Search

The lack of good seeds is one of the significant obstacles to Grain Production. This study intends to investigate the circumstances surrounding the availability of quality seeds for rice cultivation and establish policy strategies for quality seed production at the farmer level. The study focused on rice and a significant grain crop, and data were gathered using several survey questionnaires and in-person interviews. The acquired data was gathered and reviewed to write a paper utilizing the quantitative technique. The findings showed that farmers utilize between 70 and 80 percent of their rice seed throughout the research regions. Farmers (20–30%) can acquire rice seeds from NGOs, seed dealers, Bangladesh Agricultural Development Corporation (BADC), the Department of Agricultural Extension (DAE), and other external sources in the most extensive quantities. However, practically all farmers rely entirely on seed dealers or companies for their hybrid rice seeds. Keywords: ; Rice; Food Security; Yield.

ObjectivesThe study aimed to determine the seroprevalence, the fraction of asymptomatic infections, and risk factors of SARS-CoV-2 infections among the Forcibly Displaced Myanmar Nationals (FDMNs).DesignIt was a population-based two-stage cross-sectional study at the level of households.SettingThe study was conducted in December 2020 among household members of the FDMN population living in the 34 camps of Ukhia and Teknaf Upazila of Cox’s Bazar district in Bangladesh.ParticipantsAmong 860 697 FDMNs residing in 187 517 households, 3446 were recruited for the study. One individual aged 1 year or older was randomly selected from each targeted household.Primary and secondary outcome measuresBlood samples from respondents were tested for total antibodies for SARS-CoV-2 using Wantai ELISA kits, and later positive samples were validated by Kantaro kits.ResultsMore than half (55.3%) of the respondents were females, aged 23 median (IQR 14–35) years and more than half (58.4%) had no formal education. Overall, 2090 of 3446 study participants tested positive for SARS-CoV-2 antibody. The weighted and test adjusted seroprevalence (95% CI) was 48.3% (45.3% to 51.4%), which did not differ by the sexes. Children (aged 1–17 years) had a significantly lower seroprevalence 38.6% (95% CI 33.8% to 43.4%) compared with adults (58.1%, 95% CI 55.2% to 61.1%). Almost half (45.7%, 95% CI 41.9% to 49.5%) of seropositive individuals reported no relevant symptoms since March 2020. Antibody seroprevalence was higher in those with any comorbidity (57.8%, 95% CI 50.4% to 64.5%) than those without (47.2%, 95% CI 43.9% to 50.4%). Multivariate logistic regression analysis of all subjects identified increasing age and education as risk factors for seropositivity. In children (≤17 years), only age was significantly associated with the infection.ConclusionsIn December 2020, about half of the FDMNs had antibodies against SARS-CoV-2, including those who reported no history of symptoms. Periodic serosurveys are necessary to recommend appropriate public health measures to limit transmission.

ObjectiveTo evaluate the diagnostic performance and feasibility of rapid antigen testing for SARS-CoV-2 detection in low-income communities.DesignWe conducted a cross-sectional community-based diagnostic accuracy study. Community health workers, who were trained and supervised by medical technicians, performed rapid antigen tests on symptomatic individuals, and up to two additional household members in their households and diagnostic results were calibrated against the gold standard RT-PCR.SettingLow-income communities in Dhaka, Bangladesh.ParticipantsBetween 19 May 2021 and 11 July 2021, 1240 nasal and saliva samples were collected from symptomatic individuals and 993 samples from additional household members (up to two from one household).ResultsThe sensitivity of rapid antigen tests was 0.68 on nasal samples (95% CI 0.62 to 0.73) and 0.41 on saliva (95% CI 0.35 to 0.46), with specificity also higher on nasal samples (0.98, 95% CI 0.97 to 0.99) than saliva (0.87, 95% CI 0.85 to 0.90). Testing up to two additional household members increased sensitivity to 0.71 on nasal samples (95% CI 0.65 to 0.76), but reduced specificity (0.96, 95% CI 0.94 to 0.97). Sensitivity on saliva rose to 0.48 (95% CI 0.42 to 0.54) with two additional household members tested but remained lower than sensitivity on nasal samples. During the study period, testing in these low-income communities increased fourfold through the mobilisation of community health workers for sample collection.ConclusionsRapid antigen testing on nasal swabs can be effectively performed by community health workers yielding equivalent sensitivity and specificity to the literature. Household testing by community health workers in low-resource settings is an inexpensive approach that can increase testing capacity, accessibility and the effectiveness of control measures through immediately actionable results.

In response to unusual crow die‐offs from avian influenza A(H5N1) virus infection during January‐February 2017 in Dhaka, Bangladesh, a One Health team assessed potential infection risks in live bird markets (LBMs). Evidence of aerosolized avian influenza A viruses was detected in LBMs and in the respiratory tracts of market workers, indicating exposure and potential for infection. This study highlighted the importance of surveillance platforms with a coordinated One Health strategy to investigate and mitigate zoonotic risk.

Diagnostics for COVID-19 detection are limited in many settings. Syndromic surveillance is often the only means to identify cases, but lacks specificity. Rapid antigen testing is inexpensive and easy-to-deploy but concerns remain about sensitivity. We examine how combining these approaches can improve surveillance for guiding interventions in low-income communities in Dhaka, Bangladesh. Rapid-antigen-tests and PCR validation was performed on 1172 symptomatically-identified individuals at home. Statistical models were fit to predict PCR status using rapid-antigen-test results, syndromic data, and their combination. Model predictive and classification performance was examined under contrasting epidemiological scenarios to evaluate their potential for improving diagnoses. Models combining rapid-antigen-test and syndromic data yielded equal-to-better performance to rapid-antigen-test-only models across all scenarios. These results show that drawing on complementary strengths across two rapid diagnostics, improves COVID-19 detection, and reduces false-positive and -negative diagnoses to match local requirements; improvements achievable without additional expense, or changes for patients or practitioners.

ObjectiveTo estimate the proportion of SARS-CoV-2 and influenza virus coinfection among severe acute respiratory infection (SARI) cases-patients during the first wave of COVID-19 pandemic in Bangladesh.DesignDescriptive study.SettingNine tertiary level hospitals across Bangladesh.ParticipantsPatients admitted as SARI (defined as cases with subjective or measured fever of ≥38 C° and cough with onset within the last 10 days and requiring hospital admission) case-patients.Primary and secondary outcomesProportion of SARS-CoV-2 and influenza virus coinfection and proportion of mortality among SARI case-patients.ResultsWe enrolled 1986 SARI case-patients with a median age: 28 years (IQR: 1.2–53 years), and 67.6% were male. Among them, 285 (14.3%) were infected with SARS-CoV-2; 175 (8.8%) were infected with the influenza virus, and five (0.3%) were coinfected with both viruses. There was a non-appearance of influenza during the usual peak season (May to July) in Bangladesh. SARS-CoV-2 infection was significantly more associated with diabetes (14.0% vs 5.9%, pConclusionsOur findings suggest that coinfection with SARS-CoV-2 and influenza virus was not very common and had less disease severity considering mortality in Bangladesh. There was no circulating influenza virus during the influenza peak season during the COVID-19 pandemic in 2020. Future studies are warranted for further exploration.

Antimicrobial resistance is a global problem. Surveillance is one of the effective tools to address this multifaceted problem. In Bangladesh a countrywide antimicrobial resistance surveillance is ongoing since 2016-2020. The main objective of this surveillance is to know the sensitivity pattern of some common bacteria which will eventually help to formulate the guideline for the clinician and to assist the policy makers to know the gravity of the AMR problem in Bangladesh. It is a case based surveillance conducted by Institute of Epidemiology, Disease Control & Research (IEDCR) in nine sentinel sites where five types of clinical cases were selected according to case definition, tested in the microbiology department of the sites and ten types of bacteria were identified from six types of preselected specimens and their sensitivity test were done. All the laboratory works were done following the same standard operative procedure supplied by the AMR surveillance Reference laboratory at IEDCR. Total 19,263 samples were processed during the period of March 2017- March 2020 among which wound swab yielded highest growth (57%). E.coli was the highest (1717) isolated organism among the ten priority pathogens which showed highest sensitivity (91%) to Imipenem. Imipenem also showed higher sensitivity to other organisms like K. pneumoniae (77%), Salmonella species (100%), P. aeruginosa (53%) and Acb complex (29%). Third generation cephalosporin like ceftriaxone was found less than 50% sensitive to E.coli (37%) and K.pneumoniae (28%) although Salmonella species showed higher sensitivity (97%) to it. Acb complex, mostly isolated from ICU patients showed alarming resistance to all of the antibiotics and was less than 50% sensitive to even the highest sensitive antibiotic Imipenem (29%). Salmonella species isolated from blood showed higher susceptibility to most of the antibiotics except ciprofloxacin (7%). Alarmingly, only 36% of the Staphylococcus aureus isolates showed susceptibility to cefoxitin indicates high prevalence of MRSA infection. The result of the surveillance representing whole country is surely alarming as many of the bacteria are resistant to the commonly used as well some of the reserve groups of antibiotics. Concerted effort should be taken from all concerned authorities to curb the problem immediately.

A dramatic resurgence of COVID-19 cases and deaths in Bangladesh in March 2021 coincided with the SARS-CoV-2 B.1.351 (501Y.V2) variant of concern rapidly becoming the dominant circulating variant. Concurrently, increasing numbers of reinfections have been detected and the effective Reproductive number, Rt, has doubled, despite high levels of prior infection in Dhaka city. These data support the prediction that acquired immunity from past infection provides reduced protection against B.1.351, and highlights the major public health concern posed by immune escape variants, especially in populations where vaccination coverage remains low.

Background: Diagnostics for COVID-19 detection are limited in many settings. Syndromic surveillance is often the only means to identify cases, despite lack of specificity and asymptomatic cases. Rapid antigen testing is inexpensive and easy-to-deploy but concerns remain about sensitivity. We examine how combining these approaches can improve surveillance for guiding interventions. Methods: Community-based volunteers were trained to syndromically assess potential COVID-19 cases in low-income communities in Dhaka, Bangladesh. Rapid antigen tests and PCR validation was performed on 1172 syndromically-identified individuals at their households. Statistical models were fit to predict PCR status using rapid-antigen-test results, syndromic data, and their combination. Model predictive and classification performance was examined under contrasting epidemiological scenarios to evaluate their potential for improving diagnoses. Findings: Models combining rapid-antigen-test and syndromic data yielded equal performance to rapid-antigen-test-only models in the “Agnostic” scenario and performed better under scenarios of “Low Incidence” and “Epidemic Growth”. Under “Epidemic Growth”, the combined model’s false negative rate is 26 (IQR:24-29) percentage points lower than the rapid-antigen-test-only model’s, with a false positive rate

Replication of influenza A virus (IAV) from negative-sense viral RNA (vRNA) requires the generation of positive-sense RNA (+RNA). Most molecular assays, such as conventional real-time reverse transcriptase PCR (rRT-PCR), detect total RNA in a sample without differentiating vRNA from +RNA. These assays are not designed to distinguish IAV infection versus exposure of an individual to an environment enriched with IAVs but wherein no viral replication occurs. We therefore developed a strand-specific hybridization (SSH) assay that differentiates between vRNA and +RNA and quantifies relative levels of each RNA species. The SSH assay exhibited a linearity of 7 logs with a lower limit of detection of 6.0 × 102 copies of molecules per reaction. No signal was detected in samples with a high load of nontarget template or influenza B virus, demonstrating assay specificity. IAV +RNA was detected 2 to 4 h postinoculation of MDCK cells, whereas synthesis of cold-adapted IAV +RNA was significantly impaired at 37°C. The SSH assay was then used to test IAV rRT-PCR positive nasopharyngeal specimens collected from individuals exposed to IAV at swine exhibitions (n = 7) or while working at live bird markets (n = 2). The SSH assay was able to differentiate vRNA and +RNA in samples collected from infected, symptomatic individuals versus individuals who were exposed to IAV in the environment but had no active viral replication. Data generated with this technique, especially when coupled with clinical data and assessment of seroconversion, will facilitate differentiation of actual IAV infection with replicating virus versus individuals exposed to high levels of environmental contamination but without virus infection.

Background Several refugee settlements in Bangladesh have provided housing and medical care for the forcibly-displaced Myanmar nationals (FDMN, also known as Rohingya) population. The identification of malaria infection status in the refugee settlements is useful in treating infected persons and in developing malaria prevention recommendations. Assays for Plasmodium antigens and human IgG against Plasmodium parasites can be used as indicators to determine malaria infection status and exposure. Methods Dried blood spot (DBS) samples (N = 1239) from a household survey performed April–May 2018 in three settlements in Cox’s Bazar district, Bangladesh were utilized for a sample population of children from ages 1–14 years of age. The samples were tested using a bead-based multiplex antigen assay for presence of the pan-Plasmodium antigen aldolase as well as Plasmodium falciparum histidine rich protein 2 (HRP2). A bead-based multiplex assay was also used to measure human IgG antibody response to P. falciparum, Plasmodium malariae, and Plasmodium vivax merozoite surface protein 1 antigen (MSP1) isoforms, and P. falciparum antigens LSA1, CSP, and GLURP-R0. Results There were no detectable Plasmodium antigens in any samples, suggesting no active malaria parasite infections in the tested children. IgG seroprevalence was highest to P. vivax (3.1%), but this was not significantly different from the percentages of children antibody responses to P. falciparum (2.1%) and P. malariae (1.8%). The likelihood of an anti-Plasmodium IgG response increased with age for all three malaria species. Evidence of exposure to any malaria species was highest for children residing 8–10 months in the settlements, and was lower for children arriving before and after this period of time. Conclusions Absence of Plasmodium antigen in this population provides evidence that children in these three Bangladeshi refugee settlements did not have malaria at time of sampling. Higher rates of anti-malarial IgG carriage from children who were leaving Myanmar during the malaria high-transmission season indicate these migrant populations were likely at increased risk of malaria exposure during their transit.

Background During August 2017–January 2018, more than 700,000 forcibly displaced Rohingyas crossed into Cox’s Bazar, Bangladesh. In response to measles and diphtheria cases, first documented in September and November 2017, respectively, vaccination campaigns targeting children 6 years were not assessed. In MSs, measles seroprotection was similarly high among 1- to 6-year-olds and 7- to 14-year-olds (91% [95% CI 86%–94%] and 99% [95% CI 96%–100%], respectively, p < 0.001). Rubella and diphtheria seroprotection in MSs were significantly lower among 1- to 6-year-olds (84% [95% CI 79%–88%] and 63% [95% CI 56%–70%]) compared to 7- to 14-year-olds (96% [95% CI 90%–98%] and 77% [95% CI 69%–84%]) (p < 0.001). Tetanus seroprevalence was similar among 1- to 6-year-olds and 7- to 14-year-olds (76% [95% CI 69%–81%] and 84% [95% CI 77%–89%], respectively; p = 0.07). Vaccination campaign coverage was consistent with seroprotection in both camps. However, nonresponse, the main limitation of the study, may have biased the seroprotection and campaign coverage results. Conclusions In this study, we observed that despite multiple vaccination campaigns, immunity gaps exist among children in MSs, particularly for diphtheria, which requires serial vaccinations to achieve maximum protection. Therefore, an additional tetanus-diphtheria campaign may be warranted in MSs to address these remaining immunity gaps. Rapid scale-up and strengthening of routine immunization services to reach children and to deliver missed doses to older children is also critically needed to close immunity gaps and prevent future outbreaks., In a cross-sectional study, Leora R. Feldstein and colleagues investigate vaccination coverage and seroprevalence among forcibly-displaced Rohingya children in Cox’s Bazar, Bangladesh in 2018., Author summary Why was this study done? Rohingyas living in camps and makeshift settlements (MSs) are at risk of outbreaks of vaccine-preventable diseases (VPDs). Ongoing outbreaks of measles and diphtheria, despite vaccination campaigns, suggest gaps in immunity for some children. We conducted this survey among Rohingya children to better understand these immunity gaps and risk for ongoing and future outbreaks of VPDs. What did the researchers do and find? We conducted a cross-sectional serologic and vaccine coverage survey in 2 camps in April and May 2018. The youngest children living in the MSs, who are more recent arrivals from Myanmar, had low levels of seroprotection for rubella (84% of children), diphtheria (63%), and tetanus (76%). Seroprotection for the youngest children living in Nayapara registered camp was high for measles, rubella, diphtheria, and tetanus (91%–98% of children). What do these findings mean? These findings suggest that despite vaccination campaigns, immunity gaps remain for VPDs, especially among children who are more recent arrivals from Myanmar and now live in MSs. Remaining immunity gaps may increase the risk of outbreaks of VPDs. An additional diphtheria-tetanus containing vaccine (DTCV) campaign may be beneficial to address the very low seroprotection levels identified among children living in the MSs. Rapid scale-up of routine immunization services is necessary to close remaining immunity gaps among children and those that have missed campaign opportunities. Nonresponse, the main limitation of this study, may have biased the seroprotection and campaign coverage results.

Background We performed a cross-sectional survey in April–May 2018 among Rohingya in Cox’s Bazar, Bangladesh, to assess polio immunity and inform vaccination strategies. Methods and findings Rohingya children aged 1–6 years (younger group) and 7–14 years (older group) were selected using multi-stage cluster sampling in makeshift settlements and simple random sampling in Nayapara registered camp. Surveyors asked parents/caregivers if the child received any oral poliovirus vaccine (OPV) in Myanmar and, for younger children, if the child received vaccine in any of the 5 campaigns delivering bivalent OPV (serotypes 1 and 3) conducted during September 2017–April 2018 in Cox’s Bazar. Dried blood spot (DBS) specimens were tested for neutralizing antibodies to poliovirus types 1, 2, and 3 in 580 younger and 297 older children. Titers ≥ 1:8 were considered protective. Among 632 children (335 aged 1–6 years, 297 aged 7–14 years) enrolled in the study in makeshift settlements, 51% were male and 89% had arrived after August 9, 2017. Among 245 children (all aged 1–6 years) enrolled in the study in Nayapara, 54% were male and 10% had arrived after August 9, 2017. Among younger children, 74% in makeshift settlements and 92% in Nayapara received >3 bivalent OPV doses in campaigns. Type 1 seroprevalence was 85% (95% CI 80%–89%) among younger children and 91% (95% CI 86%–95%) among older children in makeshift settlements, and 92% (88%–95%) among younger children in Nayapara. Type 2 seroprevalence was lower among younger children than older children in makeshift settlements (74% [95% CI 68%–79%] versus 97% [95% CI 94%–99%], p < 0.001), and was 69% (95% CI 63%–74%) among younger children in Nayapara. Type 3 seroprevalence was below 75% for both age groups and areas. The limitations of this study are unknown routine immunization history and poor retention of vaccination cards. Conclusions Younger Rohingya children had immunity gaps to all 3 polio serotypes and should be targeted by future campaigns and catch-up routine immunization. DBS collection can enhance the reliability of assessments of outbreak risk and vaccination strategy impact in emergency settings., Concepción Fernandez Estívariz et al report that Rohingya children aged 1-6 years have immunity gaps to all polio serotypes and should be targeted by future campaigns for catch up immunisation., Author summary Why was this study done? Between August 2017 and January 2018, almost 700,000 Rohingya people arrived in Cox’s Bazar District, Bangladesh, and settled in 2 refugee camps and in makeshift settlements around the camps. Crowding and inadequate access to safe water, sanitation, and healthcare facilitated outbreaks of infectious diseases that spread to the surrounding community. Ongoing outbreaks of measles and diphtheria in May 2018, despite several vaccination campaigns, suggested that some children remained unprotected for vaccine-preventable diseases. We conducted this survey to evaluate immunity against poliovirus and guide new vaccination activities. What did the researchers do and find? We conducted a cross-sectional survey among Rohingya children 1–14 years of age during April–May 2018 that included an interview about vaccines received in recent campaigns and collection of blood samples through finger prick to test for antibodies against poliovirus. Protection against poliovirus type 1 was lower among children aged below 7 years than in older children in the makeshift settlements, despite most children having received several doses of oral polio vaccine in campaigns. Protection against all poliovirus was lowest in children below 3 years of age. What do these findings mean? These findings suggested that children below 7 years of age recently arrived in the camp/settlements had immunity gaps after the vaccination campaigns that increased the risk of polio outbreaks. Based upon this information, we recommended to the agencies that conducted the campaigns that they include polio vaccines in future campaigns targeting only children below 5 years of age. Rapid scale-up of routine immunization services would be necessary to close immunity gaps among children below 2 years of age. Collection of dried blood specimens through finger prick for antibody testing is feasible in emergency settings, and provides crucial information for assessment of outbreak risk and impact of outbreak response strategies.

A 22 year old married woman presented with the complaints of severe dyspareunia, difficulty in conceiving for 18 months, menorrhagia and dysmenorrhoea since menarche. Clinical examination revealed longitudinal vaginal septum. Ultrasound scan revealed two endometrial cavities with a single cervix. Hysterosalpingogram revealed septum which had separated the endometrial cavity with no free spillage of contrast media on both fallopian tubes. Ultrasound KUB and intravenous urethrography did not reveal any abnormality in the urinary system. Resection of vaginal septum, hysteroscopic septoplasty and diagnostic laparoscopy were performed. Three months after the surgery, she was relieved from the symptoms. However, no comments on fertility issue can be made at the moment as the couple is practicing contraceptive methods.

Objective Understanding the costs of influenza-associated illness in Bangladesh may help health authorities assess the cost-effectiveness of influenza prevention programs. We estimated the annual economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh. Design From May through October 2010, investigators identified both outpatients and inpatients at four tertiary hospitals with laboratory-confirmed influenza infection through rRT-PCR. Research assistants visited case-patients' homes within 30 days of hospital visit/discharge and administered a structured questionnaire to capture direct medical costs (physician consultation, hospital bed, medicines and diagnostic tests), direct non-medical costs (food, lodging and travel) and indirect costs (case-patients' and caregivers' lost income). We used WHO-Choice estimates for routine healthcare service costs. We added direct, indirect and healthcare service costs to calculate cost-per-episode. We used median cost-per-episode, published influenza-associated outpatient and hospitalization rates and Bangladesh census data to estimate the annual economic burden of influenza-associated illnesses in 2010. Results We interviewed 132 outpatients and 41 hospitalized patients. The median cost of an influenza-associated outpatient visit was US$4.80 (IQR = 2.93–8.11) and an influenza-associated hospitalization was US$82.20 (IQR = 59.96–121.56). We estimated that influenza-associated outpatient visits resulted in US$108 million (95% CI: 76–147) in direct costs and US$59 million (95% CI: 37–91) in indirect costs; influenza-associated hospitalizations resulted in US$1.4 million (95% CI: 0.4–2.6) in direct costs and US$0.4 million (95% CI: 0.1–0.8) in indirect costs in 2010. Conclusions In Bangladesh, influenza-associated illnesses caused an estimated US$169 million in economic loss in 2010, largely driven by frequent but low-cost outpatient visits.

SummaryBackgroundDuring July 2010, newspapers reported a respiratory disease outbreak in southwestern Bangladesh resulting in the admission of children to a secondary care hospital. We investigated this outbreak to determine the etiology and explore possible risk factors.MethodsThe hospital's physician diagnosed children aged

A simple, selective, linear, precise and accurate ultraviolet detection (UV) method has been developed and applied for the determination of doxycycline hyclate in different pharmaceutical samples. Acid-base analysis and titrimetric method were utilized to determine the value of pH and moisture content of purchased pharmaceutical samples. A mixture of methanol and hydrochloric acid (0.01N methanolic HCl) was used to determine the biochemical properties of doxycycline hyclate. UV detector set at 349 nm was used to monitor the effluent. The purified water was used as solvent. In 1% aqueous solution of doxycycline, three samples (4th, 5th and 7th) showed lower pH values of 1.97, 1.98, and 1.99 respectively. Furthermore, the same samples indicated the additional moisture contents of 2.81%, 2.85% and 2.83% respectively while considering the acceptance level (1.4% to 2.8%). The method proved to be linear (R2 = 0.993), precise (RSD = 0.79% for inter-day precision), accurate (Recovery = 100.59%) and selective regarding possible impurities and excipients of the samples. The doxycycline content obtained in the sample analysis was within the range of 84.05% to 85.80%. The optimized and validated method may be successfully employed to perform routine quality control analyses. Investigation of the pH, moisture content and potency of doxycycline hyclate in different samples give a general view of local pharmacies trade and ensure that the method applied here was validated for this kind of analysis.

To explore Bangladesh’s ability to detect novel influenza, we examined a series of laboratory-confirmed pandemic (H1N1) 2009 cases. During June–July 2009, event-based surveillance identified 30 case-patients (57% travelers); starting July 29, sentinel sites identified 252 case-patients (1% travelers). Surveillance facilitated response weeks before the spread of pandemic (H1N1) 2009 infection to the general population.

To determine how much influenza contributes to severe acute respiratory illness (SARI), a leading cause of death in children, among people of all ages in Bangladesh.Physicians obtained nasal and throat swabs to test for influenza virus from patients who were hospitalized within 7 days of the onset of severe acute respiratory infection (SARI) or who consulted as outpatients for influenza-like illness (ILI). A community health care utilization survey was conducted to determine the proportion of hospital catchment area residents who sought care at study hospitals and calculate the incidence of influenza using this denominator.The estimated incidence of SARI associated with influenza in children 5 years old was 6.7 (95% confidence interval, CI: 0-18.3); 4.4 (95% CI: 0-13.4) and 6.5 per 1000 person-years (95% CI: 0-8.3/1000) during the 2008, 2009 and 2010 influenza seasons, respectively. The incidence of SARI in people aged ≥ 5 years was 1.1 (95% CI: 0.4-2.0) and 1.3 (95% CI: 0.5-2.2) per 10,000 person-years during 2009 and 2010, respectively. The incidence of medically attended, laboratory-confirmed seasonal influenza in outpatients with ILI was 10 (95% CI: 8-14), 6.6 (95% CI: 5-9) and 17 per 100 person-years (95% CI: 13-22) during the 2008, 2009 and 2010 influenza seasons, respectively.Influenza-like illness is a frequent cause of consultation in the outpatient setting in Bangladesh. Children aged less than 5 years are hospitalized for influenza in greater proportions than children in other age groups.ملخص الغرض: تحديد مقدار مسؤولية الأنفلونزا في حدوث المرض التنفسي الحاد الوخيم، وهو سبب رئيسي في وفيات الأطفال، في جميع فئات العمر في بنغلاديش. الطريقة: جمع الأطباء مسحات من الأنف والحلق لفحص وجود فيروس الأنفلونزا فيها، وذلك من مرضى أدخلوا المستشفى للعلاج وخلال 7 أيام منذ بدء المرض التنفسي الحاد الوخيم، أو من مرضى خارجيين أجروا مشاورة طبية حول الأمراض الشبيهة بالأنفلونزا. وأجرى الباحثون مسحاً لتحديد نسبة ساكني منطقة الخدمة الطبية الذين التمسوا الرعاية في المستشفى موقع الدراسة، ولحساب معدل وقوع الأنفلونزا مستخدمين هذا القاسم. النتائج: بلغ المعدل التقديري لوقوع المرض التنفسي الحاد الوخيم المرتبط بالأنفلونزا في الأطفال أقل من عمر خمس سنوات 6.7 (فاصلة الثقة 95%: 0-18.3)، و 4.4 (فاصلة الثقة 95%: 0-13.4)، و 6.5 وذلك لكل 1000 شخص سنوياً (فاصلة الثقة 95%: 0-8.3/1000) وذلك خلال مواسم الإصابة بالأنفلونزا في الأعوام 2008، 2009، 2010 بالترتيب. وبلغ معدل وقوع المرض التنفسي الحاد الوخيم في من هم أكبر من أو يساوي عمر خمس سنوات 1.1 (فاصلة الثقة 95%: 0.4-2.0)، و 1.3 (فاصلة الثقة 95%: 0.5-2.2) لكل 10000 شخص سنوياً خلال العامين 2009، 2010 بالترتيب. وبلغ معدل وقوع الأنفلونزا الموسمية في المرضى الخارجيين الذين كشف عليهم طبياً وتم التأكد مختبرياً من إصابتهم ولديهم أمراض شبيهة بالأنفلونزا 10 (فاصلة الثقة 95%: 8-14)، و 6.6 (فاصلة الثقة 95%: 5-9)، و 17 لكل 100 شخص سنوياً (فاصلة الثقة 95%: 13-22) وذلك أثناء مواسم الإصابة بالأنفلونزا في الأعوام 2008، و 2009، و 2010، بالترتيب. الاستنتاج: تعد الأمراض الشبيهة بالأنفلونزا سبباً متكرراً لطلب المشورة الطبية في العيادات الخارجية في بنغلاديش. والأطفال في عمر أقل من خمس سنوات الذي يجري علاجهم في المستشفيات يشكلون النسبة الأكبر من الأطفال في الفئات العمرية الأخرى.Resumen OBJETIVO: Determinar en qué medida contribuye la gripe a la enfermedad respiratoria aguda grave (ERAG), una de las principales causas de muerte infantil, en personas de todas las edades en Bangladesh. MÉTODOS: Los médicos tomaron muestras de exudado nasal y faríngeo para realizar la prueba del virus de la gripe en pacientes que estuvieron hospitalizados en los 7 días posteriores al inicio de la infección respiratoria agua grave (IRAG) o que acudieron a consulta como pacientes ambulatorios por síndrome gripal (SG). Se llevó a cabo un estudio sobre el uso de la asistencia sanitaria comunitaria para determinar la proporción de residentes del área de cobertura del hospital que solicitaron asistencia médica en hospitales pertenecientes al estudio y se calculó la incidencia de la gripe con este denominador. RESULTADOS: La incidencia estimada de la IRAG asociada con la gripe en niños menores de 5 años fue del 6,7 (95% de intervalo de confianza, IC: 0-18,3); 4,4 (95% IC: 0-13,4) y 6,5 por 1000 años-persona (95% IC: 0-8,3/1000) durante las temporadas de gripe de 2008, 2009 y 2010, respectivamente. La incidencia de la IRAG en las personas con una edad igual o superior a 5 años fue del 1,1 (95% IC: 0,4- 2,0) y 1,3 (95% IC: 0,5-2,2) por 10 000 años-persona durante 2009 y 2010, respectivamente. La incidencia de la gripe de temporada tratada médicamente y confirmada en laboratorio en pacientes ambulatorios con SG fue de 10 (95% IC: 8-14); 6,6 (95% IC: 5-9) y 17 por 100 años-persona (95% IC: 13-22/1000) durante las temporadas de gripe de 2008, 2009 y 2010, respectivamente. CONCLUSIÓN: El síndrome gripal es una causa frecuente de consulta en los centros ambulatorios en Bangladesh. La proporción de niños menores de 5 años hospitalizados por gripe es mayor que la de niños en otros grupos de edad.Résumé OBJECTIF: Déterminer l'impact de la grippe sur le syndrome respiratoire aigu sévère (SRAS), une cause majeure de la mortalité chez les enfants, chez les personnes de tous les âges au Bangladesh. MÉTHODES: Les médecins ont obtenu des écouvillons de prélèvement de nez et de gorge afin de tester le virus de la grippe chez des patients qui avaient été hospitalisés dans les 7 jours suivants l'apparition de l'infection respiratoire aiguë sévère (SRAS) ou qui avaient eu une consultation déambulatoire pour un syndrome de type grippal (STG). Une enquête sur l'utilisation des soins de santé communautaires a été effectuée afin de définir la proportion des riverains de la circonscription hospitalière, qui avaient reçu des soins dans les hôpitaux universitaires, et afin de calculer l'incidence de la grippe à l'aide de ce dénominateur. RÉSULTATS: L'estimation de l'incidence du SRAS associé à la grippe chez les enfants de moins de 5 ans était de 6,7 (intervalle de confiance de 95%, IC: 0-18.3); de 4,4 (IC de 95%: 0-13.4) et de 6,5 pour 1 000 personnes-années (IC de 95%: 0-8.3/1000) lors des saisons de la grippe de 2008, 2009 et 2010, respectivement. L'incidence du SRAS chez les personnes âgées de plus de 5 ans était de 1,1 (IC de 95%: 0.4-2.0) et 1,3 (IC de 95%: 0.5-2.2) pour 10 000 personnes-années en 2009 et 2010, respectivement. L'incidence de la grippe saisonnière traitée médicalement et confirmée en laboratoire chez les patients en consultation ambulatoire souffrant du STG était de 10 (IC de 95%: 8-14), 6,6 (IC de 95%: 5-9) et de 17 pour 100 personnes-années (IC de 95%: 13-22) lors des saisons de la grippe de 2008, 2009 et 2010, respectivement. CONCLUSION: Le syndrome de type grippal est une cause fréquente de consultation dans la configuration de la consultation ambulatoire au Bangladesh. Les enfants de moins de 5 ans sont hospitalisés pour la grippe dans des proportions supérieures aux enfants des autres groupes d'âge.Резюме Цель: Определить, в какой степени грипп способствует заражению лиц всех возрастов в Бангладеш тяжелой острой респираторной инфекцией (ТОРИ), которая является основной причиной детской смертности. Методы: Врачами были взяты мазки из носа и зева для анализа на вирус гриппа у пациентов, которые были госпитализированы в течение семи дней от начала заболевания тяжелой острой респираторной инфекцией (ТОРИ) или консультировались у врача в амбулаторном режиме по поводу гриппоподобной болезни (ГПБ). Было проведено исследование пользования медико-санитарной помощью на уровне общин для определения доли жителей участка, обслуживаемого больницей, которые обращались за помощью в обследуемые медицинские учреждения, и расчета заболеваемости гриппом с использованием указанного показателя в качестве знаменателя. Результаты: Оценочные показатели заболеваемости ТОРИ, коррелируемой с гриппом, у детей в возрасте до 5 лет, составили 6,7 (95% доверительный интервал, ДИ: 0-18,3); 4,4 (95% ДИ: 0-13,4) и 6,5 (95% ДИ: 0-8,3/1000) на 1000 человеко-лет за эпидемиологические сезоны гриппа 2008, 2009 и 2010 годов, соответственно. Заболеваемость ТОРИ у лиц в возрасте от 5 лет и старше составила 1,1 (95% ДИ: 0,4-2,0) и 1,3 (95% ДИ: 0,5-2,2) на 10 тыс. человеко-лет за 2009 и 2010 годы, соответственно. Заболеваемость лабораторно подтвержденным гриппом, потребовавшим обращения к врачу, у амбулаторных больных с ГПБ составила 10 (95% ДИ: 8-14), 6,6 (95% ДИ: 5-9) и 17 (95% ДИ: 13-22) на 100 человеко-лет за эпидемиологические сезоны гриппа 2008, 2009 и 2010 годов, соответственно. Вывод: Гриппоподобная болезнь - распространенная причина обращения к врачу в амбулаторном режиме в Бангладеш. Доля детей в возрасте до 5 лет, госпитализируемых по поводу гриппа, выше, чем доля госпитализируемых детей других возрастных групп.摘要 目的: 确定流感在多大程度上导致孟加拉国所有年龄段人群中的严重急性呼吸系统疾病（SARI），SARI是导致儿童死亡的主要原因。 方法: 医师从发生严重急性呼吸道感染7天内住院的病人或因流行性感冒样疾病就医的门诊病人获得咽喉抹片，进行流感病毒检测。对社区医疗保健利用情况进行了调查，从而确定处于医院服务区内的居民到医院寻求医疗服务的比例，并以此为标准计算流感发病率。 结果: 2008、2009和2010年流感季节，估计5岁以下儿童中与流感相关的严重急性呼吸系统疾病的发病率分别为每年每千人中6.7例 (95%可信区间，0-18.3)、4.4例（95%可信区间，0-13.4）和6.5例 (95%可信区间，0-8.3/1000)。2009和2010流感季节5岁及以上人群严重急性呼吸系统疾病的发病率分别为每年每万人中1.1例（95%可信区间，0.4-2.0）和1.3例（95%可信区间，0.5-2.2）。此外，2008、2009和2010年流感季节患有流行性感冒样疾病的门诊病人中，就医且经实验室确认的季节性流感的发病率分别为每年每百人中10例（95%可信区间，8-14），6.6例（95%可信区间，5-9）和17例（95%可信区间，13-22）。 结论: 流行性感冒样疾病是孟加拉国门诊就医的常见病。与其他年龄段的儿童相比，5岁以下儿童因流感住院的比例更大。

Rotavirus strain diversity in Bangladesh has been explored since 1985 and as seen in other parts of the world, rotaviruses have shown tremendous strain diversity overtime. Rotavirus antigen was detected in stool specimens using a solid-phase sandwich-type enzyme immunoassay. A multiplex reverse transcription polymerase chain reaction (RT-PCR) was performed for rotavirus G and P genotypes. This current study was carried out between 2006 and 2009 during which time 1,607 (23%) of 7,058 fecal specimens tested positive for group A rotaviruses with the highest incidence rate being observed in winter each year. Genotyping of rotaviruses showed a sharp decline in G2P[4] between 2008 and 2009 with a gradual increase in G1 and G9 strains. Since the Government of Bangladesh is planning to include rotavirus vaccine in the national immunization program, these data on rotavirus strain diversity should be taken into consideration for vaccine strain selection.

Polytropic murine leukemia viruses (MuLVs) are generated by recombination of ecotropic MuLVs with env genes of a family of endogenous proviruses in mice, resulting in viruses with an expanded host range and greater virulence. Inbred mouse strains contain numerous endogenous proviruses that are potential donors of the env gene sequences of polytropic MuLVs; however, the precise identification of those proviruses that participate in recombination has been elusive. Three different structural groups of proviruses in NFS/N mice have been described and different ecotropic MuLVs preferentially recombine with different groups of proviruses. In contrast to other ecotropic MuLVs such as Friend MuLV or Akv that recombine predominantly with a single group of proviruses, Moloney MuLV (M-MuLV) recombines with at least two distinct groups. In this study, we determined that only three endogenous proviruses, two of one group and one of another group, are major participants in recombination with M-MuLV. Furthermore, the distinction between the polytropic MuLVs generated by M-MuLV and other ecotropic MuLVs is the result of recombination with a single endogenous provirus. This provirus exhibits a frameshift mutation in the 3′ region of the surface glycoprotein-encoding sequences that is excluded in recombinants with M-MuLV. The sites of recombination between the env genes of M-MuLV and endogenous proviruses were confined to a short region exhibiting maximum homology between the ecotropic and polytropic env sequences and maximum stability of predicted RNA secondary structure. These observations suggest a possible mechanism for the specificity of recombination observed for different ecotropic MuLVs.

Polytropic murine leukemia viruses (MLVs) are generated by recombination of ecotropic MLVs with members of a family of endogenous proviruses in mice. Previous studies have indicated that polytropic MLV isolates comprise two mutually exclusive antigenic subclasses, each of which is reactive with one of two monoclonal antibodies termed MAb 516 and Hy 7. A major determinant of the epitopes distinguishing the subclasses mapped to a single amino acid difference in the SU protein. Furthermore, distinctly different populations of the polytropic MLV subclasses are generated upon inoculation of different ecotropic MLVs. Here we have characterized the majority of endogenous polytropic MLV-related proviruses of NFS/N mice. Most of the proviruses contain intact sequences encoding the receptor-binding region of the SU protein and could be distinguished by sequence heterogeneity within that region. We found that the endogenous proviruses comprise two major groups that encode the major determinant for Hy 7 or MAb 516 reactivity. The Hy 7-reactive proviruses correspond to previously identified polytropic proviruses, while the 516-reactive proviruses comprise the modified polytropic proviruses as well as a third group of polytropic MLV-related proviruses that exhibit distinct structural features. Phylogenetic analyses indicate that the latter proviruses reflect features of phylogenetic intermediates linking xenotropic MLVs to the polytropic and modified polytropic proviruses. These studies elucidate the relationships of the antigenic subclasses of polytropic MLVs to their endogenous counterparts, identify a new group of endogenous proviruses, and identify distinguishing characteristics of the proviruses that should facilitate a more precise description of their expression in mice and their participation in recombination to generate recombinant viruses.

Background: Better understanding the etiology-specific incidence of severe acute respiratory infections (SARIs) in resourcepoor, rural settings will help further develop and prioritize prevention strategies. To address this gap in knowledge, we conducted a longitudinal study to estimate the incidence of SARIs among children in rural Bangladesh. Methods: During June through October 2010, we followed children aged ,5 years in 67 villages to identify those with cough, difficulty breathing, age-specific tachypnea and/or danger signs in the community or admitted to the local hospital. A study physician collected clinical information and obtained nasopharyngeal swabs from all SARI cases and blood for bacterial culture from those hospitalized. We tested swabs for respiratory syncytial virus (RSV), influenza viruses, human metapneumoviruses, adenoviruses and human parainfluenza viruses 1–3 (HPIV) by real-time reverse transcription polymerase chain reaction. We calculated virus-specific SARI incidence by dividing the number of new illnesses by the person-time each child contributed to the study. Results: We followed 12,850 children for 279,029 person-weeks (pw) and identified 141 SARI cases; 76 (54%) at their homes and 65 (46%) at the hospital. RSV was associated with 7.9 SARI hospitalizations per 100,000 pw, HPIV3 2.2 hospitalizations/ 100,000 pw, and influenza 1.1 hospitalizations/100,000 pw. Among non-hospitalized SARI cases, RSV was associated with 10.8 illnesses/100,000 pw, HPIV3 1.8/100,000 pw, influenza 1.4/100,000 pw, and adenoviruses 0.4/100,000 pw. Conclusion: Respiratory viruses, particularly RSV, were commonly associated with SARI among children. It may be useful to explore the value of investing in prevention strategies, such as handwashing and respiratory hygiene, to reduce respiratory infections among young children in such settings.

This study assessed hepatitis B prevalence among pregnant women attending health care facilities in rural Bangladesh. Blood samples were collected from 480 participants. HBsAg was positive in 0.4% of subjects, anti-HBc was positive in 21.5% and anti-HBs was positive in 8.5% of subjects. HBsAg was more prevalent among the older age group. Hepatitis B has a low prevalence among pregnant women in rural Bangladesh. Existing hepatitis B vaccination schedule in the Expanded Program on Immunization (EPI) to vaccinate the children in rural Bangladesh is appropriate.

Background: Pneumonia is the leading cause of childhood death in Bangladesh. We conducted a longitudinal study to estimate the incidence of virus-associated pneumonia in children aged ,2 years in a low-income urban community in Dhaka, Bangladesh. Methods: We followed a cohort of children for two years. We collected nasal washes when children presented with respiratory symptoms. Study physicians diagnosed children with cough and age-specific tachypnea and positive lung findings as pneumonia case-patients. We tested respiratory samples for respiratory syncytial virus (RSV), rhinoviruses, human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV 1, 2, 3), and adenoviruses using real-time reverse transcription polymerase chain reaction assays. Results: Between April 2009–March 2011, we followed 515 children for 730 child-years. We identified a total of 378 pneumonia episodes, 77% of the episodes were associated with a respiratory viral pathogen. The overall incidence of pneumonia associated with a respiratory virus infection was 40/100 child-years. The annual incidence of pneumonia/100 child-years associated with a specific respiratory virus in children aged ,2years was 12.5 for RSV, 6 for rhinoviruses, 6 for HMPV, 4 for influenza viruses, 3 for HPIV and 2 for adenoviruses. Conclusion: Young children in Dhaka are at high risk of childhood pneumonia and the majority of these episodes are associated with viral pathogens. Developing effective low-cost strategies for prevention are a high priority.

We conducted a nationwide study at six tertiary hospitals from December 2008 through November 2009 to investigate etiologies of febrile illnesses in Bangladesh. Febrile patients meeting a clinical case definition were enrolled from inpatient and outpatient medicine and pediatric units. We assessed 720 febrile patients over 12 months; 69 (9.6%) were positive for IgM antibodies against dengue virus by enzyme-linked immunosorbent assay, and four malaria patients (0.56%) were confirmed with immuno-chromatography and microscopic slide tests. We identified dengue cases throughout the year from rural (49%) and urban areas (51%). We followed-up 55 accessible dengue-infected patients two months after their initial enrollment: 45 (82%) patients had fully recovered, 9 (16%) reported ongoing jaundice, fever and/or joint pain, and one died. Dengue infection is widespread across Bangladesh, but malaria is sufficiently uncommon that it should not be assumed as the cause of fever without laboratory confirmation.

To estimate influenza-associated mortality in Bangladesh in 2009.In four hospitals in Bangladesh, respiratory samples were collected twice a month throughout 2009 from inpatients aged5 years with severe pneumonia and from older inpatients with severe acute respiratory infection. The samples were tested for influenza virus ribonucleic acid (RNA) using polymerase chain reaction. The deaths in 2009 in five randomly selected unions (the smallest administrative units in Bangladesh) in each hospital's catchment area were then investigated using formal records and informal group discussions. The deaths of those who had reportedly died within 14 days of suddenly developing fever with cough and/or a sore throat were assumed to be influenza-associated. The rate of such deaths in 2009 in each of the catchment areas was then estimated from the number of apparently influenza-associated deaths in the sampled unions, the proportion of the sampled inpatients in the local hospital who tested positive for influenza virus RNA, and the estimated number of residents of the sampled unions.Of the 2500 people known to have died in 2009 in all 20 study unions, 346 (14%) reportedly had fever with cough and/or sore throat within 14 days of their deaths. The estimated mean annual influenza-associated mortality in these unions was 11 per 100,000 population: 1.5, 4.0 and 125 deaths per 100,000 among those aged5, 5-59 and59 years, respectively.The highest burden of influenza-associated mortality in Bangladesh in 2009 was among the elderly.

We identified avian influenza virus A (H5N1) infection in a child in Bangladesh in 2008 by routine influenza surveillance. The virus was of the same clade and phylogenetic subgroup as that circulating among poultry during the period. This case illustrates the value of routine surveillance for detection of novel influenza virus.

Mammalian genomes harbor a large number of retroviral elements acquired as germ line insertions during evolution. Although many of the endogenous retroviruses are defective, several contain one or more intact viral genes that are expressed under certain physiological or pathological conditions. This is true of the endogenous polytropic retroviruses that generate recombinant polytropic murine leukemia viruses (MuLVs). In these recombinants the env gene sequences of exogenous ecotropic MuLVs are replaced with env gene sequences from an endogenous polytropic retrovirus. Although replication-competent endogenous polytropic retroviruses have not been observed, the recombinant polytropic viruses are capable of replicating in numerous species. Recombination occurs during reverse transcription of a virion RNA heterodimer comprised of an RNA transcript from an endogenous polytropic virus and an RNA transcript from an exogenous ecotropic MuLV RNA. It is possible that homodimers corresponding to two full-length endogenous RNA genomes are also packaged. Thus, infection by an exogenous virus may result not only in recombination with endogenous sequences, but also in the mobilization of complete endogenous retrovirus genomes via pseudotyping within exogenous retroviral virions. We report that the infection of mice with an ecotropic virus results in pseudotyping of intact endogenous viruses that have not undergone recombination. The endogenous retroviruses infect and are integrated into target cell genomes and subsequently replicate and spread as pseudotyped viruses. The mobilization of endogenous retroviruses upon infection with an exogenous retrovirus may represent a major interaction of exogenous retroviruses with endogenous retroviruses and may have profound effects on the pathogenicity of retroviral infections.

The nucleotide sequences of RNA segment 7 (nonstructural protein gene; NS) were compared among 34 influenza C virus strains isolated between 1947 and 1992. The results showed that all the NS genes analysed had the potential to encode NS1 and NS2 proteins of 246 and 182 amino acids, respectively. The deduced amino acid sequence of the previously unidentified NS2 was fairly well conserved, although it was more divergent than the NS1 protein sequence. Moreover, immunoprecipitation experiments with rabbit immune serum against a glutathione S-transferase fusion protein containing the C-terminal region of the 182 amino acid NS2 protein revealed synthesis of a protein with an apparent molecular mass of ∼22 kDa in infected cells. A phylogenetic analysis showed that the 34 NS genes were split into two distinct groups, A and B. Comparison of the phylogenetic positions of the individual isolates in the NS gene tree with those in the haemagglutinin–esterase (HE) gene tree suggested that most of the influenza C viruses currently circulating in Japan, irrespective of their HE gene lineage, had acquired group B NS genes through reassortment events that presumably occurred either in the 1970s or in the early 1980s.

Background In 2010, an acute illness outbreak was reported in school students eating high-energy biscuits supplied by the school feeding programme in northwest Bangladesh. We investigated this outbreak to describe the illness in terms of person, place and time, develop the timeline of events, and determine the cause and community perceptions regarding the outbreak. Methods We defined case-patients as students from affected schools reporting any two symptoms including abdominal pain, heartburn, bitter taste, and headache after eating biscuits on the day of illness. We conducted in-depth interviews and group discussions with students, teachers, parents and community members to explore symptoms, exposures, and community perceptions. We conducted a questionnaire survey among case-patients to determine the symptoms and ascertain food items eaten 12 hours before illness onset, and microbiological and environmental investigations. Results Among 142 students seeking hospital care, 44 students from four schools qualified as case-patients. Of these, we surveyed 30 who had a mean age of 9 years; 70% (21/30) were females. Predominant symptoms included abdominal pain (93%), heartburn (90%), and bitter taste (57%). All students recovered within a few hours. No pathogenic Vibrio cholerae, Shigella or Salmonella spp. were isolated from collected stool samples. We found no rancid biscuits in schools and storage sites. The female index case perceived the unusually darker packet label as a “devil’s deed” that made the biscuits poisonous. Many students, parents and community members reported concerns about rumors of students dying from biscuit poisoning. Conclusions Rapid onset, followed by rapid recovery of symptoms; female preponderance; inconsistent physical, microbiological and environmental findings suggested mass sociogenic illness rather than a foodborne or toxic cause. Rumours of student deaths heightening community anxiety apparently propagated this outbreak. Sharing investigation results and reassuring students and parents through health communication campaigns could limit similar future outbreaks and help retain beneficiaries’ trust on nutrition supplementation initiatives.

We conducted a cross-sectional study in 2009 to determine the seroprevalence and risk factors for highly pathogenic avian influenza A (H5N1) [HPAI H5N1] virus antibodies among poultry workers at farms and live bird markets with confirmed/suspected poultry outbreaks during 2009 in Bangladesh. We tested sera by microneutralization assay using A/Bangladesh/207095/2008 (H5N1; clade 2.2.2) virus with confirmation by horse red blood cell hemagglutination inhibition and H5-specific Western blot assays. We enrolled 212 workers from 87 farms and 210 workers from three live bird markets. One hundred and two farm workers (48%) culled poultry. One hundred and ninety-three farm workers (91%) and 178 market workers (85%) reported direct contact with poultry that died during a laboratory confirmed HPAI H5N1 poultry farm outbreak or market poultry die-offs from suspected HPAI H5N1. Despite exposure to sick poultry, no farm or market poultry workers were seropositive for HPAI H5N1 virus antibodies (95% confidence interval 0-1%).

Background: Recent population-based estimates in a Dhaka low-income community suggest that influenza was prevalent among children. To explore the epidemiology and seasonality of influenza throughout the country and among all age groups, we established nationally representative hospital-based surveillance necessary to guide influenza prevention and control efforts. Methodolgy/Principal Findings: We conducted influenza-like illness and severe acute respiratory illness sentinel surveillance in 12 hospitals across Bangladesh during May 2007–December 2008. We collected specimens from 3,699 patients, 385 (10%) which were influenza positive by real time RT-PCR. Among the sample-positive patients, 192 (51%) were type A and 188 (49%) were type B. Hemagglutinin subtyping of type A viruses detected 137 (71%) A/H1 and 55 (29%) A/H3, but no A/H5 or other novel influenza strains. The frequency of influenza cases was highest among children aged under 5 years (44%), while the proportions of laboratory confirmed cases was highest among participants aged 11–15 (18%). We applied kriging, a geo-statistical technique, to explore the spatial and temporal spread of influenza and found that, during 2008, influenza was first identified in large port cities and then gradually spread to other parts of the country. We identified a distinct influenza peak during the rainy season (May–September). Conclusions/Significance: Our surveillance data confirms that influenza is prevalent throughout Bangladesh, affecting a wide range of ages and causing considerable morbidity and hospital care. A unimodal influenza seasonality may allow Bangladesh to time annual influenza prevention messages and vaccination campaigns to reduce the national influenza burden. To scale-up such national interventions, we need to quantify the national rates of influenza and the economic burden associated with this disease through further studies.

Oral pharyngeal isolation of Gram-negative bacteria was compared in four groups of Bengali children; acutely ill, severely malnourished outpatients swabbed on hospital admission; ill but less severely malnourished outpatients from the same area as the malnourished children; orphans also less severely malnourished but not acutely ill; and well controls drawn from a priviledged socioeconomic group. The expected weight for height percentage (National Center Health Statistics/Center for Disease Control median) of the four groups was respectively 67, 91, 97, and 97%. Isolation of Gram-negative bacteria from 74 of 87 (85%) severely malnourished children was significantly greater (p less than 0.01) compared to 43 of 113 (38%) outpatients, to 20 of 93 (22%) orphans, and to five of 51 (10%) controls. A total of 71 malnourished children under 5 yr of age (90%) had higher rates of Gram-negative throat colonization than did 16 older children (63%) (p less than 0.01). Thus there was an increased rate of Gram-negative colonization in severely malnourished children especially among the younger age group. In the subset of ill children, Gram-negative pharyngeal colonization was significantly associated inversely with nutritional indices and age. The high rate of such carriage may be partly responsible for the increased susceptibility of Gram-negative infection demonstrated in these children.

Fifty-three patients suffering from cerebrovascular disease admitted to the Neurology unit of the Institute of Postgraduate Medicine and Research, Dacca, have been analyzed. It has been observed that the age incidence, sex ratio, causes and clinical pattern of cerebrovascular diseases are similar in developed and developing countries.

Background We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh. Methods We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC). Results Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Ten patients were identified with Coxiella. We isolated Leptospira from two patients and Bartonella from one patient. Ten patients had antibodies against Chikungunya virus. The proportion of patients who died was higher with rickettsial fever (5%) compared to those without a diagnosis of rickettsial infection (2%). None of the patients were initially diagnosed with rickettsial fever. Conclusions Rickettsial infections are frequent yet under-recognized cause of febrile illness in Bangladesh. Clinical guidelines should be revised so that local clinicians can diagnose rickettsial infections and provide appropriate drug treatment.