Nipah virus is a paramyxovirus whose natural host is fruit bats. It was discovered in 1999 during an outbreak among pig farmers in Malaysia. The virus can be transmitted to humans via contact with infected bats or pigs, or through contaminated food/drinks. Person-to-person transmission is also possible. Symptoms in humans range from asymptomatic infection to fatal encephalitis. There is no vaccine yet. Prevention involves avoiding contact with bats/pigs and consuming only thoroughly cooked fruits/drinks.
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
Flu Vaccination Dr Sharda Jain
Contents
What is Influenza
Influenza outbreaks and pandemics
Impact of Influenza
Influenza vaccine: Rationale
Influenza vaccine safety & effectiveness
When, whom & how to vaccinate?
Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the poliovirus. In about 0.5 percent of cases there is muscle weakness resulting in an inability to move.
Two types of vaccine are used throughout the world to combat polio. Both types induce immunity to polio, efficiently blocking person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community.
The new virus has made the jump from pigs to humans and has demonstrated it can also pass from human to human. This is why it is demanding so much attention from health authorities. The virus passes from human to human like other types of flu, either through coughing, sneezing, or by touching infected surfaces, although little is known about how the virus acts on humans.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
coronavirus disease (COVID-19),origin,epidemiology,risk factors and causes,mode of transmission,pathophysiology,signs and symptoms,management,comlication,preventive measures
Live hepatitis a vaccine - Biovac A - A Long term followup studyGaurav Gupta
Live hepatitis a vaccine - Biovac A - A Long term followup study..
Biovac A, Patiala CME - why Hepatitis A is a problem in India, and why Single dose Live HAV is preferable
ARVs are included in the drugs with narrow therapeutic index. It's important for every doctors and health care workers to understand mechanism of ARV resistance. Video file is available in the following link: http://www.youtube.com/watch?v=TvNOmwRh0I0&feature=player_detailpage
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
Flu Vaccination Dr Sharda Jain
Contents
What is Influenza
Influenza outbreaks and pandemics
Impact of Influenza
Influenza vaccine: Rationale
Influenza vaccine safety & effectiveness
When, whom & how to vaccinate?
Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the poliovirus. In about 0.5 percent of cases there is muscle weakness resulting in an inability to move.
Two types of vaccine are used throughout the world to combat polio. Both types induce immunity to polio, efficiently blocking person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community.
The new virus has made the jump from pigs to humans and has demonstrated it can also pass from human to human. This is why it is demanding so much attention from health authorities. The virus passes from human to human like other types of flu, either through coughing, sneezing, or by touching infected surfaces, although little is known about how the virus acts on humans.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
coronavirus disease (COVID-19),origin,epidemiology,risk factors and causes,mode of transmission,pathophysiology,signs and symptoms,management,comlication,preventive measures
Live hepatitis a vaccine - Biovac A - A Long term followup studyGaurav Gupta
Live hepatitis a vaccine - Biovac A - A Long term followup study..
Biovac A, Patiala CME - why Hepatitis A is a problem in India, and why Single dose Live HAV is preferable
ARVs are included in the drugs with narrow therapeutic index. It's important for every doctors and health care workers to understand mechanism of ARV resistance. Video file is available in the following link: http://www.youtube.com/watch?v=TvNOmwRh0I0&feature=player_detailpage
Growing old in a society that has been obsessed with youth may have a critical impact on the mental health of many people. This situation has serious implications for psychiatric nursing.
This chapter focuses on physical and psychological changes associated with the aging process, as well as special concerns of the elderly population, such as retirement, long-term care, elder abuse, and rising suicide rates. The nursing process is presented as the vehicle for delivery of nursing care to elderly individuals.
INTERNATIONAL NURSES DAY
International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale's birth. You can find information about Florence Nightingale on the Florence Nightingale International Foundation (FNIF) web site and the Girl Child Education Fund.
2016 - Nurses: A Force for Change: Improving health systems' resilience
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
3. Overview
• Organism
• History
• Epidemiology
• Transmission
• Disease in Humans
• Disease in Animals
• Prevention and Control
• Actions to Take
Center for Food Security and Public Health, Iowa
State University, 2011
4. Agent
• Genus Henipavirus
– Virus discovered, 1999
– Related to Hendra virus
• Severe, rapidly progressive encephalitis in
humans
– High mortality rate
– Close contact with infected pigs
• Severe, respiratory disease in pigs
Center for Food Security and Public Health, Iowa
State University, 2011
5. • Nipah virus (NiV) is a
paramyxovirus whose reservoir
host is fruit bats of the genus
Grey-headed flying foxes
(Pteropus poliocephaluss)
Center for Food Security and Public
Health, Iowa State University, 2011
7. Center for Food Security and Public
Health, Iowa State University, 2011
8. History
• 1998-1999: Peninsular Malaysia
– Human febrile encephalitis, high
mortality
– New virus discovered
• 1999: Singapore
– Outbreak in abattoir workers
– Pigs imported from Malaysia
●Since 2001 – Bangladesh, India
Center for Food Security and Public Health, Iowa
State University, 2011
9. Center for Food Security and Public Health, Iowa
State University, 2011
11. Reservoir
• Flying foxes (fruit bats)
– Carry the virus
– Are not affected
• Virus found in
– Urine
– Partially eaten fruit (saliva?)
• No known secondary host
Center for Food Security and Public Health, Iowa
State University, 2011
12. Transmission
• Pigs in Malaysia
– Direct contact
– Contact with body fluids
– Aerosolization of respiratory or
urinary secretions
– Vertical transmission across the placenta?
– Semen and iatrogenic spread?
Center for Food Security and Public Health, Iowa
State University, 2011
13. Transmission
• Person-to-person
– Not reported in Malaysia
– Likely in Bangladesh and India
• Nosocomial infections
• Bat-to-person
– Not reported in Malaysia
– Common in Bangladesh and India
• Contaminated fruit, unpasteurized date palm juice
Center for Food Security and Public Health, Iowa
State University, 2011
14. Center for Food Security and Public Health, Iowa
State University, 2011
Photo courtesy of James Roth, DVM, PhD, ISU
15. Center for Food Security and Public Health, Iowa
State University, 2011
Photo courtesy of James Roth, DVM, PhD, ISU
16. Center for Food Security and Public
Health, Iowa State University, 2011
17. Center for Food Security and Public
Health, Iowa State University, 2011
19. Epidemiology
• 1998-1999: Malaysia
– 265 persons hospitalized; 105 deaths
– Primarily adult males with swine contact
– Disease in swine
• Severe respiratory disease
• Transmitted by movement of infected pigs
• 1.1 million pigs culled
• Great economic loss
– Surveillance and testing
Center for Food Security and Public Health, Iowa
State University, 2011
20. Epidemiology
• 1999: Singapore
– 22 seropositive persons (1.5%)
– All were male abattoir workers
– 12 symptomatic
• Encephalitis, pneumonia, or both
– 10 asymptomatic
Center for Food Security and Public Health, Iowa
State University, 2011
21. Epidemiology
• 2001: Siliguri, India
– Nosocomial transmission
• 2004: Bangladesh
– 34 cases; 26 deaths
– Transmission
• Close contact
• Exposure to common source
Center for Food Security and Public Health, Iowa
State University, 2011
22. Epidemiology
• 2005: Bangladesh
– 44 cases; 12 deaths
– Contaminated palm fruit
juice
• 2007: Bangladesh
– 7 cases; 3 deaths
– Person-to-person
transmission
Center for Food Security and Public Health, Iowa
State University, 2011
24. Human Illness
• Incubation period: 4 to 20 days
– Fever and headache
– Encephalitis
• Dizziness, drowsiness, vomiting
• Seizures
• Progresses to coma in 24-48 hours
– Respiratory difficulty
– Relapsing neurologic symptoms
Center for Food Security and Public Health, Iowa
State University, 2011
25. Human Illness
• Complications (Malaysian outbreak)
– Septicemia (24%)
– GI bleeding (5%)
– Renal impairment (4%)
• Asymptomatic
– Relapse or late-onset encephalitis
– Residual neurological deficits
• Treatment: Supportive, ribavirin
Center for Food Security and Public Health, Iowa
State University, 2011
27. Disease in Animals
• Pigs
– Highly contagious
– May be asymptomatic
– Acute fever (>104°F)
– Severe respiratory disease
• Characteristic cough – harsh, “barking”
– Neurological changes
– Low mortality
Center for Food Security and Public Health, Iowa
State University, 2011
28. Disease in Animals
• Dog
– Distemper-like signs
– Fever, respiratory distress
– Ocular and nasal discharge
• Cat
– Fever, depression
– Severe respiratory signs
• Horses
– Encephalitis
Center for Food Security and Public Health, Iowa
State University, 2011
29. Sampling
• Before collecting or sending any samples,
the proper authorities should be contacted
• Samples should only be sent under
secure conditions and to authorized
laboratories to prevent the spread of the
disease
Center for Food Security and Public Health, Iowa
State University, 2011
33. Prevention and Control
• Keep fruit bats away from pigs
• Stay away from the urine and fecal
matters of bats
• Do not drink unpasteurized fruit juices
• Wash, peel, and/or cook all fruit
thoroughly before eating.
• Do not eat fruits like guava, mango etc
bitten by bats
Center for Food Security and Public Health, Iowa
State University, 2011
34. Center for Food Security and Public
Health, Iowa State University, 2011
• To avoid being infected by the virus, avoid
drinking toddy brewed in open containers
near palm trees.
• Staying away from an infected person
• You must maintain a distance of atleast
1M from the patient and
• sanitize and wash your hands properly
after every contact
• Clean your clothes, utensils and bathroom
items like mugs and buckets separately.
Ensure that they are all maintained
hygienically.
35. • Place all the infected patients or
suspected in an isolation ward
• Wear all personal protective equipment's
while talking and assessing the patient.
• All necessary precautions taken for
communicable diseases is applicable for
nipah infected patients also.
• While hand washing use alcohol
containing hand rubs.
• Don’t allow nipah infected patients to get
in contact with other patients
Center for Food Security and Public
Health, Iowa State University, 2011
36. • Mask , gown , gloves has to be used all
the time while in contact with the patient.
• N95 mask are intended for use in a nipah
virus care setting . Specifically, single-use,
disposable respiratory protective devices
used and worn by healthcare personnel
during procedures to protect both the
patient and healthcare personnel from the
transfer of microorganisms, body fluids,
and blood
Center for Food Security and Public
Health, Iowa State University, 2011
37. • Wash your hands every 20 minutes with
chlorhexidine or alcohol contented solution
if your are taking care of the patient.
• Use disposal equipment's and in need of
reuse it has to be autoclaved with 2% glut
aldehyde.
Center for Food Security and Public
Health, Iowa State University, 2011
38. • While carrying the dead body of anyone
who dies of Nipah infection, it is important
to cover your face properly.
• Relatives or friends of the deceased
person must try and avoid hugging or
kissing the dead person.
• Take utmost care while bathing the dead
body.
Center for Food Security and Public
Health, Iowa State University, 2011
39. • Things used by the dead patients has to
kept under sunlight for a longer period if it
is to be used again.
Center for Food Security and Public
Health, Iowa State University, 2011
40. Nipah as a
Biological Weapon
• CDC Category C Bioterrorism Agent
• Emerging pathogen
• Potentially high morbidity
and mortality
• Major health impact
• Aerosolization potential
• Economic impact
• Social disruption (fear, panic)
Center for Food Security and Public Health, Iowa
State University, 2011
41. Center for Food Security and Public
Health, Iowa State University, 2011
42. Additional Resources
• World Organization for Animal Health
(OIE)
– www.oie.int
• U.S. Department of Agriculture (USDA)
– www.aphis.usda.gov
• Center for Food Security and Public Health
– www.cfsph.iastate.edu
• USAHA Foreign Animal Diseases
(“The Gray Book”)
– www.usaha.org/Publications.aspx
Center for Food Security and Public Health, Iowa State University, 2011
In today’s presentation we will cover information regarding the organism that causes Nipah virus infection and its epidemiology. We will also talk about the history of the disease, how it is transmitted, and the clinical signs seen in species it affects (including humans). Finally, we will address prevention and control measures for Nipah virus infection, as well as actions to take if an infection with Nipah virus is suspected.
Nipah virus was discovered in 1999. It is a paramyxovirus in the genus Henipavirus; Hendra virus is also within this genus. Different variants of Nipah virus were involved in outbreaks in Malaysia, Bangladesh, and India, and t least two major strains of Nipah virus were isolated from pigs in Malaysia. Nipah virus causes severe, rapidly progressive encephalitis in humans, and severe respiratory illness in pigs. Some pigs may also demonstrate nervous system signs. Nipah virus infection has a high mortality rate in humans. Transmission of the disease to humans is associated with close contact with infected pigs. Nipah virus survives in the environment for long periods in favorable conditions; it survives for days in fruit bat urine and contaminated fruit juice.
NON SEGMENTED NEGATIVE SENSE SINGLE STRANDED RNA
ENCAPSULATED
POLYMORPHIC BUT USUALLY SPHERICAL OR FILAMENTOUS
HELICO NUCLEOCAPSID
From September 1998 to April 1999, human cases of febrile encephalitis with high mortality were reported by the Malaysian Ministry of Health. Initially Japanese encephalitis (JE) was suspected; however, serological tests and the disease epidemiology suggested a different disease. Tissue culture isolation from cases identified an unrecognized paramyxovirus closely related to Hendra virus. Nipah virus was named after the village (Sungai Nipah) where the first cases were reported. (NOTE: Hendra virus is a severe respiratory and encephalitic disease causing virus that affects humans and horses.) In March 1999, a similar outbreak occurred in Singapore. The disease affected abattoir workers that had been exposed to pigs imported from Malaysia for slaughter. Since 2001, human outbreaks and clusters of cases have been reported periodically in Bangladesh and a neighboring region of northern India.
This is a map showing peninsular Malaysia and its close proximity to Singapore; these are the two locations of the Nipah virus outbreaks in 1998 and 1999. Serological surveys (indicated by the boxes and circles) of various animal species were conducted to determine the reservoir host as well as the potential spread to humans.
[The map is from Emerging Infectious Diseases 2001;7(3):439-41].
The primary reservoir for Nipah virus are flying foxes (also known as fruit bats) of the genus Pteropus. Transmission of Nipah virus from bats to swine has not been shown conclusively; however, there are various biologically plausible means for infected secretions of primary hosts to enter pigs, including direct contact with infected secretions contaminated fruit or dead bats. Scavenging animals may also play a role in the transport of virus into proximity of pigs. Flying foxes are able to carry the virus without being affected by it. Investigation of potential secondary hosts (peridomestic species) have also been conducted. Rats, house shrews, dogs, and chickens have been tested, but no indication of a secondary host has been found.
[This is a picture of a Malayan flying fox (Pteropus vampyrus) (picture is courtesy of Dr. Jasbir Singh, Veterinary Research Institute, Ipah Malaysia).]
It is unclear how the virus was transmitted from bats to pigs in Malaysia. However, it is suspected that fruit trees close to pig confinement areas are foraged by the bats and the virus is spread by urine or saliva-contaminated partially-eaten fruit on which the pigs feed. The majority of human cases (93%) have been related to close contact with pigs, either from direct contact or contact with body fluids, urine, or feces. Aerosolization of urinary or respiratory secretions may be a possible route of transmission and is being investigated. The role of dogs and cats (in close contact with infected pigs) in the transmission of the disease is also being explored. Anecdotal evidence suggests that vertical transmission may occur across the placenta. Transmission in semen and iatrogenic spread on re-used needles have also been suggested.
To determine the potential for person-to-person transmission in Malaysia, a survey of persons involved with case-patients was conducted. Family members, physicians, nurses, and pathologists who had direct contact with infected persons had no signs of illness or serological evidence of Nipah virus infection. Additionally, there was no serological evidence of human infection among bat handlers, although children who ate contaminated fruit did become sick in Bangladesh. Ingestion of virus in contaminated, unpasteurized date palm juice may have been the source of an outbreak in Bangladesh in 2005. Since 2001, human outbreaks and clusters of cases have been reported periodically in Bangladesh and a neighboring region of northern India. In some of these outbreaks, Nipah virus seems to have been transmitted directly from bats to humans, with person-to-person transmission the most significant means of spread. Humans can shed Nipah virus in upper respiratory secretions and urine. Nipah virus may be transmitted on fomites. Nipah virus survives in the environment for long periods in favorable conditions; it survives for days in fruit bat urine and contaminated fruit juice.
These are several of the hog confinement barns that were affected during the Malaysia Nipah virus outbreak. The reservoir fruit bats live in these caves and feed on the fruit trees that are in close proximity to the hog confinement barns.
(Photo courtesy of James Roth, DVM, PhD – Iowa State University)
This slide shows additional hog confinement barns in Malaysia. There are many fruit trees and caves close to this location.
(Photo courtesy of James Roth, DVM, PhD – Iowa State University)
The 1998-1999 outbreak of Nipah virus in Malaysia occurred in three clusters. A total of 265 persons were infected and required hospitalization. There were 105 fatalities (40% mortality). Ninety-three percent (93%) of these cases had close contact with infected pigs. Adult males, pig farmers in particular, were the majority affected. Pigs were also affected during this outbreak. Severe respiratory disease was rapidly spread by movement of infected pigs from farm to farm. Some pigs also demonstrated neurological signs. The pig population in Malaysia prior to the outbreak was 2.4 million animals. [The total value of annual national output was estimated at about US$400 million, and total export value at US$100 million.] During the outbreak, over 1.1 million pigs were culled to prevent further spread of the disease, which resulted in a substantial economic loss for this country (an estimated cost of about US$97 million) and loss of export trade (estimated cost of about US$120 million). Additionally, local pork consumption during the outbreak dropped by 80%. Serological surveillance of farms and random testing of pigs at abattoirs is currently being performed.
Shortly after the 1999 outbreak in Singapore, a serological survey of various risk groups was conducted in Singapore. From the 1,469 persons tested, 22 were found to be infected with Nipah virus. Ten of these individuals were asymptomatic. Of the 12 persons (54.6%) demonstrating symptoms, 9 had encephalitis, 2 pneumonia, and 1 had both.
An outbreak in Siliguri, India in 2001 was linked to nosocomial transmission in hospitals and ended after effective barrier nursing precautions were put in place. A 2004 outbreak of Nipah virus occurred in the Faridpur District of Bangladesh in mid-March 2004. Thirty-four human cases were identified, and 26 people (76%) died of the disease. Transmission of the disease may have occurred through close contact with infected patients or exposure to a common source (www.cdc.gov/eid).
In 2005, an outbreak began in the Tangail District on Bangladesh when 13 people lost consciousness after drinking palm fruit juice. The fruit may have either been contaminated with fruit bat droppings or saliva as the fruit may have been partially eaten by the bats. Blood samples from the suspected cases were sent to the CDC to confirm Nipah virus infection, and one was a confirmed positive. There were a total of 44 cases and 12 deaths from Nipah virus as of February, 2005 (http://www.promedmail.org).
In February 2007 an outbreak of Nipah virus encephalitis occurred in Thakurgaon District of northwest Bangladesh. Seven people were infected, three of whom died. Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to Nipah virus confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission.
The incubation period in humans is usually four to 20 days; however, incubation periods as short as two days or as long as a month have been reported. Some people may remain asymptomatic during the initial infection, but develop serious neurological disease up to four years later. The first symptoms are generally fever, headache, and myalgia followed by dizziness, drowsiness, disorientation, and vomiting. Encephalitis and seizures occur in severe cases which progress to coma within 24-48 hours. Some patients have respiratory illness.
Septicemia, bleeding from the gastrointestinal tract, renal impairment, and other complications can occur in severely ill patients. In the Malaysia outbreak, the mean time from onset of illness to death was 10.3 days. Duration of illness for those that recovered was 14.1 days. Cases that progress to encephalitis are often fatal. Surviving patients may have mild to severe residual neurological deficits, or remain in a vegetative state. Patients who recover from neurologic disease may relapse with encephalitis several months to several years later. Encephalitis can also occur as long as four years or more after an asymptomatic or non-encephalitic infection. In the Malaysian outbreak, the subclinical infection rate was estimated to be 8 to 15%. The case fatality rate in the various outbreaks has varied from 33% to approximately 75%; the overall case fatality rate for all outbreaks in Bangladesh between 2001 and February 2005 was 64%. Current treatment involves intensive supportive care. Early treatment with ribavirin may reduce the severity of the disease.
Nipah virus in swine is highly contagious and easily spreads by transport of pigs from farm-to-farm. The incubation period has been reported to be 7 to 14 days (as short as 4 days). Many affected swine can be asymptomatic. Those affected develop an acute fever (>104 degree˚F) and rapid, labored, open-mouth breathing. They also have an unusual loud and explosive barking cough (called the “1 mile cough”). Clinical disease in swine varies according to the age of the pigs. In nursery and grower pigs, acute febrile illness with respiratory signs are most commonly seen. In severe cases, blood-tinged mucous discharge from the nostrils may been seen. In less severe cases, open mouth breathing occurs. Neurological signs are also possible and include trembling, twitching, muscular spasms, rear leg weakness and possible lameness or spastic paresis. In sows and boars, affected animals may be found dead overnight or may demonstrate acute febrile illness with labored breathing (panting), increased salivation, and serous, mucopurulent, or blood tinged nasal discharge. Neurological signs in sows appear to be more common than in younger animals, and may include agitation and head pressing, tetanus-like spasms and seizures, nystagmus, and pharyngeal muscle paralysis. Abortions in affected sows have also been reported. The morbidity rate is estimated to approach 100% but the mortality rate is low (1 to 5%), except in piglets (40%). In some instances, illness in pigs occurred 1-2 weeks before illness in humans, making pigs good sentinels for human disease.
Disease in other animal species is poorly documented; however, serological evidence of Nipah virus infection has been reported in bats, dogs, horses, and cats. Clinical signs reported for infected dogs include signs that resemble canine distemper: fever, respiratory distress, conjunctivitis, and mucopurulent nasal and conjunctival discharge. There has only been 1 reported field case of a cat infected with Nipah virus; however, an experimental study on 2 cats indicated they are affected by Nipah virus. Both cats became febrile, depressed, and exhibited respiratory distress. 3,000 horses in Malaysia were serologically examined (by the serum neutralization test); two had neutralizing antibodies to Nipah virus and one showed neurological signs. All three horses were from a single property surrounded by infected pig farms.
Before collecting or sending any samples from animals with a suspected foreign animal disease, the proper authorities should be contacted. Samples should only be sent under secure conditions and to authorized laboratories to prevent the spread of the disease.
Differential diagnoses for Nipah virus in swine include: classical swine fever, PRRS (porcine reproductive and respiratory syndrome), Aujeszky’s disease (pseudorabies), swine enzootic pneumonia (Mycoplasma hyopneumoniae), and porcine pleuropneumonia (Actinobacillus pleuropneumoniae). Laboratory diagnostic methods for Nipah virus include serology, histopathology, immunohistochemistry, electron microscopy, polymerase chain reaction (PCR), and virus isolation.
Preventing infections in pigs can decrease the risk of infection for humans. In endemic areas, pigs and fruit bats should be avoided whenever possible. Fruit tree plantations should be removed from areas where pigs are kept. Wire screens can help prevent contact with bats when pigs are raised in open-sided pig sheds. Run-off from the roof should be prevented from entering pig pens. Transmission on fomites is also possible; re-used vaccination needles may have contributed to the spread of the virus in Malaysia. During an outbreak, equipment and other fomites should be cleaned and disinfected. In addition, dogs and cats should be prevented from contacting infected pigs or roaming between farms. Unpasteurized juices should not be drunk, and fruit should be washed thoroughly, peeled, or cooked. Good personal hygiene, including hand washing, also reduces the risk of infection.
(Photos of flying fox and partially eaten fruit taken from the Department of Sustainability and Environment, Victoria, Australia at www.dse.vic.gov.au)
Nipah virus has been listed by the Centers for Disease Control and Prevention as a Category C potential bioterrorist agent - an emerging pathogen which has potentially high morbidity and mortality rates as well as a major health impact. Currently, spread of the disease involves close contact with pigs; however, aerosolization may be a possible bioterrorist method of dispersal. Additionally, the potential for this virus to infect a wide range of hosts and produce significant mortality in humans makes this emerging virus one of public health concern. Due to the need to cull infected pigs, attack with this agent could have a great economic impact on our pork industry. Additionally, during the Nipah virus outbreak in Malaysia, widespread panic and fear occurred until the outbreak was brought under control.