KOLEJ KEMAHIRAN TINGGI MARA LEDANG, JOHOR

BIOMEDICAL ELECTRONICS ENGINEERING (DIAGNOSTIC)

DUE10062 ENGLISH FOR COMMUNICATION

JAPANESE ENCEPHALITIS VIRUS

OUTBREAK 1999

LECTURER: MADAM THERESA MARION A/P B.NAMBIRAJAN

GROUP MEMBERS: ALIA NATASYA BINTI AMIRUDIN (DD12004)

NAJIHAH BINTI NORFAZLINIZAM (DD12025)
NURINA IZZATI BINTI MOHD SOFIAN (DD12034)
SARAHADLINA BINTI MD JAFRI (DD12039)

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 TABLE OF CONTENTS

1.0 Introduction 2-3

2.0 Method of Gathering Information 4
3.0 Findings/ Discussion 3-8
4.0 Conclusion 9
5.0 Individual Reflection
5.1 Alia Natasya 10
5.2 Najihah 11
5.3 Nurina Izzati 12
5.4 Sarahadlina 13

REFERENCES

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1.0 INTRODUCTION

1. PURPOSE

The main objective of this report is to think further into the causes of the spread of the
Japanese Encephalitis Virus or also known as outbreak of Nipah virus in Malaysia in 1999. This
report will also include all actions taken to control the spread of the Nipah virus in Malaysia.

2. BACKGROUND

The first outbreaks were registered in late September 1998 in villages near the city of Ipoh,
West of Malaysia. Where pig farming is a multibillion- dollar industry. Cases continued to
occur in the region until early February (1999). The second cluster occurred in December 1998
and January 1999 near Sikamat, a small town in a different state, Negeri Sembilan. In
December 1998, the third and largest cluster began near the city of Bukit Pelandok in the
same state. At first, the cases were likened to Japanese B encephalitis (JE), which had
previously caused porcine-associated outbreaks in Malaysia.

3. METHOD OF INVESTIGATION

After all health tests and observation that had been carried out on the patients the
characteristics of this outbreak were unusual for JE. The majority patients were adult males
rather than children and most of the victim of the virus had direct physical contact with pigs
.Base on the analysis that had been made, cluster among members of the same house, the
attack rate was as high as 33%, implying higher attack rate than JE virus, which only effects
one out of every 300 infected people. Besides that, patients that had been immunized against
JE, and anti – JE measures were ineffective in in stopping the increases in new cases. There
were also reports of sick animals, with sick pigs developing a severe barking cough and many
dying from the disease, which was not a feature of JE.

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 4. SCOPE

After all the investigation, Malay villages is not affected by the outbreak and there is no cases
were reported. Even though they are close proximity to adjacent Chinese farms that had
encephalitis case .Malays, the largest ethnic group in Malaysia and are predominantly
Muslims. They are forbidden from having any close contact with pigs or any pig products.
In 1999, the virus were then is identify as a completely new virus and its association with pigs
by virologists form University of Malaya. After further testing showed the virus reacting with
antibodies to the Hendra virus, and subsequent sequencing of the viral genome at the Centers
for Disease Control and Prevention showed the new virus to be about 20% different from the
Hendra virus.
Actions have been taken to control the virus's spread. The actions is started by giving health
education on personal protection , barrier precation and handwashing after handling animals
to people that are working on pig farms.
As well as environmental disinfection, via radio and television .All infected pig farms in the
outbreak areas were subjected to pig-culling operations. More than 1 million pigs were culled
in phase I, which involved culling in areas where outbreak cases had occurred. Phase II
entailed monitoring all pig farms across the country. Farms with three positive Nipah virus
(NiV) testing results were considered positive, and all pigs on the affected farms and farms
within a 500-meter radius were culled. This procedure is continued to carry out over a three-
month. The most recent human fatality occurred on May 27, 1999. Through that moment,
Malaysia had recorded 265 cases of acute NiV encephalitis, with 105 deaths.

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2.0 METHOD OF GATHERING INFORMATION
We investigated case-patient features related with onward transmission and variables
associated with the probability of infection among patient contacts using data from all Nipah
virus cases reported during outbreak investigations in Malaysia between September 1998 and
2018.

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FINDINGS AND DISCUSSION

The development of pathogens may be addressed by answering two critical questions: "why
here?" and "why now?" The combination of commercial fruit production, intensive pig
farming, and resident fruit bat populations in the region surrounding the index farm of the
1998–1999 outbreak explains the "why here" component of Nipah virus emergence. Fruit
trees were commonly planted in close proximity to pig sites throughout the pandemic.
Farmers increased their revenue by planting orchards, but an unforeseen consequence was
the attraction of flying foxes to their holdings. Fruit tree branches were commonly hanging
over the pig cages on the big pig farm where Nipah virus infection initially arose in pigs and
eventually humans (the "index farm"). The detection of Nipah virus from chewed fruit
dropped by bats shows that pigs at the index farm may have been exposed to the virus by
eating of bat saliva or urine contaminated fruit.
The "why now?" part of Nipah virus emergence is more difficult to explain. A recent research
proposed that spill-over was a one-time occurrence caused by a severe El Nio Southern
Oscillation drought and human forest fires in Indonesia, forcing Nipah virus–infected bats to
migrate to Malaysia. This theory proposes that bats were introduced into the Ipoh region in
early 1998, shortly prior to the epidemic, resulting in the establishment of the Nipah virus.
Our surveillance and tracking data indicate that Pteropodid bats are continuously present in
the Ipoh region, even during non-drought years, and that P. vampyrus migrates between
Sumatra and mainland Malaysia in the absence of severe meteorological circumstances or
haze. Furthermore, some Nipah virus encephalitis cases linked to the index farm were
identified as having occurred in early 1997, before to the El Nino related drought. As a result,
the "why now" of Nipah overflow must be viewed as entirely random: Transmission from
flying foxes to pigs, and then from pigs to humans, may have occurred on several occasions
over an unknown time period.

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There are a lot of things we need to avoid for protect ourselves from to get infected to Nipah
Virus such as do not eat food that has been contaminated by bat bodily fluid or urine/feces
and drinking from an open container under palm trees is not a good idea. Then, avoid close
and frequent contact with an infected individual also avoid direct physical contact with
patients who may be infected. Next, Do not share their utensils,clothes, or restrooms.
Remember to always wash your hand before meals and after visits to public areas and the
hospital are encouraged as good hygiene habits. For pig meat fans, pig meat and by-products
should be avoided since they are the host of the Nipah virus, which is transmitted directly to
humans by bats. Protective gear, like as gowns and face masks, should be worn by health
care personnel who treat infected people. Lastly, avoid fruits that may have been polluted by
bat excreta or that come from bat-infested areas.

According to Dr. Satish Kumar, Consultant Internal Medicine, Columbia Asia Hospital, Mysuru,
Nipah virus is a recently developing zoonotic disease that causes severe illness and high
mortality in both animals and humans.
"The Nipah virus was first detected when it caused a brain fever outbreak among pig farmers
in Malaysia in 1998, with pigs serving as intermediate hosts. Following that, in 2004, cases
were reported in Bangladesh of persons who had swallowed date palm sap tainted by the
infected fruit bat's excreta or saliva. This infection still has no effective antiviral treatment
"Dr. Satish offered his two cents.

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As of 17 July 2018, a total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported
from Kerala State: 18 of the cases were laboratory-confirmed and the deceased index case
was suspected to have NiV but could not be tested. The outbreak was localized to two districts
in Kerala State: Kozhikode and Malappuram. No new cases or deaths have been reported
since 1 June 2018 and, as of 30 July, human-to-human transmission of NiV has been contained
in Kerala State.
As reported in the Disease Outbreak News published on 31 May 2018, three deaths due to
NiV infection were reported on 19 May from Kozhikode District, Kerala State. Three of the
four reported deaths were confirmed positive for NiV by real-time polymerase chain reaction
(RT-PCR) and IgM ELISA for NiV.
Two patients recovered completely and were discharged from the hospital. Acute respiratory
distress syndrome and encephalitis were observed among the patients infected. This was the
first NiV outbreak reported in Kerala State and the third NiV outbreak known to have occurred
in India; the two previous outbreaks occurred in the state of West Bengal in 2001 and 2007.

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People in areas where outbreaks of the Nipah virus (NiV) have occurred (Bangladesh,
Malaysia, India, and Singapore) should:
a) Handwashing with soap and water should be done on a regular basis.
b) Do not come into contact with sick bats or pigs.
c) Avoid roosting bats in known bat roosting places.
d) Raw date palm sap should not be consumed.
e) Avoid eating fruits that may have been infected by bats.
f) Avoid coming into contact with the blood or bodily fluids of somebody who has been
infected with NiV.

Standard infection control methods and correct barrier nursing techniques are critical in
preventing hospital-acquired infections (nosocomial transmission) in circumstances where a
patient has confirmed or suspected NiV infection since NiV can be passed from person to
person.
Other areas, such as those where flying foxes (bat genus Pteropus) reside, may be vulnerable
to NiV epidemics in the future. Cambodia, Indonesia, Madagascar, the Philippines, and
Thailand are all home to these bats. People who live in or visit these locations should take the
same precautions as people who live in places where outbreaks have already happened.

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The Malaysian pig-related business suffered huge harm as a result of the Nipah outbreak.
Even now, exports have not rebounded, implying that the country has lost one of its primary
sources of foreign cash. It was also established that reducing hog rearing had a bigger impact
on allied businesses than reducing other agricultural sectors such as perm oil, coconuts, and
tea, all of which are key exporting commodities. This means that the cattle industry is strongly
and broadly intertwined with other economic sectors. Because harmful consequences are
widespread, preventative and control actions are more valuable than the direct cost.
If, at the start of the outbreak, the Malaysian government had considered other alternatives
than JE and performed surveys with a diverse range of specialists, they may have barred
animal traffic, reducing the risk of the virus spreading to the southern states. Also, in order to
minimise confusion, the authorities provided a limited amount of information about the
hazards, but this had the opposite effect, and inhabitants in the epidemic regions voluntarily
left. There are signs that the pigs that were not fed ate the sick deceased pigs, spreading the
virus further. When an epidemic of a cattle disease or zoonosis is detected, the example of
the Nipah virus clearly demonstrates the significance of rapid risk assessment by a wide
variety of specialists and proper risk communication based on facts. Furthermore, in order to
respond quickly and effectively to outbreaks of livestock illnesses, it is necessary to undertake
steps to educate livestock farmers and communities, as well as to build procedures and rules
to compensate and penalise farmers or businesses.
So we did a discussion about how to protect yourself from The Nipah Virus through personal
hygiene. First, through personal cleanliness and frequent hand washing are essential. Then
avoid fruits and eat only well-cooked, clean, prepared food. If you want to eat pig by-products,
avoid them or only eat the ones that have been highly processed. Although it is not
encouraged, staying away from it is the best option. Next, when travelling or working in
public settings where the virus has been documented, you should wearing a mask. Be aware
and notify your doctor right once for an accurate diagnosis and treatment. It's best to stay
clear from densely packed dark locations where bats are likely to congregate.

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Our work provides a list of species to guide early surveillance and should not be taken as a
definitive list of reservoirs. A series of further studies are required to triangulate on the
reservoir hosts that pose a risk to humans. A major reason these studies do not identify
definitive reservoirs is because almost all previous Nipah virus studies relied on serology,
but serological assays often lack specificity; detection of Nipah virus may represent cross-
reactions to closely related viruses. For example, multiple studies have shown cross
reactivity among Hendra, Cedar, and Nipah viruses using glycoprotein assays. It is likely that
many of the positive tests reported here represent exposure to uncharacterized
henipaviruses with antigenic similarity to Nipah virus. These viruses may or may not be
zoonotic. PCR is specific and sensitive, and positive results demonstrate presence of Nipah
virus RNA; however, the prevalence of Nipah virus is usually so low that large sample sizes
are needed to yield positive detections outside of pulses of shedding.
Therefore, PCR may not be informative in the early stages of identifying reservoirs. Serology
remains an important tool for these initial surveys as long as the assays are interpreted
correctly, and positive detections are followed by virological studies to detect shedding. These
field surveys need to be followed by virological studies to characterize viruses and their
zoonotic risk and then epidemiological studies to understand risk to public health.
The findings of our investigation suggest that Nipah virus infections occurred in all age groups
and that fever, altered mental status, cough, and respiratory symptoms were the most
common symptoms among those infected in Bangladesh. Severe neurologic manifestations
are consistently the most substantial and severe components of Nipah virus infection. Severe
chronic sequelae occur in many survivors, adding to the significant public health burden of
Nipah virus-associated disease. Future priorities should include ongoing surveillance and
investigation of outbreaks of Nipah virus infection, identification and evaluation of strategies
to prevent Nipah virus transmission, and improvement of clinical management of cases in
resource-poor settings.
Nipah virus has a wide host breadth in both reservoir bat species and recipient animal species.
Therefore, identifying the reservoir in a new location can be challenging. We used a
systematic literature search to collate data from previous studies of Nipah virus in bats. We
then prioritized surveillance of bats in Kerala, and more generally in India, on the basis of
these data. We applied a trait-based generalized boosted regression that identified species
with traits similar to those associated with serological or virological evidence of Nipah virus.

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3.0 CONCLUSION
As conclusion, NiV emerged as a new virus exactly 20 years ago, causing severe morbidity and
mortality in both humans and animals and destroyed the pig-farming industry in Malaysia,
and it continues to cause outbreaks in Bangladesh and India. As the reservoir
host Pteropus bat is widespread, and NiV has been found in bats in various countries, the
potential for outbreaks to occur in new regions remains significant. NiV has emerged as a
deadly zoonotic disease. Bats, the natural reservoir of the virus, are effective at virus
dissemination and human outbreaks continue to be reported regularly. Due to the worldwide
distribution of bats, outbreaks in new areas are likely to occur. The high case fatality rate and
acute course of disease make the infection difficult to diagnose. This is further compounded
by the lack of easily available low-cost diagnostic tests and facilities equipped to handle viral
samples. Effective treatment and prophylaxis are unavailable due to a lack of studies in human
subjects because the overall case burden is small and the course of infection is acute. The
recent outbreak in India highlights the possibility of potential spillover events in areas where
currently known risk factors do not exist. Establishment of surveillance systems for NiV is
necessary, particularly in South and Southeast Asia.
There is an urgent need for countries in South and Southeast Asia to work together to
strengthen surveillance systems in order to monitor spillover events and prevent
transmission. A better understanding of bat ecology and the causes of spill-over events, the
development of effective treatment and prophylaxis for humans and animals and
strengthening of surveillance systems to prevent outbreaks is required to curb the threat
posed by NiV. The NiV outbreaks in Malaysia and Singapore demonstrated that pigs can play
a key role in the epidemiology of NiV by acting as an amplifier host. The region most at risk of
NiV infection has some of the highest pig population densities found anywhere in the world,
which are rising fast due to the demand of a growing human population. This increases the
risk of NiV transmission to pigs and humans. The development of a NiV vaccine for use in pig
populations would decrease the major risk NiV poses to the developing pig industries, as well
as to the livelihoods of poor livestock keepers in Southeast Asia. The use of non-human animal
models is crucial for vaccine development against diseases such as NiV since efficacy testing
in humans is impossible. The pig model may therefore contribute to human vaccine
development, supporting human vaccine licensure under the Animal Rule.
It is important to note in this regard that the practical utility of this understanding will be
reflected in the entry of Nipah viral vaccines into clinical trials in humans, and modification of
risk factors in order to prevent infection. Further, such understanding will be great aid in
developing techniques along with therapeutics for treatment of infected subjects for
reduction of morbidity as well as mortality. Prevention of such zoonotic disease in agricultural
and healthcare workers should be a priority. Scientists have presented from platform like
Global Outbreak Alert and Response Network (GOARN) especially after the outbreaks in
Bangladesh and India and marked the necessity of development of network communicating
between veterinary and medical services concerning this disease. By involving the multiple
sectors and with multidisciplinary approach, precise and concrete preventive strategies can
be planned and implemented.

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4.0 INDIVIDUAL REFLECTION

1. ALIA NATASYA’S REFLECTION

Japanese Encephaltis Virus Outbreak 1999 or known as Virus Nipah by the Malaysian left such
a big impact, one of the most vicious viruses that has ever attacked Malaysia. This virus left
such a big impact only to malaysian but also to other country that got effected.
As I sit down to reflect myself through this Nipah Virus assignment, I realize how important
personal cleanliness are, personal cleaniness actually keep ourselves save too! It’s an eyes
opener issue to me how can we avoid from get effected just by keep ourselves clean?
My team members elaborated with nowdays issue which is covid-19. Same issue as virus
nipah, personal cleanliness help everyone avoid effected to covid – 19 virus such as wash your
hands often with soap and water or alcohol-based hand sanitisers, avoid touching your eyes,
nose and mouth clean and disinfect surfaces you use often such as benchtops, desks and
doorknobs clean and disinfect objects you use often such as mobile phones, keys, wallets and
work passesincrease the amount of fresh air by opening windows or changing air
conditioning.
So ive learnt good hygiene is vital because it helps prevent you and everyone from getting or
spreading germs and infectious diseases. So I want to apply and ask everyone to keep hygiene
and live a healthy lifestyle including keep clean. For example, according to experts aiming for
six to 10 washes a day can make a big difference when it comes to keeping viruses and
bacteria at bay.

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 2. NAJIHAH’S REFLECTION
Nipah virus was first identified in Malaysia in 1998. Cases such as the recent death of a boy
in Kerala, India have raised concerns that it could mutate and increase its efficiency of
transmission, leading to widespread circulation.
That scenario is frightening people as the virus currently has a case fatality rate of over 50%
and there is no vaccine or tried-and-tested treatment. As for pandemic preparedness in the
medium and long term, we need to turn our attention to identifying which other viruses
pose a threat and work to develop vaccines and other defensive measures against those.
This outbreak highlights the importance and urgency of establishing a strong surveillance
system supported by a network of state-of-the-art laboratories equipped to handle and
diagnose new pathogens and including patient isolation techniques, use of personal
protective equipment, barrier nursing and safe disposal of potentially infected material in
the prevention and control measures for Nipah/Hendra virus infection.
To assess the risk we need to look at how the virus transmits and replicates. Nipah is a
paramyxovirus. It is related to a human virus, human parainfluenza virus, one of the handful
of viruses that cause the common cold. Its natural host is the fruit bat, the large and small
flying foxes which are distributed across South and Southeast Asia. All cases of human
infection with the Nipah virus to date have been due to direct or indirect contact with
infected bats.
That is an important finding. As we have seen with SARS-CoV-2, better transmitting viruses
evolve while the virus is circulating among its human, not animal, hosts. So, keeping the
number of infections in people to a minimum not only minimises the death rate from Nipah
itself but also reduces the chance of virus adaptation. Stop the transmission and you stop
the pandemic threat.
In my view, Nipah does not pose a high risk of causing a pandemic. Its current pattern of
outbreak is likely to remain the norm. Instead, as has been discussed elsewhere, we need to
ensure that surveillance, improved awareness and effective public health measures are in
place and adhered to. They will have a much bigger impact on the control of Nipah virus
cases in the immediate future.

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3. NURINA IZZATI’S REFLECTION
The process of researching and writing my report "Japanese Encephalitis Virus in
Malaysia" presented me with an invaluable chance to not only learn about a specific virus
type that exists in the globe, but also to make a unique contribution to that issue. My
study began with a wide desire to understand more about the virus and how it affects our
lives, as well as the virus's causes. Over the course of a semester, that spark of curiosity
drove me to learn about a variety of health conditions and to create my own unique
arguments on the key issues of this ideological growth.
The research for this study, like with every report, involves a lengthy process of removal
and rejection. Because of the broad scope with which I began, I spent dozens of hours
reading articles, news, and reports from many writers such as physicians with the goal of
discovering the consequences and causes of the Japanese Encephalitis Virus that occur in
Malaysia. Similarly, I combed through collections of consequences and causes in search of
Nipah Virus. Despite the fact that both searches generated fascinating results, I finally
determined that the absence of secondary sources for these topics made them too
difficult to understand for a single semester-long study. Discussions with my teammates,
who worked on this report with me, led me to the conclusion that widening my focus
outside Malaysia would provide too many obstacles for this duration of project.
I understood that in order to do this assignment, I needed to become well-versed in all of
the intellectual ideas and disputes around this specific issue. I utilised Google Scholar to
request more than a dozen publications about the Japanese Encephalitis Virus. To
discover scientific publications, I also used internet databases provided by certain articles,
such as PubMed and the World Health Organization (WHO). I decided to try to fill this void
by doing a new investigation of the Nipah Virus that impacted us and its causes.
I realised I couldn't rely on a compilation of remarks and materials compiled by some
physicians to develop a really unique take on the scientist. As a result, I attempted to
return to original sources in quest of prevalent patterns and opinions among scientists. To
begin this section of my investigation, I acquired books and lecture collections by
biomedical experts. However, I immediately recognised that a review of Oxford Academic
would need a larger number of papers than I could reasonably get in printed form
throughout the remainder of the semester. Fortunately, I learned that hundreds of
published scientists from the Nipah Virus have been digitised by institutions and made
freely available online. I scoured every accessible online repository for relevant material,
but the assortment housed by the Current Science Inc. and Springer Link websites really
pleased me.
Once I had obtained a large number of papers from the articles, I used internet news and
magazines to learn about the causes and effects of the Nipah Virus. This procedure
assisted me in prioritising the pieces that best exemplified popular organisation. It also
assisted me in determining the kind of Nipah Infection, which motivated me to create
anything related to the virus.

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Although I had overall success with my primary source research, the inclusion of the Nipah
Virus was a challenge. During the Nipah Virus outbreak, I was unable to discover a diverse
range of lectures, books, or articles from writers' perspectives. Due to a shortage of
primary materials, I was forced to rely on secondary sources to obtain a knowledge of
Japanese Encephalitis in Malaysia during the epidemic. I spent the rest of my time
constructing a clear manner to describe and substantiate this hypothesis, thanks to
Madam Theresa's great counsel and direction.

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 4. SARAHADLINA’S REFLECTION
The outbreak of the Nipah virus in 1999 taught farmers not only to be more cautious
when dealing with sick animals. It is critical to maintaining cleanliness after handling sick
animals because many of them may have carried a very dangerous virus to us. Believe it or
not, some people were unaware of the existence of this virus, and the likelihood of the virus
spreading in Malaysia is high. To prevent the virus from resurfacing in the future. We must all
contribute to maintaining our cleanliness and environment. Raising awareness about the
spread of the Nipah virus among the younger generation will have a significant impact on our
society, not only in preventing the Nipah virus but also other viruses in the future. People who
are aware of the symptoms of the Nipah virus, for example, can take precautions to avoid
becoming infected.
Preparing this study case through online classes during the pandemic of covid-19 is not
limiting my knowledge about this virus. As all of my references are from journals that are
made by a professional. As I go through all journals I find myself falling deeper into the
journals about the virus. Going through online classes, during this pandemic is not easy at all
into completing these study cases. But we find a way to overcome the situation by discussing
it in a group chat and through an online meeting. During the group discussion in choosing the
topic and all the steps it takes to complete this study case, we listened to all the opinions
expressed by each member of the group. I have also learned my weakness , in preparing this
study case with the help of the group members.

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