Nipah outbreak investigation in one health approach, January 2023 in the Northern Region of Bangladesh
Abir Shaqran Mahmood, Md Sayik Bin Alam, Md Abu Sayeed, Nabila Nujhat Chowdhury, Wasik Rahman Akib, Dewan Imtiaz Rahman, Kamal Ibne Amin Chowdhury, Fateha Akhter Ema, Md Zulqarnine Ibne Noman, Md Arif Khan, Ahmad Raihan Sharif, Mohammad Ferdous Rahman Sarker, Sharmin Sultana, Mohammed Ziaur Rahman, Ariful Islam, Nazneen Akhter, Syed Moinuddin Satter, Tahmina Shirin
Corresponding author: Abir Shaqran Mahmood, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh 
Received: 26 Dec 2024 - Accepted: 25 Oct 2025 - Published: 16 Mar 2026
Domain: Epidemiology,Infectious diseases epidemiology,Public health emergencies
Keywords: Nipah virus, encephalitis, outbreaks, zoonotic spillover, one health, Bangladesh
Funding: This work received no specific grant from any funding agency in the public, commercial, or non-profit sectors.
This article is published as part of the supplement Teaching Case Studies in Field Epidemiology and Public Health for the Eastern Mediterranean Region, commissioned by Mirwais Amiri, Eastern Mediterranean Public Health Network, (EMPHNET ), href="mailto:mamiri@emphnet.net"> ✉ .
©Abir Shaqran Mahmood et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Abir Shaqran Mahmood et al. Nipah outbreak investigation in one health approach, January 2023 in the Northern Region of Bangladesh. Pan African Medical Journal. 2026;53(1):14. [doi: 10.11604/pamj.supp.2026.53.1.46346]
Available online at: https://www.panafrican-med-journal.com//content/series/53/1/14/full
PDF in process Case study 
Nipah outbreak investigation in one health approach, January 2023 in the Northern Region of Bangladesh
Nipah outbreak investigation in one health approach, January 2023 in the Northern Region of Bangladesh
Abir Shaqran Mahmood1,&, Md Sayik Bin Alam1, Md Abu Sayeed1, Nabila Nujhat Chowdhury1, Wasik Rahman Akib2, Dewan Imtiaz Rahman2, Kamal Ibne Amin Chowdhury2, Fateha Akhter Ema2, Md Zulqarnine Ibne Noman1,2, Md Arif Khan1, Ahmad Raihan Sharif1, Mohammad Ferdous Rahman Sarker1, Sharmin Sultana1, Mohammed Ziaur Rahman2, Ariful Islam1, Nazneen Akhter1, Syed Moinuddin Satter2, Tahmina Shirin1
&Corresponding author
Nipah virus is a pandemic potential viral disease. On 13 January 2023, a confirmed case of Nipah Virus Disease (NiV) was reported through Nipah Enhanced Surveillance. We investigated to determine the scope and magnitude of the outbreak and the source of infection, also to explore the contributing perception, cultural patterns to control and prevent further spread. Face-to-face interviews of the contacts were performed between 14-28 January 2023. An operational case definition was prepared for identifying confirmed, probable cases and contacts. Data were collected by semi-structured questionnaire both prospectively (to identify other cases and line listing) and retrospectively (to obtain information on notified cases). Blood and throat swabs were collected from high risk and symptomatic contacts for detection of NIV infection by RT-PCR and ELISA. On 23 December 2022, eleven members of the same family drank Raw Date Palm Sap (RDPS) in Naogaon. Twelve days later, a 13-year-old boy and his 50-year-old aunt developed fever, diarrhoea, restlessness, incoherent speech and became unconscious. The boy was admitted into ICU later and survived, but the woman died before investigation. We identified total 107 contacts. And we tested 55 high-risk and symptomatic contacts and all were negative for NiV by RT-PCR. We maintained regular follow-ups according to protocol. Four bat roosts were found within a 10km radius (including the nearest roost which was within 2 km) from the source tree where the relative of the cases collected RDPS. We identified one confirmed and one probable case of NiV infection. The outbreak was contained since there were no cases among the contacts. We suspect the source of NiV was RDPS. As there is no specific vaccine and therapeutics, community awareness and enhanced surveillance can aid early detection and control of spillover events.
General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 20 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor´s notes for facilitation are coupled with each question in the instructor´s guide to aid facilitation.
Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.
Prerequisites: before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.
Materials needed: Flash drive, flip charts, markers, computers with MS Excel
Level of training and associated public health activity: Novice - Outbreak investigation
Time required: 2-3 hours
Language: English
- Download the case study student guide;
- Request the case study facilitator guide.
The authors declare no competing interests.
We wish to acknowledge Institute of Epidemiology, Disease Control and Research (IEDCR), MoHFW, US-CDC Bangladesh country office, all the members of ICDDR,B and EcoHealth Alliance Nipah Surveillance and outbreak investigation team, other partners, FETP,B team, Dr. Gretchen Cowman, Prof. Dr. Mahmudur Rahman and the Eastern Mediterranean Public Health Network (EMPHNET) for their support to develop this case study. Artificial Intelligence (AI) like chatgpt was used to facilitate some answers of the questions prepared for the facilitator´s guide of this case study.
Figure 1: chronological sequence of events on notified cases
Figure 2: contribution of the outbreak investigation team members
Figure 3: location of the contacts of the Nipah cases
Figure 4: the date palm tree identified by the team
Figure 5: locations of date palm tree and site of exposure of Nipah Cases in Naogaon Sadar, Bangladesh, Jan 2023
Figure 6: location of bat roosts along with the aerial distance from the source tree
Figure 7: health Education materials distributed in the community (originally printed in local language Bangla and then translated to English version here for the readers)
- World Health Organization. WHO to identify pathogens that could cause future outbreaks and pandemics. 2022. Accessed on 30 September 2024.
- Satter SM, Aquib WR, Sultana S, Sharif AR, Nazneen A, Alam MR et al. Tackling a global epidemic threat: Nipah surveillance in Bangladesh, 2006-2021. PLoS Negl Trop Dis. 2023 Sep 27;17(9):e0011617 eCollection 2023 Sep. PubMed | Google Scholar
- Chua KB. Nipah virus outbreak in Malaysia. J Clin Virol. 2003 Apr;26(3):265-75. PubMed | Google Scholar
- Hsu VP, Hossain MJ, Parashar UD, Ali MM, Ksiazek TG, Kuzmin I et al. Nipah virus encephalitis reemergence, Bangladesh. Emerg Infect Dis. 2004 Dec;10(12):2082-7. PubMed | Google Scholar
- IEDCR. Nipah Virus Transmission in Bangladesh. Internet. 2023.
- Shirin T. Nipah virus (NiV) surveillance. National Bulletin of Public Health. 2024;4(2):6-7.
- Sultana S, Shirin T. Nipah - the deadly disease and public health concern. National Bulletin of Public Health. 2018;1(3):10-13.
Search
This article authors
On Pubmed
- Abir Shaqran Mahmood
- Md Sayik Bin Alam
- Md Abu Sayeed
- Nabila Nujhat Chowdhury
- Wasik Rahman Akib
- Dewan Imtiaz Rahman
- Kamal Ibne Amin Chowdhury
- Fateha Akhter Ema
- Md Zulqarnine Ibne Noman
- Md Arif Khan
- Ahmad Raihan Sharif
- Mohammad Ferdous Rahman Sarker
- Sharmin Sultana
- Mohammed Ziaur Rahman
- Ariful Islam
- Nazneen Akhter
- Syed Moinuddin Satter
- Tahmina Shirin
On Google Scholar
- Abir Shaqran Mahmood
- Md Sayik Bin Alam
- Md Abu Sayeed
- Nabila Nujhat Chowdhury
- Wasik Rahman Akib
- Dewan Imtiaz Rahman
- Kamal Ibne Amin Chowdhury
- Fateha Akhter Ema
- Md Zulqarnine Ibne Noman
- Md Arif Khan
- Ahmad Raihan Sharif
- Mohammad Ferdous Rahman Sarker
- Sharmin Sultana
- Mohammed Ziaur Rahman
- Ariful Islam
- Nazneen Akhter
- Syed Moinuddin Satter
- Tahmina Shirin
Citation [Download]
Navigate this article
Similar articles in
Key words
Tables and figures
Article metrics
Recently from the PAMJ
Authors´ services
