Nipah Alert: One more tests positive, Centre to get 20 more doses of antibody from Australia

Kozhikode: India's southern state of Kerala shut some schools and offices this week as officials raced to halt the spread of the deadly Nipah virus after it killed two people in the fourth outbreak since 2018.

The Nipah virus was first identified in 1998 during an outbreak of illness among pig farmers in Malaysia and Singapore.

It is able to infect humans directly through contact with the bodily fluids of infected bats and pigs, with some documented cases of transmission among humans.

There are no vaccines to prevent or cure the infection, which has a mortality rate of about 70%. The usual treatment is to provide supportive care.

Infected people initially develop symptoms that include fever, respiratory distress, headaches, and vomiting, the World Health Organization (WHO) says. Encephalitis and seizures can also occur in severe cases, leading to coma.

The 1998 outbreak in Malaysia and Singapore killed more than 100 people and infected nearly 300. Since then, it has spread thousands of miles, killing between 72% and 86% of those infected.

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More than 600 cases of Nipah virus human infections were reported between 1998 to 2015, WHO data shows.

A 2001 outbreak in India and two more in Bangladesh killed 62 of 91 people infected.

In 2018, an outbreak in Kerala claimed 21 lives, with other outbreaks in 2019 and 2021.

Parts of Kerala are among those most at risk globally for outbreaks of bat viruses, a Reuters investigation showed in May.

One more tests positive

A fresh case of Nipah virus was confirmed in Kozhikode, where two people were killed by the brain-damaging virus recently, the Kerala government said on Friday.

With the new Nipah infection in the state, taking the total number of active cases to four, the Indian Council of Medical Research (ICMR) has decided to procure from Australia 20 more doses of monoclonal antibody for its treatment.

Intensifying its efforts to contain the spread of the virus, the state government also decided to test everyone who is on the high-risk contact list of the infected persons.

State Health Minister Veena George said a 39-year-old man tested positive for the virus, which was transmitted to him through direct contact with an infected person who died on August 30.

George said that the man was confirmed to have the Nipah virus infection after his samples turned positive, taking the total number of people infected in the state to six, of whom two had died earlier.

She said the man found infected had sought treatment at a private hospital where Nipah-infected persons were treated for other ailments earlier.

Meanwhile, in a slight relief to Kerala, the test results of 30 healthcare workers, who were the primary contacts of the first deceased Nipah-virus-infected person, returned negative on Friday.

George said the test results also showed that the person who died on August 30 was the index case.

“It was important that we properly identify the index case. Today, the results of the samples of the 30 health workers, who were the primary contacts of the index patient who died on August 30, returned negative,” she told reporters in Kozhikode after attending a high-level review meeting.

She also said that those who turned negative should remain in isolation as per the instructions of the health authorities.

In New Delhi, while announcing the decision to procure 20 more doses of monoclonal antibody from Australia, ICMR DG Rajeev Bahl said that mortality among the infected is very high in Nipah (between 40 and 70 per cent) compared to the mortality in COVID-19, which was 2-3 per cent.

He asserted that all efforts are on to contain the spread of the virus in Kerala.

Addressing a press meet in New Delhi, he said all patients are contacts of an index patient.

On why cases keep surfacing in Kerala, Bahl said, “We do not know. In 2018, we found that the outbreak in Kerala was related to bats. We are not sure how the infection passed from bats to humans. The link couldn’t be established. Again, we are trying to find out this time. It always happens in the rainy season.” He said monoclonal antibody has been given to 14 patients infected with the Nipah virus outside India, and all of them have survived.

“Only the phase 1 trial to establish the safety of the medicine has been done outside. Efficacy trials have not been done. It can only be given as compassionate use medicine,” he said.

Meanwhile, the central team arrived in Kozhikode to study the situation and conducted an inspection at the house of the index patient at the Maruthonkara panchayat.

The central team, headed by scientist Balasubramanyam, comprises members including Hanul Thukral, M Santhosh Kumar and Gajendrasingh.

The Kerala Health Department said it has identified a total of 1,080 persons in the contact list of the positive patients and has started collecting samples.

The government had earlier announced that everyone who is on the high-risk contact list of the infected persons will be tested.

George said the health conditions of those affected, including the nine-year-old boy on ventilator support, were stable.

The ICMR’s National Institute of Virology (NIV) in Pune had on Thursday sent its mobile BSL-3 (Biosafety Level-3) laboratory to Kozhikode to test the samples for the virus in the district.

This is the fourth time the viral infection has been confirmed in the state. It was detected in Kozhikode in 2018 and 2021 and in Ernakulam in 2019.

The district administration has already declared a holiday for educational institutions in Kozhikode on Saturday (September 16), in addition to Thursday and Friday.

On Wednesday, a 24-year-old health worker became Kerala’s fifth confirmed Nipah case in the latest outbreak.

The World Health Organisation and ICMR studies have found that the entire state, not just Kozhikode, is prone to such infections.

People living in forest areas have to take the highest precautions, it said, adding that the latest virus originated within five kilometres of a jungle area.

Dr Anoop Kumar, Director, Critical Care Medicine, Astar MIMS Hospital, Calicut who was the first doctor in Kerala to identify Nipah outbreak in 2018, also identified the first case in the latest outbreak this year. He informed TOI about how he and his team identified the elusive virus.

"Clustering of patients from a family sparked our first suspicion. When we looked at their medical history, we found that the father of the kids, aged 9 and 4 years, died on August 30 at another private hospital in Kozhikode with symptoms of pneumonia. We immediately contacted the hospital and learnt that though he was admitted with pneumonia, his condition worsened quickly leading to his death. He had tested negative for Covid and influenza," said Dr Kumar.

Later, when he spoke to the wife of the deceased, he found that the patient had symptoms like slurred speech, disorientation and diplopia (seeing two images) which were neurological symptoms. His nine-year-old son, who was admitted at Aster MIMS hospital with breathing difficulty, had a seizure and was put on ventilator support. That also raised suspicions as seizures were not a common symptom associated with pneumonia.

"All these factors led to a grave suspicion as the patients came from an area which was 10km away from Soopikada where the first case of 2018 was reported and preliminary lab test parameters gave an indication that it could be Nipah. Like 2018, our suspicion increased based on three factors: Unusual clinical symptoms, clustering and contact with an index case and the preliminary blood and other tests pointed to such a possibility," he said.

Also, the hospital received another patient (a 40-year-old male) from Ayanchery panchayat on Monday. He was referred by a hospital in Vadakara with fever that progressed to difficulty in breathing by day three. He reached the emergency wing in a serious condition and even before treatment began, he died of cardiac arrest, said Dr Kumar.

"We found an unusual pattern in his disease progression different from pneumonia cases. We found that he had gone to a private hospital for his father's treatment around the same time the first patient was present at the emergency wing of the hospital. We immediately accessed the discharge summary of the patient's father, contacted the hospital and found that the first and second patients were there in the emergency wing from the night of Aug 28 till Aug 29 morning. We didn't release his body and informed health department," he said.

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