A DECADE ago, Professor Chua Kaw Bing was holed up day and night in his laboratory in Universiti Malaya, garbed in white and protective gear. Eye shield, mask and gloves.

A plastic sheet placed underneath a tree in Tioman island, in which the bats roost, to collect fecal and urine samples.

But every time before he got down to business, the virologist mouthed a little prayer. He had good reasons to.

The virus, unknown then, which he was trying to isolate from a patient's brain fluid, was the cause for 265 encephalitis cases and 105 deaths in Malaysia within eight months.

"Knowing that so many died from the virus, I actually said my prayer each time I did any of the lab work.

"Certainly, this is a deadly and very unpleasant virus. People had asked me why I am still working on it," he said, relating his experience of the Nipah episode in Kuala Lumpur recently.
As more than 700 public healthcare professionals -- attending the Training Programmes in Epidemiology and Public Health Interventions Network (Tephinet) Global Scientific conference -- stayed glued to his every word, Chua recounted the fear, excitement and confusion that made up his journey towards the discovery of the virus.

Despite advice from well-meaning friends then, asking him to not risk it all (his life was at stake, after all), Chua carried on regardless.

He ran test after test to prove, or disprove, the niggling feeling he had that something bigger and more sinister than Japanese encephalitis was at play.

The JE mix-up

Right from the start, after the outbreak first made its mark at a pig farm in the small village of Ampang, Ipoh, the government had intensively taken drastic measures to contain it.

Sadly, said Chua, opinions from experts and the country's senior consultant virologists led the health authorities to believe that the mosquito-borne Japanese encephalitis virus was the culprit.

"The manifestation of the disease in the pigs was something unusual but it was initially erroneously labelled as classical swine fever. There was no investigation into other possibilities," he recalled.

"And when the people started to get sick, because they were pig farmers, the label of Japanese encephalitis came about.

"Even when the disease showed more prevalence in male adults, which was not a JE trait, some experts stuck to their guns."

The government did everything to rid the farming communities of the onslaught from the disease, including chartering helicopters to fog the areas, vaccinating residents, and promoting awareness on how JE is transmitted.

Fogging was, in fact, so intensive that other livestock in the adjoining farms developed cloudiness in their corneas. But it didn't stop the disease from spreading.

It was very sad, said Chua, that the populace and the Health Ministry were misguided for six months because of the JE label.

He felt sorry particularly for the pig farmers and workers who were given the JE vaccines, went back to the farms, only to be infected.

"The most tragic thing is when the breadwinner of the family died. There were instances in which both parents passed away just a few days apart.

"When all the measures didn't work, the people thought the government, the ministry especially, abandoned them, which wasn't the case."

New and dangerous

The whole fiasco surrounding the JE label was partly attributed to the lack of readiness to explore the possibility that something new or different was taking place.

As Chua said rather matter-of-factly to the conference participants, he was not the first but probably the fifth person to be given the chance to discover the virus.

"The initial four people or institutions had the chance to do so but they gave it to me, so that was why I did the work."

The work, however, did not come easy for Chua, who had a tough time trying to convince his former superior and colleagues in Universiti Malaya to accept that a new virus was surfacing.

He was officially involved in work related to Nipah virus on Feb 27, 1999 when the first patient from the southern part of the country was admitted to University of Malaya Medical Centre, formerly known as University Hospital, and Chua tested the patient's serum and brain fluid samples.

Instead of wearing blinkers and performing tests to confirm that it was JE, he carried out a multitude of tests that might suggest otherwise.

Indeed, cultured cells derived from canine kidney, African green monkey's kidney, pig's spleen, and other human body parts which were infected with the virus, showed an unusual development.

The changes suggested that the virus belongs to paramyxovirus, a group of viruses that can cause measles and mumps, instead of arbovirus, which is transmitted by bloodsucking arthropods like ticks, fleas or mosquitoes.

With this revelation, and through his former boss's connection, Chua flew to the Centres for Disease Control and Prevention in Fort Collins, and later to CDC Atlanta in the United States, to seek confirmation.

The discovery of the Nipah virus prompted the Malaysian government to transform the control measures for the outbreak.

Fogging and JE vaccination were halted, and children no longer wore long-sleeved shirts and put on mosquito repellent.

Instead, about one million pigs were culled as the animals have been identified as amplifying hosts for the virus. Pig farms, too, were demolished.

Two species of fruit bats were later identified as natural reservoirs of the virus, after similarities were drawn between Nipah and the Hendra virus in Australia, which also originated from fruit bats of the Pteropid species.

Investigating Nipah

Chua's work did not end with the discovery.

"I wanted to find out how the spillover happened from bats to pigs, to put to rest the public's perception that pigs may have been the reservoir host. This is almost a detective story, going to the place and talking to people."

He visited numerous farms, worked out the hypothesis that pigs got infected by eating bat-eaten fruits that had dropped into the pens, and swapped many bats for test samples.

His curiosity to find out as much as possible about the virus took him to the roosting sites of bats on Tioman island, where he collected half-eaten fruit and urine samples by placing plastic sheets under the trees.

To protect himself and a student who had bravely volunteered to assist him, they wore leftover CDC protective disposal gowns and covered their heads with cut-up plastic bags during their fieldwork.

A picture of Chua in such an unconventional 'uniform' flashed across the screen in the conference hall, drawing laughter from the floor.

"It looked primitive, but it worked," Chua quipped, adding that he had to resort to such plain instruments as the initial expenses of his research had come from his own pocket.

Today, this method of collecting urine or fecal samples from bats without the need to capture or kill them is widely employed in countries like Cambodia, Thailand and Bangladesh.

Not content with the isolation of the Nipah virus from bats, Chua went on to explore the reason for the outbreak - why it had to happen then, in 1998.

Together with some colleagues, Chua studied how human population growth and development over the decades were eating into the bats' habitats through deforestation.

They also studied how forest fires in Indonesia, enhanced by severe drought brought on by El Nino, caused the prolonged haze, especially to the southern part of peninsular Malaysia.

This dimmed the flowering process of fruit trees due to the lack of sunlight in the air.

Linking the chain of events, Chua came up with the theory that the haze and the drop in the availability of flowering and fruiting forest trees for foraging led to the unprecedented encroachment of bats to orchards in the suburb of Ipoh.

The location of the pig sties, being surrounded by fruit tress, and the design of the sties, led to the spillover of the virus from flying foxes through partially eaten fruits or urine.

One farmer even told Chua that bat-eaten fruits were sometimes swept into the pens as the pigs loved eating them.

Chua's hypothesis and findings have in recent years been substantiated by studies conducted by the Veterinary Research Institute and the Consortium of Conservation Medicine, New York, under a US$1.4 million funding from the US National Institutes of Health.

Today, the virus detective in Chua has earned him a prominet role at the National Public Health Laboratory in Sungai Buloh, Selangor.