Raw Sap Consumption Habits and Its Association with Knowledge of Nipah Virus in Two Endemic Districts in Bangladesh

'Community people are the most powerful resources': qualitative critical realist analysis and framework to support co-produced responses to zoonotic disease threats with(in) Nepali communities

BACKGROUND

Co-production between researchers, service providers, and members of affected communities is an old concept renewed by current efforts to decolonise global health, reduce exploitative practices, and develop more sustainable, context-relevant interventions to address global health issues. Working with communities- how ever defined- is central to healthcare improvement but engaging with communities and identifying priorities remains challenging for disease control professionals. Co-production aims to help ensure community members have some control over the design and implementation of any intervention, and greater ownership of processes and outcomes. We aimed to identify what would encourage co-production of activities to prevent potential transmission of zoonoses.

METHODS

In this qualitative study, we (British and Nepali researchers) interviewed 73 participants from six communities across Nepal, with 10 participating in photovoice. We also interviewed 20 healthcare professionals and policymakers, 14 representing human and six representing animal health. We interpreted data using reflexive thematic analysis.

RESULTS

Thirty-nine people in six communities participated in interviews, with another 34 in 5 focus groups. We generated three overarching themes: (i) constrained healthcare-seeking behaviours, (ii) experience of community programmes, and (iii) community priorities and co-production. Community participants, despite strong opinions and desire to participate in disease control interventions, had experienced little or no attempt by intervention organisers to engage them in design, implementation, evaluation, or accountability. Most had no experience of programmes at all. Participants highlighted the significance of working in 'local' languages, respecting religious and cultural realities, relating initiatives to lived experience, and ensuring that local leaders are involved.

CONCLUSIONS

Meaningful co-production requires recognising communities- through legitimate leadership/representation- as expert and equal partners who can 'work alongside' at all stages of any initiative. Implications from this research include the importance of promoting trust in communities through inclusion of influential community members (community health volunteers, traditional medicine practitioners, women's group leaders); the use of indigenous languages; the acceptability of different media for interventions (theatre, drama); and the need to be pragmatic about available resources, to manage the expectations of community members.

Assessment of the general population knowledge about the emergence of Nipah virus outbreak in Bangladesh: A nationwide cross-sectional study

The emergence of the Nipah virus (NiV) poses a significant global health threat, particularly in South-East Asian countries. This cross-sectional nationwide study is a pioneer in assessing knowledge levels of NiV outbreak among the general population in Bangladesh. It was conducted among the general population of Bangladesh from 15th January to 10th February 2024. A conveniently selected sample of individuals participated in the assessment of their knowledge about NiV. A semi-structured questionnaire was used as the data collection tool. After data curation, a total of 2121 responses that met the inclusion criteria were retained for analysis. Among 2121 participants, 69.38 % were aware of NiV. Overall, 62 % demonstrated good knowledge of the virus. The main sources of information were social media (29.9 %), television (25.41 %), educational institutions (18.95 %), newspapers (13.65 %), friends (6.39 %), and workplaces (5.91 %). Multivariate logistic regression analysis showed that participants aged 31-40 years had lower odds of poor knowledge (OR = 0.57, 95 % CI: 0.39-0.82, p < 0.01) compared to those aged 21-30. Females had higher odds of poor knowledge (OR = 1.38, 95 % CI: 1.05-1.81, p = 0.02) than males. Lower education levels were associated with higher odds of poor knowledge. Moreover, non-healthcare workers also had higher odds of poor knowledge compared to healthcare workers. There were regional differences, with varying odds in Rangpur (OR = 0.43, 95 % CI: 0.26-0.70, p < 0.01), Khulna (OR = 1.70, 95 % CI: 1.10-2.61, p = 0.01), and Mymensingh (OR = 2.77, 95 % CI: 1.70-4.53, p < 0.01) compared to Dhaka. The current study underscores the importance of evidence-based educational strategies, and may guide government and policymakers to design future targeted interventions to enhance public health literacy and mitigate the spread of NiV in Bangladesh as well as in its neighbouring countries.

Human-bat contacts in the Netherlands, and potential risks for virus exchange

BACKGROUND

Contacts between people and free-ranging animals have a potential to cause viral disease epidemics when novel viruses are exchanged. The Netherlands has approximately 18 native bat species, of which some generally use buildings for roosting, and has a dense human population. Frequent indirect and direct contacts between bats and humans could thus be expected, however, this has hardly been studied.

METHODS

To study human-bat contacts, people living in the Netherlands were questioned about the type and frequency of their bat contacts, their bat knowledge and perception of bats. For analyses respondents were grouped into (1) general population, (2) bat contact risk group, and (3) people that live in a house with a roost site for a Common Pipistrelle Bat maternity group. Associations between human-bat contacts and other variables were tested by an ordinal logistic regression model.

RESULTS

We show that 85% (226/265) of group 1 reported no contacts, while 11% (28/265) reported indirect, and 4% (11/265) direct contacts with live bats, dead bats or bat products as their closest type of contacts. These contacts occurred mostly less than yearly. Somewhat similarly, the majority, 69% (9/13) of group 3 reported no contacts, and 15% (2/13) reported indirect contacts and 15% (2/13) reported direct contacts. These occurred monthly to less than yearly. In contrast, a minority, 5% (11/227) in group 2 reported no contacts, while 37% (85/227) reported direct bat contacts, mostly yearly, and 38% (86/227) reported bat-related injury, mostly less than yearly, as their closest type of contact. Overall, an increase in knowledge on bats and bat-related diseases was correlated with closer bat contacts.

CONCLUSIONS

We conclude that even though bats live close to people in the Netherlands, direct contacts between bats, or bat products, and humans are rare in people from the general population, while being common in people involved in bat-related work. Mitigation of human-bat contacts will be most efficient when targeted to specific groups that are likely to have contacts with bats.

Nipah virus: epidemiology, pathogenesis, treatment, and prevention

Nipah virus (NiV) is a zoonotic paramyxovirus that has recently emerged as a crucial public health issue. It can elicit severe encephalitis and respiratory diseases in animals and humans, leading to fatal outcomes, exhibiting a wide range of host species tropism, and directly transmitting from animals to humans or through an intermediate host. Human-to-human transmission associated with recurrent NiV outbreaks is a potential global health threat. Currently, the lack of effective therapeutics or licensed vaccines for NiV necessitates the primary utilization of supportive care. In this review, we summarize current knowledge of the various aspects of the NiV, including therapeutics, vaccines, and its biological characteristics, epidemiology, pathogenesis, and clinical features. The objective is to provide valuable information from scientific and clinical research and facilitate the formulation of strategies for preventing and controlling the NiV.

Knowledge and attitude among Bangladeshi healthcare workers regarding the management and infection prevention and control of Nipah virus

Background

The Nipah virus (NiV) is a zoonotic pathogen that belongs to the Paramyxoviridae family. It can cause severe respiratory and neurological diseases in humans, with varying clinical symptoms. Recognized as a critical public health concern by the World Health Organization, it requires concerted efforts in research and development to prevent outbreaks.

Methodology

An analytical cross-sectional study was conducted on 455 healthcare workers across four major regions in Bangladesh from April 2022 to May 2023. Using multistage convenient sampling and face-to-face interviews with a semi-structured questionnaire, we have examined the level of knowledge, attitudes, and individual perceptions of the preparedness for NiV. Data analysis included univariate and bivariate analyses, followed by binary logistic regression to ascertain the association with demographic factors.

Results

The study identified a gender disparity favoring female healthcare workers (HCWs). Approximately 46.15 % of participants demonstrated a good knowledge about NiV, with doctors showing significantly higher knowledge odds (OR = 5.197, p < 0.001). Interestingly, graduate and post-graduate education levels did not yield a statistically significant correlation with knowledge. Specific training received was positively associated with knowledge levels (OR = 1.832, p = 0.014), highlighting the gap in routine infection prevention education. Regional differences were notable, with participants from Chittagong having a lower level of knowledge compared to Dhaka (OR = 0.307, p = 0.004). Attitudes towards NiV were predominantly positive, although higher education inversely correlated with positive attitudes, suggesting a potential gap between theoretical knowledge and practical attitudes.

Conclusion

While the attitude towards NiV is generally positive among Bangladeshi HCWs, there is a need to enhance knowledge levels, especially in primary care settings and certain regions. To effectively prepare for NiV outbreaks, it is crucial to prioritize continuous education and practical training. The study underscores the importance of implementing uniform educational strategies to equip HCWs across all categories and regions with adequate NiV knowledge and preparedness.

Bacterial Metabarcoding of Raw Palm Sap Samples from Bangladesh with Nanopore Sequencing

The traditional practice of harvesting and processing raw date palm sap is not only culturally significant but also provides an essential nutritional source in South Asia. However, the potential for bacterial or viral contamination from animals and environmental sources during its collection remains a serious and insufficiently studied risk. Implementing improved food safety measures and collection techniques could mitigate the risk of these infections. Additionally, the adoption of advanced food analytical methods offers the potential to identify pathogens and uncover the natural bacterial diversity of these products. The advancement of next-generation sequencing (NGS) technologies, particularly nanopore sequencing, offers a rapid and highly mobile solution. In this study, we employed nanopore sequencing for the bacterial metabarcoding of a set of raw date palm sap samples collected without protective coverage against animals in Bangladesh in 2021. We identified several bacterial species with importance in the natural fermentation of the product and demonstrated the feasibility of this NGS method in the surveillance of raw palm sap products. We revealed two fermentation directions dominated by either Leuconostoc species or Lactococcus species in these products at the first 6 h from harvest, along with opportunistic human pathogens in the background, represented with lower abundance. Plant pathogens, bacteria with the potential for opportunistic human infection and the sequences of the Exiguobacterium genus are also described, and their potential role is discussed. In this study, we demonstrate the potential of mobile laboratory solutions for food safety purposes in low-resource areas.

Development and evaluation of a quadruple real-time fluorescence-based quantitative reverse transcription polymerase chain reaction assay for detecting Langya, Mojiang, Nipah, and Cedar viruses

The emerging viruses within the genus Henipavirus in the family Paramyxoviridae pose a great threat to public biosafety. To develop a quadruple real-time fluorescence-based quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay is pivotal for the early warning of the potential of zoonotic infectious diseases. Specific primers and probes were designed for the relatively conserved regions based on whole genome sequences of Langya virus (LayV), Mojiang virus (MojV), Nipah virus (NiV), and Cedar virus (CedV), followed by the establishment of a quadruple real-time fluorescence-based qRT-PCR detection method. No cross-reactivity was observed with other viral nucleic acids. The optimal linear detection range for LayV, MojV, NiV, and CedV was 101-108 copies/μL, and the lower limit of detection was 10 copies/μL. Three different DNA concentrations of LayV, MojV, NiV, and CedV (104, 105, and 106 copies/μL) were tested 14 times, achieving good repeatability. The standard deviation of the cycle threshold values for each concentration was <0.5 and the coefficient of variation was <3 %. Furthermore, the amplification efficiency of quadruple real-time fluorescence-based qRT-PCR was >90 %, and the correlation coefficient was >0.99. The established quadruple real-time fluorescence-based qRT-PCR assay for the detection of LayV, MojV, NiV, and CedV exhibits good sensitivity, specificity, and repeatability. Therefore, it can be used to detect Henipavirus and other related clinical specimens.

Immunogenicity of poxvirus-based vaccines against Nipah virus

Nipah virus (NiV), an emerging zoonotic pathogen in Southeast Asia, is transmitted from Pteropus species of fruit bats to a wide range of species, including humans, pigs, horses, dogs, and cats. NiV has killed millions of animals and caused highly fatal human outbreaks since no vaccine is commercially available. This study characterized the immunogenicity and safety of poxvirus-based Nipah vaccines that can be used in humans and species responsible for NiV transmission. Mice were vaccinated with modified vaccinia Ankara (MVA) and raccoon pox (RCN) viral vectors expressing the NiV fusion (F) and glycoprotein (G) proteins subcutaneously (SC) and intranasally (IN). Importantly, both vaccines did not induce significant weight loss or clinical signs of disease while generating high circulating neutralizing antibodies and lung-specific IgG and IgA responses. The MVA vaccine saw high phenotypic expression of effector and tissue resident memory CD8ɑ+ T cells in lungs and splenocytes along with the expression of central memory CD8ɑ+ T cells in lungs. The RCN vaccine generated effector memory (SC) and tissue resident (IN) CD8ɑ+ T cells in splenocytes and tissue resident (IN) CD8ɑ+ T cells in lung cells. These findings support MVA-FG and RCN-FG viral vectors as promising vaccine candidates to protect humans, domestic animals, and wildlife from fatal disease outcomes and to reduce the global threat of NiV.

Henipaviruses: an expanding global public health concern?

Nipah virus (NiV) and Hendra virus (HeV) are highly pathogenic zoonotic viruses of the genus Henipavirus, family Paramyxoviridae that cause severe disease outbreaks in humans and also can infect and cause lethal disease across a broad range of mammalian species. Another related Henipavirus has been very recently identified in China in febrile patients with pneumonia, the Langya virus (LayV) of probable animal origin in shrews. NiV and HeV were first identified as the causative agents of severe respiratory and encephalitic disease in the 1990s across Australia and Southern Asia with mortality rates reaching up to 90%. They are responsible for rare and sporadic outbreaks with no approved treatment modalities. NiV and HeV have wide cellular tropism that contributes to their high pathogenicity. From their natural hosts bats, different scenarios propitiate their spillover to pigs, horses, and humans. Henipavirus-associated respiratory disease arises from vasculitis and respiratory epithelial cell infection while the neuropathogenesis of Henipavirus infection is still not completely understood but appears to arise from dual mechanisms of vascular disease and direct parenchymal brain infection. This brief review offers an overview of direct and indirect mechanisms of HeV and NiV pathogenicity and their interaction with the human immune system, as well as the main viral strategies to subvert such responses.

Henipavirus Immune Evasion and Pathogenesis Mechanisms: Lessons Learnt from Natural Infection and Animal Models

Nipah henipavirus (NiV) and Hendra henipavirus (HeV) are zoonotic emerging paramyxoviruses causing severe disease outbreaks in humans and livestock, mostly in Australia, India, Malaysia, Singapore and Bangladesh. Both are bat-borne viruses and in humans, their mortality rates can reach 60% in the case of HeV and 92% for NiV, thus being two of the deadliest viruses known for humans. Several factors, including a large cellular tropism and a wide zoonotic potential, con-tribute to their high pathogenicity. This review provides an overview of HeV and NiV pathogenicity mechanisms and provides a summary of their interactions with the immune systems of their different host species, including their natural hosts bats, spillover-hosts pigs, horses, and humans, as well as in experimental animal models. A better understanding of the interactions between henipaviruses and their hosts could facilitate the development of new therapeutic strategies and vaccine measures against these re-emerging viruses.

Drivers of zoonotic disease risk in the Indian subcontinent: A scoping review

Literature on potential anthropogenic drivers of zoonotic disease risk in the Indian subcontinent is sparse. We conducted a scoping review to identify primary sources, published 2000-2020, to clarify what research exists and on which areas future research should focus. We summarised findings thematically by disease. Of 80 sources included, 78 (98%) were original research articles and two were conference abstracts. Study designs and methods were not always clearly described, but 74 (93%) were quantitative (including one randomised trial), five (6%) were mixed-methods, and one was qualitative. Most sources reported research from India (39%) or Bangladesh (31%), followed by Pakistan (9%), Nepal (9%), Bhutan and Sri Lanka (6% each). Topically, most focused on rabies (18; 23%), Nipah virus (16; 20%) or leptospirosis (11; 14%), while 12 (15%) did not focus on a disease but instead on knowledge in communities. People generally did not seek post-exposure prophylaxis for rabies even when vaccination programmes were available and they understood that rabies was fatal, instead often relying on traditional medicines. Similarly, people did not take precautions to protect themselves from leptospirosis infection, even when they were aware of the link with rice cultivation. Nipah was correlated with presence of bats near human habitation. Official information on diseases, modes of transmission and prevention was lacking, or shared informally between friends, relatives, and neighbours. Behaviour did not correspond to disease knowledge. This review identifies various human behaviours which may drive zoonotic disease risk in the Indian subcontinent. Increasing community knowledge and awareness alone is unlikely to be sufficient to successfully change these behaviours. Further research, using interdisciplinary and participatory methods, would improve understanding of risks and risk perceptions and thus help in co-designing context-specific, relevant interventions.

Knowledge of people in the East London District of South Africa about Coronavirus SARS-CoV-2: an online survey

Introduction: World Health Organization declared Coronavirus SARS-CoV-2 a pandemic after two months of its propagation in China. The lack of coordination among people about the new Coronavirus threat is evident mainly due to the dearth of knowledge. Objective: To assess the knowledge of people in the East London district of South Africa about Coronavirus SARS-CoV-2. Methods: The study was anchored on a quantitative method approach and adopted a descriptive research design. The sample consisted of 160 adults. Using the virtual snowball sampling technique, people who were 18 years and above of age and can read English were selected for the online survey. The data were collected using a 3-point Likert scale questionnaire which was uploaded in Google Form. Data were analyzed using descriptive and inferential statistics. Results: The majority of the participants knew the myths and facts about the news. They were aware that wearing a face mask prevents Coronavirus transmission, drinking liquor and using hand dryers would not kill the virus. Some people were not sure whether eating garlic or rinsing the nose regularly with saline water would help to prevent from being affected by Coronavirus. The findings also showed that there was a significant difference (p<0.05) among different age groups of people on their knowledge about the Coronavirus. Conclusion: By comparing the overall findings with the facts issued by World Health Organization, people in the East London district of South Africa had sound knowledge about Coronavirus SARS-CoV-2 on its transmission and what preventive measures should be taken.

Hunting and consumption of rodents by children in the Lassa fever endemic area of Faranah, Guinea

As a consequence of the Ebola outbreak, human-animal contact has gained importance for zoonotic transmission surveillance. In Faranah (Upper Guinea), daily life is intertwined with rodents, such as the Natal multimammate mouse, Mastomys natalensis; a reservoir for Lassa virus (LASV). However, this contact is rarely perceived as a health risk by residents, although Lassa fever (LF) is known to be endemic to this region. Conversely, these observations remain a great concern for global health agendas. Drawing on ethnographic research involving interviews, focus group discussions, participant observations, and informal discussions over four months, we first identified factors that motivated children to hunt and consume rodents in Faranah villages, and thereafter, explored the knowledge of LF infection in children and their parents. Furthermore, we studied two dimensions of human-rodent encounters: 1) space-time of interaction and 2) factors that allowed the interaction to occur and their materiality. This approach allowed us to contextualize child-rodent contacts beyond domestic limits in the fallow fields, swamps, and at other times for this practice. A close look at these encounters provided information on rodent trapping, killing, and manipulation of cooking techniques and the risk these activities posed for the primary transmission of LASV. This research facilitated the understanding of children's exposure to M. natalensis during hunting sessions and the importance of rodent hunting, which is a part of their boyish identity in rural areas. Determination of when, where, why, and how children, rodents, and environments interacted allowed us to understand the exposures and risks important for human and animal surveillance programs in the Lassa-endemic region.

Understanding the Community Perceptions and Knowledge of Bats and Transmission of Nipah Virus in Bangladesh

Simple Summary

We assessed people’s knowledge, attitudes, and perceptions regarding bat ecology, myths associated with bats, and their involvement in the transmission of Nipah virus (NiV). We found that community people in Bangladesh had inadequate knowledge of bat ecology and myths surrounding NiV. People’s demographic characteristics, such as sex, age, occupation, level of education, and exposure to a Nipah outbreak, were determined to be key factors influencing their knowledge, attitudes, and perceptions of bat ecology, myths, and their transmission of NiV. Educational interventions are recommended for targeted groups in the community to raise awareness and to improve people’s current knowledge of the role of bats in ecosystem services and their risky behavioral practices driving NiV transmission in Bangladesh.

Abstract

Bats are known reservoirs of Nipah virus (NiV) and some filoviruses and also appear likely to harbor the evolutionary progenitors of severe acute respiratory syndrome coronavirus (SARS-CoV), severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and Middle East respiratory syndrome coronavirus (MERS-CoV). While bats are considered a reservoir of deadly viruses, little is known about people’s knowledge, attitudes, and perceptions of bat conservation and ecology. The current study aimed to assess community people’s knowledge, attitudes, and perceptions of bat ecology, myths, and the role of bats in transmitting NiV in Bangladesh. Since 2001, NiV has been a continuous threat to public health with a mortality rate of approximately 70% in Bangladesh. Over the years, many public health interventions have been implemented to raise awareness about bats and the spreading of NiV among the community peoples of Nipah outbreak areas (NOAs) and Nipah non-outbreak areas (NNOAs). We hypothesized that people from both areas might have similar knowledge of bat ecology and myths about bats but different knowledge regarding their role in the spreading of NiV. Using a four-point Likert scale-based questionnaire, our analysis showed that most people lack adequate knowledge regarding the role of bats in maintaining the ecological balance and instead trust their beliefs in different myths about bats. Factor score analysis showed that respondents’ gender (p = 0.01), the outbreak status of the area (p = 0.03), and their occupation (p = 0.04) were significant factors influencing their knowledge of bat ecology and myths. A regression analysis showed that farmers had 0.34 times the odds of having correct or positive knowledge of bat ecology and myths than businesspersons (odds ratio (OR) = 0.34, 95% confidence interval (95% CI) = 0.15–0.78, p = 0.01). Regarding the spreading of NiV via bats, people had a lower level of knowledge. In NOAs, age (p = 0.00), occupation (p = 0.00), and level of education (p = 0.00) were found to be factors contributing to the amount of knowledge regarding the transmission of NiV, whereas in NNOAs, the contributing factors were occupation (p = 0.00) and level of education (p = 0.01). Regression analysis revealed that respondents who were engaged in services (OR = 3.02, 95% CI = 1.07–8.54, p = 0.04) and who had completed primary education (OR = 3.06, 95% CI = 1.02–9.17, p < 0.05) were likely to have correct knowledge regarding the spreading of NiV. Based on the study results, we recommend educational interventions for targeted groups in the community, highlighting the ecosystem services and conservation of bats so as to improve people’s current knowledge and subsequent behavior regarding the role of bats in ecology and the spreading of NiV in Bangladesh.

Nipah virus circulation at human-bat interfaces, Cambodia

Objective

To better understand the potential risks of Nipah virus emergence in Cambodia by studying different components of the interface between humans and bats.

Methods

From 2012 to 2016, we conducted a study at two sites in Kandal and Battambang provinces where fruit bats (Pteropus lylei) roost. We combined research on: bat ecology (reproductive phenology, population dynamics and diet); human practices and perceptions (ethnographic research and a knowledge, attitude and practice study); and Nipah virus circulation in bat and human populations (virus monitoring in bat urine and anti-Nipah-virus antibody detection in human serum).

Findings

Our results confirmed circulation of Nipah virus in fruit bats (28 of 3930 urine samples positive by polymerase chain reaction testing). We identified clear potential routes for virus transmission to humans through local practices, including fruit consumed by bats and harvested by humans when Nipah virus is circulating, and palm juice production. Nevertheless, in the serological survey of 418 potentially exposed people, none of them were seropositive to Nipah virus. Differences in agricultural practices among the regions where Nipah virus has emerged may explain the situation in Cambodia and point to actions to limit the risks of virus transmission to humans.

Conclusion

Human practices are key to understanding transmission risks associated with emerging infectious diseases. Social science disciplines such as anthropology need to be integrated in health programmes targeting emerging infectious diseases. As bats are hosts of major zoonotic pathogens, such integrated studies would likely also help to reduce the risk of emergence of other bat-borne diseases.

Are the medical interns ready to deal with the treatment, prevention and control of Nipah virus infection at the tertiary care hospital?

Context:

Nipah virus infection is an emerging life threatening zoonotic disease. Health care workers are at the highest risk of getting the infection.

Objectives:

To assess the level of knowledge and attitude regarding Nipah virus infection among medical interns of a tertiary care hospital, Mangaluru and also to assess the readiness of medical interns dealing with cases of Nipah virus infection.

Setting and Design:

A cross-sectional study was conducted among 94 medical interns of a teaching hospital in Mangaluru.

Methods and Material:

Questionnaire comprising of 33 questions was used to assess the knowledge, attitude and practice behaviors of the medical interns.

Statistical Analysis Used:

Descriptive statistics as mean and standard deviation and Pearson correlation coefficient.

Results:

The mean knowledge, attitude and practice scores were 10.28 (± 2.31), 8 (± 2.9) and 15.85 (± 3.7). Three (3.2%) of the medical interns correctly knew the best modality of diagnosis of Nipah. All the interns correctly answered the samples to be collected for diagnosis and 72 (76.6%) correctly answered the lab where samples have to be sent. Majority i.e. 64 (68.1%) of the medical interns correctly enumerated the preventive measures to be employed. Eighty four (89.4%) of them were aware about the availability of vaccine. The correlation between the adequate facilities available with practice domain and training provided with practice domain were found to be statistically significant.

Conclusion:

In this study, the knowledge, attitude and practice regarding Nipah virus infection were found to be inadequate. There is an urgent need to address these gaps.

Nipah virus: a narrative review of viral characteristics and epidemiological determinants

OBJECTIVES

The objectives of this article are to highlight the properties of the Nipah virus (NiV) and discuss its epidemiological determinants.

STUDY DESIGN

A review of conjectures, epidemiological and clinically related studies, and identification and discussion of preventive approaches is conducted.

METHODS

A review of the current literature is performed going through online search engines: PubMed and Google Scholar. The search strategy was focused on two main components, first on the NiV ('Nipah' OR 'Nipah Virus') and subsequently on its epidemiology, including determinants and preventive measures ('Epidemiology/determinants' OR 'Epidemiology/prevention').

RESULTS

NiV infection is an emerging zoonotic infectious disease causing sporadic outbursts in many developing countries within Asia, Africa, and South America. Pteroid bats are the natural reservoirs, but human-to-human transmission is possible. Clinical course ranges from non-specific influenza-like symptoms to rapidly progressive respiratory and neurologic complications. Vector control has been challenging because of its widely distributed ecological niche. Currently, no definitive treatment protocols are available in humans, but profound breakthrough in vaccine technology and successful equine vaccines has shown the way for the development of NiV vaccine and immunization in the near future.

CONCLUSIONS

The NiV poses a significant public health risk because of its intricate transmission cycle, unpredictable viral course, murky management protocol, and unavailability of vaccine. Complicated by emergence and subsequent reemergence, prevention and containment are the two most important public health promotion strategies. Early anticipation, intergovernmental preparedness and cooperation, and surveillance of zoonotic infections still remain the key to mitigate the risk.

Diagnostics for Nipah virus: a zoonotic pathogen endemic to Southeast Asia

Nipah virus (NiV) is an emerging pathogen that, unlike other priority pathogens identified by WHO, is endemic to Southeast Asia. It is most commonly transmitted through exposure to saliva or excrement from the Pteropus fruit bat, or direct contact with intermediate animal hosts, such as pigs. NiV infection causes severe febrile encephalitic disease and/or respiratory disease; treatment options are limited to supportive care. A number of in-house diagnostic assays for NiV using serological and nucleic acid amplification techniques have been developed for NiV and are used in laboratory settings, including some early multiplex panels for differentiation of NiV infection from other febrile diseases. However, given the often rural and remote nature of NiV outbreak settings, there remains a need for rapid diagnostic tests that can be implemented at the point of care. Additionally, more reliable assays for surveillance of communities and livestock will be vital to achieving a better understanding of the ecology of the fruit bat host and transmission risk to other intermediate hosts, enabling implementation of a ‘One Health’ approach to outbreak prevention and the management of this zoonotic disease. An improved understanding of NiV viral diversity and infection kinetics or dynamics will be central to the development of new diagnostics, and access to clinical specimens must be improved to enable effective validation and external quality assessments. Target product profiles for NiV diagnostics should be refined to take into account these outstanding needs.

Nipah virus infection: A review

Nipah virus (NiV) is an emerging bat-borne pathogen. It was first identified 20 years ago in Malaysia and has since caused outbreaks in other parts of South and Southeast Asia. It causes severe neurological and respiratory disease which is highly lethal. It is highly infectious and spreads in the community through infected animals or other infected people. Different strains of the virus show differing clinical and epidemiological features. Rapid diagnosis and implementation of infection control measures are essential to contain outbreaks. A number of serological and molecular diagnostic techniques have been developed for diagnosis and surveillance. Difficulties in diagnosis and management arise when a new area is affected. The high mortality associated with infection and the possibility of spread to new areas has underscored the need for effective management and control. However, no effective treatment or prophylaxis is readily available, though several approaches show promise. Given the common chains of transmission from bats to humans, a One Health approach is necessary for the prevention and control of NiV infection.

Convergence of Humans, Bats, Trees, and Culture in Nipah Virus Transmission, Bangladesh

Preventing emergence of new zoonotic viruses depends on understanding determinants for human risk. Nipah virus (NiV) is a lethal zoonotic pathogen that has spilled over from bats into human populations, with limited person-to-person transmission. We examined ecologic and human behavioral drivers of geographic variation for risk of NiV infection in Bangladesh. We visited 60 villages during 2011–2013 where cases of infection with NiV were identified and 147 control villages. We compared case villages with control villages for most likely drivers for risk of infection, including number of bats, persons, and date palm sap trees, and human date palm sap consumption behavior. Case villages were similar to control villages in many ways, including number of bats, persons, and date palm sap trees, but had a higher proportion of households in which someone drank sap. Reducing human consumption of sap could reduce virus transmission and risk for emergence of a more highly transmissible NiV strain.

Transmission of henipaviruses

The genus Henipavirus has expanded rapidly in geographic range, number of species, and host range. Hendra and Nipah virus are two henipaviruses known to cause severe disease in humans with a high case-fatality rate. Pteropid spp. bats are the natural reservoir of Hendra and Nipah virus. From these bats, virus can be transmitted to an amplifying host, horses and pigs, and from these hosts to humans, or the virus can be transmitted directly to humans. Although the main route of shedding varies between host species, close contact is required for transmission in all hosts. Understanding the transmission routes of Hendra and Nipah virus in their respective hosts is essential for devising strategies to block zoonotic transmission.

A Controlled Trial to Reduce the Risk of Human Nipah Virus Exposure in Bangladesh

Human Nipah virus (NiV) infection, often fatal in Bangladesh, is primarily transmitted by drinking raw date palm sap contaminated by Pteropus bats. We assessed the impact of a behavior change communication intervention on reducing consumption of potentially NiV-contaminated raw sap. During the 2012-2014 sap harvesting seasons, we implemented interventions in two areas and compared results with a control area. In one area, we disseminated a "do not drink raw sap" message and, in the other area, encouraged only drinking sap if it had been protected from bat contamination by a barrier ("only safe sap"). Post-intervention, 40% more respondents in both intervention areas reported knowing about a disease contracted through raw sap consumption compared with control. Reported raw sap consumption decreased in all areas. The reductions in the intervention areas were not significantly greater compared to the control. Respondents directly exposed to the "only safe sap" message were more likely to report consuming raw sap from a protected source than those with no exposure (25 vs. 15%, OR 2.0, 95% CI 1.5-2.6, P < 0.001). While the intervention increased knowledge in both intervention areas, the "only safe sap" intervention reduced exposure to potentially NiV-contaminated sap and should be considered for future dissemination.

A large-scale behavior change intervention to prevent Nipah transmission in Bangladesh: components and costs

Background

Nipah virus infection (NiV) is a bat-borne zoonosis transmitted to humans through consumption of NiV-contaminated raw date palm sap in Bangladesh. The objective of this analysis was to measure the cost of an NiV prevention intervention and estimate the cost of scaling it up to districts where spillover had been identified.

Methods

We implemented a behavior change communication intervention in two districts, testing different approaches to reduce the risk of NiV transmission using community mobilization, interpersonal communication, posters and TV public service announcements on local television during the 2012–2014 sap harvesting seasons. In one district, we implemented a “no raw sap” approach recommending to stop drinking raw date palm sap. In another district, we implemented an “only safe sap” approach, recommending to stop drinking raw date palm sap but offering the option of drinking safe sap. This is sap covered with a barrier, locally called bana, to interrupt bats’ access during collection. We conducted surveys among randomly selected respondents two months after the intervention to measure the proportion of people reached. We used an activity-based costing method to calculate the cost of the intervention.

Results

The implementation cost of the “no raw sap” intervention was $30,000 and the “only safe sap” intervention was $55,000. The highest cost was conducting meetings and interpersonal communication efforts. The lowest cost was broadcasting the public service announcements on local TV channels. To scale up a similar intervention in 30 districts where NiV spillover has occurred, would cost between $2.6 and $3.5 million for one season. Placing the posters would cost $96,000 and only broadcasting the public service announcement through local channels in 30 districts would cost $26,000.

Conclusions

Broadcasting a TV public service announcement is a potential low cost option to advance NiV prevention. It could be supplemented with posters and targeted interpersonal communication, in districts with a high risk of NiV spillover.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2549-1) contains supplementary material, which is available to authorized users.

Loss in lung volume and changes in the immune response demonstrate disease progression in African green monkeys infected by small-particle aerosol and intratracheal exposure to Nipah virus

Nipah virus (NiV) is a paramyxovirus (genus Henipavirus) that emerged in the late 1990s in Malaysia and has since been identified as the cause of sporadic outbreaks of severe febrile disease in Bangladesh and India. NiV infection is frequently associated with severe respiratory or neurological disease in infected humans with transmission to humans through inhalation, contact or consumption of NiV contaminated foods. In the work presented here, the development of disease was investigated in the African Green Monkey (AGM) model following intratracheal (IT) and, for the first time, small-particle aerosol administration of NiV. This study utilized computed tomography (CT) and magnetic resonance imaging (MRI) to temporally assess disease progression. The host immune response and changes in immune cell populations over the course of disease were also evaluated. This study found that IT and small-particle administration of NiV caused similar disease progression, but that IT inoculation induced significant congestion in the lungs while disease following small-particle aerosol inoculation was largely confined to the lower respiratory tract. Quantitative assessment of changes in lung volume found up to a 45% loss in IT inoculated animals. None of the subjects in this study developed overt neurological disease, a finding that was supported by MRI analysis. The development of neutralizing antibodies was not apparent over the 8–10 day course of disease, but changes in cytokine response in all animals and activated CD8+ T cell numbers suggest the onset of cell-mediated immunity. These studies demonstrate that IT and small-particle aerosol infection with NiV in the AGM model leads to a severe respiratory disease devoid of neurological indications. This work also suggests that extending the disease course or minimizing the impact of the respiratory component is critical to developing a model that has a neurological component and more accurately reflects the human condition.

Nipah virus (NiV) was identified in the late 1990s as the causative agent of severe respiratory and neurological disease in Malaysia and Bangladesh. The virus is transmitted by inhalation, contact or consumption of contaminated material. In this study, our objective was to characterize NiV-induced disease progression in the African Green Monkey model utilizing clinical imaging capabilities. In this work, we also provide the first temporal evaluation of the immune response to infection following NiV infection and the first characterization of disease following aerosol exposure. Here, we found that NiV infection following intratracheal and aerosol exposure lead to a severe respiratory disease and rapid disease course with no overt clinical evidence of neurological disease. Despite the rapid course of disease, changes in the cytokine response and peripheral immune cell populations suggest development of a cell-mediated immune response in the latter stage of disease. While the current model for evaluating NiV infection is useful for testing of medical countermeasures, further work is required to understand how this model can represent human disease.

Understanding the interaction between henipaviruses and their natural host, fruit bats: Paving the way toward control of highly lethal infection in humans

Hendra virus and Nipah virus (NiV) are highly pathogenic zoonotic paramyxoviruses, from henipavirus genus, that have emerged in late 1990s in Australia and South-East Asia, respectively. Since their initial identification, numerous outbreaks have been reported, affecting both domestic animals and humans, and multiple rounds of person-to-person NiV transmission were observed. Widely distributed fruit bats from Pteropodidae family were found to be henipavirus natural reservoir. Numerous studies have reported henipavirus seropositivity in pteropid bats, including bats in Africa, thus expanding notably the geographic distribution of these viruses. Interestingly, henipavirus infection in bats seems to be asymptomatic, in contrast to severe disease induced in numerous other mammals. Unique among the mammals by their ability to fly, these intriguing animals are natural reservoir for many other emerging and remerging viruses highly pathogenic for humans. This feature, combined with absence of clinical symptoms, has attracted the interest of scientific community to virus-bat interactions. Therefore, several bat genomes were sequenced and particularities of the bat immune system have been intensively analyzed during the last decade to understand their coexistence with viruses in the absence of disease. The peculiarities in inflammasome activation, a constitutive expression of interferon alpha, and some differences in adaptive immunity have been recently reported in fruit bats. Studies on virus-bat interactions have thus emerged as an exciting novel area of research that should shed new light on the mechanisms that regulate viral infection and may allow development of novel therapeutic approaches to control this highly lethal emerging infectious disease in humans.

Investigating Rare Risk Factors for Nipah Virus in Bangladesh: 2001-2012

Human Nipah encephalitis outbreaks have been identified almost yearly in Bangladesh since 2001. Though raw date palm sap consumption and person-to-person contact are recognized as major transmission pathways, alternative pathways of transmission are plausible and may not have been identified due to limited statistical power in each outbreak. We conducted a risk factor analysis using all 157 cases and 632 controls surveyed in previous investigations during 2004-2012 to identify exposures independently associated with Nipah, since date palm sap was first asked about as an exposure in 2004. To further explore possible rare exposures, we also conducted in-depth interviews with all cases, or proxies, since 2001 that reported no exposure to date palm sap or contact with another case. Cases were 4.9 (95% 3.2-7.7) times more likely to consume raw date palm sap and 7.3 (95% 4.0-13.4) times more likely to have contact with a Nipah case than controls. In-depth interviews revealed that 39/182 (21%) of Nipah cases reporting neither date palm sap consumption nor contact with another case were misclassified. Prevention efforts should be focused on interventions to interrupt transmission through date palm sap consumption and person-to-person contact. Furthermore, pooling outbreak investigation data is a good method for assessing rare exposures.