I’ve been really interested in Nipah over this past quarter
and over Thanksgiving Dr. Luby was kind enough to entertain my questions. Steve
Luby is cited in virtually every single paper on Nipah in Bangladesh and I’m
really glad I got the chance to talk with him.
One question I had about Nipah is how to best understand the
differences between the Malaysian and Bangladesh outbreaks. Nipah first came to
the world’s attention in an outbreak in commercial pig farmers in Malaysia in
1998. The disease spread from there to Singapore. Nipah outbreaks have occurred
every year in Bangladesh beginning in 2001.
The Nipah in Bangladesh and neighboring West Bengal have been
characterized by higher rates of respiratory disease, higher mortality rates,
and human-to-human transmission. Date palm sap has been implicated as an
important route of virus transmission from Pteropus
fruit bats to humans.
Dr. Luby had a number of really insightful things to say
about the disease. He said that it’s possible that the Malaysian outbreak was
just a more mild strain. However, he thought that the differences more likely have
to do with differences in supportive care and the viral dose. Bangladesh has a much poorer health care
system than Malaysia. Only one or two patients have been intubated in
Bangladesh despite the severity of the disease. This could easily explain the
higher mortality rates in Bangladesh. Additionally, in animal studies, animals
given a larger dose are more likely to develop pneumonia. People drinking date
palm sap contaminated with bat feces or saliva may have been exposed to higher
doses of virus.
Interestingly despite human-to-human transmission of Nipah
in Bangladesh, there haven’t been any nosocomial cases. Dr. Luby highlighted
how crowded government hospitals are and that family members usually do most of
the care, which would explain why health workers aren’t getting sick.
Ironically, hospitals are a place where disease can easily spread.
I also wondered why Nipah has just recently become a problem.
Rather than attribute the disease outbreak to a change in bat ecology, Dr. Luby
thought that this was more likely a reporting issue. For example, people in
Faridpur previously thought that Nipah was an outbreak of avian influenza.
Bangladesh has just put in good surveillance for outbreak and response and there
still isn’t surveillance in place in West Bengal, India. Luby thinks that it is
likely that this zoonotic spillover has been happening for centuries. We just
recently have the diagnostic tools and the surveillance in place to find
it.
By Olivia
By Olivia
6 comments:
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