Today's article will be an interview with Prof. Lam Sai Kit. Among the standard questions we ventured to get his opinion on the enterovirus 71 outbreak affecting Taiwan. I have been following the outbreak with interest and updates and further information can be obtained from my enterovirus outbreak site. (

Prof. Lam Sai Kit is the Head of Department of Medical Microbiology and Senior Consultant Virologist, University hospital, Faculty of Medicine, University of Malaya.

He obtained his B.Sc in 1960 from the University of Western Australia, M.Sc two years later from University of Queensland and in 1966 his PhD from Australian National University. Among others he is a

Prof. Lam Sai Kit sits on the Editorial Board of several International journals as well as

Prof. Lam Sai Kit has published numerous papers and is interested in the following viruses - dengue, enterovirus (EV71), influenza, hantavirus and emerging viral infections.

  1. How and when did you come to know about the Internet? How did you learn the "ropes" in using it?

    As the saying goes, it is difficult to teach an old dog new tricks! I acquired my first computer in 1982 just before I joined WHO, Geneva, for a 2-year stint. I did not make good use of it then, not even for simple word processing since all that was taken care of by a competent English secretary. When I returned to my position in University of Malaya, I had this mental block that people my age cannot be  Prof. Lam Sai Kittaught such skills. Thanks to a younger colleague, I was embarrassed and coerced into using the computer. Looking back, I really do not know how I could have managed my work without computer literacy.

    2. What do you use the Internet for mainly? Email? Browsing? etc.

    There is so much information on the Internet. We can access homepages of institutions all over the world and know exactly who is doing what there. This is most useful to source for experts in my own field, whether for technical information or even to look for an external examiner. I use the e-mail daily to maintain contact with friends and colleagues all over the world and it makes life so much easier. I can contact my son in Monash University on the chatline and now and again on Internet phone.

    3. Has the Internet helped you in your work? Do you think it has all the resources you need?

    Tremendously. When I have a problem, I can surf the net for an answer or float the question on the net. This has served me well in the area of emerging diseases. There is one particular software programme called GIDEON (Global Infectious Disease & EpidemiOlogy Network) which is invaluable when one is trying to diagnose a disease of unusual presentation. It will provide you with not only the epidemiology but also the likely aetiology. For me there are more than enough resources on the Internet, only not enough hours in a day!

4. You have been very active in the International scene particularly with WHO, and recently a Taiwan Newspaper quoted your presentation of four cases of enterovirus 71 which had helped the medical team in Taiwan make some clinical decisions in management. I have a few questions on this outbreak which now not only threatens Taiwan with more cases but also raises a possibility of spread of the disease to neighbouring countries of Hong Kong, China, Japan and Korea. Like the previous outbreak in Malaysia a lot of questions as to the exact aetiology of the disease is being questioned. How likely is it that this outbreak may spread beyond the borders of Taiwan?

The situation in Taiwan is very similar to that seen in Malaysia last year. When we had all those deaths in young children during an outbreak of hand, foot and mouth disease (HFMD), the nation was in a panic and there were actually parents who fled with their children overseas. I was contacted on the Internet by a paediatrician in Australia about some children who left Sarawak and had HFMD with positive EV71 isolation. I was able to reassure him that the risk was not high but the children should be closely monitored.

Japan too reported 3 fatal cases at about the same time as the Sarawak outbreak, with isolation of EV71 from one case. This is just to show that there is really no boundary in disease and what happens in one country is likely to spread to other countries. However, it must be remembered that EV71 is probably endemic in most if not all countries as a cause of HFMD but it may not give rise to severe infection.

5.From the lessons learned from the Malaysian episode how would you recommend the crises in Taiwan be managed.

Crisis management is dependent on the resources of each country and what applies to one may not be suitable for others. In Malaysia, it was a learning experience for us and we gained much from it. There is no substitute for good epidemiology as well as clinical and laboratory investigations and support. Teamwork is paramount in outbreak investigation and we in University of Malaya are grateful to the Ministry of Health to be invited to be part of the team. There have been criticisms levied on some officials in Taiwan and whether this is justified or not, I cannot comment. In an outbreak with many deaths involving young lives, the issue becomes very emotional and finger-pointing is not going to help. I hope the investigative team in Taiwan will stay calm and collected and be allowed to get on with the task ahead, which is outbreak control.

6.There have been a lot of questions recently on the Internet as to the exact pathogen involved. Some say its EV71 and some say its a type of Adenovirus, and yet some feel it may be a combination of pathogens. Based on your observation and experience taking into consideration clinical, serology, virology, post-mortem, previous literature (historical), etc what in your opinion is the likely pathogen.

I think good science and hard facts must apply in such a situation. We must be clear in the case definition based on clinical histories. Once we have a consensus on the cause of death, then we can move on and look at the laboratory evidence and see whether this can support the clinical events.

In the four cases in University Hospital, we were fortunate that permission for post mortem was given. Histopathology clearly showed brain stem encephalomyelitis, which can explain fully the clinical events of cardiorespiratory failure and pulmonary oedema. In addition, we isolated EV71 from these tissues. EV71 is not a new virus and it has been reported to cause similar outbreaks in Australia, Bulgaria, Hungary, Japan and now Taiwan.

As to other aetiological agents, we must follow the same process of deduction and clinical correlation.

7.Are there any rapid test to diagnose this disease and what and how much samples must be taken and to whom should it be sent?

The most rapid laboratory support is using autopsy materials. Our UH pathologists were able to provide provisional evidence of brain stem lesions within two days, using frozen sections. Virus isolation takes quite a few days but polymerase chain reaction for nucleic acid detection can be faster.

A number of laboratories were involved in the Malaysian outbreak and any of these labs should be able to provide assistance (IMR, Unimas, UM).

8.We have yet to see a final report from MOH or CDC on the outbreak in Malaysia. Important information from our experience should be made available as it would be useful to other countries and to us medical doctors as to diagnose a similar case or manage a similar outbreak. Care to comment?

The Minister of Health yesterday said that the 36 (now 38) deaths in Taiwan are the same as the 47 deaths in Sarawak and peninsular Malaysia last year. I guess this is equivalent to a final official report. Open communication is so vital and we should learn to share our information and experiences quickly. One up for the Internet!

9.Recently you have posted at Promed ( site that the EV71 found in Malaysia is a new strain. Care to elaborate?

We did not claim that the EV71 isolates are new strains. However, we did find characteristic 5'UTR sequences ( Link Changed) in the Malaysian isolates, which differ from published sequences. Whether these differences are significant or not, and whether they could account for the increased virulence, remain to be seen. From the press releases from Taiwan, there was also mention of hybrid or mutant viruses causing the outbreak there but we need to examine the evidence and compare with our findings.

10. Are you married? Any children? Are they on the Net?

Married for over 20 years to a tolerant wife who can put up with my long hours at work, and my travels. She has started using Microsoft words and feel quite at home on the net.

My 19-year-old son, Alex, is a computer-nut. He has a natural flare for it and before he left for Monash, he started a small company to provide service to his many clients. I don't think he made any money out of it because his clients were mainly his college mates who expected free service! It was a good learning experience.

My 15-year-old daughter, Sarah, gets on the net whenever she can. She finds it useful to source for information for school projects. She tries to compose musical pieces and finds that challenging. For relaxation, she plays games or watches VCD.

With that I let your "mouse" or your "keyboard" do the "talking". 

Till next month, "Happy Surfing".


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