NIPAH VIRUS OUTBREAK IN KERALA - 10 DEATHS

WHAT YOU SHOULD KNOW:

HISTORY:

  1998-1999: Peninsular Malaysia Human febrile encephalitis, the high mortality-New virus discovered
  1999: Singapore Outbreak in abattoir workers through Pigs imported from Malaysia
  Since 2001 – Bangladesh, India

 RESERVOIR          

                                                             

     Flying foxes (fruit bats):
          Carry the virus and are not affected by the virus. This virus found in Urine, partially eaten fruit (saliva?)

          No known secondary host.

TRANSMISSION:

       
Pigs in Malaysia

•   Direct contact
•   Contact with body fluids
  
•    Aerosolization of respiratory or 
•    Urinary secretions
•    Vertical transmission across the placenta?
•    Semen and iatrogenic spread?

Person-to-person

• Not reported in Malaysia
• Likely in Bangladesh and India
• Nosocomial infections
• Touch and air bourne

Bat-to-person

• Not reported in Malaysia
• Common in Bangladesh and India
• Contaminated fruit, unpasteurized date palm juice 

Symptoms

• Incubation period: 4 to 20 days
• Fever and headache
• Encephalitis
• Dizziness, drowsiness, vomiting 
• Seizures
• Progresses to coma in 24-48 hours
• Respiratory difficulty
• Relapsing neurologic symptoms 

Complications (Malaysian outbreak)

• Septicemia (24%)
• GI bleeding (5%)
• Renal impairment (4%)

Asymptomatic

• Relapse or late-onset encephalitis
• Residual neurological deficits

Diagnosis:

• ELISA 
• Immunohistochemistry
• PCR
• Virus isolation

Prevention and Control:

• Keep fruit bats away from pigs
• Do not drink unpasteurized fruit juices
• Wash, peel, and/or cook all fruit thoroughly before eating

Treatment: 

• Supportive, ribavirin
• There is no specific medication or vaccine available.

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