As Winter Nears, Many in Bangladesh Fear a Nipah Virus Re-emergence

It was an evening of late October in Lalmonirhat. Taposhi Ghosh — a mother of two, could be seen cleaning dust off a photo of her son and daughter. Tears flow down her cheeks on the photo frame as Ghosh recalls the time 10 years ago when both her children died of the dreaded Nipah virus, leaving her only with their memories to hold on to.
 
In February 2011, Ghosh's son Aronno Kumar, age eight, was the first of the two children to get infected by the virus. Two days later, his sister Ananya, age four, also became infected. Ghosh suspects that both the children may have eaten guavas from their yard that were half eaten by bats or drunk raw date juice with friends.  
     
Since then, Taposhi, a former NGO worker, and Ashok Kumar Ghosh, headteacher of Char Dhuboni Govt Primary School, have been living in the Bandar area of Hatibandha Upazila in the Lalmonirhat district with their memories of children as they have no other children. After Ananya was born, Taposhi permanently adopted the method of birth control. 
 
Taposhi said, "My kids ate half-eaten fruits because of ignorance. I wish no other parents have to endure such pain. The government should do more to prevent this from happening."

Taposhi and Ashok are not the only parents who lost their children to Nipah. In the same month that year, another kid in the area, Sudipta Sarker Dwip, age 12, a VI-grade student of the S S High School, also died in a Dhaka hospital of the same deadly virus.
 
Like Aronno, Sudipta was also the only son of his father, Subal Chandra Sarker.

"With his friends at school, he (Sudipta) drank raw date palm juice from the local market. Then he suffered from fever, pain and headache," Sarkar recalls.

The tragic death of his son created a huge wave of panic in the neighborhood, Sarkar recalls. As a result, the family was socially ostracized which only added to their pain.
 
"When my son died of the Nipah virus, the area turned into a desert due to fear. Our close relatives kept their distance out of concern for infection. Nobody talked to us or took care of us," said Sarkar, who, ironically, is a doctor himself.
 
"We could not cremate my son's body the usual way. I had to carry my son's body alone to the crematorium, in a pushcart and manage to cremate him. Our neighbors avoided us for at least two years. So, winter emerges to us as a panic," added Sarker. 
 
In Lalmonirhat district so far, 30 people have been infected, while in 2011, it turned into an epidemic that caused several deaths in a week.

Nipah virus in Bangladesh

Nipah virus (NiV) first emerged in Malaysia in 1998 while Bangladesh reported its first Nipah case in 2001. According to the Infectious Diseases Division of icddr.b,  a total of 322 Nipah cases have been reported as of 2021, and 229 of them have succumbed to the infection. The infection has claimed the lives of 71.1% of the patients.

Several researchers speculate that Nipah Virus (NiV) may be the next pandemic agent after COVID-19, and World Health Organisation (WHO) has listed Nipah virus as one of the ten viruses with pandemic potential.

So far two strains were found named NiV — in Bangladesh (NiVB), and in Malaysia (NiVM). According to research titled "Pathogenic Differences between Nipah Virus Bangladesh and Malaysia Strains in Primates: Implications for Antibody Therapy," NiVB is more infectious than NiVM. 

Bangladesh has detected this virus in 32 of its 64 districts.  The highest number of infections —over 30 infected patients — were found in the Faridpur district, where preious epidemics occurred in 2004 and 2011.

The second highest infected districts are Lalmonirhat, Nagoan and Rajbari where 21-30 infected patients were found. These districts experienced more than once epidemic of the virus.  

Nine districts had 11 to 20 infected patients, seven other districts had six to ten infected patients and nine each district had one infected patient.

Experts say that the widespread infections by Nipah virus are mostly caused by virus spillover from a primary reservoir (bats) to intermediate hosts (pig) to humans. However, transmission origins are still poorly understood.

Deadly virus in a winter delicacy

In Bangladesh, Nipah transmits mainly from traditional liquor made from Date Palm sap, a very popular drink across the country. People drink the juice untreated or raw – which is collected overnight from date palm trees. Often at night, bats visit the tree and leave their saliva or body fluid on the tree which gets mixed in the juice collected by raw juice sellers. As bats are a natural reservoir of Nipah virus — meaning the virus lives in their bodies naturally, the saliva also can contain the virus. Unaware of this bat saliva or the possible existence of Nipah virus in the raw juice, sellers and drinkers use it freely which makes them highly vulnerable to an infection.  

Dr Syed Moinuddin Satter, Assistant Scientist, and Deputy Project Coordinator, Emerging Infections, Infectious Diseases Division of ICDDRB tells The Business Standard, “It is one of the most fatal communicable diseases of our time and unfortunately, it is endemic to our country.” 
 
"It is spread from bats to humans which is considered a spillover event. The most common medium of this spillover is through consumption of raw date palm sap, contaminated with bat saliva, urine, or feces. It can also spread from one infected person to another via bodily secretions e.g., saliva, blood, urine, feces, etc. In addition to this, there is a history of human infection through infected domestic animals," he adds. 

Post-recovery complications

In February 2011, Sharmin Zaman Mare, 32, of Lalmonirhat Matibhanga, became infected after eating plum picked up from the ground under a plum tree. After three weeks of treatment, she recovered, but the infection left lasting effects.

"I have regular headaches, memory loss, weakness, breathing problems and a regular mild fever," she said. 

"Bats used to visit the plum tree, but I was always tempted to eat some ripe plums in the morning. One day, a few hours after eating the fruits, I became sick. My husband took me to the hospital where I was diagnosed with Nipah," she says.

According to Dr Satter of iccdr.b, after recovering from the initial infection, almost all the survivors suffer from neurological problems such as difficulty to perform fine movement, difficulty to maintain balance, diminished or loss of cognitive functioning, partial or complete paralysis, and ophthalmological complications such photophobia as well as mild to severe form of visual impairment. All these radically affect their mental health, quality of living, ability to earn and maintain a stable societal status.  

Along with the health problems, Nipah survivors and family members of deceased patients also face severe social stigma even when they are no longer infected. They are stigmatized by neighbors and relatives who avoid contact in fear of infection. Sharmin Zaman Mare, one of the survivors, explained that many of her relatives avoided her family for a long time.  

 "Anyone who heard about my Nipah virus infection still continue to act negligently," said Sharmin.

 Subal Chandra Sarker, who has a medicine shop in the local market, says that social stigma led to economic hardship for him. "I had lost all my customers after my son died of Nipah," he says.

Expert recommendations

Experts recommend that people should be more careful and avoid the known mediums of infection, such as avoiding raw date palm sap, handling live or dead infected animals, and eating fruits eaten by bats or birds. Experts' emphasize the importance of more awareness as no medicine or vaccine has been developed against Nipah virus infection among humans. 

Dr Syed Moinuddin Satter of iccdr.b said, "Nipah virus infection is more prevalent in Bangladesh, from December to end of April as the winter is raw date palm sap harvesting season."

Healthcare workers and doctors in the country should be more cautious when they encounter patients who have a history of raw date palm sap consumption.

 "We have no formal large awareness campaign program.  The local hospital educates patients who come for treatment during the winter since the virus spreads more in the winter season," says Dr Siddiqur Rahman Civil Surgeon of Faridpur district, the most infected district in Bangladesh.
 
"We also inform people in different programs when we get an opportunity," added Rahman.   

The civil surgeonof Lalmonirhat district, Dr Nirmelendo Roy, also suggested a large government campaign to raise awareness about the virus as he said, "Many people are infected due to a lack of proper awareness." 

This story was produced with the support of Internews’ Earth Journalism Network. It was originally published in The Business Standard on 26 November 2021. It has been lightly edited for length and clarity. 

Banner image: Taposhi Ghosh and Ashok Kumar Ghosh lost their two children, Aronno Kumar and Ananya to the Nipah virus 10 years ago. Nipah virus, a zoonotic disease, can be transmitted through contaminated food or directly between people / Credit: The Business Standard.