More than two dozen people have died and hundreds have been affected by viral fever in the past few months in the district of Jajarkot in mid-western Nepal, which is located about 400 km west of Kathmandu. Most of the patients suffered from a flu-like illness, and showed symptoms like fever, headache, cough, common cold, nausea, joint pain, vomiting and diarrhoea. A severe shortage of medicines has made it difficult to control the problem.

According to the National Public Health Laboratory (NPHL), the cause of viral fever in Jajarkot and Bajura is the H3N2 strain of the influenza A virus. It was first detected in Hong Kong in early 1968, and so is commonly called the Hong Kong flu. The World Health Organisation (WHO) recommends flu vaccination. Prompt flu antiviral treatment is also key for people who exhibit severe flu symptoms and are at high risk of developing complications.

Why Jajarkot?

Different disease outbreaks have been reported in Jajarkot in recent years. In 2009, a cholera outbreak claimed about 400 lives. In 2016, there was an outbreak of swine flu which killed 17 people. And in the beginning of 2018, a viral fever outbreak disseminated throughout the district disproportionately. A question has been raised. Why is Jajarkot being hit by frequent disease outbreaks? As per government officials, poor sanitation and lack of awareness are the cardinal factors. But why is the state ignoring the disease of poverty? Disease outbreaks lock sufferers into a cycle of poverty from which it is nearly impossible to escape. Additionally, there is a severe shortage of even ordinary medicines, doctors and basic health facilities in Jajarkot which allows the disease to spread rapidly.

According to the Epidemiology and Disease Control Division (EDCD), Teku, the number of influenza type patients is higher this year compared to last year. For the past month, seasonal flu has been spreading fast in Jajarkot and surrounding districts, and it is becoming difficult to provide timely treatment to all patients. The EDCD has warned, “Being a highly communicable viral disease, it may spread to other parts of the country; and there is no cure except sanitation and awareness.”

The virus attacks mainly the upper respiratory tract. It poses a serious risk to the elderly, the very young and people with underlying medical conditions such as kidney, lung or heart problems, cancer or diabetes. Influenza viruses normally remain confined to the respiratory tract because the protease enzymes that cleave HA are common only at these sites. The influenza virus is spread from person to person through airborne droplets or by contact with contaminated surfaces or hands.

The incubation period from exposure to the virus and the onset of illness varies from one to four days, depending on the size of the viral load and the immune status of the host. Within a short time, many cells in the respiratory tract are infected and killed. Symptoms of classic influenza normally appear abruptly and include headache, chills and dry cough followed by high fever, malaise, muscular aches and anorexia. Febrile convulsions and croup can occur in children. An influenza epidemic causes a high number of deaths due to pneumonia and cardiopulmonary diseases. Influenza infection enhances susceptibility of patients to bacterial superinfection.

Misdiagnosis a concern

The only reference laboratory for influenza disease diagnosis in Nepal is the influenza centre at the NPHL. The cardinal symptoms of this virus are similar to other respiratory viral diseases, and this leads to misdiagnosis and wrong treatment or delays in detection in the absence of the required diagnostic kits and equipment. Specimens of choice for detecting H3N2 virus infection are nasal washings, gargles and throat swabs. Samples should be collected within three days after the onset of symptoms. Reverse-transcription polymerase chain reaction (RT-PCR) helps in the direct detection of viral RNA or specific viral antigens in the collected specimens. However, this is not currently available in all clinical settings. Viral culture procedures take three to 10 days.

There is no perfect vaccine or specific drug against this viral infection. Only pain, fever and nasal congestion can be treated. Patients should drink plenty of liquids and get bed rest. If complications develop, get to a doctor immediately. For secondary bacterial infection, the physician would prescribe the Azithromycin antibiotic.

The government needs to conduct a series of awareness programmes and manage the required diagnostic kits and experts in all healthcare settings in the affected districts. The authorities should run screening and protection protocols to stop any consequences regarding this virus. Staying updated about its pattern of dissemination is also important. Washing hands with soap and water or using an alcohol-based hand sanitiser is highly effective in reducing the virus load. Individuals should stay away from crowds and wear mouth masks when engaged in outdoor activities.

Rayamajhee and Aryal are associated with the research faculty, Kathmandu Research Institute for Biological Sciences