VZCZCXRO9771
RR RUEHAST RUEHCHI RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHKL #0621/01 2110109
ZNR UUUUU ZZH
R 300109Z JUL 09
FM AMEMBASSY KUALA LUMPUR
TO RUEHC/SECSTATE WASHDC 3034
INFO RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHGV/USMISSION GENEVA 1754
RUEKJCS/SECDEF WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE

UNCLAS SECTION 01 OF 02 KUALA LUMPUR 000621 
 
SENSITIVE 
SIPDIS 
 
STATE FOR CA/OCS/EAP 
STATE FOR M/PRI FOR RMORRITZ 
STATE FOR S/ES-O/CMS FOR EPARRA 
STATE FOR EAP/MTS FOR DBISCHOF 
STATE FOR OES/AIAG FOR AMBASSSADOR LOFTIS, DWINN AND 
CPATTERSON 
STATE FOR REO/BKK FOR HHOWARD 
STATE FOR OES/IHB, AAIT, MED 
HHS FOR OGHA STEIGER AND HICKEY 
CDC ATLANTA FOR CCID AND COGH 
USDA FOR APHIS 
 
E.O. 12958: N/A 
TAGS: KFLU AEMR ASEC AMED CASC KFLO TBIO KSAF KPAO PREL
PINR, AMGT, TF, MY 
SUBJECT: MALAYSIA H1N1 UPDATE - July 29, 2009 
 
¶1. (SBU) SUMMARY: The Malaysian Ministry of Health reported the 
third and fourth Influenza A (H1N1) related deaths on July 29. 
These deaths both involve local transmission of H1N1.  The total 
number of locally transmitted cases now exceeds the number of 
imported cases.  In the first three cases, the individuals were 
treated at private hospitals and clinics and were not tested or 
treated for H1N1 for at least several days after showing some 
symptoms.  In the fourth and most recent death, a 20 year old woman 
was treated at a MOH hospital but she did not report any symptoms 
until 11 days after onset.  Minister of Health Liow Tiong Lai has 
expressed his concern and "discomfort" with the worsening situation 
and has called on private hospital to be more vigilant with regard 
to H1N1 surveillance and treatment.  Malaysia continues to define 
its mitigation approach and MOH has announced they will preorder the 
H1N1 vaccine.  END SUMMARY. 
 
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H1N1 Deaths 
----------- 
 
¶2. (SBU) The fourth and most recent H1N1 related death in Malaysia 
was reported on July 29.  A 20 year old woman sought treatment at a 
MOH hospital in Malacca on July 26, reportedly 11 days after she 
began experiencing symptoms.  Her condition worsened on July 27 and 
she was tested for H1N1.  She passed away on July 28 before the 
results of the test were known.  MOH reported that the individual 
was obese. 
 
¶3.  (SBU) MOH reported on July 29 that a 42 year old Malaysian man 
had died from H1N1 related causes on July 27.  He reported to a 
private clinic on July 6 with flu-like symptoms but was not referred 
to the hospital until July 18.  The man was treated for 10 days in a 
private hospital and developed pneumonia.  The hospital did not 
perform a throat swab to test for H1N1 until July 22.  The 
individual reportedly was infected locally and not overseas, making 
this the first death involving local transmission.  Health Minister 
Liow Tiong Lai expressed concern that the individual was not treated 
for H1N1 early enough; like the prior two deaths, he was not treated 
at a MOH designated hospital and flu-like symptoms were reported 
several days before any H1N1 tests or treatments were performed.  He 
urged private clinics and hospitals to be more vigilant. 
 
¶4. (SBU) Malaysia's second H1N1 related death involves a 46 year old 
Malaysian man who passed away on July 26 after testing positive for 
H1N1.  He reportedly traveled to Langkawi with his family on July 13 
where he developed flu-like symptoms, although MOH suspects he may 
have encountered the disease while traveling in Europe.  The man 
went to a private hospital in the Kuala Lumpur area on July 16 and 
was given a chest x-ray, which showed pneumonia.  He was admitted to 
the ICU of a different private hospital on July 19.  MOH confirmed 
he was positive for H1N1 on July 22 and he died four days later.  It 
is unclear why he was not tested sooner and at what point, if ever, 
he received antiviral treatment.  MOH did not disclose any 
complicating preconditions about the victim, something they were 
quick to do with the first death case. 
 
¶5. (SBU) Malaysia's first H1N1-related death was reported on July 
¶24.  A 30 year old Indonesian student entered Malaysia on July 5 
with flu-like symptoms.  He reportedly fainted at a private medical 
facility while waiting for medication on July 21 and died that same 
day.  Minister of Health Liow Tiong Lai stated, "Influenza A (H1N1) 
was not a direct cause of his death" and described the individual as 
obese with a heart condition. 
 
---------------- 
Clusters of H1N1 
---------------- 
 
¶6. (SBU) Malaysia reported a total of 1219 confirmed cases from the 
start of the pandemic until July 28.  MOH has not estimated how many 
H1N1 cases may be positive but not reported.  MOH reports that 
approximately 53% of these cases were locally transmitted.  Local 
 
KUALA LUMP 00000621  002 OF 002 
 
 
transmission has far outpaced imported cases in the last two weeks. 
Liow had previously stated on July 27 that the situation in Malaysia 
was confined mostly to clusters of infection with a few isolated 
cases with limited community transmission.  The latest death 
prompted a much more grim assessment from Liow.  He stated that 
there were 95 new cases of local transmission in the last 24 hours 
with 19 new clusters of infection.  However, MOH has reported that 
almost 98% of all confirmed cases have already fully recovered. 
 
¶7. (SBU) MOH has publicly adopted a mitigation approach after slowly 
transitioning from a strict containment policy.  This means that 
some surveillance measures have relaxed.  Airport screening has 
loosened with health declaration cards still being distributed but 
ESTHoff observed that the cards are often not collected.  The cards 
primarily served to help health screeners identify if passengers had 
traveled to countries with local transmission of H1N1.  This 
information is no longer helpful now that Malaysia and all of its 
major transit points meet that criterion. 
 
¶8. (SBU) While MOH has shifted away from a containment strategy, 
this message still has not completely filtered down, leaving some 
inconsistent implementation.  The Ministry of Education (MOE) issued 
guidance on July 17 requiring all schools to form a special unit for 
H1N1 monitoring.  This MOE circular asked all schools to require 
students traveling back to Malaysia from overseas to receive a 
medical certificate of good health before returning to class.  This 
requirement does not apply to students already in Malaysia.  This 
guidance supersedes the previous instruction that all students 
returning from overseas must undergo seven days of home quarantine 
prior to returning to class regardless of whether or not they 
exhibit any symptoms.  However, MOH Principal Assistant Director for 
Infectious Disease Control Dr. Devan Ramu has stated this policy is 
outdated even though MOE has not said so.  Until MOE clarification 
is received the International School of Kuala Lumpur (ISKL) will 
follow the July 17 protocol and the Embassy will set up additional 
hours in the medical unit to examine Embassy children returning from 
summer vacation or other travel. 
 
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Flu Vaccine 
----------- 
 
¶9. (SBU) MOH confirmed on July 15 that it would place orders for the 
H1N1 vaccine.  Once the vaccine is available, MOH plans to vaccinate 
the 200,000 "frontliners" first, including police, health, and 
immigration officers. 
 
KEITH