Nipah virus or NiV all you need to know

by Dr. Madhav Prabhu
Nipah virus or NiV is doing the rounds recently and a lot of worried patients are asking me questions about the virus.Infact the virus was not in the picture till around the 5th of May when a 23 year old person died in Kerala and later two of his relatives died around two weeks from then , the blood samples were sent to a nationally recognized lab in Pune and the virus was confirmed. Since then there has been panic which has been aggravated by further deaths. Thus it’s imperative that we know more about this virus. ere is what is known about the virus and it’s symptoms.

But first we should know that Belagavi is not new to viruses and we doctors have previously encountered several of them including, Japanese Encephalitis, Kyasnur Forest disease and Dengue, some of them are hemorrhagic and others encephalitic. Which means they either cause bleeding all over the body or swelling of the brain.

NiV is not a very different story , the virus was first isolated from a dead man in the Nipah village of Malaysia in 1998 .The virus is not a native of humans and fruit bats of the Pyeropus genus Pteropodidae family are the natural hosts of the virus.

The virus also breeds in other animals like pigs , rats etc. The proposed theory is that the disease came from the bats to the pigs when the pigs ate fruits that were dropped by the bats eating a part of it. The bats saliva and other secretions have high amount of virus especially when they are agitated and hungry , this happens frequently with deforestation.

The humans acquired the virus either consuming the fruit or coming in contact with the pigs and their excreted materials. In Bangladesh where palm dates sap are consumed , humans acquired it by eating palm saps left half eaten by bats. Human to human transmission has been noticed like the ones in Kerala and is due to aerosols and fomites.

Aerosols are tiny droplets of secretions which remain suspended when someone sneezes, if inhaled by others they cause infection. Fomites are inanimate objects like door knobs , soaps etc to which virus can be attached , if another person touches those object and inhales them , they can acquire the virus. The disease usually is seen in pigs and piglets are seen dying more often.

So how does a patient present with this virus, well initially he can present just like any other flu with respiratory infection and fever. After acquiring the virus the exposed person is asymptomatic for 5-14 days which means that the patient is completely asymptomatic for upto 14 days after being exposed to the infection. If a person travels during this period the patient can transmit the disease to the place of travel. Also the person may transmit the virus in a unsuspecting person in a distance place. After this incubation period where the virus is growing inside the body , the virus presents with different clinical features , the patient may be asymptomatic or may develop fever for 3-14 days, fever is associated with intense headache , nausea , vomiting , chocking , abdominal pain progressing to drowsiness , disorientation and mental confusion, this is usually because of the encephalitis which is the swelling of the brain. In severe cases the patient can develop coma in 24 to 48 hours. Almost 50 to 60 percent of the cases may die. Severe lung infections are also known. Even after the disease is cured the patient may develop long term problems like he may have convulsions and personality changes. Somethings the virus can remain dormant , re activate and kill the person. Since we are not seeing much of these cases we can easily confuse this with the Japanese Encephalitis , like the deaths that happened in Uttar Pradesh recently.

The virus can be confused with many diseases and the only way to have a confirmed diagnosis is by doing specific tests for the virus, this may take time and the patient may be dead by the time the results come , also there is no specific treatment , so the tests may be more in the interest of the society to prevent epidemics.

There is no specific treatment for NiV and what can be done is to give supportive care and wait for the person to recover. We usually treat the fever and the neurological symptoms but there is no definitive treatment , some anti viral drugs like ribavarin may give symptomatic relief. Ventilator and drugs to increase BP may be required in extreme cases. There are also presently no vaccines available to prevent the disease.

Like most diseases I think the best treatment is prevention. It’s fruits season and strictly do not eat fruits fallen from trees especially those half eaten by birds, If there is a mysterious death of pigs stay away from them and their wastes. In case a person comes from a place of exposure we need to quarantine the patient for the incubation period of the virus. Cover your nose especially when you are exposed to a person sneezing all the time, a simple N95 mask is good enough.
Wash your hands often especially when dealing with suspected infection contact.
Refrain from hugging and kissing patients with suggestive symptoms.
Personal use things like soap , tumblers , utensils of suspected patients should be sterilized and not shared.
The government needs to actively find the patients and try and isolate them as early as possible.

The best possible thing is to stay calm ,not panic and take all the precautions required. Visit your doctor if you see anything unusually suspicious. Do not self medicate.

About the Author: Dr. Madhav Prabhu M.B.B.S, M.D (General Medicine) is Consultant in KLE’s Dr Prabhakar Kore Hospital, Teaches in JNMC.