An analysis of the recently experienced pandemics and endemics shows that the evolution of human civilisation and thereby encroachment of the wild habitats by humans for settlements and agricultural practices, climate change and excessive deforestation have resulted in the spilling over of the new viruses from wild animals to domestic animals and humans
Nepal has not yet completely resuscitated from the ongoing COV- ID-19 pandemonium, and the menace of another potential endemic is hovering over the country. Recently, an outbreak of Nipah virus (NiV) infection was reported in neighbouring India, 23 years after the first ever cases of it were identified on pig farms in Malaysia in 1998. The first casualty of the recent outbreak was a 12-year-old boy from Kozhikode district in Kerala on September 5. Since then, NiV infection has claimed at least 20 lives and is rapidly spreading in the southern state of India.
Taking a leaf out of the recent experiences with COVID-19, the Ministry of Health and Population (MoHP) has issued a press statement stating that the risk of the virus's propagation in Nepal through the open borders could not be ruled out. Therefore, the concerned authority needs to remain on high alert to cope with the unprecedented adversity of NiV.
NiV infection is a zoonotic illness that is transmitted to humans from animals as well as through contaminated food or directly from person-to-person. The natural reservoir of the virus is the fruit bat. The World Health Organisation (WHO) has classified NiV as a virus of concern for future epidemics as the virus seems to be frequently spilling over from its animal reservoir into humans.
NiV infection presents itself with non-specific symptoms ranging from mild to severe course of illness. The common symptoms are fever and headache along with signs of respiratory illness – cough, sneezing, sore throat, breathlessness and a tight chest. The symptoms typically appear in 4-14 days after exposure to the virus.
In severe cases, a stage of brain encephalitis may follow; the symptoms include drowsiness, disorientation and mental confusion. This severe condition can rapidly progress to a coma within 24-48 hours. A convenient way of diagnosis of the disease is not available; the confirmatory diagnosis relies entirely on sophisticated molecular techniques.
Prophylaxis through drugs or vaccines against the virus has not been approved so far. Therefore, appropriate precautions are the only currently available prevention options.
In light of reoccurrence of NiV infection, amidst the ongoing COVID-19 mayhem, it has raised disquiet of scientists. In fact, over the last century, researchers have been subtly acknowledging the increasing outbreaks of infectious diseases at regular intervals.
Ebola, H1N1-influenza (swine flu), severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), avian influenza and COVID-19 are the recent infectious diseases that our generation has already experienced, either as endemic or as a pandemic, in the first quarter of the 21st century.
A study on global trends in emerging infectious diseases published in Nature in 2008 reveals that almost two-thirds of all infectious diseases are zoonotic in nature, and more than 70 per cent of known infectious diseases have originated in wildlife.
There is an understanding that the reconnaissance of increasing frequency of these outbreaks in recent times is due to advancement in scientific approaches as well as improved surveillance and technological prowess in identifying new viruses.
However, a careful analysis of the recently experienced pandemics and endemics shows that the evolution of human civilisation and thereby encroachment of the wild habitats by humans for settlements and agricultural practices, climate change and excessive deforestation have resulted in the spilling over of the new viruses from wild animals to domestic animals and humans.
In addition, intensive animal husbandry in the form of poultry, pig farming and cattle rearing has severely increased this risk. The so-called wet markets where animals are slaughtered in unhygienic conditions are also breeding beds for transmission of zoonotic diseases.
Another factor that has contributed in the rapid transmission of infectious diseases is the ruthless increase of the human population over the years. The dense clustering of humans, especially in urban areas, is encouraging the outbreaks to spread like a wildfire. Large scale people's movement and increased frequency of livestock and goods transport in modern times have also contributed in the rapid transmission of contagious viruses across continents.
Coming back to NiV infection, the disease is said to have been transmitted to humans from bats that are omnipresent in all continents.
However, bats typically prefer warmer temperatures, and hence, countries like Nepal and other south Asian countries are territorial habitats of bats. Although NiV infection is not yet reported in Nepal, the risk of a possible outbreak anytime soon cannot be ruled out. Therefore, ecologists, scientists, health care professionals and sociologists should be well prepared to tackle the possible adversities of NiV infection.
It is high time an alert mode was activated immediately in Nepal.
The recent experiences in COVID management should be taken as a launching pad for the productive management of a possible NiV outbreak and unprecedented outbreaks of other infectious diseases in the future.
The first and the foremost requirement is a wellequipped centralised diagnostic facility for novel bacterial and viral infection within the country. In addition, the government should be prepared to clog the porous borders as soon as the threat of the spread of the infectious diseases prevails in the neighbourhood.
Simultaneously, a long-term rapid action task force comprising public health experts should be constituted, and the concerned authorities should act according to their suggestions.
This is not yet too late for Nepal; however, time is running out swiftly.
Dr Joshi is senior scientist and Assistant Professor of Neurobiology, Martin-Luther University Halle-Wittenberg, Germany
A version of this article appears in the print on October 4, 2021, of The Himalayan Times.