A 14-year-old boy from Kerala’s Malappuram district passed away on Sunday after contracting Nipah Virus infection. The State Health Minister, Veena George, confirmed that the boy suffered a massive cardiac arrest at 10:50 am and despite efforts to revive him, he died at 11:30 am. The National Institute of Virology in Pune had earlier confirmed the presence of the Nipah virus in the boy.
The World Health Organization (WHO) classifies Nipah virus (NiV) as a zoonotic virus. This signifies that the virus is transmissible from animals to humans and can also spread through contaminated food or directly from person to person. Humans can become infected by accidentally consuming fruits contaminated with bat droppings.
During the initial outbreak in Malaysia and Singapore, most human infections stemmed from direct contact with sick pigs or their contaminated tissues. The WHO states that transmission likely occurred through unprotected exposure to pig secretions or contact with the tissues of infected animals.
Later outbreaks in Bangladesh and India were linked to the consumption of fruits or fruit products tainted with urine or saliva from infected fruit bats. Human-to-human transmission of the Nipah virus has also been documented among family members and caregivers of infected patients. The WHO explains that during the Bangladesh and India outbreaks, the virus spread directly from person to person through close contact with infected individuals’ secretions and excretions.
Nipah Virus: Recognizing the Symptoms
Individuals infected with the Nipah virus exhibit a range of illnesses, from asymptomatic infection to acute respiratory illness and fatal encephalitis. The virus can cause severe disease and death, making it a significant public health concern. Common symptoms include fever, headaches, muscle pain, vomiting, and sore throat. These can progress to dizziness, drowsiness, altered consciousness, and neurological signs indicating acute encephalitis. Some patients may also experience atypical pneumonia and severe respiratory problems, including encephalitis and seizures, which in severe cases can progress to coma within 24 to 48 hours.
The Severity of the Disease
According to the WHO, the incubation period – the time between infection and the onset of symptoms – is believed to be between 4 to 14 days. However, an incubation period as long as 45 days has been reported. While most individuals who survive acute encephalitis make a full recovery, long-term neurological conditions have been observed in some survivors. The WHO reports that approximately 20 percent of patients experience residual neurological consequences such as seizure disorders and personality changes. A small percentage of individuals who recover may later relapse or develop delayed-onset encephalitis.
The case fatality rate for Nipah virus infection is estimated to be between 40 percent to 75 percent. The WHO emphasizes that this rate can vary depending on the outbreak and local capabilities for epidemiological surveillance and clinical management. The virus can also cause severe disease in animals like pigs, leading to substantial economic losses for farmers.
Diagnosing and Addressing the Challenges
The primary tests used to diagnose Nipah virus infection are real-time polymerase chain reaction (RT-PCR) from bodily fluids and antibody detection via enzyme-linked immunosorbent assay (ELISA). Other tests include polymerase chain reaction (PCR) assay and virus isolation by cell culture. The quality, quantity, type, timing of sample collection, and the time required to transport samples to the laboratory can impact the accuracy of laboratory results.
Treatment Options and Prevention Strategies
Currently, there is no specific treatment for Nipah virus infection, though the WHO has designated it as a priority disease for its Research and Development Blueprint. Treatment primarily focuses on supportive care and syndromic management of acute encephalitis syndrome. In the absence of a vaccine, the best approach to reducing or preventing infection is by raising awareness about the risk factors among the public.
The WHO recommends public health educational messages that emphasize:
* Reducing bat access to date palm sap and other fresh food products.
* Wearing gloves and other protective clothing while handling sick animals or their tissues, and during slaughtering and culling procedures.
* Avoiding close, unprotected physical contact with individuals infected with Nipah virus.
* Washing hands regularly after caring for or visiting sick individuals.
* Healthcare workers caring for patients with suspected or confirmed infection, or handling specimens from them, should always implement standard infection control precautions.
Indian Government’s Advisory to Kerala
Following the reported Nipah virus death in Kerala, the Indian government issued the following public health measures for the state to implement:
* Active case search within the family of the confirmed case, the neighborhood, and areas with similar topography.
* Active contact tracing (for any contacts) during the past 12 days.
* Strict quarantine of the case’s contacts and isolation of any suspects.
* Collection and transportation of samples for laboratory testing.
The Union Health Ministry also announced the deployment of a joint outbreak response Central team to assist the state with case investigation, identification of epidemiological linkages, and technical support.
