Nipah ward kozhikode kerala
Staff members install a sign reading "Nipah isolation ward, entry strictly prohibited" at a hospital where a ward is being prepared for suspected Nipah virus patients in Kozhikode district, Kerala, India, September 12, 2023. Image Credit: Reuters

New Delhi: India’s southern state of Kerala shut some schools, offices and public transport on Wednesday in a race to stop the spread of the rare and deadly Nipah virus, which has killed two people.

An adult and a child were still infected in hospital, and more than 130 people have been tested for the virus, spread via contact with the bodily fluids of infected bats, pigs or people, a state health official said.

“We are focusing on tracing contacts of infected persons early and isolating anyone with symptoms,” said the state’s Health Minister Veena George, who told reporters the virus detected in Kerala was the Bangladesh variant, which spreads from human to human with a high mortality rate but has a history of being less infectious.

“Public movement has been restricted in parts of the state to contain the medical crisis,” she said.

Two infected people have died since Aug. 30 in the state’s fourth outbreak of the virus since 2018, forcing authorities to declare containment zones in at least seven villages in the district of Kozhikode.

In a reply to a query by CPI MLA P Balachandran in the Assembly, George said on Wednesday, “It is now confirmed that the two patients, who died on Monday at a private hospital in Kozhikode, were infected with Nipah virus. There are two active cases in the district presently. Both the active cases — a 9-year-old child and a 24-year-old person — are relatives of one of the deceased.”

“After the unnatural death of two persons, the health director swung into action immediately. On Tuesday, the central government sent a team of health experts to Kerala after the Union Health Minister (Mansukh Mandaviya) confirmed that the two unnatural deaths were caused by Nipah virus,” the minister added.

The health department has taken every possible step to prevent the spread of Nipah infection. The priority for the department at this stage is to prevent more people from catching the Nipah virus and arrange timely treatment of suspected patients, including psychological support.

- Veena George, Health Minister

Strict isolation rules have been adopted, with medical staff being quarantined after contact with the infected.

The first victim was a small landholder growing bananas and areca nuts in the district’s village of Marutonkara, said a government official who retraced the movement of the victim to track down all the people he could have interacted with and the places visited before his health started to deteriorate.

The victim’s daughter and brother-in-law, both infected, are in an isolation ward, while other family members and neighbours are being tested.

The second death followed contact in hospital with the first victim, an initial investigation has shown, but the two were not related, added the official, who sought anonymity as he was not authorised to talk to the media.

Contact list of suspected patients has grown to 350
Kozhikode District Collector A. Geetha on Wednesday said the list of contacts of patients, suspected to have been infected by the virus, has grown to about 350 and 50 per cent of them are in the high-risk category.

Seeking to allay fears of children at risk of catching the virus at schools, the district collector said there was no need to panic as the government will soon arrange online classes in areas declared 'containment zones'.

Earlier, on Tuesday, the state Health Department issued an alert for Kannur, Wayanad and Malappuram districts after the confirmation of Nipah infection in Kozhikode.

The samples were sent to the Pune Institute of Virology for confirmation of Nipah even as the administration stepped up containment efforts in the district.

Three federal teams, including experts from the National Virology Institute, arrived on Wednesday to conduct more tests and to survey the fruit bat population from the isolated villages.

Alert issued along Tamil Nadu-Kerala border

Tamil Nadu's Directorate of Public Health and Preventive Medicine has issued an alert in the border areas following the Nipah virus-related deaths in Kozhikode, Kerala.

Dr T. S. Selvanivayagam, Director of Public Health and Preventive Medicine, Government of Tamil Nadu, in a statement, said: "In view of two Nipah virus cases reported from Kerala , we would screen passengers from Kerala at border check posts by the health team. A separate team has been deployed round the clock in six districts of Tamil Nadu that share borders with Kerala."

The six districts are The Nilgiris,Coimbatore, Tiruppur, Theni, Tenkasi and Kanyakumari.

The deputy directors of health services are directed to screen all symptomatic fever cases at the borders with necessary protective equipment.

Tamil Nadu Health Minister Ma Subramanian interacted with the media at Gudalur in the Nilgiri district and informed people that there was no need for panic over the Nipah outbreak in Kerala.

The minister also said that screening would be done for those who were having fever symptoms.

What is Nipah virus?

The Nipah virus was first identified in 1999 during an outbreak of illness among pig farmers and others in close contact with the animals in Malaysia and Singapore.

Outbreaks are sporadic and previous infections in South Asia have occurred when people drank date-palm sap contaminated with bat excreta.

Nipah virus infection in humans causes a range of clinical presentations, from asymptomatic infection to acute respiratory infection and fatal encephalitis. Nipah virus can be transmitted to humans from animals, or contaminated foods and can also be transmitted directly from human-to-human. Fruit bats of the Pteropodidae family are the natural host of Nipah virus.

The case fatality rate is estimated at 40% to 75%, according to WHO. This rate can vary by outbreak depending on local capabilities for epidemiological surveillance and clinical management.

In Kerala’s first Nipah outbreak, 21 of the 23 infected died, while outbreaks in 2019 and 2021 claimed two more lives.