Bangladesh reports two Nipah deaths in 2024 to date
Both cases from the Dhaka division
In a follow-up to a report in January, the World Health Organization (WHO) reported in a Disease Outbreak News today since 1 January and as of 9 February 2024, two laboratory-confirmed cases of Nipah virus (NiV) have been reported from the Dhaka division of Bangladesh. Both cases have died.
They offer more details on the two epidemiologically unlinked cases of NiV infection:
The first patient is a 38-year-old male from Manikganj district, Dhaka division. The patient developed a fever followed by respiratory distress, restlessness, and insomnia on 11 January 2024 and was admitted to a local hospital on 16 January. He was transferred to the intensive care unit of a hospital in Dhaka City on 18 January where he was intubated due to worsening of symptoms.
On 21 January, blood and throat samples were collected and the patient tested positive by reverse transcription polymerase chain reaction (RT-PCR) for NiV RNA from the throat sample and by enzyme-linked immunosorbent assay (ELISA) for anti-NiV Immunoglobulin M (IgM) from serum. On 27 January, the case was transferred to another hospital in Dhaka city, where he died on 28 January.
The case had a history of consuming raw date palm sap on 31 December 2023. As of 30 January 2024, a total of 91 contacts had been identified, including 11 family members, 20 from the community, and 60 healthcare personnel from different hospitals. However, none of the contacts tested positive for NiV by PCR or anti-NiV IgM by ELISA.
The second patient is a three-year-old female from Shariatpur district, Dhaka division. The patient visited a healthcare facility on 30 January 2024 with a two-day history of fever, altered consciousnesses, and seizures. The case was diagnosed with encephalitis and shock and was transferred to the isolation ward of another hospital in Dhaka city on the same day. Blood and throat samples were collected on 30 January and on 31 January, the case was laboratory-confirmed with NiV infection by RT-PCR for NiV RNA from the throat sample and by ELISA for anti-NiV IgM from serum and died on the same day.
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The case had a history of regularly consuming fresh raw date palm sap. As of 7 February 2024, 67 contacts were identified, including three family members, 21 from the community and 46 healthcare personnel from different hospitals. All identified contacts tested negative for NiV by PCR or anti-NiV IgM by ELISA.
Nipah virus (NiV) is an emerging and serious viral zoonotic disease that carries with it a high case fatality rate (in the ballpark of 70% or more)—Since the report of the first case in 2001, human infections have been reported almost every year, with case fatality rate varying between 25% (in 2009) and 92% (in 2005).
NiV is an enveloped RNA virus and along with Hendra virus make up the Henipahviruses.
The natural host of the virus are fruit bats of the Pteropodidae family, Pteropus genus.
It was first recognized in a large outbreak in Kampung Sungai Nipah, Malaysia and Singapore from Sep 1998 – May 1999.
276 cases were reported, the vast majority (93%) being pig farmers or people who had contact with pigs. The disease presented as encephalitis and four out 10 people died.
It is theorized that the pigs got infected consuming partially bat-eaten fruit that ended up in a pigsty. Pigs were the intermediate host in this case; however, subsequent outbreaks had no intermediate hosts.
No new outbreaks have been reported in Malaysia since 1999.
Since the Malaysia outbreak, multiple outbreaks have been reported in Bangladesh and India.
The outbreaks since the initial one in Malaysia have been linked to two possible routes of transmission—consumption of raw date palm sap that had been contaminated with urine or saliva from infected fruit bats and strong evidence points to human-to-human transmission (close physical contact, especially contact with body fluids).
Winter is “Nipah season” as this is the traditional date palm sap collecting time and this coincides with outbreaks.
What is date palm sap?
According to Bangladeshi officials, a cut is made in the stem of a date palm tree and the sap is collected in a container. The sap is consumed raw, fermented as an alcoholic beverage or boiled to form molasses.
Fruit bats also consume the date palm sap and can contaminate it with saliva, feces or urine.