Nipah virus in Kerala: All you need to know about symptoms and precautions

Three years after an outbreak was first reported in Kerala, a fresh case of the Nipah virus has been reported in the state again. A 12-year-old boy has succumbed to the infection, the Kerala government has said, and the Union government has rushed a team from the National Centre for Disease Control to the state’s Kozhikode district. The state of Kerala has also stepped up measures to try and contain the spread of the virus and Health Minister Veena George is scheduled to reach Kozhikode as well. 

The first major outbreak of NiV in 1998 that left more than 100 people dead in Malaysia supposedly saw domesticated pigs as the hosts. In 2001, the first outbreak occurred in India in the state of West Bengal and was attributed solely to fruit bats. WHO has also stated that human to human transmission is also seeing a steady rise. The 2018 Nipah virus outbreak had claimed 17 lives out of the 18 confirmed cases reported in the state. Here is all you need to know about the Nipah virus. 

What causes Nipah virus infection? 

Direct contact with infected pigs, other infected animals, or through contaminated fruits (half-eaten fruits left by fruit bats), and even direct contact with sick persons have been cited as the underlying cause of outbreaks according to a report in the Indian Journal of Virology.  

Symptoms

The incubation period for the virus ranges from 5 to 14 days and symptoms become visible after this period. Symptoms include fever, headache, fainting and nausea.  In some cases, symptoms like choking, stomach pain, vomiting, fatigue and blurred vision could also be there. The patient can possibly go into a coma just two days after the symptoms begin. The chance of contracting encephalitis that affects the brain is also high.

Precautions to be taken by the public

Take caution to ensure that food is not contaminated by bats. Take precautions to ensure bats don’t eat the food or drop feces on it. Do not eat fruits that may have been bitten by bats. Do not drink toddy that is brewed in open containers near palm trees.

It is also important to safeguard oneself after coming in contact with someone who has contracted the virus. It is important to maintain a distance from the patient, to sanitise and wash hands thoroughly.

Clothes, utensils and items typically used in the toilet or bathroom, like buckets and mugs, should be cleaned separately and maintained hygienically. Hands should always be kept clean using soap or alcohol hand rubs. Hands should be washed with soap for at least twenty seconds.

Precautions to be taken by hospitals

All patients who come with the symptoms should be admitted in isolation wards. Doctors and other medical staff should wear gloves and masks while examining and mingling with the persons who are suspected to have contracted the disease. All precautionary measures that are taken for infectious diseases should be taken in Nipah suspected cases also. Government authorities should be informed if a suspected person is admitted.

The equipment used for treatment, the clothes worn by the patients and the bed sheets should be handled safely. Only a limited number of health officials should be posted for duty in the isolated wards. 

There should be at least a one-metre distance between the beds of two patients. All medical staff should wear N-95 masks and should take utmost care while removing the mask and gloves after mingling with the patient.

Hands should be washed with soap for at least twenty seconds - hands can be washed with chlorhexidine or hand wash containing alcohol after nursing a patient. The equipment used for nursing should be disposable as far as possible. If equipment is being used again, it should be properly sterilised with glutaraldehyde.

Dealing with dead bodies

A detailed post by InfoClinic in Malayalam says that it is important to cover one’s face while transporting the dead body of anyone who dies after contracting Nipah fever. The post also says that relatives should try to refrain from hugging or kissing the dead person and should take utmost care while bathing the body before cremation or burial.

It is important to not come in contact with face or body fluids at the time when the dead body is brought for cremation. Face should be covered while cleaning the dead body. Those who have cleaned the dead body should take a shower using soap throughout the body.

Vaccine

At present, there is no vaccine present to tackle the Nipah virus, however, other preventive measures have been suggested by experts. Most infectious diseases specialists, including Dr Benjamin A Satterfield from the Department of Microbiology and Immunology at the Mayo Clinic, have suggested that tackling risk factors may be more effective than vaccines themselves. “Preventing humans from being infected through non-vaccination efforts will perhaps play an even more important, and less expensive, role in controlling NiV disease,” he had stated.

In some areas of Malaysia, such measures are already in place to avoid further exposure or outbreak of Nipah virus. Livestock, such as pigs and cattle, which can act as a host, are kept isolated to prevent them from coming into contact with NiV. In humans, it has been suggested to quarantine those who may have come in contact with the disease or who are showing symptoms of the same, as it is highly contagious.

Treatment as of now consists of giving supportive measures to the patient as required.

Disease confirmation

With the help of reverse transcription polymerase chain reaction (RT-PCR), it is possible to separate the virus from the fluids present in the nose and throat, from the blood and urine and from spinal fluid. The virus can also be identified using the Enzyme-linked immunosorbent assay (ELISA) test, which is a test that can be used to determine if you have antibodies related to certain infectious conditions. The virus can also be identified in dead bodies, by doing an immunohistochemistry examination on the samples collected from the body during postmortem.