Abstract

Introduction: 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.
Methods: 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.
Results: 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.
Conclusion: 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.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Published In

cover image Vector-Borne and Zoonotic Diseases
Vector-Borne and Zoonotic Diseases
Volume 12Issue Number 1January 2012
Pages: 65 - 72
PubMed: 21923274

History

Published online: 4 January 2012
Published in print: January 2012
Published ahead of print: 16 September 2011

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Authors

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Muhammad Aziz Rahman
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Mohammad Jahangir Hossain
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Sharmin Sultana
Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Nusrat Homaira
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Salah Uddin Khan
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Mahmudur Rahman
Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Emily S. Gurley
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Pierre E. Rollin
Centers for Disease Control and Prevention, Atlanta, Georgia.
Michael K. Lo
Centers for Disease Control and Prevention, Atlanta, Georgia.
James A. Comer
Centers for Disease Control and Prevention, Atlanta, Georgia.
Luis Lowe
Centers for Disease Control and Prevention, Atlanta, Georgia.
Paul A. Rota
Centers for Disease Control and Prevention, Atlanta, Georgia.
Thomas G. Ksiazek
Centers for Disease Control and Prevention, Atlanta, Georgia.
Galveston National Laboratory, Department of Pathology, University of Texas Medical Branch, Galveston, Texas.
Eben Kenah
Department of Biostatistics, University of Washington Seattle, Seattle, Washington.
Yushuf Sharker
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Stephen P. Luby
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Centers for Disease Control and Prevention, Atlanta, Georgia.

Notes

Address correspondence to:Muhammad Aziz RahmanDiscipline of Public HealthThe University of AdelaideLevel-9, 10 Pulteney St.Adelaide, SA-5000Australia
E-mail: [email protected]

Disclosure Statement

No competing financial interests exist for any of the authors.

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