#Evolution and #Global #Transmission of a #MDR, CA #MRSA #Lineage from the #Indian Subcontinent (MBio, abstract)

[Source: MBio, full page: (LINK). Abstract, edited.]

Evolution and Global Transmission of a Multidrug-Resistant, Community-Associated Methicillin-Resistant Staphylococcus aureus Lineage from the Indian Subcontinent

Eike J. Steinig, Sebastian Duchene, D. Ashley Robinson, Stefan Monecke, Maho Yokoyama, Maisem Laabei, Peter Slickers, Patiyan Andersson, Deborah Williamson, Angela Kearns, Richard V. Goering, Elizabeth Dickson, Ralf Ehricht, Margaret Ip, Matthew V. N. O’Sullivan, Geoffrey W. Coombs, Andreas Petersen, Grainne Brennan, Anna C. Shore, David C. Coleman, Annalisa Pantosti, Herminia de Lencastre, Henrik Westh, Nobumichi Kobayashi, Helen Heffernan, Birgit Strommenger, Franziska Layer, Stefan Weber, Hege Vangstein Aamot, Leila Skakni, Sharon J. Peacock, Derek Sarovich, Simon Harris, Julian Parkhill, Ruth C. Massey, Mathew T. G. Holden, Stephen D. Bentley, Steven Y. C. Tong

Paul J. Planet, Invited Editor, Victor J. Torres, Editor

DOI: 10.1128/mBio.01105-19



The evolution and global transmission of antimicrobial resistance have been well documented for Gram-negative bacteria and health care-associated epidemic pathogens, often emerging from regions with heavy antimicrobial use. However, the degree to which similar processes occur with Gram-positive bacteria in the community setting is less well understood. In this study, we traced the recent origins and global spread of a multidrug-resistant, community-associated Staphylococcus aureus lineage from the Indian subcontinent, the Bengal Bay clone (ST772). We generated whole-genome sequence data of 340 isolates from 14 countries, including the first isolates from Bangladesh and India, to reconstruct the evolutionary history and genomic epidemiology of the lineage. Our data show that the clone emerged on the Indian subcontinent in the early 1960s and disseminated rapidly in the 1990s. Short-term outbreaks in community and health care settings occurred following intercontinental transmission, typically associated with travel and family contacts on the subcontinent, but ongoing endemic transmission was uncommon. Acquisition of a multidrug resistance integrated plasmid was instrumental in the emergence of a single dominant and globally disseminated clade in the early 1990s. Phenotypic data on biofilm, growth, and toxicity point to antimicrobial resistance as the driving force in the evolution of ST772. The Bengal Bay clone therefore combines the multidrug resistance of traditional health care-associated clones with the epidemiological transmission of community-associated methicillin-resistant S. aureus (MRSA). Our study demonstrates the importance of whole-genome sequencing for tracking the evolution of emerging and resistant pathogens. It provides a critical framework for ongoing surveillance of the clone on the Indian subcontinent and elsewhere.



The Bengal Bay clone (ST772) is a community-associated and multidrug-resistant Staphylococcus aureus lineage first isolated from Bangladesh and India in 2004. In this study, we showed that the Bengal Bay clone emerged from a virulent progenitor circulating on the Indian subcontinent. Its subsequent global transmission was associated with travel or family contact in the region. ST772 progressively acquired specific resistance elements at limited cost to its fitness and continues to be exported globally, resulting in small-scale community and health care outbreaks. The Bengal Bay clone therefore combines the virulence potential and epidemiology of community-associated clones with the multidrug resistance of health care-associated S. aureus lineages. This study demonstrates the importance of whole-genome sequencing for the surveillance of highly antibiotic-resistant pathogens, which may emerge in the community setting of regions with poor antibiotic stewardship and rapidly spread into hospitals and communities across the world.

Keywords: Antibiotics; Drugs Resistance; Staphylococcus aureus; MRSA; CA-MRSA; India; Bangladesh.


Safety and immunogenicity of the #oral, inactivated, enterotoxigenic #Escherichia coli #vaccine #ETVAX in #Bangladeshi #children and #infants:… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Safety and immunogenicity of the oral, inactivated, enterotoxigenic Escherichia coli vaccine ETVAX in Bangladeshi children and infants: a double-blind, randomised, placebo-controlled phase 1/2 trial

Firdausi Qadri, PhD, Marjahan Akhtar, PhD, Taufiqur R Bhuiyan, PhD, Mohiul I Chowdhury, MD, Tasnuva Ahmed, MSc, Tanzeem A Rafique, MSc, Arifuzzaman Khan, MBBS, Sadia I A Rahman, MSc, Farhana Khanam, MPhil, Anna Lundgren, PhD, Gudrun Wiklund, BSc, Joanna Kaim, MSc, Madeleine Löfstrand, BSc, Nils Carlin, PhD, A Louis Bourgeois, PhD, Nicole Maier, PhD, Alan Fix, PhD, Thomas Wierzba, PhD, Richard I Walker, PhD, Prof Ann-Mari Svennerholm, MD

Open Access / Published: November 19, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30571-7




Enterotoxigenic Escherichia coli causes diarrhoea, leading to substantial mortality and morbidity in children, but no specific vaccine exists. This trial tested an oral, inactivated, enterotoxigenic E coli vaccine (ETVAX), which has been previously shown to be safe and highly immuongenic in Swedish and Bangladeshi adults. We tested the safety and immunogenicity of ETVAX, consisting of four E coli strains overexpressing the most prevalent colonisation factors (CFA/I, CS3, CS5, and CS6) and a toxoid (LCTBA) administered with or without a double-mutant heat-labile enterotoxin (dmLT) as an adjuvant, in Bangladeshi children.


We did a randomised, double-blind, placebo-controlled, dose-escalation, age-descending, phase 1/2 trial in Dhaka, Bangladesh. Healthy children in one of three age groups (24–59 months, 12–23 months, and 6–11 months) were eligible. Children were randomly assigned with block randomisation to receive either ETVAX, with or without dmLT, or placebo. ETVAX (half [5·5 × 1010 cells], quarter [2·5 × 1010 cells], or eighth [1·25 × 1010 cells] adult dose), with or without dmLT adjuvant (2·5 μg, 5·0 μg, or 10·0 μg), or placebo were administered orally in two doses 2 weeks apart. Investigators and participants were masked to treatment allocation. The primary endpoint was safety and tolerability, assessed in all children who received at least one dose of vaccine. Antibody responses to vaccine antigens, defined as at least a two-times increase in antibody levels between baseline and post-immunisation, were assessed as secondary endpoints. This trial is registered with ClinicalTrials.gov, NCT02531802.


Between Dec 7, 2015, and Jan 10, 2017, we screened 1500 children across the three age groups, of whom 430 were enrolled and randomly assigned to the different treatment groups (130 aged 24–59 months, 100 aged 12–23 months, and 200 aged 6–11 months). All participants received at least one dose of vaccine. No solicited adverse events occurred that were greater than moderate in severity, and most were mild. The most common solicited event was vomiting (ten [8%] of 130 patients aged 24–59 months, 13 [13%] of 100 aged 12–23 months, and 29 [15%] of 200 aged 6–11 months; mostly of mild severity), which appeared related to dose and age. The addition of dmLT did not modify the safety profile. Three serious adverse events occurred but they were not considered related to the study drug. Mucosal IgA antibody responses in lymphocyte secretions were detected against all primary vaccine antigens (CFA/I, CS3, CS5, CS6, and the LCTBA toxoid) in most participants in the two older age groups, whereas such responses to four of the five antigens were less frequent and of lower magnitude in infants aged 6–11 months than in older children. Faecal secretory IgA immune responses were recorded against all vaccine antigens in infants aged 6–11 months. 78 (56%) of 139 infants aged 6–11 months who were vaccinated developed mucosal responses against at least three of the vaccine antigens versus 14 (29%) of 49 of the infants given placebo. Addition of the adjuvant dmLT enhanced the magnitude, breadth, and kinetics (based on number of responders after the first dose of vaccine) of immune responses in infants.


The encouraging safety and immunogenicity of ETVAX and benefit of dmLT adjuvant in young children support its further assessment for protective efficacy in children in enterotoxigenic E coli-endemic areas.


PATH (Bill & Melinda Gates Foundation and the UK’s Department for International Development), the Swedish Research Council, and The Swedish Foundation for Strategic Research.

Keywords: E. Coli; Vaccines; Bangladesh; Pediatrics.


#Contamination of #hospital #surfaces with #respiratory #pathogens in #Bangladesh (PLOS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Contamination of hospital surfaces with respiratory pathogens in Bangladesh

Md. Zakiul Hassan , Katharine Sturm-Ramirez, Mohammad Ziaur Rahman, Kamal Hossain, Mohammad Abdul Aleem, Mejbah Uddin Bhuiyan, Md. Muzahidul Islam, Mahmudur Rahman, Emily S. Gurley


Published: October 28, 2019 / DOI: https://doi.org/10.1371/journal.pone.0224065



With limited infection control practices in overcrowded Bangladeshi hospitals, surfaces may play an important role in the transmission of respiratory pathogens in hospital wards and pose a serious risk of infection for patients, health care workers, caregivers and visitors. In this study, we aimed to identify if surfaces near hospitalized patients with respiratory infections were contaminated with respiratory pathogens and to identify which surfaces were most commonly contaminated. Between September-November 2013, we collected respiratory (nasopharyngeal and oropharyngeal) swabs from patients hospitalized with respiratory illness in adult medicine and paediatric medicine wards at two public tertiary care hospitals in Bangladesh. We collected surface swabs from up to five surfaces near each case-patient including: the wall, bed rail, bed sheet, clinical file, and multipurpose towel used for care giving purposes. We tested swabs using real-time multiplex PCR for 19 viral and 12 bacterial pathogens. Case-patients with at least one pathogen detected had corresponding surface swabs tested for those same pathogens. Of 104 patients tested, 79 had a laboratory-confirmed respiratory pathogen. Of the 287 swabs collected from surfaces near these patients, 133 (46%) had evidence of contamination with at least one pathogen. The most commonly contaminated surfaces were the bed sheet and the towel. Sixty-two percent of patients with a laboratory-confirmed respiratory pathgen (49/79) had detectable viral or bacterial nucleic acid on at least one surface. Klebsiella pneumoniae was the most frequently detected pathogen on both respiratory swabs (32%, 33/104) and on surfaces near patients positive for this organism (97%, 32/33). Surfaces near patients hospitalized with respiratory infections were frequently contaminated by pathogens, with Klebsiella pneumoniae being most common, highlighting the potential for transmission of respiratory pathogens via surfaces. Efforts to introduce routine cleaning in wards may be a feasible strategy to improve infection control, given that severe space constraints prohibit cohorting patients with respiratory illness.


Citation: Hassan MZ, Sturm-Ramirez K, Rahman MZ, Hossain K, Aleem MA, Bhuiyan MU, et al. (2019) Contamination of hospital surfaces with respiratory pathogens in Bangladesh. PLoS ONE 14(10): e0224065. https://doi.org/10.1371/journal.pone.0224065

Editor: Sarah Tschudin-Sutter, University Hospital Basel, SWITZERLAND

Received: February 11, 2019; Accepted: October 4, 2019; Published: October 28, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: Emily S Gurley received the funding award. The Grant No. is GR-00720 (cooperative agreement number 5U01CI000628). The study was funded by the Centers for Disease Control and Prevention (CDC), Atlanta (https://www.cdc.gov/). US CDC provided technical support in the study design, data collection and analysis and preparation of the manuscript

Competing interests: The authors have declared that no competing interests exist

Keywords: Infectious diseases; Nosocomial outbreaks; Klebsiella pneumoniae; Bangladesh.


Where #backyard #poultry raisers seek care for sick poultry: implications for #avian #influenza #prevention in #Bangladesh (BMC Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Public Health. 2018 Aug 3;18(1):969. doi: 10.1186/s12889-018-5819-5.

Where backyard poultry raisers seek care for sick poultry: implications for avian influenza prevention in Bangladesh.

Rimi NA1, Sultana R2,3, Ishtiak-Ahmed K2,4, Haider N2,5, Azziz-Baumgartner E6, Nahar N2, Luby SP2,6,7.

Author information: 1 Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. nadiarimi@icddrb.org. 2 Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr, b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. 3 Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 4 University of Copenhagen, Copenhagen, Denmark. 5 Technical University of Denmark, Copenhagen, Denmark. 6 Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. 7 Stanford University, Stanford, California, USA.




In Bangladesh, backyard poultry raisers lack awareness of avian influenza and infrequently follow government recommendations for its prevention. Identifying where poultry raisers seek care for their ill poultry might help the government better plan how to disseminate avian influenza prevention and control recommendations.


In order to identify where backyard poultry raisers seek care for their ill poultry, we conducted in-depth and informal interviews: 70 with backyard poultry raisers and six with local poultry healthcare providers in two villages, and five with government veterinary professionals at the sub-district and union levels in two districts during June-August 2009.


Most (86% [60/70]) raisers sought care for their backyard poultry locally, 14% used home remedies only and none sought care from government veterinary professionals. The local poultry care providers provided advice and medications (n = 6). Four local care providers had shops in the village market where raisers sought healthcare for their poultry and the remaining two visited rural households to provide poultry healthcare services. Five of the six local care providers did not have formal training in veterinary medicine. Local care providers either did not know about avian influenza or considered avian influenza to be a disease common among commercial but not backyard poultry. The government professionals had degrees in veterinary medicine and experience with avian influenza and its prevention. They had their offices at the sub-district or union level and lacked staffing to reach the backyard raisers at the village level.


The local poultry care providers provided front line healthcare to backyard poultry in villages and were a potential source of information for the rural raisers. Integration of these local poultry care providers in the government’s avian influenza control programs is a potentially useful approach to increase poultry raisers’ and local poultry care providers’ awareness about avian influenza.

KEYWORDS: Avian influenza; Backyard poultry raiser; Bangladesh; Informal care provider, poultry care provider, poultry disease; Perception

PMID: 30075714 PMCID: PMC6090748 DOI: 10.1186/s12889-018-5819-5 [Indexed for MEDLINE] Free PMC Article

Keywords: Avian Influenza; Poultry; Human; Public Health; Bangladesh.


Emerging #HFMD in #Bangladeshi #Children- First Report of Rapid Appraisal on Pocket #Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency (F1000Res., abstract)

[Source: F1000 Research, full page: (LINK). Abstract, edited.]

Emerging Hand Foot Mouth Disease in Bangladeshi Children- First Report of Rapid Appraisal on Pocket Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency [version 3; peer review: 2 approved]

Md. Azraf Hossain Khan1, Kazi Selim Anwar 2, A. K. M. Muraduzzaman3, Md. Abid Hossain Mollah4, S. M. Akhter-ul-Alam1, Kazi Munisul Islam5, Sheikh Ariful Hoque6, Md. Nazrul Islam1, Md. Ahasan Ali7

Author details: 1 Department of Dermatology and Venereology, Pabna Medical College and General Hospital, Pabna, 6600, Bangladesh; 2 US-CDC’s GHSA Project, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh; 3 Department of Virology, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh; 4 Department of Pediatrics, Ibrahim Medical College & Hospital, Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, 1200, Bangladesh; 5 Infectious Disease Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh; 6 Tissue Culture Laboratory, Centre for Advanced Research in Sciences (CARS), University of Dhaka, Dhaka, 1000, Bangladesh; 7 Microbiology Section, Institute of Public Health (IPH), Mohakhali, Dhaka, 1212, Bangladesh




Hand, foot and mouth disease (HFMD) is a common contagious disease among children under 5 years, particularly in the Asia-Pacific-region. We report a localized outbreak of childhood HFMD for the first time from Bangladesh, diagnosed only based on clinical features due to lack in laboratory-diagnostic facilities.


Following the World Health Organization’s case-definition, we conducted a rapid-appraisal of HFMD among all of the 143 children attending Pabna Medical College and General Hospital with fever, mouth ulcers and extremity rash. Data were collected between September and November 2017 using a preset syndromic approach and stringent differential diagnostic-protocols.


The mean age of children was 2.9±2.3 years. There was a significant difference among the age and sex of children (P=0.98), first sibling being more belonging to middle-income families (62%). Younger children (<5 years) were more likely to suffer with moderate-to-high (38.5°C) fever (P<0.04), painful oral ulcers (P<0.03) and painful/itchy rash (P<0.01). Sex did not differ with other symptoms, but boys had less painful oral ulcers than girls (P<0.04). Fever (63%) and chicken-pox-like-rash (62%) was observed more in mid-October to mid-November than September to mid-October (P<0.01 and P<0.03, respectively). No differences in symptoms (fever, oral ulcers and extremity rash) were observed with precipitation, nor with ambient temperature. Children <5 years (85%) had quicker recovery (within 5 days) than those ≥5 years (69%), (P<0.04), with marginal differences in sex (P<0.05).


Our findings highlight potential usefulness in diagnosing HFMD based on clinical parameters, although stringent differential diagnosis remains indispensable, which is particularly applicable for resource-constrained countries lacking appropriate virology/essential laboratories. Since no specific treatment or effective vaccination is available for HFMD, supportive therapy and preventive measures remain the primary methods to circumvent disease-transmission augmented by climate-related factors. Standardized virology laboratory warrants appropriate diagnosis and globally representative multivalent-vaccine deem essential towards preventing HFMD.

Keywords: Emerging Childhood-HFMD, Bangladesh, Rapid-Appraisal, Pocket-Outbreak

Corresponding author: Kazi Selim Anwar

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright:  © 2019 Hossain Khan MA et al. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

How to cite: Hossain Khan MA, Anwar KS, Muraduzzaman AKM et al. Emerging Hand Foot Mouth Disease in Bangladeshi Children- First Report of Rapid Appraisal on Pocket Outbreak: Clinico-epidemiological Perspective Implicating Public Health Emergency [version 3; peer review: 2 approved]. F1000Research 2019, 7:1156 (https://doi.org/10.12688/f1000research.15170.3)

First published: 30 Jul 2018, 7:1156 (https://doi.org/10.12688/f1000research.15170.1)

Latest published: 28 Jun 2019, 7:1156 (https://doi.org/10.12688/f1000research.15170.3)

Keywords: HFMD; Bangladesh.


A new #reassortant clade #H5N1 highly pathogenic #avian #influenza virus causing recent #outbreaks in #ducks, geese, #chickens and turkeys in #Bangladesh (Transbound Emerg Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Transbound Emerg Dis. 2019 Jun 6. doi: 10.1111/tbed.13264. [Epub ahead of print]

A new reassortant clade H5N1 highly pathogenic avian influenza virus causing recent outbreaks in ducks, geese, chickens and turkeys in Bangladesh.

Nooruzzaman M1, Mumu TT1, Hasnat A1, Akter MN1, Rasel MSU1, Rahman MM1, Parvin R1, Begum JA1, Chowdhury EH1, Islam MR1.

Author information: 1 Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh.



A total of 15 dead or sick birds from 13 clinical outbreaks of avian influenza in ducks, geese, chickens and turkeys in 2017 in Bangladesh were examined. The presence of H5N1 influenza A virus in the affected birds was detected by RT-PCR. Phylogenetic analysis based on full length gene sequences of all eight gene segments revealed that these recent outbreaks were caused by a new reassotant of clade H5N1 virus, which had been detected earlier in 2015 during surveillance in live bird markets (LBMs) and wet lands. This reassortant virus acquired PB2, PB1, PA, NP and NS genes from low pathogenic avian influenza viruses mostly of non-H9N2 subtypes but retained HA, NA and M genes of the old clade viruses. Nevertheless, the HA gene of these new viruses was 2.7% divergent from that of the old clade viruses circulated in Bangladesh. Interestingly, similar reassortment events could be traced back in four virus isolates of 2013 from backyard ducks. It suggests that this reassortant virus emerged in 2013, which took two years to be detected at a broader scale (i.e. in LBMs), another two years until it became widely spread in poultry and fully replaced the old viruses. Several mutations were detected in the recent Bangladeshi isolates, which are likely to influence possible phenotypic alterations such as increased mammalian adaptation, reduced susceptibility to antiviral agents and reduced host antiviral response.

This article is protected by copyright. All rights reserved.

KEYWORDS: Bangladesh; H5N1 HPAIV; clade; domestic poultry; new reassortant

PMID: 31168925 DOI: 10.1111/tbed.13264

Keywords: Avian Influenza; H5N1; H9N2; Reassortant Strain; Poultry; Bangladesh.


#Transmission of #Nipah Virus — 14 Years of #Investigations in #Bangladesh (N Engl J Med., abstract)

[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).


Author Affiliations

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 hsalje@pasteur.fr.

Keywords: Nipah virus; Bangladesh.