exudates and Paramyxoviridae-Infections

Nipah virus, a newly emerging deadly paramyxovirus isolated during a large outbreak of viral encephalitis in Malaysia, has many of the physical attributes to serve as a potential agent of bioterrorism. The outbreak caused widespread panic and fear because of its high mortality and the inability to control the disease initially. There were considerable social disruptions and tremendous economic loss to an important pig-rearing industry. This highly virulent virus, believed to be introduced into pig farms by fruit bats, spread easily among pigs and was transmitted to humans who came into close contact with infected animals. From pigs, the virus was also transmitted to other animals such as dogs, cats, and horses. The Nipah virus has the potential to be considered an agent of bioterrorism.

Topics: Agricultural Workers' Diseases; Animals; Bioterrorism; Cats; Disease Outbreaks; Disease Reservoirs; Dogs; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases; Zoonoses

Nipah virus, a novel paramyxovirus, closely related to Hendra virus emerged in northern part of Peninsular Malaysia in 1998. The virus caused an outbreak of severe febrile encephalitis in humans with a high mortality rate, whereas, in pigs, encephalitis and respiratory diseases but with a relatively low mortality rate. The outbreak subsequently spread to various regions of the country and Singapore in the south due to the movement of infected pigs. Nipah virus caused systemic infections in humans, pigs and other mammals. Histopathological and radiological findings were characteristic of the disease. Fruitbats of Pteropid species were identified as the natural reservoir hosts. Evidence suggested that climatic and anthropogenic driven ecological changes coupled with the location of piggeries in orchard and the design of pigsties allowed the spill-over of this novel paramyxovirus from its reservoir host into the domestic pigs and ultimately to humans and other animals.

Topics: Agriculture; Animal Husbandry; Animals; Brain Damage, Chronic; Chiroptera; Disease Outbreaks; Disease Reservoirs; Ecology; Encephalitis, Viral; Hematologic Diseases; Housing, Animal; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Population Surveillance; Radiography; Recurrence; Respiratory Tract Infections; Singapore; Swine; Swine Diseases

Traceback systems in most countries of Asia are not well developed, as indicated by responses to a questionnaire by veterinary officials in thirteen countries. Marking of animals for traceback is practised only in a limited number of countries in specific areas or zones and for specific purposes only. In Malaysia, traceback has been undertaken by marking farm code tattoos on pigs. This enables the identification of the farm of origin of pigs found to be infected by Nipah virus in sero-surveillance programmes. The origin of the foot and mouth disease (FMD) virus that surfaced in the Republic of Korea in March 2000 was investigated through several epidemiological studies of suspected sources of contamination such as imported hay, yellow sand, milk collection trucks and feed delivery trucks. None of these studies gave results that indicated the origin of the FMD virus. The origin of the FMD virus that was recorded in Japan in March 2000 was also investigated in epidemiological studies; in this case, imported wheat straw was incriminated as the most likely source of infection. Comparative studies of the pathogenicities of FMD (type O) viruses isolated in Taipei China, the Republic of Korea and Japan, suggest that these viruses might have originated as vaccine strains used in a third country.

Topics: Abattoirs; Animal Feed; Animal Husbandry; Animal Identification Systems; Animals; Cattle; Cattle Diseases; Disease Outbreaks; Foot-and-Mouth Disease; Humans; Japan; Korea; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases

Topics: Animals; Disease Outbreaks; Encephalitis, Viral; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Prognosis; Swine; Time Factors

Topics: Animals; Asia; Communicable Diseases, Emerging; Democratic Republic of the Congo; Disease Outbreaks; Disease Reservoirs; Disease Transmission, Infectious; Hantavirus Infections; Hemorrhagic Fever, Ebola; Hong Kong; Humans; Malaysia; Orthomyxoviridae Infections; Paramyxoviridae Infections; Paramyxovirinae; RNA Virus Infections; Sudan; Swine

Between late 1998 and 1999, the spread of a new disease of pigs, characterized by a pronounced respiratory and neurological syndrome, sometimes accompanied by the sudden death of sows and boars, was recorded in pig farms in peninsular Malaysia. The disease appeared to have a close association with an epidemic of viral encephalitis among workers on pig farms. A previously unrecognised paramyxovirus was later identified from this outbreak; this virus was related to, but distinct from, the Hendra virus discovered in Australia in 1994. The new virus was named 'Nipah' and was confirmed by molecular characterization to be the agent responsible for the disease in both humans and pigs. The name proposed for the new pig disease was 'porcine respiratory and neurological syndrome' (also known as 'porcine respiratory and encephalitis syndrome'), or, in peninsular Malaysia, 'barking pig syndrome'. The authors describe the new disease and provide the epidemiological findings recorded among infected pigs. In addition, the control programmes which were instituted to contain the virus in the national swine herd are outlined.

Topics: Animals; Disease Outbreaks; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases; Zoonoses

Human metapneumovirus (HMPV) is established as one of the causative agents of respiratory tract infections. To date, there are limited reports that describe the effect of HMPV genotypes and/or viral load on disease pathogenesis in adults. This study aims to determine the role of HMPV genetic diversity and nasopharyngeal viral load on symptom severity in outpatient adults with acute respiratory tract infections.. Severity of common cold symptoms of patients from a teaching hospital was assessed by a four-category scale and summed to obtain the total symptom severity score (TSSS). Association between the fusion and glycoprotein genes diversity, viral load (quantified using an improved RT-qPCR assay), and symptom severity were analyzed using bivariate and linear regression analyses.. Overall, HMPV genetic diversity and viral load did not impact symptom severity in adults with acute respiratory tract infections. Differences in viral load dynamics over time between genotypes may have important implications on viral transmission.

Topics: Acute Disease; Aged; Cohort Studies; Female; Genetic Variation; Genotype; Hospitals, Teaching; Host-Pathogen Interactions; Humans; Linear Models; Malaysia; Male; Metapneumovirus; Middle Aged; Molecular Epidemiology; Nasopharynx; Outpatients; Paramyxoviridae Infections; Respiratory Tract Infections; Severity of Illness Index; Viral Load

Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are frequent causes of pneumonia and death among children at Sibu and Kapit Hospitals in Sarawak, Malaysia.. To determine the prevalence and risk factors for RSV subtypes A and B and PIV types 1-4 among patients hospitalized with pneumonia.. In a cross-sectional, pilot study nasopharyngeal swabs were studied with real-time reverse transcription polymerase chain reaction assays. Concurrently, we helped Sibu and Kapit Hospitals adapt their first molecular diagnostics for RSV and PIV.. Of 129 specimens collected (June to July 2017), 39 tested positive for RSV-A (30.2%), two were positive for RSV B (1.6%), one was positive for PIV-3 (0.8%) and one was positive for PIV-4 (0.8%). No samples were positive for PIV-1 or PIV-2. Of the 39 RSV-A positive specimens, 46.2% were collected from children under one year of age and only 5.1% were from patients over the age of 18. A multivariable analysis found the odds of children <1 year of age testing positive for RSV-A were 32.7 (95% CI: 3.9, 276.2) times larger than >18 years of age, and the odds of patients hospitalized at Kapit Hospital testing positive for RSV-A were 3.2 (95% CI: 1.3, 7.8) times larger than patients hospitalized at Sibu Hospital.. This study found an unusually high prevalence of RSV-A among pneumonia patients admitted to the two hospitals. Subsequently, Sibu Hospital adapted the molecular assays with the goal of providing more directed care for such pneumonia patients.

Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Female; Hospitalization; Humans; Infant; Infant, Newborn; Malaysia; Male; Odds Ratio; Paramyxoviridae Infections; Pneumonia, Viral; Prevalence; Public Health Surveillance; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Risk Factors; Young Adult

Human metapneumovirus (HMPV) is an important viral respiratory pathogen worldwide. Current knowledge regarding the genetic diversity, seasonality and transmission dynamics of HMPV among adults and children living in tropical climate remains limited. HMPV prevailed at 2.2% (n = 86/3,935) among individuals presented with acute respiratory tract infections in Kuala Lumpur, Malaysia between 2012 and 2014. Seasonal peaks were observed during the northeast monsoon season (November-April) and correlated with higher relative humidity and number of rainy days (P < 0.05). Phylogenetic analysis of the fusion and attachment genes identified the co-circulation of three known HMPV sub-lineages, A2b and B1 (30.2% each, 26/86) and B2 (20.9%, 18/86), with genotype shift from sub-lineage B1 to A2b observed in 2013. Interestingly, a previously unrecognized sub-lineage of A2 was identified in 18.6% (16/86) of the population. Using a custom script for network construction based on the TN93 pairwise genetic distance, we identified up to nine HMPV transmission clusters circulating as multiple sub-epidemics. Although no apparent major outbreak was observed, the increased frequency of transmission clusters (dyads) during seasonal peaks suggests the potential roles of transmission clusters in driving the spread of HMPV. Our findings provide essential information for therapeutic research, prevention strategies, and disease outbreak monitoring of HMPV.

Topics: Adolescent; Adult; Aged; Child; Genetic Variation; Humans; Malaysia; Metapneumovirus; Middle Aged; Molecular Epidemiology; Nasopharynx; Paramyxoviridae Infections; Phylogeny; Respiratory Tract Infections; Viral Fusion Proteins; Young Adult

Human metapneumovirus (HMPV) is a recently discovered cause of viral respiratory infections. We describe clinical and molecular epidemiology of HMPV cases diagnosed in children with respiratory infection at University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The prevalence rate of HMPV between 2010 and 2012 was 1.1%, and HMPV contributed 6.5% of confirmed viral respiratory infections. The HMPV patients had a median age of 1.6 years, and a median hospital admission of 4 days. The most common clinical presentations were fever, rhinitis, pneumonia, vomiting/diarrhoea, and bronchiolitis. Based on the partial sequences of F fusion gene from 26 HMPV strains, 14 (54%) were subgenotype A2b, which was predominant in 2010; 11 (42%) were subgenotype B1, which was predominant in 2012; and 1 (4%) was subgenotype A2a. Knowledge of the circulating subgenotypes in Malaysia, and the displacement of predominant subgenotypes within 3 years, is useful data for future vaccine planning.

Topics: Adolescent; Age Distribution; Child; Child, Preschool; Cluster Analysis; Female; Genotype; Hospitalization; Humans; Infant; Length of Stay; Malaysia; Male; Metapneumovirus; Molecular Epidemiology; Molecular Sequence Data; Paramyxoviridae Infections; Phylogeny; Prevalence; Respiratory Tract Infections; RNA, Viral; Sequence Analysis, DNA; Sequence Homology

Tioman virus, a relatively new paramyxovirus, was isolated from fruit bats (Pteropus species) on Tioman Island, Malaysia, in 2001. The objective of this study was to determine the prevalence of antibodies to T. virus in island inhabitants, by use of comparative ELISA and serum neutralization assays. Of the 169 human sera analyzed, 5 (approximately 3.0%) were positive for T. virus, by comparative ELISA. Of these 5 sera, 3 (1.8% of the total) had neutralizing antibodies against T. virus, suggesting previous infection of this study population by this virus or a similar virus.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Antibodies, Viral; Chiroptera; Enzyme-Linked Immunosorbent Assay; Female; Humans; Malaysia; Male; Middle Aged; Neutralization Tests; Paramyxoviridae Infections; Paramyxovirinae; Seroepidemiologic Studies; Zoonoses

Between September 1998 and June 1999, there was a severe outbreak of viral encephalitis among the pig farm workers in Malaysia.. This is a review of the published literature related to the outbreak with the focus on human diseases.. The encephalitis was caused by a newly discovered paramyxovirus related to Hendra virus, later named Nipah virus. There were 265 patients with acute encephalitis. The disease is thought to spread from pig to man through close contact. The risk of human-to-human spread is thought to below. The disease affected mainly adult Chinese males, half of whom had affected family members. The disease presented mainly as acute encephalitis with a short incubation period of less than two weeks, with the main symptoms of fever, headache, and giddiness followed by coma. Distinctive clinical signs include segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia. Initial cerebrospinal fluid was abnormal in 75% of patients. Serology was helpful in confirming the diagnosis. Magnetic resonance imaging showed distinctive changes of multiple, discrete, and small high signal lesions, best seen with fluid-attenuated inversion recovery (FLAIR) sequences. Mortality was high at 40% and death was probably due to severe brainstem involvement. The main necropsy finding in acute encephalitis was that of disseminated microinfarction associated with vasculitis and direct neuronal involvement. Ribavirin was able to reduce the mortality by 36%. Relapse encephalitis was seen in 7.5% of those who recovered from acute encephalitis, and late-onset encephalitis in 3.4% of those with initial non-encephalitic or asymptomatic diseases. The mean interval between initial illness and the onset of the complication was 8.4 months. The relapse and late-onset encephalitis which manifested as focal encephalitis arose from recurrent infection.. Nipah virus, a recently discovered paramyxovirus, causes a unique encephalitis with high mortality as well as relapse and late-onset encephalitis. The infection is mainly spread from pigs to man.

Topics: Agriculture; Animals; Chiroptera; Disease Outbreaks; Disease Reservoirs; Encephalitis, Viral; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Retrospective Studies; Swine

An outbreak of infection with the Nipah virus, a novel paramyxovirus, occurred among pig farmers between September 1998 and June 1999 in Malaysia, involving 265 patients with 105 fatalities. This is a follow-up study 24 months after the outbreak. Twelve survivors (7.5%) of acute encephalitis had recurrent neurological disease (relapsed encephalitis). Of those who initially had acute nonencephalitic or asymptomatic infection, 10 patients (3.4%) had late-onset encephalitis. The mean interval between the first neurological episode and the time of initial infection was 8.4 months. Three patients had a second neurological episode. The onset of the relapsed or late-onset encephalitis was usually acute. Common clinical features were fever, headache, seizures, and focal neurological signs. Four of the 22 relapsed and late-onset encephalitis patients (18%) died. Magnetic resonance imaging typically showed patchy areas of confluent cortical lesions. Serial single-photon emission computed tomography showed the evolution of focal hyperperfusion to hypoperfusion in the corresponding areas. Necropsy of 2 patients showed changes of focal encephalitis with positive immunolocalization for Nipah virus antigens but no evidence of perivenous demyelination. We concluded that a unique relapsing and remitting encephalitis or late-onset encephalitis may result as a complication of persistent Nipah virus infection in the central nervous system.

Topics: Adolescent; Adult; Brain; Child; Electroencephalography; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Malaysia; Male; Middle Aged; Paramyxoviridae Infections; Paramyxovirinae; Recurrence; Time Factors; Tomography, Emission-Computed, Single-Photon

Topics: Disease Outbreaks; Female; Humans; Incidence; Infectious Disease Transmission, Patient-to-Professional; Malaysia; Male; Paramyxoviridae; Paramyxoviridae Infections; Risk Factors

In late 1998, a novel paramyxovirus named Nipah virus, emerged in Malaysia, causing fatal disease in domestic pigs and humans with substantial economic loss to the local pig industry. Pteropid fruitbats have since been identified as a natural reservoir host. Over the last two decades, the forest habitat of these bats in Southeast Asia has been substantially reduced by deforestation for pulpwood and industrial plantation. In 1997/1998, slash-and-burn deforestation resulted in the formation of a severe haze that blanketed much of Southeast Asia in the months directly preceding the Nipah virus disease outbreak. This was exacerbated by a drought driven by the severe 1997-1998 El Niño Southern Oscillation (ENSO) event. We present data suggesting that this series of events led to a reduction in the availability of flowering and fruiting forest trees for foraging by fruitbats and culminated in unprecedented encroachment of fruitbats into cultivated fruit orchards in 1997/1998. These anthropogenic events, coupled with the location of piggeries in orchards and the design of pigsties allowed transmission of a novel paramyxovirus from its reservoir host to the domestic pig and ultimately to the human population.

Topics: Animals; Climate; Conservation of Natural Resources; Disease Outbreaks; Disease Reservoirs; Encephalitis, Viral; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases; Weather; Zoonoses

An outbreak of viral encephalitis occurred among pig industry workers in Malaysia in September 1998 to April 1999. The encephalitis was attributed to a new paramyxovirus, Nipah virus. This is a description of the clinical features of 103 patients treated in the Seremban Hospital with characterization of the prognostic factors.. Clinical case records and laboratory investigations were reviewed. The case definition was: patients from the outbreak area, direct contact or in close proximity with pigs, clinical or CSF features of encephalitis.. The mean age was 38 years, 89% were male, 58% were ethnic Chinese, 78% were pig farm owners or hired workers. The mean incubation period was 10 days. The patients typically presented with nonspecific systemic symptoms of fever, headache, myalgia and sore throat. Seizures and focal neurological signs were seen in 16% and 5% respectively. In the more severe cases, this was followed by drowsiness and deteriorating consciousness requiring ventilation in 61%. Autonomic disturbances and myoclonic jerks were common features. The mortality was high at 41%. Systolic hypertension, tachycardia and high fever were associated with poor outcome. On the other hand, 40% recovered fully. As for the other 19%, the residual neurological signs were mostly mild.. Nipah virus caused an encephalitis illness with short incubation period and high mortality. The prognosis for the survivors was good.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Disease Outbreaks; Encephalitis, Viral; Female; Humans; Malaysia; Male; Middle Aged; Paramyxoviridae Infections; Paramyxovirinae; Prognosis; Risk

In late 1998, Nipah virus emerged in peninsular Malaysia and caused fatal disease in domestic pigs and humans and substantial economic loss to the local pig industry. Surveillance of wildlife species during the outbreak showed neutralizing antibodies to Nipah virus mainly in Island flying-foxes (Pteropus hypomelanus) and Malayan flying-foxes (Pteropus vampyrus) but no virus reactive with anti-Nipah virus antibodies was isolated. We adopted a novel approach of collecting urine from these Island flying-foxes and swabs of their partially eaten fruits. Three viral isolates (two from urine and one from a partially eaten fruit swab) that caused Nipah virus-like syncytial cytopathic effect in Vero cells and stained strongly with Nipah- and Hendra-specific antibodies were isolated. Molecular sequencing and analysis of the 11,200-nucleotide fragment representing the beginning of the nucleocapsid gene to the end of the glycoprotein gene of one isolate confirmed the isolate to be Nipah virus with a sequence deviation of five to six nucleotides from Nipah virus isolated from humans. The isolation of Nipah virus from the Island flying-fox corroborates the serological evidence that it is one of the natural hosts of the virus.

Topics: Animals; Antibodies, Viral; Chiroptera; Chlorocebus aethiops; Cytopathogenic Effect, Viral; Disease Reservoirs; Fruit; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Vero Cells

Topics: Animals; Australia; Chiroptera; Disease Outbreaks; Disease Vectors; Humans; Indonesia; Malaysia; Pacific Islands; Paramyxoviridae Infections; Paramyxovirinae; Philippines; Population Surveillance; Zoonoses

Emerging infectious diseases involving zoonosis have become important global health problems. The 1998 outbreak of severe febrile encephalitis among pig farmers in Malaysia caused by a newly emergent paramyxovirus, Nipah virus, is a good example. This disease has the potential to spread to other countries through infected animals and can cause considerable economic loss. The clinical presentation includes segmental myoclonus, areflexia, hypertension, and tachycardia, and histologic evidence includes endothelial damage and vasculitis of the brain and other major organs. Magnetic resonance imaging has demonstrated the presence of discrete high-signal-intensity lesions disseminated throughout the brain. Nipah virus causes syncytial formation in Vero cells and is antigenically related to Hendra virus. The Island flying fox (Pteropus hypomelanus; the fruit bat) is a likely reservoir of this virus. The outbreak in Malaysia was controlled through the culling of >1 million pigs.

Topics: Animals; Chiroptera; Chlorocebus aethiops; Disease Outbreaks; Disease Reservoirs; Encephalitis; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Vero Cells

During 1998-1999, an outbreak of Nipah virus encephalitis occurred in Malaysia. To assess the possibility of nosocomial transmission, 338 health care workers (HCWs) exposed and 288 HCWs unexposed to outbreak-related patients were surveyed, and their serum samples were tested for anti-Nipah virus antibody. Needlestick injuries were reported by 12 (3%) HCWs, mucosal surface exposure to body fluids by 39 (11%), and skin exposure to body fluids by 89 (25%). No encephalitis occurred in either group. Three exposed and no unexposed HCWs tested positive by EIA for IgG antibodies. It is likely that these 3 were false positives; no IgM response occurred, and the serum samples were negative for anti-Nipah virus neutralizing antibodies. The risk of nosocomial transmission of Nipah virus appears to be low; however, given the high case-fatality rate and the presence of virus in respiratory secretions and urine of some patients, standard and droplet infection-control practices should be maintained with these patients.

Topics: Antibodies, Viral; Cohort Studies; Cross Infection; Disease Outbreaks; False Positive Reactions; Female; Humans; Immunoenzyme Techniques; Immunoglobulin G; Infectious Disease Transmission, Patient-to-Professional; Malaysia; Male; Paramyxoviridae Infections; Paramyxovirinae; Risk Factors; Surveys and Questionnaires

To study the excretion of Nipah virus in the upper respiratory secretions and urine of infected patients in relation to other clinical features.. Isolation of Nipah virus from the respiratory secretions and urine was made in Vero cells and identified by indirect immunofluorescence assay using anti-Hendra specific hyperimmune mouse ascitic fluid and FITC-conjugated goat anti-mouse IgG.. During the peak outbreak of Nipah virus encephalitis in Malaysia, Nipah virus was isolated from the upper respiratory secretions and urine in eight of 20 patients who were virologically and/or serologically confirmed to be infected with the virus. From these eight patients, Nipah virus was isolated from six throat swab specimens, three urine specimens and only one nasal swab specimen. The positive virus isolation rate was related to the collection of these specimens during the early phase of the illness (P = 0.068). The presence of serum anti-Nipah specific IgM appeared to reduce the chance of isolating the virus (P = 0.049). There was no significant difference in the isolation rate with respect to the age, gender, ethnic group and clinical features associated with grave prognosis and mortality outcome of the patients.. This study shows that it is possible to be infected from secretions of infected patients, but epidemiological survey on close contacts so far did not suggest that human-to-human transmission is common.

Topics: Adolescent; Adult; Animals; Ascites; Disease Outbreaks; Encephalitis, Viral; Female; Fluorescent Antibody Technique, Indirect; Humans; Immunoglobulin G; Malaysia; Male; Mice; Middle Aged; Nasal Mucosa; Paramyxoviridae Infections; Paramyxovirinae; Pharynx; Prognosis; Respiratory System; Virus Shedding

Nipah virus is a newly discovered paramyxovirus transmitted directly from pigs to humans. During a large encephalitis outbreak in Malaysia and Singapore in 1998-9, most patients presented acutely. A 12 year old child is described who developed encephalitis 4 months after exposure to the virus. She was diagnosed by a new indirect IgG enzyme linked immunosorbent assay (ELISA), which is also described. The late presentation and IgG subclass responses had similarities to subacute sclerosing panencephalitis. Nipah virus should be considered in patients with encephalitis even months after their possible exposure.

Topics: Animals; Antibodies, Viral; Child; Encephalitis, Viral; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin G; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Zoonoses

An outbreak of encephalitis primarily affecting pig farmers occurred during 1998-1999 in Malaysia and was linked to a new paramyxovirus, Nipah virus, which infected pigs, humans, dogs, and cats. Because five abattoir workers were also affected, a survey was conducted to assess the risk of Nipah infection among abattoir workers.. Workers from all 143 registered abattoirs in 11 of 13 states in Malaysia were invited to participate in this cross-sectional study. Participants were interviewed to ascertain information on illness and activities performed at the abattoir. A serum sample was obtained to test for Nipah virus antibody.. Seven (1.6 %) of 435 abattoir workers who slaughtered pigs versus zero (0%) of 233 workers who slaughtered ruminants showed antibody to Nipah virus (P = 0.05). All antibody-positive workers were from abattoirs in the three states that reported outbreak cases among pig farmers. Workers in these three states were more likely than those in other states to have Nipah antibody (7/144 [4.86%] versus 0/291 [0%], P < 0.001) and report symptoms suggestive of Nipah disease in pigs admitted to the abattoirs (P = 0.001).. Nipah infection was not widespread among abattoir workers in Malaysia and was linked to exposure to pigs. Since it may be difficult to identify Nipah-infected pigs capable of transmitting virus by clinical symptoms, using personal protective equipment, conducting surveillance for Nipah infection on pig farms which supply abattoirs, and avoiding handling and processing of potentially infected pigs are presently the best strategies to prevent transmission of Nipah virus in abattoirs.

Topics: Abattoirs; Adult; Animals; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Occupational Diseases; Paramyxoviridae Infections; Paramyxovirinae; Swine

Topics: Abattoirs; Animals; Humans; Malaysia; Occupational Diseases; Paramyxoviridae Infections; Paramyxovirinae; Swine

An epidemic of suspected Japanese encephalitis occurred in Malaysia in 1998-1999 among pig farmers. In neighboring Singapore, an outbreak occurred among pig slaughterhouse workers. It was subsequently established that the causative agent in the outbreak was not the Japanese encephalitis virus but a previously unknown Hendra-like paramyxovirus named Nipah virus.. The brain MR images of eight patients with Nipah virus infection were reviewed. All patients tested negative for acute Japanese encephalitis virus. Seven patients had contrast-enhanced studies and six had diffusion-weighted examinations.. All patients had multiple small bilateral foci of T2 prolongation within the subcortical and deep white matter. The periventricular region and corpus callosum were also involved. In addition to white matter disease, five patients had cortical lesions, three had brain stem involvement, and a single thalamic lesion was detected in one patient. All lesions were less than 1 cm in maximum diameter. In five patients, diffusion-weighted images showed increased signal. Four patients had leptomeningeal enhancement and four had enhancement of parenchymal lesions.. The brain MR findings in patients infected with the newly discovered Nipah paramyxovirus are different from those of patients with Japanese encephalitis. In a zoonotic epidemic, this striking difference in the appearance and distribution of lesions is useful in differentiating these diseases. Diffusion-weighted imaging was advantageous in increasing lesion conspicuity.

Topics: Abattoirs; Adult; Aged; Agricultural Workers' Diseases; Animals; Brain; Diagnosis, Differential; Disease Outbreaks; Encephalitis, Japanese; Encephalitis, Viral; Female; Humans; Magnetic Resonance Imaging; Malaysia; Male; Middle Aged; Paramyxoviridae Infections; Paramyxovirinae; Singapore; Swine; Swine Diseases; Zoonoses

Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia.. We studied the clinical features of the patients with Nipah virus encephalitis who were admitted to a medical center in Kuala Lumpur. The case definition was based on epidemiologic, clinical, cerebrospinal fluid, and neuroimaging findings.. Ninety-four patients with Nipah virus infection were seen from February to June 1999 (mean age, 37 years; ratio of male patients to female patients, 4.5 to 1). Ninety-three percent had had direct contact with pigs, usually in the two weeks before the onset of illness, suggesting that there was direct viral transmission from pigs to humans and a short incubation period. The main presenting features were fever, headache, dizziness, and vomiting. Fifty-two patients (55 percent) had a reduced level of consciousness and prominent brain-stem dysfunction. Distinctive clinical signs included segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia and thus suggest the involvement of the brain stem and the upper cervical spinal cord. The initial cerebrospinal fluid findings were abnormal in 75 percent of patients. Antibodies against Hendra virus were detected in serum or cerebrospinal fluid in 76 percent of 83 patients tested. Thirty patients (32 percent) died after rapid deterioration in their condition. An abnormal doll's-eye reflex and tachycardia were factors associated with a poor prognosis. Death was probably due to severe brain-stem involvement. Neurologic relapse occurred after initially mild disease in three patients. Fifty patients (53 percent) recovered fully, and 14 (15 percent) had persistent neurologic deficits.. Nipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. The infection is associated with recent contact with pigs.

Topics: Adult; Animal Husbandry; Animals; Antibodies, Viral; Cerebrospinal Fluid; Disease Outbreaks; Electroencephalography; Encephalitis, Viral; Female; Humans; Logistic Models; Magnetic Resonance Imaging; Malaysia; Male; Nervous System Diseases; Paramyxoviridae Infections; Paramyxovirinae; Recurrence; Swine

Topics: Australia; Disease Outbreaks; Humans; Malaysia; Paramyxoviridae; Paramyxoviridae Infections; Paramyxovirinae

An outbreak of encephalitis affecting 265 patients (105 fatally) occurred during 1998-1999 in Malaysia and was linked to a new paramyxovirus, Nipah, that infected pigs, humans, dogs, and cats. Most patients were pig farmers. Clinically undetected Nipah infection was noted in 10 (6%) of 166 community-farm controls (persons from farms without reported encephalitis patients) and 20 (11%) of 178 case-farm controls (persons from farms with encephalitis patients). Case patients (persons with Nipah infection) were more likely than community-farm controls to report increased numbers of sick/dying pigs on the farm (59% vs. 24%, P=.001) and were more likely than case-farm controls to perform activities requiring direct contact with pigs (86% vs. 50%, P=.005). Only 8% of case patients reported no contact with pigs. The outbreak stopped after pigs in the affected areas were slaughtered and buried. Direct, close contact with pigs was the primary source of human Nipah infection, but other sources, such as infected dogs and cats, cannot be excluded.

Topics: Agricultural Workers' Diseases; Animals; Case-Control Studies; Cat Diseases; Cats; Disease Outbreaks; Dog Diseases; Dogs; Encephalitis, Viral; Female; Humans; Malaysia; Male; Occupations; Paramyxoviridae Infections; Paramyxovirinae; Risk Factors; Swine; Swine Diseases; Zoonoses

During 10-19 March 1999, 11 workers in 1 of 2 Singaporean abattoirs developed Nipah-virus associated encephalitis or pneumonia, resulting in 1 fatality. A case-control study was conducted to determine occupational risk factors for infection. Case patients were abattoir A workers who had anti-Nipah IgM antibodies; control subjects were randomly selected abattoir A workers who tested negative for anti-Nipah IgM. All 13 case patients versus 26 (63%) of 41 control subjects reported contact with live pigs (P=.01). Swine importation from Malaysian states concurrently experiencing a Nipah virus outbreak was banned on 3 March 1999; on 19 March 1999, importation of Malaysian pigs was banned, and abattoirs were closed. No unusual illnesses among pigs processed during February-March were reported. Contact with live pigs appeared to be the most important risk factor for human Nipah virus infection. Direct contact with live, potentially infected pigs should be minimized to prevent transmission of this potentially fatal zoonosis to humans.

Topics: Abattoirs; Adult; Animals; Antibodies, Viral; Case-Control Studies; Disease Outbreaks; Encephalitis, Viral; Female; Humans; Immunoglobulin M; Malaysia; Male; Occupational Diseases; Paramyxoviridae Infections; Pneumonia, Viral; Risk Factors; Singapore; Swine; Swine Diseases; Zoonoses

A paramyxovirus virus termed Nipah virus has been identified as the etiologic agent of an outbreak of severe encephalitis in people with close contact exposure to pigs in Malaysia and Singapore. The outbreak was first noted in late September 1998 and by mid-June 1999, more than 265 encephalitis cases, including 105 deaths, had been reported in Malaysia, and 11 cases of encephalitis or respiratory illness with one death had been reported in Singapore. Electron microscopic, serologic, and genetic studies indicate that this virus belongs to the family Paramyxoviridae and is most closely related to the recently discovered Hendra virus. We suggest that these two viruses are representative of a new genus within the family Paramyxoviridae. Like Hendra virus, Nipah virus is unusual among the paramyxoviruses in its ability to infect and cause potentially fatal disease in a number of host species, including humans.

Topics: Animals; Antibodies, Viral; Disease Outbreaks; Encephalitis, Viral; Endothelium, Vascular; Genes, Viral; Giant Cells; Humans; Malaysia; Microscopy, Electron; Molecular Sequence Data; Nucleocapsid; Paramyxoviridae Infections; Paramyxovirinae; Phylogeny; Respiratory System; Respiratory Tract Infections; Sequence Analysis, DNA; Singapore; Swine; Swine Diseases; Vasculitis; Viral Proteins

Two major epidemics of viral encephalitis occurred in Asia in 1997 and 1998. The first was a re-emergence of neurovirulent strains of enterovirus 71, which caused severe encephalomyelitis in children in Malaysia, Taiwan and Japan, on a background of hand, foot and mouth disease. Necropsy studies of patients who died of enterovirus 71 infection showed severe perivascular cuffing, parenchymal inflammation and neuronophagia in the spinal cord, brainstem and diencephalon, and in focal areas in the cerebellum and cerebrum. Although no viral inclusions were detected, immunohistochemistry showed viral antigen in the neuronal cytoplasm. Inflammation was often more extensive than neuronal infection, suggesting that other factors, in addition to direct viral cytolysis, may be involved in tissue damage. The second epidemic of viral encephalitis was the result of a novel paramyxovirus called Nipah, which mainly involved pig handlers in Malaysia and Singapore. Pathological evidence suggested that the endothelium of small blood vessels in the central nervous system was particularly susceptible to infection. This led to disseminated endothelial damage and syncytium formation, vasculitis, thrombosis, ischaemia and microinfarction. However, there was also evidence of neuronal infection by the virus and this may also have contributed to the neurological dysfunction in Nipah encephalitis. Some patients who seemed to recover from the acute symptoms have been re-admitted with clinical findings suggestive of relapsing encephalitis. As these two epidemics indicate, the emergence and re-emergence of viral encephalitides continue to pose considerable challenges to the neuropathologist, in establishing the diagnosis and unravelling the pathogenesis of the neurological disease.

Topics: Animals; Central Nervous System; Cytopathogenic Effect, Viral; Disease Outbreaks; Encephalitis, Viral; Enterovirus; Enterovirus Infections; Humans; Japan; Kidney; Malaysia; Microcirculation; Paramyxoviridae Infections; Paramyxovirinae; Singapore; Swine; Taiwan; Virulence

Scientists are a step closer to unraveling a medical mystery that killed 105 people in Malaysia last year and destroyed the country's pig industry. The Nipah virus, which caused the disease, most likely originated in a native fruit bat species, Malaysian researchers reported here at a meeting last week. They say the findings will help Malaysian health authorities prevent future outbreaks of the Nipah virus. Others see the case as an argument for expanding research into infections that can leap the boundary between animals and humans.

Topics: Animals; Antibodies, Viral; Chiroptera; Disease Outbreaks; Disease Reservoirs; Encephalitis, Viral; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases; Zoonoses

Topics: Abattoirs; Agriculture; Animals; Disease Outbreaks; Humans; Malaysia; Occupational Diseases; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases; Zoonoses

Topics: Animals; Australia; Chiroptera; Horse Diseases; Horses; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Zoonoses

A hospital-based case-control study of viral encephalitis was carried out at Port Dickson Hospital, in the state of Negeri Sembilan, Malaysia. Between March and May 1999, 69 clinically diagnosed viral encephalitis cases and 31 controls were interviewed. Job histories on pig farming activities were assessed by a group of epidemiologists and veterinary surgeons. Results show that among clinical cases of viral encephalitis, 52 (75.4%) cases were diagnosed to have Nipah virus infection based on positive serology for antibodies to the cross-reacting Hendra virus antigen. The Nipah virus encephalitis was significantly associated with a history of working in pig farms (p < 0.001, OR = 196.0, 95% CI = 20.4-4741.6), history of contact with animals (p < 0.001, OR = 38.3, 95% CI = 8.2-209.0) and with history of direct contact with pigs (p = 0.002, OR = 34.4, 95% CI = 2.6-1,024.4). The Nipah virus infection was also significantly associated with history of feeding/cleaning pigs (p < 0.001, OR = 102, 95% CI = 11.9-2,271.5). These results provide evidence that involvement in pig farming activities is significantly associated with the risk of getting Nipah virus infection. They are potential risk factors for Nipah virus transmission in the major pig-producing area of Bukit Pelandok, Port Dickson Negeri Sembilan.

Topics: Adolescent; Adult; Aged; Agricultural Workers' Diseases; Animal Husbandry; Animals; Case-Control Studies; Encephalitis, Viral; Female; Humans; Malaysia; Male; Middle Aged; Odds Ratio; Paramyxoviridae Infections; Paramyxovirinae; Risk Factors; Swine

Between September 1998 and May 1999, 265 cases of encephalitis were reported from among those involved in pig rearing. A few cases were also reported among abattoir workers. This raised questions of the risk of transmission among those who handled raw pork. A serosurvey was conducted among pork sellers in Seremban town, which is about 20 km from one of the pig rearing areas which had reported cases of encephalitis. It was found that out of the 28 pork sellers tested, only one tested positive for Nipah virus antibodies and that this pork seller also worked in an abattoir in the same district, removing the urinary bladders from slaughtered pigs. Based on these findings, it was concluded that the risk of transmission of the virus from handling raw pork appeared to be low.

Topics: Animals; Cross-Sectional Studies; Disease Outbreaks; Encephalitis, Viral; Female; Humans; Malaysia; Male; Meat; Middle Aged; Occupational Diseases; Paramyxoviridae Infections; Paramyxovirinae; Risk Factors; Swine

A pig-borne virus causing viral encephalitis amongst human beings in Malaysia was detected in 1997 by the Ministry of Health. Initially, the disease was considered to be Japanese encephalitis. Subsequently, it was thought to be a Hendra-like viral encephalitis, but on 10th April, 1999 the Minister of Health announced this mysterious and deadly virus to be a new virus named Nipah virus. The virus was characterized at CDC, Atlanta, Georgia. The gene sequencing of the enveloped virus revealed that one of the genes had 21% difference in the nucleotide sequence with about 8% difference in the amino acid sequence from Hendra virus isolated from horses in Australia in 1994. The virus was named after the village Nipah. In all, the Ministry of Health declared 101 human casualties, and 900,000 pigs were culled by April, 1999. The worst affected area in Malaysia was Negri Sembilan. The symptoms, incubation period in human being and pigs, animal to human transmission, threat of disease to other livestock, and control program adopted in Malaysia is described.

Topics: Animals; Australia; Centers for Disease Control and Prevention, U.S.; Horse Diseases; Horses; Humans; Incidence; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine; Swine Diseases; United States; Zoonoses

Topics: Agricultural Workers' Diseases; Animals; Disease Outbreaks; Encephalitis, Japanese; Humans; Malaysia; Paramyxoviridae; Paramyxoviridae Infections; Swine; Swine Diseases

Topics: Animal Welfare; Animals; Malaysia; Paramyxoviridae Infections; Swine; Swine Diseases

Topics: Abattoirs; Adult; Animals; Brain; Chiroptera; Disease Outbreaks; Encephalitis, Japanese; Encephalitis, Viral; Female; Fever; Humans; Malaysia; Male; Occupational Exposure; Paramyxoviridae; Paramyxoviridae Infections; Swine; Swine Diseases

Topics: Adult; Animals; Child; Diagnosis, Differential; Disease Outbreaks; Encephalitis, Viral; Humans; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Swine

Between February and April, 1999, an outbreak of viral encephalitis occurred among pig-farmers in Malaysia. We report findings for the first three patients who died.. Samples of tissue were taken at necropsy. Blood and cerebrospinal-fluid (CSF) samples taken before death were cultured for viruses, and tested for antibodies to viruses.. The three pig-farmers presented with fever, headache, and altered level of consciousness. Myoclonus was present in two patients. There were signs of brainstem dysfunction with hypertension and tachycardia. Rapid deterioration led to irreversible hypotension and death. A virus causing syncytial formation of vero cells was cultured from the CSF of two patients after 5 days; the virus stained positively with antibodies against Hendra virus by indirect immunofluorescence. IgM capture ELISA showed that all three patients had IgM antibodies in CSF against Hendra viral antigens. Necropsy showed widespread microinfarction in the central nervous system and other organs resulting from vasculitis-induced thrombosis. There was no clinical evidence of pulmonary involvement. Inclusion bodies likely to be of viral origin were noted in neurons near vasculitic blood vessels.. The causative agent was a previously undescribed paramyxovirus related to the Hendra virus. Close contact with infected pigs may be the source of the viral transmission. Clinically and epidemiologically the infection is distinct from infection by the Hendra virus. We propose that this Hendra-like virus was the cause of the outbreak of encephalitis in Malaysia.

Topics: Adult; Agricultural Workers' Diseases; Animals; Antibodies, Viral; Disease Outbreaks; Encephalitis, Viral; Fatal Outcome; Humans; Malaysia; Male; Middle Aged; Paramyxoviridae Infections; Paramyxovirinae; Swine