KATHMANDU: Following the confirmation of Nipah virus infection in India’s West Bengal, concerns have grown in Nepal over the potential risk of its spread. So far, no Nipah cases have been reported in Nepal. However, due to the open border with eastern India, the government and health authorities have gone on alert. As a precautionary measure, health surveillance has been intensified at eastern border points.
Nipah is an extremely deadly and fast-spreading zoonotic virus that is transmitted from animals to humans. The World Health Organization has listed it among high-risk viruses with the potential to cause future pandemics. Experts say the fatality rate of Nipah virus infection can range from 40 to 75 percent.
Amid such serious concerns, how prepared is Nepal to deal with this virus? What preparations are underway to control potential risks? And what precautions should the public take?
To explore these issues, Khabarhub spoke with Dr. Sher Bahadur Pun, senior infectious disease specialist at Sukraraj Tropical and Infectious Disease Hospital, Teku.
How high is the risk of the Nipah virus spreading to Nepal after outbreaks in neighboring India?
With the Nipah virus spreading rapidly in India, the risk has also increased for Nepal. Since cross-border movement between Nepal and India is relatively easy, there is a possibility that the virus could enter Nepal. There is also a risk of internal transmission.
The virus was first identified in Malaysia in 1999, where it spread through pigs. However, the strain currently seen in India appears to be transmitted from bats. Reports suggest that the virus spreads when humans come into contact with food partially eaten by bats or with bodily fluids from bats.
From that perspective, it would not be wrong to say that Nepal is also within the Nipah risk zone. Although the virus has been present in Bangladesh and India since 2001, it has not spread on a massive scale like COVID-19. However, the current outbreak in India is spreading at nearly double the rate seen in Malaysia. While the fatality rate in Malaysia was around 40 percent, it has been reported to be more than double that in India.
This means Nepal must remain alert. The species of bats identified as carriers in India are also found in Nepal. However, there is no confirmed evidence so far that transmission from these bats has occurred in Nepal. This raises the question of whether cases may exist but remain undetected.
In India and Bangladesh, people have easier contact with bats because forests are rich in fruit-bearing trees. There have been reports of people getting infected after consuming fruits partially eaten by bats.
Nepal’s situation is somewhat different. People do not frequently enter forests, and even those who go for firewood or fodder generally do not come into direct contact with bats.
However, with the growing trend of hiking and forest picnics, future risks cannot be ruled out. Recently, some patients have also reported being bitten by bats inside homes. Increased human–bat contact, deforestation, and climate change could raise the risk of Nipah and similar viruses.
How can one identify Nipah virus infection? What symptoms appear?
The main symptom is swelling of the brain, known as encephalitis. In the early stage, symptoms resemble those of seasonal flu. These include cough, fever, body aches, sore throat, and headache.
Because these symptoms are also common in pneumonia and seasonal flu, people often do not take them seriously. As a result, early detection becomes difficult.
What tests are required to confirm infection?
The virus can be detected through body fluids such as blood, stool, urine, and cerebrospinal fluid. Similar to COVID-19 testing, nasal and throat swab tests can also be used.
However, since Nipah is a highly fatal virus, testing must be conducted in high-level laboratories. Nepal currently lacks suitable laboratories for such testing. This raises concerns about whether Nepal is already late in preparing to deal with such dangerous viruses.
What is the government doing to prevent the spread of Nipah in Nepal?
The government has been working on various preventive measures. However, even during COVID-19, despite significant efforts, Nepal faced serious challenges. Nipah is not yet widely recognized among the general public, so awareness campaigns are crucial.
Anyone arriving from an infected area should be kept in isolation for at least 12 to 14 days. While the risk period is said to extend up to 45 days, symptoms usually appear within 12 to 14 days. The government should clearly inform the public about testing protocols if symptoms emerge during this period.
Another important step is identifying bat species in Nepal that could potentially transmit the virus and determining whether they come into contact with humans. Since Nipah is also linked to pigs, livestock monitoring should also be conducted.
If someone is infected, how is Nipah treated?
Based on recent fatality data, treatment is extremely challenging. Because early symptoms resemble common flu, many people ignore them.
Within 24 to 48 hours of symptom onset, patients may develop encephalitis and fall into a coma, which significantly increases the risk of death. Treatment therefore focuses on managing symptoms at an early stage.
There is currently no specific medicine developed exclusively for Nipah virus. Early medical intervention can save some patients, but delayed treatment makes survival difficult.
What advice would you give to the government and the general public?
The government should assess whether there is an internal risk in Nepal. For example, if pigs fall ill, they should be tested for Nipah. Research is needed to determine whether humans are coming into contact with bats and to what extent.
The general public should stay informed about the virus and not ignore prolonged symptoms such as cough, fever, headache, and body aches. People returning from affected areas should avoid contact with others for at least 12 to 14 days and seek medical testing if symptoms appear.
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