By Dr Elizabeth Khin Yi Oo
As a Public Health Microbiologist, I find my work interesting. Like detectives, we work with epidemiologists and clinicians to find the cause of an outbreak of unknown infection. Sometimes it may just be an outbreak of cholera or dysentery, but without the lab confirmation, we cannot put a name to the disease. It is of no surprise that the Microbe Hunters by Paul de Kruif is one of my favourite books.
When the Human Immunodeficiency Virus (HIV), known as the pandemic of the 20th Century, started spreading to Asia, the Ministry of Health began surveying for HIV/AIDS in Burma (Myanmar as it was known then) in 1985. The first HIV case in Burma was reported in 1988, and the first AIDS patient in Burma in 1991.
In 1987, I worked as a junior Microbiologist at the Virology Section of the National Health Laboratory (NHL), the Central Public Health and Reference Laboratory in Yangon, Burma. In late December 1987, a seaman was deported back from Greece with an HIV-positive result, and he was warded at the Yangon General Hospital. At that time, NHL was not prepared to test for Human Immunodeficiency Virus, although the ELISA test kits, as well as the ELISA reader, had arrived.
At that time, there was a repository of serum samples from various risk groups for survey in the freezer. We were asked to confirm the HIV-positive case in our laboratory. During those periods, NHL was not very well-equipped, and lab personnel was then sent out to be trained in various methods. We had never run an ELISA test before, but we had a Microbiologist who had recently come back from CDC, Atlanta (trained in Hepatitis diagnosis using ELISA). She was the person who did the actual testing. Another person and I were helping as runners – to support her with anything she needed.
The Head of the department and his son (who was a medical student) read the instructions and assembled the ELISA reader. The reader was ready just in time as the ELISA test was done. It was already after midnight. We found the test was negative. The next day we retested together with the other sera from the repository and some sera sent from the hospitals. That serum was still negative on retesting, but we found a patient’s serum sent from the Neurology Medical ward to be strongly positive. We were not expecting that, but we have a Burmese saying, “Trap to catch a rabbit but caught a cat instead.”
We retested that positive serum, and it was still strongly positive. We gave the result to the respective ward. It was on a Friday. On Monday, we went to the hospital to see the patient and take some clinical notes, but he passed away on Sunday. He was a foreign-going seaman who had been travelling abroad and had neurological symptoms on return and had seen a general practitioner who suspected and had him hospitalized. I remembered the patient’s registration number at our lab. He was C001/1988- clinical case number 1 for 1988. The Greece case and our first positive case were sent to Thailand’s Reference Center for confirmation. The Greece case was negative, but our first patient was confirmed positive.
During the initial phase of the HIV pandemic, the ELISA test was very sensitive, and there were many false-positive results. After that, we started screening suspected cases and the survey samples, but for the whole of 1988, he was the only positive case imported into the country. Only in the latter part of 1989, did we start seeing more positive cases in blood donors.
The pandemic had arrived in the country.
Dr Khin Yi Oo had her schooling at Methodist Girls’ School in Singapore during the 60s. She graduated as a Medical Doctor in her home country, Myanmar. She specialized in Medical Microbiology and worked as a Public Health Microbiologist for 33 years before her retirement. She now works part-time as Lab Advisor at INGO.
