Kuliah 19 ALAM SEKITAR DAN (1)MENINGITIS (2) JAPANESE ENCEPHALITIS

1. MENINGITIS

1. Pengenalan2. 10 Julai 2002, dua orang pelajar UPM mati disebabkan oleh meningitis3. Keadaan panic hampir berlaku di kampus tersebut4. Dua pelajar lain dimasukkan ke hospital kerana disyakki terkena penyakit yang sama5. Mereka yang mengerjakan haji, dikehendaki vengambil suntikan vaksin anti penyakit ini6. Pelajar atau pelawat luar Negara mempunyai potensi untuk menyebarkan penyakit ini7. Apakah meningitis? Meningitis is the inflammation of the linings of the brain and spinal cord8. Selalunya berkaitan dengan septicaemia: the blood poisoning form of the disease9. Boleh disebabkan oleh backteria, virus, atau fungus . Yang disebabkan oleh bakterian lebih

bahaya10. Meningococcal bakteria menyebabkan meningitis atau septicaemia atau keduanya11. Jenis: Bacteria meningitis: meningococcal;pneumococcal; haemophilus influenza b (Hib);

Group b streptococcal(GBS) . Listeria : tubercular; viral meningitis, fungal meningitis12. Siapa yang terdedah kepada bahaya penyakit ini? Kumpulan umur 15-24 tahun13. kebelakangan ini berlaku peningkatan dikalangan pelajar IPT. 14. Bagaimana berlaku? One in ten of us, at any time, are carrying the bacteria which cause

meningococcal meningitis and septicaemia.  We pass them between each other by regular, close, prolonged contact.  Most of us can carry these bacteria without getting ill.  But, in a very few people the bacteria overcome the body's immune defences and get into the blood stream, causing meningitis and septicaemia.

15. Septicaemia happens when bacteria in the blood multiply and produce poisons, making the person feel ill and feverish.  These poisons attack the walls of blood vessels so that blood leaks out.  Blood leaking out under the skin causes the non-blanching rash typical of meningococcal septicaemia.  As more blood is lost in this way, the circulatory system begins to shut down, causing other symptoms of septicaemia, such as cold hands and feet and rapid breathing.  Unless this process can be reversed by medical treatment, the person will go into shock, and this leads to heart failure or multiple organ failure.  It is this process that ultimately causes death from meningococcal septicaemia.

16. In people who develop meningitis, bacteria cross from the blood into the membranes surrounding the brain.  Bacterial toxins cause inflammation of tissue around the brain, producing symptoms of meningitis such as headaches, stiff neck, dislike of bright lights and drowsiness.  Without life saving treatment, the final result is coma which can be fatal.

17. Meningococcal meningitis dan septicaemia dikenali sebagai penyakit meningococcal. Nama sintifik untuk meningococcal bacteria is Neisseria meningitidis. Bakteria ini dikenal pasti penyebab kematian seorang daripada pelajar UPM.

18. Meningococcal bacteria : A, B, C, W-135, and Y. 19. Kumpulan W-135 amat kurang berlaku, tetapi sejak tahun 2000 apabila berlaku wabak di Afrika,

jemaah haji ramai yang terkena penyakit ini ramai yang terlibat menyebabkan kejadian meningitis jenis ini meningkat di Negara lain.

20. Kumpulan A kerap berlaku di Afrika sub-Sahara, Pakistan, Nepal, Bhutan dan India.21. Tanda-tanda meningitis: sakit kepala yang kuat, sakit tengkuk, tidak tahan kena cahaya,

demam/muntah, hilang ingatan, ruam.

22. Tanda-tanda septicaemia: ruam, demam/muntah, tangan dan kaki sejuk, bernafas dengan cepat, sakit pada perut, otot dan sendi, hilang ingatan

23. Bagaimana mengelaknya. Dengan mengambil suntikan vaksin.24. Kesimpulan

Lapan mati akibat meningitis

(Utusan Malaysia,  Isnin – 31 Januari 2005) 

Beijing (China) – Wabak meningitis yang kini telah menular di 11 buah wilayah di timur China kini telah meragut nyawa lapan orang manakala tujuh yang lain dimasukkan ke hospital.  Kebanyakan mangsa penyakit itu adalah di kalangan mereka yang berumur dalam lingkungan antara 13 hingga 18 tahun.

NOTA TAMBAHAN MENGENAI MENINGITIS

Meningitis and septicaemia can kill in hours.

Meningitis is the inflammation of the linings of the brain and spinal cord, whilst septicaemia is the blood poisoning form of the disease.  The two forms of the disease have different symptoms. People who recover from meningitis and septicaemia may be left with a range of after effects that dramatically alter their lives.

Meningitis is usually bacterial or viral, and occasionally is due to fungal infections, although almost any microbe can cause it.  Viral meningitis can be very unpleasant but it is almost never life threatening and most people quickly make a full recovery.  Bacterial

meningitis is more serious and can be caused by a range of different bacteria, although most cases in the UK and Ireland are caused by meningococcal bacteria. 

Meningococcal bacteria can cause meningitis or septicaemia or both.  Most people who get the disease have some symptoms of both meningococcal meningitis and meningococcal septicaemia; together these two forms of the disease are known as meningococcal disease.  Septicaemia is the more life threatening form of the disease and is more dangerous when there are no signs of meningitis.

There are vaccines available against some types of meningitis and septicaemia and the new Men C vaccine introduced in 1999/2000 has drastically reduced the number of cases of group C meningococcal disease in the age groups targeted for vaccination.  Despite this, many other equally deadly forms of the diseases are not vaccine preventable, so until research finds the key to defeating these diseases, knowing about the diseases and being able to recognise the symptoms is vital.

Types

Meningitis is usually bacterial or viral.

Bacterial Meningitis

At least 50 kinds of bacteria can cause meningitis, but the main types are:

Meningococcal

Meningococcal infection causes most cases of bacterial meningitis in the UK and Republic of Ireland.  Meningitis and septicaemia have different sets of symptoms, but most people who are infected have symptoms of both.  When septicaemia occurs without meningitis it is more life-threatening.   

Pneumococcal

Pneumococcal bacteria are the second biggest cause of bacterial meningitis in the UK and Ireland, and in some countries it is the main type of meningitis.  The bacteria are quite commonly carried, and are more likely to cause earache, pneumonia and less serious illnesses than meningitis.

Most cases of pneumococcal meningitis are in children under two years old and adults with specific problems (head injuries, diseases of the blood or circulation, or immune deficiency). 

Haemophilus influenzae b (Hib)

This used to be the most common type of meningitis in children under five in many countries.  Since introduction of the Hib vaccine in 1992, cases have dropped by over 90%. Hib meningitis is now rare in countries that use the vaccine, but is still a major problem in countries that do not.

Group B Streptococcal (GBS)

This is the main cause of meningitis in newborn babies.  GBS bacteria can cause septicaemia, meningitis and pneumonia.  Up to 90% of babies who get this disease survive and a recent study found that half of those who recovered from GBS disease had no significant after effects.  GBS bacteria are carried by at least 30% of people and are usually harmless. 

E coli

Certain strains of these bacteria can cause meningitis, especially in newborn babies, and people of any age who have particular health problems.  It is a much more important cause of meningitis in developing countries. 

Listeria

This is an uncommon cause of meningitis, occurring mainly in babies, elderly people and those with weakened immune systems.  There are fewer cases now than in previous years due to increased awareness of foods that can cause listeriosis in pregnant women and people with certain conditions that increase their risk to infections.

Tubercular (TB)

This is a rare form of meningitis due to the tuberculosis bacteria.  Most patients who have got TB meningitis have tuberculosis of the lungs or elsewhere.  This type of meningitis does not come on suddenly like typical bacterial meningitis.  TB meningitis develops slowly, and this makes diagnosis more difficult. 

Viral Meningitis

This type of meningitis is usually relatively mild, with symptoms of headache, fever and general ill feeling, although some serious features of meningitis may occur.  Since people with viral meningitis often recover without medical treatment, it is difficult to be certain how common it actually is, but it is probably more common than bacterial meningitis.

Fungal Meningitis

Fungal meningitis is quite rare.  It mainly affects people with immune deficiencies.

Meningococcal disease

Meningococcal bacteria cause most cases of bacterial meningitis and septicaemia in the UK and Ireland.  Meningitis and septicaemia have different sets of symptoms, and may occur separately or together.  Together, meningococcal meningitis and septicaemia are known as meningococcal disease.  The scientific name for meningococcal bacteria is Neisseria meningitidis.

Overall, more than 90% of people who get meningococcal disease recover.  Of the two forms, septicaemia is more dangerous.  While fewer than 5% of people with meningococcal meningitis die of the disease, the death rate for meningococcal septicaemia alone with no symptoms of meningitis is around 20%, rising to 50% or more if the patient goes into shock before they get medical help.  Most deaths from meningococcal infection are caused by septicaemia.  Over 50% of people with meningococcal infection get both meningitis and septicaemia, while over 30% get septicaemia alone and fewer than15% get meningitis alone.

How do meningococcal bacteria cause disease?

One in ten of us, at any time, are carrying the bacteria which cause meningococcal meningitis and septicaemia.  We pass them between each other by regular, close, prolonged contact.  Most of us can carry these bacteria without getting ill.  But, in a very few people the bacteria overcome the body's immune defences and get into the blood stream, causing meningitis and septicaemia.

Septicaemia happens when bacteria in the blood multiply and produce poisons, making the person feel ill and feverish.  These poisons attack the walls of blood vessels so that blood leaks out.  Blood leaking out under the skin causes the non-blanching rash typical of meningococcal septicaemia.  As more blood is lost in this way, the circulatory system begins to shut down, causing other symptoms of septicaemia, such as cold hands and feet and rapid breathing.  Unless this process can be reversed by medical treatment, the person will go into shock, and this leads to heart failure or multiple organ failure.  It is this process that ultimately causes death from meningococcal septicaemia.

In people who develop meningitis, bacteria cross from the blood into the membranes surrounding the brain.  Bacterial toxins cause inflammation of tissue around the brain, producing symptoms of meningitis such as headaches, stiff neck, dislike of bright lights and drowsiness.  Without life saving treatment, the final result is coma which can be fatal.

Are there different types of meningococcal bacteria?

Meningococcal bacteria can be divided into several groups, but nearly all disease is caused by groups A, B, C, W-135, and Y.  In recent years Group B has caused up to 60% of cases in the United Kingdom and Ireland, with the remaining cases caused by Group C and more rarely by the other groups listed.  Now that Men C vaccine is available,

providing effective protection against Group C meningitis and septicaemia, this strain of the disease is declining.  The incidence of Group B has been unaffected by the Men C vaccine and in the UK there has been a rising trend since the mid 1990's. 

Group W135 is rarer than other forms, with only a few dozen cases a year.  However, since 2000, cases of W135 have risen, so that we now see over 100 cases per year in the UK.  This has coincided with Group W135 outbreaks in Africa, and amongst visitors to Mecca on the Hajj pilgrimage, including pilgrims from across Europe, especially the UK.  Close family contacts of pilgrims have often been affected.

Group A meningococcal infection is almost unknown in the UK and Ireland, but is prevalent in sub-Saharan Africa, Pakistan, Nepal, Bhutan and parts of India.

Click here for information on vaccines that protect against some forms of meningococcal disease.

How common is meningococcal disease?

Within each year there are more cases of meningitis and septicaemia in winter, and over a period of years the disease has a cyclic pattern with peaks when the disease becomes more prevalent and troughs when it becomes more rare.  The largest peak in 50 years occurred at the end of the 1990s, but with the introduction of Men C vaccine in the UK in 1999 and in the Republic of Ireland in 2000, Group C cases are in decline.

Currently, cases of meningococcal meningitis and septicaemia occur at a rate of about 1 case per 20,000 people per year in England, and this rises as you go from Scotland to Wales to Northern Ireland.  It is highest of all in the Republic of Ireland.  With an incidence of around 3 cases per 20,000 people per year, the Republic of Ireland has the second highest rate of meningococcal disease in Europe.

Most of these cases are isolated events and are not linked to other cases.  Local outbreaks of meningitis and septicaemia occur from time to time, but most do not last long.  In recent years, outbreaks have most often been associated with Group C infection, but with the introduction of Men C vaccine, situations like this are much less frequent

Although the risk of contracting meningitis and septicaemia is very small, infection rates are highest in children under the age of five, and there is a second rise in infections in the 15 to 24year age group.  Scientists do not yet fully understand why some people are more susceptible to meningococcal infection, and this is an area in which Meningitis Research Foundation is funding research.

Can I protect myself and my family against meningococcal disease?

A vaccine against group C meningococcal meningitis and septicaemia is offered to all children and young people under 25 in the UK and under 23 in the Republic of Ireland, and is now part of routine immunisation programmes.  Although it is very effective, it

cannot prevent other kinds of meningococcal disease.  It may recur in people with certain immune deficiencies. Click here for more information on the Men C Vaccine.

There is also a quadrivalent (4 type) vaccine available that protects against group A, group C, group W135 and group Y meningococcal disease.  This is recommended for people travelling abroad to Saudi Arabia during the Hajj and Umrah pilgrimages. For more information about these vaccines click here.

In the absence of a universally effective vaccine it is important to be aware of the symptoms of meningitis and septicaemia to protect ourselves and others from this infection, because prompt treatment provides the best chance of a full recovery.

The early signs of septicaemia are non-specific and similar to those of flu and other viral infections.  This makes diagnosis very difficult.  However, a person with meningococcal septicaemia will get severely ill, usually very quickly.  For more information on the signs and symptoms of meningitis and septicaemia please click here.

Penicillin and other antibiotics can kill meningococcal bacteria in the blood or in the fluid around the brain.  Early recognition of meningococcal disease and prompt treatment with antibiotics greatly improve chances of survival.

Pneumococcal

Pneumococcal bacteria (Streptococcus pneumoniae) are the second biggest cause of bacterial meningitis in the UK and Ireland.

Many people, including up to 60% of children, carry pneumococcal bacteria in the back of their nose and throat, and constantly pass them around by coughing and sneezing and close contact.  Most of the time this is completely harmless.  But in a susceptible person, pneumococcal bacteria can cause disease such as fairly minor bronchitis and ear and sinus infections, pneumonia, life-threatening infection of the blood (including septicaemia), and meningitis.  In some cases, pneumococcal meningitis can develop from more minor forms of the infection such as ear ache.

Pneumococcal meningitis is not considered to be contagious - although the bacteria are easy to pass on, contact with a person with pneumococcal meningitis does not pose a higher risk of infection than normal day-to-day contact with healthy children.

Pneumococcal meningitis has the same symptoms as other forms of bacterial meningitis. 

Pneumococcal infection can cause septicaemia, the blood-poisoning form of the disease, but not necessarily with meningitis. 

People with pneumococcal disease do not normally get the rash which is typical of the most common kind of meningitis and septicaemia, meningococcal disease. About 85% of people who get pneumococcal meningitis recover, most of them without serious

problems.  Even so, it is among the most life-threatening of major forms of meningitis, and survivors are more likely to have after effects, including deafness, seizures and long-term brain damage than in other forms.  In many cases, after effects are temporary or improve over time, and especially with young children in the early stages of recovery, it can be difficult to tell if problems will be long-lasting.

People most likely to get pneumococcal disease are young children, the elderly and people with health conditions that increase their risk of infection. Risk factors include:

having no spleen, due to injury or disease, or a non-functioning spleen as in sickle cell disorder, thalassaemia, and coeliac syndrome;

other immunodeficiency, whether inherited or acquired (eg: HIV);

immunosuppression as with cancer therapy or organ transplant;

chronic disease of the heart, lung, kidney or liver (including nephrotic syndrome and alcoholic cirrhosis) and diabetes;

head injury or skull defect

There are at least 90 different strains, or serotypes, of pneumococcal bacteria, based on differences in the bacterial polysaccharide or 'sugar coat'. However, most disease is caused by only a few strains.

There is a 23-type 'polysaccharide' vaccine recommended for people over the age of two with risk factors (except people with skull defect/injury whom it cannot protect). In the UK pneumoccal vaccination is also recommended for people with cochlear implants.  Where possible, patients are recommended to receive vaccination prior to implantation. It is also recommended for those aged above 65 in Northern Ireland and the Republic of Ireland. It can protect most adults for five years or more against the top 23 disease-causing strains. However, it does not work in children under two years old and is less effective in people with immune deficiencies and the under-fives.

A new 7-type 'conjugate' vaccine is now licensed in Europe for children from two months to two years of age. Its routine use in America since June 2000 has established a good safety record and been effective in reducing cases in children under two. It is similar to the successful Hib and Men C vaccines, which provide stronger, more long-term protection than the plain polysaccharide vaccines. This vaccine covers the seven strains that cause about 80% of serious pneumococcal disease in UK children aged six months to two years and about 75% in young children in Europe generally.

The current recommendation in the UK and Ireland is that children under two years of age in the at-risk groups should be offered the new conjugate pneumococcal vaccine.  In the UK pneumococcal vaccination is also recommended for those with cochlear implants.  Where possible, vaccination should occur prior to implantation. Infants under 6 months should be given three doses at 2, 3 and 4 months of age, followed by a booster after the first birthday. Infants aged 7 to 11 months should be given two doses a month apart, with a booster dose after the first birthday. Children aged 12 to 23 months should be given two doses two months apart. Following their second birthday, they should be offered a single dose of the old polysaccharide vaccine for protection against strains not covered by the conjugate vaccine.

The UK government will consider wider use of conjugate pneumococcal vaccine for babies and children when further information on how this would work in the routine immunisation programme

has been evaluated. Information on the potential wider use of conjugate pneumococcal vaccine in Ireland is awaited.

Travel and Hajj pilgrims

Information about meningitis for travellers and pilgrims

What precautions can travellers take against meningitis and septicaemia?

Travellers to certain destinations, including some countries in sub-Saharan Africa and parts of the Indian subcontinent, are advised to get vaccinated against A- and C-strain meningococcal infection. A list of countries where this vaccination is recommended is given in the Department of Health leaflet 'Health Advice for Travellers' available from post offices, and can also be found on CEEFAX.

For pilgrims travelling to Saudi Arabia for Hajj or Umrah, quadrivalent ACWY meningococcal vaccination is now a visa requirement. This protects against four meningococcal strains: A, C, W135 and Y. Although the older A-C polysaccharide vaccine has been compulsory for pilgrims to the Hajj for many years, since 2000 there have been outbreaks of group W135 meningococcal disease among pilgrims. Group W135 can not be prevented by either the AC polysaccharide travel vaccine or the new Men C conjugate vaccine, only the quadrivalent vaccine provides protection. Pilgrims to the Hajj can get the quadrivalent vaccine from their doctor or travel clinic and will need to do this at least two weeks before arriving in Saudi Arabia. Information about quadrivalent vaccine and the Hajj is also available in Arabic, Bengali (Sylheti), Gujarati, Punjabi, Somali and Urdu (click here)

Immunity lasts for about 2 or 3 years. The vaccines are ineffective against C-strain and W135 in children under 2 years of age and against A-strain in children under 3 months of age. Although they provide 80-90% protection to adults they are generally less effective in young children. The vaccines are not 'live' and cannot cause even a very mild form of the disease. Serious side effects to the vaccinations are very rare.

A more effective vaccination that provides long-term protection against C-strain has now been offered to most people under 20 years of age in the UK and under 23 in Ireland. It is routinely offered to all babies at 2, 3 and 4 months of age. In the UK the vaccination was recently extended to everyone under 25 years of age. There is no vaccine against B-strain meningococcal infection.

Since there is no universally effective vaccine the best defence against the disease is knowing the symptoms to look out for so that cases of meningitis and septicaemia are recognised early and treated promptly. Information on symptoms, level of risk and meningitis vaccines is available in 18 different languages in audio or written format by clicking here.

Can you catch meningitis and septicaemia from other travellers on the same aeroplane, ship, bus, or train or in the same hotel or resort?

Getting meningitis and septicaemia from this sort of contact is unlikely. While at least 10% of the people you meet every day carry meningococcal bacteria in the back of their nose and throat, usually, this causes no harm. It is never possible to be completely certain that bacteria will not be transmitted, but the risk in these settings is no higher than in every day situations where contact with other people is neither intimate nor prolonged

Meningitis & Septicaemia

can kill in hours - know the symptoms

Babies may also suffer from:

Tense or bulging soft spot on their head Blotchy skin, getting paler or turning blue Refusing to feed Irritability when picked up, with a high pitched or moaning cry A stiff body with jerky movements, or else floppy and lifeless

For more information about symptoms in babies and toddlers click here

Symptoms can appear in any order. Not everyone gets all these symptoms.

Septicaemia can occur with or without meningitis.

Remember...trust your instincts.Someone who has meningitis or septicaemia needs medical help urgently.

Septicaemic rash

Watch out for tiny red or brown pin prick marks which can change into purple blotches or blood blisters.

Early stages of septicaemia (blood poisoning)(picture courtesy: Dr A Riordan)

Later stages of septicaemia

Septicaemic rash on conjunctiva(picture courtesy: D A Warrell)

Septicaemic rash on dark skin - late stage

A septicaemic rash can be harder to see on dark skin, so check for spots over the whole body, especially on paler areas like palms of the hands, the soles of the feet, on the stomach, inside the eyelids (conjunctiva) and on the roof of the mouth (palate).

Tumbler test for septicaemia

If a glass tumbler is pressed firmly against a septicaemic rash, the marks will not fade.

You will be able to see the rash through the glass. If this happens get medical advice immediately. It is harder to see on dark skin, so check paler areas. Remember someone who is very ill needs medical help even if they have no rash or a rash that fades.

2. JAPANESE ENCEPHALITIS

1. Pengenalan2. JE merupakan penyakit yang berbahaya3. Disebarkan oleh nyamuk Culex

(a) Culex gelidus

Culex

(b) Culex tritaeniorhynchus sedang bertelur

4. Nyamuk ini mengigit waktu senja hingga subuh ( 7:00 petang – 7:00 pagi) 5. Nymauk ini membiak di takungan air kotor seperti kolam, lopak air, parit dan sawah padi

6. Tanda-tanda penyakit JE: 1. Demam 2. Sakit kepala 3. Lemah anggota badan (malaise) 4. Mengantuk (drowsy) 6. Sawan (convulsion/fit) 7. Lumpuh (paralysis) 8. Tidak sedar diri (coma)

7. Disebabkan oleh virus Japanese encephalitis8. Menyerang system saraf pusat (central nervous system)9. Virus ini boleh dibawa oleh binatang seperti babi, lembu, kerbau, biri-biri, kuda, burung, anjing10. Babi adalah perumah pengganda (amplifier host)11. Virus JE banyak didaapti dalam darah babi12. Suhu badan babi yang tinggi dan permukaan yang tidak berambut menjadi tarikan kepada beribu-

ribu nyamuk pada waktu malam13. Manusia dan kuda menjadi perumah terakhir (dead-end host)14. Manusia dan kuda tidak menyebarkan JE15. Cara penyekit ini merebak adalah dengan kegiatan nyamuk16. Nyamuk Culex betina menghisap darah host yang ada virus17. Setelah tempuh inkubasi antara 9-12 hari selesai, nyamuk ini boleh menjangkitkan virus kepada

mangsa yang digigit18. Jika terdapat banyak nyamuk yang aktif, maka penyebaran virus ini menjadi meluas dan mudah

tersebar dengan cepatnya19. Peranan kebersihan alam sekitar adalah amat penting kerana dengan menyediakan tempat untuk

nyamuk ini membiak, maka penyakit ini boleh merebak dengan cepat20. Keadaan kebersihan lading-ladang penternakan babi juga menjadi punca kepada masaalah ini21. Boleh dikatakan kesemua lading-landang yang menternak binatang ini mempunyai persekitaran

yang kotor

22. Bukan sahaja ternakan babi yang kotor, malah kebanyakan ladang penternakan di negara ini, tidak bersih

23. Keadaan ini boleh mengundang pelbagai penyakit.24. Bukan sahaja JE, tetapi berbagai penyakit lain juga boleh tersebar disebabkan keadaan

persekitaran yang kotor.25. Kesimpulan

ANALISIS JAPANESE ENCEPHALITIS DI MALAYSIA

1. Pengenalan2. Mula melanda Malaysia 19993. Peringkat awal dikesan berlaku di Perak 19984. 26 Dis. 1998, kes pertama di Negeri Sembilan; di Sikamat, Seremban5. Melibatkan penternak babi6. NS mempunyai kawasan penternakan babi terbesar di Asia Tenggara : 1. Bukit Pelanduk 2. Sg.

Nipah 3. Kg. Jawa 4. Kg. Wong Seng Chuan7. 4 Jan. 1999. Kebanyakan babi di sekitar Seremban mati8. 9 Jan. 1999. Lima orang mati disebabkan JE9. Di Bukit Pelanduk: Kes pertama berlaku pada 23 Feb. 1999 melibatkan viral encephalitis10. Keadaan menjadi lebih teruk apabila virus baru dikesan – Hendra-like virus (HLV) di Hospital

Seremban11. 1 Mac 1999, bilangan babi mati meningkat di Sg. Nipah. 15 orang mati dan 25 dimasukkan ke

hostpital12. 3 Mac. 1999, JE telah menimbulkan kebimbangan penduduk. Penduduk mengadakan demonstrasi

di Seremban13. 5 Mac 1999. 80 % penduduk Bkt. Pelandunk berpindah keluar 14. 20 Mac 1999. Jaabatan Kesihatan mengesan 30 pesakit diserang oleh virus baru (HLV)15. 20 Mac. 1999. Operasi pemusnahan babi oleh tentera16. Menggunakan Lysol pada kekuataan 10% - untuk tujuan disinfeksi17. 16 April 1999. 519 ladang iaitu 74% daripada keselurahan ladang di NS telah didisinfeksi18. Hasil daripada kawalan dan pencegahan : menghapuskan Culex dan memberi vaksin kepada

golongan berisiko tinggi > kes JE menurun19. 1 Jun. 1999. Kematian disebabkan oleh JE diseluruh Negara adalah 106 orang20. 86 kematian adalah di Bkt. Pelanduk, Kg. Jawa dan Kg. Nipah21. Dis. 1998: 50%. Jan . 1999 : 36.4% . Feb. 1999: 33.3%; Mac 1999: 9.4%22. Kesimpulan

NOTA TAMBAHAN

Japanese Encephalitis and Hendra-like Virus in Malaysia

To date (19 March 1999), there are 133 reported cases of either confirmed or suspected cases of Japanese Encephalitis in the outbreak which first started in Perak, and later in Negeri Sembilan. Of these, 54 persons have died. In this outbreak, out of 133 reported cases, 42 have been confirmed to have Japanese Encephalitis. Many cases may soon be confirmed as the laboratory results become available.

In addition to Japanese Encephalitis, there is now evidence of a new virus. This virus was isolated from the cerebrospinal fluid of 5 out of 30 patients sent to Professor S K Lam and his team at the Department of Medical Microbiology, University of Malaya. Their finding was subsequently confirmed by the Centers for Disease Control in Atlanta, USA. This virus is a member of the Paramyxovirus family. It is closely related to Hendra virus which was first isolated in Hendra, a suburb of Brisbane in Queensland, Australia. In the outbreak which occurred in 1994, race horses and 3 persons whose work involved close contact with horses were taken ill. 2 of the 3 persons subsequently died, one died of severe respiratory infection and the other of encephalitis after a latent period of 13 months.

Source:  Department of Public Health, Ministry of Health, Malaysia

Disease outbreaks reported

26 March 1999

Epidemic Encephalitis in Malaysia

The following is a Press Release from the World Health Organization, Regional Office for the Western Pacific, WP/PR8, 25 March 1999.   For updates on the number of cases and deaths, please visit the web site of the Department of Public Health, Ministry of Health, Malaysia at: http://dph.gov.my/press/press2/japan_e.htm

Cases of viral encephalitis have been occurring in Malaysia since October 1998. To date, there have been 157 cases and 58 deaths. New information indicates that both Japanese encephalitis (JE) and a second virus are circulating. The second virus, a new member of the paramyxovirus family could be similar to the Hendra virus found earlier in Australia. Japanese encephalitis has been confirmed to be the cause of 18 of the reported deaths. Further investigations are now underway to determine the role of the new viruses in the reported cases.

Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia with 30 000 to 50 000 cases reported annually. Acute encephalitis can lead to paralysis, coma and death. In Malaysia, between 9 and 91 cases of JE are reported each year. Major outbreaks occurred in Langkawi in 1974, Penang in 1988 and in the Serian district of Sarawak in 1992.

Japanese encephalitis virus usually affects pigs and is transmitted by the bite of culex mosquitos. Normally the disease is transmitted among pigs and it is only in exceptional circumstances that humans are involved.

The initial stages of the current outbreak evidence pointed to JE because of the association of all the cases with pigs and piggeries. However, JE usually affects children but most of the cases in this outbreak have been young adult males. All have been workers at or closely associated with piggeries. This suggests the presence of another virus.

The current outbreak of viral encephalitis involves the Kinta district of Perak and the Sikamat and Bukit Pelandok districts of Negri Sembilan state. The highest number of cases and deaths have been reported from Bukit Pelandok.

The Malaysian Ministry of Health has mounted a well-funded campaign to control the disease. To date, 64 767 people have been vaccinated, 150 000 farms and houses have been sprayed with insecticide, and an active programme of health education and social mobilization has been mounted in affected areas. In addition, the Government intends to destroy more than 300 000 pigs as a means of eliminating the source of the virus.

WHO has been monitoring the situation and has been in regular contact with the Malaysian Ministry of Health since early in the outbreak through its office in Kuala Lumpur. The Regional Office in Manila has provided technical advice, including information on JE vaccines.

The WHO Collaborating Centre for Arbovirus Reference and Research at the Department of Medical Microbiology of the University of Malaya in Kuala Lumpur has been at the forefront of the virological investigation of the current outbreak. Another WHO Collaborating Centre at the Institute for Tropical Medicine, Nagasaki University, Nagasaki, Japan has also been carrying out serological confirmation on samples from Malaysia.

Two international teams, one from the United States of America and the other from Australia are now in Kuala Lumpur to help investigate the outbreak. Their role will be to carry out detailed serological and virological investigations that will provide a clearer picture of the dynamics of the current outbreak.

WHO fully supports the control efforts being taken by the Malaysian Ministry of Health and is ready to provide technical advice and mobilize additional international resources to help control the current outbreak.

 

Outbreak of Viral Encephalitis - Malaysia, 1999

The Ministry of Health, Malaysia, has reported the occurrence of an outbreak of a febrile encephalitic illness among pig farmers, as well as severe disease among pigs, in the Malaysian states of Perak and Negeri Sembilan. According to Malaysian health authorities, between October 1998 and March 23, 1999, over 150 humans contracted the illness, which is characterized by fever, headache, and central nervous system symptoms. More than 50 of these people have died. Most of the human cases have been in men who appear to have had close contact with pigs.

The initial diagnosis of the illness in Malaysia was Japanese encephalitis, the most common form of viral encephalitis in Asia. Subsequent laboratory testing at CDC identified the presence of a paramyxovirus related to Hendra virus (formerly called equine morbillivirus) in clinical samples from some Malaysian patients. Hendra virus was first recognized in 1994 in Australia, where it caused illness in racehorses and three humans. Two of these Australian patients died, one of acute respiratory infection and the other of encephalitis 1 year after the initial exposure. All three previous Hendra virus infections in humans appear to have been acquired from close contact with horses.

Relatively little is known about the clinical syndrome associated with this new Hendra-like virus in Malaysia. Reports indicate that the illness begins with fever, followed by drowsiness and coma. The late stages of the illness are reported to be accompanied by autonomic instability with fluctuating blood pressure and body temperature. The transmissibility of the virus to humans who are not involved with pig farming appears to be low; nevertheless, the virus is being studied by using strict biosafety level precautions.

At the request of the Malaysian government, CDC has sent a team of scientists to Malaysia to join local and international health officials in an investigation of the outbreak. The CDC team includes medical epidemiologists, zoonotic disease epidemiologists, and microbiologists. Two Australian specialists in Hendra virus research are also participating in the investigation. The purpose of the investigation is to assist the Malaysian government by conducting detailed epidemiologic and virologic studies to determine the nature and extent of the outbreak among humans and animals. CDC's

participation in the investigation is being supported by the Office of Foreign Disaster Assistance, U.S. Agency for International Development.

In addition to the outbreak in Malaysia, cases of a similar encephalitic illness have recently been reported among 10 abattoir workers in Singapore; one of these patients died. Laboratory testing at CDC has confirmed the presence of the Hendra-like virus in clinical samples from these patients.

CDC's Division of Quarantine has issued no travel restrictions to Malaysia at this time. For additional information about the outbreak in Malaysia, refer to the web site of the Ministry of Health, Malaysia, at http://dph.gov.my/;or to the Division of Quarantine's web sites at www.cdc.gov/travel.index.htm or http://www.cdc.gov/travel/seasia.htm.

KAWASAN YANG TERLIBAT DENGAN SERANGAN JAPANESE ENCEPHALITIS