title: Evolving epidemiology of Nipah virus infection in Bangladesh: evidence from outbreaks during 2010-2011.
abstract: Drinking raw date palm sap is the primary route of Nipah virus (NiV) transmission from bats to people in Bangladesh; subsequent person-to-person transmission is common. During December 2010 to March 2011, we investigated NiV epidemiology by interviewing cases using structured questionnaires, in-depth interviews, and group discussions to collect clinical and exposure histories. We conducted a case-control study to identify risk factors for transmission. We identified 43 cases; 23 were laboratory-confirmed and 20 probable. Thirty-eight (88%) cases died. Drinking raw date palm sap and contact with an infected person were major risk factors; one healthcare worker was infected and for another case transmission apparently occurred through contact with a corpse. In absence of these risk factors, apparent routes of transmission included drinking fermented date palm sap. For the first time, a case was detected in eastern Bangladesh. Identification of new epidemiological characteristics emphasizes the importance of continued NiV surveillance and case investigation.
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: A
authors.initials: A
authors.lastname: Chakraborty
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: M J
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: M S
authors.initials: MS
authors.lastname: Islam
authors.affiliation: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Parveen
authors.affiliation: Institute of Epidemiology,Disease Control and Research (IEDCR),Dhaka,Bangladesh.
authors.forename: M
authors.initials: M
authors.lastname: Husain
authors.affiliation: Institute of Epidemiology,Disease Control and Research (IEDCR),Dhaka,Bangladesh.
authors.forename: S S
authors.initials: SS
authors.lastname: Banu
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: Division of High-Consequence Pathogens and Pathology,National Center for Emerging and Zoonotic Diseases,Centers for Disease Control and Prevention,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: International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b),Dhaka,Bangladesh.
authors.forename: S P
authors.initials: SP
authors.lastname: Luby
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: E S
authors.initials: ES
authors.lastname: Gurley
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D045464:Henipavirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D045405:Nipah Virus / Q000302:isolation & purification* / Q000502:physiology*; D012307:Risk Factors; D055815:Young Adult
keywords: Encephalitis; Nipah virus; nosocomial infection; outbreak