Nipah Virus

Avoid Eating Fruits that Have Signs of Biting

Fruit Bats Love to Drink a Cup of Raw Date Palm Sap

Kerala is on fire over Nipah virus ever since May 19th, 2018 when the Nipah virus disease (NiV) was first reported in the Kozhikode district of the state. Till now, there are 15 cases of confirmed deaths in the two affected districts, Kozhikode and Mallapuram in Kerala.
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Tracing the Origin of the Virus
First outbreak of this virus was in the year 1998 in the Malaysian village Sungai Nipah (hence the name Nipah virus!) among pig farmers but there were no cases reported after that. Here, the virus transmission was traced to human exposure to pig secretions or contact with the tissue of a sick animal. Yet another outbreak occurred in Bangladesh in 2001 and the country has witnessed at least a few cases almost every year since then. Eastern India also witnessed rare outbreaks of the disease since 2001 (Siliguri in West Bengal was the first affected city in India). The disease outbreak in 2004 in Bangladesh and India were linked to the consumption of date palm sap contaminated by infected fruit bats (urine or saliva). 

Later outbreaks in Bangladesh and India were mostly due to human-to-human exposure through people’s saliva or excretions. Almost 75% cases reported in the Siliguri city of West Bengal (2001) was within a health-care setting amongst hospital staff or visitors. According to WHO, the Nipah virus has claimed over 300 lives across Malaysia, Singapore, Bangladesh and India between the years 1998 and 2008. Researchers have confirmed that the Bangladesh strain of the Nipah virus is the reason for this latest outbreak in Kerala (2018).
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Nipah Virus: Zoonotic Disease
Nipah virus (NiV) is a zoonic disease (transmitted from animals to humans) that spreads via food or humans. NiV can also affect animals such as pigs severely and incur unwanted expenditure and losses for farmers. While the occurrence rate and numbers are low, the death percentage and severity are high making NiV a public health concern.

Signs & Symptoms
What makes this disease a deadly one is the incubation period which ranges anywhere from 4-14 days generally and even 45 days sometimes. Initial symptoms include fever, headache, muscle pain, vomiting and sore throat which is followed by dizziness, drowsiness, altered consciousness and neurological symptoms that indicate acute encephalitis (inflammation of the brain). Rarely, people do experience atypical pneumonia, severe respiratory problem and fatal encephalitis.

Fatality rates exist anywhere between 40 and 75%. Mostly people with acute encephalitis recover fully but among them, almost 20% people are left with long-term neurologic conditions such as seizure disorder and personality changes. But if proper care is not taken within 24-48 hours after symptoms of delirium, drowsiness and confusion, it can turn into coma. Read more on encephalitis at www.firsteatright.com. 

Diagnosis
Symptoms include influenza-like ones, don’t present themselves immediately and are non-specific which can prevent appropriate intervention, delay detection and take proper control measures. Also, the virus strain is evident only during the acute and convalescent phase of the disease. ELISA, PCR, virus isolation by cell culture and RT-PCR are the various test methods used for detection.

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Protect the Raw Date Palm Sap with Bamboo Covering

Treatment
As of 2018, there are no drugs or vaccines available for treating the infection and the only feasible option is to offer intensive supportive care 24×7. Firstly, all patients suspected/confirmed of NiV must be isolated and given support care. Although the drug ribavirin shows positive effects against the virus in vitro, further research is needed. Also, passive immunization using a human monoclonal antibody targeting Nipah G glycoprotein has been evaluated in the post-exposure therapy in the ferret (mammal) model and was found to be beneficial (Centre for Disease Control and Prevention, United States). All treatment options are in the research stage and need further analysis. Given below are certain precautionary measures that need to be followed:

1. Avoid exposure to bats in endemic areas and infected pigs. If there is suspicion of an outbreak, the animal premises should be quarantined immediately and appropriate action must be taken (killing and burying the animals to reduce spread of infection).
2. In India, humans often contracted the virus by drinking raw date palm sap tapped directly from trees and sadly, this is a beverage often relished by the fruit bats too! It is necessary to keep the bats away from gaining access to date palm sap and fruits as much as possible by preventing their entry into sap collection sites, covering the collected beverage carefully and boiling the palm juice before consumption.
3. Avoid eating fruits that have signs of biting, wash any fruit thoroughly before consuming and stay hygienic by washing your hands thoroughly.
4. Human-to-human infection is the most-reported form of transmission in India, especially in healthcare settings. Individuals caring infected people should do it with utmost precaution, even taking care of droplet and contact precautions alongside standard precautionary procedures. One cannot forget the selflessness of the nurse in Kerala who sacrificed her life tending to the needs of the infected people, in fact caring for the first infected person in 2018 May.
5. Samples for testing must be handled by trained staff in well-equipped laboratories.

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