Risk of Nipah Virus Seroprevalence in Healthcare Workers: A Systematic Review with Meta-Analysis

Abstract

Nipah virus (NiV) is a zoonotic pathogen with the potential to cause human outbreaks with a high case fatality ratio. In this systematic review and meta-analysis, available evidence on NiV infections occurring in healthcare workers (HCWs) was collected and critically appraised. According to the PRISMA statement, four medical databases (PubMed, CINAHL, EMBASE, and Scopus) and the preprint repository medRixv were inquired through a specifically designed searching strategy. A total of 2593 entries were identified; of them, 16 studies were included in qualitative and quantitative analysis detailing the outcome of NiV infection on HCWs and estimates of seroprevalence among healthcare professions. All studies reported data from Asian countries: Malaysia, Singapore, Bangladesh, India (States of Kerala and Bengal), and Philippines. Seroprevalence was estimated from seven studies in 0.00% (95%CI 0.00 to 0.10) for IgM-class antibodies and 0.08% (95%CI 0.00 to 0.72) for IgG class-antibodies, but four of the sampled studies did not report any seropositive cases. A case fatality ratio of 73.52% (95%CI 34.01 to 99.74) was calculated from 10 studies. In conclusion, the present study shows that NiV may result in a possible occupational infection among HCWs involved in managing incident cases. As most NiV outbreaks occur in limited resources settings, it is reasonable that even basic preventive measures (i.e., mandatory use of PPE and appropriate isolation of incident cases with physical distancing) may be quite effective in avoiding the occurrence of new infections among HCWs.

Keywords: Nipah virus (NiV); bats; control; diagnosis; encephalitis; epidemiology; pathology; prevention; therapeutics; vaccines; zoonosis.

Figure A1

Random Effect Model Meta-analysis for the proportion of Healthcare Workers (HCWs) among the sampled individuals with a history of Nipah Virus (NiV) infection [16,18,30,31,32,60,64,65,66,67].

Figure 1

Flow chart of included studies [16,18,19,27,30,31,32,37,60,61,62,63,64,65,66,67].

Figure 2

Geographic distribution of retrieved studies. Dotted line represents the geographic distribution of the main documented hosts of Nipah virus, the fruit bats or flying foxes from Pteropus genus. Numbers between brackets are the reference to the retrieved studies [16,18,19,27,30,31,32,37,60,61,62,63,64,65,66,67]. The present map has been created by means of mapchart.net, licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Figure 3

Forest plots for the prevalence of Nipah virus antibodies in healthcare workers (HCWs). Estimates for IgM class antibodies are provided in subfigure (a). Estimates for IgG class antibodies are provided in subfigure (b) [19,27,37,60,61,62,63] (Note: 95%CI = 95% confidence interval; EIA = enzyme immunoassay; ELISA = enzyme-linked immunosorbent assay).

Figure 3

Forest plots for the prevalence of Nipah virus antibodies in healthcare workers (HCWs). Estimates for IgM class antibodies are provided in subfigure (a). Estimates for IgG class antibodies are provided in subfigure (b) [19,27,37,60,61,62,63] (Note: 95%CI = 95% confidence interval; EIA = enzyme immunoassay; ELISA = enzyme-linked immunosorbent assay).

Figure 4

Forest plots for case fatality ratio (CFR) among healthcare workers (HCWs) infected by Nipah virus (NiV) following their exposure to index cases [16,18,30,31,32,60,64,65,66,67].

Figure 5

Funnel plots for the prevalence of IgM (a) and IgG (b) against Nipah (NiV) virus and for the reported case fatality ratio for NiV-related infections from retrieved studies (c). Similarly, subfigures (d–f) provide the radial plots on the publication bias for the reported prevalence of NiV-targeting IgM and IgG and for the NiV-related case fatality ratio.

Figure 6

Doi plots for estimates on seroprevalence of IgG (a) and IgM (b) class antibodies and for case fatality ratio (c). For each plot, corresponding Luis Furuya-Kanamori (LFK) index is reported. Values exceeding 2 were major asymmetry and suspected publication bias.

Figure 7

Forest plots reporting on the sensitivity analysis for the seroprevalence of Nipah virus (NiV) targeting IgM (a) and IgG (b) antibodies and on the NiV-related case fatality ratio (c) in healthcare workers [16,18,19,27,30,31,32,37,60,61,62,63,64,65,66,67].

Figure 7

Forest plots reporting on the sensitivity analysis for the seroprevalence of Nipah virus (NiV) targeting IgM (a) and IgG (b) antibodies and on the NiV-related case fatality ratio (c) in healthcare workers [16,18,19,27,30,31,32,37,60,61,62,63,64,65,66,67].