Nepal must prepare for the ‘worst-case scenario’ in the fight against Nipah virus, which has claimed at least 18 lives in neighbouring India, as well as other emerging and re-emerging infectious diseases
At least 18 persons have died of Nipah virus in India, according to the Indian media, while other suspected or confirmed cases are being treated locally at different hospitals. The number of deaths, albeit small, has sparked widespread panic not only in India but also in neighbouring countries.
The sudden appearance of this brain-damaging Nipah virus in India has stoked concerns as well as fear among the Nepali populace as well.
It may well be argued that Nipah virus is even more dangerous than Ebola virus due to its higher mortality rate (more than 70 per cent) compared to Ebola virus (currently 50 per cent). Since the reservoir of this virus, a bat known as “Pteropus giganteus” is widely available in Nepal, there is a cause for concern. It, hence, is time to learn some lessons and ensure preparedness – not only about Nipah virus but also about the ways to deal with other highly contagious Nipah-like illnesses in future.
Occasionally the virus is introduced into human populations and causes severe illness characterised by encephalitis or respiratory disease.
Hence, laboratory confirmation is a must.
Even though India has its own virological laboratory and skilled manpower, it took several days to confirm this virus. Nipah virus is a biosafety level 4 (BSL-4) pathogen.
The number of people going abroad, particularly African countries for better employment, and tourists entering Nepal has increased significantly in recent years. This is one of the most common ways of transfer of deadly infectious diseases. Early identification of infection can help in assessing the risk and identifying preventive measures accordingly.
Separate or isolation room limits the possible spread of contagious illnesses during hospital stay. During Ebola epidemic, many health care providers lost their lives while treating patients. In India, a nurse, who was involved in treating patients, died after contracting Nipah virus. It shows how important it is to have a separate treatment room as well as personal protective equipment (PPE).
So far, I have had only one opportunity to attend and see PPE – that too during its demonstration. Almost all hospitals in Nepal neither have PPE nor the ability to use it properly. Thus training is of paramount importance to ensure safe clinical practices, especially at healthcare centres/ hospitals that are dealing with infectious diseases.
Public fear and overreaction to outbreaks of deadly diseases is one of the biggest challenges for government.
People living in Nipah virus affected area in India are living with panic. They are even afraid of eating fruits, and local health officers have advised to avoid fruits having bite marks. Studies have shown that the virus can survive for up to three days in some fruits juice or mango fruit, while at least seven days in artificial date palm sap.
Likewise Nipah virus remains active up to four days in bat urine and at least for one day in sap contaminated with bat urine. It is thus essential to run public education campaigns to raise awareness about Nipah virus, especially in tropical forest areas where bats are found in abundance.
It is worth noting that bats in large numbers reside in Kathmandu urban area, especially on the premises of Narayanhiti, former royal palace, and around it. It is not known whether they pose a threat to human health. Nonetheless, there is a need to focus on zoonotic research to understand the dynamics of bats and potential threats to human health in Nepal.
A “One-Health” approach can be the best option to better understand emerging infectious diseases. “One-Health” recognises the health of people is connected to the health of animals and the environment.
An outbreak of a disease in India always is a cause for concern, as Nepalis in large numbers work there. Hundreds of Nepalis go to south Indian cities to study. This time Nipah virus has been detected in Kerala, one of the favoured destinations among Nepali students.
The likelihood of the Nipah virus being imported to Nepal, hence, cannot be completely ruled out. Some believe that Nipah virus may never arrive in Nepal from India because an infected patient falls into coma or dies within 48 hours of symptoms.
Nevertheless, the virus can spread during the patient’s incubation period (time period between infection and symptoms onset).
For instance, Ebola virus was first imported to the US while the person was in the incubation period. Thus, the possibility of an imported case of Nipah virus from India cannot be ruled out. Effective surveillance is hence necessary to detect, respond and prevent spread of this virus.
Relapse after recovery (20 per cent), developing late onset encephalitis months or even years later (one case occurred after 11 years), rapid deterioration and human-to-human transmission are some of the setbacks associated with this virus. Survival rate for patients with Nipah virus is less than 30 per cent.
Given the recent Nipah virus outbreak in India, Nepal must prepare for the “worst-case scenario” in the fight against this brain-damaging virus as well as other highly infectious diseases.
Pun is coordinator of Clinical Research Unit at Sukraraj Tropical & Infectious Disease Hospital
A version of this article appears in print on June 04, 2018 of The Himalayan Times.