[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]
Transmission of Nipah Virus — 14 Years of Investigations in Bangladesh
Birgit Nikolay, Dr.rer.nat., Henrik Salje, Ph.D., M. Jahangir Hossain, M.B., B.S., A.K.M. Dawlat Khan, M.S.S., Hossain M.S. Sazzad, M.B., B.S., Mahmudur Rahman, Ph.D., Peter Daszak, Ph.D., Ute Ströher, Ph.D., Juliet R.C. Pulliam, Ph.D., A. Marm Kilpatrick, Ph.D., Stuart T. Nichol, Ph.D., John D. Klena, Ph.D., et al.
Nipah virus is a highly virulent zoonotic pathogen that can be transmitted between humans. Understanding the dynamics of person-to-person transmission is key to designing effective interventions.
We used data from all Nipah virus cases identified during outbreak investigations in Bangladesh from April 2001 through April 2014 to investigate case-patient characteristics associated with onward transmission and factors associated with the risk of infection among patient contacts.
Of 248 Nipah virus cases identified, 82 were caused by person-to-person transmission, corresponding to a reproduction number (i.e., the average number of secondary cases per case patient) of 0.33 (95% confidence interval [CI], 0.19 to 0.59). The predicted reproduction number increased with the case patient’s age and was highest among patients 45 years of age or older who had difficulty breathing (1.1; 95% CI, 0.4 to 3.2). Case patients who did not have difficulty breathing infected 0.05 times as many contacts (95% CI, 0.01 to 0.3) as other case patients did. Serologic testing of 1863 asymptomatic contacts revealed no infections. Spouses of case patients were more often infected (8 of 56 [14%]) than other close family members (7 of 547 [1.3%]) or other contacts (18 of 1996 [0.9%]). The risk of infection increased with increased duration of exposure of the contacts (adjusted odds ratio for exposure of >48 hours vs. ≤1 hour, 13; 95% CI, 2.6 to 62) and with exposure to body fluids (adjusted odds ratio, 4.3; 95% CI, 1.6 to 11).
Increasing age and respiratory symptoms were indicators of infectivity of Nipah virus. Interventions to control person-to-person transmission should aim to reduce exposure to body fluids. (Funded by the National Institutes of Health and others.)
Supported by a grant (2R01-TW005869) from the National Institutes of Health; by the CDC; by support from the Laboratory of Excellence Integrative Biology of Emerging Infectious Diseases(to Drs. Nikolay and Cauchemez); by support from the National Institute of General Medical Sciences Models of Infectious Disease Agent Study Initiative (to Drs. Nikolay and Cauchemez); by support from the INCEPTION project (PIA/ANR-16-CONV-0005) (to Drs. Nikolay, Salje, and Cauchemez); by support from the AXA Research Fund (to Drs. Nikolay and Cauchemez); and by core or unrestricted support from the governments of Bangladesh, Canada, Sweden, and the United Kingdom.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. Cauchemez and Gurley contributed equally to this article.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
From the Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, Centre National de la Recherche Scientifique, Paris (B.N., H.S., S.C.); the Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia (M.J.H.); the Infectious Diseases Division, icddr,b, (M.J.H., A.K.M.D.K., H.M.S.S., S.A., E.S.G.), and the Institute of Epidemiology Disease Control and Research (M.R., S.S.) — both in Dhaka, Bangladesh; the Kirby Institute, University of New South Wales, Sydney (H.M.S.S.); the EcoHealth Alliance, New York (P.D.); the Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta (U.S., S.T.N., J.D.K.); the South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa (J.R.C.P.); the Department of Ecology and Evolutionary Biology, University of California, Santa Cruz (A.M.K.), and the Infectious Diseases and Geographic Medicine Division, Stanford University, Stanford (S.P.L.) — both in California; Auburn University, Auburn, AL (S.A.); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.S.G.).
Address reprint requests to Dr. Salje at the Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 25-28 Rue du Dr Roux, 75015, Paris, France, or at firstname.lastname@example.org.
Keywords: Nipah virus; Bangladesh.