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Nipah Virus Infection Outbreak with Nosocomial and Corpse-to-Human Transmission, Bangladesh
Abstract
Abstract
Active Nipah virus encephalitis surveillance identified an encephalitis cluster and sporadic cases in Faridpur, Bangladesh, in January 2010. We identified 16 case-patients; 14 of these patients died. For 1 case-patient, the only known exposure was hugging a deceased patient with a probable case, while another case-patient’s exposure involved preparing the same corpse for burial by removing oral secretions and anogenital excreta with a cloth and bare hands. Among 7 persons with confirmed sporadic cases, 6 died, including a physician who had physically examined encephalitis patients without gloves or a mask. Nipah virus–infected patients were more likely than community-based controls to report drinking raw date palm sap and to have had physical contact with an encephalitis patient (29% vs. 4%, matched odds ratio undefined). Efforts to prevent transmission should focus on reducing caregivers’ exposure to infected patients’ bodily secretions during care and traditional burial practices.
Supplementary resources (3)
Data
February 2013
... There are various compartmental models available in the literature that explain the transmission dynamics of the Nipah outbreak in different regions and suggest possible measures to control it. Nipah virus can also spread from one individual to another through unsafe contact with the dead body of an infected person prior to their funeral or burial [21]. When a person is infected with Nipah, they experience symptoms such as fever, headache, and tiredness during the first two weeks after virus exposure. ...
... Further, putting (21) in (22), we obtain ...
In the last two decades, Nipah virus (NiV) has become a significant paramyxovirus transmitted by bats, causing severe respiratory illness and encephalitis in humans. Due to the severity of the disease, its potential for human-to-human transmission, zoonotic characteristics , and the absence of approved therapeutic treatments, NiV has been included in the World Health Organization’s Blueprint list of priority pathogens. In this paper, a novel mathematical model is proposed to investigate the dynamics and optimal control of the NiV. The model incorporates two modes of transmission: human-to-human and food-borne. It also considers the impact of coming in contact with an infected corpse as a potential route for virus transmission. The NiV model is initially assessed with constant controls. The analysis identifies three equilibrium states: the NiV-free equilibrium, the infected flying foxes-free equilibrium, and the NiV-endemic equilibrium state. Furthermore, a theoretical analysis is conducted to ascertain the stability of both the Nipah virus-free equilibrium and the Nipah virus endemic equilibrium points of the model. In addition to enhance the biological importance of the study, the model is fitted to the reported cases in Bangladesh during 2001 to 2015 and the model parameters are estimated using standard nonlinear least square technique. A sensitivity analysis of the model-embedded parameters is conducted to derive the optimal time-dependent controls. An optimal control model is formulated using the sensitivity indices, and numerical simulations are employed to determine the most effective strategy for disease eradication. The model is optimized via optimal control theory coupled with well-established Pontryagin’s maximum principle utilized to achieve primary optimality simulation. Finally, simulation results are provided to verify the theoretical results.
... Our research on control measures and intervention strategies helps model Earth systems and environmental processes to better understand complex global issues by analysing and simulating them. According to the review by Sazzad et al. (2013) and reported as Win (2014), the infection can be transmitted from one person to another if the body of a person infected with the Nipah virus is handled without protection prior to burial or burning. In order to achieve this goal, we present and study a SIRD model that takes into account the disposal rate as well as the possibility of Nipah virus transmission through unsanitary burial practices or unprotected contact with the remains of infected people, using a fractal-fractional derivative in the caputo-fabrizio sense. ...
This paper proposes a SIRD model to investigate the impact of burial or cremation practices on the transmission dynamics of the Nipah virus, which is highly fatal and can spread rapidly through communities via contact with deceased bodies. An analysis is conducted to determine the stability of the disease-free and endemic equilibria and to compute the reproduction number. A comprehensive sensitivity analysis of the reproduction number is conducted to assess the effectiveness of different control measures. It has been found that avoiding unnecessary contact with infected or buried/cremated bodies can greatly reduce the transmission of viruses. Aditionally, an investigation is conducted on the stability conditions of Hyers–Ulam and Hyers–Ulam–Rassias, discuss existence and uniqueness conditions, and verify theoretical findings via MATLAB-based numerical simulations presenting graphical representations of the data. This analysis provides insightful information about potential treatments to slow the spread of the Nipah virus.
... Though its capacity for human-to-human spread has so far been middling (particularly compared to SARS-CoV-2) (Dudas et al. 2018), outbreaks have reached over two dozen countries. Despite limited evidence of community spread, both pathogens have a notable track record of spreading in healthcare settings: in the 2015 outbreak of MERS-CoV, a single infected patient seeking treatment at multiple facilities in South Korea sparked an outbreak of 186 cases, including 25 healthcare workers (Lee et al. 2017;Hui et al. 2018); during the 2018 Kerala outbreak of Nipah virus, nosocomial transmission accounted for most or all secondary cases (Arunkumar et al. 2019), and more limited instances have been reported in smaller outbreaks (Tan and Tan 2001;Sazzad et al. 2013). ...
Multinational epidemics of emerging infectious diseases are increasingly common, due to anthropogenic pressure on ecosystems and the growing connectivity of human populations. Early and efficient vaccination can contain outbreaks and prevent mass mortality, but optimal vaccine stockpiling strategies are dependent on pathogen characteristics, reservoir ecology, and epidemic dynamics. Here, we model major regional outbreaks of Nipah virus and Middle East respiratory syndrome, and use these to develop a generalized framework for estimating vaccine stockpile needs based on spillover geography, spatially-heterogeneous healthcare capacity and spatially-distributed human mobility networks. Because outbreak sizes were highly skewed, we found that most outbreaks were readily contained (median stockpile estimate for MERS-CoV: 2,089 doses; Nipah: 1,882 doses), but the maximum estimated stockpile need in a highly unlikely large outbreak scenario was 2-3 orders of magnitude higher (MERS-CoV: ~87,000 doses; Nipah ~1.1 million doses). Sensitivity analysis revealed that stockpile needs were more dependent on basic epidemiological parameters (i.e., death and recovery rate) and healthcare availability than any uncertainty related to vaccine efficacy or deployment strategy. Our results highlight the value of descriptive epidemiology for real-world modeling applications, and suggest that stockpile allocation should consider ecological, epidemiological, and social dimensions of risk.
... NiV and HeV are neurotropic and can cause severe respiratory and neurological symptoms in humans and animals [21,[58][59][60][61][62][63]. The pathogenesis of these viruses is complex and involves multiple cellular and molecular mechanisms. ...
Paramyxoviruses are a family of single-stranded negative-sense RNA viruses, many of which are responsible for a range of respiratory and neurological diseases in humans and animals. Among the most notable are the henipaviruses, which include the deadly Nipah (NiV) and Hendra (HeV) viruses, the causative agents of outbreaks of severe disease and high case fatality rates in humans and animals. NiV and HeV are maintained in fruit bat reservoirs primarily in the family Pteropus and spillover into humans directly or by an intermediate amplifying host such as swine or horses. Recently, non-chiropteran associated Langya (LayV), Gamak (GAKV), and Mojiang (MojV) viruses have been discovered with confirmed or suspected ability to cause disease in humans or animals. These viruses are less genetically related to HeV and NiV yet share many features with their better-known counterparts. Recent advances in surveillance of wild animal reservoir viruses have revealed a high number of henipaviral genome sequences distributed across most continents, and mammalian orders previously unknown to harbour henipaviruses. In this review, we summarize the current knowledge on the range of pathogenesis observed for the henipaviruses as well as their replication cycle, epidemiology, genomics, and host responses. We focus on the most pathogenic viruses, including NiV, HeV, LayV, and GAKV, as well as the experimentally non-pathogenic CedV. We also highlight the emerging threats posed by these and potentially other closely related viruses.
... These alterations are consistent with vasculitis-associated microangiopathy brought on by NiV and differ from the defining characteristics of HSV and JEV. Patients with late-onset and relapses of encephalitis have different MRI findings, and their neuroimaging shows confluent hyperintense cortical lesions that are probably the product of long-term microembolic damage from vasculitis (61). Treatment NiV outbreaks are more potent when they spread quickly through nosocomial and zoonotic pathways and have an asymptomatic incubation period. ...
Nipah contagion is an acute febrile illness that can beget fatal encephalitis. It's an arising zoonotic paramyxovirus aboriginal to south- east Asia and the western Pacific, and can be transmitted by its primary force of fruit batons, through intermediate beast vectors and by mortal- to- mortal spread. Outbreaks of Nipah contagion encephalitis have passed in Malaysia, Singapore, Philippines, India and Bangladesh, with the most recent outbreak being in Kerala, India in late. Extremely high case casualty rates have been reported from these outbreaks, and to date no vaccines or remedial operation options are available. Combining this with its propensity to present non-specifically, Nipah contagion encephalatis present a grueling opinion that should not be missed in cases returning from aboriginal regions. Raising mindfulness of the epidemiology clinical donation and threat factors of constricting Nipah contagion is vital to honor and manage implicit outbreaks of this complaint in the UK
The recent emergence of the Nipah virus in the same district of Kozhikode, India, following its outbreak in 2018 and 2021, has elicited heightened apprehension among the public amidst the era of COVID-19. The potential fatality associated with this virus has been effectively mitigated through mass awareness, community and healthcare involvement, and stringent implementation of preventive measures. Nevertheless, the rate of transmission has consistently escalated over a span of several years, suggesting an emerging potential for global public health implications. Although the transmission rate remains low, the elevated mortality linked to the Nipah virus constitutes a potential threat, accentuated by the absence of vaccines and dependable treatments, thereby underscoring the risk to public health and emphasising the necessity for proactive measures to protect the wellbeing of the community. This narrative review provides an overview of the Nipah outbreaks in Kerala, India, and its global impact by conducting a thorough search of databases such as PubMed, Google Scholar, and ResearchGate using the following keywords: "Nipah virus," "Henipavirus," and "Kerala." Key Points 1. Recurrent Nipah outbreaks in Kerala, India, emphasise the critical need for preparedness due to its high fatality rate and potential for human transmission, underscoring the urgency of proactive measures to prevent it from emerging as a pandemic. Article 124 EMJ • June 2024 •
Objective: This study assessed Nipah virus (NiV) encephalitis epidemiology, clinical outcomes, and risk variables to inform treatment and prevention. Methodology: In a PubMed systematic search, 929 citations were found. After screening and eligibility, 22 studies were included. This study obtained age, gender, geographic regions, diagnostic methods, data collection methods, and bias risk. The case fatality rate (CFR) and NiV infection risk variables were evaluated by meta-analysis. Results: Southeast Asia, especially Bangladesh and Malaysia, had the most NiV cases. The major diagnostic method was blood and cerebrospinal fluid IgM and IgG antibody tests, and males predominated. Proxy respondents and matched controls were utilized for risk factor analyses when patients could not answer. The pooled CFR for NiV encephalitis was 61.0%, indicating severity. Risk factors included pigs, nighttime bats near homes, tree climbing, and male gender. Conclusion: Southeast Asian public health is plagued by NiV encephalitis. The high CFR calls for better diagnosis, treatment, and prevention. NiV's multiple risk factors must be understood for targeted therapy. Future research should fill knowledge gaps and improve NiV infection prevention.
A BSTRACT
Objective
This study assessed Nipah virus (NiV) encephalitis epidemiology, clinical outcomes, and risk variables to inform treatment and prevention.
Methodology
In a PubMed systematic search, 929 citations were found. After screening and eligibility, 22 studies were included. This study obtained age, gender, geographic regions, diagnostic methods, data collection methods, and bias risk. The case fatality rate (CFR) and NiV infection risk variables were evaluated by meta-analysis.
Results
Southeast Asia, especially Bangladesh and Malaysia, had the most NiV cases. The major diagnostic method was blood and cerebrospinal fluid IgM and IgG antibody tests, and males predominated. Proxy respondents and matched controls were utilized for risk factor analyses when patients could not answer. The pooled CFR for NiV encephalitis was 61.0%, indicating severity. Risk factors included pigs, nighttime bats near homes, tree climbing, and male gender.
Conclusion
Southeast Asian public health is plagued by NiV encephalitis. The high CFR calls for better diagnosis, treatment, and prevention. NiV’s multiple risk factors must be understood for targeted therapy. Future research should fill knowledge gaps and improve NiV infection prevention.
Nipah virus (NiV) is a highly pathogenic paramyxovirus that causes fatal encephalitis in humans. The initial outbreak of NiV infection occurred in Malaysia and Singapore in 1998-1999; relatively small, sporadic outbreaks among humans have occurred in Bangladesh since 2001. We characterized the complete genomic sequences of identical NiV isolates from 2 patients in 2008 and partial genomic sequences of throat swab samples from 3 patients in 2010, all from Bangladesh. All sequences from patients in Bangladesh comprised a distinct genetic group. However, the detection of 3 genetically distinct sequences from patients in the districts of Faridpur and Gopalganj indicated multiple co-circulating lineages in a localized region over a short time (January-March 2010). Sequence comparisons between the open reading frames of all available NiV genes led us to propose a standardized protocol for genotyping NiV; this protcol provides a simple and accurate way to classify current and future NiV sequences.
We investigated a cluster of patients with encephalitis in the Manikgonj and Rajbari Districts of Bangladesh in February 2008 to determine the etiology and risk factors for disease.
We classified persons as confirmed Nipah cases by the presence of immunoglobulin M antibodies against Nipah virus (NiV), or by the presence of NiV RNA or by isolation of NiV from cerebrospinal fluid or throat swabs who had onset of symptoms between February 6 and March 10, 2008. We classified persons as probable cases if they reported fever with convulsions or altered mental status, who resided in the outbreak areas during that period, and who died before serum samples were collected. For the case-control study, we compared both confirmed and probable Nipah case-patients to controls, who were free from illness during the reference period. We used motion-sensor-infrared cameras to observe bat's contact of date palm sap.
We identified four confirmed and six probable case-patients, nine (90%) of whom died. The median age of the cases was 10 years; eight were males. The outbreak occurred simultaneously in two communities that were 44 km apart and separated by a river. Drinking raw date palm sap 2-12 days before illness onset was the only risk factor most strongly associated with the illness (adjusted odds ratio 25, 95% confidence intervals 3.3-∞, p<0.001). Case-patients reported no history of physical contact with bats, though community members often reported seeing bats. Infrared camera photographs showed that Pteropus bats frequently visited date palm trees in those communities where sap was collected for human consumption.
This is the second Nipah outbreak in Bangladesh where date palm sap has been implicated as the vehicle of transmission. Fresh date palm sap should not be drunk, unless effective steps have been taken to prevent bat access to the sap during collection.
In March 2007, we investigated a cluster of Nipah encephalitis to identify risk factors for Nipah infection in Bangladesh.
We defined confirmed Nipah cases by the presence of IgM and IgG antibodies against Nipah virus in serum. Case-patients, who resided in the same village during the outbreak period but died before serum could be collected, were classified as probable cases.
We identified three confirmed and five probable Nipah cases. There was a single index case. Five of the secondary cases came in close physical contact to the index case when she was ill. Case-patients were more likely to have physical contact with the index case (71% cases versus 0% controls, p = <0.001). The index case, on her third day of illness, and all the subsequent cases attended the same religious gathering. For three probable cases including the index case, we could not identify any known risk factors for Nipah infection such as physical contact with Nipah case-patients, consumption of raw date palm juice, or contact with sick animals or fruit bats.
Though person-to-person transmission remains an important mode of transmission for Nipah infection, we could not confirm the source of infection for three of the probable Nipah case-patients. Continued surveillance and outbreak investigations will help better understand the transmission of Nipah virus and develop preventive strategies.
In February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of northwest Bangladesh affected seven people, three of whom died. All subsequent cases developed illness 7-14 days after close physical contact with the index case while he was ill. Cases were more likely than controls to have been in the same room (100% vs. 9.5%, OR undefined, P<0.001) and to have touched him (83% vs. 0%, OR undefined, P<0.001). Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to NiV confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission. Risk of NiV infection in family caregivers highlights the need for infection control practices to limit transmission of potentially infectious body secretions.
Nipah virus (NiV) is a paramyxovirus whose reservoir host is fruit bats of the genus Pteropus . Occasionally the virus is introduced into human populations and causes severe illness characterized by encephalitis or
respiratory disease. The first outbreak of NiV was recognized in Malaysia, but 8 outbreaks have been reported from Bangladesh
since 2001. The primary pathways of transmission from bats to people in Bangladesh are through contamination of raw date palm
sap by bats with subsequent consumption by humans and through infection of domestic animals (cattle, pigs, and goats), presumably
from consumption of food contaminated with bat saliva or urine with subsequent transmission to people. Approximately one-half
of recognized Nipah case patients in Bangladesh developed their disease following person-to-person transmission of the virus.
Efforts to prevent transmission should focus on decreasing bat access to date palm sap and reducing family members' and friends'
exposure to infected patients' saliva.
Human Nipah outbreaks recur in a specific region and time of year in Bangladesh. Fruit bats are the reservoir host for Nipah virus. We identified 23 introductions of Nipah virus into human populations in central and northwestern Bangladesh from 2001 through 2007. Ten introductions affected multiple persons (median 10). Illness onset occurred from December through May but not every year. We identified 122 cases of human Nipah infection. The mean age of case-patients was 27 years; 87 (71%) died. In 62 (51%) Nipah virus-infected patients, illness developed 5-15 days after close contact with another Nipah case-patient. Nine (7%) Nipah case-patients transmitted virus to others. Nipah case-patients who had difficulty breathing were more likely than those without respiratory difficulty to transmit Nipah (12% vs. 0%, p = 0.03). Although a small minority of infected patients transmit Nipah virus, more than half of identified cases result from person-to-person transmission. Interventions to prevent virus transmission from bats to humans and from person to person are needed.
Islam holds life as sacred and belonging to God and that all creatures will die one day. Suicide is forbidden. Muslims believe death is only a transition between two different lives. The terminally ill Muslim desires to perform five ritual requirements. Do not resuscitate (DNR) orders are acceptable. A deceased Muslim must always be buried after being ritually washed and wrapped. There are different Muslim schools of thought, but they are united regarding their views on death and dying.
The structure and genetic organization of Hendra and Nipah viruses places them in the subfamily Paramyxovirinae. However, low homology with other subfamily members and several novel biological and molecular features such as genome length and F0 cleavage site suggest classification in a new genus within the Paramyxovirinae.
Nipah virus (NiV) infection is a seasonal disease in Bangladesh that coincides with the date palm sap collection season. Raw date palm sap is a delicacy to drink in Bengali culture. If fruit bats that are infected with NiV gain access to the sap for drinking, they might occasionally contaminate the sap through saliva and urine. In February 2007, we conducted a qualitative study in six villages, interviewing 27 date palm sap collectors (gachhis) within the geographical area where NiV outbreaks have occurred since 2001. Gachhis reported that bats pose a challenge to successful collection of quality sap, because bats drink and defecate into the sap which markedly reduces its value. They know some methods to prevent access by bats and other pests but do not use them consistently, because of lack of time and resources. Further studies to explore the effectiveness of these methods and to motivate gachhis to invest their time and money to use them could reduce the risk of human Nipah infection in Bangladesh.