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Hassan MZ, Shirin T, Satter SM, Rahman MZ, Bourner J, Cheyne A, Torreele E, Horby P, Olliaro P. Nipah virus disease: what can we do to improve patient care? THE LANCET. INFECTIOUS DISEASES 2024; 24:e463-e471. [PMID: 38185127 DOI: 10.1016/s1473-3099(23)00707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
The year 2023 marked the 25th anniversary of the first detected outbreak of Nipah virus disease. Despite Nipah virus being a priority pathogen in the WHO Research and Development blueprint, the disease it causes still carries high mortality, unchanged since the first reported outbreaks. Although candidate vaccines for Nipah virus disease exist, developing new therapeutics has been underinvested. Nipah virus disease illustrates the typical market failure of medicine development for a high-consequence pathogen. The unpredictability of outbreaks and low number of infections affecting populations in low-income countries does not make an attractive business case for developing treatments for Nipah virus disease-a situation compounded by methodological challenges in clinical trial design. Nipah virus therapeutics development is not motivated by commercial interest. Therefore, we propose a regionally led, patient-centred, and public health-centred, end-to-end framework that articulates a public health vision and a roadmap for research, development, manufacturing, and access towards the goal of improving patient outcomes. This framework includes co-creating a regulatory-compliant, clinically meaningful, and context-specific clinical development plan and establishing quality standards in clinical care and research capabilities at sites where the disease occurs. The success of this approach will be measured by the availability and accessibility of improved Nipah virus treatments in affected communities and reduced mortality.
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Affiliation(s)
- Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK.
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Syed M Satter
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mohammed Z Rahman
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Josephine Bourner
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Ashleigh Cheyne
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Els Torreele
- Institute for Innovation and Public Purpose, University College London, London, UK; Independent Researcher and Advisor, Geneva, Switzerland
| | - Peter Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Piero Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
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Shahrin L, Nowrin I, Afrin S, Rahaman MZ, Al Hasan MM, Saif-Ur-Rahman KM. Monitoring and evaluation practices and operational research during public health emergencies in southeast Asia region (2012-2022) - a systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 21:100340. [PMID: 38361592 PMCID: PMC10866922 DOI: 10.1016/j.lansea.2023.100340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 02/17/2024]
Abstract
This systematic review aimed to explore the monitoring and evaluation (M&E) and operational research (OR) practices during public health emergencies (PHE) in the southeast Asian region (SEAR) over the last decade. We searched electronic databases and grey literature sources for studies published between 2012 and 2022. The studies written in English were included, and a narrative synthesis was undertaken. A total of 29 studies were included in this review. Among these 25 studies documented M&E and four studies documented OR practices. The majority of the studies were from India and Bangladesh, with no evidence found from Sri Lanka, Bhutan, Myanmar, and Timor-Leste. M&E of surveillance programs were identified among which PHE due to COVID-19 was most prevalent. M&E was conducted in response to COVID-19, cholera, Nipah, Ebola, Candida auris, and hepatitis A. OR practice was minimal and reported from India and Indonesia. India conducted OR on COVID-19 and malaria, whereas Indonesia focused on COVID-19 and influenza. While most SEAR countries have mechanisms for conducting M&E, there is a noticeable limitation in OR practices. There is a compelling need to develop a standard framework for M&E. Additionally, enhancing private sector engagement is crucial for strengthening preparedness against PHE. Furthermore, there is a necessity to increase awareness about the importance of conducting M&E and OR during PHE.
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Affiliation(s)
- Lubaba Shahrin
- Clinical and Diagnostic Services, icddr,b, Dhaka, Bangladesh
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
| | - Iffat Nowrin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sadia Afrin
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Md Zamiur Rahaman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - KM Saif-Ur-Rahman
- College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
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Satter SM, Nazneen A, Aquib WR, Sultana S, Rahman MZ, Klena JD, Montgomery JM, Shirin T. Vertical Transfer of Humoral Immunity against Nipah Virus: A Novel Evidence from Bangladesh. Trop Med Infect Dis 2022; 8:16. [PMID: 36668923 PMCID: PMC9866109 DOI: 10.3390/tropicalmed8010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
A major obstacle to in-depth investigation of the immune response against Nipah virus (NiV) infection is its rapid progression and high mortality rate. This paper described novel information on the vertical transfer of immune properties. In January 2020, a female aged below five years and her mother from Faridpur district of Bangladesh were infected. Both had a history of raw date palm sap consumption and were diagnosed as confirmed NiV cases. The daughter passed away, and the mother survived with significant residual neurological impairment. She conceived one and a half year later and was under thorough antenatal follow-up by the surveillance authority. A healthy male baby was born. As part of routine survivor follow-up, specimens were collected from the newborn and tested for NiV infection at the reference laboratory to exclude vertical transmission. Although testing negative for anti-Nipah IgM and PCR for NiV, a high titre of anti-Nipah IgG was observed. The transfer of humoral immunity against NiV from mother to neonate was confirmed for the first time. The article will serve as a reference for further exploration regarding NiV-specific antibodies that are transferred through the placenta, their potential to protect newborns, and how this may influence vaccine recommendations.
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Affiliation(s)
- Syed Moinuddin Satter
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Arifa Nazneen
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Wasik Rahman Aquib
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sharmin Sultana
- Institute of Epidemiology, Disease Control & Research, 44 Mohakhali, Dhaka 1212, Bangladesh
| | - Mohammed Ziaur Rahman
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control & Research, 44 Mohakhali, Dhaka 1212, Bangladesh
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McKee CD, Islam A, Rahman MZ, Khan SU, Rahman M, Satter SM, Islam A, Yinda CK, Epstein JH, Daszak P, Munster VJ, Hudson PJ, Plowright RK, Luby SP, Gurley ES. Nipah Virus Detection at Bat Roosts after Spillover Events, Bangladesh, 2012-2019. Emerg Infect Dis 2022; 28:1384-1392. [PMID: 35731130 PMCID: PMC9239894 DOI: 10.3201/eid2807.212614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Knowledge of the dynamics and genetic diversity of Nipah virus circulating in bats and at the human-animal interface is limited by current sampling efforts, which produce few detections of viral RNA. We report a series of investigations at Pteropus medius bat roosts identified near the locations of human Nipah cases in Bangladesh during 2012–2019. Pooled bat urine was collected from 23 roosts; 7 roosts (30%) had >1 sample in which Nipah RNA was detected from the first visit. In subsequent visits to these 7 roosts, RNA was detected in bat urine up to 52 days after the presumed exposure of the human case-patient, although the probability of detection declined rapidly with time. These results suggest that rapidly deployed investigations of Nipah virus shedding from bat roosts near human cases could increase the success of viral sequencing compared with background surveillance and could enhance understanding of Nipah virus ecology and evolution.
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Skowron K, Bauza-Kaszewska J, Grudlewska-Buda K, Wiktorczyk-Kapischke N, Zacharski M, Bernaciak Z, Gospodarek-Komkowska E. Nipah Virus-Another Threat From the World of Zoonotic Viruses. Front Microbiol 2022; 12:811157. [PMID: 35145498 PMCID: PMC8821941 DOI: 10.3389/fmicb.2021.811157] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022] Open
Abstract
Among the diseases that pose a serious threat to public health, those caused by viruses are of great importance. The Nipah virus (NiV) belonging to the Paramyxoviridae family was reported in Malaysia in 1998/1999. Due to its high mortality in humans, its zoonotic nature, the possibility of human-to-human transmission, and the lack of an available vaccine, the World Health Organization (WHO) has recognized it as a global health problem. Depending on strain specificity, neurological symptoms and severe respiratory disorders are observed in NiV infection. In most confirmed cases of NiV epidemics, the appearance of the virus in humans was associated with the presence of various animal species, but generally, bats of Pteropus species are considered the most important natural animal NiV reservoir and vector. Consumption of contaminated food, contact with animals, and “human-to-human” direct contact were identified as NiV transmission routes. Due to the lack of vaccines and drugs with proven effectiveness against NiV, treatment of patients is limited to supportive and prophylactic.
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Affiliation(s)
- Krzysztof Skowron
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Justyna Bauza-Kaszewska
- Department of Microbiology and Food Technology, Jan and Jędrzej Śniadecki University of Technology in Bydgoszcz, Bydgoszcz, Poland
| | - Katarzyna Grudlewska-Buda
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Natalia Wiktorczyk-Kapischke
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Maciej Zacharski
- Department of Biochemistry and Molecular Biology, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Zuzanna Bernaciak
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Eugenia Gospodarek-Komkowska
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Nikolay B, Ribeiro Dos Santos G, Lipsitch M, Rahman M, Luby SP, Salje H, Gurley ES, Cauchemez S. Assessing the feasibility of Nipah vaccine efficacy trials based on previous outbreaks in Bangladesh. Vaccine 2021; 39:5600-5606. [PMID: 34426025 DOI: 10.1016/j.vaccine.2021.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nipah virus (NiV) is an emerging, bat-borne pathogen that can be transmitted from person-to-person. Vaccines are currently being developed for NiV, and studies have been funded to evaluate their safety and immunogenicity. An important unanswered question is whether it will be possible to evaluate the efficacy of vaccine candidates in phase III clinical trials in a context where spillovers from the zoonotic reservoir are infrequent and associated with small outbreaks. The objective of this study was to investigate the feasibility of conducting a phase III vaccine trial in Bangladesh, the only country regularly reporting NiV cases. METHODS We used simulations based on previously observed NiV cases from Bangladesh, an assumed vaccine efficacy of 90% and other NiV vaccine target characteristics, to compare three vaccination study designs: (i) cluster randomized ring vaccination, (ii) cluster randomized mass vaccination, and (iii) an observational case-control study design. RESULTS The simulations showed that, assuming a ramp-up period of 10 days and a mean hospitalization delay of 4 days,a cluster-randomized ring vaccination trial would require 516 years and over 163,000 vaccine doses to run a ring vaccination trial under current epidemic conditions. A cluster-randomized mass vaccination trial in the two most affected districts would take 43 years and 1.83 million vaccine doses. An observational case-control design in these two districts would require seven years and 2.5 million vaccine doses. DISCUSSION Without a change in the epidemiology of NiV, ring vaccination or mass vaccination trials are unlikely to be completed within a reasonable time window. In this light, the remaining options are: (i) not conducting a phase III trial until the epidemiology of NiV changes, (ii) identifying alternative ways to licensure such as observational studies or controlled studies in animals such as in the US Food and Drug Administration's (FDA) Animal Rule.
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Affiliation(s)
- Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | | | - Marc Lipsitch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Stephen P Luby
- Infectious Diseases and Geographic Medicine Division, Stanford University, Stanford, CA, USA
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge, UK.
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
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McKee CD, Islam A, Luby SP, Salje H, Hudson PJ, Plowright RK, Gurley ES. The Ecology of Nipah Virus in Bangladesh: A Nexus of Land-Use Change and Opportunistic Feeding Behavior in Bats. Viruses 2021; 13:169. [PMID: 33498685 PMCID: PMC7910977 DOI: 10.3390/v13020169] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Nipah virus is a bat-borne paramyxovirus that produces yearly outbreaks of fatal encephalitis in Bangladesh. Understanding the ecological conditions that lead to spillover from bats to humans can assist in designing effective interventions. To investigate the current and historical processes that drive Nipah spillover in Bangladesh, we analyzed the relationship among spillover events and climatic conditions, the spatial distribution and size of Pteropus medius roosts, and patterns of land-use change in Bangladesh over the last 300 years. We found that 53% of annual variation in winter spillovers is explained by winter temperature, which may affect bat behavior, physiology, and human risk behaviors. We infer from changes in forest cover that a progressive shift in bat roosting behavior occurred over hundreds of years, producing the current system where a majority of P. medius populations are small (median of 150 bats), occupy roost sites for 10 years or more, live in areas of high human population density, and opportunistically feed on cultivated food resources-conditions that promote viral spillover. Without interventions, continuing anthropogenic pressure on bat populations similar to what has occurred in Bangladesh could result in more regular spillovers of other bat viruses, including Hendra and Ebola viruses.
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Affiliation(s)
- Clifton D. McKee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Ausraful Islam
- Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh;
| | - Stephen P. Luby
- Infectious Diseases and Geographic Medicine Division, Stanford University, Stanford, CA 94305, USA;
| | - Henrik Salje
- Department of Genetics, Cambridge University, Cambridge CB2 3EJ, UK;
| | - Peter J. Hudson
- Center for Infectious Disease Dynamics, Pennsylvania State University, State College, PA 16801, USA;
| | - Raina K. Plowright
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT 59717, USA;
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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Wong MCS, Huang J, Teoh JYC, Wong SH. Identifying a Capability Framework That Could Mitigate the Coronavirus Disease 2019 Pandemic in a Global Health Community. J Infect Dis 2020; 222:880-881. [PMID: 32563189 PMCID: PMC7337870 DOI: 10.1093/infdis/jiaa357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin C S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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