Transmission of Nipah Virus - 14 Years of Investigations in Bangladesh

Birgit Nikolay (1) , Henrik Salje (1) , M. Jahangir Hossain (2, 3) , A.K.M. Dawlat Khan (3) , Hossain M. S. Sazzad (3, 4) , Mahmudur Rahman (5) , Peter Daszak (6) , Ute Ströher (7) , Juliet R. C. Pulliam (8) , A. Marm Kilpatrick (9) , Stuart T. Nichol (7) , John D. Klena (7) , Sharmin Sultana (5) , Sayma Afroj (3, 10) , Stephen P. Luby (11) , Simon Cauchemez (1) , Emily S. Gurley (3, 12)

1 Modélisation mathématique des maladies infectieuses - Mathematical modelling of Infectious Diseases
2 MRC - Medical Research Council Unit The Gambia
3 ICDDR,B - International Centre for Diarrhoeal Disease Research, Bangladesh
4 UNSW - University of New South Wales [Sydney]
5 IEDCR - Institute of Epidemiology Disease Control and Research [Dhaka, Bangladesh]
6 EcoHealth Alliance [New York]
7 CDC - Centers for Disease Control and Prevention [Atlanta]
8 Stellenbosch University
9 UC Santa Cruz - University of California [Santa Cruz]
10 AU - Auburn University
11 Stanford University
12 Johns Hopkins Bloomberg School of Public Health [Baltimore]

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.)

Domains: Statistics [math.ST]; Life Sciences [q-bio]

Birgit Nikolay, Henrik Salje, M. Jahangir Hossain, A.K.M. Dawlat Khan, Hossain M. S. Sazzad, et al.. Transmission of Nipah Virus - 14 Years of Investigations in Bangladesh. New England Journal of Medicine, 2019, 380 (19), pp.1804-1814. ⟨10.1056/NEJMoa1805376⟩. ⟨pasteur-03326039⟩