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Understanding the Recent Nipah Virus Infections in Bangladesh: Cases and Prevention Strategies

In early 2024, the World Health Organization (WHO) was alerted by the Bangladesh National Focal Point for the International Health Regulations of two distinct cases of Nipah Virus (NiV) infection. These instances remind us of the importance of continual infection prevention, a topic that should be of key concern to all healthcare professionals, particularly those in hospitals. The first case was a 38-year-old man from Manikganj district who showed symptoms including fever, respiratory distress, and restlessness. Admitted to Dhaka City hospital on January 16, his condition progressively worsened, necessitating a move to the intensive care unit where he was intubated. The patient was tested using reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) where he was found positive for NiV RNA though the throat swab and anti-NiV Immunoglobulin M (IgM) in the blood serum. Sadly, he died on January 28. Notably, the man had consumed raw date palm sap on December 31, 2023. As of January 30, none of his 91 contacts, including family, community members, or healthcare personnel, tested positive for NiV.

The second patient, a three-year-old girl from Shariatpur district, presented with fever, altered consciousness, and seizures. She was rapidly diagnosed with encephalitis and shock, tested, and confirmed to have NiV infection. Unfortunately, she died on the day her results were confirmed, January 31. Subsequent testing of her identified contacts revealed no further infections. NiV is zoonotic, typically transmitted to humans by infected animals such as bats or pigs, or through consumption of food contaminated by infected animal’s excretions. Direct person-to-person transmission is possible but less common. The virus’ main host is the fruit bat. Incubation varies from 4 to 14 days, with reports of up to 45 days. Diagnosis is primarily done using RT-PCR for body fluids and ELISA for antibody detection.

NiV in humans results in a variety of symptoms, including acute respiratory infection and potentially lethal encephalitis. In outbreaks across Bangladesh, India, Malaysia, and Singapore, fatality rates have been as high as 40% to 100%. Necessitating its control is the fact that currently, no licensed vaccines or antivirals exist for NiV. WHO demonstrates its commitment to infection prevention, assessing the national and regional risks as moderate, and global as low, basing this on the geographic scope of past incidents and the shared ecological corridor for the virus’s natural bat host.

The best strategy for combating NiV infection without a vaccine or licensed treatment includes strengthening early detection, contact tracing, educating the populace about risk factors, backing persons reducing their exposure, delivering prompt supportive care, and ensuring good laboratory practices. Recommended protectives include boiling date palm sap before consumption, avoiding fruits with bat bites, and protective gear when handling sick animals. Health workers should prioritize standard infection control precautions when caring for NiV-infected patients or handling their specimens. Airborne precautions may be necessary. WHO currently advises against any travel or trade restrictions towards Bangladesh on the current evidence.

Source: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON508

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