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Tuesday, September 28, 2021

As Kerala grapples with Covid, Nipah returns: 12-year-old succumbs to virus

The new crisis came as Kerala continues to grapple with the Covid-19 pandemic, with around 25,000 cases being detected every day. Of the total 4.1 lakh active cases of the disease in India, as many as 2.5 lakh are in Kerala.

Written by Shaju Philip | Thiruvananthapuram |
Updated: September 6, 2021 1:42:09 am
At the burial of the 12-year-old boy who died due to Nipah in Kerala

A 12-year-old boy succumbed to the Nipah virus in Kerala’s Kozhikode district on Sunday, the third time in four years that the state has been hit by the zoonotic infection that has a very high fatality rate.

The new crisis came as Kerala continues to grapple with the Covid-19 pandemic, with around 25,000 cases being detected every day. Of the total 4.1 lakh active cases of the disease in India, as many as 2.5 lakh are in Kerala.

A Nipah virus outbreak in Kozhikode had claimed 17 lives in 2018. A single case had been reported in Ernakulam district in 2019, but there was no fatality.

After a high-level meeting of health and revenue officials on Sunday, state Health Minister Veena George told reporters in Kozhikode that the source of the 12-year-old boy’s infection was yet to be ascertained.

The Nipah infection travels from bats to humans and some other animals including dogs and horses. The index case in the 2018 outbreak, a 27-year-old man, was found to have caught the infection from fruit bats in his village, Changaroth, in Kozhikode district.

All other infections in 2018 were cases of human-to-human transmission of the virus. The village of the boy who died on Sunday, Chathamangalam, is at a distance of about 50 km from Changaroth in the same district.

Police have cordoned off an area of three km radius around the house of the boy.

Minister George said infection with the Nipah virus was confirmed by the National Institute of Virology (NIV) in Pune late on Saturday night after tests on the boy’s plasma, serum, and cerebrospinal fluid (CSF) returned positive results.

A total 188 persons who have been identified as having had contact with the infected boy, have been put in quarantine. Most of these individuals are healthcare workers at various hospitals in Kozhikode, where the boy had been treated or had consulted doctors from August 29 onward.

Twenty of these individuals have been identified as being in the high-risk category, and have been moved to an isolation ward at the Government Medical College in Kozhikode, the Minister said. Two of them, both healthcare workers, have developed symptoms of the infection.

The next seven days will be critical, George said. A point-of-care-testing facility will be set up at the hospital on Monday with the help of experts from NIV. In case of a positive test result, a confirmation test will be carried out at NIV, which has promised to make the result available in 12 hours, she said.

Adequate supplies of medicine for treatment have also been ensured. The Indian Council of Medical Research (ICMR) has promised to make available monoclonal antibodies within a week, the Minister said.

Dr E K Suresh Kumar, head of the paediatric department at Aster MIMS Kozhikode, where the boy was treated, said, “The patient was brought intubated from medical college hospital on September 1 with high fever and vomiting. He had reported epilepsy at the medical college. We suspected Nipah infection as the patient was not responding to medicines and had myocarditis (inflammation of heart muscles). Hence, we sent samples to NIV Pune on September 2 itself.’’

The Union Health Ministry said in a statement on Sunday morning that following a “suspected case” of death from Nipah, a team of experts from the National Centre for Disease Control (NCDC) had been sent to Kerala.

“Nipah virus has been detected in the Kozhikode district of Kerala. Central Government has rushed a team to Kerala to support the State in public health measures and provide technical support,” Health Minister Mansukh Mandaviya said in a tweet.

The Ministry directed the Kerala public health department to take four specific actions: active case search in the families, village, and areas with similar topography, especially in Malappuram district; active contact tracing for any contacts during the past 12 days; strict quarantine of the contacts and isolation of any suspects; and collection and transportation of samples for lab testing.

The state government has declared a containment zone in a radius of 3 km around Chathamangalam village. All roads leading to Pazhoor ward under Chathamangalam have been blocked by police and health authorities to prevent movement of people. The panchayat, which had 500 active Covid-19 cases on Saturday, has been a containment zone for the last six days.

The health department has sounded an alert for the adjacent districts of Malappuram and Kannur. All districts have been directed to maintain vigil and ensure surveillance for acute encephalitis, which is one of the symptoms of infection with the Nipah virus. A control room and a call centre have been opened in Kozhikode for management of a possible outbreak.

The health department said that the boy, the son of a coconut climber, had played with other children near his home on August 27. After he developed a fever, he was taken to a local clinic on August 29, after which he returned home.

As there was no let-up in the fever, on August 31, he was taken to a hospital in Mukkom, which immediately referred him to another private hospital at Omassery, another town nearby.

That same day, as his condition deteriorated, the boy was rushed to Kozhikode Medical College hospital. But as the ICU at the medical college hospital was full with Covid and non-Covid patients, he was moved to a private speciality hospital on September 1.

“We were ready to arrange a ventilator bed, but the patient was shifted out at the request of the family,’’ medical college superintendent Dr M P Sreejayan said. The boy died at Aster MIMS on Sunday morning.

A team from NCDC visited the village of the boy on Sunday. Chathamangalam panchayat president Abdul Gafoor said 17 people from the panchayat — all close relatives of the boy — are under observation. “The region has the presence of fruit bats. The boy had consumed rambutan fruit a few days back before he developed fever,’’ Gafoor said.

The boy was buried in Kozhikode as per WHO protocols. —With ENS, New Delhi

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