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  1. Fulltext Hepatitis B in jaundiced neonates admitted to a special care nursery
    Nem-Yun B, Isahak I
    Med J Malaysia, 1988 Jun;43(2):162-5.
    PMID: 3237132
  2. Fulltext Adult immunization--a neglected issue in Southeast Asia
    Isahak I, Steering Committee for Prevention and Control of Infectious Diseases in Asia
    Southeast Asian J. Trop. Med. Public Health, 2000 Mar;31(1):173-84.
    PMID: 11023089
    Adult immunization is a neglected and underpublicised issue in Southeast Asia. Vaccine-preventable diseases cause unnecessary morbidity and mortality among adults in the region, while inadequate immunization results in unnecessary costs, including those associated with hospitalization, treatment, and loss of income. Childhood vaccination coverage is high for the EPI diseases of diphtheria, tetanus and pertussis; however, unvaccinated, undervaccinated, and aging adults with waning immunity remain at risk from infection and may benefit from vaccination. Catch-up immunization is advisable for adults seronegative for hepatitis B virus, while immunization against the hepatitis A and varicella viruses may benefit those who remain susceptible. Among older adults, immunization against influenza and pneumococcal infections is likely to be beneficial in reducing morbidity and mortality. Certain vaccinations are also recommended for specific groups, such as rubella for women of child-bearing age, typhoid for those travelling to high-endemicity areas, and several vaccines for high-risk occupational groups such as health care workers. This paper presents an overview of a number of vaccine-preventable diseases which occur in adults, and highlights the importance of immunization to protect those at risk of infection.
  3. Comparison of direct immunoperoxidase and direct immunofluorescence for the detection of herpes simplex virus antigen in cell culture
    Sabil D, Othman SK, Isahak I
    Malays J Pathol, 1990 Jun;12(1):35-8.
    PMID: 1965320
    150 specimens from suspected herpes simplex genital and skin lesions were received in virus transport medium. They were inoculated into Hep-2 cell monolayers, examined for the presence of virus by cytopathic effect (CPE), direct immunoperoxidase (DIP) and direct immunofluorescence (DIF). Of 39 (26.0%) virus-positive specimens by CPE, 37 (24.7%) were HSV-positive by DIP and 36 (24.0%) by DIF staining. DIP staining had a sensitivity of 100%, specificity of 99.1%, positive predictive value of 97.3% and negative predictive value of 100% in relation to DIF as a standard test. Of 39 specimens positive by CPE, only 25.6% were HSV-positive within 24 h post-inoculation compared to 94% HSV-positive by DIP and DIF staining at the same time.
  4. Fulltext Influenza and Respiratory Syncytial viral infections in Malaysia: Demographic and Clinical perspective
    Rahman MM, Wong KK, Hanafiah A, Isahak I
    Pak J Med Sci, 2014 Jan;30(1):161-5.
    PMID: 24639853 DOI: 10.12669/pjms.301.4272
    Respiratory infections represent a major public health problem worldwide. The study aimed to determine the prevalence of respiratory syncytial and influenza virus infections and analyzed in respect to demography and clinical perspective. Methods : The specimens were processed by cell culture and immunofluorescent assay (IFA) and real-time reverse transcriptase-PCR (rRT-PCR) for detection of respiratory viruses. Results : Out of 505 specimens 189 (37.8%) were positive, in which RSV was positive in 124(24.8%) cases and influenza A was positive in 65(13%) cases. Positive cases for influenza virus A and RSV were analyzed based on demography: age, gender, ethnicity and clinical symptoms. There were no significant differences among gender, ethnicity and clinical symptoms in both RSV and influenza A virus infections. It was observed that children below 3 years of ages were more prone to RSV infections. On the contrary, influenza virus A infected all age groups of humans.
  5. Effectiveness of influenza vaccination in prevention of influenza-like illness among inhabitants of old folk homes
    Isahak I, Mahayiddin AA, Ismail R
    Southeast Asian J. Trop. Med. Public Health, 2007 Sep;38(5):841-8.
    PMID: 18041300
    The aims of the study were to determine the attack rate of influenza-like illness among inhabitants of five old folk homes nationwide using influenza vaccine as a probe and the effectiveness of influenza vaccination in prevention of influenza-like illness. We conducted a nonrandomized, single-blind placebo control study from June 2003 to February 2004. VAXIGRIP(R) 2003 Southern hemisphere formulation was used. Among 527 subjects, the attack rates of influenza-like illness in the influenza vaccine group were 6.4, 4.6 and 2.4% during the first, second and third 2-month periods, respectively. The attack rates of influenza-like illness in the placebo group were 17.7, 13.8 and 10.1%. Influenza vaccination reduced the risk of contracting influenza-like illness by between 14, and 45%. The vaccine effectiveness in reducing the occurrence of influenza-like illness ranged from 55 to 76%, during the 6-month study followup. The presence of cerebrovascular diseases significantly increased the risk of influenza-like illness (p < 0.005). Vaccine recipients had fewer episodes of fever, cough, muscle aches, runny nose (p < 0.001) and experience fewer sick days due to respiratory illness. Subjects who received influenza vaccination had clinically and statistically significant reductions in the attack rate of influenza-like illness. Our data support influenza vaccination of persons with chronic diseases and >50 year olds living in institutions.
  6. Fulltext Antibody to hepatitis C virus in thalassemia patients
    Isahak I, Baharin R, Hakim AS, Abu Bakar M, George E
    Malays J Pathol, 1993 Jun;15(1):85-7.
    PMID: 8277796
    A specific enzyme immunoassay (EIA) for the diagnosis of hepatitis C virus (HCV) infection was developed by recombinant DNA technology. Abbott HCV EIA was used to detect antibody to HCV (anti-HCV) in non-transfused and multiply-transfused thalassemia patients. None of 11 non-transfused patients had anti-HCV but 3 of 52 (5.8%) multiply-transfused patients had anti-HCV. This study showed that the prevalence rate of HCV infection is low in thalassemia patients. However, it is still important to identify hepatitis C virus infected patients in high risk groups because hepatitis C is associated with chronic hepatitis, cirrhosis and hepatocellular carcinoma.
  7. Pneumococcal infection in hospitalized patients: a four-year study in Malaysia
    Jamal F, Pit S, Isahak I, Abdullah N, Zainal Z, Abdullah R, et al.
    Southeast Asian J. Trop. Med. Public Health, 1987 Mar;18(1):79-84.
    PMID: 3660072
    A total of 90 cases of pneumococcal infections were identified at a major referral hospital in Kuala Lumpur, Malaysia during a study period of four years. Pneumonia was the most common clinical presentation (41 cases) followed by meningitis (19 cases). Of 48 patients who were followed-up during the microbiology consultation round, 11 died, 9 were children below two years old. Capsular typing was carried out on 57 strains of Streptococcus pneumoniae isolated from blood and body fluids of 43 children and 14 adults. 38 strains isolated from pharyngeal specimens were also typed. Types 6A (11 strains), 6B (7 strains), 14 (8 strains) and 19A (8 strains) predominated in children. The strains from older patients comprised 3 isolates from cerebrospinal fluid (types 18B, 6B and 14), five from blood (4 strains, type 1 and 1 strain, type 4) and six from pus (1 strain, type 14, 3 strains type 23F and 2 strains type 34). The isolates from pharyngeal specimens belonged to capsular type similar to those implicated in infections. 90% of the types reported in this study are included in the 23 valent pneumococcal vaccines. Minimum inhibitory concentrations of penicillin, cefuroxime, chloramphenicol and rifampicin were determined for selected strains. 4.1% of isolates were resistant to penicillin (3/74), 4.5% to cefuroxime (2/44), 6.5% to chloramphenicol (3/46) and 14.6% to rifampicin (6/41).
  8. Fulltext The evaluation of Engerix-B in healthy Malaysian medical students
    Isahak I, Abdul Malik Y, Hakim AS, Baharin R
    Singapore Med J, 1990 Aug;31(4):314-6.
    PMID: 2147781
    Fifty medical students were screened for hepatitis B serological markers of whom 42 students entered the study. Those who were found to be negative for all markers were vaccinated with 1.0 ml (20 mcg HBsAg) Engerix-B vaccine intramuscularly in the deltoid region according to the 0, 1, 6 month schedule. Blood samples were taken at 1, 2, 3, 6, 9 months. One month following the first dose, 7% showed detectable AntiHBs with a GMT of 11 IU/I. By the sixth month, just before the third dose was given, 79% seroconverted with a GMT of 2952 IU/I. Three months following the third dose all had seroconverted with a GMT of 18,381 IU/I. No serious adverse reactions were noted and none of the subjects showed evidence of hepatitis B infection during the study. This study thus confirms the high immunogenicity and safety of recombinant yeast-extract hepatitis B vaccine.
  9. Fulltext Influenza and respiratory syncytial viruses: Efficacy of different diagnostic assays
    Rahman MM, Wong KK, Alfizah H, Hussin S, Isahak I
    Pak J Med Sci, 2015 Jul-Aug;31(4):791-4.
    PMID: 26430404 DOI: 10.12669/pjms.314.7003
    To determine the efficacy of cell culture, immunoflourescence Assay (IFA) and real time polymerase chain reaction (rRT-PCR) in relation to diagnosis of influenza and Respiratory Syncytial Virus (RSV).
  10. Fulltext Cerebrospinal fluid lactic acid concentration in bacterial meningitis
    Pit S, Jamal F, Isahak I, Minhaj AA
    Med J Malaysia, 1987 Dec;42(4):302-5.
    PMID: 3454403
    Lactic acid concentration was determined in 37 specimens of cerebrospinal fluid by gas liquid chromatography. It was found to be raised (30 mg/dl) in 15 specimens from culture positive cases of bacterial meningitis and one of fungal meningitis. It was < 30 mg/dl in cerebrospinal fluid from four cases of viral meningoencephalitis and 10 contaminated specimens. It was also raised in two specimens from culture negative cases. Determination of cerebrospinal fluid lactic acid concentration by gas liquid chromatography provides a useful, additional test in the diagnosis of bacterial meningitis
  11. Could antiseptic gargling prevent COVID-19?
    Mohamed NA, Ahmad Zainol Hady A, Abdul Aziz AH, Isahak I
    Trop Biomed, 2020 Dec 01;37(4):1141-1145.
    PMID: 33612766 DOI: 10.47665/tb.37.4.1141
    Coronavirus Disease 2019 (COVID-19) has infected more than 8 million people globally since its discovery in December 2019. For COVID-19 prevention, the World Health Organization recommended regular handwashing with soap, cough etiquette, mask wearing and social distancing. However, COVID-19 is rather difficult to contain because of its high transmissibility property. Gargling is effective for reducing infection in the respiratory tract. Most antiseptic gargles have antimicrobial properties against common respiratory pathogens. No published study on the effectiveness of antiseptic gargling among COVID-19 patients has been available to date. This article reviewed available literature on methods and solutions available for gargling and their effect on respiratory tract infections.
  12. Knowledge, attitude and health seeking practice on bats-borne diseases among residents of Tioman Island, Malaysia
    Mohamed NA, Said MH, Mohd Rani MD, Ramli S, Isahak I
    Trop Biomed, 2019 Sep 01;36(3):709-717.
    PMID: 33597493
    Bats are slowly gaining recognition as a potential reservoir for viruses harmful to human (Smith and Wang, 2013). Bats are reservoir to viruses causing Ebola virus diseases (EBV) (Leroy et al., 2005), Nipah Encephalitis (NiV) (Chua et al., 2002), SARS(Li et al., 2005) and MERS-CoV (Yang et al., 2015) being the latest one making headlines. About 18 years ago, a major outbreak of Nipah virus encephalitis occurred in Peninsular Malaysia resulted in the deaths of 105 persons and the slaughter of approximately 1.1 million pigs. In 2006, a novel bat orthoreovirus was found to be associated with acute respiratory syndrome in Malaysia. Following that incidents, many studies have been done on bats, particularly to determine their species, behaviour, and antibody level and there were also studies in human on antibody prevalence to batsrelated viruses e.g. Nipah and Hendra and PRV. Humans may become infected with viruses from bats through intermediate host (swine, horse) or through aerosol or direct contact with bats. Communities living adjacent to bat roosts should aware of possible risk of infection transmission from bats. An earlier study in Guatemala demonstrated that risk of exposure to bats in communities near bats roosts was common, but recognition of the potential for disease transmission from bats was low (Moran et al., 2015). Surprisingly, there is no local published data on public awareness towards bats-related infection despite potential risk of getting the infection. This study aimed to determine knowledge and awareness on bat-related infections, attitudes towards bats and practices related to health-seeking behaviours following exposure to bats.
  13. Fulltext Staphylococcus aureus carriage in selected kindergartens in Klang Valley
    Mohamed NA, Ramli S, Amin NN, Sulaiman WS, Isahak I, Jamaluddin TZ, et al.
    Med J Malaysia, 2016 04;71(2):62-5.
    PMID: 27326943 MyJurnal
    INTRODUCTION: Nasal colonisation of S. aureus in healthy children was 18% to 30%. One to three percent of them were colonised by Methicillin-resistant Staphlycoccus aureus (MRSA). Although MRSA infection has become increasingly reported, population-based S. aureus and MRSA colonisation estimates are lacking. The main objective of this study was to determine the prevalence of S. aureus carriage among children.

    METHODS: Nasal samples for S. aureus culture were obtained from 250 children from three kindergartens in the Klang Valley, after consent was obtained from the children and their parents. Swabs were transported in Stuart medium, and inoculated on mannitol-salt agar within four hours of collection. Identification and disk diffusion test were done according to guidelines. Polymerase chain reaction was done on MRSA isolates for the presence of mecA and lukS/FPV genes.

    RESULTS: Overall prevalence of S. aureus and MRSA carriage were 19.2% (48/250) and 1.6% (4/250) respectively. mecA gene was present in all isolates, 50% isolates carried Panton-Valentine leucocidin (PVL) gene. Sccmec type I was found in 2 isolates and the remaining isolates has Sccmec type V.

    CONCLUSION: The prevalence of S. aureus and MRSA carriage were similar to other studies. However, risk of contracting severe infection might be higher due to presence of PVL gene in half of the MRSA isolates.
  14. Fulltext Assessment of acceptability of the COVID-19 vaccine based on the health belief model among Malaysians-A qualitative approach
    Rani MDM, Mohamed NA, Solehan HM, Ithnin M, Ariffien AR, Isahak I
    PLoS One, 2022;17(6):e0269059.
    PMID: 35700197 DOI: 10.1371/journal.pone.0269059
    INTRODUCTION: Several countries have started mass vaccination programs to halt the spread of the COVID-19 pandemic. With an R naught value of 2 to 3, about 70% of the population needs to be immunized to achieve herd immunity. This study aimed to investigate the reasons for acceptance or refusal of COVID-19 vaccines among the Malaysian population.

    METHODOLOGY: An exploratory, descriptive qualitative design was performed. The cross-sectional survey used a non-probability convenient sampling technique to recruit the respondents, who were required to answer an open-ended question: Either "If you are willing to get the vaccine, please state your reason" or "If you are not willing to get vaccinated, please state your reason." The survey also included questions on demography such as age, gender, and place of residence. According to the Health Belief Model, the data was transcribed, translated, and analyzed: perceived susceptibility, perceived severity, perceived barrier, and cues for action.

    RESULTS: A total of 1091 respondents who completed the online survey comprised 685 (62.8%) females, 406 (37.2%) males, with a mean age of 38.16 (SD = 16.44). The majority (81.1%) were willing to get vaccinated. Thematic analysis showed that most respondents perceived that the vaccine is safe, effective, protective and will provide herd immunity. Barriers to vaccination include unknown long-term side effects, rapid vaccine production, inadequate information and concerns regarding halal status. Cues to vaccination included individual desire, social responsibility, economic concerns and wait-and-see behavior.

    CONCLUSIONS: The public should be well informed about the vaccine, its efficacy, side effects, and halal status to increase vaccine acceptability and achieve herd immunity.

  15. Fulltext Hepatitis A virus: declining seroprevalence in children and adolescents in Southeast Asia
    Kunasol P, Cooksley G, Chan VF, Isahak I, John J, Loleka S, et al.
    Southeast Asian J. Trop. Med. Public Health, 1998 Jun;29(2):255-62.
    PMID: 9886108
    The prevalence of hepatitis A virus (HAV) in a country largely reflects its standards of hygiene and socioeconomic conditions. Countries which undergo socioeconomic development show major change in HAV prevalence from high to low endemicity, and this is largely reflected in patterns of age-related seroprevalence. This paper presents age-related HAV seroprevalence patterns of SE Asian countries, and highlights how these patterns have changed over recent decades. Singapore, Thailand and Malaysia have experienced a decline in childhood and adolescent HAV seroprevalence, typical of countries which undergo socioeconomic development. By contrast, India has remained a country of high endemicity, with almost universal seroconversion in childhood. The Philippines and Vietnam show age-related seroprevalence patterns typical of high to moderate endemicity, while Indonesia shows significant regional variation in HAV seroprevalence. Populations within countries which exhibit major improvements in endemicity and age related HAV seroprevalence patterns are at risk of HAV epidemics, and a paradoxical increase in incidence tends to occur as seroconversion shifts from children to adults. The residents of these countries, a significant number of whom are at-risk, would benefit from a program of vaccination, as would non-infected individuals visiting high-risk areas.
  16. Fulltext The effectiveness of various gargle formulations and salt water against SARS-CoV-2
    Tiong V, Hassandarvish P, Bakar SA, Mohamed NA, Wan Sulaiman WS, Baharom N, et al.
    Sci Rep, 2021 10 15;11(1):20502.
    PMID: 34654867 DOI: 10.1038/s41598-021-99866-w
    The COVID-19 is difficult to contain due to its high transmissibility rate and a long incubation period of 5 to 14 days. Moreover, more than half of the infected patients were young and asymptomatic. Virus transmission through asymptomatic patients is a major challenge to disease containment. Due to limited treatment options, preventive measures play major role in controlling the disease spread. Gargling with antiseptic formulation may have potential role in eliminating the virus in the throat. Four commercially available mouthwash/gargle formulations were tested for virucidal activity against SARS-CoV-2 in both clean (0.3 g/l BSA) and dirty (0.3 g/l BSA + 3 mL/L human erythrocytes) conditions at time points 30 and 60 s. The virus was isolated and propagated in Vero E6 cells. The cytotoxicity of the products to the Vero E6 was evaluated by kill time assay based on the European Standard EN14476:2013/FprA1:2015 protocol. Virus titres were calculated as 50% tissue culture infectious dose (TCID50/mL) using the Spearman-Karber method. A reduction in virus titer of 4 log10 corresponds to an inactivation of ≥ 99.99%. Formulations with cetylperidinium chloride, chlorhexidine and hexitidine achieved > 4 log10 reduction in viral titres when exposed within 30 s under both clean and dirty conditions. Thymol formulations achieved only 0.5 log10 reduction in viral titres. In addition, salt water was not proven effective. Gargle formulations with cetylperidinium chloride, chlorhexidine and hexetidine have great potential in reducing SAR-CoV-2 at the source of entry into the body, thus minimizing risk of transmission of COVID-19.
  17. A review of Hib epidemiology in Asia
    Lolekha S, Cooksley G, Chan V, Isahak I, Ismael S, John J, et al.
    Southeast Asian J. Trop. Med. Public Health, 2000 Dec;31(4):650-7.
    PMID: 11414406
    Meningitis due to an invasive Haemophilus influenzae type b (Hib) infection, has been previously perceived to be relatively uncommon in Asia. However, the incidence of disease and its impact may have been underestimated. In addition to a lack of microbiological facilities in some hospitals, difficulties in culturing the organism and the widespread use of antibiotics may have hidden the true incidence of the disease in some countries. Furthermore, the reported disease burden probably underestimates the incidence of Hib pneumonia. The epidemiology of invasive Hib disease for various Asian nations is reviewed in this paper. Hospital-based studies show that Hib is a major cause of bacterial meningitis and/or pneumonia in the Philippines, India, Thailand, Malaysia, Indonesia and Vietnam. Singapore and Hong Kong have a low incidence of infection compared with Western and other Asian nations. This low incidence is not due to a higher level of natural protective antibodies, but may be related to an interaction between environmental and genetic factors. Therefore the widespread belief that Hib infection is unimportant in Asia does not refer to Asia as a whole and possibly to Chinese patients only, and failure to recognize this has serious implications. The inclusion of Hib vaccine in the routine infant immunization schedule in many industrialized nations has significantly reduced the incidence of invasive disease. Recent studies have shown Hib vaccination is also effective in preventing invasive disease in children in developing countries. While population-based data may be required to confirm the need for public-funded infant Hib immunization in Asia, its introduction in countries with a high incidence of Hib meningitis and/or pneumonia has the potential to significantly improve pediatric health and survival.
  18. Assessment on Hand Hygiene Knowledge and Practices Among Pre-school Children in Klang Valley
    Tengku Jamaluddin TZM, Mohamed NA, Mohd Rani MD, Ismail Z, Ramli S, Faroque H, et al.
    Glob Pediatr Health, 2020;7:2333794X20976369.
    PMID: 33335950 DOI: 10.1177/2333794X20976369
    Background. Pre-school children are at a higher risk to acquire infectious diseases such as hand, foot and mouth disease due to their immature immune system. Good hand hygiene prevents transmission of infectious diseases. This study aimed to determine the knowledge and practices of hand hygiene among pre-schoolers. Methods. In this prospective, multi-center study, the pre-schools were selected according to the selection criteria. A questionnaire consisting of socio-demographics, knowledge and practices of hand hygiene were administered via face-to-face interview during the pre- and post-intervention period. A total of 435 pre-schoolers aged 5 and 6 years old from 2 pre-schools within Klang Valley, School P (test group) and School C (control group) were involved in this study. The test group was provided with comprehensive hand hygiene education including video on proper handwashing technique during the 2 months intervention period, whereas the control group did not receive any form of intervention. The data were statistically analyzed using descriptive analysis and independent t-test. Results. Majority of pre-schoolers gained knowledge of handwashing from their parents. However, only 63% demonstrated good handwashing technique. Test group were significantly better (P 
  19. Fulltext Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley, Malaysia: a quasi-experimental study
    Mohamed NA, Mohd Rani MD, Tengku Jamaluddin TZM, Ismail Z, Ramli S, Faroque H, et al.
    World J Pediatr, 2020 Aug;16(4):416-421.
    PMID: 31286426 DOI: 10.1007/s12519-019-00283-x
    BACKGROUND: Absenteeism amongst pre-school children is often due to illnesses such as hand, foot, and mouth disease, acute gastroenteritis, cold and flu, which are easily spread amongst them. This is because of weak immunity and lack of knowledge on proper hand hygiene. This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme, along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley, Malaysia.

    METHODS: A total of 377 school children, male and female, aged 5-6 years old, participated and were assigned to either the intervention or a control group. During the 2 months intervention period, children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets. The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention.

    RESULTS: In the test group, there was a 25% increase in the total number of absent days from the pre-intervention period to the intervention period, a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%. Results showed a significant difference (P 

  20. Fulltext Effectiveness of comprehensive hand hygiene module on preschool children in Klang Valley, Malaysia
    Mohd Rani MD, Mohamed NA, Tengku Jamaluddin TZM, Ismail Z, Ramli S, Faroque H, et al.
    Clin Exp Pediatr, 2020 Mar;63(3):115-116.
    PMID: 32023401 DOI: 10.3345/cep.2019.01277
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