Thought this might interest some of you. I must have missed a mess of
ProMED postings on this topic while gone in June. But this seems to
summarize the issue very well. The issue of etiology is important, as
those of you following prion diseases well know. I find pigs of
especial interest because of their biological similarities to humans.
Rick, if you think this would be of interest to Marty, would you
please pass it along? Thanks.
NIPAH VIRUS - MALAYSIA (18)
A ProMED-mail post
Date: Sat, 10 Jul 1999
From: Chan Yow Cheong
ProMED-mail Regional Moderator for Asia
Source: Daily Express, 9 Jul 1999 [edited]
A report by 25 foreign experts confirms that the viral encephalitis which
hit the country recently was caused by two viruses, the Japanese
Encephalitis (JE) and Nipah. Deputy Director-General of Health (Public
Health) Datuk Dr Abdul Aziz Mahmood said the report submitted to the Health
Ministry last month rejected claim that the authorities had wrongly
identified the viruses responsible.
"The experts have acknowledged that the move by the government to cull
infected pigs had succeeded in controlling the outbreak," he said at a news
conference to announce the findings of the foreign experts, here [Kuala
Opposition leader Lim Kit Siang had in the Dewan Rakyat [Parliament]
recently accused the government of failing to identify the culprit virus
when it announced two viruses instead of one for causing the viral
encephalitis. He claimed that only one virus was responsible and that was
the Nipah virus.
Dr Abdul Aziz said the foreign experts headed by zoonotic expert Dr Thomas
G. Ksiazek from the Centre of Disease Control, United States, also
discovered that dogs, cats and horses in the affected areas were also
infected by the viruses. However, he said studies showed that these
animals could not spread the viruses to other animals of the same species.
The foreign experts, comprising 12 from CDC, five from Japan, three each
from Australia and the World Health Organisation (WHO) and two from
Germany, also commended the Malaysian government for adopting correct
measures in checking the viral encephalitis since it was detected in
September last year.
Dr Abdul Aziz said the last JE/Nipah infected case was reported on 27 May,
involving seven pig farmers in Sungai Buloh, Selangor. Four of the farmers
later died, he said. As at May 27, there were 265 JE/Nipah cases detected
and 105 of the patients died.
[Caveat emptor; if you are prepared to buy this, beware. Until at least
very recently, there has not been a shred of evidence reported (no virus
isolations, no seroconversions) that any Malaysian encephalitis case within
the past months has been caused by Japanese encephalitis virus. Call me a
skeptic (the American humorist Will Rogers, said: "There's no trick to
being a humorist when you have the whole government working for you.") but
I recall the report posted on ProMED-mail in early June [Nipah virus -
Malaysia: official report 990606113005]. Below we repost the germane
portions of that report. Not a shred of evidence that any 1999
encephalitis cases were caused by Japanese encephalitis virus. Still, the
official line from Malaysia is not only that the epidemic was of mixed
etiology (Nipah virus as well as Japanese encephalitis virus) but that the
265 cases were caused by "JE/Nipah". If this is not nonsense, I owe a huge
apology to an entire country. Let's wait and see. I expect that hard data
will be presented at the International Congress of Virology in Sydney next
month and at the American Society for Tropical Medicine and Hygiene annual
meeting the end of November. I would like to see data on virus isolations
and confirmed serodiagnoses, not diagnoses based on tests of single serum
samples. If one of the 25 foreign experts would be willing to provide such
data, we would be pleased to post it. Meanwhile, it's a bit too early for
me to draft that letter of apology. - Mod CHC]
BEGINNING OF COPIED REPORT
'Emergency report' by the Director General of the Malaysian Veterinary
Services, Dr Mohd Nordin Mohd Nor, to the OIE, published in their weekly
DISEASE INFORMATION of 28 May 1999, Vol. 12 - No. 20.
Text of a report received on 17 May 1999 from Dr Mohd Nordin Mohd Nor,
Director General of Veterinary Services, Ministry of Agriculture, Kuala
Lumpur; Report date: 15 May1999.
1. History of human cases
The outbreak of Nipah disease in Malaysia, which has caused human
fatalities, has been attributed to a viral infection in pigs. The outbreak
in 1998/99 has been investigated and traced back to earlier incidences
which were provisionally diagnosed as Japanese encephalitis (JE).
In 1997, the illness was reported in a number of pig-farm workers, one of
whom died. Most of them received treatment at private hospitals.
In 1998, more cases of viral encephalitis were reported and two more
villages were affected. A special Task Force comprising officers from the
medical and veterinary departments was formed. By the end of 1998, ten
workers from Tambun, Ulu Piah and Ampang had died from the disease after
being in a coma for periods ranging from four days to a few weeks. Among
the viral encephalitis cases, only about 15% were confirmed as JE, leaving
the remaining 85% undetermined.
By mid-December 1998, the disease had spread to Sikamat, about 60 km south
of Kuala Lumpur, through movement of infected pigs. Seven of the 20 workers
developed the disease and five died in January 1999.
By March 1999 the disease had spread to the major pig producing area of
Bukit Pelandok in the State of Negeri Sembilan.
The Department of Medical Microbiology, University of Malaya, successfully
isolated an unknown virus. The virus was sent to the Arbovirus Research
Center, Center for Disease Control (CDC) in Fort Collins, Colorado, United
States of America. There, the Malaysian and United States scientists worked
together to study the characteristics of the virus. On 18 March 1999, the
CDC announced that the isolate was of a genus closely related to the Hendra
virus, a paramyxovirus first isolated in Brisbane, Australia, in 1994. On
10 April 1999, the isolate was officially called the Nipah virus, named
after the village Sungai Nipah in Negeri Sembilan, where the worker from
whom the virus was isolated had died.
The disease spread to more farms and, from 1 March to 10 May 1999, a total
of 224 suspected cases of viral encephalitis occurred in Negeri Sembilan
with 80 fatalities.
Out of a total of 258 persons suspected of being infected with the Nipah
virus, 100 have died.
As a measure to control the spread of the new virus, farmers and their
families have been instructed to leave their villages and settle
temporarily in schools and community halls outside the affected district.
Assistance has been sought from experts in the CDC and Australia to help
with the diagnosis and control of Nipah disease.
6.2 Serological tests
Two laboratories, namely the Veterinary Research Institute (VRI), Ipoh, and
the Task Force Laboratory at the Department of Medical Microbiology,
University of Malaya, were selected to carry out serological tests on the
veterinary and human sera respectively. Samples were tested using the IgG
and IgM capture ELISA at the above laboratories and virus neutralisation
tests at AAHL, Geelong (Australia).
7. Results of serological surveillance in animals during the outbreak period
In a previously infected farm, more than 95% of sows had Nipah virus
antibodies. More than 90% of the piglets had antibodies assumed to be
maternal antibodies. Antibody prevalence across all ages is currently being
studied in an infected farm.
END OF COPIED REPORT
[This is the first comprehensive report we have seen and may be the first
comprehensive report. Japanese encephalitis is no longer being reported as
the etiologic agent of Nipah disease and other steps forward obviously have
been taken. The overall mortality rate in humans is 38.8%. Many questions
remain (Are pigs persistently infected? Does Nipah virus react with
antibodies to paramyxoviruses other than Hendra virus? What is the
significance of antibody if "some patients have shown serological
reactivity without clinical signs"? and more). Nonetheless, the picture is
clearing. - Mod.CHC]
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