Abstract
Introduction: Cluster Mador was the first longhouse COVID-19 cluster declared in Sarawak. This cluster posed a unique challenge by being the first cluster within the longhouse setting. This study reviews the experience gained from managing the cluster within the longhouse setting. It describes the epidemiology of the cluster outbreak, the cluster control strategies used within a longhouse setting, and presents unique physical and cultural considerations in managing longhouse outbreaks in Sarawak.
Methodology: Public health report, field epidemiological investigation report and results of all cases and contacts to the index case were analysed. All nasopharyngeal swab samples were analysed using RT-PCR to detect the presence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2). Results: A total of n=8 cases (including index case) were reported from this longhouse cluster outbreak. It was a family cluster outbreak on a background of various potential amplification events. The index case was an import case from known outbreak areas (outside of Sarawak) and local transmission was driven by intensity of interaction between case and contacts. The index case had a total of n=155 close family contacts and longhouse contact in this outbreak. Their mean age was 34.7 (SD 22.60) years and were mainly males (52.26%). Positive secondary cases were detected mainly amongst family members (n=6, 85.7%) including parents, sibling, nephews and nieces. All positive cases (n=8) were admitted to the hospital and had an uneventful recovery and discharge. These positive cases were mainly Category I (n=5, 62.5%) and Category II (n=3, 37.5%) during detection. Further enhanced surveillance and mass community screening (n=851) within the district showed no positive cases. Discussion: A four-pronged cluster control strategy was employed: (i.) Rapid deployment, (ii.) Extensive ACD, (iii.) Targeted testing, and (iv.) Enhanced surveillance. Key considerations in managing the cluster include: (i.) an understanding of the culture and physical structure layout of an Iban longhouse which encourages communal gathering at the Ruai (common area), (ii.) awareness of amplification events such as year-end gatherings, population movement, and celebrations, (iii.) limited testing capacity and turn-around-time of laboratory results, (iv.) immunologically naïve population, and (v.) managing community expectations and risk communication. This first outbreak within a longhouse in Sarawak demonstrated the importance of adapting outbreak control strategies according to the local cultural, structural, and geographical setting. Furthermore, it serves to inform future planning of strategies as well as resilience building among the community.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-27.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-27,
title = {Cluster Control Strategy: First longhouse COVID-19 cluster in Sarawak, Malaysia.},
author = {Emmanuel Joseph Fong Tsung and Jamie Lo Chieng Yee},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-27.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/APCPH2022-P-27-final-edited-79e89be7515775e48cf5eb9d4c5008e4.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: Cluster Mador was the first longhouse COVID-19 cluster declared in Sarawak. This cluster posed a unique challenge by being the first cluster within the longhouse setting. This study reviews the experience gained from managing the cluster within the longhouse setting. It describes the epidemiology of the cluster outbreak, the cluster control strategies used within a longhouse setting, and presents unique physical and cultural considerations in managing longhouse outbreaks in Sarawak.
Methodology: Public health report, field epidemiological investigation report and results of all cases and contacts to the index case were analysed. All nasopharyngeal swab samples were analysed using RT-PCR to detect the presence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2). Results: A total of n=8 cases (including index case) were reported from this longhouse cluster outbreak. It was a family cluster outbreak on a background of various potential amplification events. The index case was an import case from known outbreak areas (outside of Sarawak) and local transmission was driven by intensity of interaction between case and contacts. The index case had a total of n=155 close family contacts and longhouse contact in this outbreak. Their mean age was 34.7 (SD 22.60) years and were mainly males (52.26%). Positive secondary cases were detected mainly amongst family members (n=6, 85.7%) including parents, sibling, nephews and nieces. All positive cases (n=8) were admitted to the hospital and had an uneventful recovery and discharge. These positive cases were mainly Category I (n=5, 62.5%) and Category II (n=3, 37.5%) during detection. Further enhanced surveillance and mass community screening (n=851) within the district showed no positive cases. Discussion: A four-pronged cluster control strategy was employed: (i.) Rapid deployment, (ii.) Extensive ACD, (iii.) Targeted testing, and (iv.) Enhanced surveillance. Key considerations in managing the cluster include: (i.) an understanding of the culture and physical structure layout of an Iban longhouse which encourages communal gathering at the Ruai (common area), (ii.) awareness of amplification events such as year-end gatherings, population movement, and celebrations, (iii.) limited testing capacity and turn-around-time of laboratory results, (iv.) immunologically na\~{A}¯ve population, and (v.) managing community expectations and risk communication. This first outbreak within a longhouse in Sarawak demonstrated the importance of adapting outbreak control strategies according to the local cultural, structural, and geographical setting. Furthermore, it serves to inform future planning of strategies as well as resilience building among the community.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Sarikei Divisional Health Office, Sarawak State Health Department, Ministry of Health Malaysia; Family Health Development Branch, Sarawak State Health Department, Ministry of Health Malaysia},
keywords = {cluster control, Covid-19, longhouse, Sarawak, strategy},
pubstate = {published},
tppubtype = {proceedings}
}