Practical 2 Mohd Fahmi Bin Ahmad Jamizi BEHP22106112

FACULTY OF HEALTH SCIENCE
BACHELOR OF ENVIRONMENTAL HEALTH AND SAFETY (HONS)
PRACTICAL TRAINING II (DISEASE, PEST & VECTOR CONTROL)
EHPT 6216
PRACTICAL STATION :
JEMPOL DISTRICT HEALTH OFFICE, NEGERI SEMBILAN
PREPARED BY :
MOHD FAHMI BIN AHMAD JAMIZI
STUDENT ID :
BEHP22106112 (C20 FLEXI)
SUBMITTED TO:
MR PUAD BIN MAON

Contents
Subject : Disease Control

Introduction...........................................................................................................................................4
Vision.................................................................................................................................................4
Mission..............................................................................................................................................4
Objective...........................................................................................................................................4
Role of CDC Unit................................................................................................................................4
2.1 Biostatistics data..........................................................................................................................5
2.1.1 Present the prevalence rate of the disease in the form of charts, graphs and computer
software:........................................................................................................................................5
2.1.2 Interpret the data in the unit of measurement of central tendency and scattering
measurement (measurement of central tendency, standard deviation and variance)..................5
2.2 Conducting Investigation and report preparation........................................................................5
2.2.1 Water borne and food borne diseases..................................................................................5
2.2.2 Air borne disease..................................................................................................................5
2.2.3 Infectious disease through body fluids.................................................................................5
2.2.4 Vector borne diseases...........................................................................................................6
2.2.5 Zoonotic disease...................................................................................................................6
2.3 Supervise the corpse due to an infectious disease (AIDS/Cholera/Typhoid)................................6
2.4 Describe activities and plan of action (Epidemic Operation Room) and roles of Assistant
Environment Health Officers during outbreak control.......................................................................6
2.5 Manage epidemiological data (for one disease) for 5 years.........................................................6
2.6 Exposure (Hands-on) Preparation of all disease control report (CDCIS)/ VECTOR/ Vekpro..........6
2.7 Exposure (Hands-on) Disease Control/ Vector `Quality Assurance` program...............................6
2.8 Join the healthy life style campaign activity at district/ state level..............................................6
2.9.1 Prevention activities, control and surveillance of communicable diseases under the
International Health Regulations (IHR)..............................................................................................6
2.9.2 Food Safety And Quality Activities:-......................................................................................6
2.9.3 Aedes mosquito control and Ovi-trap installation.................................................................7
2.9.4 Rodent Control......................................................................................................................7
2.9.5 Airport Sanitation.................................................................................................................7
2.10 The Port Health Services (International Health).........................................................................7
2.10.1 Prevention activities, control and surveillance of communicable diseases under the
International Health Regulations (IHR)..........................................................................................7
2.10.2 Check the certificates of "Maritime Declaration of Health" for the crew and passengers. .7
2.10.3 Conducting inspections of ships for the purpose of issuing Free Practique Certificates.....7
2.10.4 Conduct Inspections on ships that have been quarantined................................................7
2.10.5 Conduct inspections on ships for the purpose of certification of SSCC / SSCEC (Ship
Sanitation Control Certificate / Ship Sanitation Control Exemption Certificate)............................7
2.10.6 Aedes mosquito control......................................................................................................7
2.10.7 Rodent control....................................................................................................................7
2.10.8 Airport Sanitation...............................................................................................................7
2.11 Border Check Point (International Health).............................................................................7
2.11.1 Infectious Disease control- Import and Export dead body..................................................7
2.11.2 Development of current issues of local / state /global........................................................7
Subject : Pest & Vector Control

Introduction...........................................................................................................................................8
Vision.................................................................................................................................................8
Mission..............................................................................................................................................8
Objective...........................................................................................................................................8
Role of Vector Unit............................................................................................................................9
3.1 Vector Control............................................................................................................................10
3.1.1 Dengue Control...................................................................................................................10
3.1.3 Malaria Control...................................................................................................................10
3.1.4 Filariasis control and other vectors.....................................................................................10
3.2 Exposure (Hands-on) Preparation of all disease control report (CDCIS)/ VECTOR/ Vekpro........10
3.3 Exposure (Hands-on) Disease Control/ Vector `Quality Assurance` program.............................10
3.4 Pest and vector control at international entry point..................................................................10
Subject : Disease Control
Introduction
The Communicable Disease Control Unit (CDC) is one of the units under the Public Health
Division, Department of Health Negeri Sembilan, and also in Jempol District Health Office Negeri
Sembilan. They are responsible for monitoring the occurrence of communicable diseases within the
state and district. This unit is in charge of monitoring all types of diseases listed in the Infectious
Diseases Prevention and Control Act 1988 (Act 342), except for vector-borne diseases, HIV/STIs, and
TB/Leprosy, which are monitored by dedicated units for those specific diseases.
The monitoring of communicable diseases is conducted daily through the e-notification

system. Additionally, disease outbreak monitoring is carried out using the e-Wabak system. The CDC
Unit is also responsible for ensuring that all preparedness plans for dealing with communicable
diseases are well-organized, up-to-date, and regularly tested. Furthermore, the CDC Unit plays a role
in conducting training related to communicable disease control for personnel at the district level.
Vision
Towards creating healthy and prosperous individuals, families, and communities in Negeri
Sembilan, ensuring that they can enjoy a life free from the occurrence of communicable diseases.
Mission
Implementing comprehensive, integrated, and efficient control and prevention programs

together with all government agencies and the community to curb the spread of infectious disease
outbreaks.
Objective
To reduce the mortality rate and the incidence of cases caused by communicable diseases.
Role of CDC Unit
1. Reducing the occurrence of diseases and deaths caused by infectious diseases to prevent
them from becoming a public health threat in Jempol District.
2. Managing the activities of the Crisis Preparedness and Response Center (CPRC) of the Jempol
District to oversee activities, monitoring, and analysis of real-time surveillance data during
outbreaks and disasters.
3. Providing an Initial Outbreak Report (Laporan Awal Wabak) for Infectious Diseases.
2.1 Biostatistics data
In Malaysia, the control and prevention of communicable diseases started as early as 1961. It
was established to ensure that every occurrence of a communicable disease is promptly detected
and followed by immediate control and preventive actions.
The monitoring of communicable disease occurrences is based on the Infectious Diseases

Prevention and Control Act 1988 (Act 342). Communicable diseases that require reporting are listed
in Schedules I and II of the Act. Additionally, there are several diseases classified as emerging and re-
emerging diseases that must be reported if detected.
The surveillance of communicable diseases in the country is carried out through a

surveillance system comprising of various components, including Mandatory Disease Notification
using the e-notification system, Clinical-Based Surveillance (such as for Hand, Foot, and Mouth
Disease - HFMD and Acute Flaccid Paralysis - AFP), Laboratory-Based Surveillance, Community-Based
Surveillance, and Surveillance conducted by other agencies like FOMEMA and the Department of
Veterinary Services.
2.1.1 Present the prevalence rate of the disease in the form of charts, graphs and
computer software:
Scope Of Study
To study the prevalence rate of disease such as waterborne and foodborne disease, vector-
borne disease, airborne disease, AIDS/STD disease and non communicable diseases. This data will be
present in the form of charts and graph by using Microsoft Excel software analysis.
In Jempol District Health Office, it is compulsory to notify cases by using e-Notification

system. Unless the case is not listed in the e-Notification system, the cases will be notified by using
Manual Notification Form (Annex 2’) where the form will be dispatch to the office manually. A
timeframe for diseases notification also has to be obligated which is regulated by the State Health
Department and Ministry of Health based on Case Definition for Infectious Disease in Malaysia 3 rd
Edition. The timeline for disease cases notification is as shown below:
Within 24 Hours of diagnosis
1. Avian Influenza 10. MERS-CoV

2. Cholera 11. Plague
3. Dengue Fever 12. Poliomyelitis
4. Diphtheria 13. Rabies
5. Ebola 14. Yellow fever
6. Food Poisoning 15. Zika Virus
7. HFMD 16. Covid-19
8. Malaria
9. Measles
Within 7 days of diagnosis
1. Dysentery 5. Typhoid
2. Pertussis 6. Typhus
3. Relapsing fever 7. Viral Encephalitis
4. Tetanus
Within 7 days of diagnosis with laboratory confirmed result
1. HIV/AIDS 5. Leprosy
2. Chancroid 6. Leptospirosis
3. Gonorrhoea 7. Tuberculosis
4. Syphilis
Cases notified in manual notification form (Annex 2’)
1. Melioidosis
2. Brucellosis
3. Animal Bite
Figure 1: Notification Timeline of disease cases for Negeri Sembilan State and District Level
Source Of Data
For this report, the data of disease in Jempol District in the year of 2022 have been chosen
and have been obtained from several sources. The main contributors of data were generated from E-
notification system and Manual Notification Form (Annex 2’). An e-notification account also has been
generated in order to access the portal.
Figure 2 : The front interface of e-notification System for case notification
Figure 3: Annex 2' Manual Notification form

Data Configuration and Analysis
Prevalence Rate
Prevalence rate is a term commonly used in epidemiology and public health to describe the
proportion or percentage of a population that has a specific condition or disease at a particular point
in time or over a defined period. It provides an understanding of how widespread a particular
condition is within a given population.
To calculate the prevalence rate, two pieces of information is needed which is:
1. The number of individuals with the condition (i.e., the number of cases).
2. The total population at risk or the entire population being studied.
The formula for prevalence rate is:
Prevalence Rate = (Number of cases of the condition) / (Total population at risk) × 100
For example, a study for HFMD cases in a town with a population of 10,000 people and the finding
found that there are 500 individuals diagnosed with HFMD, the prevalence rate of diabetes in that
town would be:
Prevalence Rate = (500 cases) / (10,000 population) × 100 = 5%
This means that 5% of the population in the town has infected by HFMD at that point in time or over
the defined period.
Prevalence rate is an essential metric in public health as it helps in:
1. Assessing the burden of a disease: It provides a measure of how common a disease is in a

population, which helps health authorities allocate resources and plan interventions
accordingly.
2. Monitoring trends over time: By tracking prevalence rates over time, health professionals
can observe changes in disease patterns and understand the effectiveness of preventive
measures or treatments.
3. Comparing different populations: Prevalence rates allow for comparisons between different
groups or regions, which can help identify high-risk areas or populations that require
targeted interventions.
Below shown is the prevalence rate by the types of disease assessed in Jempol District based on
134,000 Population by 2022 (Malaysia Population and Housing Census,2022).
(a) Waterborne and foodborne
Disease Confirmed Case Prevalence Rate (%)

Registered 2022
Food Poisoning 52 Population (134,000: 0.03
Dysentery 0 2022) 0
Typhoid 0 0
Cholera 0 0
(b) Vector-borne

Registered 2022
Dengue Fever / DHF 124 0.09
Population (134,000:
Chikungunya 0 0
2022)
Japanese Encephalitis 0 0
Scrub / Typhus 0 0
Malaria 2 0.001
(c) Airborne

Registered 2022
Tuberculosis 75 Population (134,000: 0.05
Diphtheria 0 2022) 0
HFMD 808 0.6
Influenza Like Illness 413 0.3
(d) AIDS/ STD

Registered 2022
Population (134,000:
HIV / Aids 29 0.02
2022)
Syphilis 13 0.009
Gonorrhoea 2 0.001
2.1.2 Interpret the data in the unit of measurement of central tendency and scattering
measurement (measurement of central tendency, standard deviation and variance)
Calculating the measures of central tendency, standard deviation, and variance involves
different formulas depending on the type of data you are working with (i.e., individual data points or
frequency distributions).
Measures of Central Tendency
a. Mean: To calculate the mean (average) of a set of individual data points, sum all the data values
and divide by the total number of data points.
Mean (μ) = (Sum of all data points) / (Total number of data points)
b. Median: To find the median, first arrange the data in ascending order. If the number of data points
is odd, the median is the middle value. If the number of data points is even, the median is the
average of the two middle values.
c. Mode: The mode is the value that appears most frequently in the data set.
Measures of Variability
a. Variance: To calculate the variance, first find the mean of the data set. Then, for each data point,
subtract the mean, square the result, and sum up all the squared differences. Finally, divide the sum
by the total number of data points.
Variance (σ^2) = Σ [(x - μ)^2] / n
b. Standard Deviation: The standard deviation is simply the square root of the variance. It represents
the average deviation of data points from the mean and provides a measure of the spread or
dispersion of the data.
Standard Deviation (σ) = √Variance (σ^2)
When dealing with frequency distributions (data grouped into classes with corresponding
frequencies), you'll need to modify the formulas slightly. Here are the adjusted formulas:
Mean: For a frequency distribution, the mean is calculated by summing the product of each class
midpoint and its corresponding frequency, then dividing by the total number of data points.
Mean (μ) = Σ [(Midpoint of class * Frequency)] / (Total number of data points)
Variance: To calculate the variance for a frequency distribution, you'll need to use the formula:
Variance (σ^2) = Σ [(Midpoint of class - μ)^2 * Frequency] / (Total number of data points)
Standard Deviation: The standard deviation for a frequency distribution is the square root of the
variance.
Standard Deviation (σ) = √Variance (σ^2)
Below shown is the epidemiological curve with measurement of central tendency, standard deviation
and variance data for registered case in Jempol District in 2022.
(a) Waterborne and foodborne
Food Poisoning
Figure 4: Food Poisoning Registered Case in Jempol Epid Curve for 2022
Mean 1
Measurement of central tendency Median 0
Mode 0
Standard deviation 5.667243339
Variance 32.11764706
(b) Vector-borne
Dengue Fever / DHF
Figure 5: Dengue Registered Case in Jempol Epid Curve for 2022
Mean 2.365385
Mode 0
Variance 4.510935
Malaria
Figure 6: Malaria Registered Case in Jempol Epid Curve for 2022
Mean 0.038462
Mode 0
Variance 0.037707
(c) Airborne
Tuberculosis
Figure 7: Tuberculosis Registered Case in Jempol Epid Curve for 2022
Mean 1.423077
Mode 1
Variance 1.425339
HFMD
Figure 8: HFMD Registered Case in Jempol Epid Curve for 2022
Mean 15.53846
Mode 1
Variance 1.425339
Influenza Like Illness
Figure 9: Influenza Like Illness Registered Case in Jempol Epid Curve for 2022
Mean 7.942308
Mode 8
Variance 1.425339
(d) AIDS/ STD
HIV / Aids
Figure 10: HIV/AIDS Registered Case in Jempol Epid Curve for 2022
Mean 0.557692
Mode 0
Variance 1.425339
Syphilis
Figure 11: Syphilis Registered Case in Jempol Epid Curve for 2022
Mean 0.25
Mode 0
Variance 1.425339
Gonorrhoea
Figure 12: Gonorrhoea Registered Case in Jempol Epid Curve for 2022
Mean 0.038462
Mode 0
Variance 1.425339
2.2 Conducting Investigation and report preparation.
2.2.1 Water borne and food borne diseases
(a) Cholera/AGE
In the past 5 years, there is no Cholera diseases reported in Jempol Health District Office.
However, below shown is the procedure on how to investigate Cholera Diseases based on Guidelines
and Procedure by Ministry of Health Malaysia and Case Definition for Infectious Diseases in Malaysia
Edition 3 2017.
Cholera is a highly contagious and potentially life-threatening bacterial infection that primarily
affects the intestines. It is caused by the bacterium Vibrio cholerae, specifically the serogroups O1
and O139. Cholera is typically transmitted through contaminated water or food, and it can spread
rapidly in areas with poor sanitation, inadequate access to clean water, and overcrowded living
conditions.
Case Definition
Clinical case definition - Acute watery diarrhoea with or without vomiting.
Laboratory criteria for diagnosis - Isolation of Vibrio cholerae O1 or O139 from stools in
patient with diarrhoea or body fluids.
Case Classification
Suspected - A case that meets the clinical case definition.
Confirmed - A suspected case that is laboratory-confirmed.
Types of Surveillance
Mandatory notification under the Prevention and Control of Infectious Disease Act 1988.
When to notify
All suspected cholera cases shall be notified but only laboratory confirmed cases should be
registered. An asymptomatic person with positive Vibrio cholera need not be registered but must be
notified for prevention and control activities.
How to notify
A cholera case should be notified to the nearest District Health Office within 24 hours of
diagnosis.
Outbreak situations
A cholera outbreak occurs when there is one or more cases of cholera in a locality at any
given time. The cholera outbreak ends when no new cases are reported within two incubation
periods (i.e., 10 days) from the date of onset of the last reported case in that locality.
During outbreak situation, surveillance should be intensified with active case finding (ACD). Stool
culture for V. cholerae must be performed to symptomatic cases. High rectal swab is preferred than
normal rectal swab should stool culture not logistically possible in outbreak investigation.
Close Contact
Contact occurs with individuals who had close contact with the patient during the incubation
period, which is 5 days before the onset of symptoms until the patient is admitted to the
hospital/isolated. This includes:
a. Household contacts during the period of infection. If these contacts stay overnight in another
household for 1 - 2 nights, all members of that household are also considered contacts.
b. Workplace contacts.
c. School contacts.
d. Social contacts like friends, teammates who visit the patient's home.
e. Contacts at premises/restaurants.
Case Investigation
Investigation should be initiated as soon as notification is received. As a guide, the

Investigation Form for Food and Waterborne Diseases FWBD/UMU/BG/007 should be used (Refer to
General Guidelines, Appendix 18). For cases residing outside the operational area, they should be
referred to the Health Office in that area. It is the responsibility of the respective Health Office to
take further action.
The history of movement and food intake should be gathered within 5 days before the onset
of symptoms until the patient is identified as having cholera and isolated. For example, if a patient is
admitted to the hospital and diagnosed with cholera 5 days after the onset of symptoms, the history
of movement and food intake should be collected for the 10 days before their admission to the
hospital (5 days before the onset).
To facilitate the investigation, investigators can create a mind map or "bubble chart" of the
patient's movements, the hypothesis of infection, and important matters discussed during the
briefing session and incorporate them into the investigation form.
Case Detection
Active Case Detection (ACD):
The health team conducts field visits to nearby houses of the confirmed cholera case or
other relevant places to investigate if there are cases of severe diarrhoea (acute gastroenteritis -
AGE). Rectal swabs are taken from suspected contacts of the case. All severe diarrhoea cases should
be referred to the hospital for further assessment and treatment. ACD activities should also be
carried out in areas or localities with a high incidence of severe diarrhoea cases (AGE). For this
purpose, medical assistants in health clinics, outpatient departments, and private clinics need to be
contacted daily to obtain the daily AGE case statistics.
Passive Case Detection (PCD):
PCD is conducted at all health clinics and outpatient departments after receiving a cholera alert.
It is recommended to randomly take rectal swabs from patients experiencing non-severe diarrhoea
(randomly, 1 out of every 3 or 4 patients). All severe diarrhoea cases should be referred to the
hospital for treatment and admission. Rectal swabs should also be taken, and the names of these
patients recorded to inform health officers for the purpose of investigating their family members at
home.
Prevention and Control Measure
Environmental Control
Food premises may be closed down if they violate the Prevention and Control of Infectious
Diseases Act 1988 or the Food Act 1983 and the Food Regulations 1985. Inspections of food premises
and food safety in the outbreak area should be conducted.
Health Education
The target groups include cases, carriers, contacts, local residents, food handlers,
visitors/patients at clinics, local leaders, and the general public.
Food/Drink/Environmental Sampling
The type of swab to be taken depends on the case history. Among the swabs that need to be
taken are swabs of food preparation surfaces and swabs of effluent water from bathrooms.
Example: To sample river water or wastewater, use Moore swabs (gauge) or Jeli's swabs, and leave
them in the water for 24 hours before analysing for cholera. It is recommended to use "Double
Strength APW" media.
In addition to that, sampling of aquatic water can also be done to identify reservoirs in the
environment. There are several methods for taking such samples, including Moore swabs and Jeli's
swabs.
(b) Typhoid
In the past 5 years, there is no Typhoid diseases reported in Jempol Health District Office.
However, below shown is the procedure on how to investigate Typhoid Diseases based on Guidelines
and Procedure by Ministry of Health Malaysia and Case Definition for Infectious Diseases in Malaysia
Edition 3 2017.
Typhoid fever is caused by an infection with the bacteria Salmonella typhi (S. typhi) or Salmonella
paratyphi (S. paratyphi). Typhoid fever is a systemic disease caused by the bacterium S. typhi, while
paratyphoid fever is caused by S. paratyphi. Paratyphoid fever exhibits clinical manifestations that are
similar to typhoid fever but generally milder. Throughout this guideline, the terms S. typhi and S.
paratyphi will be used.
The symptoms of typhoid fever are diverse and not very specific. In the early stages, they include
prolonged high fever, headache, malaise (feeling of discomfort or unease), and loss of appetite.
Patients may also experience gastrointestinal symptoms like diarrhoea or constipation. Signs of
typhoid fever include a body temperature exceeding 38°C, a relatively low heart rate (relative
bradycardia), enlargement of the spleen and liver, red rashes ("rose spots") on the chest, abdomen,
and back, and respiratory infections (bronchitis and pneumonia). Without prompt treatment, 10% of
typhoid patients may experience serious complications such as colitis or intestinal perforation (bowel
leakage). Patients may also suffer from abdominal tenderness and bloody stools. Other possible
serious complications include meningitis, psychosis, myocarditis, disseminated intravascular
coagulation (DIC), hemolytic uremic syndrome, shock, and coma.
The mortality rate for typhoid fever is high, reaching 10-20% if patients do not receive
appropriate treatment. However, with the availability of antibiotic treatment, the mortality rate can
be reduced to less than 1%. The percentage of relapse cases for this infection is between 15-20%.
Usually, relapse cases exhibit milder symptoms. The percentage of carrier cases is approximately 1-
5%.
Case Definition
Clinical case definition - An illness with insidious onset of prolonged fever, constitutional
symptoms (e.g. malaise, headache, anorexia), non-productive cough in the early stage of the
illness, constipation more often than diarrhoea and hepatosplenomegaly. Rose spots are
often seen in fair-skinned patients.
Laboratory criteria for diagnosis - Isolation of Salmonella typhi/paratyphi from blood, stool or
other clinical specimens.
Case Classification
Suspected - A case that fulfils the clinical case definition.
Probable - A suspected case with positive serology or antigen detection test but without
isolation of Salmonella typhi/paratyphi
Confirmed - A suspected case with Isolation of Salmonella typhi/paratyphi from blood, stool
or other clinical specimens.
Types of Surveillance
Mandatory notification under the Prevention and Control of Infectious Disease Act 1988.
When to notify
Any suspected, probable or confirmed case should be notified within 7 days from the
diagnosis date. A Salmonella typhi/paratyphi case should be notified to the nearest District Health
Office. Only laboratory confirmed cases should be registered.
How to notify
All suspected and probable cases must be notified/reported by healthcare practitioners to

the nearby District Health Office within seven (7) days via phone, while confirmed cases must be
reported immediately. Healthcare practitioners are requested to make notifications through the web-
based e-notification system for all suspected typhoid cases within 24 hours after the diagnosis is
made. This is done to investigate promptly and interrupt the transmission of the infection. Although
written notification is required within 1 week as mandated by the Prevention and Control of
Infectious Diseases Act 1988, healthcare practitioners are expected to do so earlier to prevent
further transmission to others.
The responsible personnel in the laboratory must directly inform the healthcare practitioner
from the requesting Health Facility/Ward through phone or by providing a copy of the laboratory test
result immediately after Salmonella typhi bacteria is detected.
Outbreak situations
Surveillance should be intensified with the introduction of active case finding. The isolates
should be sent for finger printing to determine the source. Food or water samples should be sent for
Salmonella typhi/paratyphi.
The outbreak of this disease occurs when there are 2 or more cases within the same
incubation period in a specific locality or with an epidemiological link (Epidemiological linked).
The outbreak is declared to have ended when no new cases have been reported for 42 days
(2 incubation periods) from the date of onset of the last reported case. For managing the outbreak,
please refer to the General Guidelines for outbreak management.
Close Contact
Contact occurs with individuals who had close contact with the patient during the incubation
period, which is 5 days before the onset of symptoms until the patient is admitted to the
hospital/isolated. This includes:
a. Household contacts during the period of infection. If these contacts stay overnight in another
household for 1 - 2 nights, all members of that household are also considered contacts.
b. Workplace contacts.
c. School contacts.
d. Social contacts like friends, teammates who visit the patient's home.
e. Contacts at premises/restaurants.
All contacts of the case must be traced and investigated. The contact investigation is based on the
FWBD/TYP/BG/004 investigation report.
 Stool specimens from contacts should be collected for analysis of S. typhi/paratyphi.

 Any contact with symptoms of typhoid disease must be referred to the hospital for further
examination.
 All contacts should be provided with health education about the dangers of typhoid disease,
including its mode of transmission and other relevant information.
 Positive contact cases should be treated similarly to confirmed cases or carriers, depending
on the status. Treatment should be administered accordingly.
 To detect carriers among contacts, especially during an outbreak, serological testing
(Typhidot Carrier) is conducted. If the result is positive (IgA +ve, IgG +ve, or IgA & IgG +ve),
repeat stool culture will be performed.
Case Investigation
The investigation of each typhoid case that is notified should be conducted using the Food
and Waterborne Disease Investigation Form (FWBD/UMU/BG/007) (Refer to General Guidelines,
Appendix 18). All information should be filled out completely and as much as possible. All
suspected/probable cases that are Widal positive (from private facilities) should be subjected to
prevention and control measures similar to positive culture cases.
The following information should be asked:
 Date of the onset of illness or when signs and symptoms first appeared.
 Signs and symptoms experienced by the patient.
 Any previous treatment received before admission to the hospital.
 Patient's movements, food, and drinks consumed within 7 to 21 days before getting sick.
 Additional information about the patient's movements.
 Ceremonies or gatherings attended.
 Risky foods eaten during the incubation period.
 Visits to outbreak areas.
 Meetings or gatherings attended.
 Contacts or typhoid patients who visited the patient's home.
 Contacts of the patient.
 Food premises where the food was obtained.
 Types of food purchased.
 Water supply, sewage disposal system, waste disposal system, and sanitation facilities used.
 History of receiving typhoid immunization.
The following aspects should be noted:
 The patient's physical health.

 The cleanliness of the patient's home environment.
 Breeding sources of flies, cockroaches, and rats.
 The level of cleanliness of food premises related to the case and the water supply facilities
used.
Information that should be obtained from the hospital:
 Date of specimen collection (blood, stool, and urine).

 Laboratory results.
 Case history from the patient's file (bed head ticket).
For cases outside the reporting area, the report should be made to the respective District Health
Officer, and the investigation is the responsibility of the involved district.
Follow-up for Cases

Follow-up examinations should be conducted at 3, 6, and 12 months after the date of discharge.
The actions during follow-up are as follows:
 Clinical examination to detect any signs or symptoms. If present, refer to the hospital.
 Stool specimen collection for S. typhi testing at each follow-up. If positive, refer to the
hospital.
 Inspection of the patient's home environment and contacts:
o Ensuring safe water supply.
o Properly used toilets.
o Satisfactory hygiene around the house.
7.6.2 Follow-up for Carriers
Carriers can be treated as inpatients or outpatients. During the treatment period, follow-up
should be conducted every 2 weeks until the treatment is completed. Ensure that the patient
complies with the medication and report any side effects. Advise the patient not to handle food
during this period.
After completing the antibiotic treatment, stool specimens should be collected every month
for the first 3 months, followed by follow-up at 6 and 12 months. If the result is positive, they should
be referred to a Family Medicine Specialist/Medical Specialist at Health Clinic/Hospital for treatment
as a carrier.
During monitoring, carriers are not allowed to handle and prepare food for the public. For
food handling at home, carriers must practice personal hygiene, especially proper handwashing.
Patients can only resume food handling after being confirmed to have fully recovered and no longer
pose a risk of typhoid transmission, as determined by medical practitioners.
If they are food handlers, they must obtain health clearance from a Registered Medical
Officer (Regulation 31, Food Hygiene Regulations 2009).
Providing health education.
Patient and contact records should be continuously updated. If there is a change of address,
inform the relevant District Health Officer. The expected follow-up dates should be written in
advance in the patient/carrier register. After the follow-up has been conducted, mark the dates with
red ink.
Prevention and Control Measure
Environmental Control
1. Premises Inspection and Closure: Inspection of food premises and food safety in the
outbreak area should be intensified. Food premises should be closed if they violate the
Prevention and Control of Infectious Diseases Act 1988, Food Act 1983, Food Regulations
1985, and Food Hygiene Regulations 2009.
2. Sanitary Disposal of Faeces: Every house must have sanitary toilets. The BAKAS unit should
prioritize areas with cases and outbreaks and provide advice on constructing sanitary toilets
or building sanitary toilets under the BAKAS program.
3. Clean Water Supply: In areas with treated water supply, the chlorine levels should be
increased to a minimum of 2 ppm at the treatment plant or 0.5 ppm at the end point, and
monitoring should be carried out. For houses without treated water supply but located
within the coverage area of treated water supply, assistance should be provided to connect
the water pipe system through the KKM BAKAS project. If there is no treated water pipe
system, a safe water supply can be provided by constructing controlled wells or Gravity Feed
Systems (GFS) for areas near water sources.
4. Controlled Waste Disposal: Encourage residents to establish a controlled and sanitary waste
disposal system to prevent attraction of flies, cockroaches, rats, and stray animals. Use
covered waste bins, incinerate, or bury waste.
5. Wastewater Disposal: Supervise wastewater disposal with controlled disposal systems such
as the Sewage Disposal System (SPAL) project.
6. Chlorination of Well Water: Refer to the general outbreak control guidelines [FWBD/
UMU/GP/001].
7. Disinfection: Use Lysol in places that require disinfection, such as floors, toilets, waste
disposal areas in the patient's house, and areas contaminated by patient's vomit or feces.
Health Education
1. General health education in individual or group settings using methods like lectures,
distribution of leaflets, posters, etc. should be provided to all contacts, food handlers, and
residents in the infected area
2. Specific health education should be given to food handlers. If confirmed as a patient or
carrier, they must not handle food until fully recovered (comply with stool clearance).
Comprehensive health checkups and stool tests should be done. Obtain typhoid
immunization as per regulations.
3. Inform the District Health Office 2 weeks before organizing events or gatherings, especially in
outbreak areas.
Typhoid Immunization
a. Types of Vaccines
i. Typhim Vi (Vi CPS)
 Used in the Ministry of Health, Malaysia

 A single dose of 0.5 ml (25 micrograms) intramuscularly in the deltoid area.
 Not recommended for children under 2 years.
 Booster given every 3 years.
ii. Ty21a (live attenuated oral vaccine, available in enteric-coated capsule form)
 One (1) capsule is taken on alternate days (days 1, 3, 5) for a total of 3 capsules.
 The capsules should be kept cool (not frozen).
 All doses must be taken for maximum efficacy.
 Each capsule should be taken with cold water (temperature below 37°C) 1 hour before a
meal.
 Not recommended for children under 6 years.
 Booster given every 3 years.
(c) Hepatitis A
In the past 5 years, there is no Hepatitis A diseases cases reported on in Jempol Health
District Office. However, below shown is the procedure on how to investigate Hepatitis A Diseases
based on Guidelines and Procedure by Ministry of Health Malaysia and Case Definition for Infectious
Diseases in Malaysia Edition 3 2017.
Hepatitis A is a viral infection that primarily affects the liver. It is caused by the hepatitis A
virus (HAV), which is typically transmitted through the consumption of contaminated food or water,
or by close contact with an infected person. Hepatitis A is one of the several types of hepatitis
viruses, which also include hepatitis B, C, D, and E.
Transmission
The most common mode of transmission for hepatitis A is the ingestion of food or water
contaminated with the faeces of an infected person. This can happen through inadequate
handwashing by infected individuals who handle food or water sources. Additionally, the virus can
spread through close personal contact with an infected person, such as living with or caring for
someone who has the disease.
Symptoms
Symptoms of hepatitis A can vary, but they typically appear two to six weeks after exposure
to the virus. Some individuals may not show any symptoms, especially young children. However,
common symptoms include:
 Fatigue and weakness  Jaundice (yellowing of the skin and

 Loss of appetite eyes)
 Nausea and vomiting  Dark urine
 Abdominal pain or discomfort,  Pale-coloured stools
especially in the liver area
Treatment
There is no specific treatment for hepatitis A. Most cases are self-limiting, meaning the
body's immune system can clear the infection on its own over time. Supportive care is usually
recommended to manage symptoms and promote recovery. Rest, proper nutrition, and adequate
hydration are essential during the recovery process.
Prevention
The most effective way to prevent hepatitis A is through vaccination. The hepatitis A vaccine
is safe and highly effective, and it is recommended for individuals at risk of infection, including
travellers to areas with high hepatitis A prevalence, individuals with chronic liver disease, and people
in certain high-risk occupations. Proper hygiene practices, such as regular handwashing, especially
after using the bathroom and before handling food, can also help prevent the spread of the virus.
Hepatitis A is generally considered a short-term and non-life-threatening infection, but it is essential
to take preventive measures to reduce its transmission and protect vulnerable populations from
severe complications.
(d) Food poisoning

Last year in 2022, there is an outbreak of Food Poisoning diseases reported in Jempol Health
District Office. However, below shown is the procedure on how to investigate Hepatitis A Diseases
based on Guidelines and Procedure by Ministry of Health Malaysia and Case Definition for Infectious
Diseases in Malaysia Edition 3 2017.
Food poisoning, also known as foodborne illness, is a condition caused by consuming

contaminated or spoiled food or beverages. It occurs when harmful microorganisms, such as
bacteria, viruses, parasites, or toxins, are present in the food and ingested into the body. These
pathogens can lead to various gastrointestinal symptoms and, in some cases, can be severe or even
life-threatening.
Causes
Food poisoning can be caused by various factors, including:
Bacterial contamination: Bacteria like Salmonella, Escherichia coli (E. coli), Campylobacter, and
Listeria can contaminate food and multiply rapidly, leading to illness when consumed.
Viral infections: Viruses such as norovirus, rotavirus, and hepatitis A can be transmitted through
contaminated food or water.
Parasitic infections: Parasites like Giardia and Cryptosporidium can cause foodborne illnesses, usually
due to consuming contaminated water or food.
Toxins: Certain toxins produced by bacteria, such as Staphylococcus aureus and Clostridium
botulinum, can contaminate food and lead to poisoning if ingested.
Symptoms
The symptoms of food poisoning can vary depending on the type of pathogen and the
individual's immune system. Common symptoms include:
 Nausea and vomiting  Headache

 Diarrhea  Muscle aches
 Abdominal pain and cramps  Fatigue and weakness
 Fever  Dehydration
In most cases, the symptoms appear within a few hours to a few days after consuming the
contaminated food. While most food poisoning cases are mild and resolve on their own within a few
days, some severe cases may require medical attention, especially in vulnerable populations such as
the elderly, young children, pregnant women, and individuals with weakened immune systems.
Prevention
Preventing food poisoning involves practicing proper food safety measures, including:
 Washing hands thoroughly before handling food.

 Cooking food at the appropriate temperature to kill harmful pathogens.
 Avoiding cross-contamination between raw and cooked foods.
 Refrigerating perishable foods promptly.
 Using clean utensils and cutting boards.
 Avoiding consumption of raw or undercooked meats, eggs, and seafood.
 Drinking clean and safe water.
Being cautious about food handling and preparation can significantly reduce the risk of food
poisoning and help maintain a safe and healthy food supply.
2.2.2 Air borne disease
(a) Tuberculosis
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium

tuberculosis. It primarily affects the lungs but can also spread to other parts of the body, such as the
kidneys, spine, and brain. TB is a serious global health concern and one of the top causes of death
due to infectious diseases worldwide.
Transmission
TB is spread through the air when an infected person with active TB in their lungs or throat coughs,
sneezes, speaks, or sings. People nearby can inhale the bacteria and become infected. Not everyone
infected with TB becomes sick immediately; in some cases, the immune system can keep the bacteria
in check, leading to latent TB infection. However, if the immune system weakens or becomes
compromised, latent TB can progress to active TB disease.
Symptoms
The symptoms of TB vary depending on whether it is active or latent. Latent TB typically doesn't
cause any symptoms and is not contagious. However, latent TB can become active TB if the immune
system is weakened, leading to symptoms such as:
 Persistent cough that lasts for weeks

 Chest pain
 Coughing up blood or phlegm
 Fatigue
 Unintended weight loss
 Loss of appetite
 Night sweats
 Fever
Diagnosis
TB is diagnosed through various tests, including:
1. Tuberculin Skin Test (TST): A small amount of TB protein is injected under the skin, and the
reaction is checked after 48-72 hours.
2. Interferon-Gamma Release Assays (IGRAs): A blood test that measures the release of specific
substances by immune cells in response to TB proteins.
3. Chest X-ray: It can reveal abnormalities in the lungs.
4. Sputum Culture: Sputum samples are collected and cultured to identify the presence of M.
tuberculosis.
Prevention
Preventing TB involves several strategies, including:
1. Vaccination: The Bacillus Calmette-Guérin (BCG) vaccine provides some protection against
severe forms of TB in children.
2. Identifying and Treating Latent TB: Detecting and treating latent TB infection in high-risk
individuals can prevent the progression to active TB disease.
3. Infection Control: Proper ventilation and respiratory hygiene can help reduce the
transmission of TB in healthcare settings and crowded places.
4. Contact Tracing: Identifying and screening individuals who have been in close contact with TB
patients to detect new infections early.
(b) Diphtheria
Diphtheria is a serious infectious disease caused by the bacterium Corynebacterium diphtheriae.

It primarily affects the mucous membranes of the throat and nose and can lead to severe
complications if left untreated. Diphtheria is highly contagious and can spread from person to person
through respiratory droplets or by touching objects contaminated with the bacteria.
Transmission
Diphtheria is mainly spread through respiratory droplets when an infected person coughs or
sneezes. It can also be transmitted by touching objects or surfaces contaminated with the bacterium
and then touching the mouth, nose, or eyes.
Symptoms
The symptoms of diphtheria can range from mild to severe and typically appear 2 to 5 days
after exposure to the bacteria. Common symptoms include:
 Sore throat
 Fever and chills
 Swollen lymph nodes in the neck
 Weakness and fatigue
 Loss of appetite
 Nasal discharge
 Difficulty breathing and swallowing
 A thick, grayish-white membrane in the throat or nose, which can obstruct the airway
Severe cases of diphtheria can lead to complications such as airway obstruction, heart
problems (myocarditis), nerve damage (polyneuropathy), and kidney problems.
Diagnosis
Diphtheria is diagnosed based on clinical symptoms and laboratory tests. A swab is taken
from the throat or nose to check for the presence of the C. diphtheriae bacterium. Additionally,
blood tests may be performed to look for signs of toxin production.
Prevention
Vaccination is the most effective way to prevent diphtheria. The diphtheria vaccine is often
given in combination with tetanus and pertussis vaccines, and this combination is known as the DTaP
vaccine (for children) or Tdap vaccine (for adolescents and adults). Routine vaccination helps create
immunity to diphtheria and protects individuals from severe disease and complications.
(c) Hand, food and mouth disease (HFMD)
Hand, Foot, and Mouth Disease (HFMD) is a common viral infection that primarily affects
infants and young children. It is caused by several different viruses, most commonly the
Coxsackievirus A16 and Enterovirus 71. HFMD typically presents with mild symptoms and is usually
not a serious illness, but in some cases, it can lead to complications.
Transmission
HFMD is highly contagious and spreads from person to person through direct contact with
respiratory secretions, saliva, fluid from blisters, and feces of an infected person. It can also spread
through contact with contaminated surfaces and objects.
Symptoms
The incubation period for HFMD is usually 3 to 7 days. The typical symptoms include:
 Fever: HFMD often starts with a fever, which is usually mild to moderate in intensity.
 Sore Throat: A sore throat is a common early symptom of HFMD.
 Mouth Sores: Painful sores or ulcers can develop inside the mouth, including the tongue,
gums, and inside of the cheeks. These sores may be red with a white or grayish center.
 Skin Rash: A rash of small red spots or blisters can appear on the hands, feet, and sometimes
on the buttocks.
In most cases, the symptoms of HFMD are mild and resolve on their own within a week
without any specific treatment.
Complications
While HFMD is generally a mild illness, some individuals, especially infants and young children, may
experience complications. These can include:
 Dehydration: Painful mouth sores can make it difficult for children to drink fluids, leading to
dehydration.
 Viral Meningitis: In some cases, HFMD can cause viral meningitis, which is an inflammation of
the membranes surrounding the brain and spinal cord.
 Encephalitis: Rarely, HFMD can lead to encephalitis, which is a swelling of the brain.
Prevention
 Preventing the spread of HFMD is essential, especially in settings like childcare centers and
schools. Some preventive measures include:
 Frequent Handwashing: Encourage regular handwashing with soap and water, especially
after using the bathroom, changing diapers, and before eating.
 Avoid Close Contact: Limit contact with individuals who have HFMD, and avoid sharing
personal items.
 Disinfect Surfaces: Clean and disinfect frequently touched surfaces and objects regularly.
 Practice Respiratory Hygiene: Cover your mouth and nose with a tissue or your elbow when
coughing or sneezing.
 Stay Home: If you or your child have HFMD, stay home from school, work, or public places
until symptoms have resolved to prevent spreading the virus to others
(d) Influenza like illness
Influenza-like illness (ILI) refers to a set of symptoms that are similar to those caused by the
influenza virus but may be caused by other viral or bacterial infections as well. ILI is a clinical
diagnosis based on the presence of certain symptoms commonly associated with influenza.
Symptoms of Influenza-like illness
ILI symptoms typically include:
 Sudden onset of high fever (usually  Headache

above 100.4°F or 38°C)  Sore throat
 Chills and shivering  Dry cough
 Muscle aches and body pain  Nasal congestion
 Fatigue and weakness  Runny nose
Causes
Influenza-like illness can be caused by a variety of respiratory viruses, not just the influenza
virus. Common culprits include:
 Influenza viruses: Influenza A, B, and, less commonly, C viruses.

 Rhinovirus: Responsible for the common cold.
 Respiratory syncytial virus (RSV): Common in young children and older adults.
 Adenovirus: Can cause a range of respiratory illnesses.
 Parainfluenza virus: Causes croup and other respiratory infections.
 Coronavirus: Some strains can cause ILI, including the one responsible for COVID-19 (SARS-
CoV-2).
Prevention
Preventing ILI involves practicing good hygiene, such as frequent handwashing, avoiding
close contact with sick individuals, and covering the mouth and nose when coughing or sneezing.
Annual influenza vaccination is also recommended, especially for individuals at higher risk of
complications, like young children, elderly individuals, pregnant women, and those with chronic
health conditions.
2.2.3 Infectious disease through body fluids
(a) HIV
HIV, which stands for Human Immunodeficiency Virus, is a virus that attacks the immune
system, specifically the CD4 cells (T cells) that play a crucial role in helping the body fight off
infections and diseases. If left untreated, HIV can lead to the disease known as AIDS (Acquired
Immunodeficiency Syndrome).
Transmission
HIV is primarily transmitted through certain body fluids, including blood, semen, vaginal
fluids, rectal fluids, and breast milk. The most common modes of transmission include:
 Unprotected sexual contact: The virus can be transmitted through vaginal, anal, or oral sex
with an infected partner, especially if there are open sores or cuts.
 Sharing contaminated needles: Sharing needles or syringes used for injecting drugs can lead
to HIV transmission, as the virus can be present in the blood.
 From mother to child: HIV can be passed from an infected mother to her child during
childbirth or through breastfeeding.
Symptoms
The symptoms of an acute HIV infection, also known as primary HIV infection, can resemble
those of the flu and may include fever, fatigue, sore throat, swollen lymph nodes, and rash. However,
some people with HIV may not experience any noticeable symptoms during this early stage. As the
infection progresses, HIV attacks and gradually destroys the CD4 cells, weakening the immune
system. Without proper treatment, individuals with HIV become more susceptible to various
opportunistic infections and certain types of cancers.
Prevention
Preventing HIV transmission is essential in controlling the spread of the virus. Key prevention
strategies include:
 Using condoms consistently and correctly during sexual activity.

 Avoiding the sharing of needles or syringes for drug use.
 HIV testing and early diagnosis to initiate timely treatment.
 Pre-exposure prophylaxis (PrEP) for individuals at high risk of HIV infection.
 Eliminating mother-to-child transmission through proper medical interventions.
Stigma and Awareness
HIV is often associated with stigma and discrimination, which can create barriers to testing,
treatment, and care for individuals living with HIV. Raising awareness, combating stigma, and
promoting HIV testing and support are critical components of effective HIV prevention and
management. HIV remains a global health concern, but advances in research, treatment, and
prevention have made significant progress in managing the disease and improving the quality of life
for those living with HIV. Early diagnosis, access to proper medical care, and community support play
vital roles in combating HIV and working towards an HIV-free world
(b) Sex transmitted diseases
Syphillis
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema

pallidum. It can also be transmitted from a pregnant woman to her fetus during pregnancy or
childbirth, leading to congenital syphilis in the newborn.
Transmission
Syphilis is primarily transmitted through sexual contact, including vaginal, anal, and oral sex,
with an infected partner. The bacterium enters the body through breaks in the skin or mucous
membranes during sexual activities with an infected individual.
Symptoms
The symptoms of syphilis vary depending on the stage of the infection. It progresses through several
stages, each with different symptoms:
 Primary Syphilis: The first stage usually begins with the appearance of a painless sore or ulcer
known as a chancre at the site of infection, typically the genitals, anus, or mouth. The sore
lasts for a few weeks before healing on its own.
 Secondary Syphilis: In the secondary stage, a rash may develop on the palms of the hands
and soles of the feet. Other symptoms may include fever, fatigue, sore throat, swollen lymph
nodes, and patchy hair loss. The symptoms may come and go for several weeks.
 Latent Syphilis: After the secondary stage, the infection can progress to the latent stage,
during which there are no visible symptoms. However, the bacterium remains in the body
and can continue to cause damage to internal organs.
 Tertiary Syphilis: If syphilis remains untreated, it may progress to the tertiary stage, which
can occur years after the initial infection. Tertiary syphilis can lead to severe complications,
including damage to the heart, brain, nerves, eyes, bones, and other organs. Neurosyphilis,
affecting the nervous system, is one of the severe complications of untreated syphilis.
Prevention
Preventing syphilis involves practicing safe sex, using condoms consistently and correctly during
sexual activities, and knowing the sexual health status of partners. Regular STI testing, especially for
individuals with multiple sexual partners, is crucial for early detection and treatment. Syphilis during
pregnancy can lead to serious health issues for the fetus, including congenital syphilis. Pregnant
women should be routinely screened for syphilis, and early treatment can prevent transmission to
the baby. Syphilis is a preventable and treatable STI, and with awareness, education, and access to
healthcare, the spread of syphilis can be controlled and its impact minimized.
Gonorrhoea
Gonorrhea, also spelled as gonorrhoea, is a common sexually transmitted infection (STI)

caused by the bacterium Neisseria gonorrhoeae. It primarily affects the mucous membranes of the
genital tract, but it can also infect the rectum, throat, and eyes.
Transmission
Gonorrhea is primarily transmitted through sexual contact, including vaginal, anal, and oral
sex, with an infected partner. It can be passed from one person to another through the exchange of
bodily fluids, such as semen, vaginal fluids, and rectal fluids. It can also be transmitted from an
infected mother to her newborn during childbirth.
Symptoms
The symptoms of gonorrhea can vary and may differ between men and women. However, it
is important to note that some individuals, especially women, may not show any noticeable
symptoms, leading to unknowing transmission of the infection.
Common symptoms in men may include:
 Painful or burning sensation during urination

 White, yellow, or greenish discharge from the penis
 Swelling or redness at the opening of the penis
 Pain or swelling in the testicles
 Common symptoms in women may include:
 Increased vaginal discharge
 Painful or burning sensation during urination
 Vaginal bleeding between periods or after sex
 Pain or tenderness in the lower abdomen
 Rectal and throat infections may cause discomfort, but they often do not present with any
noticeable symptoms.
Prevention
Preventing gonorrhea involves practicing safe sex, using condoms consistently and correctly
during sexual activities, and knowing the sexual health status of partners. Regular STI testing,
especially for individuals with multiple sexual partners, is crucial for early detection and treatment.
Gonorrhea during pregnancy can lead to serious health issues for the baby, including eye infections
and blindness. Pregnant women should be routinely screened for gonorrhea, and early treatment
can prevent transmission to the baby. Gonorrhea is a preventable and treatable STI. However, due to
its potential to cause serious complications, such as pelvic inflammatory disease (PID), infertility, and
an increased risk of acquiring HIV, early detection and prompt treatment are essential to prevent
long-term health consequences.
2.2.4 Vector borne diseases
(a) Dengue fever/DHF/ DSS
Dengue fever is a mosquito-borne viral infection caused by the dengue virus, which is
primarily transmitted to humans through the bites of infected female mosquitoes, mainly the Aedes
aegypti mosquito. Dengue is a significant public health concern in many tropical and subtropical
regions of the world, including parts of Southeast Asia, the Pacific Islands, the Caribbean, and Central
and South America.
Symptoms
Dengue fever can range from mild to severe, and the symptoms typically appear 4 to 10 days
after being bitten by an infected mosquito. The symptoms of dengue fever may include:
 High fever
 Severe headache
 Pain behind the eyes
 Joint and muscle pain
 Nausea and vomiting
 Rash, which may appear a few days after the fever starts
 Mild bleeding, such as nosebleeds, gum bleeding, or easy bruising
Severe Dengue
In some cases, dengue fever can progress to a severe and life-threatening form known as
severe dengue or dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS). Severe dengue
can cause plasma leakage, severe bleeding, organ failure, and shock, leading to potentially fatal
outcomes. Severe dengue requires immediate medical attention and hospitalization.
Prevention
Preventing dengue fever involves controlling mosquito populations and avoiding mosquito bites.
Measures to prevent dengue include:
 Using mosquito repellents containing DEET, picaridin, or oil of lemon eucalyptus when
outdoors.
 Wearing long-sleeved shirts and long pants to minimize skin exposure to mosquitoes.
 Using mosquito nets while sleeping, especially during daytime hours when Aedes
mosquitoes are active.
 Eliminating standing water around the living area to reduce mosquito breeding sites.
(b) Chikungunya
Chikungunya is a viral infection caused by the chikungunya virus, which is primarily

transmitted to humans through the bites of infected female mosquitoes, specifically Aedes
mosquitoes, such as Aedes aegypti and Aedes albopictus. Chikungunya is most commonly found in
tropical and subtropical regions of the world.
Symptoms
Chikungunya fever typically manifests with the sudden onset of symptoms, usually 3 to 7
days after being bitten by an infected mosquito. The symptoms of chikungunya may include:
 High fever (often exceeding 102°F or 39°C)

 Severe joint pain (arthralgia), affecting the wrists, knees, ankles, and other joints
 Headache
 Muscle pain
 Fatigue and weakness
 Skin rash, which may appear 2 to 5 days after the fever starts
 Chronic Joint Pain
One distinctive feature of chikungunya is the prolonged joint pain that may persist for weeks
or even months after the acute phase of the infection has subsided. Some individuals may
experience chronic joint pain and inflammation, which can significantly impact their daily activities
and quality of life.
Diagnosis and Treatment
Diagnosing chikungunya is based on the presence of characteristic symptoms and the

patient's travel history to regions where the virus is prevalent. Laboratory tests, such as blood tests
to detect the chikungunya virus or antibodies, can confirm the diagnosis. There is no specific antiviral
treatment for chikungunya. Similar to dengue fever, supportive care is the mainstay of management,
which includes managing fever and pain with over-the-counter medications (not aspirin) and
maintaining adequate hydration. Rest is essential during the acute phase of the infection.
Prevention
Preventing chikungunya involves controlling mosquito populations and avoiding mosquito bites.
Measures to prevent chikungunya include:
 Using mosquito repellents containing DEET, picaridin, or oil of lemon eucalyptus when
outdoors.
 Using mosquito nets while sleeping, especially during daytime hours when Aedes
mosquitoes are active.
(c) Malaria
Malaria is a life-threatening infectious disease caused by Plasmodium parasites, which are

transmitted to humans through the bites of infected female Anopheles mosquitoes. The disease is
prevalent in many tropical and subtropical regions of the world, including sub-Saharan Africa,
Southeast Asia, and parts of Central and South America.
Transmission
When an infected mosquito bites a human, it injects Plasmodium parasites into the
bloodstream. These parasites then travel to the liver, where they multiply and mature. After leaving
the liver, the parasites enter the red blood cells, where they continue to multiply and eventually
cause the cells to burst, releasing more parasites into the bloodstream. The bursting of red blood
cells leads to the characteristic cycles of fever and chills associated with malaria.
Symptoms
The symptoms of malaria typically appear 1 to 4 weeks after being bitten by an infected
mosquito. The severity of the symptoms can vary depending on the species of Plasmodium and the
individual's immunity. Common symptoms of malaria include:
 High fever
 Chills and sweating
 Headache
 Muscle and joint pain
 Fatigue and weakness
 Diarrhea
 Anemia (low red blood cell count)
In severe cases, malaria can lead to complications such as cerebral malaria (a severe form of
the disease affecting the brain), severe anemia, kidney failure, and organ damage. Severe malaria can
be life-threatening and requires immediate medical attention.
Diagnosing malaria involves a combination of clinical evaluation and laboratory tests, such as
a blood smear, to detect the presence of the Plasmodium parasites in the blood. Malaria is treatable
with antimalarial medications. The choice of medication and duration of treatment depend on the
type of malaria, the severity of the infection, and the region where the infection was acquired.
Prompt and effective treatment is essential to prevent severe complications and reduce the risk of
transmission to others.
Prevention
Preventing malaria involves controlling mosquito populations and taking measures to avoid mosquito
bites. Preventive measures include:
 Using mosquito nets while sleeping, especially insecticide-treated bed nets (ITNs).
 Applying mosquito repellents containing DEET, picaridin, or oil of lemon eucalyptus to
exposed skin.
(d) Japanese encephalitis (JE)
Japanese encephalitis (JE) is a viral disease caused by the Japanese encephalitis virus (JEV). It
is a mosquito-borne infection primarily transmitted to humans through the bites of infected
mosquitoes, mainly Culex species, which pick up the virus by feeding on infected birds or pigs. JE is a
significant public health concern in many countries in Asia and the western Pacific, particularly in
rural agricultural areas where rice cultivation and pig farming create favorable conditions for
mosquito breeding.
Symptoms
The majority of individuals infected with the Japanese encephalitis virus do not show any
symptoms (asymptomatic). However, in some cases, the infection can lead to symptoms ranging from
mild flu-like illness to severe neurological complications.
Mild cases may present with:
 Fever
 Headache
 Fatigue
In more severe cases, especially in children and the elderly, the virus can infect the brain and cause
encephalitis, leading to:
 High fever  Seizures

 Stiff neck  Paralysis
 Severe headache  Coma
 Confusion or disorientation  Death (in severe cases)
Diagnosing Japanese encephalitis involves clinical evaluation, a medical history, and

laboratory tests to detect the virus or antibodies in the blood or cerebrospinal fluid. There is no
specific antiviral treatment for Japanese encephalitis. Supportive care, including treatment for fever,
pain, and hydration, is provided to manage the symptoms. Severe cases of encephalitis may require
hospitalization, and treatment aims to alleviate complications and provide the best possible
outcome.
Prevention
Preventing Japanese encephalitis primarily revolves around mosquito control and vaccination.
Preventive measures include:
 Using mosquito nets while sleeping, especially insecticide-treated bed nets (ITNs).
 Applying mosquito repellents containing DEET, picaridin, or oil of lemon eucalyptus to
exposed skin.
 Wearing long-sleeved shirts and long pants to minimize skin exposure to mosquitoes,
especially during peak mosquito-biting hours.
(e) Scrub/ Urban Typhus
Scrub typhus, also known as bush typhus or urban typhus, is a bacterial infectious disease
caused by the Orientia tsutsugamushi bacterium. It is primarily transmitted to humans through the
bites of infected larval mites, known as chiggers, found in the habitat of rodents and other small
animals. Scrub typhus is most common in rural and agricultural areas of the Asia-Pacific region,
including parts of Southeast Asia, Japan, Korea, India, and northern Australia.
Symptoms
The symptoms of scrub typhus typically appear within 1 to 3 weeks after being bitten by an infected
chigger. The severity of the disease can vary, and some individuals may have mild symptoms or
remain asymptomatic.
Common symptoms of scrub typhus include:
 High fever  Rash, which may be present on the

 Severe headache trunk and extremities
 Muscle and joint pain  Enlarged lymph nodes
 Fatigue and weakness  Chills and sweating
 Cough
Diagnosing scrub typhus can be challenging because its symptoms can resemble those of other
infectious diseases like dengue fever, malaria, or typhoid fever. It requires clinical evaluation, a
medical history, and laboratory tests to detect the bacterium or antibodies in the blood. Scrub
typhus is treatable with antibiotics, such as doxycycline or azithromycin. Early and appropriate
antibiotic treatment is crucial to prevent severe complications and reduce the risk of mortality.
Prevention
Preventing scrub typhus involves avoiding exposure to chiggers and taking measures to protect
oneself from bites:
 Wearing protective clothing, such as long-sleeved shirts and long pants, when spending time
in areas known to have chiggers.
 Using insect repellents containing DEET, picaridin, or oil of lemon eucalyptus on exposed
skin.
 Avoiding sitting or lying on the ground in areas with tall grass or vegetation where chiggers
may be present.
 Conducting vector control measures, such as rodent control, to reduce the population of
chiggers' hosts and prevent the transmission of the bacteria.
2.2.5 Zoonotic disease
(a) Rabies
Rabies is a deadly viral disease that affects mammals, including humans. It is caused
by the rabies virus, which belongs to the Lyssavirus genus. Rabies is primarily transmitted to
humans through the bite or scratch of an infected animal, usually a dog, bat, raccoon, skunk,
fox, or other wild carnivores.
Transmission
The rabies virus is usually present in the saliva of an infected animal. When an
infected animal bites or scratches a person, the virus can enter the body through the wound
and travel along the nerves to the brain and spinal cord. From there, the virus spreads
throughout the body, leading to inflammation of the brain and ultimately causing severe
neurological symptoms.
Symptoms
The symptoms of rabies typically appear within a few weeks to a few months after
exposure to the virus, although in some cases, the incubation period can be much shorter or
much longer. The early symptoms of rabies can be nonspecific and may include fever,
headache, and discomfort at the site of the bite. As the disease progresses, more severe
symptoms develop, including:
 Agitation and anxiety  Excessive salivation

 Hallucinations  Muscle spasms and paralysis
 Hydrophobia (fear of water) due to  Difficulty swallowing
painful throat spasms when  Confusion and delirium
attempting to drink
Once the symptoms of rabies appear, the disease is almost always fatal. Death usually occurs within a
few days to a few weeks after the onset of symptoms due to respiratory failure or cardiac arrest.
Diagnosing rabies in humans is challenging in the early stages of the disease, as the symptoms can be
similar to other viral infections. Laboratory tests, including tests on samples from the skin around the
bite wound and cerebrospinal fluid, are used to confirm the diagnosis. There is no cure for rabies
once symptoms develop. Therefore, prevention is essential.
Prevention
Preventing rabies involves a combination of strategies:
 Vaccination: Pre-exposure prophylaxis with a series of rabies vaccines is recommended for

individuals at higher risk of exposure, such as animal handlers, veterinarians, and travellers
to regions where rabies is prevalent.
 Post-exposure prophylaxis (PEP): Immediately after a potential rabies exposure, PEP involves
thoroughly washing the wound with soap and water and receiving a series of rabies vaccines
and, in some cases, rabies immune globulin (RIG) to boost the immune response.
 Control of Rabies in Animals: Vaccinating domestic animals (such as dogs and cats) and
implementing measures to control rabies in wildlife can help prevent transmission to
humans.
(b) Leptospirosis
Leptospirosis is a bacterial infection caused by the spirochete bacteria of the genus Leptospira.
This zoonotic disease can affect both humans and animals. Leptospirosis is prevalent in many parts of
the world, particularly in tropical and subtropical regions with warm and humid climates.
Transmission
Leptospirosis is primarily transmitted through contact with water, soil, or food contaminated
with the urine of infected animals. Common carriers of the Leptospira bacteria include rodents, dogs,
cattle, pigs, and wild animals. The bacteria can enter the body through cuts or abrasions on the skin,
or through mucous membranes (eyes, nose, and mouth). It can also be contracted by consuming
contaminated food or water.
Symptoms
The symptoms of leptospirosis can vary widely, ranging from mild to severe. In some cases,
individuals infected with the Leptospira bacteria may not exhibit any symptoms at all
(asymptomatic). However, when symptoms do appear, they typically manifest 5 to 14 days after
exposure. Common symptoms include:
 High fever  Jaundice (yellowing of the skin and

 Chills eyes)
 Headache  Abdominal pain
 Muscle aches (especially in the calves  Diarrhea
and lower back)  Rash
 Red eyes  Vomiting
 Fatigue
Diagnosing leptospirosis can be challenging as its symptoms are similar to those of other
diseases. A definitive diagnosis is typically made by testing blood, urine, or cerebrospinal fluid for the
presence of Leptospira antibodies or the bacteria itself. The main treatment for leptospirosis is with
antibiotics, such as doxycycline or penicillin, which are most effective when administered early in the
course of the disease. In severe cases, hospitalization may be necessary to manage complications
and provide supportive care, including intravenous fluids.
Prevention
 Avoiding contact with potentially contaminated water and soil.

 Wearing protective clothing (e.g., gloves, boots) if working in areas where the bacteria may
be present.
 Maintaining proper hygiene and washing hands thoroughly after outdoor activities.
 Keeping living areas clean and free from rodents and other potential carriers of the bacteria.
 Vaccinating animals that can be carriers of Leptospira to reduce the risk of transmission to
humans.
Investigation
A notification regarding the occurrence of a zoonotic infectious disease, Leptospirosis, has

been received from a healthcare facility involving a 53-year-old male who works as a board cutter
and resides in a house provided within the factory premises. The case has been admitted to the CCU
ward at Tuanku Ampuan Najihah Hospital. Verification was conducted by an Assistant Environmental
Health Officer on duty, confirming that the case meets the criteria for Leptospirosis and is supported
by a positive rapid test, making it a probable case. MAT (Microscopic Agglutination Test) has also
been sent on January 3, 2023, with the results is equivocal (MAT 1:200).
Investigations have been conducted on the case, and it was found that the individual's illness
is not associated with any water-related activities or recreational areas. The case worked at Hj
Hashim's sawmill, which is located approximately 2.7 km from Pekan Batu Kikir with coordinates
(2.8458294, 102.3298429). This sawmill is also situated close to and facing Kilang Papan Murad Sdn
Bhd. Further investigations into the case revealed that the residential area where the individual lives
has the potential for Leptospirosis infection due to the presence of many rodents in the sawmill and
around residential.
Figure 13: Hj Hashim Sawmill, Batu Kikir Negeri Sembilan
An investigation team was dispatched to the field to conduct an examination and risk
assessment at both the workplace and the residential area of the affected individual. However,
during the team's presence, no representative from the factory was present, even though an
appointment had been made a day before the visit.
As the presence of a factory representative is crucial to understand the situation at the
workplace and take appropriate actions, the Department of Labor, Kuala Pilah, has been consulted
regarding the placement of workers at this factory to assess its suitability based on relevant
guidelines. A joint visit will be planned together with the relevant agency to gather information
regarding this issue.
Findings
The observation from the first visit to the workplace revealed that the living conditions of the
affected individual were unsanitary and had a high potential for the presence of rodents. The
worker's living quarters lacked proper sanitation facilities and a wastewater system, which invites
health problems related to zoonotic diseases as well as water and foodborne illnesses.
Figure 14: Condition of workers living houses inside Hj Hashim Sawmill

Figure 15: Surrounding area of case house in Hj Hashim Sawmill Batu Kikir
The living environment of the house was shown to be overgrown and unclean, as depicted in
Figure 6, where there was no proper waste disposal system. This situation can lead to health
problems for the workers due to the presence of animals that can transmit diseases.
Examination was also conducted inside the house of the affected individual, where the case
lived with another co-worker. The house did not have separate rooms. It was reported that there is
no individual proper disposal of urine inside the house.
Figure 16:The arrow shown is the iImproper urine disposal detected in the case house
Risk Control
Table 1: Risk control based on risk assesment
ELIMINATION Conducting pest control activities by certified pest control

companies.
SUBSTITUTION -
ISOLATION -
ENGINEERING CONTROL -
ADMINISTRATIVE CONTROL Conducting area cleaning activities
Continuous training on environmental cleanliness for
workers
PPE -
Conclusion
Based on the visit and risk assessment conducted at the affected individual's residence, it
was found that the area has a high risk of infectious disease transmission. The risk assessment also
revealed that the structural condition of the worker's house is not suitable for habitation due to
safety and health concerns. It is important to address these issues promptly to prevent the spread of
infectious diseases and ensure the safety and well-being of the workers. Taking appropriate
measures, such as improving the living conditions and implementing proper sanitation practices, can
help mitigate the risks and create a healthier and safer living environment for the workers.
2.3 Supervise the corpse due to an infectious disease (AIDS/Cholera/Typhoid)
Handling Highly Infectious Disease-Infected Corpses

Introduction
Based on the Guidelines for Potentially Infectious Diseases, Edition 1, Ministry of Health
Malaysia, 2004, high-risk infectious diseases include those classified as Risk Category 3 and Risk
Category 4 infectious diseases.
Risk Category 3 infectious diseases include diseases such as Tuberculosis, Human Immunodeficiency
Virus (HIV), Hepatitis B (virus), and Hepatitis C (virus). These diseases are caused by microorganisms
that can cause severe infections in individuals and have the potential to spread within the
community. However, appropriate treatment measures are available for infectious diseases in this
category.
Risk Category 4 infectious diseases are highly infectious diseases that cause severe infections, and
there is no effective treatment available to manage them. These diseases have a high potential for
large-scale community spread. Examples of such diseases are Ebola, Marburg, Nipah Virus, Lassa
Fever, and Congo-Crimean Hemorrhagic Fever.
Proper handling of corpses infected with high-risk infectious diseases according to

established guidelines is essential to minimize the risk of infection transmission to healthcare
workers and the public. Safety measures and preventive steps must be taken seriously.
Acceptance of Corpses from Hospital Wards
Corpses from hospital wards will be placed in tightly sealed body bags and labeled as high-
risk corpses before being transported to the mortuary. All personnel handling the corpses must wear
complete personal protective equipment according to the established guidelines to avoid infection.
Personal protective equipment includes face masks (N95/100), disposable body suits, plastic
aprons, gloves, and boots. Equipment decontamination, such as corpse trolleys, will be performed to
reduce infection risk. Germicidal agents, such as chlorine solution and 70% sodium hypochlorite, will
be used for decontamination.
Acceptance of Corpses from Outside the Hospital, Brought in Dead (BID) Cases
The handling and use of personal protective equipment for accepting corpses from outside
the hospital are the same as when receiving and handling corpses from hospital wards.
Corpse Storage
Corpses received in the mortuary, whether from hospital wards or outside the hospital, will
be promptly handed over to the next of kin if they are ready to receive the body. Corpses without
next of kin will be stored in mortuary refrigerators and treated as unclaimed bodies. Corpse-
containing body bags will not be opened unless there is a need for post-mortem examination, and
the body will be kept in the mortuary at 4°C and labelled as a biohazard with the deceased's identity
information. The mortuary refrigerators will be regularly checked for proper functioning, and
disinfection will be conducted after the body is handed over to the relevant authorities to reduce the
risk of disease transmission. Personal protective equipment such as face masks (N95/100), water-
resistant body suits, gloves, aprons, and boots must be worn every time the corpse is handled to
avoid exposure to infectious diseases.
Post-Mortem Examination
Post-mortem examinations will only be conducted if the appropriate application form or

Police Order (Polis 61) has been obtained. Post-mortem examinations for high-risk corpses should be
carried out in specialized facilities, such as Biosafety Level 3 post-mortem rooms or upgraded
Biosafety Level 2 post-mortem rooms. These facilities have specific features, such as separate
entrances and exits, separate ventilation systems with negative pressure rooms, separate clinical
waste management, separate drainage systems, and germicidal rooms for staff involved in post-
mortem examinations.
Personal protective equipment for high-risk post-mortem examinations includes disposable

water-resistant body suits (Class A biohazard suits, Tyvek Dupont), disposable plastic aprons, face
masks (N95/100), respiratory devices with HEPA filters, head covers with visors, double-layered
gloves, and anti-static boots.
Personnel involved in high-risk post-mortem examinations must have sufficient knowledge

and training in post-mortem techniques and safety procedures. The number of personnel involved
(not exceeding 3 individuals) should be limited to minimize the risk of infection.
The post-mortem examination will be performed inside the body bag without removing the
corpse. After completion of the examination, facility and post-mortem equipment decontamination
will be conducted. Waste materials from the examination, including disposable personal protective
equipment, will be labeled as high-risk waste and managed separately from regular clinical waste.
After the examination, the body will be placed in two layers of body bags, securely sealed,
and labeled as a high-risk corpse. Corpses to be handed over directly to the next of kin for burial will
be placed in a casket without being opened or embalmed. If the body is not immediately handed
over to the next of kin, it will be stored in the mortuary refrigerator.
Handling of Post-Mortem Specimens
Two types of specimens will be taken as needed: medico-legal specimens and clinical
specimens. Medico-legal specimen collection follows the Criminal Procedure Code (Act 593, Section
331, Chapter XXXII). Clinical specimen collection follows the procedures established by the relevant
laboratories. The facility must be equipped with Class 1 or 2 safety cabinets for the storage and
handling of collected specimens.
Safety precautions during specimen collection and handling must be prioritized. Appropriate
preservatives will be used, and collected specimens will be placed in leak-proof containers, labeled
with information about the deceased, high-risk labels, and placed in designated containers for
transportation. Medico-legal specimens will be handed over to the police for delivery to the relevant
laboratories, such as the Department of Chemistry Malaysia.
Examples of clinical specimens to be collected include cerebrospinal fluid, conjunctival

swabs, throat swabs, pleural fluid from the lungs, and more. Commonly collected medico-legal
specimens include blood and urine for toxicology analysis.
Transportation of Corpses Overseas
The transportation of high-risk corpses overseas is subject to the Prevention and Control of
Infectious Diseases Act 1988 (Act 342), where any transportation requires approval from the Ministry
of Health Malaysia.
The next of kin must notify and obtain approval from the Ministry of Health Malaysia for
transporting the body to the desired location. The application will be reviewed to ensure compliance
with regulations or guidelines set by the receiving country.
Approval will only be issued if documents such as the Death Certificate, Burial Permit, and
Preservation Certificate (if necessary) are complete and the casket used for transporting the body is
in good condition.
The process of transporting the high-risk corpse overseas follows the Guidelines for
Importing or Exporting Corpses or Any Part Thereof, First Edition, 2006. The high-risk corpse to be
sent must be placed in a body bag before being placed in the prepared casket according to the
specified specifications.
The casket used should be equipped with a sealed zinc box to ensure airtightness. The body
will be transferred into the zinc box before being placed in the casket. The zinc box's lid will be sealed
with a sealant to close any potential openings, such as the box lid and screw holes. After ensuring
that the zinc box is securely closed and leak-free, the casket's cover will be closed and nailed shut.
For air travel, the high-risk corpse will be wrapped in cloth or sack as required by the airline.
The body must be buried or cremated as soon as possible upon arrival at the destination. Any
equipment or vehicles used to handle the transportation must be decontaminated to prevent disease
transmission.
Handling Infectious Disease (HIV/AIDS) Cadavers
Introduction
HIV stands for Human Immunodeficiency Virus, which weakens the body's natural immune
defenses against foreign organisms, making the infected person vulnerable to various infections.
AIDS stands for Acquired Immunodeficiency Syndrome, which is the final stage of someone infected
with the HIV virus. At this stage, the patient's immune system, specifically the white blood cells, is
attacked and destroyed by the HIV virus, leaving the individual susceptible to infections from various
viruses, bacteria, and other microorganisms.
HIV can be transmitted to someone through the blood and body fluids of an infected
individual. Blood and body fluids containing HIV can enter a person's body through cuts or wounds
on the skin, the mucous membranes of the eyes, mouth, respiratory tract, and digestive tract. The
cadaver of an HIV-infected individual may also pose a potential threat to the health of the cadaver
handler if the body fluids manage to enter their body. Proper preventive measures need to be taken
to prevent such infections.
Managing a cadaver is the responsibility and duty of the living. For Muslims, managing a cadaver
involves fulfilling four obligatory acts, namely:
 Washing (Taharah) the body.

 Shrouding (Kafan) the body.
 Performing the funeral prayer (Solat Jenazah).
 Burial (Kebumikan) of the body.
The management of Islamic cadavers infected with infectious diseases, including carriers of
HIV and AIDS, must encompass these four obligations and is a joint responsibility of the deceased's
family, the Hospital/District Health Office, and the Islamic Religious Department at the State/District
level.
Notification of Death of an HIV Carrier or AIDS Patient
Death in Hospital
Every death of an HIV carrier and AIDS patient that occurs in a hospital must be immediately
reported via phone to:
The District Health Office.
The deceased's family - If the family cannot be contacted by phone, assistance from the
police may be requested, but the HIV status of the deceased must be kept CONFIDENTIAL.
Death at Home
For every death of an HIV carrier and AIDS patient that occurs at home, it is the responsibility
of the deceased's family to notify the nearest District Health Office IMMEDIATELY via phone for the
purpose of supervising the management of the cadaver and taking other necessary actions.
Supervision of Cadavers
Once notification/notification to the District Health Office regarding the death of an HIV
carrier and AIDS patient has been carried out, supervision regarding cadaver management, such as
washing, shrouding, performing prayers, burying, and cadaver transfer, is the responsibility of the
following healthcare personnel:
 Male Environmental Health Assistant (PPKP) for male cadavers.

 Female Environmental Health Assistant/Health Nurse for female cadavers.
Selection of Cadaver Handlers at Home
For cadaver handling at home, the following factors need to be considered:
 Cadaver handlers should not exceed 4 individuals.

 Cadaver handlers should consist of family members or mahram (close relatives) of the
deceased and trained mosque personnel/officers experienced in handling HIV carrier and
AIDS patient cadavers.
 Ensuring that each cadaver handler does not have any wounds or skin conditions, especially
on their hands.
 Cadaver Handling Equipment at Hospitals or at Home
Equipment
 Plastic aprons, rubber gloves, rubber boots, and masks are provided based on the number of
cadaver handlers involved.
 All cadaver handlers of HIV carriers and AIDS patients must wear two layers of rubber gloves.
 A solution of Sodium Hypochlorite (NaClO) is prepared by mixing 1 bottle of NaClO with 9
liters of ordinary water to make a NaClO solution with a ratio of 1:10 (1 part NaClO mixed
with 9 parts water).
 3 buckets and 1 broom are used for cadaver handling purposes.
Cadaver Bathing
For the death of an HIV carrier or AIDS patient in a hospital, cadaver management, including
washing and shrouding, should ideally be carried out at the hospital before being claimed by the
deceased's heirs. If the heirs request to handle the cadaver at home, the transfer of the cadaver from
the hospital mortuary to the home must be supervised by trained healthcare personnel from the
nearest District Health Office. For handling the cadaver at home, the following considerations need
to be made:
Preparation of Cadaver Bathing Water Disposal Site:
For handling the cadaver at home, the deceased's family needs to dig a pit or hole for the
purpose of disposing of the cadaver bathing water if the home does not have a drain or trench. The
Environmental Health Assistant/Health Nurse is responsible for supervising the preparation of the
disposal site.
Preparation of Cadaver Bathing Site:
A special area (cadaver bathing basin) is used for bathing the cadaver. If there is no specific
cadaver bathing basin, a thick plastic liner can be used, but it should be shaped in a way that allows
the cadaver bathing water to flow to the disposal site (ditch/trench/hole).
Cadaver Bathing Process:
The bathing of Islamic cadavers must follow the usual and recognized procedures of cadaver
management by the State Islamic Religious Department. However, there are some changes in the
cadaver bathing process for HIV carrier and AIDS patient cadavers to prevent cadaver handlers from
being infected with the AIDS virus.
The cadaver handlers must protect themselves by wearing:
 Plastic apron.
 2 layers of rubber gloves.
 Mask covering the mouth and nose.
 Rubber boots.
 The NaClO solution (1:10) is prepared in 3 buckets and 1 broom.
1. The clothing worn by the cadaver is removed and soaked in the NaClO solution (1:10) in one
bucket for at least 30 minutes.
2. The cadaver is placed in a special cadaver bathing basin. If no such basin is available, the
cadaver is placed on a thick plastic lining soaked in NaClO solution (1:10).
3. The body cavities, including the mouth, ears, nose, and vagina, are cleaned and plugged with
cotton soaked in NaClO solution using forceps (this step needs to be done first if there is
continuous bleeding or fluid discharge from these cavities whenever the cadaver is
repositioned for bathing).
4. The cadaver is then washed and bathed with the NaClO solution (1:10).
5. During the bathing process, clean cotton is used to clean the anus, and it is then plugged
with cotton soaked in NaClO solution.
6. The cadaver is washed with ordinary/blessed water according to Islamic teachings.
7. If there is a need to clean the cavities again, cotton soaked in NaClO solution is used with
forceps, and the cavities are plugged with NaClO-soaked cotton.
8. The cadaver is then sprinkled with water infused with daun bidara, kapur barus, or cendana.
9. The cadaver is rinsed with NaClO solution (1:100) in the final rinse.
Shrouding of the Cadaver
The shrouding process is as follows:
1. Thick plastic lining is placed to shroud the cadaver, collecting any fluids, liquids, or blood
without contaminating the surroundings to prevent transmission to others.
2. The shroud is wrapped as the first layer. The shroud does not need to be soaked in NaClO
solution (1:10) if there are no fluids, liquids, or blood leaking from the cadaver or no wounds
or skin conditions on the cadaver's surface.
3. For cadavers that release fluids, liquids, blood, or have wounds/skin conditions on their
surface, the cadaver should be placed in a plastic bag (body bag) or wrapped in plastic used
to line the bathing area. The cadaver does not need to be wrapped in plastic or placed in a
body bag if there are no spills of fluids, liquids, blood, or no wounds/skin conditions on the
cadaver's surface. However, the plastic lining can be wrapped around the cadaver.
4. Next, the cadaver is shrouded using two layers of cloth as the final layers. Note that the last
layer should be the shroud and not the plastic lining.
5. Disinfection of Equipment and Cadaver Bathing Water
The disinfection process is as follows:
1. Equipment used to bathe the cadaver must be soaked in NaClO solution (1:10) for at least 30
minutes before being washed.
2. The cadaver bathing water on the floor must be mopped with NaClO without mixing it with
water.
3. The cadaver bathing water in the basin must be sprinkled with chlorinated lime and covered.
Cadaver Prayer (Sembahyang Mayat)
The cadaver prayer is similar to that performed for other Muslim cadavers.
Burial of the Cadaver
The burial process for HIV carrier and AIDS patient cadavers is the same as the burial process for
other Muslim cadavers.
Conclusion
All cadaver handlers must always take precautionary measures to prevent infections of
infectious diseases like HIV when handling any death. These precautions are necessary as sometimes
the HIV status of the cadaver being handled is unknown, or the notification of the death of an HIV
carrier or AIDS patient is not submitted to the District Health Office by the deceased's heirs.
Supervising healthcare personnel are not allowed to wear uniforms or use government vehicles to
protect the reputation of the deceased and their family.
2.4 Describe activities and plan of action (Epidemic Operation Room) and roles
of Assistant Environment Health Officers during outbreak control
Introduction
An epidemic or a disease outbreak is the occurrence of the disease at an unusual

(unexpected) frequency. Under the Prevention and Control of Infectious Diseases Act (PCID) 1988,
the person authorised to declare an outbreak is the Minister of Health. Early investigation and
verification to an infectious disease outbreak and institution of control measures must proceed such
declaration of an outbreak.
General Objective
To provide prompt and effective response to infectious disease outbreaks and to reduce
morbidity and mortality to a minimum by being constantly and adequately prepared in managing the
outbreak.
Specific Objectives
 To prevent, control and contain infectious disease outbreaks.

 To reduce morbidity and mortality due to infectious disease outbreaks.
 To strengthen public health infectious disease surveillance.
 To provide general guidelines and develop a mechanism for effective implementation of
outbreak management.
 To enhance effective emergency and risk communication.
 To collaborate and coordinate activities with other relevant agencies, both within and
outside the country in managing the outbreak.
GENERAL PRINCIPLE OF OUTBREAK PREVENTION IN MINISTRY OF HEALTH

MALAYSIA
Outbreak management planning
Health organisations at district, state and national levels should undertake surveillance on infectious
diseases. Regular surveillance will enable the organisations to forecast possible outbreaks (early
warning signals) and develop plans to prevent such occurrences. Such planning helps the
organisations to take action before an outbreak occurs.
Organising training and simulation exercises.
Appropriate training must be provided to the people in an organisation for people who would be
involved in outbreak investigation. Various categories of people should know what is expected of
them when a certain type of outbreak occurs. This training can take the form of simulation, seminars
and exercises.
Learning from previous crisis situations
Learning and reflecting on lessons from previous outbreak management which the organisation had
experienced would help avert future outbreaks or better manage new outbreaks when they occur.
OUTBREAK PREPAREDNESS
Rapid Response Team (RRT)
A Rapid Response Team (RRT) is a pre-established team consisting of individuals with specific
expertise and experience, brought together based on their skills and the needs of a particular
incident. The primary goal of an RRT is to provide a swift and effective response in managing disease
outbreaks.
RRTs should be organized at the district, state, and national levels. Their general roles and functions
include:
 Analysing and acting on surveillance information related to infectious diseases.

 Planning control and response strategies for managing outbreaks.
 Identifying additional resources required for a rapid response.
 Investigating and managing outbreaks, including communication with the public and the
media.
 Collaborating and coordinating with other relevant agencies in outbreak management.
 Evaluating the effectiveness of response and intervention measures during the outbreak.
 Producing detailed reports on outbreak investigations and control activities, along with
recommendations.
 Predicting and planning for the management of future outbreaks.
At the district level, the RRT may consist of various professionals, including the District
Medical Officer of Health (MOH)/Epidemiologist as the team leader, Hospital
Director/Physician/Medical and Health Officer, Senior Health Inspector, Health Inspectors (Disease
Control/Vector Borne Disease Control), Health Matron/Health Sister, and Health Education
Officer/Health Education Coordinator. Other relevant agencies may also provide additional members
when necessary.
The roles and functions of the District RRT involve outbreak preparedness, rapid assessment,
outbreak investigation, control activities, and producing reports and recommendations. The team
takes actions like surveillance of infectious diseases, risk analysis, establishment of team leaders and
members, holding regular meetings to review data and evaluate measures, conducting simulation
exercises, and predicting potential future outbreaks.
The activation of the District Level RRT can be based on unusual occurrences of notifiable
infectious diseases in the district, unusual occurrences of other infectious diseases, unusual
occurrences/clusters of diseases/deaths in the district, or directives from higher authorities.
Table 2 : Flow Chart for mobilization of District RRT
Alerting other relevant parties when an outbreak is suspected
District Level
When an outbreak or impending outbreak is suspected based on surveillance activities, the district
shall immediately alert:
 The State Health Office by telephone to be followed by a written report within 24 hours to
confirm the outbreak or otherwise
 The District Hospital and Microbiology Laboratory by phone to be on standby
 Other relevant governmental agencies in the district to be on standby depending on the
nature of the outbreak
 The MOHs of neighbouring districts depending on the nature of the outbreak
INITIATION OF OUTBREAK INVESTIGATION AND CONTROL ACTIVITIES
Once an outbreak has been verified by the Rapid Assessment Team, depending on the nature
of the outbreak, the MOH of the district or State Director of Health or the Deputy Director General of
Health (Public Health) will initiate activities designed to investigate, control and contain the outbreak
Table 3: Outbreak Management Flowchart
STANDARD OPERATING PROCEDURE FOR SETTING UP OF AN OPERATIONS ROOM
When to set up an Operations Room
1. Infectious disease outbreak occurring in more than one states (national level), more than
one district (state level) and if only one district (district level).
2. Infectious disease outbreak causing lost of life.
3. Incidence of bioterrorism.
4. Global alert on any infectious disease that may occur locally.
5. When ordered by a higher authority.
Term of Reference (TOR)
1. To compile and monitor all information on activities concerning the infectious disease outbreak
done at the relevant level.
2. To coordinate all activities involving inter-agency co-operation and collaboration. e.g. education,
veterinary services, defence, information etc.
3. Updating of information concerning the outbreak
 Number of cases reported (case listing)

 Control activities
 Health education activities
 Current situation of the outbreak.
4. To manage the hotline – to provide information
5. To prepare the daily report.
6. To prepare press release if require.
7. To prepare information for dissemination to relevant parties.
Function of every unit at National Operations Room for the control of an Infectious Disease
Outbreak.
A. Task Force Secretariat.
 Secretariat to National Outbreak Control Task Force.

 Secretariat to Inter-agency Committee
 Arrange Task Force Meeting
 Co-ordinate activity reports from all departments involved.
B. Technical Information Unit.
 Managing source of technical information about the outbreak.

 Download all information related to the disease from the internet.
 Compile the technical information.
 Distribute the technical information to those concerned.
C. Epidemiological Analysis Unit
 Analyse the epidemiological data from case investigation / notifications received.

 Input of data to data base.
 Perform epidemiological analysis.
 Prepare and distribute of reports to the secretariat.
D. Supplies and Procurement Unit
 Manage supply of vaccines / insecticides / drugs / personal protective equipment (PPE) and
other supplies wherever applicable.
E. Health Education Unit
 Prepare of health education materials.

 Distribute of the health education material to related agencies and the public.
 Coordinate health education activities with mass media.
F. Logistic Unit
 Prepare Operations Room equipment

 Prepare transportation
 Prepare refreshments
 Maintain the cleanliness of Operation Room.
 Act as the secretariat for Operations Room daily meeting.
G. Human Resource Unit
 Prepare the duty roster (according to shift).

 List down the telephone numbers of all officers on duty.
 Ensure the presence of officers on duty according to the roster (or their replacement).
However, it is the officer responsibility to find the replacement and inform the Human
Resource Officer.
 Coordinate with other departments for officers to be on called.
H. Documentation Unit
 Receive daily reports from various departments.

 Prepare the daily report.
 Distribute the daily report to the relevant parties.
 Document the chronology of events taken place in the outbreak.
 Review newspaper cuttings.
 Be responsible in maintaining the letters in–out files.
I. IT Support Unit
 Update the Homepage Information (if any).

 Response to queries received through e-mail.
 Manage guidelines in a software form.
J. Guidelines Preparation Unit
 Prepare guidelines related to the infectious disease outbreak i.e. case management, case
follow-up, quarantine, screening, transportation of cases surveillance of health staff
K. Hotline Unit
 Answer the hotline telephone calls.
Equipment needed in an Operations Room.

1. Telephones for direct lines, hotlines, mobile telephones
2. Facsimile machines.
3. Computers (with installed related software) and printers.
4. INTERNET with homepage and e-mail group
5. White boards.
6. Soft board.
7. Stationery.
8. Smart Television
9. Maps and / or GIS.
10. Directory of state health departments, district health offices, government / NGO / private
hospitals and laboratories / staff / personnel with address and contact numbers.
11. Protocols and guidelines (related to outbreak).
12. Rapid response kits.
13. Health information materials.
14. Files with systematic filing system.
When to close an Operation Room.
1. No new cases / transmission within 2 incubation periods or longer if necessary. However

monitoring should be continued by a designated unit / personnel.
2. Ordered by a higher authority.
Roles of Assistant Environment Health Officers during outbreak control
Assistant Environmental Health Officers (AEHOs) play essential roles in outbreak control in
Malaysia, working alongside other public health professionals to manage and mitigate the spread of
diseases. Their specialized knowledge in environmental health and disease prevention makes them
valuable assets in public health emergency responses. Here are some key roles and responsibilities of
AEHOs during outbreak control in Malaysia:
1. Surveillance and Early Detection: AEHOs actively participate in disease surveillance

activities, monitoring health data and trends to identify potential outbreaks early on. They
work with health authorities to promptly report and investigate any unusual patterns or
clusters of diseases.
2. Outbreak Investigation: AEHOs are involved in investigating suspected or confirmed cases of
outbreaks. They conduct interviews, gather information on potential sources of infection,
and identify the mode of transmission to understand the dynamics of the outbreak.
3. Contact Tracing and Quarantine Management: AEHOs play a crucial role in contact tracing,
identifying and monitoring individuals who may have been exposed to the disease. They
ensure that contacts are appropriately quarantined or isolated to prevent further
transmission.
4. Infection Prevention and Control: AEHOs provide guidance on infection prevention and
control measures to healthcare facilities, communities, and public places. They ensure
proper implementation of measures such as hand hygiene, environmental cleaning, and
personal protective equipment (PPE) usage.
5. Environmental Assessment: AEHOs assess environmental factors that may contribute to the
outbreak, such as water quality, sanitation conditions, and waste management practices.
They recommend improvements to minimize risks and prevent further outbreaks.
6. Public Health Education and Risk Communication: AEHOs conduct public health education
programs to raise awareness about the outbreak, its symptoms, modes of transmission, and
preventive measures. They communicate crucial information to the public and stakeholders
to reduce misinformation and panic.
7. Resource Coordination: During outbreak response, AEHOs collaborate with other public
health agencies, healthcare providers, and local authorities to ensure a coordinated and
effective response. They contribute to the development of response plans and strategies.
8. Data Management and Reporting: AEHOs are responsible for organizing and managing
outbreak-related data. They maintain accurate records of cases, interventions, and outcomes
for reporting to higher authorities and evaluation purposes.
9. Training and Capacity Building: AEHOs participate in training programs to enhance their
outbreak response skills. They may also train healthcare workers and community volunteers
on outbreak control measures.
10. Assessment of Control Measures: AEHOs assess the effectiveness of control measures
implemented during the outbreak and recommend adjustments if necessary to optimize
response efforts.
11. Post-Outbreak Evaluation: After the outbreak is controlled, AEHOs participate in post-
outbreak evaluations to identify strengths and weaknesses in the response. Lessons learned
are used to improve future outbreak preparedness and response.
2.5 Manage epidemiological data (for one disease) for 5 years

HFMD
2.6 Exposure (Hands-on) Preparation of all disease control report (CDCIS)/
VECTOR/ Vekpro
Introduction
Infectious diseases pose a threat to public health. In this era, various emerging diseases and
re-emerging diseases have the potential to endanger lives and cause financial losses, indirectly
impacting the country's economy. Past experiences have taught us to be more prepared to face the
threat of infectious disease outbreaks. It is essential to establish a systematic infectious disease
notification system to detect possible outbreaks early on.
The Communicable Disease Control Information System (CDCIS) aims to empower the
infectious disease notification system with current technology. This electronic system helps save time
in processing notifications, ensuring that information reaches the District Health Office promptly.
Early and rapid notifications received by the District Health Office enable health personnel to take
immediate preventive and control measures, limiting the spread of outbreaks.
Objective
Based on the Prevention and Control of Infectious Diseases Act 1988 (Act 342), all infectious
diseases listed in Schedule 1 of Act 342 must be notified to health officers immediately. To streamline
the notification process, an online notification system has been established. The first online
notification system was implemented in Malaysia in 2006, known as the CDCIS (Communicable
Disease Control Information System) Notification System. It was later updated in 2010 and renamed
as CDCIS e-Notification.
Table 4: E-notification User List
Facilities User Assignment Actions / Responsibilities

Hospital / Clinic / Medical Notification Make input on the case of infectious
Lab Practitioner / Nurse / input diseases to be notified.
Assistant Medical
Officer / Record
Officer etc.
District Health PPKP U29 Notification Make input on manually received
Office – input infectious disease notifications.
Surveillence Unit / These two scopes of work are done
CDC using different 'IDs'.
Verification Make a verification up
of all notifications received in terms of
notifications name, no. k / p, address and
Register of diagnosis and make a register
notifications
Move
notifications
Ignore
notifications
Facilities User Assignment Actions / Responsibilities
District Health PPKP U29 Please Conducting case investigations
Office – CDC / ignore Updating case information
Vector / Tb / Please move Take action – please ignore / move /
Leprosy / HIV / Apply for register
AIDS Unit case
registration
Please
update the
case register
(after 4
weeks)
Request
cancel
register
PPKP U32 Support Make actions on all applications
PPKP U36 ignore received.
PKP U40 and above Support
register
Pass the
move
Pass the
register
Pass case
register
updates
District Health Peg. District Health Pass ignore Make actions on all applications
Office Peg. Epid Peg District. Pass the received from the use of the access
Authorized medicine register level.
Support
cancel
register
State Health State Epidemiology Pass cancel Make actions on all applications
Department Officer list received from the use of the access
level.
Ministry of Health Senior Assistant Monitoring national data
Malaysia Director
Headquarters
Table 5 : Notification Flowchart
Procedure
Log In
The e-Notification system can be accessed through the website

http://enotifikasi.moh.gov.my/ using a computer and smartphone. Every user who wants to use the
e-Notification system must have a valid ID and password. User ID registration can be done by the
System Admin at the State Health Department (PKD), District Health Office (JKN), or the Ministry of
Health Headquarters.
Figure 17: Front Interface of CDCIS Enotification System

Attempted login with the ID and password should not exceed 3 times to prevent the user
from being blocked. If you forget the password, please reset it by clicking the 'Forgot Password'
button. Please enter the ID and email address as registered by the Admin previously.
Notification Input
The notification input process can be performed at several registered user levels:
 Hospitals (Government / Private)

 Clinics - Health Clinics, Village Clinics, Private Clinics
 District Health Office
 Public Health Laboratories and Medical Research Institutes (IMR)
 National Blood Bank.
The notification input process can be done either by submitting the notification form
received or directly through the e-Notification system. If the notification input is done through the
notification form, please ensure that the form is filled out completely.
The Search/Notification Input function.
The Search/Notification Input function is the first step when notifying any infectious disease
case.
Figure 18: Search/Notification input function button
After selecting the Search/Notification Input function, the user must search for the case by
entering the patient's information into the relevant field, such as the identification number (IC
number or Passport number).
Figure 19: Search/Notification input function button

If there is no record, the user can make a notification by clicking the 'New Case Input' button.
If the record appears in the list of records, the user needs to review the details, especially the
diagnosis and input date. If the diagnosis is different, the user should select 'New Case Input'. If the
diagnosis is the same but the case is more than a week old, the user should select 'New Case Input'.
If the diagnosis is the same but the case is less than a week old, the user does not need to 'New Case
Input'.
Figure 20: Case Input Button for Case detail input
After clicking the 'New Case Input' button, the user can fill in the patient's personal
information, residential details, disease diagnosis, laboratory tests, and notifier information. The
information provided must be consistent with what was filled in the notification form. Information
highlighted in red indicates mandatory fields that must be filled.
Figure 21: Personal Information Input Section
N Field Description
o
1. Name:
Patient’s Name a) The name field must be filled using the full name as stated in the
identification document.
b) A combination of letters and numbers is allowed.
c) For patients without any identification, the name should follow the
given name tag provided by the hospital or clinic that examined the
patient.
d) For infants/children who do not have a name yet, the use of "baby
of" or "B/O [mother's name]" should be used.
Patient’s ID Fill in the patient full official ID and makesure the inputted ID is correct
2. Nationality :
Nationality Status Please indicate the relevant space. If not a citizen, please ensure that
the space for the country of origin is filled.
N Field Description
o
Passport / ID The system has filled in the information based on "Search/Notification

Input." If there is no patient identification number (ID card number),
please enter the MYKID number, birth certificate number, passport
number, police/military number, or accompanying identification
number (symbols like - & / are not allowed) in the ID Number input
box. Do not input the patient's name or 'NONE' in the ID Number box.
Ethnic The user needs to select the ethnicity (race) of the patient.
Sub-ethnic group Sub-ethnicity needs to be selected if the patient is of indigenous
descent from Peninsular Malaysia (Orang Asli), indigenous descent
from Sabah (Pribumi Sabah), or indigenous descent from Sarawak
(Pribumi Sarawak).
3. Gender :
Gender Choose "Male" or "Female."
For Malaysian citizens who have their 12-digit identification number
(MyKad), if you select "self," the system will be able to determine the
patient's gender automatically.
4. Birthdate
For Malaysian citizens who have their 12-digit identification number
(MyKad), if you select "self," the system will be able to determine the
Birthdate patient's age automatically.
For non-Malaysian citizens or Malaysian citizens who have other types
of identification numbers, the user needs to manually determine the
patient's age.
Figure 22 : Residential Information Display
Bil Field Description

5. Patient Residence Information / Patient Incident
Current a) The current address is the address of the current residence and not
address/ necessarily the same address as the address in mykad or other
occurrence identification documents.
b) The current address is not necessarily the same as the address of the
incident or where the patient got the infection.
c) In case of food poisoning, the required address is the address where the
incident occurred.
d) For those who are identified as having an infection while in an
institution, the residential address refers to the address of the
institution.
e) For patients diagnosed in Malaysia whether Malaysian or not, but do
not have a permanent address in Malaysia, write down the patient's
permanent address in their home country except for food poisoning
cases. This can help the case referral process. However, the district and
state addresses are according to the district of the facility that made the
diagnosis.
Zip code Record the Postcode number of the current address.
Record the telephone number of the patient or next of kin of the patient
Phone No. who can be contacted for the purpose of investigating the case (if any).
If no record as "None"
State Select the current address state.
Select Division or Area for the State of Sarawak or
Bhg/Kaw Sabah.
District Select District/ Colonial (Kelantan) current address.
Sector Select Sector for Sarawak / Sabah.
Mukim/Zone Select Mukim / Zone / District (Kelantan) current address.
Locality Select the locality / village of the current address.
6. Employment/Institution/ etc Information
Address a) The address of the patient's current place of employment.
b) Name and address of the institution / school for students.
No. Tel Record the patient's office/institution phone number if any.
No. Mobile Record the mobile phone number of the patient or next of kin/guardian if
any.
Email Record the patient's email address if available.
Job Category Users are asked to choose from the category
Listed
Job Name Record the name of the patient's job.
Figure 23: Patient Diagnosis Display

7. Notification Information
No Series The serial number of the notification should be recorded if any.
Notification (Notification Form)
Don't receive Record the date the notification was made. The date of notification must
notifications be less than or equal to the date of input of the notification.
Tkh Input The system has filled in the information based on the date when the
Notification notification input was made.
Patient Admission/Treatment Information
8. No./ Name of Make sure this room is filled.
Ward/ Clinic Record the names of wards / treatment clinics such as Ward 1, Ward,
Mahsuri, OPD etc
No. Register of Record the hospital / clinic register number
Treatment
Hospital Admission Record the date of hospitalisation or the date of treatment at the
Date/ healthcare facility if the patient is not admitted to the ward
Treatment
9. Diagnosis of Disease
Diagnosis Please select the diagnosis of the notified disease as
listed in the system.
Sub Diagnosis Make sure that this column is filled, if there is a subdiagnosis in this
patient.
Date of diagnosis Please enter the date of diagnosis.
10. Ways of Case Detection
Ways of Case Please select "Active" or "Passive" or "Filter",
Detection
Screening Please select the type of screening, if the case is detected through
screening make sure that the screening type field is filled. FOMEMA,
blood bank, anenatal, prison, stop center, MBS, medical center, contact
tracing, routine screening, harm reduction, pre-wedding, anonymous
screening and others.
11. Status Patient

Patient Status Select "On" or "Off"
Dead Date Record the date of death.
Cause of Death Select cause-of-death
Other causes of Record causes of death other than the above
death
12. Onset Date
Onset Date a) The onset date is the date of onset of the signs of the disease. The
onset date must be less than or equal to the date of diagnosis.
b) For diseases with long or unknown onset such as Tuberculosis,
Leprosy and HIV/AIDS, the system allows the onset date to be
unfilled.
Figure 24: Labaratory Test Input Display

13. Laboratory/investigation tests
There's a Test Select either "Available or "None"
Lab Test 1 Related laboratory tests can be inputted over 1 test. If more than 2
laboratory tests are made please add laboratory tests. Only tests specific
to related diseases are available.
Verification Test a) Laboratory tests / investigations are laboratory confirmation tests or
Name probes (such as chest x-rays) made to confirm the diagnosis of the
disease.
b) Select one of the laboratory/investigation tests conducted.
c) Some diagnoses do not require tests to be performed such as Food
Poisoning and Neonatal Tetanus
Posts Please record additional information of the decision if necessary.
Sample Date a) The sample date must be more or equal to the onset date.
Taken b) The sample date can be more than the date of diagnosis as the
dengue case is notified first then the test is made.
Lab Acceptance Please record the date the sample was received by the laboratory
Date
Decision Date Please record the date the test results were squeezed
Test Results a) The results are either positive or not ready. If the test result is
negative at the time the notification is made, the notification
received does not need to be inputted.
b) Notifications do not need to be input if the results of laboratory
verification tests are negative. However, the input process is still
allowed for clinical diagnosis such as food poisoning, and neonatal
tetanus.
c) Some diagnoses require that test results must be positive before a
case can be notified such as Malaria, Tibi, HIV, AIDS.
14. Classification Case
Status Diagnosis a) The status of the diagnosis is according to the definition of each
case. The patient can be notified even if the status of diagnosis of the
infectious disease is still clinical or confirmed.
b) A diagnosis that is still of clinical status means that the diagnosis of
the disease has not yet been confirmed by laboratory verification
tests.
c) The status of the diagnosis has been confirmed by confirmation tests
or specific diagnostic tests are positive.
d) For the diagnosis of Food Poisoning, Tetanus and HFMD, cases can be
diagnosed clinically only and the status of diagnosis is calculated as
confirmed. Please refer to "notification input criteria by type of
disease".
Classification Date The system will fill in the current date information when status
the diagnosis is filled.
Types of Infection Choose the type of infection in question whether it is "Local" or
"Import"
Figure 25: Notifier Notification Display

15 Clinical Information and Comments
. Comment State any comments related to the patient.
Other relevant Record any clinical information related to the patient that can
clinical assist in terms of patient investigation, contact tracing, control
information (if and prevention of infections such as symptoms, patient's
any) condition, significant non-confirmatory test results, diagnoses of
other diseases and many others.
16 Notifier Information
.
Doctor Name & Record the full name of the medical practitioner who made the
No MMC notification of the infectious disease. If this diagnosis is made by a
member other than a medical practitioner, record the name of
the medical practitioner in charge of the hospital/ clinic or health
office.
No Tel Please record the telephone number of the office/institution.
Email Please record the medical practitioner's email number if any.
Notification Date Please record the date the notification was made.
No fax Please record the facsimile number if available.
17 Health Facility Information
. Health Facilities The system has filled in information based on the relevant User
ID.
Complete
Address
Type
Sub-types
Place of Please select the place of treatment.
Treatment
If the information required to be filled in is incomplete, an incomplete data input display will
appear. Users need to fill in the patient information especially the information must be filled in red.
Figure 26: Incomplete Data Input View

Figure 27 : Successful Notification Display
ASSIGNMENT FUNCTION
Tasks will display a to-do list that requires user action.
Figure 28 : Assignment View
This function can be accessed by users who have tasks.
Sub-function Not Taken Action (Belum Ambil Tindakan)
The Untaken Action sub-function will appear on the Verification Level PPKP U29 access user when
there is a new notification that requires verification.
Figure 29: Unacted Sub-function View
After the case has been inputted, PPKP U29 needs to verify the input of the notification. Once further
investigation is made and verification is carried out, the user can update the case that requires action
by clicking on the name of the listed case.
Figure 30: Notification Information Display
The status of the case will be displayed. Please click the 'Update' button to make an update. Antara
thing that needs to be updated is
i. Incident Classification – Choose between Single/Sporadic or Cluster/Plague
ii. How to Detect Case – Choose between Active, Passive or Screening
iii. Other information that needs to be updated or corrected.
Figure 31 Notification Update View

Click the 'Update' button again after the update is made, and click the 'Exit' button.
Transfer notification
If there is a notification of a case that requires the transfer of notification for the actions of
the District Health Office, this action can be made during the verification of the notification. Please
refer to Sub-function Not Take for notification verification steps.
Figure 32: Final View of Notification Verification
In the final step of notification verification, there is a 'Move' button. Please click 'Move' to make a
transfer notification. Users do not need to choose a PKD destination as the selection of PKD is done
automatically (please make sure that the address used is accurate).
Figure 33: Display Successfully Move Notification
The Move Successful View will be displayed if the notification is successfully transferred.
Request Notification Register
Input Notifications that have been verified by PPKP U29 users can be made to request a notification
register. This task can be done after verification of the notification is performed. Please refer to the
Sub-function Not Take on page 74 for the notification verification process.
Figure 34: Final View of Notification Verification, to Apply for Notification Register
At the end of the notification verification step, please click the 'Register Notification' button to apply
for a notification register.
Figure 35: Display Successfully Request Notification
The display successfully requesting notification will be displayed.
Update Notification Sub-function
The Update Notification sub-function will appear on the Access user of the PPKP U29
Verification Level when notification has been made action requiring an update of the information.
Sub-function of the Notification Register
Sub-functions of the Notification Register will appear on the access user of PPKP U29 CDC Unit /
Vector Unit / TB/Leprosy Unit / HIV Unit when the request for notification action has been made.
Figure 36: To Do List Notification Tab

Please click the name of the case that needs to register notification action
Figure 37: Notification register update view
Click the 'Update' button to update the case. Please check the notification information and make the
relevant updates. Click the 'Save' button once the relevant revisions and updates have been done.
Figure 38: Apply Case Register View
Figure 39: Display Successfully Register Notification

The Register of Notification Successful view will be displayed.
2.7 Exposure (Hands-on) Disease Control/ Vector `Quality Assurance` program
On 26th April 2023, CDC Unit of Jempol District Health Office has organised a workshop for E-
notification and OMS system usage. This workshop aimed to provide knowledge and preparation in
managing case notifications from Health Facility levels. The workshop focused on infectious diseases
that require notification based on specific criteria, understanding the infectious disease case
reporting systems and Outbreak Management System (OMS), and training medical practitioners on
e-Notification applications and OMS.
The objectives of the workshop were to introduce new Medical Officers to the infectious
disease notification system and OMS, enhance the management of the notification system in
occupational and private health facilities, and familiarize medical practitioners with the legislation
used for notifying infectious diseases.
The target participants were Medical Officers from both government and private health
facilities. The workshop took place on 26th April 2023, at Bilik Zamrud, PKD Jempol, from 9:00 am to
4:30 pm.
The course content included an overview of infectious disease cases and notification
requirements, an introduction to the CDCIS e-Notification System Application, and training on its
usage. Additionally, participants were introduced to the Outbreak Management System (OMS)
Application.
The methodology involved talks and training sessions, and participants were evaluated
through pre-test and post-test assessments. The workshop speakers were experts in their respective
fields, sharing valuable insights into the subject matter.
The organizer of the workshop was the Infectious Disease Control Unit (CDC) of Jempol
District Health Office. Overall, the workshop aimed to equip medical practitioners with the necessary
knowledge and skills for effective infectious disease notification and outbreak management.
JEMPOL DISTRICT LEVEL ENOTIFICATION AND OMS WORKSHOP 2023
IDENTITY This workshop was held to provide knowledge and as a preparatory measure in the
management of case notification from the Health Facility level . This workshop will
provide knowledge on infectious diseases that need to be notified according to the
duration and requirements, provide knowledge on infectious disease case reporting
systems and OMS, train medical practitioners using e-notification applications and OMS
PURPOSES 1) Provide knowledge on infectious diseases that need to be notified according to the
duration and requirements.
2) Provide knowledge on infectious disease case reporting systems and OMS.
3) Train medical practitioners to use e-notification and OMS applications
TYPES OF
FUNCTIONAL
COURSES
1) To expose new Medical Officers with infectious disease notification system and OMS.
2) To strengthen the management of infectious disease notification system and OMS in

OBJECTIVE occupational and private health facilities.
3) To disclose the Medical Practitioner to the acts of the Legislation used in the
notification of the occurrence of infectious diseases.
TARGET Medical Officers from Government and Private Facilities
DATE / PLACE / Date : 26 April 2023 (Tuesday)

TIME
Time : 9.00 am – 4.30 pm
Venue : Bilik Zamrud, PKD Jempol
TENTATIVE PROGRAM TENTATIVE

COURSE
OMS SYSTEM APPLICATION WORKSHOP, CDCIS E-NOTIFICATION
CONTENT /
PROGRAM
9.00a.m – 9. 30a.m : Registration, Pre-Test
9.30 am - 10.30 am: Overview of cases of Infectious Diseases and notification

requirements
Dr Abdul Mueez bin Ahmad Shahbuddin
Epidemiology Officer
Jempol District Health Office
10.30a.m – 11.15 a.m.: Introduction to CDCIS e-Notification System Application,
PPKPK Ts. Masnita Binti Md Yusof
Assistant Environmental Health Officer U32 (CDC)
11.15a.m – 1.00p.m: Introduction to e-Notification System Application and
Usage Training
PPKP En. Mohd Fahmi Bin Ahmad Jamizi,
Assistant Environmental Health Officer (CDC),
Jempol District Health Office.
1.00p.m – 2.30p.m: Rest
2.30p.m – 3.30p.m : Introduction to Outbreak System Application
Management System (OMS)
Dr Md Hanif Nazruddin bin Md Zin,
Medical Officer (CDC),
3.30p.m – 4.00p.m : Discussion Session/ Post Test/ Dispersed
METHODOLOGY TALKS AND TRAINING
VALUATION PRE-TEST AND POST TEST
SPEAKERS Overview of cases of Infectious Diseases and notification requirements

Dr Abdul Mueez bin Ahmad Shahbuddin
Introduction to CDCIS e-Notification System Application,
PPKPK Ts. Masnita Binti Md Yusof
Introduction to e-Notification System Application and Usage Training
PPKP Mohd Fahmi Bin Ahmad Jamizi
Introduction to Outbreak Management System (OMS) System Application
Dr Md Hanif Nazruddin Bin Md Zin
ORGANIZER & Infectious Disease Control Unit (CDC)

COMMITTEE
2.8 Join the healthy life style campaign activity at district/ state level
Introduction
On 28 May 2023, Health Promotion Unit of Jempol Health District Office has organized a
Healthy Lifestyle program at Kolej Yayasan Feldajaya Serting, Jempol. The idea of this programme is
to inculcate students to maintain a healthier, more stable and active way of life. The objective of this
programme is to provide exposure by raising awareness to students on the concept of healthy
lifestyle, fostering positive attitudes in balanced eating practices, and creating awareness and
encouragement to students. the practice of a non-smoking lifestyle.
Program tentative
The program starts at 12 noon in the college lobby hall. The first thing to do is we start the
preparation by arranging the table as well as the pamphlets and also sorting the food which is the
bread and water that will be given to the students. After we got everything done, we started to
distribute leaflets to students who passed through the area and explained a little bit about the
concept of a healthy lifestyle. We also explain the benefits of adopting a healthy lifestyle as well as
how to eat healthily from the brochure given. In addition, we encourage students to practice tips to
quit smoking. It turns out that they concentrate and understand with the description given by our
group. They are also aware of the importance of adopting a healthy lifestyle.
After we explain to them about a healthy lifestyle, we give bread and a bottle of water to the
students from our side. This is a souvenir to them for listening to our explanation. The program ends
around 4pm in the same day
Observation Results
This program in particular has had a positive impact not only on individuals but also on the
attitude to work together as a team. We have done and run the program successfully with the
concept of a healthy lifestyle. With the collaborative attitude we practice, we have come together to
provide exposure to the students by creating awareness and train the students to the concept of a
healthy lifestyle as a whole. The programs we have implemented affect our level of collaboration and
leadership in teamwork. All members of the group have been directly involved in improving the
healthy lifestyle in the student-student environment. Thus, this indirectly improves the positive
attitude for all members of the group, improves performance, improves good work for all members.
In terms of work, we have collaborated to produce several posters and brochures as

reference materials during the implementation of the programme. We exchange views and ideas to
ensure that the inputs produced are beneficial and always motivate each other.
Therefore, in conclusion, the findings from the implementation of this programme can
elevate us towards a better direction in the value of leadership and teamwork as well as being able
to strengthen the relationship with each other.
Conclusion
In conclusion, a healthy lifestyle is extremely important for all individuals. This is because
health is the foundation of life and should always be emphasized. Through this healthy lifestyle
module, the importance of health can be emphasized. Among the ways highlighted in this
programme are practicing healthy eating and getting used to exercise. Although this is often
underestimated, the implications and effects are profound. The ever-dense and busy schedule of
work makes many take a stance in this matter. The program also aims to emphasize the
disadvantages of smoking. The smoking culture is becoming more acute among the young Malaysian
community including students. Smoking is one of the practices that should be avoided due to the
long-term effects that smokers themselves can face. Thus, more effort needs to be made to cultivate
healthy living.
2.9.1 Prevention activities, control and surveillance of communicable diseases

under the International Health Regulations (IHR)
The International Health Regulations (IHR) are a set of global health standards that aim to
prevent, protect against, control, and provide a public health response to the international spread of
diseases. The IHR are legally binding on all 194 Member States of the World Health Organization
(WHO). One of the key pillars of the IHR is the prevention and control of communicable diseases. The
IHR require countries to have strong surveillance and response capacities in place to detect and
respond to public health threats. This includes:
 Surveillance: Countries must have systems in place to monitor and detect communicable
diseases. This can be done through a variety of methods, such as disease reporting,
laboratory testing, and contact tracing.
 Response: Countries must have plans in place to respond to public health threats. This
includes having the necessary resources and trained personnel to investigate outbreaks,
implement control measures, and communicate with the public.
The IHR also include specific provisions for the control of communicable diseases at borders.
This includes measures such as vaccination, quarantine, and isolation. The IHR have been credited
with helping to prevent the spread of a number of communicable diseases, including SARS, Ebola,
and Zika. The IHR are an important tool for protecting global health and preventing the international
spread of disease. Specific examples of prevention activities, control measures, and surveillance
activities that are carried out under the IHR:
Prevention activities
Prevention activities under the IHR involve implementing measures to reduce the risk of
disease transmission and protect populations. Vaccination programs are emphasized to prevent
vaccine-preventable diseases. Disease screening programs help identify individuals at risk of
infection, enabling early intervention. Public health education campaigns raise awareness and
educate the public on disease prevention measures. Below stated are the prevention activities done:
 Vaccination programs: Vaccination is one of the most effective ways to prevent

communicable diseases. The IHR require countries to have strong vaccination programs in
place to protect their populations from vaccine-preventable diseases.
 Disease screening programs: Disease screening programs can help to identify people who
are at risk of contracting a communicable disease. This can help to prevent the spread of the
disease to others.
 Public health education campaigns: Public health education campaigns can help to raise
awareness of communicable diseases and how to prevent them. This can help to reduce the
risk of infection in the population.
Control measures
Control measures are essential to contain outbreaks and prevent further transmission.
Quarantine and isolation are used to separate individuals who may have been exposed to a
communicable disease or are infected, respectively, to prevent spread. Contact tracing involves
identifying and monitoring individuals who had close contact with infected individuals to control
transmission. Travel restrictions can be implemented to limit the spread of diseases across borders.
Below stated are the control measures:
 Quarantine: Quarantine is the isolation of people who have been exposed to a

communicable disease but who do not yet show symptoms. This can help to prevent the
spread of the disease to others.
 Isolation: Isolation is the isolation of people who are sick with a communicable disease. This
can help to prevent the spread of the disease to others.
 Contact tracing: Contact tracing is the process of identifying and following up with people
who have been exposed to a communicable disease. This can help to prevent the spread of
the disease to others.
 Travel restrictions: Travel restrictions can be used to prevent the spread of communicable
diseases. For example, countries may restrict travel from countries where a communicable
disease is widespread.
Surveillance activities
Surveillance activities are crucial for detecting and monitoring communicable diseases.
Disease reporting involves timely collection and sharing of data on infectious diseases. Laboratory
testing is used to confirm diagnoses and guide treatment decisions. Contact tracing helps identify
potential chains of transmission and assess the extent of an outbreak. Below stated are the
surveillance activities done:
 Disease reporting: Disease reporting is the process of collecting data on communicable

diseases. This data can be used to track the spread of diseases and to identify potential
public health threats.
 Laboratory testing: Laboratory testing can be used to confirm the diagnosis of
communicable diseases. This information can be used to make decisions about treatment
and control measures.
 Contact tracing: Contact tracing is the process of identifying and following up with people
who have been exposed to a communicable disease. This can help to prevent the spread of
the disease to others.
The IHR's comprehensive approach to prevention, control, and surveillance has been
instrumental in managing disease outbreaks effectively. By fostering international cooperation and
collective action, the IHR plays a pivotal role in safeguarding global health security and preventing
the international spread of communicable diseases.
IHR activities and control in KLIA
Introduction
The IHR framework provides a comprehensive approach to managing public health risks
related to international travel and trade. At international airports like Kuala Lumpur International
Airport (KLIA), where millions of travellers from various countries converge, the implementation of
IHR becomes critically important.
The KLIA Health Office, in line with the IHR principles, takes on various responsibilities to
safeguard public health and prevent the importation and exportation of communicable diseases.
They conduct body temperature screenings on travellers arriving on international flights, identifying
potential cases of infectious diseases before they enter the country. This measure aligns with the
IHR's emphasis on early detection and response to public health threats.
Additionally, the KLIA Health Office conducts sanitary inspections of international aircraft
arriving at the airport, ensuring compliance with IHR requirements for disinfection. This step is vital
to prevent the transmission of vectors that may carry communicable diseases.
Furthermore, the management and handling of notifications received from private clinics
also demonstrate adherence to the IHR principles. Early notification and reporting of suspected or
confirmed infectious disease cases from private clinics help in timely identification and response to
potential outbreaks.
Moreover, the KLIA Health Office's surveillance of travellers arriving from Yellow Fever
endemic countries aligns with the IHR's emphasis on monitoring and controlling the international
spread of specific diseases.
Overall, the KLIA Health Office's activities are intrinsically linked to the IHR's core objectives
of prevention, detection, and control of infectious diseases at international borders. By following the
IHR guidelines, the KLIA Health Office contributes to global health security, ensuring that infectious
disease risks are managed effectively, protecting both the local population and the global community
from the threats of communicable diseases.
Activities and Control in KLIA Malaysia
1. Management and handling of notifications received from private clinics
The KLIA Health Office receives notifications of suspected or confirmed infectious disease
cases from private clinics, such as PUSRAWI MAS Medical Centre and Medical Centre. They create
data input notifications for e-notification, which are sent to the District Health Office (PKD) Sepang
online. This helps in early detection and response to potential disease outbreaks.
2. Conducting investigations and implementing preventive measures/controls in the event of

suspected or confirmed infectious disease cases and outbreaks
In response to suspected or confirmed infectious disease cases and outbreaks, the KLIA
Health Office conducts thorough investigations. They collaborate with other health agencies, like the
Ministry of Health, to identify and track cases and implement control measures. These actions help
contain the spread of infectious diseases and protect public health.
3. Management and control of suspected infectious disease-related deaths
The KLIA Health Office manages and controls cases of suspected infectious disease-related
deaths. They conduct investigations into deaths that are suspected to be caused by infectious
diseases and take preventive measures to prevent further transmission of the disease.
4. Performing body temperature screening on travellers arriving on international flights
To prevent the spread of communicable diseases, the KLIA Health Office conducts body
temperature screening on travellers arriving on international flights. Those with a high body
temperature (37.5°C) are referred to the Health Quarantine Centre for further examination and
possible isolation if necessary.
5. Surveillance of travellers arriving from or through Yellow Fever endemic countries
The KLIA Health Office closely monitors travellers arriving from or transiting through Yellow
Fever endemic countries. They inspect vaccination certificates of these travellers and conduct
random checks at the International Arrivals Level. Additionally, they distribute Yellow Fever leaflets
and provide briefings to relevant personnel at the airport.
6. Management of the import and export of cadavers, human tissues, and organisms
The KLIA Health Office oversees the import and export of cadavers, human tissues, and
organisms. They review all importation and exportation applications, issue permits based on
compliance with regulations, and thoroughly examine consignments to ensure compliance with
health and safety requirements.
7. Conducting sanitary inspections of international aircraft arriving at the airport
The KLIA Health Office conducts sanitary inspections of international aircraft upon arrival.
They check for evidence of disinsertions in the General Declaration and update data in the Monthly
Report of Foreign Investment. These inspections ensure that international aircraft comply with
health regulations and prevent the introduction of communicable diseases through traveling
passengers or cargo.
2.9.2 Food Safety And Quality Activities:-
In Jempol District Health Office, there were no International Gateway. Therefore, Ill explain
on the guidelines and management of Food Safety and Quality in International Gateway based on
International Health Regulations 2005.
Introduction
Food safety is a critical concern within the airline industry, and it holds particular significance
at designated airports worldwide. The Annex 1B of the International Health Regulations (2005)
underscores the necessity for these airports to establish measures ensuring the safety of travellers
utilizing point-of-entry facilities. This includes maintaining the safety of potable water supplies,
eating establishments, flight catering facilities, public washrooms, and appropriate waste disposal
services. To achieve this, inspection programs are diligently conducted to mitigate potential risks and
uphold a secure environment for all passengers.
Objectives
 The need to provide airline passengers food that is hygienic and safe according to
international food safety and security standards.
 The need to apply preventive procedures like HACCP, to ensure passengers’ a safe healthy
flight
Law
The statutes pertaining are:
 Food Act 1983 and its Regulations

 Food Hygiene Regulations 2009
 Prevention and Control of Infectious Diseases Act 1988
 International Health Regulations 2005
The implications for caterers are:-

 Enforcement of the food hygiene provisions of the Food Act 1983.
 Health authorities will be able to prosecute owner of establishments for offences under the
Section 11 of the Food Act 1983 which enables an Officer authorized by the Director to make
a Temporary Closure Order for insanitary premises.
 To obtain registration or licensing, the premises are required to be fit for the purpose of
manufacturing or preparation of food by the Local Authority or Ministry of Health.
a) Examination of the Flight Kitchen
The kitchen structure and facilities are essential components in ensuring food safety and
maintaining high hygiene standards. The building's location should be free from contaminants, and it
should be designed to facilitate easy cleaning, maintenance, and disinfection. Adequate space and a
proper layout are necessary to allow smooth operations and adherence to Good Manufacturing
Practices (GMP) and Hazard Analysis and Critical Control Points (HACCP) in food services.
Physical standard of Flight Kitchen based on IHR 2005
Flooring
The floors should be designed to be easy to clean and disinfect, made of durable materials to
withstand various substances and temperature variations, and have a slip-resistant finish. Junctions
with walls should be coved to facilitate cleaning, and raised pattern tiles should be avoided due to
difficulties in cleaning.
Walls
Walls should be made of waterproof, non-absorbent, and non-toxic materials, and well-
jointed, glazed ceramic tiles are recommended to avoid textured paint finishes. Proper protection of
corners and wall surfaces behind sinks and cooking equipment is essential to resist heat, moisture,
and physical damage.
Ceiling
The ceiling should be smooth, impervious, and easily cleaned, avoiding false or acoustic
ceilings that can pose fire hazards and harbor pests. It should also provide access for pest control
inspections and be insulated to prevent condensation issues.
Door
Doors should be designed for easy cleaning, flushed with adjacent surfaces, and wide
enough for equipment passage without damage. Ensuring doors are pest-proof and self-closing
enhances food safety.
Windows
Windows should be pest-proof, equipped with easily removable screens, and have inward-
sloping sills to prevent item accumulation. They should allow effective cleaning to avoid dirt
accumulation.
Drainage system
Proper drainage systems are crucial, with drains of suitable depth and gradient, covered with
removable gratings. Designs providing individual waste traps for each piece of equipment are
recommended. Grease traps and interceptors, if needed, should be located outside the kitchen area,
with cleaning performed by designated staff.
Sinks
Sinks should be dedicated to food preparation and washing up, made of stainless steel for
easy cleaning. Sterilizing sinks for crockery and equipment should maintain water at temperatures
above 60°C. Sinks must not be used for personal hygiene purposes, and hands-free operated taps are
encouraged.
Basins
Wash-hand basins, preferably stainless steel and in sufficient numbers, should be provided in
all entry and preparation areas. They should have hands-free operated taps, soap dispensers, and
disposable paper towels or hand dryers. Proper signage should be displayed to identify wash hand
basins and encourage staff to practice handwashing.
Regular inspections and preventive maintenance of lifts and hoists are necessary to ensure
proper functionality, with clear operating and cleaning instructions displayed for safety purposes.
Ensuring adherence to these guidelines is crucial in upholding food safety and hygiene standards,
aligning with the requirements set by the International Health Regulations (IHR) for a safe
environment for travellers at designated airports.
Delivery Bay/Goods Entrance
The delivery bay or goods entrance is a crucial part of the kitchen design, ensuring the
smooth and efficient flow of incoming supplies. It should be designed with the following
considerations in mind:
 The entrance should be spacious enough to accommodate delivery vans, allowing them to
back up easily under a roof or canopy. This provides protection from the weather during
unloading.
 The surface of the delivery bay should be even and impervious, making it easy to clean and
maintain hygiene standards. Additionally, it should be equipped with a water standpipe, tap,
and retractable hose reel for efficient sorting, washing, and receiving of goods.
 Sufficient lighting is essential to ensure visibility during the loading and unloading of goods.
Where possible, separate areas for incoming and outgoing goods should be designated to
prevent cross-contamination.
 Keeping access points clear at all times is vital for smooth operations. Any refuse or
unwanted containers should be promptly removed to a proper refuse area, preventing
obstructions and potential hazards.
 To maintain food safety standards and prevent fire risks, a strict "NO SMOKING" policy
should be enforced on-site and in the vicinity of the delivery dock.
Dry Foods Store
The dry foods store is an important area for storing non-perishable goods and should be
designed accordingly:
 The store should be dry, well-ventilated, and well-lit to preserve the quality of stored items
and allow easy access to all contents.
 Racks with impervious shelving should be installed to facilitate cleanliness and prevent
contamination. The lowest shelf should be at least 20 cm above ground level, avoiding direct
contact with the floor.
General Stores
Properly organized general stores are essential for efficient kitchen operations.
Considerations include:
 Separate store rooms should be designated for different items, such as equipment, crockery
and utensils, chemical and detergent supplies, and packaging materials.
 Adjustable shelves should be provided in each store, with the lowest shelf placed at least 20
cm above ground level for ease of access and cleanliness.
Cold Storage
Cold storage areas are critical for preserving perishable food items and ensuring food safety:
 Doors must be close-fitting and equipped with an airtight gasket to maintain temperature
control. They should open from both inside and outside to ensure easy access and exits.
Additionally, plastic curtains can help retain cold air while allowing smooth movement of
staff and goods.
 Removable and adjustable shelves, preferably made of stainless steel or alloy, should be
installed inside the cold storage area for proper organization and easy cleaning. Large cold
stores should have easy-clean surfaces like stainless steel sheeting on the interior.
 All chiller, chiller rooms, and freezers with a capacity of around 10 cubic ft or more should be
equipped with clearly visible external thermometers and alarms for temperature monitoring
and auto defrost functions.
 To prevent spoilage during power outages, all chiller, chiller rooms, and freezer rooms should
be connected to an alternative power supply.
 Flooring in cold storage areas should be made of grooved stainless steel, which is durable,
easy to clean, and equipped with water outlet drainage to prevent water accumulation.
 Properly covered and easy-to-clean lighting should be installed in cold storage areas.
 Essential power supply should be considered when designing the kitchen to accommodate
these cold storage facilities.
Chiller/Chiller Room
Chilled storage areas, larders, and cooling rooms are essential for maintaining the freshness
of perishable foods. Their design should prioritize the following:
 Controlled ventilation to maintain temperatures below 5°C in the chiller area. This helps
preserve the quality of food items stored in these areas.
 The floors in the kitchen and chiller area should be at the same level to facilitate the smooth
movement of mobile food-storage racks and trolleys.
 The kitchen refrigeration should be regularly checked and maintained to ensure that
temperatures remain within the recommended range of 0°C to 10°C. Ideally, the
temperature should be set at 3°C, as chillers calibrated at this temperature often come with
automatic defrost facilities.
Freezer/Freezer Room
Deep-freeze storage areas are necessary for preserving quick-frozen foods over extended periods.
The design considerations are as follows:
 Deep-freeze stores must maintain temperatures below minus 18°C to preserve the quality
and safety of quick-frozen foods.
 The same design recommendations applicable to chiller rooms apply to deep-freeze stores.
 The working temperatures for foods in storage should be displayed on the outside of the
store to allow easy monitoring and compliance with food safety standards.
Preparation and Cooking Areas
Efficient preparation and cooking areas are essential for maintaining food safety and hygiene.
Design considerations include:
 Preparation and storage surfaces should be impervious and capable of thorough cleaning to
prevent food contamination.
 Cutting slabs and chopping boards/blocks should be made of impermeable materials to
ensure food safety. Additionally, using color-coded chopping boards/blocks for different
types of food, such as meat, fish, vegetables, and fruits, helps prevent cross-contamination.
 Tables and worktops should be positioned away from walls to facilitate easy cleaning and
prevent debris accumulation. Mobile stainless-steel worktops are preferable due to their
durability, hygienic properties, and ease of cleaning.
Refuse Collection Area
Proper waste management and disposal are essential for maintaining a hygienic kitchen
environment. Design considerations for the refuse collection area include:
 A separate covered room or area should be designated for the storage of refuse prior to
collection.
 The area should be well-ventilated and constructed with smooth, non-absorbent finishes on
the walls to facilitate easy cleaning and prevent pest infestations.
 Proper drainage, equipped with a standpipe, tap, and retractable hose reel, should be
provided in the refuse area to aid in cleaning and sanitation.
 Refuse areas should be situated to minimize nuisance and should be kept well away from
areas where food is delivered to prevent cross-contamination.
 All bins in the refuse collection area should have close-fitting lids and be covered to prevent
the spread of odours and pests.
 It is essential to separate wet refuse from dry refuse to facilitate proper waste management.
 Wet refuse should be kept in a location with suitable temperature, preferably with air
conditioning, to minimize unpleasant odours and potential health hazards.
Waste Disposal
Proper waste disposal facilities are vital for maintaining a clean and hygienic kitchen
environment. The design should consider the following:
 Waste bins throughout the kitchen should be well-maintained, clean, and equipped with
foot-operated lids. To prevent cross-contamination and ensure proper waste management, it
is recommended to have different waste bins for different types of waste, such as meat and
fish, vegetables, and recyclables.
 Waste should be removed regularly and when necessary to prevent the build-up of waste
and maintain a clean and sanitary kitchen.
Washing Area
The washing area is critical for ensuring the cleanliness of kitchen equipment and utensils.
Design considerations include:
 Separate areas should be designated for washing equipment, trolleys, crockeries, and
cooking utensils.
 The walls in the washing area should be tiled up to a height of 2 meters, with the rest
painted with impervious paint in white or a light colour. This ensures ease of cleaning and
prevents contamination.
 Steam cleaning apparatus may be kept in this area to maintain proper sanitation.
Toilet Facilities/Rest Room
Proper toilet facilities and restrooms are essential for the comfort and hygiene of food
service staff. Design considerations include:
 Adequate toilet facilities should be provided for food service staff, including proper
handwashing facilities with soap and water.
 A ventilated corridor or space should be provided between the toilet and food preparation
area to prevent cross-contamination.
 Toilet areas should be well-lit and properly ventilated to maintain a clean and pleasant
environment.
 Walls, floors, and window ledges in the toilet facilities should have impervious and easy-to-
clean surfaces to prevent the accumulation of dirt and facilitate proper hygiene.
 The toilet facilities should meet the required norms and standards for sanitation and
hygiene.
 Female toilets should include sanitary towel dispensers and disposers with clear instructions
displayed for proper disposal.
Changing Rooms
Changing rooms are necessary to provide a designated area for staff to change into clean
protective clothing. Design considerations include:
 Adequate lighting and proper ventilation to maintain a comfortable and hygienic
environment.
 Each staff member should have a locker or at least hanging space for their outdoor clothes,
which should be kept separate from clean protective clothing to prevent contamination.
 Shower rooms should be included in the changing rooms to allow staff to maintain personal
hygiene during work hours.
 A container for dirty linen should be provided and removed daily to ensure cleanliness and
prevent odors.
Staff Entry Area
An allocated staff entry area should be determined to ensure organized and controlled
access for kitchen staff.
Staff Dining Room
The staff dining room is essential for providing a space where employees can rest and have
meals. Design considerations include:
 The room should be of adequate size to accommodate staff comfortably during meal times.
 Proper ventilation should be provided to ensure a pleasant and fresh dining environment.
 The staff dining room should be kept clean and well-maintained to promote a positive dining
experience for employees.
b) Food premises at the airport
(c) Procedures for food assessment and “Hold Test Release”.
(d) System information in FoSIM
2.9.3 Aedes mosquito control and Ovi-trap installation
2.9.4 Rodent Control
2.9.5 Airport Sanitation

2.10 The Port Health Services (International Health)
2.10.1 Prevention activities, control and surveillance of communicable diseases under

the International Health Regulations (IHR)
2.10.2 Check the certificates of "Maritime Declaration of Health" for the crew and
passengers
2.10.3 Conducting inspections of ships for the purpose of issuing Free Practique
Certificates
2.10.4 Conduct Inspections on ships that have been quarantined.
2.10.5 Conduct inspections on ships for the purpose of certification of SSCC / SSCEC
(Ship Sanitation Control Certificate / Ship Sanitation Control Exemption Certificate)
2.10.6 Aedes mosquito control
2.10.7 Rodent control
2.10.8 Airport Sanitation
2.11 Border Check Point (International Health)
2.11.1 Infectious Disease control- Import and Export dead body.
2.11.2 Development of current issues of local / state /global
Identify issues related to Global Environmental Health:
(a) Environment
(b) Infectious Disease

Subject : Pest & Vector Control
Introduction
The Vector-Borne Disease Control Unit is the backbone of services in the implementation of
activities to prevent, control, and eliminate Vector-Borne Diseases. The Vector-Borne Disease Control
Program (VBDC) began in Malaysia in 1986 and was later restructured into the Vector-Borne Disease
Branch (VBDB) in 1994. The scope of prevention and control activities covers vector-borne diseases
such as Dengue, Chikungunya, Malaria, Filariasis, Japanese Encephalitis, Typhus, Plague, and Yellow
Fever. In the district of Jempol, special emphasis is given to Dengue as it is a major public health
concern in the region.
The focus of the Malaria and Lymphatic Filariasis Control Program is to achieve elimination
status for both diseases by the year 2020. Monitoring and prevention activities for other diseases
such as Chikungunya, Typhus, Japanese Encephalitis, Plague, and Yellow Fever continue to be carried
out and regularly monitored.
Vision
To transform Jempol into a district with healthy and prosperous individuals, families, and
communities, we strive to implement Vector-Borne Disease Control Programs that are professional,
efficient, fair, and community-friendly.
Mission
The Vector-Borne Disease Control Unit will carry out Vector-Borne Disease Control programs
that encompass prevention and control measures. This will be achieved through highly skilled and
trained personnel, supported by state-of-the-art and fully equipped technology.
Objective
The objectives of the Vector-Borne Disease Control Unit are as follows:
1. To reduce the morbidity (incidence) and mortality (deaths) caused by Vector-Borne Diseases,
thereby preventing them from becoming public health problems in Peninsular Malaysia.
2. To prevent the occurrence of Vector-Borne Diseases in areas that are already free from these
diseases.
The major Vector-Borne Diseases include Malaria, Dengue Fever/Dengue Hemorrhagic Fever,
Filariasis, Scrub Typhus, Japanese Encephalitis (JE), Chikungunya, Plague, and Yellow Fever.
Role of Vector Unit
The role of the Vector-Borne Disease Control Unit in Jempol Health District Office are as follows:
1. Monitor the reporting of all cases of Vector-Borne Diseases through phone, notification
forms, or the e-notification system within the specified timeframe.
2. Ensure and monitor the data entry in surveillance databases through systems like e-
Notification, e-Dengue, Vekpro Online, and other manual reporting methods, ensuring that
the surveillance databases are complete, accurate, and up-to-date for Vector-Borne Disease
cases.
3. Implement Integrated Vector Management (IVM) concept for Vector Control, including
activities such as Breeding Place Destruction (BPD), Thermal Space Spraying (TSS), Ultra-Low
Volume Space Spraying (ULVSS), Distribution of Medicinal Mosquito Nets, and Residual
Spraying.
4. Monitor vector presence by installing ovitraps in priority and outbreak areas.
5. Early detection and treatment of cases, including conducting investigations within 24 hours
of notified Vector-Borne Disease cases to determine the source of infection.
6. Conduct screening tests for high-risk groups through smart partnerships with employers in
agricultural, construction, and logging industries to obtain a list of workers for easier
screening activities.
7. Conduct Active Case Detection (ACD) in areas with Vector-Borne Disease problems to detect
new cases and contacts.
8. Perform blood smears for ACD in cases of Malaria and Filariasis at the district level and
report positive blood smears to the State Health Department.
9. Take follow-up actions on all registered Vector-Borne Disease cases according to established
guidelines.
10. Refer Vector-Borne Disease cases for immediate treatment at nearby clinics or hospitals.
11. Preparedness and response to outbreaks, including activating the Operation Room within 24
hours of an outbreak declaration, controlling 100% of Dengue outbreaks within 14 days,
conducting risk assessments in outbreak areas, and holding Outbreak Committee Meetings
at the district level if an outbreak is declared.
12. Communicate and mobilize the community to participate in Vector-Borne Disease control
efforts through effective communication and smart collaborations to bring about behavioural
changes in the community.
13. Mobilize Vector-Borne Disease Control Unit members to high workload districts to carry out
control activities within the specified timeframe.
14. Capacity development, including providing training to vector staff to enhance skills and
competence in their work, ensuring sufficient and appropriate staffing in the Vector-Borne
Disease Control Unit, supplying Combo Dengue Rapid Tests to government clinics and
hospitals for Dengue confirmation, and providing insecticide stocks for Vector-Borne Disease
control activities.
15. Conduct research studies on vector-related issues in problematic areas in Negeri Sembilan
and conduct Environmental Risk Assessments (ERA) in such areas.
3.1 Vector Control

3.1.1 Dengue Control
(a) Aedes larvae survey (including identification & samples preservation)
(b) Conduct fogging (including chemicals dose calculation)
(c) Data interpretation on Aedes larvae survey
(d) Aedes larvae survey (including identification & samples preservation)
(e) Conduct fogging (including chemicals dose calculation)
(f) Data interpretation on Aedes larvae survey
3.1.3 Malaria Control

Participate in Malaria Control Program Activities
(a) Source Reduction Physical, Biological & Chemical
(b) Conduct Anopheles Larva Survey
(c) Transmission Control Activities (ACD/PCD/RBS/MBS/Treatment)
3.1.4 Filariasis control and other vectors

(a) Carry-out Fly survey
(b) Conduct study on Anopheles,Culex and Mansonia
(c) Rodent control

3.2 Exposure (Hands-on) Preparation of all disease control report (CDCIS)/
VECTOR/ Vekpro
3.3 Exposure (Hands-on) Disease Control/ Vector `Quality Assurance` program
3.4 Pest and vector control at international entry point

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FACULTY OF HEALTH SCIENCE

BACHELOR OF ENVIRONMENTAL HEALTH AND SAFETY (HONS)

PRACTICAL TRAINING II (DISEASE, PEST & VECTOR CONTROL)

JEMPOL DISTRICT HEALTH OFFICE, NEGERI SEMBILAN

MOHD FAHMI BIN AHMAD JAMIZI

BEHP22106112 (C20 FLEXI)

MR PUAD BIN MAON

Subject : Disease Control

Subject : Pest & Vector Control

The monitoring of communicable diseases is conducted daily through the e-notification

Implementing comprehensive, integrated, and efficient control and prevention programs

Role of CDC Unit

The monitoring of communicable disease occurrences is based on the Infectious Diseases

The surveillance of communicable diseases in the country is carried out through a

In Jempol District Health Office, it is compulsory to notify cases by using e-Notification

Within 24 Hours of diagnosis

1. Avian Influenza 10. MERS-CoV

Within 7 days of diagnosis with laboratory confirmed result

Cases notified in manual notification form (Annex 2’)

Figure 2 : The front interface of e-notification System for case notification

Figure 3: Annex 2' Manual Notification form

The formula for prevalence rate is:

Prevalence Rate = (500 cases) / (10,000 population) × 100 = 5%

Prevalence rate is an essential metric in public health as it helps in:

1. Assessing the burden of a disease: It provides a measure of how common a disease is in a

(a) Waterborne and foodborne

Disease Confirmed Case Prevalence Rate (%)

Disease Confirmed Case Prevalence Rate (%)

Disease Confirmed Case Prevalence Rate (%)

(d) AIDS/ STD

Disease Confirmed Case Prevalence Rate (%)

Measures of Central Tendency

Variance (σ^2) = Σ [(x - μ)^2] / n

Standard Deviation (σ) = √Variance (σ^2)

Mean (μ) = Σ [(Midpoint of class * Frequency)] / (Total number of data points)

Standard Deviation (σ) = √Variance (σ^2)

Dengue Fever / DHF

Figure 5: Dengue Registered Case in Jempol Epid Curve for 2022

Figure 6: Malaria Registered Case in Jempol Epid Curve for 2022

Figure 7: Tuberculosis Registered Case in Jempol Epid Curve for 2022

Figure 8: HFMD Registered Case in Jempol Epid Curve for 2022

2.2.1 Water borne and food borne diseases

Clinical case definition - Acute watery diarrhoea with or without vomiting.

Suspected - A case that meets the clinical case definition.

Confirmed - A suspected case that is laboratory-confirmed.

Investigation should be initiated as soon as notification is received. As a guide, the

Active Case Detection (ACD):

Passive Case Detection (PCD):

Prevention and Control Measure

Suspected - A case that fulfils the clinical case definition.

All suspected and probable cases must be notified/reported by healthcare practitioners to

 Stool specimens from contacts should be collected for analysis of S. typhi/paratyphi.

The following information should be asked:

The following aspects should be noted:

 The patient's physical health.

Information that should be obtained from the hospital:

 Date of specimen collection (blood, stool, and urine).

Follow-up for Cases

7.6.2 Follow-up for Carriers

Providing health education.

Prevention and Control Measure

i. Typhim Vi (Vi CPS)

 Used in the Ministry of Health, Malaysia