Introduction
From time immemorial, diseases have been a threat to human existence. Without prevention and control measures, communicable diseases spread from one individual to another, from one community to another, and from one continent to another. In history, humans have used quarantine, adoption of environmental control measures, vaccination, and drugs to contain these diseases (Katherine 2007, p. 47). Notably, vaccinations have become major public health success stories. Vaccination programs have saved millions of lives worldwide, and are among the safest and most effective ways of controlling a number of infectious diseases.
Edward Jenner, Louis Pasteur, and Maurice Hillman are the three pioneers in the development of human vaccines (Katherine 2007, p. 47). Jenner developed small pox vaccination in the year 1796. Pasteur attenuated several viruses for use as vaccines. On the other hand, Hillman developed more than 40 vaccines against mumps, measles, rubella, and hepatitis A and B during the post world war II. Currently, a number of vaccines are being developed against Nipah virus, malaria, and Ebola. Once these vaccines are fully developed and testing concluded, manufacturers will be required to obtain approval for their use through national drug regulation institutions such as WHO and Australia’s Therapeutic Goods Administration.
Despite the efficiencies of these new strategies focused on controlling and eradicating human diseases, some experts argue that strengthening the current approaches is the best option to manage and eliminate the diseases. This article evaluates whether the introduction of new strategies such as vaccine and drug measures to control and prevent Nipah virus transmission in Malaysia is the most appropriate course of action compared with strengthening the current approach used.
Epidemiology
Nipah virus is an infection common in Southeast Asia (Chua 2007, p. 265). Fruit bats that belong to the Pteropus genus have been identified as the natural host of the virus. To date, the route of transmission of virus from bats to some domesticated animals is debatable. However, pigs can be infected if they feed on fruits that have been contaminated by bats’ saliva, foetuses, urine, and contaminated water (House & Kocan 2007, p.123). It is believed that the virus spreads to other domesticated animals if they are exposed to infected pigs through sharing the same feeds and water. This virus has been isolated in the urine, kidneys, and faeces of these bats. The disease affects human beings, swine, cats, dogs, and other domesticated animals. Human beings can be infected with the disease if they feed on contaminated fruits, or if they are exposed to nasal or throat secretions from infected swine. Once a human has been infected, the virus may be transmitted through saliva, faeces, and nasal or throat secretions to other persons who are not in direct contact with the pigs. The virus was initially detected in Malaysia during a prevalent outbreak that occurred between the years 1998 and 1999 (Lal 2007, p. 39). It is estimated that the virus had circulated in pigs from as early as 1996. Due to the low death rate and the disease’s similarity to other infections, the disease was not discovered right away as a new infection. The disease was later identified as a new infection when it crossed over to pig farmers and slaughterhouse workers in Malaysia. The outbreak caused severe encephalitis in more than 260 individuals resulting in the deaths of 100 labourers and financial loss of millions of dollars in the pig industry.
Description of primary prevention and control strategies in place and their effectiveness
Following the emergence of the disease, the Malaysian government took drastic measures to control its spread. The signs of the disease are sore throat, nausea, fever, and headache. These symptoms might be accompanied by dizziness and unconsciousness. Infected patients were immediately isolated from the rest of the population. Clinical management of the patients was critical toward their survival (Garber & Gross 2010, p. 230). Most of these patients went through intubation. Hypertension patients were administered with intravenous fluids and anti blood-pressure agents. On the other hand, seizure patients were treated with anticonvulsive drugs. Several other patients with the diseases were similarly administered with ribavarin drugs. However, the efficiency of ribavarin drugs could not be accessed. To control the spread of the disease, Malaysian army personnel were deployed to identify all active pig farms in the region (Phua 2009, p. 78). These personnel were mandated to identify sick animals, cull them, and bury the dead pigs. When the serological testing of pigs was conducted, it was identified that in affected farms most of the adult pigs had been contaminated. This led to a national testing and eradication program. In the program, blood samples from every pig farm in Malaysia were tested twice in a period of 3 weeks. Across Malaysia, pig farmers are required to adopt appropriate bio-security measures to prevent the recurrence of the disease (Garber & Gross 2010, p. 230). As such, farmers are necessitated to eliminate fruit trees that attract bats near pig dens. Similarly, farmers are advised to use wire screens in areas where pigs are raised in open fields to avoid their coming into contacts with bats. Equally, runoff from the roofs is drained away from the pigpens. In addition, other domesticated animals are prevented from roaming between farms when an outbreak occurs.
It was later identified, during the control process, that the virus might have been spread through re-use of vaccination needles (Howard 2011, p. 34). Therefore, sterilised needles are now used in animals every time there is a vaccination program. Through these initiatives, the cycle of transmission of the disease from pigs to humans in Malaysia has been broken.
Current challenges associated with controlling and preventing the disease
Although the disease has been eliminated in all the pigs in Malaysia, it should be noted that the disease still poses possible health risks in the region. To date, no vaccination has been approved for the prevention of the disease, the natural host of the virus is still unidentified, and the virus is not well documented (Epstein & Hassan 2008, p. 148). Despite the fact that the disease has been eradicated in domestic animals, there are risks of the disease re-occurring since some fruit bats, which may transmit the diseases to humans and domesticated animals via contaminated fruits and water are still infected with the virus. Therefore, Malaysians should put in place measures that will reduce the exposure of their animals and themselves to the fruit bats. These measures include disinfecting the pigpens regularly, reducing direct contact with pigs, and reporting any symptoms of the disease whenever it occurs (Pine 2010, p. 79). Disease control has been a challenge since the disease symptoms resemble other porcine diseases. This implies that it is very challenging to detect the diseases during its early stages without testing. Another challenge that exists in the control and prevention of this disease is that as the human population expands, the bats’ natural habitat is being depleted and their feeding grounds destroyed (Mooney & Knox 2009, p. 128). Through this, bats have been forced to live near human residences increasing their exposure. In addition, failure to come up with the cure for the disease or approved vaccine implies that the virus can reoccur anytime in the future.
Perceived advantages and challenges associated with implementing a new strategy
In the year 2012, a group of Canadian, American, and Australian researchers effectively tested a possible vaccine for the virus in monkeys (Stephen 2013, p. 67). The vaccine was created from the Hendra virus, which is related to the Nipah virus. Earlier, Hendra vaccine had been tested successfully on cats. Nipah vaccine was noted to have been effective in preventing African green monkeys from contracting the disease. The development of this vaccine marked a crucial step towards the control and eradication of the deadly virus (Garber & Gross 2010, p. 230). If the vaccine is approved for human usage, incidences of Nipah viruses and its effects on the human body will be eliminated. Similarly, if the vaccine works effectively in preventing domestic animals against contracting the virus, several millions of dollars will be saved in Malaysia. So far, a huge amount of money has been spent on preventing the recurrence of the diseases in both humans and domestic animals (Uppal 2010, p. 355). The budget spent on these mitigations will be directed to other uses, if the vaccine is successfully approved. Despite the fact that there are possibilities of eradicating Nipah virus through this vaccine, it should be noted that developing an adequate vaccine for domestic animals, wild animals, and human beings is very expensive (Garber & Gross 2010, p. 230). Therefore, eradicating the virus will be expensive in the short term, but not in the long term.
Rationale for introducing the new strategy verses relying on current prevention methods
Once the virus is approved, the introduction of Nipah virus vaccine in Malaysia will be the most appropriate course of action compared with strengthening the current approaches used. If the current approaches are strengthened, the virus will be eliminated in human and domestic animals. However, the current approach does not guarantee elimination of the virus in wild animals. This implies that wild animals can still transmit the virus to both humans and domestic animals in the future. Equally, with the current approach the disease will continue to be fatal to human beings if it reoccurs, as 75% of the patients infected succumb to the disease (Barrett & Stanberry 2009, p. 320). Therefore, introduction of a vaccine will be helpful because if the disease will reoccur more immunized human beings will survive. Equally, the introduction of a vaccine will be economical in the long term. The current approach of controlling and preventing the disease is very expensive because whenever there is an outbreak, all the infected animals are expected to be culled. Because the pig industry in Malaysia is a major agricultural sector, such incidences result in huge financial losses. In addition, when an outbreak of the virus is reported, major domestic animal exports from Malaysia are suspended affecting its foreign earnings. To control and prevent the virus completely in Malaysia and its neighbouring countries, relevant authorities should adopt approved vaccine rather than strengthening the existing approaches (Mills 2009, p. 951). The adoption of polio and measles vaccines over the existing approaches in the past, led to eradication of these fatal diseases in most parts of the world (Banwell 2013, p. 45). In this regard, vaccination and other modern approaches such as drug and environmental control measure are the appropriate methods of controlling and preventing diseases compared to the existing approaches.
Conclusion
In conclusion, we should note that vaccination programs have saved millions of lives worldwide. During the mid 20th century, when several vaccines were created to prevent mumps, measles, and hepatitis A and B, fatal diseases were thought to have been overwhelmed (Berger 2011, p. 12). However, in the 1970s, a new strain of viral diseases started crossing over from animals to humans (Ahmad 2007, p. 230). Between the years 1998 and 1999, Nipah virus crossed over to human beings and domestic animals from fruit bats. The disease resulted in huge economic losses as well human and domestic losses. Several effective health approaches were adopted to combat the disease from spreading in the country. Despite the effectiveness of these methods, I believe that the introduction of the Nipah virus vaccine in Malaysia will be the most appropriate course of action compared with strengthening the current approach used. Vaccination is among the safest and most effective way of controlling a number of infectious diseases. With regard to prevention and control of Nipah virus in Malaysia, if the recently manufactured vaccine is approved to be used in humans, I believe that tremendous steps towards the eradication of the disease would be achieved.
References
Ahmad, K. 2007. Malaysia Culls Pigs As Nipah Virus Strikes Again. The Lancet, 356(9225), 230-230.
Banwell, C. 2013. When culture impacts health: global lessons for effective health research. Elsevier Academic Press. San Diego.
Barrett, A. D., & Stanberry, L. R. 2009. Vaccines for biodefense and emerging and neglected diseases. Academic. Amsterdam.
Berger, S. A. 2011. Hendra virus and nipah virus global status.Gideon Informatics. Los Angeles.
Chua, K. 2007. Nipah Virus Outbreak In Malaysia. Journal of Clinical Virology, 26(3), 265-275.
Epstein, J., & Hassan, S. 2008. The Emergence Of Nipah Virus In Malaysia: The Role Of Pteropus Bats As Hosts And Agricultural Expansion As A Key Factor For Zoonotic Spillover. International Journal of Infectious Diseases, 12(2), 146-196.
Garber, J. S., & Gross, M. 2010. Avoiding common nursing errors. Wolters Kluwer Health/Lippincott Williams & Wilkins. Philadelphia.
Howard, C. R. 2011. Lecture Notes on Emerging Viruses and Human Health: A Guide to Zoonotic Viruses and Their Impact. Gideon Informatics. Los Angeles.
House, J. A., & Kocan, K. M. 2007. Tropical veterinary diseases: control and prevention in the context of the new world order. New York Academy of Sciences. New York.
Katherine, S. K. 2007. Biology of emerging viruses: SARS, avian and human influenza, metapneumovirus, Nipah, West Nile, and Ross River virus. Blackwell Pub. on behalf of the New York Academy of Sciences. Boston.
Lal, S. (2007). Emerging Viral Diseases of Southeast Asia. Issues in Infectious Diseases. Academy of Sciences. New York.
Mills, J. N. 2009. Nipah Virus Infection In Dogs, Malaysia, 1999. Emerging Infectious Diseases, 15(6), 950-952.
Mooney, L. A., & Knox, D. 2009. Understanding social problems (6th ed.). Wadsworth/Cengage Learning. Belmont.
Phua, K. 2009. The Nipah virus outbreak in Malaysia and its aftermath: a continuing saga. Elsevier Academic Press. San Diego.
Pine, P. 2010. The Nipah Virus Outbreak In Malaysia. Journal of Emergency Management, 8(1), 77-80.
Stephen, E. 2013. The blue book guidelines for the control of infectious diseases. Infectious Diseases Section, Victorian Government Dept. of Human Services. Melbourne.
Uppal, P. K. 2010. Emergence Of Nipah Virus In Malaysia. Annals of the New York Academy of Sciences, 916(1)354-357.