Nipah virus: UAE issues Kerala travel warning

The UAE Ministry of Health and Prevention (Mohap) has asked people to put off unnecessary travel to Kerala, India where a Nipah virus (NiV) outbreak has claimed 10 lives while at least 40 others are in quarantine.
In a statement issued on Thursday, the ministry said that it was closely monitoring the situation. "The ministry works with its strategic partners to assess the risk of importation of Nipah virus (NiV) cases to the country and put the necessary control measures. Also, Mohap is in continuous coordination with the World Health Organisation (WHO) to implement the global recommendations," read the statement.
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"Mohap alerts the people travelling to Kerala to be aware of possibly of contracting the infection and advises them to postpone unnecessary travel till the situation will be controlled," it added.
In a statement Dubai-based airline, Emirates said that they are monitoring the situation closely. The statement read: 

"Emirates is aware of recent Nipah cases reported in the state of Kerala, India. The safety of our passengers and crew will always be our top priority, and we are monitoring the situation closely. With regards to preventive or other measures, we will take guidance from the World Health Organisation (WHO) and other international bodies. At this time, there are no recommended actions for airlines.

Reports indicate that the Nipah cases originated in, and are currently contained in the area around Kozhikode, a northern district of Kerala. We do not operate to Kozhikode. The closest airport that Emirates operates to, is Kochi, which is about 5.5 hours drive to the south."

While the WHO has not issued any specific advice to countries - including the UAE - that have not been affected by the Nipah virus (NiV), it has asked them to enhance level of preparedness.
The organisation said that the preparedness level should be enhanced due to the population and goods movements between the countries and India where a current outbreak has claimed 10 lives while at least 40 others have been put in quarantine.
Among the advisories given, the WHO has advised countries to enhance surveillance at health care facilities including at points of entry and give case definitions among healthcare workers (HCWs).
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The health body said that NiV symptoms are none specific and include flu like illness, hence can be confused with any respiratory illness.
"Therefore, training of HCW might be needed to early detect cases including for those who serve at clinics at points of entry," it said.
WHO has also recommended establishing hospital-based surveillance for encephalitis and ensuring presence of lab diagnostic capacities among a range of other clinical measures including detection and reporting as well as educational measures displayed at key entry points.

Background

NiV was first detected in Malaysia in 1998. In that outbreak, 265 human cases were identified in Malaysia, and 11 abattoir workers in Singapore became ill following contact with imported pigs, with an overall case fatality rate of 40 per cent.
NiV infection was subsequently recognized in Bangladesh in 2001 and annual outbreaks have occurred in that country since, with disease also occurring periodically in eastern India with a case fatality ranging from 75 per cent to 100 per cent.
The fourth country reporting Nipah virus infection is the Philippines. This is the first time to have NiV confirmation in Kerala, which can be attributed to the movement of animal hosts.
The natural host of the virus are fruit bats. Human infections can result from contacts with infected pigs, which have been documented to be intermediate hosts (and amplifiers) in some outbreaks.
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Also, humans became infected with NiV as a result of consuming food products contaminated by secretions of infected fruit bats (including raw date palm sap contaminated by infected fruit bats).
Human-to-human transmission has also been documented, including in a hospital setting in India.

Signs and symptoms

NiV infection in humans has a range of clinical presentations, from asymptomatic infection to acute respiratory syndrome and fatal encephalitis. NiV is also capable of causing disease in pigs and other domestic animals.
NiV infection is a newly emerging zoonosis that causes severe disease in both animals and humans.
Symptoms of the disease include:
> Breathing trouble
> Brain swelling
> Fever
> Headache
> Drowsiness, disorientation and delirium.
> A patient can fall into a coma within 48 hours.
The disease travels through direct contact with a patient. There is no vaccine for the virus yet and main treatment for those infected is intensive supportive care.

Key facts

* Nipah virus is an RNA virus that is part of the Paramyxovidae family that was first identified as a zoonotic pathogen after an outbreak involving severe respiratory illness in pigs and encephalitic disease in humans in Malaysia and Singapore in 1998 and 1999.
* Nipah virus can cause a range of mild to severe disease in domestic animals such as pigs.
* Nipah virus infection in humans causes a range of clinical presentations, from asymptomatic infection (subclinical) to acute respiratory infection and fatal encephalitis.
* Nipah virus can be transmitted to humans from animals (bats, pigs), and can also be transmitted directly from human-to-human.
* Fruit bats of the Pteropodidae family are the natural host of Nipah virus.
* There is no treatment or vaccine available for either people or animals. The primary treatment for humans is supportive care.
* Nipah virus is on the WHO list of Blueprint priority diseases
In the absence of a licensed vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to and decrease infection from NiV.
asmaalizain@khaleejtimes.com

• India

Asma Ali Zain

asmaalizain@khaleejtimes.com