Nipah Virus Infection Outbreak with Nosocomial and Corpse-to-Human Transmission, Bangladesh

Hossain M.S. Sazzad

, M. Jahangir Hossain, Emily S. Gurley, Kazi M.H. Ameen, Shahana Parveen, M. Saiful Islam, Labib I. Faruque, Goutam Podder, Sultana S. Banu, Michael K. Lo, Pierre E. Rollin, Paul A. Rota, Peter Daszak, Mahmudur Rahman, and Stephen P. Luby

Author affiliations: Author affiliations: icddr,b, Dhaka, Bangladesh (H.M.S. Sazzad, M.J. Hossain, E.S. Gurley, S. Parveen, M.S. Islam, L.I. Faruque, G. Podder, S.P. Luby); Institute of Epidemiology, Disease Control and Research, Dhaka (K.M.H. Ameen, S.S. Banu, M. Rahman); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.K. Lo, P.E. Rollin, P.A. Rota, S.P. Luby); EcoHealth Alliance, New York, New York, USA (P. Daszak)

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.

In Bangladesh, 135 probable or confirmed cases of Nipah virus (NiV) infection in humans were identified from 2001 through 2008; 98 (73%) were fatal (1). Drinking raw date palm sap, contaminated by NiV from urine or saliva of Pteropus spp. fruit bats, has been identified as a vehicle for transmission of NiV to humans in Bangladesh (2,3). NiV, an RNA paramyxovirus (4), was isolated from human respiratory secretions, saliva, and urine during the outbreaks (5,6). Outbreak investigations in Bangladesh and India have repeatedly implicated person-to-person transmission of NiV, including health care–associated transmission in the Siliguri, India, outbreak in 2004 (7–10). However, to our knowledge, no evidence of NiV transmission to health care workers had been confirmed in Bangladesh (11).