R.measles-Prevention and Control in Malaysia

MEASLES PREVENTION & CONTROL IN MALAYSIA
Handbook for Healthcare Personnel

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Contents
Foreword 3
PART 1 - GENERAL 4
1.1 Introduction 4
1.2 The Disease 4
1.3 Complication 6
1.4 People At Risk 6
1.5 Measles Vaccination 7
1.6 Measles Epidemiology Global 7

PART 2 - MEASLES PREVENTION AND CONTROL IN MALAYSIA 8
2.1 Measles Epidemiology - Malaysia 8
2.2 Measles Elimination 9
2.2.1 Goal & Objectives 9
2.2.2 Strategies 10
2.3 Measles Vaccination 10
2.3.1 Schedule 10
2.3.2 Contraindication 11
2.4 Measles Surveillance 11
2.4.1 Objectives 11
2.4.2 Case Defnition 12
2.4.3 Case Classifcation 12
2.4.4 Procedures Of Surveillance 13
2.4.5 Performance Indicators 14

APPENDICES
Appendix 1 : Flow Chart Of Measles Surveillance Activities 16
Appendix 2 : Measles Laboratory Request Form 17
Appendix 3 : Procedures To Collect, Store And Transport Clinical Specimens 19
Appendix 3a : Blood Specimen Collection For Measles Specifc IgM Test 20
Appendix 3b : Urine Specimen Collection For Measles Virus Isolation 21
Appendix 3c : Nasopharyngeal Specimen Collection For Measles Virus Isolation 22
Appendix 3d : Throat / Nasal Swab Specimen Collection For Measles Virus 23
Isolation
Appendix 4 : Flow Chart Of Clinical Specimen For Laboratory Confrmation 24
And Result
Appendix 5 : Notifcation Form (Malay Version) 25
Appendix 6 : Notifcation Flow 26
Appendix 7 : Measles Investigation Form (Malay Version) 27
Appendix 8 : Classifcation Of Measles Case 30

Telephone Numbers 31
References 32
Acknowledgement 33
PAGE
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FOREWORD
M
easles is one of the major childhood killer before the introduction of its vaccine.
and World Health Organization (WHO) estimated that 130 million children below
6 years die due to measles annually. Since the introduction of measles vaccine in 1964, the
morbidity and mortality due to measles have been reduced drastically. Measles
vaccination was included in the Expanded Program for Immunization (EPI) in 1974.
Since then, coverage of measles vaccination climbed steadily in all regions throughout
the year 1980s.
In 1980s, after the success of smallpox eradication, some scientist and public health
offcials have considered of global effort to eradicate measles. Since 1990s
strategies have been planned and implemented in many developing countries to
eliminate and eradicate measles. Three regions of the World Health Organization that
targeted elimination by 2000s are; in 1994, the American Region targeted elimination
by 2000, in 1997, the Eastern Mediterranean targeted elimination by 2010 and in 1998,
the European Region targeted elimination by 2007. In 2005, WHO for the Western
Pacifc Region targeted elimination by 2012.
As we have succeeded in controlling measles occurrence at low level, the
Ministry of Health in February 2003 decided to initiate measles elimination in
Malaysia starting in 2004. Therefore, all healthcare personnel should implement the
measles prevention and control strategies and activities as required for the elimination.
This handbook is intended to serve as guiding tool in continuing to create
awareness and assisting healthcare personnel in the implementation of Measles
Elimination Programme strategies.
Dato Dr. Hj. Ramlee Hj. Rahmat
Director of Disease Control
Ministry of Health, Malaysia
18 December 2006
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1.1 INTRODUCTION
Before the introduction of measles vaccine, measles is one of the major
childhood killer and the World Health Organization (WHO) estimated that
130 millions children below 6 years die due to measles annually. Since the
introduction of measles vaccine in 1964, the morbidity and mortality due
to measles have been reduced drastically.
However, despite the availability of vaccine for the past 40 years, measles
is remains a leading cause of death among young children. An estimated
454,000 people died from measles worldwide in 2004.
Measles vaccination and surveillance are two main strategies to prevent
and control the diseases.
1.2 THE DISEASE
Measles is highly infectious disease caused by a virus in the
paramyxovirus family. The disease spread by airborne droplets, close
personal contact or direct contact with nasal or throat secretion of
infected persons.
The incubation period is usually 10 to 12 days but may range up to 21 days.
The frst sign of infection is high fever. During this initial stage, patient
may develop coryza, cough, red and watery eyes (conjunctivitis) and
white spots inside the cheek known as Kopliks spot. After several days
(2 4 days), a rash develops, usually started on the face and upper
neck. The rash proceeds downwards, reaching hands and feet and
lasted for fve to sic days, then fades. The rash occurs, on average, at
day 14 after exposure to the virus with a range of seven to 18 days, rarely
as long as 19 21 days.
An infected individual can transmit the virus from four days prior to the
onset of rash to four days after onset. The virus remains active and
contagious in the air or on infected surfaces for up to two hours.
PART 1
GENERAL
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Figure 1: Kopliks spot and skin rash in person with measles infection
Kopliks spot
Maculopapular rash
Downward trend
spread of rash
Rash begins
around hairline,
on face and neck,
behind ears
Rash spreads
downward to
chest and
abdomen
Rash effects
arms and legs
last
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1.3 COMPLICATION
Measles is often a mild or moderate severe illness. However, severe
measles likely occur in poorly nourished young children. The most serious
complications include, blindness, encephalitis (1 per 1,000 cases),
severe diarrhoea, ear infection (1 in every 5 10 cases) and pneumonia
(5 10 % of cases). Case fatality rate in developing countries is in the
range of 1% to 5%.
1.4 PEOPLE AT RISK
Un-immunised persons, especially young children are at highest risk.
People who have not been immunised with vaccine or who have not
acquired immunity through having experienced the disease can become
infected.
Figure 2: Time course of clinical events in measles disease
Day of
illness
1 2 3 4 5 6 7 8 9 10
Measles
Rash
Kopliks
Conjunctivitis
Coryza
Cough
T
E
M
P
E
R
A
T
U
R
E
104
103
102
101
100
99
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Source: Infectious Diseases of Children, 9th Edition, Figure 13-1, page
224, 1992. Editors Saul Krugman Samuel L. Katz, Anne A. Gershon,
Catherine M. Wilfert. By permission of Mosby Year Book, St. Louis
Missouri
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1.5 MEASLES VACCINE
Measles vaccine was available since 1963. Measles vaccine induces
long-term and probably lifelong immunity in most individuals. Natural
infection produces lifelong immunity.
Live attenuated measles virus vaccine are in use. Measles antibodies
develop in approximately 85% of children vaccinated at 9 months of
age, 95% of children vaccinated at 12 months of age and 98% of those
vaccinated at 15 months of age. Second dose vaccination is given to
children to overcome this lack detectable antibody.
Measles vaccines available in form of monovalent, bivalent
(MR measles-rubella) and trivalent (MMR measles-mumps-rubella).
1.6 MEASLES EPIDEMIOLOGY GLOBAL
Worldwide, measles cases and deaths are under-reported especially in
areas with the highest burden.
In 2003, 528,400 cases were reported (from 174 countries) compared
to 3,852,242 cases in 1980 (from 148 countries). Worldwide annual
deaths from measles (2002) were estimated by WHO at 610,000. About
88.5% of them (540,000) occurred among children under 5 years of age.
In Western Pacifc Region, measles cases and deaths estimated of about
one million and 30,000 per year, respectively.
WHO and UNICEF estimated that the measles vaccination coverage in
2003 was around 77%.
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2.1 MEASLES EPIDEMIOLOGY MALAYSIA
In the pre vaccine era, measles was highly endemic among Malaysian
population especially among children. Measles vaccination program was
included as part of the Expanded Programme on Immunisation in 1982 and
single dose measles vaccination was given to children at 9 months of
age. Since the introduction of measles vaccination in Malaysia, the
occurrence of measles reduced with the increased of the measles
vaccination coverage.
The incidence rate of measles reported cases in 1982 was 65.62 per
100,000 populations. In 1989 1998, measles incidence rates in Malaysia
were ranged between 1.51 5.87 per 100,000 population.
However, measles cases increased drastically in 1999 and 2000 with
incidence rates 11.48 (2,608 cases) and 26.59 (6,187 cases) per 100,000
populations, respectively despite measles administrative immunization
coverage was 86.6% (1999) and 88% (2000). In these two years, the
increased of measles cases occurred in all states and outbreaks were
scattered throughout the country both in urban and rural areas. The
measles outbreak in 1999 2000 suggested that the outbreak was due to
primary vaccine failure and failure to vaccinate that caused accumulation of
susceptible individuals
PART 2
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Figure 3: Measles incidence rate of measles reported cases and
vaccination coverage, Malaysia, 1976 2005.
Incidence rate Immunisation Coverage
2.2 MEASLES ELIMINATION
As we have succeeded in controlling measles occurrence at low
level, the Ministry of Health in February 2003 decided to initiate measles
elimination in Malaysia starting in 2004. Following this decision, vaccination
and surveillance strategies have been reviewed and changed to achieve
the elimination goals and objectives.
2.2.1 Goals and objectives
The main goal of this elimination initiative is to achieve sustainable
reduction of measles morbidity and mortality and to interrupt the
transmission of indigenous measles virus in Malaysia.
Specifc objectives of elimination initiative are to;
1) maintain the number of susceptible individuals below the critical
number required to sustain transmission of the virus;
2) eliminate measles by year 2010;
3) achieve 0 measles mortality.
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2.2.2 Strategies
Sustainable reduction of measles morbidity, mortality and interruption of
the transmission of the indigenous measles virus in Malaysia are possible
by implementing the following strategies;
1) Vaccination strategies
routine two dose MMR vaccine given to children
2) Surveillance strategies
enhancing measles surveillance with integration of
epidemiological and laboratory information.
3) Laboratory strategies
laboratory confrmation should be done on all suspect
measles cases
4) Response to outbreak
all measles outbreaks will be carefully investigated
5) Case management
improving the management of every measles case
6) Training
2.3 MEASLES VACCINATION
2.3.1 Schedule
Two dose of measles vaccine are recommended as the 5 10 percent
who fail to be protected by the frst dose will nearly all be protected by the
second. The measles vaccination schedule is as follows;
Peninsular Malaysia First dose MMR 12 months
and Sarawak Second dose MMR 7 year (standard one)

Sabah First single dose 6 months
measles
First dose MMR 12 months (1 year)
Second dose MMR 7 year (standard one)
Area Measles vaccination Age vaccination given
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2.3.2 Contraindications
Contraindications include;
individuals with proven anaphylaxis to neomycin
children with immune suppression
children who have received another live vaccine in previous month
children with HIV infection who are severely immune
compromised
pregnant women
women of children age, who should be advised to avoid
pregnancy for the next three months after MMR of measles
vaccine.
2.4 MEASLES SURVEILLANCE
Adequate disease surveillance data and analysis will permit
implementation of appropriate measures to control and eliminate
measles. It also will be used in the assessment of progress and in making
adjustments to programmes as required. Measles is a notifablle disease
under the Control of Communicable Disease Act 1988.
In the elimination phase the surveillance of measles should be
case-based or known as enhanced measles surveillance (laboratory
confrmation should be done).
2.4.1 Objectives
The general objectives of measles surveillance are to immediate
detecting any suspected cases, confrming cases by laboratory
diagnosis and identifying importations and possible sources of
infection so that can be used to plan, monitor and evaluate measles
elimination programme.
The specifc objectives of measles surveillance are to;
1) monitor incidence and coverage in order to assess progress;
2) identify areas at high risk or with poor programme performance;
3) identifying high-risk population;
4) describe the changing epidemiology of measles in terms of age,
immunization status and the intervals between epidemics;
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5) predict the next outbreak that may occur because of a build-up of
susceptible persons;
6) detect and investigate measles outbreaks so that cause of
outbreaks can be determined
7) determine where measles virus is circulating;
8) assess the performance of surveillance system;
9) ensure proper case management
2.4.2 Case defnition
Clinical case defnition for suspect measles case that should be reported/
notify is as follows;
2.4.3 Case classifcation
Case classifcation according to laboratory confrmation;
Any person with fever and maculopapular rash and cough,
coryza (runny nose) or conjunctivitis (red eyes)
or
Any person in whom a clinician suspects measles infection
Clinically confrmed:
A case that meets the clinical case defnition
Laboratory confrmed:
A case that meets the clinical case defnition and is laboratory
confrmed (based on laboratory criteria for diagnosis)
Epidemiologically confrmed:
A case that meets the clinical case defnition and is linked
epidemiologally to a laboratory confrmed case.
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2.4.4 Procedures of surveillance
Flow of measles surveillance activities is as Appendix 1.
i) Case detection
take a proper history on the complaint of suspect measles cases
who fulfl measles case defnition
if the onset of rash is less than 4 days, take blood/serum sample
and urine or respiratory specimens from the patient
if the onset of rash more than 4 days, take blood/serum from the
patient
send the clinical sample/s to laboratory identifed by District
Health Offce together with Measles Laboratory Request From
(MSLF: 01/2004 as Appendix 2). Procedures to collect, store and
transport of samples are as in Appendix 3 and 4. The sample/s
then transported to National Public Health Laboratory (NPHL),
Sungai Buloh for confrmation.

ii) Notifcation
All suspect measles cases must be notifed to nearest District Health
Offce within 48 hours of rash onset via telephone. As most of the
cases detected within few days of rash onset, it is advisable that the
case should be notifed as soon as a case detected. Notifcation using
Notifcation Form should follow using current system of notifcation.
Notifcation Form and notifcation fow are as Appendix 5 and 6.
Case classifcation according to source of infection
Indigenous infection:
A person becomes infected in Malaysia (no history of out from
Malaysia 21 days of rash onset), either,
Epidemiologically linked to an international imported; or
Not linked epidemiologically to an international imported case
Imported infection:
A person who has confrmed measles and whose rash onset was
within 21 days of arrival in Malaysia.
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iii) Case investigation
Identifed Offcer in District Health Offce must investigate all
suspect measles cases within 48 hours of notifcation using Measles
Investigation Form. Investigation Form is as Appendix 7.
iv) Case classifcation
After case has been investigated and laboratory result has been
available, case must be classifed according the laboratory
confrmation and source of infection as following (Appendix 8);
clinically confrmed
epidemiologically confrmed
laboratory confrmed

indigenous infection
imported infection
v) Data analysis and interpretation
Data should be analyse on weekly basis and information should be
generate.
2.4.5 Performance indicators
The following are the performance indicators that should be evaluated on
weekly basis.
% of suspected cases notifed within 48 hours of onset of rash
% of suspected cases investigated
% of cases investigated within 48 hours of notifcation
% of cases with laboratory confrmation
% of cases with adequate specimen taken
% laboratory result (serology) within 7 days
% laboratory result (virus isolation) within 14 days
% of confrmed cases with sources of infection identifed

The target of all above indicators to be 80%.
** Details on procedures of measles surveillance, refer Measles Surveillance
Manual
Laboratory confrmation
Source of infection
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APPENDICES
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Appendix 1
Flow chart of measles surveillance activities
Case detection
Case notifcation
Case investigation
Data analysis
Case classifcation
Data verifcation & validation
Evaluation
Action
Information dissemination
(feedback)
Reports
Interpretation
Health
facility
State Health
Department &
Disease Control
Division,
Ministry of
Health
District Health
Offce
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A. MAKLUMAT PESAKIT
Negeri: Daerah:
Hospital / Klinik Kesihatan:
Nama Pesakit:
No. K/P: Umur: Jantina: L / P
B. MAKLUMAT IMUNISASI MEASLES
Imunisasi measles: Ada Tiada Tidak diketahui Tarikh dos terakhir diberi:
C. MAKLUMAT KLINIKAL
Gejala (Simptom) Ada / Tiada (Tandakan diruang berkenaan) Tarikh mula
Demam
Ruam (maculopapular rash)
Konjunktivitis
Batuk
Coryza
D. SPESIMEN KLINIKAL
Spesimen: Pertama Kedua
Spesimen (tandakan diruang berkenaan) Tarikh diambil Tarikh penghantaran
Darah / Serum
Sekresi pernafasan (Respiratory secretion)
Air kencing (urine)
E. MAKLUMAT PEMOHON
Nama dan Cop Pegawai: No. telefon:
No. Fax:
Tandatangan: e-mail:
F. MAKMAL (Untuk Kegunaan Makmal)
Keadaan spesimen: Tarikh terima spesimen:
Spesimen Jenis ujian Keputusan ujian Komen
Darah / Serum
Sekresi pernafasan (Respiratory secretion)
Air kencing (Urine)
Nama dan tandatangan Pegawai Makmal:
Jawatan Pegawai Makmal dan Cop Makmal: Tarikh:
Appendix 2
MSLF:01/2004
No. Rujukan Makmal
MEASLES - BORANG PERMOHONAN DAN KEPUTUSAN UJIAN MAKMAL
* Nota: Spesimen klinikal (darah / sekresi pernafasan / air kencing) hendaklah diambil jika pesakit disyakki sebagai kes measles.
Defni kes (case defnition) adalah seperti dinyatakan di belakang.
Jika spesimen ini adalah spesimen kedua, maklumat klinikal dan imunisasi tidak perlu diisi jika telah diisi pada borang spesimen
pertama.
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(at the back of laboratory request form)
Measles
Defnisi Kes
Seseorang yang mengalami gejala berikut;
Demam dan ruam (maculopapular rash) dan; konjunktivitis atau
batuk atau coryza
atau
Sesiapa yang didiagnos sebagai kes campak oleh Pegawai
Perubatan
Case Defnition
Any person with
Fever and maculopapular rash and; conjunctivitis or cough or
coryza
or
Any person in whom a clinician suspects measles infection
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Appendix 3
PROCEDURES TO COLLECT, STORE AND TRANSPORT
CLINICAL SPECIMENS
Basic kit for specimen collection
Equipments:
1. Needles
2. Syringes
3. Tourniquet
4. Sharp bins
5. Gloves, alcohol swabs
6. Sterile urine container
7. Plain Screw-capped tube (do not use vacutainer)
8. VTM ( Viral transport medium)
9. Sterile cotton swab
10. Cold box
11. Ice packs
12. Ziplock (biohazard) plastic bag
13. Specimen Measles Surveillance Laboratory Form (MSLF-001)
14. Specimen label
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Appendix 3a
Blood Specimen collection for measles specifc IgM test
Transfer the serum into a new plain tube
Centrifuge the specimen at 1000 X g for 10 minutes to separate the serum from
the blood cells (immediately after the specimen taken)
Label the new container with patient identifcation and collection date (name,
Full new I/C no., date of specimen taken, type of test eg.
Measles Specifc IgM)
Complete the request form including the last measles immunization date,
onset of rash, date specimen taken, telephone and fax numbers and name
of requesting medical offcer.
Label the container with patient identifcation and collection date
(name, Full new I/C No., date of specimen taken, type of test eg.
Measles Specifc IgM)
Send to National Public Health Laboratory (NPHL) Sungai Buloh
Store the specimen at 4 8
o
C before and during transportation
(use cold box with ice pack)
Put the specimens into their respective biohazard bag and individually packed
Note: Maximum period of specimen storage is seven days before transportation
Take 5ml of venous blood for adult, 2.5ml for children (< 7 y.o )
Use plain tube with screw cap (do not use vacutainer).
Blood to be taken any time, preferable 4 to 28 days after the onset of rashes
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Appendix 3b
Urine specimen collection for measles virus isolation
Collect 10 50 ml of urine into a sterile screw-capped container. First
passed, morning specimens of urine are preferable. Urine can be collected
as soon after rash onset and at least within 5 days of rash onset
(name, Full New I/C No., date of specimen taken, type of test eg.
Measles Virus Isolation)
Complete the request form including the last measles immunization date
given, onset of rash, date specimen taken, telephone and fax numbers
and name of requesting medical offcer.
Put the specimens into their respective biohazard bag and should be
individually packed
o
(use cold box with ice pack) and send to National Public Health
Laboratory (NPHL) within 24 hours.
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Appendix 3c
Nasopharyngeal specimen collection for measles virus isolation
Collect nasopharyngeal specimen (aspirates or lavage) and put into
a sterile screw-capped container. The specimen should be collected
as soon as possible after onset and not longer than 7 days after the
appearance of rash
(Name, Full New I/C No., date of specimen taken, type of test eg.
Complete the request form including the last measles immunization
date, onset of rash, date specimen taken, telephone and fax numbers
and name of requesting medical offcer.
Put the specimen into their respective biohazard bag.
Specimen should be individually packed.
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Appendix 3d
Throat / nasal swab specimen collection for measles virus isolation
Take throat / nasal swab and put into 2.0 ml Viral Transport
Medium (VTM) [VTM can be purchased / supplied by PHL]
(name, Full New I/C No., date of specimen taken, type of test eg.
o
Put the specimen into their respective biohazard bag.
Specimen should be individually packed.
Complete the request form including the last measles
immunization date, onset of rash, date specimen taken,
telephone and fax numbers and name of
requesting medical offcer.
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Appendix 4
Flow chart of clinical specimens for laboratory confrmation
and result
Local laboratory at District Level
(identifed by District Health Offce)
National Public Health (NPHL)
Sungai Buloh
Local
laboratory can
send sample
direct to NPHL
Health facility
(Blood / Respiratory
secretion / Urine)
State laboratory
Disease Control
Division
District Health Offce
Specimen
Specimen
Specimen
Result
Result
Result
Result
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A. MAKLUMAT PESAKIT.
1. Nama Penuh(HURUF BESAR) :
Nama Ibu/Bapa/Penjaga (Jika 12 Tahun Dan Ke bawah) :

2. No. Pengenalan Diri/Dokumen Perjalanan : Sendiri Pengiring 3. Warganegara Malaysia:
No. Daftar Hospital/Klinik: Ya Keturunan :
Subketurunan :
Tahun : Tidak Negara Asal :
Izin Tanpa Izin Pemastautin Tetap
No./Nama Wad: 4. Jantina : Lelaki Perempuan
5. Tarikh Lahir : - - 6. Umur : ___Hari/___Bulan/___Tahun
7. Pekerjaan : (Jika tidak bekerja, nyatakan status diri) :
8. Alamat Kediaman:

9. Alamat Tempat Kerja/Belajar/Pusat Asuhan Kanak-Kanak:( Nyatakan alamat tempat kejadian jika Keracunan Makanan)
10. Nombor Telefon : Ada Tiada Rumah :
Pejabat : Tel. Bimbit : E-Mail :
B. DIAGNOSIS PENYAKIT
11. Pilihan Diagnosis
1. Acute Flaccid Paralysis 16. Kolera. 31. Tuberkulosis PTB smear positif.
2. AIDS. 17. Kusta (Paucibacillary). 32. Tuberkulosis PTB smear negatif.
3. Batuk Kokol. 18. Kusta (Multibacillary). 33. Tuberkulosis Extra Pulmonary.
4. Campak. 19. Malaria (Sp:). 34. Tuberkulosis Extra PTB dengan smear +ve.
5. Chancroid. 20. Plague (Jenis:..). 35. Tuberkulosis Extra PTB dengan smear ve.
6. Demam Denggi 21. Poliomielitis (Akut). 36. Viral Ensefalitis Japanese.
7. Demam Denggi Berdarah. 22. Rabies. 37. Viral Ensefalitis Nipah
8. Demam Kuning 23. Relapsing Fever. 38. Viral Ensefalitis (Lain-lain).
9. Difteria. 24. Siflis acquired. 39. Viral Hepatitis A (Akut).
10. Disenteri. 25. Siflis congenital. 40. Viral Hepatitis B (Akut).
11. Ebola. 26. Tetanus Neonatorum. 41. Viral Hepatitis C (Akut).
12. Gonorea. 27. Tetanus (Lain-lain). 42. Viral Hepatitis Lain-lain (Akut).
13. Hand, Foot and Mouth Disease. 28. Tifoid Salmonella typhi. 43. Lain-lain (Nyatakan):....
14. HIV 29. Tifoid Paratyphoid (Jenis:.).
15. Keracunan Makanan. 30. Tifus scrub.
12. Status Pesakit : Tarikh Mati : 13. Tarikh Mula :
Hidup Mati 14. Cara Pengesanan : Kes Kontek Kes FOMEMA Ujian Saringan ( .)
Notifkasi melalui telefon dalam masa 24 jam perlu dilakukan bagi kes berikut selain dari notifkasi bertulis : Poliomielitis (Akut) , Kolera,
Demam Denggi, Difteria, Keracunan Makanan, Plague, Rabies dan Demam Kuning
15. Status Diagnosis (Mengikut Defnisi Kes) 16. Ujian Makmal/Siasatan : Ada Tiada
Sementara (Provisional/Suspected) 17. Nama Ujian Makmal/Siasatan :
Disahkan (Confrmed) 18. Tarikh Sampel Diambil/ 19. Keputusan Ujian Makmal/Siasatan :
Siasatan Dibuat : Positif Negatif Belum Siap
Tarikh Diagnosis : ..........................................................................
20. Maklumat Klinikal Yang Relevan: 21. Komen :
C. MAKLUMAT PEMBERITAHU
22. Nama Pengamal Perubatan(HURUF BESAR) :
23. Nama Hospital/Klinik dan Alamat :
24. Tarikh Notifkasi : 25. No Telefon : 26. No Faks: 27. E-Mail :
Borang: Health 1 Rev 2001
No Siri: .
BORANG
Subperaturan 10(2)
AKTA PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT 1988
PERATURAN-PERATURAN PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT (BORANG NOTIS) 1993
NOTIFIKASI PENYAKIT BERJANGKIT YANG PERLU DILAPORKAN
Appendix 5
Poskod Negeri

Poskod Negeri
- - - -
- - - -
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Appendix 6
NOTIFICATION FLOW
District Health Offce
Health facility /
Community
Case-based
investigation
State Health
Department
Via CDCIS
Disease Control
Division & IDS
Analysis
Interpretation
Response
Feedback
Feedback
Analysis
Interpretation
Response
Via telephone / other
communication system
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BORANG SIASATAN CAMPAK (MEASLES)
KEMENTERIAN KESIHATAN MALALAYSIA
Nota : Semua kes yang disyaki sebagai kes campak yang dilaporkan hendaklah disiasat
dengan serta merta dan tidak lewat dari tempoh 48 jam selepas notifkasi.
FASILITI
Negeri : Daerah Kesihatan: Pejabat Kesihatan Daerah :
MAKLUMAT PESAKIT MAKLUMAT NOTIFIKASI
Nama Pesakit : Diagnosa :
Tarikh Diagnosa : Tarikh Notifkasi :
____/____/____ ____/____/____

No. K/P :
Jantina : T. Lahir : Umur : Punca Pengesahan Kes :
Aktif Pasif
Warganegara : Nama Pemberitahu :
Ya; Kumpulan Etnik : __________________ Nama Fasiliti Pemberitahu :
Tidak; Negara Asal : __________________ No. Telefon / Faks :
Status Imigrasi : ______________________ No. Rujukan Kes :
Alamat Kediaman : MAKLUMAT SIASATAN KES
Tarikh Notifkasi Diterima : ____/____/____
Alamat Tempat Kerja : Tarikh Kes Didaftar : ____/____/____

No. daftar kes:
No. Telefon :- Rumah: Pejabat: Tarikh Siasatan : ____/____/____
Tel. Bimbit: Nama Penyiasat Kes :
E-Mel : Jawatan :
Pekerjaan :

MAKLUMAT KLINIKAL
Demam : Ruam : Jenis Ruam :
Ya; Tarikh mula : ____/____/____ Ya; Tarikh mula : ____/____/____ Maculopapular
Tidak Tidak Maculo-vesicular
Tidak Diketahui Tidak Diketahui
Batuk : Coryza : Conjunctivitis :
Ya Ya Ya
Tidak Tidak Tidak
Tidak Diketahui Tidak Diketahui Tidak Diketahui
Jika tiada sebarang simptom campak, adakah diagnosa campak ini dibuat oleh Pegawai Perubatan/Pengamal Perubatan?
Ya Tidak Status rawatan :
Pesakit Luar
Jika ya, catitkan , Pesakit Dalam
Nama Pegawai /Pengamal Perubatan :
Jawatan:
Appendix 7
28
29
29
(Samb.) MAKLUMAT KLINIKAL
Adakah kes mengalami komplikasi jangkitan :
Tiada Tidak Diketahui
Diarrhea Otitis media
Encephalitis / SSPE Lain-lain, nyatakan :
Status kes :
Hidup Mati; Tarikh Mati : ____/____/____ Tidak Diketahui
EPIDEMIOLOGI KES (PUNCA JANGKITAN)
Adakah kes mempunyai kontak dengan pesakit campak yang lain dalam tempoh 7 12 hari sebelum
mula ruam?
Ya Tiada Tidak Diketahui
Jika ada, catitkan ; Nama : No. Daftar :
Tarikh mula ruam : ____/____/____
Adakah terdapat kes campak yang dilaporkan di lokaliti tersebut sebelum kes ini (dalam tempoh inkubasi
yang sama)?
Jika ada, catitkan ; Nama : No. Daftar :
Tarikh mula ruam : ____/____/____
Adakah kes keluar negara dalam tempoh 7 21 hari sebelum tarikh mula ruam?
Adakah kes bekerja di dalam bidang pelancongan atau bekerja di kawasan/tempat yang terdapat ramai
pelancong antarabangsa/pendatang?
Individu disyaki kes campak yang dikesan semasa penyiasatan kes :
Nama : No. K.Pengenalan :
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
Adakah terjadi wabak? Ya Tidak
Jika ya, nombor wabak :_____/______ (nombor / tahun)

MAKLUMAT UJIAN MAKMAL
Sampel darah/serum untuk ujian serologi
Sampel darah/serum diambil : Ya Tiada Tidak Diketahui
Tarikh

Jenis Sampel Pengambilan Sampel Terima Keputusan
Sampel Hantar ke Sampel oleh Ujian
MKAK MKAK dilaporkan

Sampel Darah Pertama
Sampel Darah Kedua
P
o
s
i
t
i
f
N
e
g
a
t
i
f
E
q
u
i
v
o
c
a
l
T
i
d
a
k

D
i
k
e
t
a
h
u
i
Keputusan Ujian IgM
29
29
(Samb.) MAKLUMAT UJIAN MAKMAL
Sampel sekresi respiratori/urin untuk ujian viral culture & indentifcation:
Sampel sekresi respiratori/urin diambil : Ya Tiada Tidak Diketahui
Tarikh
Jenis Sampel Pengambilan Sampel Terima Keputusan
Sampel Hantar ke Sampel oleh Ujian
MKAK MKAK dilaporkan
Sekresi respiratori
Urin
Keputusan Ujian viral culture &
indentifcation
STATUS IMUNISASI CAMPAK
Telah diberi imunisasi campak Ya Tiada Belum layak Tidak Diketahui
Sumber maklumat imunisasi : Kad imunisasi Sejarah lisan Tidak diketahui
Bilangan Dos :
Tarikh dos terakhir diberi :
KLASIFIKASI KES
Kes yang dilaporkan ini dikategori sebagai : Status jangkitan/penularan kes ini :
Clinically confrmed Jangkitan tempatan
Epidemiologically-linked Imported Cases
Laboratory confrmed Tidak dapat ditentukan
Discarded

ULASAN
Nama Pegawai Kesihatan Daerah:
Tarikh :
P
o
s
i
t
i
f

&
N
a
m
a
V
i
r
u
s
N
e
g
a
t
i
f
T
i
d
a
k
D
i
k
e
t
a
h
u
i
30
31
31
Appendix 8
CLASSIFICATION OF MEASLES CASE
If the serum specimens taken
< 4 days of onset of rash &
result negative for Measles IgM
and no 2
nd
serum specimen or
no urine / respiratory specimens
taken
If the cases
not fulflled
case
defnition
Note:
Case should be classifed as clinically confrmed even though serology test result
negative with adequate specimen if the specimen taken < 4 days of rash onset and
no second serum specimen or urine / respiratory specimens taken.

Suspect case also can be classifed as discard if the case is obviously not fulflled
case defnition
Discard
Specimen
adequate
Laboratory
confrmed
Suspect case
(Clinical case)
Epidemiologically
confrmed
No
epidemiological
linked to
laboratory
confrmed case
Epidemiological
linked to
laboratory
confrmed case
Clinically
confrmed
IgM
negative
IgM
positive
No specimen /
no adequate
specimen
31
31
No. State Health Department Tel. No. Fax No.
1. Communicable Disease Control Section
Disease Control Division
Ministry of Health 03-88834506 03-88891013
2. Perlis State Health Department 04-9773333 04-9760764
3. Kedah State Health Department 04-7335533 04-7314936
4. P. Pinang State Health Department 04-2625533 04-2613508
5. Perak State Health Department 05-2533489 05-2552821
6. Selangor State Health Department 03-51237333 03-51237329
7. K.L.F.T. Health Department 03-26940701 03-26938742
8. N. Sembilan State Health Department 06-7625231 06-7638543
9. Melaka State Health Department 06-2828344 06-2864761
10. Johor State Health Department 07-2245188 07-2277577
11. Pahang State Health Department 09-5161366 09-5135528
12. Terengganu State Health Department 09-6222866 09-6245829
13. Kelantan State Health Department 09-7413300 09-7444486
14. Sabah State Health Department 088-265960 088-221477
15. Sarawak State Health Department 082-256566 082-234571
16. Labuan F.T. Health Department 087-411702 087-411298
Telephone Numbers
Any questions regarding the Prevention and Control of Measles in
Malaysia, please contact the Medical Offcer of Health (Epidemiology) at the
Communicable Disease Control Section, Disease Control Division, Ministry of
Health or/and the State Health Department as follows,
32
33
33
REFERENCES
1. Module on best practice for measles surveillance. Geneva, World Health
Organization, 2001.
2. WHO Guidelines for Epidemic Preparedness and Response to Measles
Outbreaks. Geneva, World Health Organization, 1999
3. Expanded Programme on Immunization Using Surveillance Data and
Outbreak Investigations to Strengthen Measles Immunization
Programmes. Geneva, World Health Organization, 1996.
4. Manual for the laboratory diagnosis of measles viral infection. Geneva,
World Health Organization, 1999.
5. Plan of action Revised national immunisation programme for children
with a special focus on Hib and MMR immunisation. Ministry of Health,
Malaysia, 2002.
6. Rosemawati A. Measles situation in Malaysia 1999 2000. Ministry of
Health, Malaysia, 2003 (unpublished document)
33
33
ACKNOWLEDGEMENT
We would like to thanks the following persons for made this
handbook possible;
Y. Bhg. Dato Dr. Hj. Ramlee Hj. Rahmat
Director of Disease Control
Dr. Abdul Rasid Kasri
Deputy Director of Disease Control (Com. Disease)
Dr. Hasan Abdul Rahman
Director
Pahang State Health Department
[formerly the Deputy Director of Disease Control (Com. Disease)]
Dr. Devan Kurup
Principal Assistant Director
Communicable Disease Control Section
All Participants of the
Operationalisation of Enhanced Measles Surveillance & Mass Campaign
Meeting, 9 12 December 2003, Le Paris Hotel, Port Dickson
Prepared by
Dr. Rosemawati Ariffn
Principal Assistant Director
Communicable Disease Control Section
34
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MEASLES PREVENTION & CONTROL IN MALAYSIA

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