Nipah virus: will it start the new pandemic?

A few weeks ago, the Punjab Department of Health suddenly issued a health advisory for a possible Nipah virus infection in Pakistan. While I was trying to find the reasons for this alert, one after another, provincial departments of health started to issue similar alerts, creating some panic among the population. TV channels and YouTube vloggers had a couple of field days spreading more fear and, in return, gaining “views”. But how dangerous is the Nipah virus, and how likely is it to spread in Pakistan? Is it also true that Nipah has the potential to start the next pandemic? Let’s try to find answers to these questions.

Nipah was identified as a new disease in 1999 in Malaysia. The disease spread from pigs to humans and killed more than two hundred people. Nearly a million pigs were also culled to stop the transmission, creating a huge economic loss for the country. Quickly, this new virus was identified, including its host, which is a type of fruit bat also called a flying fox. These bats eat fruits and the remaining fruit which has the saliva of the bat, is dropped on the ground. This is eaten by pigs, making them infected and sick, and then this infection is passed on to humans who are taking care of these pigs. In the beginning, infection was concentrated among those who had animal exposure. However, later, Bangladesh and India started reporting yearly outbreaks of Nipah. In the absence of commercial pig farms in Bangladesh, the raw consumption of palm sap was identified as the major risk factor. Also, human to human transmission became established, raising the risk of a wider spread of the disease.

With a fatality rate of 40–75% (meaning more than half of patients could not survive this disease), the WHO has added this to its “Priority Pathogen” list, meaning it has a high potential of starting an epidemic, and currently we don’t have effective vaccines or medicines against it.

Once infected, it is difficult to diagnose in the early phase as it is indistinguishable from other viral diseases, but it affects mostly brain tissues, and diagnostic tests are available such as PCR. We could stop the transmission by using earlier Covid-19 preventive measures like washing hands with soap and water, keeping surfaces clean, and avoiding exposure to sick animals or humans. In hospitals, we need to strengthen infection control practices not only for Nipah but for all infectious diseases.

So, what are the chances of Nipah virus outbreaks in Pakistan or other countries where it has not been reported yet? The first lesson about infectious diseases is that “infectious diseases don’t respect national borders”. So, an infected person could reach anywhere because we are too well connected these days. Pakistan is at the edge of the range of these flying bats, but nearly half of Pakistan is within their reach. We don’t have pig farms, but we do have a lot of palm trees, including date trees, in the south of the country. Even though no case has ever been reported, I would still recommend that the public should be educated to not to eat fallen fruit, especially if half eaten by bats or birds. Wash all fruits fully before consuming them. If palm sap is consumed anywhere, it should be boiled before use.

At this moment, there is no urgent threat of Nipah, but the emergence of an unknown virus is what keeps me awake. SARS-CoV-2, the virus that started the Covid-19 pandemic, was a new virus but killed more than seven million people in just three years. To ensure the safety and survival of our population, we need to strengthen our public health system, have a strong disease surveillance system so that we can detect an emerging threat quickly, and then have a response system that could contain it locally and eventually control it. Unfortunately, none is here in a meaningful way. That is what our health departments need to do, rather than just issuing disease alerts.

Published in The Express Tribune, October 26^th, 2023.

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