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Stephen Luby

Professor of Medicine (Infectious Diseases) and Senior Fellow at the Woods Institute and the Freeman Spogli Institute and Professor, by courtesy, of Health Research and Policy (Epidemiology)

Dr. Luby studied philosophy and earned a Bachelor of Arts summa cum laude from Creighton University. He earned his medical degree from the University of Texas Southwestern Medical School at Dallas and completed his residency in internal medicine at the University of Rochester-Strong Memorial Hospital. He studied epidemiology and preventive medicine at the Centers for Disease Control and Prevention.

Dr. Luby's previous positions include directing the Centre for Communicable Diseases at the International Centre for Diarrhoeal Diseases Research, Bangladesh in Dhaka, Bangladesh from 2004 - 2012, conducting research and teaching epidemiology at the Aga Khan University in Karachi, Pakistan from 1993 - 1998, and working as an epidemiologist in the Foodborne and Diarrheal Diseases Branch of the U.S. Centers for Disease Control and Prevention.
Administrative Appointments: 
Director of Research, Stanford Center for Innovation in Global Health (2012 - Present)
Honors and Awards: 
Alexander D. Langmuir Prize, Centers for Disease Control and Prevention (2001)
Favourite paper in infectious diseases, Lancet Infectious Diseases (2005)
Shepard Award, Centers for Disease Control and Prevention (2006, 2014 & 2015)
International WaTER Prize, Oklahoma University (2009)
Medal of Excellence in Global Health, Center for Global Health, Centers for Disease Control and Prevention (2012)
Begum Rokeya Sakhawat Hossain Teaching Excellence Award, James P Grant School of Public Health (2012, 2014, 2015)
Fellowship, Centers for Disease Control and Prevention, Epidemiology (1992)
Residency, Strong Memorial Hospital, Internal Medicine (1989)
Internship, Strong Memorial Hospital, Internal Medicine (1987)
MD, University of Texas, Southwestern, Medicine (1986)
BA, Creighton University, Philosophy (1981)
Board Certification, American Board of Internal Medicine, Internal Medicine (1989)
Community and International Work: 
WASH Benefits, Rural Bangladesh
Lotus Water, Dhaka, Bangladesh
Improving communal toilets, Dhaka, Bangladesh
Leveraging social networks to improve child immunizations, Bangladesh
Burden of pneumococcal disease, Bangladesh
Lead exposure in rural Bangladesh, Bangladesh
Research & Scholarship
Current Research Interests: 
Dr. Luby’s research interests include identifying and interrupting pathways of infectious disease transmission in low income countries. He works primarily in Bangladesh but also has projects in Western China and Liberia. His ongoing work includes 1) assessing the impact on health and child cognitive development of scalable strategies to improve water, sanitation and hygiene; 2) efforts to better understand the burden of disease from typhoid fever and evaluating approaches to reduce that burden; 3) developing and evaluating interventions to reduce the risk of a Nipah virus pandemic; 4) evaluating the impact of the Bangladesh national vaccine program on the burden of pneumococcal and Haemophilus influenzae type B infection..
Courses Taught: 
Academic Year: 
Independent Study Courses: 
Directed Reading in Environment and Resources
ENVRES 398 (Aut, Win, Spr, Sum)
Directed Research in Environment and Resources
ENVRES 399 (Aut, Win, Spr, Sum)
Graduate Research
HRP 399 (Aut, Win, Spr)
Graduate Research
MED 399 (Win, Spr)
Medical Scholars Research
MED 370 (Aut, Win, Spr)
Undergraduate Research
MED 199 (Win, Spr)
Academic Year: 
Independent Study Courses: 
Directed Reading in Environment and Resources
ENVRES 398 (Aut, Win, Spr, Sum)
Directed Research in Environment and Resources
ENVRES 399 (Aut, Win, Spr, Sum)
Graduate Research
MED 399 (Win, Spr)
Medical Scholars Research
MED 370 (Aut, Win, Spr)
Undergraduate Research
MED 199 (Win, Spr)
Academic Year: 
Independent Study Courses: 
Academic Year: 
Research Methods in Global Health
IPS 290, MED 226 (Spr)
Postdoctoral Advisees: 
Graduate and Fellowship Program Affiliations: 
Pediatric Infectious Diseases (Fellowship Program)
Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011-2014 EMERGING INFECTIOUS DISEASES Islam, M. S., Sazzad, H. M., Satter, S. M., Sultana, S., Hossain, M. J., Hasan, M., Rahman, M., Campbell, S., Cannon, D. L., Stroeher, U., Daszak, P., Luby, S. P., Gurley, E. S. 2016; 22 (4): 664-670
Evolving epidemiology of Nipah virus infection in Bangladesh: evidence from outbreaks during 2010-2011 EPIDEMIOLOGY AND INFECTION Chakraborty, A., Sazzad, H. M., Hossain, M. J., Islam, M. S., PARVEEN, S., Husain, M., Banu, S. S., Podder, G., Afroj, S., ROLLIN, P. E., Daszak, P., Luby, S. P., Rahman, M., Gurley, E. S. 2016; 144 (2): 371-380


Drinking raw date palm sap is the primary route of Nipah virus (NiV) transmission from bats to people in Bangladesh; subsequent person-to-person transmission is common. During December 2010 to March 2011, we investigated NiV epidemiology by interviewing cases using structured questionnaires, in-depth interviews, and group discussions to collect clinical and exposure histories. We conducted a case-control study to identify risk factors for transmission. We identified 43 cases; 23 were laboratory-confirmed and 20 probable. Thirty-eight (88%) cases died. Drinking raw date palm sap and contact with an infected person were major risk factors; one healthcare worker was infected and for another case transmission apparently occurred through contact with a corpse. In absence of these risk factors, apparent routes of transmission included drinking fermented date palm sap. For the first time, a case was detected in eastern Bangladesh. Identification of new epidemiological characteristics emphasizes the importance of continued NiV surveillance and case investigation.

View details for DOI 10.1017/S0950268815001314

View details for Web of Science ID 000368638100019

View details for PubMedID 26122675

Towards sustainable public health surveillance for enteric fever. Vaccine Luby, S. P., Saha, S., Andrews, J. R. 2015; 33: C3-7


Enteric fever that results from infection by the typhoidal Salmonellas (Salmonella Typhi and Salmonella Paratyphi A, B and C) is a life-threatening preventable illness. Surveillance of enteric fever is important to understand current burden of disease, to track changes in human health burden from increasing antimicrobial resistance and to assess the impact of efforts to reduce disease burden. Since enteric fever occurs predominantly in low income communities, expensive surveillance is not sustainable. Traditional hospital-based surveillance does not estimate population burden and intensive community-based cohort studies do not capture the severe disease that is crucial to policy decisions. While cohort studies have been considered the gold standard for incidence estimates, the resources required to conduct them are great; as a consequence, estimates of enteric fever burden have been highly geographically and temporally restricted. A hybrid approach combining laboratory diagnosis that is already being conducted in healthcare centers with community-based surveillance of health care facility use offers a low-cost, sustainable approach to generate policy relevant data.

View details for DOI 10.1016/j.vaccine.2015.02.054

View details for PubMedID 25912287

Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial PLOS ONE Ercumen, A., Naser, A. M., Unicomb, L., Arnold, B. F., Colford, J. M., Luby, S. P. 2015; 10 (3)


Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in NCT01350063.

View details for DOI 10.1371/journal.pone.0121907

View details for Web of Science ID 000352133600126

View details for PubMedID 25816342

Differences in field effectiveness and adoption between a novel automated chlorination system and household manual chlorination of drinking water in Dhaka, Bangladesh: a randomized controlled trial. PloS one Pickering, A. J., Crider, Y., Amin, N., Bauza, V., Unicomb, L., Davis, J., Luby, S. P. 2015; 10 (3)


The number of people served by networked systems that supply intermittent and contaminated drinking water is increasing. In these settings, centralized water treatment is ineffective, while household-level water treatment technologies have not been brought to scale. This study compares a novel low-cost technology designed to passively (automatically) dispense chlorine at shared handpumps with a household-level intervention providing water disinfection tablets (Aquatab), safe water storage containers, and behavior promotion. Twenty compounds were enrolled in Dhaka, Bangladesh, and randomly assigned to one of three groups: passive chlorinator, Aquatabs, or control. Over a 10-month intervention period, the mean percentage of households whose stored drinking water had detectable total chlorine was 75% in compounds with access to the passive chlorinator, 72% in compounds receiving Aquatabs, and 6% in control compounds. Both interventions also significantly improved microbial water quality. Aquatabs usage fell by 50% after behavioral promotion visits concluded, suggesting intensive promotion is necessary for sustained uptake. The study findings suggest high potential for an automated decentralized water treatment system to increase consistent access to clean water in low-income urban communities.

View details for DOI 10.1371/journal.pone.0118397

View details for PubMedID 25734448

Differences in Field Effectiveness and Adoption between a Novel Automated Chlorination System and Household Manual Chlorination of Drinking Water in Dhaka, Bangladesh: A Randomized Controlled Trial. PloS one Pickering, A. J., Crider, Y., Amin, N., Bauza, V., Unicomb, L., Davis, J., Luby, S. P. 2015; 10 (3)

View details for DOI 10.1371/journal.pone.0118397

View details for PubMedID 25734448

Is targeting access to sanitation enough? The Lancet. Global health Luby, S. 2014; 2 (11): e619-20

View details for DOI 10.1016/S2214-109X(14)70326-2

View details for PubMedID 25442678

Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. The American journal of tropical medicine and hygiene Amin, N., Pickering, A. J., Ram, P. K., Unicomb, L., Najnin, N., Homaira, N., Ashraf, S., Abedin, J., Islam, M. S., Luby, S. P. 2014; 91 (2): 415-423


We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among mothers to compare microbial efficacy of soapy water (30 g powdered detergent in 1.5 L water) with bar soap and water alone. Fieldworkers collected hand rinse samples before and after the following washing regimens: scrubbing with soapy water for 15 and 30 seconds; scrubbing with bar soap for 15 and 30 seconds; and scrubbing with water alone for 15 seconds. Soapy water and bar soap removed thermotolerant coliforms similarly after washing for 15 seconds (mean log10 reduction = 0.7 colony-forming units [CFU], P < 0.001 for soapy water; mean log10 reduction = 0.6 CFU, P = 0.001 for bar soap). Increasing scrubbing time to 30 seconds did not improve removal (P > 0.05). Scrubbing hands with water alone also reduced thermotolerant coliforms (mean log10 reduction = 0.3 CFU, P = 0.046) but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbiologically effective cleansing agent to improve handwashing among households with vulnerable children.

View details for DOI 10.4269/ajtmh.13-0475

View details for PubMedID 24914003

The Role of Landscape Composition and Configuration on Pteropus giganteus Roosting Ecology and Nipah Virus Spillover Risk in Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Hahn, M. B., Gurley, E. S., Epstein, J. H., Islam, M. S., Patz, J. A., Daszak, P., Luby, S. P. 2014; 90 (2): 247-255


Nipah virus has caused recurring outbreaks in central and northwest Bangladesh (the "Nipah Belt"). Little is known about roosting behavior of the fruit bat reservoir, Pteropus giganteus, or factors driving spillover. We compared human population density and ecological characteristics of case villages and control villages (no reported outbreaks) to understand their role in P. giganteus roosting ecology and Nipah virus spillover risk. Nipah Belt villages have a higher human population density (P < 0.0001), and forests that are more fragmented than elsewhere in Bangladesh (0.50 versus 0.32 patches/km(2), P < 0.0001). The number of roosts in a village correlates with forest fragmentation (r = 0.22, P = 0.03). Villages with a roost containing Polyalthia longifolia or Bombax ceiba trees were more likely case villages (odds ratio [OR] = 10.8, 95% confidence interval [CI] = 1.3-90.6). This study suggests that, in addition to human population density, composition and structure of the landscape shared by P. giganteus and humans may influence the geographic distribution of Nipah virus spillovers.

View details for DOI 10.4269/ajtmh.13-0256

View details for Web of Science ID 000331009000010

View details for PubMedID 24323516

The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings BMC PUBLIC HEALTH Dreibelbis, R., Winch, P. J., Leontsini, E., Hulland, K. R., Ram, P. K., Unicomb, L., Luby, S. P. 2013; 13


Promotion and provision of low-cost technologies that enable improved water, sanitation, and hygiene (WASH) practices are seen as viable solutions for reducing high rates of morbidity and mortality due to enteric illnesses in low-income countries. A number of theoretical models, explanatory frameworks, and decision-making models have emerged which attempt to guide behaviour change interventions related to WASH. The design and evaluation of such interventions would benefit from a synthesis of this body of theory informing WASH behaviour change and maintenance.We completed a systematic review of existing models and frameworks through a search of related articles available in PubMed and in the grey literature. Information on the organization of behavioural determinants was extracted from the references that fulfilled the selection criteria and synthesized. Results from this synthesis were combined with other relevant literature, and from feedback through concurrent formative and pilot research conducted in the context of two cluster-randomized trials on the efficacy of WASH behaviour change interventions to inform the development of a framework to guide the development and evaluation of WASH interventions: the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH).We identified 15 WASH-specific theoretical models, behaviour change frameworks, or programmatic models, of which 9 addressed our review questions. Existing models under-represented the potential role of technology in influencing behavioural outcomes, focused on individual-level behavioural determinants, and had largely ignored the role of the physical and natural environment. IBM-WASH attempts to correct this by acknowledging three dimensions (Contextual Factors, Psychosocial Factors, and Technology Factors) that operate on five-levels (structural, community, household, individual, and habitual).A number of WASH-specific models and frameworks exist, yet with some limitations. The IBM-WASH model aims to provide both a conceptual and practical tool for improving our understanding and evaluation of the multi-level multi-dimensional factors that influence water, sanitation, and hygiene practices in infrastructure-constrained settings. We outline future applications of our proposed model as well as future research priorities needed to advance our understanding of the sustained adoption of water, sanitation, and hygiene technologies and practices.

View details for DOI 10.1186/1471-2458-13-1015

View details for Web of Science ID 000329290200003

View details for PubMedID 24160869

The pandemic potential of Nipah virus. Antiviral research Luby, S. P. 2013; 100 (1): 38-43


Nipah virus, a paramyxovirus whose wildlife reservoir is Pteropus bats, was first discovered in a large outbreak of acute encephalitis in Malaysia in 1998 among persons who had contact with sick pigs. Apparently, one or more pigs was infected from bats, and the virus then spread efficiently from pig to pig, then from pigs to people. Nipah virus outbreaks have been recognized nearly every year in Bangladesh since 2001 and occasionally in neighboring India. Outbreaks in Bangladesh and India have been characterized by frequent person-to-person transmission and the death of over 70% of infected people. Characteristics of Nipah virus that increase its risk of becoming a global pandemic include: humans are already susceptible; many strains are capable of limited person-to-person transmission; as an RNA virus, it has an exceptionally high rate of mutation: and that if a human-adapted strain were to infect communities in South Asia, high population densities and global interconnectedness would rapidly spread the infection. Appropriate steps to estimate and manage this risk include studies to explore the molecular and genetic basis of respiratory transmission of henipaviruses, improved surveillance for human infections, support from high-income countries to reduce the risk of person-to-person transmission of infectious agents in low-income health care settings, and consideration of vaccination in communities at ongoing risk of exposure to the secretions and excretions of Pteropus bats.

View details for DOI 10.1016/j.antiviral.2013.07.011

View details for PubMedID 23911335

Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. The American journal of tropical medicine and hygiene Lin, A., Arnold, B. F., Afreen, S., Goto, R., Huda, T. M., Haque, R., Raqib, R., Unicomb, L., Ahmed, T., Colford, J. M., Luby, S. P. 2013; 89 (1): 130-137


We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = -0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = -0.62, -0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.

View details for DOI 10.4269/ajtmh.12-0629

View details for PubMedID 23629931

Nipah virus outbreak in Bangladesh with nosocomial and corpse to human transmission. Emerging Infectious Diseases Sazzad HMS, Hossain MJ, Gurley ES, Ameen KMH, Parveen S, Islam MS, Faruque LI, Podder G, Banu SS, Lo MK, Rollin PE, Rota PA, Daszak P, Rahman M, Luby SP. 2013; 19 (2): 210-17
Improvements in child development following a cluster-randomized, controlled trial of intensive handwashing promotion in Karachi, Pakistan. Arch PediatrAdolesct Med Bowen A, Agboatwalla M, Luby S, Tobery T, Ayers T, Hoekstra RM. 2012; 166 (11): 1037-44
Incidence of severe diarrhoea due to Vibrio cholerae in the catchment area of six surveillance hospitals in Bangladesh EPIDEMIOLOGY AND INFECTION Paul, R. C., Faruque, A. S., Alam, M., Iqbal, A., Zaman, K., Islam, N., SOBHAN, A., Das, S. K., Malek, M. A., Qadri, F., Cravioto, A., Luby, S. P. 2016; 144 (5): 927-939


Cholera is an important public health problem in Bangladesh. Interventions to prevent cholera depend on their cost-effectiveness which in turn depends on cholera incidence. Hospital-based diarrhoeal disease surveillance has been ongoing in six Bangladeshi hospitals where a systematic proportion of patients admitted with diarrhoea were enrolled and tested for Vibrio cholerae. However, incidence calculation using only hospital data underestimates the real disease burden because many ill persons seek treatment elsewhere. We conducted a healthcare utilization survey in the catchment areas of surveillance hospitals to estimate the proportion of severe diarrhoeal cases that were admitted to surveillance hospitals and estimated the population-based incidence of severe diarrhoea due to V. cholerae by combining both hospital surveillance and catchment area survey data. The estimated incidence of severe diarrhoea due to cholera ranged from 0·3 to 4·9/1000 population in the catchment area of surveillance hospitals. In children aged <5 years, incidence ranged from 1·0 to 11·0/1000 children. Diarrhoeal deaths were most common in the Chhatak Hospital's catchment area (18·5/100 000 population). This study provides a credible estimate of the incidence of severe diarrhoea due to cholera in Bangladesh, which can be used to assess the cost-effectiveness of cholera prevention activities.

View details for DOI 10.1017/S0950268815002174

View details for Web of Science ID 000371720700004

View details for PubMedID 26391481

Increased Morbidity and Mortality in Domestic Animals Eating Dropped and Bitten Fruit in Bangladeshi Villages: Implications for Zoonotic Disease Transmission. EcoHealth Openshaw, J. J., Hegde, S., Sazzad, H. M., Khan, S. U., Hossain, M. J., Epstein, J. H., Daszak, P., Gurley, E. S., Luby, S. P. 2016; 13 (1): 39-48


We used data on feeding practices and domestic animal health gathered from 207 Bangladeshi villages to identify any association between grazing dropped fruit found on the ground or owners directly feeding bat- or bird-bitten fruit and animal health. We compared mortality and morbidity in domestic animals using a mixed effects model controlling for village clustering, herd size, and proxy measures of household wealth. Thirty percent of household heads reported that their animals grazed on dropped fruit and 20% reported that they actively fed bitten fruit to their domestic herds. Household heads allowing their cattle to graze on dropped fruit were more likely to report an illness within their herd (adjusted prevalence ratio 1.17, 95% CI 1.02-1.31). Household heads directly feeding goats bitten fruit were more likely to report illness (adjusted prevalence ratio 1.35, 95% CI 1.16-1.57) and deaths (adjusted prevalence ratio 1.64, 95% CI 1.13-2.4). Reporting of illnesses and deaths among goats rose as the frequency of feeding bitten fruit increased. One possible explanation for this finding is the transmission of bat pathogens to domestic animals via bitten fruit consumption.

View details for DOI 10.1007/s10393-015-1080-x

View details for PubMedID 26668032

Safety and acceptability of Lactobacillus reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624 in Bangladeshi infants: a phase I randomized clinical trial. BMC complementary and alternative medicine Hoy-Schulz, Y. E., Jannat, K., Roberts, T., Zaidi, S. H., Unicomb, L., Luby, S., Parsonnet, J. 2016; 16 (1): 44-?


Probiotics have rarely been studied in young healthy infants from low-income countries. This phase I study investigated the safety and acceptability of two probiotics in Bangladesh.Healthy infants aged four to twelve weeks from urban slums in Bangladesh were randomized to one of three different intervention dosing arms (daily, weekly, biweekly - once every two weeks) of Lactobacillus reuteri DSM 17938 and Bifidobacterium longum subspecies infantis 35624 over one month or to a fourth arm that received no probiotics. All subjects were followed for two additional months. Reported gastrointestinal and respiratory symptoms as well as breastfeeding rates, hospitalizations, differential withdrawals, and caretakers' perception of probiotic use were compared among arms.In total, 160 infants were randomized (40 to each arm) with 137 (Daily n = 35, Weekly n = 35, Biweekly n = 35, Control n = 32) followed up for a median of twelve weeks; 113 completed the study. Illness and breastfeeding rates were similar across all arms. Ten hospitalizations unrelated to probiotic use occurred. Forty eight percent of the caretakers of infants in intervention arms believed that probiotics improved their baby's health.These two commonly used probiotics appeared safe and well-accepted by Bangladeshi NCT01899378 . Registered July 10, 2013.

View details for DOI 10.1186/s12906-016-1016-1

View details for PubMedID 26832746

Early priming with inactivated poliovirus vaccine (IPV) and intradermal fractional dose IPV administered by a microneedle device: A randomized controlled trial VACCINE Anand, A., Zaman, K., Estivariz, C. F., Yunus, M., Gary, H. E., Weldon, W. C., Bari, T. I., Oberste, M. S., Wassilak, S. G., Luby, S. P., Heffelfinger, J. D., Pallansch, M. A. 2015; 33 (48): 6816-6822
Early priming with inactivated poliovirus vaccine (IPV) and intradermal fractional dose IPV administered by a microneedle device: A randomized controlled trial. Vaccine Anand, A., Zaman, K., Estívariz, C. F., Yunus, M., Gary, H. E., Weldon, W. C., Bari, T. I., Steven Oberste, M., Wassilak, S. G., Luby, S. P., Heffelfinger, J. D., Pallansch, M. A. 2015; 33 (48): 6816-6822


Inactivated poliovirus vaccine (IPV) introduction and phased oral poliovirus vaccine (OPV) cessation are essential for eradication of polio.Healthy 6-week old infants in Bangladesh were randomized to one of five study arms: receipt of trivalent OPV (tOPV) or bivalent OPV (bOPV) at ages 6, 10 and 14 weeks, intramuscular IPV or intradermal one-fifth fractional dose IPV (f-IPV) at ages 6 and 14 weeks, or f-IPV at ages 6 and 14 weeks with bOPV at age 10 weeks (f-IPV/bOPV). All participants received tOPV at age 18 weeks.Of 975 infants randomized, 95% (922) completed follow-up. Type 1 seroconversion after 3 doses at 6, 10 and 14 weeks was higher with bOPV compared with tOPV (99% vs 94%, p=0.019). Seroconversions to types 1 and 3 after 2 IPV doses at ages 6 and 14 weeks were no different than after 3 doses of tOPV or bOPV at ages 6, 10 and 14 weeks. A priming response, seroconversion 1 week after IPV at 14 weeks among those who did not seroconvert after IPV at 6 weeks, was observed against poliovirus types 1, 2 and 3 in 91%, 84% and 97%, respectively. Compared with IPV, f-IPV failed non-inferiority tests for seroconversion with 1 or 2 doses and priming after 1 dose.The findings demonstrate considerable priming with IPV at age 6 weeks, comparable immunogenicity of tOPV and bOPV, and inferior immunogenicity of one-fifth f-IPV compared with IPV. If IPV induced priming at age 6 weeks is similar to that at age 14 weeks, IPV could be administered at a younger age and possibly with a higher coverage.

View details for DOI 10.1016/j.vaccine.2015.09.039

View details for PubMedID 26476367

Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial LANCET Qadri, F., Ali, M., Chowdhury, F., Khan, A. I., Saha, A., Khan, I. A., Begum, Y. A., Bhuiyan, T. Q., Chowdhury, M. I., Uddin, M. J., Khan, J. A., Chowdhury, A. I., Rahman, A., Siddique, S. A., Asaduzzaman, M., Akter, A., Khan, A., You, Y. A., Siddik, A. U., Saha, N. C., Kabir, A., Riaz, B. K., Biswas, S. K., Begum, F., Unicomb, L., Luby, S. P., Cravioto, A., Clemens, J. D. 2015; 386 (10001): 1362-1371
Why highly polluting methods are used to manufacture bricks in Bangladesh ENERGY FOR SUSTAINABLE DEVELOPMENT Luby, S. P., Biswas, D., Gurley, E. S., Hossain, I. 2015; 28: 68-74
Integrated cluster- and case-based surveillance for detecting stage III zoonotic pathogens: an example of Nipah virus surveillance in Bangladesh EPIDEMIOLOGY AND INFECTION Naser, A. M., Hossain, M. J., Sazzad, H. M., Homaira, N., Gurley, E. S., Podder, G., Afroj, S., Banu, S., ROLLIN, P. E., Daszak, P., Ahmed, B., Rahman, M., Luby, S. P. 2015; 143 (9): 1922-1930


This paper explores the utility of cluster- and case-based surveillance established in government hospitals in Bangladesh to detect Nipah virus, a stage III zoonotic pathogen. Physicians listed meningo-encephalitis cases in the 10 surveillance hospitals and identified a cluster when ⩾2 cases who lived within 30 min walking distance of one another developed symptoms within 3 weeks of each other. Physicians collected blood samples from the clustered cases. As part of case-based surveillance, blood was collected from all listed meningo-encephalitis cases in three hospitals during the Nipah season (January-March). An investigation team visited clustered cases' communities to collect epidemiological information and blood from the living cases. We tested serum using Nipah-specific IgM ELISA. Up to September 2011, in 5887 listed cases, we identified 62 clusters comprising 176 encephalitis cases. We collected blood from 127 of these cases. In 10 clusters, we identified a total of 62 Nipah cases: 18 laboratory-confirmed and 34 probable. We identified person-to-person transmission of Nipah virus in four clusters. From case-based surveillance, we identified 23 (4%) Nipah cases. Faced with thousands of encephalitis cases, integrated cluster surveillance allows targeted deployment of investigative resources to detect outbreaks by stage III zoonotic pathogens in resource-limited settings.

View details for DOI 10.1017/S0950268814002635

View details for Web of Science ID 000355760600016

View details for PubMedID 25342551

An Outbreak of Chikungunya in Rural Bangladesh, 2011. PLoS neglected tropical diseases Khatun, S., Chakraborty, A., Rahman, M., Nasreen Banu, N., Rahman, M. M., Hasan, S. M., Luby, S. P., Gurley, E. S. 2015; 9 (7)

View details for DOI 10.1371/journal.pntd.0003907

View details for PubMedID 26161995

An Outbreak of Chikungunya in Rural Bangladesh, 2011. PLoS neglected tropical diseases Khatun, S., Chakraborty, A., Rahman, M., Nasreen Banu, N., Rahman, M. M., Hasan, S. M., Luby, S. P., Gurley, E. S. 2015; 9 (7)


The first identified Chikungunya outbreak occurred in Bangladesh in 2008. In late October 2011, a local health official from Dohar Sub-district, Dhaka District, reported an outbreak of undiagnosed fever and joint pain. We investigated the outbreak to confirm the etiology, describe the clinical presentation, and identify associated vectors.During November 2-21, 2011, we conducted house-to-house surveys to identify suspected cases, defined as any inhabitant of Char Kushai village with fever followed by joint pain in the extremities with onset since August 15, 2011. We collected blood specimens and clinical histories from self-selected suspected cases using a structured questionnaire. Blood samples were tested for IgM antibodies against Chikungunya virus. The village was divided into nine segments and we collected mosquito larvae from water containers in seven randomly selected houses in each segment. We calculated the Breteau index for the village and identified the mosquito species.The attack rate was 29% (1105/3840) and 29% of households surveyed had at least one suspected case: 15% had ≥3. The attack rate was 38% (606/1589) in adult women and 25% in adult men (320/1287). Among the 1105 suspected case-patients, 245 self-selected for testing and 80% of those (196/245) had IgM antibodies. In addition to fever and joint pain, 76% (148/196) of confirmed cases had rash and 38%(75/196) had long-lasting joint pain. The village Breteau index was 35 per 100 and 89%(449/504) of hatched mosquitoes were Aedes albopictus.The evidence suggests that this outbreak was due to Chikungunya. The high attack rate suggests that the infection was new to this area, and the increased risk among adult women suggests that risk of transmission may have been higher around households. Chikungunya is an emerging infection in Bangladesh and current surveillance and prevention strategies are insufficient to mount an effective public health response.

View details for DOI 10.1371/journal.pntd.0003907

View details for PubMedID 26161995

Towards sustainable public health surveillance for enteric fever VACCINE Luby, S. P., Saha, S., Andrews, J. R. 2015; 33: C3-C7
Effects of oseltamivir treatment of index patients with influenza on secondary household illness in an urban setting in Bangladesh: secondary analysis of a randomised, placebo-controlled trial LANCET INFECTIOUS DISEASES Fry, A. M., Goswami, D., Nahar, K., Sharmin, A. T., Rahman, M., Gubareva, L., Trujillo, A., Barnes, J., Azim, T., Bresee, J., Luby, S. P., Brooks, W. A. 2015; 15 (6): 654-662


Antiviral drugs are a proposed medical intervention to reduce household transmission of influenza viruses. In a previously described randomised, placebo-controlled trial in Dhaka, Bangladesh, we showed that oseltamivir treatment of index patients was able to reduce influenza symptom duration and virus shedding. In a further analysis that is part of the same study, we aimed to assess efficacy of oseltamivir to reduce secondary household illnesses in the same cohort.In this double-blind oseltamivir efficacy trial, we identified index patients aged older than 1 year through surveillance of households in Dhaka, Bangladesh. We randomly allocated eligible patients (1:1) to receive oseltamivir or placebo twice-daily for 5 days, and we stratified them by enrolment 48 h versus 48-120 h since illness onset. Participants provided nasal wash specimens at enrolment and 2, 4, and 7 days after enrolment and were visited daily by a research assistant to record symptoms, both in index patients and in household members. For this part of the study, household members were asked to give respiratory specimens for influenza PCR testing. Our primary outcomes were household secondary illness and PCR-confirmed influenza virus infection, assessed in household members of all randomly allocated index patients. This trial is registered with, number NCT00707941.From May 11, 2008, to Dec 31, 2010, we enrolled 1190 index patients with 4694 household members. 592 patients were allocated to placebo (2292 household members) and 598 to oseltamivir (2402 household members). Household secondary illness was lower in the oseltamivir group (196 [8%] influenza cases) than in the placebo group (233 [10%]; odds ratio [OR] 0·77, 95% CI 0·60-0·98, p=0·031). PCR-confirmed influenza virus infection did not differ between the placebo (103 [5%]) and oseltamivir groups (92 [4%]; 0·84, 0·59-1·19, p=0·319); however, only 243 (57%) of ill household members gave a specimen for analysis.In a crowded, low income setting, oseltamivir treatment of index patients resulted in a small reduction of secondary influenza in their households. Even this slight reduction, in the setting of widespread antiviral use during a community influenza outbreak, might result in reductions in overall disease burden.Centers for Disease Control and Prevention (in an agreement with the International Centre for Diarrhoeal Disease Research, Bangladesh).

View details for DOI 10.1016/S1473-3099(15)70041-1

View details for Web of Science ID 000354638000030

View details for PubMedID 25788164

Serological Evidence of Coxiella burnetii Infection in Cattle and Goats in Bangladesh. EcoHealth Haider, N., Rahman, M. S., Khan, S. U., Mikolon, A., Osmani, M. G., Gurley, E. S., Shanta, I. S., Paul, S. K., MacFarlane-Berry, L., Islam, A., Islam, A., Desmond, J., Epstein, J. H., Priestley, R. A., Kersh, G. J., Rahman, M. Z., Daszak, P., Luby, S. P., Massung, R. F., Zeidner, N. 2015; 12 (2): 354-358


We tested 1149 ruminant sera conveniently collected from three districts of Bangladesh to identify the serological evidence of Coxiella burnetii infection in cattle and goats by enzyme-linked immunosorbent assay. We found that 0.7% (8/1149) of ruminants had detectable immunoglobulin G for C. burnetii: 0.65% (4/620) in cattle and 0.76% (4/529) in goats. A sub-set of ruminant samples was retested and confirmed by immunofluorescence assay (18/112). Although we cannot rule out false-positive reactions, our study suggests the presence of C. burnetii in cattle and goats in Bangladesh. Further studies are required to estimate disease burden at the population level and identify risk factors for Q fever in ruminants in Bangladesh.

View details for DOI 10.1007/s10393-015-1011-x

View details for PubMedID 25649716

Observed Practices and Perceived Advantages of Different Hand Cleansing Agents in Rural Bangladesh: Ash, Soil, and Soap AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Nizame, F. A., Nasreen, S., Halder, A. K., Arman, S., Winch, P. J., Unicomb, L., Luby, S. P. 2015; 92 (6): 1111-1116


Bangladeshi communities have historically used ash and soil as handwashing agents. A structured observation study and qualitative interviews on the use of ash/soil and soap as handwashing agents were conducted in rural Bangladesh to help develop a handwashing promotion intervention. The observations were conducted among 1,000 randomly selected households from 36 districts. Fieldworkers observed people using ash/soil to wash their hand(s) on 13% of occasions after defecation and on 10% after cleaning a child's anus. This compares with 19% of people who used soap after defecation and 27% after cleaning a child who defecated. Using ash/soil or soap was rarely (< 1%) observed at other times recommended for handwashing. The qualitative study enrolled 24 households from three observation villages, where high usage of ash/soil for handwashing was detected. Most informants reported that ash/soil was used only for handwashing after fecal contact, and that ash/soil could clean hands as effectively as soap.

View details for DOI 10.4269/ajtmh.14-0378

View details for Web of Science ID 000355785400005

View details for PubMedID 25870425

Household-level risk factors for influenza among young children in Dhaka, Bangladesh: a case-control study TROPICAL MEDICINE & INTERNATIONAL HEALTH Doshi, S., Silk, B. J., Dutt, D., Ahmed, M., Cohen, A. L., Taylor, T. H., Brooks, W. A., Goswami, D., Luby, S. P., Fry, A. M., Ram, P. K. 2015; 20 (6): 719-729


To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh.We conducted a case-control study using existing active surveillance for respiratory illness. Cases were children aged 12-59 months with laboratory-confirmed influenza. Controls were children frequency-matched by age group with no respiratory illness in the prior 6 months. We interviewed caregivers and observed household handwashing behaviour. Soap consumption was estimated by summing weight differences of three bars of soap sequentially left in each household. We measured concentrations of airborne particulate matter <2.5 μg in diameter (PM2.5) in a subset of households. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).We enrolled 145 cases and 341 controls between March 2009 and April 2010. Case and control household members were observed to wash hands with similar frequency during a 5-h period (mean, 0.64 events vs. 0.63, P = 0.87), and similar daily soap consumption per capita (mean 2.92 grams vs. 2.93, P = 0.92). Case households were more likely than controls to have crowded (≥4 persons) sleeping areas (aOR = 1.67, CI: 1.06-2.63) and cross-ventilated cooking spaces (aOR = 1.75, CI: 1.16-2.63). Case and control households had similar median 24-h geometric mean PM2.5 concentrations in the cooking (69.2 vs. 69.6 μg/m(3), P = 0.45) and sleeping (65.4 vs. 67.4 μg/m(3), P = 0.19) spaces.Handwashing with soap was practiced infrequently and was not associated with paediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

View details for DOI 10.1111/tmi.12475

View details for Web of Science ID 000354186900004

View details for PubMedID 25682788

Explaining low rates of sustained use of siphon water filter: evidence from follow-up of a randomised controlled trial in Bangladesh TROPICAL MEDICINE & INTERNATIONAL HEALTH Najnin, N., Arman, S., Abedin, J., Unicomb, L., Levine, D. I., Mahmud, M., Leder, K., Yeasmin, F., Luoto, J. E., Albert, J., Luby, S. P. 2015; 20 (4): 471-483


To assess sustained siphon filter usage among a low-income population in Bangladesh and study relevant motivators and barriers.After a randomised control trial in Bangladesh during 2009, 191 households received a siphon water filter along with educational messages. Researchers revisited households after 3 and 6 months to assess filter usage and determine relevant motivators and barriers. Regular users were defined as those who reported using the filter most of the time and were observed to be using the filter at follow-up visits. Integrated behavioural model for water, sanitation and hygiene (IBM-WASH) was used to explain factors associated with regular filter use.Regular filter usage was 28% at the 3-month follow-up and 21% at the 6-month follow-up. Regular filter users had better quality water at the 6-month, but not at the 3-month visit. Positive predictors of regular filter usage explained through IBM-WASH at both times were willingness to pay >US$1 for filters, and positive attitude towards filter use (technology dimension at individual level); reporting boiling drinking water at baseline (psychosocial dimension at habitual level); and Bengali ethnicity (contextual dimension at individual level). Frequently reported barriers to regular filter use were as follows: considering filter use an additional task, filter breakage and time required for water filtering (technology dimension at individual level).The technological, psychosocial and contextual dimensions of IBM-WASH contributed to understanding the factors related to sustained use of siphon filter. Given the low regular usage rate and the hardware-related problems reported, the contribution of siphon filters to improving water quality in low-income urban communities in Bangladesh is likely to be minimal.

View details for DOI 10.1111/tmi.12448

View details for Web of Science ID 000350755800008

View details for PubMedID 25495859

Screening for long-term poliovirus excretion among children with primary immunodeficiency disorders: preparation for the polio posteradication era in Bangladesh. journal of infectious diseases Sazzad, H. M., Rainey, J. J., Kahn, A., Mach, O., Liyanage, J. B., Alam, A. N., Kawser, C. A., Hossain, A., Sutter, R., Luby, S. P. 2014; 210: S373-9


Persons with primary immune deficiency disorders (PIDD) who receive oral poliovirus vaccine (OPV) may transmit immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) and cause paralytic polio. The objective of this study was to identify children with PIDD in Bangladesh, and estimate the proportion with chronic poliovirus excretion.Patients admitted at 5 teaching hospitals were screened for PIDD according to standardized clinical case definitions. PIDD was confirmed by age-specific quantitative immunoglobulin levels. Stool specimens were collected from patients with confirmed PIDD.From February 2011 through January 2013, approximately 96 000 children were screened, and 53 patients were identified who met the clinical case definition for PIDD. Thirteen patients (24%) had age-specific quantitative immunoglobulins results that confirmed PIDD. Of these, 9 (69%) received OPV 3-106 months before stool specimen collection. Among 11 patients, stool specimens from 1 patient tested positive for polioviruses 34 months after OPV ingestion. However, the poliovirus isolate was not available for genetic sequencing, and a subsequent stool specimen 45 days later was negative.The risk of chronic poliovirus excretion among children with PIDD in Bangladesh seems to be low. The national polio eradication program should incorporate strategies for screening for poliovirus excretion among patients with PIDD.

View details for DOI 10.1093/infdis/jiu221

View details for PubMedID 25316858

Serological evidence of henipavirus exposure in cattle, goats and pigs in Bangladesh. PLoS neglected tropical diseases Chowdhury, S., Khan, S. U., Crameri, G., Epstein, J. H., Broder, C. C., Islam, A., Peel, A. J., Barr, J., Daszak, P., Wang, L., Luby, S. P. 2014; 8 (11)


Nipah virus (NiV) is an emerging disease that causes severe encephalitis and respiratory illness in humans. Pigs were identified as an intermediate host for NiV transmission in Malaysia. In Bangladesh, NiV has caused recognized human outbreaks since 2001 and three outbreak investigations identified an epidemiological association between close contact with sick or dead animals and human illness.We examined cattle and goats reared around Pteropus bat roosts in human NiV outbreak areas. We also tested pig sera collected under another study focused on Japanese encephalitis.We detected antibodies against NiV glycoprotein in 26 (6.5%) cattle, 17 (4.3%) goats and 138 (44.2%) pigs by a Luminex-based multiplexed microsphere assay; however, these antibodies did not neutralize NiV. Cattle and goats with NiVsG antibodies were more likely to have a history of feeding on fruits partially eaten by bats or birds (PR=3.1, 95% CI 1.6-5.7) and drinking palmyra palm juice (PR=3.9, 95% CI 1.5-10.2).This difference in test results may be due to the exposure of animals to one or more novel viruses with antigenic similarity to NiV. Further research may identify a novel organism of public health importance.

View details for DOI 10.1371/journal.pntd.0003302

View details for PubMedID 25412358

Lot-to-lot consistency of live attenuated SA 14-14-2 Japanese encephalitis vaccine manufactured in a good manufacturing practice facility and non-inferiority with respect to an earlier product. Vaccine Zaman, K., Naser, A. M., Power, M., Yaich, M., Zhang, L., Ginsburg, A. S., Luby, S. P., Rahman, M., Hills, S., Bhardwaj, M., Flores, J. 2014; 32 (46): 6061-6066


We conducted a four-arm, double-blind, randomized controlled trial among 818 Bangladeshi infants between 10 and 12 months of age to establish equivalence among three lots of live attenuated SA 14-14-2 JE vaccine manufactured by the China National Biotec Group's Chengdu Institute of Biological Products (CDIBP) in a new Good Manufacturing Practice (GMP) facility and to evaluate non-inferiority of the product with a lot of the same vaccine manufactured in CDIBP's original facility. The study took place in two sites in Bangladesh, rural Matlab and Mirpur in urban Dhaka. We collected pre-vaccination (Day 0) and post-vaccination Day 28 (-4 to +14 days) blood samples to assess neutralizing anti-JE virus antibody titers in serum by plaque reduction neutralization tests (PRNT). Seroprotection following vaccination was defined as a PRNT titer ≥1:10 at Day 28 in participants non-immune at baseline. Follow-up for reactogenicity and safety was conducted through home visits at Day 7 and monitoring for serious adverse events through Day 28. Seroprotection rates ranged from 80.2% to 86.3% for all four lots of vaccine. Equivalence of the seroprotection rates between pairs of vaccine lots produced in the new GMP facility was satisfied at the pre-specified 10% margin of the 95% confidence interval (CI) for two of the three pairwise comparisons, but not for the third (-4.3% observed difference with 95% CI of -11.9 to 3.3%). Nevertheless, the aggregate seroprotection rate for all three vaccine lots manufactured in the GMP facility was calculated and found to be within the non-inferiority margin (within 10%) to the vaccine lot produced in the original facility. All four lots of vaccine were safe and well tolerated. These study results should facilitate the use of SA 14-14-2 JE vaccine as a routine component of immunization programs in Asian countries.

View details for DOI 10.1016/j.vaccine.2014.09.012

View details for PubMedID 25239483

A duplex recombinant viral nucleoprotein microbead immunoassay for simultaneous detection of seroresponses to human respiratory syncytial virus and metapneumovirus infections. Journal of virological methods Zhang, Y., Brooks, W. A., Goswami, D., Rahman, M., Luby, S. P., Erdman, D. D. 2014; 206: 55-62


Serologic diagnosis of human respiratory syncytial virus (hRSV) and human metapneumovirus (hMPV) infections has been shown to complement virus detection methods in epidemiologic studies. Enzyme immunoassays (EIAs) using cultured virus lysate antigens are often used to diagnose infection by demonstration of a ≥4-fold rises in antibody titer between acute and convalescent serum pairs. In this study, hRSV and hMPV nucleocapsid (recN) proteins were expressed in a baculovirus system and their performance compared with virus culture lysate antigen in EIAs using paired serum specimens collected from symptomatic children. The recN proteins were also used to develop a duplex assay based on the Luminex microbead-based suspension array technology, where diagnostic rises in antibody levels could be determined simultaneously at a single serum dilution. Antibody levels measured by the recN and viral lysate EIAs correlated moderately (hRSV, r(2)=0.72; hMPV, r(2)=0.76); the recN EIAs identified correctly 35 of 37 (94.6%) and 48 of 50 (96%) serum pairs showing diagnostic antibody rises by viral lysate EIAs. Purified recN proteins were then coupled to microbeads and serum pairs were tested at a single dilution on a Luminex MAGPIX(®) analyzer. The duplex recN assay identified correctly 33 of 39 (85%) and 41 of 47 (86.7%) serum pairs showing diagnostic rises to hRSV and hMPV, respectively. The recN assay permits simultaneous testing for acute hRSV and hMPV infections and offers a platform for expanded multiplexing of other respiratory virus assays.

View details for DOI 10.1016/j.jviromet.2014.05.008

View details for PubMedID 24859050

Nudging to use: Achieving safe water behaviors in Kenya and Bangladesh JOURNAL OF DEVELOPMENT ECONOMICS Luoto, J., Levine, D., Albert, J., Luby, S. 2014; 110: 13-21
Incidence of and Risk Factors for Hospital-Acquired Diarrhea in Three Tertiary Care Public Hospitals in Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Bhuiyan, M. U., Luby, S. P., Zaman, R. U., Rahman, M. W., Sharker, M. A., Hossain, M. J., Rasul, C. H., Ekram, A. R., Rahman, M., Sturm-Ramirez, K., Azziz-Baumgartner, E., Gurley, E. S. 2014; 91 (1): 165-172
Identification and Epidemiology of a Rare HoBi-Like Pestivirus Strain in Bangladesh TRANSBOUNDARY AND EMERGING DISEASES Haider, N., Rahman, M. S., KHAN, S. U., Mikolon, A., Gurley, E. S., Osmani, M. G., Shanta, I. S., Paul, S. K., Macfarlane-Berry, L., Islam, A., Desmond, J., Epstein, J. H., Daszak, P., Azim, T., Luby, S. P., Zeidner, N., Rahman, M. Z. 2014; 61 (3): 193-198


The genus pestivirus of the family flaviviridae consists of four recognized species: bovine viral diarrhoea virus 1 (BVDV-1), bovine viral diarrhoea virus 2 (BVDV-2), classical swine fever virus and border disease virus. A new putative pestivirus species tentatively named as either 'HoBi-like pestivirus' or BVDV-3 has recently been identified in Brazil, Italy and Thailand. Despite reports of serological evidence of BVDV in Bangladesh, the types of the virus circulating in cattle have not been identified. We conducted surveillance in cattle from May 2009 to August 2010 in three government veterinary hospitals to characterize BVDV in cattle of Bangladesh. We tested serum for BVDV using an antigen-capture ELISA. Of 638 cattle samples, 3% (16/638) tested positive for BVDV antigen. The ELISA-positive samples were selected for further molecular detection and characterization of BVDV. Molecular analysis of the partial 5' untranslated region (UTR) nucleotide sequences of BVDV-positive samples identified the rare HoBi-like pestivirus or BVDV-3 virus circulating in cattle of Bangladesh. The identification of this rare HoBi-like pestivirus or BVDV-3 strain in Bangladesh warrants further surveillance to evaluate its impact on livestock production.

View details for DOI 10.1111/tbed.12218

View details for Web of Science ID 000334298300001

View details for PubMedID 24650238

Kala-azar in Pregnancy in Mymensingh, Bangladesh: A Social Autopsy. PLoS neglected tropical diseases Rahman, K. M., Olsen, A., Harley, D., Butler, C. D., Mondal, D., Luby, S. P., Sleigh, A. C. 2014; 8 (5)

View details for DOI 10.1371/journal.pntd.0002710

View details for PubMedID 24786280

Household Air Quality Risk Factors Associated with Childhood Pneumonia in Urban Dhaka, Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Ram, P. K., Dutt, D., Silk, B. J., Doshi, S., Rudra, C. B., Abedin, J., Goswami, D., Fry, A. M., Brooks, W. A., Luby, S. P., Cohen, A. L. 2014; 90 (5): 968-975


To inform interventions to reduce the high burden of pneumonia in urban settings such as Kamalapur, Bangladesh, we evaluated household air quality risk factors for radiographically confirmed pneumonia in children. In 2009-2010, we recruited children < 5 years of age with pneumonia and controls from a population-based surveillance for respiratory and febrile illnesses. Piped natural gas was used by 85% of 331 case and 91% of 663 control households. Crowding, a tin roof in the living space, low socioeconomic status, and male sex of the child were risk factors for pneumonia. The living space in case households was 28% less likely than in control households to be cross-ventilated. Particulate matter concentrations were not significantly associated with pneumonia. With increasing urbanization and supply of improved cooking fuels to urban areas, the high burden of respiratory illnesses in urban populations such as Kamalapur may be reduced by decreasing crowding and improving ventilation in living spaces.

View details for DOI 10.4269/ajtmh.13-0532

View details for Web of Science ID 000335707600033

View details for PubMedID 24664785

Toys and toilets: cross-sectional study using children's toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices TROPICAL MEDICINE & INTERNATIONAL HEALTH Vujcic, J., Ram, P. K., Hussain, F., Unicomb, L., Gope, P. S., Abedin, J., Mahmud, Z. H., Islam, M. S., Luby, S. P. 2014; 19 (5): 528-536


To evaluate household faecal contamination using children's toys among 100 rural Bangladeshi households categorised as 'cleaner' (toilet that reliably separates faeces from the environment and no human faeces in/around living space) or 'less clean' (no toilet or toilet that does not reliably separate faeces from the environment and human faeces in/around living space).We distributed toy balls to each household and rinsed each study toy and a toy already owned by the household in 200 ml of Ringer's solution. We enumerated faecal coliforms and faecal streptococci from each rinse using membrane filtration methods.Study toys from 39 cleaner households had lower mean faecal coliform contamination than toys from 61 less clean households (2.4 log10 colony-forming units (CFU)/200 ml vs. 3.2 log10 CFU/200 ml, P = 0.03). However, wealth measures explained a portion of this relationship. Repeat measures were moderately variable [coefficient of variation (CV) = 6.5 between two toys in the household at the same time, CV = 37.6 between toys in the household at two different times 3-4 days apart]. Too few households owned a non-porous toy to compare groups without risk of bias.In rural Bangladesh, improved sanitation facilities and practices were associated with less environmental contamination. Whether this association is independent of household wealth and whether the difference in contamination improves child health merit further study. The variation found was typical for measures of environmental contamination, and requires large sample sizes to ascertain differences between groups with statistical significance.

View details for DOI 10.1111/tmi.12292

View details for Web of Science ID 000333984600006

View details for PubMedID 24645919

Coverage and cost of a large oral cholera vaccination program in a high-risk cholera endemic urban population in Dhaka, Bangladesh VACCINE Khan, I. A., Saha, A., Chowdhury, F., Khan, A. I., Uddin, M. J., Begum, Y. A., Riaz, B. K., Islam, S., Ali, M., Luby, S. P., Clemens, J. D., Cravioto, A., Qadri, F. 2013; 31 (51): 6058-6064


A feasibility study of an oral cholera vaccine was carried out to test strategies to reach high-risk populations in urban Mirpur, Dhaka, Bangladesh. The study was cluster randomized, with three arms: vaccine, vaccine plus safe water and hand washing practice, and no intervention. High risk people of age one year and above (except pregnant woman) from the two intervention arms received two doses of the oral cholera vaccine, Shanchol™. Vaccination was conducted between 17th February and 16th April 2011, with a minimum interval of fourteen days between two doses. Interpersonal communication preceded vaccination to raise awareness amongst the target population. The number of vaccine doses used, the population vaccinated, left-out, drop out, vaccine wastage and resources required were documented. Fixed outreach site vaccination strategy was adopted as the mode of vaccine delivery. Additionally, mobile vaccination sites and mop-up activities were carried out to reach the target communities. Of the 172,754 target population, 141,839 (82%) and 123,666 (72%) received complete first and second doses of the vaccine, respectively. Dropout rate from the first to the second dose was 13%. Two complete doses were received by 123,661 participants. Vaccine coverage in children was 81%. Coverage was significantly higher in females than in males (77% vs. 66%, P<0.001). Vaccine wastage for delivering the complete doses was 1.2%. The government provided cold-chain related support at no cost to the project. Costs for two doses of vaccine per-person were US$3.93, of which US$1.63 was spent on delivery. Cost for delivering a single dose was US$0.76. We observed no serious adverse events. Mass vaccination with oral cholera vaccine is feasible for reaching high risk endemic population through the existing national immunization delivery system employed by the government.

View details for DOI 10.1016/j.vaccine.2013.10.021

View details for Web of Science ID 000329010400005

View details for PubMedID 24161413

Handwashing before Food Preparation and Child Feeding: A Missed Opportunity for Hygiene Promotion AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Nizame, F. A., Unicomb, L., Sanghvi, T., Roy, S., Nuruzzaman, M., Ghosh, P. K., Winch, P. J., Luby, S. P. 2013; 89 (6): 1179-1185


Enteric diseases are often caused by poor hygiene and can contribute to stunting. From 50 randomly selected villages in Bangladesh, we collected quantitative and qualitative data on handwashing linked to child feeding to integrate handwashing promotion into a young child complementary feeding program. Most participants stated that the community knew the importance of handwashing with soap before food preparation and feeding a child, but had not developed the habit. We observed no handwashing with soap at these key times; sometimes hands were rinsed with water only. Most participants cited the unavailability of soap and water near the cooking place as a barrier to handwashing before food preparation. Most caregivers ranked nurturing messages as the best motivator to encourage handwashing with soap. An integrated intervention should include having soap and water available near the food preparation area and should use nurturing themes to encourage habitual handwashing with soap.

View details for DOI 10.4269/ajtmh.13-0434

View details for Web of Science ID 000328726100019

View details for PubMedID 24080638

Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH) BMC PUBLIC HEALTH Hulland, K. R., Leontsini, E., Dreibelbis, R., Unicomb, L., Afroz, A., Dutta, N. C., Nizame, F. A., Luby, S. P., Ram, P. K., Winch, P. J. 2013; 13


In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations--a dedicated, convenient location where both soap and water are available for handwashing--are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour.We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs.Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials.A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

View details for DOI 10.1186/1471-2458-13-877

View details for Web of Science ID 000329279200002

View details for PubMedID 24060247

Household Environmental Conditions Are Associated with Enteropathy and Impaired Growth in Rural Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Lin, A., Arnold, B. F., Afreen, S., Goto, R., Huda, T. M., Haque, R., Raqib, R., Unicomb, L., Ahmed, T., Colford, J. M., Luby, S. P. 2013; 89 (1): 130-137
Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ open Arnold, B. F., Null, C., Luby, S. P., Unicomb, L., Stewart, C. P., Dewey, K. G., Ahmed, T., Ashraf, S., Christensen, G., Clasen, T., Dentz, H. N., Fernald, L. C., Haque, R., Hubbard, A. E., Kariger, P., Leontsini, E., Lin, A., Njenga, S. M., Pickering, A. J., Ram, P. K., Tofail, F., Winch, P. J., Colford, J. M. 2013; 3 (8)


Enteric infections are common during the first years of life in low-income countries and contribute to growth faltering with long-term impairment of health and development. Water quality, sanitation, handwashing and nutritional interventions can independently reduce enteric infections and growth faltering. There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children. The objective of the WASH Benefits study is to help fill this knowledge gap.WASH Benefits includes two cluster-randomised trials to assess improvements in water quality, sanitation, handwashing and child nutrition-alone and in combination-to rural households with pregnant women in Kenya and Bangladesh. Geographically matched clusters (groups of household compounds in Bangladesh and villages in Kenya) will be randomised to one of six intervention arms or control. Intervention arms include water quality, sanitation, handwashing, nutrition, combined water+sanitation+handwashing (WSH) and WSH+nutrition. The studies will enrol newborn children (N=5760 in Bangladesh and N=8000 in Kenya) and measure outcomes at 12 and 24 months after intervention delivery. Primary outcomes include child length-for-age Z-scores and caregiver-reported diarrhoea. Secondary outcomes include stunting prevalence, markers of environmental enteropathy and child development scores (verbal, motor and personal/social). We will estimate unadjusted and adjusted intention-to-treat effects using semiparametric estimators and permutation tests.Study protocols have been reviewed and approved by human subjects review boards at the University of California, Berkeley, Stanford University, the International Centre for Diarrheal Disease Research, Bangladesh, the Kenya Medical Research Institute, and Innovations for Poverty Action. Independent data safety monitoring boards in each country oversee the trials. This study is funded by a grant from the Bill & Melinda Gates Foundation to the University of California, Berkeley.Trial registration identifiers ( NCT01590095 (Bangladesh), NCT01704105 (Kenya).

View details for DOI 10.1136/bmjopen-2013-003476

View details for PubMedID 23996605

Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ open Arnold, B. F., Null, C., Luby, S. P., Unicomb, L., Stewart, C. P., Dewey, K. G., Ahmed, T., Ashraf, S., Christensen, G., Clasen, T., Dentz, H. N., Fernald, L. C., Haque, R., Hubbard, A. E., Kariger, P., Leontsini, E., Lin, A., Njenga, S. M., Pickering, A. J., Ram, P. K., Tofail, F., Winch, P. J., Colford, J. M. 2013; 3 (8)

View details for DOI 10.1136/bmjopen-2013-003476

View details for PubMedID 23996605

Maternal and neonatal deaths associated with jaundice during pregnancy in Bangladesh: Using verbal autopsy data to estimate of the burden of endemic hepatitis E infection. Am J Public Health Gurley ES, Halder AK, Streatfield PK, Sazzad HMS, Huda MT, Hossain MJ, Luby SP 2012; 102 (12): 2248-54
Epidemiology of henipavirus disease in humans. Current topics in microbiology and immunology Luby, S. P., Gurley, E. S. 2012; 359: 25-40


All seven recognized human cases of Hendra virus (HeV) infection have occurred in Queensland, Australia. Recognized human infections have all resulted from a HeV infected horse that was unusually efficient in transmitting the virus and a person with a high exposure to infectious secretions. In the large outbreak in Malaysia where Nipah virus (NiV) was first identified, most human infections resulted from close contact with NiV infected pigs. Outbreak investigations in Bangladesh have identified drinking raw date palm sap as the most common pathway of NiV transmission from Pteropus bats to people, but person-to-person transmission of NiV has been repeatedly identified in Bangladesh and India. Although henipaviruses are not easily transmitted to people, these newly recognized, high mortality agents warrant continued scientific attention.

View details for DOI 10.1007/82_2012_207

View details for PubMedID 22752412

The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: An observational study. PLoS Med Luby SP, Halder AK, Huda T, Tronchet C, Unicomb L, Johnston RB. 2011; 8 (6): e1001052