Mon. Jun 25th, 2018

NIV Advisory

Notification

The Ministry of Health would like to inform the general public that there is an ongoing Nipah virus outbreak in some parts of Kerala, India. Ministry of health is closely monitoring the situation and would like to urge the general public not to panic as we have mechanisms in place to prevent, to detect and to respond to such public health event.

General public are advised to take the following precautions:

  • Do not panic.
  • Practice good hand hygiene at all times.
  • If you have fever after travelling to affected areas, please report immediately to the nearest health facility.

Nipah virus

Key facts

  • Fruit bats of the Pteropodidae family are the natural host of Nipah virus (NiV).
  • Nipah virus can cause a range of mild to severe disease in domestic animals such as pigs.
  • Nipah virus can be transmitted to humans from animals (bats, pigs), and can also be transmitted directly from human-to-human.
  • Nipah virus infection in humans causes a range of clinical presentations, from asymptomatic infection to acute respiratory infection and fatal encephalitis.
  • The primary treatment for humans is supportive care. There is no treatment or vaccine available for either people or animals.

Transmission

  • NiV is a zoonotic virus (a virus transmitted to humans from animals).
  • Transmission occurs via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.
  • Consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats is also a source of infection.
  • Limited human to human transmission of NiV has also been reported among family and care givers of infected NiV patients.
  • Nipah virus also spreads directly from human-to-human through close contact with people’s secretions and excretions.
  • Transmission of the virus has also been reported within a health-care setting (nosocomial).

Signs and symptoms

  • Human infections range from asymptomatic infection, acute respiratory infection (mild, severe), and fatal encephalitis. Infected people initially develop influenza-like symptoms of fever, headaches, myalgia (muscle pain), vomiting and sore throat.
  • This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis.
  • Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.
  • The incubation period ranges from 4-14 days (up to 45 days has been reported).
  • Most people who survive acute encephalitis make a full recovery, but long term neurologic conditions have been reported in survivors.
  • The case fatality rate is estimated at 40% to 75%.

Diagnosis

  • Initial signs and symptoms of NiV infection are non-specific and the diagnosis is often not suspected at the time of presentation.
  • NiV infection can be diagnosed together with clinical history during the acute and convalescent phase of the disease.
  • Main tests including real time polymerase chain reaction (RT-PCR) from bodily fluids as well as antibody detection via ELISA.

Treatment

  • There are currently no drugs or vaccines specific for NiV infection.
  • Intensive supportive care is recommended to treat severe respiratory and neurologic complications.

Prevention

  1. Controlling Nipah virus in domestic animals
  • Currently, there are no vaccines available against Nipah virus.
  • Routine and thorough cleaning and disinfection of pig farms (with appropriate detergents).
  • If an outbreak is suspected, the animal premises should be quarantined immediately.
  • Culling of infected animals with close supervision of burial or incineration of carcasses will  reduce the risk of transmission to people.
  • Restricting or banning the movement of animals from infected farms to other areas.
  • As Nipah virus outbreaks in domestic animals have preceded human cases, establishing an animal health surveillance system, using a One Health approach, to detect new cases is essential in providing early warning for veterinary and human public health authorities.
  • The only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to and decrease infection from NiV.
  1. Public health educational messages should focus on the following:
  • Reducing the risk of bat-to-human transmission:
    • Efforts to prevent transmission should first focus on decreasing bat access to date palm sap and to other fresh food products.
    • Keeping bats away from sap collection sites with protective coverings (e.g., bamboo sap skirts) may be helpful.
    • Freshly collected date palm juice should be boiled.
    • Fruits should be thoroughly washed and peeled before consumption.
  • Reducing the risk of animal-to-human transmission:
    • Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.
    • People should avoid being in contact with infected pigs.
  • Reducing the risk of human-to-human transmission:
    • Avoid unprotected physical contact with Nipah virus-infected people.
    • Wash hands immediately after contact with sick people.
  1. Controlling infection in health-care settings
  • Health-care workers caring for patients with suspected or confirmed NiV infection, or handling specimens from them, should implement standard infection control precautions for all patients at all times.
  • As human-to-human transmission in particular nosocomial transmission have been reported, contact and droplet precautions should be used in addition to standard precautions.
  • Samples taken from people and animals with suspected NiV infection should be handled by trained staff working in suitably equipped laboratories.

More information:

About Nipha: http://www.who.int/csr/disease/nipah/en/

Nipha factsheet: http://www.who.int/news-room/fact-sheets/detail/nipah-virus

Nipha Research: http://www.who.int/blueprint/priority-diseases/key-action/nipah/en/