news desk Lord, save her
in Follow-up cases of Nipah virus Notified in Bangladesh in 2023, From 4th January 2023 till 13th February 2023, 11 cases (10 confirmed and 1 probable) including eight deaths (case fatality rate 73%) were reported across two districts in Bangladesh, According to the World Health Organization.
This is the highest number of cases since 2015 when 15 cases including 11 deaths were reported.
Six cases were reported from Dhaka district including four deaths from Narsingdi districts (one death), Rajbari (four cases including three deaths) and Shariatpur (one case). Rajshahi division reported five cases including four deaths from the districts of Naugaon (two cases including one death), Natur (one death), Papna (one death), and Rajshahi (one death)
Since 2001, Bangladesh has reported seasonal outbreaks of Nipah virus infection between December and May, corresponding to the palm sap harvest season (DPS) occurring in the country from November to March. Reported cases ranged from zero (in 2002, 2006, and 2016) to 67 (in 2004). Fewer reported cases have been observed since 2016 after a massive advocacy campaign against the consumption of raw palm sap.
The following public health response has been implemented by the Government of Bangladesh.
coordination:
- The Communicable Disease Control Unit and Directorate General of Health Services (CDC-DGHS) held an emergency meeting on January 28, 2023 with all department directors, civilian surgeons, health and family planning staff and other public health experts to discuss response and strategize for the outbreak.
monitoring:
- Outbreaks including contact tracing are being investigated by the National Rapid Response Team (NRRT) in collaboration with the International Center for Disarmament Research, b.
- CDC-DGHS, IEDCR, Office of Health Education, ICDDR, B, and WHO, focus on strengthening the existing surveillance system; formulating a strategy for immediate interventions; and information, education and communication (IEC) content for advocacy and awareness.
case management:
- The Center for Disease Control and Prevention (CDC-DGHS) and senior physicians at Dhaka Medical Hospital are strengthening case management. The hospital’s COVID-19 intensive care unit (ICU) beds have been temporarily reassigned to manage a case of Nipah virus infection.
- The Infectious Diseases Hospital (IDH) in Dhaka has been designated to support the quarantine and isolation of suspected Nipah virus cases.
Infection prevention and control:
- Healthcare workers at all levels are required to optimally monitor infection prevention and control, including wearing masks and gloves, investigating and managing cases locally, and only referring cases to Dhaka for management when necessary.
- the National guideline for management, prevention and control of Nipah virus infection It is reviewed and updated, with a focus on safety measures for healthcare workers and infection, prevention, and control (IPC).
Risk communication and community engagement:
- Risk and Community Engagement (RCCE) advocacy and communication activities are ongoing.
- Two Nipah hotline numbers, one at IEDCR and the other at ICDDR, B, have been activated with the aim of collecting official and unofficial reports on Nipah cases and also to satisfy general inquiries of the public about Nipah and other infectious diseases.
WHO risk assessment
WHO rates overall risk as high at the national level for the following reasons:
- Although cases of Nipah virus infection have been reported in Bangladesh almost every year, 11 cases and eight deaths have already been reported in 2023, which is unusual compared to the past seven years.
- The death rate due to Nipah virus infection is high (73%). The initial signs and symptoms of Nipah virus infection are nonspecific, and the diagnosis is often not suspected at the time of presentation. This can hinder accurate diagnosis and create challenges in outbreak detection, timely and effective infection control measures, and outbreak response activities.
- There are currently no specific drugs or vaccines available for Nipah virus infection although the World Health Organization has designated Nipah as a priority disease for the WHO Research and Development Scheme. Intensive supportive care is recommended for severe respiratory and neurological complications.
- Currently, the level of awareness among the general population remains low, despite ongoing efforts to communicate about the risks and community involvement.
- There has already been one case of suspected human-to-human transmission during the current outbreak, and secondary cases were previously reported in Bangladesh.
- Fruit bats or flying foxes (Patyrops species.), the natural reservoir of Nipah virus, is present in Bangladesh and the genetic diversity of Nipah virus isolated from infected persons in Bangladesh indicates high diversity of the virus in the wildlife reservoir and frequent spread of the virus from its reservoir to the population.
The risk at the regional level is moderate as Rajshahi district borders India. Although there have not been any cases of cross-border transmission by humans previously, this risk remains given the common ecological pathway of the natural host of the virus (fruit bats or flying foxes) and its presence between domestic animals and humans previously in both countries. India has also had previous outbreaks of Nipah virus infection.
The global risk assessment is low given the lack of a natural host in many countries and the fact that there were no previous cases outside of Bangladesh, India, Malaysia and Singapore.
