Amid fears that Nipah virus has spread to other states such as Karnataka and Himachal Pradesh, the Union Health Ministry on Thursday night issued an advisory for general public and healthcare personnel mentioning the preventive measures they should adopt in high-risk areas, along with information on how the disease spreads and what are the symptoms.
The ministry advised the general public to avoid consuming raw date palm sap or toddy, half-eaten fruits from the ground and refrain from entering into abandoned wells and eat only washed fruits. It informed that handling of bodies of those who died due to the disease should be done in accordance with the government advisory and that during this emotional moment traditional rituals and practices may need to be modified to prevent the exposure of family members to the disease.
The advisory informed that Nipah virus which commonly affects animals such as bats, pigs, dogs, horses, etc. can spread from animals to humans and can sometimes cause serious illness among humans. Spread of Nipah virus to humans may occur after close contact with other Nipah infected people, infected bats, or infected pigs. Bat secretions laden with virus can infect people during fruit tree climbing, eating/handling contaminated fallen fruits or consuming raw date palm sap/juice or toddy, the advisory mentioned.
It said that human-to-human infection can occur from close contact with persons affected with Nipah at home while providing care or close contact and in hospital setting if appropriate personal protective equipments are not used. It highlighted that people who are exposed to areas inhabited by fruit bats/ articles contaminated by secretions such as unused wells, fruit orchards, etc. are likely to be at higher risk of infections.
Persons with direct contact with sick pigs or their contaminated tissues, persons in close contact with a Nipah virus affected deceased during burial or cremation rituals or health care workers having direct contact with probable or confirmed cases without using standard precautionary measures are also at a high risk of developing the infection.
The ministry issued a separate advisory for healthcare personnel and advised them to wash hands thoroughly with soap and water for 20 seconds after contact with a sick patient, practice precautions for infection control while handling Nipah cases (suspected/ confirmed), limiting use of injections and sharp objects. For aerosol-generating procedures, personal protective equipment (PPE) such as individual gowns (impermeable), gloves, masks and goggles or face shields and shoe cover and the procedure should be performed in airborne isolation room.
All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected as per manufacturers’ instructions and hospital policies. If the use of sharp objects cannot be avoided, ensure that precautions are observed like never replace the cap on a used needle, never direct the point of a used needle towards any part of the body, do not remove used needles from disposable syringes by hand, and do not bend, break or otherwise manipulate used needles by hand, never re-use syringes or needles, dispose of syringes, needles, scalpel blades and other sharp objects in appropriate, puncture-resistant containers.
Ensure that containers for sharps objects are placed as close as possible to the immediate area where the objects are being used (‘point of use’) to limit the distance between use and disposal, and ensure the containers remain upright at all times, the advisory said.
Earlier today, Minister of State for Health Ashwini Kumar Choubey asked people not to panic, asserting that it was a “localised” occurrence in Kerala, where the number of deaths due to the outbreak has reached 12. Amid reports that dead bats have been found on the premises of a government school in Himachal Pradesh and two people suspected to be infected with the brain-damaging Nipah virus are under treatment in Karnataka, Choubey said the samples of dead bats found in HP have been sent to the National Institute of Virology (NIV) for investigation.
A multi-disciplinary central team led by the Director of the National Centre for Disease Control (NCDC) is constantly reviewing the situation of the Nipah virus disease in Kerala. According to the advisory, large fruit bats of Pteropus genus are the natural reservoir of NiV. Presumably, pigs may become infected after consumption of partially bat eaten fruits that are dropped in pigsties. Seasonality was strongly implicated in NiV outbreaks in Bangladesh and India. All of the outbreaks occurred during the months of winter to spring (December-May) and the incubation period varies from 6-21 days.