Nipah virus infection in Kerala: What we know, and don't know, about the disease
Nipah can kill as many as 3 in 4 people it infects in case of an outbreak
Highlights
- Health authorities in Kerala confirmed the death of a 12-year-old boy from Nipah virus on September 5, 2021.
- The incident led to containment measures involving contact-tracing and quarantining of more than 180 people.
- The suspicion was that the virus was transmitted from bats that were feeding on rambutan.
- Nipah, which can kill as many as 3 in 4 people it infects, seen as a much bigger headache than COVID
Thiruvananthapuram: Health authorities in India are racing against time to contain a potential Nipah virus outbreak. Extensive contact tracing and subsequent quarantining of dozens of people came following the death of a 12-year-old boy from the deadly virus, which was detected in the midst of a raging COVID-19 outbreak.
Officials said the Nipah virus, which can kill as many as three out of four people it infects, can be a bigger headache than COVID-19. Kerala is currently grappling with COVID-19, having reported nearly 20,000 cases reported on Monday.
Here’s what we know so far:
How many new Nipah virus cases and deaths have been reported so far in India?
One death from Nipah was confirmed on Monday (September 5, 2021). Up to 188 people were identified as close contacts of the victim, a 12-year-old boy who died Monday. Two health workers were found to have symptoms of Nipah virus in southern India.
188
What do we know about the patient who died?
The boy’s name was not revealed. Local health officials suspect the boy was infected after eating contaminated rambutan fruits. They confirmed the victim died of Nipah virus. India has several virology institutes that helped detect past Nipah virus outbreaks.
What are the latest updates?
Samples of 10 high-risk contacts of the 12-year-old boy who died of the Nipah virus all tested negative on Tuesday (September 7, 2021).
State health minister Veena George said three sets of samples of the 10 high-risk contacts had been sent to the National Institute of Virology (NIV) in Pune, Maharashtra.
All had been found to be negative. The samples were of the boy’s parents, family members and health workers who were close contacts of the boy during his treatment at a private hospital and at the Kozhikode Medical College Hospital (KMCH).
Health and animal husbandry department officials had also collected swab samples from a goat reared by the family in Pazhoor, Chathamangalam, a farming village in the Kozhikode district of India’s southern state of Kerala (Chathamangalam is about 6km away from the city of Kunnamangalam). Authorities said the goat had come in contact with the victim.
What does the negative test result mean?
The negative test result of high-risk contacts has given the state health department some breathing space to tackle the virus even as it grapples with the COVID-19 pandemic. Kerala, with nearly 20,000 new COVID cases reported Tuesday, has been driving India’s new COVID-19 cases, with the daily average hovering around the 30,000-mark.
Why is rambutan suspected?
Doctors and health workers are still perplexed about how the boy in Kozhikode contracted the virus. One suspect is the rambutan fruit which the boy’s family said he had eaten a few days prior to his death.
Rambutan is a fruit native to south-east Asia and grown in large tracts in the region. It has made an entry into Kerala farms on a commercial scale only in recent years. The fruit retails for about Rs150 per kg.
The boy reportedly ate rambutan from a neighbouring house, and there was a colony of bats in the area. The suspicion was that the virus was transmitted from bats that were feeding on rambutan.
What did authorities do with the boy’s close contacts?
The health department has prepared a contact list of the deceased boy, numbering 188 persons. The high-risk patients were shifted to the Kozhikode Medical College Hospital; others are under isolation. Experts have said that the existing measures to combat COVID-19 have come in handy to deal with the Nipah virus because people have already been following hygiene practices like washing hands with soap and using masks and sanitisers.
How is the Nipah virus test being conducted in Kerala?
A Nipah virus testing laboratory has been established locally with support from the NIV-Pune, the NIV-Alappuzha and the Kozhikode Medical College. A team from the NIV-Bhopal is also expected to reach Kerala on Wednesday (September 8, 2021). Health experts will test serum samples from bats, known hosts of the Nipah virus.
• fever
• headache
• vomiting
• dizziness
• loss of consciousness (in extreme cases)
These symptoms typically last about 10-12 days, say doctors. The virus can then seriously impact the brain, which can be fatal.
When were the previous Nipah outbreaks in India?
The first case of Nipah outbreak in India was reported in 2001, when it surfaced in Siliguri, in India’s West Bengal state. It was again detected in 2007. In 2018, the virus was reported both in Kozhikode and Malappuram, both in Kerala. It left 17 people dead, including Lini Puthussery, a nurse who treated some of the early patients. In June 2019, more than over 300 people from different parts of Kerala were under observation following a Nipah outbreak that year.
When and where was the first documented Nipah virus outbreak?
Nipah virus encephalitis was first identified among Malaysia’s pig farmers following an outbreak of the disease in Malaysia and Singapore in 1998 and 1999, when over 1 million pigs were destroyed to control the disease. On this occasion, pigs were the intermediate hosts.
Besides Malaysia and India, where else did Nipah virus detected?
Outbreaks have also been reported in Bangladesh, Cambodia, Laos, the Philippines, Singapore and Thailand. In Bangladesh in 2004, humans were infected with Nipah virus after consuming date palm sap that had been contaminated by infected fruit bats.
Nipah virus (NiV) is a paramyxovirus (Henipavirus genus, Paramyxovirinae subfamily, Paramyxoviridae family, order Mononegavirales), an emerging virus that can cause severe respiratory illness and deadly encephalitis in humans.
The virus has been named Nipah, from the sample taken in Nipah River Village of Pelandok Hill, Malaysia. The area has become synonyms with the deadly virus.
In 2018, the outbreak was memorialised in a museum named “Nipah River Time Tunnel Museum” in the Nipah River Village. Several of the surviving victims’ stories have been filmed in a documentary which will be featured at the museum.
Is there a cure for Nipah virus infection?
Currently, there are no licensed treatments or vaccines available for Nipah virus (NiV) infection. Treatment is limited to supportive care, including rest, hydration, and treatment of symptoms as they occur.
What is the death rate among people infected with Nipah virus?
Currently, the mortality rate of the disease is upwards of 70% in reported cases. Intensive supportive care may save patients completely. However, after-effect of encephalitis on survivors can result in periodic seizures or relapse into encephalitis.
What is the transmission route of the Nipah virus?
- Fruit bats acts as natural reservoir of Nipah viruses (NiVs). Fruit bats with NiV feeds on date palm sap. Virus can survive in solutions that are rich in sugar, viz., fruit pulp.
- Virus transmitted to human through the consumption of date palm sap.
- Fruit bats of Pteropus spp. which are NiV reservoirs visited such fruit trees and got opportunity to naturally spill the drop containing virus in the farm to contaminate the farm soil and fruits.
- Contaminated fruits are consumed by pigs and other animals. Pigs act as intermediate as well as amplifying host. Combination of close surroundings of fruiting trees, fruits-like date palm, fruit bats, pigs and human altogether form the basis of emergence and spread of new deadly zoonotic virus infection like Nipah.
- Pork meat infected with NiV are exported to other parts.
- Consumption of infected pork can act as a source of infection to human.
- Close contact with NiV affected human can lead to spread of NiV to other persons.
What are the guidelines in handling Nipah virus?
Kerala Health Ministry has set guidelines in identifying and containing Nipah virus. All the hospitals in the area have been given clear directives on how to prepare for and tackle cases effectively.
The guidelines cover everything from the way suspected cases must be treated, screened and isolated, as well as sample collection. Protocols are in place for collecting, storing and transporting suspected or confirmed cases and health workers.
All the samples go through the District Medical Officer’s office onward to Manipal, where government-approved virology testing centre handle samples. If samples test positive, prompt information is given to the treating hospital.
Guidelines are also laid down on everything from what level of personal precautions carers (nurse, doctors, family) need, to what measures to take. These include the use of mask or full-on personal protective gear, methods of washing clothes worn by patients and carers, and how the contact surfaces need to be cleaned.
Any precautions to take?
- Stay calm, don’t believe or distribute in rumours or wrong information that may spread through social media.
- If you suffer from a mild cold, visit the nearest hospital and follow the doctor’s instruction to rest, hydrate and eat appropriately.
- Avoid large crowds.
- Hand hygiene is the best way to protect yourself against the virus from spreading through body fluids on surfaces.
- Avoid eating fallen fruits.
- Avoid eating uncooked vegetables or fruits.
- Restrain from drinking toddy, date palm sap and other raw fluids that come from trees.
- Stay updated with information from official sources.
[Source: WHO]