fruit bat flying fox nipah virus infection

All the news channels in Kerala are singing horror stories of Nipah virus 24/7 and still, the lay man has many doubts! A visit to Kozhikode district will reveal the true picture there. People travelling in the bus, those commuting on the streets are wearing their protective face masks, which is now in quite high demand. Taluk hospital at Perambra seems to be abandoned and other Government hospitals have a significant decrease in the out-patient numbers because of the fear of Nipah!

This article is about the rare Nipah virus infection which as of date (24 May) has taken 12 lives in Kerala. There are many questions that needs to be answered for the benefit of the common man and I will try to do just that.

Update: As of 5 June, 2018 17 people have lost their lives due to the Nipah virus infection in Kerala

 

What is Nipah virus infection?

Nipah virus is seen in bats, all of you know that by now. Last week test results on blood samples from the dead bats found in the notorious well in Kozhikode could not detect any Nipah virus. But that doesn’t mean that the infection which took several lives is not caused by the Nipah virus! The virus could have come from other fruit bats and the source of infection is yet to be identified.

The usual symptoms of the illness starts with flu like condition and it rapidly progresses to involve the brain and lungs. Multiple organ failure is very common in the Nipah virus infection. The only thing to fear about it is that the fatality rate is more than 70 percent. That means, if you get the virus infection and the diseases starts in your body, you are most likely going to die, and that’s the terrible truth! Now, this article is an attempt to answer the most common questions pondering in the minds of Keralites and those who are planning to visit Kozhikode. So, if you want to learn more about the clinical picture, diagnosis and treatment options of Nipah virus infection, go to this page.

 

How does it spread?

Let’s go straight to the point. You don’t have to worry about bats and chicken and other birds. Don’t chase and shoo away those innocent bats wearing masks and gloves.

Nipah virus infection spreads only from a person who has the infection. There is a very dedicated isolation ward at Kozhikode Medical College and all the suspected persons are hosted there. If any one of them has been confirmed to have the virus infection, and you have been giving care to that person without proper precautions, then you’re at risk.

The virus spreads through direct contact, body fluids like saliva, sweat and blood. The very first person who succumbed to the Nipah virus infection could have transmitted the virus to others who later died. Four persons in one home died and the Nurse who gave healthcare services to these persons also passed away unfortunately.

The virus can even spread from the dead bodies of those persons who had the infection. That means, persons who deal with dead bodies before cremating or burying it should take adequate precautions. If you have visited the above mentioned isolation ward, or if you know someone who has visited that ward and now has fever, kindly go to your nearest hospital and get yourself tested.

Nipah virus has been shown to be harbouring several domestic animals including dogs, cats, goat, sheep, pigs etc. Considering the outbreak of Nipah virus infection, it would be wise not to come in direct contact with sick domestic animals. Persons who have poultry or animal farms should also be cautious about dying animals and birds and it taking personal protective measures will be the best possible option.

 

Treatment & Prevention

Currently, there is no cure or proper treatment for Nipah virus infection. The only treatment options available are conservative, which means the treatment is directed at improving the patient’s symptoms. Encephalitis is very dangerous and if respiratory failure happens, death is imminent.

So, prevention is the only weapon in our arsenal as of now. And how do you prevent yourself? Well, simply follow the following steps:

 

  1. Maintain good personal hygiene particularly after reaching back home from an outdoor visit
  2. Take all personal precautions while dealing with poultry, pig rearing, slaughter houses. Wear gloves, masks, goggles and protective clothing so that your body parts are not exposed to any kind of animal or bird body fluids.
  3. Wash your hands with soap thoroughly after public transit. No need to roam about wearing masks and all. Wear masks if you’re going to a busy hospital ward or OPD or if you’re giving care to someone who has been suspected of Nipah virus infection.
  4. If anyone in your house or neighbourhood develops fever and other symptoms after being in close contact with a known case of Nipah infection, ask them to visit the nearest isolation ward and inform healthcare workers at the earliest.
  5. Take a detailed bathe and change your clothes after visiting a hospital or other public place

 

If you have been approached by representatives of alternative medicine system informing you about the availability of treatment for Nipah, simply consider it as a scam. All systems of medicine should be giving primary importance to prevention of Nipah and that’s done by not taking any medicine as such, but by following the precautions mentioned above.

 

Who should be worried?

You should be worried if you belong to the following group of persons:

  • Healthcare worker who doesn’t follow the personal protective measures while giving care. Your risk has more than doubled if any one of the patient to whom you have attended has been confirmed with Nipah virus infection or has died due to it.
  • If you have visited a person who was confirmed with Nipah virus infection without any proper protective precautions. You could be that person’s family member, friend, neighbour, a religious or political leader.
  • You are a coconut or palm sap extracting worker.
  • Healthcare workers who are immune-compromised and are taking steroid medicines daily
  • You have a pig rearing farm or other animal farm and you don’t follow the personal protective measures

You need not be worried for:

  • Visiting hospitals and going outdoors without masks
  • Living in Perambra or Kozhikode or Kerala for that matter!
  • Mingling with persons or relatives of persons whose family member was recently confirmed with Nipah virus infection
  • A fever or headache that has been mildly bothering you for last 2 days. Get medical advice soon though!
  • Eating chicken or other meat products, including pork

 

What is your role?

If you’re not a healthcare worker, consider the following:

  • Educating your friends and family about Nipah virus infection and proper personal protection measures
  • Be cautious and vigilant if someone in your family or neighbourhood has been recently detected to have Nipah virus infection
  • Don’t chase behind bat colonies. It’ll prove to be more dangerous rather than helping!
  • Avoid unnecessary visits to the isolation ward or other busy hospitals.
  • Give more emphasis on personal hygiene and personal protection particularly after an outdoor visit to a public place
  • Share this article and spread the word

If you’re a healthcare worker, the personal protection measures also called the universal protection measures need to be followed strictly and they are given below.

 

Healthcare workers, be cautious!

It’s time to bring in those universal protective measures that you learned in college to real life. Not just for the Nipah virus infection control, but for the rest of your lifetime! We have already lost a life from the healthcare community and we should never let it happen again.

protective precautions healthcare workers nipah virus infection

 

Universal precautions may not be feasible in all hospitals particularly where resources are permitted. The World Health Organization recommends the use of standard precautions for healthcare workers which is the minimum precautions that need to be followed by every hospital staff who are providing care. This includes nursing attendants, laboratory technicians, pharmacists, cleaning staff, nurses and of course doctors. In short, it’s protection from human body fluids by advocating proper hand washing techniques, use of protective masks, gowns, goggles and gloves.

You can find a full PDF file on the standard precautions at WHO website here.

 

How to differentiate Nipah virus infection?

Monsoons have already started in Kerala and it’s the time of the year when Dengue fever and Leptospirosis becomes common household terms here. So, how do you differentiate a fever from the one associated with Nipah virus infection? This question was raised by one of my patient at the PHC and here’s the answer.

Nipah virus infection when it starts in a person, there’ll be high grade fever. Other associated symptoms that may or may not occur are headache, nausea, confusion, vomiting, fatigue, sleepiness. The disease progresses very rapidly and if encephalitis happens, you can expect seizures, loss of consciousness which may eventually lead to coma and death. Pneumonia like presentation is also common in Nipah virus infection with the sudden onset of breathlessness, severe chest pain, wheezing etc. It’s very difficult to diagnose Nipah virus infection from clinical findings and that’s why blood samples are taken for isolating the virus detection by immunological tests or electron microscope tests.

So, what do you need to do if you’ve visited someone last week who has now been confirmed to have Nipah virus? Don’t panic, just visit your nearest health facility and get proper advice there. If other nervous system symptoms develop, better visit a regional hospital like the medical college or district hospital where isolation wards are functioning.

 

Should you wear protective face masks?

Yes and yes if you’re a healthcare worker. Read the standard precautions by visiting the link above and follow it till you retire from the job.

If you’re not a healthcare worker, you don’t have to wear face masks 24/7. You don’t have to wear them while visiting the market or when you go out for shopping.

In case you are at the hospital giving care to a family member or friend who has been confirmed to have the Nipah virus infection, then you SHOULD be wearing a face mask. In that situation, you are not different from a healthcare worker and following the universal precautions will be the right thing to do.

Doctors and nurses are advised to wear surgical face masks at the first point of care. If N95 masks are not available, use 3 common face masks and don’t remove them frequently and unnecessarily.

3M N95 masks are available at Amazon though, here’s the link to it.

Use a good hand sanitiser too, like this one.

 

So, how did you like this article? Was it helpful? Do you have any more questions? Write down a comment below and share this article if you liked it.

 

 

Dr Prasoon

Dr Prasoon

Author at BeingTheDoctor
Dr Prasoon, founder of BeingTheDoctor is a qualified medical practitioner who finds time to write articles on "health" and his "clinical experiences". He is currently engaged in providing primary health care services in rural India. Learn more in the "about" page.
Dr Prasoon
Nipah virus infection, all the frequently asked questions answered
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