Major Nipah outbreak feared as infections hit eight-year high

Bangladesh is at risk of facing a major outbreak of the Nipah virus as the number of Nipah cases in the country has hit an eight-year high already this year, with infections occurring in different districts in isolation, health experts have said.

Data from the health directorate show that nine people have been diagnosed with Nipah infections in six districts – Rajshahi, Naogaon, Rajbari, Shariatpur, Pabna, and Dhaka – so far this year. Five of them, including two children, have died.

Besides, several patients have been admitted to hospitals with symptoms of Nipah virus infection.

Among the nine cases reported till Friday, three are children and the rest are aged between 18 and 35. Five of them are women and four are men.

Because the victims acquired the virus principally through the consumption of date palm sap contaminated with bat saliva or urine, health experts have advised people not to consume raw date palm juice and fallen half-eaten fruits to prevent Nipah virus infections.

An official of the Institute of Epidemiology Disease Control and Research (IEDCR) on condition of anonymity said that two to three cases of Nipah were reported in the country in each of the past few years.

"The number of Nipah cases is much higher this year, but an even greater problem is the cases have been reported in separate places. Earlier, many cases were reported in one area with all of them contracting the virus by consuming the same date palm juice. But this time the cases are scattered. And this is a risk factor," the expert said.

"Many districts have infected bats. There is a risk of major outbreaks if people living in those districts consume date palm juice in large numbers. Nipah cases usually occur during the December-April period. There is a risk as long as date palm juice is available," continued the expert.

In 2015, 15 people were infected with Nipah virus in the country, with 11 of them succumbing to death.

According to the IEDCR data, Nipah virus infection has turned out to be the deadliest among all communicable diseases in Bangladesh in terms of mortality rate as 71% of the 334 people who had contracted the virus in the last 22 years died from the disease.

Nipah virus was first detected in the country in 2001 in Meherpur. Since then, cases of Nipah virus have been reported in the country every year except for 2002, 2006 and 2016.

Dr M Mushtuq Husain, adviser of the IEDCR, told The Business Standard that once a Nipah virus patient is found in a place, that place is considered risky.

"This is because anywhere a Nipah virus patient is found is also likely to have bats and palm sap. All parts of the country are vulnerable to the Nipah virus, but the districts where it has been detected are advised to take extra precautions," he explained.

On Thursday, the health directorate said that 32 districts had been marked as "risky" owing to Nipah virus infection. The directorate instructed doctors to take precautionary measures while serving patients coming to the hospital with fever.

The DGHS issued six instructions for healthcare workers who will be treating patients with symptoms of Nipah virus infection. The instructions include wearing a mask and also washing hands with soap before and after seeing a patient.

They have also been advised to move a patient to the isolation ward if they start showing symptoms of a fever. Besides, patients should be admitted to the intensive care unit if their condition is critical. Caregivers of patients in intensive care are only required to wear gloves and masks.

But the Nipah virus is not aerially transmissible, according to the health directorate.

Besides, there is no need to refer an infected patient to another hospital as the treatment for Nipah infection can be ensured in the ICUs. 

Meanwhile, the Dhaka North City Corporation's Covid-dedicated hospital in Mohakhali has been equipped with 20 beds, including 10 isolation beds and 10 ICU beds, for the treatment of Nipah virus patients. Already a 60-year-old patient from Jashore is being treated for suspected Nipah virus in the ICU ward of the hospital. She drank date palm sap and has developed Nipah symptoms.

IEDCR Director Professor Tahmina Shirin said the Nipah virus spreads through the saliva or urine of bats. People get infected with the virus when they drink contaminated raw date palm sap. These persons then spread the infection to their family members or health workers.

She advised people not to consume raw date palm juice and fallen half-eaten fruits to prevent Nipah virus infections.

Professor Dr Nazmul Islam, spokesperson of the Directorate General of Health Services (DGHS), told TBS that to avoid Nipah infections, raw date juice cannot be consumed under any circumstances, and therefore marketing and display of raw date palm juice should be discouraged.

Date juice is being sold through advertising on the social media platform Facebook, he said, adding that the administration should also be proactive in stopping this.

"We have kept the ICUs ready in the hospitals because this is a fatal infection and no private hospital will take in these patients. Patients in the ICUs of government hospitals also face risks because of them [Nipah patients]. So we have separated them. Everyone should be aware of Nipah without getting into a state of panic."