EPIDEMIOLOGY OF

COMMUNICABLE DISEASES
IN MALAYSIA

By
Dr. Mohd Rahim bin Sulong
Public Health Physician
MD (USM), M.Comm. Med.(USM)
FADUSM, CMIA (NIOSH)
Epidemiology Unit, Pahang State Health Department
 Learning objectives
Current situation of Describe what communicable
Communicable Diseases 01
in Pahang/ Malaysia
06 diseases are

Explain the
Explain the process epidemiologic principles
of notification and
05 02 in control and prevention
Public Health action of communicable
diseases
Name the notifiable
diseases in Malaysia
04 03 Describe the surveillance
system in Malaysia
page
02
Objective of The Communicable Diseases Unit
General: To reduce morbidity & mortality of
communicable diseases
Specific:

01 02 03 04 05
To monitor, To implement the
conduct situational To conduct To prevent & To enforce
control the communicable health promotion &
analysis and epidemiological
communicable diseases law education activities
evaluate the surveillance of
diseases pertaining to
epidemiological communicable
outbreaks control &
pattern of the diseases
prevention of
communicable communicable
diseases disease
 Definition of Epidemiology

The study of distribution &

determinants of health related states
or events in specified populations, and
the application of this study to the
control of health problems

From 3 Greek words

Epi = upon; Demos = people; Logos = study
 The study of what “upon the people”
 Epidemiology Perspective
Information needed for health planning
Supervision & evaluation of health prevention & control
activities
Key Questions
WHO?
WHERE ?
WHY ? WHAT
NEXT ? WHEN ?
HOW ?
WHAT ?
page
05
 CONCEPTS OF EPIDEMIOLOGY
 Health/disease in an individual/community are the dynamic relationship
between the agent, the host & environment

Epidemiological Triad & their Interaction

Agent Host

Environment
 Epidemiology of Communicable Diseases

 Causative agents – micro-organisms that cause the disease

- virus, bacteria, parasites, protozoa, fungus
 Reservoir – the habitat in which the agents normally lives,
grow & multiplies- person, animal, environment from which the
infection is acquired
 Source of infection – humans/animals/object that a person
get the infection from
 Exposure & infected – one has to be exposed to a source of
infection to get infected
 Epidemiology of Communicable Diseases

 Mode of transmission(s) – eg: direct, indirect, person to

person, air-borne, water-borne, food borne, vector borne
 Host – susceptible host - the final link in the chain of infection
 Incubation period
The time from the moment a person is infected until they
develop symptoms of disease
 Infectious period
The time period during which a person can transmit a disease
SPECTRUM OF DISEASE
 PCID Act 1988 (Act 342)
• An Act to amend and consolidate
the law relating to the prevention
and control of infectious diseases
and to provide for other matters
connected therewith
• This act may be cited as the
Prevention and Control of
Infectious Diseases Act 1988 and
shall apply throughout Malaysia
 Notification
• Started 1967 with Malaria Eradication Program
• 1970s – surveillance of 36 notifiable disease
• Mandatory notification - under Section 10(2) Act 342:
Prevention & Control of Infectious Disease Act 1988.
– for surveillance and disease control and prevention
activities
• 31 infectious diseases – within 24 hrs / 1 week.
• Every medical practitioners (notifying facilities) to nearest
District Health Office
• Compounded offenses if fail to notify. Notification – phone &
form – fax/post/by hand – MANUAL SYSTEM
Part II:
HIV Infection (All forms)
 Notification within 24 hours
FOOD
CHOLERA EBOLA RABIES DIPHTERIA
POISONING

YELLOW
HFMD MEASLES MERS-CoV PLAGUE
FEVER

AVIAN ACUTE
ZIKA DENGUE
INFLUENZA POLIOMYELITIS
 Notification
form
of
Communicable
Diseases
 REQUIREMENT TO NOTIFY

• Part IV – Prevention and Control of Infectious Diseases Act

1988, Section 10 (2) states :

• ” Every medical practitioner who treats or becomes aware

of the existence of any infectious disease in any premise
shall, with the least practicable delay, give notice of the
existence of the infectious disease to the nearest Medical
Officer of Health in the form prescribed ... “
Communicable Disease Programmes in Ministry of Health Malaysia
Disease/case - Case detection
detected/diagnosed by -Received notification/reports
doctors at clinics/hospitals - Register/record the information
- Case investigation / Contact tracing / Active case
detection / Outbreak investigation / Control
Notification/report to District
measures
Health Office
- monitoring /reports the progress of disease
E-notifikasi /outbreak/ activities
- Report writing
- Received report from district / compile
- Ensure appropriate action taken by district
Report to State
- Rapid assessment of situation /Technical consultation
Mobilization of resources/logistic – if needed
-Monitoring the progress of disease /outbreak/
Ministry of Health activities by districts
- Communicate /reports to MOH
E-NOTIFIKASI
 Communicable Disease
• (or infectious disease) is defined as an illness caused
by a specific infectious agent or its toxic product that
results from transmission of that agent or its products
from an infected person, animal, or reservoir to a
susceptible host,

• either directly or indirectly through an intermediate plant

or animal host, vector or inanimate environment
 Communicable Disease - Prevention and
Control
• Case detection • Outbreak ? Outbreak
prevention and control
Case definition
Case notification • Control measures
Case surveillance  Disinfection/
fogging/larvaciding etc
• Case Control
Case treatment • Prevention
 Health Education and
Contact tracing and Promotion
treatment  Specific Protection e.g
Personal Protective
Equipment, Immunisation
etc
 Public Health Surveillance

“is the ongoing systematic collection, analysis,

interpretation, and dissemination of health
data. “
- use surveillance data to describe and monitor
health events in their jurisdictions, set priorities,
and to assist in the planning, implementation,
and evaluation of public health interventions
and programs
 Surveillance
• Ongoing, systematic data
• collection,
• analysis
• interpretation
• dissemination
– INFORMATION FOR ACTION!!
- control a disease
 Surveillance
Health Care System Public Health Authority
Reporting
Data Information

Analysis &
Evaluation
Interpretation

Feedback
Action Decision
 Why we do surveillance?
Estimate burden of disease
Epidemic (Outbreak) prediction and detection
Detect changes in health practices
Develop policies and program
Evaluate program
 What surveillance tells us
 Where health problems are
 Who is affected
 Where to direct prevention and control activities
 To define priorities for health programs and policies
 To evaluate the effectiveness of public health
interventions
 METHODS IN SURVEILLANCE

1. Mandatory vs Voluntary
2. Active vs Passive
3. Sentinel vs All-inclusive
 SURVEILLANCE SYSTEMS IN MALAYSIA
Laboratory-Based Mandatory notification Clinical -Based Comm. based Other Agencies
Surveillance Diseases surveillance surveillance surveillance
(Notification Disease)
(Sentinel / National /
Syndromic) Dept of
PUBLIC: Veterinary
Microbiology Sentinel (selected Community /
Health Centre Services
Laboratories clinics) Media /
Hospitals (Zoonotic
Public / Private National (hospitals) International
PRIVATE: Diseases)
Syndromic sources FOMEMA
GP Clinics (A&E/wards/ clinics)
Hospitals Sdn. Bhd.
Notification of
micro-organisms

District Health
Isolates and Office
notification of
Notifications micro- State Health
of micro- organisms Department
organisms IMR / PHL Results National:
Disease Control
Div., MOH
 Sentinel Surveillance
• Monitoring of key health indicators in the general
population or in special populations.

• Serve as an early warning

• Networks of health-care providers who agree to report on

health events.

• Clinical cases and laboratory based

 Sentinel Surveillance
CLINICAL-BASED

• ILI
– Selected gov. hosp & clinics / GP/ Private Hospital.

• HFMD (Viral study)

– Selected gov. clinics
 Rate of ILI Cases per 1,000 Patient Attendance To Sentinel Location According
40 To Epidemiological Week (2008 -2012)
Rate per 1,000 patients

30

20

10

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Minggu Epid
2008 2009 2010 2011 2012
 Syndromic Notification
• Cluster of cases/deaths occurring within a
short period of time from similar group of
symptoms and signs to be notified to
both State and National levels without
delay from A&E and wards.
 The SIX Syndromes
1. Acute Dermatological Syndrome
2. Acute Hemorrhagic Fever
3. Acute Jaundice Syndrome
4. Acute Neurological Syndrome
5. Acute Respiratory Syndrome
6. Acute Diarrheal Syndrome
Overview of current situation
of Communicable Diseases
in Malaysia / Pahang
 KES PENYAKIT BERJANGKIT DI NEGERI PAHANG
TAHUN 2016 & 2017
TAHUN
BIL PENYAKIT
2016 2017
FOOD WATERBORNE DISEASES (FWBD)
a) Cholera 0 0
b) Dysentery 22 16
1 c) Food Poisoning 1333 (28 wabak) 507 (14 wabak)
d) Hepatitis A 1 3
e) Typhoid 1 4
VACCINE PREVENTABLE DISEASES (VPD)
a) Acute Poliomyelitis 0 0
b) Diphteria 0 1
2 c) Hepatitis B 252 257
d) Measles 35 (2 wabak) 35 (5 wabak)
e) Pertussis 22 (1 wabak) 16
f) Tetanus 1 0
ZOONOSIS
a) Brucellosis* 4 0
b) Ebola 0 0
c) HFMD 822 (16 wabak) 487 (4 wabak)
3 d) Leptospirosis 239 193
e) Melioidosis* 79 111
f) Rabies 0 0
g) Avian Influenza 0 0
h) MERS-CoV 0 0
*Notifikasi secara pentadbiran
 KES PENYAKIT BERJANGKIT DI NEGERI PAHANG
TAHUN 2017 & 2018 (SEHINGGA JULAI)

FWBD VPD ZOONOSIS

2018 2018 2018
2017 (SEHINGGA 2017 (SEHINGGA 2017 (SEHINGGA
JULAI) JULAI) JULAI)
Kolera 0 0 Acute Brucellosis* 0 1
0 0
Disenteri basic
16 5 Poliomyelitis Ebola 0 0
Keracunan Difteria 1 2 #HFMD 487 (4) 792(25)
507 (14) 381 (8)
makanan Hepatitis B 257 171 Leptospirosis 193 81
Hepatitis A 3 0 Measles 30 (5) 13 (1) #Melioidosis* 102 37
Tifoid 4 1 Pertussis 16 24 Rabies 0 0
Tetanus 0 2 Avian
0 0
Influenza
* Notifikasi secara pentadbirtan
# bukan penyakit zoonosis MERS-CoV 0 0
( ) wabak
Vaccine preventable disease
(VPD)
 MEASLES INCIDENCE IN MALAYSIA;
1980 – SEPT 2017
700

2012: 1,876 cases (63.9)

Incidence Rate per 1 million population

600 2013: 195 cases (6.6)

2014: 235 cases (7.8)
500
2015: 1,316 cases (43.2)
2016: 1,587(51.4)
400
2016: 1,147(annualized IR 47.2)

300

200

100

0
1986

2004
1980
1981
1982
1983
1984
1985

1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003

2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Year
 MEASLES INCIDENCE BY STATE (PER 1 MILLION
POPULATION), 2012 – SEPT 2017
200

180

160

140

120

100

80

60

40

20

2012 2013 2014 2015 2016 2017(annualized)

 TREN KES MEASLES NEGERI PAHANG
TAHUN 2006-2017
80
70 70
70
58
60
47
BIlangan Kes

50
37 35 35
40
30 26

20 15
9
10 3
0
0

Tahun
 KES MEASLES MENGIKUT DAERAH DI NEGERI PAHANG
BAGI TAHUN 2017, N=35
18
Wabak Sporadik
16
16
14
12
Bilangan kes

10
8 9
8
6
4
2
0 1 1

Daerah
 KES RUBELLA DI NEGERI PAHANG
TAHUN 2013 – 2017
35

30 33

25
Bilangan kes

20

15

10 11
5 6
4 1
0

Tahun
 PROGRAM ELIMINASI MEASLES NEGERI PAHANG
TAHUN 2012-2017
25.0
Kadar Insiden/ 1 juta

20.0
penduduk

15.0
10.0
5.0
0.0
2013 2014 2015 2016 2017
Tahun

2013 2014 2015 2016 2017

0/1,000,000 1.9/ 1,000,000 16.0/ 1,000,000 21.2/ 1,000,000 20.9/ 1,000,000

SASARAN : Tiada kes tempatan (indigenous)

 PENCAPAIAN INDIKATOR PROGRAM ELIMINASI
MEASLES NEGERI PAHANG TAHUN 2017
INDIKATOR

KLASIFIKASI KES

KES DISAHKAN

KES DISAHKAN
KES DISIASAT

ASOSIATED
DAERAH POPULASI SASARAN KES INSIDEN BUKAN

EPID LINK

MEASLES
KLINIKAL

PENDING
DISCARD
VACCINE
MAKMAL
INSIDEN KES DALAM 48 JAM

SECARA
DINOTIFIKASI KES NOTIFIKASI MEASLES
(<1/1 juta) NOTIFIKASI
(≥2/100,000) (≥2/100,000)
(≥80%)

Bentong 131,500 3 21 1 20 7.6 15.2 100.0%

Bera 108,900 2 6 6 0.0 5.5 100.0%

Cameron 43,000 1 1 1 0.0 2.3 100.0%

Jerantut 98,900 2 38 3 35 0.0 38.4 100.0%

Kuantan 540,500 11 213 9 2 202 16.7 37.7 99.5%

Lipis 97,000 3 8 1 7 10.3 7.2 100.0%

Maran 118,800 2 37 1 35 1 0.0 31.1 100.0%

Pekan 124,700 2 22 8 1 13 64.2 11.2 95.5%

Raub 101,900 2 18 1 17 0.0 17.7 88.9%

Rompin 126,300 3 60 10 6 38 6 126.7 34.8 98.3%

Temerloh 184,400 4 17 1 16 0.0 9.2 100.0%

PAHANG 1,675,900 34 441 29 0 6 9 390 7 20.9 24.2 98.9%

 PERTUSSIS IN MALAYSIA
1976 –2017
1000 3.5
Incidence Rate
900
2016: 282 cases Acellular pertussis 3
800 Introduced
Annualised IR: 0.91 2.5
700
No. of Cases

600
2
500
PCR 1.5
400
300 1
200
0.5
100
0 0
1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
Year
PERTUSSIS CASES AND INCIDENCE RATE
MALAYSIA, 2011 – 2017 (EW39)

50
Preliminary Data E-Notifikasi
 PERBANDINGAN KES PERTUSSIS YANG DIDAFTAR DI NEGERI
PAHANG MENGIKUT DAERAH BAGI TAHUN 2016 DAN 2017

30
12 22
2016 2017
10
20 16
10 9 10
8
BILANGAN KES

0
Pahang
6

4 3 3 3 3

2 1 1 1 1 1 1 1
0 0
0

DAERAH
KES PERTUSSIS MENGIKUT UMUR DAN STATUS IMUNISASI
BIL DAERAH
BAGI TAHUN 2017 PERTUSSIS
BIL KES 2017 Umur Jenis Sampel Positif Status Immunisasi

1 Jerantut 1 3M PCR Belum Layak

2 Kuantan 10 2M PCR Belum Layak
2M PCR Belum Layak
2M PCR Belum Layak
3M PCR Belum Layak
4M PCR Belum Layak
Belum Layak
4M PCR
Belum Layak
4M PCR
Belum Layak
5M PCR Belum Layak
1M PCR Belum Layak
2M PCR
3 Maran 1 1Y 8M PCR Lengkap
4 Pekan 1 2M PCR Belum Layak

5 Temerloh 3 1M PCR Belum Layak

2M PCR Belum Layak
2M PCR Belum Layak
ZOONOSIS
 Tren Leptospirosis di Malaysia, 2011 – September 2017
300

250

200
Bil.Kes

150

100

50 ME39(65)

0
1 1121314151 9 19293949 7 17273747 5 15253545 2 12223242521020304050 8 18283848

2011 2012 2013 2014 2015 2016 2017

Minggu Epid/Tahun
 Bilangan Kes & Kematian Leptospirosis
di Malaysia, 2004 – September 2017
9000 8291 100
7806 90
8000
7000 80
6000 70
5285

Kematian
Kes

60
5000 4457
50
4000 3665 3207 40
3000
1976 2268 30
2000 1418
949 1263 20
1000 263 378 527 10
0 0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Tahun
 Kadar Insiden (IR) & Mortaliti (MR) Leptospirosis
di Malaysia, 2004 – September 2017
30.00 27.20 0.35
25.94
0.30

MR per 100,000 penduduk

IR per 100,000 penduduk

25.00
0.25
20.00 17.12
15.00 0.20
15.00 13.20
12.49 0.15
10.00 6.99 7.94 0.10
5.01
5.00 3.49 4.55
0.05
1.03 1.45 1.98
0.00 0.00
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Tahun
 KES LEPTOSPIROSIS YANG DIDAFTAR MENGIKUT DAERAH
TAHUN 2016 & 2017 DI NEGERI PAHANG

140
300 239
2016 2017 130 193
200
120
100
100
0
Bilangan Kes

80 76 PHG
60

40 32
24
19
20 12 13 1111 1415
7 9 8 10 9 9
6 5 5 6
1
0
BTG BR CH JRT KTN LPS MRN PKN RB RPN TML
Daerah
DEMOGRAFI KES LEPTOSPIROSIS NEGERI PAHANG
Kategori
TAHUN 2017 Bil. Kes (N=193) Peratus (%)
Jantina Lelaki 136 70.5
Perempuan 57 29.5
Warganegara Malaysia 160 82.9
Bukan Warganegara 33 17.1
Bangsa Melayu 143 74.1
Cina 10 5.2
India 6 3.1
OA/ Pribumi 12 6.2
Warga Asing 22 11.4
Kategori umur ≤10 Tahun 15 7.8
11-20 Tahun 31 16.1
21-30 Tahun 35 18.1
31-40 Tahun 37 19.2
41-50 Tahun 37 19.2
≥ 51 Tahun 38 19.7
Status Pekerjaan Bekerja 112 58.0
Surirumah/Pelajar/Kanak-kanak 50 25.9
Tidak bekerja 31 16.1
 SIASATAN PERSEKITARAN KES LEPTOSPIROSIS NEGERI
PAHANG TAHUN 2017 ( N=193)
140 131; 67.9%
120
100
Bilangan

80
58; 30.1%
60 48; 24.9% 44; 22.8%
40 25; 13.0% 21; 10.9%
20
0

Siasatan Persekitaran
PUNCA JANGKITAN KES LEPTOSPIROSIS TAHUN 2017 ,
N=193
14,7.25% 2, 1.04%
19 ,9.84%

Tempat tinggal
105, 54.40% Tempat kerja
63 ,32.64% Tempat rekreasi
Lain-lain
Sekolah
 KES KEMATIAN LEPTOSPIROSIS DI PAHANG DARI TAHUN
2012 – 2017
Disebabkan Lepto Bukan disebabkan Lepto Kadar Mortaliti
20 6
18 5.5
5
16
4.5
Bilangan kes kematian

14

Kadar Mortaliti
4
12 3.5
10 17 3
8 2.5
3 2
6 3
4 1.5
4
1 1
2 5
3 3 3 0.5
0 0 1 0
2012 2013 2014 2015 2016 2017
Tahun
HFMD
 Tren HFMD di Malaysia, 2005 – September 2017
120

100

80
Kes

60

40

20
ME39(8)
0

Minggu Epid
2010 2011 2012 2013 2014 2015 2016 2017
 Kadar Insiden (IR) HFMD di Malaysia, 2005 - 2017
160.00
152.25
140.00
IR per 100,000 penduduk

120.00 117.66
100.00 104.07 105.11

80.00 78.52 74.09

60.00 56.13 60.60
46.21 47.41
40.00
20.00 24.21 19.30 24.52

0.00
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Tahun
*per 100,000 penduduk
 PERBANDINGAN KES HFMD DI NEGERI PAHANG
MENGIKUT MINGGU EPID, TAHUN 2016 & 2017
50

40

30
BILANGAN KES

20 Paras Epidemik (>15 kes)

Paras Amaran (≥10 kes)

10

MINGGU EPID
2016 2017 Paras Amaran Paras Epidemik
 KES HFMD MENGIKUT DAERAH
TAHUN 2016 & 2017 DI NEGERI PAHANG
2017 (N = 487)
1000 812
600 800
2016 2017
600 487
500 400
427
200
400
Bilangan Kes

0
293 PHG
300

200

100 56 61 62
25 2411 4036 3119 31 35 3023 37
5 22 16 8 17
0

Daerah
KES HFMD NEGERI PAHANG MENGIKUT KATEGORI TAHUN 2017, N=487
JANTINA UMUR
3.5% 0.2%

15% < 1 Tahun (73)

1-6 Tahun (396)

7-12 Tahun (17)

53% Lelaki (216)
47% Perempuan (192) > 13 Tahun (1)

81.3%

BANGSA
Melayu 417; 85.6%

Cina 47; 9.7%

Orang Asli 12; 2.5%

India 9; 1.8%

Pribumi Sarawak 1; 0.2%

Lain-lain 1; 0.2%%

0 100 200 300 400 500

Bilangan Kes
FOOD WATER BORNE
DISEASES (FWBD)
 TREN EPISOD KEJADIAN KERACUNAN MAKANAN DI
NEGERI PAHANG TAHUN 2008-2017
50
44
45
40
Bil. episod keracunan makanan

35
30 28 28 28 28

25 22 22
20 18 18

15 14
10
5
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Tahun
EPISOD KERACUNAN MAKANAN MENGIKUT DAERAH
TAHUN 2013 – 2017 DI NEGERI PAHANG
2013 2014 2015 2016 2017
30
25
Bilangan episod

20
15
10
5
0
BTG BR CH JRT KTN LPS MRN PKN RB RPN TML PHG
2013 3 0 2 3 6 0 1 0 1 3 3 22
2014 0 2 0 1 9 0 1 0 1 8 6 28
2015 2 0 0 2 5 0 1 1 0 6 1 18
2016 3 2 1 2 14 1 1 1 0 3 0 28
2017 1 1 1 1 5 0 2 0 1 1 1 14
Daerah
 TREN KES DISENTERI DI NEGERI PAHANG
TAHUN 2012 – 2017
25

22
20

15 15
Bilangan Kes

10 10

7
5 5

0 0
2012 2013 2014 2015 2016 2017
Tahun
KES DISENTERI MENGIKUT DAERAH DI NEGERI PAHANG
TAHUN 2013-2017
25

20
Bilangan Kes

15

10

0
BTG BR CH JRT KTN LPS MRN PKN RB RPN TML PHG
2013 0 1 1 0 2 0 1 2 0 0 1 0
2014 0 0 2 0 0 1 0 1 0 1 0 0
2015 0 0 0 0 6 1 3 0 0 0 0 10
2016 0 0 0 0 17 0 1 4 0 0 0 22
2017 0 0 2 0 11 1 0 0 0 1 0 15
Tuberculosis
MALAYSIA REPORTED NOTIFICATION RATE VS WHO ESTIMATED INCIDENCE
RATE (1990-2015)

WHO estimated incidence rate Malaysia reported notification rate

150
Rate per 100,000

100
population

50
0

Year
 TREND OF TB CASES ACCORDING TO STATES
(JAN-JUNE, 2013- 2016)
2013 2014 2015 2016
2500
2000
Total case

1500
1000
500
0

State
TB AMONG HCW, MALAYSIA (2002-2015)
 SURVELAN ILI 2017
Sentinel Survelan Influenza Like Illness (ILI) di
Pahang – KK Temerloh
 Sentinel Survelan Influenza Like Illness (ILI) di
KK Temerloh, Pahang Tahun 2016 & 2017
350

300

250
Bilangan Kes

200

150

100

50

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Minggu Epid

2017 2016
SURVELAN AGE 2017
 Trend AGE di Negeri Pahang
Tahun 2016 dan 2017
900
800
700
Paras Epidemik ≥603 kes
600
Bilangan Kes

Paras Amaran ≥518 kes

500
400
300
200
100
0

Minggu Epid
2016 2017 Paras Amaran Paras Epidemik
 300 AGE KUANTAN 70 AGE PEKAN
250 60
PE ≥ 51
PE ≥ 196 50
200
40 PA ≥ 39
BIL. KES

BIL. KES
150 PA ≥ 150
30
100
20
50 10
0 0

ME ME
2016 2017 Paras Amaran Paras Epidemik 2016 2017 Paras Amaran Paras Epidemik

140 AGE ROMPIN 80 AGE MARAN

PE ≥ 130 PE ≥ 75
120 70
PA ≥ 102 60 PA ≥ 56
100
50
80

BIL. KES
BIL. KES

40
60
30
40
20
20 10
0 0

ME ME
2016 2017 Paras Amaran Paras Epidemik 2016 2017 Paras Amaran Paras Epidemik
 250 AGE TEMERLOH AGE BERA
70

200 60
50 PE ≥ 51
150
BIL. KES

BIL. KES
40
PA ≥ 42
100 PE ≥ 93 30
20
50 PA ≥ 72
10
0 0

ME ME
2016 2017 Paras Amaran Paras Epidemik 2016 2017 Paras Amaran Paras Epidemik

35 AGE RAUB 90 AGE JERANTUT

30 80
70
25
PE ≥ 22 60 PE ≥ 55
20 50
BIL. KES

BIL. KES
PA ≥ 16 PA ≥ 44
15 40
30
10
20
5 10
0 0

ME ME
2016 2017 Paras Amaran Paras Epidemik 2016 2017 Paras Amaran Paras Epidemik
 AGE LIPIS 180
AGE BENTONG
40
PE ≥ 37
35 160
30 140
PA ≥ 28
120
25
BIL. KES

BIL. KES
100
20 PE ≥ 88
80
15
60 PA ≥ 67
10 40
5 20
0 0

ME ME
2016 2017 Paras Amaran Paras Epidemik 2016 2017 Paras Amaran Paras Epidemik

AGE CAMERON
10
9
8
7
PE ≥ 6
6
BIL. KES

5
4 PA ≥ 4
3
2
1
0

ME
2016 2017 Paras Amaran Paras Epidemik