A virus is a small, contagious organism that can only replicate inside living cells. They are the most prevalent class of biological organisms, present in practically every habitat on Earth.

NiV (Nipah virus) is a zoonotic virus (it is transmitted from animals to humans) and can also be transmitted directly between people or through contaminated food. In infected people, it causes a range of illnesses from subclinical (asymptomatic) infection to fatal encephalitis and acute respiratory illness.

Although the Nipah virus has caused only a few known outbreaks in India, it infects a wide range of animals and causes severe disease and death in people, making it a public health concern. Supportive care is the only current treatment for this viral infection, so meeting your healthcare provider for further guidance is of prime importance. 

What is the Nipah virus?

Nipah virus infection is a zoonosis transferred by contact with a NiV-infected person or animal or their secretions that has a high fatality rate in infected humans.

The Nipah virus (NiV) is the origin of a Nipah virus infection. The virus can cause a variety of symptoms in people, and cases can range from mild to deadly. NiV is a zoonotic virus (a disease that animals can transmit to humans, known as a zoonosis); the virus often infects animals like fruit bats and pigs, but they might not show any symptoms (asymptomatic). 

What are the Symptoms of the Nipah Virus?

Infection with NiV (Nipah virus) can cause mild to severe disease, including swelling of the brain (encephalitis) and potentially death.

Symptoms often occur 4 to 14 days after viral contact. The illness initially presents as 3-14 days of headache and fever and often includes signs of respiratory illness, like difficulty breathing, sore throat and cough. A phase of brain swelling (encephalitis) might follow, where symptoms can include mental confusion, disorientation and drowsiness which can rapidly progress to coma within 24-48 hours.

Symptoms might Initially include One or Several of the Following:

• Vomiting
• Difficulty breathing
• Sore throat
• Cough
• Headache
• Fever

Severe Symptoms might Follow, like:

• Encephalitis (brain swelling)
• Coma
• Seizures
• Confusion, drowsiness or disorientation

Death might occur in 40-75% of cases. Long-term side effects in survivors of Nipah virus infection have been noted, including personality changes and persistent convulsions. 

Infections that lead to symptoms and sometimes death much later after exposure (known as latent or dormant infections) have also been reported months and even years after exposure.

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What are the Causes of the Nipah Virus?

NiV (Nipah virus) can Spread to People from:

• Close contact with a person infected with NiV or their body fluids (including respiratory droplets or nasal, blood or urine)
• Consuming food products that have been contaminated by the body fluids of infected animals (like palm sap or fruit contaminated by an infected bat)
• Direct contact with infected animals, like pigs or bats, or their body fluids (like saliva, urine or blood)

People likely contracted the virus during the first recorded NiV epidemic through close contact with sick pigs. The NiV strain found in that epidemic appears to have been propagated first among bats before moving on to pigs and then pig populations. Then, those who had regular contact with the diseased pigs started becoming sick. In the epidemic, there was no information on person-to-person transmission.

However, the person-to-person spread of NiV is regularly reported in India. This is most commonly seen in the caregivers and families of NiV-infected patients and healthcare settings. Transmission may also occur as a result of exposure to food products contaminated by ill animals. Examples include eating fruit tainted with bat urine or saliva or raw date palm sap. Additionally, there have been some incidences of NiV infection among those who climb trees where bats frequently roost.

What is the Treatment for the Nipah Virus?

Currently, there are no licensed treatments available for NiV (Nipah virus) infection. Treatment is limited to supportive care, including hydration, rest and treatment of symptoms as they occur.

There are, however, immunotherapeutic treatments (monoclonal antibody therapies) that are currently under evaluation and development for the treatment of NiV infections. A phase 1 clinical trial for one of these monoclonal antibodies, m102.4, has been completed and it has been applied on a compassionate use basis.

In addition, the antiviral medicine remdesivir has been effective in nonhuman primates when given as post-exposure prophylaxis and might be complementary to immunotherapeutic treatments. 

How can We Prevent the Nipah Virus?

In areas where NiV (Nipah virus) Outbreaks have Occurred, People should:

• Avoid contact with the body fluids or blood of any person known to be infected with NiV
• Avoid drinking or eating products that could be contaminated by bats, like raw fruit, raw date palm sap, or fruit that is found on the ground
• Avoid contact with sick pigs or bats 
• Practise hand washing regularly with water and soap 

Standard infection control procedures and effective barrier nursing methods are crucial in avoiding hospital-acquired infections (nosocomial transmission) in circumstances where a patient has a suspected or confirmed NiV infection since NiV can transmit from person to person.

In addition to steps that individuals can take to lower their risk for NiV infection, it will be critical for communities, researchers and scientists at risk to continue learning about NiV to prevent future outbreaks. Broader prevention efforts include:

• Raising awareness about the symptoms, signs and risk of NiV among populations at higher risk due to:
  • Work in healthcare or as a caregiver for NiV-infected individuals
  • Contact with animals or pigs that could come into contact with fruit bats
  • Contact with fruit bats or items contaminated by fruit bats
  • Geographic location
• Establishing guidelines for conventional infection control procedures in healthcare settings to avoid person-to-person transmission.
• Improving tools to detect the virus early in livestock and communities.
• Evaluation of novel methods or technologies to minimise the spread of the virus within bat populations.
• Increasing research on the ecology of fruit bats to understand where they live and how they spread the virus to other people and animals.
• Increasing surveillance of people and animals in areas where NiV is known to exist.

Conclusion

NiV (Nipah virus) can be transmitted through various means, such as animals to humans, human to human and through contaminated food. It can cause a variety of illnesses which can either be asymptomatic or even severe, like acute respiratory illness and fatal encephalitis. It is always advisable to seek medical help from an experienced general physician. Timely care and help can ensure an appropriate diagnosis and treatment of your condition. 

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult a general physician, reach out to us, or book a direct appointment with Dr. Rajeev Gupta at the CK Birla Hospital.

FAQs

What is the Nipah Outbreak?

Nipah virus is a type of zoonotic disease, meaning it is mainly found in animals and can initially spread between animals and people. It was first discovered in 1999 after a disease affected both people and pigs in Singapore and Malaysia. 

Is the Nipah Virus Life-threatening?

The virus can lead to severe symptoms, including seizures, drowsiness, disorientation or encephalitis, which is inflammation of the brain. Within 24 to 48 hours, these can turn into comas. Deaths range anywhere between 40% and 75% among all cases.