On 4 September 2023, the Pertubuhan Kumpulan Sokongan Ibu Bapa Dan Bayi Pramatang Malaysia (BPM) and the Galen Centre for Health and Social Policy partnered to organize a media roundtable called Taking a Closer Look at RSV.
RSV is short for respiratory syncytial virus, one of the most prevalent viruses that infect the respiratory system of mostly children below 3.
FEATURED EXPERT
ASSOCIATE PROFESSOR DR ADLI ALI
Head of Clinical Immunology
UKM Children’s Specialist Hospital
“RSV is a disease that has been around for a long time, yet the number of cases is still high. The actual burden of the disease is not known from the economic impact on the healthcare system which includes admission costs, utilization of respiratory supports, as well the economic and social impact on the family of patients. Therefore, prevention is very important in addressing the further progression of the disease in the country.”
FEATURED EXPERT AZRUL ABDUL KHALIB
Founder and Chief Executive Officer
Galen Centre for Health and Social Policy
“With the varied guidelines on prevention, we need to prioritize and respond with more urgency to RSV which can have a life-long impact. Parents, caregivers and the community at large need to understand the severity of the disease, how it can affect the future of our nation and what can be done to address them immediately.”
Azrul also called for more streamlined guidelines for RSV prevention and to ensure the channels for parents to seek support and financial aid for their children are made more accessible.
Furthermore, increased availability of preventive options would help reduce mortality and save children’s lives.
Parent Nur Suhana sharing her personal experience caring for her child Shafiq Rizqi who was born premature, and her experience in dealing with the RSV infection.
Parent Nursyahirah shared the challenges in caring for her child Wan Nur Afeeya who was born prematurely at 25 weeks.
Wan Nur Afeeya who was born prematurely at 25 weeks, was infected with RSV this year.
Norazleena Yaha, founder of Pertubuhan Kumpulan Sokongan Ibu Bapa Dan Bayi Pramatang Malaysia (BPM) spoke about how the organisation help parents access the available financial support to purchase the vaccines.
Associate Professor Dr. Adli Ali, Head of Immunology and Rheumatology Services, UKM Children's Specialist Hospital
Associate Professor Dr Choo Yao Mun, Consultant Neonatologist and Paediatrician, University of Malaya Medical Centre
Azrul Abdul Khalib, Founder and Chief Executive Officer of the Galen Centre for Health and Social Policy
On 17 August 2023, the Malaysian Society of Infection Control and Infectious Disease (MyICID), the National Cancer Society of Malaysia (NCSM), and the Malaysian Red Crescent (MRCS), in collaboration with Pfizer Malaysia, launched the MyPELINDUNG campaign.
WHAT’S MyPELINDUNG?
It’s a public educational campaign aimed at mitigating the threat of COVID-19 in Malaysia by increasing the awareness levels of Malaysians on the importance of up-to-date vaccination and seeking of prompt COVID-19-specific treatment.
Group Photo On Stage
The Malaysian Society of Infection Control and Infectious Disease (MyICID)
Her Highness Dato' Seri DiRaja Tan Sri Tunku Puteri Intan Safinaz & Tan Sri Dato Sri Michelle Yeoh
The MyPELINDUNG campaign is a testament to the power of collaboration
Tan Sri Michelle Yeoh returns home to support the MyPELINDUNG initiative
The event was witnessed by Her Highness Dato Seri DiRaja Tan Sri Tunku Puteri Intan Safinaz
Among the luminaries gracing the launch were:
Her Highness Dato’ Seri DiRaja Tan Sri Tunku Puteri Intan Safinaz binti Almarhum Sultan Abdul Halim Mu’adzam Shah, Tunku Temenggong Kedah, who is the National Chairperson of the Malaysian Red Crescent
Datuk Dr Norhayati Rusli, Deputy Director-General of Public Health, Ministry of Health
Yang Berbahagia Tan Sri Dato’ Seri Michelle Yeoh, Oscar-winning actress
Dr Shaharudeen Bin Kamaludeen, the President of MyICID
Dato Dr. Saunthari Somasundaram, the President of NCSM
Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life
Madam Luksanawan Thangpaibool, the Country Cluster Lead of Pfizer Malaysia, Pakistan and Brunei
A PRINCESS’S WORD OF WISDOM
“Just as it takes many drops to form an ocean, our shared actions—however small they may seem —can create significant impact in the fight against COVID-19,” says Yang Teramat Mulia Dato’ Seri Diraja Tan Sri Tunku Puteri Intan Safinaz.
She adds: “It’s through initiatives like MyPELINDUNG that we can harness our collective strength to navigate this health issue. Together, with the strength of unity and shared responsibility, we can contribute to a healthier, safer nation for all Malaysians.”
WAIT, ISN’T COVID-19 OLD NEWS?
Not so! Yes, Malaysia has made significant strides but the virus responsible for COVID-19 continues to circulate in our communities and can still lead to hospitalizations and even death, especially among high-risk groups.
Hence, the experts driving MyPELINDUNG advocates constant vigilance, updating of COVID-19 vaccinations, adherence to recommended health measures, and prompt seeking of COVID-19-specific treatment if one is tested positive.
VACCINATION IS KEY, EXPERTS SAY
MyPELINDUNG aims to reduce public hesitancy around the COVID-19 booster doses by disseminating scientifically-accurate information and addressing common concerns held by Malaysians about these boosters.
The campaign’s efforts will particularly focus on high-risk groups, as up-to-date vaccination (including booster doses) can reduce their risk of severe illness, hospitalization, and death.
Dr Shaharudeen Kamaludeen, President of MyICID, tells us: “It’s paramount that we understand the critical role vaccinations play in mitigating the severity of COVID-19. Vaccinations, including recommended booster doses, are our primary line of defence against this virus.”
He also adds that prompt medical consultation and treatment after a positive test for COVID-19 are equally vital.
Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life, further emphasizes the importance of maintaining one’s up-to-date vaccination status.
“Full vaccination significantly reduces the risk of severe disease outcomes,” he says. “We urge everyone, particularly those in high-risk groups, to consider vaccinations as their personal shield against the virus, and to remember that this shield is most robust when all recommended doses, including boosters, have been administered.”
THE ACTRESS ADVOCATES
Tan Sri Dato’ Seri Michelle Yeoh concurs with the experts, adding that she herself had 2 brushes with the COVID-19 vaccine.
She participated in an educational video for MyPELINDUNG, a video that she is very proud of, and will continue to commit to encouraging Malaysians to remain vigilant and take the appropriate protective steps against COVID-19.
“Trust the science,” she urges.
PROMPT & QUICK TREATMENT CAN SAVE LIVES
“The most important thing to remember about treatment for COVID-19 is that it should be started as soon as possible after diagnosis to be effective,” states Dato Dr Saunthari Somasundram. “If you test positive for COVID-19, treatments are available that can reduce the likelihood of severe illness, hospitalization, and death. Please don’t delay because COVID-19 specific treatment must be started within days after you first develop symptoms to be effective.”
Tan Sri Michelle Yeoh concurs. “On screen, I’ve navigated flying stunts and leapt off moving vehicles, but life isn’t an action film, and we can’t afford to wait for the dramatic last-minute rescue. If you’re showing any symptoms, act fast, seek help at once.”
For more information about the MyPELINDUNG initiative and its efforts to combat COVID-19, please visit https://www.facebook.com/MyPELINDUNG (link opens in a new tab).
FEATURED EXPERT PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University (IMU)
Tuberculosis, often abbreviated as TB, has been around for a long time. In fact, it was known as “consumption” back in the 1800s.
Perhaps this is what many of us rarely spare this disease a thought unlike, say, dengue and COVID-19.
WHAT CAUSES TUBERCULOSIS
It is caused by the bacteria Mycobacterium tuberculosis.
TUBERCULOSIS CAN ATTACK DIFFERENT PARTS OF THE BODY
“It can attack different parts of the body, with the lungs–referred to as pulmonary tuberculosis– being the most common,” says Professor Dr James Koh Kwee Choy,
These different parts of the body include the lymph nodes and bones (usually the spine), in rare cases in the gut. The bacteria can also attack the brains of people with suppressed immune system, such as those living with HIV. Such cases of tuberculosis are called extrapulmonary tuberculosis (EPTB for short).
Symptoms and prevention of tuberculosis. Click on the image to view a larger, clearer version.
WHO IS AT RISK OF CATCHING THIS DISEASE?
According to Prof James, the most susceptible groups of people are:
The elderly
People with lowered immunity, including young children whose immune system is still developing
People with suppressed immune system, such as those on chronic steroid therapy and people living with HIV
People living in overcrowded living spaces, such as the poor and migrant workers, as this close proximity makes it easy for the bacteria to be passed on from person to person
HOW EASILY DOES TUBERCULOSIS SPREAD?
Similarly to all respiratory diseases, it is spread by water droplets that come from coughing or spitting.
However, the bacteria responsible for this disease need to be in significant amount in water droplets for the disease to spread.
“You have to be in quite close contact and in a situation where there’s prolonged exposure. Generally, more than eight hours a day,” says Prof James.
It is also worth noting that the bacteria can become dormant in the body of the host, and someone with dormant bacteria will not pass the bacteria on to others.
Similarly, people with only extrapulmonary tuberculosis—the infection doesn’t affect their lungs—will not spread the bacteria to other people.
THE SYMPTOMS OF TUBERCULOSIS
Detecting tuberculosis at its early stage can be challenging because the symptoms may not show immediately.
“You could have been exposed long ago, and the bacteria will stay latent or dormant in the body and hibernate. Symptoms can come up months or even years later,” says Prof James.
SYMPTOMS OF PULMONARY TUBERCULOSIS (TUBERCULOSIS IN THE LUNGS)
Chronic cough
Profuse sweating at night
Unexplained weight loss
Recurrent rise in body temperature in the evenings
SYMPTOMS OF EXTRAPULMONARY TUBERCULOSIS (TUBERCULOSIS IN OTHER PARTS OF THE BODY)
Swollen lymph nodes
Chronic back pain and fragile bones
A sensitive gut and
Seizures, headaches, confusion and even alterations in personality if the brain is infected
WHAT TO DO IF YOU BELIEVE THAT YOU HAVE TUBERCULOSIS
“Don’t wait to cough up blood,” says Prof James. “See a doctor if you have had a persistent cough for two weeks!”
Also see a doctor if you have unexplained night sweats and weight loss together with swollen lymph nodes or chronic back pain.
“If you are aware that you’ve been exposed to someone with TB, someone you share a working or living space with, then you might also want to see a doctor to be screened,” Prof James adds.
HOW IS THIS DISEASE TREATED?
Treatment is straightforward, but can take place over a long period of time.
Once the treatment is started, a person will be non-infective in ten to 14 days. In hospitals, a patient will be put in isolation but there is no prescribed quarantine period. “The most important thing is to wear a mask and wash your hands frequently,” Prof James says.
Antibiotics to overcome tuberculosis
“A combination of 4 antibiotics will be prescribed for a period of 6 months to a year, depending on which part of the body is affected,” explains Prof James.
There are newer medications can potentially treat tuberculosis within 3 months, but Prof James shares that, unfortunately, they are not yet available in Malaysia. “At the moment, we’re still using the old regime,” he says.
It is crucial to take these antibiotics on time and as prescribed by the doctor
Otherwise, the bacteria can become resistant to the antibiotics. “This can escalate into extensively drug-resistant TB (XDR TB) and multidrug-resistant TB (MDR TB) – or what is commonly known as superbugs!” Prof James warns.
“Those with MDR/XDR TB can spread it to others and unfortunately for that someone, because the bacteria is already resistant, it becomes very hard to treat. These cases will need a lot of alternative medications involving injections and much longer therapy for up to 2 years. It gets very, very complicated,” he further explains.
WHY ARE WE STILL CONCERNED ABOUT TUBERCULOSIS? WE ALREADY HAVE THE BCG VACCINE TO PROTECT US FROM IT
The Bacille Calmette-Guerin (BCG for short) vaccine is given to Malaysians when they are babies and at primary school.
While the vaccine confers protection against tuberculosis, its effectiveness decreases over the years,
“By the time we are adults, many of us no longer have immunity against the disease,” says Prof James.
Tuberculosis cases in Malaysia are on the rise
Malaysia is still considered a country with a high incidence rate, estimated at 92 per 100,000 population. Prof James reveals that we have about 20,000 to 25,000 new cases every year, with an average of 1,500 to 2,000 resulting deaths.
Interestingly, the number of cases went down during the lock down, when we were wearing masks and practicing social distancing as well as movement control orders. It is when the SOPs are relaxed that the number of cases is up again.
CAN’T WE JUST GET A BOOSTER SHOT?
Sadly, there is no such booster shot currently in existence!
Prof James advises that the best way to keep tuberculosis at bay is to ensure a healthy lifestyle. “Generally, a person who is healthy with a good immune system should be able to fight off TB on their own.”
It is also important to be aware of the symptoms and seek early treatment. “If left for too long, even after recovery, tuberculosis can leave scarring on the lungs that will forever curb a person’s lung capacity,” Prof James states.
Also, it is equally important to stay healthy after recovering from tuberculosis. “Maintain a good diet, exercise, don’t smoke. You can get re-infected with TB and that can be quite bad,” says Prof James.
FEATURED EXPERT ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN
Family Medicine Specialist
International Medical University (IMU)
Myth 1
YOU ONLY CATCH DENGUE ONCE IN YOUR LIFETIME
Unfortunately, no.
“There are 4 dengue serotypes,” says Associate Professor Dr Verna Lee Kar Mun.
Serotype is a word used to describe a strain of microorganism, which means that there are 4 different types of the dengue virus that can infect us.
This means that each of us can get infected up to 4 times, once with each serotype, and achieve total immunity to dengue only after being infected with all 4 serotypes!
“However, before you start thinking it’s a good idea to get infected four times, bear in mind that subsequent infections are likely to be more serious than the first,” warns Assoc Prof Dr Verna, “and each infection only increases your chances of getting severe dengue.”
Myth 2
YOU’RE GETTING BETTER WHEN YOUR FEVER GOES AWAY
Well, things are not so simple.
You see, according to Assoc Prof Dr Verna, there are 3 different stages of dengue fever.
Febrile phase: 1 to 2 days of high fever that begins suddenly. During this time, we’re likely to have experience aches, headache with pain behind the eyes, flushed faces, and sometimes blotchy skin or rashes.
Critical phase: the fever subsides, and we may feel that we are getting better. However, these 1 to 2 days are also a period when our blood capillaries may leak plasma, leading to a sudden drop in blood pressure and sending us into shock.
The next phase will depend on the outcome of the critical phase. We may get better after receiving proper medical treatment and proceed to the recovery phase, or we may get worse and experience severe dengue instead.
“Many viral illnesses such as dengue are self-limiting, which means they will naturally subside,” Assoc Prof Dr Verna shares. “In most cases, patients only need self-care at home, and the most important thing to remember is to take plenty of fluids to prevent the dehydration that comes with plasma leakage.”
“Anyone who gets dengue fever should aim to drink at least 3 litres of water daily for the first 3 days,” she adds.
Myth 3
DENGUE IS ONLY A SMALL CONCERN; AFTER ALL, YOU CAN GET BETTER FROM PRACTICING SELF CARE AT HOME
Not necessarily true.
“An estimated 1% of patients will experience severe dengue, also known as haemorrhagic dengue, which will require hospitalization,” says Assoc Prof Dr Verna.
She goes on to explain that one may begin to experience bleeding during the febrile phase, usually in the skin or gums. If the bleeding weren’t managed well, the dengue will worsen during the critical phase, forcing us to be admitted into the hospital.
“Those with a healthy immune system usually recover in 2 days, but if there is inflammation affecting the organs such as the heart, liver or brain, it can take up to a week, longer if there are other complications,” she goes on to say.
Myth 4
YOU SHOULD ONLY TEST FOR DENGUE AFTER 3 DAYS
“It is true that the initial symptoms are vague, as a fever can be a sign of many different illnesses,” says Assoc Prof Dr Verna.
However, with dengue, the high fever usually comes suddenly.
“The S1 dengue rapid antigen test can detect dengue from the first day, so don’t delay seeking medical advice if you suddenly develop a high fever,” she advises.
Delay in getting tested may lead to severe consequences, as we will enter the critical phase 1 to 2 days after catching dengue—a time when our condition can suddenly take a turn for the worse!
Myth 5
ONCE YOUR NEIGHBOURHOOD HAS BEEN FOGGED, THERE IS NO NEED TO DO ANYTHING ELSE TO PREVENT DENGUE
Not true.
Assoc Prof Dr Verna reveals that while fogging helps to kill adult mosquitoes and getting rid of stagnant water in public drains and other places helps to prevent breeding sites, this method are only partially effective.
To illustrate, millions are spent on fogging efforts every year—an estimated RM777 million was spent on fogging efforts in the 2009 to 2010 period—but dengue remains prevalent to this day. There is even evidence that mosquitoes have grown resistant to the common insecticides used in fogging!
“On a personal level, all of us can do something at home to help prevent mosquito bites and breeding sites. We need to make a bigger effort to protect ourselves and our loved ones by making sure our home environment is clear of any breeding sites, covering up exposed skin and using mosquito repellents, especially during sunrise and sundown,” she advises.
As we welcomed 2023, China reported a huge spike in daily COVID-19 cases during the end of year holiday seasons 2022.
After a period of pandemic fatigue and indifference, the event sparked sudden and short-lived fear and caution among the global as well as Malaysian community.
The news triggered some Malaysians to be up in arms, calling for a ban on travelers from China and reinforcement of pandemic SOPs such as the mandatory wearing of mask in public areas.
Nonetheless, the interest soon died down as other headlines made their way in the news.
It appears that it is only when crises are about to hit our shores that we react.
In fact, as highlighted by the World Health Organisation (WHO), we need to always be prepared and cannot afford to be reactive.
On January 27, 2023, it announced and reminded member countries that COVID-19 remains a public health emergency of international concern.
WHO compared 28-days data between Dec 5, 2022 to Jan 1, 2023 and Jan 2 to Jan 29, 2023.
It found that although the number of cases reported decreased by 78%, the number of deaths increased steeply by 65%.
This result is mainly due to the large wave of cases and deaths in the Western Pacific Region, especially in China.
WHO further states that the numbers may be an underestimation due to the reduction in testing and delay in reporting in many countries.
STAY VIGILANT & PROTECT THE VULNERABLE
3 years into the pandemic, Malaysia has reported more than 5 million cases and over 36,000 deaths.
In 2021, it became the main cause of death in Malaysia, overtaking heart disease.
The risk of death is higher among:
Those above 60 years
Individuals with underlying health conditions
Unvaccinated individuals
According to MOH data between Jan 1, 2022 to July 31, 2022, 75% of COVID-19 deaths were among individuals 60 years and above, and 86% of deaths were among those with at least one underlying health condition .
Compared to the first year of pandemic, we are now more prepared to curb COVID-19 due to advancement in preventive measures, rapid diagnoses, and management tools such as vaccination, rapid test kits (RTK) as well as early treatment with antivirals.
These tools are important particularly to prevent severe COVID-19, keeping individuals especially those with risk factors away from hospitalization, intensive care unit (ICU) admissions and ultimately death.
Nonetheless, these tools will only be useful if they are being utilized optimally.
While Malaysians were quick on the uptake of primary COVID-19 vaccination doses, the uptake of booster doses are very poor with only 49.7% uptake of the 1st booster and a mere 1.6% of the 2nd booster (as of Feb 7, 2023) .
While no concrete data is available, there are good reasons to believe that due to pandemic fatigue, people are now less likely to test and seek treatment for COVID-19.
It is also important to note that antiviral treatment needs to be taken within the first 5 days of symptom onset. Thus, speed is of the essence.
We cannot risk another surge of COVID-19 globally or locally as it would put a toll on our healthcare system and risk overwhelming it.
As it stands, we are currently experiencing overcrowding in Emergency Departments.
Hence, it is crucial that we answer the calls of WHO and the Ministry of Health Malaysia to continue urging the public especially those who are in the high-risk groups (older persons, individuals with underlying medical conditions) to take precautions against COVID-19.
OUR CAMPAIGN
The Malaysian Society of Infection Control and Infectious Diseases (MyICID) in collaboration with the Family Medicine Association Malaysia (FMSA) and Malaysian Medical Association (MMA) are organising an educational campaign themed COVID-19: QUICKLY TEST & TREAT.
Our objectives
This campaign aims to urge the public especially individuals who are at high-risk as well as their family members to continue protecting themselves and others from severe COVID-19 by:
Getting primary and booster doses
Testing immediately upon onset of symptoms
Seeking early treatment, within the first five days of symptoms
Our campaign’s panel of experts
Dr Alif Adlan Mohd Thabit Infectious disease physician
Dr Ang Peng Peng Infectious disease physician
Dr Suriani Sulaiman Family medicine specialist
Dr Balachandran S Krishnan General practitioner
THIS IS A PUBLIC COMMUNITY MESSAGE BROUGHT TO YOU BY
WORDS DR SAPNA SHRIDHAR PATIL & ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN
FEATURED EXPERTS
DR SAPNA SHRIDHAR PATIL School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
Recently, our Ministry of Health detected SARS-CoV-2, the virus responsible for COVID-19, during wastewater surveillance at airports in the country. It was also reported that China has begun SARS-CoV-2 wastewater surveillance for selected cities after the cessation of the country’s zero COVID policy.
WASTEWATER SURVEILLANCE EXPLAINED
In wastewater surveillance, samples of untreated sewage from selected communities and institutions are routinely collected and sent to laboratories for identification and quantification of virus content and testing for different or new virus variants.
Benefits of wastewater surveillance
It provides a rapid real-time ‘snapshot’ of the disease prevalence in the community where the wastewater was sampled from.
Wastewater surveillance also addresses challenges of disease under-reporting due to asymptomatic infections, self-home treatment, and delayed or absent notifications from medical practitioners.
Information from wastewater surveillance can be used to monitor disease burden patterns, reintroduction or emergence of a new pathogen/variant, and even evaluate the impact of community behavioural campaigns such as masking and physical distancing.
An example of the importance of wastewater surveillance is the detection, in 2022, of wild polio virus in sewage samples during routine testing in London and New York before any clinical cases were reported. This prompted the local health authorities to implement immediate measures to enhance the coverage of primary polio vaccination together with polio boosters in at-risk communities.
Limitations of wastewater surveillance
However, wastewater surveillance cannot replace the existing disease notification system and clinical testing as the wastewater comes from pooled community sewage samples and cannot be used for individual diagnosis.
Apart from this, technical and logistic challenges can also affect the accuracy of the results of wastewater surveillance.
Nonetheless, the information from an effective wastewater surveillance system can greatly complement existing notification system, as it provides an early warning alert for local health authorities to implement prompt targeted interventions in the communities at risk.
WASTEWATER SURVEILLANCE & COVID-19 DETECTION
Since the emergence of the COVID-19 pandemic in 2020, there has been ongoing research into the transmission dynamics and ways to curb the disease spread.
It is known that the SARS-CoV-2 virus spreads mainly through oral and nasal secretions. However, the virus is also shed in stools for prolonged periods of time. Individuals infected with the virus can shed the virus in their stools, irrespective of whether they have symptoms of COVID-19.
Wastewater surveillance has been implemented in many countries as an environmental monitoring tool to rapidly detect the presence of the SARS-CoV-2 virus in a community and enable local health authorities to be aware of the transmission risk factors, emergence of new variants, and the impact of community preventive measures.
Hong Kong
Hong Kong detected the delta variant in the sewage samples since the end of December 2020 and strengthened public health interventions by informing the public about the common symptoms, and the importance of continuing physical distancing and masking, in addition to hand hygiene and respiratory etiquette.
United States
In July 2022, California researchers reported that sampling of community wastewater in San Diego detected the presence of the alpha, delta, epsilon, and omicron COVID-19 variants up to 14 days before they started appearing on nasal swabs. This implies that wastewater surveillance applied to transportation-based sanitation systems can serve as an early indicator of possible community transmission.
SO, SHOULD WE BE WORRIED ABOUT COVID-19 IN OUR WASTEWATER?
The general public need not be alarmed by the news regarding the detection of the SARS-CoV-2 virus in human waste.
As COVID-19 has now become endemic across most countries around the world, the detection of the SARS-CoV-2 virus in sewage samples is not an unusual finding.
From the Ministry of Health’s initial reports, the variants isolated are already in circulation in Malaysia and the risk posed to human health and the environment is minimal.
However, being aware of such a system enables all of us to be better receptive of updated information shared by the Ministry of Health from time to time.
WORDS PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
FEATURED EXPERT PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
Infectious Disease Professor
University Malaya Medical Centre (UMMC)
As Malaysia and most of the world transitioned to the endemic phase of COVID-19, it’s easy to forget that just two years ago, the pandemic had led to millions of lives lost, rise in unemployment rates, and the near-collapse of healthcare systems due to the tsunami of cases. Today, thanks to the quick development of medical innovations such as COVID-19 vaccines, we are now able to continue living our lives in the new normal, resuming productivity, and building towards economic recovery and growth.
Now that we have seen the long-lasting and devastating impact that a pandemic can leave, it is vital that we draw our attention to tackling another urgent public health crisis—antimicrobial resistance, which continues to rise to alarming levels across the world.
A SILENT PANDEMIC
Over the years, antimicrobial resistance has become an urgent health challenge on a global scale. This is because microbes such as bacteria, fungi, and viruses no longer respond to commonly used medicines, resulting in infections becoming harder to treat.
How antibiotic resistance happens. Click the image above for a larger, clearer version.
Antimicrobial treatment no longer serves their desired effect, which in turn will increase the risk of poor outcomes in patients with an infection caused by antimicrobial resistance.
During the COVID-19 pandemic, there was a significant increase in antibiotic prescriptions despite a relatively low bacterial co-infection rate.
The misuse of antibiotics in these patients can result in increased selective pressure for antimicrobial resistance leading to a lasting consequence of the COVID-19 pandemic .
Apart from overprescribing of antibiotics unnecessarily, the increased risk of antimicrobial resistance is compounded by the lack of awareness of appropriate antibiotic use and a poor understanding on the consequences of misusing antibiotics among the public .
It is estimated that drug resistance claims 700,000 lives every year, and this toll is projected to increase exponentially to 10 million a year by 2050 without immediate action.
CONCERNING IMPACTS OF ANTIMICROBIAL RESISTANCE
Development of new antibiotics may not be fast enough to replace those that have become less effective due to antimicrobial resistance
The discovery of antibiotics was a turning point in human history, revolutionizing medicine and increasing the survival rates of infected patients over time.
However, the growing burden of antimicrobial resistance threatens the return to a world with a scarcity of effective treatments for even common bacterial infections such as urinary tract infection, pneumonia, skin infection, and surgical site infections.
As the effects of antimicrobial resistance continue to increase today, the discovery and development of new antimicrobials is not able to keep up against the emergence of AMR.
There is an urgent need for new antibacterial drugs in the market, but with this, comes the importance of ensuring that these antibiotics are used wisely.
Patients should be prescribed antibiotics only when needed, at the right dose, frequency, and duration. Otherwise the new antibiotics will also suffer the same fate as its predecessors and eventually lose effectiveness .
Antimicrobial resistance can also result in productivity loss caused by sickness and premature death, as well as rise of healthcare cost that stems from prolonged hospital stays and care
Without effective tools for the prevention and adequate treatment of drug-resistant infections, treatment may fail for an increasing number of patients. There will also be an increased risk in major medical procedures such as surgery, chemotherapy, and organ transplants .
WHAT CAN WE DO TO REDUCE & PREVENT ANTIMICROBIAL RESISTANCE?
We should only take antibiotics when prescribed by a doctor and correctly follow the prescription directions.
Don’t demand for antibiotics and buy medication without a prescription, or share or take leftover antibiotics.
Maintain strict infection prevention measures such as hand hygiene to reduce the spread of antimicrobial resistance organisms.
There is now increasing evidence that certain vaccines currently available for infectious diseases can decrease the risks of AMR by preventing bacterial and viral infections. Keeping up to date on vaccination schedules. particularly for children and elderlies, may be able to reduce the use of antibiotics, and thus prevent antibiotic-resistant infections.
A CALL TO STAKEHOLDERS TO RISE UP & REDUCE THE SPREAD OF ANTIMICROBIAL RESISTANCE
Besides creating awareness among consumers and healthcare professionals, combatting antimicrobial resistance also requires action from governments, policymakers, and industry players to really address the crux of the issue.
Investment is required in antibiotic research and development, both as a tool to control novel disease outbreaks, and to treat known pathogens developing resistance to currently available treatments.
We must learn from the COVID-19 pandemic to address the next global and public health threat. We have seen that it is indeed possible for all parties to work together to reduce the spread of COVID-19—from citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the creation of vaccines and COVID-19 treatment, and governments who put in place and enforced guidelines for the people, while also supporting the R&D of these innovations.
The same urgency is needed so that we can prevent the next public health crisis.
FEATURED EXPERT DATUK DR CHRISTOPHER LEE KWOK CHOONG
Consultant Infectious Diseases Physician
Member of the Malaysian Influenza Working Group
FLU FACTS THAT ARE NOTHING TO SNEEZE AT
On board the plane, you have an 80% chance of getting the flu if there is an infected person–who may or may not have symptoms–sitting one row in front or behind you, within 2 seats to either side.
Flu viruses can survive for up to 48 hours on certain surfaces, including your overhead compartment handle, seat-belt buckle, video screen, food tray, arm-rest, and control panel.
You can try disinfecting the items mentioned in the above point, but it would be impractical to disinfect everything you will touch when you land, such as your luggage bag, trolley, the toilet flush, car door handle and so on.
TRAVELING SOON? HERE ARE 2 SIMPLE TIPS
Tip 1: Follow the COVID-19 SOPs when possible
Masking, although no longer promoted in most countries, may help reduce the chances of catching the flu.
However, it is less effective when those around you are not masked. This is where the next tip comes in.
Tip 2: Get the flu shot
The additional protection conferred by the annual flu vaccination is therefore recommended to prevent the disease.
When injected, the vaccine introduces inactivated flu viruses into the body. These have been killed and are unable to cause disease.
Instead, they stimulate your body to produce antibodies that will spring to your defense if you happen to be exposed to the flu.
Allow 2 weeks to reach the desired level of immunity before flying off.
MORE ABOUT THE FLU VACCINE
It gives you a better shot at beating the flu and reducing your risks of heart problems
Flu vaccination helps prevent severe flu-related infection, hospitalization, and death . It is also associated with a 34% lower risk of major adverse cardiovascular events . There was also an 18% reduced risk of death reported in patients with heart failure .
In people with type 2 diabetes, flu vaccination has been associated with a reduced risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15% .
With the COVID-19, flu, & RSV triple threat in the northern hemisphere, the flu shot is a good bet
Noting that flu viruses mutate constantly, Datuk Dr Christopher Lee explains that currently available flu vaccines have been updated to effectively fight virus sub-types that are circulating in the northern hemisphere at this time.
“This will help reduce your risk of contracting the disease. The flu vaccination is recommended for those travelling abroad, especially high-risk groups as the importation of flu cases through air travel can result in the spread of flu within the community,” he adds. “So, if you have not been vaccinated against the flu, now is a good time to get it done. The annual flu vaccination is your passport to healthy holidays. Don’t leave home without it.”
In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!
DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?
Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.
This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!
Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.
Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”
HOW THE FLU AFFECTS YOUR HEART
When the flu virus enters your system, your immune system strings into action.
Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can alsodamage your own healthy tissues and organs.
One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.
This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.
An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.
Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.
Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.
OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU
In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.
Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”
She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”
“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.
FLU VACCINATION CAN PROTECT YOUR HEART
Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.
There is also an 18% reduced risk of death reported in patients with heart failure.
For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.
Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.
This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).
The article has been edited by HealthToday for publication on this website.
For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).
References:
Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351
FEATURED EXPERT DR LOW LEE LEE
Infectious Disease Physician
Sultanah Bahiyah Hospital
FUNGI: OUR FRIENDS & FOES (IT’S COMPLICATED)
Fungi are found naturally in our environment. There are many different types of fungi, over 2 million species however about 600 fungi have caused diseases.
Invasive fungal infections typically manifest as a severe and aggressive form of the disease, leading to corresponding to high prevalence and death rates if left untreated.
These infections include invasive mold infections.
INVASIVE MOLD INFECTIONS AT A GLANCE
Usually caused by Aspergillus (giving rise to invasive aspergillosis) but can also be caused by other rarer molds such as Mucormycetes (giving rise to mucormycosis).
These molds produce spores; most of us encounter these spores every day without getting ill, but people with compromised immune systems may develop complications as a result of these spores.
Despite invasive aspergillosis and mucormycosis being relatively uncommon, invasive mold infections are often life threatening. If left untreated, the mortality rates can reach 100%!
Various parts of the world reported superinfections of invasive aspergillosis and mucormycosis in patients with COVID-19, which are associated with increased risk of death. COVID-19 likely increases the risk for fungal infections because it weakens the immune system or due to certain therapies used for treatment such as steroids.
There are no specific symptoms, as symptoms can vary depending on the type of infection. This makes diagnosis an infection a challenging and sometimes complicated task!
Invasive Aspergillosis
Aspergillosis and how it affects our lungs. Click on the image for a larger, more detailed version.
Invasive aspergillosis is uncommon and occurs primarily in immunocompromised people.
Commonly seen in people that have undergone stem cell and other organ transplants (especially lung transplant), as well as in patients with blood-related cancers such as acute leukemia.
Typically affects the lungs, but it can also spread to other parts of the body.
Mucormycosis
Mucormycosis is rare and estimated to affect approximately 10,000 cases worldwide, barring India. If India is included the numbers rise to 910,000 cases annually!
Typically occurs in the sinuses of the nose or lungs; however it can spread to the brain and other organs as well.
COMMON SYMPTOMS OF A POSSIBLE INVASIVE MOLD INFECTION
Typical pneumonia symptoms including fever, chest pain, cough, coughing up blood, and shortness of breath
Sinus infection, which may be painful
Pain, tenderness, swelling and pressure around the eyes, cheeks, nose or forehead
One-sided facial swelling
Headaches
Nasal or sinus congestion
Black lesions on nasal bridge
HOW TO REDUCE YOUR RISK OF AN INVASIVE MOLD INFECTION
When performing activities that involve close contact with soil and dust, such as yard work or gardening, take care to wear shoes, long pants, and long-sleeved shirts
Whenever possible, avoid dusty areas like construction or excavation sites; wear a N95 mask when you have to visit these areas
Keep your house dry and mold-free
Avoid staying in a moldy home (even while it is being cleaned)
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DR SAPNA SHRIDHAR PATIL
ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN
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