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Kerala on alert after two Nipah virus deaths

Kerala on alert after two Nipah virus deaths

The two victims, whose identity has been withheld, died in the past two weeks at a hospital in Kozhikode
File photo of health officials in full protective gear walk inside an isolation ward of Ernakulam Medical College in Kochi, Kerala, in June 2019. (Photo by AFP)

Union health minister Mansukh Mandaviya on Tuesday confirmed that the two deaths in Kerala’s Kozhikode were due to Nipah virus infection.

Kerala had witnessed two unnatural deaths in the past two weeks with suspected Nipah infection and their specimen samples were sent to National Institute of Virology, Pune for tests. “A central team from New Delhi has been sent to Kerala to take stock of the situation and assist the state government,” said Mandaviya.

This is the second time in the last five years Kerala is witnessing an outbreak of Nipah. Earlier in May 2018, the state had seen a similar outbreak in Kozhikode and Malappuram districts.

The state government of Kerala has geared up to the situation with surveillance measures, contact tracing.

Currently, four persons who were primary contacts of the first Nipah Victim (index case) are in hospital. “This includes a nine-year-child who is on ventilator and on closely being monitored,” Veena George, Kerala health minister said. She added that a ten-month-old baby is also being admitted.

The state government has formed 16 core committees to monitor the Nipah situation. “The state government will shortly set up a control room and a helpline,” George added. The state government has instructed all hospitals to strictly adhere to infection control measures. “Public must try to avoid hospital visits. There must be only one bystander for an admitted patient,” George said. She emphasized the need to wear mask while in public places as part of Nipah control protocol. High-risk contacts are in isolation wards, which have been set up in hospitals across the district of Kozhikode.

Two persons, whose identity has been withheld, reportedly died in the past two weeks. The two unrelated individuals were admitted following high fever, followed by breathing difficulty.

Nipah alert in Kerala

The surveillance wing in Kerala also found out that the two deceased persons had come in contact with each other. “There have been two deaths, suspected due to Nipah. The person, the index case died on Monday morning. The first deceased person’s children and brother have also been admitted.  The second person died in the evening. The first and the second person had come in contact for an hour in a hospital,” said George. The state government has issued a high alert in Kozhikode, while the test results are being awaited.

Surveillance and contact tracing is going on in hospitals across the district. We are categorizing the contacts as primary and secondary,” George said.

One of the relatives of the deceased person is in the ICU of a private hospital in Kozhikode.

Nipah virus infection: How does it spread?

It can be recalled that Kerala had faced an outbreak of Nipah in May 2018. The natural reservoir of Nipah virus infection is said to be large fruit bats of Pteropus genus, and pigs are identified as intermediate hosts, according to Nipah guidelines issued by the Kerala health ministry in 2018. “In a study conducted during the outbreak 2018, the high positivity of NiV was detected in bat throat swabs, and showed persistence of virus for a couple of hours on contaminated fruits, which enhance the chances of human infection. NiV positivity was identified in bats from Northeastern Region states and Kerala,” the guidelines read.

Symptoms of Nipah

According to Centres for Disease control and prevention (CDC), US, the symptoms may initially include one or several of the following:

  • Fever
  • Headache
  • Cough
  • Sore throat
  • Difficulty breathing
  • Vomiting

 Severe symptoms may follow, such as:

  • Disorientation, drowsiness, or confusion
  • Seizures
  • Coma
  • Brain swelling (encephalitis)

According to Nipah fact sheet by World Health Organisation, the case fatality rate is estimated at 40% to 75%. This rate can vary by outbreak depending on local capabilities for epidemiological surveillance and clinical management.

Exercise caution, but do not panic

Speaking to Happiest Health, Dr Rajeev Jayadevan, convener Indian Medical Association, Kochi says that the need of the hour is to exercise caution and not panic. Considering that the current season of monsoon also has led to viral fever cases, Dr Jayadevan adds that not everyone with fever needs to be worried about Nipah, unless the person is one of the contacts of Nipah infected person. “One must follow the instructions of the official health authorities. And not that of fear mongers. It is important prevent misinformation,” said Dr Jayadevan.

Though there is a need to remain cautious, there must not be knee jerk reactions, said Dr Jayadevan.  “That is, in case if there is an outbreak in a hospital, an entire city must not be shut down. Nipah virus spreads from an infected person to another though body fluids, only through prolonged, close interaction. It is not spread easily through air as COVID,” said Dr Jayadevan.

Nipah treatment

While there is no specific antiviral treatment for Nipah, the viral infection is treated symptomatically, along with supportive care, hydration, rest, usage of nebulization, anti-seizure medication based on the condition of the person.

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