Did you know the fundamental facts on the recent outbreak of the Nipah virus?

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Epidemic. Isolation. Awareness.

Rainy season arrives as a relief to the mercury rise and scorching heat waves. However, every monsoon cloud carries a tuft of micro-organisms causing deadly infections. Diagnosis and treatment become complicated when there is no specific antibiotic identified. And yes, the above-mentioned three terms raise a need for medical emergency, create a reason to panic, and repeatedly appear in the headlines.

The recent outbreak in Kerala was caused by the Nipah virus (NiV). The viral infection resulted in a dozen numbers of casualties; among all, the sad demise of the caretaker was the most heart-breaking. The diagnosis of NiV is made from body fluids of the NiV-infected patients (for an instance, blood, saliva, cerebrospinal fluid, urine).

To date, as there has been no specific vaccine discovered for NiV, the struggle for health professionals was tough and the unwelcomed carrier of this viral infection became tougher to get it nailed. Once the diseased sample is confirmed, the immediate step taken by the hospital authorities is to isolate the diseased and provide an intensive care. The risk of exposure is extremely high among the doctors and caretakers. In North Kerala, the death toll went up to 17 within a period of 1 month. With all due respect, the care and concern and the countless sacrifices taken by the healthcare professionals taking utmost care of the NiV-infected patients and all those who were quarantined in hospitals being suspected to catch an infection should be remembered every moment. The sincere effort to earnestly deliver their duty round the clock can never be overlooked

Before I start writing something about Nipah, I can’t stop myself from referring the ‘spooky’ image of a virus that appeared in the science textbooks of lower classes. As far as I remember, it had a geometrically shaped head portion with long hinged ‘legs’. Little do we realize those days that such microscopic creatures could ever cause a horrifying medical emergency in the living world. What more, surprisingly humans strongly believe and consider themselves as the superpowers on the planet Earth. And, little do we still realize that such micro-organisms can entirely wash out the brain cells and create disorientation.

What is Nipah?

Nipah is the deadly virus that literally twisted every common man upside-down. It’s been a month past the death of the first reported case of Nipah fever in the Malabar region. And yet, the origin of the virus remains a mystery unsolved. Fruit bats, pets, pigs, rats, and even people who travelled to the state during this period — all quarantined!

According to the standard scientific classification of viruses, the deadly Nipah virus is placed in the family Paramyxoviridae and the genus Henipavirus. It was isolated for the first time in the village of Sungai Nipah in the Malaysian Peninsula (and hence, the organism gets a name).

Studies showed similarities between the NiV and Hendra virus found in bat species, especially the flying foxes (belonging to the genus, Pteropus). These flying fox species were found to be the reservoir of the deadly micro-organism. The farmers in pig farms from Malaysia and Singapore were the first among the reported human cases with NiV.

The disease outbreak in Malaysia occurred in the year 1999 among the pig farmers who suffered from encephalitis. Around 300 human cases were reported during the outbreak and the death toll shot above 100. The pigs were found to have affected with a mild form of the disease. However, more than a million animals were euthanized to prevent further epidemic infection. Subsequently, no NiV cases were reported in humans or swine.

Much later, in 2001, a few nosocomial cases were reported in Bangladesh and India that resulted from person-to-person transmission in the hospital environment.

How is Nipah virus transmitted?

Earlier reported cases from Malaysia and Singapore were found in humans occupied in pig farms and in those who stayed in close contact with the infected animals. The disease is also spread on consuming raw date palm sap as there are chances for the sap being contaminated by infectious bat excreta. In Kerala, the medical authorities warned people from consuming toddy in areas endemic to bats.

Person-to-person NiV infection occurs among the family members and the caretakers of infected individuals. The risk of exposure can be minimized by stringently following safety measures put forward by medical professionals.

Medical experts have defined NiV infections as airborne and can spread through aerosol infection (sneezing, coughing). Close contact with the affected individuals can land one in trouble if not glued to the precautionary measures.

What are the symptoms of Nipah infection?

The symptoms of NiV infection appear after a period of 5 to 14 days’ time. This is the incubation period of NiV. The common signs of NiV infection are fever, severe respiratory ailment, drowsiness, and nausea. NiV-infected individuals also show disorientation and gradually progress into a state of mental confusion. In the advanced state of diseased condition, they can even enter into coma state within a period of 24 hours of NiV infection.

In humans, the NiV affects the brain cells causing fatal encephalitis and inflammation in brain tissues. This condition can last for up to 10 days.

Some people might suffer from drowsiness, lethargy, and might even show an altered personality. Patients suffer from severe respiratory and neurological disorders and seizures.

With the rise of a new case every single day during the entire vacay time, the panic and confusion remained deep in the public minds and couldn’t be easily wiped out.

What preventive measures should be taken to stay away from Nipah infection?

Since the treatment of NiV infection is limited to isolation of the patient and providing intensive care, hospital-acquired infections happen to be the most important risk factor. The nursing staff and the caretakers were instructed to strictly follow the standard recommended techniques in order to prevent disease outbreak in the hospital environment.

Instead of circulating flaw messages through social media, sincere efforts had to be taken to create public awareness on NiV. Let us have a look at the preventive measures to stay safe and healthy.

  • Practising personal hygiene and strictly following the safety guidelines can only prevent the epidemic NiV infection. Make sure you and your kids wash your hands thoroughly after hospital visits, travelling in a bus, or after a busy shopping in marketplaces. Avoid direct contact of hands with eyes and mouth in crowded places.
  • As mentioned earlier, the virus has a longer incubation period. Hence, it is not safe to travel in crowded buses and trains without wearing masks. Make it mandatory to wearing N95-grade masks while moving into crowded places.
  • It’s school time. A piece of advice to all parents would be to keep ill-health kids at home and not send them to school with their medicines inside the school bags. (I have personally seen parents doing the same!)
  • Avoid eating ripe fruits that are partially bitten. (It could be an infected bat.)
  • The NiV infection can spread through secretions of NiV-infected person, so it is better to postpone any travel plans to over-crowded locations, such as religious spots.
  • Stop making assumptions and carrying out self-treatment methods. Consult a physician and get prescribed medication for persistent common cold and fever.

That was regarding the first-ever reported cases from Malaysia, the disease symptoms, the mode of transmission, and how to prevent Nipah infection. Next, let’s talk about the medication and antibiotics that produce antibodies against the deadly virus in human beings.

What is the treatment for Nipah infection?

According to the medical reports from the U.S. Centers for Disease Control and Prevention (CDC), critical care is the only mode of treatment for Nipah infection. Since there has been no frequent outbreak after the first reported occurrence of the Nipah virus, a definite vaccine has not been discovered for humans. When intensive care becomes the sole way of treating the victims, the nursing techniques should be carried out with utmost care and concern. The caretakers have to strictly follow the infection control methods while being in close contact with the patients.

What is the medication provided for Nipah infection?

Ribavirin is a drug that has been found to have antiviral properties. However, scientific research data related to humans is quite less in number. There are studies that prove the efficacy of a human monoclonal antibody, m102.4. This antibody was infused into the research models, and all the samples were found to survive from the lethal virus-RNA.

What is a human monoclonal antibody?

It is a type of antibody developed by combining a human antibody with a fine portion of a rat or a mouse monoclonal antibody. The portion of the antibody that comes from the rat recognizes the antigen (here, viral RNA) and the human portion makes sure that it doesn’t get destroyed in a human body by its immune system. I guess that was the simplest way of explaining it to my non-science pals.

Treating Nipah with the human monoclonal antibody, m102.4

Nipah virus causes a high degree of mortality in both animals and humans. This viral infection is spread through secretions from the infected body. It’s called aerosol infection, as it could be infected from the victim’s sneezing as well.

Studies found that this particular antibody possesses properties to neutralize the antiviral characteristics of Nipah virus. Research using the human monoclonal antibody, m102.4, has been conducted in ferrets and results displayed a complete protection from the virus infection.

Extensive research on pre-clinical testing will have to be conducted to completely prove the efficacy of the antibody in humans. The virus that caused Nipah fever is aptly categorized in Category C biothreat agents by NIH, as they are extremely virulent and lethal.

This time the antibody was flown from Australia after the outbreak of Nipah fever in Kozhikode. Let us all hope the Indian scientists would achieve all the required support and encouragement to create the clinical set-up and be able to produce the vaccine in our own country.

Where is the origin of human monoclonal antibody, m102.4?

The human monoclonal antibody, m102.4, is developed by the Australian Animal Health Laboratory (Australia) in collaboration with Uniformed Services University of Health Sciences (USA). The vaccine is reported to have undergone trials in Singapore and Australia.

The medical authorities had confirmed that the vaccine will be used for treatment only for those patients with sure shot signs of the deadly Nipah.

However, people who had to part their loved ones one fine day due to the deadly virus were not even allowed to have the last embrace or perform the last rites before they would simply remain in their memories. Although that was the most saddening emotions, the authorities were more cautious to keep the viral contamination under control.

That was all about the Nipah — make sure you take all the precautionary measures to keep yourself away from the Nipah virus and let there be no reason to panic. The personnel who is at the highest point of risk exposure — from the healthcare professionals to the people who earn their living from the burial ground — all have done their best to follow the preventive measures, worked day–night, and even during terrible weather to stop the viral threat entering into the second phase of infection.

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