Medical staff wearing protective suits check patients at the Medical College hospital in Kozhikode. Image Credit: PTI

Two people suspected to be infected with the brain-damaging Nipah virus are under treatment in India's Karnataka state, a health official said on Wednesday, after an outbreak of the rare virus in neighbouring Kerala state killed 10.

Symptoms of the virus were seen in a 20-year old woman and a 75-year-old man in Karnataka's port city of Mangalore after they travelled to Kerala and came into contact with infected patients there, Rajesh B.V., a district surveillance officer said by phone.

"They are not confirmed Nipah cases yet, so there is no need to panic ... the situation is under control," he said, adding that blood samples of the two people have been sent to Manipal Centre for Virus Research and results are awaited by Thursday. The Kerala government on Tuesday confirmed that a dozen people in the state had contracted the dreaded Nipah virus, and that 10 of them were dead.

The deceased include two siblings in Malappuram district, Mohammad Sadiq and Mohammad Salih, both in their twenties, and a nurse identified as Lini Sajeesh, who contracted the disease by her proximity to patients as part of her duties.

Where and how did it all start?

The outbreak started in the Malapurram district with three people being infected. The patients were a father and his two sons, Mohammad Sadiq and Mohammad Salih, who were in their twenties.

Dr Bijayraj R., Consultant-Family Medicine, Aster MIMS Calicut spoke to Gulf News about the incident. “Yes, there could be a specific reason for this outbreak. The first three people who got infected, they bought a plot in an area near their house. This plot had an old well, which all three of them helped in cleaning. This well was infested with bats”, he said. Officials have collected bats from this particular well, and are testing them for the presence of the virus.

The siblings passed away earlier this week while the father is reportedly still in treatment. The Kerala government on Tuesday confirmed that a dozen people in the state had contracted the dreaded Nipah virus, and that 10 of them were dead.

“If the bats’ body fluids show the presence of the virus, it can be confirmed that there is a link between the outbreak and the cleaning of the well by these three people”, Dr Bijayraj said. He also answered some questions about the condition, the mode of infection and treatment options all of which can be found below.

While answering our questions, Dr Bijayraj maintained that people needed to “be aware, but not panic”, just as the ministry announced on Tuesday that that the situation was under control.

What is the Nipah virus?

A type of Henipavirus, Nipah virus (NiV) is from a category of RNA (ribonucleic acid) viruses naturally carried by pteropid fruit bats or flying foxes, and microbats of several species.

What happens when the Nipah virus affects humans?

Once the virus affects a human, there is an incubation period as the virus spreads which could range from four to 14 days. While this could be asymptomatic, people usually show symptoms of mild fever, muscle pain, cough and fatigue.

This can then progress to full-blown acute respiratory infection and encephalitis (inflammation of the brain tissue). Both of these conditions could be fatal. The patients can also slip into a coma once the encephalitis reaches severe conditions.

Are bats natural carriers of the virus?

This particular virus is usually found in the fruit-consuming bats, so it’s safe to say that they are natural carriers.

Does the virus affect other mammals?

Yes, there have been cases of the same virus infecting pigs and horses. This is based on limited primary research conducted during previous outbreaks. The thing with viruses is that they can easily shift from one species to another given a chance or favourable conditions.

Viruses can mutate quickly and adapt to a different host if they find conditions conducive to their existence in the new host. Usually this host may not even be the final or primary target (affected by the virus), they may just be another intermediate or accidental host or carrier.

How does the infection spread between humans?

The spread of infection is established to be through body fluids. If someone sneezes or coughs, drops or particles of the fluids may be inhaled by an unsuspecting person; or if these particles or drops falls on a surface and another person touches the same surface proceeding to bring their hands to the mouth or other open area – the virus can spread in this way.

When you consider aerial infection, the virus is not known to be able to survive in the air or transfer that way. The virus is in the droplet which may be thrown into the air, which can then infect another person.

It has been noticed so far that the infection spreads through direct physical contact through body fluids which include urine, blood, sweat and saliva. We are still trying to learn more about the disease as time passes.

What are the initial symptoms of the condition?

It can be something as mild as a fever, headache, cough, cold or a generalised feeling of tiredness or weakness – as is common with a cold or mild fever.

What are the treatment options?

There is no specific anti-viral agent for Nipah virus, and it is very difficult to control viral diseases with anti-virals. Clearly, antibiotics also have no role in helping with infections caused by the virus, so it is futile to approach a doctor or a pharmacy for antibiotics and it is not recommended.

The only care possible is said to be intensive supportive care, what does this include?

When we say supportive care it is based on the condition of the patient. If there is a high fever, you bring down the fever with paracetamol; if the patient is dehydrated, ensure that they get fluids through the mouth or through IV fluid line; if the person has trouble breathing, we may have to give him or her oxygen support and maintain oxygen concentration levels in the blood stream.

If the symptoms get severe, the care needs to be escalated which includes artificial ventilation through tubes or masks. There is no fixed protocol and this is all at the discretion of the treating doctor in the ward or in an intensive care unit (ICU) depending on the severity of the symptoms.

Treatment may also be based on the organ in a particular patient most susceptible to damage at a particular point of time. If the lungs are at risk, respiratory support is to be given. If the brain is failing resulting in seizures or loss of consciousness, medicines appropriate to that should be given. If the heart is not pumping normally, appropriate measures need to be taken. In another set of cases, all these conditions could combine in various permutations and combinations – care may have to be tailored according to that.

What are the Kerala Health Ministry guidelines on controlling the disease?

The Ministry has been very quick in identifying and containing the disease effectively and all the hospitals in the area have been given very clear directives on how to prepare effectively for what may come next. The guidelines state that all patients have to be treated in a certain kind of way; they have to be screened first, and in case of any suspicious symptoms they need to be transferred to an isolated room or ward.

Samples have to be collected, clear directives on how to collect, store and transport have also been given to health care providers. All the samples go through the District Medical Officer’s office onward to Manipal where there is a government approved virology testing centre. If the samples turn out to be positive, prompt information is given to the treating hospital.

There are clear guidelines on pretty much everything in this case from what level of personal precautions carers (nurse, doctors, family) need to what measures we need to be prepared for. This includes what level of precaution are needed, a mask or full on protective gear and who needs them, methods of washing clothes worn by patients and carers, and how the contact surfaces need to be cleaned.

So it’s clear that we all have very clear and exhaustive guidelines to control and prepare for any circumstances forthwith.

Is this the first Nipah virus outbreak?

Nipah virus was first identified during an outbreak of the disease in Malaysia in 1998. On this occasion, pigs were the intermediate hosts.

Outbreaks have also been reported in India, Bangladesh, Thailand, Cambodia, the Philippines, Laos and Malaysia.

In Bangladesh in 2004, humans were infected with Nipah virus after consuming date palm sap that had been contaminated by infected fruit bats.

What precautions should people take?

The first and foremost thing is to stay calm and not believe in rumours or wrong information spread through social media channels.

If you suffer from a mild cold, make sure you visit the nearest hospital and follow the doctor’s instruction to rest, hydrate and eat appropriately. Avoid large crowds in this case. Hand hygiene is the best way to protect yourself against the virus from spreading through body fluids on surfaces.

In other precautions released by WHO and government health organisation, people have been advised to avoid eating fallen fruits, avoid eating uncooked vegetables or fruits and restrain from drinking toddy, date palm sap and other raw fluids that come from trees.

Can a person be saved?

Currently the mortality rate of the disease is upwards of 70 per cent in reported cases.

Intensive supportive care may save patients completely. However, after effect of encephalitis on survivors can result in periodic seizures or relapse into encephalitis.

* Inputs from agencies