Health: Decoding ‘Nipah’ – Dos and Don’ts –

The recent Nipah virus (NiV) scare has resulted in several state governments to issue advisories; the Union Health Ministry has maintained that the virus outbreak is a ‘localised’ occurrence without the need to panic. However, with the recent linkages of transmissions allegedly from certain strains of bats as seen with Kerala victims, fear has gripped common folks to seek preventive measures. Simple precautionary and hygienic measures seem to be the call from doctors and care-givers. Nipah virus is a ‘zoonotic’ disease that is naturally transmitted from vertebrate animals to humans. Corporate Citizen presents a few facts

Health professionals investigating the Nipah outbreak in Kerala

According to a World Health Organization (WHO) fact-sheet, there is strong evidence that emergence of bat-related viral infection communicable to humans and animals has been attributed to the loss of natural habitats of bats.

Even as Kerala remains as the prime ‘hold’ for the most recent incidences of Nipah virus (NiV) related casualties, Himachal Pradesh too bore the brunt recently when several bats were found dead at the Government Senior Secondary School in Barmapapri in Sirmaur district. But, tests at the National Institute of Virology in Pune has since ruled out that the Himachal Pradesh ‘bats’ in question were carrying the ‘Nipah’ virus.

Kerala Health Secretary, Rajeev Sadanandan, said (to the BBC) that a multidisciplinary central team from the National Centre for Disease Control (NCDC) is already in the district. “We have sent blood and body fluid samples of all suspected cases for confirmation to National Institute of Virology in Pune. We are now concentrating on precautions to prevent the spread of the disease since the treatment is limited to supportive care,” he added.

Bat’-tling the virus

Are bats alone to be blamed for carrying the ‘Nipah’?

• Scientifically, while the natural host of the NiV are fruit bats of the pteropodidae family, Pteropus genus, surprisingly, test results have shown that a particular variety of bats found in and around Kozhikode, Kerala and around its worst-affected town, Perambara (located 40 km from Kozhikode), are actually not the carriers of the virus.
• Investigations by the National Institute of High Security Animal Diseases found that body fluid samples collected from insectivorous bats in Changaroth Gram Panchayat in Kozhikode district, where the first Nipah-related death occurred, did not have the virus at all. But, they have not ruled out the role of fruit bats in spreading the infection.
• A special Pune-based team is now expected to collect samples from other varieties of bats found in the affected Kerala district to ascertain the ‘culprit strain’ of the ‘Nipah’ bat.
• Experts say that even if the Nipah outbreak gets eventually linked to bats, the transfer of bat viruses to humans is still considered a rarity. Meanwhile, given how critical bats are to ecosystems, the Kerala government has taken a stand against culling bats in response to the outbreak.

How did bats get linked to the ‘Nipah’?

• Facts indicate that the virus was first identified among pig farmers in Malaysia, and the disease first surfaced in India in 2001 at Siliguri, West Bengal with a second recurrence in 2007. Nipah virus is known to be transmitted by infected pigs or by infected fruit bats and is transmitted through their secretions of saliva, urine or faeces. It can also be transmitted from an infected human to another human through body or respiratory secretions.
• In the 1998 Malaysian episode, the virus first moved to pigs theorising that maybe a domestic pig had consumed fruit contaminated with bat saliva. Once it spread widely on pig farms, the virus began jumping to humans who came in contact with the animals. Around 260 people fell ill after such contact.
• The Kozhikode case stands unique from the Malaysian case as there was no person-to-person transmission then, unlike what happened in Kozhikode.

Who are most vulnerable to catch the ‘Nipah’?

• Historically, the virus is shown to have remained in a cluster and this way affected only those that came in close contact with Nipah patients. While the latest outbreak in India has reportedly impacted four districts of Kerala Kozhikode, Malappuram, Kannur and Wayanad, people in other states allegedly do not need to panic.
• The worry would be when people travel to the affected areas, or somehow come in contact with someone who has contracted the virus in these areas.

What are the common symptoms and other indications?

• Contracting the Nipah virus causes an upper respiratory infection and there is a need to watching out for causative symptoms such as fever, headaches, body-ache, breathlessness and coughing.
• Depending on the exposure to the virus, symptoms could be fatal, leading to encephalitis (inflammation of the brain). Contracting encephalitis could result in mental confusion and deterioration into a comatose state. Doctors say that while the progression is very severe, the incubation period is long for some, on an average in 90% of the cases the disease can manifest itself within two weeks of exposure to the virus.

Is there a single cure or management of the symptoms?

While social media platforms are touting alternate therapy such as homeopathy medicines for protection against the NiV, doctors have prescribed specific treatment patterns depending on the severity of the ailment in patients. The Kerala government has recommended using anti- viral ribavarin as a life-saving measure in some proven cases. But, the medical fraternity says that administering ribavarin is not a confirmed treatment, but has been approved because of a few studies in the past where ribavarin proved its’ anti-viral benefits.

Preventive guidelines as suggested by Dr. Arpita Samui Nayek, MBBS, DPH, Medical Officer, WBHS.

Dos

• Wash hands properly and thoroughly before eating or cooking food
• Fruits and vegetables have to be thoroughly cleaned before eating
• Add turmeric to clean water and soak raw fruits and vegetables in this water before use
• While travelling and in public place, make use of an N95 type mask
• Avoid any contact with pigs and pig handlers
• If suffering from fever, visit your doctor at the earliest; at the early onset of any of the symptoms

Don’ts:

• Avoid consuming fruits and raw vegetables that have been half eaten, fallen, have cut marks or are contaminated
• Avoid eating out; consume home-cooked food
• Do not eat anything without thoroughly washing your hands
• Avoid proximity of pig handlers
• Avoid drinking fresh date palm sap in areas that are known to be infested with bat population

Doctorspeak

“Those infected should be isolated for at least 10- 15 days, till the virulence of the virus settles and our immune system also starts fighting.”

Vikas Maurya, Head of Department, Pulmonolgy, Fortis Hospital, New Delhi

“People suffering from fever are treated for it, for those with breathlessness, support is provided to them with artificial ventilators and for those with seizures or convulsions, anti-epileptic drugs are given as a support to the brain.”

- Vidya Menon, Clinical Professor, Department of Medicine, Amrita Institute of Medical Sciences, Kochi

“There is no need to panic, but if you have symptoms or if you have visited the state recently, visit a doctor at the earliest.”

Suranjit Chatterjee, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospitals, New Delhi

By Sangeeta Ghosh Dastidar