The Nipah virus outbreak represented one of several bat-derived paramyxoviruses that has emerged during the last decade to cause severe human and animal disease. The pathogenesis of Nipah infection is associated with its ability to infect blood vessels and extravascular parenchyma in many organs, particularly in the central nervous system. The clinical manifestations of acute Nipah infection range from fever and mild headache to a severe acute encephalitic syndrome in which there is a high mortality. Much remains to be understood about this new disease, including its intriguing ability to cause relapsing encephalitis in some survivors. This review provides an overview of the Nipah outbreak, focussing on what is presently known about it as an infectious disease, including the clinical aspects, pathology and pathogenesis.
OBJECTIVE: Pulsed-field gel electrophoresis (PFGE) was used to investigate an outbreak of gastroenteritis caused by Salmonella enteritidis. The outbreak occurred among university undergraduates who consumed contaminated food.
METHOD: Molecular typing was done by analyzing DNA band patterns of isolates of S. enteritidis after digestion of chromosomal DNA with infrequently-cutting restriction endonucleases XbaI, AvrII, and SpeI and separation of DNA fragments using PFGE.
RESULTS: Twenty-nine outbreak isolates of S. enteritidis had identical or highly similar PFGE patterns, whereas different PFGE patterns were observed among three epidemiologically unrelated isolates obtained during the same period.
CONCLUSION: The data obtained confirm the value of PFGE in epidemiologic investigations of outbreaks caused by S. enteritidis.
Serratia marcescens is a well-known cause of nosocomial infections and outbreaks, particularly in immunocompromised patients with severe underlying disease. An outbreak due to S. marcescens infection was detected from 13 to 22 February 2001 at the intensive care unit (ICU) of our institution. We used pulsed-field gel electrophoresis (PFGE) typing to analyse the outbreak strains involved.
The organic foods’ market is becoming one of the rapidly growing sections in agricultural economies in the world. During the last two decades, food-borne outbreaks associated with fresh produce have rapidly increased. E. coli O57:H7, the caustic agent of acute hemorrhagic diarrhea and abdominal cramps, is mainly associated with meat and poultry product outbreaks but frequent outbreaks linked to the consumption of vegetables have been reported. The aim of this study was to investigate prevalence of E. coli O157:H7 in some organic foods. A total of 230 organic food samples including four-winged bean, tomato, white radish, red cabbage, chinese cabbage, lettuce, cucumber and chicken form retailed groceries and supermarkets in Malaysia were investigated. Low prevalence of E. coli O157:H7 was detected in organic vegetables and chickens. The estimated quantity of E. coli O157:H7 in all samples ranged from 2400 MPN/g. The overall MPN/g estimate of E. coli O157:H7 in the samples from organic groceries was higher than supermarket with the maximum of >2400 MPN/g. Most of the samples from supermarket showed a minimum of
Shiga toxin-producing E. coli (STEC) is an important foodborne pathogen causing diarrhea, hemorrhagic colitis and hemolytic-uremic syndrome in humans. STEC is an implicated in the vast majority of outbreaks, widely via consumption of STEC contaminated beef, as important vehicle of transmission of this organism to human. The E. coli O157:H7 serotype is traditionally identified by serological identification of the somatic antigen (O157) and structural flagella (H7). In this study, the bacteria were identified as STEC serotype O157:H7 with three primer pairs that amplified fragments of secD, rfbE and fliC genes in PCR assays. These primer pairs specifically amplified different sizes of target genes: a 244bp region of the E. coli diagnostic marker gene (secD); a 317bp region of the O157 lipopolysacharide (LPS) gene (rfbE); and a 381bp region of the H7 flagellin gene (fliC). The singleplex, duplex and triplex PCR assay developed in this study have a sensitivity limit at 2.8 x 103, 2.8 x 105 and 2.8 x 107 CFU/ml of E. coli O157:H7, respectively. Sensitivity to detect trace amount of E. coli O157:H7 DNA was reduced as the number of primer used was increased for competing to the same DNA template.
Dengue fever (DF) has been endemic in Malaysia since 1902 and reached epidemic proportions in 1973. The incidence rate of the disease in 1973 was 5.4 cases per 100,000 and reached 10.4 cases per 100,000 in 1987. The Chinese are the main ethnic community affected showing an overall morbidity rate of 9.0 cases per 100,000 followed by Malays 2.9 cases per 100,000 and Indians 2.4 cases per 100,000. The ethnic race ratio between Chinese, Malays and Indians which was 3.7:1:1.3 in 1975 reached 3.7:1:0.9 in 1987. The attack rates were observed to be higher in the males. The mean male:female ratio among Chinese was 1.1:1, while for Malays and Indians it was 1.5:1. The age-specific morbidity rate was highest in the 10- to 19-year age group followed by the 20- to 29-year age group. Epidemics of dengue fever were found to occur seasonally with the appearance of two peaks, viz. one in June and the other in August. Dengue fever, a rural disease before, has established itself as an urban disease.
Publication year=1992-1993
Acute-phase serum samples collected during an outbreak of dengue fever and dengue haemorrhagic fever in Penang, Malaysia, were tested by a method involving antibody-dependent enhancement of infectivity in the mouse macrophage-like cell line, P388D1. 58 of 71 (81.7%) serologically positive cases yielded virus.
Haemorrhagic fever with renal syndrome (HFRS) is caused by a group of RNA viruses within the family of Bunyaviridae known as hantaviruses. The classical, severe form of HFRS is characterized by fever, headache, abdominal and lumbar pain, proteinuria, haemorrhagic phenomena, shock and renal failure. The disease is associated with the prototype Hantaan virus and occurs in rural areas of Korea and China with Apodemus mice as reservoir hosts. A clinically less severe form of HFRS, which is caused by Seoul virus, occurs in urban areas with the house rat Rattus novegicus as the main reservoir host. The disease in nonendemic areas may be atypical and patients with symptoms the hepatitis and minimal renal involvement have been observed in Malaysia. Outbreaks of HFRS in humans involving infected laboratory rat colonies have occurred in several medical centres in various countries. Hantaviruses cause a chronic, asymptomatic infection in rodents which excrete the virus in their lungs, saliva and urine. Man becomes infected mainly by inhalation of infected droplets from healthy rodent carriers. Seroepidemiological studies using mainly the indirect immunoflourescent antibody test of sera from humans and rats showed that hantaviruses have a worldwide distribution.
Little is known about the sero-prevalence of diphtheria anti-toxoid antibody levels among medical students in Malaysia. They too, just like other health care workers (HCWs) are at risk of contracting and transmitting diphtheria. Fortunately, this can be prevented by giving a specific vaccine: the diphtheria, tetanus and pertussis (DTP) vaccine. Nonetheless, data from local or regional surveys are needed before any decision is made by the respective authorities. General objective: We studied the epidemiology of diphtheria anti-toxoid antibody levels and vaccination history amongst medical students and staff in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Specific objectives: We determined the level of diphtheria anti-toxoid antibodies amongst pre-clinical students and staff. Methodology: A total of 152 sera were collected from subjects aged 19 to 63, and diphtheria anti-toxoid levels were measured by an enzyme-linked immunosorbent assay. Results: One hundred and fifty-two (94.4%) blood samples out of 161 participants were successfully withdrawn, which comprised 105 (69.1%) and 47 (30.9%) medical students and staff, respectively. A total of 77.6% and the other 22.4% of the subjects had full and basic protection, respectively. Higher levels were predominant amongst males and they were 1.3 times more protected than females in 20-29 year-old group (85.1% vs 66.2%; odd ratios 1.25 [95% CI 1.03-1.50]; P=0.03). No significant difference in the levels of immunity among subjects for ethnicity and academic position (P>0.05). Recommendations: Level of full protection against diphtheria toxin should be clearly defined by broad population based studies using several comparable detection methods. Medical students and staff with basic protection should be closely monitored or should be given a booster dose for those who are at high risk of acquiring the disease. Thus, a standard degree of coverage should be clearly determined for health workers to prevent a potential outbreak. Conclusion: Students and staff possess immunity towards diptheria toxin however the level of full protective antibody is yet to be determined in future.
This review places emphasis on the food and water borne protozoal diseases like, cryptosporidiosis, giardiasis, cyclosporiasis, and toxoplasmosis which are endemic in many parts of the world. The article addresses cryptosporidiosis, giardiasis, cyclosporiasis, and toxoplasmosis. Cryptosporidium and Giardia are widespread in the environment and major outbreaks have occurred as a result of contaminated drinking water. Cyclospora has significance in the preparation and consumption of fresh food that have not received heat treatment. Toxoplasma gondii, transmission occur through contaminated water, unpasteurised milk and also the consumption of raw meat, which has been regarded as a major route of transmission to humans .These parasitic protozoa do not multiply in foods, but they may survive in or on moist foods for months especially in cool and damp environment. Their ecology makes control of these parasites difficult. Transmission, clinical manifestations, outbreaks, public health surveillance and control measures that are used for those diseases will be reviewed in this article.
Vibrio parahaemolyticus is one of the most widely recognized pathogenic Vibrio species due to numerous outbreaks and its’ wide occurrence in marine environment. In this study, 32 isolates of V. parahaemolyticus isolated from cockles were tested for sensitivity to 16 antibiotics and the presence of plasmids. All the isolates were multi-resistance, defined as resistant to atleast three different antibiotics with multiple antibiotic resistance indexes ranging from 0.31 to 0.69, indicating the isolates originate from high risk sources of contamination where antibiotics are often used. In the plasmid profiling test, only 15 isolates (47%) harbored plasmid DNA, which ranged in size from 2.7 to 56.2 kb, separating the isolates into 14 plasmid profiles. Hence, food contaminated with antibiotic resistant V. parahaemolyticus could be a major threat to public health due to the distinct possibility that they can be a significant reservoir of genes encoding antibiotic resistance determinants that can be transferred intra or interspecies. As in many developing countries, raw food hygiene and antimicrobial resistance epidemiology is still in the infancy stage in the locality of the study and thus our data provide a current baseline profile of antimicrobial resistance and plasmid of V. parahaemolyticusfrom cockles in Padang, Indonesia.
Cronobacter sakazakii is an emerging food borne pathogen which has been associated with outbreaks of a rare form of infant meningitis. Although the origin of the microorganism has not been established, several
infection cases have been associated with the consumption of contaminated powdered infant formula (PIF). In the present study, growth characteristics of three C. sakazakii strains isolated from PIF samples and C.
muytjensii strain ATCC 51329, which was formerly the ATCC Preceptrol™ strain for the quality control of
‘Enterobacter sakazakii’ prior to the taxonomic revision, were investigated in Tryptone Soya broth (TSB) and
reconstituted PIF at 4, 10, 25, 37, 45 and 50ºC. The viability of heat treated cells of Cronobacter strains was
evaluated by plating on Violet Red Bile Glucose agar (VRBGA) and the Druggan-Forsythe-Iversen (DFI)
chromogenic agar followed by incubation at 37ºC. These strains were also subjected to higher temperatures
between 52 to 60ºC to measure their thermal tolerance. The mean generation time of all Cronobacter strains
were slightly lower in PIF than in TSB. C. muytjensii ATCC 51329 showed lower generation time in all culture
media and all temperatures compared to the Cronobacter food isolates, but the results were not significantly
different (P>0.05). The results also indicated that combination of PIF: DFI culture media had higher recovery at
all temperatures compared to other combinations. Survival study also indicated that C. muytjensii ATCC 51329
had higher D-value compared to food isolates at all incubation temperatures.
Background : Safe potable water is critical during and post flood. In the pre-flood period, Johore has an excellent, systematic and comprehensive water supply system. More than 98.6% of Johore population received treated water supply from the water treatment plants.
Methodology : Data collection was performed by conducting additional water sampling at routine sampling stations as well as the flood relief centres, water tankers (lorries) and static water tanks. Water treatment plant outlet and water tanker inlet shall have a minimum level of 2.0 mg/l of residual chlorine so that reticulation, water tanker outlets and static water tanks would have at least 0.5 mg/l as a measure to prevent the incidence of water borne diseases. Sampling was done everyday to monitor water quality at the flood relief centres as well as flood-hit areas. Inspections and surveillance on sanitation were also conducted on latrines, solid waste disposal systems and on the surrounding environment.
Results : A total of 6,283 water samples had been collected during and post flood. Violations on E. coli, turbidity and residual chlorine were 0.8%, 0.6% and 4.0% respectively with the Kluang district recorded the highest percentages for all the three parameters. A number of 621 wells had been inspected with 378 of them (60.9%) had been chlorinated. In order to ensure environmental cleanliness, 26,815 houses in 708 villages had been visited. Out of them, 2,011 houses (7.5%) were not satisfactory. Sanitation inspections found that 1,778 latrines, 2,719 domestic water sewerage systems and 2,955 solid waste disposal systems were under substandard conditions thus remedial actions had been taken immediately.
Conclusion : Although the flood disaster was massive with prolonged flooding period, however, an overall quality status on treated water supply was satisfactory whilst sanitary hygiene was under control. Hence, the incidence of communicable disease especially water borne diseases would not progress into serious outbreak, in fact, neither cholera nor typhoid was reported during the Johore flood disaster.
Background and Objective : Johor was affected by the worst flood in 100 years in December 2006 and again in January 2007. The concern that improper sanitary facilities and contaminated water supply at relief centres would result in contaminated food made monitoring of food hygiene vital. The objective of this paper is to describe food hygiene surveillance activities carried out in flood relief centres and flood affected areas and the challenges faced in carrying out these activities.
Methodology : The food hygiene surveillance activities were carried out by the Assistant Environmental Health Officers (AEHO) in the districts. Among the surveillance activities carried out are inspection of food preparation areas in relief centres, inspection of food premises in flood affected areas and food sampling. Premise inspections were carried out using a specific inspection format. Food samples taken were sent to Public Health Laboratory, Johor Bahru for microbiological analysis. Anti typhoid vaccination for food handlers were also carried out. Apart from that, observations made by the health teams were alsotaken into account.
Results : A total of 3,159 food preparation areas in relief centres were inspected. During the same period, a total of 2,317 food premises in flood affected areas were inspected as soon these premises started operating after the floods. Inspections showed that 69 food preparation areas in relief centres and 181 food premises in flood affected areas had unsatisfactory hygiene. A total of 1,566 holding samples were taken and 425 samples were sent to the laboratory for analysis. Forty-six of the samples analysed were found to be positive for pathogenic bacteria such as e. coli, staphylococcus aureus and salmonella.
Conclusion : The health personnel from the Johor Health Department in various districts carried out an excellent job in ensuring food safety during the floods. There were no outbreaks of food poisoning. However analysis of food samples taken during the floods did show the presence of pathogenic organisms but probably their numbers were not high enough to cause any food poisoning. The promotion and enforcement of food hygiene requirements should be carried out continuously to ensure that every individual understands the need for hygiene and food safety during disaster situation such as flood.
Foodborne disease has been associated with microorganisms like bacteria, fungi, viruses and parasites. Most commonly, the outbreaks take place due to the ingestion of pathogenic bacteria like Salmonella Typhi, Escherichia coli, Staphylococcus aureus, Vibrio cholera, Campylobacter jejuni, and Listeria monocytogenes. The disease usually happens as a result of toxin secretion of the microorganisms in the intestinal tract of the infected person. Usually, the level of hygiene in the food premises reflect the quality of the food item, hence restaurant or stall with poor sanitary condition is said to be the contributor to food poisoning outbreak. In Malaysia, food poisoning cases are not rare because the hot and humid climate of this country is very suitable for the growth of the foodborne bacteria. The government is also implementing strict rules to ensure workers and owners of food premises prioritize the cleanliness of their working area. Training programme for food handlers can also help them to implement hygiene as a routine in a daily basis. A lot of studies have been done to reduce foodborne diseases. The results can give information about the types of microorganisms, and other components that affect their growth. The result is crucial to determine how the spread of foodborne bacteria can be controlled safely and the outbreak can be reduced.