Rubella antibody rates in the female population of Kuala Lumpur were lower than those reported from temperate countries, though similar to rates found in other tropical countries excepting Singapore. Among the major ethnic groups, the immunity status of the Chinese was higher than that of the Malay and Indian groups.
Although dengue haemorrhagic fever is widely established in South-East Asia, no cases have been reported from Borneo. In order to help to assess whether the infection could become established in Borneo, a survey was made, using the single-larva collection method, of the distribution and prevalence of the principal vector, Aedes aegypti, in Sabah and in a few towns and villages of Brunei and Sarawak. In addition, the prevalence of Ae. aegypti was compared with that of certain other species of Aedes.Ae. aegypti was found to be well established in the north, east, and south-west of Sabah but to be absent from almost all of the west coast. It was either uncommon in, or absent from, several small coastal villages; in others, very high Breteau indices were recorded. No reasonable explanation for this discontinuous distribution can be suggested. Large numbers of potential larval habitats were found, giving reason to believe that Ae. aegypti will spread further within these territories.
Surveys were conducted in the southern Malay peninsula to assess intestinal parasitism in the aboriginal ethnic minority groups. Faecal specimens from 1 273 persons were examined by the thiomersal-iodine-formol direct-smear technique. Prevalences are reported and, for helminth infections, data on worm burdens. The state of sanitation in each of 9 cultural-ecological groups was assessed by means of a simplified system of scoring for variables. Particular attention was paid to relationships between cultural and ecological factors, sanitation, and observed patterns of intestinal parasitism. The author also discusses the fact that the number of parasitic species diminishes in habitats simplified by man, whereas an increase occurs in the prevalence and intensity of the more adaptable species that persist in ecosystems of low complexity.
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.
The levels of susceptibility of C. p. fatigans larvae from four different localities in Malaya to DDT, dieldrin, malathion, fenthion, diazinon and Sevin have been studied; their toxicity was: diazinon > fenthion > malathion > dieldrin > DDT > Sevin.Larvae from different localities showed a wide range of susceptibility to the chlorinated hydrocarbon insecticides, dieldrin (40x) and DDT (10x), but the organophosphorus compounds and the carbamate compound, Sevin, gave consistent results from all localities. One strain from a rural area (Lamir) was the most susceptible to all insecticides and has been used as a reference strain for related studies on the development of resistance.
There has been little change since 1955 in the laboratory techniques for seeking new antifilarial compounds, although one valuable addition to laboratory study has been the experimental infection of cats with Brugia malayi.The chief drug for the treatment and control of filariasis-whether caused by Wuchereria bancrofti or by B. malayi-continues to be diethylcarbamazine, and the author reviews the reports recently published on its use. In India and China large-scale campaigns involving the use of this drug have been undertaken; and in Tahiti filariasis has been suppressed and almost eliminated. Campaigns on a smaller scale and pilot projects considered in this survey include those conducted in Pacific islands, Malaya, Ceylon, Brazil, Surinam and East and West Africa.It is generally agreed that the administration of diethylcarbamazine produces a great diminution in the microfilarial counts of those taking it, and in many persons both microfilariae and adult worms are eradicated. The difficulties which arise are due to toxic effects which occur in some recipients and which may adversely affect the acceptability of treatment.
Because of the risk of introduction of yellow fever to South-East Asia, comparative studies were made of yellow fever vaccination in Malayans who had a high prevalence of antibody to related viruses and in volunteers without related antibody. The proportions of positive neutralizing antibody responses to subcutaneous vaccination with 17D vaccine were not significantly different between volunteers with and without heterologous antibody but the degree of antibody response was greater in those without. The ID(50) of 17D in both groups was about 5 mouse intracerebral LD(50). Multiple puncture vaccination with 17D gave a much lower response rate than subcutaneous vaccination in volunteers with heterologous antibody. In both groups subcutaneous doses of about 50 mouse intracerebral LD(50) gave larger antibody responses than higher doses. The neutralizing indices and analysis of results were calculated by a method based on the survival time of the mice. This method, which has advantages over that of Reed & Muench, is fully described in an annex to this paper.
The author reviews the distribution, epidemiology, and treatment of filarial infection due to Brugia malayi, with special reference to Malaya. B. malayi infection in man is confined to the Far East between longitudes 75 degrees E and 140 degrees E and is essentially rural. The chief vectors are Mansonia spp., Anopheles hyrcanus group, A. barbirostris group, and Aëdes togoi. The epidemiological picture is complicated by the fact that B. malayi and other closely related species have now been found in several species of animals. The existence of an animal reservoir of infection might have important implications for filariasis control. As to the treatment of B. malayi infection, diethylcarbamazine has been found to reduce the microfilaria count and to kill the adult worms; the severe febrile reactions of microfilaria carriers to the initial doses of this drug may be reduced by administration of the steroid prednisolone.
After two years' use of hexachlorocyclohexane (BHC) as a larvicide in Georgetown, on Penang Island, control of Culex fatigans breeding became unsatisfactory. Two laboratory colonies of fatigans were established, one from Georgetown, and one from Kuala Lumpur where no insecticides had been used; tests were then made to determine the median lethal concentrations (MLC) of BHC, dieldrin, and DDT for the larvae of the two strains. The Georgetown strain was found to have acquired a tenfold resistance to BHC, and also to dieldrin to which it had not been exposed, but it showed no significant increase of resistance to DDT, to which it had also not been exposed. A year later, when both strains had passed through some ten generations in the laboratory without exposure to insecticides, the Georgetown strain was found to have lost much of its resistance to BHC, although the MLC was still twice that of the non-resistant Kuala Lumpur strain.
A new enterovirus, now classified as enterovirus type 70, was isolated from the conjunctiva of patients with acute haemorrhagic conjunctivitis during the 1971 epidemics that occurred in Japan, Singapore, and Morocco. These epidemics were parts of a pandemic involving Africa (Algeria, Ghana, Morocco, Nigeria, and Tunisia), Asia (Cambodia, China (Province of Taiwan), Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, and Thailand), and England during 1969-71. A representative strain from each of the three epidemic areas was studied cooperatively. The strains exhibited the physicochemical characteristics of enteroviruses. Cross-neutralization tests showed that these viruses were distinct from all known human enterovirus immunotypes, but that they were antigenically closely related. The human origin of the viruses was demonstrated by the appearance of homologous neutralizing antibodies during convalescence in patients with acute haemorrhagic conjunctivitis.
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 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.