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Volume 14, Number 10—October 2008

Research

Risk Factors for Nipah Virus Encephalitis in Bangladesh1

Joel M. Montgomery2Comments to Author , Mohamed J. Hossain, E. Gurley, D.S. Carroll, A. Croisier, E. Bertherat, N. Asgari, P. Formenty, N. Keeler, J. Comer, M.R. Bell, K. Akram, A.R. Molla, K. Zaman, Mohamed R. Islam, K. Wagoner, J.N. Mills, P.E. Rollin, T.G. Ksiazek, and R.F. Breiman
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.M. Montgomery, D.S. Carroll, N. Keeler, J. Comer, M.R. Bell, K. Wagoner, J.N. Mills, P.E. Rollin, T.G. Ksiazek); International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh (M.J. Hossain, E. Gurley, R.F. Breiman); World Health Organization, Geneva, Switzerland (A. Croisier, E. Bertherat, N. Asgari, P. Formenty); World Health Organization, Dhaka (K. Akram, K. Zaman); Institute of Epidemiology Disease Control and Research, Dhaka (A.R. Molla, M.R. Islam);

Main Article

Table 2

Exposures and activities associated with Nipah virus infection, Bangladesh, December 2003–January 2004*

Exposure or activity No. (%) study participants with reported exposure or activity†
Case-patients, n = 12 Controls, n = 36 OR (95% CI) p value‡
Animal exposure
Touched any ill animal§ 9 (75) 31 (85) 1.8 (0.29–8.52) 0.613
Touched or observed a dead animal§ 6/10 (60) 12 (34) 2.4 (0.4–616.5) 0.392
Killed any animal§ 3 (25) 6 (16) 1.8 (0.2–79.51) 0.670
Other animal exposures
Contact with animal stool 2/9 (22) 12 (35) 0.5 (0.05–3.04) 0.679
Visited a poultry farm 3 (25) 13 (37) 0.6 (0.08–3.29) 0.740
Observed fruit bats around household at night 
 (1 mo before outbreak)
4/11 (36)
7 (19)
4.1 (0.27–261.9)
0.491
Outdoor activity
Climbed trees 10 (83) 19 (51) 8.2 (1.25–∞) 0.025
Picked fruit from trees 8 (67) 18 (49) 3.2 (0.54–36.0) 0.262
Picked fruit from the ground 7/11 (64) 27 (74) 0.79 (0.13–6.09) 1.000
Fished 6 (50) 10 (28) 4.5 (0.69–49.7) 0.139
Hunted 2/10 (20) 10 (28) 7.3 (0.38–432.6) 0.240
Played hide and seek 8/11 (73) 21 (58) 4.3 (0.38–∞) 0.256
Played cricket 4 (33) 18 (51) 0.5 (0.09–2.76) 0.552
Played soccer
5 (42)
9 (24)
2.4 (0.44–16.9)
0.403
Exposure to human illness
Had contact with a suspect or probable Nipah virus encephalitis case-patient 8 (67) 3 (9) 21.4 (2.78–966.1) <0.001
Visiting a hospital
12 (100)
7 (19)
32.4 (5.18–∞)
<0.0001
Consumption of fruit
Bananas¶ 11 (92) 24 (67) 4.9 (0.61–226.7) 0.199
Buroys 7 (58) 28 (77) 0.4 (0.078–2.37) 0.433
Papaya 3 (25) 14 (40) 0.49 (0.08–2.24) 0.497
Guava 2 (17) 12 (33) 0.5 (0.05–2.70) 0.608
Sofeda 1 (8) 2 (5) 2.0 (0.03–38.4) 0.976
Kamranga
1 (8)
3 (9)
1.0 (0.006–165.9)
1.000
Other environmental exposures
Drinking raw DPS 10/11 (91) 26 (72) 4.1 (0.47–197.0) 0.328
Harvesting DPS 3 (25) 3 (8) 3.4 (0.37–43.6) 0.365
Drinking DPS from collection vessel 5/10 (50) 12 (32) 1.7 (0.36–8.34) 0.612
Someone in household collects DPS 4 (33) 5 (15) 2.3 (0.38–13.3) 0.454

*OR, odds ratio; CI, confidence interval; DPS, date palm sap.
†Data are no. of study participants responding affirmatively/total no. responding (%) unless otherwise noted.
‡Exact method using univariate conditional logistic regression.
§Cows, horses, sheep, goats, pigs, ducks, chickens, dogs, cats, or fruit bats.
¶Fruit was obtained from a market or another person, if not picked directly from the tree or ground.

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1Presented in part at the 54th Annual Meeting of the American Society of Tropical Medicine and Hygiene, 2004 Nov 7–11, Miami, Florida, USA.

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