By DATO’ DR. QUAZA NIZAMUDDIN BIN HASSAN NIZAM DIRECTOR GENERAL VETERINARY SERVICES MALAYSIA & DR. FALIZAH ABDULLAH SALLEH SHEIKH IBRAHIM

1. Current Challenges In Controlling
Zoonotic Diseases- New Knowledge And
Paradigms
DATO’ DR. QUAZA NIZAMUDDIN BIN HASSAN NIZAM
DIRECTOR GENERAL
VETERINARY SERVICES MALAYSIA
&
DR. FALIZAH ABDULLAH
SALLEH SHEIKH IBRAHIM

2. WHO
“Any disease or infection caused by all
types of agents (bacteria, parasites, fungi,
viruses and unconventional agents)
transmissible from vertebrate animals to
humans and vice-versa”
ZOONOTIC DISEASE

3. http://www.onehealthinitiative.com/map.php
Estimated that there
are over 2.5Billion
cases of human
illness and 2.7
million
deaths annually due
to the top 56
zoonoses

4. 4
Zoonotic Diseases…
Human diseases are zoonotic in
origin. 75% are re-emerging from
animal
15 deadly global
outbreak in 15
years
’15’
1 b
75%
Identified zoonotic diseases that
represent a clear threat to our health
and the welfare of animals.
The economical impact of six
zoonotic diseases outbreak
occurred 1995 -2009. Many of
them are preventable –World
Bank
120b USD
200
Global Animal production
is lost to diseases
20%
3/5New human disease
appear yearly. 3 out
of 5 of them animal
origin
Agents with bio-terror
potential are zoonotic
pathogens
80%

5. Selected Zoonotic Diseases: causative agents
Bacteria
Virus
Fungi/
Others
Parasite
Rabies
Avian Influenza
Q Fever
Japanese
Encephalitis
Rift Valley Fever
Nipah
Toxocariasis
Toxoplasmosis
Taeniasis
Brucellosis
Tuberculosis
Salmonellosis
Leptospirosis
Anthrax
Dermatomycoses
BovineSpongioform
Encephalitis-Prion

6. EXOTIC PETS
FACTORS INFLUENCING NEW AND REEMERGING
ZOONOSES.
EXOTIC MEATS
COMPANION
ANIMALS
ALTERATION IN
LIVESTOCK
MANAGEMENT ACQUISATIONOF
NEW VIRULENCE
TRAITS
PATHOGENS
ADAPT
TO NEW
HOST SPECIES
CHANGE OF
LAND USE
TOURISM
TRANSLOCATION
OF INFECTED
INDIVIDUALS
CLIMATE CHANGE
INFLUENCING
ATHROPODS
INFECTION OF HUMAN OR
ANIMALS
Intrinsic and extrinsic factors
Reemergence of diseases through opportunistic host
switching continue to be the major source of human
infectious disease.

7. STATUS

8. Zoonotic diseases in Malaysia
RABIES
NIPAH
AVIAN INFLUENZA
01
02
03
04 ‘Q’ FEVER
OIE free status in 2013
Re emerging in 2015
Mass vaccination program and
Controlling number of strays
LAST INCIDENCE IN 1999 in pig farms
Cause 105 human death
PREVALENCE RATE SINCE 2000: 0%.
First outbreak in 2004
Last outbreak in 2018
Declared free from HPAI in Dec 2018
Prevalence rate 7.2%

9. Zoonotic diseases in Malaysia
ANIMAL
Fever, reduced milk production, debilitated and respiratory problems
Testing and culling are carried out by DVS. Compensation scheme.
HUMAN
Respiratory problems, coughing, chest pain
TUBERCULOSIS
ANIMAL
May or may not be apparent (some become carrier),diarrhoea, abortion
HUMAN
Food Poisoning, fever, diarrhoea, vomiting
SALMONELLOSIS
Compensation scheme to encourage farmers to cull infected animals.
ANIMALS
Contagious abortion
HUMAN
Undulating fever, abortion, testicular inflammation
BRUCELLOSIS
05
06
07

10. LIST OF ZOONOTIC DISEASES INCLUDED IN
DISEASE SURVEILLANCE BY DVS
Active Surveillance Not Yet Found in the Country
ANTHRAXBRUCELLOSIS
WEST NILE VIRUS
INFECTION
RABIES
RIFT VALLEY
FEVER
TUBERCULOSIS
BOVINE
SPONGIFORM
ENCEPHALOPATHY
NIPAH
JAPANESE
ENCEPHALITIS

11. Year 2016 2017
Disease
No of samples
tested
No. of
positive
samples
Prevalence
(%)
No of
samples
tested
No. of
positive
samples
Prevalence
(%)
Nipah 262 0 0.00 923 0 0.00
Avian Influenza 17,164 0 0.00 21,785 0 0.00
Salmonellosis 10554 1079 10.22 20584 1874 9.10
B.abortus 20170 616 3.05 12199 516 4.23
B.melitensis 22691 173 0.76 15872 110 0.69
B.Suis 856 57 6.65 1905 142 7.45
Tuberculosis
(M.Bovis)
1403 41 2.92 1427 289 20.25
Q Fever 1061 84 7.91 998 102 10.22
Johnes’ - - - 6834 449 6.57
Disease Surveillance Program(DVS)

12. No. of cases, Incidence rate and Mortality Rate for Zoonotic
Diseases (In Human) for (2015-2017)
Source: Malaysia (KKM)
Year 2015 2016 2017
Disease Case IR Death MR Case IR
Deat
h
MR Case IR Death MR
Brucellosis 34 0.11 0 0 26 0.08 0 0 42 0.13 0 0
Q Fever 4 0.02 0 0 6 0.02 0 0 6 0.02 1 0.003
Salmonella
Enteritidis
1231 4.04 0 0 962 3.12 0 0 1066 3.29 0 0
Salmonella
Thypimurium
155 0.51 0 0 103 0.33 0 0 67 0.21 0 0
Tuberculosis 23562 77.29 1696 5.56 25005 80.98 1945 6.4 25469 78.63 2132 6.58

13. ISSUES AND
CHALLENGES IN
CONTROLLING
ZOONOTIC DISEASES

14. 14
Climatic change
Change in the eco-system cause disease vector in new
geographic location – new zoonotic disease emerging
Animal trading – trans-boundary diseases
Issues and
Challenegs
Globalisation

15. 15
Reduce the quantity of arable crops – especially
cereals – fed to livestock, and increase the
research and knowledge transfer on novel feeding
strategies, including the use of agro-industrial
by-products
Issues and
Challenegs
Cross-species
Transmission
The ability of some virus to undergo mutation and infect
other host species.
The necessity to do phylogenetic study to do comparison
of genomic data to study the risk of cross species
transmission.
Interfere with vaccine efficacy and disease control and
eradication.

16. 16
Issues and
Challenges
Human Intervention
Increase in human animal contact through significant growth
in exotic pets industry
Lead to cross species transmission
Awareness in zoonotic diseases. Aware about zoonosis but
not practicing the best practice when handling the situation
especially among farmers
Xenotransplant – Transplanting animal cells and organs to
human increased the risk of transmitting zoonosis to human

17. 17
Focus on control and eradication of zoonosis in
domesticated animal but lack in controlling the
disease in the wild and strays.
Wildlife may act as reservoir and may transmit the
disease to human through hunting and gaming.
Improved data on the wildlife diseases required with
adequate disease surveillance activity
Inter agency collaboration and cooperation to
minimizing emerging of diseases in wildlife
Issues and
Challenges
Role Of Wildlife On The Emergence
Of Zoonotic Disease

18. 18
Issues and
Challenges
Bio-weaponization
The use of biological toxins and infectious agent
(zoonosis) as biological weapon to kill or incapacitate
human.
Eg. Anthrax , botulinum, Yersinia pestis (Bubonic
plague), Smallpox (18th Century)

19. SPECIFIC DISEASES OF
INTEREST
& CHALLENGES IN CONTROL

20. RABIES
20
Zoonotic disease of
warm blooded animal
Of human cases of
rabies are due to dog bites.
95%
People killed
worldwide, mostly
children in developing
countries
60,000
Survival rate
One of the most deadly
zoonotic
4% 7days
To live, after the onset of
symptoms
100%
preventable in humans with
vaccines
1-5Weeks common incubation
period.

21. 1925 1931 2000-2013
Wells, 1956
Average 112 cases per
year
Northern States
39 Cases
1 to 2 Cases per year
RABIES - TIME LINE
19521946 – 1951 1985 - 1999
Kedah
60 CASES
Selangor
Major epidemic
Declaration of Country
Free Rabies by OIE
0 case
1955
Establishment of
Immune Belt
Perlis, Kedah, Perak,
Kelantan

22. Free rabies
status
Outbreak
resolved
11 dog cases
(Perlis, Kedah,
Penang)
Sarawak
327 dog cases ,
25 cat cases
17 human cases,
16 human death
Immune belt,
Northern
Peninsular
Malaysia (Perlis,
Kedah,
Penang )
Outside immune belt
(Perak Coastline)
2 human bite cases,
1 dog case
2013
July
2015
Sept
2015
July
2017
July 2017
updated
until Dec
2018
June
2018
Perlis
2 dog cases
4 dog cases
January
2019
Perak
Kedah
1 cat, 1 dog
First dog case
detected
November
2018
Rabies Outbreak Timelines (2013-2019) in
Malaysia

23. 23
Immune belt comprising of
whole state of Perlis,
4 districts of Kedah,
whole upper Perak,
3 districts of Kelantan
50 to 80 km wide along the Malaysian
side of the Malaysia/Thailand border
Intensive control measures as a
safeguard against the spread of rabies
As an area for containment
Activities:
Compulsory licensing .
Compulsory vaccinations.
Targeted removal of strays.
Registration and Identification of owners and animals.
1955 Immune Belt

24. DISTRIBUTION OF RABIES CASES IN SARAWAK JUL 2017 - FEB 2019

25. Declared Rabies-affected Areas in SARAWAK as at
12 February 2019
Total number of areas: 61
KUCHING (7)
SAMARAHAN (3)
SERIAN (22) SRI AMAN (4)
BETONG (3)
SARIKEI (5)
SIBU (2)
MUKAH (4)
KAPIT (1)
BINTULU (4)
MIRI (6)
LIMBANG

26. ISSUES & STRATEGIES TO CONTROL
PENINSULAR MALAYSIA
ISSUES
Thailand not free
Movement of dogs from border
Movement of dogs from infected area
Dogs in fishing villages
STRATEGIES
Immune belt strictly enforced
Dogs in fishing villages to be
vaccinated especially the ones which
may go to the sea with the owner

27. ISSUES & STRATEGIES TO CONTROL
SARAWAK
ISSUES
Kalimantan cases & Movement of dogs from
border
Dog keeping culture: let loose
Strays in high numbers
Movement of dogs from infected area
Awareness & action for vaccination
STRATEGIES
Assistance to Kalimantan
Immune belt created &strictly enforced
Targeted removal of strays
Multi agency integrated approach

28. NIPAH
LAST INCIDENCE
IN 1999 in pig
farms
Cause 105
human deaths
PREVALENCE
RATE SINCE 2000
0%
ANIMAL – fever,
headache,
drowsiness
followed by
disorientation and
mental confusion
HENIPAVIRUS
HUMAN – Encephalitis and
coma

29. ISSUES & CHALLENGES
Surveillance
Still happening; Kerala, Bangladesh
Have to be vigilant

30. ZERO DISCHARGE
BUFFER ZON 200 METER
CLOSED HOUSE
GAHP
Currently, the buffer
zone set by the Pig
Enactment according
to states are different
from each other.
MODERN PIG FARMING
(MPF)
4 CRITERIAS
Modernisation of pig farmingContigency plan

31. AVIAN INFLUENZA
FIRST
OUTBREAK IN
2004
LAST
OUTBREAK IN
2018
STAMPING OUT
WITH
COMPENSATION
HIGH
MORTALITY IN
POULTRY
DECLARED FREE
FROM HPAI ON 13
DEC 2018

32. STAMPING OUT OPERATION
1. The crisis management and
operation room was activated.
2. All team were assembled immediately
(including culling, compensation,
enforcement,
disinfection,and
logistic)
3. Inter agency cooperation includes
MOH, APM, police and
local government.
4. Culling operation and disinfection was
done in the infected premise
and within 1 km radius

33. ISSUES & CHALLENGES
Wild bird migration
Neighbouring countries not free
Cross border movement-transboundary

34. STRATEGIES
Increase surveillance
Improve bio-security
Close House Farming system

35. ‘Q’ Fever ANIMAL – ASYMPTOMATIC
CARRIER
ABORTION AND
FEVER
PREVALENCE RATE
7.2%
HUMAN – OCCUPATIONAL
HAZARD
SIGNS INCLUDE FEVER ,
CHEST AND ABDOMINAL PAIN

36. DIAGNOSTIC OPTIONS:
IMPROVED APPROACHES

37. Serology VS Molecular Infectious Disease Testing
Cloning nucleic acids of microbial
pathogens directly from clinical specimens
Higher success rate of detection
Binary and Definite
Specific and Sensitive
False-positive
High- throughput
Straightforward
Costly
Molecular
An assay which can detect a protein
(antibody or antigen).
Specificity and sensitivity depend
on reagents and methods
Inconclusive (Include past exposures,
individual immune response)
Non-specific
Economic
Serology

38. Molecular Detection - Approach
Host response profiling
Immunological systems
for microbe detection
RNA expression
(cDNA) libraries,
Phage display
Direct analysis of
microbial protein sequences
Mass
spectrophotometry
Direct analysis of
microbial nucleic acid
sequences
DNA Microarray
Consensus PCR
Quantitative
PCR, Expressed
Sequence Tags
(ESTs)

39. CONTROL MEASURES:
BETTER APPROACHES & OPTIONS

40. NEW AND REEMERGING ZOONOSES - STRATEGIES
Observe disease
patterns and
ultimately forecast
spread and
establishment into
new areas.
Understand the epidemiology of the infections
Identify pathogens
Identify vertebrate hosts
Identify methods of transmission
Identify the disease spatiotemporal (time and space)
patterns and their changes over time.
Improve surveillance in regions with potential disease
re-emergence
Detection of pathogens in reservoirs
Early outbreak detection (sentinel animals),
Broad-based research on factors that favor reemergence
Effective control of movements

41. ONE WORLD, ONE HEALTH
ANIMAL
HEALTH
FOOD & FEED
SAFETY
PUBLIC
HEALTH
ONE
HEALTH
OIE, WHO and FAO work
closely to promote multi-sectoral
responses to food safety
hazards, risks from zoonoses,
and other public health threats at
the human-animal-ecosystem
interface and provide guidance
on how to reduce these risks.

42. ONE WORLD, ONE HEALTH - Challenges
should involved different disciplines both within and beyond
the health sciences- civil authority, land use decision,
education and religious group
Problem of working collaboratively
Liberalism – Community Interest vs Public
Interest
Protection of individual and animal welfare,
public fear, doubt, misinformation and
disobedience with public health directives
Ethical concern
Different set of values and belief
Egoism, perceptions, short term
solutions, populism.
Political intervention in zoonotic
disease prevention and control
Socio-political challenges
Laws that govern disease outbreak control
mechanism in most jurisdictions are scattered,
confusing and interpreted based one sided
perspectives.
It’s the choice between economic development
or health security
Legal challenges
Difficult to monitor diseases in wildlife,
afraid of aggressive wild animals,
lack of knowledge and experience,
Wildlife ecosystem

43. Antmicrobial Resistance Seminar & Launching of Malaysian Action Plan on
AMR - MyAP AMR, 27 Februari 2018
Outlined the strategies and
activities undertaken by all
agencies in addressing
increased incidence of
antibiotic resistance in
Malaysia
Implementation of this plan
uses an integrated approach
since this issue covers
components of human health,
animal health, food chain and
the environment
ONE WORLD, ONE HEALTH – Malaysia Initiatives

44. TREATMENT AND PREVENTION
Introduction of
DNA that contains
genes for foreign
antigens
e.g Rabies
killed viruses or
“attenuated”
versions of the
virus
Classical
Viral
Vaccines
DNA
Vaccines
RNA
Vaccines
Polysaccharide
And
Recombinant
Vaccine
Introduction of RNA
that contains genes
for foreign antigens
e.g Influenza A
Introduction of
Polysaccharide or
recombinant protein
subunit of bacteria
surface
e.g Salmonella
Typhi

45. TERIMA KASIH!