Investigating Rare Risk Factors for Nipah Virus in Bangladesh: 2001–2012
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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.
KeywordsNipah virus Bangladesh risk factors zoonoses rare exposures prevention
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.
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.
- Chua KB, Bellini WJ, Rota PA, Harcourt BH, Tamin A, Lam SK, Ksiazek TG, Rollin PE, Zaki SR, Shieh W, Goldsmith CS, Gubler DJ, Roehrig JT, Eaton B, Gould AR, Olson J, Field H, Daniels P, Ling AE, Peters CJ, Anderson LJ, Mahy BW (2000) Nipah virus: a recently emergent deadly paramyxovirus. Science 288:1432–1435.CrossRefPubMedGoogle Scholar
- Gurley ES, Montgomery JM, Hossain MJ, Bell M, Azad AK, Islam MR, Molla MA, Carroll DS, Ksiazek TG, Rota PA, Lowe L, Comer JA, Rollin P, Czub M, Grolla A, Feldmann H, Luby SP, Woodward JL, Breiman RF (2007a) Person-to-person transmission of Nipah virus in a Bangladeshi community. Emerging Infectious Disease 13:1031–1037.CrossRefPubMedPubMedCentralGoogle Scholar
- Gurley ES, Montgomery JM, Hossain MJ, Islam MR, Molla MA, Shamsuzzaman SM, Akram K, Zaman K, Asgari N, Comer JA, Azad AK, Rollin PE, Ksiazek TG, Breiman RF (2007b) Risk of nosocomial transmission of Nipah virus in a Bangladesh hospital. Infectious Control & Hospital Epidemiology 28:740–742.CrossRefPubMedGoogle Scholar
- Gurley ES, Rahman M, Hossain MJ, Nahar N, Faiz MA, Islam N, Sultana R, Khatun S, Uddin MZ, Haider MS, Islam MS, Ahmed BN, Rahman MW, Mondal UK, Luby SP (2010) Fatal outbreak from consuming Xanthium strumarium seedlings during time of food scarcity in northeastern Bangladesh. PLoS One 5:e9756. doi: 10.1371/journal.pone.0009756.CrossRefPubMedPubMedCentralGoogle Scholar
- Halpin K, Hyatt AD, Fogarty R, Middleton D, Bingham J, Epstein JH, Rahman SA, Hughes T, Smith C, Field HE, Daszak P, Group HER (2011) Pteropid bats are confirmed as the reservoir hosts of henipaviruses: a comprehensive experimental study of virus transmission. American Journal of Tropical Medicine and Hygiene 85:946–951.CrossRefGoogle Scholar
- Homaira N, Rahman M, Hossain MJ, Epstein JH, Sultana R, Khan MS, Podder G, Nahar K, Ahmed B, Gurley ES, Daszak P, Lipkin WI, Rollin PE, Comer JA, Ksiazek TG, Luby SP (2010) Nipah virus outbreak with person-to-person transmission in a district of Bangladesh, 2007. Epidemiology & Infection 138:1630–1636.CrossRefPubMedGoogle Scholar
- ICDDRB (2003) Outbreaks of encephalitis due to Nipah/Hendra-like viruses, Western Bangladesh. Health and Science Bulletin 1:1–6.Google Scholar
- ICDDRB (2005) Nipah virus outbreak from date palm juice. Health and Science Bulletin 3:1–5.Google Scholar
- Islam MS, Luby SP, Sultana R, Rimi NA, Zaman RU, Uddin M, Nahar N, Rahman M, Hossain MJ, Gurley ES (2014) Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control. American Journal of Infectious Control 42:305–310. doi: 10.1016/j.ajic.2013.09.012.CrossRefPubMedPubMedCentralGoogle Scholar
- Islam S (2011) Nipah transmission from bats to humans associated with drinking traditional liquor (tari) in northern Bangladesh. Health Science Bulletin 10:16–20.Google Scholar
- Luby SP, Hossain MJ, Gurley ES, Ahmed BN, Banu S, Khan SU, Homaira N, Rota PA, Rollin PE, Comer JA, Kenah E, Ksiazek TG, Rahman M (2009b) Recurrent zoonotic transmission of Nipah virus into humans, Bangladesh, 2001–2007. Emerging Infectious Disease 15:1229–1235.CrossRefPubMedPubMedCentralGoogle Scholar
- Montgomery JM, Hossain MJ, Gurley E, Carroll GD, Croisier A, Bertherat E, Asgari N, Formenty P, Keeler N, Comer J, Bell MR, Akram K, Molla AR, Zaman K, Islam MR, Wagoner K, Mills JN, Rollin PE, Ksiazek TG, Breiman RF (2008) Risk factors for Nipah virus encephalitis in Bangladesh. Emerging Infectious Disease 14:1526–1532.CrossRefPubMedPubMedCentralGoogle Scholar
- Nahar N, Mondal UK, Hossain MJ, Khan MSU, Sultana R, Gurley ES, Luby SP (2014) Piloting the promotion of bamboo skirt barriers to prevent Nipah virus transmission through date palm sap in Bangladesh. Global Health Promotion 21:7–15. doi: 10.1177/1757975914528249.CrossRefPubMedPubMedCentralGoogle Scholar
- Nahar N, Paul RC, Sultana R, Gurley ES, Abedin J, Sumon SA, Banik KC, Asaduzzaman M, Rimi NA, Rahman M, Luby SP (2015) Raw sap consumption habits and its association with knowledge of Nipah virus in two endemic districts in Bangladesh. PLOS ONE http://dx.doi.org/10.1371/journal.pone.0142292.
- Rahman MA, Hossain MJ, Sultana S, Homaira N, Khan SU, Rahman M, Gurley ES, Rollin PE, Lo MK, Comer JA, Lowe L, Rota PA, Ksiazek TG, Kenah E, Sharker Y, Luby SP (2012) Date palm sap linked to Nipah virus outbreak in Bangladesh, 2008. Vector-Borne and Zoonotic Disease 12:65–72.CrossRefPubMedGoogle Scholar
- Ram PK, Jahid I, Halder AK, Nygren B, Islam MS, Granger SP, Molyneaux JW, Luby SP (2011) Variability in hand contamination based on serial measurements: implications for assessment of hand-cleansing behavior and disease risk. The American Journal of Tropical Medicine and Hygiene 84:510–516. doi: 10.4269/ajtmh.2011.10-0299.CrossRefPubMedPubMedCentralGoogle Scholar
- Ramasundram V, Tan CT, Chua KB, Chong HT, Goh KJ, Chew NK, Tan KS, Thayaparan T, Kunjapan SR, Petharunam V, Loh YL, Ksiazek TG, Lam SK (2000) Kinetics of IgM and IgG seroconversion in Nipah virus infection. Neurology Journal of Southeast Asia 5:23–28.Google Scholar
- Rothman KJ, Lash TL, Greenland S (2012) Modern Epidemiology, Philadelphia: Lippincott Williams & Wilkins.Google Scholar
- Sazzad HM, Hossain MJ, Gurley ES, Ameen KM, Parveen S, Islam MS, Faruque LI, Podder G, Banu SS, Lo MK, Rollin PE, Rota PA, Daszak P, Rahman M, Luby SP (2013) Nipah virus infection outbreak with nosocomial and corpse-to-human transmission, Bangladesh. Emerging Infectious Disease 19:210–217.CrossRefPubMedPubMedCentralGoogle Scholar
- Sejvar JJ, Hossain J, Saha SK, Gurley ES, Banu S, Hamadani JD, Faiz MA, Siddiqui FM, Mohammad QD, Mollah AH, Uddin R, Alam R, Rahman R, Tan CT, Bellini W, Rota P, Breiman RF, Luby SP (2007) Long-term neurological and functional outcome in Nipah virus infection. Annals of Neurology 62:235–242.CrossRefPubMedGoogle Scholar