Nipah cases rise in Kerala; ICMR says mortality among infected between 40% and 70%: What we know so far

Nipah cases in Kerala’s northern district Kozhikode mounted to six, with one more person testing positive for the zoonotic virus on Friday. State Health Minister Veena George said that a 39-year-old man has been confirmed with the Nipah virus after his samples turned positive. He was under observation in a hospital. He had sought treatment at a private hospital where Nipah-positive affected were treated for other ailments earlier, it said in a statement.

Meanwhile, Indian Council of Medical Research (ICMR) Director General Rajeev Bahl Friday said the mortality among the infected is very high in Nipah – between 40 and 70 per cent – compared to that of Covid-19 which was 2-3 per cent. Adding that efforts are on to contain the Nipah outbreak, Bahl, however, noted that it is not yet known why Nipah cases keep surfacing in Kerala. He further stated that India will procure from Australia 20 more doses of monoclonal antibody for the treatment of Nipah virus infection.

Two dead, six confirmed cases

The latest person to test positive for the deadly virus has been under observation in a hospital in Kozhikode. On Thursday, 11 samples collected from those in the contact list of other confirmed cases had tested negative. The Nipah outbreak killed two persons in the last two weeks.

Control measures in place

Nine panchayats have been categorised as containment zones and restrictions are in place. Educational institutions in Kozhikode will remain closed till Saturday and functions have been banned till September 24. The number of those under observation rose to 950 on Thursday and route maps of those who tested postive have been traced, more persons in contact list have been tracked. In case of any adversity, 75 isolation rooms, six ICUs and four ventillators have been set up at Medical College Hospital in Kozhikode.

Centre team visits to review situation

A six-member team from the National Centre for Disease Control in Delhi has arrived in Kozhikode to take stock of the situation. The team includes epidemiologists, microbiologists, neurologists, and a wildlife officer. As part of their investigation, the team, headed by Dr Mala Chhabra, microbiologist from Dr Ram Manohar Lohia hospital in Delhi, is set to visit Ayancheri and Maruthonkara, two epicentres of the outbreak. In order to ramp up sample testing, the National Institute of Virology Pune has brought a mobile lab with bio bio-safety level-3 facility.

Monoclonal antibody for treatment

Monoclonal antibody is the only available antiviral treatment for the brain damaging disease, according to state Health Minister Veena George. The medicine arived in the state on Thursday. The virus transmitted from animals, primarily bats, to humans causes acute respiratory illness and fatal encephalitis. It poses fatal risk to not only humans but also animals.

KK Shailaja recalls 2018 Nipah outbreak

Former Health Minister and CPI (M) MLA K K Shailaja recalled Nipah outbreak in 2018 and said the situation is not as scary as it was five years ago. The veteran CPI (M) leader had won accolades for handling the outbreak effectively in 2018. She said the southern state has a protocol and Standard Operating Procedure (SOP) to effectively fight the infection and prevent its spread.

Insights from Covid pandemic and earlier bouts of Nipah come handy

The state's previous experience with Nipah outbreaks and Covid pandemic have helped the administration in fighting the virus for the fourth time. Similar to 2018 outbreak, the hospitals have contributed to the virus transmission this year as well. Notably, a nurse named Lini Puthussery, who worked at a taluk hospital in Perambra died of the infection while treating a patient. This year, it was found prima facie that the index case came into contact with the second victim at a private hospital, leading to the development of a cluster at the latter’s home.

Neighbouring Karnataka steps up vigil

As a precautionary measure amid the Nipah outbreak, the Karnataka health department has issued surveillance guidelines in districts bordering Kerala. People has been advised to avoid unnecessary travel from Karnataka to affected areas of Kerala. Hospital administrations have been directed to train staff including those in primary health centres to tackle emergency situations.

Nipah outbreaks in India so far

India first reported Nipah in 2001 in West Bengal's Siliguri. Out of the 66 cases reported, there were 45 fatalities. The second outbreak was in Bengal's Nadia with five fatalities and 50 cases. The deadly virus was first reported in Kerala in 2018 and 16 people succumbed then. Later in 2019, one case was reported in the state and during the Covid pandemic, a 12-year-old died in Kerala's Ernakulam due to Nipah.

How to prevent Nipah infection

While the virus does not spread quickly, the fatality rate is high. The preventive measures include avoiding fruits usually consumed by fruit bats, avoid direct contact with pigs, keep fruit bats at bay. Strict infection control measures have to be taken to prevent transimission such as wearing protective hand gloves while administering medical care to those infected, maintaining hand hygiene and using personal protective equipment (PPE)

What is Nipah and how does it transmit

Nipah is a zoonotic disease, that is, it is transmitted to humans through infected animals or contaminated food. According to WHO, it also gets transmitted directly from person to person through close contact with an infected person. Consumption of raw date, palm sap or fruit consumed by infected bats and even climbing trees on which bats often roost pose risk. The symptoms include fever, headache, cough, sore throat, difficulty in breathing, and vomiting.

Mortality among Nipah infected between 40-70%: ICMR DG

Indian Council of Medical Research (ICMR) Director General Rajeev Bahl Friday said the mortality among the infected is very high in Nipah - between 40 and 70 per cent - compared to that of Covid which was 2-3 per cent. He added that efforts are on to contain the Nipah outbreak. He, however, noted that it is not yet known why Nipah cases keep surfacing in Kerala.

Addressing media, Bahl stated that ICMR has monoclonal antibody doses only for 10 patients, however, no one so far has been administered with it. India has sought 20 more doses of monoclonal antibody and the medicine needs to be given during the early stage of infection, he said.

Bahl further said efficacy trials of monoclonal antibodies have not been done yet and that only phase 1 trial has been completed. He added that the medicine can be given only on compassionate grounds.

(With PTI inputs)