In an effort to track and contain an outbreak of the Nipah virus, which has killed two people but can kill as many as three out of every four people it infects, and has been flagged by experts as having the potential to start a new pandemic, health officials in India have closed schools, offices and public transportation and are testing hundreds of people.

Key Facts

After an outbreak among pigs and pig farmers in Malaysia and Singapore in 1999, the unusual and possibly fatal Nipah virus was initially identified.

As a zoonotic virus that may transfer from animals to people, nipah can infect people either directly through contact with infected animals or their bodily fluids, or indirectly through contaminated food, such as fruit items tainted with bat urine or saliva.

During previous epidemics, cases of Nipah transmission from person to person were also noted, notably among afflicted people’s families and carers.

According to the World Health Organisation, symptoms in humans typically appear between a few days and two weeks after infection, though periods as long as 45 days have been reported, and it’s possible that people may still be contagious during this time (the WHO states that pigs are “highly contagious” during this incubation period).

The typical initial symptoms of nipah include fever, headache, and signs of a respiratory infection like coughing. These symptoms can quickly deteriorate to include brain swelling (encephalitis), seizures, and a coma within a day or two.

Health organisations predict that between 40% and 75% of those who contract the Nipah virus will pass away from it; the exact percentage depends on the outbreak and the effectiveness of local medical systems in controlling the illness (long-term neurological conditions like seizures and personality changes have been reported among those who recover from encephalitis).

News Peg

Kerala, a state in southern India, is scrambling to track down and contain a Nipah outbreak that has already claimed the lives of two people and hospitalised three more. Numerous employees have been tested by public health officials, and in order to prevent the spread of the disease, schools, government buildings, religious institutions, public transportation, and public offices have all been shuttered or suspended in high-risk locations. The state has experienced four outbreaks since 2018, and researchers warn that given the region’s degradation of natural bat habitats by people, the area may be particularly vulnerable to virus spillovers.

Important Context

The natural hosts for Nipah are fruit bats, sometimes referred to as flying foxes. Nipah is in the same virus family as several other infections that are known to infect people, such as measles and mumps. The virus is known to infect a wide range of hosts, including humans, pigs, sheep, goats, horses, cats, and dogs, and has been proven to cause serious disease in at least humans and pigs in previous epidemics, while it does not appear to produce any observable illness in fruit bats. Public health professionals may find it challenging to monitor and control its spread because of its capacity to infect a wide range of hosts. In addition to Malaysia, the Philippines, and Singapore, nipah outbreaks have also been documented in Bangladesh and India, the two countries where the disease has been most frequently reported since 2001. According to the WHO, there were 600 documented cases of Nipah between 1998 and 2015.

What to look out for

Nipah virus cannot be treated with medications or vaccinations in either people or animals. Only supportive care and symptom-specific treatment is available to those who have been infected. According to the Centres for Disease Control and Prevention, early clinical trials are being conducted on a few immunological treatments utilising monoclonal antibodies. In animal experiments, the antiviral drug remdesivir, which is already used in people to treat other illnesses, was also effective when administered after exposure to the virus, according to the CDC. In Australia, there is also a vaccine for horses against Hendra virus, a close sibling of Nipah, which looks to provide some defence against Nipah infection.

Tangent

One of just 10 illnesses that the WHO regards as having the potential to start the next pandemic and for which we have few to no effective responses, Nipah has been named a priority pathogen for urgent study and development. The list also includes illnesses like Zika, Ebola, Marburg, Lassa fever, Crimean-Congo haemorrhagic fever, and Rift Valley Fever, as well as three illnesses brought on by coronaviruses: COVID-19, Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). The WHO includes “Disease X” as a pathogen that could start a pandemic, a term for a pathogen that is not currently known to cause disease in humans but could lead to an outbreak in the future. The WHO claims that their list is not thorough.

What We Don’t Know

Due to its vague symptoms and potentially lengthy incubation period (the interval between infection and the onset of symptoms), Nipah can be difficult to diagnose. Nipah is “often initially misdiagnosed,” according to the European Centre for Disease Prevention and Control. Antibody tests can be used in the later stages of the disease, though access to the technology and safety protocols required for testing may not be available everywhere in the world. In the early stages of the disease, genetic testing of material from the patient can reveal an infection, similarly to Covid-19 PCR tests.

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