Chikungunya virus outbreak and the Influenza ?pandemic

Chikungunya Virus Outbreak and the Influenza ?pandemic- Cybermed Berita MMA

"Chik..what"? This arthropod borne virus, "chikungunya virus" had appeared as an outbreak recently in Selangor. It is yet another mosquito transmitted disease coming on the heel of Japanese Encephalitis, and increasing numbers of Dengue cases. One wonders, if we are doing enough to control vector-borne diseases. I have made another web page on information(links) pertaining to this virus at .

Prof.Lam Sai Kit from University Malaya has come to the rescue again with a timely article on Alphaviruses which is available with this issue of Berita MMA. It can viewed on the web at .

Another wonderful article Preventing Emerging Infectious Diseases - A Strategy for the 21st Century can be viewed at . It is available also in pdf format.

Recently there had been a lot of concern of a global pandemic from Influenza virus. Our Health Minister had come out with a statement that surveillance is being carried out and no new strain of this virus has been detected so far. Here are some links and information on Influenza.

Influenza index in the Disease Outbreak News from WHO. Outbreak in China reported on 23rd December 1998. ( )

Influenza Surveillance (WHO)( ) A summary of global influenza activity is maintained in the Country Information Report for the current season, and for the previous season . ( )

FluNet a must visit site of WHO at .Influenza

Hong Kong has a surveillance page on the Internet at

CDC Influenza Homepage is at . Useful information on the virus and current surveillance reports in USA is available at this site. USA: (Week 99/05 12/02/1999):

EuroGROG at, states recent information received from 20 countries the Influenza activity is now epidemic in a majority of reporting European countries. Mainly circulation of  both influenza A(H3N2) and B viruses.

European Influenza Surveillance Scheme at , has latest data compiled in graphic form ( for easy interpretention of the influenza trend.

Infectious Disease Surveillance Center in Japan ( has its own FluSurv Influenza Surveillance Center ( with weekly reports, comparison with past 10 years trends, weekly influenza virus isolation and influenza susceptibility survey.

National Influenza Surveillance Scheme Australia ( another site closer to home. The National Health and Medical Research Council (NHMRC) recommends routine annual influenza vaccination for all individuals over the age of 65 years1. It is also recommended for Aboriginal and Torres Strait Islander adults over 50 years of age. The NHMRC also advises vaccination for those in the following groups:

Annual vaccination should also be considered for those in the following groups:

It is recommended that vaccination take place in the autumn in anticipation of winter outbreaks. The formulation of the vaccine is reviewed annually to take account of the antigenic variation of the virus. The composition of the 1997 Australian vaccine has been published previously2.

  1. National Health and Medical Research Council The Australian Immunisation Handbook. 6th Edition. Canberra: Australian Government Publishing Service;1997.

  2. Composition of the Australian influenza vaccine for the 1997 winter. Comm Dis Intell 1997;21:332.

PHLS (Public Health Laboratory service) Surveillance of Influenza Activity Updates for information regarding influenza status in U.K.( )

Flu Watch Canada ( shows an increasing trend in the number of cases reported.

SCIENTIFIC INSTITUTE OF PUBLIC HEALTH - LOUIS PASTEUR shows influenza virus has reached epidemic status in Belgium. ( ).

In Malaysia we do not have a surveillance system that is accessible on the Internet, but the WHO National Influenza Centre in the Faculty of Medicine, University of Malaya has released some information that is available in this issue of the Berita MMA. It can also be viewed at .

APEC EINet (Emerging Infections Network) at . Latest report on February 9, 1999, on Influenza Update states the following - Hong Kong is preparing for a major outbreak of influenza before the Chinese New Year holiday which falls on Feb. 16 and lasts until mid-March. 8807 suspected cases of influenza were admitted over one weekend and samples have been sent to WHO for confirmation of the strain of influenza virus. The Department of Health has announced that 11 Holiday Clinics would remain open during the first three days of the Chinese New Year to tackle the rising trend of "influenza-like-illnesses". The Department of Health's surveillance program has shown the predominant strain affecting Hong Kong is the influenza A H3N2 Sydney-like strain. Doctors in Singapore confirmed that there was an increase in the number of influenza cases by 20-50% when compared to previous weeks in 1998. Patients are also taking a longer time to recover (10-14 days) than normal (3-4 days). No new or unusual strains of influenza have been isolated in Singapore. The isolated strains were influenza A H1N1, influenza A H3N2 and influenza B. (Down)

Japan is experiencing a widespread epidemic of influenza this winter that has already left 96 people dead. 85% of them were elderly people, a substantial number of them living in nursing homes or residential facilities located in Iwate, Miyagi, Niigata, Gunma and Saitama prefectures. The Health and Welfare Ministry has instructed prefectural governments to vaccinate residents in such facilities and to take other preventive measures. According to the National Institute of Infectious Diseases, the disease is more prevalent in adults than in children possibly due to a lower percentage of adults having immunity against this winter's virus. 761 schools have been forced to suspend some or all classes because of low attendance. As of January 16, a 16-fold increase in influenza cases was recorded among schoolchildren in 10 days. A total of 62,500 schoolchildren are believed to have been affected by the outbreak. Influenza B, influenza A (H3N2)/Sydney, and influenza A (H1N1) strains have been isolated in Japan.
Regions in Canada continue to report sporadic, localized or widespread influenza activity, and as of January 15, 1999, influenza B, influenza A (H3N2), and influenza A (H1N1) have been identified.
United States is also experiencing a worsening of the flu season wherein more than 30 states have reported outbreaks. Influenza A (H1N1)/Bayern, influenza A (H3N2)/Sydney, and influenza have been reported. An upsurge in type A flu was seen during the second half of January.

In this same report, it was noted that for Dengue in MALAYSIA the number of dengue cases recorded in 1998 showed a 42.4% increase from 1997. A total of 27,370 dengue cases and 58 deaths were documented. This increase has been attributed to inappropriate storage of water as a result of drought that in turn facilitated breeding grounds for mosquitoes. Construction and factory sites that failed to eliminate breeding grounds for mosquitoes are additional reasons for an increase in the mosquito population. The province of Sabah did see a marked decrease of 25.8% in the number of dengue cases in 1998 when compared to 1997, unlike some states that had increases even up to 200%. The Ministry of Health has decided to adopt the Cuban strategy in high risk areas to contain dengue. The Cuban method aims at eradication of the vector involving total community effort combined with a structural organisation. Legislative measures to encourage household compliance, health education, biological control and chemical control were instituted in Cuba along with reduction of larval habitats and modification of drinking-water storage tanks. Dengue transmission was not detected between 1981 and 1996 in Cuba and reemerged only in 1997. This reemergence was attributed to various factors including increased migration of people from disease-endemic areas, and a breakdown of eradication measures.

An outbreak of chikungunya fever in Port Klang has affected 27 people since December 1998. 80% of the patients were adult females. The predominant symptoms were fever, maculopapular rash, and migratory polyarticular arthralgia predominantly affecting the small joints of the hands, wrists, ankles and feet. The outbreak followed flooding in the locality resulting in an increase in the vector, the Aedes aegypti mosquito which is also the vector for dengue fever. In collaboration with the Western Australian Centre for Pathology and Medical Research, Perth, Australia, causative organisms like rubella, dengue, and other alphaviruses were ruled out. 6 out of 6 tested samples were IgM positive for chikungunya virus. The WHO Collaborating Centre for Arbovirus Reference and Research (DF/DHF) in Kuala Lumpur, with the help of Australia, will have the test available locally soon. (Confirmed to be available). ( )

This article marks the end of the second anniversary(24 articles) since the first article on Cybermed appeared.


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

Till next month, "Happy Surfing".

Cyberdoc (

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