Nipah
virus (NiV) infection is a newly emerging zoonosis that causes severe disease
in both animals and humans.
The
natural host of the virus is fruit bats of the Pteropodidae family, Pteropus
genus.
NiV
was first identified during an outbreak of disease that took place in Kampung
Sungai Nipah, Malaysia in 1998.
In
1998, pigs were the intermediate hosts. However, in subsequent NiV outbreaks,
there were no intermediate hosts.
In
Bangladesh in 2004, humans became infected with NiV after consuming date palm
sap that was contaminated by infected fruit bats.
Human-to-human
transmission has also been documented.
What
are the symptoms? How do you know if you are infected?
NiV
infection in humans has a range of clinical presentations, from asymptomatic
infection to acute respiratory syndrome and fatal encephalitis (inflammation
of the brain).
Experts
are of the opinion that Nipah Virus is an airborne transmission infection and
can affect those who come in direct contact with contaminated bodies.
Nipah
Virus is usually associated with inflammation of the brain due to which several
days of fever can often lead to a state of confusion, disorientation and even
persistent drowsiness.
If
not taken care of, these symptoms can even cause a coma in a span of 24 to 48
hours.
There
are many patients who show neurological, respiratory and pulmonary signs as
well. Therefore, do not ignore any such signs.
Some
common signs and symptoms of NiV are headache, fever, nausea, dizziness,
drowsiness and mental issues such as confusion.
These
symptoms can last up to 7 to 10 days. Watching out for respiratory illness
during the early stages is also very important.
What
are the dos and don'ts to follow?
As
of now, there is no particular vaccine available purely for the treatment of
Nipah Virus.
The only way to treat this virus is through intensive supportive
care.
Since
drinking raw date palm sap bitten by a bat can also cause NiV, it is safe to
say that you should stay from consuming date palm for some time.
Hospitals
also need to raise awareness about symptoms and transmission to avoid
human-to-human infections in such settings.
Detection
is another issue with NiV and anyone who feels the symptoms should get tested
thoroughly from a recognized facility.
Avoiding
direct contact with infected pigs, bats and humans in endemic regions should be
practiced.
Health
professionals attending to such patients should take precautionary measures,
such as wearing masks and gloves.
If
you feel uneasiness when in and around an infected region, get yourself tested
immediately.
If
you are infected, what should you do next?
Currently
there is no effective treatment for Nipah virus infection. The treatment is
limited to supportive care.
It
is important to practice standard infection control practices and proper
barrier nursing techniques to avoid the transmission of the infection from
person to person.
All
suspected cases of Nipah virus infection should be isolated and given intensive
supportive care.
Ribavirin
(an antiviral medication) has been shown effective in vitro tests, but
has not yet been proven effective in humans.
Passive
immunisation using a human monoclonal antibody that targets the Nipah G
glycoprotein has been evaluated in the ferret model as post-exposure
prophylaxis.
The
anti-malarial drug chloroquine was shown to block the critical functions needed
for maturation of Nipah virus, although no clinical benefit has yet been
observed.
m102.4,
a human monoclonal antibody, has been used in people on a compassionate use
basis in Australia and is presently in pre-clinical development.
If
a family member is infected, what to do next?
- Immediately hospitalise the family member.
- Avoid direct contact -- shaking hands, physical contact and use of patient's personal items.
- Do not consume fresh fruits, date palm and other poorly washed fruits/half consumed fruits.
- Learn about the possible mental symptoms and confusion etc. Be sympathetic and provide emotional support.
Currently, what kind of people is at risk of
the infection?
The
risk of exposure is high for hospital workers and caretakers of those infected
with the virus.
In
Malaysia and Singapore, Nipah virus infection occured in those with close
contact to infected pigs.
In
Bangladesh and India, the disease has been linked to consumption of raw date
palm sap (toddy) and contact with bats.
How
can you prevent yourself?
Prevention
of Nipah virus infection is important since there is no effective treatment for
the disease.
The
infection can be prevented by avoiding exposure to bats in endemic areas and
sick pigs.
Drinking
of raw palm sap (palm toddy) contaminated by bat excretes, eating of fruits
partially consumed by bats and using water from wells infested by bats should
be avoided.
Bats
are known to drink toddy that is collected in open containers, and occasionally
urinate in it, which makes it contaminated with the virus.
Surveillance
and awareness are important for preventing future outbreaks.
The
association of this disease within reproductive cycle of bats is not well
studied.
Standard
infection control practices should be enforced to prevent nosocomial
infections.
A
subunit vaccine using the Hendra G protein was found to produce
cross-protective antibodies against henipavirus and nipavirus has been used in
monkeys to protect against Hendra virus, although its potential for use in
humans has not been studied.
What
advice would you like share with those travelling to and from that infected
area?
- Do not eat partly consumed fruits
- Avoid mangoes
- Avoid raw date palm
- Eat only properly washed fruits
- Maintain personal hygiene.
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