Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011-2014.

M Saiful Islam,Murshid Hasan,Syed Moinuddin Satter,Mahmudur Rahman,Hossain M.S Sazzad,Emily S Gurley,M Jahangir Hossain,M Jahangir Hossain,Deborah L Cannon,Stephen P Luby,Stephen P Luby,Peter Daszak,Ute Ströher,Shelley Campbell,Sharmin Sultana

doi:10.3201/eid2204.151747

Abstract

Nipah virus (NiV) is a paramyxovirus, and Pteropus spp. bats are the natural reservoir. From December 2010 through March 2014, hospital-based encephalitis surveillance in Bangladesh identified 18 clusters of NiV infection. The source of infection for case-patients in 3 clusters in 2 districts was unknown. A team of epidemiologists and anthropologists investigated these 3 clusters comprising 14 case-patients, 8 of whom died. Among the 14 case-patients, 8 drank fermented date palm sap (tari) regularly before their illness, and 6 provided care to a person infected with NiV. The process of preparing date palm trees for tari production was similar to the process of collecting date palm sap for fresh consumption. Bat excreta was reportedly found inside pots used to make tari. These findings suggest that drinking tari is a potential pathway of NiV transmission. Interventions that prevent bat access to date palm sap might prevent tari-associated NiV infection.

Highlights

Nipah virus (NiV) is a bat-borne emerging infection, and Pteropus spp. bats are the wildlife reservoir [1]
The laboratory, clinical, and qualitative findings in this study suggest that the 14 case-patients in the 3 clusters we investigated were infected with NiV
The primary NiV casepatients identified in the clusters drank tari regularly in the evenings before their illness onsets, and none of them had a history of fresh date palm sap consumption or any exposure to other NiV case-patients, which were the main transmission pathways for NiV infection identified in previous outbreak investigations in Bangladesh [9,26]

Summary

Introduction

Nipah virus (NiV) is a bat-borne emerging infection, and Pteropus spp. bats are the wildlife reservoir [1]. Investigations of NiV-associated outbreaks in Bangladesh identified consumption of fresh date palm sap as the primary route of bat-to-human transmission [1,9]. From December 2010 through March 2014, the surveillance identified 18 clusters of NiV infection; in 15 of these clusters, the index case-patients had exposure to fresh date palm sap before illness onset. For the remaining 3 clusters, the index case-patients had no known contact with date palm saps, bats, or sick animals other than bats. Nipah Virus Transmission, Bangladesh other possible exposures to NiV by applying epidemiologic and anthropological approaches in our study of these 3 NiV disease clusters. The objectives of our investigation were to describe the clinical signs and symptoms of the case-patients and determine the possible route of transmission for these clusters

Methods

Results

Conclusion