Langya virus emergence: is the ongoing COVID pandemic and monkeypox re-emergence not enough?

In the recent scenario of the ongoing COVID pandemic and re-emergence of the monkeypox virus, another zoonotic disease causing febrile illness in humans was reported from China in the first week of August 2022 and is gaining global attention, the causative agent of which is Langya virus (LayV), a new Henipavirus1,2. LayV belongs to the family Paramyxoviridae under the genus Henipavirus, which also contains Hendra and Nipah virus, zoonotic viruses which affect livestock and humans1,3,4. Nipah and Hendra viruses are biosafety level-4 (BSL-4) pathogens. So, LayV may require BSL-4 facilities until its risk is well known5. The disease has affected the people of Shandong and Henang provinces of Eastern China. From 2018 to 2022, 35 patients with a recent history of animal exposure were investigated1,3. The virus was identified using the swab sample of a patient's throat by subjecting the sample to metagenomic analysis, and subsequent isolation of the virus as a phylogenetically distinct Henipavirus1,4. The LayV genome comprises 18 402 nucleotides with genome organization similar to other Henipavirus6. Phylogenetically, it is most related to Mojiang henipavirus, a rat-borne virus first identified in China1,7. The disease presents as fever (being the most common symptom), cough, fatigue, loss of appetite, muscle pain, nausea, headache, and vomiting. Laboratory investigations show leukopenia and thrombocytopenia. Complications like pneumonia, liver failure, and kidney failure may occur8. However, no deaths have been reported from LayV till now1,8. Among 35 cases detected in China, the majority were farmers and factory workers, with LayV being the potential pathogen in 26 patients. Serum samples collected from 14 patients during the acute and convalescent phases of infection showed the immunoglobulin G (IgG) titers in the majority of samples (86%), with samples collected during the convalescent phase having four times more IgG titers than samples collected during the acute phase. The viral load was found to be higher in patients with pneumonia than in those without pneumonia1. Among the testing of 25 animals for the natural reservoir, RNA of the virus was isolated from shrews, which are also found to spread Hantavirus and Mammarenavirus9. The absence of infection in close contact suggests the sporadic nature of the disease10. Human-to-human transmission has not been reported yet1. There are no approved drugs and vaccines for the virus to date. However, some researchers suggest the use of Ribavarin (an antiviral), which is used for RNA virus infection with respiratory symptoms. However, some suggest its combination with chloroquine (antimalarial), which was found useful in Henra and Nipah viral infections2,11. Various measures can be applied to prevent the spread of this disease, which include environmental sanitation to prevent climate crisis that plays a major role in zoonotic disease spillovers, mass awareness about the disease, regular testing of animals and humans for virological disease reservoirs, specialized laboratory facilities for viral infection tracking in humans, surveillance of reservoir, host, and agent of this disease taking into consideration the mutagenic potential of this RNA virus which could happen if occurs and may pose upon serious health hazards in future if not done so and lastly early implementation of control strategies to prevent its spread to other regions and country. Since there have not been any reports about human-to-human transmission of this virus, that is a relief in the fact that it may not cause any pandemic like that of COVID-19. For a country like Nepal, neighboring China, there is a possibility of its spread if the above measures are not applied in China itself as Nepal is a poor country that cannot afford advanced laboratory setup for identification and isolation of this emerging virus and implementation of standardized control strategies. The need of the hour is the planning of outbreak management strategies for limiting the spread and confinement of this virus with not much data about infectivity potential. Ethics approval Ethical approval is not required for an editorial. Consent Not applicable. Sources of funding Since we are medical students under supervision, we do not have any financial support for our research. Author contribution A.B. and N.K.: literature review, writing the manuscript, and final approval of the manuscript. Conflicts of interest disclosure There are no conflicts of interest. Research registration unique identification number (UIN) Name of the registry: not applicable. Unique identifying number or registration ID: not applicable. Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable. Guarantor Amrit Bhusal. Provenance and peer review Not commissioned, externally peer-reviewed.