H5N1

WHO DON: Nipah virus infection - Bangladesh

A disease outbreak news report from WHO: Nipah virus infection - Bangladesh. Excerpt:

Situation at a Glance  

Outbreaks of Nipah virus (NiV) infection are seasonal in Bangladesh, with cases usually occurring annually between December and April corresponding with the harvesting and consumption of date palm sap. Since 1 January and as of 9 February 2024, two laboratory-confirmed cases of NiV have been reported from the Dhaka division of Bangladesh. Both cases have died.  

WHO assesses the overall risk at the national levels to be moderate due to the severity of the disease, the limitation of treatment, the shared natural habitat of bats and zoonotic transmission partners, and the fact that there are no licensed vaccines to prevent NiV infection.  

Description of the Situation  

On 30 January and 7 February 2024, the Bangladesh National Focal Point (NFP) for the International Health Regulations (IHR) notified the World Health Organization (WHO) of two epidemiologically unlinked cases of NiV infection.  

First case confirmed on 21 January 2024  

The first patient is a 38-year-old male from Manikganj district, Dhaka division. The patient developed a fever followed by respiratory distress, restlessness, and insomnia on 11 January 2024 and was admitted to a local hospital on 16 January. He was transferred to the intensive care unit of a hospital in Dhaka City on 18 January where he was intubated due to worsening of symptoms.  

On 21 January, blood and throat samples were collected and the patient tested positive by reverse transcription polymerase chain reaction (RT-PCR) for NiV RNA from the throat sample and by enzyme-linked immunosorbent assay (ELISA) for anti-NiV Immunoglobulin M (IgM) from serum. On 27 January, the case was transferred to another hospital in Dhaka city, where he died on 28 January.   

The case had a history of consuming raw date palm sap on 31 December 2023. As of 30 January 2024, a total of 91 contacts had been identified, including 11 family members, 20 from the community, and 60 healthcare personnel from different hospitals. However, none of the contacts tested positive for NiV by PCR or anti-NiV IgM by ELISA.   

Second case confirmed on 31 January 2024  

The second patient is a three-year-old female from Shariatpur district, Dhaka division. The patient visited a healthcare facility on 30 January 2024 with a two-day history of fever, altered consciousnesses, and seizures. The case was diagnosed with encephalitis and shock and was transferred to the isolation ward of another hospital in Dhaka city on the same day. Blood and throat samples were collected on 30 January and on 31 January, the case was laboratory-confirmed with NiV infection by RT-PCR for NiV RNA from the throat sample and by ELISA for anti-NiV IgM from serum and died on the same day.    

The case had a history of regularly consuming fresh raw date palm sap. As of 7 February 2024, 67 contacts were identified, including three family members, 21 from the community and 46 healthcare personnel from different hospitals. All identified contacts tested negative for NiV by PCR or anti-NiV IgM by ELISA.  

Since the report of the first case in 2001, human infections have been reported almost every year, with case fatality rate varying between 25% (in 2009) and 92% (in 2005). Clusters of cases are mainly reported in the country’s central and northwest districts. 

Bangladesh: One dies of Nipah virus in Rajshahi

Thanks to ProMED-mail for linking to this report in the Dhaka Tribune: One dies of Nipah virus in Rajshahi.

One woman died of Nipah virus in Rajshahi Medical College Hospital (RMCH) Wednesday afternoon.  

The deceased, Farida Yasmeen, 25, was admitted to the neuro medicine ward of RMCH with common symptoms like fever and seizures.   

Complications escalated after she was diagnosed with Nipah virus on Wednesday morning and was eventually referred to Nipah ICU. She died around 5pm while undergoing treatment.  

Besides, her mother-in-law Rahima Begum is admitted in the Nipah Suspect Ward with the same symptoms. Farida's father-in-law Abdul Haque had died at home with the same symptoms two weeks ago.  

Although the family thinks it was a natural death, however, doctors believe that her father-in-law was also infected with Nipah virus. Besides, it has been reported that their entire family eats date juice without boiling it, a common cause of the spread of this disease.  

Dr Azizul Haque, medicine specialist at Rajshahi Medical College Hospital, said: “Relatives of deceased patients are at higher risk of infection. So, they need to be extra careful. We are working in coordination with IEDCR.”  

He urged to be careful while drinking date juice.  

However, Rajshahi Civil Surgeon Dr Abu Yusuf Mohammad Farooq said that there is no need for regular care of the patient's relatives. The IECCR has collected and tested the samples of everyone who came in contact with the infected patient. However, everyone should be careful while drinking date juice.   

A total of five people have died in Rajshahi Medical College Hospital (RMCH) so far. All of them have a history of drinking date palm juice. Besides, everyone was admitted to the general ward of the hospital with common symptoms like jaundice. Then suddenly the physical condition started to deteriorate. Death occurred on admission to the ICU. Nipah in one of the deceased was identified after death.

An experimental Ebola cure may also protect against Nipah virus

Via The New York Times, news of a veritable panacea: An Experimental Ebola Cure May Also Protect Against Nipah Virus. Excerpt:

An experimental drug has protected monkeys against infection with Nipah virus, a lethal disease and emerging pandemic threat for which there is no approved vaccine or cure, scientists reported on Wednesday.  

The antiviral drug, remdesivir, is also being tested against the Ebola virus in the outbreak now underway in the Democratic Republic of Congo.  

The only current treatment for Nipah virus infection is a monoclonal antibody that is still experimental; it was tested during an outbreak in India last year. 

In the new trial, eight African green monkeys were given lethal doses of Nipah virus. Half of them later got intravenous remdesivir. All four monkeys that got the drug survived; the four that did not died within eight days.

If the drug wins approval for use against Nipah, “it will give us an extra treatment that could be used relatively quickly,” said Emmie de Wit, a virologist at the National Institute of Allergy and Infectious Diseases and one of the study’s lead authors. “The average person who reaches a hospital dies within two days, so it’s hard to protect them once they’re infected.” 

Ebola and Nipah belong to different viral families, but remdesivir — made by Gilead Sciences and also known as GS-5734 — appears effective against both.

In mice or cells cultivated in the laboratory, the drug has also shown some effectiveness against two other pandemic threats: Lassa fever and MERS coronavirus. It is also effective against respiratory syncytial virus, which infects children all over the world.  

Although the outer shells of all these viruses are very different, their polymerases — the genome-copying enzyme that remdesivir targets — are similar, Dr. de Wit explained.  

The new study, done jointly by the N.I.A.I.D. and the Centers for Disease Control and Prevention, was published in Science Translational Medicine.

Transmission of Nipah virus — 14 years of investigations in Bangladesh

Via NEJM: Transmission of Nipah Virus — 14 Years of Investigations in Bangladesh. The abstract:

BACKGROUND Nipah virus is a highly virulent zoonotic pathogen that can be transmitted between humans. Understanding the dynamics of person-to-person transmission is key to designing effective interventions.  

METHODS We used data from all Nipah virus cases identified during outbreak investigations in Bangladesh from April 2001 through April 2014 to investigate case-patient characteristics associated with onward transmission and factors associated with the risk of infection among patient contacts.  

RESULTS Of 248 Nipah virus cases identified, 82 were caused by person-to-person transmission, corresponding to a reproduction number (i.e., the average number of secondary cases per case patient) of 0.33 (95% confidence interval [CI], 0.19 to 0.59). The predicted reproduction number increased with the case patient’s age and was highest among patients 45 years of age or older who had difficulty breathing (1.1; 95% CI, 0.4 to 3.2). Case patients who did not have difficulty breathing infected 0.05 times as many contacts (95% CI, 0.01 to 0.3) as other case patients did. Serologic testing of 1863 asymptomatic contacts revealed no infections. Spouses of case patients were more often infected (8 of 56 [14%]) than other close family members (7 of 547 [1.3%]) or other contacts (18 of 1996 [0.9%]). The risk of infection increased with increased duration of exposure of the contacts (adjusted odds ratio for exposure of >48 hours vs. ≤1 hour, 13; 95% CI, 2.6 to 62) and with exposure to body fluids (adjusted odds ratio, 4.3; 95% CI, 1.6 to 11).  

CONCLUSIONS Increasing age and respiratory symptoms were indicators of infectivity of Nipah virus. Interventions to control person-to-person transmission should aim to reduce exposure to body fluids.

Outbreak investigation of Nipah virus disease in Kerala, India, 2018

Thanks to IDSA for tweeting the link to this report in the Journal of Infectious Diseases: Outbreak investigation of Nipah Virus Disease in Kerala, India, 2018. The abstract:

Background 

Nipah Virus (NiV) is a highly fatal emerging zoonotic virus with potential threat to global health security. Here we describe the characteristics of the NiV outbreak occurred in Kerala, India during May -June 2018. 

Methods 

We used real-time RT PCR in throat swabs, blood, urine and CSF to detect NiV. Further, the viral genome was sequenced and subjected to phylogenetic analysis. We conducted an epidemiological investigation to describe the outbreak and to elucidate transmission dynamics. 

Results 

During May 2 – 29, 2018, 23 cases were identified including the index case; 18 were lab-confirmed. This NiV was closer to the Bangladesh lineage. Median age of cases was 45; 15 (65%) were male. The median incubation period was 9.5 days (6 – 14 days). Of the 23 cases, 20 (87%) had respiratory symptoms. The case fatality rate (CFR) was 91%; two cases survived.. Risk factors for infection included close proximity (touching, feeding or nursing an NiV infected person) enabling exposure to droplet infection. The public health response included isolation of cases, contact tracing, and enforcing hospital infection control practices. 

Conclusion 

This is the first recorded NiV outbreak in South India. Early laboratory confirmation and immediate public health response contained the outbreak.

WHO: Nipah virus – India

WHO has published Nipah virus – India. Excerpt:

As of 17 July 2018, a total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported from Kerala State: 18 of the cases were laboratory-confirmed and the deceased index case was suspected to have NiV but could not be tested. The outbreak was localized to two districts in Kerala State: Kozhikode and Malappuram. No new cases or deaths have been reported since 1 June 2018 and, as of 30 July, human-to-human transmission of NiV has been contained in Kerala State.  

As reported in the Disease Outbreak News published on 31 May 2018, three deaths due to NiV infection were reported on 19 May from Kozhikode District, Kerala State. Three of the four reported deaths were confirmed positive for NiV by real-time polymerase chain reaction (RT-PCR) and IgM ELISA for NiV.  

Two patients recovered completely and were discharged from the hospital. Acute respiratory distress syndrome and encephalitis were observed among the patients infected. This was the first NiV outbreak reported in Kerala State and the third NiV outbreak known to have occurred in India; the two previous outbreaks occurred in the state of West Bengal in 2001 and 2007.

Bollywood-style video celebrates India's success in battling deadly Nipah virus

Via NPR's blog Goats and Soda, a long article: Bollywood-Style Video Celebrates India's Success In Battling Deadly Nipah Virus. After describing the outbreak and its resolution, the article concludes: 

Arunkumar feels that heightened awareness and monitoring for encephalitis symptoms should continue among health-care practitioners in India. "There is a possibility that this can happen again," he says. "Fruit bats are endemic to India and other parts of Southeast Asia." 

But along with the caution about the future there was a celebratory mood.  

When the announcement was made that Kozhikode was Nipah-free, a group of musicians and filmmakers decided to make a video to celebrate. 

On June 14, they released "Bye Bye Nipah."  

"It was a labor of love," says music composer Sai Balan, who composed the tune for the video in an hour. "It's our way of saying that the anguish and suffering is behind us now."  

"The song was an effort to reclaim and celebrate our public spaces after the threat of the epidemic almost shut the city down in fear," says A. Shaji Kumar, who wrote the lyrics. "We wanted to honor the effort and sacrifice of our healthcare professionals as well." The video shows smiling images of local doctors, nurses and health-care workers, giving a thumbs-up.  

With scenes from malls, the beach, the emerald-green backwaters, the main streets and restaurants, the video is a slice of everyday life in Kozhikode. "We shot images of actual residents going about their day with health and hope," says Kumar.  

"Don't forget that this is Kozhikode," say the lyrics. "We beat the contamination with strength and determination. We won't break down. We won't ever tire. Bye Bye Nipah!"

India’s Nipah virus outbreak and misleading media

Via The Interpreter, a blog published by the Lowy Institute: India’s Nipah virus outbreak and misleading media. Excerpt:

Arun Kumar, a virologist with Manipal Centre for Virus Research, told me the links established in Kerala following the 2009 flu pandemic in India greatly improved its health systems: 

"Those investments are paying off during the current outbreak, as the government and private hospitals could act swiftly in tackling the menace, curtailing the death toll to 17."  

Over two weeks of perseverance and hard work, the Nipah virus was contained, and no new cases have been reported since 30 May. However, the area cannot be declared Nipah-free until, according the WHO guidelines, 42 days have passed since the last recorded case. But Kumar was insistent: “There is no need to panic.”   

Traditional and social media failure 

Despite the gargantuan government efforts, some practitioners of alternative forms of medicine made conflicting statements in social media, even casting doubt over the existence of Nipah virus. 

This confusion was compounded by a string of statements on social media declaring that “fruits” were a vehicle for the virus. This led to the shutdown of fruit shops not only in the virus-affected district but also thousands of kilometres away in Hyderabad, leading to huge losses for farmers and vendors.  

Distorted media statements led to other countries banning Kerala fruits, even as experts confirmed consumption of the fruit was safe.  

Previously, there were concerns that remnants of fruit partially consumed by fruit bats led to the outbreak, as occurred in Bangladesh in 2004. Yet it was later confirmed that in this instance bats were not responsible for transmitting the virus. 

Certain media organisations usually regarded as credible and ethical subverted the credibility of the government. Even in early June – a week after the last reported case, and with no new cases discovered – some media organisations were discussing which other countries were likely to be affected by Nipah virus.  

Shoddy reporting only created fear and trepidation when the government had already taken steps to quarantine the patients and their close contacts. Chellenton Jayakrishnan, a neurologist at Kozhikode Baby Memorial Hospital, told me that unlike other viruses, such as swine flu, Nipah virus does not transmit extensively:  

"It usually gets transmitted to people who are having close contact, like the caregiver or patient’s relatives, without proper personal protection equipment, like a mask, gloves, etc. The lack of awareness regarding the Nipah virus has triggered new cases. But now it has been contained. The public at large needs to be alert, but there is no need for panic."

Yet the media games had a profound effect on the public, with many people taking to wearing masks in the streets after authorities had already declared that only people in close contact with the patients required protection. This continued even after 14 June, when the remaining Nipah-affected patients were discharged. 

Media exaggeration and misreporting about Nipah virus only hindered progress made by the government and medical community. The experience stands again as a warning that during an outbreak, bad information can be just as dangerous as the virus itself.

Nipah virus contained, last two positive cases have recovered: Kerala Health Ministry

Via The News Minute: Nipah virus contained, last two positive cases have recovered: Kerala Health Min. Excerpt:

The deadly Nipah virus that struck Kozhikode district in Kerala last month and claimed 16 lives in the state has been finally contained and the last of the two positive cases have fully recovered, said Kerala Health Minister KK Shailaja on Sunday.  

Including Mohammed Sadik who was the first person suspected to have died of the infection, the death toll stands at 17.  

The virus struck at Kozhikode which saw 13 people dying, while three deaths were reported from nearby Malappuram district, and more than 2,000 patients with fever was kept under close observation. 

After presiding over a review meeting, the Health Minister told media persons that the virus scare is finally over.  

"We visited the two Nipah positive patients who have been completely cured and according to many, this is something rare. The scare of this getting spread is finally over, as no more patients have tested positive, but a caution has to be there who are under observation, as they have to take complete rest," said Shailaja. 

The district authorities, following the scare, had asked to wait for schools to reopen in the new academic year and now schools all set to open from Tuesday onwards while the ban on public functions has also been lifted.  

The Kozhikode Medical College hospital, where a special Nipah ward was opened, is now seeing patients returning home, said an official.

Nipah virus, dangerous and little known, spreads in India

Via The New York Times: Nipah Virus, Dangerous and Little Known, Spreads in India. Excerpt:

A rare, brain-damaging virus that experts consider a possible epidemic threat has broken out in the state of Kerala, India, for the first time, infecting at least 18 people and killing 17 of them, according to the World Health Organization.  

The Nipah virus naturally resides in fruit bats across South and Southeast Asia, and can spread to humans through contact with the animals’ bodily fluids. There is no vaccine and no cure.  

The virus is listed by the W.H.O. as a high priority for research. Current treatment measures are insufficient, according to Dr. Stuart Nichol, the head of the viral special pathogens branch at the Centers for Disease Control and Prevention.  

“There’s a market failure for protecting people from this,” said Dr. Steve Luby, an epidemiologist at Stanford University. “It’s not like treating baldness or breast cancer, where wealthy people will pay for your product. There’s no big customer here, no incentive, until it escalates.” 

 If the virus were to spread outside India, it would likely appear first in Dubai, where many Indians work, according to an analysis of flight patterns conducted by the EcoHealth Alliance, a nonprofit research group. 

Among United States airports, an infected traveler would likely arrive first at John F. Kennedy Airport.  

“The goal of mapping scenarios out is not to create panic. It’s to get countries ready,” said Dr. Peter Daszak, the president of the alliance. “This virus will get better and better at spreading — that’s what we’re up against. We need to be ahead of the curve.”

The Nipah infection produces flulike symptoms, including fevers, body aches and vomiting, which often progress to acute respiratory syndrome and encephalitis, or brain inflammation. Some survivors show persistent neurological effects, including personality changes. 

The virus was first identified during an outbreak in 1998 among pig farmers in Malaysia, where it killed over 100 people and led to the slaughtering of more than one million pigs. Cases now appear almost annually in Bangladesh.  

The current outbreak likely began when people drew water from a bat-infested well, according to the India’s National Centre for Disease Control, which is leading the investigation.