What Is Nipah Virus?

Nipah virus (Nipah virus), a unique and dangerous RNA virus, made its first appearance in Malaysia in 1998. Nipah virus can cause severe brain inflammation and has a high mortality rate. In recent years, it has resurfaced in India with alarming death rates, proving that it's still a global concern.

This article will delve deeper into how the virus affects the human body, its transmission, high-risk areas, symptoms to watch out for, prevention measures, the current status of treatments and vaccines, and ongoing research efforts. Stay informed to protect yourself and your community.

Introduction

A closer look at Nipah virus

Nipah virus is a distinct-looking RNA virus with a lipid and protein coating.¹ It can cause a serious disease called the Nipah virus infection, which may spread from animals to humans (known as zoonotic transmission), or directly from person to person. This virus has been a source of worry ever since it was first discovered in 1998 in a community named Kampung Sungai Nipah in the state of Perak, Malaysia.¹ Nipah virus has a high mortality rate and can cause severe encephalitis, which refers to inflammation of the brain.⁴

The importance of being informed

In the case of an epidemic, public awareness is essential. Managing and preventing outbreaks might be improved by being aware of the symptoms, knowing how this virus spreads, and the best preventative measures to avoid infection.

Why Nipah virus keeps making headlines

In May 2018, Nipah virus returned to Kerala, India, bringing to mind the threat it still poses.² It struck Kerala again in late 2021, with alarmingly high death rates.⁴ The most recent outbreak, which began in August 2023 in Kerala, led state officials to close schools, offices, and public transport networks. This virus is a persistent public health emergency rather than a one-time phenomenon. 

The global reach

Although Nipah virus is native to Southeast Asia and the Western Pacific, it is a worldwide concern due to its potential for transmission.⁴ The virus has been found in countries such as Bangladesh, Singapore, India, and the Philippines, which makes it a global issue.³

What is Nipah virus?

Definition and origin

Nipah virus and its close relative, Hendra virus (HeV), belong to a unique category of viruses within the Paramyxoviridae family and Henipavirus genus.¹ Fruit bats from the Pteropodidae family and Pteropus bat species (flying foxes) are the main carriers of this virus.³

Brief history and past outbreaks

Nipah virus was first discovered in Malaysia among pig farmers in 1998.¹ Even though Malaysia has not recorded any new cases since 1999, the virus has continued to spread, especially to Bangladesh, Singapore, India, and the Philippines.^1,3 These ongoing epidemics act as a sombre reminder that Nipah virus is still a problem on a worldwide scale.¹ In Cambodia, the virus has also been isolated from bats, which broadens its geographic distribution even more.¹

The science behind Nipah virus

How it affects the human body

Nipah virus can cause respiratory problems, deadly brain inflammation, or almost no symptoms at all.¹ Fever is a typical sign, followed by extreme exhaustion, mental disorientation, and breathing issues.³ Additionally, 20% of those who recover could go on to have ongoing neurological problems including seizures and personality abnormalities.³

Latest scientific findings

Recent research has revealed that Nipah virus is unique among paramyxoviruses because it has cytoplasmic inclusions near the endoplasmic reticulum.² These inclusions might play a role in various aspects of the virus's lifecycle, such as viral replication, assembly, or release. Additionally, Nipah virus is bigger than most other paramyxoviruses.² For the development of successful medicines and vaccinations, it is essential to comprehend these subtleties.⁷

How is Nipah virus transmitted?

Transmission from animals to humans

Nipah virus was first spread by coming into contact with infected pigs.¹ However, Nipah virus may infect both people and other animals, and it is currently known that bats are the primary carriers.^3,4

Human-to-human transmission

Nipah virus can still be transmitted from person to person, even when it is not airborne.³ Particular attention has been paid to this in Bangladesh and India, two countries where human-to-human transmission has been confirmed.¹

Environmental factors

Bats are the primary reservoirs of Nipah virus. These bats often feed on ripe fruits and may  drink from date palm sap collection vessels that humans then consume, which may lead to viral spread.^1,4 

High-risk areas and activities

Geographical locations where outbreaks have occurred

Although it has been documented in several nations, Southeast Asia is where Nipah virus is most common.^1,3 From 2001 to 2007, outbreaks were common in Bangladesh, while the Indian state of Kerala has been a hotspot since 2018.³

Activities that increase the risk of transmission

If you're involved in pig farming or frequently come into contact with fruit bats, you're at a higher risk of contracting Nipah virus.^1,4 Consuming date palm sap or fruits that have fallen to the ground can also increase the risk.⁴

Symptoms of Nipah virus

For early recognition and treatment of Nipah virus, understanding its symptoms is essential.^1,3 Symptoms usually emerge 4-14 days after being exposed to the virus. 

Early symptoms

• Fever: Almost everyone with the virus experiences a fever
• Headache
• Cough
• Trouble breathing
• Diarrhoea
• Myalgia: Muscle pain or soreness
• Dizziness

These early symptoms can be deceiving because they frequently mirror those of the flu or other less serious illnesses.^1,3

Following this, a phase of brain swelling (encephalitis) may occur. Symptoms such as tiredness, disorientation, and mental confusion are possible and can quickly develop into a coma within 24-48 hours.

Severe symptoms

• Altered mental state: Confusion or disorientation
• Severe weakness: Feeling unusually weak or fatigued
• Fatal encephalitis: Inflammation of the brain, which can be deadly
• Residual neurological consequences: About 20% of survivors experience long-term neurological issues like seizures and altered personality
• Delayed onset encephalitis: Some recovered patients develop brain inflammation much later

Unique features

Nipah virus is unique in that it may manifest in a variety of ways, from being entirely asymptomatic to causing serious respiratory problems and lethal brain inflammation.³ Nipah virus infection has a distinctive clinical appearance that sets it apart from other infections.³ Therefore, it may be prudent to get medical attention if you or someone you know begins to suffer a combination of these symptoms after visiting a high-risk location.^1,4

Prevention and control

When it comes to the Nipah virus, prevention is key, especially since there's no specific cure available yet.^1,3 So, how can you safeguard your family and yourself?

Personal hygiene practices

• Hand hygiene: Handwashing with soap and water should be done on a regular basis
• Avoid contact: Steer clear of any contact with the blood or bodily fluids of someone known to have a Nipah virus infection

Safe food handling

• Avoid contaminated food: Steer clear of uncooked date palm sap that could be contaminated, or raw fruit that has been found on the ground¹

Avoiding high-risk areas

• Bat reservoirs: If you're in an area known for bat populations, it's best to avoid it¹

Good farming practices

• Pig farming: If you're involved in pig farming, make sure to follow best practices to minimise the risk of infection⁵
• Crop protection: Take steps to protect crops from contamination by bats⁵
• Stay alert: If you observe that your pigs are unwell, especially in an area where bats reside, it's crucial to notify the authorities and avoid coming into contact with sick animals

Vaccination and treatment

No FDA-approved medication or vaccine is currently available to treat or prevent the illness.³ Since there's no specific treatment, supportive care is crucial. This means treating symptoms as they arise.¹

Current status of treatments

• Symptomatic treatment: Right now, doctors can only treat the symptoms as they appear. This is known as supportive care.¹

• Experimental drugs: Some drugs like ribavirin, chloroquine, remdesivir, and favipiravir have shown promise in animal studies. Ribavirin, for instance, has been reported to increase the overall survival rate to some extent when tested on patients with Nipah encephalitis.³

• Monoclonal antibodies: the CDC advised that a particular monoclonal antibody, m102.4, successfully completed phase I clinical trials in 2020 and was administered on a compassionate basis. However, as of 2023, it has not yet received general approval for use.³

Future prospects

Although we've come a long way in our understanding of Nipah virus, there is still more to discover. In order to develop efficient vaccinations and therapies, future research intends to increase our understanding of the molecular properties of this virus.⁷ Therefore, it is up to us to take these preventative steps seriously even if scientists are working hard to decipher the Nipah code. After all, prevention is always preferable to treatment.^1,3,5,7

Real-life cases and studies

Nipah virus has affected people and communities in several nations, and it isn't merely a theoretical issue for scientific textbooks. To further understand the scenario, let's examine a few of these real-life examples and research.

Case studies

Nipah virus first made its appearance in 1998 among pig farmers in Malaysia.³ After emerging in Malaysia, the virus didn't just vanish. It was detected in countries like Bangladesh, Singapore, India, and the Philippines.³ Bangladesh saw recurrent zoonotic transmissions of the Nipah virus from 2001 to 2007.³ In India, the state of Kerala has been hit with Nipah virus outbreaks since 2018, including an outbreak in the midst of the COVID-19 pandemic. The most recent outbreak in 2023 has unfortunately resulted in the loss of two lives.

Impact on communities

• High mortality rates: Depending on the strain, the mortality rate due to Nipah virus infection ranges from 40% to 75%. Moreover, mortality rates were the highest in Bangladesh (77.03%) and India (75.56%).³ These figures reflect actual individuals, families, and communities that have been severely affected by the virus; they are not merely statistics.

• Global concern: The virus's ability to emerge in different countries reminds us that this is a global concern, and not only limited to one particular region or community.^1,3

Government and NGO interventions

Recognising the severity and potential global threat of the Nipah virus, the World Health Organization (WHO) has listed it as a priority disease for research and development.³ Various studies have been undertaken to understand its epidemiology, how it presents clinically, and how it spreads.³ These studies aim to equip healthcare professionals and communities with the knowledge to tackle potential outbreaks.

Summary

Nipah virus is a dangerous virus that may cause lethal brain inflammation and its symptoms differ greatly from a typical flu infection.³ It has an international impact, affecting nations like India, Bangladesh and Malaysia.³ Its symptoms can vary greatly, and survivors frequently deal with ongoing neurological problems.³ 

Bats and pigs are the main source of this virus, which may also transfer from animals to people and even between humans.^1,3,4 
Since there is currently no specific treatment or vaccine, prevention relies on maintaining basic hygiene and avoiding high-risk areas.^1,5 With death rates as high as 75.56% in India and 77.03% in Bangladesh,³ the disease has a catastrophic effect, although continuing research raises some hope for potential treatments.⁷