The author discusses some of the features of the cholera epidemic caused by El Tor vibrios in 1961-62 in the Western Pacific. The disease originated in the Celebes and spread from there to other parts of Indonesia, to Sarawak and, possibly, to Kwangtung. Hong Kong and Macau were most probably infected from Kwangtung. Subsequently the disease reached the Philippines, progressing from Manila southwards to the other islands, whence it invaded British Borneo. The El Tor epidemic did not differ clinically or epidemiologically from other cholera outbreaks observed during the past decade. The disease attacked poor, under-nourished people living under insanitary conditions. It spread along the coastline and, to a limited extent, along inland waterways. The authorities in the affected territories recommended that the quarantine regulations, sanitary measures and treatment methods used against cholera caused by the so-called "true" cholera vibrios be applied also to cholera caused by El Tor vibrios.
Although mosquitos of the Anopheles umbrosus group have long been recognized as important vectors of human malaria in Malaya, there have been doubts about the origin of some of the malaria infections found, especially in A. umbrosus and A. letifer. Investigations have accordingly been carried out in the Malayan swamp-forest, in conjunction with laboratory studies, into the nature of malaria infections in wild-caught mosquitos, the biting behaviour of anophelines and the presence of malaria infection in man and animals. The authors conclude from the results reported in this paper that A. umbrosus is a vector of mouse deer malaria and rarely, if ever, transmits primate malaria; that A. letifer transmits both human and mouse deer malaria; and that A. baezai and A. roperi are probably vectors of mouse deer malaria.
In view of the risk of introduction of yellow fever into South-East Asia, comparative studies have been made of yellow fever vaccination in Malayan volunteers with a high prevalence of antibody to related viruses and in volunteers without related antibody. In a previous paper the neutralizing antibody responses of these volunteers were reported. The present paper describes the haemagglutinin-inhibiting (HI) antibody responses of the same groups of volunteers and discusses the relationship of these responses to the neutralizing antibody responses.The HI responses to yellow fever following vaccination closely paralleled the neutralizing antibody responses whether vaccination was subcutaneous or by multiple puncture. Volunteers with a high level of YF HI antibody due to infection with other group B viruses were found to be less likely to show a significant YF HI response than those without antibody. 90% of HI responses could be detected by the 21st day after vaccination.As with neutralizing antibody responses, volunteers given vaccine doses of 50-500 mouse intracerebral LD(50) subcutaneously gave greater responses than those given higher doses.
Studies have recently been published of surveys of antibodies to common respiratory viruses in human sera from several parts of the world. The present article reports the findings of a survey of antibodies to two more viruses (adenovirus type 8 and coxsackievirus type A21) in human sera mainly collected from six widely separated geographical regions (Alaska, England, Marshall Islands, Sarawak, South-West Africa and Tunisia).A world-wide geographical distribution of infection with these two viruses was found. However, antibodies to individual viruses were not found with the same frequency in all countries; and, in marked contrast to the findings in the earlier surveys of antibodies to the common respiratory viruses, the frequency of antibodies was not the same for each virus in sera from the same country. It was not possible to draw any final conclusions as to the reasons for the observed differences.
In view of the problems caused by the chloroquine-resistance of some strains of Plasmodium falciparum, the authors have investigated the effectiveness of diaphenylsulfone against two such resistant strains, from Malaya and Viet-Nam. They found that diaphenylsulfone given during acute attacks of malaria had a blood schizontocidal activity against the Malayan resistant strain but was not rapidly effective in terminating acute attacks in non-immune persons, and that, when the drug was given prophylactically in relatively small doses, it was substantially effective in preventing patency of mosquito-induced infection with the same strain. The protective effect of diaphenylsulfone is that of a clinical prophylactic or suppressive drug; it does not appear to be a true causal prophylactic. It was also found that the protective effect is vitiated by the concurrent administration of paraaminobenzoic acid.These studies indicate a need for further assessment of the antimalarial value of sulfones and sulfonamides, both alone and in combination with other drugs, for prevention and cure.
During the past decade outbreaks of a severe haemorrhagic disease caused by dengue viruses of multiple types have been reported in the Philippines, Thailand, Malaysia, Viet-Nam and eastern India. In many of these outbreaks chikungunya virus, a group A arbovirus, was simultaneously the cause of similar but probably milder disease. Both these viruses appear to be able to be able to produce classical dengue fever in some individuals and disease with haemorrhagic manifestations in others. Because of the growing public health importance and the progressive spread of this disease a unified review of its clinical and epidemiological features has been needed. This paper presents the history and salient clinical features of mosquito-borne haemorrhagic fever and summarizes recent epidemiological studies and current diagnostic and control methods.
The yellow fever mosquito Aedes aegypti has developed resistance to DDT in the Caribbean region and in South-East Asia, but not in West Africa. Therefore West African strains were compared with South-East Asian strains for their response to laboratory selection with DDT. It was found that West African strains were much slower to respond initially, but eventually could build up a high degree of DDT-resistance. By crossing and backcrossing with a susceptible marker-gene strain, it was found that this resistance was due to a single gene linked with the gene y (yellow) on chromosome 2 at a cross-over distance of approximately 35 units in an Upper Volta strain as in a Bangkok strain; interstrain crosses indicated that the gene was the same as that in a Trinidad strain and in one from Penang. Dieldrin-resistance could be readily induced in the Upper Volta strain and proved to be due to a gene also linked with y but at a crossover distance of approximately 25 units, comparable to that in Caribbean strains previously studied. Material from Karachi, West Pakistan, developed a dieldrin-resistance also showing 25% crossing over with y, and a DDT-resistance also linked with this chromosome-2 marker gene.
The immunological characteristics of 26 strains of Japanese encephalitis virus (JEV) isolated in Japan and Malaya between 1935 and 1966 have been investigated mainly by the antibody-absorption variant of the haemagglutination-inhibition test, and to a certain extent also by conventional haemagglutination-inhibition and complement-fixation tests. The antibody-absorption technique shows promise as a routine method for the immunotyping of JEV.At present, two immunotypes can be distinguished. One comprises 2 strains, Nakayama-NIH and I-58, and is designated as the I-58 immunotype. The other immunotype, JaGAr 01, comprises 17 strains which share the characteristics of the JaGAr 01 strain, including one subline of the Nakayama strain, Nakayama-Yakken. The Nakayama-RFVL strain was found to have the characteristics of both immunotypes. The I-58 immunotype differs more markedly from related arboviruses, such as the Murray Valley encephalitis virus and the West Nile Eg101 strain, than does the JaGAr 01 immunotype.Evidence is presented which suggests that a given JEV strain can change immunotype on repeated passage through mice.
The fluorescent antibody (FA) technique was used to detect the presence of malarial antibody in populations living in 3 different ecological areas of Malaysia. Serum samples were tested using Plasmodium falciparum, P. vivax, P. malariae and P. fieldi antigens. An area of hyperendemic malaria had a good correlation between the antibody responses and active parasitaemias. The percentage and intensity of responses increased with the age of the individuals. In an area of hypoendemic malaria, each of 17 sites had ecological conditions which would favour or discourage the transmission of malaria. The reasons for high FA responses in some villages and low responses in others were readily apparent. The effect of even limited control programmes on the malarial ecology could be measured by an examination of the antibody responses. An aboriginal population receiving suppressive drugs had FA responses indicating both past experience and the effect of the drug programme.
In certain areas of Sabah, East Malaysia, local houses are frequently built without walls or with incomplete walls. Also, the people in these areas often refuse permission for their houses to be sprayed inside with insecticide (DDT). These special conditions are the reason for the persistence of malaria transmission under a WHO malaria eradication programme.Field trials were conducted in specially constructed huts, similar to the local houses, in which all-night collections of mosquitos were made, both those biting human baits and those resting on walls, in order to determine (1) the effectiveness of spraying DDT in houses without, or with incomplete, walls; and (2) the best way to protect people against mosquito bites with DDT-spraying where the house-owners have refused indoor spraying.The results indicate that (1) as expected, DDT-spraying inside a hut with incomplete walls is less effective than in a hut with complete walls, especially 6 months or more after spraying; (2) external spraying of walls with DDT at double the normal dose (i.e., 4 g/m(2)) greatly reduced contacts between man and mosquito and thereby limited transmission of malaria.
Epidemiological studies of human leptospirosis have generally been limited to countries with specialized laboratories employing the microscopic-agglutination (MA) test. The sensitized-erythrocyte-lysis (SEL) test is much simpler for routine hospital laboratories to carry out and it has been found valuable in the diagnosis of human leptospirosis. This paper reports the results of studies of the SEL test as an epidemiological tool in serological surveys.The results showed that the significant SEL titre was 1:80 and that the sensitivity of the test depended possibly on the antigen preparation and the amount of complement used. Most of the SEL antibodies were found to persist at significant titres for about 1 year after active infection, but less than half persisted longer than that. The SEL test is therefore useful for detecting recent infections and for indicating that stability of leptospirosis in an area.The endemicity of leptospirosis in West Malaysia was confirmed by the SEL test, based on the employment of 1:80 as the significant titre.
Serological surveys have been widely used in South-East Asia to determine the presence and activity of arboviruses. The haemagglutination-inhibition test has been most frequently employed but complement-fixation and neutralization tests have also been used in some investigations.Although virus isolations provide the most conclusive evidence, they can be carried out in a few specialized centres only, and serological surveys are very important for studying the distribution of arboviruses.The surveys have shown that group B arboviruses (principally all four types of dengue, Japanese encephalitis, and West Nile) are widely prevalent. Dengue and Japanese encephalitis viruses are more widespread than West Nile virus, which was not known previously to extend east of India although recent survyes have shown that its range extends to Burma. Japanese encephalitis is frequent in most of South-East Asia but in India is found mainly in eastern and south-eastern parts of the country. Kyasanur Forest disease (KFD) and Langat viruses are the only tick-borne group B arboviruses definitely known to occur in the region, the former in India, the latter in Malaysia. KFD virus has been isolated only from a small focus in Mysore, although human and animal sera containing neutralizing antibodies to this virus have been found sporadically in widely scattered areas. Among the group A arboviruses, chikungunya and Sindbis have been detected in serological surveys, but the former has not yet been found in Malaysia.
Measurements of child growth have become the most accepted means of assessing the protein-calorie nutritional status of economically developing populations. International reference standards have been suggested for a number of body measurements, but there has been little evaluation of their applicability in South-East Asia.In order to delineate the present range of nutritional standards in West Malaysia, and to aid in the development of guidelines for further nutritional work in this region, anthropometric tests were made on 3 groups of children below school age belonging to the Malay ethnic group and living under diverse conditions. Children of Malaysian Army personnel differed significantly in most measurements from rural village children in Trengganu and children from a small urban elite in Kuala Lumpur. Measurements for the latter group approximated to internationally used standards of height and weight. Parental height data suggest that these differences are not primarily genetic. Anaemia, malaria, and ascariasis were common among the Trengganu children.Weight and height emerge as the measurements that are most sensitive in differentiating between the groups; arm circumferences and skinfold measurements are also useful because they are relatively independent of age. Measurement of chest and head circumferences and of crown-rump lengths appeared to be of little value.