title: Case-control study of risk factors for human infection with a new zoonotic paramyxovirus, Nipah virus, during a 1998-1999 outbreak of severe encephalitis in Malaysia.
abstract: An outbreak of encephalitis affecting 265 patients (105 fatally) occurred during 1998-1999 in Malaysia and was linked to a new paramyxovirus, Nipah, that infected pigs, humans, dogs, and cats. Most patients were pig farmers. Clinically undetected Nipah infection was noted in 10 (6%) of 166 community-farm controls (persons from farms without reported encephalitis patients) and 20 (11%) of 178 case-farm controls (persons from farms with encephalitis patients). Case patients (persons with Nipah infection) were more likely than community-farm controls to report increased numbers of sick/dying pigs on the farm (59% vs. 24%, P=.001) and were more likely than case-farm controls to perform activities requiring direct contact with pigs (86% vs. 50%, P=.005). Only 8% of case patients reported no contact with pigs. The outbreak stopped after pigs in the affected areas were slaughtered and buried. Direct, close contact with pigs was the primary source of human Nipah infection, but other sources, such as infected dogs and cats, cannot be excluded.
authors.affiliation: Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. UAP2@CDC.GOV.
authors.forename: U D
authors.initials: UD
authors.lastname: Parashar
authors.forename: L M
authors.initials: LM
authors.lastname: Sunn
authors.forename: F
authors.initials: F
authors.lastname: Ong
authors.forename: A W
authors.initials: AW
authors.lastname: Mounts
authors.forename: M T
authors.initials: MT
authors.lastname: Arif
authors.forename: T G
authors.initials: TG
authors.lastname: Ksiazek
authors.forename: M A
authors.initials: MA
authors.lastname: Kamaluddin
authors.forename: A N
authors.initials: AN
authors.lastname: Mustafa
authors.forename: H
authors.initials: H
authors.lastname: Kaur
authors.forename: L M
authors.initials: LM
authors.lastname: Ding
authors.forename: G
authors.initials: G
authors.lastname: Othman
authors.forename: H M
authors.initials: HM
authors.lastname: Radzi
authors.forename: P T
authors.initials: PT
authors.lastname: Kitsutani
authors.forename: P C
authors.initials: PC
authors.lastname: Stockton
authors.forename: J
authors.initials: J
authors.lastname: Arokiasamy
authors.forename: H E
authors.initials: HE
authors.lastname: Gary
authors.forename: L J
authors.initials: LJ
authors.lastname: Anderson
mesh_terms: D000382:Agricultural Workers' Diseases / Q000453:epidemiology / Q000821:virology; D000818:Animals; D016022:Case-Control Studies; D002371:Cat Diseases / Q000635:transmission / Q000821:virology; D002415:Cats; D004196:Disease Outbreaks; D004283:Dog Diseases / Q000635:transmission / Q000821:virology; D004285:Dogs; D018792:Encephalitis, Viral / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D009790:Occupations / Q000706:statistics & numerical data; D018184:Paramyxoviridae Infections / Q000453:epidemiology* / Q000635:transmission / Q000662:veterinary*; D018098:Paramyxovirinae; D012307:Risk Factors; D013552:Swine; D013553:Swine Diseases / Q000635:transmission / Q000821:virology; D015047:Zoonoses / Q000453:epidemiology*