Research: Monoclonal Antibodies Against Nipah

Geographic Range of Nipah, Hendra, and fruit bats of the Pteropodidae family – Credit WHO

 

 

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In 2011, in  NIH: Investigating A Potential Treatment For Hendra & Nipah Viruses we looked at research using the human monoclonal antibody (hmAb) m102.4 to protect African green monkeys (AGMs) against a Hendra Virus challenge. Twelve subjects were infused with a 100-mg dose of m102.4 beginning at either 10, 24, or 72 hours after infection and again about 48 hours later.

 

All twelve primates that received the antibodies survived, while all control subjects died by day 8.

 

The results were so promising, Australian health officials requested m102.4 for emergency use in a woman and her 12-year-old daughter who had been exposed to a horse with the Hendra virus in 2010. Both the woman and child survived and showed no side effects from the treatment (cite).

 

Similarly, in 2009, research published in PLoS Pathogens  illustrated its protective effect against Nipah in ferrets (see A Neutralizing Human Monoclonal Antibody Protects against Lethal Disease in a New Ferret Model of Acute Nipah Virus Infection).

 

Monoclonal antibodies would not work like a vaccine and confer long-term protection.  Instead, a single injection (or series of injections) is hoped to serve as a treatment, or to work as a temporary (several week) prophylaxis.

 

While the research above was promising, most of these studies involved starting treatment before, or just shortly after, infection, an unrealistic scenario for most therapeutic uses.  

 

Today, we’ve a new study – conducted by University of Texas Medical Branch at Galveston, the Uniformed Services University of the Health Sciences at Bethesda, MD and three NIH Labs (2 at Hamilton, MT & 1 Frederick, MD) -  that shows impressive results (on non-human primates, anyway), even when therapy is started 5 days post exposure.

 

 

Science Translational Medicine

INFECTIOUS DISEASE

Therapeutic Treatment of Nipah Virus Infection in Nonhuman Primates with a Neutralizing Human Monoclonal Antibody

Thomas W. Geisbert¹,²,*,†, Chad E. Mire¹,²,*, Joan B. Geisbert¹,², Yee-Peng Chan³, Krystle N. Agans¹,², Friederike Feldmann⁴, Karla A. Fenton¹,², Zhongyu Zhu⁵, Dimiter S. Dimitrov⁵, Dana P. Scott⁴, Katharine N. Bossart⁶, Heinz Feldmann⁷ and Christopher C. Broder³,†

Abstract

Nipah virus (NiV) is an emerging zoonotic paramyxovirus that causes severe and often fatal disease in pigs and humans.

There are currently no vaccines or treatments approved for human use. Studies in small-animal models of NiV infection suggest that antibody therapy may be a promising treatment. However, most studies have assessed treatment at times shortly after virus exposure before animals show signs of disease.

We assessed the efficacy of a fully human monoclonal antibody, m102.4, at several time points after virus exposure including at the onset of clinical illness in a uniformly lethal nonhuman primate model of NiV disease.

Sixteen African green monkeys (AGMs) were challenged intratracheally with a lethal dose of NiV, and 12 animals were infused twice with m102.4 (15 mg/kg) beginning at either 1, 3, or 5 days after virus challenge and again about 2 days later. The presence of viral RNA, infectious virus, and/or NiV-specific immune responses demonstrated that all subjects were infected after challenge.

All 12 AGMs that received m102.4 survived infection, whereas the untreated control subjects succumbed to disease between days 8 and 10 after infection. AGMs in the day 5 treatment group exhibited clinical signs of disease, but all animals recovered by day 16. These results represent the successful therapeutic in vivo efficacy by an investigational drug against NiV in a nonhuman primate and highlight the potential impact that a monoclonal antibody can have on a highly pathogenic zoonotic human disease.

Copyright © 2014, American Association for the Advancement of Science

 

Now that this hmAb has been shown effective against the Nipah virus in non-human primates, researchers hope they may have the basis for what will eventually become a viable treatment for these deadly viruses.  For a bit more background, the following is an excerpt from a press release from the University of Texas Medical Branch.

 

Researchers one step closer to countering deadly Nipah virus

June 25, 2014

Human antibody therapy successfully combats virus five days after infection

An interdisciplinary research team from the University of Texas Medical Branch at Galveston, the Uniformed Services University of the Health Sciences and three groups within the National Institutes of Health reports a new breakthrough in countering the deadly Nipah virus. The human monoclonal antibody known as m102.4 is the first effective antiviral treatment for Nipah that has the potential for human therapeutic applications.

Nipah and the closely related Hendra virus are highly infectious agents that emerged from Pteropid fruit bats in the 1990s, causing serious disease outbreaks in a variety of domestic animals and humans in Australia, Malaysia, Singapore, Bangladesh and India. Recent Nipah outbreaks have resulted in acute respiratory distress syndrome and encephalitis, person-to-person transmission and greater than 90 percent fatality rates among people. These properties make both Nipah and Hendra viruses a concern to human and livestock health.

(Continue . . . )

For some other blogs on the development, and testing of monoclonal antibodies, you may wish to revisit:

 

• In 2009 in Research: Monoclonal Antibodies Against Influenza researchers at the Dana-Farber Cancer Institute (Dana-Farber), Burnham Institute for Medical Research (Burnham) and the Centers for Disease Control and Prevention (CDC) announced the identification of human monoclonal antibodies (mAb) that work against a wide range of influenza viruses, including the H5N1 bird flu virus.
• And in 2010, in Monoclonal Antibodies Revisited, we looked a Korean company (Celltrion) working on Human Monoclonal Antibodies (moAb) that are designed to work against a wide variety of influenza viruses. 

 

Bangladesh: Nipah Update

WHO Nipah Virus (NiV) Infection GAR page

Photo by Chi Liu 

 

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For many infectious disease watchers, Nipah virus (NIV) holds a certain fascination. Identified only 14 years ago, this bat-borne virus produces deadly, albeit small, outbreaks of disease each year between December and May in Bangladesh.

 

The primary route of infection in Bangladesh is linked to the consumption of of raw (uncooked) date palm juice - which is `tapped’ from cuts in trees much in the same way as maple trees are for their syrup.

Date Palm Sap Collection – Credit FAO

 

But human-to-human transmission has been reported as well, along with infection from intermediate hosts.

 

In 1999, hundreds of abattoir workers in Malaysia and Singapore were infected from pigs carrying the virus (see MMWR Update: Outbreak of Nipah Virus -- Malaysia and Singapore, 1999) killing more than 100.

 

And once infected, humans can transmit the virus on to others, albeit not terribly efficiently (see EID Journal Person-to-Person Transmission of Nipah Virus in a Bangladeshi Community).

 

Nipah (and its Australian cousin Hendra, discovered in 1994) are sufficiently different from other members of the Paramyxoviridae family to have led to the creation of a new genus; Henipavirus.

 

This year, we’ve been following Nipah’s progress in Bangladesh (see here and here), and today their Institute of Epidemiology Diseases Control and Research (IEDCR) has a new update.

 

As you will see, victims are predominantly male, and the CFR (Case Fatality Ratio) is nearly 90%.

 

 

Nipah Infection in 2013

Update on 12 March, 2013

Situation Update:

12 March 2013:  19 Nipah cases were identified among them 17died  (mortality rate 89%);. These cases are from 13 districts (Gaibandha, Natore, Rajshahi, Naogaon, Rajbari, Pabna, Jhenaidah, Mymensingh, Nilphamari, Chittagong, Kurigram, Kustia). Age distribution of cases are 8 months to 55 years among them 13 are male and 6 are Female.

Nipah

Human Nipah virus (NiV) infection, an emerging zoonotic disease, was first recognized in a large outbreak of 276 reported cases in Malaysia and Singapore from September 1998 through May 1999.

Agent

NiV is a highly pathogenic paramyxovirus belonging to genus Henipavirus. It is an enveloped RNA virus.

Incubation period

The median incubation period of the secondary cases who had a single exposure to Nipah case was nine days (range 6–11 days) but exposure to onset of illness varies from 6-16 days. The median incubation period following single intake of raw date palm sap to onset of illness is 7 days (range: 2-12 days) in Bangladesh.

Transmission:

1. Drinking of raw date palm sap (kancha khejurer rosh) contaminated with NiV

1. Close physical contact with Nipah infected patients

Surveillance

Nipah surveillance began in 2006, Institute of Epidemiology, Disease Control and Research (IEDCR) in collaboration with ICDDR,B established Nipah surveillance in 10 District level Government hospitals of the country where Nipah outbreaks had been identified. Presently surveillance system is functioning in five hospitals of Nipah Belt.

 

While as many as half of all Nipah infections reported in Bangladesh appear to be secondary infections (due to close contact with someone already infected) the virus has not managed to spark an epidemic. 

 

The caveat being that viruses – particularly singled-stranded RNA viruses like Nipah (along with influenzas, hantaviruses, filoviruses, and others) -are known for their ability to mutate.

 

When Steven Soderbergh made his pandemic thriller `Contagion’ a couple of years ago, technical advisor Professor Ian Lipkin created fictional MEV-1 virus based on a mutated Nipah virus (see The Scientific Plausibility of `Contagion’).

 

While the Nipah virus continues to produce only small, limited outbreaks, we watch these developments closely each year for any signs of change.

Bangladesh: Updating The Nipah Outbreak

Date Palm Sap Collection – Credit FAO

 

 

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The history of emerging infectious diseases in recent decades has increasingly implicated bats as significant reservoirs of potentially dangerous zoonotic pathogens.

 

While long known for carrying the most dreaded of viruses – rabies – during the 1990s we learned that certain types of  bats were also natural hosts of  both Nipah and Hendra, henipaviruses in the family Paramyxoviridae.

 

In recent years Marburg virus has been isolated in Egyptian Fruit bats in Kenya, and antibodies to Ebola viruses have been found in bats in both Africa and Asia (see EID Journal: Ebola Virus Antibodies From Bats In Bangladesh.

 

In 2003 the SARS epidemic – caused by a novel coronavirus which was initially linked to Civits, but later linked to bats, emerged (see EID Journal  Review of Bats and SARS).

 

In 2012, for the first time a `bat influenza virus’ was discovered (see A New Flu Comes Up To Bat), and the newly detected novel coronavirus from the Middle East - EMC/2012 – has been tentatively linked to bats as well (see EID Journal: EMC/2012–related Coronaviruses in Bats).

 

Bats are abundant, geographically widespread, and able to move over long distances – and  according to the Bat Conservation Trust - there are more than 1,000 types of bats, which make up roughly 1/5th of all mammalian species.

 

All things considered, Chiroptology (the study of bats) among infectious disease investigators has never been more in vogue.

 

Since we’ve already seen one major epidemic spring from bats – bat coronaviruses are closely monitored - but the Nipah virus, which has demonstrated a limited ability to transmit from human-to-human, keeps a lot of researchers up at night as well.

 

Since it was first identified in Malaysia in 1998, most of the outbreaks have been centered around Bangladesh.

 

Epidemiological investigations have fingered the consumption of raw (uncooked) date palm juice - which is `tapped’ from cuts in trees much in the same way as maple trees are for their syrup – as the virus’s primary route into the human population.

 

Fruit bats of the Pteropodidae family are the reservoir host for the virus, and usually carry it asymptomatically. Roosting in trees rather than caves, they can easily contaminate the date juice collection jars with their virus laden urine and feces.

 

From there the virus can jump into unwary imbibers of the beverage. But it isn’t necessarily a dead end infection for Nipah, as humans can spread the virus amongst themselves as well (see EID Journal Person-to-Person Transmission of Nipah Virus in a Bangladeshi Community).

 

Collection of date palm juice is a seasonal activity (December - May) in Bangladesh, so that time period also defines their Nipah season as well.

 

Last Sunday, in Bangladesh: Nipah Returns, we looked at a fresh outbreak that had infected 8, and killed 6 in recent weeks. 

 

Today, an update from Bangladesh’s Institute of Epidemiology Diseases Control and Research (IEDCR) which raises the total number of infections (as of Jan 30th) to 11, with 8 deaths.

 

Update on 30 January, 2013

Situation Update:

30^th January 2013:  11 Nipah cases were identified among them 8 died  (mortality rate 73%); 3 cases are still under treatment. These cases are from 8 districts (Gaibandha, Natore, Rajshahi, Naogaon, Rajbari, Pabna, Jhenaidah, Mymensingh). Age distribution of cases are 8 months to 43 years among them 8 are male.

 

Till January 30, 2013, a total of 176 human cases of Nipah infection in Bangladesh were recognized from outbreak among them 136 (77%) died.

Nipah

Human Nipah virus (NiV) infection, an emerging zoonotic disease, was first recognized in a large outbreak of 276 reported cases in Malaysia and Singapore from September 1998 through May 1999.

Agent

NiV is a highly pathogenic paramyxovirus belonging

to genus Henipavirus. It is an enveloped RNA virus.

Incubation period

The median incubation period of the secondary cases who had a single exposure to Nipah case was nine days (range 6–11 days) but exposure to onset of illness varies from 6-16 days. The median incubation period following single intake of raw date palm sap to onset of illness is 7 days (range: 2-12 days) in Bangladesh.

Transmission:

1. Drinking of raw date palm sap (kancha khejurer rosh) contaminated with NiV

1. Close physical contact with Nipah infected patients

Surveillance

Nipah surveillance began in 2006, Institute of Epidemiology, Disease Control and Research (IEDCR) in collaboration with ICDDR,B established Nipah surveillance in 10 District level Government hospitals of the country where Nipah outbreaks had been identified. Presently surveillance system is functioning in five hospitals of Nipah Belt.

 

 

So far, while roughly half of all Nipah infections in Bangladesh appear to be secondary infections (due to close contact with someone already infected) the virus has not managed to spark an epidemic. 

 

But viruses – particularly singled-stranded RNA viruses like Nipah (along with influenzas, hantaviruses, filoviruses, and others) can mutate at exceptionally high rates, and so what we can say is true about them today may not hold true tomorrow.

 

For more on  bats, and bat-hosted viruses, you may wish to revisit:

 

Disease Transmission At The Human-Animal Interface

Coronavirus `Closely Related’ To HK Bat Strains

Virology Journal: Ebola Virus In Chinese Bats

Bangladesh: Updating Nipah & The CDC Director’s Visit

Credit – The CDC’s GDDER

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I wrote at length yesterday on the Nipah virus, and the current outbreak in Bangladesh (see Bangladesh: Nipah Returns, so I’ll not bother repeating those points this morning. 

 

What is new this morning is a report from Xinhua News indicating that three more Nipah cases (two fatal) have been reported in Bangladesh, and the arrival on Saturday of U.S. CDC Director Thomas Frieden in Dhaka to discuss their plans to assist that nation in strengthening disease surveillance.

 

First the report from Xinhua on the latest Nipah cases.

 

Virus Nipah strikes back in Bangladesh, claims 8 more lives within one week

2013-01-28 10:00:41 GMT2013-01-28 18:00:41(Beijing Time) by Naim-Ul-Karim

 

DHAKA, Jan. 28 (Xinhua) -- Bangladesh on Monday reported eight more deaths from infection with the deadly Nipah virus within one week as the bat-borne disease has struck early and hard.

 

The country's Institute of Epidemiology, Disease Control & Research (IEDCR) confirmed two more deaths Sunday from the Nipah infection, tallying the toll at eight from Jan. 22.

 

"Outbreak of the deadly Nipah virus has claimed eight lives since January 22," Mahmudur Raman, head of the IEDCR, told Xinhua Monday.

 

"As of today, there are 11 cases from eight Bangladesh districts including Dhaka and eight of them died," he said, adding "Three Nipah-infected patients remain critically ill."

(Continue . . .)

 

The Institute of Epidemiology, Disease Control and Research (IEDCR) in Bangladesh has far more to deal with than just the Nipah virus. The 150+ million inhabitants of Bangladesh are also subject to H5N1 bird flu, Dengue, Anthrax, and Chikungunya, along with many other diseases.

 

The United States has been providing ongoing technical, financial, and logistical support to Bangladesh for several years to assist them in upgrading their disease detection and surveillance systems.  Hence the visit this past weekend by the CDC’s Director.

The news site BDNews24 has details of Director Frieden’s 2-day visit.  Follow the link to read:

 

 

Bangladesh to be 'Global Disease Detection site'

Senior Correspondent,  bdnews24.com

Published: 2013-01-27 14:56:52.0 Updated: 2013-01-27 18:24:00.0

The US Centres for Disease Control and Prevention (CDC) is strengthening its ties with Bangladesh as part of its initiative to protect the global community from the urgent public health threats.

(Continue . . . )

 

 

Improving disease surveillance, detection, and prevention in those regions where emerging diseases are most apt to occur is not only the humanitarian thing to do, it also helps to keep the world from being blind-sided by emerging infectious disease threats.

 

We’ve far too many `blind spots’ around the world where a novel virus could emerge, and take hold in the population, before it could be identified and (hopefully) contained.

 

To counter that threat, the CDC has developed a Global Disease Detection and Response division (GDDER).

 

 

Global Health - Global Disease Detection and Emergency Response

The Division of Global Disease Detection and Emergency Response (GDDER) protects Americans and the global community from urgent public health threats and provides public health relief for humanitarian emergencies. Activities include:

• Detecting and containing emerging health threats
• Deploying CDC experts 24 hours a day, 7 days a week at host country requests for technical assistance and other support
• Building capacity by providing technical assistance in support of International Health Regulations (IHR)
• Promoting policies for public health and bio-security
• Improving the health of populations affected by complex humanitarian emergencies.

 

According to the GDDER website, nations are selected by the following criteria:

 

• Public health significance: The country has a high population density or history of infectious diseases or expected potential for emerging diseases;
• Country commitment: The country supports and values partnership with CDC and will actively engage in collaborative activities and identify new partners;
• Established CDC presence: The country has an established, effective working relationship with CDC and supports CDC staff in-country;
• Established regional reach: The country has the infrastructure and regional stature to serve as regional resource, or is already acting as a regional leader in other arenas;
• International partner presence: The country has other U.S. Government agencies and international partners operating in-country.

The GDDER is a program that will hopefully not only help alert us of an emerging infectious disease threat, but that may also provide a chance to stop it in its tracks before it can spread.

While there are no guarantees of success, this is a public health advantage that previous generations could only have dreamed of.

Queensland: A Hendra Watch & A New Vaccine

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

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Although long known to carry rabies, over the past two decades bats have increasingly been linked to emerging infectious diseases.

 

The SARS-CoV (coronavirus) outbreak of 2002-2003 – which infected roughly 8,000 people and killed nearly 800 – is undoubtedly the best known of these diseases, but is by no means the only one to emerge.

 

Genetic analysis of two recent novel coronavirus infections in the Middle East suggest (but fall short of proving) that bats may be the primary host for this virus as well (see Coronavirus `Closely Related’ To HK Bat Strains).

 

And the natural reservoir for the Ebola viruses (including Marburg) are believed to be fruit bats of the Pteropodidae family.

 

Prior to the SARS outbreak - during the 1990s – two new bat-borne viruses made headlines; Nipah and Hendra, both henipaviruses of the family Paramyxoviridae.

 

Of the two, Nipah has been the deadliest, causing outbreaks primarily in India and Bangladesh. But the virus was first discovered in April of 1999 when an outbreak occurred at a pig farm in Malaysia. 

 

During this initial outbreak, the virus jumped to local swine herds from bats, and infected more than 250 people, killing more than 100. The virus was then exported via live pigs to Singapore, where 11 more people died (see MMWR Update: Outbreak of Nipah Virus -- Malaysia and Singapore, 1999)

 

Over the past decade, Nipah has sparked a hand full of smaller outbreaks across Southern Asia with the greatest activity centered around Northern India and Bangladesh. Fruit bats (Pteropodidae) are considered the natural host of Nipah virus.

 

Perhaps most concerning has been evidence of limited nosocomial, or human-to-human transmission, of the Nipah virus (see Bangladesh: Updating The Nipah Outbreak).

 

The Nipah virus, like it’s close cousin the Hendra virus, is classified as a biosecurity level 4 (BSL-4) agent.

 

While not associated with as many human fatalities, the Hendra virus was first identified after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia in 1994. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak was later identified as having taken place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis. He recovered, but developed neurological symptoms and died 14 months later.

 

Over the past 18 years 40 outbreaks of Hendra virus – all involving horses – have been reported in Australia. Four human fatalities have been linked to the virus as well.

 

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

Unlike Nipah, to date no human-to-human transmission of Hendra has been documented.

All of which brings us to the latest outbreak news, and hope for a new vaccine for horses that just became available. First stop, an update from the QLD Department of Agriculture, Fisheries, and Forestry.

 

November 2012

---

Hendra virus communique no.10-5 November 2012

Hendra virus incident Ingham

Biosecurity Queensland is managing a Hendra virus incident in Ingham after a positive test result was received on Friday 2 November 2012.

 

A mare was first noticed unwell on Wednesday 31 October 2012 by her owner. She was not interested in food, had a slight nasal discharge, rapid, laboured breathing, elevated heart rate, lowered head and was unsteady on her feet.

 

A private veterinarian visited the horse and collected samples for Hendra virus testing. The horse deteriorated and went down and was euthanased on Thursday 1 November 2012.

Movement restrictions

Biosecurity Queensland has quarantined the property and undertaken tracing and risk assessments to determine susceptible animals that may have had exposure to the virus.

 

There are eight horses remaining on the property as well as dogs and cats. Several rounds of testing will be conducted on animals assessed to be at risk of being exposed to Hendra virus before the quarantine can be lifted.

 

Restrictions will apply to moving horses and horse materials on and off the infected property, and the property will be quarantined for at least one month. There are no other movement restrictions for the general Queensland horse population because of Hendra virus.

Hendra virus vaccine

A commercial pharmaceutical company has released a Hendra virus vaccine for use in horses under a Minor Use Permit. Under permit conditions, only accredited veterinarians can administer the vaccine.

 

The vaccine provides another option for the horse industry to reduce the risk of Hendra virus infection; however it is important to remember no vaccine is 100% effective and people in contact with horses need to continue to practice good biosecurity and hygiene measures even if horses are vaccinated.

 

Horse owners should discuss with their veterinarian whether vaccinating their horse is appropriate.

 

From CSIRO (Commonwealth Scientific and Industrial Research Organisation) we get more details on this newly available vaccine, via a 9 minute audio podcast & transcript.

 

Vaccine for killer Hendra virus launched

Australian horse owners and the equine industry have received an important boost in their fight against the deadly Hendra virus with the introduction of Equivac® HeV vaccine. (9:02)

• 1 November 2012

 

 

A final note, in the QLD notice above, it mentions that dogs and cats are quarantined, as well as horses. This comes about primarily because in 2011, we saw the first evidence of canine infection with the virus (see Australia: Dog Tests Positive For Hendra Virus).

 

The Queensland DAFF maintains a FAQ file on Hendra and dogs, where they write:

 

What animals have been shown to get Hendra virus?

Naturally occurring infection is limited to horses, flying foxes, humans and dogs. In animals, naturally occurring clinical disease is limited to horses.

 

Hendra virus is present in wild flying fox populations but does not appear to cause disease in them.

Laboratory studies have shown that other species including cats, guinea pigs, ferrets and pigs can develop disease when inoculated with Hendra virus in an experimental setting. Other species, including rabbits and dogs, have developed antibodies to Hendra virus in an experimental setting, but did not develop any signs of illness.

 

Although transmission from animals other than horses to humans has not been demonstrated, it is always a concern whenever a virus adapts to or jumps to a new host.

 

It not only gives the pathogen fresh opportunities to mutate and evolve, it provides another potential vector to spread the disease.

 

And when that host is a dog or a cat – animals with whom humans closely interact – it naturally serves to increases those concerns.

Virology Journal: Ebola Virus In Chinese Bats

Common pipistrelle (Pipistrellus pipistrellus) – Credit Wikipedia

 

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We are ten months into 2012, and so far it has been a pretty good year for Chiroptologists (scientists that study bats). 

 

While bats are often associated with diseases like rabies and histoplasmosis, over the past year we’ve seen bats linked to at least five exotic disease outbreaks around the globe and one rather unexpected discovery. 

 

In January we watched as Nipah Claimed 5 Lives in Bangladesh. Nipah, and its close cousin Hendra from Australia, are bat borne viruses that occasionally jump to humans (or other mammals) and can spark outbreaks.

 

Nipah, you may recall, was used as the basis for the fictional MEV-1 virus in the movie Contagion last year (see The Scientific Plausibility of `Contagion’).

 

 

Although no human cases are involved, last February the CDC announced the unusual discovery of a novel flu strain in little yellow-shouldered bats (Sturnira lilium) captured at two locations in Guatemala.(see A New Flu Comes Up To Bat).

While common in waterfowl, this was the first time that influenza had been detected in bats.

 

In July we saw an outbreak of Ebola Sudan in western Uganda (see Uganda: Ebola Sudan And A Timely Dispatch From The EID Journal), followed in August by an outbreak of Ebola-Bundibugyo in the Democratic Republic of the Congo (see WHO: DRC Ebola Update).

 

The natural reservoir for Ebola viruses are believed to be fruit bats of the Pteropodidae family, although the virus in humans is usually linked to the consumption of infected bushmeat (considered an intermediate host).  

 

In early September, we learned of the discovery of two cases of a novel coronavirus out of the Middle East, and once again a bat host is considered likely (see Coronavirus `Closely Related’ To HK Bat Strains).

 

And only last week, news emerged of a Marburg Virus outbreak in Uganda, which is still ongoing (WHO Update on Marburg Virus In Uganda). 

 

A close cousin to Ebola, Marburg is also believed carried by fruit bats of the Pteropodidae family, which can pass the virus on to other intermediate hosts, or directly to humans.

 

There are currently five known strains of the Ebola virus - Ebola-Zaire, Ebola-Sudan, Ebola-Reston, Ebola-Ivory Coast and Ebola-Bundibugyo – which along with the Marburg virus make up the family Filoviridae.

 

Of these, only Ebola-Reston – found in the Philippines – does not cause illness in humans. It is pathogenic in non-human primates, and has been found to infect pigs, which gives scientists some cause for concern.

 

Ebola Reston is also the only ebolavirus known to circulate outside of Africa.

 

That is . . . until now.

 

We’ve a new open access study, published this month in the Virology Journal, that has found evidence suggesting that Ebola viruses are circulating in Chinese bats, although the exact strain involved isn’t clear.

 

 

Serological evidence of ebolavirus infection in bats, China

Junfa Yuan, Yuji Zhang, Jialu Li, Yunzhi Zhang, Lin-Fa Wang and Zhengli Shi

Background

The genus Ebolavirus of the family Filoviridae currently consists of five species. All species, with the exception of Reston ebolavirus, have been found in Africa and caused severe human diseases. Bats have been implicated as reservoirs for ebolavirus. Reston ebolavirus, discovered in the Philippines, is the only ebolavirus species identified in Asia to date. Whether this virus is prevalent in China is unknown.

Findings

In this study, we developed an enzyme linked immunosorbent assay (ELISA) for ebolavirus using the recombinant nucleocapsid protein and performed sero-surveillance for the virus among Chinese bat populations. Our results revealed the presence of antibodies to ebolavirus in 32 of 843 bat sera samples and 10 of 16 were further confirmed by western blot analysis.

Conclusion

To our knowledge, this is the first report of any filovirus infection in China.

 

While researchers were able to detect cross-reactive antibodies to two types of Ebola viruses (Zaire and Reston), identification of the exact EBOV strain in China was not possible.  The author’s write:

 

The unsuccessful identification of ebolavirus-related genes in the samples is likely attributable to the often low-level of virus replication, the similarly transient nature of the infection in bats or the sequence mismatch of the PCR primers used and the target sequence of the potential unknown ebolavirus genomes.

 

 

Until the late 1990s, little thought was given to bats as reservoirs of epidemic diseases. Outbreaks of Nipah in Malaysia in 1998 - which lead to  265 cases of acute encephalitis and more than 100 deaths (cite) – put bats suddenly under the spotlight. 

 

Four years later - after the SARS outbreak in China - the SARS coronavirus was detected in horseshoe bats in China (cite), solidifying bats as important reservoirs of emerging infectious diseases. 

 

Since then scientists have discovered an increasing array of viral diseases that are carried by bats, although in many cases in isn’t clear how big a threat they actually pose to humans.

 

None of this is meant to demonize bats, as we are surrounded by a great many different hosts of zoonotic diseases.

 

Still, the CDC offers some sage advice when it comes to avoid coming in contact with bats.

 

 Take Caution When Bats Are Near

Bats play an important role in our ecosystem. However, they are also associated with diseases deadly to humans. Learn how you can stay safe when bats are near.

Bangladesh: Nipah Claims 5 Lives

 

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

 

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Last summer the movie `Contagion’ showed the world how a bat virus might mutate, evolve, and eventually move into the human population. While the movie used a fictionalized MEV-1 virus, it was based on the all-too-real Nipah Virus, which first came to prominence in the 1990s after a deadly outbreak in Malaysia in 1998.

 

While human infections with Nipah (or its Australian cousin Hendra) have been relatively uncommon, when they have occurred they have proven particularly lethal, with fatality rates pushing 60%.

 

During the Malaysian outbreak in 1998, the virus jumped to local swine herds from bats, and along with infecting hundreds of people 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 sparked a number of small outbreaks across Southern Asia, although the most intense activity has been centered around Bangladesh.

 

Over the past 48 hours we’ve seen some reports coming out of Bangladesh indicating that several people have been infected with the Nipah virus. Nipah reports out of this region typically come between December and May.

 

Today, the IEDCR issued the following statement, indicating there have been 5 fatalities thus far.

 

Nipah Outbreak at Joypurhat in January 2012

From 20 January 2012, two clusters of Nipah were identified in the Joypurhat Municipality area and Khetlal upazila of Joypurhat district. A joint team of IEDCR and ICDDR,B are working in the field now.

 

Till date (23 rd January 2012), the team identified 3 cases from the municipal area and 2 cases from Khetlal. All 5 cases have died. Laboratory tests for Nipah were done in IEDCR. All four samples collected from suspected cases were positive for Nipah.

 

 

Map Credit- Wikipedia

 

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.

 

For now - while Human-to-human transmission has been documented - only limited outbreaks have been reported.

 

Last February, in Bangladesh: Updating The Nipah Outbreak I wrote about a couple of EID Journal  studies that looked at Nipah transmission between humans.

 

The World Health Organization has this to say about the human-to-human transmission of the Nipah Virus.

 

Transmission

During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.

 

In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.

 

During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.

Reducing the risk of infection in people

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

 

Public health educational messages should focus on the following.

• Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.
• Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
• Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.

 

While the Nipah Virus may not pose anywhere near as great of a threat to the world as a pandemic influenza, it does point out the need for increased surveillance and improved public health programs around the world.

NIH: Investigating A Potential Treatment For Hendra & Nipah Viruses

 

 

# 5911

 

 

The movie `Contagion’ showed the world how a bat virus could mutate, evolve, and move into the human population. While the movie used a fictionalized MEV-1 virus, bats in some parts of the world are known to carry deadly pathogens, such as the Nipah and Hendra viruses.

 

While human infections with these two viruses have been relatively uncommon, when they have occurred they have proven particularly lethal, with fatality rates exceeding 60%.

 

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.

 

The Hendra virus was first isolated in 1994 after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak took place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis.

 

He recovered, but developed neurological symptoms and died 14 months later.

 

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

 

Although very similar, unlike Hendra, the Nipah virus has been shown to be transmissible from human-to-human. Like all viruses, both have the potential to mutate and evolve - and over time - become better adapted to their hosts.

 

According to the World Health Organization there are currently no effective treatments for either of these diseases (see here and here), but according to a new study just published in the journal Science Translational Medicine, there is hope that may change.

 

The study is called:

 

Sci Transl Med 19 October 2011:
Vol. 3, Issue 105, p. 105ra103
Sci. Transl. Med. DOI:

10.1126/scitranslmed.3002901

A Neutralizing Human Monoclonal Antibody Protects African Green Monkeys from Hendra Virus Challenge

Katharine N. Bossart, Thomas W. Geisbert, Heinz Feldmann, Zhongyu Zhu, Friederike Feldmann, Joan B. Geisbert, Lianying Yan, Yan-Ru Feng, Doug Brining, Dana Scott, Yanping Wang, Antony S. Dimitrov, Julie Callison, Yee-Peng Chan, Andrew C. Hickey, Dimiter S. Dimitrov, Christopher C. Broder,† and Barry Rockx

 

The NIH – which supported this research – issued a press release yesterday afternoon describing this study:

 

Embargoed for Release
Wednesday, October 19, 2011
2 p.m. EDT

Antibody treatment protects monkeys from Hendra virus disease

NIH-supported group exploring whether protection extends to Nipah virus disease

A human antibody given to monkeys infected with the deadly Hendra virus completely protected them from disease, according to a study published by National Institutes of Health (NIH) scientists and their collaborators. Hendra and the closely related Nipah virus, both rare viruses that are part of the NIH biodefense research program, target the lungs and brain and have human case fatality rates of 60 percent and more than 75 percent, respectively. These diseases in monkeys mirror what happens in humans, and the study results are cause for hope that the antibody, named m102.4, ultimately may be developed into a possible treatment for people who become infected with these viruses.

 

In May 2010, shortly after the NIH study in monkeys successfully concluded, Australian health officials requested m102.4 for emergency use in a woman and her 12-year-old daughter. They had been exposed to Hendra virus from an ill horse that ultimately was euthanized. Both the woman and child survived and showed no side effects from the treatment.

(Continue . . . )

 

 

The human monoclonal antibody (hmAb) m102.4 has been the object of Hendra-Nipah research for a number of years. In 2009 research published in PLoS Pathogens  illustrated its protective effect against Nipah in ferrets.

 

A Neutralizing Human Monoclonal Antibody Protects against Lethal Disease in a New Ferret Model of Acute Nipah Virus Infection

 

 

Now that this hmAb has been shown effective against the Hendra virus in primates, researchers hope they may have the basis for what will eventually become a viable treatment for these deadly viruses.

 

For more on human monoclonal antibodies, and their potential to treat influenza, you may wish to revisit a couple of blogs I wrote in 2009 and 2010:

 

Research: Monoclonal Antibodies Against Influenza

Monoclonal Antibodies Revisited

The Scientific Plausibility of `Contagion’

 

 

 

# 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:

 

• Cinematic science

• 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.

Australia: Dog Tests Positive For Hendra Virus

 

 

 

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

 

 

 

# 5716

 

 

Over the past month more than a dozen horses in and around Queensland Australia have died from the Hendra Virus – a pathogen normally carried by flying foxes (bats), but that can be transmitted to horses and, on rare occasions, to humans as well.

 

The virus was first isolated in 1994 after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak took place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis. 

 

He recovered, but developed neurological symptoms and died 14 months later.

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

In 1999, a very similar virus emerged at a Malaysian pig farm, resulting in 105 human deaths and the culling of one million pigs.  Exported pigs caused another outbreak at an abattoir in Singapore, resulting in 11 infections and 1 additional death.

This virus was designated Nipah, named after the place where it was first isolated in humans. It too, is believed to be carried by the fruit bat.

 

 

Since then, there have been scattered outbreaks of both viruses in Australia (Hendra virus) and in Bangladesh and adjacent parts of India (Nipah).  Of the two, the Nipah virus has infected and killed the most humans.

 

For more background on these two rare viruses, the CDC’s Special Pathogens Branch maintains a fact sheet:

 

Hendra Virus Disease and Nipah Virus Encephalitis

 

The World Health Organization maintains a website on the Hendra Virus (Hendra Virus (HeV) Infection) and Nipah Virus (Nipah Virus (NiV) Infection) on their Global Alert And Response (GAR) site.

 

Today, we’ve news of an unusual discovery out of Australia.  

 

A dog on one of the quarantined ranches in Queensland has tested positive for antibodies to the Hendra Virus.  Although the dog appears healthy, this indicates a previous exposure to the virus.

 

And this marks the first known infection of a dog by the virus in the wild.

 

The following notice appears on the Queensland Government Primary Industry & Fisheries website:

 

Current situation as at 26 July 2011

The Australian Animal Health Laboratory (AAHL) in Geelong has confirmed that a dog has tested positive for Hendra virus.

 

This is an unprecedented situation, and the first time outside a laboratory that an animal other than a flying fox or horse, or a human has been confirmed with Hendra virus infection.

 

Biosecurity Queensland´s policy is to test cats and dogs on properties where there are infected horses.

 

The remaining horses and dogs on this property are still being monitored daily and show no signs of illness.

 

We recommend that people keep dogs and cats away from sick horses to reduce the risk of such an infection happening.

 

 

While it is too soon to gauge the impact of this particular discovery, anytime a virus jumps species we tend to pay close attention.

 

Many of the common illnesses we think of as `human’ diseases actually began in other species, and only later migrated to humans.

 

Tuberculosis probably jumped to humans when man began to domesticate goats and cattle. Measles appears to have evolved from canine distemper and/or the Rinderpest virus of cattle.   And Influenza, as most of you know, is native to aquatic birds.

 

The list of zoonotic diseases (those shared between humans and animals) is long and continually expanding, and includes: SARS, Babesiosis, Borrelia (Lyme), Nipah, Hendra, Malaria, Hantavirus, Ebola, Bartonella, Leptospirosis, Q-Fever, bird flu and many, many others.

 

When a virus adapts to a new host, it not only gives it fresh opportunities to mutate and evolve, it provides another potential vector to spread the pathogen.

 

And when that host is a dog or a cat – animals with whom humans closely interact – the risks of spreading to humans are even greater.

 

As the following article from the Sydney Morning Herald tells us, in light of this latest discovery scientists are now tasked with determining what – if any – changes may have occurred in the Hendra virus.

 

 

Scientists guessing over Hendra dog

Kym Agius, Jessica Marszalek and Petrina Berry

July 26, 2011 - 5:49PM

AAP

The first dog to contract the Hendra virus has scientists guessing whether the virus is being transmitted differently or if humans can now catch the disease from canines.

(Continue . . . )

 

 

For now, there are far more questions than answers.

 

 

 

Bangladesh: Mystery Fever Identified As Nipah

 

 

Note:  I’ll be away from my desk for much of the next two days, although I’ll endeavor to check in when I can.

To stay current on the latest infectious disease news, visit Crofsblog, Chen Qi, Arkanoid Legent, and A Time’s Memory along with the other bloggers, flu forums, and resources in my sidebar. 

 

# 5288

 

 

Over the past two days reports of a `mystery fever’ that has claimed as many as 19 lives in Bangladesh's Hatibandha sub-district of Lalmonirhat district have been coming across the news wires.

Initially, some type of encephalitis was suspected, but now authorities reportedly believe they’ve identified the Nipah virus as the culprit.

 

Nipah virus electron micrograph  Image courtesy of C.S. Goldsmith and P.E. Rollin (CDC), and K.B. Chua (Malaysia). (From CDC  Nipah Fact Sheet).

 

You can follow the progression of this story on FluTrackers over the past couple of days in this thread.

 

This morning Shiloh has this report from bdnews24.com.

 

 

BREAKING NEWS

Killer virus identified as Nipah

Fri, Feb 4th, 2011 5:33 pm BdST

Dhaka, Feb 4 (bdnews24.com) — The virus that has taken 14 lives in Hatibandha of Lalmonirhaat has been identified as the Nipah virus.

 

Locals claim the death toll was 19.

 

Institute of Epidemiology Diseases Control and Research (IEDCR) director Mahmudur Rahman told reporters on Friday afternoon that tests had confirmed the virus was Nipah.

 

IEDCR advised against drinking raw date juice to avoid infection.

  

Unknown until 1998, Nipah appears to be carried by certain species of fruit bats that are distributed across portions of of Australia, Indonesia, Malaysia, and the Philippines islands.  While the bats are the natural host for this virus (along with another variant called the Hendra Virus), they are unaffected by it.

 

The bats are believed to transmit the virus, via their saliva or other fluids, to pigs (Nipah) or horses (Hendra).  From there, the virus has found its way into the human population.

 

The Nipah virus was first detected in Malaysia in 1998, where it infected 250 people and claimed 100 lives.   The most common vector appeared to be from pigs to humans.  Over 1 million pigs were culled in Malaysia to control that outbreak.

 

The World Health Organization has this to say about the human-to-human transmission of the Nipah Virus.

 

Transmission

During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.

 

In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.

 

During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.

 

Reducing the risk of infection in people

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

 

Public health educational messages should focus on the following.

• Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.
• Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
• Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.

 

 

While the Nipah Virus may not pose anywhere near as great of a threat to the world as a pandemic influenza, it does point out the need for increased surveillance and improved public health programs around the world.

 

We ignore these emerging diseases, at our peril.  For once they establish themselves, they can quickly spread out of control.

 

And the next zoonotic disease to emerge may be a lot harder to deal with than the Nipah virus.