Why is the Nipah virus so deadly? Mumbai doctors delve into the deadly virus wreaking havoc in Kerala

Earlier this week, Kerala reported its first death from Nipah virus - a 14-year-old boy from Malappuram, who was undergoing treatment for it. It is the first death, but the state has already taken it seriously. In the latest development, the state's health minister Veena George stated that 16 out of the 58 samples that were tested for the virus have come back negative. In a ripple effect, neighbouring states have also issued guidelines. While there are border check posts set up between Kerala and Tamil Nadu to avoid the spread of the virus in the state, Karnataka has also issued an advisory stating that people should avoid travelling to the affected areas unless absolutely necessary. But why is this becoming so serious?

According to the World Health Organization, the first outbreak of Nipah Virus (NiV) was reported in 1999 in Malaysia among pig farmers. It was followed by outbreaks in Singapore, Bangladesh and India's West Bengal and Kerala since then. Known to affect countries in Southeast Asia, one of the first cases of Nipah virus in India was found in 2001 in West Bengal and there have been several outbreaks after that. Over the years, Kerala has become a hotspot for the virus with the first case being reported in 2018, followed by cases in 2019, 2021, 2023 and 2024, according to media reports.

As several southern states have got ready to deal with the deadly virus, Mumbai experts share a word of caution even though Mumbai is miles away because it is better to be safe than sorry. As a health guide, mid-day.com spoke to Dr Chhaya Vaja, internal medicine expert, Apollo Spectra Mumbai and Dr Manjusha Agarwal, senior consultant - Internal Medicine Gleneagles Hospitals Parel to dissect the virus. They not only stressed on Nipah virus is deadly and fatal but also why people should avoid fruits that either have cuts or have been half-eaten. They also emphasise on the need for people to avoid visiting affected areas.

Kerala has reported the death of a boy from the Nipah virus, among other cases. What is the Nipah virus and how is it caused?
Vaja: Nipah virus is also known as Henipavirus nipahense. It is a type of virus that is caused by zoonotic pathogens. This means that it can be easily transmitted from animals to humans. It is caused due to infection with the Nipah virus (NiV), which belongs to the Paramyxoviridae family. Nipah virus is transmitted in humans after coming in direct contact with infected bats, their secretion, and also through eating contaminated fruits. Human-to-human transmission is also possible via close contact with an infected individual's bodily fluids such as saliva, and blood.

Agarwal: So, a human can get infected with this virus via fruit bats (flying foxes) and even other animals such as pigs and other animals like goats, horses, dogs, or cats. Currently, the Nipah virus is creating havoc in Kerala and has surfaced again. This brain-damaging virus was also seen in Singapore and Malaysia.

What are the symptoms of Nipah virus?
Vaja: Symptoms of the Nipah virus can vary from person to person. The intensity of these symptoms can range from mild to severe. One can experience symptoms such as fever, persistent headache, muscle pain, vomiting, sore throat, dizziness, drowsiness, unconsciousness, acute encephalitis (a serious condition that leads to inflammation in the brain), acute respiratory distress syndrome (ARDS), breathing difficulties, cough, and shortness of breath. These symptoms can cause discomfort negatively affect individuals' overall well-being and create hindrances in performing daily activities.

Agarwal: The infected person can be completely asymptomatic or one can even experience severe problems. One can also encounter symptoms such as diarrhoea, muscle weakness, breathing problems, seizures, and confusion. One will experience the occurrence of symptoms after 4-5 days from transmission of the virus. These symptoms shouldn't be ignored and require immediate intervention. Currently there is no vaccination available for tackling this virus.

What are the effects of the Nipah virus?
Vaja: The effects of Nipah virus infection can be severe and even life-threatening in some cases. It initially negatively affects the brain, which further leads to acute encephalitis. Encephalitis is a serious condition and results in fatal effects. This can cause long-term neurological effects on the affected individual's brain and even death in some. It allegedly affects the respiratory system and leads to difficulties in breathing which can worsen over time. The mortality rate of the Nipah virus is comparatively high depending on how it was transmitted. Individuals who survive the Nipah virus may suffer from long-term neurological defects including seizures and personality changes.

Agarwal: This virus can negatively impact one's brain by causing seizures, coma apart from encephalitis that damages the brain, and even death. Moreover, acute respiratory infection is also a complication of this virus.

What is the available treatment for the Nipah virus?
Vaja: There is no specific or certified treatment option or vaccine to effectively combat a harmful virus like the Nipah virus. It is a deadly infection that has the potential to cause a pandemic. The only option available for monitoring and managing the symptoms caused by the Nipah virus is supportive care. It significantly helps reduce the intensity of the symptoms and lowers the risk of further complications. Supportive care involves using mechanical ventilation to alleviate respiratory distress caused by the virus, hydration, and also treating secondary infections. Various research and studies are going on to effectively treat and prevent the spread of the Nipah virus.

Agarwal: Currently, there is no treatment available for this virus. The infected person will be provided supportive care and may require hospitalisation, proper hydration, and symptomatic treatment. However, one should refrain from self-medication as it can be risky. It is essential to follow the advice given by the doctor. One infected with this virus will have to ensure he/she takes enough rest to recover quickly.

What makes the Nipah virus deadly and why should people not take it for granted?
Vaja: Nipah virus is deadly and severe as it possesses a higher mortality rate. It can cause various neurological and respiratory complications that can heavily impact their quality of life. The lack of a specific treatment plan or vaccination to effectively tackle the widespread of this fatal virus from person to person. Individuals are advised not to take the Nipah virus for granted and to take necessary precautions and safety measures to avoid getting infected. This can potentially help in managing the symptoms and prevent them from spreading to others.

Vaja: This virus damages the brain by leading to inflammation and hence, shouldn't be taken lightly at all. This virus is known to cause mortality in infected patients and needs timely attention.

When do the cases of the Nipah virus increase? Is there a particular season?
Vaja: Nipah virus cases can significantly rise during certain seasons, making it essential to stay alert for the betterment of your health. It is often connected with fruit bats and their breeding and feeding patterns. Fruit bats are the primary cause of the Nipah virus. The widespread of this virus is more common in seasons like winter and spring in India and worldwide. This is because fruit bats are more likely to search for food during these seasons which can significantly increase the risk of humans and bats interactions. However, it is important to note that the timings and specific seasons can vary from different regions and countries due to different ecological, environmental, and geological factors.

Agarwal: Nipah virus outbreak is commonly seen during the flu season, and post-monsoon period.

In Mumbai, what are the possibilities of people getting affected by the Nipah virus?
Vaja: The possibility of people in Mumbai getting affected by the Nipah virus is relatively low but one should not neglect the harmful effects of this lethal virus. This is because Mumbai is a densely populated city that has significant human movements due to occupational or personal purposes. People in Mumbai are less likely to interact with fruit bats compared to rural areas or areas around the forest. This is because fruit bats are commonly found in forested areas. However, the risk associated with consuming contaminated fruits sustains making it essential to take necessary precautions to minimise the risk.

Agarwal: It is not possible to tell whether people in Mumbai can get infected with the virus. However, if people from Mumbai go to Nipah-virus-prone areas then they have higher chances of getting affected by this virus.

How can people prevent themselves from being infected by the Nipah virus?
Vaja: Preventive measures and strategies are crucial in lowering the risk of getting affected by the Nipah virus. It includes avoiding combining in contact with bats and their secretions. Make sure to thoroughly wash fruits before eating them as they are infected by fruit bats. Avoid buying fruits that have cuts, or marks as if it has been partially eaten by bats or any other animal. Maintaining hygiene can be helpful. Refrain from traveling to areas that are affected areas or existing cases of the Nipah virus.

Agarwal: People need to avoid coming in contact with bats and pigs. Make sure that the fruits they are eating are not contaminated due to bats. Follow good hygiene like washing hands from time to time.

What are the foods that people can eat to prevent the Nipah virus?
Vaja: There are no specific foods or dietary plans to prevent Nipah virus infection. However, maintaining healthy food choices that contain plenty of essential nutrients such as vitamins, minerals, fibres, omega-3 fatty acids, carbohydrates, and zinc can help strengthen your immune system. Healthy and strengthened immune systems effectively help in combating the Nipah virus. Consuming well-cooked food andensuring that fruits are thoroughly washed or peeled to eliminate the risk of infection.

Agarwal: One will have to strengthen the immune system by adhering to a well-balanced diet. Opt for vitamins C and E, such as citrus fruits, nuts, and seeds, and stay hydrated by drinking enough water, foods like garlic and ginger have antimicrobial properties so include them in curries, soups, and lentils. Eating cucumber will also ensure to maintain proper hydration levels in the body.

Are there fruits that people need to avoid to prevent the Nipah virus?
Vaja: Make sure that fruits are washed and disinfected before eating. One can peel the specific fruits to ensure safety such as apple, pear, and chikkoo.

Agarwal: Fruits like dates that have fallen from the trees shouldn't be consumed.

What are the common misconceptions about the Nipah virus?
Vaja: The common misconception about the Nipah virus is that only pigs are more likely to get affected by the Nipah virus. However, it can affect humans and other animals like horses, cats, dogs, and goats. Another common myth is that the Nipah virus is an airborne disease. It can be spread through human contact from person to person.

Agarwal: Here are some of them:

Myth: Nipah is an airborne virus just like Covid-19

Fact: The Nipah virus is transmitted via contact with infected bats, pigs, or their contaminated bodily fluids. It is not like Covid-19.

Myth: All fruit bats carry Nipah Virus that causes brain damage

Fact: Fruit bats are known as natural hosts of Nipah virus but not all bats carry this virus. Only some bats are infected with this virus.

Currently, how many cases have been reported of the Nipah virus? Why has it only affected Kerala till now, and West Bengal in the past?
Vaja: The specific number of reported cases in a particular area varies depending on the number of people affected. Kerala has been severely affected by the Nipah virus due to factors like the presence of fruit bats and increased chances of human and bat interactions. The same goes with West Bengal which also experienced the outbreak of the Nipah virus in the year 2001.

Agarwal: There is no specific reason known regarding why this virus was seen in Kerala and West Bengal. However, these places may have more bats, goats, horses, dogs, or cats that are known to carry this virus.