1. EPIDEMIOLOGICAL HEALTH RISK ASSESSMENT DURING HEAVY FLOOD IN EAST COAST MALAYSIA Ahmad Faudzi Yusoff, Amal Nasir Mustafa, Tharmarajah Nagalingam, Kee Chee Cheong, Zamtira Seman, Nur Farhanah Khalil

2. Introduction  History : ‘Bah Merah’ in Kelantan in 1926 and 1967 (38 deaths)  Disaster again hits the country, several states heavily affected including Kelantan-25 December 2014.  Immediately Ministry activated Crisis Preparedness & Response Centre (CPRC)  Emergency teams mobilized to the field with a proper preparation.  IMR involved doing epidemiological health risk assessment : Leptospirosis & Melioidosis.

3. Risk Assessment Framework During and post flood assessment The mode of transmission PPE (Personal Protective Equipment) Environmental factors Sanitation Water and food supplies Host factors: co-morbidity, activity Reservoir

8.  Questionnaire preparation and discussion  Formation of investigation teams.  Study design : Case-control study vs Cohort study  Confidence interval 95%, significant level 0.05, power of study 80%, sample size estimation  Risk estimate : Odds Ratio(OR) vs Relative risk

9.  Epidemiological link  Laboratory supports  Environmental sampling  Briefing and Training  Ethical approval was not required.

10. Briefings& Training

12.  Case definition  Suspected cases vs confirmed cases  Confirmation of cases : the role of IMR and MKA(KB) for laboratory diagnosis.  Coordination and management of laboratory support.  Involvement of the stakeholders.

13.  Flood affected areas  Health facilities : Hospitals in flood affected districts, Reference hospitals (Kota Bharu, HUSM and Private Hospitals).  Representative of the state.  Visit to the affected areas : During and Post flood.  Identification and observation of high risk area of disease transmission.

14. Site Visit in Affected Area

17. Melioidosis BilDistrict Number of cases Suspected Blood Sample Taken Confirmed 1Kota Bharu975820 2Kuala Krai1292 3Machang1092 4Tanah Merah14 0 5Gua Musang28237 6Tumpat660 7Jeli991 8Pasir Mas880 Total18413632

18. Leptospirosis BilDistrict Number of cases Suspected Blood Sample Taken Confirmed 1Kota Bharu977723 2Kuala Krai1293 3Machang10 7 4Tanah Merah14 7 5Gua Musang28231 6Tumpat662 7Jeli991 8Pasir Mas883 Total18415647

19.  Ideally, the investigation teams should be functioning independently during disaster. E.g. Sample collection, blood taking, interviewing patients, sample transportation and logistic preparation.  Full support, commitment and understanding from top management during disaster.  Coordination from relevant department.  Sense of urgency, significant of the issues and accountability

22.  Strengthening the coordination and cooperation in laboratory supports.  Risk communication : Public (Awareness )vs Medical Staff (Alertness and awareness).  Team of experts from IMR to be established for flood disaster health risk assessment.  IMR to collaborate with other expert agencies e.g. EIP

23.  It was a successful risk assessment for Leptospirosis and Melioidosis which were carried out and detail results will be presented and published in peer-review journals.  Full financial support.