Health Ministry director-general Tan Sri Dr Ismail Merican said authorities identified the case as due to local transmission after finding out that the teenager had not visited any of the countries where a flu pandemic had been declared.

He said the girl went to the Universiti Malaya Medical Centre (UMMC) at about 10am on Monday to seek treatment after developing a fever and was later sent to the Kuala Lumpur Hospital.

'Investigations revealed that the girl, who is the 19th confirmed A (H1N1) case in Malaysia, had contact with the 12th case that was confirmed on June 13,' he said in statement issued on Wednesday.

Dr Ismail said the girl was not placed under quarantine earlier as she was not one of those identified as having had contact with the 12th patient -- as a result, 20 others have been exposed to the virus.

He said it was vital that all those confirmed as having the A (H1N1) flu give their fullest cooperation by providing complete information on all those who had contact with them as this was the only way to avoid local transmission.

'Action can be taken under the Disease Prevention and Control Act 1988 if they fail to provide complete information to us,' he said.

Dr Ismail said that another four confirmed cases were also reported in the 24 hours up to 9am Wednesday, including a 23-year-old local university student who was part of a group of 12 students and lecturers that went on a seven-day visit to Australia on June 7.

The male student had been on the same flight as the 17th confirmed case reported on June 15, which is AirAsia X flight D7 2723 (seat 37J) that landed at the Low Cost Carrier Terminal (LCCT) at 7:15am on June 14, he said.

The student developed a fever about five hours after landing here and sought treatment at a private clinic at 9am the next day before being referred to the Tuanku Jaafar Hospital in Seremban.

He was confirmed as having the flu at 6pm on Tuesday and the Health Ministry is now tracing 37 contacts including other passengers, members of the travel group, relatives and staff at the private clinic where he first sought treatment. -- THE STAR