KETUA PENGARAH KESIHATAN MALAYSIA DIRECTOR GENERAL OF HEALTH MALAYSIA Kementerian Kesihatan Malaysia Aras 12, Blok E7, Kompleks E Pusat Pentadbiran Kerajaan Persekutuan 62590 PUTRAJAYA

Tel. : 03-8883 2545 Faks : 03-8889 5542 Web : anhisham@moh.gov.my

SENARAI EDARAN

YBhg. Datuk I Dato’ /Datu I Tuan I Puan,

“UPDATED ZIKA ALERT” DAN ARAHAN PENTADBIRAN UNTUK PEMANTAUAN DAN PENGURUSAN JANGKITAN VIRUS ZIKA

Dengan segala hormatnya saya merujuk kepada perkara di atas. 2. Seperti YBhg. Datuk I Dato' I Datu I Tuan I Puan sedia maklum, jangkitan virus Zika di Amerika Selatan yang mula dilaporkan di Brazil pada May 2015, telah merebak dengan pantas ke 24 negara lain di rantau berkenaan sehingga 28 Januari 2016, seperti yang dilaporkan oleh 'World Health Organization" (WHO) dan "Pan America Health Organization" (PAHO). Penyakit Zika ini menunjukkan tanda- tanda dan gejala menyerupai demam denggi seperti demam, sakit otot, sakit sendi, sakit kepala, sakit di belakang mata, konjunktivitis dan ruam.Namun begitu, sebahagian besar mereka yang dijangkiti, tidak menunjukkan sebarang gejala klinikal. WHO juga telah melaporkan bahawa terdapat kaitan diantara kejadian jangkitan virus Zika dengan kejadian "microcephaly" di Brazil dan "Guillain-Barre Syndrome" di beberapa negara lain.

3. Pada 1 Februari 2016 mesyuarat pertama "Emergency Committee under International Health Regulation" (IHR 2005) telah diadakan. Berikutan itu Ketua Pengarah WHO telah mengisytiharkan jangkitan virus Zika adalah merupakan "Public Health Emergency of International Concern"(PHEIC). 4. Sehubungan itu, semua Jabatan Kesihatan Negeri dan Bahagian berkaitan perlu mewujudkan sistem pemantauan dan pengurusan Jangkitan virus Zika dengan kadar segera sebagai langkah kesiapsiagaan. Pengujudan sistem pemantauan dan pengurusan ini melibatkan perkara-perkara berikut:

KKM.600-29/4/142 (38) 11 September 2016

i. Survelan klinikal untuk kes Zika di klinik kesihatan serta hospital

kerajaan dan swasta (Lampiran 2A1, 2A2, 2A3 dan Lampiran 2B)

ii. Survelan Makmal

a. Virus survelan yang telah dilaksanakan merujuk kepada surat rujukan MKAK 600-1/7/5 bertarikh 3 Disember 2015. Semua pihak hendaklah memastikan arahan ini dilaksanakan dengan serius dan memastikan ujian pengesanan Zika yang dibuat bagi semua kes yang memenuhi kriteria kes definisi seperti yang dijelaskan dalam surat berkenaan.

b. Notifikasi Makmal kepada MKAK (daripada makmal kerajaan dan swasta)

iii. Survelan “microcephaly” dilaksanakan oleh Jawatankuasa pakar pakar pediatrik dan “Gullain-Barré Syndrome” dilaksanakan oleh pakar pakar perubatan.

iv. Tindakan pencegahan dan kawalan oleh Pejabat Kesihatan Daerah dan Jabatan Kesihatan Negeri.

v. Garispanduan Kesiapsiagaan dan Respons Pintu Masuk Antarabangsa Negara

Sehingga 10 September 2016, 4 kes Zika telah disahkan di Malaysia. Selaraskan dengan fasa pengekangan perebakan (containment phase), tindakan segera yang perlu dilaksanakan di pelbagai peringkat adalah seperti berikut:

A. Sistem pelaporan kes disyaki (suspected case) Zika, kes

disahkan (confirmed case), “microcephaly” dan “Guillain-Barré Syndrome”.

i. Semua kes yang memenuhi kriteria definisi kes disyaki

jangkitan virus Zika (“suspected case”) dan kes yang disahkan (“confirmed case”) seperti di dalam Lampiran 1 hendaklah dilaporkan kepada Pejabat Kesihatan Daerah (PKD) dalam tempoh 24 jam dari tarikh didiagnosis melalui panggilan telefon diikuti dengan menghantar borang notifikasi kes format Zika1 / case/ 2016 (Lampiran 3) atau melalui sistem eNotifikasi.

ii. Semua kes “microcephaly” seperti di dalam Lampiran 1

hendaklah dilaporkan kepada Pejabat Kesihatan Daerah

(PKD) (Lampiran 5) dengan kadar segera menggunakan

borang notifikasi “microcephaly” format Zika 2/ microcephaly/

2016 (Lampiran 4).

iii. Semua kes “Guillain-Barré Syndrome” seperti di dalam

Lampiran 1 hendaklah dibuat ujian saringan virus Zika dan

dinotifikasi kepada Pejabat Kesihatan Daerah (PKD)

(Lampiran 5) dengan kadar segera menggunakan borang

notifikasi format Zika 1/ case/ 2016 (Lampiran 3).

B. Pengurusan Klinikal

1.1 Fasiliti Kesihatan Primer

i. Bagi kes yang memenuhi kriteria definisi kes disyaki jangkitan virus Zika (Lampiran 1) akan dirujuk ke hospital untuk pemantauan dan rawatan (Lampiran 2B).

ii. Bagi kes yang tidak memenuhi kriteria definisi kes disyaki akan diberikan panduan penjagaan kesihatan pesakit luar (Lampiran 6).

1.2 Hospital

i. Bagi kes yang memenuhi kriteria definisi kes disyaki jangkitan

virus Zika (Lampiran 1), sampel darah dan air kencing hendaklah diuji di Hospital KKM yang menawarkan ujian tersebut mengikut negeri masing-masing. Sekiranya negeri tersebut tidak mempunyai hospital yang menawarkan ujian bagi virus Zika, sampel tersebut perlu dihantar ke Makmal Kesihatan Awam mengikut zon yang telah ditetapkan atau ke Hospital KKM berdekatan. Bagi hospital swasta, sampel boleh dihantar ke makmal swasta (sila rujuk Lampiran 8).

ii. Ujian darah perlu diulangi selepas 48 jam pesakit didiagnosa dan pesakit boleh di discaj/dibenarkan pulang ke rumah setelah ujian serum darah negatif. (sila rujuk Lampiran 1)

1.3 Kes “Microcephaly”

i. Bagi kes yang didiagnosa sebagai “microcephaly” mengikut kes definisi “microcephaly” (Lampiran 1),sampel klinikal hendaklah dihantar ke IMR untuk ujian pengesahan jangkitan virus Zika dengan segera (Lampiran 2A1).

ii. Bagi kes “microcephaly” yang disahkan positif hendaklah dirujuk kepada Pakar Pediatrik di negeri masing-masing untuk tindakan lanjut.

iii. Bagi kesiapsiagaan dan respons pintu masuk antarabangsa

negara, garis panduan pencegahan dan pengurusan

jangkitan virus Zika dinyatakan dalam lampiran 7.

1.4 Kes “Guillain-Barré Syndrome”

i. Bagi kes yang didiagnosa sebagai “Guillain-Barré Syndrome”

mengikut kes definisi “Guillain-Barré Syndrome” (Lampiran

1), sampel klinikal hendaklah dihantar ke IMR untuk ujian

pengesahan jangkitan virus Zika dengan segera (Lampiran

2A2).

C. Tindakan Pencegahan dan Kawalan di Pejabat Kesihatan

Daerah dan Jabatan Kesihatan Negeri (JKN)

i. Semua kes yang disahkan positif untuk jangkitan Zika hendaklah dimasukkan ke dalam wad dan pesakit yang negatif diberikan nasihat mengenai penjagaan kesihatan (Lampiran 6).

ii. Pejabat Kesihatan Daerah hendaklah melaporkan kes yang

memenuhi kriteria definisi kes disyaki dan disahkan jangkitan virus Zika (Lampiran 1), kes “microcephaly” dan “Guillain-Barrȇ Syndrome” (GBS) yang disahkan jangkitan virus Zika ke Jabatan Kesihatan Negeri dan seterusnya ke Crisis Preparedness Response Center (CPRC) Kebangsaan secara harian dan memasuk data ke dalam sistem Vekpro online dalam tempoh 24 jam. Talian untuk dihubungi ialah 03-88810200 atau 0388810700 dan menghantar laporan melalui email kepada cprc@moh.gov.my (Lampiran 5).

iii. Bagi setiap kes yang memenuhi kriteria definisi kes disyaki dan disahkan jangkitan virus Zika (Lampiran 1) hendaklah dikendalikan dengan segera dan sebagai “public health emergency”. Kaedah kawalan adalah sama seperti mengawal wabak denggi iaitu kawalan dalam lingkungan 400 meter dari kediaman kes indeks. Ini adalah bagi memastikan penyebaran virus Zika di kawal sepenuhnya sebelum merebak kepada individu dan kawasan lain.

iv. Pejabat Kesihatan Daerah (PKD) hendaklah melakukan Active

Case Detection (ACD) dan aktiviti pencegahan dalam lingkungan 400 meter dari kediaman kes indeks. Kontek kepada kes indeks contohnya isi rumah (household) atau rakan sekelas yang menunjukkan gejala (sign and symptom) Zika, perlu diambil sampel darah dan air kencing untuk pengesanan virus Zika. Manakala penduduk tetap yang tinggal dalam lingkungan tersebut atau mana-mana pelawat yang telah tinggal di kawasan itu yang menunjukkan gejala (sign and symptom) Zika, mestilah diambil sampel darah dan air kencing untuk pengesanan virus Zika.

v. Bagi Pejabat Kesihatan Daerah (PKD) yang telah melaporkan kes Zika, hendaklah mengaktifkan Jawatankuasa Wabak Peringkat Daerah serta mengadakan mesyuarat membincangkan tindakan pencegahan dan kawalan. Jawatankuasa wabak hendaklah diaktifkan sebaik sahaja kes pertama dilaporkan di daerah berkenaan.

vi. Bagi PKD yang tiada atau belum lagi melaporkan kes Zika, hendaklah membuat pembentangan mengenai Zika dalam Mesyuarat Jawatankuasa Tindakan dan Pembangunan Daerah (JKTPD) yang dipengerusikan oleh Pegawai Daerah. Ia bertujuan untuk meningkat pengetahuan ahli mesyuarat mengenai Zika, implikasinya kepada masyarakat serta risiko penularan Zika ke daerah masing-masing, supaya langkah-langkah proaktif diambil oleh JKTPD bagi mengekang perebakan Zika, selaras dengan konsep “inter-sectoral approach and health in all policies”.

vii. Pada masa yang sama, PKD dan agensi-agensi berkaitan perlu meningkatkan kesedaran dan mengerakkan masyarakat untuk melakukan aktiviti pembersihan persekitaran bagi menghapuskan tempat-tempat pembiakan Aedes setiap minggu. Masyarakat juga perlu digalakkan untuk melindungi diri daripada gigitan nyamuk dengan memakai pakaian yang menutupi anggota badan dan menggunakan ubat pencegahan gigitan (repelen) secara tetap. PKD juga hendaklah memastikan fasiliti kesihatan bebas daripada pembiakan Aedes

viii. Bagi pelancong atau rakyat Malaysia yang datang dari negara-

negara dijangkiti virus Zika atau yang memenuhi kriteria definisi kes disyaki perlu dirujuk kepada fasiliti kesihatan (Lampiran 2B).

ix. Jabatan Kesihatan Negeri iaitu Pengarah Kesihatan Negeri

perlu memaklumkan Exco Kesihatan Negeri dan mewujudkan Pasukan Petugas Khas Peringkat Negeri.

x. Jabatan Kesihatan Negeri perlu mengeluarkan “Zika Alert” dan

memaklumkan mengenai situasi virus Zika serta pelaksanaan pengurusan jangkitan virus Zika kepada fasiliti kesihatan kerajaan dan swasta.

xi. Semua Jabatan Kesihatan Negeri dan juga Pejabat Kesihatan

Daerah perlu mewujudkan sistem pemantauan rapi untuk kes jangkitan virus Zika, kes “microcephaly” dan “Guillain-Barrȇ Syndrome” (GBS) termasuk pemantauan pintu masuk darat, udara dan laut.

D. Kesiapsiagaan dan Respons Pintu Masuk Antarabangsa Negara

i. Bagi kesiapsiagaan dan respons pintu masuk antarabangsa negara, garispanduan pencegahan dan pengurusan jangkitan virus Zika dinyatakan dalam lampiran 7.

5. Arahan Pentadbiran ini akan dilaksanakan dengan serta merta dari tarikh surat ini dikeluarkan. Pengarah Kesihatan Negeri adalah diminta untuk memastikan tindakan ini dilaksanakan dengan kadar segera

bagi menghalang penularan virus Zika di Malaysia. Manakala komitmen Pengarah Bahagian yang berkaitan diperlukan agar sistem pemantauan dan pengurusan jangkitan virus Zika dilakukan secara teratur dan tindakan segera dapat dilaksanakan. Kerjasama YBhg. Datuk I Dato' I Datu I YB Dato' I Tuan I Puan dalam perkara ini amat dihargai dan diucapkan ribuan terima kasih.

Sekian.

“BERKHIDMAT UNTUK NEGARA”

Saya yang menurut perintah,

(DATUK DR NOOR HISHAM ABDULLAH)

Ketua Pengarah Kesihatan Malaysia

s.k.

i. Ketua Setiausaha Kementerian Kesihatan Malaysia

ii. Timbalan Ketua Pengarah Kesihatan (Kesihatan Awam)

iii. Timbalan Ketua Pengarah Kesihatan (Perubatan)

iv. Timbalan Ketua Pengarah Kesihatan (Penyelidikan & Sokongan Teknikal)

v. Pengarah Bahagian Kawalan Penyakit

vi. Pengarah Bahagian Pembangunan Kesihatan Keluarga

vii. Pengarah Bahagian Perkembangan Perubatan

viii. Pengarah Pusat Darah Negara

ix. Pengarah Institut Penyelidikan Perubatan

x. Pengarah Pendidikan Kesihatan

Lampiran 1

ZIKA VIRUS INFECTION

1 CASE DEFINITION, ADMISSION AND DISCHARGE CRITERIA

1.1 Suspected case:

1.1.1 Patient with rash (usually pruritic and maculopapular) with 2 or more of the following symptoms:

- Fever - Arthralgia - Arthritis/ periarticular edema - Conjunctivitis (Non-purulent/ hyperemia)

AND

Recent history of travelling to the country / affected area with Zika infection (within 7 days after arrival) or history of *contact with confirmed Zika case.*Contact

*Person who has association in time and place with a confirmed case e.g

in the same household or history of sexual intercourse with a confirmed

case

1.1.2 Guillain-Barré Syndrome (GBS) Signs and symptoms of Guillain-Barre syndrome may include: - Prickling, "pins and needles" sensations in your fingers, toes, ankles

or wrists - Weakness in your legs that spreads to your upper body - Unsteady walking or inability to walk or climb stairs - Difficulty with eye or facial movements, including speaking, chewing

or swallowing - Severe pain that may feel achy or cramp-like and may be worse at

night - Difficulty with bladder control or bowel function - Rapid heart rate - Low or high blood pressure - Difficulty breathing

1.1.3 Microcephaly and other congenital malformation of central nervous

system - Diagnosed in utero or postnatal as microcephaly using standard

growth chart by medical profession

1.2 Confirmed case:

A suspected case with laboratory positive result for the specific detection of Zika virus (see algorithm for laboratory diagnosis). The case definition has been adapted from Pan American Health Organization; Epidemiological Update, Zika Virus Infection, 16 October 2015 (Available at:, WHO; Zika virus Fact sheet , Updated January 2016 .) (Available at http://www.who.int/mediacentre/factsheets/Zika/en/) and CDC, Morbidity and Mortality Weekly Reports, 29 January 2016 /Vol.65(3);59–62. (Available at http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e2.htm) and may be subject to further modifications as new knowledge and information on the disease and the etiological agent is available.

1.3 Admission Criteria

Fulfil case definition of suspected and confirmed case.

1.4 Discharge Criteria

- Patient clinically well

- If serum PCR result is negative and urine PCR result is positive, the patient can be discharge.

- If serum PCR result is positive and urine PCR result is positive or

negative, repeat serum PCR until it’s become negative. Do not repeat

more frequently than 48 hourly.

Lampiran 2A1

-

TESTING ALGORITHM FOR ZIKA VIRUS

*Will be reviewed during mitigation phase

Suitable samples for ZIKA Virus Investigation (Blood and Urine samples send in ice with accompanying request forms)

- Samples from the Public Health clinics must be sent to Public Health Lab and samples from Hospital must be sent to Hospital Labs with PCR for Zika virus testing within that state.

- States that do not have any or only one laboratory that offers PCR for ZIKA virus, the samples must be sent to a nearby facility (hospital or Public Health Lab) regardless where the samples are from.

- Samples from private clinics and private hospitals must be sent to the listed private labs

- Sample from close contact of positive Zika patient should be sent to public health lab

12 Hospitals Public Health Labs Refer Lampiran 8 5 Private Labs

IMR*

8

Real Time RT-PCR for ZIKA Virus

Not Detected

For Confirmation

All positive test at any labs should be send to

IMR for confirmation before it can be reported.

Report Result

Detected

Report Result 1. Respective requestor 2. Respective KPP State

Vector 3. CPRC KKM

Send line listing of all

sample tested to

MKAK daily

drfaridah_ma@moh.

gov.my

Lampiran 2A2

TESTING ALGORITHM FOR ZIKA VIRUS (INFANTS SUSPECTED

MICROCEPHALY AND GUILLAIN-BARRÉ SYNDROME)

*All positive results must be informed to KPP Vector by IMR

Suitable samples for ZIKA Virus Investigation (Blood, Urine, CSF and Tissue sample send in ice with request forms)

- Infants with suspected microcephaly – please collect blood directly from the infants within 2 days of birth or blood from the umbilical cord or tissue sample from the placenta at delivery or maternal serum.

*Ref: Centre for Disease Control MMWR Interim Guidelines for the evaluation and testing of Infants with possible congenital Zika virus infection, 29 Jan 2016/65(3):63-67

Samples from

Private Hospitals

Samples from MOH

Hospitals

Listed Private Labs (Lampiran 8) Labs IMR

Real Time RT-PCR for ZIKA Virus

Not Detected Detected

Report Result For Confirmation-All positive tests

should be send to IMR for

confirmation before it can be

reported.

Report Result

Lampiran 2A3

LABORATORY SPECIMENS COLLECTION, STORAGE AND TRANSPORTATION FOR

PATIENT SUSPECTED ZIKA VIRUS INFECTION

A. TYPE OF SPECIMEN

NO SAMPLE TYPE VOLUME TUBE / CONTAINER

1.

Blood

Minimum 5 ml

Plain Tube with gel separator (orange cap).

2.

Urine

Minimum 10 ml

Sterile universal container*

3.

CSF

Amniotic fluid

1 ml

2 ml

Bijoux sterile tube*

4.

Tissue

Sterile universal container with VTM / saline*

* Please ensure a tight seal as leaking specimens cannot be accepted.

B. SPECIMEN STORAGE

i. Kept all specimen at 2 - 8 ⁰C ii. If tested more than 48 hours, blood should be aliquot in a sterile plastic tube iii. Kept all type of specimen frozen at -20 ⁰C for up to 7 days or at -70 ⁰C if longer than 7

days.

C. TRANSPORTATION

i. Specimens have to put in biohazard plastic and transport in ice at 2 – 8 ⁰C ii. Send immediately to the designated laboratory (refer Lampiran 10)

D. LABORATORY TURN AROUND TIME (LTAT) The laboratory turnaround time for all specimens is 1 – 2 days.

Lampiran 2B

WORKFLOW FOR SUSPECTED ZIKA INFECTION

FOR KLINIK KESIHATAN

(CONTAINMENT PHASE)

Fulfil case definition criteria

(CURRENT)

Referral to Hospital

(ID/ Medical specialist)

Home care advice

(Panduan Penjagaan Sebagai

Pesakit Luar)(Lampiran 6)

Admission

to ward

Patient arrive at clinic

YES NO

Other, specify:

Others, please state:[dd/mm/yy] :

Date: Date :

If patient died:

(please state)

NOTIFICATION FORM

FOR ZIKA VIRUS

Disease Control Division

Lampiran 3 Zika1 /case/2016

*For GBS please specify in no. 3 (sign and symptoms)

Other, specify:

Others, please state: [dd/mm/yy] :

Date:

Date :

If patient died:

Date of travelling: From_________________ to _______________

(please state)

NOTIFICATION FORM

FOR MICROCEPHALY

Disease Control Division

Lampiran 4 Zika 2/ microcephaly/ 2016

Lampiran 5

CARTA ALIR BAGI NOTIFIKASI PENYAKIT ZIKA

notifikasi

Jabatan Kesihatan Negeri Bilik Gerakan Vektor (Zika) di CPRC

Negeri (Ketua Penolong Pengarah (Vektor)

Crisis Preparedness and Response Centre, KKM Pegawai Petugas CPRC

( 03-88810700/10200) (email:cprc@moh.gov.my)

Makmal Kesihatan Awam Kebangsaan

(MKAK)

Pejabat Kesihatan Daerah

Hospital / Klinik (kerajaan dan swasta)

Sektor Penyakit Bawaan Vektor, KKM Dr Zailiza Binti Suli

(03-88834260; email: drzailiza@moh.gov.my) Dr Izwan Effendy Bin Zainudin

(03-88834265; email: jdrizwan@moh.gov.my) Dr Syed Sharizman Bin Syed Abdul Rahim

(03-88834263; email: dr.sharizman@moh.gov.my) En Zuraime Bin Mohd Daud / En Kamarulzaman Bin Daniel email: bgvektor@moh.gov.my

(03-88834340 / 4339)

Lampiran 6

PANDUAN PENJAGAAN KESIHATAN PESAKIT LUAR

Menggunakan repellent, memakai baju berlengan panjang dan berseluar

panjang atau menggunakan kelambu untuk mengelakkan daripada gigitan

nyamuk.

Sekiranya pesakit mengidap gejala-gejala dan tanda-tanda Guillain-Barré

Syndrome yang dikaitkan dengan masalah sistem saraf atau demam

berpanjangan atau keadaan bertambah teruk, dapatkan rawatan di hospital

dengan kadar segera.

Makan ubat demam seperti paracetamol mengikut nasihat doktor.

Sponge atau lap badan dengan kain basah bagi mengurangkan suhu badan.

Berehat secukupnya.

Minum banyak cecair seperti susu, jus buah-buahan, minuman isotonik dan

air barli (minum melebihi 5 gelas). Meminum air kosong sahaja tidak

mencukupi.

Menggunakan semburan aerosol, penghalau nyamuk seperti lingkaran

nyamuk, kepingan pengewapan cecair dan sebagainya.

Memasang jejaring pada tingkap untuk mengelakkan nyamuk masuk ke

dalam rumah.

Lampiran 7

1.1 PREPAREDNESS AND RESPONSE AGAINST ZIKA VIRUS INFECTION AT INTERNATIONAL AIRPORT

A. On board Announcements:

I. All international flights arriving at Malaysian entry points, are required to conduct an onboard health announcement on Zika virus infection. The script for the announcement is attached as Annex 1.

II. The health announcement seeks cooperation from the passengers and crew who have

history of travel or originating from the affected countries since the last seven (7) days to present themselves to the Health Personnel at the Health screening area after disembarking the aircraft.

B. Passengers and crew who have history of travel to the affected countries and

fulfill the criteria of suspected case are required to report to Health Personnel at the Health Screening area at entry point.

I. At the Health Screening area/Health Quarantine Centre, passengers and crew fulfill the

criteria of suspected case will be screened for Zika virus infection through history taking and examination as detailed in Annex 2.

II. Cases suspected of Zika virus infection will be referred to the nearest health facilities

for further management.

III. Cases not suspected of Zika virus infection will be provided with health advice and issued with a Health Alert Card (HAC) as in Annex 3.

IV. Suspected case (name, citizenship, passport number/identification number, contact

details and address in Malaysia) will be submitted to the relevant State Vector Officer for immediate implementation of surveillance and prevention activities.

C. Suspected Zika virus case on-board flight

I. The suspected cases which have been identified by the crew and the crew will informed

the health authority at the point of entry.

II. Suspected case will be received by health personnel at the arrival gates. Other passengers and crew are allowed to disembark from the aircraft and proceed to health screening at arrival hall.

III. Health personnel will bring the suspected case to Health screening area for full examination and history taking.

IV. Cases suspected of Zika virus infection will be referred to the nearest health facility for

further management.

V. Suspected case (name, citizenship, passport number/identification number, contact details and address in Malaysia) will be submitted to the relevant State Vector Officer for immediate implementation of surveillance and prevention activities.

VI. All cases of suspected Zika virus infection are to be notified to the National and State

CPRC and the nearest District Health Office.

D. Public Health Procedures on the aircraft with a case suspected of Zika virus infection on-board

I. When a case suspected of Zika virus infection is present on-board, an Assistant

Environmental Health Officer (PPKP) will immediately perform an inspection of the aircraft .

II. Under * *Annex 5 (6), IHR 2005, a conveyance may be regarded as suspect and

should be inspected for vectors and reservoirs if; a) it has a possible case of vector-borne disease on board; b) a possible case of vector-borne disease has occurred on board during an

international voyage; or c) it has left an affected area within a period of time where on-board vectors could

still carry disease.

III. Confirming that the aircraft disinsection has been carried out by verifying the evidence and validity and records of the disinsection procedures (eg. empty spray can, residual disinsection certificate etc.).

IV. The health part of the Aircraft General Declaration is to be inspected. The presence

of control measures used to control vectors should be included in the health part of the Aircraft General Declaration.

V. In the presence of vector during the inspection of aircraft, PPKP will/shall instruct the aircraft

to be disinsected o r o t her appropr ia t e measure by the groundhandlers / competent officers who has been identified by the company and to be supervised by the PPKP.

E. Management of suspected Zika virus case at Ground Crossing

I. All passengers will disembark conveyance to proceed for fever screening. Passengers

without symptoms will be provided a Health Alert Card (HAC) (Annex 3).

II. The details of passengers with symptoms will be recorded for follow up actions as

required.

III. Cases suspected of Zika virus infection will be referred to the nearest health facility for

further management.

IV. Cases suspected of Zika details (name, citizenship, passport number/identification

number, contact details and address in Malaysia) will be submitted to relevant DHO and

State Vector Officer for immediate implementation of surveillance and prevention

activities.

V. All cases of suspected Zika virus infection are to be notified to the nearest District Health

Office, State CPRC and national CPRC.

F. Public Health Procedures on the conveyance with a case suspected of Zika virus

infection

I. When a case suspected of Zika virus infection is present on conveyance, an Assistant

Environmental Health Officer (PPKP) will immediately perform an inspection.

II. Under **Annex 5 (6), IHR 2005, a conveyance may be regarded as suspect and should

be inspected for vectors and reservoirs if;

a) it has a possible case of vector-borne disease on board;

b) a possible case of vector-borne disease has occurred on board during an

international voyage; or

c) it has left an affected area within a period of time where on-board vectors could

still carry disease.

III. In the presence of vector during the inspection of conveyance, PPKP shall instruct the conveyance to be disinsected o r o ther appropr ia t e measure by the operator who has been identified by the company or the operator of conveyance and to be supervised by the PPKP.

1.2 SCREENING OF PASSENGER / CRUISE SHIPS / CONVENTIONAL SHIPS FROM ZIKA AFFECTED COUNTRIES– ANNEX 7

1. Assistant Enviromental Officer (PPKP) receives information from Ship Captain or

Shipping Agent regarding passengers or crew suspected with Zika symptoms or ships arriving from Zika affected countries within incubation period of seven (7) days.

2. PPKP will inform Medical Officer of Health regarding the information received of

suspected passengers or crew having Zika symptoms.

3. Ship will be given quarantine status and to be anchored at the wharf.

4. Instructions given to the Ship Captain / Shipping Agent to isolate all the suspected passengers or crew in the cabin or medical room for further examination and investigations by the Medical Officer / Port Health Officer.

5. Medical Officer / PPKP will go on board and verify the health status of passengers or crew suspected with Zika symptoms from the Captain / Medical Officer on board.

6. Temperature screening of passengers and crew who disembarks as well as those isolated in the cabin is carried out by the Medical Team. Passengers and crew with Zika symptoms will be referred to the nearest health facility for further management and investigations.

7. All the passengers and crew without Zika symptoms who disembarks will be given travel advisory and Health Alert Card (Annex 3).

8. PPKP will carry out inspection on sanitation and vector on the ship.

9. Free Pratique and Port Health Clearance will be issued to the Captain or Shipping Agent if the ship is free from vector infestation and has good sanitary condition.

10. Order of Ship Sanitation (OSS) will be issued to the Captain or Shipping Agent should there be presence of vectors or unsatisfactory sanitary condition.

11. Reinspection will be done by PPKP and Free Pratique and Port Health Clearance will be issued to the Captain or Shipping Agent if the Order of Ship Sanitation is complied.

12. Cases suspected of Zika details (name, citizenship, passport number/identification number, contact details and address in Malaysia) will be submitted to relevant DHO and State Vector Officer for immediate implementation of surveillance and prevention activities.

13. All cases of suspected Zika virus infection are to be notified to the nearest District Health Office, State CPRC and national CPRC.

14. All procedures and investigations carried out will be documented by PPKP and notified to State Vector Department.

1.3 OTHER PREPAREDNESS AND RESPONSE AGAINST ZIKA VIRUS INFECTION AT INTERNATIONAL POINT OF ENTRY

A. Awareness to public, passengers and crew on Zika virus

Heighten awareness on Zika virus, prevention and control measures such as:

I. Distribution of education materials such as pamphlets, posters and Travel advisory to passengers, crew, airport/port/ground crossing workers.

II. Updated information on social media – Website, Facebook (FB)

III. Distribution of Health Alert Card (HAC) to passengers and crew with history of visiting to Zika virus affected countries.

IV. Providing talks and briefings about the disease, mode of transmission and prevention and control measures.

V. Health announcements and messages focused at public and tourist area and especially at international airports and seaports

B. Vector surveillance, Prevention and control at Points of Entry

Enhanced vector surveillance, and vector prevention and control activities at points of entry (Please refer to the existing guidelines).

I. All international flights arriving Malaysian international points of entry are required to

disinsect the aircraft prior to disembarkation of passengers and crew. Evidence by means of empty spray cans or residual disinsection certificate or any proof of treatment (approved by MOH, WHO or accredited organisation/agencies) must be provided to the health authority on arrival.

II. Aircraft General Declaration of Health / Maritime Declaration of Health to be collected

and inspected for any declaration on the presence of vectors and control measures used to eradicate the vectors *Annex 5 (2), IHR 2005.

III. Increase awareness among all agencies/stakeholders on the importance of vector

free areas at entry points, as to prevent the spread of vector borne disease such as Dengue, Yellow fever, Zika virus and others.

C. Collaboration with other Agencies/Ministries

I. Ministry of Health Malaysia (MoH) is working in close collaboration with other relevant agencies such as The Immigration Department of Malaysia, Royal Malaysian Customs, Royal Malaysian Police Force, Department of Civil Aviation Malaysia, Airport/Port/Ground crossing authorities and agencies, Airlines, Shipping companies, Ground handlers, Pest Control Operators, etc.

II. Dissemination of information regarding Zika virus and travel advisory to personnel

and clients going to / coming from the affected countries thus increasing their awareness and to prevent the spread of disease into Malaysia.

III. Participation with all related agencies/stake holders in ensuring areas around entry

points (inside and outside buildings) at a minimum distance of 400 meters or with extension of the minimum distance if vectors with a greater range are present at these areas, are free from vectors.

IV. Emphasizing the importance of reducing breeding places for mosquitoes by “search

and destroy” activities. These precautions do not only reduce the risk of Zika virus infection, Yellow fever and also dengue fever.

V. Immigration Department of Malaysia to assist in referring travelers from Zika virus

affected countries detected at the international points of entry to Health Personnel, Health screening area/Health Quarantine Centre for assessment.

VI. All aircraft / ship / vehicle are required to inform the health authorities at the points of

entry if there are passengers from Zika virus affected countries showing signs and symptoms of Zika virus infection.

VII. To obtain assistance and cooperation as and when needed from all agencies/stake

holders in disease prevention and control activities.

*Annex 5 (2) refer IHR 2005 **Annex 5(6)refer IHR 2005

ANNEX 1

FLIGHT ONBOARD ANNOUNCEMENT: ZIKA VIRUS ADVISORY

(Announcement is to be made just prior to landing, NOT at departure).

Ladies and gentlemen

We extend you a welcome on board. For your health safety, we would appreciate your attention and action on this Health Advisory, concerning Zika Virus from Ministry of Health Malaysia.

We wish to seek the cooperation of passengers who have history of travel to Zika virus transmission countries (as listed by WHO) since the past seven (7) days to present your selves to the Health Personnel at the health screening centre after disembarking from the aircraft.

Countries with Zika virus transmission (with a first reported outbreak from 2015 onwards) are as follow:

AMRO/PAHO :

Anguilla; Bonaire Curaçao Guatemala

Antigua and Barbuda Sint Eustatius and

Saba– Netherlands Dominica Guyana

Argentina Brazil Dominican Republic Haiti

Aruba British Virgin Islands Ecuador Honduras

Bahamas Cayman Islands El Salvador Jamaica

Barbados Colombia French Guiana Martinique;

Belize Costa Rica Grenada Mexico

Bolivia (Plurinational

State of Cuba Guadeloupe

AFRO

Cabo Verde; Guinea-Bissau

WPRO

American Samoa; Fiji; Marshall Islands; Micronesia (Federated States of); Samoa; Singapore;

Tonga

We thank you for your attention.

The list of countries with Zika virus transmission will be updated from time to time based on WHO Zika situation report.

ANNEX 2

Senarai Semak Saringan Penyakit Virus Zika di Pintu Masuk:……………………….... Tarikh pemeriksaan :

Masa:

A) Maklumat pesakit

Nama Email

Umur No Telefon (di Malaysia)

Jantina Warganegara

Sekiranya wanita mengandung atau tidak

Alamat Tempat Tinggal di Malaysia (WAJIB isi alamat dengan lengkap/detail)

No Kad Pengenalan / Pasport

B) Butiran Lanjut

1. Telah tiba dari negara dijangkiti penyakit Zika dalam masa 7 hari sebelum ini

Sila maklumkan nama negara :

2. Butiran penerbangan pulang

Route : ………………………………….. No penerbangan : ……………………..

No tempat duduk : ………………………

3. Gejala yang dikesan (Sila pilih YA atau Tidak (√)bagi setiap gejala yang disenaraikan ) :

DEMAM YA TIDAK RUAM YA TIDAK

SAKIT OTOT /

SENDI

YA TIDAK SAKIT KEPALA YA TIDAK

KONJUNKTIVITIS YA TIDAK KELESUAN

(MALAISE)

YA TIDAK

C) Pemeriksaan FiZikal

Umum

Suhu Badan - ……………°C konjuktiva - …………..

Tekanan darah - ………….mmHg

Nadi -…………. / minit

D) Rawatan dan Tindakan susulan :

………………………………………………………………………………………………………………….………………………………………………………………………………………………..…………………………………………………………………………………………………………

E) Pemeriksaan oleh :

Nama :

Jawatan :

Negara –negara dengan transmisi Virus Zika :

AMRO/PAHO: Anguilla; Antigua and Barbuda; Argentina; Aruba; Bahamas; Barbados; Belize; Bolivia Plurinational

State of), Bonaire, Sint Eustatius and Saba – Netherlands*; Brazil; British Virgin Islands; Cayman Islands; Colombia;

Costa Rica; Cuba; Curaçao; Dominica; Dominican Republic; Ecuador; El Salvador; French Guiana; Grenada;

Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico;Nicaragua; Panama; Paraguay;

Peru; Puerto Rico; Saint Barthélemy; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines;Sint Maarten;

Suriname; Trinidad and Tobago; Turks and Caicos;United States of America; United States Virgin Islands;

Venezuela(Bolivarian Republic of);

AFRO: Cabo Verde; Guinea-Bissau;

WPRO: American Samoa; Fiji; Marshall Islands; Micronesia (Federated States of); Samoa; Singapore; Tonga

akan dikemaskini berdasarkan laporan WHO

ANNEX 3

MINISTRY OF HEALTH MALAYSIA

Keep this card for the next seven (7) days after arriving to Malaysia. Monitor your body temperature and look out for fever, skin rash (exanthema), muscle or joint pain, feeling weak, headache and conjunctivitis (red eye). If these symptoms developed and you are not feeling

well, seek medical advice immediately.

Attention to The Attending Doctor:

The person presenting this HEALTH ALERT CARD had recently travelled or returned from a Zika Affected Country (within the past 7days). If the person presents with fever (low grade fever less than 38.5°C), skin rash (exanthema), muscle or joint pain, malaise, headache and conjunctivitis (red eye), please refer him/her immediately to the nearest hospital for investigation and treatment.

* Countries with Zika virus transmission:

AMRO/PAHO:

Anguilla; Antigua and Barbuda; Argentina; Aruba; Bahamas; Barbados; Belize; Bolivia Plurinational State of), Bonaire, Sint

Eustatius and Saba – Netherlands*; Brazil; British Virgin Islands; Cayman Islands; Colombia; Costa Rica; Cuba; Curaçao;

Dominica; Dominican Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti;

Honduras; Jamaica; Martinique; Mexico;Nicaragua; Panama; Paraguay; Peru; Puerto Rico; Saint Barthélemy; Saint Lucia; Saint

Martin; Saint Vincent and the Grenadines;Sint Maarten; Suriname; Trinidad and Tobago; Turks and Caicos;United States of

America; United States Virgin Islands; Venezuela(Bolivarian Republic of);

AFRO:

Cabo Verde; Guinea-Bissau;

WPRO:

American Samoa; Fiji; Marshall Islands; Micronesia (Federated States of); Samoa; Singapore; Tonga

Note: The list of countries with Zika virus transmission will be updated from time to time based on WHO Zika situation report.

Date issued:

Name of Entry points:

HEALTH ALERT CARD FOR VISITORS AND CREW FROM THE ZIKA VIRUS AFFECTED COUNTRIES

ANNEX 4

TRAVEL ADVISORY FOR TRAVELLERS TO COUNTRIES WITH ZIKA VIRUS TRANSMISSION

Background

Zika virus is a mosquito-borne flavivirus closely related to dengue virus. It was first isolated

from a rhesus monkey in Zika forest, Uganda in 1947, in mosquitoes (Aedes africanus) in the same

forest in 1948 and in humans in Nigeria in 1954.

Prior to 2015, Zika virus outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands.

In May 2015, the WHO Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil. In December 2015, the Ministry of Health, Brazil reported a sharp increase in the number of reported cases of microcephaly of unknown cause in areas affected by Zika virus outbreak.

In 1st February 2016 WHO announce virus Zika infection as Public Health Emergency of International Concern (PHEIC)

As at 1 September 2016, Countries with Zika virus transmission*:

AMRO/PAHO:

Anguilla; Antigua and Barbuda; Argentina; Aruba; Bahamas; Barbados; Belize; Bolivia Plurinational State of), Bonaire, Sint

Eustatius and Saba – Netherlands*; Brazil; British Virgin Islands; Cayman Islands; Colombia; Costa Rica; Cuba; Curaçao;

Dominica; Dominican Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti;

Honduras; Jamaica; Martinique; Mexico;Nicaragua; Panama; Paraguay; Peru; Puerto Rico; Saint Barthélemy; Saint Lucia;

Saint Martin; Saint Vincent and the Grenadines;Sint Maarten; Suriname; Trinidad and Tobago; Turks and Caicos;United

States of America; United States Virgin Islands; Venezuela(Bolivarian Republic of);

AFRO:

Cabo Verde; Guinea-Bissau;

WPRO:

American Samoa; Fiji; Marshall Islands; Micronesia (Federated States of); Samoa; Singapore; Tonga

Note: The list of countries with Zika virus transmission will be updated from time to time based on WHO Zika situation report.

Key facts

Zika virus disease is caused by a virus transmitted by Aedes mosquitoes. It causes low grade fever and rash. Other symptoms include Muscle pain, joint pain,

headache, pain behind the eyes and conjunctivitis.

These symptoms normally last for 2-7 days

There is scientific consensus that Zika virus is a cause of microcephaly and Guillain-Barré syndrome. Links to other neurological complications are also being investigated.

The disease has similar clinical signs to dengue, and may be misdiagnosed in areas where dengue

is common.

There is no specific treatment or vaccine currently available. Treatment is focused on relieving

the symptoms.

The best form of prevention is protection against mosquito bites. Prevention and control relies on reducing the breeding of Aedes mosquitoes and minimizing contact between mosquito vectors and people by using barriers (such as

repellents, insect screens), reducing water-filled habitats supporting mosquito larvae in and close to dwellings, and reducing the adult mosquito populations around at-risk communities.

The virus is known to circulate in Africa, the Americas, Asia and the Pacific

Health Advisory:

Based on the current available information WHO does not recommend any travel or trade restrictions

to Zika virus affected countries. Given the current global situation of Zika virus infections, the Ministry

of Health, Malaysia would like to advise the public who wish to visit countries affected by the Zika

virus to take the same precautionary measures used to prevent dengue to minimize risk of infection

of Zika virus as follows;

1. Prevent mosquito bites by;

covering skin with long-sleeve clothing, trousers and hats,

use insect repellents on exposed body surfaces,

sleep protected by mosquito nets,

2. Avoid doing outdoor activities during peak biting times of the Aedes mosquitoes, i.e. a few hours

after dawn and before dusk.

3. Individuals travelling in or returning from areas where transmission of Zika virus is known to

occur:

i. should adopt

safer sex practices or consider abstinence for at least 6 months upon return to prevent

Zika virus infection through sexual transmission.

Couples or women planning a pregnancy, who are returning from areas where

transmission of Zika virus is known to occur, are advised to wait at least 6 months before

trying to conceive to ensure that possible Zika virus infection has cleared.

Sexual partners of pregnant women, returning from areas where transmission of Zika

virus is known to occur, should be advised to practice safer sex or abstain from sexual

activity for at least the whole duration of the pregnancy.

ii. and presenting with the following symptoms within 7 days of travel, should seek medical

advice immediately and inform the attending doctor of their travel history;

fever

skin rash (exanthema)

muscle or joint pain

malaise

headache

conjunctivitis (red eye)

As a precautionary measure, the Ministry of Health would like to advise pregnant women, especially

those in the first trimester, to postpone their trip to affected countries. MOH would like to emphasize

that the public should continue the “search and destroy” activities to reduce the breeding places of

Aedes mosquitoes in their homes and surroundings. These precautions do not only reduce the risk

of Zika virus infection but also dengue fever, Yellow fever, Chikungunya and other vector borne disease.

Prepared by: Disease Control Division Ministry of Health Malaysia

6 September 2016

Not From

Zika Virus

Affected

Countries

Refer to the nearest health

facilities for further

management

Allow to enter

into Malaysia

after Immigration

clearance

Allow home with

Health Alert Card

(HAC) and advice

Immigration

Counter -

screening

Affected

Countries

Suspected

Zika Virus

No Ye

ANNEX 5

FLOW CHART FOR SCREENING OF TRAVELLERS AND CREW ARRIVING

FROM ZIKA VIRUS AFFECTED COUNTRIES AT THE

INTERNATIONAL ENTRY POINTS (AIRPORT AND GROUND CROSSING) (WITH THERMAL SCANNER)

s

Self-referralto health

unit

Thermal Scanner

HEALTH SCREENING AT HEALTHSCREENING AREA/COUNTER FOR SUSPECTED ZIKA INFECTION

History taking

Clinical examination

To record the suspected travelers/crew

details and immediately submit to State

Vector Officer for vector surveillance and

prevention activities.

Yes

Arrival of travellers and crew at the international

entry points

From Zika Virus Affected Countries

No

Fever

From Zika Virus

Allow home with

Health Alert Card

(HAC) and advice

Refer to the nearest health facilities for

further management

No Suspected

Zika Virus

Yes

ANNEX 6

FLOW CHART FOR SCREENING OF TRAVELLERS AND CREW ARRIVING FROM ZIKA VIRUS AFFECTED COUNTRIES AT

THE INTERNATIONAL ENTRY POINTS (AIRPORT AND BORDER CROSSING) (WITHOUT THERMAL SCANNER)

Not From Zika Virus

Affected Countries Self-referral

to Health

Allow enter into

Malaysia after

Immigration

clearance

From Zika Virus

Affected Countries

Refer for Health Screening

HEALTH SCREENING AT HEALTH SCREENING AREA/COUNTER FOR SUSPECTED ZIKA INFECTION

History taking

Clinical examination

To record the suspected travelers/crew details and

immediately submit to State Vector Officer for vector

surveillance and prevention activities.

Arrival of travellers and crew at the international entry

points

Immigration

counter

ANNEX 7

FLOW CHART ON SCREENING OF PASSENGER/CRUISE SHIPS/CONVENTIONAL SHIPS FROM ZIKA AFFECTED COUNTRIES

With Zika symptoms Without Zika

symptoms

With vector

infestation

Record the suspected

travelers/crew details and

immediately submit to State

Vector Officer for vector

surveillance and prevention

activities.

MOH /PPKP inform the

nearest health

facilities for further

management and

investigations

Issue Free Pratique

& PHC

Satisfactory

Unsatisfactory

MOH : Medical Officer of Health PHC : Port Health Clearance HAC : Health Alert Card PPKP: Assistant Enviromental Officer IP : Incubation Period All ships will quarantined at the wharf

& the inspection will take about 1

hour

Receive information through advice regarding passenger or crew suspected having Zika symptoms

OR arriving from Zika affected countries (IP 7 days)

Refer MOH

Temperature screening of isolated passengers/crew/those who

disembarks

Ship is given quarantine status at the wharf

Sanitation and vector inspection

Verify the health status of passengers or crew suspected having Zika symptoms from

Medical Officer onboard

All the suspected passengers/crew are isolated at cabin/medical room

Issue Free

Pratique & PHC

- All the

passengers/crew

who disembark

given travel

advisory &HAC

Without vector

infestation

‘Order of Ship Sanitation (OSS)’ is

issued and disinsection or other

appropriate health measures is

carried out by ship agent/owner

Lampiran 8

LIST OF GOVERNMENT HOSPITALS,PUBLIC HEALTH AND PRIVATE

LABORATORIES PROVIDING SERVICES FOR ZIKA REAL TIME RT-PCR.

NO. CONFIRMATORY TEST BY SEQUENCING Contact Number

1. Institute for Medical Research (IMR) 03-26162671

NO. HOSPITAL LABORATORIES

1. Hospital Umum Sarawak 082-276818

2. Hospital Tuanku Jaafar Negeri Sembilan 06-7684318

3. Hospital Raja Perempuan Zainab II 09-7452000 Ext: 2739

4. Hospital Sultanah Bahiyah Kedah 04-7406233 Ext: 6244

5. Hospital Kuala Lumpur 03-26906852

6. Hospital Sungai Buloh 03-61454333

7. Hospital Sultanah Aminah Johor 07-2231666 Ext: 2660

8. Hospital Raja Permaisuri Bainun Perak 05-2085285

9. Hospital Pulau Pinang 04-2225220

10. Hospital Sultanah Nurzahirah Terengganu 09-6212121 Ext: 2105 /2878

11. Hospital Tengku Ampuan Afzan Pahang 09-5572869

12. Hospital Melaka 06-2892851

NO. PUBLIC HEALTH LABORATORIES

1. Makmal Kesihatan Awam Kebangsaan (MKAK) Sungai Buloh

03-61261200

2. Makmal Kesihatan Awam Kota Kinabalu 088-250710

3. Makmal Kesihatan Awam Kota Bharu 09-7138000

4. Makmal Kesihatan Awam Ipoh 05-5287829

5. Makmal Kesihatan Awam Johor Bahru 07-2387162

NO. PRIVATE LABORATORIES Contact Person

1. Lablink (M) Sdn Bhd. Dr Muhammad Nazri Aziz 03-40234588

2. GeneFlux Dr Mangalam Sinniah 03-80701154

3. CliniPath Dr Mangalam Sinniah 03-33422828

4. DNA Lab Dr Wong Yong Wee 03-89252700

5. Pantai Premier Laboratory Mr Adam Hathsey -Bronson

03-42979911

6. Gribbles Pathology Dr Cheong Yuet Meng 03-78417650