T2D Management Among a Community Clinic Patient Sample After California's May 2022 Medicaid Expansion.

Nipah virus (NiV) is a zoonotic Henipavirus (family Paramyxoviridae) that causes severe disease in humans, most commonly acute encephalitis with or without respiratory involvement [–]. Pteropus fruit bats serve as the natural reservoir [–]. Human infection occurs through ingestion of raw date-palm sap or fruit contaminated by bat secretions and through person-to-person transmission during close caregiving or exposure to respiratory secretions [–]. The incubation period is usually 3–14 days, although intervals up to 45 days have been reported [–]. Illness typically begins with fever, headache, myalgia, vomiting, and sore throat, and can progress rapidly to altered consciousness, seizures, and coma within 24–48 h, often with acute respiratory involvement [, , ]. This clinical pattern is consistent with NiV neurotropism and vasculitic pathology; human autopsy studies demonstrate infection of neurons and vascular endothelium with widespread vasculitis and parenchymal necrosis, findings consistent with high case-fatality rates and persistent neurological sequelae among survivors [–]. Since emergence in Malaysia in 1998–1999 and recognition in Bangladesh in 2001, NiV has caused recurrent outbreaks in South and Southeast Asia [, , , ]. In Bangladesh, outbreaks occur almost annually between December and April, coincide with the date-palm sap harvesting season, and are concentrated in north-western and central districts [, ]. Case-fatality ratios have remained high across outbreaks in Malaysia, India, and Bangladesh, ranging from 40% to 100% depending on the outbreak setting and healthcare context [, ]. Because of its zoonotic origin, capacity for human-to-human transmission, and absence of licensed treatments or vaccines, NiV is listed by the World Health Organization (WHO) as a priority pathogen with epidemic and pandemic potential [, ]. In response, the Institute of Epidemiology, Disease Control and Research (IEDCR, Bangladesh), in collaboration with icddr, b and the U.S. Centers for Disease Control and Prevention (CDC), established a hospital-based Nipah surveillance system in 2006 that has supported early case detection and outbreak response at sentinel tertiary hospitals []. As of 2025, Bangladesh has reported over 341 confirmed human NiV cases with an overall case-fatality rate of approximately 71% (about 29% survival), yielding a small but highly burdened survivor population [, ]. Follow-up studies from Bangladesh indicate persistent neurological impairment and delayed-onset complications among a substantial subset of survivors [], with similar long-term effects reported in Malaysia and Singapore, including neuropsychiatric symptoms and cognitive impairment. In addition to physical and psychological morbidity, survivors often encounter social challenges []. Qualitative research and outbreak investigations in Bangladesh describe stigma and social exclusion linked to fear of contagion, caregiving exposure, and local explanatory beliefs, including in settings where biomedical transmission is understood [, ].