title: Integrated cluster- and case-based surveillance for detecting stage III zoonotic pathogens: an example of Nipah virus surveillance in Bangladesh.
abstract: This paper explores the utility of cluster- and case-based surveillance established in government hospitals in Bangladesh to detect Nipah virus, a stage III zoonotic pathogen. Physicians listed meningo-encephalitis cases in the 10 surveillance hospitals and identified a cluster when ⩾2 cases who lived within 30 min walking distance of one another developed symptoms within 3 weeks of each other. Physicians collected blood samples from the clustered cases. As part of case-based surveillance, blood was collected from all listed meningo-encephalitis cases in three hospitals during the Nipah season (January-March). An investigation team visited clustered cases' communities to collect epidemiological information and blood from the living cases. We tested serum using Nipah-specific IgM ELISA. Up to September 2011, in 5887 listed cases, we identified 62 clusters comprising 176 encephalitis cases. We collected blood from 127 of these cases. In 10 clusters, we identified a total of 62 Nipah cases: 18 laboratory-confirmed and 34 probable. We identified person-to-person transmission of Nipah virus in four clusters. From case-based surveillance, we identified 23 (4%) Nipah cases. Faced with thousands of encephalitis cases, integrated cluster surveillance allows targeted deployment of investigative resources to detect outbreaks by stage III zoonotic pathogens in resource-limited settings.
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: A M
authors.initials: AM
authors.lastname: Naser
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: H M S
authors.initials: HM
authors.lastname: Sazzad
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: N
authors.initials: N
authors.lastname: Homaira
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: E S
authors.initials: ES
authors.lastname: Gurley
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: G
authors.initials: G
authors.lastname: Podder
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Afroj
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Banu
authors.affiliation: Centers for Disease Control and Prevention (CDC),Atlanta,GA,USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Rollin
authors.affiliation: EcoHealth Alliance,New York,NY,USA.
authors.forename: P
authors.initials: P
authors.lastname: Daszak
authors.affiliation: Directorate General of Health Services,Ministry of Health and Family Welfare,Dhaka,Bangladesh.
authors.forename: B-N
authors.initials: BN
authors.lastname: Ahmed
authors.affiliation: Institute of Epidemiology Disease Control and Research (IEDCR),Dhaka,Bangladesh.
authors.forename: M
authors.initials: M
authors.lastname: Rahman
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: S P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001459:Bangladesh / Q000453:epidemiology; D020808:Central Nervous System Protozoal Infections / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D002648:Child; D016000:Cluster Analysis; D004196:Disease Outbreaks; D005260:Female; D045464:Henipavirus Infections / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D045405:Nipah Virus / Q000502:physiology*; D011159:Population Surveillance / Q000379:methods*; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission
keywords: Cluster; Nipah; encephalitis; outbreak; stage III pathogen; surveillance