One Health Manual on Handling Disease Outbreaks in Malaysia

In the past few decades, several emerging infectious and zoonotic disease outbreaks have occurred at an unprecedented rate, resulting in suffering and the death of human and animals, and an enormous financial burden on society. The unique nature of emerging infectious and zoonotic diseases requires rigorous procedures in outbreak investigation involving a multidisciplinary team — a team of many individuals from different specialties and expertise to collaborate together as one, the goal of One Health.

Outbreak investigations are not only important for immediate identification of the source of the outbreak but also to prevent future outbreaks by increasing the knowledge and skills of the people involved in the investigations. Outbreak investigation provide a unique opportunity for collaboration, training, and cooperation between people with different disciplines. The importance of this collaboration cannot be emphasized enough since collaboration increases strategic thinking and effectiveness, optimizes resources, breaks down the practice and mentality of working in silos. It also fosters the creation of new networks and the expansion of existing networks among professionals through multidisciplinary communication, cooperation, and collaboration.

With the financial support from the United States Agency for International Development (USAID) One Health Workforce project, and in collaboration with the University of Minnesota and Tuft University, a multidisciplinary team consisting of members of the Malaysia One Health University Network (MyOHUN) created the One Health Manual: Handling Disease Outbreaks in Malaysia. The creation of this manual provides us with the opportunity to understand our invaluable roles in zoonotic disease prevention and control. This manual is not meant to replace existing manuals or standard operating procedures, but rather, to complement and provide opportunities for field workers to consider all aspects of disease control. It is hoped that this manual will address, to some extent, the numerous issues and barriers related to the implementation of One Health, thereby bridging the gap between concept and implementation.

Users of this Manual should first read the introduction to gain a quick understanding of the One Health Paradigm, as well as its history and development. The six chapters of the manual cover the following topics: (1) Preparations for outbreak investigation, (2) Establish and verify the diagnosis of zoonotic diseases, (3) Laboratory involvement, (4) Developing, evaluating and refining hypotheses, (5) Implementation of control measures, and (6) Communication during outbreak investigations. The authors have done their best to address the topics based on the One Health concept.

Considering this user-friendly multidisciplinary One Health manual on handling disease outbreaks is the first of its kind, we look forward to receiving feedback and suggestions for improvement in future editions, and to provide an avenue to educate the existing and future One Health workforce.

Please contact nco@myohun.com for more information. The complete manual is available to download on Google Play.

Antimicrobial Resistance Surveillance Workshop

On 7-9 March, 2017, a workshop on Antimicrobial Resistance Surveillance was held in Pullman Putrajaya Lakeside with more than 50 participants from various backgrounds attended such as the Department of Fisheries, Department of Veterinary Service, Fisheries Research Institute, Veterinary Research Institute, Institute for Medical Research, Ministry of Health, Universiti Putra Malaysia, Universiti Kebangsaan Malaysia, Universiti Malaysia Kelantan, Hospitals and other institutions and healthcare companies.This workshop was a continuation from the seminar that was held the day before with the same objectives which are to develop the AMR surveillance in animal health, to strengthen and harmonize the AMR surveillance in human, animal and also food.

The first day of the workshop began with the Welcoming Remarks by Dr. Mohamed Nazir Paa from the Ministry of Health and continued with an Introduction to the Workshop by Dr Suraya Amir Husin from the Ministry of Health. In her introductory speech, Dr. Suraya explained that the aim of the workshop was to establish a Malaysian Antimicrobial Resistance Surveillance System (MARSS) by the end of the workshop.

The workshop then continued with the introduction to the AMR Surveillance Manual Development to the participants from the guest speakers; Dr Amanda Beaudoin and Dr. Julio Alvarez, from University of Minnesota, United State in which they also facilitated the participants throughout the 3-days workshop. In the beginning of the workshop, the participants were divided into 2 groups according to their discipline in categories of human and animal. After a deep and informative discussion with the facilitators about the framework and elements that should be in the surveillance’s manual, the participants were divided into a smaller group to come out with their own ways to produce the surveillance’s manual based on their own discipline and expertise. On the last day of the workshop, each group presented their findings and the workshop ended with the Closing Remarks from Assoc. Prof. Dr. Latiffah Hassan from Universiti Putra Malaysia.

Click here to see more photos from this event

Into the Woods

The Malaysian One Health Workforce seeks to prevent Zoonotic Diseases among Jahai community In Belum Forest.

On 11 – 12 February, 2017, students from the Department of Public Health Medicine at Penang Medical College (PMC) and the Faculty of Veterinary Medicine at Universiti Putra Malaysia (UPM) conducted a field attachment trip to Sungai Tiang in Belum forest – one of the world’s oldest rainforests located in Perak, Malaysia. The trip was part of a research grant from Malaysia One Health University Network (MyOHUN), a network under the USAID One Health Workforce project, to study the Knowledge, Attitude and Practices and the potential interventions in response to zoonotic infections primarily transmitted by dogs among the Jahai community in the area. Being cognizant of the fact that the Orang Asli of the Jahai people are a marginalized tribe living in the forests of the jungle, which contributes to problems with stray dog population in their community. The researchers conducted this study among this group of indigenous people to develop One Health intervention strategies to break the chain of zoonotic infections transmitted by dogs among them.

The Jahai are generally hunter gatherers and use dogs for hunting purposes, however due to uncontrolled breeding and lack of general predators, the dogs now number about 100 and live as strays. The dogs in the communities run around without proper care or healthcare, including vaccinations or deworming procedures. This lack of care can potentially lead to the emergence of zoonotic infections in human as a result of transmission through these dogs. As part of the intervention from One Health Workforce, the students were able to instill knowledge and bring awareness of the potential morbidity and mortality associated with zoonotic infections transmitted by dogs.

Performing a survey to a Jahai family by a student participated in the trip

The 35 students from PMC and UPM participated in the first phase of the project to interact with the community. The group met in the morning on Banding Island to start their journey to the location by house boat. The day’s project centered around a group of students performing data collection, which included a questionnaire on knowledge, attitudes and practices of the Jahai community on zoonotic infections transmitted by dogs, while another group collected blood and swab samples from the stray dogs. In total, 175 people responded to the survey and 35 dog samples were collected. Beyond the data collection process, the students had the opportunity to share information on the awareness of potential risks associated with the stray dogs. Learning was not one sided, the students took this opportunity to learn about the Jahai community and their social and cultural structure besides getting to know each other.

The trip ended with debriefing by Prof. Dr. Abdul Rashid Khan of PMC and Dr. Lau Seng Fong of UPM the next afternoon. The UPM and PMC team began their long journey home with better understanding of the human, animal and environment interaction and an appreciation of the importance of working together to achieve a common goal. The project also exposed the students to a community that showcased how important their work and awareness building in One Health is to certain populations.

Students captured a memory with the Jahai children

“The trip teaches me that there is a need of kindness and appreciation in this neglected part of our mother land for both man and animals. It is always better to give rather than to receive,” said Ching Jia Jie, a year 4 Veterinary Medicine student in UPM.

The second phase of the project is scheduled for May 2017 as another opportunity for students and lecturers to share knowledge, experience, to become effective One Health workers and ambassadors.

One Health Young Leader

In making a stronger and reliant future generation, it is vital to give them the right start, and nurture their development and it is no difference with our One Health (OH) future workforce today. In enhancing the capabilities of the young leaders, from 10th to 14th November 2016, the One Health Young Leader’s workshop was held in Perdana Resort and Pantai Cahaya Bulan Resort, Kota Bharu, Kelantan. The aims of the program were to enhance OH knowledge among the young leaders and to establish sustainable networking for the future One Health Workforce (OHW). A total of 117 participants attended the program from 3 different Universities namely Universiti Sains Malaysia (USM), Universiti Malaysia Kelantan (UMK) and Universiti Sultan Zainal Abidin (UNISZA) from a variety of backgrounds. Several lectures were given by notable speakers to encourage the future OHW to use the knowledge and understanding of the One Health concept to develop, implement and sustain the health of human, wildlife and environment

Mapping One Health Implementation in Curriculum

Educating and implementing One Health concept to the younger workforce is one of the key elements in the One Health approach. This can be done through implementing the One Health concept through the existing curriculum in institutions. In tandem with the idea, a workshop in Mapping One Health Implementation in Curriculum was held from 20th to 23rd October in Ramada Plaza Hotel, Melaka. Aimed to document the implementation of One Health core competencies according to the Malaysian Universities Curriculum, 33 participants attended the workshop who came from a variety of expertise related to the Human-Animal-Environmental Health. Two academicians from MyOHUN members; Dr Razitasham Safii from Universiti Malaysia Sarawak, and Dr Rozaihan Mansor from Universiti Putra Malaysia were invited to share their experience on the implementation of One Health core competencies in their courses. Dr Karin Hamilton from the University of Minnesota, USA guided and facilitated the discussions on mapping One Health competencies and concepts into the curriculum and courses. The compilation of information on One Health core competencies progressed well since most institutions involved have already documented the implementation of One Health core competencies in their courses.

A Workshop on the Development of a One Health Manual on Handling Disease Outbreaks III

Continuing from the last workshop in August, from 19th to 22nd October at the Swiss Garden Resort, Lumut Perak, a Workshop on the Development of a One Health Manual on Handling Disease Outbreaks III was held in order to finalize the manual. In this workshop, each groups had to review their chapter as well as reviewing a chosen chapter from another group. This workshop was the third of the three workshops planned to develop the first ever user-friendly multi-disciplinary One Health Manual on handling disease outbreaks in Malaysia. Only 12 participants were involved at this stage where there were 5 representatives from universities, 5 from Department of Veterinary Services and 2 from the Ministry of Health. During the workshop, constructive comments were made by members and participants and amendments to the manual were made in the workshop itself. The final draft of the manual was assembled by the project leader before another meeting with representatives from each group will be held to check and finalize the draft. Afterward, the finalized manual will be forwarded to the Director General of Ministry of Health and Department of Veterinary Service to contribute their foreword.

In-Situ One Health Problem Based Learning

The In-Situ One Health Problem Based Learning was held from 7th to 9th October and also from 14th to 16th October 2016. The program was held at the Centre for Livestock Farming, Lenggong, Perak. The objective of the program was to expose students to the application of theories learned in class at the pre-clinical level to the problem investigation used by the One Health concept. Other than that, this program also aimed to introduce in-situ Problem Based Learning (PBL) experience to a more diverse group of students covering medical, veterinary and ecosystem health. 160 participants from various courses namely Animal Conservation, Biology, Biomedical Science, Veterinary Medicine, Public Health, Environmental Health, Medicine, Pharmacy, and Plant Science were involved in this program. PBL cases were designed in this program to integrate the knowledge of One Health with inputs and participation from local and international facilitators. At the end of the session, the participants acquired knowledge about One Health and were able to relate concepts of PBL in the field compared to the knowledge they acquired in a classroom setting. Participants also had the opportunity to learn and understand more about the real-life situation faced by the respected agencies during a zoonotic disease outbreak and safety measures that need to be taken to curb and prevent the occurrence of the diseases.

Training of Communication and Leadership for One Health Community Education

Organised in Pasir Mas, Kelantan, the Training of Communication and Leadership for One Health Community Education was held from 16th to 18th September 2016. A total of 92 undergraduate students from 5 universities namely Universiti Kebangsaan Malaysia, Universiti Putra Malaysia, Cyberjaya University College of Medical Sciences, Penang Medical College and Universiti Malaysia Kelantan were involved in this program. The program achieved all the objectives aimed at promoting the One Health concept to the community, to train future workforce of the One Health program, and also to develop students’ communication and leadership skills. Using the concept of foster families, 2-3 students were assigned to a foster family while promoting health knowledge using the material provided to the families. The communities involved also had the opportunities to attend health talks, a health screening test and health exhibitions. This program not only exposed students to the larger and worthy experiences but also provided the opportunity for the students to give back and reach out to the community.

Training of Trainer (ToT) and Simulation of IN-SITU Problem Based Learning Cases Workshop

The Training of Trainers (ToT) and Simulation of in-situ Problem Based Learning (PBL) Cases Workshop was held at the Copthorne Hotel and Jaya Dairy Farm, Cameron Highlands, Pahang from 22nd to 25th of August 2016. 31 participants from different disciplines such as Veterinary Health, Medicine, and Environmental Health presented. The workshop aimed to prepare facilitators to meet the requirements to conduct the in-situ PBL, assess the suitability of the current One Health PBL cases, and also to train new facilitators from other related disciplines in facilitating the in-situ PBL session. Engaged in scenarios created, participants were actively involved in activities which prompted their skills that will be needed in real-life situations. In relation to the workshop, most participants acknowledged the importance of the knowledge and workshops in order to develop a better and greater One Health future workforce.

Workshop on the Development of One Health manual on Handling Disease Outbreaks II

Progressing on the Development of a One Health manual on Handling Disease Outbreaks, a second workshop was held from 22nd to 25th August in Melaka at the Ramada Plaza Hotel. Previously there were 5 groups from each discipline that has made a preliminary outline of the manual which provided a step to step guide to an outbreak investigation. This manual can be used by a novice and also act as reference for the experts in the field during the management of an outbreak. There were 25 participants involved in the workshop in which 14 participants came from universities, 1 from the Institute of Medical Research, 8 from the Department of Veterinary Services, and 2 from the Ministry of Health. During this workshop, each multidisciplinary group made appropriate corrections and changes for the manual. A draft of the manual was completed respectively according to the template of the manual. A number of issues were detected and resolved when discussing the chapters. During this workshop, experts from the Ministry of Health and Department of Veterinary Services who were part of the team gave impromptu talks on what their responsibilities are and gave a clear image of the human-veterinary service role during an outbreak.