A 26-year-old employee of a cruiser-liner has been admitted to the Langkawi hospital for probable severe acute respiratory syndrome (Sars). Thirteen people who had been in close contact with her have been placed under quarantine o­n board the ship.

The patient is the country's fourth probable Sars case and the first foreigner to be admitted for treatment.

'Imported from Singapore '

Health Ministry deputy director-general Dr Mohd Ismail Merican said the woman, an Indian national, was taken to hospital o­n April 7 and is now "stable and recovering".

"According to her manager, she developed Sars symptoms o­n March 30 and was immediately quarantined o­n the ship until her admission to Langkawi hospital," Mohd Ismail said.

The cruise ship had sailed to Malacca, Port Klang, Singapore and Phuket Island and is currently berthed at Port Klang. The ministry had no information o­n the owners of the vessel.

Mohd Ismail said that, as the patient had been in Singapore o­n March 28 while o­n transit, " we have classified this as a probable case, although it was imported from Singapore".

The 13 people under quarantine are being isolated for 10 days, but the ministry could not immediately reveal details about them or if any passengers were among them.

"(The cruise ship) has a doctor o­n board and they adhere very strictly o­n the outline of quarantine by the ministry," Mohd Ismail said.

Six suspected cases

During the ministry's daily briefing - held at Hospital Kuala Lumpur (HKL) this morning - Mohd Ismail revealed that six new suspected Sars cases were reported yesterday. Two were reported in Kedah, and o­ne each in Selangor, Kuala Lumpur, Perak and Sarawak.

"A total of 13 notification cases were reported to us yesterday (but two were cleared)," Mohd Ismail said. Eleven were warded, of whom six were identified as suspected cases. The rest are still under observation.

Notification cases are those who have developed Sars symptoms such as high fever and cough, but may not need to be warded. Admission to hospital is at the discretion of medical officers.

Suspected cases are patients with Sars symptoms, who have had close contact with probable Sars patients and have travelled to highly-affected Sars countries. Probable cases refer to suspected cases with chest X-ray findings of pneumonia or respiratory distress syndrome.

The new cases bring the total suspected cases to 13 as at yesterday, with nine being male. There is also an African in this group.

A total of 27 people (see chart) - both suspected and notified cases -had been isolated in designated hospitals as at yesterday. Kedah, with seven people, topped the list.

Meanwhile, the ministry has traced 24 people to date who have had close contact with the third probable Sars patient, a 26-year-old man in Penang. Mohd Ismail said all are under home quarantine and have not shown symptoms of Sars. Among them are doctors and nurses.

Of the four probable Sars cases in the country, o­ne person has recovered and has been discharged. Two are still in hospital. o­ne person died o­n March 30, becoming the first probable Sars death to be recorded in Malaysia.

Measures for protection

In a related development, Health Minister Chua Jui Meng ( left ) said the government will not prohibit the public from visiting hospitals with designated wards for Sars, but advised them - especially children - to avoid such visits as far as possible.

"(For instance) HKL is a referral hospital. Patients go to the hospital daily from all over the country including Sabah and Sarawak. We must still attend to other patients and not cease normal functions," Chua said.

The minister also urged healthcare providers, including those in private and non-designated hospitals, to implement universal surveillance measures to protect against infectious disease outbreaks.

"Out of the eight suspected cases reported in Singapore yesterday, seven were hospital personnel, (just like) the majority of Sars patients there.

We know cases will definitely increase (here) if hospitals don't adhere to guidelines," Chua added.

He outlined three levels of protection systems - to protect personnel from Sars patients; to protect patients from personnel deal with Sars; and to protect visitors or other patients from contracting the Sars virus.

Asked the ministry would issue any directive to non-designated and private hospitals o­n the guidelines or act against facilities that ignore these, he said the Malaysian Medical Association (MMA) has to play its role.

"This is an advisory and not a directive. Furthermore, we have MMA, it is their role to make sure their members to implement the universal guidelines....no need to come to a stage where the ministry is asked to punish them. They have to realise that the measures are to protect their staff," he said.

Cabinet approval

On the guideline to make compulsory for certain groups to wear respiratory masks, Chua said this could o­nly be released after the cabinet gives its approval at its next meeting o­n Wednesday.

"The guideline has been prepared...we have to propose it and brief the cabinet at the next meeting. We can o­nly make it public after it is approved."

Chua, accompanied by ministry officials, checked the Sars surveillance measures at HKL.

It identified dedicated wards and ambulances from March 19, a day after the government declared a Sars alert, and placed 61 personnel o­n standby to deal with suspected Sars patients.

According to latest figures compiled by the World Health Organisation, 2,281 Sars cases have been reported worldwide. The disease has killed 111 people to date.