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In-Depth Assessment of an Outbreak of Nipah Encephalitis with Person-to-Person Transmission in Bangladesh: Implications for Prevention and Control Strategies

Continued Nipah encephalitis outbreaks in Bangladesh highlight the need for preventative and control measures to reduce transmission from bats to humans and human-to-human spread. Qualitative research was conducted at the end of an encephalitis outbreak in Faridpur, Bangladesh in May 2004 and continued through December 2004. Methods included in-depth interviews with caretakers of cases, case survivors, neighbors of cases, and health providers. Results show contrasts between local and biomedical views on causal explanations and appropriate care. Social norms demanded that family members maintain physical contact with sick patients, potentially increasing the risk of human-to-human transmission. Initial treatment strategies by community members involved home remedies, and public health officials encouraged patient hospitalization. Over time, communities linked the outbreak to supernatural powers and sought care with spiritual healers. Differing popular and medical views of illness caused conflict and rejection of biomedical recommendations. Future investigators should consider local perceptions of disease and treatment when developing outbreak strategies.

Received July 9, 2008. Accepted for publication September 17, 2008.

Acknowledgments: We thank Steve Luby and Emily Gurley (International Centre for Diarrhoeal Disease Research, Bangladesh) for technical support, and the study respondents for the time they gave to share their often tragic experiences.

Financial support: This study was supported by the United States Agency for International Development (USAID) (grant no. 00089). The International Centre for Diarrhoeal Disease Research, Bangladesh acknowledges with gratitude the commitment of USAID to the Center’s research efforts.

^* Address correspondence to Lauren S. Blum, American Embassy Kinshasa, Unit 2220, Box 178, DPO, AE 09828-0178. E-mail: laurensblum{at}yahoo.com

Authors’ addresses: Lauren S. Blum, American Embassy Kinshasa, Unit 2220, Box 178, DPO, AE 09828-0178, E-mail: laurensblum{at}yahoo.com. Rasheda Khan and Nazmun Nahar, International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh, E-mails: rkhan{at}icddrb.org and mnnahar{at}icddrb.org Robert F. Breiman, Global Disease Detection Division, Centers for Disease Control and Prevention–Kenya Medical Research Institute, Mbagathi Way, Off Mbagathi Road, Nairobi, Kenya, E-mail: RBreiman{at}ke.cdc.gov.

^* A pseudonym is used to protect the identity of the person.

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