Nipah strikes in India; an urgent call for outbreak preparedness in Pakistan

Dear Editor,

We refer transmission of infections in India which have implications for Pakistan [1]. As compared to Pakistan, the range and burden of infectious diseases are enormous in India including Severe Acute Respiratory Syndrome (SARS) contagion in 2002–2003, Influenza A virus epidemic of 2006 (avian influenza), 2007 Equine influenza, Swine flu pandemic outbreaks in 2009 and 2014 [2]. Moreover, episodes of infectious diseases continue to rise in India, with a recent surge of chikungunya and dengue cases in 2016 [1]. In the light of these facts, we believe that probability of infectious disease transmission from India to Pakistan should not be ignored.

India has experienced third outbreak of Nipah Infection claiming 14 lives which explicitly indicates how unprepared the country was for an epidemic emergency [3]. India is experiencing the quadruple burden of viral infections including dengue, chikungunya and Zika from last few years, which has created many concerns among surrounding countries, particularly in Pakistan. There are numerous examples of spread of exotic pathogens to new geographic locations by cross-border movements including malaria, dengue, Chikungunya, West Nile and Crimean-Congo hemorrhagic fever (CCHF). This process is facilitated when the environmental conditions across borders share common characteristics [4]. Pakistan shares 2912-kilometer eastern border with India and hundreds of people travel between two countries on daily basis by several routes. Additionally, bilateral trade ties between two countries also increase the risk of disease transmission across borders. In this context, we felt inclined to share our point of view about the potential risk of Nipah outbreak in Pakistan.

Current outbreak of Nipah is believed to be associated with fruit bats evidenced by the dead animals found in the well of a house where four people succumbed to death due to infection [3]. Since Nipah virus can transmit from bats to fruits and vegetables, trade of these commodities from India poses high propensity of disease spread to importer regions including Pakistan. It is pertinent to mention that Pakistan follows disease epidemics of India [5] and risks of Nipah virus spillover cannot be disregarded. We strongly believe that the infectious diseases can easily spread with infected travelers or trade commodities entering the Pakistan, therefore dire aggressive maneuvers to cull the trade or to initiate the surveillance programs are warranted. Since Pakistan is harboring two bat species (Pteropus giganteus, Scotophilus kuhlii) previously shown to have Nipah Virus [6], Government should chalk out the strategies to handle the current situation of deadly viral load in the region with collaborative efforts, both countries should set aside their differences and conduct joint vector surveillance and control in order to strengthen the preparedness, response and recovery of future epidemics.

Authors contributions

THM and TMK conceived the idea and collected the data; THM devised the initial draft and final draft was reviewed by YHK. THM, YHK and TMK finalized the draft for submission.

Conflicts of interest

Authors have no conflict of interest.

Funding

The author(s) received no specific funding for this work.