Dream - Mohammedali, 49 years old, has been feeling unwell since Tuesday, August 22, 2023. Suddenly, his body had a high fever and he experienced shortness of breath and dizziness. However, on Friday, August 25, 2023, he still managed to attend the Friday Prayer held at Kultiady Mosque in the Kozhikode district, Kerala, India. After that, his condition worsened. His fever got higher. He then went to the hospital. He was transferred to three different hospitals before finally being treated at Iqraa Hospital.

However, the condition worsened. He was admitted to the ICU of the hospital due to his deteriorating condition. But on Wednesday, August 30, 2023, at 04.15 in the early morning, he passed away. A similar condition also occurred in the second victim, Haris Ayacheri. He started feeling feverish and experiencing respiratory problems since Tuesday, September 5, 2023. On Friday, September 8, 2023, he briefly visited the mosque to attend Friday prayers. On that day, he also went to Iqraa Hospital because he felt increasingly unwell.

"But his soul was not saved. On Monday, September 11, 2023, Haris passed away. At the time of his death, the laboratory results came out. Haris was declared positive for the Nipah virus (NiV) infection. The deaths of the two victims due to the Nipah virus prompted the state of Kerala in India to immediately close schools, offices, and public transportation in the Kozhikode district in response to the re-emergence of the potentially deadly Nipah virus. This decision on September 13 was taken as a preventive measure against the spread of the virus, which so far has caused two deaths and six confirmed cases."

The test conducted at the National Virology Institute in Pune confirmed that the death of Mohammedali, a 49-year-old man in Kerala on August 30, was caused by the Nipah virus. The second victim in the state, Haris Ayacheri, a 40-year-old man, also died on September 11 due to the Nipah virus.***Indeed, there has been a deadly Nipah virus outbreak in Kerala, India. Six people have been infected with this virus, two of whom have died.

The authorities in the Kozhikode district, where this outbreak occurred, have declared a "containment zone" in the area and schools have been closed. Seventy-six individuals who have had contact with the infected person are being closely monitored for signs of the disease. Hundreds of people have been examined. This is the fourth Nipah virus outbreak in Kerala. The most deadly one occurred in 2018, with dozens of laboratory-confirmed cases and 21 deaths among them.

Virus Nipah is an RNA virus from the Paramyxoviridae family. The outbreak in humans was first detected in Sungai Nipah Village, Malaysia in 1998, causing 300 cases and 105 deaths. Since then, one or two outbreaks occur every year. More than half of the infected individuals die. Outbreaks are most commonly reported not only in Bangladesh but also in India, Malaysia, Singapore, and the Philippines.

The proportion of Nipah virus infections that do not show symptoms varies from one outbreak to another and ranges from 17% to 45%. If the virus does cause illness, the main impact is encephalitis (inflammation of the brain). Patients experience high fever and severe headaches, and many experience disorientation, drowsiness, and confusion. Some patients also experience chest infections. There is no specific medication to treat Nipah virus, so medical care is only supportive, which means treating individual symptoms and ensuring the comfort of the patient until recovery is expected.

Some treatments appear to have potential, at least in animal studies, but only a few studies have been conducted in humans. A small trial of a drug called ribavirin showed that it could reduce mortality, but further research is needed. A targeted therapy called monoclonal antibodies has been proven effective in reducing mortality in green monkeys when given early enough during Nipah virus infection. However, there is no research yet indicating how effective this drug is in humans with Nipah virus.

However, the Indian authorities have purchased monoclonal antibodies from Australia to be used in the current outbreak. Until now, there is no vaccine to fight the Nipah virus, although mRNA vaccines to combat the virus are being tested on humans.***The problem is, how can people get infected with the Nipah virus?

During the early outbreak in Malaysia, the main risk factor was contact with pigs or being a pig farmer, but there was no evidence of transmission from person to person. At that time, it was still unclear why pigs started transmitting the infection. There was a suspicion that pigs became infected after consuming infected fruits from fruit bats. Since the beginning of the outbreak, the public has learned more about this virus and the risk factors associated with its transmission to humans. It is now known that the primary host of the Nipah virus is fruit bats. The Nipah virus has previously been detected in bats in Kerala.

Most infections are believed to come from contact with infected animals, either fruit-eating bats themselves or intermediate animals such as pigs, as in the first epidemic detected in Malaysia. However, there are interesting differences between epidemics. In Bangladesh, it is related to drinking date palm sap, both raw and fermented. In a study in Bangladesh, researchers used infrared cameras with motion sensors to show that fruit bats often visit date palm trees where villages collect date palm sap for consumption.

Initially, the Nipah virus was believed to not be transmitted from person to person because no healthcare workers were infected during the major outbreak in Malaysia. Since then, healthcare workers have been reported to be infected with the virus, as in this recent outbreak, where one death occurred among healthcare workers who were caring for those infected with the virus.

A study on 248 cases of Nipah virus infection in Bangladesh conducted over several years concluded that approximately one third of them were transmitted from other humans. The researchers estimated the R value - the number of people likely to be infected by one person - to be around 0.33, which means the infection is unlikely to spread far from its animal source. Although Nipah virus causes deadly infections, there is no evidence to suggest that it is likely to spread widely outside the areas where humans or their livestock come into contact with infected bats.

However, the Nipah virus outbreak may be another indication that the loss of forest habitat due to human encroachment forces greater contact between humans and animals, thereby increasing the risk of transmission from animals to humans. Although the R-value is low, if infected animals are transported to major cities, the increase in population density will increase the risk of transmission from person to person, allowing the virus to evolve more easily and trigger a new pandemic.***The Nipah outbreak is the fourth outbreak to hit Kerala in the last five years - the latest occurring in 2021.

The Nipah outbreak is the fourth outbreak to hit Kerala in the last five years – the most recent one occurred in 2021. Although the outbreak usually occurs in a relatively small geographical area, it can be fatal, and some scientists are concerned that increased human-to-human transmission could lead to deaths as the virus becomes more contagious.

The following is the translation of the 'Bahasa' text to 'English' while preserving any html tags: "Virus Nipah has a death rate between 40% and 75% depending on the type of the virus, said Rajib Ausraful Islam, a veterinarian specializing in bat-transmitted pathogens at the International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka. "Every outbreak causes concern," he said. "Every outbreak gives the pathogen an opportunity to modify itself."

This virus can cause fever, vomiting, respiratory problems, and inflammation in the brain. This disease is mainly carried by fruit bats, but it can also infect pets such as pigs, and humans as well. The disease spreads through contact with body fluids from infected animals or humans. There is currently no approved vaccine or treatment, but researchers are investigating candidates.

The Nipah virus was first detected over two decades ago, following an outbreak among pig farmers in the village of Sungai Nipah, in Port Dickson, Negeri Sembilan, Malaysia. Within a few months, the disease spread to Singapore through infected pigs. This outbreak resulted in nearly 300 cases and over 100 deaths. One million pigs were culled in an effort to prevent the spread of the Nipah virus. Since then, no other Nipah virus outbreaks have been reported in Malaysia. However, in 2001, the virus emerged in Bangladesh and India, where this outbreak continues to periodically increase.

In Bangladesh, this epidemic occurs almost every year, and research has linked this infection to drinking fermented date palm sap contaminated with fruit bat urine. It is not clear exactly when and how the virus jumped from bats to humans in the current Kerala outbreak, but scientists are investigating it. The types of viruses circulating in India and Bangladesh are different from those that emerged in Malaysia, said Stephen Luby, an epidemiologist at Stanford University in California.

Although the Malaysian strain spreads from animals to humans, there is only limited human-to-human transmission. However, the version behind the recent outbreak in Kerala can be transmitted from person to person and is much deadlier. "This reminds us that this is an evil virus," said Luby. Although potentially lethal, the Nipah virus does not spread easily between humans compared to infections transmitted through animals, so the likelihood of it spreading overseas is small, according to Danielle Anderson, a virology expert at the Royal Melbourne Hospital in Australia.

A study in 2019 on nearly 250 cases of Nipah virus in Bangladesh over a span of 14 years found that about a third of human infections were transmitted to others. The high death rate caused by this virus also reduces the chances of it spreading rapidly throughout the population, said Christopher Broder, an expert in emerging infectious diseases at the Uniformed Services University Medical School in Bethesda, Maryland.

"\u201cIt is not in the best interest of this virus to kill all infected people.\u201d He added, the circulating strain in Kerala has not changed much since it first emerged compared to two decades ago in Bangladesh, although future outbreaks could be larger if the virus mutates into a milder but more contagious type of virus. An important step in preventing Nipah outbreaks and other bat-transmitted viruses is to develop better ways of managing wildlife living close to communities, said Andrew Breed, a veterinary epidemiologist at the University of Queensland near Brisbane, Australia."

Research on the Hendra virus - another pathogen transmitted by bats and closely related to Nipah - shows that infected bats release more virus particles when they are stressed, increasing the likelihood of the disease spreading to pets and then to humans, said Breed. One approach that can help prevent future outbreaks is by restoring forest areas to improve bat habitats, which will provide them with more reliable food sources and reduce the risk of transmission, said Breed.

Another way to reduce the risk of disease transmission from bats to humans is by planting more trees that produce fruits preferred by bats but not by humans. This can help prevent infected bats from contaminating food. "We need to learn how to live safely alongside bats," he said. The Indonesian government itself has "increased vigilance" against the Nipah virus, following the discovery of six cases in the state of Kerala, India, which resulted in the death of two people.

The precautionary measures include monitoring at the country's entry points as well as within the country for cases of illness or sudden deaths in large numbers. Research conducted by the Veterinary Research and Development Agency - now the Veterinary Research Center of BRIN - and published in 2013 found genetic material of the virus in the fruit bat species Pteropus vampyrus in Sumatra. Furthermore, the genetic material of the Nipah virus found in Sumatra is very similar to that found in Malaysia, suggesting the possibility of Pteropus vampyrus bats carrying this virus flying across national borders.

"Previously, a serological survey of 610 pigs and 99 bats in West Kalimantan did not find any exposure to Nipah virus in pigs but found Nipah virus antibodies in 19% of the 84 Pteropus vampyrus bat samples. However, until now, no cases of Nipah virus have been found in humans or livestock in Indonesia. "Only the genetic material was found, not the whole virus. We also conducted surveillance in Sulawesi, where some of them were also negative," said Prof. Indi Dharmayanti, Head of the Health Research Organization at the National Research and Innovation Agency (BRIN), to BBC News Indonesia."

Former Director of Communicable Diseases at the WHO Southeast Asia, Prof. Tjandra Yoga Aditama explained that the discovery of genetic material of viruses in animals does not necessarily develop into an epidemic in humans. It depends on how many animals are affected and how likely it is to be transmitted to humans, he added. WHO has stated that there are three diseases that are likely to become the next pandemic — influenza, zoonosis or diseases transmitted from animals to humans (including the Nipah virus), and what is known as Disease X or an unknown pathogen.

The Ministry of Health (MoH) of the Republic of Indonesia (RI) has understood that Indonesia is at high risk of experiencing an extraordinary event (KLB) of the Nipah virus, considering its geographical location that directly borders Malaysia. In 2021, the MoH released the Guidelines for Prevention and Control of Nipah Virus Disease in Indonesia, which outlines procedures for epidemiological surveillance, laboratory testing, and risk factor control.

The increase in Nipah virus cases in Kerala in 2023 serves as a warning for the Indonesian government to enhance vigilance, said the Head of the Ministry of Health's Communication Bureau, Siti Nadia Tarmizi. "So when we hear about Nipah disease cases in India and Bangladesh, we increase our alarm, our vigilance," she told BBC News Indonesia. These vigilance measures include monitoring or surveillance of symptoms and risk factors of Nipah virus in incoming travelers at the country's entry points.

"Those who enter our borders are then educated that if they have symptoms, especially if they have a history of risk, they should immediately come to healthcare facilities," Nadia explained. Surveillance reinforcement is also carried out domestically by monitoring whether there are sudden cases of death or illness in large numbers. She explained that patients infected with the Nipah virus do not require special isolation rooms. However, until now, there is no cure or vaccine for the disease."

Until now, Indonesia has not found any cases of the Nipah virus. But that doesn't mean Indonesia should relax its vigilance. Especially considering the high fatality rate of this virus: 40-75%. Vigilance against the danger of the Nipah virus should not be relaxed! (eha)Source: Times of India, BMJ, Conversation, Nature, BBC News Indonesia