Bangladesh - 36 dead from Nipah Virus

[Ronan Kelly]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Official count from IEDCR;

Nipah Outbreak at Lalmonirhat

From February 2011, Nipah outbreak occurred in Hatibandha Upazila under Lalmonirhat district which is in northern part of Bangladesh. Till to date (7th February, 2011) there are 24 cases and 17 deaths. Several joint teams of IEDCR and ICDDRB are working in the field. These teams are epidemiology team, qualitative team and veterinarian team. Laboratory tests were done at IEDCR.


Daily Update on Hatibandha, Lalmonirhat Outbreak: (Updated on 7th February, 2011)
Number of Cases: 24
Number of Deaths: 17

http://www.iedcr.org/

 

[Treyfish]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

08/02/2011 00:45:00 Admin
Nipah virus under control, claim health officials

javascript:tsz('article_body','12px') javascript:tsz('article_body','16px')
Staff Correspondent
Four people from Rangpur and Nilphamari are admitted to Rangpur Medical College Hospital with symptoms similar to nipah infection, director general of directorate of health services Khandaker Shefayet Ullah said on Monday.
Shefayet Ullah, who visited the northern division on Monday, told New Age, ?Based on symptoms, the doctors assumed that they might be nipah infected. The patients are being treated in isolation. But we can confirm about the infection after laboratory tests.?
He said panicked people who had left Hatibandha in fear of the ?mystry disease? might be spreading the virus in the other Upazilas.
Shefayet Ullah said they were working to restore confidence in the community people. ?Frightened people left their homes in panic. Now we are working to involve the local people including the rural elite and political leaders to fight the epidemic.?
He also said that the emergency units at the government hospitals were not well equipped. He said that the government has planned to develop the emergency units of all the district hospitals and hospitals besides the highways.
There was no fresh case of nipah infection at Hatiban-dha in the last couple of days, he said adding it seemed that the situation is now under control at the Upazila.
Institute of Epidemiology, Diseases Control and Research senior scientific officer Mushtak Hossain told New Age that there was no death caused by nipah virus on Monday.
?But we examined a new patient at Hatibandha who has some symptoms like nipah virus infection,? said Mustak.
He said they had provided training to the health workers of the area so that they can handle the cases of nipah infection.
Death toll from encephalitis caused by nipah virus at Hatibandha in Lalmonirhat reached 25 till Monday, according to local sources.
However, the IEDCR confirmed the death of 17 people out of 24 nipah infected patients in the area.
The outbreak of the virus was first marked a week back in Hatibandha. IEDCR laboratory reports later confirmed it was virus nipah.
The government has, meanwhile, intensified surveillance and measures including distribution of leaflets and closing down of all educational institutions in the Hatibandha Upazila for a week to check the spread of the virus.:tiphat:http://newagebd.com/newspaper1/national/8011.html

 

[Treyfish]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Lalmonirhat exempted from hartal as Nipah virus kills two more :tiphat:
http://bangladesh-web.com/

 

[alert]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

http://www.bdnews24.com/details.php?id=186825&cid=13

Lab testing of nipah virus underway
Tue, Feb 8th, 2011 9:50 pm BdST Dial 2000 from your GP mobile for latest news



Dhaka, Feb 8 (bdnews24.com) ? The Institute of Epidemiology, Disease Control and Research is collecting blood samples from suspected nipah cases in northern Bangladesh for lab tests.

IEDCR Director Prof Mahmudur Rahman said they would test 30 such samples on Wednesday.

"All were collected from surveillance site at Rangpur Medical College Hospital and two other districts of the region," Rahman told bdnews24.com without giving the name of those districts.

He, however, said that no new cases were reported from Hatibandha where 17 people died of nipah infection out of 24.

"We collected the samples to see whether it was nipah," he said urging people not to panic rather be 'aware of the virus that enters into human only after drinking raw date sap or eating bat-bitten fruits.'

Director General for health Dr Khandaker Md Shefayetullah on Monday told bdnews24.com that 'they were suspecting the virus could be spreading across the northern region, although it seemed to be waning in Hatibandha.'

The DG said the IEDCR team was working on allaying panic among the jittery people of Hatibandha.

Team leader Dr M Mushtuq Husain said they were holding awareness campaigns with local people and they are having a positive impact.

"People stopped drinking raw sap. We are monitoring those who had come in contact with the infected people as the virus can pass from person to person," he said.

They team observe them for the next two weeks (until incubation period is over).

According to IEDCR, nipah was first detected in Malaysia in 1998, but at present Bangladesh, a hotspot for emerging diseases, is the only country in the world that reports nipah infection.

It spreads between December and April, when people collect sap from date tree.

Meherpur, Naogoan, Rajbari, Faridpur, Tangail, Thakurgoan, Kushtia, Manikganj, and Rangpur are the districts where the highly fatal virus was detected.

The outbreak of the virus was in Hatibandha first reported on January 31. IEDCR lab reports confirmed the virus nipah on February 4.

Since its first outbreak in 2001 in Meherpur, the virus has so far killed 130 people out of 176 affected, including the recent deaths.

IEDCR suggests nursing patients carefully. "Those who take care of patients should wash their hands with soap and use mask to protect themselves," the director said.

"Patient's cough and spit should be collected in a pot and buried underground," he said.

bdnews24.com/nih/am/2135h

 

[Vibrant62]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Nipah suspected in Rangpur
Tue, Feb 8th, 2011

http://www.bdnews24.com/details.php?id=186738&cid=2

Rangpur, Feb 7 (bdnews24.com) — Four people were admitted to Rangpur Medical College with symptoms similar to those of Nipah infection.

Director general of health directorate Khondaker Mohammad Sefayetullah .....said that doctors were suspecting Nipah ... "However, nothing can be confirmed before laboratory tests."

He said people were leaving their houses in panic. "We are trying to subdue their fear and bring back sense."

Experts say only awareness can combat the virus, which ..... has a 75 percent mortality rate in Bangladesh.

and Nipah encephalitis claimed one more life in Rangpur yesterday raising the death toll to 25.

Nipah kills another in Rangpur
http://www.thedailystar.net/newDesign/news-details.php?nid=173323

Moyez Uddin, 45, of Annodanagar in Pirgachha upazila, died at Rangpur Medical College Hospital around 5:00am. He was admitted to the hospital on Saturday.

In Kurigram, two people are suspected to have died from the virus on Sunday.

The deceased are Anwarul Islam, 16, of Hemerkuthi village of sadar upazila and one-year-old Moon of Gharial Danga union of Rajarhat upazila.

...
"A medical team led by Civil Surgeon, referred Anwarul to Rangpur Medical College Hospital suspecting it a case of Nipah encephalitis," he added

 

[Emily]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Anisur Rahman Khan, a blogger in Bangladesh reports that schools are being closed to contain the virus.

http://arrkhan.blogspot.com/2011/02/schools-closed-to-contain-nipah.html

 

[Ronan Kelly]

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Re: Bangladesh - 25 dead from Nipah Virus, 23 under treatment

Nipah kills 2 more
Death toll stands at 27
Star Online Report

Nipah encephalitis claimed two more lives at Rangpur Medical College Hospital (RMCH) on Thursday, raising the death toll to 27.


Eleven-year-old Moni hailed from Bilaimari village in Parbatipur upazila of Dinajpur and Muktar, 45, from Gobindaganj upazila of Gaibandha, died at the RMCH at about 12:00pm and 12:30pm respectively, hospital sources said.


Moni was admitted to the hospital with high fever on Tuesday while Muktar on Wednesday, reports our Rangpur correspondent.


...

Eighteen Nipah encephalitis-infected people are now undergoing treatment at RMCH.
http://www.thedailystar.net/newDesign/latest_news.php?nid=28396

 

[Vibrant62]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

These two deaths seem to be from a 'new' area - Al, not being lazy (just cant work out the map technology) but is there any chance of an updated map?

 

[Laidback Al]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

These two deaths seem to be from a 'new' area - Al, not being lazy (just cant work out the map technology) but is there any chance of an updated map?

The current Nipah outbreaks seems to have spread to four zilas (Districts). Here is a map.

 

[JimO]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Are there still no reports of cases across the border into India?

 

[Ronan Kelly]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Nothing yet Jim. There have been viral encephalitis outbreaks in the West in Gujarat and Maharashtra, but nothing from the Eastern states.

 

[Vibrant62]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

We also need to remember that set against a background of low level fatalities due to a host of illnesses, the odd death here or there wont be remarked upon - its only when deaths cluster and reach a higher number that any outbreak comes to the attention of the authorities.

Anywhere between 3 - 6 days time is when the average incubation period for Nipah will be up after the first reported cluster of infections, and we will very likely see more cases. The critical question will be in what numbers the cases occur, and where.

 

[JimO]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Forgive the dumb questions, but from what I have read, nipah viruses can transmit H2H, but can they evolve like the flu virus to acquire a more efficient H2H transmissibility and use humans as a primary host? In other words, could nipah present a realistic regional epidemic threat that becomes adapted to humans?

 

[alert]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Possibly. No one really knows, but that is certainly something to keep an eye out for. Nipah is a paramyxovirus, the same family that contains the measles virus, which is a solely human pathogen, so that is certainly not unreasonable.

Note the timing on the new cases reported below; perhaps the incubation period for the Nipah outbreak going on is shorter than previous outbreaks for whatever reason (muation, unusual exposure, etc.). That might explain the unusual epidemiology. Note also the possible mention of milder cases.

http://www.thedailystar.net/newDesign/news-details.php?nid=173755

Friday, February 11, 2011
Front PageNipah claims 2 more lives
Star ReportNipah encephalitis claimed two more lives in Dinajpur and Gaibandha yesterday, raising the death toll to 27.

Masuma Akhter Moni, 11, of Belaichandi village in Parbatipur upazila of Dinajpur, and Muktar, 45, of Gobindaganj upazila of Gaibandha, died at Rangpur Medical College Hospital around 12:00noon.

Moni was admitted to the hospital with high fever on Tuesday while Muktar on Wednesday, said a source at the hospital.

Contacted, Dr Towfiqur Rahman, director of the hospital, confirmed the deaths.

Md Monsur Ali Sarker, civil surgeon of Dinajpur, visited Belaichandi village in Parbatipur.

Eighteen Nipah encephalitis infected people are now undergoing treatment at RMCH, hospital sources said.

Meanwhile, Dr Khondoker Mohammad Shefayetullah, director general of the Directorate General of Health Services yesterday said that no new cases of Nipah virus infection were found in the last four days.

“The infection of Nipah virus is now under control. The crisis period is over and there is almost no chance of secondary infection,” said Dr Shefayetullah at a press conference at the auditorium of Institute of Epidemiology, Disease Control and Research (IEDCR).

Meantime, three people from Rajbari were admitted to Dhaka Medical College Hospital last night with symptoms of Nipah virus, DMCH sources said.

The three are Abul Kalam, 55, his son Rusel, 18, and his nephew Abul Kalam, 18.

Kalam's wife Asma Begum told this correspondent that five members of her family fell sick after taking some date juice on Monday.

Two of them, however, recovered by taking some medicines at home.

The three were first taken to Faridpur Medical College Hospital where the doctors refused to admit them.

They then went to Enam Medical College Hospital at Savar yesterday morning. After some initial tests, doctors suspected them to be affected with Nipah virus and referred them to Mohakhali Infectious Disease Hospital.

Refused to be admitted, they finally came to DMCH.

 

[Vibrant62]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

It is also possible that the first cases were attributed to another cause and went undetected, with some earlier H2H2 transmission - or in other words, this outbreak could be further along than previously supposed.

It looks like the deaths in the next report are the ones detailed in the post above.

Nipah claims two more lives
http://www.thefinancialexpress-bd.com/more.php?news_id=125789&date=2011-02-11

Two more people have died in Rangpur reportedly of Nipah virus, hours after the authorities said the deadly virus was under control. Rangpur Medical College director Dr Toufiqul Islam told the news agency that the deceased had Nipah-like symptoms, though it could not be confirmed. The two - one aged about 45 and another 11 - died between noon and 12.30 pm Thursday.

— bdnews24.com

 

[Vibrant62]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Apologies Alert - I see your point vis a vis the report that the family fell sick within days after consuming date juice.

I wonder if they asked her about date juice consumption prior to this - for example the week before? That would be more consistent with the known incubation period.

Another point of concern is the refusal of three hospitals to admit the patients referred to in the latter part of the report; how frequently is this occurring, and how many people are ill and dying within their homes? These hospitals are a long way apart, and for the poor in Bangladesh it may be beyond their means to travel these distances. I suspect that many would go home and consult the local fakir after the first or second try to get help at the hospitals.

Does anyone also know about state health provision here, i.e does it all have to be paid for in part or whole?

 

[Vibrant62]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

From http://cid.oxfordjournals.org/content/49/11/1743.full

This may explain healthcare providers concerns

"In both the Faridpur outbreak in 2004 and the Thakurgaon outbreak in 2007, persons who were in a room when a Nipah patient was coughing or sneezing were at increased risk of Nipah virus infection [21, 23]. Across all recognized outbreaks in Bangladesh from 2001 through 2007, Nipah patients with respiratory symptoms were more likely to transmit Nipah [27].

The capacity for NiV to spread in hospital settings to both staff and patients, was clearly illustrated in a large outbreak affecting 66 people in Siliguri, India in 2001. The outbreak apparently originated from an unidentified patient admitted to Siliguri District Hospital who transmitted infection to 11 additional patients, all of whom were transferred to other facilities. In 2 of the facilities, subsequent transmission infected 25 staff and 8 visitors [25].

There is a lot of high quality epidemiological information in this paper which is well worth studying.

On symptomology

"In Bangladesh, severe respiratory disease is more common [in Nipah infection cf Malasia], with 62% of cases having cough, 69% developing respiratory difficulty, and available chest radiographs showing diffuse bilateral opacities covering the majority of the
lung fields [31]. "

This is very similar to what you might expect with a severe H1N1 infection, or for that matter an H5N1 infection. And,

And finally

(1) the annual total per capita spending on health is $12 per person per year [44];
(2) over 99% of respiratory disease and over 99% of acute meningoencephalitis in Bangladesh is not caused by Nipah;
(3)most of the people who contract Nipah are dead by the time the diagnosis is considered by local practitioners;

Further excerpts of note follow below and basically summarise what we dont know.

" Unanswered questions regarding Nipah transmission include the following:
(1) Why is respiratory disease and person-toperson transmission more common among human NiV infection in Bangladesh compared to Malaysia? Are certain strains of virus more likely to cause respiratory tract disease in humans, or might the different clinical syndromes in Bangladesh and Malaysia reflect differences in host susceptibility from malnutrition or other causes?
(2) How stable is the genome of Nipah? The overall nucleotide homology between a prototypical Malaysian strain of NiV and a strain of NiV from Bangladesh was 91.8% [28]. Is there a substantial risk of mutation that would improve the efficiency of person-to-person transmission of the virus?
(3) How common is unrecognized, including subclinical, infection with NiV?

 

[alert]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Apologies Alert - I see your point vis a vis the report that the family fell sick within days after consuming date juice.

I wonder if they asked her about date juice consumption prior to this - for example the week before? That would be more consistent with the known incubation period.

Another point of concern is the refusal of three hospitals to admit the patients referred to in the latter part of the report; how frequently is this occurring, and how many people are ill and dying within their homes? These hospitals are a long way apart, and for the poor in Bangladesh it may be beyond their means to travel these distances. I suspect that many would go home and consult the local fakir after the first or second try to get help at the hospitals.

Does anyone also know about state health provision here, i.e does it all have to be paid for in part or whole?

Agreed. A family that consumed the juice on Monday and got ill Wednesday might also have consumed infected juice the week before, fixing the incubation period. However, the sudden start of this outbreak (14 deaths in the first two days) also raises suspicions that something unusual might be resulting in a shorter incubation period than previously reported.

I also wonder whether the timing reported might be incorrect; it seems the five family members did an awful lot (several hospitals, etc.) in a very short period of time. Perhaps the reporters are errantly compressing time, and perhaps the events reported in the first few articles of this thread actually occurred over several weeks, as the death toll per day seems to have slowed considerably.

 

[Ronan Kelly]

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 27 dead from Nipah Virus, 18 under treatment

Nipah kills 2 more, toll reaches 29

Encephalitis Virus disease cycle.
Star Online ReportNipah encephalitis claimed two more lives at Rangpur Medical College Hospital (RMCH) on Friday, raising the death toll to 29.


Four-year-old Mim hailed from Satighat village in Joldhaka upazila of Nilphamari and Hamida, 28, from Nilphamari sadar upazila, died at the RMCH at about 12:00am and 3:00am respectively, reports our Rangpur Correspondent.

...

http://www.thedailystar.net/newDesign/latest_news.php?nid=28413

 

[Ronan Kelly]

Re: Bangladesh - 29 dead from Nipah Virus, 18 under treatment

Re: Bangladesh - 29 dead from Nipah Virus, 18 under treatment

Nipah kills another
Star Online ReportNipah encephalitis claimed one more life at Rangpur Medical College Hospital (RMCH) Saturday morning, raising the death toll to 30.


Monoranjan, 4, son of Dhirendra Nath of Kaharol upazila of Dinajpur, was admitted to the RMCH with high fever on Friday.


He died at about 9:00am Saturday, reports our Rangpur correspondent.

...

http://www.thedailystar.net/newDesign/latest_news.php?nid=28422