Asia Pacific region has been witnessing numerous public health emergencies in recent years with the Nipah outbreak in North Kerala (2018), India, needs special mention. Threats posed and experiences gained have compelled health systems to draft frameworks nationally and internationally for preparedness, outbreak response, and recovery. Our failure to obtain comprehensive guiding frameworks for application in the Indian context for Ebola, Severe Acute Respiratory Syndrome, Influenza A (H1N1), and Nipah outbreaks led us to the search outside India for frameworks that have worked in the past. A thorough review of the WHO, Centers for Disease Control and Prevention, and Malaysian framework was done to identify explicit components and replicable objectives to the national context. In the absence of a specific framework, Nipah recovery and response experience that worked in Kerala outbreak (2018) was compared against novel H1N1 (2015) guidelines at national level. This article provides the groundwork and insights as a value addition toward an India-specific framework of action for response and recovery for Nipah outbreaks in future.
Congenital malaria from Malaysia is reported here for the first time. It occurred in a baby boy born to a 16-year-old primigravida who contracted Plasmodium falciparum infection during pregnancy. She suffered malaria during the later stages of pregnancy and at parturition. The placenta was heavily infested with various asexual stages of P. falciparum. Gametocytes were not seen. Extensive search did not show other species. Cord blood showed very light infection with young trophozoites of P. falciparum. Serological studies using IFA technique showed specific IgG and IgM antibodies to P. falciparum in maternal cord and two early neonatal sera. These serum samples showed lower levels of IgG antibodies against P. vivax and P. malariae, but there were no specific IgM antibodies against these species. The value of specific IgM antibody in the diagnosis of congenital malaria is discussed.
Fluorescent antibodies were detected in 89% of 288 Orang Asli (Malaysian aborigines) with Plasmodium falciparum antigen and in 62% with P. brasilianum (for P. malariae) antigen. Blood films from 18 donors were positive for P. falciparum; 2 of them had mixed infection with P. vivax. Seven of the P. falciparum-positive blood films were from children in the 2- to 9-year age group. Of 17 sera from cord blood, 16 had significant levels of P. falciparum antibody and 14 of P. malariae antibody, the levels being the same as those of the mothers. None of these babies had congenital malaria. A higher percentage of male donors reacted to both antigens. There was an age dependent increase in the number positive and the maximum titers.
Sera from 243 donors belonging to the four main ethnic groups in West Malaysia (Orang Asli, Malays, Chinese and Indians) were tested, using the indirect fluorescent antibody technique for the prevalence of antibodies to Sarcocystis. Almost 20% reacted positively at dilutions of 1:64 or higher and eight among the Orang Asli and Malays gave the highest titres of 1:256. Prevalence was highest in the Orang Asli and lowest in Chinese. 22 sera also reacted positively to Toxoplasma, whether due to polyparasitism or cross-reaction is, as yet, unknown.
A total of 736 sera collected from cord blood babies, children and adults of both sexes and of different age groups in Malaysia were tested using indirect fluorescent antibody technique for Toxoplasma antibodies. The RH strain of Toxoplasma gondii zoites were used as antigen. One hundred and twenty five sera which were reactive at 1:64 or high titres were tested with IgM specific conjugate. Results of the present studies showed that the prevalence of Toxoplasma antibody was highest among the Malays and lowest among children than among adults. The significance of Toxoplasma specific IgM was discussed.
Three groups of people with different clinical histories and manifestations to house dust were skin tested with Dermatophagoides pteronyssinus extracts. The results showed close correlation between positive skin tests and clinical sensitivity to dust. The correlation was not, however, perfect and, although D. pteronyssinus is a major factor in house dust allergy, it does not appear to be the sole antigen involved.