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Washington Post, April 29, 1999

Malaysia Slow to Act On Virus

Disease Spread by Pigs Has Killed More Than 100

By Keith B. Richburg

BUKIT PELANDOK, Malaysia:This hamlet of automotive shops, grocery stores and sprawling pigsties behind wooden fences now has the look and feel of a ghost town.

Its inhabitants -- the ones who haven't died -- have mostly fled, and hundreds of thousands of pigs have been slaughtered, herded into a pit where they were shot, clubbed and suffocated. A stench still hangs over the town, as overpowering as the eerie silence.

The houses and stores are locked and shuttered. Metal grilles are pulled down over plate-less windows. A stray dog scavenges the deserted main road looking for food. And the only road leading into, and out of, the town is blocked and barricaded by policemen, one of them wearing a surgical mask to ward off infection.

Selveraj, 51, a convenience store owner, returned last week to survey what is left of the town where he was born. Dozens of friends and neighbors, including his sister-in-law, have died since mid-February of a mysterious and deadly disease that is believed to have festered in the pigsties just behind the houses. By official count, more than 70 people died here, mostly pig farm workers or others who had direct contact with pigs. Nationwide, more than 100 people have died of the disease.

"They were my customers, my friends," said Selveraj, who recalls watching the painfully swift progression of the disease. "The first pigs to die were always the males. When the pigs were dead, they had phlegm coming from the nose. That phlegm was what affected the people who died.

"They took the pigs and buried them," he said. "When they came back, they had headaches. By the third day, they were shivering. The fourth day, they were in a coma. The fifth day, they were dead."

Scientists report a similar course of symptoms in those afflicted.

The Malaysian government initially said the killer disease was Japanese encephalitis, or JE, a well-known virus transmitted by mosquitoes. The Health Ministry waged an all-out war against mosquitoes to wipe out the breeding grounds. The government also began administering vaccines against JE to pig farm workers and people living in hard-hit areas, particularly here in Bukit Pelandok.

But as the death toll mounted, the victims' bodies were dispersed to various hospitals -- allowing independent analysts at the University of Malaya Hospital to conduct their own tests and conclude that something other than JE was on the loose.

Now health officials, including scientists from the Atlanta-based Centers for Disease Control and Prevention (CDC), say the strange virus is not JE at all, but a never-before-seen similar virus called Hendra, a strain of which appeared in horses in Australia five years ago. The new Malaysian strain, which has been named Nipah, after the district where it appeared, is not transmitted by mosquitoes but by direct human contact with pigs, the experts say.

This is something that Selveraj knew when his friends started dying two months ago.

"It's not a mosquito virus," Selveraj said. "They claim it's from a mosquito, but they can't identify it.

"There is a pig farm right beside here," he said, pointing to a fenced enclosure a few feet behind his store. "If it was from a mosquito, I would have been bitten. It was the people who went in to feed the pigs who were infected."

Also, he said, most of the town's pig farm workers had received injections of the JE vaccine, but many still became infected and died.

Since conceding the scope of the crisis, the government has slaughtered nearly 900,000 pigs in three states -- Negeri Sembilan, Perak and Selangor -- and began testing pigs in other states this week. Moreover, a CDC specialist in the country was quoted as saying the investigating team would now begin testing dogs, cats, rats and any other animals that may have come in contact with pigs in infected areas.

The CDC expert, Tom G. Ksiazek, was quoted by the government news agency Bernama as saying that the pig culling likely had eliminated the main source of the disease. But other virus experts asked whether this could be the "calm before the storm," since the virus may have been raging unchecked for six months or more.

What began as a killer epidemic shows signs of becoming a major political crisis for Prime Minister Mahathir Mohamad.

Despite the early evidence that the disease was something other than Japanese encephalitis, the government insisted it was JE and continues its anti-mosquito campaign. The government-controlled press still issues charts of "encephalitis casualties," and headlines sometimes refer to the disease as JE.

In fact, critics say the government's haste in labeling the virus as JE, its slowness in recognizing the disease as something new and its early reluctance to bring in outside experts for advice may have added to the death toll.

"They are still talking about how the war against JE is being won. They cannot admit that they made a mistake, that the whole focus was wrong," said Lim Kit Siang, head of the opposition Democratic Action Party. "They were worried it would affect the economic recovery. They were worried it would affect the tourism industry."

Lim said he visited Bukit Pelandok five times early last month as the death toll mounted. It was his prodding that finally got the government to publicly concede the virus was something new and to call for outside experts.

Lim said he suspects there was an ethnic motivation as well. Pigs are taboo to the country's Malay Muslim majority, who are the core supporters of Mahathir's ruling United Malays National Organization. The victims, including the pig farmers, were almost all ethnic Chinese, with a few Malaysians of Indian descent. "I think they basically regarded it as a Chinese problem," Lim said.

Among other missteps, the Health Ministry didn't consult in-country experts until the death toll had mounted.

Jane Cardosa, a Malaysian Indian virologist at the University of Malaysia in Sarawak, has been studying Japanese encephalitis for the past 10 years and said, "I know JE when I see it." And from the first pig-related deaths here, in October, Cardosa was convinced that the new virus was not JE. Among other signs, JE affects mostly children. And, since pig farm workers were becoming ill, there was a clear early sign that the disease was spread by human contact with pigs, not by mosquitoes.

"I offered in October and November and December to do tests for them," Cardosa said. "We do tests for JE every day." But the Health Ministry relied on its own lab, the Institute for Medical Research, and early on "they made a clear stand that this was JE," she said.

"At the time, it was probably an honest mistake. . . . They made sure that no samples got into our hands, so they had total control of the information," she said.

Cardosa said that by immunizing pig farm workers against JE, the government then compounded its initial mistake, creating what she called a topological knot: That is, as people continued to die, autopsy results showed JE antibodies in their system -- but the antibodies came from the vaccine, not the disease.

Cardosa said she is baffled that the government continues to label the disease JE, even as international experts, including the CDC scientists, have confirmed it is a Hendra-like virus.

The pig crisis could have long-term political implications, particularly as the country is already deeply polarized over the jailing of the popular former deputy prime minister, Anwar Ibrahim. National elections are due by mid-2000, but many analysts expect they will be called sooner. The deadly outbreak and the government's early mishandling of it could become an issue with Chinese voters who might desert Mahathir's governing coalition for the opposition.


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