What Is Nipah Virus (NiV)?

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In the midst of a worldwide pandemic, the last thing you want to hear about is another virus with pandemic potential. Yet, an outbreak of one has appeared in India. It’s called the Nipah virus (NiV).

Before you sound the alarm, it should be noted that, unlike CoVID-19, NiV is already known to science. A member of the Paramyxoviridae viral family, the first outbreak of Nipah was in 1999, when 265 cases were reported in Malaysia and Singapore. Of these,105 died, making NiV much more lethal than the current pandemic.

Fortunately, it’s much less contagious, with an R-Nought number less than 1.0 (CoVID ranges from 1.4-3.9, depending on the area). Also reassuring is that no other outbreaks have since occurred in the countries of origin. For some reason, however, it’s become an almost annual event in other places like Bangladesh and India.

Cute (for a bat) but carries all sorts of nasty viruses

Nipah virus (NiV) is a zoonotic virus, which means it passes across different species (including from animals to people). Fruit bats, also called flying foxes, are the animal reservoir for NiV in nature. For those who are experiencing déjà vu, they’re the same animals thought to be responsible for Ebola. In this case, it seems to sometimes use pigs as a “middleman” host. Indeed, one million pigs had to be slaughtered to contain the 1999 outbreak.

People become infected from contact with an infected animal or its body fluids, and then from the sick individual to other humans. The World Health Organization classifies it as a “virus of concern” for future epidemics because of its tendency to spill over from animals to humans.

Each time a virus replicates in a person, however, mutations may occur. This leads to new strains which could possibly be more easily transmitted person to person. If this happens, it could surpass Ebola in lethality. During the 2014 epidemic in West Africa, Ebola had a death rate of about 40-45%. Although the death rate from NiV in 1999 was similar, some of the latest outbreaks of NiV came with a 70 percent death rate, suggesting a more deadly strain may have emerged.

Surprisingly, some COVID-19 precautions may have helped control the spread of Nipah this year. Hospital workers had stockpiles of masks, gloves, and gowns, giving protection to the people most at risk. Social distancing may have prevented contact with bodily fluids.

Symptoms may initially include one or several of the following:

  • Fever
  • Headache
  • Cough
  • Sore throat
  • Difficulty breathing
  • Vomiting

In the worst cases, brain swelling and inflammation known as “encephalitis” can occur, leading to altered mental status, seizures, coma, and death.  

Symptoms usually become apparent about 4-14 days following exposure to NiV. You can expect several days to two weeks of fever, headache, and other flu-like symptoms. Progression to critical status can happen within 48 hours in some cases.

Nipah infection can be diagnosed via blood tests, but there is no proven treatment or cure at present. Monoclonal antibody therapy and Remdesivir, both in the news for CoVID therapy, are under development for NiV.

In areas where Nipah virus outbreaks have occurred, people should:

  • Wash hands regularly with soap and water.
  • Avoid contact with sick animals, like bats or swine.
  • Stay away from areas where bats are known to roost.
  • Avoid consumption of fruits or other food products that may be contaminated by bats.
  • Avoid contact with blood or other body fluids of any infected individual.

Because NiV can be spread from person-to-person, proper infection control and nursing care, such as we’ve described previously in various of our website articles and books, should be instituted.

Is all this overkill? Hopefully. The folks in India are working hard to contain the virus so, for now, it’s doubtful that a NiV epidemic will be coming to your town. Then again, how many said that about a new virus that began in a city called Wuhan in China? It’s wise to be aware of all infectious disease threats before they arrive in your neighborhood.

Joe Alton MD

Dr. Alton aka Dr. Bones

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