Nipah kerala
Health workers wearing protective gear shift people who have been in contact with a person infected with the Nipah virus to an isolation centre at a goverment hospital in Kozikode, in India's Kerala state on September 14, 2023. Image Credit: AFP

Schools, public offices, parks and beaches in the Kozhikode district of Kerala have been shut after two people died of Nipah, a virus from bats or pigs that causes deadly fever, officials said Thursday.

Three others have tested positive, and nearly 800 people including 153 health workers who came in contact with those infected are under observation, health officials said.

“We are in a stage of hypervigilance and detection,” Veena George, the state’s health minister said, adding that 77 people had been identified as being at high risk of infection.

The state is battling its fourth outbreak of Nipah virus since 2018. At least 17 people died after being infected by the virus in Kerala in the first outbreak.

We have some patients in isolation in private hospitals. Eleven have got mild symptoms, so their samples are also being taken and sent to the lab.

- Veena George, Health Minister

Experts have fanned out in Kerala to collect samples of fluid from bats and fruit trees.

“We are testing human beings ... and at the same time experts are collecting fluid samples from forested areas that could be the hotspot for the spread,” George said.

Samples of bat urine, animal droppings and half-eaten fruit were collected from Maruthonkara, the village where the first victim lived.

Nipah Kerala
Members of a medical team from Kozhikode Medical College carry areca nut and guava fruit samples to conduct tests for Nipah virus in Maruthonkara village in Kozhikode district, Kerala, India, September 13, 2023. Image Credit: Reuters

The virus has no vaccine and a fatality rate ranging from 40 to 75 percent, according to the World Health Organisation.

Symptoms include intense fever, vomiting and a respiratory infection, but severe cases can involve seizures and encephalitis, an inflammation of the brain, and result in a coma.

The neighbouring states of Karnataka and Tamil Nadu have ordered tests for visitors from Kerala, with plans to isolate any who show symptoms of influenza.

The Rajiv Gandhi Centre for Biotechnology (RGCB) in Kerala on Thursday rolled out a fully-equipped mobile virology testing laboratory, in a bid to contain the Nipah virus.

Here’s a closer look at the Nipah virus and why it can be deadly:

What is the Nipah virus?

The Nipah Virus (NiV) is a zoonotic virus that is spread from animals to humans. The virus is known to spread primarily through fruit bats. However, other animals such as pigs, horses, dogs, and goats can also be the carrying agents of the virus.

How does the virus spread?

This virus spreads from animals to humans or from human-to-human in multiple ways.

- Contact with bodily fluids of an infected animal or person

- Ingestion of foods that have come into contact with an infected animal or person

- People, usually caretakers, who have come into close contact with an infected person.

The virus is highly contagious and airborne, riding on cough droplets and saliva that is expelled when an infected person coughs or sneezes.

Nipah ward kozhikode kerala
Staff members install a sign reading "Nipah isolation ward, entry strictly prohibited" at a hospital where a ward is being prepared for suspected Nipah virus patients in Kozhikode district, Kerala, India, September 12, 2023. Image Credit: Reuters

Which areas are more prone to the virus?

Fruit bats are a species of bats that are largely exclusive to Southeast Asia. Due to this exclusivity, the Nipah virus is local to countries like India, Bangladesh, Malaysia, Singapore, and Philippines. There have been no records of cases outside of Southeastern Asia.

What makes the Nipah virus so dangerous?

There are many factors that make the Nipah virus lethal, primary among them being the lack of treatment.

The virus, as of date, has no known vaccination or medication that promises cure, making it difficult to restrict the rate of infection.

Another issue is the high mortality rate. The virus replicates within the body at an alarming rate, allowing the infection to spread rapidly and rendering it problematic to contain. According to WHO, out of 100 cases, death may occur in 40% to 75% of the cases.

There has been limited research on this particular virus, leaving it shrouded in medical mystery. As a consequence, the virus remains unpredictable in terms of severity of symptoms, pattern of infection, and prevention.

What are the identifying symptoms of the Nipah Virus?
The symptoms are quite akin to that of the Coronavirus (COVID-19) but, depending on the severity of the infection, can have potentially life-threatening impacts.
In light or mild cases of infection the symptoms may be as follows:-
- Respiratory difficulties
- Sore throat and/or cough
- Diarrhea
- Nausea and vomiting
- Weakness in the limbs and muscle pain
- Fever and headache
In severe cases the symptoms can become fatal, the worst-case scenario leading to acute encephalitis or brain infection. Other symptoms may also include slurred speech, seizures, and coma.
The incubation time is 4 to 14 days after contact with the virus, beginning with mild indications of coughs and headaches.

How is the virus diagnosed?

The Real-Time Polymerase Chain Reaction test (RT-PCR) is the only known way of diagnosing and confirming Nipah virus. In the case of severe contamination, blood tests can pinpoint the stage at which the infection is at.

What precautions can you take against the virus?

- Disinfect or wash your hands often

- Wash and disinfect all fruits before consuming

- Keep a safe distance from trees that host bats

- Avoid contact with pigs or pig farms. If it is necessary for you to be in contact with pigs, ensure that they are regularly and thoroughly washed.

- Avoid contact with people with the virus. In the case that you have to act as caretaker for an infected individual, ensure that you are equipped with the proper Personal Protective Equipment (PPE) kit.

What are some previous recorded cases of the Nipah virus?

The first discovery of the Nipah virus and its fatal impact on humans was made in Malaysia in 1999. The infections began in 1998 but healthcare providers misdiagnosed them as cases of Japanese encephalitis, causing widespread infection that resulted in 256 severe cases and claimed 105 lives.

Bangladesh recorded its first case of Nipah virus in 2001. The country has annual outbreaks of the virus during the palm sap harvesting season. The origin of the virus in Bangladesh, lies in drinking raw palm sap. While the numbers of diagnosed cases has remained in the single digits since 2001, February 2023 brought with it the largest outbreak. So far, 11 cases of the Nipah virus have been recorded.

Is the Nipah virus similar to COVID-19?

Although some traits and symptoms seem to match those of the coronavirus, the two viruses are quite different when it comes to risk. The mortality rate of COVID-19 is estimated to be less than that of the Nipah virus, which has a mortality rate of 40% to 75%.

While the Coronavirus outbreak has warranted extensive research into the development of efficient vaccines and method of treatment that has brought about major respite in the infection rates, the same cannot be said about the Nipah virus. There is no known treatment, vaccination or medication for this lethal virus, an absence that stems from scarce research.

What is the treatment for Nipah virus?
There is no treatment or cure for the virus. Management of symptoms include:
- Staying hydrated
- Sleeping and resting
- Taking monitored and prescribed doses of ibuprofen
- Taking prescribed doses of medication for nausea
- Using nasal congestion relief sprays, nebulisers, or inhalers to control or mitigate breathing difficulties as and when required.
- Isolating or quarantining oneself in order to reduce risk of aggravating the infection and containing the spread of infection.

Sources: WHO / Cleveland Clinic

- Sampurna Dutta is an intern at Gulf News / with inputs from agencies