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Investigating Rare Risk Factors for Nipah Virus in Bangladesh: 2001–2012

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Abstract

Human Nipah encephalitis outbreaks have been identified almost yearly in Bangladesh since 2001. Though raw date palm sap consumption and person-to-person contact are recognized as major transmission pathways, alternative pathways of transmission are plausible and may not have been identified due to limited statistical power in each outbreak. We conducted a risk factor analysis using all 157 cases and 632 controls surveyed in previous investigations during 2004–2012 to identify exposures independently associated with Nipah, since date palm sap was first asked about as an exposure in 2004. To further explore possible rare exposures, we also conducted in-depth interviews with all cases, or proxies, since 2001 that reported no exposure to date palm sap or contact with another case. Cases were 4.9 (95% 3.2–7.7) times more likely to consume raw date palm sap and 7.3 (95% 4.0–13.4) times more likely to have contact with a Nipah case than controls. In-depth interviews revealed that 39/182 (21%) of Nipah cases reporting neither date palm sap consumption nor contact with another case were misclassified. Prevention efforts should be focused on interventions to interrupt transmission through date palm sap consumption and person-to-person contact. Furthermore, pooling outbreak investigation data is a good method for assessing rare exposures.

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Acknowledgments

Funded by icddr,b and CDC cooperative agreement (no. 5U01CI000628-01), NIH Grant No. 07-015-0712- 52200 (Bangladesh-NIH/Emerging). icddr,b is grateful to the Governments of Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC Bangladesh or the U.S. Centers for Disease Control and Prevention.

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Author notes

  1. Sonia T. Hegde

    Present address: University of Michigan, Ann Arbor, Michigan, USA

  2. Stephen P. Luby

    Present address: Stanford University, Palo Alto, CA, USA

Authors and Affiliations

  1. Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    Sonia T. Hegde, Pierre Rollin & Stephen P. Luby

  2. icddr,b (formerly, International Center for Diarrheal Disease Research, Bangladesh), Centre for Communicable Diseases icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh

    Hossain M. S. Sazzad, M. Jahangir Hossain, Mahbub-Ul Alam & Emily S. Gurley

  3. Medical Research Council Unit, Banjul, The Gambia

    M. Jahangir Hossain

  4. University of Florida, Florida, USA

    Eben Kenah

  5. EcoHealth Alliance, New York, USA

    Peter Daszak

  6. Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh

    Mahmudur Rahman

Authors
  1. Sonia T. Hegde
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  2. Hossain M. S. Sazzad
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Correspondence to Emily S. Gurley.

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Hegde, S.T., Sazzad, H.M.S., Hossain, M.J. et al. Investigating Rare Risk Factors for Nipah Virus in Bangladesh: 2001–2012. EcoHealth 13, 720–728 (2016). https://doi.org/10.1007/s10393-016-1166-0

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  • DOI: https://doi.org/10.1007/s10393-016-1166-0

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