VZCZCXRO6464
RR RUEHAST RUEHCHI RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHKL #0555/01 1900907
ZNR UUUUU ZZH
R 090907Z JUL 09
FM AMEMBASSY KUALA LUMPUR
TO RUEHC/SECSTATE WASHDC 2951
INFO RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHGV/USMISSION GENEVA 1747
RUEKJCS/SECDEF WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE

UNCLAS SECTION 01 OF 03 KUALA LUMPUR 000555 
 
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 9, 2009 
 
¶1. (SBU) SUMMARY:  Influenza A (H1N1) cases continue to grow in 
Malaysia with over 300 new cases in the last week.  Most cases 
continue to be imported but about one-third involve local 
transmission.  The Ministry of Health (MOH) reported the first case 
of second-generation local transmission on July 5.  The MOH is 
gradually transitioning from containment to mitigation and its 
current measures involve aspects of both approaches.  MOH expects to 
move toward more mitigation activities as local transmission 
increases compared to imported cases.  While Malaysia's transition 
from containment to mitigation has created some unclear messages and 
observed inconsistent implementation, the local WHO representative 
is satisfied that Malaysia's overall approach is appropriate and 
generally effective.  END SUMMARY. 
 
----------------- 
Growing Case Load 
----------------- 
 
¶2. (U) MOH has confirmed a total of 513 cases of H1N1 with 317 new 
cases occurring in the last week.  Most cases continue to be 
individuals who were infected abroad and then traveled to Malaysia. 
However, there are a growing number of local transmissions.  MOH 
also reported the first instance of second-generation local 
transmission on July 5.  All cases continue to show improvement with 
Tamiflu treatment and there have been no deaths.  In fact, 430 of 
the 513 confirmed cases have already fully recovered and been 
released from quarantine. 
 
--------------------------------------- 
Containment Transitioning to Mitigation 
--------------------------------------- 
 
¶3. (SBU) MOH has been pursuing a strict containment strategy with 
regard to H1N1.  Border screening including thermal scanning was 
required for all travelers entering Malaysia.  Immediate in-hospital 
quarantine for one week was mandatory for all H1N1 positive 
individuals.  Close contacts of infected individuals also faced a 
week-long quarantine period; however, this could take place at home. 
 With the increased caseload and limited lethality of H1N1, MOH has 
shown signs of relaxing this containment policy and moving more 
toward a mitigation approach.  However, health minister Liow Tiong 
Lai has stated that MOH will only adopt a complete mitigation 
strategy "when there is sustained local transmission and the sources 
of the flu cannot be traced."  The inter-ministerial pandemic 
response committee met on July 8 to discuss the next steps for 
moving away from containment but a formal policy change is still 
forthcoming. 
 
------------ 
Surveillance 
------------ 
 
¶4. (SBU) As part of the gradual shift toward a mitigation approach, 
screening, testing, and quarantining protocols have been adjusted. 
MOH border surveillance will continue for the time being, including 
a mandatory health declaration card and thermal scanning.  MOH 
policy instructs that all passengers, local and foreign, submit to 
this screening.  As an example of the shift away from strict 
containment, Dr. Devan Kurup, MOH Principal Assistant Director for 
Infectious Disease Surveillance, informed ESTHoff that only 
foreigners are being screened at the Singapore land crossing due to 
logistical considerations.  However, ConGen observed on July 5 at 
the Singapore-Malaysia land crossing that only those individuals who 
obviously appeared to be Western were put through any H1N1 
screening. 
 
------- 
Testing 
------- 
 
¶5. (SBU) MOH policy dictates testing of symptomatic individuals at 
MOH hospitals and ports of entry to be done by a throat swab. 
 
KUALA LUMP 00000555  002 OF 003 
 
 
Individuals with relevant health complications and risk factors 
(including pregnant women, those with respiratory illness, obese 
individuals, and children) and passengers who have traveled to the 
United States, Melbourne, or Manila will have their samples sent to 
the Institute of Medical Research (IMR) with results available 
within a few hours.  They are also given two days of antivirals and 
released to home quarantine until the test result is returned.  For 
most other individuals, the sample is sent to the National Public 
Health Laboratory with results available approximately 24 hours 
later.  These individuals are released to home without antivirals 
and asked to call MOH to obtain the results of the test. 
 
---------- 
Quarantine 
---------- 
 
¶6. (SBU) Confirmed positive cases are still required to be brought 
to a MOH hospital for quarantine and treatment.  Individuals may now 
be released from quarantine if they have had no further 
complications, had at least three days of antiviral treatment, and 
no fever in the last 24 hours.  This has resulted in most patients 
being released from quarantine in three or four days, down from the 
previously mandated seven day quarantine period.  Children are 
required to quarantine for a minimum of five treatment days. 
However, MOH continues to publicly state that the quarantine period 
is seven days and Post has observed inconsistencies in the 
implementation of MOH's policy. 
 
¶7. (SBU) While most patients are now released prior to the seven day 
quarantine period, one AmCit family experienced a longer period.  A 
young AmCit girl was confirmed positive for H1N1 on July 4 after 
reporting to MOH with symptoms on July 2.  The girl and both parents 
were placed under quarantine on July 4 and remained in quarantine 
until July 8 with no complications or further symptoms, thus 
fulfilling four days of treatment.  However, MOH ordered the family 
to complete three more days of quarantine in their hotel, which was 
inconsistent with MOH protocol.  ESTHoff and ConOff were able to 
intercede with MOH to obtain the release of the family on July 9. 
 
-------------- 
Close Contacts 
-------------- 
 
¶8. (SBU) MOH is still attempting to trace all close contacts of 
confirmed cases but has reduced the amount of resources spent on 
this tactic.  "Close contacts" has now been defined as those who 
live in the same house or those who have sustained close contact of 
less than three feet for more than four hours.  These individuals 
will be given prophylaxis antiviral treatment assuming contact was 
within the last 48 hours. 
 
¶9. (SBU) Close contacts are asked now to "self-quarantine" rather 
than "home-quarantine" as before.  This distinction is to indicate 
that there will be no MOH enforcement of the quarantine. 
Previously, MOH had made several public statements reminding 
individuals that they must undergo the quarantine subject to the 
Prevention and Control of Infectious Diseases Act 1988.  As another 
example of unclear messages from MOH, the mother of the 
abovementioned AmCit child who tested positive for H1N1 was asked on 
July 4 to quarantine in her hotel room.  This mother reported to 
ConOff that, contrary to MOH's stated softer approach, she was told 
she faced two years imprisonment if she left her hotel room. 
 
------------------------- 
Policy and Implementation 
------------------------- 
 
¶10. (SBU) Dr. Harpal Singh of WHO's Malaysia office told ESTHoff on 
July 7 that WHO is generally pleased with Malaysia's policy 
approach, notwithstanding the abovementioned inconsistencies in 
policy implementation.  He pointed to the relatively slow rate of 
local infection in Malaysia as a sign that the containment measures 
 
KUALA LUMP 00000555  003 OF 003 
 
 
were actually working, mentioning neighboring Brunei as an example 
of containment measures that did not work.  He also said that 
Malaysia's gradual movement toward mitigation was appropriate at 
this juncture. 
 
 
KEITH