AH1N1 – Pressing Need to Re-strategize and Prevent secondary bacterial pneumonia

By Dr Ng Swee Choon, Committee member of the Medical Affairs Committee, Federation of Private Medical Practitioners’ Associations Malaysia


A H1N1 is a very infectious disease. It spreads by droplet spread and so it is easily transmitted. The DG of Health calls it a high attack rate. For a country of 27 million, struggling with this crisis since April 2009, and with national and international transportation being so widely used, for such an infectious disease, 4,200 reported cases so far is a severe under-reporting.

There has been much alarm over the rising number of cases and fatality rate and rightly so, because this ithe A(H1N1) is an very infectious disease. While alarm and widespread panic is not necessary, there exists the pressing need to restrategize and implement mechanisms and Standard Operating Procedures (SOP) for the prevention of secondary bacterial pneumonia

There are probably 20x that number of cases out there that are not reported. Because of this issue of under-reporting, many countries have stopped trying to report the number of new cases.

Unfortunately, 67 have died in Malaysia. But if you were to be objective, 67 deaths, out of possible 70-80,000 cases, give a death rate of 0.08%. Still a bit higher than the usual seasonal flu death rate of 0.04%, but surely not any where near panic proportions.

A closer look at the deaths revealed that 80% were A H1N1 associated, or were incidentally found to have contacted the virus, the virus by no means causing the death.

We can call this A H1N1 associated death or death with incidental A H1N1 infection. So, if the certification of death is proper, it may be that only 15 deaths were actually due to A H1N1, giving a fatality rate of 0.02%.

The flu itself is usually a mild disease in the majority of cases. From all available clinical epidemiological evidence, the bulk of patients dying in flu pandemics are from secondary bacterial pneumonias.

This has been shown to be the case in all flu epidemics and pandemics.

This is why we need to consolidate measures that are already in place. This should include a national level SOP whereby all affected patients with secondary bacterial pneumonias would be immediately triage for intensive tertiary level care.

There is no cause for panic but we should all be vigilant, because there is a very infectious disease in our midst.

Good personal hygiene is crucial, now and at all times, even after this crisis. If you are not well, as always, seek medical advice. There is certainly no need to panic and there is no national emergency here.

There is already too much misinformation and misperception of the situation out in the lay media without having to distract the public with the hype about national emergency.