Kerala in India faced a catastrophic outbreak of Nipah virus recently and around eighteen people have died. Immediate actions from the state and central agencies have contained the outbreak of the virus. As of June 4, the state health department had declared that apart from the 18 positive cases, no new cases were reported.

What is Nipah Virus?

Nipah virus (NiV) is a newly emergent zoonotic pathogen of the family Paramyxoviridae (a virus transmitted to humans from animals) that can cause rapid, fatal respiratory and neurologic disease in both humans and animals. Nipah virus causes NiV. The Nipah virus infection is moderately contagious as it needs close observation and mostly infects the family members and/or medical caretakers of NiV-infected individuals.

When was it discovered?

Nipah Virus was first detected in 1998-99 in Malaysia. It was named after Kampung Sungai Nipah, a village in the Malaysia, where it was first discovered. Being an unknown virus, it spread widely and killed around 110 people. Medical experts suspected the infection to be Japanese encephalitis (JE) which, like the Nipah virus, induces brain inflammation. During a medical investigation, the virus, which was traced back to the pigs, led to a large-scale culling of the animals in the areas. Further researches, pointed that the initial transmission from bats to pigs probably occurred, when the pig feed was contaminated with bat excretions. These findings were titled ‘Lessons from the Nipah virus outbreak in Malaysia’, published in The Malaysian Journal of Pathology in 2007. In Bangladesh in 2004, humans became infected with NiV as a result of consuming date palm sap that had been contaminated by infected fruit bats. But, it is not only in Kerala, India has already confirmed its first Nipah outbreak in Siliguri, West Bengal, in 2001. Around 45 people were killed due to Nipah. Once again, a second outbreak in Nadia district in 2007 led to the deaths of all the five persons infected.

How was it transmitted?

Researchers believe that Nipah virus was transmitted from flying foxes (mega bats) as they live by eating fruits and surviving in the trees. As the flying fox habitat are destroyed by human activities, these bats get stressed, weak and hungry, their immune system becomes bad, their virus load goes up and a lot of virus spills out in their urine and saliva. As a result, most of the bats often end up being pool for a number of severe infectious diseases, including Ebola, SARS coronavirus, Nipah and Hendra. When it comes to Nipah, disease transmission or the means by which a pathogen can be passed from one organism to another. When person or animal consumes infected fruits and fresh date palm sap contaminated by these bats, they get infected.

Outbreak in Kerala

In May 2008, Nipah virus outbreak occurred in Kerala (India). Fruit bats, pigs and rabbits were the more likely the sources of NiV than infected people. Despite finding the disease, Nipah was fast as at least 11 people have died and another 14 people contracted the virus. The National Virology Institute in Pune had confirmed that the deceased were infected with Nipah virus (NiV). This is the first time in Kerala, where a virus, with a high fatality rate and spreads mainly through bats, pigs and other animals.

How was it contained?

The early diagnosis of the infection fetched good results. Medical community of Kerala can be proud that the very second case was diagnosed as the deadly Nipah Virus which was confirmed by the National Virology Institute (Pune). Apart from the slightly unusual symptoms, the death of a close relative with similar symptoms within two weeks ago was the biggest clue that pointed in the right direction. Immediately, person and several others were tested and Nipah infection was confirmed promptly. Early diagnosis meant that the people who had already contracted the infection were limited. This was a good start. On the flip side, many of those infected were from hospitals and included a nurse who later succumbed to the disease. Aware of the severity, containment teams and its staff were swifter and more than 2,000 patients with fever were kept under close observation. When confirmed that all the cases and suspected cases were moved to the Government Medical College in Kozhikode through ambulance. A similar isolation protocol, similar to that for Ebola, was announced and implemented.

It should be noted that the authorities in Kerala were able to trace every single case reported thereafter in the first case or his contacts/carers. With this confirmation, it was found that the disease is transmitted only during the symptomatic phase through close personal contact. This meant that tracing all contacts, active surveillance and isolation of symptomatic cases was the perfect way forward. Besides, the Nipah cases were treated symptomatically with life support measures, including ventilation. Medical experts were quick as the anti-viral drug Ribavirin and a monoclonal antibody were imported and tried in some patients for possible effect.

What are the lessons learnt?

Nipah Virus spreads through those who visited the hospital. Well, some were merely visitors who had come to see other patient’s relatives. It is, therefore, time to examine how hospitals are becoming congesting and unclean, so there is a great need to decongest hospitals. Besides, developing a strong referral system and controlling visitors is needed. Bystanders or public who help out with many routine hospital chores can be reduced by appointing more caretaking staff. Infection control protocols within hospitals also need to be followed keeping in mind the universal health practices and precautions for health workers in dealing with any patient. When it comes to media and mass communication, misinformation or wrong messages through the social media and the mainstream media had fuelled panic in the early days. This forced the people even to step out. This had resulted in great financial loss. Fake messages and mischievous and false propaganda needs to be checked by appropriate legal action must be exerted. A multi-disciplinary technical team should be instituted to implement the action. It is hoped that the government and health department will follow up its success with the actions, as its best efforts are not diluted by mischief and fake news.

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