Table of Contents
What is Nipah Virus?
- Nipah virus is a zoonotic virus i.e. it spreads from animals to humans.
- Nipah virus is a highly pathogenic and deadly virus which has high fatality rate
- In ill people, it causes a range of ailments from asymptomatic (subclinical) infection to acute respiratory illness and lethal encephalitis.
- The virus can cause severe disease in animals for instance pigs, resulting in substantial economic losses for agriculturalists.
- Though the Nipah virus has caused simply a few identified outbreaks in Asia, it affects wide range of animals and causes life-threatening disease and death in people, making it a public health concern.
Global Facts About Nipah Virus
- Nipah Virus was first identified in Malaysia in 1998.
- Fruit bats of the genus (Pteropus), also known as flying fox, are the natural reservoir/host of the Nipah Virus.
- The virus has the capacity to transmit from animals to humans and also possesses transmission potential from human-to-human transmission.
- Its infection in humans causes a range of medical expositions, from asymptomatic infection (subclinical) to acute respiratory infection and serious encephalitis.
- The case fatality rate is expected at 40% to 75%. This rate can differ by outbreak reliant on local competencies for epidemiological surveillance and clinical management.
- Nipah virus can be transmitted to humans from animals (such as bats or pigs), or contaminated foods and can be transferred directly from human-to-human.
- There is no treatment or vaccine accessible for either one i.e. people or animals. The crucial treatment for humans is supportive care.
- Due to its epidemic potential and lack of treatment options, World Health Organization (WHO) has categorized Nipah virus as ‘priority pathogen’ for research and development.
Geographic Distribution of Outbreaks
- Malaysia: 1998-99
- Singapore: 1999
- Bangladesh: 2001- present (at regular intervals)
- India: (2001, 2007, 2018, 2021)
Transmission of Nipah Virus
1. Animal to human transmission
- Direct contact with infected animals
- Contaminated foods: consumption of raw date palm sap contaminated by bat secretions.
2. Human-to-human transmission
- Close contact with infected persons through respiratory droplets or body fluids
- Human-to-human transmission of Nipah virus has also been described among family and care supporters of infected patients.
3. Environmental contamination
- Contamination of the objects/subjects where bats feed or excrete.
Incubation Period of Nipah Virus
- The incubation period (interval from infection to the onset of symptoms) of Nipah virus is supposed to range from 4 to 14 days. Yet, an incubation period as long as 45 days has been stated.
Symptoms of Nipah Virus
Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis.
Initial symptoms (3-14 days of exposure)
- Fever
- Sore throat
- Vomiting
- Muscle pain
- Headache
Advanced symptoms
- Seizures
- Dizziness
- Altered mental status
- Encephalitis
- Coma (in severe cases)
- Unusual pneumonia and severe respiratory problems (in some cases)
- Most people who persist acute encephalitis make a complete recovery, but long-term neurologic conditions have been reported in survivors. Roughly, 20% of patients are left with remaining neurological consequences such as seizure disorder and personality changes
Fatality Rate of Nipah Virus
- The case fatality rate is projected at 40% to 75%.
- This rate can differ by outbreak dependent on local competencies for epidemiological surveillance and clinical management.
Diagnosis of Nipah Virus
Nipah Virus can be diagnosed through laboratory tests. It includes:
Laboratory tests
- RT-PCR: Gold standard
- ELISA (Enzyme-Linked Immunosorbent Assay)
- Virus isolation
- Immunohistochemistry
Prevention and Control Measures of Nipah Virus
- Avoid contact with sick animals, mainly bats and pigs
- Avoid the consumption of raw date palm sap in outbreak-prone areas.
- Repetitive and comprehensive cleaning and decontamination of pig farms with suitable detergents.
- If an outbreak is doubted, detain the animal location instantly.
- Burial or ignition of carcasses of an infected animal to lessen the risk of spread to people.
- Controlling or prohibition of the movement of animals from plague-ridden farms to other areas
- As Nipah virus outbreaks have tangled pigs and/or fruit bats, forming an animal health/wildlife surveillance system, by a One Health approach, to identify Nipah cases is crucial in providing early warning for veterinary and human public health specialists.
- Developing an early warning systems
- Health education and community awareness
- Capacity building of health workers on infection control practices
- Prioritizing Occupational health and safety practices for the health workers to prevent infection in them
- Use of Personal Protective Equipment (PPE)
- Joint research and monitoring between veterinary and human medicine
Treatment of Nipah Virus
- There are presently no drugs or vaccines particular for Nipah virus infection although WHO has recognized Nipah as a priority disease for the WHO Research and Development Blueprint.
- Different vaccines are in pre-clinical and early clinical stages.
- Intensive supportive care is suggested to treat severe respiratory and neurologic problems.
- Stabilize neurological and respiratory functions
- Provide proper balanced diet and nutrition
- Ensure adequate hydration
- Control seizure
Strategies to Handle a Nipah Virus Outbreak
Although there can be different strategies to handle an outbreak, based on the context, available resources and other settings, some of the key strategies that can support in the best management of an outbreak includes:
- Establishing isolation wards for those infected with the virus
- Conducting contact tracing
- Developing quarantine centers
- Enforce travel restriction to the infected persons and those under contact tracing
- Media mobilization about an outbreak
- Health education and awareness campaign
References and For More Information
https://www.who.int/csr/disease/nipah/en/
https://www.who.int/news-room/fact-sheets/detail/nipah-virus
https://www.publichealthupdate.com/nipah-virus-niv-key-facts-transmission-prevention/
https://testbook.com/blog/nipah-virus-causes-symptoms-diagnosis/
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