Kuliah 19 ALAM SEKITAR DAN (1)MENINGITIS (2)
2. 10 Julai 2002, dua orang pelajar UPM mati disebabkan oleh meningitis
3. Keadaan panic hampir berlaku di kampus tersebut
4. Dua pelajar lain dimasukkan ke hospital kerana disyakki terkena penyakit yang sama
5. Mereka yang mengerjakan haji, dikehendaki vengambil suntikan vaksin anti penyakit ini
6. Pelajar atau pelawat luar Negara mempunyai potensi untuk menyebarkan penyakit ini
7. Apakah meningitis? Meningitis is the inflammation of the linings of the brain and spinal cord
8. Selalunya berkaitan dengan septicaemia: the blood poisoning form of the disease
9. Boleh disebabkan oleh backteria, virus, atau fungus . Yang disebabkan oleh bakterian lebih
10. Meningococcal bakteria menyebabkan meningitis atau septicaemia atau keduanya
11. Jenis: Bacteria meningitis: meningococcal;pneumococcal; haemophilus influenza b (Hib);
Group b streptococcal(GBS) . Listeria : tubercular; viral meningitis, fungal meningitis
12. Siapa yang terdedah kepada bahaya penyakit ini? Kumpulan umur 15-24 tahun
13. 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
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.
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
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.
Meningitis is usually bacterial or viral.
At least 50 kinds of bacteria can cause
meningitis, but the main types are:
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 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
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
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.
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.
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.
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 is quite rare. It mainly affects people with immune deficiencies.
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
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
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
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 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
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
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
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.
2. JAPANESE ENCEPHALITIS
2. JE merupakan penyakit yang berbahaya
3. Disebarkan oleh nyamuk 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 encephalitis
8. Menyerang system saraf pusat (central nervous system)
9. Virus ini boleh dibawa oleh binatang seperti babi, lembu, kerbau, biri-biri, kuda, burung, anjing
10. Babi adalah perumah pengganda (amplifier host)
11. Virus JE banyak didaapti dalam darah babi
12. Suhu badan babi yang tinggi dan permukaan yang tidak berambut menjadi tarikan kepada beribu-
ribu nyamuk pada waktu malam
13. Manusia dan kuda menjadi perumah terakhir (dead-end host)
14. Manusia dan kuda tidak menyebarkan JE
15. Cara penyekit ini merebak adalah dengan kegiatan nyamuk
16. Nyamuk Culex betina menghisap darah host yang ada virus
17. Setelah tempuh inkubasi antara 9-12 hari selesai, nyamuk ini boleh menjangkitkan virus kepada
mangsa yang digigit
18. Jika terdapat banyak nyamuk yang aktif, maka penyebaran virus ini menjadi meluas dan mudah
tersebar dengan cepatnya
19. Peranan kebersihan alam sekitar adalah amat penting kerana dengan menyediakan tempat untuk
nyamuk ini membiak, maka penyakit ini boleh merebak dengan cepat
20. Keadaan kebersihan lading-ladang penternakan babi juga menjadi punca kepada masaalah ini
21. Boleh dikatakan kesemua lading-landang yang menternak binatang ini mempunyai persekitaran
22. Bukan sahaja ternakan babi yang kotor, malah kebanyakan ladang penternakan di negara ini,
23. Keadaan ini boleh mengundang pelbagai penyakit.
24. Bukan sahaja JE, tetapi berbagai penyakit lain juga boleh tersebar disebabkan keadaan
persekitaran yang kotor.
ANALISIS JAPANESE ENCEPHALITIS DI
2. Mula melanda Malaysia 1999
3. Peringkat awal dikesan berlaku di Perak 1998
4. 26 Dis. 1998, kes pertama di Negeri Sembilan; di Sikamat, Seremban
5. Melibatkan penternak babi
6. NS mempunyai kawasan penternakan babi terbesar di Asia Tenggara : 1. Bukit Pelanduk 2. Sg.
Nipah 3. Kg. Jawa 4. Kg. Wong Seng Chuan
7. 4 Jan. 1999. Kebanyakan babi di sekitar Seremban mati
8. 9 Jan. 1999. Lima orang mati disebabkan JE
9. Di Bukit Pelanduk: Kes pertama berlaku pada 23 Feb. 1999 melibatkan viral encephalitis
10. Keadaan menjadi lebih teruk apabila virus baru dikesan – Hendra-like virus (HLV) di Hospital
11. 1 Mac 1999, bilangan babi mati meningkat di Sg. Nipah. 15 orang mati dan 25 dimasukkan ke
12. 3 Mac. 1999, JE telah menimbulkan kebimbangan penduduk. Penduduk mengadakan demonstrasi
13. 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 tentera
16. Menggunakan Lysol pada kekuataan 10% - untuk tujuan disinfeksi
17. 16 April 1999. 519 ladang iaitu 74% daripada keselurahan ladang di NS telah didisinfeksi
18. Hasil daripada kawalan dan pencegahan : menghapuskan Culex dan memberi vaksin kepada
golongan berisiko tinggi > kes JE menurun
19. 1 Jun. 1999. Kematian disebabkan oleh JE diseluruh Negara adalah 106 orang
20. 86 kematian adalah di Bkt. Pelanduk, Kg. Jawa dan Kg. Nipah
21. Dis. 1998: 50%. Jan . 1999 : 36.4% . Feb. 1999: 33.3%; Mac 1999: 9.4%
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
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
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
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
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
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