# 5822
Like a great many other infectious disease geeks out there, I’ll be in line tomorrow night to watch Steven Soderbergh's new film `Contagion’.
If you’ve been living under a rock for the past few months, and aren’t aware of this movie, you can view the trailer on YouTube.
Instead of creating a 1918-style influenza, or `bird flu’ pandemic, the creators of this film have gone with a novel contagion based on Nipah – a particularly nasty virus carried by bats and first identified in Malaysia in the 1990s.
As we learn from Nature.com’s Spoonful of Medicine blog, the producers went to extremes to get the science right (see Hollywood goes viral with new Contagion movie).
They enlisted the scientific expertise of epidemiologist Ian Lipkin, director of Columbia University’s Center for Infection and Immunity in New York, who served as technical advisor for the film.
This month’s Nature Medicine Podcast features an interview with Dr. Lipkin about his role in this film’s creation. Listen at the link below:
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Cinematic science
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The Hollywood thriller Contagion strives for biomedical realism
Nipah is an interesting, and scientifically plausible choice for a pandemic virus, even though in its present incarnation it doesn’t have the ability to transmit well enough to spark a global outbreak.
A few choice mutations in the right places, however, and all that might change.
Nipah is a close cousin to the Hendra Virus, which has recently been in the news in Australia (see Australia: Dog Tests Positive For Hendra Virus).
Nipah was first identified in Malaysia in 1998, where it jumped to local swine herds from bats, and along with infecting hundreds of people, it caused the loss over 100 lives. The virus was then exported via live pigs to Singapore, where 11 more people died.
Over the past decade, Nipah has caused a number of small outbreaks across Southern Asia, although the most intense activity has been centered around Bangladesh.
Nipah/Hendra Virus & Fruit Bat Home Range – WHO
The World Health Organization maintains a Nipah Virus information page, which provides the following summary:
Nipah virus
Fact sheet N°262
Revised July 2009
KEY FACTS
- Nipah virus causes severe illness characterized by inflammation of the brain (encephalitis) or respiratory diseases.
- Nipah virus can be transmitted to humans from animals, and can also be transmitted directly from human-to-human; in Bangladesh, half of reported cases between 2001 and 2008 were due to human-to-human transmission.
- Nipah virus can cause severe disease in domestic animals such as pigs.
- There is no treatment or vaccine available for either people or animals.
- Fruit bats of the Pteropodidae family are the natural host of Nipah virus.
CIDRAP has a nicely done Overview of the Nipah Virus including the clinical symptom chart below:
Exactly how the Nipah virus is transmitted from human-to-human isn’t well understood, although it is thought to be mostly through direct contact with respiratory secretions or other bodily fluids.
Last February, in Bangladesh: Updating The Nipah Outbreak I wrote about a couple of EID Journal studies that looked at Nipah transmission between humans.
Like all viruses, Nipah has the potential to mutate and evolve - and over time - become better adapted to its hosts.
The scenario presented in Contagion, that a Nipah-like virus could one day mutate into a pandemic virus, isn’t new.
In October of 2008 (6 months before swine flu emerged) Lloyd's issued a pandemic impact report for the Insurance industry, which can be downloaded here that lists both Nipah and Hendra as pandemic risks.
The Lloyds report takes pains to point out that although the most likely scenario is seeing another influenza pandemic – because of its high infectivity and frequent mutations - there are other candidates out there that could spark a pandemic (or at least a serious localized epidemic).
They list:
- Hendra Virus
- Nipah Virus
- Cholera
- Small Pox
- HIV/AIDS
- Bubonic Plague
- Tuberculosis
- Lassa fever
- Rift Valley fever
- Marburg virus
- Ebola virus
- Bolivian hemorrhagic fever
- MRSA
- SARS
To this list, we can also add Pathogen X, the one we don't know about yet. After all, until it emerged in rural China in 2002, no one even knew SARS existed.
For more on other, non-influenza, pandemic threats you may wish to revisit some of these earlier blogs:
Bushmeat,`Wild Flavor’ & EIDs
The Pathogen That Lies Ahead
It Isn’t Just Swine Flu
Nathan Wolfe And The Doomsday Strain
Nathan Wolfe: Virus Hunter
I’ll post my thoughts on the movie later this weekend. I’m hopeful that it will not only be entertaining, but educational and eye-opening to the public as well.
