Anika Tabassum Hiya
Senior
School of Life Sciences
Independent University, Bangladesh
October 6th, 2017
The flying fox, the creature that spread its wings and brought misfortune over Bangladesh. These fruit bats, more specifically identified as Indian flying foxes, are quite common in Bangladesh, and can have wingspans of up to six feet. Alongside being famous as one of the largest bats in the world, this species of fruit bat is also well-known for spreading a deadly virus called Nipah virus – one of the viruses that inspired the movie Contagion. Symptoms can include normal fever, vomiting, dizziness, brain inflammation, hallucinations, seizures, and coma, and mortality rates often exceed fifty percent. An unfortunate aspect of the disease is that there is yet to be a proper vaccine or cure.
But how did a virus in bats which have little to no contact with people end up in people?
There is more than one route that the virus took. In Malaysia, it came into humans from bats indirectly through pigs in farms. In Bangladesh, transmission was tied to a food preference that bats and humans share: the date palm sap. In many villages, it is one of the most popular drinks to have on a winter morning, or even consume in its fermented form as booze. The famous winter pitha-uthshob (pitha is a kind of sweet; uthshob means festival) includes sweet cakes made from the date palm sap. The sap is harvested by cutting a tap into the tree and collecting the sap into a pot. The pot is often left out overnight to collect the sap dripping from the tap, and during this time, the bats can take a few sips from the pot and even urinate in it. This is how the viruses came to be in humans in Bangladesh. Once in humans, person-to-person was possible through bodily secretions or saliva.
Since the 2001 Nipah virus outbreak in Meherpur (a village in Bangladesh), there have been similar small but deadly outbreaks of the virus every few years in various rural regions of Bangladesh. The 2010 outbreak in Faridpur provides a particularly interesting case study in outbreak control [1]. Outbreak control simply refers to limiting the spread of a pathogen through a population by employing a variety of possible strategies such as quarantining and vaccination (if vaccines are available; in this case, it was not). It was the second outbreak of Nipah virus in Faridpur after the big 2004 outbreak, in which 27 out of 36 infected individuals had died.
Early communication efforts during the 2010 outbreak had only focused on instructing people to follow guidelines such as stopping date palm sap consumption, via loudspeakers and household visits. The villagers were not listening, and the outbreak persisted To solve this problem, a team composed of three anthropologists and one sociologist was recruited to help.
Before they could recommend strategies for better communication, they needed to understand the basis of the villagers’ mistrust. To that end, they established a rapport with them through frequent interactions, visits, and conversations. Through actually listening to the villagers, a multitude of issues came to light.
After the 2004 outbreak, locals had remained uncertain as to the cause of death in these individuals, suggesting a lack of effective communication from healthcare professionals at the time. In addition, due to the high mortality rate, locals had developed suspicions over the healthcare providers’ ability to actually help. This mistrust carried over to the 2010 outbreak. The lack of trust in modern medicine reinforced the superstitious leanings of many of the villagers. They came to believe that the deaths were due to a curse that they called asmani bala, a curse sent from the heavens. Instead of going to doctors they resorted to religious healers, who prescribed superstitious treatments such as pani pora (drinking water that has been turned sacred by a priest blowing into it after recitating from the Quran). The early announcements to stop date palm sap consumption had not made it clear that the bats were responsible for transmission via sap. Date palm sap is very dear to these villagers, and they were understandably reluctant to listen to these outsiders who did not even provide a proper justification for their instructions.
Having garnered an improved understanding of the problems, the investigators approached the matter in a more interactive and culturally sensitive manner, trying to take into account the villagers’ social beliefs, norms, and local practices. Instead of simply instructing people to do or not do things, they communicated risks and strategies as part of a conversation with the community, and described the causative mechanism of the illnesses and deaths. They offered solutions such as boiling the sap, and wearing gloves and masks while bathing the dead to prevent coming into contact with bodify fluids containing the virus. Such solutions allowed them to continue following their traditions, but with minimized risk. The villagers responded positively to this interactive approach; not only did they start following the recommended guidelines for preventing bat-to-person and person-to-person transmission, they also began participating in meetings and efforts to control the outbreak. Without this strategy, the outbreak would have been much harder to control.
Effective communication with local communities is essential during disease outbreaks. Fighting a disease becomes much more difficult if victims do not understand how it is caused or how they might prevent it. Epidemics can therefore be dealt with much more efficiently if a holistic approach is taken as in the 2010 Nipah virus outbreak, in which investigators did not spare causative details while communicating with the affected community. The solutions themselves should ideally be sensitive to local culture while effectively dealing with the threat.
Bibliography:
[1] S. Parveen et al., “It’s not only what you say, it’s also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh,” BMC Public Health, vol. 16, pp. 726–726, Aug. 2016.
Anika is a Biochemistry student who loves experimenting with food, and is passionate about science and literature.
Senior
School of Life Sciences
Independent University, Bangladesh
October 6th, 2017
The flying fox, the creature that spread its wings and brought misfortune over Bangladesh. These fruit bats, more specifically identified as Indian flying foxes, are quite common in Bangladesh, and can have wingspans of up to six feet. Alongside being famous as one of the largest bats in the world, this species of fruit bat is also well-known for spreading a deadly virus called Nipah virus – one of the viruses that inspired the movie Contagion. Symptoms can include normal fever, vomiting, dizziness, brain inflammation, hallucinations, seizures, and coma, and mortality rates often exceed fifty percent. An unfortunate aspect of the disease is that there is yet to be a proper vaccine or cure.
But how did a virus in bats which have little to no contact with people end up in people?
There is more than one route that the virus took. In Malaysia, it came into humans from bats indirectly through pigs in farms. In Bangladesh, transmission was tied to a food preference that bats and humans share: the date palm sap. In many villages, it is one of the most popular drinks to have on a winter morning, or even consume in its fermented form as booze. The famous winter pitha-uthshob (pitha is a kind of sweet; uthshob means festival) includes sweet cakes made from the date palm sap. The sap is harvested by cutting a tap into the tree and collecting the sap into a pot. The pot is often left out overnight to collect the sap dripping from the tap, and during this time, the bats can take a few sips from the pot and even urinate in it. This is how the viruses came to be in humans in Bangladesh. Once in humans, person-to-person was possible through bodily secretions or saliva.
How date palm sap is collected. Wikimedia Commons
Since the 2001 Nipah virus outbreak in Meherpur (a village in Bangladesh), there have been similar small but deadly outbreaks of the virus every few years in various rural regions of Bangladesh. The 2010 outbreak in Faridpur provides a particularly interesting case study in outbreak control [1]. Outbreak control simply refers to limiting the spread of a pathogen through a population by employing a variety of possible strategies such as quarantining and vaccination (if vaccines are available; in this case, it was not). It was the second outbreak of Nipah virus in Faridpur after the big 2004 outbreak, in which 27 out of 36 infected individuals had died.
Early communication efforts during the 2010 outbreak had only focused on instructing people to follow guidelines such as stopping date palm sap consumption, via loudspeakers and household visits. The villagers were not listening, and the outbreak persisted To solve this problem, a team composed of three anthropologists and one sociologist was recruited to help.
Before they could recommend strategies for better communication, they needed to understand the basis of the villagers’ mistrust. To that end, they established a rapport with them through frequent interactions, visits, and conversations. Through actually listening to the villagers, a multitude of issues came to light.
After the 2004 outbreak, locals had remained uncertain as to the cause of death in these individuals, suggesting a lack of effective communication from healthcare professionals at the time. In addition, due to the high mortality rate, locals had developed suspicions over the healthcare providers’ ability to actually help. This mistrust carried over to the 2010 outbreak. The lack of trust in modern medicine reinforced the superstitious leanings of many of the villagers. They came to believe that the deaths were due to a curse that they called asmani bala, a curse sent from the heavens. Instead of going to doctors they resorted to religious healers, who prescribed superstitious treatments such as pani pora (drinking water that has been turned sacred by a priest blowing into it after recitating from the Quran). The early announcements to stop date palm sap consumption had not made it clear that the bats were responsible for transmission via sap. Date palm sap is very dear to these villagers, and they were understandably reluctant to listen to these outsiders who did not even provide a proper justification for their instructions.
Having garnered an improved understanding of the problems, the investigators approached the matter in a more interactive and culturally sensitive manner, trying to take into account the villagers’ social beliefs, norms, and local practices. Instead of simply instructing people to do or not do things, they communicated risks and strategies as part of a conversation with the community, and described the causative mechanism of the illnesses and deaths. They offered solutions such as boiling the sap, and wearing gloves and masks while bathing the dead to prevent coming into contact with bodify fluids containing the virus. Such solutions allowed them to continue following their traditions, but with minimized risk. The villagers responded positively to this interactive approach; not only did they start following the recommended guidelines for preventing bat-to-person and person-to-person transmission, they also began participating in meetings and efforts to control the outbreak. Without this strategy, the outbreak would have been much harder to control.
Effective communication with local communities is essential during disease outbreaks. Fighting a disease becomes much more difficult if victims do not understand how it is caused or how they might prevent it. Epidemics can therefore be dealt with much more efficiently if a holistic approach is taken as in the 2010 Nipah virus outbreak, in which investigators did not spare causative details while communicating with the affected community. The solutions themselves should ideally be sensitive to local culture while effectively dealing with the threat.
Bibliography:
[1] S. Parveen et al., “It’s not only what you say, it’s also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh,” BMC Public Health, vol. 16, pp. 726–726, Aug. 2016.
