Influenza A Virus, H1N1 Subtype; Influenza A Virus, H3N2 Subtype; Influenza, Human; Malaysia; Male; Middle Aged; Seroepidemiologic Studies; Young Adult

Assessment of schoolchildren's knowledge, attitudes, and practices towards influenza A (H1N1) is crucial as schools play a major role in spreading the infection. The aims of this study were to determine the level of knowledge, attitudes, and practices on influenza A (H1N1) and the factors associated with practices of preventive behavior.A cross sectional study was conducted from July until December 2010. Two public secondary schools for two districts in Kelantan, Malaysia were randomly selected. Data were collected using a self-administered questionnaire. The questionnaire consisted of five constructs: sociodemographic, risk factors of containing influenza A (H1N1) infection, knowledge, attitudes, and practices. The questionnaire had been te,sted for its construct validity and reliability. General linear regression was applied in the data analysis. A sample of 436 secondary school students were recruited in this study involved Malay students aged 16 years old. The total knowledge, attitudes and practices scores for the overall respondents were 69.4, 82.2, and 73.8%, respectively. The significant influencing factors for the practices of preventive behavior were attended talk on H1N1 and attitudes score.This study suggested that health education is important for promoting the health of adolescents and contributing to the overall health of the public so that they will take precautions against the H1N1 infection.

Topics: Adolescent; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Multivariate Analysis; Pandemics; Surveys and Questionnaires

Global public health policies span national borders and affect multitudes of people. The spread of infectious disease has neither political nor economic boundaries, and when elevated to a status of pandemic proportions, immediate action is required. In federal systems of government, the national level leads the policy formation and implementation process, but also collaborates with supranational organisations as part of the global health network. Likewise, the national level of government cooperates with sub-national governments located in both urban and rural areas. Rural areas, particularly in less developed countries, tend to have higher poverty rates and lack the benefits of proper medical facilities, communication modes and technology to prevent the spread of disease. From the perspective of epidemiological surveillance and intervention, this article will examine federal health policies in three federal systems: Australia, Malaysia and the USA. Using the theoretical foundations of collaborative federalism, this article specifically examines how collaborative arrangements and interactions among governmental and non-governmental actors help to address the inherent discrepancies that exist between policy implementation and reactions to outbreaks in urban and rural areas. This is considered in the context of the recent H1N1 influenza pandemic, which spread significantly across the globe in 2009 and is now in what has been termed the 'post-pandemic era'.

Topics: Australia; Cooperative Behavior; Disease Outbreaks; Global Health; Health Plan Implementation; Health Policy; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Pan American Health Organization; Politics; Public Health; Rural Health; Sentinel Surveillance; United States; Urban Health; World Health Organization

Viral respiratory tract infections (RTI) are relatively understudied in Southeast Asian tropical countries. In temperate countries, seasonal activity of respiratory viruses has been reported, particularly in association with temperature, while inconsistent correlation of respiratory viral activity with humidity and rain is found in tropical countries. A retrospective study was performed from 1982-2008 to investigate the viral etiology of children (≤ 5 years old) admitted with RTI in a tertiary hospital in Kuala Lumpur, Malaysia.. A total of 10269 respiratory samples from all children ≤ 5 years old received at the hospital's diagnostic virology laboratory between 1982-2008 were included in the study. Immunofluorescence staining (for respiratory syncytial virus (RSV), influenza A and B, parainfluenza types 1-3, and adenovirus) and virus isolation were performed. The yearly hospitalization rates and annual patterns of laboratory-confirmed viral RTIs were determined. Univariate ANOVA was used to analyse the demographic parameters of cases. Multiple regression and Spearman's rank correlation were used to analyse the correlation between RSV cases and meteorological parameters.. A total of 2708 cases were laboratory-confirmed using immunofluorescence assays and viral cultures, with the most commonly detected being RSV (1913, 70.6%), parainfluenza viruses (357, 13.2%), influenza viruses (297, 11.0%), and adenovirus (141, 5.2%). Children infected with RSV were significantly younger, and children infected with influenza viruses were significantly older. The four main viruses caused disease throughout the year, with a seasonal peak observed for RSV in September-December. Monthly RSV cases were directly correlated with rain days, and inversely correlated with relative humidity and temperature.. Viral RTIs, particularly due to RSV, are commonly detected in respiratory samples from hospitalized children in Kuala Lumpur, Malaysia. As in temperate countries, RSV infection in tropical Malaysia also caused seasonal yearly epidemics, and this has implications for prophylaxis and vaccination programmes.

Topics: Analysis of Variance; Child, Preschool; Female; Hospitalization; Humans; Influenza, Human; Malaysia; Male; Orthomyxoviridae; Regression Analysis; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Retrospective Studies; Seasons; Virus Diseases

The World Health Organization confirmed that the novel influenza A, H1N1 as a pandemic on 11 June 2009. After less than three months, 182 countries were affected by the pandemic accounting for about 150,000 infected cases and 3000 mortality. Successful H1N1 pandemic management strategies' shaped by making changes in health behavior. The aim of this study was to document patients' knowledge, attitudes and practices (KAP) regarding the pandemic influenza A (H1N1) and its prevention. We performed a cross-sectional study on knowledge, attitudes and practices (KAP) on preventive measures of Influenza A (H1N1) involving 322 patients attending Klinik Kesihatan Jinjang, a primary health care clinic in Kuala Lumpur, Malaysia from May 10 to 26, 2010 using a face to face interview with a structured pre-tested questionnaire. The majority of the respondents were females (56.8%), Malays (43.2%) aged between 18-27 years old (28.9%). There were significant association between knowledge on the complication of H1N1, effectiveness of the treatment, preventive measures of Influenza A (H1N1) and race (p<0.001) and educational level (p<0.001). There were also significant associations between attitude scores of these patients and their gender (p=0.03), and educational level (p=0.001). Practice scores related to H1N1 were found to be significantly associated with race (p<0.001) and educational level (p<0.001). The significant associations were observed between knowledge and attitude (p<0.001), knowledge and practices (p<0.001), as well as attitude and practices related to H1N1 (p<0.001). Knowledge has a crucial effect on patients' attitude and practice particularly in a pandemic spread. So health policy makers should attempt to disseminate information about preventive measures to community in order to improve their preventive practices during pandemics.

Topics: Adolescent; Adult; Chi-Square Distribution; Cross-Sectional Studies; Disease Outbreaks; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Primary Health Care; Surveys and Questionnaires

(i) To determine knowledge of, and self-protecting preventive behaviours towards influenza A(H1N1)pdm09 and (ii) to identify the factors influencing intention to take influenza A(H1N1)pdm09 vaccination among the study population.. This is a cross-sectional survey carried out in Mantin Town, a semi-urban area of Malaysia. A structured questionnaire consisted of sociodemographic characteristics, knowledge of pandemic influenza symptoms, mode of transmission, self-protecting preventive behaviours, and intention to receive the influenza A(H1N1)pdm09 vaccine was used for face-to-face interviews with the household members.. Of 230 who heard about pandemic influenza A(H1N1), 86% had misconception about mode of transmission of influenza A(H1N1)pdm09, and 52% had sufficient self-protecting behaviours. A majority (58.3%; 134/230) had intended to receive the vaccine. In the multivariate analysis, the intention to get vaccinated was significantly higher among 'those who trusted in efficacy of vaccine for prevention of influenza A(H1N1)pdm09' (p<0.001), 'those who were equipped with higher education level' (p=0.015) and 'those who worry about themselves contracting illness' (p=0.008).. Our findings highlight the need to scale up the community's knowledge regarding influenza A(H1N1)pdm09. Recognizing the factors affecting the acceptance of vaccination documented in this study will allow decision makers to devise effective and efficient vaccination strategies.

Topics: Adult; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza Vaccines; Influenza, Human; Malaysia; Male; Middle Aged; Multivariate Analysis; Patient Acceptance of Health Care; Surveys and Questionnaires; Young Adult

In the setting of the new A(H1N1) outbreak, the study was conducted to assess: (1) fear of the A(H1N1) pandemic; (2) risk avoidance behavior; (3) health-protective behavior; and (4) psychosocial impact in the ethnically diverse population of Malaysia. A cross-sectional, computer-assisted telephone interview was conducted between July 11 and September 12, 2009. A total of 1,050 respondents were interviewed. Fear about the pandemic was high, with 73.2% of respondents reporting themselves as Slightly fearful/Fearful. High risk avoidance and health protective behavior were reported, with 78.0 and 99.0% reporting at least one avoidance and protective behavior respectively. Knowledge was a significant predictor for practice of healthprotective behavior across the three ethnic groups. Level of fear was significantly correlated with number of protective and avoidance behaviors. The study highlights the need for provision of accurate information that increases risk avoidance and health protective behaviors, while at the same time decreases fear or panic in the general public.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Disease Outbreaks; Fear; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Linear Models; Malaysia; Male; Middle Aged; Multivariate Analysis; Socioeconomic Factors

Assessment of general public's knowledge and attitudes toward the development and prevention of new disease outbreaks is imperative because they have profound effects on health behaviors and may contribute to the control of the epidemic.. To investigate the level of knowledge and attitudes towards the influenza A(H1N1) outbreak across various ethnic groups and socio-demographic backgrounds in Malaysia.. A cross-sectional, population-based, computer-assisted telephone interview exploring knowledge and attitudes regarding influenza A(H1N1) was conducted in Malaysia. Between July 11 and September 12, 2009, a total of 1,050 respondents were interviewed (response rate 69.3%).. The mean total knowledge score for the overall sample was 7.30 (SD ± 1.961) out of a possible score of 13 (Chinese had the highest scores, followed by Indians, then Malays). Some erroneous beliefs about the modes of transmission were identified. The majority of the participants (73.8%) perceived the A(H1N1) infection as often deadly. Despite the overestimation of the severity of A(H1N1) infection, high confidence in preventing infection and low perceived susceptibility of infection were reported. Influenza A(H1N1)-related stigma was prevalent and exhibited differences across ethnic groups.. Findings suggest that provision of education and clear information are essential to correct the misconceptions, and increase perceived susceptibility to infection so that the general public will take precautions against A(H1N1) infection.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza Vaccines; Influenza, Human; Interviews as Topic; Malaysia; Male; Middle Aged; Pandemics

Data on the immunogenicity of the influenza vaccine in children after liver transplantation are sparse. Our study aims to evaluate the response of such patients to the trivalent influenza vaccine, administered by different protocols in 2 influenza seasons.. Children attending the Liver Transplantation Unit of a tertiary care medical center were prospectively recruited and immunized with the inactivated subvirion influenza vaccine during the influenza seasons of 2004/2005 (1 dose, n = 18) and 2005/2006 (2 doses 4-6 weeks apart, n = 32). Antibodies were measured by hemagglutination inhibition assay. Immunity was defined as a titer of ≥1:40, and response was defined as a ≥4-fold increase in antibody titer from baseline.. In 2004/2005, the proportions of patients with protective antibodies were similar before and after 1 dose of vaccine. We found significant difference after the first dose for the A/H3N2 Wisconsin strain (43.2% vs. 70.3%, P = 0.003) and B/Malaysia strains (8.1% vs. 35.1%, P = 0.003) and for A/H1N1 New Caledonia strain (48.6% vs. 64.9% vs. 75%, P = 0.08, 0.005, respectively) after the second dose in 2005/2006 season. In 2004/2005, geometric mean titers rose significantly (P = 0.03) for the A/H3N2 New York strain; in 2005/2006, geometric mean titers for A/H3N2 New York and B/Malaysia increased after the first dose and for A/H1N1 New Caledonia after the second dose. Antibody titers were unrelated to age at transplantation, time from transplantation, and number of immunosuppressive drugs used. No serious vaccine-related events were documented.. Liver-transplanted children respond to influenza vaccination. For some strains, the response is similar to that reported for healthy children. A second vaccine dose yielded no statistically significant benefit.

Topics: Adolescent; Antibodies, Viral; Child; Child, Preschool; Female; Hemagglutination Inhibition Tests; Humans; Infant; Influenza Vaccines; Influenza, Human; Liver Transplantation; Malaysia; Male; Prospective Studies; Transplantation; Vaccines, Inactivated; Vaccines, Subunit

Abstract. The 2009 pandemic influenza A(H1N1) infection in Malaysia was first reported in May 2009 and oseltamivir was advocated for confirmed cases in postexposure prophylaxis. However, there are cases of oseltamivir-resistance reported among H1N1-positive patients in other countries. Resistance is due to substitution of histidine by tyrosine at residue 275 (H275Y) of neuraminidase (NA). In this study, we have employed Sanger sequencing method to investigate the occurrence of mutations in NA segments of 67 pandemic 2009 A(H1N1) viral isolates from Malaysian patients that could lead to probable oseltamivir resistance. The sequencing analysis did not yield mutation at residue 275 for all 67 isolates indicating that our viral isolates belong to the wild type and do not confer resistance to oseltamivir.

Topics: Amino Acid Substitution; Antiviral Agents; Disease Outbreaks; Drug Resistance, Viral; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Mutation, Missense; Neuraminidase; Oseltamivir; Reverse Transcriptase Polymerase Chain Reaction; Sequence Analysis, DNA; Viral Proteins

To determine effects of pandemic (H1N1) 2009 on children in the tropics, we examined characteristics of children hospitalized for this disease in Malaysia. Of 1,362 children, 51 (3.7%) died, 46 of whom were in an intensive care unit. Although disease was usually mild, ≥ 1 concurrent conditions were associated with higher death rates.

Topics: Child; Child, Preschool; Female; Hospitalization; Humans; Infant; Infant, Newborn; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Pandemics

The 2009 pandemic influenza A(H1N1) was first detected in Malaysia in May 2009. It quickly spread in the general population and contributed to a number of influenza-like illness. The objective of the study is to characterize genetic changes in early Malaysian isolates of mild and severe illness of the novel influenza, and to compare sequences of viruses circulating in Malaysia to those in other countries between May to September 2009. Viral isolates of 56 mild cases and 10 severe (intensive care unit or fatal) cases were sequenced for haemagglutinin (HA) and neuraminidase (NA). Genome sequencing of the viral RNA was conducted on 5 isolates (3 were from fatal cases). Highly conserved sequences with few sporadic variations were identified in HA and NA. E374K and D222N were identified in 2 viral isolates from patients with severe illness. Phylogenetic analysis showed close genetic relatedness to the vaccine strain A/California/07/09 and other isolates circulating worldwide during the same period. Sporadic variations were identified in the viral isolates, however a larger sample size is required to make associations with disease severity.

Topics: Adult; Child, Preschool; Female; Hemagglutinin Glycoproteins, Influenza Virus; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Middle Aged; Neuraminidase; Pandemics; Phylogeny; Polymerase Chain Reaction; RNA, Viral

Novel influenza viruses are seen, internationally, as posing considerable health challenges, but public responses to such viruses are often rooted in cultural representations of disease and risk. However, little research has been conducted in locations associated with the origin of a pandemic. We examined representations and risk perceptions associated with swine flu amongst 120 Malaysian pig farmers. Thirty-seven per cent of respondents felt at particular risk of infection, two-thirds were somewhat or very concerned about being infected. Those respondents who were the most anxious believed particular societal "out-groups" (homosexuals, the homeless and prostitutes) to be at higher infection risk. Although few (4%) reported direct discrimination, 46% claimed friends had avoided them since the swine flu outbreak. Findings are discussed in the context of evolutionary, social representations and terror management theories of response to pandemic threat.

Topics: Adult; Aged; Animal Husbandry; Animals; Fear; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Middle Aged; Pandemics; Psychological Theory; Risk Assessment; Swine

Bats are increasingly being recognized as important reservoir hosts for a large number of viruses, some of them can be highly virulent when they infect human and livestock animals. Among the new bat zoonotic viruses discovered in recent years, several reoviruses (respiratory enteric orphan viruses) were found to be able to cause acute respiratory infections in humans, which included Melaka and Kampar viruses discovered in Malaysia, all of them belong to the genus Orthoreovirus, family Reoviridae. In this report, we describe the isolation of a highly related virus from an adult patient who suffered acute respiratory illness in Malaysia. Although there was no direct evidence of bat origin, epidemiological study indicated the potential exposure of the patient to bats before the onset of disease. The current study further demonstrates that spillover events of different strains of related orthoreoviruses from bats to humans are occurring on a regular basis, which calls for more intensive and systematic surveillances to fully assess the true public health impact of these newly discovered bat-borne zoonotic reoviruses.

Topics: Acute Disease; Adult; Animals; Antibodies, Viral; Female; Fluorescent Antibody Technique; Genome, Viral; Humans; Influenza, Human; Malaysia; Male; Middle Aged; Orthoreovirus; Phylogeny; Sequence Homology, Amino Acid; Zoonoses

A cross-sectional survey was conducted with the objective to explore a community's knowledge and practices towards prevention of Influenza A (H1N1) in three residential areas in Tampin. Respondents were randomly selected from a list of residences and interviewed face-to-face using a structured questionnaire. A total of 221 respondents (80.9%) were involved with the majority (64.7%) comprising female and who had attained secondary level of education (86.0%). The main source of information was from television/radio. The total score for knowledge questions was 15 and practice questions were 25. A total of 60.2% attained "adequate knowledge" and 52.0% "good practice". Mean (SD) for knowledge score was 11.6 (2.3) and practice was 18.1 (4.1). Ethnicity, education, income and practice score were identified as predictors for knowledge score. Income and knowledge scores were predictors for practice score. There was positive correlation between knowledge and practice scores.

Topics: Adult; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Middle Aged; Socioeconomic Factors

The clinical impact of seasonal influenza is understudied in tropical countries. The aim of this study was to describe the clinical features and seasonal pattern of influenza in children hospitalized in Malaysia, and to identify predictors of severe disease.. Children hospitalized with community-acquired, laboratory-confirmed influenza at a teaching hospital in Kuala Lumpur, Malaysia during 2002-2007 were identified retrospectively. Clinical data were collected, and predictors of severe disease were identified by multivariate logistic regression. All influenza cases from 1982 to 2007 were also analyzed for seasonal patterns.. A total of 132 children were included in the study, 48 (36.4%) of whom had underlying medical conditions. The mean age was 2.5 years and 116 (87.9%) were <5 years old. The most common presenting features were fever or history of fever, cough, rhinitis, vomiting, and pharyngitis. Severe influenza was seen in 16 patients (12.1%; nine previously healthy), including 12 (9.1%; eight previously healthy) requiring intensive care. There were three (2.3%) deaths. Severe disease was associated with age <12 months, female sex, and absence of rhinitis on admission. Influenza was seen year-round, with peaks in November-January and May-July.. Seasonal influenza has a considerable impact on children hospitalized in Malaysia, in both the healthy and those with underlying medical conditions.

Topics: Age Factors; Child, Preschool; Community-Acquired Infections; Female; Hospitalization; Humans; Infant; Influenza, Human; Malaysia; Male; Multivariate Analysis; Retrospective Studies; Risk Factors; Seasons; Sex Factors

This paper aimed to examine the temporal changes in psychobehavioral responses in relation to reported 2009 H1N1 influenza deaths.. Telephone interviews with 1050 members of the lay public in the Kuala Lumpur metropolitan area, Malaysia, were conducted between July 11 and September 12, 2009.. The study demonstrated that public psychobehavioral responses closely mirrored the daily number of reported deaths due to 2009 H1N1 influenza. During the weeks of escalating reported deaths, sharp rises of various domains of fear, health avoidance and protective behaviors, and impact were observed. In particular, health avoidance and protective behaviors decreases were consistent with the decline of reported deaths, indicating the paramount importance of efforts to sustain behavioral change in the general public.. These temporal trends provide important guidance toward health promotion and prevention initiatives in future outbreaks.

Topics: Adolescent; Adult; Attitude to Death; Cross-Sectional Studies; Disease Outbreaks; Fear; Health Behavior; Humans; Incidence; Influenza A Virus, H1N1 Subtype; Influenza, Human; Interviews as Topic; Malaysia; Time Factors; Urban Population; Young Adult

Providing health information during disease outbreaks is a fundamental component of outbreak control strategies. This study aimed to explore sources of influenza A(H1N1)-related information, specific information needs and preferences of the lay public during the peak of the outbreak. A cross-sectional, population-based, computer-assisted telephone interview of 1,050 respondents was conducted in Malaysia between July 11 and September 12, 2009. Newspaper, television and family were three main sources of information about A(H1N1). There were substantial ethnic differences; the Malays were significantly more likely to identify television as main source, while newspapers and family were identified as the main sources by the Chinese and Indians, respectively. Overall, the two main information needs identified were prevention and treatment. The Malays expressed lesser need for overall information than other ethnic groups. The three most preferred sources of information were television, newspapers and healthcare providers. There were significant positive correlations between amount of information received with knowledge (r = 0.149), perceived susceptibility to infection (r = 0.177), and other behavioral responses. Health information dissemination should be dedicated to meeting the information needs of diverse sociodemographic and ethnic groups. The findings highlight the importance of providing information that increases awareness and behavioral changes in disease prevention yet reduce fear.

Topics: Adolescent; Adult; Aged; Consumer Behavior; Consumer Health Information; Cross-Sectional Studies; Ethnicity; Family; Female; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Information Dissemination; Malaysia; Male; Middle Aged; Newspapers as Topic; Pandemics; Qualitative Research; Television; Young Adult

The study aimed to determine factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population. Population-based, cross-sectional survey was conducted between October and December 2009. Approximately 70% of overall participants indicated willingness to be vaccinated against the 2009 H1N1 influenza. Participants who indicated positive intention to vaccinate against 2009 H1N1 influenza were more likely to have favorable attitudes toward the 2009 H1N1 vaccine. A halal (acceptable to Muslims) vaccine was the main factor that determined Malay participants' decision to accept vaccination, whereas safety of the vaccine was the main factor that influenced vaccination decision for Chinese and Indian participants. The study highlights the challenges in promoting the 2009 H1N1 vaccine. Ethnic-sensitive efforts are needed to maximize acceptance of H1N1 vaccines in countries with diverse ethnic communities and religious practices.

Topics: Adult; Asian People; Cross-Sectional Studies; Ethnicity; Female; Health Knowledge, Attitudes, Practice; Humans; Influenza A Virus, H1N1 Subtype; Influenza Vaccines; Influenza, Human; Logistic Models; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Surveys and Questionnaires; Vaccination; Young Adult

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; Female; Health Care Costs; Hospitalization; Hospitals, Teaching; Humans; Infant; Infant, Newborn; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Middle Aged; Pandemics; Polymerase Chain Reaction; Young Adult

In a very closed and overcrowding environment, influenza transmission during Hajj season is almost inevitable. The aim of this study was to determine the association between pre-morbid conditions and influenza-like illness (ILI) amongst Hajj pilgrims. A cross-sectional study was conducted amongst Malaysian Hajj pilgrims in year 2007. Survey forms were distributed at Madinatul-Hujjaj, Jeddah and Tabung Haji Clinic, Medina, Saudi Arabia where pilgrims stay on transit before returning to Malaysia. Allergic rhinitis was significantly associated with sore throat (p=0.047), longer duration of cough (p=0.017) and runny nose (p=0.016). Pilgrims who suffered from chronic obstructive pulmonary diseases (COPD) had significant association with longer duration of cough (p=0.041) and those with diabetes mellitus had significant association with longer duration of sore throat (p=0.048). Underlying asthma was significantly associated with severe influenza like illness requiring admission to hospital for further treatment of respiratory symptoms (p=0.016). Based on these findings, we suggest those with underlying asthma should be discouraged from participating in the hajj and they should seek early treatment if they develop respiratory symptoms.

Topics: Adult; Female; Humans; Influenza, Human; Islam; Malaysia; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Diseases; Risk Factors; Saudi Arabia; Travel

From 2005 to 2009, the Institute for Medical Research (IMR), Kuala Lumpur received a total of 7,117 respiratory specimens from patients with influenza-like illness (ILI) for influenza screening. Seasonal influenza virus was isolated from 17.3% of patients with ILI in 2005, 31.6% in 2006, 12.8% in 2007, 10.2% in 2008 and 13.5% in 2009. There were one or more influenza A and B virus strains circulating in Malaysia throughout the year, with distinctly a peak in May to August. The predominant circulating strains of seasonal influenza A were A/California/7/2004-like (H3N2) in 2005, A/New Caledonia/20/99-like (H1N1) in 2006, A/ Brisbane/10/2007-like (H3N2) in 2007 and 2008, and A/Perth/16/2009-like (H3N2) virus in 2009. The predominant circulating strains of influenza B were B/Hong Kong/330/2001-like in 2005, B/Malaysia/2506/2004-like in 2006, B/Florida/4/2006-like in 2007 and 2008, and B/Brisbane/60/2008-like in 2009.

Topics: Humans; Influenza A virus; Influenza B virus; Influenza, Human; Malaysia; Sentinel Surveillance

The outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world. Previous pandemics have led to stockpiling of goods, the victimisation of particular population groups, and the cancellation of travel and the boycotting of particular foods (e.g. pork). We examined initial behavioural and attitudinal responses towards Influenza A, H1N1 ("Swine flu") in the six days following the WHO pandemic alert level 5, and regional differences in these responses.. 328 respondents completed a cross-sectional Internet or paper-based questionnaire study in Malaysia (N = 180) or Europe (N = 148). Measures assessed changes in transport usage, purchase of preparatory goods for a pandemic, perceived risk groups, indicators of anxiety, assessed estimated mortality rates for seasonal flu, effectiveness of seasonal flu vaccination, and changes in pork consumption. 26% of the respondents were 'very concerned' about being a flu victim (42% Malaysians, 5% Europeans, p < .001). 36% reported reduced public transport use (48% Malaysia, 22% Europe, p < .001), 39% flight cancellations (56% Malaysia, 17% Europe, p < .001). 8% had purchased preparatory materials (e.g. face masks: 8% Malaysia, 7% Europe), 41% Malaysia (15% Europe) intended to do so (p < .001). 63% of Europeans, 19% of Malaysians had discussed the pandemic with friends (p < .001). Groups seen as at 'high risk' of infection included the immune compromised (mentioned by 87% respondents), pig farmers (70%), elderly (57%), prostitutes/highly sexually active (53%), and the homeless (53%). In data collected only in Europe, 64% greatly underestimated the mortality rates of seasonal flu, 26% believed seasonal flu vaccination gave protection against swine flu. 7% had reduced/stopped eating pork. 3% had purchased anti-viral drugs for use at home, while 32% intended to do so if the pandemic worsened.. Initial responses to Influenza A show large regional differences in anxiety, with Malaysians more anxious and more likely to reduce travel and to buy masks and food. Discussions with family and friends may reinforce existing anxiety levels. Particular groups (homosexuals, prostitutes, the homeless) are perceived as at greater risk, potentially leading to increased prejudice during a pandemic. Europeans underestimated mortality of seasonal flu, and require more information about the protection given by seasonal flu inoculation.

Topics: Adolescent; Adult; Aged; Anxiety; Attitude to Health; Cross-Sectional Studies; Disease Outbreaks; Europe; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Middle Aged; Travel; Young Adult

Topics: Animals; Disease Outbreaks; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Swine

This study was designed to evaluate the health and economic benefits of a workplace vaccination programme against influenza funded by the employer. Employees of a Malaysian petrochemical plant volunteered to take part in this prospective, non-randomised, non-placebo-controlled study. Demographic and health information, including influenza-like symptoms, sick leave and post-vaccination adverse events were collected via questionnaires. Cost-benefit analyses were performed from the employer's perspective.. A total of 1,022 employees took part in the study, with 504 choosing to be vaccinated against influenza, and 518 remaining unvaccinated. The rate of influenza-like illness (ILI) was lower among vaccinated (8.13%) than non-vaccinated subjects (30.31%). Fever and respiratory symptoms were associated with all ILI cases. ILI-related sick leave was taken by 58.54% of vaccinated employees with ILI and 71.34% of non-vaccinated employees with ILI. Vaccination was financially beneficial, with the employer saving up to US dollar 53.00 per vaccinated employee when labour costs only were considered. Savings rose to up to US dollar 899.70 when the operating income of each employee was also considered. Workplace vaccination of healthy adults against influenza had a clear impact on ILI rates, absenteeism and reduced productivity in this Malaysian company. The health benefits translated into financial benefits for the employer, with cost savings significantly outweighting the costs of the vaccination programme.

Topics: Adult; Cost-Benefit Analysis; Female; Humans; Influenza, Human; Malaysia; Male; Prospective Studies; Workplace

Topics: Africa; Disease Outbreaks; Europe; Humans; India; Influenza A Virus, H5N1 Subtype; Influenza, Human; Malaysia; Middle East

In the months of July and August 2003, an outbreak of acute respiratory illness caused by influenza A virus occurred among students in seven residential schools situated in the northern part (Perak) of Peninsular Malaysia. Out of 4989 students, aged 13 to 18 years (mean = 15.9), 1419 (28%) were effected by influenza-like illness. All patients were treated as outpatients except for 36 students who required admission for high fever, severe coughing and shortness of breath. Abnormal chest X-ray findings were noted for those that required inpatient management. Influenza A virus was isolated from 37 sputum specimens, 20 throat swabs and three nasal swab specimens from a total of 278 clinical samples obtained from 180 patients. Isolates from each of the outbreaks were sent to WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia for antigenic and genetic analysis. One school outbreak was due to influenza A (H1N1), A/New Caledonia/20/99-like virus while the other six school outbreaks were due to influenza A (H3N2) viruses which were A/Fujian/411/2002-like).

Topics: Adolescent; Adult; Disease Outbreaks; Humans; Influenza A Virus, H1N1 Subtype; Influenza A Virus, H3N2 Subtype; Influenza, Human; Malaysia; Retrospective Studies; Schools

An influenza C virus was isolated from a Japanese traveler who had visited Malaysia in April 1999. Phylogenetic analysis indicated that the genome composition of this virus was distinct from that of any other strain isolated in Japan. The possibility that a genetically unique influenza C virus was introduced into Japan by a traveler is shown.

Topics: Adult; DNA, Viral; Gammainfluenzavirus; Humans; Influenza, Human; Japan; Malaysia; Male; Molecular Sequence Data; Phylogeny; Sequence Analysis, DNA; Travel; Viral Proteins

To determine influenza vaccine effectiveness against clinically defined influenza-like illness among Malaysian pilgrims attending the Haj in Saudi Arabia.. During February and March 2000, the authors conducted an unmatched case-control study. Case patients were identified at one of five hotel clinics, while controls were residents of these hotels who had not attended a clinic.. Among 820 case patients--84% of whom had received antibiotics--and 600 controls, the adjusted vaccine effectiveness against clinic visits for influenza-like illness was 77% (95% confidence interval: 69, 83), and that against receipt of antibiotics was 66% (95% confidence interval, 54, 75). The vaccine did not prevent clinic visits for non-influenza-like upper respiratory tract illness (adjusted vaccine effectiveness, 20%; 95% confidence interval: -24, 49).. Influenza vaccine was effective in preventing clinic visits for influenza-like illness and antibiotic use. Pilgrims traveling to the Haj in Saudi Arabia should consider influenza vaccination use.

Topics: Case-Control Studies; Female; Humans; Influenza A virus; Influenza B virus; Influenza Vaccines; Influenza, Human; Islam; Malaysia; Male; Middle Aged; Saudi Arabia; Travel; Vaccination

Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.

Topics: Acute Disease; Adolescent; Age Factors; Asia, Southeastern; Bangladesh; Child; Child, Preschool; Diarrhea; Female; Gastrointestinal Diseases; Humans; Infant; Influenza, Human; Malaysia; Male; Philippines; Sex Factors; Singapore; Thailand

Topics: Animals; Antibodies, Viral; Female; Hemagglutination Inhibition Tests; Humans; Influenza, Human; Malaysia; Male; Swine; Swine Diseases

Topics: Adolescent; Adult; Aged; Antibodies, Viral; Child; Child, Preschool; Disease Outbreaks; Female; Hemagglutination Inhibition Tests; Humans; Influenza, Human; Malaysia; Male; Middle Aged; Time Factors

Topics: Adolescent; Adult; Age Factors; Camping; Disease Outbreaks; Humans; Influenza, Human; Malaysia; Male

Topics: Adult; Africa; Age Factors; Asia; Congresses as Topic; Disease Outbreaks; Europe; Hong Kong; Humans; Influenza, Human; Iran; Malaysia; Middle Aged; Pacific Islands; Physicians; Taiwan

Topics: Humans; Influenza, Human; Malaysia; Military Medicine; Military Personnel

Topics: Betaretrovirus; Disease Outbreaks; Herpesvirus 1, Cercopithecine; Humans; Influenza, Human; Malaysia; Male; Schools