What is Nipah Virus? - Seeker's Thoughts

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What is Nipah Virus?

There is no vaccine available for the infection. Only preventive measures can be the key to control the spread.

In Kerala since 2018, the Nipah virus outbreak took 17 lives. In June 2019 again the government of Kerala confirmed one more case of the Nipah virus.
The virus remains extremely dangerous and has the potential for great threats to humans and animals. It can potentially wipe out a large amount of population if not handled well. Therefore, precautions to prevent deadly disease are suggested.

What is Nipah virus?
Nipah virus is a zoonotic virus. It is transmitted from animals to humans and can also be transmitted through contaminated food or directly between people.
It causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis.
The virus can also cause severe diseases in animals such as pigs. 
Although the Nipah virus has caused only a few known outbreaks in Asia, it infects a wide range of animals and causes severe diseases and death in people, making it a public health concern.

What is a Zoonotic Disease?
Zoonotic Disease is an infectious disease of animals which can naturally be transferred to humans. Ebola Virus also comes in the same category as the Nipah virus.
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Historical outbreaks from 1998 to 2019
Nipah virus was first recognized in 1999 during an outbreak among pig farmers in Kampung Sungai Nipah Malaysia.
Human infection was first recognized in a large outbreak of 276 reported cases in Peninsular Malaysia and Singapore from September 1998 through May 1999.
Three years later, a genetically distinct Nipah virus independently emerged in India as well as in Bangladesh, where human Nipah virus outbreaks events have reportedly nearly every year since.

A putative Nipah virus also caused an outbreak of the diseases in horses and people in the Philippines in 2014. The Nipah virus was first recognized in Bangladesh in 2001 and nearly annual outbreaks have occurred in that country with periodic disease events in eastern India bordering to Bangladesh. 


Other regions may be at risk for Nipah virus infection, as serologic evidence for Nipah virus has been found in the known natural reservoir namely Pteropus bats. There are over 50 species of Pteropus bats in South and Southeast Asian region, including Cambodia, Thailand, Indonesia, Madagascar, Ghana and the Philippines.
The virus spreads from animals to humans and then to other humans.
In 2018 after much investigation, fruit-eating bats were identified as the primary source of the infection and people were advised not to consume fruits partly eaten by bats.

How does the Nipah Virus spread or get transmitted?
The Virus is present in bat urine and potentially, bat faeces, saliva and birthing fluids. Presumably, the first incidence of Nipah virus infection occurred when pigs in Malaysian farms came in contact with bats who had lost their habitats due to deforestation.
Furthermore, Transmission between farms may be due to fomites -- or carrying the virus on clothing, equipment, boots vehicles.
How to prevent the spread of the Nipah Virus?
There is no vaccine available for the infection. Only preventive measures can be key to control the spread. With fruits bats being the primary cause of infection, the farm animals should be prevented from eating fruit contaminated by bats. 

Consumption of contaminated date palm sap including toddy should also be avoided. Physical barriers can be put in place in order to prevent bats from accessing and contaminating palm sap.
 Basic precautions like washing hands, using a gown, cap mask and wearing gloves can be applicable. 
For laboratory personnel, the Nipah virus is classified internationally as a biosecurity level (BSL) 4 agent. BSL 2 facilities are sufficient if the virus can be first inactivated during specimen collection.
In the case of animals, wire screens can help prevent contact with bats when pigs are raised in open-sided pig sheds. Run-off from the roof should be prevented from entering pig pens.
Early recognition of infected pigs can help protect other animals and human. Due to the highly contagious nature of the virus in swine populations, mass culling of seropositive animals may be necessary.
Since encephalitic-symptoms are seen in Nipah virus, the fundamental mode of treatment is limited to intensive supportive care for neurological and respiratory complications.
Since no cure/vaccine has been invented yet, treatment is limited to intensive supportive care which basically means treating the symptoms individually. For example, someone complaining of breathlessness can be put on artificial ventilators.
Ribavirin is being used for its anti-viral properties for handling the Nipah virus.

Global Initiatives and implications for Global Health security
Deadly epidemics have been threatening humanity since our earliest days. The recent 2013–2016 outbreak of Ebola virus disease in West Africa and the Zika virus in South America in 2016.
Epidemics can only be prevented when health systems are prepared for them. In 2017, with US $540 million, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched and aims to develop vaccines for diseases identified by the WHO that have high epidemic potential but no vaccine or curative options such as Nipah virus.
The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, with support from the Welcome Trust and in collaboration with the WHO, has been tasked with facilitating the collaborative development of a draft “Nipah R&D Roadmap” to prioritize the development of diagnostics, therapeutics, and vaccines that are most needed by Nipah-affected countries.
The WHO's International Health Regulations (IHR) aim to provide a legal framework for the prevention, detection, and containment of public health risks at source, before they spread across borders, through the collaborative actions of States Parties and WHO.
There is a close link between globalization, urbanization, and the behaviour of emerging viruses in the modern era, which can be addressed well through “One Health.”
Approaches to such a potential global health security threat should be consistent, proactive, and should involve coordinated, multipronged, multilateral collaborative efforts that actively engage local, regional, national, and global levels.

Currently, the Nipah virus is an emerging infectious disease of public health significance for the countries in the Southeast Asia region, which is a natural habitat for the fruit bats.
As the Nipah virus can be transmitted by various methods, there is a potential public health threat for the global population.
Because Nipah virus is an issue to be addressed by multiple stakeholders to promote health to all citizens, the concept of global health diplomacy holds a great promise to address the need of global health security through its binding or nonbinding instruments enforced by the global governance institutions.
The ministries of health and stakeholders (e.g. CEPI, CIDRAP) need to work together to develop a vaccine and ensure health security from this bat-borne disease. There is a great need to strengthen intersectoral coordination, review the treatment procedures, infection control practices, and ensure the use of PPE and availability of drugs to handle the suspected cases in a better way.

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