Nipah virus (NiV) causes severe disease in humans and domesticated animals. NiV reside in their natural hosts- fruit bats of the Pteropodidae family and can be transmitted to other mammalian hosts through secretions of infected bats. First identified in 1998, Nipah derives its name from the Malaysian village where the virus was transmitted from bats (primary host) to pigs (intermediate host) and subsequently pig farming communities.
During the 2004 NiV outbreak in Bangladesh, humans became infected after consuming date palm sap (locally known as khejur ras; খেজুর রস) contaminated by bat bodily fluids. Although an epidemiological link of the current NiV outbreak in India has not yet been ascertained, the crisis has been associated with more than 80% fatality rate claiming 14 lives (including one health care worker which happens to be the first report of human-human transmission in a clinical setting) in Kozhikode, Kerala and 1 in Kolkata, WB. Hitherto no secondary/tertiary transmission source has been identified, and if we remain vigilant for atleast 18 days i.e through the first couple of June weeks (the maximal known NiV incubation period), the odds of containing the infection is enhanced. In case other transmission sources are identified, additional measures need to be adopted.
Immediate Goals: There is no vaccine for NiV yet and only intensive supportive care is available. NiV infection in humans presents a broad range of clinical parameters, from asymptomatic infection to acute respiratory syndrome and fatal encephalitis. The incubation period is believed to range from 4 to 14 days. According to WHO guidelines, to reduce the risk of NiV transmission the following measures can be adopted:
Seeking early primary care intervention in the case of flu like symptoms
Avoiding close unprotected physical contact with NiV infected individuals
Regular hand washing after caring for or visiting sick people
Boiling freshly collected khejur ras before consumption/sale
Thoroughly washing and peeling fruits before consumption.
Discarding fruits with sign of bat bites
Using gloves and other protective clothing when handling sick animals
Long term Goals: Since the virus resides primarily in wild fruit bat populations, human interventions seeking to alter the reservoir host population dynamics, would be ecologically unsustainable. In South East Asia and Oceania, studies of reducing livestock farming in areas adjacent to fruit trees have been performed. The effectiveness of such experiments need to be critically analyzed and the feasibility of adoption in the Indian context need to be considered when establishing new livestock farms in endemic areas with high fruit bat density. In Bangladesh and India, measures need to be standardized for regulating the unorganized sectors involved in khejur ras collection and fruit juice extraction to prevent contamination with NiV. Health policy makers in India need to deliberate upon clinical trials/facilitate compassionate use of the m102.4 antibody that has demonstrated success in neutralizing NiV isolates in pre-clinical studies. The official guidelines from the Ministry of Health, Government of India can be accessed at: http://www.ncdc.gov.in/index4.php?lang=1&level=0&linkid=113&lid=228
The ability to cause fatal disease and the extensive species-wide tropism makes NiV a transboundary biological threat requiring urgent countermeasures. A collaboration between WHO, Wellcome Trust and CIDRAP, University of Minnesota is facilitating the “Nipah R&D Roadmap” to prioritize development of diagnostics, therapeutics and vaccines in NiV affected countries. The draft is available here: http://www.who.int/blueprint/priority-diseases/key-action/Nipah_Draft_Roadmap_publiccomment_MAY2018.pdf?ua=1
Researchers, healthcare professionals, policy makers and the general public have been invited to contribute to the further development and refinement of the roadmap. If you have any feedback, you can email NipahRDRoadmap@who.int with the subject line “Comments on draft Nipah R&D roadmap” by Friday, 8 June 2018.
Government Circular for spreading awareness about Nipah viral fever. Kindly consider translating the message in vernaculars to the community living adjacent to sites of NiV outbreak. Additionally, consider distributing printouts of cartoon at community bulletin boards at nearest transport hubs ( e.g Since NiV + case has been reported in Fort William, Kolkata., neighborhoods in its vicinity as well as Dumdum airport, Howrah/Sealdah rail station, Maidan/Esplanade Metro stations, Esplanade bus depot, Babughat ferry junction etc will be appropriate)