Bangladesh - 36 dead from Nipah Virus

[alert]

Re: 17 died, others fall sick of unknown disease in Bangladesh

http://bdnews24.com/details.php?id=186392&cid=2

3 more die of unknown disease
Thu, Feb 3rd, 2011 10:28 pm BdST Dial 2000 from your GP mobile for latest news



Lalmonirhat, Feb 3 (bdnews24.com) ? Raising the death toll to 16, three more people have died of fever caused by an unknown virus at Hatibandha Upazila in Lalmonirhat.

Health officials said at least 30 people are believed to have been affected by the disease so far.

Hatibandha Upazila Executive Officer Ashrafuzzaman on Thursday said there were nine deaths recorded on Wednesday, while four died on Tuesday.

The deceased are Zafar Ali and Ananya Ghose, 4, Khairul Islam, 50, 'Karim', 30, and Sudipta Roy, 11.

Meanwhile, a team of experts from the Institute of Epidemiology Diseases Control and Research (IEDCR) reached Lalmonirhat to investigate the outbreak of the mysterious disease.

The 10-member team led by scientific officer Subodh Kumar Kundu includes five physicians.

They will work in two groups and visit Rangpur hospital and the affected areas in Hatibandha.

On Wednesday, a three-member physicians' team from Rangpur led by divisional health director Dr Shahadat Hossain visited Hatibandha.

Shahadat later told reporters that, it could be a viral fever spread by bats. "We've asked people not to eat local fruits including date juice, sugarcane and papaya."

IEDCR director Mahmudur Rahman on Wednesday told bdnews24.com: "The disease causes high fever and is followed by brain infection."

The major symptom of the disease is high temperature at intervals and sudden sharp fall, resulting in the patient's death.

[Vibrant62]

Re: 17 died, others fall sick of unknown disease in Bangladesh

If this is Nipah, with the long incubation period, this could turn into a major tragedy very rapidly. The sooner the infective agent is identified and quarantines enforced (if they are needed) the better to limit this outbreak.

As Alert said, they need to determine the cause with all haste so that appropriate actions can be taken to limit spread.

[alert]

Re: 17 died, others fall sick of unknown disease in Bangladesh

http://www.promedmail.org/pls/apex/f?p=2400:1001:2459180726371070::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86935

Archive Number 20110203.0393
Published Date 03-FEB-2011
Subject PRO/AH/EDR> Undiagnosed encephalitis - Bangladesh: (RP) RFI


UNDIAGNOSED ENCEPHALITIS - BANGLADESH: (RANGPUR) REQUEST FOR INFORMATION
************************************************** **********************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 2 Feb 2011
Source: bdnews24.com (Bangladesh) [edited]
<http://www.bdnews24.com/details.php?id=186262&cid=13>


Undiagnosed disease with fever and CNS symptoms
-----------------------------------------------
An investigation has been launched to identify the unknown disease
that claimed 4 lives, including 3 children, at Hatibandha in
Lalmonirhat [Rangpur division].

A team of the Institute of Epidemiology Disease Control and Research
(IEDCR) left Dhaka for Lalmonirhat on Wednesday noon [2 Feb 2011].
The team was formed with 5 physicians, IEDCR director Mahmudur Rahman
told bdnews24.com. "I think t he disease which causes high fever is
followed by brain infection."

On Tuesday [1 Feb 2011], the 4 people, including the children, died
between 12 pm and 8:30 pm. One of them died at Rangpur Medical
College Hospital, while the rest died either at home or on their way
to hospital.

At least 30 people were affected by the disease in the last 2 days.

The major symptom of the disease is the rise of temperature at
certain interval and it finally drops sharply, resulting in the
patient's death.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The information is very sparse and the few symptoms -- fever and
"brain infection" are rather unspecific. Malaria is unlikely as it
usually does not occur in small outbreaks; meningitis or encephalitis
-- for instance enterovirus, Chandipura virus, Nipah virus, or
Japanese encephalitis -- are possibilities. Haemophilus influenza
meningitis usually is not seen in outbreaks and meningococcal
infection would be expected to be associated with skin symptoms.
ProMED-mail will be happy to post further information. - Mod.EP]

******
[2]
Date: Thu 3 Feb 2011
Source: The Daily Star [edited & summ. Mod.TY]
<http://www.thedailystar.net/newDesign/latest_news.php?nid=28287>


The latest overnight [edition] reports an increase in the death toll
to 17, with a symptomatic diagnosis of encephalitis. Experts on
Thursday [3 Feb 2011], clinically identified the unknown disease as
"encephalitis", which claimed 5 more lives in Lalmonirhat and Rangpur
[Rangpur division] Wednesday night and Thursday [2 and 3 Feb 2011].
The final diagnosis will come after examining the specimens at the
Disease Control and Research (IEDCR) laboratory on Fri 4 Feb 2011,
they said. The death toll from the disease now stands at 17.

The dead were identified as [individuals whose ages and locations
are], 10 and 40, of South Goddimari village; 23 of West Bejpur; 50 of
Tongbhanga; and another 8, of local bus terminal area in Hatibandha
upazila [sub-district] of Lalmonirhat.

--
Communicated by:
Ronan Kelly
<ronankelly@comcast.net>

[If this outbreak turns out to be caused by Japanese encephalitis
virus, it will be the 1st report from Bangladesh posted by
ProMED-mail. However, there have been several ProMED posts for Nipah
virus infection, which occurs periodically in Bangladesh. In the same
edition of The Daily Star, another article reported that 8 people,
mostly children, of Hatibandha and Pirgachha upazilas sub-districts]
of Lalmonirhat and Rangpur districts died of an "unknown disease"
yesterday (2 Feb 2011), raising the death toll to 12 while 24 more
patients are admitted to different hospitals. They will collect blood
samples of the patients and examine the specimens at the Institute of
Epidemiology, Disease Control and Research laboratory, according to
Mahmudur Rahman, director of the institute. Based on the symptoms, he
suspects the disease might be Japanese encephalitis or Nipah virus
infections. He indicated that viral encephalitis is not a new disease
in the country. Every year during the winter, a number of people get
infected with the mosquito borne disease. It is not clear if these 8
cases are part of the 17 mentioned above or not.

[alert]

Re: 17 died, others fall sick of unknown disease in Bangladesh

http://www.thedailystar.net/newDesign/news-details.php?nid=172768

It's encephalitis
Says IEDCR, death toll rises to 16 in northern districts
Staff Correspondent The disease that claimed at least 16 lives in Lalmonirhat and Rangpur in the last three days has been identified as encephalitis, a brain infection caused by bacteria, fungi or virus.

"Seeing the symptoms and considering the patients' history, we have identified it as encephalitis," said Mahmudur Rahman, director of the Institute of Epidemiology, Disease Control and Research (IEDCR) in Dhaka.

The eight-member IEDCR team that visited the affected areas has sent blood samples of the patients to the capital for tests, he said.

"We hope to confirm the type of encephalitis by tomorrow [today] afternoon," he told The Daily Star yesterday.

Encephalitis -- a condition in which the brain swells due to infection or allergic reaction -- are of various types.

Experts said the disease is quite common in Faridpur, Rajbari and Madaripur region where the government has surveillance programmes.

There is no specific treatment against it but early diagnosis can reduce death rate, they add.

A common symptom of the disease is high fever along with headache and vomiting.

?If someone has fever [in the affected area], they should immediately go to a doctor," advised Dr Subodh Kumar Kundu, who headed the IEDCR team.

One can get encephalitis in two ways -- from direct infection of the brain or from a previous infection that causes one's immune system to fail, experts say.

Direct infection can be caused by bacteria, fungi and virus.

"It can result from certain viral infections passed between humans, or from contact with infected animals or insects," said virologist Prof Nazrul Islam, former vice-chancellor of Bangabandhu Sheikh Mujib Medical University.

Meanwhile, our Lalmonirhat correspondent reported four more deaths apparently caused by the disease in the northern district yesterday.

The dead are Zafar Ali, 40, of South Goddimari village; Abdul Karim, 23, of West Bejpur; Khairul Islam, 50, of Tongbhanga; and Aranyo Ghosh, 8, of Hatibandha upazila.

Panicked, many people have started leaving the area.

Dr Subodh of IEDCR said he is worried about the situation in Lalmonirhat and urged the people to remain alert.

In Bangladesh, two types of encephalitis -- Japanese and Nipah -- are common.

Japanese encephalitis is caused by mosquito bite.

Nipah, which is mostly spread by bats, was first reported in the country in 2001. People should be careful about bats and avoid drinking date juice the bats love to drink.

Because, the doctor says, drinking the juice earlier licked by an infected bat from the tree can cause encephalitis.

Vaccine of Japanese encephalitis has been proven effective in many countries, but it is yet to be tested in Bangladesh, said Alamgir Hossain, virologist of IEDCR.

[Ronan Kelly]

Re: 17 died, others fall sick of unknown disease in Bangladesh

19 fall to the unidentified virus
Fri, Feb 4th, 2011 3:50 pm BdST Dial 2000 from your GP mobile for latest news



Lalmonirhat, Feb 3 (bdnews24.com) ? Three more people have died of a fever, caused by an unknown virus, at Hatibandha Upazila in Lalmonirhat, raising the death toll to 19.

The deceased are Bachchu Miya, 55, Asadul Islam, 14 and Jaynal Abedin, 42.

Upazila Health Complex doctors on Friday said at least 50 people have been affected by the disease so far.

Hatibandha Upazila Executive Officer Ashrafuzzaman on Thursday said there were nine deaths recorded on Wednesday, while another four died on Feb 1.



....

http://www.bdnews24.com/details.php?id=186422&cid=13

[Shiloh]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

Source: http://www.bdnews24.com/details.php?id=186437&cid=2

Killer virus identified as Nipah
Fri, Feb 4th, 2011 5:33 pm BdST

Dial 2000 from your GP mobile for latest news
Dhaka, Feb 4 (bdnews24.com) — The virus that has taken 14 lives in Hatibandha of Lalmonirhaat has been identified as the Nipah virus.

Locals claim the death toll was 19...

************************************************** ****************

Source: http://www.bdnews24.com/details.php?id=186448&cid=13

Killer virus is Nipah: IEDCR
Fri, Feb 4th, 2011 7:24 pm BdST

Dhaka, Feb 4 (bdnews24.com) — The virus that killed 14 people at Hatibandha Upazila in Lalmonirhat in the last four days has been identified as Nipah.

Director of the Institute of Epidemiology Diseases Control and Research (IEDCR) Mahmudur Rahman told reporters on Friday afternoon that they have been able to identify the virus through tests.

The outbreak of the virus was first marked a week back in the area. A team of IEDCR started working to identify the cause on Wednesday following a number of deaths.

The director also said 22 cases of infections have been recorded so far and 14 of them have died. The death toll was also confirmed by Hatibandha Upazila Executive Officer (UNO) Mohammad Ashrafuzzaman...

[Vibrant62]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

From WHO Factsheet - Excerpts

Nipah virus
Fact sheet N&#176;262
Revised July 2009


--------------------------------------------------------------------------------

KEY FACTS
Nipah virus causes severe illness characterized by inflammation of the brain (encephalitis) or respiratory diseases.
Nipah virus can be transmitted to humans from animals, and can also be transmitted directly from human-to-human; in Bangladesh, half of reported cases between 2001 and 2008 were due to human-to-human transmission.
Nipah virus can cause severe disease in domestic animals such as pigs.
There is no treatment or vaccine available for either people or animals.
Fruit bats of the Pteropodidae family are the natural host of Nipah virus.

--------------------------------------------------------------------------------

Signs and symptomsHuman infections range from asymptomatic infection to fatal encephalitis. Infected people initially develop influenza-like symptoms of fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.

The incubation period (interval from infection to onset of symptoms) varies from four to 45 days.

Most people who survive acute encephalitis make a full recovery, but around 20&#37; are left with residual neurological consequences such as persistent convulsions and personality changes. A small number of people who recover subsequently relapse or develop delayed onset encephalitis. In the long term, persistent neurological dysfunctions are observed in more than 15% of people.

The case fatality rate is estimated at 40% to 75%; however, this rate can vary by outbreak depending on local capabilities for surveillance investigations.

Controlling infection in health-care settingsHealth-care workers caring for patients with suspected or confirmed Nipah virus infection, or handling specimens from them, should implement standard infection control precautions.

Samples taken from people and animals with suspected Nipah virus infection should be handled by trained staff working in suitably equipped laboratories.

Full Factsheet at

http://www.who.int/mediacentre/factsheets/fs262/en/

There is not much indication of the degree of transmissibility between humans before patients become symptomatic, but Nipah is highly contagious between pigs, and pigs are infectious during the incubation period - so I suspect the same may be true for humans.

[alert]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

The lab in Bangladesh is among the best in the world for detecting Nipah, according to a previous post in this thread; if they say it's Nipah, it's Nipah.

The timing is a bit odd here. These cases are too close together in time to represent significant H2H transmission; perhaps the entire village had a mass exposure a couple weeks ago to infected bats, fruit, or juice (or the one previous confirmed case mentioned in a previous post, although the fact that the dead are predominantly children makes that less likely).

There is a table at the link below with Nipah cases by region since 2001, including the current outbreak (and also the belatedly reported outbreak in Faridpur here http://www.flutrackers.com/forum/sho...d=1#post391160):

http://www.bdnews24.com/details.php?id=186461&cid=2

[Laidback Al]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

The case fatality rate is estimated at 40% to 75%; however, this rate can vary by outbreak depending on local capabilities for surveillance investigations.

Based on the table in the link posted by alert above, the overall CFR is .71 for the 174 reported cases in Bangladesh. It is certainly is a dangerous disease.

[alert]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

Based on the table in the link posted by alert above, the overall CFR is .71 for the 174 reported cases in Bangladesh. It is certainly is a dangerous disease.

And there are certainly some peculiarities about this outbreak. 50 probable cases in four days is very unusual, if there have only been about 174 in the past 11 years in the whole country. Perhaps the investigation will reveal an unusual exposure, or perhaps the pathogen has gained enhanced transmission. Definitely one to keep a close eye on, even though it is not flu...

[Vibrant62]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

Alert - I am trying to follow your logic (but hope you are right about the H2H transmission).

The initial report posted by RoRo states
"Five people, including three minors, died and six others fell seriously sick after being attacked by an unknown disease at different villages in Bangladesh's Hatibandha sub-district of Lalmonirhat district, 343 km northwest of capital Dhaka, on Tuesday and Wednesday."

That argues against a single transmission event - as the cases are in differing locations. Cases are spread across the age range.

There are only a couple of possiblities that spring to my mind:-
a) widespread infection in an intermediate vector such as pigs in the area, leading to multiple point sources of human infections
b) human index cases that went undetected (when set against the high levels of background deaths in the region e.g. H1N1 and other respiratory viral diseases, including JE etc) leading to multiple human infections i.e what is being reported now could be 2nd or 3rd generation infections

Other options anyone?

[alert]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

By mass exposure, I didn't mean a single event; perhaps "common, ongoing exposure" would have been more accurate. Nipah is widespread in bats, which would likely be the intermediate vector. The obvious explanation is that all these people may have had contact with infected bats, or with fruit or juice contaminated by such bats. Several of the articles suggest that if that was the case, contaminated fruit or juice could be widespread. I think that's essentially option (a) above.

I don't think it's possible that too many Nipah cases could be missed; this illness is so severe and unusual that the reports started coming immediately after the fatalities started Tuesday. The WHO bulletin on Nipah above indicates that the incubation period is 4-45 days. Just because not much H2H has occurred does not mean that it might not, however. I have seen a couple articles that suggest an R0 for Nipah of about 0.5 (see below).

I agree that this is odd; it's why personally I had thought something insect-borne might have been more likely. It will take some investigation on the ground to determine exactly how this happened.

[alert]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

http://www.bdnews24.com/details.php?id=186448&cid=13

In Bangladesh, half of the reported cases between 2001 and 2008 were due to human-to-human transmission, the WHO website says.

------------

OK. Using the above information, I calculate an R0 of 0.5 for Nipah as follows:

Suppose a disease has an R0 of 0.5. Imagine that one person is infected by an animal. Then he infects 0.5 people. That 0.5 people then infects 0.25 (0.5 x 0.5) people. Repeating this, one gets a total of:

1 + 0.5 + 0.25 + 0.125 + ...

as a geometric series, whose sum is 2. So you have 2.0 infections, of which 1.0 is the result of H2H, and 1.0 was the result of the animal infection. Thus half of the cases would be the result of H2H.

That's why I estimate an R0 of 0.5 for Nipah in Bangladesh.

[Vibrant62]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

On this basis, so long as the R0 of this outbreak remains at the level you have calculated, it should naturally die out with quarantine of infected individuals.

[Laidback Al]

Re: 19 died, others fall sick of unknown disease in Bangladesh- report it's Nipah

General maps for reference. Hantibandha Upazila