What is Nipah virus? India rushes to contain outbreak

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The Indian state of Kerala is racing to contain a new outbreak of the deadly Nipah virus, which has killed two people so far and infected at least five, according to government officials.

Schools in the affected Kozhikode district are closed, several villages have been declared containment zones, and 950 contacts have been identified, 213 of which are considered “high risk.” Kerala Health Minister Veena George on Wednesday, Sept. 13, 2023, confirmed the fifth person infected, a 24-year-old health-care worker. An infected 9-year-old remains on ventilation, government media said.

In a statement on social media, Pinarayi Vijayan, chief minister of Kerala, told residents not to panic but to “face this situation with caution” and “fully cooperate with the restrictions” to contain the disease. Kerala has seen four outbreaks of Nipah since 2018, the last of which occurred in 2021, as the state was also fighting a wave of covid-19 cases.

The World Health Organization estimates the Nipah virus’s fatality rate to be between 40 and 75 percent and has listed it as a priority disease because of its epidemic potential. The strain identified in Kerala, known as the Bangladesh strain, has a high mortality but is less infectious, Indian media reported.

Here’s what you need to know.

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What is Nipah virus and how does it spread?

Nipah virus (NiV) was discovered during an outbreak among pig farmers in Malaysia in 1999. The workers are thought to have contracted the virus through infected livestock and their secretions.

Fruit bats, which are also known as “flying foxes,” are the natural host of the Nipah virus, according to the WHO. The virus can be transmitted from animals to humans – primarily from bats or pigs – or through human-to-human contact.

The fruit bats, from the Pteropodidae family, often live in date trees near markets, and the virus has spread from bats to humans through food items – such as fruit and raw date palm juice – that were contaminated by infected bats.

Domestic animals, including horses, cats and dogs, are also able to catch and spread the infection, but the virus is considered highly contagious among pigs, which can pass the virus on to humans who come into contact with their bodily fluids or tissue.

The deadly infection can also be transmitted through close human contact; the virus can spread from an infected individual to their family or caregivers through the person’s bodily fluids.

In 2018, India grappled with an outbreak in Kerala that killed 21 of 23 people infected. In 2019, a new case was recorded in the country, but swift action and widespread contact tracing prevented further spread. A 12-year-old boy in Kerala died in September 2021 after contracting the virus and showing symptoms of brain swelling and inflammation of the heart, Indian media reported.

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What are the symptoms of Nipah virus?

Symptoms of the disease are wide-ranging. Milder symptoms include fever and headaches, vomiting, sore throat and muscle aches.

In severe cases, patients can experience acute infections such as encephalitis (inflammation of the brain) and respiratory issues. Other reported side effects include seizures, which may lead to personality changes or a coma.

Some who contract the virus remain asymptomatic.

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How widespread is Nipah virus?

In the decades since it was first detected, outbreaks have been recorded in many Southeast Asian countries, including Singapore, Bangladesh and India.

In some parts of Asia, new cases of the Nipah virus have been recorded “almost annually,” according to the Centers for Disease Control and Prevention.

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Why is Kerala particularly vulnerable?

Kerala is a tropical state of 35 million people on the southwest coast of India that has seen deforestation and rapid urbanization, creating conditions in which people and animals – such as bats that can carry the virus – have closer contact. An investigation by Reuters published in May found that Kerala is particularly vulnerable to spillover of diseases from bats to humans. It is home to more than 40 species of bats and “prime bat habitat” that has been progressively cleared for human development, the investigation said.

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How is Nipah virus diagnosed, and is it treatable?

Awareness of the Nipah virus remains extremely low, health experts say, making it harder to prevent, treat and diagnose. Because of this lack of knowledge, the virus is not always suspected in patients displaying symptoms.

Polymerase chain reaction (PCR) tests using samples of bodily fluids are mainly used to confirm an infection of the virus, along with antibody detection methods.

There is no certain cure for the Nipah virus, and there is no vaccine that can help to prevent infection.

According to the WHO and CDC, the main treatment is simply managing the symptoms and ensuring those infected have as much rest and hydration as possible.

Close, unprotected physical contact with Nipah-virus-infected people should be avoided. Individuals should regularly wash their hands after caring for or visiting sick people.

Ways to prevent animal-to-human infections include avoiding foods contaminated by fruit bats – or washing and peeling fruits that could be affected – and avoiding unprotected contact with infected bats or pigs.

The CDC recommends people living in areas where outbreaks have occurred regularly wash their hands with soap and water, and avoid contact with the bodily fluids or blood of those infected.