nipahvirus-180525062654 (1).pdf
- 1. NIPAH VIRUS By: Dr Harivansh Chopra Dr Abhishek Agarwal
- 2. Introduction • Nipah virus (NiV) infection is a newly emerging zoonosis that causes severe disease in both animals and humans • It is named after the Malaysian Village from where it was first discovered.
- 3. Introduction • Nipah virus causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis.
- 4. Introduction • Nipah virus is closely related to Hendra virus. • Both are members of the genus Henipavirus, a new class of virus in the Paramyxoviridae family.
- 5. NIPAH Virus : A public Health Problem • Though Nipah virus has caused only a few outbreaks, it infects a wide range of animals and causes severe disease and death in people, making it a public health concern.
- 6. Distribution
- 8. Problem • 1st Case reported from Malaysia in 1998 • 1st Outbreak in south east asia was in Bangladesh in 2001 • 1st Outbreak in India was in Siliguri killing over 33 Health workers • Recent Outbreak was in Kerela, killed upto 11 health workers • Till now over 457 cases of Nipah Virus has been reported killing more then 252 persons
- 9. Agent: Nipah Virus Paramyxovirus Highly pathogenic Closely related to Hendra virus Epidemiology
- 10. Incubation Period 4 – 18 days
- 11. Host • Reservoir Host: Fruit Bats • Amplifier Hosts: Pig and Horses • Dead End Host: Humans Epidemiology
- 13. Epidemiology ENVIRONMENT • Cases are more in Winter and Spring (December–May). – Breeding Season of bats – Date palm sap harvesting season
- 14. Transmission cycle of Nipah Virus
- 15. Direct Transmission: Pig to Human • Direct human contact with infected pigs was identified as the predominant mode of transmission in humans when it was first recognized in Malaysia. (outbreak of Nipah virus, 1998-99)
- 16. Direct Transmission: Human to Human • The evidence of human to human transmission of Nipah Virus was first reported from India. • During the outbreak in Siliguri, 33 health workers and hospital visitors became ill after exposure to patients hospitalized with Nipah Virus, suggesting nosocomial infection.
- 17. Body fluids responsible for human to human transmission of Nipah Virus Cerebrospinal Fluid Respiratory Secretions Saliva Urine
- 18. Direct Transmission: Bat to Human • Direct transmission of Nipah Virus from fruit bats to humans has been reported during Bangladesh Outbreak.
- 19. Indirect Transmission: Fruit Bat • The natural host of the virus are fruit bats of the Pteropodidae Family, Pteropus genus • In India the sub species Pteropus giganteus is the causative agent
- 20. Fluids from bats transmitting the disease • Virus present in its excretions and secretions – Urine – Semen – Saliva – Excreta
- 21. Indirect Transmission: Date palm sap • Drinking of date palm sap, possibly contaminated by fruit bats may have been responsible for the transmission of Nipah Virus to Humans.
- 22. Indirect Transmission: Date palm sap • Fruit bats also consume date palm sap and can contaminate it with saliva, urine feces. • This is the means by which Nipah Virus is thought to have been transmitted from infected fruit bats to humans.
- 23. Case Definition : Suspected Nipah Case High Grade Fever with :- • acute onset of altered mental status, or • Seizure, or • Headache, or • acute onset of cough with shortness of breath
- 24. Case Definition : Probable Nipah Case • Suspect cases, and/or who died before complete diagnostic specimens could be collected, including a serum antibody test 14 days after onset of illness Death: 14 days of onset of illness
- 25. Case Definition : Confirmed Nipah Case i) IgM antibody ii) RNA identified by RT-PCR iii) isolation of Nipah Virus Confirmed Nipah case: Suspected/probable case having:
- 26. Clinical Features • The classical form is an acute and rapidly progressive encephalitis with or without respiratory involvement in all age groups.
- 27. Clinical Features • The Nipah encephalitis presents with 3–14 days of fever and headache, followed by drowsiness, disorientation and mental confusion. • The acute encephalitis progresses then to coma within 24–48 hours, with high mortality rate.
- 28. Clinical Features • The respiratory involvement consists of non-productive cough during the early part of the disease, which can evolve later to severe acute lower respiratory disease, i.e., from breathing difficulties to acute respiratory distress syndrome (ARDS)
- 29. Clinical Features • Post-encephalitis sequelae have been commonly observed in NiV infection. • One third of Nipah survivors in Bangladesh have moderate to severe objective neurological dysfunction 7–30 months after infection
- 31. Treatment : Supportive • Fluid maintenance and electrolyte balance. • Nutrition • Anticonvulsant • Oropharyngeal suction in closed circuit.
- 32. Treatment : Supportive • Oxygen inhalation using disposable cannula. • Bronchodilators through large spacer devices. • Severely ill individuals may require Intensive Care Unit (ICU) support
- 33. Treatment: Drug • Ribavirin: • Monoclonal Antibodies (Post exposure therapy)
- 34. Prevention • hand hygiene • injection safety • facial protection • glove and gown wearing • waste disposal,
- 35. Prevention • Linen cleaning • Environmental cleaning • Patient care equipment and • Respiratory Hygiene
- 36. Prevention # Avoid intake of fruits bitten by animals
- 37. Prevention # Proper handling of specimen
- 39. Prevention Alvac Canary Pox Vaccine (Presently for cat) Human trials are underway
- 40. Reach us at: Dr Harivansh Chopra: harichop@gmail.com Dr Abhishek Agarwal: abhishek3april@gmail.com