22 September 2008=
=
Nipah
Virus 10 Years-After-Emergence in Malaysia<=
/st1:country-region>
and Singapore and then
outbreaks in Bangladesh and India
=
University Malaya in Kuala Lumpur<=
/st1:City>,
Malaysia will hold a
conference next month, October 20-21, to present scientific advances and a
historical perspective since the initial emergency of the Nipah virus begin=
ning
September 1998 through June 1999 in Malaysi=
a
and then Singapore. Details can be found at http://nipah.um.edu.my
A partial list of the most salient features of Nipah vir=
us
infection includes:
=
1.&n=
bsp;
The initial outbreak in 1998-99 in Malaysia and Singapore did not have any
documented person-to-person transmission, had an encephalitis-central nervo=
us
system syndrome as their main clinical abnormality, and had a very high case
fatality rate of ~ 40%. The epidemiological link was exposure contact with =
sick
pigs e.g., on pig farms or abbatoirs. Over one million pigs were culled as =
part
of the control measures.
=
2.&n=
bsp;
In early 2001 an outbreak of Nipah virus infection
occurred in Siliguri, India, where patients had both
respiratory illness and encephalitis. The case-fatality rate was ~68%. Nosocomial infection was suggested.=
=
3.&n=
bsp;
From 2001-2008, seven outbreaks of Nipah virus ha=
ve
occurred in Banglade=
sh
(Hossain MJ et al. Clin Infect Dis (April) 2008;=
46:977-984).
No exposure to pigs was noted=
, but
epidemiological links were found to date palm sap possible contaminated with
the virus by bat (pteropid) saliva and also notably person-to-person
respiratory transmission associated with lung disease.
=
4.&n=
bsp;
In =
2008
an additional outbreak occurred in Bangladesh in Feb-March
(ProMED-mail March 3, 2008).
=
5.&n=
bsp;
In 2007 Gurley et al published a study of
“Person-to-Person Transmission of Nipah Virus in a Bangladeshi
Community” (Emerg Infect Dis (July) 2007: 13:1031-37). One person “Patient F”=
, a
local religious leader, had contact with 22/36 (61%) of cases in the outbre=
ak
prior to becoming ill (see Figure 2).
Nipah virus was found on hospital surfaces by RT-PCR testing.
=
6.&n=
bsp;
The cellular receptor has been found for Nipah vi=
rus,
namely “Ephrin-B2. This receptor can be found on cells in the central
nervous system and on blood vessels. Currently there is no antiviral treatm=
ent
or vaccine for this recently emerged virus that is evolving the ability to
spread from person-to-person, cause encephalitis and lung disease, and resu=
lt
in a very high case-fatality rate.
Daniel R. Lucey, MD, MPH
EROne Institutes, Washing=
ton
Hospital Center
Geo=
rgetown University Medical<=
/st1:PlaceName>
Center=
Was=
hington, D.C.
Website for this posting: www.BePast.org
e-mail:DRL23@Georgetown.edu