All You Need to Know About Nipah Virus Infection: Causes, Symptoms, Preventive Measures, & Treatment

The Nipah Virus is an enveloped RNA virus which causes a viral infection that has been a significant contributor to outbreaks of encephalitis (brain fever) with high death rates. According to the World Health Organization (WHO), the death rate for patients varies from 40% to 75%, depending on the effectiveness of the public health measures implemented in response to the outbreak of such infections.

The term 'Nipah' originates from a Malaysian village, where the first outbreak was documented between 1998 and 1999. The outbreak of Nipah virus infection in Malaysia affected over 250 people, primarily the farm and abattoir workers, leading to cases of febrile encephalitis. This outbreak induced widespread fear and significant socio-economic upheaval.

However, it has mainly affected the Indo-Bangladesh regions in last five years. While the initial outbreak in Malaysia-Singapore was linked to contact with pigs. The Philippines outbreak was associated with horse slaughter and the most subsequent outbreaks have occurred in the Indo-Bangladesh regions. These Indo-Bangladesh outbreaks were connected to the consumption of raw date palm sap contaminated by fruit bats and exhibited a particularly high secondary attack rate.

Two initial outbreaks of Nipah Virus in India resulted in the deaths of over 50 individuals before those outbreaks were successfully managed. The virus claimed the lives of 17 individuals during the 2018 outbreak.

The recent reports of Nipah Virus infection spread in Kerala have prompted the Kerala health department to be on high alert. There have been two fatalities due to Nipah virus and an additional four confirmed cases reported in the past one month. In response, authorities have taken measures such as the closure of certain schools and the implementation of widespread testing. This marks the fourth documented cluster of Nipah cases in Kerala within five years.

Nipah Virus is a zoonotic virus, meaning it can transmit between animals and humans. The prime risk factors behind this viral infection are the sick or infected animals. The mode of transmission is through fruit bats, also known as flying foxes. However, this viral infection can also spread via other animals such as pigs, goats, horses, dogs, or cats. The causes of transmission are:

• Contact of people or animals with the body fluids (such as Blood, Feces, Urine, or Saliva) of an infected animal
• Consumption of food that has been contaminated by an infected animal
•  Close contact of people with an individual infected with Nipah Virus, typically while providing care to them. The viral infection can be transmitted via respiratory droplets, which means it can be airborne when an infected individual coughs or sneezes

Typically, these symptoms of Nipah virus infection develop within a timeframe of four to 14 days after exposure to the virus. It's common to experience initial symptoms like fever or headache, followed by the development of respiratory problems such as cough and breathing difficulties. However, researchers do not have a complete understanding of why some individuals experience severe symptoms while others have milder ones. Additionally, some individuals with the virus may remain asymptomatic.
Early signs of Nipah virus infection can be:

• Fever
• Headache
• Respiratory issues
• Cough and throat discomfort
• Diarrhea
• Vomiting
• Muscle pain and profound weakness

In severe cases, people can develop a life-threatening Brain Infection known as Encephalitis with symptoms such as:

• Confusion and Disorientation
• Slurred speech
• Seizures
• Coma
• Respiratory distress

If you reside in or travel to an area where Nipah Virus infection is prevalent, it's crucial to take the following precautions for Nipah virus prevention:

• Practice regular handwashing
• Avoid any type of contact with bats or sick pigs
• Ensure thorough cleaning and disinfection of pig farms
• Infected animals should be immediately quarantined
• Steer clear of trees or bushes known to be resting or sleeping spots for bats
• Exercise caution when consuming food and beverages that may be contaminated, such as palm sap or fruit. If you are collecting palm sap, then it should be boiled first.
• All fruits should be washed and peeled before consumption
• Discard any fruit showing signs of bat bites or fruit that has touched the ground
• Avoid direct contact with the saliva, blood, or other body fluids of an individual infected with the virus

Additionally, infection control measures play a pivotal role in preventing the spread of Nipah virus. While taking care of a person diagnosed with or suspected of having Nipah virus, it is important to wear personal protective equipment (PPE), which includes:

• Isolation gowns or full-coverage attire designed to shield against bodily fluids
• Medical gloves
• Safety glasses or goggles for eye protection
• Medical or surgical masks, the type of which may vary based on the severity of the outbreak

In healthcare facilities, healthcare providers should adhere to standard infection control procedures. The Environmental Protection Agency (EPA) recommends the use of Q-list disinfectants for sanitizing and disinfecting all clinical surfaces as precautionary measure against this viral infection.

A healthcare professional can identify Nipah virus infection by assessing your symptoms and inquiring about recent travel to regions where the virus is prevalent. In the initial stages of infection, they can employ a real-time polymerase chain reaction (RT-PCR) test to confirm the presence of the Nipah virus. This test requires the sample of any of the following body fluids:

• Nasal or throat swabs
• Cerebrospinal fluid (CSF)
• Urine samples
• Blood samples

In later stages of the infection or during recovery, healthcare providers can diagnose it by examining the blood for specific antibodies by a diagnostic test known as enzyme-linked immunosorbent assay (ELISA).

There is currently no vaccine or specific medications available for treatment of Nipah virus infection. Therefore, treatment primarily focuses on symptom management which includes:

• Adequate hydration by drinking plenty of water
• Proper resting
• Taking prescribed or over-the-counter pain relievers like acetaminophen or ibuprofen
• Taking prescribed medications to alleviate nausea or vomiting
• Using prescribed inhalers or nebulizers to manage breathing difficulties
• Taking prescribed anti-seizure medications if seizures occur

However, potential use of monoclonal antibody treatment for Nipah virus infection treatment is currently under research.

In the scenario of Nipah virus infection outbreak, being careful and doing things to prevent it is most important. Taking precautions, including stringent hygiene practices, and avoiding contact with potential carriers is critically important. Immediate quarantine measures, as well as early detection and treatment, can be life-saving.

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