By Monisha Ghosh & Siddharth Mala
New Delhi: On the evening of September 12, Kerala confirmed that four individuals tested positive for Nipah, as per tests conducted by the ICMR-National Institute of Virology (NiV), Pune. The infection has resurfaced in the state for the third time in the past five years. The state has reported two deaths so far. Union Minister of Health Mansukh Mandaviya stated that a team of experts from the central government has been dispatched to Kerala to assess the situation and aid the state government in managing the Nipah virus outbreak.
The Nipah virus, a deadly pathogen that induces brain damage, spreads to humans when they come into direct contact with the bodily fluids of infected bats, pigs, or other individuals. It was first recognised in 1999 during an outbreak that impacted pig farmers and individuals in close proximity to pigs in Malaysia and Singapore. As per the National Centre for Disease Control (NCDC), Nipah is categorised as a zoonotic virus, indicating that its initial transmission occurs from animals to humans. ETHealthworld interacted with medical experts to gain further insights into this virus.
Elucidating that Nipah virus infection is a highly contagious and potentially deadly pathogen zoonotic disease, Dr Rohit Garg, Consultant, Dept of Infectious Disease, Amrita Hospital, Faridabad, said, “The incubation period varies, the symptoms usually appear within four to 14 days after exposure. The clinical presentations varies from from mild to severe illness. The common symptoms of Nipah virus infection include fever, cough, sore throat, and difficulty breathing, Headache, myalgia, fatigue, nausea, vomiting. As the diseases progress, difficulty in swallowing, confusion, drowsiness, disorientation, seizures, coma, respiratory distress can occur in severe cases. The disease can be fatal in severe cases.”While emphasising about the transmission of the virus Dr Anurag Aggarwal, Consultant, Internal Medicine, Fortis Escorts Hospital, Faridabad explained Nipah virus is transmitted primarily from fruit bats to humans through the consumption of contaminated fruits or juices, or through direct contact with infected animals or their bodily fluids. Precautions include avoiding contact with bats and sick animals, not consuming raw date palm sap, and practicing good hygiene.
In certain regions of the southern Indian state of Kerala, educational institutions and workplaces have been closed due to the confirmation of five cases of the uncommon Nipah virus. On Wednesday, officials reported that 706 individuals, including 153 healthcare professionals, underwent testing in an effort to contain the virus’s transmission. Results are currently pending.
Dr Vandana Boobna, Associate Director, Internal Medicine, Max Super Speciality Hospital, Shalimar Bagh, underscored the fact that since there are currently no available vaccines for this virus, there is no definite or direct treatment available for this infection. Only symptomatic treatment and supportive care, including rest, hydration, and treatment of symptoms as they occur. Monoclonal antibody, the antiviral treatment Remdesivir, and the drug ribavirin have been used and are under trial.
Dr Samir Garde, Director, Dept of Pulmonology and Lung Transplant, Global Hospitals, Parel, suggested that individuals in close contact with confirmed Nipah virus cases may undergo diagnostic testing, like polymerase chain reaction (PCR) or serological tests, even if they are asymptomatic and the healthcare authorities would guide this process during an outbreak.
Advising the same, Dr Sanjith Saseedharan, Consultant and Head-Critical Care, SL Raheja Hospital, Mahim-A Fortis Associate informed that nasopharyngeal swabs for PCR can be done to test individuals who are suspected to have Nipah virus. It is not advisable to test asymptomatic individuals.
Adding to that Dr Garg highlighted that tracing of contacts i.e. testing of individuals who have been exposed to a patient with confirmed Nipah virus cases is important to break the chain of transmission, to prevent further transmission of the virus, and for outbreak control. It involves identifying and notifying all individuals who have had close contact with the confirmed case, including family members, healthcare workers, and anyone else who may have been exposed to the virus. The exposed, asymptomatic individuals may be tested with molecular tests like Nipah virus RNA PCR (polymerase chain reaction) in respiratory secretions, blood, or other relevant specimens. Asymptomatic individuals may test negative during initial contact tracing and therefore, in case of symptoms, repeat testing should be performed.
While emphasising about steps that the general public take can to protect themselves and their communities during a Nipah virus outbreak, Dr Boobna said,” Awareness and education serve as the fundamental tool for safeguarding against any illness. Due to its relative rarity, there exists a dearth of awareness about this particular ailment among the general populace. Therefore, it is imperative for individuals to proactively equip themselves with knowledge concerning the transmission of this virus. This self-education, facilitated by the dissemination of public information, plays a pivotal role in curtailing the spread of the disease.”
According to doctors, the general precautions include consistent handwashing with soap and water, refraining from contact with ailing bats or pigs, steering clear of areas where bats are known to congregate, abstaining from the consumption of products potentially contaminated by bats such as raw date palm sap, unprocessed fruit, or fruit found on the ground, and avoiding any interaction with the bodily fluids or blood of individuals identified as NiV-infected. Unfortunately, neither humans nor animals possess access to treatment or vaccination options. Consequently, the primary recourse for human cases revolves around providing supportive care.
In the case of Nipah virus infection, one is dealing with a highly transmissible and potentially lethal zoonotic disease, which means it can be transmitted from animals to humans. Healthcare professionals must exercise rigorous precautions to safeguard themselves. All the experts collectively advised the following measures for the safety of the healthcare workers from the Nipah virus:
· Patient Placement: When dealing with a patient suspected or confirmed to have Nipah infection, it is imperative to isolate them in a single-room environment, preferably one equipped with negative pressure ventilation.
· Utilisation of Personal Protective Equipment (PPE): When in contact with Nipah virus patients, their bodily fluids, or contaminated surfaces, it is crucial to use appropriate PPE, which includes gloves, masks (specifically N95 respirators), gowns, and eye protection (either goggles or face shields).
· Maintenance of Hand Hygiene
· Observing Respiratory Hygiene and Cough Etiquette: This involves covering the mouth and nose when coughing or sneezing.
· Implementation of Safe Injection Practices: This helps prevent the transmission of the virus through contaminated needles or syringes, as well as the avoidance of Needlestick Injuries.
· Thorough Environmental Cleaning and Disinfection of patient care areas.
· Consideration of Post-Exposure Prophylaxis for healthcare workers who have been exposed to Nipah virus patients or their bodily fluids without proper protection.