Eight people have died in Bangladesh after consuming contaminated raw date palm sap.

From early January to mid-February, 11 cases including eight deaths from the Nipah virus have been reported across two divisions in Bangladesh. This is the highest number of illnesses since 2015.

Of the 11 cases, four were female and seven were male. The median age of patients is 16, ranging from 15 days to 50 years old. Ten people had a history of drinking date palm sap while the 15-day-old infant is considered a secondary case.

Estimated incubation periods ranged from 3 to 15 days with a median of 14 days. All 11 cases were hospitalized following the onset of symptoms.

Six cases were reported from Dhaka including four deaths from the districts of Narsingdi, Rajbari, and Shariatpur. Rajshahi recorded five cases and four deaths from the districts of Naogaon, Natore, Pabna, and Rajshahi.

The World Health Organization (WHO) assessed the risk as high at the national level, moderate at the regional level, and low globally.

Preventing the disease
Nipah virus infection can be transmitted to humans through contact with sick animals or food products contaminated by the body fluids of infected animals. It can also be spread from person to person through close contact with an infected individual. Fruit bats are the natural hosts for the Nipah virus. There are currently no drugs or vaccines available for the infection.

Efforts to prevent transmission should focus on decreasing bat access to date palm sap and other fresh food products. Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of bat bites should be discarded, said health officials.

Nipah virus outbreaks are seasonal in Bangladesh, with cases usually occurring annually between December and May, alongside the harvesting season of date palm sap in the country from November to March.

In recent years, infections have ranged from zero in 2016 to eight in 2019. There was an extensive campaign in 2016 advising against the consumption of raw date palm sap. However, the level of awareness among the population is low, despite risk communication and community engagement efforts.

Infected people initially develop symptoms including fever, headaches, muscle pain, vomiting, and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate swelling of the brain (encephalitis).

Some people also experience severe respiratory problems. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours. Most people who survive acute encephalitis make a full recovery, but long-term neurologic conditions have been reported.