Download Guidelines of Clinical & Public Health Management of Melioidosis in Pahang PDF

TitleGuidelines of Clinical & Public Health Management of Melioidosis in Pahang
File Size953.8 KB
Total Pages55
Table of Contents
                            PAHANG MELIO GUIDELINE (final) 030811 part1
Appendix 8-Melio Inv Form 030811 part2
PAHANG MELIO GUIDELINE (final) 030811 part3
Document Text Contents
Page 2



This guideline is meant to be a guide for clinical and public health practice,
based on the best available evidence at the time of development.
Adherence to this guideline may not necessarily guarantee the best
outcome in every case. Every health care provider is responsible for the
management of his/her patient based on the clinical picture presented by
the patient and the management options available locally.


This guideline is to be reviewed after 3 years or sooner if new evidence
becomes available.

Pahang Melioidosis Guideline Secretariat
Communicable Disease Control Unit
Pahang State Health Department
12th Floor, Wisma Persekutuan
Jalan Gambut, 25000 Kuantan

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All outbreaks or any unusual event that is suspected to be an
outbreak of melioidosis must be reported within 24 hours to the
nearest district health office.

9.2.1 Investigation

All outbreaks and unusual event must be investigated. Case
investigation must be done by using the investigation form (Appendix
8). History of movement of the case during the incubation period
including activities or occupational exposure must be established to
determine possible source of infection. Any epidemiologically-linked
events that lead to an outbreak must be established to determine
possible source of infection. All other persons who are likely to be
exposed to the common source must be identified and their health
status must be assessed. Algorithm for laboratory investigation is
carried out as in Appendix 3.

9.2.2 Operation Room

An operation room must be set up in the event of an outbreak. Please
refer to the Infectious Diseases Outbreak Rapid Response Manual36
for details. The district outbreak committee must be alerted and
activated if necessary.

9.2.3 Case registration

Confirmed cases must be registered in the Pahang melioidosis

9.2.4 Prevention and control

Based on the investigation, necessary preventive and control
measures need to be taken. It may vary according to source and the
nature of infection. Preventive measures must be based on
knowledge of the groups at particular risk of infection and the local
epidemiological factors.

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28 Active Case Detection

All persons who are exposed to the common source must be
identified and their health status must be assessed. Anybody who
develops sign and symptoms of the disease must be referred to the
nearest health facility as soon as possible for further management. Passive Case Detection

All nearby health facilities must be informed to be on high alert for
cases coming to seek treatment among the exposed group. They
should be managed by Medical Officer, and the District Health Office
must be informed. Treatment of case

All cases must be given prompt treatment according to this guideline. Environmental investigation

Environmental surveillance must be done. Appropriate samples
should be taken and this could include soil and water. Please refer to
section 6.3 for details on sampling procedure. Personal protective equipm ent

For prevention of occupationally-acquired infections, appropriate
personal protective equipment must be recommended34. Management of contaminated area or source of infection

Closure of the contaminated area or infection source under CDC Act
1988 may be carried out if deemed necessary to prevent further

Alert public or users regarding the possible hazards that can arise
from the contaminated area. Health hazard warning signage needs to
be erected by the management authority of the centre in areas found
to be contaminated through environment risk assessment.
Suggested format of the signage is as attached (Appendix 11).

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Appendix 11


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AEHO Assistant Environmental Health Officer
C&S Culture and Sensitivity
CDC Communicable Disease Control
CRP C-reactive Protein
CT Computerized tomography
CXR Chest X-Ray
EHO Environmental Health Officer
ESR Erythrocyte Sedimentation Rate
FBC Full Blood Count
G-CSF Granulocyte-Colony Stimulating Factor
HoSHAS Hospital Sultan Haji Ahmad Shah
HTAA Hospital Tengku Ampuan Afzan
I & D Incision and Drainage
IFAT Indirect Fluorescent Antibody Titre
IgM Immunoglobin M
IMR Institute of Medical Research
IV Intravenous
MKAK Makmal Kesihatan Awam Kebangsaan
PCR-RT Polymerase Chain Reaction – Real Time
PPE Personal Protective Equipment
TWBC Total White Blood Count
UFEME Urine Full and Microscopic Examination
UIAM Universiti Islam Antarabangsa Malaysia
USG Urine Specific Gravity


The task force members of this guideline would like to express their gratitude and
appreciation to the following for their contributions:

• Panel of external reviewers who reviewed the draft
• The Dean of Kuliyyah Medicine, UIAM Kuantan
• Staffs of Maran District Health Office
• Staffs of CDC Unit , Pahang State Health Department
• Hospital Directors of HTAA and HoSHAS

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