The much feared Nipah virus which has taken a toll on patients in Kozhikode in north Kerala, is now a cause for concern among the medical fraternity in Karnataka. However the Karnataka health and family welfare department is in a wait and watch mode because it has not received any communication from the Union government to issue a alert and put in place a surveillance mechanism. Adding to the woes of the doctors in both Kerala and Karnataka is the lack of specific drugs and no resistance to the disease.
 
"Nipah virus outbreak in Kerala has strongly shaken the region and neighbouring states as this disease has claimed few lives in the past 48 hours. The virus spreads by consuming infected fruits like mango and fresh date palm sap contaminated by bats and also by coming in direct contact with an infected patient and sometimes infected pigs. The incubation period of the virus is 3 to 14 days. If infected, the patients may have high fever, headache and cough which may rapidly progress to breathing difficulty, respiratory failure, seizures, delirium and coma”, said Dr Mahesh Kumar, Consultant – Internal Medicine, Narayana Health City.

Sharing similar apprehensions was Dr Ravikeerthy M, Consultant Physician and HOD, Department of Internal Medicine, BGS Gleneagles Global Hospitals, Bengaluru, who said that there is no specific treatment available at present except for the drug Ribavirin which has shown to be effective in some cases in-vitro trials. But it is limited to supportive care. Standard barrier nursing techniques are important in preventing the infection because the mortality is high at 70-80%.
 
Now Ribavirin is the only available medicine that can control the symptoms but only to a certain extent, if started during early stages. Travellers should avoid visits to endemic areas until the disease is curtailed and in case of recent transit they should look out for symptoms like fever, headache and cough and will need to seek medical care immediately, stated Dr. Kumar.
 
While the R&D is going on to develop treatment and a preventive vaccine for Nipah virus, however, one of the key triggers to recent increase in disease incidence is human encroachment into breeding areas. According to WHO, there is strong evidence that emergence of bat-related viral infection communicable to humans and animals has been attributed to the loss of natural habitats of bats. As the flying fox habitat is destroyed by human activity, the bats get stressed and hungry, their immune system gets weaker, their virus load goes up and a lot of virus spills out in their urine and saliva, added Dr. Kumar.

Sharing the diagnosis for Nipah, Dr. Ravikeerthy said that the antibody detection by ELISA method. Virus isolation by RT –PCR is the confirmative test. Throat swab, blood and CSF samples are used for the tests. Along with the National Institute of Virology in Pune, in Bengaluru, Manipal Hospitals, MS Ramaiah and NIMHANS also have the ability to test and verify results.
 
It is critical to use standard barrier nursing techniques with proper isolation of the patients. Timely laboratory confirmation and aggressive epidemiologic tracing of contacts with patient quarantine and isolation can contain spread of the virus. This is important because there is no effective specific treatment for the infection, noted Dr. Ravikeerthy.