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Nipah, a henipavirus carried by fruit bats in Southeast Asia and the Indian Subcontinent (see map above), was first identified in the late 1990s after a large outbreak in Malaysia spread first from bat(s) to pigs - and then from pigs to humans - eventually infecting at least 265 people, killing 105 (see Lessons from the Nipah virus outbreak in Malaysia).
Since then, Bangladesh has reported the most cases (see chart below), although India has - since 2018 - reported several large outbreaks.
Human-to-human transmission has been occasionally documented, as in India in 2018 (see Nipah Transmission In Kerala Outbreak) where we saw apparent robust household and nosocomial transmission of the virus.
While we've not seen truly large outbreaks, in July of 2018, in IJID: Enhancing Preparation For Large Nipah Outbreaks Beyond Bangladesh, we looked at an open-access article that appeared in the International Journal of Infectious Diseases, that discussed the potential of the Nipah virus producing a large urban epidemic, similar to what we saw in West Africa with Ebola in 2014.
Once again, Kerala is on alert after a 14-year-old boy was hospitalized with Acute Encephalitis Syndrome (AES), which was recently confirmed as resulting from Nipah infection. The MOH press release follows:
Ministry of Health and Family Welfare
Immediate public health measures have been advised by the Centre to contain the disease
A joint outbreak response Central team will be deployed to assist the State with case investigation, identification of epidemiological linkages, and technical support
Posted On: 21 JUL 2024 3:29PM by PIB Delhi
A case of Nipah virus has been detected in Mallapuram district of Kerala. A 14-year-old boy from Mallapuram exhibited AES symptoms and was admitted to a healthcare facility in Perinthalmanna before being transferred to a higher health center in Kozhikode. However, the patient later succumbed to the disease. The samples were sent to NIV, Pune which has confirmed a Nipah virus infection.
The Centre has advised the following immediate public health measures to be taken by the State government:
A multi- member joint outbreak response team from the National ‘One Health Mission’ of Union Health Ministry will be deployed to support the State in investigating the case, identifying epidemiological linkages, and providing technical assistance.
- Active case search in the family of the confirmed case, the neighborhood, and areas with similar topography.
- Active contact tracing (for any contacts) during past 12 days.
- Strict quarantine of the contacts of the case and isolation of any suspects.
- Collection and transportation of samples for lab testing.
Additionally, at the State's request, ICMR had sent monoclonal antibodies for patient management, and a mobile BSL-3 laboratory for testing additional samples from contacts has arrived in Kozhikode. The Monoclonal Antibodies had reached before the patient died but could not be used due to his poor general condition.
It is important to note that outbreaks of Nipah Virus Disease (NiVD) have been reported in Kerala in the past, with the most recent one occurring in 2023 in the Kozhikode district. Fruit bats are the usual reservoir of the virus, and humans can become infected by accidentally consuming bat-contaminated fruits.
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HFW/NipahVirusDetectedinKerala/21st July/1
Eighteen months ago, in EID Journal: Nipah Virus Exposure in Domestic and Peridomestic Animals Living in Human Outbreak Sites, Bangladesh, 2013–2015, we looked at a dispatch that described the detection of NiV antibodies in cattle, dogs, and cats in proximity to known outbreaks in humans
Whether Nipah has - or will ever accrue - the `right stuff' to pose a genuine pandemic threat is unknowable, but in 2019 the WHO published their List Of Blueprint Priority Diseases, detailing 8 disease threats in need of urgent accelerated research and development.
And Nipah, along with its Australian cousin Hendra, were among them.
While Nipah remains more of a regional concern than a global threat, each new human infection and every spillover event provides the virus with another opportunity to better adapt to a new host.