Case fatality rate and risk factors for Nipah virus encephalitis: A systematic review and meta-analysis

Abstract

BackgroundA wide range of Nipah virus (NiV) encephalitis case fatality rates (CFR) have been reported. Data on the involvement of several potential risk factors in Nipah virus transmission remain controversial. We performed a systematic review and meta-analysis to estimate the pooled CFR of NiV encephalitis and to assess the risk factors for NiV infection. MethodsArticles published up to the 27thof November 2018 in MedLine, Embase and Web of knowledge databases were considered for this study. We included cross-sectional, cohort, and case-control studies that have reported NiV CFR and/or risk factors. Data were pooled with random-effects model. This review was registered in the PROSPERO, CRD42018116242. FindingsThis global review included 22 citations (25 studies) including 2156, 1682, and 474 suspected, probable, and confirmed cases of NiV encephalitis, respectively. We determined a pooled CFR for NiV encephalitis at 61.0% (95% CI, 45.7–75.4; I² = 96.8%). Climbing trees (OR = 1.4; 95% CI; 1.0–1.9), male gender (OR = 1.5; 95% CI; 1.1–2.0), travel outside their own sub-district (OR = 2.0; 95% CI; 1.4–2.9), and exposure to date palm sap (DPS) (OR = 5.7; 95% CI; 3.8–8.6) or pigs (OR = 7.6; 95% CI; 1.2–45.4) were significantly associated with NiV infection. ConclusionFindings from this study suggest that NiV Encephalitis is associated with a high CFR and that male gender, travel outside their sub-district, climbing trees, and exposure to pigs and DPS are associated with an increased risk of NiV encephalitis.