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DENGUE

MORTALITY
2012
MESYUARAT SEMAKAN KEMATIAN DENGGI KEBANGSAAN
SEKTOR PENYAKIT BAWAAN VEKTOR
BIL. 3/2012
10 OCTOBER 2012

DENGUE STATUS FOR 2012


Until EW 40/2012

Cases: 16,729 cases with 27 deaths (15,036


cases with 24 deaths in 2011)
Increase of cases 11%
increase of death 13%

Case Fatality Rate: 0.16% (0.18% last year)


KPI (NDSP)
10% reduction of cases annually
target CFR 0.2%

DENGUE STATUS FOR 2012, PERAK


Until EW 48/2012

Cases: 1,586 cases with 5 deaths (1,248 cases


with 2 deaths in 2011)
Increase of cases 27.1%
increase of death 150%

Case Fatality Rate: 0.32% (0.16% last year)


KPI (NDSP)
10% reduction of cases annually
target CFR 0.2%

DENGUE CASES
1995 2012 (Hingga ME40)

DENGUE DEATH
1997 2012 (Hingga ME40)

DENGUE CASES BY STATES FOR 2011 & 2012


(Till EW39)
KEDAH
KELANTAN
PERLIS
PERAK
MELAKA
SELANGOR
SABAH
TERENGGANU
SARAWAK
JOHOR
WP KL&PUTRAJAYA
LABUAN
PAHANG
NEGERI SEMBILAN
PULAU PINANG

350

645

551

911

136
83
944

1270

374
299
5635

6989

398
320
608
501
854
753
1246
1235
1424
1427
8
9
491
689
389
577
597

1000

1347

2000

3000

4000

5000

Bil. Kes
2012

2011

6000

7000

8000

Dengue cases 2011 and 2012, Perak


450
400
350
300
250
200
150
100
50
0
HU

LMS

KE

KK

MJG

BP

HL

PT

KT

KPR

2011 112
2012 110

116
111

53
110

226
235

192
195

113
241

88
102

38
32

286
389

42
61

2011
2012

MALAYSIA

WP LABUAN

SABAH

SARAWAK

KELANTAN

TERENGGANU

PAHANG

JOHOR

MELAKA

NEGERI SEMBILAN

9
8

10
12

30
33

32

31

47

56

56

52
57

52

47

44

37
37

38

38

50

82
81

109
134

140

WP KL&PUTRAJAYA

38

84

120

SELANGOR

PERAK

37

32

100

PULAU PINANG

20
18

55

60

KEDAH

34

40

PERLIS

Kadar Insiden /100,000 pop

INCIDENCE RATE FOR 2011 & 2012


(till EW 39)

160

80

INCIDENCE RATE BY AGE GROUPS


2011 & 2012

CASE FATALITY RATE BY AGE GROUPS


2011 & 2012

CASE FATALITY RATE 2011 & 2012


NEGERI

2011

2012

KES

MATI

CFR

KES

MATI

CFR

PERLIS
KEDAH
PULAU PINANG
PERAK
SELANGOR
WP KL&PUTRAJAYA
NEGERI SEMBILAN
MELAKA
JOHOR
PAHANG
TERENGGANU
KELANTAN
SARAWAK
SABAH
LABUAN

83
350
1347
944
5635
1427
577
299
1235
689
501
551
753
320
9

0
0
2
2
6
1
3
0
5
1
1
1
0
2
0

0.00
0.00
0.15
0.21
0.11
0.07
0.52
0.00
0.40
0.15
0.20
0.18
0.00
0.63
0.00

136
645
597
1270
6989
1424
389
374
1246
491
608
911
854
398
8

0
3
1
5
11
3
1
0
1
1
0
0
0
1
0

0.00
0.47
0.17
0.39
0.16
0.21
0.26
0.00
0.08
0.20
0.00
0.00
0.00
0.25
0.00

MALAYSIA

14720

24

0.16

16340

27

0.17

DISTRIBUTION BY GENDER
(n=27)

DISTRIBUTION BY AGE GROUP


(n=27)
41% (11) aged between
19 to 35 years old
33% (9) aged between
36 to 60 years old
11% (3) - aged between 7
to 12 years old

DURATION BETWEEN ONSET AND 1ST TREATMENT

(n=27)
85% of patients did seek
early treatment:
 within 1 days from
onset - 67% (18)
 85% within 3 days
from onset

TYPES OF HEALTH FACILITIES :


PATIENT WENT FOR THE 1ST TREATMENT
(n=27)
66% (18) of the patients
sought their first
treatment at the primer
clinic (private or
government).
44% (12) Private Clinic

DIAGNOSIS ON THE FIRST TREAMENT


(n=27)
70% (19) of deaths that were
reported as dengue deaths
were not diagnosed as dengue
during their 1st consultation in
the clinics or hospitals;
Private clinics 12 cases,
Private hospital 1 case
Govt. clinics 3 case,
Govt. hospitals 3 cases
2 out of 27 deaths were from
an Outbreak area

NUMBER OF CONSULTATION BEFORE


ADMISSION
(n=23)
19% (5) of
patients had
more than twice
consultation
before admission

DURATION BETWEEN ADMISSION AND


ONSET OF DISEASE
(n=27)
93% (25) of the patients
admitted early to the
hospital
 within 5 days from onset

DURATION BETWEEN ADMISSION AND


DEATHS
(n=27)
37% (10) patients
died within 24 hours
after admission
70% (19) patients
died within 48 hours
after admission

LOCALITY OF DEATHS OCCURRED


(n=27)
89% (25) of deaths
occurred in Non
Outbreak locality

HOSPITALS
GENERAL HOSPITAL

NO.

DISTRIC HOSPITAL

NO.

PRIVATE HOSPITAL

NO.

SUNGAI BULOH

SULTAN ABDUL HALIM


SUNGAI PETANI

ARUNAMARI MEDICAL
CENTER

PUTRAJAYA

TENGKU AMPUAN
RAHIMAH KLANG

PUSAT RAWATAN ISLAM AZZAHRAH, BANGI

BANTING

SERI MANJUNG

KULIM

HOSPITAL TELUK INTAN

HOSPITAL SLIM RIVER

KUALA LUMPUR
PUSAT PERUBATAN
UNIVERSITI KEBANGSAAN
MALAYSIA
TUANKU JAAFAR
SEREMBAN
P.PINANG
TUANKU AMPUAN AFZAN
KUANTAN
SULTANAH AMINAH
JOHOR BAHRU
DUCHESS OF KENT
SANDAKAN
RAJA PERMAISURI BAINUN
IPOH
TOTAL

GLENEGLE MEDICAL CENTRE

1
1
1
14

10

FACTORS CONTRIBUTING TO DEATH IDENTIFIED


BY STATES MORTALITY REVIEW MEETING
Cases
(n=27)

Presented with severe dengue (on admission)

18

67%

Delayed in referral

7%

Delayed in diagnosis

11%

PRE ADMISSION FACTORS

SEVERITY OF ILLNESS ON ADMISSION


(Initial Diagnosis at A&E / OPD)
Dengue without warning signs
Dengue with warning signs (7 cases) or severe
dengue (5 cases)

Cases
(n=27)

26%

20

74%

FACTORS CONTRIBUTING TO DEATH IDENTIFIED BY


STATES MORTALITY REVIEW MEETING
IN PATIENT
Delay in Diagnosis of Dengue with Warning Signs
/ Severe Dengue

Cases
n(27)

Delay in review by doctor

7%

Results delayed or not traced / not reviewed

7%

Low index of suspicion

22%

Inadequate monitoring of FBC and other blood


investigations

7%

Inadequate monitoring of vital signs

7%

FACTORS CONTRIBUTING TO DEATH


Cases
(n=27
cases)

Inadequate monitoring of FBC and other blood


investigations

15%

Inadequate monitoring of vital signs

22%

Inadequate fluid resuscitation

26%

Delayed referral

22%

Bleeding not suspected / recognized

11%

Insufficient blood products given

11%

Delay in seeking ICU care

22%

Overloading / pulmonary edema

15%

IN PATIENT
Pitfalls in management

FACTORS CONTRIBUTING TO DEATH


No.
Cases

Extremes of age (Less than 1 year / more than 60 years)

7%

Immunocompromised (eg. Leukemia / HIV Positive /


Patient on steroid / Chemotherapy)

7%

Renal Failure

4%

Obesity (based on BMI (adult) or NCHS chart [children])

33%

Pregnancy

4%

Heart Ailments

0%

Co morbid conditions

IS DEATH PREVENTABLE?
(n=27)
YES

59% (16)

NO

41% (11)

DENGUE SEROTYPES

CPG TRAINING 2012


(Kumulatif dari 2009)
Bilangan ahli yang hadir
Negeri

Pakar Perubatan

Pegawai Perubatan

Paramedik

lain-lain

Jumlah

2012

Kumulatif

2012

Kumulatif

2012

Kumulatif

2012

Kumulatif

2012

Kumulatif

PERLIS
KEDAH
PULAU PINANG
PERAK
SELANGOR
WP KL&PUTRAJAYA
NEGERI SEMBILAN
MELAKA
JOHOR
PAHANG
TERENGGANU
KELANTAN
SARAWAK
SABAH
LABUAN

0
0
2
19
0
6
0
0
4
0
0
0
0
0
0

19
27
68
86
90
65
8
30
159
20
37
44
13
79
0

0
0
99
98
0
111
0
0
48
0
31
150
0
9
0

214
201
758
514
2052
471
360
439
1549
361
268
432
504
255
0

0
0
69
118
0
61
0
0
359
0
331
650
78
44
0

118
573
1895
1135
3738
1401
530
449
5505
459
1233
1795
2865
1184
0

0
0
2
2
0
0
0
0
188
0
47
0
0
3
0

10
60
87
7
473
372
192
81
1522
40
62
106
131
744
0

0
0
170
237
0
178
0
0
599
0
409
800
78
56
0

361
861
2808
1742
2156
2309
1090
999
8735
880
1600
2377
3513
2262
0

MALAYSIA

31

745

546

8378

1710

22880

242

3887

2527

31693

THANK YOU