The audience at a public health forum on Zika.

POSSIBLY just outside your door is a potential public health nightmare, a health care time bomb just ticking away. You’ve probably not heard of it before because the disease that this “bomb” causes, melioidosis, is perhaps one of the most neglected diseases that we know of.

The funny, or perhaps scary, thing about the state of neglect that meliodosis is in is that it is not even on the World Health Organisation’s list of neglected diseases.

Despite its status as neglected, melioidosis is a disease that, in 2016, was projected to affect more than 160,000 with annual increments expected. Unfortunately, melioidosis is seldom reported and is quite often misdiagnosed as something else thus earning it the nickname — the great mimicker.

The disease known as meliodosis is not new. It had been discovered more than a century ago and is known to afflict many in the tropical regions where the bacteria that causes it, Burkholderia pseudomallei, can be found.

It was even proposed that the fictional Tapanuli fever in Sir Arthur Conan Doyle’s The Adventure of the Dying Detective, one of the Sherlock Holmes short stories, was actually melioidosis. This disease was initially believed to be localised to Southeast Asia and parts of Northern Australia. However, it has recently been reported to be more widespread with the bacteria having been found in the soil of many areas of the Indian sub-continent as well as the Americas.

Perhaps one of the most dramatic surfacing of melioidosis was when several rescuers who recovered a drowning victim in 2010 at Lubuk Yu, Pahang quickly succumbed (48 hours after exposure) to what was initially a mystery disease.

In reality, melioidosis is happening everyday. Several studies have shown that many of the endemic regions for melioidosis have an alarmingly high number of the population carrying antibodies to it — meaning that they had at one time been exposed to the B. pseudomallei bacteria.

Melioidodis has another scary angle — it can also cause what is referred to as a latent infection, a situation where the bacteria can remain dormant in the infected host for years, even possibly decades, before eventually flaring up as melioidosis. This is one reason why it has earned another nickname, the Vietnamese Time Bomb — a reference to the fact that many Vietnam War veterans came down with the disease long after they had left the battlefield in the jungles of Indochina.

Studies have also found that incidence for co-morbidity of melioidosis with diabetes is alarmingly high, indicating that diabetics may have increased susceptibility to the disease or even possibly that diabetes itself may act as a trigger for a latent infection to flare up. Melioidosis is increasingly being recognised as an infectious disease of global importance. The double burden of diabetes with bacterial infections, such as melioidosis and tuberculosis, represents a significant global challenge.

With diabetes affecting an increasing number of the world’s population, the compounding effect of co-morbidity with a bacterial epidemic or even pandemic has the potential to explode into a public health nightmare.

In a way, the state of neglect for melioidosis has parallels to our neglect of the Zika virus. We have only recently heard of the Zika virus because it did not seem to affect us directly before. Misleading reporting and headlines give the impression that Zika is a new disease. In reality, the Zika virus had been discovered decades ago and is known to be present even in Malaysia. Unfortunately, like many things that we humans focus on, we prioritise our affairs into matters that affect us directly, and after that comes the more indirect problems. Zika didn’t seem to be causing any problems other than an annoying fever. We didn’t even bother to test for it previously — so like fevers caused by other viruses that we consider not worthy of mentioning, we had just lumped it into the “viral fever” category. But more recent events have attracted our attention — this disease was starting to be a problem.

The question is — had it always been so and we simply did not notice it, or did the virus evolve the capacity to cause more serious damage to humans? The point that I am trying to make is simple — we need to take proactive measures and learn from the past to plan for the future.

I started off with melioidosis because like Zika, many of us may have never heard of it until it is perhaps too late. However, diseases like melioidosis are largely ignored because they are not yet problems, not big enough yet anyway. What is the cut-off point for us to start reacting? Ten lives? A hundred? Or should the toll reach an even thousand first? We can do much better than simply reacting to epidemics in panic. We should be ready to meet such challenges head on. This can only be achieved through intensified research into such diseases.

Previous outbreaks, such as SARS, MERS, Ebola and Zika managed to escape local containment and spread globally, have shown how unprepared the world health care system and infrastructure is when it comes to responding to infectious disease outbreaks. Earlier this year, Bill Gates, the billionaire co-founder of Microsoft, announced the launch of the Coalition for Epidemic Preparedness Innovations at the World Economic Forum in Davos, Switzerland. This multinational government-backed coalition’s mission is to finance research efforts aimed at preventing future epidemics for known and even yet unknown diseases. As a nation that can be greatly affected and is in the direct firing line of many infectious disease outbreaks, we should take steps to participate in such initiatives.

Melioidosis and other such rare or neglected infectious diseases that are in our backyards is our problem first and now. The melioidosis bacteria was actually first identified in Kuala Lumpur. It is one area that we can lead the world in and be the solutions providers to a potential global problem. So for those health care time bombs in our backyards, do we react to the carnage or should we start working to defuse them?

**The writer is a bioinformatician and molecular biologist with the Faculty of Science and Technology and a Senior Research Fellow at the Institute of Systems Biology, Universiti Kebangsaan Malaysia. Email him at firdaus@mfrlab.org

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