CME MERSCov 2023 medical public health.pptx

public health

1. PENGURUSAN DAN GARIS PANDUAN 2023 MERS-COV DR FATIMATUZZAHRA BINTI ABD.RAHMAN Pegawai Perubatan, Unit CDC, PKD Rompin

2. PENGURUSAN DAN GARIS PANDUAN MERS-COV 2023 INTRODUCTION CASE DEFINITION CLINICAL MANAGEMENT LABORATORY INVESTIGATIONS PUBLIC HEALTH PREPAREDNESS AND RESPONSE

3. INTRODUCTION

4. MERS- CoV in Malaysia Brief summary of the 1 ST laboratory-confirmed case from Malaysia: 54 year old man, a known case of diabetic on treatment Returned from a pilgrimage in Saudi Arabia on 29 March 2014 4 April 2014 (onset): Feeling unwell 9 April 2014 : Presented to ED of a public hospital, complaining of cough, fever, shortness of breath with radiographic evidence of pneumonia and subsequently was admitted 13 April 2014 : Succumbed to illness Cause of death: Severe Pneumonia Secondary to MERS- CoV The follow-up of 199 close contacts identified through contact tracing and vigilant surveillance did not result in detecting any other confirmed cases of MERS-CoV infection.

5. MERS- CoV in Malaysia The second case of lab confirmed MERS-CoV in Malaysia (30th December 2017). A 55 year old Malay man with history of performing umrah pilgrimage was tested positive for MERS-CoV on 31st December 2017. He was discharged well after 11 days of admission. ACD was conducted. Throat swabs from 58 contacts, all were tested negative for MERS-CoV. All contacts were put on Home Surveillance for 14 days.

6. CASE DEFINITION : Annex 2a SUSPECTED CASE : Three (3) options A person with an acute respiratory infection (ARI), with history of fever and cough and indications of parenchymal disease (e.g. pneumonia or ARDS), based on clinical or radiological evidence, and who has travelled within 14 days before onset of illness to the Middle East or countries where MERS- CoV is known to be circulating in dromedary camels or where human infections have recently occurred.

7. CASE DEFINITION SUSPECTED CASE : b) Individuals with ARI of any degree of severity who within 14 days before onset of illness had any of the following exposures: Close physical contact with a confirmed or probable case of MERS infection, while that patient was ill; OR Visiting / staying in healthcare facility, where hospital associated MERS- CoV outbreak have been reported; OR Direct contact with dromedary camels or consumption or exposure to dromedary camel products (raw meat, unpasteurized milk, urine) in countries where MERS is known to be circulating in dromedary camel populations or where human infections occurred as a result of presumed zoonotic transmission.

8. CASE DEFINITION SUSPECTED CASE : c) A person with ARI, with history of fever and cough and indications of pulmonary parenchymal disease (e.g. pneumonia or ARDS), based on clinical or radiological evidence, who requires admission to hospital, with no other etiology that fully explains the clinical presentation and he/she is part of cluster of severe ARI (e.g. fever, and pneumonia) of unknown etiology in which MERS is being evaluated, in consultation with state and local health departments in Malaysia.

9. PROBABLE CASE OF MERS : Three (3) options Definition 1: A febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome-ARDS); and Testing for MERS- CoV is unavailable or negative on an inadequate specimen or inconclusive; and Direct epidemiologic- link; with a confirmed MERS- CoV case.

10. PROBABLE CASE OF MERS : Definition 2: A febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or ARDS) that cannot be explained full by any other etiology; and Testing for MERS- CoV is inconclusive; and The person resides or travelled within 14 days before onset of illness to the Middle East or countries where MERS- CoV is known to be circulating in dromedary camels or where human infections have recently occurred.

11. PROBABLE CASE OF MERS : Definition 3: A febrile acute respiratory illness of any severity; and Testing for MERS- CoV is inconclusive; and Direct epidemiologic-link; with a confirmed MERS- CoV case.

12. CONFIRMED CASE OF MERS A person with laboratory confirmation of MERS- CoV infection, irrespective of clinical signs and symptoms.

13. CLINICAL MANAGEMENT OF MERS CASES

14. Flowchart for the Management of Suspected MERS- CoV Case as Outpatient in Primary Care Settings

15. LABORATORY INVESTIGATIONS

16. Flowchart for Laboratory Diagnosis of MERS-CoV using RT-PCR in Suspected Case of MERS in Public Health Clinic Annex 4d

17. Flowchart for Laboratory Diagnosis of MERS-CoV using RT-PCR in Suspected Case of MERS in Public Health Clinic 5 mls blood in plain tube immediately (first serum) and after 7-14 days (second serum). Collect early morning specimen after rinsing the mouth and gargling with water. Instruct the patient to cough deeply and expectorate only sputum and not saliva into the sterile screw-cap container. MKAK Sg Buloh

18. Technique for specimen collection Nasopharyngeal Swab (NPS) Oropharyngeal Swab (OPS) Annex 4b

19. Specimen packaging and transportation

20. Triple Layer Packaging SOP for Transport of Biological Specimens in Malaysia 2012: category B (UN3373)

21. Flowchart for Laboratory Diagnosis of MERS-CoV using RT-PCR in Suspected Case of MERS in Public Health Clinic The negative result does not conclusively rule out MERS- CoV as the causative agent of the disease for the following reason: Specimens were not collected at the time when the virus present Specimens were not collected, stored or transported in a proper manner

22. Flowchart for Laboratory Diagnosis of MERS-CoV in Close Contacts to A Confirmed Case of MERS Close physical contact is defined as: Health care associated exposure without the use of recommended PPE , including providing direct care for MERS‐ CoV patients, working with health care workers infected with MERS‐ CoV , visiting patients or staying in the same close environment of a MERS‐ CoV patient. Working together in close proximity or sharing the same class room environment with a MERS- CoV patient; Traveling together with MERS‐ CoV patient in any kind of conveyance; Living in the same household as a MERS‐ CoV patient.

23. BORANG MAKMAL MKAK-BPU-U01/Rev2018

24. PUBLIC HEALTH PREPAREDNESS AND RESPONSE

25. RESPONDING TO MERS OUTBREAK: Management of Close Contacts to A Confirmed Case of MERS

26. RESPONDING TO MERS OUTBREAK: Management of Close Contacts to A Confirmed Case of MERS ... cont

27. Tarikh jemaah Haji pulang : 23 JUN- 21 JULAI 2024

28. Notifikasi PUI MERS- CoV Borang Health 1 ( sama seperti penyakit berjangkit di bawah Akta CDC 1988) Input ke sistem e- notifikasi Annex 5d

29. Case 1, PKD Rompin 62 year old woman, a known case of diabetic and bronchial asthma on treatment Returned from a pilgrimage in Saudi Arabia on 28 June 2024 27 June 2024 (onset):Cough, fever 30 June 2024 : Presented to ED HMS, complaining of cough, fever, shortness of breath with radiographic evidence of pneumonia and subsequently was referred to Hospital Pekan.

30. Respon Fasa PUI MERS- CoV ( Setelah menerima notifikasi PUI MERS- CoV )

31. Respon Fasa PUI MERS- CoV ( Setelah menerima notifikasi PUI MERS- CoV ) Verifikasi kes Makluman awal kes (SMS atau WA) kepada CPRC Lakukan siasatan kes Kenalpasti dan senaraikan kontak terdekat

32. 1. Verifikasi kes ….. ??? Kriteria Definisi KES Nama , Jantina , Umur , Daerah Gejala – fever, cough, indication of parenchymal disease Tarikh onset Sejarah perjalanan ke negara dijangkiti MER- CoV dalam tempoh 14 hari dari onset Keadaan klinikal kes – Vital sign, lungs findings, CXR findings. Faktor risiko – co-morbid, terdedah kepada unta , memakan / minum produk unta . oleh PPKP atau Pegawai Epid / Pegawai Kesihatan Daerah

33. Makluman awal kes (SMS atau WA) kepada KPP Survelan JKNP Assalammualaikum dan salam sejahtera . Makluman awal kejadian kes PUI Mers-CoV di Wad 3A, Hospital Pekan . Notifikasi diterima oleh PKD Rompin pada 1/7/2024 jam 10.22am. Kes ZK, berumur 62 tahun , beralamat di Desa Teratai, Muadzam Shah, Rompin . Kes pergi mengerjakan Umrah bersama suami pada 5/5/2024 dan pulang pada 28/6/2024 di bawah kelolaan Agen Al-Maliki Travel, Kuala Lumpur. Kes mengalami gejala demam , batuk pada 27/6/2024, dan SOB pada 29.6.2024. Kes juga menghidap penyakit Diabetes Mellitus dan bronchial asthma tetapi tidak mendapatkan rawatan susulan yang sepatutnya . Kes tidak mempunyai sejarah melawat ladang unta . T:37.4’C, BP: 110/64, PR:70, SPO2:100% under nasal prong, Lungs: crept right lower zone, CXR: pneumonic changes at Lt lower zone. Sputum for Mers-CoV PCR telah diambil pada 30/06/2024 dan keputusan negatif . Seramai 3 orang kontak terdekat telah dikenalpasti dan sihat . Sekian , untuk makluman .

34. Nama: ZK Jantina : Perempuan Umur : 62 thn Daerah: Rompin Gejala & Tarikh onset – fever and cough (27/6/2024), SOB (29/6/2024) Sejarah perjalanan ke negara dijangkiti MER- CoV dalam tempoh 14 hari dari onset : - Berangkat ke Mekah pada 5/5/2024 dan balik ke Malaysia pada 28/6/2024 Keadaan klinikal kes – Vital sign : BP 110/64, HR 70, Spo2 100% under RA Siasatan Kes

35. lungs findings: Crepitation left lower zone CXR findings: Left lower zone consolidation Faktor risiko – co-morbid: uncontrolled DM & bronchial asthma, Kes tidak terdedah kepada unta , memakan / minum produk unta . Diagnosis: AEBA secondary to CAP, TRO MERS- CoV . 4 July 2024, result PCR : negative oleh PPKP atau Pegawai Epid / Pegawai Kesihatan Daerah

36. 4. Kenalpasti Kontak Kes Kenalpasti contact terdekat menggunakan Annex 5f

37. HOME ASSESSMENT AND MONITORING TOOL (HAMT)