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The deadly Nipah virus, which is carried by bats and occasionally infects people, is more likely to be transmitted from person to person when the infected patient is older, male and/or has breathing difficulties, according to a study co-led by scientists at the Johns Hopkins Bloomberg School of Public Health.

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The study, published May 9 in the New England Journal of Medicine, is, to date, the most comprehensive evaluation of person-to-person transmission during Nipah virus outbreaks. These outbreaks, all in Asia, have been relatively small to date, but the fatality rates at the outbreak level have been very high, ranging from 40 to 100 percent.

Epidemiologists fear that Nipah virus, a distant cousin of the measles virus, could mutate to become much more infectious among humans and cause a catastrophic pandemic. The findings suggest that reducing exposure to respiratory secretions from infected patients should be a priority in future outbreak responses.

“As health systems evolve and patients get more hands-on care from clinical staff and undergo more invasive procedures in places where Nipah virus outbreaks occur, there may be opportunities for wider transmission in hospitals,” says study co-senior author Emily Gurley, PhD, associate scientist in the Department of Epidemiology at the Bloomberg School. “By understanding the factors that influence transmission, we can reduce our future vulnerability to this dangerous pathogen.”

Nipah virus was first identified in 1999 following an outbreak in Malaysia that led to the deaths of more than 100 people in a pig-farming region and the culling of more than a million pigs from local farms. Nipah virus’ principal animal hosts are fruit bats that are found widely throughout much of the globe—from Australia, across tropical Asia and through to the east coast of Africa. But the virus sometimes spreads to pigs and other animals, as well as humans. Gurley was the senior author on a 2016 study that found bat-contaminated date palm sap was the most common source of human outbreaks in Bangladesh.

Read more at the Johns Hopkins Bloomberg School of Public Health

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