Published on March 13, 2014
Identifying Emerging Zoonotic Pathogens among Humans in Bangladesh Dr. Pritimoy Das, MBBS, MPH Research Investigator Surveillance and Outbreak Investigation Research Group CCD, icddr,b February 19, 2013 firstname.lastname@example.org 1
Burden: Most emerging infectious diseases are coming from animals Photo courtesy: Ivan V. Kuzmin et al (2011) 60% of emerging infectious diseases were zoonoses 72% of those had an origin in wildlife 2 Jones, K. E. et al. Global trends in emerging infectious diseases. Nature 451, 990–993 (2008)
Global hotspots for Emerging Pandemic Threats (EPT) http://avianflu.aed.org/eptprogram/ Bangladesh 3
Transmission of Zoonotic Infections from Animal to Human • From domestic animals • From wild animals • Through eating contaminated foods • Consuming contaminated drinks 4
Domestic animals (sick) – Contact with sick or dead animals – Handling (infected) raw meat or skin – Slaughtering sick animals – Bites and scratches 5 Anthrax outbreaks in Bangladesh. icddr,b • Health and Science Bulletin • Vol. 8 No. 4 • December 2010 Sick http://groups.yahoo.com/group/BdOsint/message/7190 http://www.demotix.com/photo/1391241
– Contact during hunting – Bites and scratches – Handling infected raw meat or skin – Close contact with animals in zoo, circus… 6 Photo: M. Monirul H. Khan. A guide to wild life. 2008 http://www.wildlifeextra.com/go/news/kali-puja.html http://www.methowvalleynews.com/story.php?id=1867 http://www.aurorahealthcare.org/yourhealth/housecalls/display.asp?Type=EA&ID=125 Wild animals
7 http://www.humanplanetblog.com/?tag=hunters Eating infected wild animal meat (Raw or under-cooked)
8 Khan MSU, Hossain J, Gurley ES, Nahar N, Sultana R, Luby SP. Ecohealth. 2010 Dec;7(4):517–25 Consuming contaminated foods or drinks http://www.willgoto.com/pictures/pictures.asp?Picture_Id=adfcc3da- ca3a-4eaf-9feb-435715969d21&Language=1&Destination=222
Some recently emerging zoonotic infections in Bangladesh Avian Influenza Japanese Encephalitis Nipah 9http://www.nanocid.com/english/news9.htm http://rupeerains.com/articles/public-health/japanese-encephalitis-menace-in-india-reasons-prevention-and-control-2/
Nipah outbreaks in Bangladesh 225 cases & 172 deaths From 2001 to 2013* 10 Dr. Hossain M S Sazzad, Nipah surveillance and outbreak, icddr,b (Personal communication) *Updated on 13-02-2013
Nipah outbreaks linked with the consumption of Raw Date Palm Sap 11Rahman MA, Hossain MJ, Sultana S, Homaira N, Khan SU, Rahman M, et al. Date palm sap linked to Nipah virus outbreak in Bangladesh, 2008. Vector Borne Zoonotic Dis. 2012 Jan;12(1):65–72.
Nipah virus is notthe only virus harbored by Pteropus bats that may threaten human health 12 http://www.naturephoto-cz.com/indian-flying-fox-photo-3714.html http://www.epernicus.com/mv31 http://-biology-.piczo.com/nipahvirus?cr=6
Recent work with Pteropus giganteus in Bangladesh has led to the discovery of GBV-D, a new virus. 13Epstein JH, Quan P-L, Briese T, Street C, Jabado O, Conlan S, et al. PLoS Pathog. 2010; 6:e1000972
• A survey of bat specimens from Bangladesh completed in November 2012 revealed a total of 55newly identified viruses. http://liambean.hubpages.com/hub/ Simon Anthony, Center for Infection and Immunity, Columbia University (Personal communication)
We Do Not Know - • Whether any newly identified bat viruses also infect humans • What additional zoonotic pathogens are causing disease in Bangladesh 15
Objectives: To measure the sero-prevalence of bat viruses in adult humans with high exposure to bats and/or date palm sap To identify zoonotic viruses among hospitalized patients with acute respiratory illnesses or meningoencephalitis and high risk exposure to wild or sick domestic animals 1 2 16
Main Outcomes • Discovery of infections with newly described bat viruses in humans • Identification of zoonotic pathogens causing diseases in Bangladesh 17
Study site and study population: 12 villages with highest date palm sap (DPS) consumption and/or highest contact with bats 200 high risk adults (age ≥18 years) Objective 1: Community Survey 18
Village List 19 2 more villages from Rangpur District
Discussion with village people to identify areas where high risk people reside Identify potential high risk adults with bat and/or date palm sap exposure Apply rapid screening questionnaire Finding study subjects 20 Objective 1: Community Survey
Bat and Date Palm Sap Exposure Screening 1. Do you consume fresh date palm sap two or more times per week during the cold harvesting season (approximately October - March)? 2. Did you consume tari at least once in the last six months? 3. In the last six months, did you catch or handle fruit bats (badur)? 4. Have you consumed fruit bats (badur) in the last 5 years? 21 Objective 1: Community Survey
22 If screen positive: offer enrollment If consent given: details of exposure & blood collection Sample test for evidence of infection with newly identified bat viruses Enrollment, data collection & test Objective 1: Community Survey
Sample testing 1/3 rd to the Center for Infection and Immunity lab, Columbia University, USA For virus discovery 2/3 rd to store in icddr,b lab for future tests Blood Serum 23 Objective 1: Community Survey
Study site and study population: 12 Hospital Based Influenzae Surveillance (HBIS) hospitals: Focus on Severe Acute Respiratory Infection (SARI) 3 Meningoencephalitis (ME) surveillance hospitals- Rajshahi MCH Rangpur MCH Faridpur MCH Objective 2: Hospital Survey 24 Courtesy to HBIS team for the Original map
SARI or ME patients in 14 surveillance hospitals Apply Rapid Screening Questionnaire Finding study subjects Existing activity New activity 25 Objective 2: Hospital Survey
Screening Questionnaire for SARI or ME Patients 1. In the three weeks prior to becoming ill: a. Did you slaughter, prepare or consume meat from a sick domestic animal? b. Were you bitten or scratched by a wild animal (i.e. rodent, bat, or primate)? c. Did you catch, slaughter, prepare, or consume a wild animal? d. Did you consume fresh date palm sap or 'Tari'? 2. Do you work as a veterinarian, butcher, skinner, or zoo worker? 26 Objective 2: Hospital Survey
27 Screen positive: offer study enrollment Consent given: details of exposure & sample collection Sample sent for routine tests as per existing HBIS/ ME protocol Routine test negative: sample tested for all known pathogens by multi-pathogen detecting process No known pathogen found: sample tested for pathogen discovery Enrollment, data collection & testing Existing activity New activity Objective 2: Hospital Survey
PDAfor data collection 28 Data collection instrument: http://www.onlineuniversities-weblog.com/50226711/2008/09/page/2
Specimens to be collected Community HBIS platform ME platform Blood* Nasal swab Blood Oral swab CSF Blood* Oral swab Urine 29 * Samples to be collected under this protocol
Timeline 30 2012 2013 2014 2015 Protocol development and submission to RRC /ERC Staff recruitment J F M A M J J A S O N D Hospital activity J F M A M J J A S O N D Community serologic survey J F M A M J J A S O N D Sample testing and site investigation J F M A M J J A S O N D
Summary: • Community serological survey: 200 high risk adults from 12 villages Specimen to be sent to Center for infection and Immunity laboratory, Columbia University, for viral discovery. • Hospital Surveillance: 14 selected hospitals screening for positive zoonotic exposure If positive & no known pathogen identified sample to be sent for pathogen discovery. 31
Collaboration with: 32
Investigators • icddr,b – Emily S Gurley (PI) – James Heffelfinger – Katharine S Ramirez – Pritimoy Das – Hossain Sazzad – Ziaur Rahman • IEDCR – Mahmudur Rahman • Columbia University – W Ian Lipkin – Simon Anthony – Amit Kapoor • Stanford University – Stephen Luby – John Openshaw • EcoHealth Alliance – Peter Daszak – Jonathan Epstein Donor: 33
Acknowledgements • Diana, Meghan & Dorothy for their writing support • Kishor Das for his statistical support 34
35 Photo: M. Monirul H. Khan. A guide to wild life. 2008
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