Lampiran 1
Confirmed case:
A suspected case with laboratory positive result for the specific detection of Zika virus (see
algorithm for laboratory diagnosis)
This case definition is developed based on the outbreak situation in Americas in 2015 -2016 that was reported to WHO.
(Available at http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika/en/). The case definition
has been adapted from Pan American Health Organization; Epidemiological Update, Zika Virus Infection, 16 October
2015 (Available at:
http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32021&lang=en), 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);5962. ( 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.
*person who live in the same locality with the Suspected case or history of sexual intercourse with person who
had travelled to affected countries.
**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
Lampiran 2A
CARTA ALIR UJIAN PENGESAHAN VIRUS ZIKA UNTUK SAMPEL DARI HOSPITAL
Suspected case
(Serum, plasma)
Microcephaly case:
- Baby (Serum, plasma, CSF, Umbilical
cord blood)
- Mother (Serum, plasma)
Virology Unit
Infectious Diseases Research Centre
Institute for Medical Research
(Refer to IMR call list Lampiran 11)
Real Time RT-PCR for Zika Virus
Viral
Isolation
(2) Further
characterization of virus
through genetic
sequencing
#Infants
Lampiran 2B
CARTA ALIR UJIAN PENGESAHAN VIRUS ZIKA UNTUK SAMPEL DARI KLINIK
KESIHATAN
A person with suspected Zika virus infection
Walk in patients
Referral from general practitioner/ other MOH Primary Healthcare facilities
Patient with Health Alert Card from Point of Entry
Primary triage
History taking
Travel history to Zika affected countries (Annex 1), AND
Symptoms (Lampiran1)
Clinical
assessment and
examination
Mild
Facilities without
doctors and
suspected Zika
infection
Severe
e.g. signs of
Guillain Barre
Syndrome
Based on clinical
judgement
Severity?
Mild
Severe
e.g. signs of Guillain
Barre Syndrome
Refer to hospital
Lampiran 3
Zika1 /case/2016
NOTIFICATION FORM
FOR ZIKA VIRUS
Phone:
State:
Fax:
2. Information of Patient
E-mail:
Name:
Age:___yr ___mth
Address:
Phone (Home):
Ethnicity:
Nationality:
Malaysian
Non Malaysian
:
Occupation
Malay
Chinese
Indian
IC No:
Country of Origin:
Passport No:
Fever
Rash
Conjuctivitis
Myalgia
Malaise
Athralgia
Other symptoms, specify :
4. Is there any alternative diagnosis that can fully explain patient's illness?
Yes
Ward:
Yes
No
No
Progress:
Isolation ward
General ward
ICU
Male
Female
RN No:
Other, specify:
Gender:
Pending
Has the patient travelled to areas reporting confirmed cases of Zika virus prior to onset of symptoms
Yes
No
6. Exposure History
If yes, please specify:
Country visited:
Country/State/province visited
Duration of stay
From [dd/mm/yr]
To [dd/mm/yr]
1.
2.
3.
Date of return to Malaysia:
7. Similar illness
8. Diagnostic Evaluation
Entry point :
Yes
No
Name of laboratory
Result
Virology
9. Working diagnosis: (please state)
10. Reporting Officer:
Signature:
Designation:
Date:
H/phone No:
Yes
No
Date:
H/Phone No:
Lampiran 4
Zika 2/ microcephaly/ 2016
NOTIFICATION FORM
FOR MICROCEPHALY
Name of Hospital
Phone:
State:
Fax:
2. Information Mothers
E-mail:
Age:___yr ___mth
Name:
Address:
Phone (Home):
Ethnicity:
Nationality:
Malaysian
Non Malaysian
Chinese
Indian
Other, specify:
Postnatal Parity:
Occupation
Malay
RN No:
IC No:
State:
Passport No:
Date of delivery
[dd/mm/yy] :
LSCS
3. Mode of delivery
SVD
Baby weight:
Name:
Ward:
Progress:
Isolation ward
General ward
ICU
Clinical status at
time of reporting
1.
2.
3.
4.
5.
Yes
No
Pending
Has the mother travelled to areas reporting confirmed cases of Zika virus during her antenatal
Yes
8.. Exposure History
No
Country/State/province visited
Duration of stay
From [dd/mm/yr]
To [dd/mm/yr]
1.
2.
3.
Date of return to Malaysia:
9. Diagnostic Evaluation
Entry point :
Date taken
Name of laboratory
Result
Virology
10. Working diagnosis: (please state)
11. Reporting Officer:
Designation:
Signature:
Date:
H/phone No:
Signature:
Date:
H/Phone No:
Lampiran 5
notifikasi
Hospital
/ klinik
( kerajaan dan swasta)
MKAK
Sungai Buloh
Lampiran 6
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 3.
ii.
The health announcement seeks cooperation from the passengers and crew who
have history of travel to 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 are
required to report to Health Personnel at the Health Screening area at entry
point.
i.
ii.
Cases suspected of Zika virus infection (Annex 5) 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 6.
iv.
ii. All passengers except cases suspected of Zika virus infection will be allowed to
disembark the aircraft/vessel/conveyance to proceed for fever screening.
Passengers and crew without symptoms will be provided a Health Alert Card
(HAC). The details of passengers and crew will be recorded for follow up actions
as required.
1
iii. The suspected case which have been identified by the crew will be interviewed
and history taking and physical examination will be conducted. Cases that do not
fulfil the case definition of a suspected case of Zika virus infection (Annex 2) will
be provided with health advice and issued with a HAC.
iv. Cases suspected of Zika virus infection will be referred to the nearest health facility
for further management.
v. Passenger and crew details (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 Zika virus infection are to be notified to the National and State CPRC
and the nearest District Health Office.
D.
Enhanced vector surveillance, and vector prevention and control activities at points
of entry (Please refer to the existing guidelines).
ii. 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.
iii. Aircraft General Declaration of Health or SSCC 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.
iv. 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.
ii.
iii.
iv.
v.
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.
Annex 3
We welcome everyone on board. For your health safety, we would appreciate your kind
attention and action on this Health Advisory concerning Zika virus
In relation to the announcement from the World Health Organization (WHO) on the recent
outbreak of Zika Virus and cluster of neurological disorders and neonatal malformations
reported in the Americas region which constitutes a Public Health Emergency of
International Concern. We wish to seek the cooperation of passengers who have history
of travel or originating from the affected countries since the past seven (7) days to present
yourselves to the Health Personnel at the Health screening area after disembarking from
the aircraft.
As to date, The World Health Organization (WHO) has reported affected countries of Zika
virus are as follows: Barbados | Bolivia | Brazil | Colombia | Costa Rica | Curaao |
Dominican Republic | Ecuador | El Salvador | French Guiana | Guadeloupe | Guatemala
| Guyana | Haiti | Honduras | Jamaica | Martinique | Mexico | Nicaragua | Panama |
Paraguay | Puerto Rico | Saint Martin | Suriname | US Virgin Islands | Venezuela (will be
updated from time to time as per WHO report)
We thank you for your attention and action on this Zika virus advisory.
Thank You.
Annex 4
Masa:
A) Maklumat pesakit
Nama
Umur
No Telefon
(di Malaysia)
Jantina
Sekiranya Wanita LMP
Alamat Tempat
Tinggal di
Malaysia
(catatkan alamat
dengan
lengkap/detail)
No Kad Pengenalan /
Paspport
B) Butiran Lanjut
1. Telah tiba dari negara penyakit Zika dalam masa
7 hari sebelum ini
2. Butiran penerbangan pulang
3.
Sila maklumkan :
Route :
..
No penerbangan : ..
No tempat duduk :
Gejala yang dikesan (Sila pilih YA atau Tidak ()bagi setiap gejala yang disenaraikan ) :
DEMAM
SAKIT OTOT /
SENDI
KONJUNKTIVITIS
YA
YA
TIDAK
TIDAK
RUAM
SAKIT KEPALA
YA
YA
TIDAK
TIDAK
YA
TIDAK
KELESUAN
(MALAISE)
YA
TIDAK
C) Pemeriksaan Fizikal
Suhu Badan - C
Conjunctiva - ..
BP .mmHg
PR . / minit
6
D) Tindakan susulan :
.
Annex 5
And
Recent history of travelling to the country affected with Zika virus infection seven (7) days
after returning to Malaysia.
ii. Confirmed case:
A suspected case with laboratory positive result for the specific detection of Zika virus.
Annex 6
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, malaise, headache
and conjunctivitis (red eye). If these symptoms were to develop 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 38.5C), 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.
*List of countries affected by Zika virus: Barbados, Bolivia, Brazil, Colombia, Dominican
Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Honduras,
Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, US Virgin
Islands, Venezuela, Haiti, Nicaragua and Samoa.
Note: This list will be updated from time to time as per WHO report.
Date issued:
Name of Entry points:
Simpan kad ini untuk tujuh ( 7 )hari akan datang selepas kembali ke Malaysia. Pantau
suhu badan untuk demam, ruam kulit (exanthema), sakit otot atau sendi, kelesuan, sakit
kepala dan konjunktivitis (mata merah). Sekiranya anda tidak sihat dan menghidap gejala
tersebut, segeralah berjumpa doktor.
Kepada Pengamal Perubatan Yang Merawat Pesakit Ini
Individu yang membawa KAD AMARAN KESIHATAN ini telah membuat perjalanan atau
kembali dari Negara yang terdapat jangkitan Virus Zika (dalam 7hari lalu). Jika individu
ini mendapat demam (demam yang rendah kurang dari 38.5C), ruam kulit (exanthema),
sakit otot atau sendi, kelesuan, sakit kepala dan konjunktivitis (mata merah), sila rujuk ke
hospital yang berhampiran dengan kadar segera untuk pemeriksaan dan rawatan.
*Senarai negara terlibat dengan jangkitan virus Zika: Barbados, Bolivia, Brazil, Colombia,
Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana,
Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, US
Virgin Islands, Venezuela, Haiti, Nicaragua dan Samoa.
Nota: Senarai ini akan dikemaskini dari masa ke masa berdasarkan laporan oleh WHO.
Tarikh dikeluarkan:
Nama Pintu Masuk:
10
Annex 7
TRAVEL ADVISORY FOR TRAVELLERS TO COUNTRIES AFFECTED BY ZIKA VIRUS
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.
As at 29 January 2016, WHO reported outbreaks of Zika virus in 22 countries*: Barbados,
Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, El Salvador, French Guiana,
Guadeloupe, Guatemala, Guyana, Honduras, Martinique, Mexico, Panama, Paraguay,
Puerto Rico, Saint Martin, Suriname, US Virgin Islands, Venezuel, Haiti, Nicaragua and
Samoa.
(Note: The list of countries will be updated from time to time as per WHO report)
Key facts
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.
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 Zika virus affected countries* 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
malaise
headache
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 Brazil until the cause of microcephaly
events associated with Zika virus infection in the country can be identified. 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
29 January 2016
12
Lampiran 8
FLOW CHART FOR SCREENING OF TRAVELLERS AND CREW ARRIVING
FROM ZIKA VIRUS AFFECTED COUNTRIES AT THE
INTERNATIONAL ENTRY POINTS (WITH THERMAL SCANNER)
Arrival of travellers and crew at the international
entry points
From Zika Virus Affected Countries
Self-referral
to Health
Thermal Scanner
Yes
No
Fever
(
Immigration
Counter screening
Not From
Zika Virus
Affected
Countries
Allow to enter
into Malaysia
after Immigration
clearance
Suspected
Zika Virus
Zik
No
Yes
Lampiran 9
FLOW CHART FOR SCREENING OF TRAVELLERS AND
CREW ARRIVING FROM ZIKA VIRUS AFFECTED COUNTRIES AT
THE INTERNATIONAL ENTRY POINTS (WITHOUT THERMAL SCANNER)
Self-referral
to Health
No
Suspected
Zika Virus
Zik
Yes
Lampiran 10
Jadual Mingguan Pegawai Bertugas Untuk Kes-Kes Urgent & Wabak (03
Jan -31 Disember 2016)
Tarikh
03.01.16 - 09.01.16
10.01.16 - 16.01.16
17.01.16 - 23.01.16
24.01.16 - 30.01.16
31.01.16 -06.02.16
07.02.16 - 13.02.16
14.02.16 - 20.02.16
21.02.16 - 27.02.16
28.02.16 - 05.03.16
06.03.16 - 12.03.16
13.03.16 - 19.03.16
20.03.16 - 26.03.16
27.03.16 - 02.04.16
03.04.16 - 09.04.16
10.04.16 - 16.04.16
17.04.16 - 23.04.16
24.04.16 - 30.04.16
01.05.16 - 07.05.16
08.05.16 - 14.05.16
15.05.16 - 21.05.16
22.05.16 - 28.05.16
29.05.16 - 04.06.16
05.06.16 - 11.06.16
12.06.16 - 18.06.16
19.06.16 - 25.06.16
26.06.16 - 02.07.16
03.07.16 - 09.07.16
10.07.16 - 16.07.16
17.07.16 - 23.07.16
24.07.16 - 30.07.16
31.07.16 - 06.08.16
07.08.16 - 13.08.16
14.08.16 - 20.08.16
21.08.16 - 27.08.16
28.08.16 - 03.09.16
04.09.16 - 10.09.16
11.09.16 - 17.09.16
18.09.16 - 24.09.16
25.09.16 - 01.10.16
02.10.16 - 08.10.16
09.10.16 - 15.10.16
16.10.16 - 22.10.16
23.10.16 - 29.10.16
30.10.16 - 05.11.16
06.11.16 - 12.11.16
13.11.16 - 19.11.16
20.11.16 - 26.11.16
27.11.16 - 03.12.16
04.12.16 - 10.12.16
11.12.16 - 17.12.16
18.12.16 - 24.12.16
25.12.16 - 31.12.16
NAMA PEGAWAI
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TS SARASWATHY
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TS SARASWATHY
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TS SARASWATHY
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TS SARASWATHY
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TS SARASWATHY
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TG ROGAYAH TG ABD RASHID
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TG ROGAYAH TG ABD RASHID
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TG ROGAYAH TG ABD RASHID
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TG ROGAYAH TG ABD RASHID
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN
DR ROZAINANEE MOHD ZAIN
MOHD APANDI YUSOF
TG ROGAYAH TG ABD RASHID
FAUZIAH MD. KASSIM
DR RAVINDRAN THAYAN