It's been 2 years since the Enterovirus outbreak in Malaysia and we have yet to see a formal report. Taiwan who faced a similar outbreak a year later has already come out with several papers. The latest being Sentinel Surveillance for Enterovirus 71, Taiwan, 1998, T.-N. Wu, S.-F. Tsai, S.-F. Li, T.-F. Lee, T.-M. Huang, M.-L. Wang, K.-H. Hsu, and C.-Y. Shen . Vol.5, No.3; May-June 1999. Emerging Infectious Diseases. Much earlier published in MMWR on August 7, 1998 / Vol. 47 / No. 30 (pdf format)"Deaths Among Children During an Outbreak of Hand, Foot, and Mouth Disease --- Twisan, Republic of China, April --- July 1998". The first paragraph of which reads " During April-July 1998, the Ministry of Health in Taiwan received approximately 90,000 reports of hand, foot, and mouth disease (HFMD) among young children based on passive surveillance from sentinel physicians. Approximately 320 children have been hospitalized with HFMD associated with suspected meningitis, encephalitis, or acute flaccid paralysis (AFP), and at least 55 have died. This report describes the clinical course of two fatal cases and presents summary findings from an ongoing clinical, epidemiologic, and laboratory investigation of the 55 deaths " .
University Malaya had come out with 2 articles
Fatal enterovirus 71 encephalomyelitis. J Pediatr. 1998 Dec;133(6):795-79 by Lum LCS, Wong KT, Lam SK, Chua KB, Goh AYT, Lim WL, Ong BB, Paul G, AbuBakar S, Lambert M [MEDLINE ABSTRACT] The Lancet Interactive
- Neurogenic pulmonary oedema and enterovirus 71 encephalomyelitis Volume 352, Number 9137, 24 October 1998 by Lucy C S Lum, K T Wong, S K Lam, K B Chua, A Y T Goh (Need to register)
We hope that two years is enough time to come up with epidemiological data and clinical presentation of this enterovirus outbreak in Malaysia. How long before we see something published about a disease that was first discovered in Malaysia, the Nipah virus outbreak?
The haze appears to be "casting its shadow" recently. Unfortunately, Department of Environment, Malaysia Air Pollutant Index page had been removed for reasons best known to them. We have "Clean Air and Blue Skies" as a pseudo index for our API readings and that too, at the time of writing this article was last updated on 8 June 1999!(Down) The last reason I heard was there was a computer breakdown and therefore they could not update the API readings frequently. I think even if they are 3 days late updating the web page during "such a crisis", it would be acceptable to many environmental conscious Malaysians. An article that appeared in the South China Morning Post - Hong Kong, headlined Web site cover-up on haze denied (05 June 1999) is worth having a look. (Links not available)This article is available to be viewed at a fee. The next best marker for us, for the time being would be the Singapore PSI readings and the Daily Air Quality from Thailand.
Nipah Virus Outbreak
Culling operations appears to be still continuing as seen in a recent promed posting. "Source: Sin Chew Jit Poh/Asia News Network ex The Straits Times, 17 Jun 1999 . Pigs from three more farms in Johor [Peninsular Malaysia's southern-most state, across the bridge from Singapore] have been found to have been infected with the deadly Nipah virus, according to the latest sample analysis. "
An interesting report from Dr Mohd Nordin Mohd Nor, Director General of Veterinary Services, Ministry of Agriculture, Kuala Lumpur (Report date: 15 May 1999) which has been published in this issue of Berita MMA appeared in World Organisation for Animal Health under the headline "Nipah Disease in Malaysia" (15 May 1999)(Down) Vol.12, No.20, 28 May 1999 . This is worth reading.
What I find interesting is the finding of nipah virus is its appearance in Sarawak (Kuching, Serian and Sibu districts, which have been declared as Nipah virus infected areas) as published in Star 27-May-1999 under the heading Sarawak bans movement of animals in three areas.(Down) It is unlikely that pigs were exported from Peninsular Malaysia to Sarawak or did it occur? If it did not then where did the virus come from? It could be that the virus had always been endemic in pigs but never been identified before, and the test used detected it. Did the test detect an active or past infection? It could also mean the test might not be very specific.
From Outbreak - A Forum on Fatal Viruses in Malaysia, a Letter from the Ministry- Steps Taken to Check Viral Outbreak by Datuk Dr Abdul Aziz Mahmood, Deputy Director General of Health, Health Ministry as published in the Star on May 28 appears in full.
Dioxin and PCB food contamination from Belgium
In this issue of Berita MMA we have published some information of this latest global health disaster. For those wanting to know more about Dioxin and Polychlorinated Biphenyls (PCB) may visit my site at http://www.vadscorner.com/dioxin.html .
I fully support our Ministry of Health stand in handling this dioxin contamination. Chronological order of the facts as it appeared can be viewed at BELGIAN FEDERAL GOVERNMENT ON LINE site. (Links Down)
These events show how fragile our environment is. Diseases and contaminants do not respect any border, culture or religion. We have to take care of our environment so that it will be able to take care of us. Having legislation is not enough if there is no proper enforcement.
When there is a disaster there should also be accountability if not during at least after the event. Have we learnt anything from our own disasters? For a start, there should at least be reports, articles and specific information available to the doctors/public. How can we learn if this information is not available? It is easy to collect data during an outbreak but the skill of an epidemiologist/clinician is only evident when it is published and viewed by his/her peers otherwise it means that they did nothing. It would be a shame if we see articles after articles on Nipah virus outbreak coming from CDC and not from our own people.
The first two articles have already appeared in CDC MMWR, Morbidity and Mortality Weekly Report.
- Outbreak of Hendra-Like Virus -- Malaysia and Singapore, 1998-1999 April 9, 1999 / Vol. 48 / No. 13 ,48(13);265-269
- Update- Outbreak of Nipah Virus -- Malaysia and Singapore, 1999 April 30, 1999 / Vol. 48 / No. 16. (This article appears to be in collaboration with MOH)
With that I let your "mouse" or your "keyboard" do the "talking".
Till next month, "Happy Surfing".
The links to URL mentioned above are valid at the time of writing (20 June 1999).
This page can be accessed at http://www.vadscorner.com/internet27.html or at http://www.vadscorner.com/mma_internet.html.
Last Updated 9th May 2005.