Major Viral Infections and their outbreak in India
Dynamic interplays of biological, socio-cultural and ecological factors, together with novel aspects of human-animal interphase, pose additional challenges concerning the emergence of infectious diseases. The rise of novel human pathogens and re-emergence of several diseases are of particular concerns in the current decade. In this article, we will discuss the major emerging and re-emerging viral infections of public health importance. Respiratory viral infections, arboviral infections and bat-borne viral infections represent three major categories of emerging viral infections in India.
1. Corona Virus Disease- 2019 (COVID-19)
Why is it of concern?
- Currently, there is no vaccine could be developed to prevent coronavirus disease (COVID-19).
- The best way to prevent is to avoid being exposed to the virus.
Where did it arise?
- The disease was first identified in 2019 in Wuhan, China, and has since spread globally, resulting in the 2019-20 coronavirus pandemic.
- The virus strain is ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2).
Declaration of the World Health Organization
The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a pandemic and a Public Health Emergency of International Concern (PHEIC). Evidence of local transmission of the disease has been found in many countries across all six WHO regions.
About the COVID-19
- Coronavirus disease (COVID-19) is an infectious disease caused by a new virus.
- The disease causes respiratory illness (like the flu) with symptoms such as a cough, fever, and in more severe cases, difficulty breathing.
- You can protect yourself by washing your hands frequently, avoiding touching your face, and avoiding close contact with unwell people.
How it spreads?
- The virus is thought to spread mainly from person to person (1 meter or 3 feet).
- Mainly it spreads through the respiratory droplets when an infected person sneezes or coughs.
- And once the virus lands into the nose or respiratory tracts of any healthy person by contact or inhalation, the disease then spreads.
(i) Clean your hands often
- Wash your hands with soap and water for at least 20 seconds, especially after coming from public space or after blowing your nose, coughing or sneezing.
- Keep sanitizer (at least 60% alcohol-based) handy, when in public spaces as you might not get soap and water around.
- Avoid touching your nose, eyes, and face with unwashed hands. Remember, coronavirus is a respiratory disease.
(ii) Practice Social Distancing
- To beat COVID-19 social distancing is a must.
- Avoid social gathering and travelling in crowded public conveyance till the disease settles or some vaccine or permanent treatment is developed.
- It is advisable to avoid any mass gathering or social events until curing procedures are established.
- Avoid close contact with people infected with COVID-19 (if anyone in your vicinity).
- Stay home if you are sick or you have low immunity as in such case people are more vulnerable to get the viral infections.
(iii) Cover coughs and sneezes
- While coughing or sneezing, cover your mouth. These are small things but with individualistic efforts, contributes immensely to a community.
- Throw used tissues in the bin after that must wash hands.
(iv) Wear a mask if you are sick
- Do wear a mask when you are ill, or you are sharing a room in public spaces where someone might be infected. Little steps avoid big catastrophes.
- Clean and disinfect
- Do not forget to disinfect and clean the frequently touched surfaces such as tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks with soap and water or any other disinfectant.
Govt of India to form ‘COVID-19 Economic Response Task Force
Government has recently announced the formation of a Covid-19 economic response task force to deal with the financial challenges faced by the country in the wake of the coronavirus outbreak. Finance minister Nirmala Sitharaman will head the Covid-19 economic response task force.
Functions of the task force:
- The Task Force will consult stakeholders, take feedback, based on which decisions will be made to meet the challenges.
- It will also ensure the implementation of the decisions taken to meet these challenges.
2. Nipah Virus Outbreak 2018 (NiV)
Why is it a concern?
- Currently, there are no specific treatments available for Nipah virus disease, and care is supportive.
- Intensive supportive care is recommended to treat severe respiratory and neurologic complications.
Where did it occur?
- The NiV outbreak was localized to two districts in Kerala State: Kozhikode and Malappuram in 2018.
- A total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported from Kerala State. This outbreak is the third Nipah virus outbreak in India.
- Fruit bats of the genus Pteropus are the natural reservoirs of NiV.
About Nipah Virus (NiV)
- NiV was first recognized in 1998-1999 during an outbreak among pig farmers in Malaysia and Singapore. No subsequent outbreaks have been reported in Malaysia or Singapore since 1999.
- NiV infection is an emerging zoonotic disease of public health importance in the WHO South-East Asia Region with a high case fatality rate estimated to range between 40 and 75%.
- NiV was first recognized in India and Bangladesh in 2001; since then, nearly annual outbreaks have occurred in Bangladesh.
- The disease has been identified periodically in eastern India (2001, 2007).
How it spreads?
- Possible routes of transmission of NiV include consumption of fruit contaminated by the saliva of infected bats, from direct contact with infected bats or their faeces/urine, or human-to-human transmission through unprotected close contact with an infected patient in the community or hospital.
- Many cases identified in the current outbreak were infected through direct unprotected contact with other infected persons.
- NiV infection can be prevented by avoiding exposure to bats and sick pigs in endemic areas, and by avoiding consuming fruits partially eaten by infected bats or drinking raw date palm sap/toddy/juice.
- The risk of international transmission via fruit contaminated with urine or saliva from infected fruit bats can be prevented by washing them thoroughly and peeling them before consumption.
- Fruit with signs of bat bites should be discarded.
Ongoing measures by WHO
- WHO is also working with the Indian Council of Medical Research (ICMR) to advance the research agenda for the Nipah research and development (R&D) blueprint.
- WHO will continue working closely with the Ministry of Health to ensure that health systems preparedness for emerging zoonoses (transferring from vertebrate animals to humans) is strengthened in the country.
- The Strategic Health Operations Centre (SHOC) at the National Centre for Disease Control was activated to monitor the outbreak.
- Training and capacity building for health care personnel were done in the following areas: sample collection and transportation; safe disposal of dead bodies; contact tracing; hospital waste management; hospital infection prevention and control; and the use of personal protective equipment.
- Research is underway for coming up with the NiV cure.
3. Zika Virus
Why it is of concern?
- There is no vaccine or specific treatment available currently.
- Instead, the focus is on relieving symptoms and includes rest, rehydration and acetaminophen for fever and pain.
- Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should be avoided.
Where did it arise?
- Its name comes from the Zika Forest of Uganda, where the virus was first isolated in 1947.
- Zika virus is related to the dengue, yellow fever, Japanese encephalitis and West Nile viruses.
About Zika infection
· Zika virus infection during pregnancy can cause infants to be born with microcephaly and other congenital malformations, known as congenital Zika syndrome.
- Infection with Zika virus is also associated with other complications of pregnancy including preterm birth and miscarriage.
- Other serious birth defects include:
- Small head size (microcephaly)
- Damage to the brain
- Problems with feeding (difficulty in swallowing)
- Problems moving limbs and body
- An increased risk of neurologic complications is associated with Zika virus infection in adults and children, including Guillain-Barré syndrome, neuropathy and myelitis.
How does it spread?
- It is spread by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus.
- Since the 1950s, it has been known to occur within a narrow equatorial belt from Africa to Asia.
- From 2007to 2016, the virus spread eastward, across the Pacific Ocean to the Americas, leading to the 2015-2016 Zika virus epidemic.
- In most cases, there are no symptoms.
- In a few cases, Zika can trigger paralysis (Guillain-Barré Syndrome).
- In pregnant women, it may cause subsequent birth defects.
- When present, symptoms are mild and last less than a week. They include fever, rash, joint pain and red eyes.
Cases reported in India
- On September 21 2018, the Ministry of Health and Family Welfare-Government of India (MoHFW) said a confirmed case of Zika virus infection in a 78-year-old woman in Jaipur, Rajasthan state, India.
- As of November 2 2018, 157 cases have been identified, including 63 pregnant women; all cases have been laboratory-confirmed by RT-PCR.
- Before this outbreak, India reported four confirmed cases of Zika virus infection in 2017, three cases in Ahmedabad Gujarat and one case in Krishnagiri District of Tamil Nadu.
- The government of India maintains a laboratory-based Zika surveillance system, involving 34 laboratories to detect Zika virus infection in patients with febrile illness, developed as part of the National Zika Action plan.
- Routine vector surveillance is also ongoing.
- Community-based programs are underway to increase public awareness, advance measures to mitigate mosquito breeding sites and promote personal protection measures against mosquito vectors.
· WHO continues to monitor the epidemiological situation and conduct a risk assessment based on the latest available information.
3. Swine Flu
Why is it a concern?
Amid the coronavirus scare across the globe, new cases of influenza virus H1N1 infection, commonly known as swine flu, have started to emerge from across India. · According to the National Centre for Disease Control (NCDC), over the last one and a half month, about 884 people have been diagnosed positive of the H1N1 flu across the country with 14 recorded deaths as on February 16, 2020.
What is it?
· Swine flu is a contagious respiratory disease caused by a subtype of influenza A virus called H1N1 (a strain that started in pigs).
Is any treatment available?
It is preventable by vaccination. Typical treatment includes rest, pain relievers and fluids. In some cases, antiviral medication and IV fluids may be required.
Where did it occur?
- Swine flu was first recognized in the 1919 pandemic and still circulates as a seasonal flu virus.
- In 2009 a strain of swine flu called H1N1 infected many people around the world.
- Swine flu is caused by the H1N1 virus strain, which started in pigs.
- The virus is contagious and can spread from human to human.
How does it spread?
- The infection enters the body via inhalation of the contaminated particles, mainly droplets present in the air.
- It can also be transferred from a contaminated surface, where the contamination has settled.
- Some of the symptoms of Swine flu disease include- high fever, severe headache, shortness of breath, runny nose, irritation in eyes, body and muscle aches, sore throat, vomiting and acute dysentery.
- Children, pregnant women and the elderly are at risk from severe infection.
· Same, as suggested in Coronavirus Disease 2019 (COVID-19).
The World Health Organisation recommends vaccine shots to prevent acquiring the virus. Moreover, following basic hygiene and washing hands thoroughly with soap and water are highly recommended by the health experts.
Therefore, it is advisable to take better care and observe good personal hygiene. We are living in times, when not only the macroscopic but the microscopic world governs and impacts us enormously. The economic costs associated with such infections can be heavy as can be inferred from the high costs of medical and intensive care, days of productive work lost, impact on travel and tourism, ban on the export of agricultural produce from affected regions, etc. The psychological impact of such outbreaks and their sequelae has also not been systematically evaluated in the country.
Que. Concerning Virus, consider the following Statements:
- By itself, the virus is a lifeless particle.
- It reproduces very fast in the cell it has invaded.
- It consists of an outer coat of protein and an inner Core of either DNA or RNA or both.
Which of the statements given above are correct?
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2 and 3
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