The 2009 swine flu pandemic in Malaysia was part of a global outbreak caused by a new strain of the influenza A virus subtype H1N1 (A/H1N1).[1] The first confirmed case in Malaysia was reported on 15 May 2009, involving an imported case from the United States. Subsequent imported cases from countries such as Australia were detected, with the first case of local transmission identified on 17 June 2009.[3]
As of 11 August 2009, Malaysia recorded over 2,253 cases, and by 21 August, the unofficial number of cases reported in the media had risen to 5,876. The first death related to the A/H1N1 virus occurred on 23 July 2009, and the total death toll reached 78 by early 2010.[4]
In response to the growing number of cases, the Malaysian government declared a national health emergency and shifted its strategy from containment to mitigation on 6 July 2009.[5] This approach aimed to minimize the impact of the virus by focusing on managing severe cases and slowing its spread within the community.[6] The government also considered imposing strict measures, including a health curfew similar to the week-long shutdown implemented in Mexico during the pandemic's early stages.[6] Schools, public gatherings, and workplaces were closely monitored, with temporary closures implemented in affected areas.[7]
On 12 August 2009, the Malaysian Health Ministry ceased issuing daily updates on the total number of H1N1 cases in line with the guidelines of the World Health Organization, emphasizing the monitoring of severe cases rather than total case counts.[8] By early 2010, while new cases were still being reported, the Malaysian government declared the situation under control, citing effective mitigation measures and the healthcare system's capacity to manage the outbreak. Health authorities continued monitoring for new cases to prevent a resurgence of the virus.[9][10]
Terminology
The flu virus was officially designated by the WHO as "Influenza A (H1N1)", following a name change from "swine flu" to avoid implying that eating pork products carried a risk of infection. This designation was also used by Malaysia's Health Minister. However, on 25 June, Information, Communications, and Culture Minister Rais Yatim suggested that the local media use "swine flu" (Malay: selsema babi) instead. He justified this by stating that the dangers of the flu would be better understood by the public and that the term would be easier to describe in Malay, a language officially used in news programs on government-owned television and radio channels.[11]
Transmission timeline
Malaysia reported no suspected cases of A(H1N1) before 4 May 2009.[12] Between 4 and 15 May, several cases were tested, but all results came back negative. The 2009 FOBISSEA Primary Games in Kuala Lumpur were canceled after an unidentified student contracted the virus while at the airport. Teams from British International Schools throughout Southeast Asia were sent home and quarantined.
On 15 May, Malaysia reported its first case of A(H1N1) infection. The patient was a 21-year-old male student who had arrived at Kuala Lumpur International Airport (KLIA) on 13 May. He traveled on Malaysia Airlines flight MH091 from Newark, New Jersey, with a transit stop at Stockholm-Arlanda Airport. The second case was confirmed on 16 May, involving a female student who had been on the same flight as the first patient. She later boarded an AirAsia flight (AK5358) to Penang.[13][14] Malaysia became the 36th country to detect A(H1N1) cases within its borders.[14]
The first patient was hospitalized at Sungai Buloh Hospital, while house quarantines were implemented for two friends of the second patient and their family members.[15][13] The Health Ministry urged all passengers of Malaysia Airlines flight (MH091) and AirAsia flight (AK5358) to contact the Ministry or health offices for preventive measures.[16] Thermal scanners continued to be used at airports despite the first patient's symptoms not being detected.[14]
Thermal scanning for swine flu at Singapore Airport
On 4 June, three inbound airline passengers were confirmed to have the virus. The first was a 23-year-old student returning from the United States on 1 June via Malaysian Airlines flight (MH091). On the same day, two German tourists, traveling in Southeast Asia, tested positive after arriving in Malaysia. They had flown into the country on 3 June via an Air Asia flight (AK702) after transferring from a Singapore Airlines flight (SQ45) from Germany to Singapore on 1 June.[17][18] All three patients showed symptoms on 3 June and were hospitalized. Passengers from their flights were traced for further action.[17][18]
On 17 June, the first local transmission was confirmed, marking Malaysia's 19th case.[19] By 20 June, Malaysia had recorded 42 cases, with the first school closure at SJK(C) Davidson after students contracted the virus locally.[20]
By early July, 574 cases were confirmed, including 159 local transmissions.[21] On 23 July, Malaysia reported its first H1N1-related death.[22]
By August 2009, daily new cases exceeded 200, with a total of 2,253 cases by mid-month.[23]
Deaths
Reported death as of 15 October 2009
Since the confirmation of Malaysia's first A(H1N1)-related death on 23 July 2009, the virus claimed several lives, particularly among high-risk individuals. The first fatality was a 30-year-old Indonesian man with multiple medical conditions, including obesity and an enlarged heart. Health Minister Liow Tiong Lai clarified that A(H1N1) was not the direct cause of his death.[24]
By early August, fatalities began to rise sharply. On 6 August, a 57-year-old diabetic pensioner with hypertension succumbed to the virus in Putrajaya.[25] The following day, a 40-year-old obese man died at Kuala Lumpur Hospital after developing acute coronary syndrome and cardiogenic shock, making him the nation's 15th fatality. By 8 August, the death toll reached 18, including a 5-year-old boy who died of acute encephalitis secondary to H1N1, and a 1-year-old toddler who succumbed to pneumonia.[26][27]
The following week saw a dramatic increase in fatalities, with eight deaths recorded on 9 August, raising the toll to 26. The victims included individuals with pre-existing conditions, such as asthma and obesity, as well as a 20-year-old college student who died unexpectedly at her hostel. A similar trend continued with six more deaths on 10 August, followed by another six the next day, pushing the total to 38.[28][29][30]
By 12 August, the death toll had climbed to 44. This included a 60-year-old man with diabetes and hypertension, an 18-year-old pregnant woman, and a 1-year-old toddler with congenital heart disease. Each succumbed to complications such as severe pneumonia and organ failure.[31]
The rising fatalities prompted public health measures and the administration of antiviral drugs such as Tamiflu. However, the virus continued to claim lives among both high-risk and seemingly healthy individuals. By the end of August, the death toll had risen to 72, with victims ranging from young children to elderly individuals with pre-existing medical conditions.[32] By mid-September, the death toll had reached 77, including a 45-year-old woman with hypertension, a 15-year-old girl with a history of asthma, and a 19-year-old teenager who succumbed to severe pneumonia.[33][34]
On 12 April 2010, Malaysia recorded another death from the virus, involving a 42-year-old male lawyer from Johor Bahru. This marked the country's 78th fatality since the outbreak began last year and the first death in 2010.[35] The Malaysian government continued to emphasize public awareness, health screenings, and the importance of timely medical intervention to mitigate the outbreak's impact.
Outbreak evolution in Malaysia:
Deaths
Confirmed cases
Government responses
The Malaysian government stockpiled over 2 million doses of Tamiflu, an antiviral drug used to treat influenza, in anticipation of a potential outbreak
The Malaysian government developed the National Influenza Pandemic Preparedness Plan (NIPPP) as a structured guide for pandemic preparedness and response. This plan provided a policy and strategic framework for a multisectoral approach, offering specific guidance to the Ministry of Health at various levels, governmental agencies, and non-governmental organizations to ensure efficient resource utilization before, during, and after a pandemic.[36]
Under the leadership of Liow Tiong Lai, the Malaysian Ministry of Health initiated health screenings at air, sea, and land entry points for passengers traveling to and from Mexico, starting on 17 April 2009.[37][38] The Health Ministry's disease control division activated its operations room to monitor the swine flu situation. Medical practitioners were advised to report cases with influenza-like symptoms, severe pneumonia, or recent travel to Mexico, California, or Texas to the district health office for immediate preventive and control measures.[39] As with several other Asian nations, thermal scanners were installed at entry points, including the Kuala Lumpur International Airport (KLIA), following the global alert on swine flu.[40] Screenings were extended to Pengkalan Hulu at the Malaysia-Thailand border by late April.[41] Additionally, quarantine rooms were allocated across 28 hospitals,[42] and the government stockpiled over 2 million doses of Tamiflu by May 2009.[43]
The Malaysian Health Ministry reminded citizens not to withhold health information, warning that violators could face penalties under the Disease Prevention Act 1988, including fines up to RM10,000, imprisonment for up to two years, or both.[44] On 18 June 2009, Deputy Prime Minister Muhyiddin Yassin announced that all travelers, including Malaysians returning from abroad, would be required to complete health declaration forms due to the global influenza A(H1N1) pandemic.[45]
Mitigation of the virus
On 17 August 2009, the government indicated that it would consider implementing a health curfew if the mortality rate for influenza A(H1N1) exceeded 0.4%, compared to the current rate of 0.1%-0.3%. Health Minister Liow Tiong Lai confirmed that the situation was being treated as a "health emergency".[46]
Public health measures
The Ministry of Health (MOH) poster urged the public to maintain hygiene by covering coughs, washing hands, wearing masks, and avoiding crowds to prevent disease spread during the 2009 swine flu pandemic in Malaysia.
Health Minister Liow Tiong Lai urged the public to wear masks if they exhibited flu symptoms, emphasizing its role in protecting others from infection.[47] In addition to wearing masks, individuals were encouraged to practice good hygiene, such as washing hands regularly and avoiding crowded places when unwell.
Closure of educational institutions
In response to the country's first confirmed case of A(H1N1), the Malaysian Ministry of Health urged the public to remain calm, assuring that the situation was under control and that comprehensive precautionary measures had been implemented in accordance with the World Health Organization's level-five alert.[48] On 16 May 2009, strict hygiene protocols were introduced in schools nationwide to minimize the risk of outbreaks among students and staff.[49] As a preventive measure, several affected schools, universities, and PLKN training camps were temporarily closed for approximately one week to curb the spread of the virus.[50][51][52][53]
Vaccination campaign
In response to the 2009 swine flu pandemic, Malaysia implemented a national vaccination campaign to curb the spread of the H1N1 influenza virus. The campaign was part of a comprehensive public health effort to protect vulnerable populations and mitigate the impact of the pandemic.[54] Vaccinations were offered free of charge to healthcare workers, who were considered at higher risk due to their frontline roles in managing the crisis. By prioritizing this group, the government aimed to ensure the stability of the healthcare system during a time of heightened demand.
The H1N1 vaccine used in Malaysia was both safe and effective, with a safety profile similar to that of the seasonal flu vaccine. Additionally, the vaccine was available in a nasal mist form, which provided an alternative to traditional injections, making administration easier for certain groups. The vaccination program specifically targeted those most at risk, including young people who lacked immunity to the virus, as well as pregnant women, individuals with pre-existing medical conditions, and residents of institutional settings where the virus could spread rapidly. Older individuals were less affected as many already had some immunity from exposure to similar influenza strains in the past.[54]
1 2 Chindambaram, Suresh Kumar. "H1N1 – Portal MyHealth". Portal MyHealth. Archived from the original on 26 November 2024. Retrieved 26 November 2024.
↑ "Health Alert H1N1 (3/2010)"(PDF). Jabatan Kerajaan Tempatan, Kementerian Perumahan dan Kerajaan Tempatan Malaysia. 2010. Archived(PDF) from the original on 28 November 2024. Retrieved 29 November 2024.
Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.
Influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus (IAV). Some human-adapted strains of H1N1 are endemic in humans and are one cause of seasonal influenza (flu). Other strains of H1N1 are endemic in pigs and in birds. Subtypes of IAV are defined by the combination of the antigenic H and N proteins in the viral envelope; for example, "H1N1" designates an IAV subtype that has a type-1 hemagglutinin (H) protein and a type-1 neuraminidase (N) protein.
An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been five major influenza pandemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.
The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus. The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".
The 2009 flu pandemic in the United States was caused by a novel strain of the Influenza A/H1N1 virus, commonly referred to as "swine flu", that was first detected on 15 April 2009. While the 2009 H1N1 virus strain was commonly referred to as "swine flu", there is no evidence that it is endemic to pigs or of transmission from pigs to people; instead, the virus spreads from person to person. On April 25, the World Health Organization declared a public health emergency, followed concurringly by the Obama administration on April 26.
The 2009 swine flu pandemic in Canada was part of an epidemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu. In Canada, roughly 10% of the populace has been infected with the virus, with 428 confirmed deaths ; non-fatal individual cases are for the most part no longer being recorded. About 40% of Canadians have been immunized against H1N1 since a national vaccination campaign began in October 2009, with Canada among the countries in the world leading in the percentage of the population that has been vaccinated. The widespread effect of H1N1 in Canada raised concerns during the months leading to the XXI Olympic Winter Games, which took place in Vancouver in February 2010.
This article covers the chronology of the 2009 novel influenza A (H1N1) pandemic. Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths, and relevant sessions and announcements of the World Health Organization (WHO), the European Union , and the U.S. Centers for Disease Control (CDC).
In March and April 2009, an outbreak of a new strain of influenza commonly referred to as "swine flu" infected many people in Mexico and other parts of the world, causing illness ranging from mild to severe. Initial reports suggested that the outbreak had started in February due to farming practices at a pig farm half-owned by Smithfield Foods. Smithfield Foods stated that it had found no clinical signs or symptoms of the presence of swine influenza in the company's swine herd, or among its employees at its joint ventures in Mexico, that it routinely administers influenza virus vaccination to their swine herds and that it conducts monthly testing for the presence of swine influenza. The new strain was identified as a combination of several different strains of Influenzavirus A, subtype H1N1, including separate strains of this subtype circulating in humans and in pigs.
Australia had 37,537 confirmed cases of H1N1 Influenza 2009 and 191 deaths reported by Department of Health but only 77 deaths reported by the Australian Bureau of Statistics. The actual numbers are much larger, as only serious cases warranted being tested and treated at the time. Suspected cases have not been reported by the Department of Health and Ageing since 18 May 2009 because they were changing too quickly to report. Sources say that as many as 1600 Australians may have actually died as a result of this virus. On 23rd of May 2009 the federal government classified the outbreak as CONTAIN phase except in Victoria where it was escalated to the SUSTAIN phase on 3rd of June 2009. This gave government authorities permission to close schools in order to slow the spread of the disease. On 17 June 2009 the Department of Health and Ageing introduced a new phase called PROTECT. This modified the response to focus on people with high risk of complications from the disease. Testing at airports was discontinued. The national stockpile of antiviral drugs were no longer made available to people with the flu unless there were more than mild symptoms or a high risk of dying.
This article deals with the status and efforts regarding the 2009 swine flu pandemic by country and continent/region.
The pandemic H1N1/09 virus is a swine origin influenza A virus subtype H1N1 strain that was responsible for the 2009 swine flu pandemic. This strain is often called swine flu by the public media due to the prevailing belief that it originated in pigs. The virus is believed to have originated around September 2008 in central Mexico.
The 2009 swine flu pandemic was confirmed to have spread to the Philippines on May 21, 2009. In the following days, several local cases were reported to be caused by contact with two infected Taiwanese women who attended a wedding ceremony in Zambales.
The 2009 flu pandemic in Asia, part of an epidemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu, afflicted at least 394,133 people in Asia with 2,137 confirmed deaths: there were 1,035 deaths confirmed in India, 737 deaths in China, 415 deaths in Turkey, 192 deaths in Thailand, and 170 deaths in South Korea. Among the Asian countries, South Korea had the most confirmed cases, followed by China, Hong Kong, and Thailand.
The 2009 swine flu pandemic in North America, part of a pandemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu, began in the United States or Mexico.
The United States experienced the beginnings of a pandemic of a novel strain of the influenza A/H1N1 virus, commonly referred to as "swine flu", in the spring of 2009. The earliest reported cases in the US began appearing in late March 2009 in California, then spreading to infect people in Texas, New York, and other states by mid-April. Early cases were associated with recent travel to Mexico; many were students who had traveled to Mexico for Spring Break. This spread continued across the country's population and by the end of May there were approximately 0 confirmed cases throughout all 50 states.
The 2009 swine flu pandemic in New Zealand was caused by a novel strain of the A/H1N1 influenza virus. A total of 3,175 cases and 69 deaths were recorded, although a seroprevalence study estimated that around 800,000 individuals may have been infected during the initial wave of the pandemic.
The 2009 swine flu pandemic in India was the outbreak of swine flu in various parts of India. Soon after the outbreak of H1N1 virus in the United States and Mexico in March, the Government of India started screening people coming from the affected countries at airports for swine flu symptoms. The first case of the flu in India was found on the Hyderabad airport on 13 May, when a man traveling from US to India was found H1N1 positive. Subsequently, more confirmed cases were reported and as the rate of transmission of the flu increased in the beginning of August, with the first death due to swine flu in India in Pune, panic began to spread. As of 24 May 2010, 10193 cases of swine flu have been confirmed with 1035 deaths.
The 2009 flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On 11 June 2009, WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experience mild symptoms", but some persons are in higher risk groups, such as those with asthma, diabetes, obesity, heart disease, or who are pregnant or have a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the person's condition declines quickly, often to the point respiratory failure.
The 2009 swine flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On the 11th of June 2009, the WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experience mild symptoms, but some persons are at higher risk of suffering more serious effects; such as those with asthma, diabetes, obesity, heart disease, or those who are pregnant or have a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the sufferer's condition declines quickly, often to the point respiratory failure. Although Ukraine was not (very) affected at first there was on outbreak of the virus in Western Ukraine in early November 2009 that led to the closing of public buildings and cancellation of meetings for three weeks.
The 2015 Indian swine flu outbreak refers to an outbreak of the H1N1 virus in India, during early 2015. The states of Gujarat and Rajasthan were the worst affected.
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