Emergence of Nipah Virus: Need More R&D and Public Health Infrastructure

Abstract

An infectious disease outbreak of Nipah virus (NiV) in Kozhikode and Malappuram districts in Kerala (India) has left at least 17 people dead of 18 cases brought the world's attention in May 2018. The most cases of this outbreak are of family members or health workers caring for individuals. NiV is a zoonotic virus whose natural host is the fruit bat (Pteropus bat species) and its outbreak was first reported in 1998-99 when virus moved to pig farmers from pigs in Malaysia and Singapore, infecting 276 and resulting in 106 deaths. Later in 2004 the Philippines NiV outbreak claimed 9 deaths out of 17 reported cases. In India, the NiV infection was first reported in 2001 followed in 2007 claiming 50 lives at the death rate of 70% in both the outbreaks. Annual outbreaks occur in Bangladesh since it was recognized in 2001 through consumption of the contaminated sap of date palm trees by infected bats and there were 199 deaths from 261 cases with case fatality ratio >76% till 2015. A total of six hundred cases have been reported between 1998 and 2015 of NiV infection by WHO in the south and east Asia. There is no specific treatment or vaccine available against NiV infection and only supportive care is offered to affected individuals. The virus has reported from Pteropus bats and other bat species from countries like Indonesia, Philippines, Thailand, Madagascar, Cambodia, and Ghana. While WHO reports the risk of geographical spread of Nipah outbreaks to be low, the wide distribution and extensive migration of fruit bats species raise concerns about the pandemic of NiV with devastating zoonotic potential. Since NiV infection is contagious with a very high mortality rate it is listed as category a biological warfare agents requiring biosafety laboratories of containment level 4 for handling limiting the interest in NiV research. The high end infrastructure requirement further hinders the research and development in the field of diagnosis and therapeutics in the low income affected countries [1-3].