Meningitis: Malaysia

[Shiloh]

Source: http://thestar.com.my/news/story.asp...615&sec=nation

Published: Sunday July 12, 2009 MYT 6:34:00 PM
Blood samples from student who died sent to IMR
By SARBAN SINGH

SEREMBAN: Blood samples of a 15-year-old student who died of a viral infection at the Tuanku Ja?afar Hospital on Saturday have been sent to the Institute of Medical Research to determine the actual cause of death.

Health Minister Datuk Seri Liow Tiong Lai said Sunday doctors at the hospital found that Chan Hui Ven?s death was caused by meningoencephalitis, or inflammation of the brain.

Hui Ven, a student at Chung Hua High School here, had been warded since Wednesday. Her condition was already serious and she was semi-conscious when she was brought to the hospital.

?She was apparently receiving treatment elsewhere before she was brought to the hospital. Doctors prescribed antibiotics but she did not respond,? Liow said.

He said those afflicted with meningoencephalitis would normally recover after being given antibiotics.

Citing an example, he said there were no casualties when more than 100 trainees at the Road Transport Department?s training academy in Tiang Dua were hit by meningococcal meningitis.

Liow said Hui Ven was believed to have travelled before she fell ill.

Coincidentally, her school was ordered closed from July 6 to 12 after another 15-year-old student tested positive for influenza A (H1N1).

However, Liow was quick to add that the two cases were not connected.

?Although this is an isloated case, we need to establish what she was actually infected with. A person can get infected with meningoencephalitis if he or she comes into contact with polluted water or unhygienic surroundings,? he said.

Liow said his ministry viewed the matter seriously as it did not want an outbreak.

?I have been told that there have been deaths caused by meningoencephalitis in the past. Although this is the first case in Seremban this year, we are going to take all preventive measures to ensure it does not spread,? he added.

Liow later visited Hui Ven?s family to convey his condolences.

[kiwibird]

Re: Meningitis: Malaysia

From http://www.flutrackers.com/forum/sho...eremban&page=3 MAY 15 2009

Today's update in the New Straits Times. Note that in the second outbreak, the quarantined police trainees appear to be asymptomatic.

Also note that the number hospitalized in the first outbreak seems to be declining with no additional deaths, strongly suggesting a bacterial cause.

http://www.nst.com.my/Current_News/N...cle/index_html

PUTRAJAYA: The Health Ministry confirmed yesterday that a trainee at the Police Training Centre in Jempol had died of meningitis at the Tuanku Ja'afar Hospital in Seremban.

Director-General of Health Tan Sri Dr Mohd Ismail Merican said the post-mortem showed that he had acute pericarditis.

"Two patients are being treated at the Jempol Hospital. Their condition is stable."

Dr Ismail also said 29 trainees were under observation by a medical team and anyone showing symptoms of the disease would be referred to the Jempol Hospital immediately.

He said 166 people had been administered the prophylaxis antibiotic while preventive and control measures had been taken to contain the disease.

He also said 32 people were being treated at Malacca Hospital, where the outbreak of meningitis was first reported at the Road Transport Department Academy in the state. -- Bernama

and then this (same thread)

http://thestar.com.my/news/story.asp...043&sec=nation

MALACCA: The last seven trainees from the Road Transport Department?s training academy in Tiang Dua, Jasin, who were amongst the 46 warded at the Malacca Hospital for bacterial meningitis since May 7, are expected to be discharged Tuesday.

They were warded at the hospital following the death of a 24-year-old trainee here on May 4.

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Re: Meningitis: Malaysia

So we return to tracking "meningitis" in Malaysia. The difference is now the H1N1 pandemic has thoroughly reached Malaysia, with Malaysia reporting hundreds of cases, so it would not be surprising to have an H1N1 death. And that is certainly what is suspected here, as the case attended school with an H1N1 confirmed case.

You're right about the earlier outbreak. There was one death. Of course, he didn't receive treatment at all. I think what the man meant to say is over 100 people were treated for meningits, and all recovered, indicating that treatment was effective. The death case wasn't treated; he died on the way to the hospital.

[kiwibird]

Re: Meningitis: Malaysia

The presumed diagnoses were always questionable and now there is a blanket of a/h1n1 to cover any otherwise "suspicious" deaths and illnesses. If there was ever a time to keep an eye on illnesses in Malaysia - it is now - especially as Indonesia is seeing an increase in their bird flu outbreaks.

[kiwibird]

Re: Meningitis: Malaysia

Student’s blood sent to IMR to determine cause of death

SEREMBAN: Blood samples of a 15-year-old student who died of a viral infection at the Tuanku Ja’afar Hospital on Saturday have been sent to the Institute of Medical Research to determine the actual cause of death.

Health Minister Datuk Seri Liow Tiong Lai said doctors at the hospital found that Chan Hui Ven’s death was caused by meningoencephalitis, or inflammation of the brain.

Hui Ven, a student at Chung Hua High School here, had been warded since Wednesday. Her condition was already serious and she was semi-conscious when she was brought to the hospital.

“She was apparently receiving treatment elsewhere before she was brought to the hospital. Doctors prescribed antibiotics but she did not respond,” Liow said.

He said those afflicted with meningoencephalitis would normally recover after being given antibiotics.

Citing an example, he said there were no casualties when more than 100 trainees at the Road Transport Department’s training academy in Tiang Dua were hit by meningococcal meningitis.

Liow said Hui Ven was believed to have travelled before she fell ill.

Coincidentally, her school was ordered closed from July 6 to 12 after another 15-year-old student tested positive for influenza A (H1N1).

However, Liow was quick to add that the two cases were not connected.

“Although this is an isloated case, we need to establish what she was actually infected with. A person can get infected with meningoencephalitis if he or she comes into contact with polluted water or unhygienic surroundings,” he said.

Liow said his ministry viewed the matter seriously as it did not want an outbreak.

“I have been told that there have been deaths caused by meningoencephalitis in the past. Although this is the first case in Seremban this year, we are going to take all preventive measures to ensure it does not spread,” he added.

Liow later visited Hui Ven’s family to convey his condolences.

http://thestar.com.my/news/story.asp?file=/2009/7/13/nation/4308332&sec=nation

[kiwibird]

Re: Meningitis: Malaysia

Meningitis not the cause, says minister
Mon, Jul 13, 2009
New Straits Times




SEREMBAN, MALAYSIA: Health Minister Datuk Seri Liow Tiong Lai said the death of a 16-year-old student here on Friday was probably caused by meningoencephalitis and not meningitis as earlier alleged. He said this was based on initial investigations which would be confirmed after results of samples sent to the Institute of Medical Research (IMR) were obtained.

"When the victim was brought to us (Seremban Hospital), she was already in a critical condition and had earlier been treated at other clinics. The victim was already in a coma and died after two days," he said.

Had the victim been suffering from meningitis, he said, she could have been treated with antibiotics, which are proven to help victims recover.

"In this case, there was already nothing our doctors could do... antibiotics cannot cure meningoencephalitis," he said after the state MCA convention here yesterday.

Chan Hui Ven, a Form Four student at Chung Hua High School, was admitted to the Seremban Hospital on July 8.

Liow said there was no connection with the H1N1 cases which were detected at the school, forcing it to be closed for a week last month. The school was reopened last Monday.

It is learnt that the victim was one of two students who were sent home last Monday after she was found to have a high temperature.

"This is the first such case in Seremban, but not in the country. We have had similar cases in other places.

"This is a virus passed through the respiratory circulation and a person only contracts it through direct contact with polluted water or in unhygienic surroundings."

Liow later visited the victim's family in Taman Seremban Jaya.

"There is no cause for worry. We will wait for the results from the IMR before drawing any conclusions."

Meningoencephalitis has been defined as a medical condition that resembles both meningitis, an infection or inflammation of the meninges (membranes that surround the brain and spinal cord), and encephalitis, an infection or inflammation of the brain.
http://news.asiaone.com/News/AsiaOne...13-154342.html

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Re: Meningitis: Malaysia

I'm a little confused by the above article. What virus is suspected here? Some type of viral meningitis? Or a side effect from an H1N1 infection?

[kiwibird]

Re: Meningitis: Malaysia

Take your pick!

[kiwibird]

Re: Meningitis: Malaysia

Fu female students suffering from meningitis in the death of Levin Liao <BR>: not related to influenza Fu without isolation of teachers and students
（芙蓉12日訊）衛生部長拿督斯里廖中萊指出，昨日在芙蓉端姑惹化醫院病逝的芙蓉中華中學16 歲女學生張匯 (Hibiscus hearing on the 12th) of Health Minister Datuk Seri Dr Lai pointed out that yesterday in Jalan Tuanku furong hospital died of the Lotus 16-year-old Chinese female students in secondary schools Zhang Department ，證實是死于腦膜炎，並非是A（H1N1）型流感。 Confirmed that death is caused by meningitis, not the A (H1N1) influenza.

他說，根據院方醫生向他報告，女死者在被送進芙蓉端姑惹化醫院時已病發，院方用盡方法和藥物搶 救卻不果。 He said that according to doctors from his hospital report, the woman was taken to the Jalan Tuanku Furong of the hospital has the disease, hospital and drug use every possible means to rescue but not fruit.

他指出，腦膜炎可分作病毒腦膜炎和細菌腦膜炎兩種，而死者是死于病毒腦膜炎。 He pointed out that the meningitis virus, there should be two types of meningitis and bacterial meningitis, and the deceased died of viral meningitis.

關注死者家屬健康 Concerned about the health of the family of the deceased

他說，死者真正死因，是因為身體抵抗力下降又遇上病毒侵襲，在這種情況之下很難搶救。 He said the actual cause of death because we are faced with decline in physical resistance to viruses, in which case it is very difficult to save under.

他指出，他已指示當局把檢驗樣本送往大馬醫藥研究中心再作檢驗，有關檢驗報告會在24小時內出 爐。 He pointed out that he has instructed the authorities to test samples sent to Malaysia for Chinese Medicine Research Center tested the inspection report will be released within 24 hours.

他今早前往芙蓉真光道堂慰問死者家屬后，在記者會上這么指出；在場者包括芙中董事長張賢炳、董事周福強、家 長會主席李偉源、芙蓉市議員鄧光洺，以及馬青中委李麒昌等人。 This morning, he went to Hibiscus True Light Church Road condolences to the family of the deceased after the press conference so that the; present included Chairman of张贤炳Fu, director Zhou Qiang, parents李伟源President, DENG Guang-Ming Furong City Council, as well as the Youth, such as China and Venezuela李麒WU people.

他也指示芙蓉端姑惹化醫院專科醫生，必須嚴密關注死者家屬健康狀況，一旦他們發燒就要馬上獲得 治療。 He also instructed Jalan Tuanku furong specialist hospital to be close attention to the health status of the family of the deceased, and when they should be readily accessible by treatment of fever.

他指出，他昨日受記者詢及時所提到需要被隔離的狀況，就是類似早前發生在馬六甲州的細菌腦膜炎，如今證實死 者是死于病毒腦膜炎，校方就不需要擔心要被隔離。 He pointed out that his timely consultation yesterday by the reporters need to be referred to the situation of isolation, that is similar to earlier occurred in bacterial meningitis in the state of Malacca, is now confirmed that the deceased died of the virus meningitis, the school will not need to be worried isolation.

來自芙中高一德班的學生張匯 From a high-Fu students in Durban, Zhang Department of （16歲，來自龍城），因發高燒而進入芙蓉端姑惹化醫院醫治，並于昨日嚥下最后一口氣。 (16-year-old, from Kowloon City), due to high fever and enter Jalan Tuanku furong of hospital for treatment, and swallow the last breath yesterday.

身體健康病發前出遊 Good health before the disease out

不幸死于病毒腦膜炎的張匯 Viral meningitis died Zhang Department ，生前沒有病痛，病發前還與表兄弟前往雲頂遊玩。 , Had no pain, before the disease went to Genting to play with cousins.

死者父親張寶發在真光道堂受詢時指出，匯在上週日上午與表兄弟前往雲頂遊玩，直到下午才由他接 送回家。 Zhang made the father of the deceased in the True Light Church Road, pointed out by the consultation, the last Sunday in the morning and cousin went to Genting to play until the afternoon transfer from his home.

他說，匯週一如常上學，隨后被告知身體不適，家人是在週二將她送到森美蘭華人接生院暨醫療中心接受治療，隨 即因為病情告急而轉送到芙蓉端姑惹化醫院。 He said that the Department go to school as usual Monday, and then was told that the body does not, family is her Tuesday Sembilan Chinese deliveries to homes and medical centers for treatment, because the condition was an emergency and transferred to Jalan Tuanku furong hospital.

他說，其女兒被送到芙蓉端姑惹化醫院，就一直在加護病房接受治療，但已陷入昏迷狀況，直至週六下午在醫院病 逝。 He said that his daughter was sent to Seremban Jalan Tuanku of hospitals, has been in the intensive care unit for treatment, but the situation had been in a coma until death in the hospital Saturday afternoon.

張氏指出，其女兒將在周一早上11時舉殯，並在仙境山庄舉行火化儀式。 Zhang pointed out that his daughter will be 11 am Monday morning举殡and cremated in a ceremony held at Wonderland Villa.

此外，芙中董事長張賢炳等人也前往治喪處慰問死者家屬，並對死者的病逝感到婉惜。 In addition, Fu and others in张贤炳chairman Funeral Service condolences also go to the family of the deceased, and feel sorrow the death of the deceased.

他還說，校方也會配合衛生部的指示辦事，如今被證實不需要進行隔離消毒，讓校方感到安心。 He also said that the school will work with the instructions of the Ministry of Health, today confirmed the isolation does not require disinfection, so the school can feel at ease.

死者生前的同窗同學，周日都有陸續前往治喪處致祭。 Classmate of the deceased students, Sunday to make funeral arrangements have been致祭Office.

http://translate.google.com/translat...history_state0

I do not understand why this case has received the attention of the press.
An individual fatality could have easily been passed off as probable h1n1 as there was a confirmed case at the same college.
I also do not understand why they are not concerned about isolating any school contacts if they are unsure about the nature of the virus. They are obviously keeping an eye on Chan Hui Vens family. It is furthermore surprising that another student with the same symptoms was sent home on the same day. The report also mentions similarities with the Malacca Police Recruit outbreak - and they do not think it is prudent to isolate.

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Re: Meningitis: Malaysia

The second student from the school was sent home because of fever and possible contact with an H1N1 case. Seeing as we are a week later and the first girl has died, the fact that we haven't heard anything about the second girl suggests she had only a mild illness (or even that the fever was not related to any illness at all).

I think the Malaysian authorities are assuming that some common virus (maybe influenza inlcuding H1N1 - although H1N1 tests might be negative, or adenovirus, enterovirus, or something else) happened to cause invasion of this girl's brain, resulting in death. In my opinion, that is what really happened in the RTD Malacca trainee. I don't think that was a bacterial meningitis outbreak, as to have over 100 cases of bacterial meningitis with only one death is highly unusual.

I would not rule out bacterial meningitis as it seems the authorities have simply because the girl died despite antibiotic treatment. She was already pretty ill and in a coma when treatment began; people do die of bacterial meningitis despite treatment. Rapid treatment is vital when dealing with bacterial meningitis, and the time from onset to treatment was at least 48 hours. I think the only reason that a viral agent is assumed as opposed to a bacterial one is that antibiotics failed to save her life.

Also possible is Japanese encephalitis, West Nile virus, or some other equivalent virus that does regularly attack the brain. In this case, no illness should be observed in any contact.

"Meningoencephalitis virus" is a symptomatic description and not the name of any virus. The statement that "these cases have occurred before, but not in Seremban" is truly bizarre, when no agent has been identified. A wide variety of agents could have caused this death, and I'm not really sure we're going to get a concrete diagnosis.

I think this death was reported because of heightened alert due to H1N1, and I think Malaysia doesn't want to admit an H1N1 death unless they are absolutely sure. And in the absence of obvious respiratory symptoms, this might not be H1N1.

[kiwibird]

Re: Meningitis: Malaysia

[kiwibird]

Re: Meningitis: Malaysia

The above map shows the death rate of birds(red) and people(burgundy) of a virus, in this case H5N1. It is remarkable that Malaysias human population is unaffected whilst all around has reported cases. I do not think that it is because Malaysia is actually free of cases, rather a problem with reporting.

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Re: Meningitis: Malaysia

H5N1 is certainly in the range of possible causes of death for this girl, but that seems fairly unlikely. There are many more common pathogens that could have caused this death. As far as monitoring the family and not school contacts, the only exposure the school contacts have is to her, and they don't think this is contagious. Her family could conceivably had been exposred to the same source she was (bad water, insects, etc.) even if this is not contagious.

Of note in the Chinese language article is her travel history (or lack thereof). The original article said there was a travel history. She visited family in Genting, Malaysia, but that is not the kind of travel history that would suggest something else (i.e. travel to US, Europe, Africa, China, etc.). That really isn't a significant travel history.

[kiwibird]

Re: Meningitis: Malaysia

http://www.malaysianmirror.com/homedetail/45-home/4966-a-fathers-story-of-a-young-me-victim

A father's story of a young ME victim Print E-mail

Honeymah Dylyani
Wednesday, 15 July 2009 11:37

KUALA LUMPUR - The news of a student?s death from meningoenchephalitis in Seremban brought heartbreaking memories to another family in Cheras.

About three months ago before 16-year-old Chan Hui Ven died, the family of little Amirul Akif had to face the agony and stark reality that the child was also a victim of the disease, also known as ME.amirul.png

"We will miss him very much for the rest of our lives and our wish is that nobody out there will need to go through what we have gone through,? said the boy's father, Mohamad Sharir.

Chan, a student of the Chung Hwa High School in Seremban, was in half coma when she was admitted to the Tuanku Ja?afar Hospital and initial tests showed that she died of the ME virus infection.

ME is a rare disease due to the inflammation of the meninges and brain, which could be transmitted by water contamination or pollution of the environment. Chan?s was the first known case in Seremban while it has not been verified if there had been other incidents aside the case of the seven-year-old boy, affectionately known as Akif, in Selangor and Kuala Lumpur.

Akif was a Year One pupil of SRK Bandar Tun Hussein and, like kids his age, was playful, active and a joy to watch. He was the third of four siblings; the others being 12-year-old Amirul Syafiq, Amirul Amin, 10, and sister Amirah Aisyah, three.

Boy complained of stiff neck

Sharir, who works with a gas and oil company, said Akif complained of stiff neck on April 6 and went to school as usual the next day.

"At around mid-day on April 7, he had had a fit and fainted at school. He was warded for three days at a specialist hospital, where doctors diagnosed he had ?middle ear infection and tonsillitis? which led to high fever.

"After he was discharged Akif was back to his usual cheerful and playful self. The high fever, however, persisted but the family thought it was temporary and would subside.

"Unfortunately, on April 12, two days after he was discharged, he was back at the hospital after he complained of muscle pains in his calves.

"He could not move and blood tests showed he had a very high virus infection. Still, the doctors did not admit him and monitored his condition at home," said Sharir.

Fever, muscle pains and fits

At about 3.30am the next day, with continued high fever plus muscle pain, Akif had a bout of seizures again. For the third time his parents rushed him to the specialist hospital, where he was given sedative medicine and admitted to the intensive care unit. He died in the ICU at 3.40am on April 14.

Sharir said he and his wife never suspected that ?something as bad as this? would happen to their little boy.

Today, nearly 100 days after Akif has gone, they are still in the dark as to what really happened and what virus had attacked him and cost him his life. But, according to Akif's death certificate, his death was due to ME.

"We were informed by the doctor that all results, including lumber puncture tests, showed negative result for certain viruses."

A boy who loved Ben-10 cartoons

?We need everybody to be alert of the risk of similar symptoms. My personal feeling on this tragedy is that the specialist hospital needs to be better equipped and manned by those who understand the symptoms so that treatment can commence much earlier. It will save lives," said Sharir.

Describing Akif as a healthy, adorable and cheerful son who loves Ben-10 cartoons, Sharir said the boy had a collection of miniature cars, loved to play with small toys and enjoyed rides on his bicycle. "Basically, he was a normal healthy boy before the virus attacked him," he said.

Sharir added: "He will always be remembered by his siblings and friends as helpful and kind-hearted Akif."

?His place in Heaven has been decided. For me, I ask this question: Am I fit to meet him there? For my wife, she too will carry this heavy sorrow until she meets him again. InsyaAllah."
Last Updated on Wednesday, 15 July 2009 12:51

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Re: Meningitis: Malaysia

I don't like the quality of that last source, but since it is the second one that mentions this, I thought I would make a few comments on "ME virus". As far as I know, that is not the accepted international name for any virus. As I commented earlier, it could easily just be a symptomatic description meaning that the patient has inflection in the brain by an unknown (but likely common) virus. That is certainly consistent with the sporadic nature of these cases, as well as the red text in the above article indicating negative test results for certain viruses. You don't mention that a patient is negative for certain viruses if you know what virus the patient is positive for. It is also possible that these cases are not viral at all.

But the statements that the virus is obtained through contaminated water and unhygenic surrounding, and the reference to tests showing a virus infection (although maybe they are talking about blood cell counts) make me wonder if "ME virus" is not the name Malaysian doctors have given to some known (to them) virus. Certainly something like Japanese encephalitis or even Nipah would be consistent symptomatically. Also possible is some virus that is known to them but not widely known. While that sounds improbable, keep in mind that Vietnamese doctors/scientists earlier this year mentioned that they were aware of a mosquito-borne encephalitis that they called "acmong virus" (Vietnamese for nightmare) for several years that was causing outbreaks of illness in children. While I am not suggesting that it is the same virus, it does show that is possible for a disease to be well-known locally, but unheard of internationally.

More information on what Malaysian doctors (or maybe just reporters) mean by "ME virus" would be appreciated.