Nipah Virus aka NiV

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Introduction

Nipah virus (NiV) is an animal-to-man zoonotic virus and may potentially be spread directly between humans via contaminated food. It leads to a number of diseases, from asymptomatic (subclinical) infection to acute respiratory and deadly encephalitis in infected patients. In animals like pigs the virus can potentially lead to major financial losses for producers.

While the Nipah virus in Asia has only led to a few recognized outbreaks, it infects a wide range of animals and causes serious sickness and death in humans, which is a worry for public health.

Past Emergencies/Outbreaks

In 1999, the first nipah virus among pig breeders in Malaysia occurred during an outbreak. Since 1999, Malaysia has had no new outbreaks.

In Bangladesh in 2001 it has also been recognized, which has caused almost annual outbreaks. In East India, the disease has also been often identified.

In some nations, the virus is present on known natural reservoirs (Pteropus bat species) and several other bat species, such as Cambodia, Ghana, Indonesia, Madagascar, the Philippines and Thailand, additional locations may be exposed to infection.

Transmission

The majority of human infections were caused by direct contact with sick pigs or their contaminated tissues during the first reported outbreak in Malaysia, which also afflicted Singapore. It is believed that transmission took place by exposed exposure to pig secretions, and/or unprotected tissue contact for a diseased animal.

The most susceptible route of infection was ingestion of fruit or fruit products in later outbreaks in Bangladesh and India (such as raw date palm juice), which had been contaminated with urine or saliva from infected fruit bats.

No viral persistence investigations in body or environmental liquids and fruit are currently available.

Nipah virus has also been found in human-to-human transmission among relatives and caregivers of sick patients.

Nipah virus moved straight from man to man by close contact with secretions and excretions of the people during subsequent epidemics in Bangladesh and India. In Siliguri, India in 2001, a disease transmission was also documented in a health environment, with 75% of hospital or visitor cases occurring. Betowering individuals infected from 2001 to 2008 accounted for approximately half of all recorded cases in Bangladesh through human to man transmission.

Symptoms and signs

Infections in humans range from asymptomatic illness to acute (mild, severe) and deadly encephalitis.

Symptoms such as fever, headaches, myalgia (muscle pain), vomiting and sore throat initially appear in infected individuals. Dizziness, sleepiness, decreased awareness and neurological symptoms indicating acute encephalitis can be followed. There may also be atypical pneumonia and severe breathing conditions, including acute breathing issues. Encephalitis and convulsions develop within 24 to 48 hours in severe instances.

Incubation time is estimated to range from 4 to 14 days from the time of infection to the onset of symptoms. There has, however, been notice of an incubation period of 45 days.

Most persons with acute encephalitis recover fully but the survivors have reported long-term neurological issues. About 20 percent of individuals have lasting neurological effects such as seizure disorder and changes in personality. A few patients recover from reoccurrence or delayed onset of encephalitis later.

It is estimated that the death rate is between 40 and 75%. Depending on local epidemiological and clinical supervision capacity, this rate can vary by outbreak.

Diagnosis

Initial symptoms and indicators of Nipah virus infection are unspecific and the diagnosis at the time of presentation is typically not suspected. This can impede correct diagnosis and provide issues in the detection of outbreaks, effective and prompt infection controls and outbreaks.

The accuracy of the laboratory results can also be affected by the quality, number, type, timing of the clinical sample collection and time necessary to transmit samples to a laboratory.

During the acute and convalescent stages of the disease, Nipah virus can be diagnosed by clinical history. Primary tests are the reaction of body fluids to RT-PCR and the detection of antimonopolies by enzyme-linked assays in the immunosorbent system (ELISA).

Other tests utilized include a chain reaction polymerase (PCR) test and cell culture virus isolation.

Treatment

Currently there are no Nipah Virus treatments or vaccinations, however the WOH identifies Nipah as the WHO Research and Development Blueprint’s priority disease. Severe respiratory and neurological problems should be treated with extensive supporting care.

Natural host: fruit bats

The natural hosts of the Nipah virus are fruit bats of the Pteropodidae family – specifically Pteropus species. In fruit bats, there is no obvious sickness.

The geography of the Henipavirus is assumed to coincide with that of the category of Pteropus. The Henipavirus infection in Pteropus bats in Australia, Bangladash, Cambodia, India, Indonesia, Madagascar, Malaysia, Papua New Guinea, Thailand and Timor-Leste is supported by this idea.

Positive antikoids against Nipah and Hendra viruses have been detected in the African fruit bats of the Eidolon genus, the family of Pteropodidase, showing that these viruses may be present in Africa for the Pteropodidae geographical distribution.

Domestic animal vs Nipah virus

Nipah virus outbreaks were originally recorded during Malaysia’s initial outbreak in 1999 in pigs and other domestic animals such horses, Goats, sheep, cats and dogs.

In pigs, the virus is quite contagious. During the incubation period from 4 to 14 days, pigs will be infectious.

There may be no symptoms for an infected pig, but others have acute feverish disease, hard work and neurological symptoms such as trembling, twitching and muscular spasms. In general, but in young piglets, mortality is minimal. These symptoms do not differ greatly from other pigs’ respiratory and neurological diseases. If pigs also have an unique bell cough or if human encephalitis cases occur, Nipah virus is suspected.

See the United Nations Food and Agriculture Organization webpage on Nipah and the World Organization for Animal Health (OIE) on Nipah for additional information on Nipah for animals.

Nipah virus prevention in pigs

No Nipah virus vaccines are currently available. The routine cleaning and careful disinfection of pig farms using appropriate cleaning agents can be beneficial to preventive infections based on experience obtained during the Nipah outbreak involving pig farms in 1999.

In the event of an outbreak, quarantine should be carried out immediately in the animal facilities. In order to decrease the risk of transmission to people, culling diseased animals – with thorough oversight of burial or carcass cremation can be necessary. The disease spread can be reduced if animals are restricted or prohibited from moving from contaminated farms to other locations.

As Nipah virus epidemics involve pigs and/or fruit bats, it is important for veterinary or human public health authorities to develop an animal health/wildlife monitoring system employing a One Health approach to detect Nipah cases.

Reduce the risk of human infection

In the absence of a vaccine, only awareness of risks and teaching people about the measures they may take to avoid Nipah exposure is the only approach to decrease or prevent infections.

Education messages for public health should concentrate on:

• Reduction in the danger of transmission from bat to human.The primary focus should be on reducing bat access to the dated palm sap and other fresh food products to prevent transmission. It may be beneficial to remove bats from sites using protective covers (for example, bamboo sap skirts). The palm juice should be cooked when obtained and the fruit washed and skinned completely before use. Fruits should be thrown with bat bite signs.
• Reduce the risk of transfer from animal to human.Gloves and other protective clothes should be worn during the treatment and slaughing and slaughter of diseased animals or their tissues. People should not contact diseased pigs as much as possible. In endemic areas, the presence of the fruit bats in the area should be considered while setting up new pig farms and pig feed and pig shed should, in general, be shielded from bats if possible.
• Reduce the risk of transmission between humans.Close physical contact should be avoided with Nipah-infected persons. After caring for or visiting diseased persons, regular hand washing should be done.

Highlights

• In humans, nipah virus infection causes various clinical manifestations, ranging from asymptomatic (subclinical) infection to acute respiratory infection and deadly encephalitis.
• It is estimated that the death rate is between 40 and 75%. Depending on local epidemiological and clinical supervision capacity, this rate can vary by outbreak.
• Animals (for example, bats or pigs) or contaminated food can spread Nipah virus to humans and can even be transmitted directly from man to humans.
• The Pteropodidae family’s fruit bats are the Nipah virus’ natural host.
• For either humans or animals, no treatment or vaccine is available. Human support is the key treatment.

The annual 2018 evaluation of the WHO R&D Blueprint for Priority Diseases reveals that increased research and development of the Nipah Virus is urgently required.

Conclusion

A thorough wash of and peeling before use can prevent the risk of the international transmission via fruit or fruit products (such as the raw date of palm juice) contaminated with urine or spirit. Fruit should be discarded with symptoms of bat bites.