Nipah virus infection

A Nipah virus infection is a viral infection caused by the Nipah virus.[2] Symptoms from infection vary from none to fever, cough, headache, shortness of breath, and confusion.[1][2] This may worsen into a coma over a day or two,[1] and 50% to 75% of those infected die. Complications can include inflammation of the brain and seizures following recovery.[2]

Nipah virus infection
Structure of a Henipavirus
SpecialtyInfectious disease 
SymptomsNone, fever, cough, headache, confusion[1]
ComplicationsInflammation of the brain, seizures[2]
Usual onset5 to 14 days after exposure[1]
CausesNipah virus (spread by direct contact)[3]
Diagnostic methodBased on symptoms, confirmed by laboratory testing[4]
PreventionAvoiding exposure to bats and to sick pigs and people.
TreatmentSupportive care only[2]
Frequency~701 human cases (1998 to May 2018)[5][6]
Deaths~50 to 75% risk of death[5][7]

The Nipah virus (NiV) is a type of RNA virus in the genus Henipavirus.[2] The virus normally circulates among specific types of fruit bats.[2] It can both spread between people and from other animals to people.[2] Spread typically requires direct contact with an infected source.[3] Diagnosis is based on symptoms and confirmed by laboratory testing.[4]

Management is restricted to supportive care;[2] as of 2020 there is neither vaccine nor specific treatment.[2] Preventive measures include avoiding exposure to bats and sick pigs, and not drinking raw date palm sap.[8] As of May 2018 about 700 human cases of Nipah virus were estimated to have occurred, and 50 to 75 percent of those infected died.[5][7][6] In May 2018, an outbreak of the disease caused 17 deaths in the Indian state of Kerala.[9][10][11]

The disease was first identified in 1998 by a team of researchers at the Faculty of Medicine, University of Malaya during an outbreak in Malaysia. The majority of the patients in Malaysia diagnosed with the disease were referred to and treated at the University of Malaya Medical Centre. The virus was isolated and identified in 1999.[2][12] The disease is named after a village in Malaysia, Sungai Nipah.[12] Pigs may also be infected, and millions were killed by Malaysian authorities in 1999 to stop the spread of disease, a measure which proved to be successful.[2][12]

Signs and symptoms

The symptoms start to appear 5 to 14 days after exposure.[12] Initial symptoms are fever, headache, and drowsiness, followed by disorientation and mental confusion. Respiratory issues can also be present during the early stages.[12] Coma may ensue within 24 to 48 hours. Encephalitis, inflammation of the brain, is a potentially fatal complication of Nipah virus infection. Nipah patients who have breathing difficulty are more likely than those without respiratory illness to transmit the virus,[13] as are those who are more than 45 years of age.[14] The disease is suspected in symptomatic individuals in the context of an epidemic outbreak.

Risks

The risk of exposure is high for hospital workers and caretakers of those infected with the virus. In Malaysia and Singapore, Nipah virus infected people with close contact to infected pigs. In Bangladesh and India, the disease has been linked to consumption of raw date palm sap (toddy), eating of fruits partially consumed by bats, and using water from wells inhabited by bats.[15][16]

  • How the Nipah virus spreads[17]
  • Fruit bats are the natural reservoirs of Nipah virus

Laboratory diagnosis
Transmission electron micrograph (TEM) depicted a number of Nipah virus virions from a person's cerebrospinal fluid (CSF).

During acute and convalescent stages of the disease, RNA can be detected using reverse transcriptase polymerase chain reaction (RT-PCR) from throat swabs, cerebrospinal fluid, urine and blood analysis.[12]

After recovery, IgG and IgM antibody detection can confirm a prior Nipah virus infection. Immunohistochemistry on tissues collected during autopsy also confirms the disease.[12]

Prevention

There is no effective treatment for Nipah disease; prevention is the only protection. The likelihood of infection through animal transmission can be reduced by avoiding exposure to sick pigs, and to bats where the disease is endemic. Bats harbour a significantly higher proportion of zoonotic viruses than all other mammalian orders,[18] and are known not to be affected by the many viruses they carry, apparently due to their developing special immune systems to deal with the stress of flying.[19] Infection via bats can be caused by drinking raw palm sap (palm toddy) contaminated by bat excreta,[20] eating fruits partially consumed by bats, and using water from wells infested by bats.[21] Bats are known to drink toddy that is collected in open containers, and occasionally urinate in it, which contaminates it with the virus;[20] switching to closed-top containers prevents transmission via this route. Outbreaks can be reduced by surveillance and awareness. The association of this disease with the reproductive cycle of bats is not well studied.

Standard infection control practices can protect against human-to-human nosocomial infections.

A subunit vaccine using the Hendra G protein was found to produce cross-protective antibodies against both henipavirus and nipavirus; this has been used in monkeys to protect against Hendra virus, although its potential for use in humans has not been studied.[22]

Treatment

As of 2020 there is no specific treatment for Nipah virus infection.[23] The mainstay of treatment is supportive care.[24][23] Standard infection control practices and proper barrier nursing techniques are recommended to avoid the spread of the infection from person to person.[24] All suspected cases of Nipah virus infection should be isolated.[25] While tentative evidence supports the use of ribavirin, it has not yet been studied in people with the disease.[24] Specific antibodies have also been studied in an animal model with potential benefit.[24] Acyclovir, favipiravir,[23] and remdesivir[26] have been assessed as potential antivirals against Nipah virus.

Outbreaks
Map showing locations of outbreaks of Nipah and Hendra virus as well as the range of Pteropus bats as of 2014

Nipah virus outbreaks have been reported in Malaysia, Singapore, Bangladesh and India. The highest mortality due to Nipah virus infection was found in Bangladesh, where outbreaks are typically seen in winter.[27] Nipah virus was first seen in 1998 in peninsular Malaysia in pigs and pig farmers. By mid-1999, more than 265 human cases of encephalitis, including 105 deaths, had been reported in Malaysia, and 11 cases of either encephalitis or respiratory illness with one fatality were reported in Singapore.[28] In 2001, Nipah virus was reported from Meherpur District, Bangladesh[29][30] and Siliguri, India.[29] The outbreak again appeared in 2003, 2004 and 2005 in Naogaon District, Manikganj District, Rajbari District, Faridpur District and Tangail District.[30] In Bangladesh there were further outbreaks in subsequent years.[31][7]

  • September 1998 - May 1999: in the states of Perak, Negeri Sembilan and Selangor in Malaysia. A total of 265 cases of acute encephalitis with 105 deaths caused by the virus were reported in the three states throughout the outbreak.[32] The Malaysian health authorities at first thought Japanese encephalitis (JE) was the cause of infection which hampered the deployment of effective measures to prevent the spread of Nipah virus.[33]
  • 2001: 31 January–23 February, Siliguri, India: 66 cases with a 74% mortality rate.[34] 75% of patients were either hospital staff or had visited one of the other patients in hospital, indicating person-to-person transmission.
  • 2001: April – May, Meherpur District, Bangladesh: 13 cases with nine fatalities (69% mortality).[35]
  • 2003: January, Naogaon District, Bangladesh: 12 cases with eight fatalities (67% mortality).[35]
  • 2004: January – February, Manikganj and Rajbari districts, Bangladesh: 42 cases with 14 fatalities (33% mortality).
  • 2004: 19 February – 16 April, Faridpur District, Bangladesh: 36 cases with 27 fatalities (75% mortality). 92% of cases involved close contact with at least one other person infected with Nipah virus. Two cases involved a single short exposure to an ill patient, including a rickshaw driver who transported a patient to hospital. In addition, at least six cases involved acute respiratory distress syndrome, which has not been reported previously for Nipah virus illness in humans.
  • 2005: January, Tangail District, Bangladesh: 12 cases with 11 fatalities (92% mortality). The virus was probably contracted from drinking date palm juice contaminated by fruit bat droppings or saliva.[36]
  • 2007: February – May, Nadia District, India: up to 50 suspected cases with 3–5 fatalities. The outbreak site borders the Bangladesh district of Kushtia where eight cases of Nipah virus encephalitis with five fatalities occurred during March and April 2007. This was preceded by an outbreak in Thakurgaon during January and February affecting seven people with three deaths.[37] All three outbreaks showed evidence of person-to-person transmission.
  • 2008: February – March, Manikganj and Rajbari districts, Bangladesh: Nine cases with eight fatalities.[38]
  • 2010: January, Bhanga subdistrict, Faridpur, Bangladesh: Eight cases with seven fatalities. During March, one physician of the Faridpur Medical College Hospital caring for confirmed Nipah cases died.[39]
  • 2011: February: An outbreak of Nipah Virus occurred at Hatibandha, Lalmonirhat, Bangladesh. The deaths of 21 schoolchildren due to Nipah virus infection were recorded on 4 February 2011. IEDCR confirmed the infection was due to this virus.[40] Local schools were closed for one week to prevent the spread of the virus. People were also requested to avoid consumption of uncooked fruits and fruit products. Such foods, contaminated with urine or saliva from infected fruit bats, were the most likely source of this outbreak.[41]
  • 2018: May: Deaths of seventeen[42] people in Perambra near Calicut, Kerala, India were confirmed to be due to the virus. Treatment using antivirals such as Ribavirin was initiated.[43][44]
  • 2019: June: A 23-year-old student was admitted into hospital with Nipah virus infection at Kochi in Kerala.[45] Health Minister of Kerala, K. K. Shailaja said that 86 people who had had recent interactions with the patient were under observation. This included two nurses who treated the patient, and had fever and sore throat. The situation was monitored and precautionary steps were taken to control the spread of virus by the Central[46] and State Government.[45] 338 people were kept under observation, 17 of them in isolation, by the Health Department of Kerala. After undergoing treatment for 54 days at a private hospital, the 23-year-old student was discharged. On 23 July, the Kerala government declared Ernakulam district to be Nipah-free.[47]

Research

Ribavirin, m102.4 monoclonal antibody and favipiravir were being studied as treatments as of 2019.[48]

Medication

Ribavirin has been studied in a small number of people. As of 2011 it was unclear whether it was useful, although a few people had returned to normal life after treatment.[49] In vitro studies and animal studies have shown conflicting results in the efficacy of ribavirin against NiV and Hendra, with some studies showing effective inhibition of viral replication in cell lines,[50][51] whereas some studies in animal models showed that ribavirin treatment only delayed but did not prevent death after NiV or Hendra virus infection.[52][53]

In 2013 the anti-malarial drug chloroquine was shown to block the critical functions needed for maturation of Nipah virus, although no clinical benefit was observed.[54]

Immunization

Passive immunization using a human monoclonal antibody, m102.4, that targets the ephrin-B2 and ephrin-B3 receptor-binding domain of the henipavirus Nipah G glycoprotein was evaluated in the ferret model as post-exposure prophylaxis.[5][12] m102.4, has been used in people on a compassionate use basis in Australia, and was in pre-clinical development in 2013.[5]

A Malayalam movie Virus was released in 2019, based on the 2018 Kerala (India) outbreak of Nipah virus.[55][56]

The fictional MEV-1 virus featured in the 2011 film Contagion was based on a combination of the Nipah and the measles viruses.[57]

See also

References
  1. "Signs and Symptoms Nipah Virus (NiV)". CDC. Retrieved 24 May 2018.
  2. "Nipah Virus (NiV) Infection". World Health Organization (WHO). Archived from the original on 26 September 2020. Retrieved 14 October 2020.
  3. "Transmission Nipah Virus (NiV)". CDC. 20 March 2014. Retrieved 24 May 2018.
  4. "Diagnosis Nipah Virus (NiV)". CDC. 20 March 2014. Retrieved 24 May 2018.
  5. Broder CC, Xu K, Nikolov DB, Zhu Z, Dimitrov DS, Middleton D, et al. (October 2013). "A treatment for and vaccine against the deadly Hendra and Nipah viruses". Antiviral Research. 100 (1): 8–13. doi:10.1016/j.antiviral.2013.06.012. PMC 4418552. PMID 23838047.
  6. "Morbidity and mortality due to Nipah or Nipah-like virus encephalitis in WHO South-East Asia Region, 2001-2018" (PDF). SEAR. Archived from the original (PDF) on 13 June 2018. Retrieved 2 June 2018. 112 cases since Oct 2013
  7. "Nipah virus outbreaks in the WHO South-East Asia Region". South-East Asia Regional Office. WHO. Archived from the original on 23 May 2018. Retrieved 23 May 2018.
  8. "Prevention Nipah Virus (NiV)". CDC. 20 March 2014. Retrieved 24 May 2018.
  9. CNN, Manveena Suri (22 May 2018). "10 confirmed dead from Nipah virus outbreak in India". CNN. Retrieved 25 May 2018.
  10. "Nipah virus outbreak: Death toll rises to 14 in Kerala, two more cases identified". Hindustan Times. 27 May 2018. Retrieved 28 May 2018.
  11. "After the outbreak". Frontline. Retrieved 10 July 2018.
  12. "Nipah Virus (NiV) CDC". www.cdc.gov. CDC. Archived from the original on 16 December 2017. Retrieved 21 May 2018.
  13. Luby SP, Hossain MJ, Gurley ES, Ahmed BN, Banu S, Khan SU, et al. (August 2009). "Recurrent zoonotic transmission of Nipah virus into humans, Bangladesh, 2001-2007". Emerging Infectious Diseases. 15 (8): 1229–35. doi:10.3201/eid1508.081237. PMC 2815955. PMID 19751584. Archived from the original on 22 May 2018.
  14. Nikolay B, Salje H, Hossain MJ, Khan AK, Sazzad HM, Rahman M, et al. (May 2019). "Transmission of Nipah Virus - 14 Years of Investigations in Bangladesh". The New England Journal of Medicine. 380 (19): 1804–1814. doi:10.1056/NEJMoa1805376. PMC 6547369. PMID 31067370.
  15. Luby SP, Gurley ES, Hossain MJ (2012). Transmission of Human Infection with Nipah Virus. National Academies Press (US). Archived from the original on 22 May 2018. Retrieved 21 May 2018.
  16. Balan, Sarita (21 May 2018). "6 Nipah virus deaths in Kerala: Bat-infested house well of first victims sealed". The News Minute. Archived from the original on 22 May 2018. Retrieved 21 May 2018.
  17. "Nipah Virus Infection symptoms, causes, treatment, medicine, prevention, diagnosis". myUpchar. Retrieved 27 January 2020.
  18. Olival, Kevin J.; Hosseini, Parviez R.; Zambrana-Torrelio, Carlos; Ross, Noam; Bogich, Tiffany L.; Daszak, Peter (2017). "Host and viral traits predict zoonotic spillover from mammals". Nature. 546 (7660): 646–650. doi:10.1038/nature22975. ISSN 0028-0836. PMC 5570460.
  19. Huang, Pien (9 February 2020). "Bats Carry Many Viruses. So Why Don't They Get Sick?". National Public Radio (npr).
  20. Islam MS, Sazzad HM, Satter SM, Sultana S, Hossain MJ, Hasan M, et al. (April 2016). "Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011-2014". Emerging Infectious Diseases. 22 (4): 664–70. doi:10.3201/eid2204.151747. PMC 4806957. PMID 26981928.
  21. Balan, Sarita (21 May 2018). "6 Nipah virus deaths in Kerala: Bat-infested house well of first victims sealed". The News Minute. Archived from the original on 22 May 2018. Retrieved 21 May 2018.
  22. Bossart KN, Rockx B, Feldmann F, Brining D, Scott D, LaCasse R, et al. (August 2012). "A Hendra virus G glycoprotein subunit vaccine protects African green monkeys from Nipah virus challenge". Science Translational Medicine. 4 (146): 146ra107. doi:10.1126/scitranslmed.3004241. PMC 3516289. PMID 22875827.
  23. Sharma, V; Kaushik, S; Kumar, R; Yadav, JP; Kaushik, S (January 2019). "Emerging trends of Nipah virus: A review". Reviews in Medical Virology. 29 (1): e2010. doi:10.1002/rmv.2010. PMID 30251294.
  24. "Nipah Virus (NiV) - Treatment". Centers for Disease Control and Prevention (CDC). 20 March 2014.
  25. "Nipah yet to be confirmed, 86 under observation: Shailaja". OnManorama. Retrieved 4 June 2019.
  26. Lo, Michael K.; Feldmann, Friederike; Gary, Joy M.; Jordan, Robert; Bannister, Roy; Cronin, Jacqueline; Patel, Nishi R.; Klena, John D.; Nichol, Stuart T.; Cihlar, Tomas; Zaki, Sherif R. (29 May 2019). "Remdesivir (GS-5734) protects African green monkeys from Nipah virus challenge". Science Translational Medicine. 11 (494): eaau9242. doi:10.1126/scitranslmed.aau9242. ISSN 1946-6234. PMC 6732787. PMID 31142680.
  27. Chadha MS, Comer JA, Lowe L, Rota PA, Rollin PE, Bellini WJ, et al. (February 2006). "Nipah virus-associated encephalitis outbreak, Siliguri, India". Emerging Infectious Diseases. 12 (2): 235–40. doi:10.3201/eid1202.051247. PMC 3373078. PMID 16494748.
  28. Eaton BT, Broder CC, Middleton D, Wang LF (January 2006). "Hendra and Nipah viruses: different and dangerous". Nature Reviews. Microbiology. 4 (1): 23–35. doi:10.1038/nrmicro1323. PMC 7097447. PMID 16357858.
  29. Chadha MS, Comer JA, Lowe L, Rota PA, Rollin PE, Bellini WJ, et al. (February 2006). "Nipah virus-associated encephalitis outbreak, Siliguri, India". Emerging Infectious Diseases. 12 (2): 235–40. doi:10.3201/eid1202.051247. PMC 3373078. PMID 16494748.
  30. Hsu VP, Hossain MJ, Parashar UD, Ali MM, Ksiazek TG, Kuzmin I, et al. (December 2004). "Nipah virus encephalitis reemergence, Bangladesh". Emerging Infectious Diseases. 10 (12): 2082–7. doi:10.3201/eid1012.040701. PMC 3323384. PMID 15663842.
  31. "Basic preventive measures can reduce Nipah virus attack". The Daily Star (Bangladesh). 8 March 2008.
  32. Looi, Lai-Meng; Chua, Kaw-Bing (2007). "Lessons from the Nipah virus outbreak in Malaysia" (PDF). The Malaysian Journal of Pathology. Department of Pathology, University of Malaya and National Public Health Laboratory of the Ministry of Health, Malaysia. 29 (2): 63–67. Archived (PDF) from the original on 30 August 2019.
  33. Looi, Lai-Meng; Chua, Kaw-Bing (2007). "Lessons from the Nipah virus outbreak in Malaysia" (PDF). The Malaysian Journal of Pathology. Department of Pathology, University of Malaya and National Public Health Laboratory of the Ministry of Health, Malaysia. 29 (2): 63–67. Archived (PDF) from the original on 30 August 2019.
  34. Chadha MS, Comer JA, Lowe L (2006). "Nipah virus-associated encephalitis outbreak, Siliguri, India". Emerging Infectious Diseases. 12 (2): 235–40. doi:10.3201/eid1202.051247. PMC 3373078. PMID 16494748.
  35. Hsu VP, Hossain MJ, Parashar UD (2004). "Nipah virus encephalitis reemergence, Bangladesh". Emerging Infectious Diseases. 10 (12): 2082–7. doi:10.3201/eid1012.040701. PMC 3323384. PMID 15663842.
  36. ICDDR,B (December 2005). "Nipah virus outbreak from date palm juice" (PDF). Centre for Population Research - Health and Science Bulletin. 3 (4): 1–5. ISSN 1729-343X.
  37. "Person-to-person transmission of Nipah infection in Bangladesh" (PDF). Health and Science Bulletin. 5 (4): 1–6. December 2007. ISSN 1729-343X. Archived from the original on 3 February 2009.
  38. ICDDR,B (2008). "Outbreaks of Nipah virus in Rajbari and Manikgonj". Health and Science Bulletin. 6 (1): 12–3. Archived from the original on 3 February 2009.
  39. ICDDR,B (2010). "Nipah outbreak in Faridpur District, Bangladesh, 2010". Health and Science Bulletin. 8 (2): 6–11. Archived from the original on 28 September 2011.
  40. "Arguments in Bahodderhat murder case begin". The Daily Star. 18 March 2008. Retrieved 21 May 2014.
  41. তাহেরকে ফাঁসি দেওয়ার সিদ্ধান্ত নেন জিয়া. prothom-alo.com. 4 February 2011
  42. "Nipah virus outbreak: Death toll rises to 14 in Kerala, two more cases confirmed". indianexpress.com. 27 May 2018. Retrieved 29 May 2018.
  43. "Kozhikode on high alert as three deaths attributed to Nipah virus". The Indian Express. 20 May 2018. Retrieved 20 May 2018.
  44. "Deadly Nipah virus claims victims in India". BBC News. 21 May 2018. Retrieved 11 December 2018 – via www.bbc.com.
  45. "Kerala Govt Confirms Nipah Virus, 86 Under Observation". New Delhi. 4 June 2019. Archived from the original on 14 July 2019. Retrieved 15 July 2019.
  46. Sharma, Neetu Chandra (4 June 2019). "Centre gears up to contain re-emergence of Nipah virus in Kerala". Mint. Retrieved 7 June 2019.
  47. "Ernakulam district declared Nipah virus free, says Kerala health minister". India Today. Press Trust of India. 23 July 2019.
  48. Banerjee, S; Gupta, N; Kodan, P; Mittal, A; Ray, Y; Nischal, N; Soneja, M; Biswas, A; Wig, N (February 2019). "Nipah virus disease: A rare and intractable disease". Intractable & Rare Diseases Research. 8 (1): 1–8. doi:10.5582/irdr.2018.01130. PMC 6409114. PMID 30881850.
  49. Vigant F, Lee B (June 2011). "Hendra and nipah infection: pathology, models and potential therapies". Infectious Disorders Drug Targets. 11 (3): 315–36. doi:10.2174/187152611795768097. PMC 3253017. PMID 21488828.
  50. Wright PJ, Crameri G, Eaton BT (March 2005). "RNA synthesis during infection by Hendra virus: an examination by quantitative real-time PCR of RNA accumulation, the effect of ribavirin and the attenuation of transcription". Archives of Virology. 150 (3): 521–32. doi:10.1007/s00705-004-0417-5. PMID 15526144.
  51. Aljofan M, Saubern S, Meyer AG, Marsh G, Meers J, Mungall BA (June 2009). "Characteristics of Nipah virus and Hendra virus replication in different cell lines and their suitability for antiviral screening". Virus Research. 142 (1–2): 92–9. doi:10.1016/j.virusres.2009.01.014. PMC 2744099. PMID 19428741.
  52. Georges-Courbot MC, Contamin H, Faure C, Loth P, Baize S, Leyssen P, et al. (May 2006). "Poly(I)-poly(C12U) but not ribavirin prevents death in a hamster model of Nipah virus infection". Antimicrobial Agents and Chemotherapy. 50 (5): 1768–72. doi:10.1128/AAC.50.5.1768-1772.2006. PMC 1472238. PMID 16641448.
  53. Freiberg AN, Worthy MN, Lee B, Holbrook MR (March 2010). "Combined chloroquine and ribavirin treatment does not prevent death in a hamster model of Nipah and Hendra virus infection". The Journal of General Virology. 91 (Pt 3): 765–72. doi:10.1099/vir.0.017269-0. PMC 2888097. PMID 19889926.
  54. Broder CC, Xu K, Nikolov DB, Zhu Z, Dimitrov DS, Middleton D, et al. (October 2013). "A treatment for and vaccine against the deadly Hendra and Nipah viruses". Antiviral Research. 100 (1): 8–13. doi:10.1016/j.antiviral.2013.06.012. PMC 4418552. PMID 23838047.
  55. Virus, retrieved 1 September 2019
  56. Virus Movie Review {3.5/5}: A well-crafted multi-starrer, fictional documentation on the Nipah virus attack, retrieved 1 September 2019
  57. "Nipah virus inspired "Contagion." We're testing a vaccine". www.path.org. Retrieved 17 May 2020.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.