Nipah UPSC NOTE

Nipah

Nipah virus (NiV) is a zoonotic virus (it is transmitted from animals to humans) and can also be transmitted through contaminated food or directly between people.
In infected people, it causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis.
The virus can also cause severe disease in animals such as pigs, resulting in significant economic losses for farmers.

Transmission:

Nipah virus (NiV) can spread to people from:

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

Signs and Symptoms:

Infection with Nipah virus (NiV) can cause mild to severe disease, including swelling of the brain (encephalitis) and potentially death.
Symptoms typically appear in 4-14 days following exposure to the virus.
The illness initially presents as 3-14 days of fever and headache, and often includes signs of respiratory illness, such as cough, sore throat, and difficulty breathing.
A phase of brain swelling (encephalitis) may follow, where symptoms can include drowsiness, disorientation, and mental confusion, which can rapidly progress to coma within 24-48 hours.

Death may occur in 40-75% of cases.
Long-term side effects in survivors of Nipah virus infection have been noted, including persistent convulsions and personality changes.
Infections that lead to symptoms and sometimes death much later after exposure (known as dormant or latent infections) have also been reported months and even years after exposure.

Diagnosis:

During early stages of the illness, laboratory testing can be conducted using real time polymerase chain reaction (RT-PCR) from throat and nasal swabs, cerebrospinal fluid, urine, and blood.
Later in the course of illness and after recovery, testing for antibodies is conducted using an enzyme-linked immunosorbent assay (ELISA).
Early diagnosis of NiV infection can be challenging due to the non-specific early symptoms of the illness.

However, early detection and diagnosis are critical to increase chances of survival among infected individuals, to prevent transmission to other people, and to manage outbreak response efforts.

Treatment:

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

There are, however, immunotherapeutic treatments (monoclonal antibody therapies) that are currently under development and evaluation for treatment of NiV infections.
One such monoclonal antibody, m102.4, has completed phase 1 clinical trials and has been used on a compassionate use basis.
In addition, the antiviral treatment remdesivir has been effective in nonhuman primates when given as post-exposure prophylaxis, and may be complementary to immunotherapeutic treatments.

Prevention:

In areas where Nipah virus (NiV) outbreaks have occurred (Bangladesh, Malaysia, India, and Singapore), people should:
Practice hand washing regularly with soap and water
Avoid contact with sick bats or pigs
Avoid areas where bats are known to roost
Avoid eating or drinking products that could be contaminated by bats, such as raw date palm sap, raw fruit, or fruit that is found on the ground
Avoid contact with the blood or body fluids of any person known to be infected with NiV.

Because NiV can be spread from person-to-person, standard infection control practices and proper barrier nursing techniques are important in preventing hospital-acquired infections (nosocomial transmission) in settings where a patient has confirmed or suspected NiV infection.
Increasing surveillance of animals and people in areas where NiV is known to exist.
Increasing research on the ecology of fruit bats to understand where they live and how they spread the virus to other animals and people.
Improving tools to detect the virus early in communities and livestock.

Reinforcing protocols for healthcare settings on standard infection control practices to prevent person-to-person spread.
Raising awareness about the signs, symptoms, and risk of NiV among populations.

Outbreaks:

So far, NiV outbreaks have only been described in Asia.
The first reported outbreak occurred in 1998–1999 and involved pig farmers in the village of Sungai Nipah (Malaysia).
Since then, outbreaks have been documented in Bangladesh, India, the Philippines & Singapore.

Nipah outbreaks in India:

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