Nipah Virus 101: The Story So Far
As the Nipah virus makes a reappearance in the country this year, it has already taken the lives of 16 people in four districts of Kerala (Kozhikode, Malappuram, Kannur and Wayanad) and has also spread to other states. In light of the increasing risks and death toll, The Manipal Journal looks into the details of the biggest disease outbreak so far in India in 2018.
What is the Nipah virus?
The Nipah virus (NiV) infection, as defined by the World Health Organisation (WHO), is a newly emerging zoonosis (a phenomenon by which this virus affects both humans and animals) which has a natural host in the fruit bats of the Pteropodidae family, Pteropus genus. The virus gets its name from the place where the first outbreak was identified, in Kampung Sungai Nipah, Malaysia in 1998. However, transmission through pigs has also been reported.
India has previously had two outbreaks of this virus in West Bengal in 2001 and 2007, wherein 50 people were killed. Similar outbreaks were also reported in the neighboring country of Bangladesh in 2004.
Apart from the current death toll this year in Kerala, two people are suspected to have been exposed to the virus in Mangaluru, and in Himachal Pradesh. About 116 people have been quarantined in Kerala since the outbreak. Consequently, the Union Health Ministry has issued an advisory for the general public and healthcare personnel, specifying preventive measures to be adopted in high-risk areas and information on the process by which this virus spreads and its symptoms. A multi-disciplinary team led by the National Centre for Disease Control (NCDC) is currently reviewing the scenario in Kerala.
This time in Himachal Pradesh, an alert was triggered after eight dead bats were found inside the premises of a government school in the Nahan district. It is suspected that the death was caused by the Nipah virus, and the samples of their dead bodies were sent to the National Institute of Virology (NIV) for investigation.
The death of Lini Puthussery
Lini Puthussery, a 30 -year-old nursing assistant at the Perambra Taluk Hospital in Kozhikode, Kerala became the face of the deadly virus outbreak in Kerala after her tragic demise on May 21. She is said to have been exposed to the Nipah virus while attending to a family of three, the first set of infected patients, that were admitted at the hospital in April end. The nurse was running a fever when she reported for work the day she died, but did not realise it would be fatal. She was hastily cremated in order to prevent the disease from spreading further.
As Lini Puthussery’s final letter to her family was brought to public notice, hundreds in India mourned the untimely demise of the young woman who contracted the deadly Nipah virus in Kerala. Her death sent shockwaves across the entire country about the outbreak of the deadly virus in India, with tributes pouring in for her.
How is the Nipah virus transmitted?
60% of all infections in humans are caused by animals. Therefore, those working in close proximity with animals are at a much greater risk of being exposed to this virus. The virus is known for its fatalness, and it is reported that it can kill between 40% and 100% of those affected by it. Human-to-human (direct) contact is also a contributing factor to the spread of this virus, with the cases reported in an outbreak in Siliguri deducing that 75% of the cases happened among hospital staff and visitors.
In the advisory issued by the Health Ministry, it has been mentioned that bat secretions laden with virus can trigger an infection among people while tree climbing, eating or handling contaminated fallen fruits and more specifically the consumption of raw date palm sap/juice or toddy too can trigger the same. The human-to-human interaction can occur with close contact with infected patients during health care and burial or cremation rituals.
What are the symptoms and what precautions could one take to avoid exposure?
The early symptoms of exposure are generic, which can be confused with those of common cold and other viral infections. This virus is known to affect both neurological and respiratory systems of humans. The incubation period of this virus is from 4 to 14 days.
The recent outbreaks reported show that in 75% of the cases, the patient’s lungs were affected. Those exposed go through increasing breathlessness and might even go through severe oxygen hunger. It can also progress to the inflammation of the brain, and the patient can slip into a coma within 48 hours. This carries a high mortality rate and the survivors can have long-term neurological issues such as seizure disorders.
If one suffers from the symptoms in the affected areas, then seeking immediate vigilance and early advice can help. Health professionals working in these areas are educated to watch out for symptoms and direct counsel is highly beneficial. The portals of the WHO and the Centre for Disease Control (CDC) are excellent resources about this virus. The Ministry has also advised people to wash their hands for 20 seconds with soap and water if they come in contact with an affected person.
There is no definitive cure yet for Nipah apart from supportive care, which involves close monitoring following admission to a hospital. The patients might be in need of respiratory support too. The Coalition for Epidemic Preparedness Innovations (CEPI), a global alliance of government, and non-profit organizations, has set up efforts to find a cure for the deadly disease. Scientists are rushing to find a vaccine for Nipah. Outbreaks along the lines of Nipah are estimated to be a more common occurrence now with the increasing population density, making human and animal contact inevitable.
Featured Graphic Courtesy: Anushka Chhikara
Edited by: Niharika Nambiar