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Volume 23, Number 9—September 2017

Research

Convergence of Humans, Bats, Trees, and Culture in Nipah Virus Transmission, Bangladesh

Emily S. Gurley1Comments to Author , Sonia T. Hegde2, Kamal Hossain, Hossain M.S. Sazzad, M. Jahangir Hossain3, Mahmudur Rahman, M.A. Yushuf Sharker4, Henrik Salje, M. Saiful Islam, Jonathan H. Epstein, Salah U. Khan, A. Marm Kilpatrick, Peter Daszak, and Stephen P. Luby
Author affiliations: icddr,b, Dhaka, Bangladesh (E.S. Gurley, S.T. Hegde, K. Hossain, H.M.S. Sazzad, M.J. Hossain, M.A. Yushuf Sharker, M.S. Islam, S.U. Khan, S.P. Luby); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.T. Hegde, S.P. Luby); Ministry of Health and Family Welfare, Bangladesh, Dhaka (M. Rahman); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (H. Salje); Institut Pasteur, Paris, France (H. Salje); EcoHealth Alliance, New York, New York, USA (J.H. Epstein, P. Daszak); University of Florida, Gainesville, Florida, USA (S.U. Khan); University of California, Santa Cruz, California, USA (A.M. Kilpatrick); Stanford University, Stanford, California, USA (S.P. Luby)

Main Article

Table 1

Characteristics of villages with cases of Nipah virus infection and control villages, Bangladesh 2011–2013*

Characteristic
Villages with cases, n = 60
Nearby control villages, n = 73
p value†
Distant control villages, n = 74
p value‡
Human population
No. persons in village 1,476 (1,202–1,749) 1.389 (1,102–1,676) 0.20 1,392 (1,010–1,774) 0.10
No. persons/km2
1,168 (1,167–2,169)
1,173 (592–1,754)
0.78
1,335 (456–2,213)
0.95
Pteropus bat population
Proportion of villages where P. medius bats were observed roosting or within 5 km of village boundary 0.85 (0.76–0.94) 0.86 (0.78–0.94) 0.86 0.76 (0.66–0.86) 0.19
No. bats roosting in village or within 5 km of village boundary
554 (319–789)
620 (364–875)
0.60
407 (226–587)
0.37
Proportion of respondents reporting large fruit bats
Roosted nearby during the day in past month 0.25 (0.17–0.34) 0.37 (0.29–0.45) 0.060 0.40 (0.31–0.49) 0.024
Fly overhead at dusk 0.51 (0.43–059) 0.64 (0.56–0.70) 0.019 0.77 (0.71–0.83) <0.001
Visit fruit trees at night 0.43 (0.35–0.51) 0.52 (0.45–0.60) 0.10 0.53 (0.45–0.61) 0.090
Date palm sap and fruiting trees
No. trees in village within a 500-m radius of village boundary 120 (88–152) 95 (78–111) 0.91 101 (65–138) 0.14
Proportion of households with fruiting trees on premises 0.97 (0.94–0.99) 0.97 (0.94–0.98) 0.81 0.94 (0.92–0.96) 0.14
No. fruiting trees on each household premise
56 (46–68)
52 (43–61)
0.81
108 (45–170)
0.47
Human behavior
Proportion of villages with >1 date palm sap collector 0.60 (0.47–0.63) 0.40 (0.29–0.52) 0.026 0.51 (0.40–0.63) 0.32
No. sap collectors in villages 4.5 (1.8–7.3) 2.3 (1.0–3.6) 0.41 3.7 (1.9–5.6) 0.54
Proportion of villages with >1 fresh date palm sap seller 0.38 (0.28–0.51) 0.32 (0.21–0.43) 0.45 0.39 (0.26–0.51) 0.92
No. (%) fresh sap sellers in villages 1.9 (0.6) 0.9 (0.2) 0.16 2.4 (0.6) 0.47
Proportion of households where >1 person drank raw sap 0.61 (0.54–0.68) 0.49 (0.42–0.56) 0.014 0.31 (0.24–0.39) <0.001
Proportion of households where someone drank raw sap >1×/wk during the past harvest season 0.35 (0.27–0.43) 0.29 (0.23–0.35) 0.26 0.21 (0.16–0.27) 0.005
No. household residents who drank >1 glass of raw date palm sap when in season 3.3 (2.7–3.9) 2.1 (1.8–2.5) 0.001 1.5 (1.1–1.9) <0.001
Proportion of villages where >1 household fed raw date palm sap to livestock 0.16 (0.10–0.21) 0.12 (0.06–0.18) 0.66 0.14 (0.08–0.21) 0.78
Proportion of villages where >1 person hunted bats 0.53 (0.40–0.66) 0.64 (0.53–0.75) 0.22 0.27 (0.17–0.38) 0.002
Proportion of households that reported residents ate bitten fruits dropped on the ground 0.42 (0.37–0.48) 0.58 (0.53–0.62) <0.001 0.66 (0.61–0.71) <0.001

*Values are mean (95% CI) except as indicated.
†Comparison of villages with cases of Nipah virus infections with nearby control villages by using generalized linear models that account for correlations within villages for characteristics measured in household surveys.
‡Comparison of villages with cases of Nipah virus infections with distant control villages by using generalized linear models that account for correlations within villages for characteristics measured in household surveys.

Main Article

1Current affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

2Current affiliation: University of Michigan School of Public Health, Ann Arbor, Michigan, USA.

3Current affiliation: Medical Research Council, Banjul, The Gambia.

4Current affiliation: University of Florida, Gainesville, Florida, USA.

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