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LETTER TO EDITOR
Year : 2018  |  Volume : 22  |  Issue : 3  |  Page : 177-178
 

Nipah virus: South India in panic mode


Department of Oral Medicine and Radiology, A. B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India

Date of Web Publication17-Dec-2018

Correspondence Address:
Jasmine Shanthi Kamath
Department of Oral Medicine and Radiology, A. B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.IJOEM_109_18

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How to cite this article:
Kamath JS, Hegde S, Ajila V. Nipah virus: South India in panic mode. Indian J Occup Environ Med 2018;22:177-8

How to cite this URL:
Kamath JS, Hegde S, Ajila V. Nipah virus: South India in panic mode. Indian J Occup Environ Med [serial online] 2018 [cited 2019 May 23];22:177-8. Available from: http://www.ijoem.com/text.asp?2018/22/3/177/247622




The current outbreak of Nipah virus (NiV) infection in South India is a matter of concern not only to the general public but also to health care providers. This zoonosis causes disease in both animals and humans. Fruit bats (Macrochiroptera of Pteropodidae Family, Pteropus genus) are the natural host of the virus. Nipah is a single-stranded RNA virus, which survives for long periods in favorable conditions in the saliva and urine of fruit bats, contaminated fruit, and fruit juice. NiV was first identified during an outbreak of disease in Malaysia in the year 1998, where it caused 265 human cases of encephalitis, with 40% mortality rate. The Bangladesh NiV outbreak in 2004 was attributed to consumption of date palm sap contaminated by infected fruit bats. Since then, NiV has become endemic to Bangladesh, and outbreaks are commonly seen during winter times, where date palm sap is harvested.[1],[2],[3]

India saw its first outbreak in Siliguri district, West Bengal in 2001, with 74% cases ending in fatality. Again in 2007, another outbreak was seen in West Bengal in Nadia district with 100% fatality rate.[4],[5] The current outbreak in the State of Kerala has caused 10 deaths, including one health care worker.[6]

Nipah virus infection results in rapidly progressing severe illness affecting the central nervous and respiratory systems. In humans, the average incubation period is 0-2 weeks. Initial illness begins with fever, headache, and drowsiness followed by disorientation, mental confusion, coma, and death. Most of the patients presenting with neurologic illness also show some amount of respiratory distress.[7]

People, who came in contact with infected hospitalized patients especially health care workers and visitors to hospital, were infected after being exposure to them in Siliguri suggestive of person-to-person transmission.[8]

In animal models, it has been shown that, the NiV affects the nasal epithelium and gains direct entry to the CNS through the cribriform plate resulting in neurologic symptoms.[9]

Hence, patients infected or who have come in close contact with an infected person must be quarantined and isolated and health care workers involved with treating suspected or confirmed NiV patients, should use standard precautions and improve infection control.

Because saliva is a medium for viral transmission, dental professionals are at an increased risk because of aerosols generated during routine procedures.

Initial diagnosis is through virus isolation using real time polymerase chain reaction (RT-PCR). The virus can be isolated in early stages from secretions of nose, throat, and other bodily fluids such as cerebrospinal fluid (CSF), urine, and blood. Enzyme-linked immunosorbent assay (ELISA) can be used to identify IgG and IgM antibodies.

Because most of these tests require well-equipped laboratories, there is an urgent need for these facilities to be made available even in small rural centers during an outbreak.

Treatment is limited to supportive care. Ribavirin, an anti-viral drug has shown promising results in vitro, but human investigations have not been conclusive. The Nipah G glycoprotein has been identified as a target for using Passive immunization using human monoclonal antibody, which has shown beneficial effects in post-exposure treatment in animal models.[10]

The main approach is to prevent NiV in humans. In the case of a known outbreak, eating fruits fallen on the ground, drinking fresh fruit juice, and consuming date palm sap must be avoided. Health care providers must use Standard infection control practices and proper barrier nursing methods must be employed in infected cases to prevent further spread.


  Conclusion Top


Nipah virus is one of the deadliest viral infections known to man. As definitive treatment is not available, treatment is limited to supportive care. Thus, prevention is the only option. The general public and health care providers need to be educated regarding modes of transmission to avoid panic and further spread.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rahman M, Chakraborty A. Nipah virus outbreaks in Bangladesh: A deadly infectious disease. WHO South East Asia J Public Health 2012;1:208-12.  Back to cited text no. 1
    
2.
Giangaspero M. Nipah virus. Trop Med Surg 2013;1:129.  Back to cited text no. 2
    
3.
Hossain MJ, Gurley ES, Montgomery JM, Bell M, Carroll DS, Hsu VP, et al. Clinical presentation of nipah virus infection in Bangladesh. Clin Infect Dis 2008;46:977-84.  Back to cited text no. 3
    
4.
Chadha MS, Comer JA, Lowe L, Rota PA, Rollin PE, Bellini WJ, et al. Nipah virus-associated encephalitis outbreak, Siliguri, India. Emerg Infect Dis 2006;12:235-40.  Back to cited text no. 4
    
5.
World Health Organization. Regional Office for South-East Asia (SEARO) Nipah Virus outbreaks in the WHO South-East Asia Region; 2012.  Back to cited text no. 5
    
6.
TOI. Nipah Virus Scare: Health Department Issues Alert; 21 May, 2018. Available from: https://www.timesofindia.indiatimes.com/city/kozhikode/10-deaths-in-kerala-due-to-nipah-virus-symptoms/articleshow/64251098.cms. [Last accessed on 2018 May 22].  Back to cited text no. 6
    
7.
Escaffre O, Borisevich V, Rockx B. Pathogenesis of hendra and nipah virus infection in humans. J Infect Dev Ctries 2013;7:308-11.  Back to cited text no. 7
    
8.
Hassan MZ, Sazzad HMS, Luby SP, Sturm-Ramirez K, Bhuiyan MU, Rahman MZ, et al. Nipah virus contamination of hospital surfaces during outbreaks, Bangladesh, 2013-2014. Emerg Infect Dis 2018;24:15-21.  Back to cited text no. 8
    
9.
Williamson MM, Torres-Velez FJ. Henipavirus: A review of laboratory animal pathology. Vet Pathol 2010;47:871-80.  Back to cited text no. 9
    
10.
Ksiazek TG, Rota PA, Rollin PE. A review of nipah and hendra viruses with an historical aside. Virus Res 2011;162:173-83.  Back to cited text no. 10
    




 

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