Date palm sap linked to nipah virus outbreak in bangladesh, 2008

Muhammad Aziz Rahman, Mohammad Jahangir Hossain, Sharmin Sultana, Nusrat Homaira, Salah Uddin Khan, Mahmudur Rahman, Emily S. Gurley, Pierre E. Rollin, Michael K. Lo, James A. Comer, Luis Lowe, Paul A. Rota, Thomas Ksiazek, Eben Kenah, Yushuf Sharker, Stephen P. Luby

Research output: Contribution to journalArticle

95 Citations (Scopus)

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 44km 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.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalVector-Borne and Zoonotic Diseases
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2012

Fingerprint

Nipah Virus
Bangladesh
Disease Outbreaks
Febrile Seizures
Sick Leave
Encephalitis
Pharynx
Rivers
Drinking
Immunoglobulin M
Cerebrospinal Fluid
Phoeniceae
Case-Control Studies
Odds Ratio
RNA
Confidence Intervals
Antibodies
Serum

Keywords

  • Bats
  • Epidemiology
  • Surveillance
  • Transmission
  • Zoonosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology
  • Virology

Cite this

Rahman, M. A., Hossain, M. J., Sultana, S., Homaira, N., Khan, S. U., Rahman, M., ... Luby, S. P. (2012). Date palm sap linked to nipah virus outbreak in bangladesh, 2008. Vector-Borne and Zoonotic Diseases, 12(1), 65-72. https://doi.org/10.1089/vbz.2011.0656

Date palm sap linked to nipah virus outbreak in bangladesh, 2008. / Rahman, Muhammad Aziz; Hossain, Mohammad Jahangir; Sultana, Sharmin; Homaira, Nusrat; Khan, Salah Uddin; Rahman, Mahmudur; Gurley, Emily S.; Rollin, Pierre E.; Lo, Michael K.; Comer, James A.; Lowe, Luis; Rota, Paul A.; Ksiazek, Thomas; Kenah, Eben; Sharker, Yushuf; Luby, Stephen P.

In: Vector-Borne and Zoonotic Diseases, Vol. 12, No. 1, 01.01.2012, p. 65-72.

Research output: Contribution to journalArticle

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, T, Kenah, E, Sharker, Y & Luby, SP 2012, 'Date palm sap linked to nipah virus outbreak in bangladesh, 2008', Vector-Borne and Zoonotic Diseases, vol. 12, no. 1, pp. 65-72. https://doi.org/10.1089/vbz.2011.0656
Rahman MA, Hossain MJ, Sultana S, Homaira N, Khan SU, Rahman M et al. Date palm sap linked to nipah virus outbreak in bangladesh, 2008. Vector-Borne and Zoonotic Diseases. 2012 Jan 1;12(1):65-72. https://doi.org/10.1089/vbz.2011.0656
Rahman, Muhammad Aziz ; Hossain, Mohammad Jahangir ; Sultana, Sharmin ; Homaira, Nusrat ; Khan, Salah Uddin ; Rahman, Mahmudur ; Gurley, Emily S. ; Rollin, Pierre E. ; Lo, Michael K. ; Comer, James A. ; Lowe, Luis ; Rota, Paul A. ; Ksiazek, Thomas ; Kenah, Eben ; Sharker, Yushuf ; Luby, Stephen P. / Date palm sap linked to nipah virus outbreak in bangladesh, 2008. In: Vector-Borne and Zoonotic Diseases. 2012 ; Vol. 12, No. 1. pp. 65-72.
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AU - Hossain, Mohammad Jahangir

AU - Sultana, Sharmin

AU - Homaira, Nusrat

AU - Khan, Salah Uddin

AU - Rahman, Mahmudur

AU - Gurley, Emily S.

AU - Rollin, Pierre E.

AU - Lo, Michael K.

AU - Comer, James A.

AU - Lowe, Luis

AU - Rota, Paul A.

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N2 - 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 44km 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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