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

 

Abstract

Background:

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.

Methods:

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.

Results:

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).

Conclusions:

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.

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A new #reassortant clade 2.3.2.1a #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 2.3.2.1a 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.

 

Abstract

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 2.3.2.1a 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 2.3.2.1a viruses. Nevertheless, the HA gene of these new viruses was 2.7% divergent from that of the old clade 2.3.2.1a viruses circulated in Bangladesh. Interestingly, similar reassortment events could be traced back in four 2.3.2.1a 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 2.3.2.1a; domestic poultry; new reassortant

PMID: 31168925 DOI: 10.1111/tbed.13264

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

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#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.

 

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.)

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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.

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#H9N2 #influenza viruses from #Bangladesh: #Transmission in #chicken and New World #quail (Influenza Other Respir Viruses, abstract)

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

Influenza Other Respir Viruses. 2018 Nov;12(6):814-817. doi: 10.1111/irv.12589. Epub 2018 Sep 8.

H9N2 influenza viruses from Bangladesh: Transmission in chicken and New World quail.

Seiler P1, Kercher L1, Feeroz MM2, Shanmuganatham K1,3, Jones-Engel L4, Turner J1, Walker D1, Alam SMR2, Hasan MK2, Akhtar S2, McKenzie P1, Franks J1, Krauss S1, Webby RJ1, Webster RG1.

Author information: 1 Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee. 2 Department of Zoology, Jahangirnagar University, Dhaka, Bangladesh. 3 Diagnostic Virology Laboratory, National Veterinary Services Laboratories, United States Department of Agriculture, Animal and Plant Health Inspection Service, Ames, Iowa. 4 National Primate Research Center, University of Washington, Seattle, Washington.

 

Abstract

The H9N2 influenza viruses that have become established in Bangladeshi live poultry markets possess five gene segments of the highly pathogenic H7N3 avian influenza virus. We assessed the replication, transmission, and disease potential of three H9N2 viruses in chickens and New World quail. Each virus replicated to high titers and transmitted by the airborne route to contacts in both species. Infected chickens showed no disease signs, and the viruses differed in their disease potential in New World quail. New World quail were more susceptible than chickens to H9N2 viruses and shed virus after airborne transmission for 10 days. Consequently, New World quail are a potential threat in the maintenance and spread of influenza virus in live poultry markets.

© 2018 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

KEYWORDS: Bangladesh; H9N2 influenza; chicken; disease; quail; transmission

PMID: 29989679 PMCID: PMC6185884 DOI: 10.1111/irv.12589 [Indexed for MEDLINE]  Free PMC Article

Keywords: Avian Influenza; H9N2; H7N3; Reassortant Strain; Bangladesh; Poultry.

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Continuing #evolution of highly pathogenic #H5N1 viruses in #Bangladeshi live #poultry #markets (Emerg Microbes Infect., abstract)

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

Emerg Microbes Infect. 2019;8(1):650-661. doi: 10.1080/22221751.2019.1605845.

Continuing evolution of highly pathogenic H5N1 viruses in Bangladeshi live poultry markets.

Barman S1, Turner JCM1, Hasan MK2, Akhtar S2, El-Shesheny R1,3, Franks J1, Walker D1, Seiler P1, Friedman K1, Kercher L1, Jeevan T1, McKenzie P1, Webby RJ1, Webster RG1, Feeroz MM2.

Author information: 1a Department of Infectious Diseases , St. Jude Children’s Research Hospital , Memphis , TN , USA. 2 b Department of Zoology , Jahangirnagar University , Dhaka , Bangladesh. 3 c Center of Scientific Excellence for Influenza Viruses , National Research Centre , Giza , Egypt.

 

Abstract

Since November 2008, we have conducted active avian influenza surveillance in Bangladesh. Clades 2.2.2, 2.3.4.2, and 2.3.2.1a of highly pathogenic avian influenza H5N1 viruses have all been identified in Bangladeshi live poultry markets (LPMs), although, since the end of 2014, H5N1 viruses have been exclusively from clade 2.3.2.1a. In June 2015, a new reassortant H5N1 virus (H5N1-R1) from clade 2.3.2.1a was identified, containing haemagglutinin, neuraminidase, and matrix genes of H5N1 viruses circulating in Bangladesh since 2011, plus five other genes of Eurasian-lineage low pathogenic avian influenza A (LPAI) viruses. Here we report the status of circulating avian influenza A viruses in Bangladeshi LPMs from March 2016 to January 2018. Until April 2017, H5N1 viruses exclusively belonged to H5N1-R1 clade 2.3.2.1a. However, in May 2017, we identified another reassortant H5N1 (H5N1-R2), also of clade 2.3.2.1a, wherein the PA gene segment of H5N1-R1 was replaced by that of another Eurasian-lineage LPAI virus related to A/duck/Bangladesh/30828/2016 (H3N8), detected in Bangladeshi LPM in September 2016. Currently, both reassortant H5N1-R1 and H5N1-R2 co-circulate in Bangladeshi LPMs. Furthermore, some LPAI viruses isolated from LPMs during 2016-2017 were closely related to those from ducks in free-range farms and wild birds in Tanguar haor, a wetland region of Bangladesh where ducks have frequent contact with migratory birds. These data support a hypothesis where Tanguar haor-like ecosystems provide a mechanism for movement of LPAI viruses to LPMs where reassortment with poultry viruses occurs adding to the diversity of viruses at this human-animal interface.

KEYWORDS: Bangladesh; H9N2 viruses; avian influenza A virus; domestic ducks; highly pathogenic H5N1 viruses; live poultry market; reassortment; surveillance

PMID: 31014196 DOI: 10.1080/22221751.2019.1605845

Keywords: Avian Influenza; H5N1; Reassortant Strain; Poultry; Live poultry markets; Bangladesh.

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#Pathology of clade 2.3.2.1 #avian #influenza virus (#H5N1) #infection in #quails and ducks in #Bangladesh (Avian Pathol., abstract)

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

Avian Pathol. 2019 Feb;48(1):73-79. doi: 10.1080/03079457.2018.1535165. Epub 2018 Oct 25.

Pathology of clade 2.3.2.1 avian influenza virus (H5N1) infection in quails and ducks in Bangladesh.

Nooruzzaman M1, Haque ME1, Chowdhury EH1, Islam MR1.

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

 

Abstract

We performed pathological and molecular virological investigation of three outbreaks of highly pathogenic avian influenza (HPAI) in a quail farm and two duck farms of Mymensingh and Netrokona districts of Bangladesh in 2011. HPAI viruses of subtype H5N1 were detected from all three outbreaks and phylogenetic analysis of HA gene sequence placed the viruses into clade 2.3.2.1. The outbreak in the quail farm was characterized by acute death with 100% mortality within two days. Marked haemorrhages and congestion with necrotic and inflammatory lesions in the respiratory tract, liver, pancreas and kidneys were the major gross and histopathological lesions. In the case of ducks, nervous signs were the remarkable clinical manifestations and the mortality was around 10%. No significant gross lesions were observed at necropsy. Non-purulent encephalitis with gliosis and neuronal degeneration was observed on histopathological examination. By immunohistochemistry, viral antigen could be detected in different organs of both quails and ducks. This study records varying clinical and pathological manifestations of HPAI in ducks and quails following natural infection with the same strain of the virus.

 

RESEARCH HIGHLIGHTS

  • HPAIV of clade 2.3.2.1 was detected from clinical outbreaks in quails and ducks
  • Sudden death with severe haemorrhages in various organs was found in quails
  • Pronounced nervous signs with non-purulent encephalitis were observed in ducks
  • Viral antigen could be localized in different organs by immunohistochemistry.

KEYWORDS: Bangladesh; HPAI; clade 2.3.2.1; ducks; immunohistochemistry; quails

PMID: 30303027 DOI: 10.1080/03079457.2018.1535165 [Indexed for MEDLINE]

Keywords: Avian Influenza; H5N8; Poultry; Bangladesh.

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#Review analysis and impact of co-circulating #H5N1 and #H9N2 #avian #influenza viruses in #Bangladesh (Epidemiol Infect., abstract)

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

Epidemiol Infect. 2018 Jul;146(10):1259-1266. doi: 10.1017/S0950268818001292. Epub 2018 May 21.

Review analysis and impact of co-circulating H5N1 and H9N2 avian influenza viruses in Bangladesh.

Parvin R1, Begum JA1, Nooruzzaman M1, Chowdhury EH1, Islam MR1, Vahlenkamp TW2.

Author information: 1 Department of Pathology,Faculty of Veterinary Science,Bangladesh Agricultural University,Mymensingh 2202,Bangladesh. 2 Faculty of Veterinary Medicine,Center of Infectious Diseases, Institute of Virology, University of Leipzig,An den Tierkliniken 29, 04103 Leipzig,Germany.

 

Abstract

Almost the full range of 16 haemagglutinin (HA) and nine neuraminidase subtypes of avian influenza viruses (AIVs) has been detected either in waterfowl, land-based poultry or in the environment in Bangladesh. AIV infections in Bangladesh affected a wide range of host species of terrestrial poultry. The highly pathogenic avian influenza (AI) H5N1 and low pathogenic AI H9N2 were found to co-circulate and be well entrenched in the poultry population, which has caused serious damage to the poultry industry since 2007. By reviewing the available scientific literature, the overall situation of AIVs in Bangladesh is discussed. All Bangladeshi (BD) H5N1 and H9N2 AIV sequences available at GenBank were downloaded along with other representative sequences to analyse the genetic diversity among the circulating AIVs in Bangladesh and to compare with the global situation. Three different H5N1 clades, 2.2.2, 2.3.2.1 and 2.3.4.2, have been detected in Bangladesh. Only 2.3.2.1a is still present. The BD LP H9N2 viruses mostly belonged to the H9 G1 lineage but segregated into many branches, and some of these shared internal genes with HP viruses of subtypes H7N3 and H5N1. However, these reassortment events might have taken place before introduction to Bangladesh. Currently, H9N2 viruses continue to evolve their HA cleavage, receptor binding and glycosylation sites. Multiple mutations in the HA gene associated with adaptation to mammalian hosts were also observed. Strict biosecurity at farms and gradual phasing out of live-bird markets could be the key measures to better control AIVs, whereas stamping out is not a practicable option in Bangladesh. Vaccination also could be an additional tool, which however, requires careful planning. Continuous monitoring of AIVs through systematic surveillance and genetic characterisation of the viruses remains a hallmark of AI control.

KEYWORDS: Avian influenza; Bangladesh; H5N1; H9N2; co-circulation; genetic evolution

PMID: 29781424 DOI: 10.1017/S0950268818001292 [Indexed for MEDLINE]

Keywords: Avian Influenza; H5N1; H7N3; H9N2; Poultry; Wild Birds; Bangladesh.

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