Re: Nipah virus kills child in Dhaka, infects his father
Re: Nipah virus kills child in Dhaka, infects his father
Published Date: 2013-01-24 14:54:28
Subject: PRO/AH/EDR> Nipah encephalitis - Bangladesh
Archive Number: 20130124.1513132
NIPAH ENCEPHALITIS - BANGLADESH
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Date: Wed 23 Jan 2013Source: BDNews 24 [edited]http://bdnews24.com/health/2013/01/23/nipah-virus-strikes-back
The virus that killed nearly 80 per cent of its total infections in Bangladesh has struck back killing an 8-year-old boy in Dhaka and leaving his father critically ill, the government's disease monitoring agency, IEDCR [Institute of Epidemiology, Disease Control & Research] confirms.
According to its director, the family drank raw date sap brought from Bhaluka on 11 Jan [2013] and fell ill 6 days later. "The boy succumbed on Tuesday [22 Jan 2013] at a Dhaka clinic and his father is in an intensive care unit," Prof Mahmudur Rahman told bdnews24.com.
He said [the presence of the Nipah virus was confirmed] in their laboratory at around 5.45 pm on Wednesday [23 Jan 2013].
The bat-borne Nipah virus that infects a person only after drinking raw date sap and later can pass it on to other persons through contact is a cause of public health concern in Bangladesh as it breaks out every year during January-April.
Since 2001, when it first broke out as an unknown disease, the virus has killed 136 of its 176 victims in 21 districts across Bangladesh.
"It is 100 percent preventable if we can prevent people from drinking raw date sap," the director said, "But once infected, we don't have a cure. It usually takes 7-8 days on average between exposure and signs of symptoms -- fever, altered mental status, and seizure," Prof Rahman said. He said they would watch the family where 8 members took the drink, up to 21 days.
They were also following the families who received the date sap from the same source. "We have discovered that one person from Bhaluka supplied 100 bottles of sap to families in Dhaka," he said. He could not rule out further outbreaks. "We are watchful."
Nipah virus was first detected in Malaysia in 1998 but at present Bangladesh, a hotspot for infectious diseases, is the only country in the world that reports the disease.
Though public health analysts believe that border districts of India have the virus, reports are not available from the Indian government to confirm it [see comment and reference below].
An anthropological study says drinking raw date or palm sap in the morning is an old practice in Bangladesh, especially in rural areas, where there is a general lack of hygiene.
An ICDDR,B study using infrared cameras found that fruit bats perch on the jars, put up on trees to collect the sap, and try to drink the juice. They also urinate into the pot. The _Pteropus_ bat saliva and urine carry the virus. But it gets destroyed if the sap is boiled. "The virus is killed in 70 deg C [158 deg F] temperature," Prof Rahman said.
Bangladesh first confirmed the virus in 2004 after testing samples from the US following the deaths of a number of people from an 'unknown' ailment since 2001.
Meherpur, Naogaon, Rajbarhi, Tangail, Faridpur, Manikganj, Rangpur, Kushtia, and Thakurgaon districts of the central and northwestern regions are highly vulnerable to Nipah [virus infections], according to IEDCR. When it breaks out in a place, panic runs so high that people even desert their homes en masse. The presence of the virus at Bhaluka in Mymensingh is new.
It is not clear why the virus is widespread in some districts, and why it strikes new places, but the date tree is very common in those areas.
"We did not find it in Jessore despite many date trees being there. It was because bats in that region do not carry the virus," Prof Rahman said.
Tracking the history of Nipah [virus] in Bangladesh, bdnews24.com found that it is highly communicable and can be passed on with minimal human contact. Many victims were infected and they died after not taking precautions in taking care of patients. "But you can prevent the infection by washing hands with soap and not sharing the same food," he said, suggesting caregivers should wear masks. "But above all, the campaign should be not to drink raw date sap."
[Byline: Nurul Islam Hasib]
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[Cases of Nipah virus infection occur sporadically in Bangladesh. The most recent major outbreaks reported occurred during the past 2 years (2011 and 2012) at this same period of time. From 31 Jan - 5 Mar 2011, an outbreak in Rangpur region resulted in the deaths of 35 persons, including infants, boys, adolescents, and women (see ProMED-mail archive no. 20110308.0756). In 2012, 6 people died of the infection (see ProMED-mail archive no. 20120212.1040138).
Scientists with villagers have constructed a type of "skirt" made of local materials that denies access of the bats to the palm sap collecting jars. Clearly, this simple technology needs to be spread around through public education, particularly when the bats are pregnant and lactating, when the virus is shed. Boiling the sap, as recommended in the report above, is an alternative. Although drinking raw palm sap is the main source of Nipah virus infection, there is some evidence that eating fruit that has been bitten and contaminated by _Pteropus_ bats has resulted in infections in children.
Although the report above indicates that human Nipah virus (NiV) infections in India have not been documented, an article published in 2012 stated, "NiV RNA was detected in a liver homogenate of _P. giganteus_ captured in Myanaguri, West Bengal. Partial sequence analysis of nucleocapsid, glycoprotein, fusion, and phosphoprotein genes showed similarity with the NiV sequences from earlier outbreaks in India. A serum sample of this bat was also positive by enzyme-linked immunosorbent assay [ELISA] for NiV-specific IgG. This is the 1st report on confirmation of Nipah viral RNA in _Pteropus_ bat from India and suggests the possible role of this species in transmission of NiV in India." India annually reports cases of undocumented "acute encaphalitis syndrome" with no identified etiologic agent in northeastern states. Perhaps some of these may be undiagnosed Nipah virus infections.
Reference
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Yadav PD, Raut CG, Shete AM, et al: Detection of Nipah virus RNA in fruit bat (_Pteropus giganteus_) from India. Am J Trop Med Hyg. 2012 Sep; 87(3): 576-8.
An image of _Pteropus_ fruit bats, "flying foxes", can be accessed at the source URL above.
