exudates and Cholera

The mass movement of migrants to Malaysia for employment is one of the factors contributing to the emergence and re-emergence of infectious diseases in this country. Despite mandatory health screening for migrants seeking employment, prevalence records of infectious diseases amongst migrant populations in Malaysia are still within negligible proportions. Therefore, the present review highlights the incidence, mortality and overall status of infectious diseases amongst migrants' populations in Malaysia, which maybe be useful for impeding exacerbation of inequalities among them and improving our national health system thru robust and effective emergency responses in controlling the prevalent diseases found among these populations and maybe, Malaysian citizens too. Peer-reviewed articles from January 2016 to December 2020 were searched through online platform including SCOPUS, PubMed, Science Direct, and Google Scholar. Non-peer-reviewed reports and publications from ministry and government websites including data from related agencies were also scoured from in order to ensure that there are no cases being overlooked, as most published articles did not have migrants as the research subjects. A total of 29 studies had been selected in the final analysis. Migrants in Malaysia were at higher risk for tuberculosis, malaria, lymphatic filariasis, cholera, leprosy and leptospirosis. Lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to cramp living conditions and poor sanitation in their settlements respectively. While malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases. Low cases of leprosy had been recorded in Malaysia but a significant proportion of it was contributed by migrant workers. As for leptospirosis, studies found that there are prominent cases among migrant workers, which particularly highest within workers with lower educational attainment. Infectious diseases are still prevalent among migrants in Malaysia due to various interplay factors including their working sectors, country of origin, immunization status, type of settlement, impoverished living conditions, and language and cultural barriers that impeding access to health facilities.

Topics: Cholera; Communicable Diseases; Elephantiasis, Filarial; Humans; Leptospirosis; Malaysia; Transients and Migrants

Although the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam.. Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available.. From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases.. We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.

Topics: Asia, Southeastern; Bangladesh; Cambodia; Cholera; Developing Countries; Diarrhea; Epidemiological Monitoring; Humans; India; Malaysia; Nepal; Pakistan; Philippines; Thailand; Vietnam

Vibrio cholerae O1 El Tor variants have been the major causative agents of cholera worldwide since their emergence in the 2000s. Cholera remains endemic in some regions in Malaysia. Therefore, we aimed to investigate the genetic characteristics of the V. cholerae O1 El Tor strains associated with outbreaks and sporadic cases to elucidate the molecular evolution among the strains circulating in this region. A total of 45 V. cholerae O1 El Tor strains isolated between 1991 and 2011 were examined. All strains were subjected to phenotypic characterization, and molecular characterization including detection of virulence genes and CTX prophage (CTXΦ) by Polymerase Chain Reaction (PCR) and genotyping by Pulsed-Field Gel Electrophoresis (PFGE). All strains were phenotypically confirmed as El Tor biotype and were mostly Ogawa serotype (96%). Antimicrobial susceptibility testing showed that the outbreak strains isolated in 1991 (Sabah) and 2009 (Terengganu) were all multidrug-resistant while the sporadic strains were resistant to erythromycin and furazolidone only. All strains (n = 45) were resistant to erythromycin. The virulence genes ctxA, ctxB, ompW, rfb, rtxC, tcpA, tcpI, rstR, zot and hlyA were present in all strains. The outbreak strains isolated in 1991 harboured El Tor cholera toxin gene (ctxB3) while sporadic strains from 2004 to 2011 harboured classical ctxB1. Four distinctive CTXΦ arrays were identified among the El Tor variants, one of which co-occurred with El Tor strains during the 2009 outbreak in Terengganu. PFGE analysis revealed that a genetically diverse El Tor variants population persisted in Sabah. The co-existence of multiple El Tor variants together with the prototypic El Tor strains suggested a multiclonal emergence of V. cholerae O1 El Tor variants in this region.

Topics: Cholera; Cholera Toxin; Disease Outbreaks; Erythromycin; Genotype; Humans; Malaysia; Vibrio cholerae O1

Cholera is an important health problem in Sabah, a Malaysian state in northern Borneo; however, Vibrio cholerae in Sabah have never been characterized. Since 2002, serogroup O1 strains having the traits of both classical and El Tor biotype, designated as atypical El Tor biotype, have been increasingly reported as the cause of cholera worldwide. These variants are believed to produce clinically more severe disease like classical strains.. The purpose of this study is to investigate the genetic diversity of V.cholerae in Sabah and whether V.cholerae in Sabah belong to atypical El Tor biotype.. ERIC-PCR, a DNA fingerprinting method for bacterial pathogens based on the enterobacterial repetitive intergenic consensus sequence, was used to study the genetic diversity of 65 clinical V.cholerae O1 isolates from 3 districts (Kudat, Beluran, Sandakan) in Sabah and one environmental isolate from coastal sea water in Kudat district. In addition, we studied the biotype-specific genetic traits in these isolates to establish their biotype.. Different fingerprint patterns were seen in isolates from these three districts but one of the patterns was seen in more than one district. Clinical isolates and environmental isolate have different patterns. In addition, Sabah isolates harbor genetic traits specific to both classical biotype (ctxB-1, rstR. This study revealed that V.cholerae in Sabah were genetically diverse and were atypical El Tor strains. Fingerprint patterns of these isolates will be useful in tracing the origin of this pathogen in the future.

Topics: Cholera; DNA Fingerprinting; DNA, Bacterial; Environmental Microbiology; Genes, Bacterial; Genetic Variation; Humans; Malaysia; Molecular Epidemiology; Phenotype; Polymerase Chain Reaction; Sequence Analysis, DNA; Vibrio cholerae O1

In this study we investigated an outbreak of Vibrio cholera O1 Ogawa serotype, occurred during December 2014 in Kudat district, situated in Sabah state of the Malaysian part of Borneo.. Active case detection and contact tracing were done at respective localities by house to house survey. Passive case detection was done among acute gastroenteritis patients attended at various health facilities. To determine the source, samples from food, water and environment were taken. A case control study was also done to determine the risk factors.. A total of 44 symptomatic and 34 asymptomatic cases from 19 localities were investigated. 39 cases were detected through passive case detection. Median age of cases was 23 years. All cases belonged to serogroup O1 and Ogawa serotype. The epidemiological investigation of time, place, and person identified that V. cholerae cross-transmission might have occurred in two fish markets and the fish-loading port. Circumstantial evidences indicated that cholera was possibly transmitted through contaminated sea foods.. We concluded that the life-style of Sea Gypsies is a challenge in cholera control; therefore vaccination might be an effective way to mitigate cholera in an outbreak prone area like Kudat.

Topics: Adolescent; Adult; Borneo; Case-Control Studies; Cholera; Disease Outbreaks; Female; Gastroenteritis; Humans; Malaysia; Male; Middle Aged; Risk Factors; Seafood; Serogroup; Surveys and Questionnaires; Transients and Migrants; Vibrio cholerae; Young Adult

A cholera outbreak in Terengganu, Malaysia, in November 2009 was caused by 2 El Tor Vibrio cholerae variants resistant to typical antimicrobial drugs. Evidence of replacement of treatable V. cholerae infection in the region with antimicrobial-resistant strains calls for increased surveillance and prevention measures.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; Bacterial Typing Techniques; Cholera; Cholera Toxin; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Bacterial; Environment; Genotype; Humans; Malaysia; Microbial Sensitivity Tests; Molecular Sequence Data; Polymerase Chain Reaction; Sequence Alignment; Sequence Analysis, DNA; Vibrio cholerae; Vibrio cholerae O1

The genome sequence analysis of a clinical Vibrio cholerae VC35 strain from an outbreak case in Malaysia indicates multiple genes involved in host adaptation and a novel Na(+)-driven multidrug efflux pump-coding gene in the genome of Vibrio cholerae with the highest similarity to VMA_001754 of Vibrio mimicus VMA223.

Topics: Base Sequence; Cholera; DNA, Bacterial; Genome, Bacterial; Humans; Malaysia; Molecular Sequence Data; Sequence Analysis, DNA; Vibrio cholerae O1

Vibrio cholerae, the causative agent of cholera, is endemic in many parts of the world, especially in countries poor in resources. Molecular subtyping of V. cholerae is useful to trace the regional spread of a clone or multidrug-resistant strains during outbreaks of cholera. Current available PCR-based fingerprinting methods such as Random Amplified Polymorphic DNA (RAPD)-PCR, Enterobacterial Repetitive Intergenic Consensus Sequence (ERIC)-PCR, and Repetitive Extragenic Palindromic (REP)-PCR were used to subtype V. cholerae. However, there are problems for inter-laboratory comparison as these PCR methods have their own limitations especially when different PCR methods have been used for molecular typing. In this study, a Vibrio cholerae Repeats-PCR (VCR-PCR) approach which targets the genetic polymorphism of the integron island of Vibrios was used and compared with other PCR-based fingerprinting methods in subtyping. Forty-three V. cholerae of different serogroups from various sources were tested. The PCR-fingerprinting approaches were evaluated on typeability, reproducibility, stability and discriminatory power. Overall, Malaysian non-O1/non-O139 V. cholerae were more diverse than O1 strains. Four non-O1/non-O139 strains were closely related with O1 strains. The O139 strain in this study shared similarity with strains of both O1 and non-O1/non-O139 serogroups. ERIC-PCR was the most discriminative approach (D value = 0.996). VCR-PCR was useful in discriminating non-O1/non-O139 strains. RAPD-PCR and REP-PCR were less suitable for efficient subtyping purposes as they were not reproducible and lacked stability. The combination of the ERIC-PCR and VCR-PCR may overcome the inadequacy of any one approach and hence provide more informative data.

Topics: Cholera; Cluster Analysis; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Feces; Genetic Variation; Genotype; Humans; Malaysia; Molecular Typing; Phylogeny; Polymerase Chain Reaction; Repetitive Sequences, Nucleic Acid; Reproducibility of Results; Seafood; Sensitivity and Specificity; Vibrio cholerae; Water Microbiology

A total of 20 Vibrio cholerae isolates were recovered for investigation from a cholera outbreak in Kelantan, Malaysia, that occurred between November and December 2009. All isolates were biochemically characterized as V. cholerae serogroup O1 Ogawa of the El Tor biotype. They were found to be resistant to multiple antibiotics, including tetracycline, erythromycin, sulfamethoxazole-trimethoprim, streptomycin, penicillin G, and polymyxin B, with 35% of the isolates being resistant to ampicillin. All isolates were sensitive to ciprofloxacin, norfloxacin, chloramphenicol, gentamicin, and kanamycin. Multiplex PCR analysis confirmed the biochemical identification and revealed the presence of virulence genes, viz., ace, zot, and ctxA, in all of the isolates. Interestingly, the sequencing of the ctxB gene showed that the outbreak strain harbored the classical cholera toxin gene and therefore belongs to the newly assigned El Tor variant biotype. Clonal analysis by pulsed-field gel electrophoresis demonstrated that a single clone of a V. cholerae strain was responsible for this outbreak. Thus, we present the first molecular evidence that the toxigenic V. cholerae O1 El Tor variant has invaded Malaysia, highlighting the need for continuous monitoring to facilitate early interventions against any potential epidemic by this biotype.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cholera; Cholera Toxin; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Bacterial; Humans; Malaysia; Microbial Sensitivity Tests; Molecular Sequence Data; Polymerase Chain Reaction; Sequence Analysis, DNA; Vibrio cholerae O1; Virulence Factors

A pair of primers targeting the hlyA gene for Vibrio cholerae which could distinguish the classical from El Tor biotypes was designed and combined with other specific primers for ompW, rfb complex, and virulence genes such as ctxA, toxR, and tcpI in a multiplex PCR (m-PCR) assay. This m-PCR correctly identified 39 V. cholerae from clinical, water and seafood samples. The efficiency of this multiplex PCR (m-PCR) was compared with conventional biochemical and serogrouping methods. One O139 and 25 O1 V. cholerae strains including 10 environmental strains harbored all virulence-associated genes except 1 clinical strain which only had toxR and hlyA genes. Thirteen environmental strains were classified as non-O1/non-O139 and had the toxR and hlyA genes only. The detection limit of m-PCR was 7 x 10(4) cfu/ml. The m-PCR test was reliable and rapid and reduced the identification time to 4 h.

Topics: Amino Acid Sequence; Animals; Bacterial Proteins; Bacterial Typing Techniques; Cholera; DNA Primers; Hemolysin Proteins; Humans; Malaysia; Molecular Sequence Data; Polymerase Chain Reaction; Seafood; Seawater; Sensitivity and Specificity; Serotyping; Vibrio cholerae; Virulence

This study evaluates and discusses the impact of the rural health improvement scheme in reducing the incidence of dysentery, enteric fever, cholera and viral hepatitis in Sarawak, Malaysia, using data compiled from state and federal health department reports. This study suggests that from 1963 to 2002, water supply intervention contributed to a more than 200-fold decrease in dysentery and a 60-fold decrease in enteric fever. Variations in reporting of viral hepatitis during that period make it difficult to detect a trend. Cholera was still endemic in 2002. Cholera and dysentery outbreaks, occurring when rural populations relied on contaminated rivers for their water supply, suggested that sanitation intervention was not as effective in reducing waterborne diseases. Recommendations are made for successive one-component interventions focusing on catchment management to ensure protection of current and alternative water supplies.

Topics: Adult; Child; Cholera; Communicable Disease Control; Disease Outbreaks; Dysentery; Female; Hepatitis, Viral, Human; Humans; Incidence; Malaysia; Male; Rural Health; Rural Health Services; Typhoid Fever; Water Microbiology; Water Supply

Of 97 strains of Vibrio cholerae isolated from various seafoods in Malaysia in 1998 and 1999, 20 strains carried the ctx gene and produced cholera toxin. Fourteen, one, and five of these toxigenic strains belonged to the O139, O1 Ogawa, and rough serotypes, respectively. The rough strains had the rfb gene of the O1 serotype. The toxigenic strains varied in their biochemical characteristics, the amount of cholera toxin produced, their antibiograms, and the presence or absence of the pTLC plasmid sequence. DNA fingerprinting analysis by arbitrarily primed PCR, ribotyping, and a pulsed-field gel electrophoresis method classified the toxigenic strains into 3, 7, and 10 types, respectively. The relatedness of these toxigenic strains to clinical strains isolated in other countries and from international travelers was examined by using a dendrogram constructed from the pulsed-field gel electrophoresis profiles. The results of the examination of the antibiogram and the possession of the toxin-linked cryptic plasmid were consistent with the dendrogram-based relatedness: the O139 strains isolated from Malaysian seafoods could be separated into two groups that appear to have been introduced from the Bengal area independently. The rough strains of Malaysian seafood origin formed one group and belonged to a cluster unique to the Thailand-Malaysia-Laos region, and this group may have persisted in this area for a long period. The single O1 Ogawa strain detected in Malaysian seafood appears to have an origin and route of introduction different from those of the O139 and the rough strains.

Topics: Animals; Bacterial Typing Techniques; Cholera; Cholera Toxin; DNA Fingerprinting; Epidemiologic Factors; Food Microbiology; Genotype; Humans; Malaysia; Phenotype; Seafood; Vibrio cholerae

This paper examines the trend and possible contributing factors for the occurrence of the food borne diseases outbreaks in Malaysia. These diseases mainly are cholera, typhoid fever, hepatitis A, dysentery and food poisoning. The outbreaks still occur sporadically in certain high risk areas throughout the country. The incidence rate of all the other three major food borne diseases steadily declined from the year 1988 to 1997 except for food poisoning and cholera. Statistic of food poisoning from the year 1996 to 1997 showed that 66.5% of the outbreak occurred in schools whereas only 0.4% originated from the contaminated food sold at various public food outlets. The school age group is always more affected than the general population. Amongst the contributing factors identified are related to unhygienic food handling practices followed by inadequate safe water supply and poor environmental sanitation. A multisectoral approach between Ministry of Health and other government agencies or private agents needs to be undertaken in the management of the food borne diseases in order to curb the incidences of food borne diseases in Malaysia.

Topics: Adolescent; Adult; Child; Child, Preschool; Cholera; Cross-Sectional Studies; Disease Outbreaks; Dysentery; Food Contamination; Foodborne Diseases; Hepatitis A; Humans; Incidence; Malaysia; Risk Factors; Time Factors; Typhoid Fever

Bacterial resistance to various antimicrobial agents is common in area with high usage of antibiotics. In this study, the data on antimicrobial susceptibility patterns of Vibrio cholerae O1 from patients during an outbreak period was found to be high but variable rates of multidrug resistance. Thirty-two of 33 V. cholerae isolates harboured the tcp, ctx, zot and ace genes, suggesting their possible roles in the outbreak cases. We analyzed the molecular diversity of a total of 33 strains of V. cholerae O1 isolated from 33 patients between November 1997 and April 1998 using random amplified polymorphic DNA (RAPD) analysis. The 30 typable isolates could be separated into four major clusters containing 5, 17, 2 and 6 isolates, respectively. However, no particular RAPD pattern was predictive of a particular pattern of antibiotic susceptibility. The findings of this study showed that multiple clones seemed to be responsible for cases in the outbreaks in the study area.

Topics: Cholera; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Genes, MDR; Humans; Malaysia; Microbial Sensitivity Tests; Polymerase Chain Reaction; Random Amplified Polymorphic DNA Technique; Vibrio cholerae

Topics: Cholera; Communicable Diseases, Emerging; Food Microbiology; Humans; Malaysia

Forty-three clinical strains of V. cholerae O1 biotype E1 Tor were isolated between 3 May and 10 June 1998 during an outbreak in the metropolitan area of Kuala Lumpur and its suburbs. With the exception of three Inaba strains that were restricted to three members of a family, all the others belonged to the Ogawa serotype. The strains were analysed for clonality using ribotyping and pulsed-field gel electrophoresis (PFGE). Two ribotypes, V/B21a and B27, were identified among 40 Ogawa isolates using BglI restriction endonuclease. Ribotype V/B21a has been described previously from Taiwan and Colombia and several Asian countries while B27 has been reported among isolates from Senegal. The three Inaba strains belonged to one ribotype, designated type A, not previously reported. PFGE analysis using NotI revealed that all isolates within a ribotype had identical profiles demonstrating clonality amongst the strains. Dice coefficient analysis of the two Ogawa genotypes revealed 89% similarity on ribotype patterns and 91.3% on PFGE profiles. Ribotype V/B21a isolates were associated with cases from dispersed areas of Kuala Lumpur and its suburbs while ribotype B27 was restricted to cases from one particular area suggesting a common-source outbreak.

Topics: Bacterial Typing Techniques; Cholera; Disease Outbreaks; DNA, Bacterial; DNA, Ribosomal; Electrophoresis, Gel, Pulsed-Field; Humans; Malaysia; Vibrio cholerae

Eighty-four strains of Vibrio cholerae O1, O139 and non-O1/non-O139 from clinical and environmental sources were investigated for the presence of the toxin co-regulated pilus gene, tcpA, the virulence cassette genes ctxA, zot, ace and cep and also for their ability to elaborate haemolysin and protease. The ctxA and zot genes were detected using DNA-DNA hybridization while the ace, cep and tcpA genes were detected using PCR. Production of haemolysin and protease was detected using mammalian erythrocytes and an agar diffusion assay respectively. Analysis of their virulence profiles showed six different groups designated Type I to Type VI and the major distinguishing factor among these profiles was in the in vitro production of haemolysin and/or protease. Clinical O1, O139 and environmental O1 strains were similar with regard to presence of the virulence cassette genes. All environmental O1 strains with the exception of one were found to possess ctxA, zot and ace giving rise to the probability that these strains may actually be of clinical origin. One strain which had only cep but none of the toxin genes may be a true environmental isolate. The virulence cassette and colonization factor genes were absent in all non-O1/non-O139 environmental strains but production of both the haemolysin and protease was present, indicating that these may be putative virulence factors. These findings suggest that with regard to its pathogenic potential, only strains of the O1 and O139 serogroup that possess the tcpA gene which encodes the phage receptor, have the potential to acquire the CTX genetic element and become choleragenic.

Topics: Cholera; DNA Primers; DNA, Bacterial; Endopeptidases; Enzyme-Linked Immunosorbent Assay; Hemolysin Proteins; Humans; Immunodiffusion; Malaysia; Nucleic Acid Hybridization; Polymerase Chain Reaction; Vibrio cholerae; Virulence

Sensitivity testing on Vibrio cholerae isolates during an epidemic in 1998 in Kelantan identified strains resistant to tetracycline. This prompted a change in the usual management of cholera in Kelantan. The antibiotic of choice was changed from tetracycline to erythromycin.

Topics: Anti-Bacterial Agents; Cholera; Drug Resistance, Microbial; Erythromycin; Humans; Malaysia; Microbial Sensitivity Tests; Tetracycline; Vibrio cholerae

A total of 31 strains of Vibrio cholerae O1 (10 from outbreak cases and 7 from surface water) and non-O1 (4 from clinical and 10 from surface water sources) isolated between 1993 and 1997 were examined with respect to presence of cholera enterotoxin (CT) gene by PCR-based assays, resistance to antibiotics, plasmid profiles and random amplified polymorphic DNA (RAPD) analysis. All were resistant to 9 or more of the 17 antibiotics tested. Identical antibiotic resistance patterns of the isolates may indicate that they share a common mode of developing antibiotic resistance. Furthermore, the multiple antibiotic resistance indexing showed that all strains tested originated from high risk contamination. Plasmid profile analysis by agarose gel electrophoresis showed the presence of small plasmids in 12 (7 non-O1 and 5 O1 serotypes) with sizes ranging 1.3-4.6 MDa. The CT gene was detected in all clinical isolates but was present in only 14 (6 O1 serotype and 8 non-O1 serotype) isolates from environmental waters. The genetic relatedness of the clinical and environmental Vibrio cholerae O1 and non-O1 strains was investigated by RAPD fingerprinting with four primers. The four primers generated polymorphisms in all 31 strains of Vibrio cholerae tested, producing bands ranging from < 250 to 4500 bp. The RAPD profiles revealed a wide variability and no correlation with the source of isolation. This study provides evidence that Vibrio cholerae O1 and non-O1 have significant public health implications.

Topics: Cholera; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Microbial; Electrophoresis, Agar Gel; Humans; Malaysia; Microbial Sensitivity Tests; Plasmids; Polymerase Chain Reaction; Serotyping; Vibrio cholerae; Water Microbiology

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholera; Disease Outbreaks; Female; Humans; Incidence; Infant; Malaysia; Male; Middle Aged; Population Surveillance; Risk Factors; Seasons

Isolates of Vibrio cholerae O1 El Tor from two well-defined cholera outbreaks in Malaysia were analyzed by using pulsed-field gel electrophoresis (PFGE). Isolates from sporadic cases occurring during the same time period were also studied. Digestion of chromosomal DNA from these isolates of V. cholerae O1 with restriction endonucleases NotI (5'-GCGGCCGC-3') and SfiI (5'-GGCCNNNN-3'), followed by PFGE, produced restriction endonuclease analysis (REA) patterns consisting of 13 to 24 bands (ranging in size from 46 to 398 kbp). Analysis of the REA patterns generated by PFGE after digestion with NotI and SfiI suggested the clonal nature and close genetic identity of the isolates obtained during each of the two outbreaks (Dice coefficient, 0.93 to 1.0). Although they had very similar REA patterns, the two outbreak clones were not identical. Isolates of V. cholerae O1 from sporadic cases, on the other hand, appeared to be much more heterogeneous (five different REA patterns detected in the five isolates tested; Dice coefficient, 0.31 to 0.81) than those obtained during the two outbreaks. We conclude that PFGE of V. cholerae O1 chromosomal DNA digested with infrequently cutting restriction endonucleases is a useful method for molecular typing of V. cholerae isolates for epidemiological purposes.

Topics: Bacterial Typing Techniques; Cholera; Disease Outbreaks; DNA Restriction Enzymes; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Malaysia; Prohibitins; Restriction Mapping; Vibrio cholerae

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Cholera; Drug Resistance; Female; Humans; Infant; Malaysia; Male; Microbial Sensitivity Tests; Middle Aged; Pteridines; Vibrio cholerae

Topics: Cholera; Diarrhea; Disease Outbreaks; Global Health; Humans; Malaysia; Vibrio cholerae

Two episodes of El Tor cholera outbreak occurred in Tumpat, Kelantan between the 13th of January and the 16th of May 1990. Every case and carrier reported were investigated to determine the source and mode of transmission and to identify specific preventive measures to break the chain of transmission. There were 109 cases and 85 carriers involved in this study. The first episode of one case only was of Inaba serotype while the second episode was caused by the imported Ogawa serotype. Two foci of spread were identified from cluster occurrence but the majority of infection had no discernible link between them. The outbreak became both explosive and protracted indicating poor basic sanitation and personal hygiene. Person-to-person transmission via food and water was the main mode of spread. The Kelantan river water and river clams were confirmed sources of reservoir during the outbreak. Recommendations for prevention are intensified surveillance throughout the year,urgent upgrading of potable water supply and concerted effort in public health education especially against the use of river water and the consumption of raw food.

Topics: Carrier State; Cholera; Disease Outbreaks; Disease Reservoirs; Humans; Incidence; Malaysia; Sanitation; Socioeconomic Factors

Cholera has been in existence in Sarawak for many years and since 1873 many major epidemics have occurred. The epidemics usually occur during the dry months of May, June and July and the population affected are those in coastal areas. As in other outbreaks the areas affected were those which had poor environmental sanitation, poor water supply, poor refuse disposal and indiscriminate disposal of faeces. Malays are more affected as in Peninsular Malaysia outbreaks. The classical biotype was common prior to 1961. In later years the El Tor (biotype) has been responsible for most outbreaks.

Topics: Cholera; Disease Outbreaks; History, 19th Century; History, 20th Century; Malaysia

Analysis of diarrhoeal disease patterns in Malaysia from 1981-1986 suggested that infectious hepatitis ranked as the most predominant diarrhoeal disease followed by typhoid, food poisoning, dysentery and cholera. Although these five major food and water-borne diseases are still endemic in this country, diarrhoeal diseases per se no longer become an important public health problem in Malaysia. Enforcement of the cholera control program brought the incidence of the disease to a minimal. Unfortunately, this fatal form of diarrhoeal disease caused the greatest mortality compared to the others. Seasonal influence also played a part in controlling the occurrence of the disease. There was a preponderance of diarrhoeal diseases during the rainy season implicating contaminated water as a source of transmission. Although greater than half of the population has been supplied with piped water and sanitary latrines, a lot more has to be done before diarrhoeal diseases could be eliminated from this country.

Topics: Child, Preschool; Cholera; Diarrhea; Dysentery; Foodborne Diseases; Hepatitis, Viral, Human; Humans; Infant; Malaysia; Socioeconomic Factors; Typhoid Fever

Topics: Adolescent; Adult; Age Factors; Carrier State; Child; Child, Preschool; Cholera; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Occupations; Racial Groups

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholera; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Middle Aged

Topics: Cholera; Ethnicity; History, 20th Century; Humans; Malaysia

Topics: Carrier State; Cholera; Disease Outbreaks; Feces; Humans; Malaysia; Water Microbiology

Topics: Cholera; Culture; Disease Outbreaks; Folklore; Humans; Malaysia; Refuse Disposal; Social Conditions; Social Values; Water Pollution; Water Supply

Topics: Agglutination Tests; Cholera; Disease Outbreaks; Feces; Food Microbiology; Humans; Malaysia; Shellfish; Vibrio; Water Microbiology

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholera; Cholera Vaccines; Disease Outbreaks; Ecology; Female; Humans; Malaysia; Male; Middle Aged; Water Pollution; Water Supply

Topics: Adolescent; Adult; Ancylostomatoidea; Child; Child, Preschool; Cholera; Colombia; Congresses as Topic; Costa Rica; Deficiency Diseases; Female; Humans; India; Infant; Infections; Malaysia; Male; Middle Aged; National Institutes of Health (U.S.); Nutritional Physiological Phenomena; Pakistan; Schistosomiasis; United States

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholera; Female; Humans; Infant; Malaysia; Male; Middle Aged

Topics: Adult; Cholera; Clinical Laboratory Techniques; Female; Humans; Infant; Malaysia; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholera; Humans; Infant; Malaysia; Middle Aged

Topics: Cholera; Disasters; Disease Outbreaks; Humans; Malaysia; Vaccination; Water Pollution

Topics: Bacteriological Techniques; Cholera; Humans; Malaysia; Vibrio; Vibrio cholerae

Topics: Cholera; Communicable Disease Control; Disease Outbreaks; Humans; Malaysia; Sewage; Water Pollution

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.

Topics: Cholera; Disease Outbreaks; Epidemics; Hong Kong; Humans; Indonesia; Malaysia; Philippines; Vibrio; Vibrio cholerae

Topics: Cholera; Disease Outbreaks; Humans; Malaysia; Vaccines