Haryana issues advisory on nipah virus gas monkey monster truck hellcat

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Stating this here, a department spokesman said NiV is a highly pathogenic paramyxo virus and large fruit bats of Pteropus genus are its natural reservoirs. Presumably, pig may become infected after consuming partially bat-eaten fruits that dropped in pigsty, he added.

He said that seasonality was strongly implicated in NiV outbreaks in Bangladesh and India. All of the outbreaks occurred during the months of winter to spring, that is between December to May and the incubation period varies from 6 to 21 days. Referring to the mode of transmission, he said two routes of transmission of Nipah virus have been identified from its natural reservoir to human, by way of drinking raw date palm sap contaminated with NiV and close physical contact with Nipah-infected patients. The person-to person transmission may occur from close physical contact, especially by contact with body fluids, he added.

He said the laboratory diagnosis of a patient with a clinical history of NiV could be made during the acute and convalescent phases of the disease by using a combination of tests. Nipah virus is classified internationally as a biosecurity level (BSL) 4 agent. In India, testing facility is available at the National Institute of Virology (NIV), Pune. The Spokesman further said that clinical features of NiV are fever, altered mental status, severe weakness, headache, respiratory distress, cough, vomiting, muscle pain, convulsion and diarrhoea. In infected people, the virus causes severe illness, characterised by inflammation of the brain or respiratory diseases. He said in general, the case-fatality rate is estimated at 40 to 75 per cent. However, this rate could vary by outbreak and could be up to 100 per cent, he added.

The Spokesman said that a systematic surveillance system is necessary to identify clusters of encephalitis cases, resulting in early detection of Nipah outbreaks. The objective of surveillance is to identify clusters of acute encephalitis cases and investigate the clusters of cases for quick detection of Nipah outbreak. He said a person from a community affected by a NiV outbreak, can have symptoms like fever, new onset of altered mental status or seizure or fever with headache or fever with cough or shortness of breath. Suspect case-patient who resided in the same village where confirmed case-patient were living during the outbreak period and who died before complete diagnostic specimens could be collected or suspect case-patients who came in direct contact with the confirmed case-patients in a hospital setting during the outbreak period and who died before complete diagnostic specimens could be collected, the Spokesman added.

He said NiV being a BSL-4 agent, universal, standard droplet and bio-containment precautions should be followed during contact with excretion, secretion and body fluids of suspected patient. Adequate bio-safety precautions should be adopted during collection, transport, storage and processing of suspected sample. The samples should be collected as early as possible, preferably within four days with all bio-safety precautions and accompanied with detailed history of patients on the performa, which could be obtained from the testing laboratory. He said that presently National Institute of Virology, Pune in public sector is the testing laboratory which is diagnosing Nipah virus infection. The Spokesman said that during sample collection, complete disposable Personal Protective Equipment like N 95 mask, double surgical gloves, gowns and goggles should be worn. The attendants collecting samples should wash hands with soap and water at least for 30 seconds and then clean hands using 1-2 ml alcohol-based hand sanitizer before and after collection of samples. The samples may include throat swab in viral transport medium, urine 10 ml in universal sterile container, blood in plain vial (at least five ml) and Cerebrospinal Fluid (CSF) at least one ml in sterile container.

He said the samples should be safely packed in triple container packing and transported under cold chain (2-6C) to the testing laboratory with prior intimation. Before dispatching the sample, the outer surface of the container should be disinfected using 1:100 dilution of bleach or five per cent Lysol solution. He said that sample containing vials should be kept in good quality plastic bags tied with rubber bands, so that inside material if leaks, should not come out of bag. The plastic bag should be kept in another container, which should be sealed with adhesive tape. This carrier should be placed in another plastic bag sealed with rubber bands and placed in thermocol or vaccine carrier containing ice. The case sheets with complete information should be placed in plastic bag and should be pasted outside the container, he said.

The Spokesman said that samples should be transported at 2-6 degree Celsius, if they arrive at the laboratory within 48 hours. If shipping time is expected more than 48 hours, the samples should be sent using dry ice. He said that samples should not be held at -20 degree Celsius for longer periods and it must be stored at -70 degrees, if storage is required for longer period.

He said that a close contact is defined as a patient or a person who came in contact with a Nipah case (confirmed or probable cases) in at least one of the ways. If he has slept in the same household as a case, has had direct physical contact with the case (alive or dead) during the illness, has had direct physical contact with the (deceased) case at a funeral or during burial preparation rituals, has touched the blood or body fluids (saliva, urine and sputum) of a case during their illness and has touched the clothes or linens of a case. These contacts need to be followed up for appearance of symptoms of NiV for the longest incubation period 21 days, he added.

He said currently, there is no known treatment or vaccine available for either people or animals. However Ribavirin, an antiviral may have a role in reducing mortality among patients with encephalitis caused by Nipah virus disease. Intensive supportive care with treatment of symptoms is the main approach to managing the infection in people.

The Spokesman said that Human Nipah virus (NiV) infection is an emerging zoonotic disease, which was first recognised in a large outbreak of 276 reported cases in Malaysia and Singapore from September 1998 to May 1999. In India, during 2001 and 2007, two outbreaks in humans were reported from West Bengal and neighboring Bangladesh. Large fruit bats of Pteropus genus are the natural reservoir of NiV. There is circumstantial evidence of human-to-human transmission in India in 2001. During the outbreak in Siliguri, 33 health workers and hospital visitors became ill after exposure to patients hospitalised with Nipah virus illness, suggesting nosocomial infection. Nipah cases tend to occur in a cluster or as an outbreak.