Kochi, Jun 4 (PTI): Kerala Health Minister K K Shailaja confirmed Tuesday that a 23-year-old college student admitted to a hospital here has been infected with the Nipah virus. The results of blood samples of the student, which were tested at the National Institute of Virology (NIV) in Pune, have confirmed Nipah, she said. The result came this morning, she said. The student has been admitted to a private hospital here. Earlier, blood samples examined at two virology institutes--Manipal Institute of Virology and Kerala Institute of Virology and Infectious Diseases--had indicated Nipah.

The Nipah virus infection is an emerging zoonotic disease and has made its appearance once again in Kerala.

Does this new case indicate an imminent Nipah outbreak in Kerala again? Could it have been prevented?

 I believe the answer to these questions is perhaps ‘yes’.

This shows no anticipation and lack of preparedness on the part of the authorities.

In 2015 and again last year, the World Health Organization (WHO) had cautioned about Nipah as one among eight emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasures exist

It was around the same time last year, when the Nipah outbreak was reported from two districts of Kerala - Kozhikode and Malappuram. ICMR had then confirmed that fruit bats were the primary source of the virus that killed 17 persons in the two districts.

This should have been warning enough for the concerned authorities to be adequately prepared to prevent the infection this year. There should have been a state of high alert for possible cases of Nipah.

Apart from avoiding direct contact with infected animals, it is also imperative to not consume fruits that have fallen on to the ground. What makes the situation tougher is that there is no drug or vaccine for Nipah infection. Supportive care with treatment of symptoms is the only approach to management.

Nipah virus is classified internationally as a biosecurity level (BSL) 4 agent.

This case of Nipah virus disease underscores the importance of monitoring systems as well as continual and not episodic disease surveillance.

There is an urgent need to establish protocols to curb the spread of the virus, which also includes contact tracing and keeping them under observation and treatment.

It’s equally important to educate the general public so that they can take due precautions. Otherwise, a single case may lead to a small outbreak, which may well turn into an epidemic. 

Nipah virus update

• Agent: Nipah virus is a highly pathogenic paramyxovirus
• Natural Reservoir: Large fruit bats of Pteropus genus are the natural reservoir of NiV. Presumably, pigs may become infected after consumption of partially bat eaten fruits that are dropped in pigsties.
• Seasonality: All of the NiV outbreaks occurred during the months of winter to spring (December-May).
• Incubation period: 6-21 days.
• Mode of transmission: Direct contact with infected bats, infected pigs, or from other Nipah virus infected people; drinking of raw date palm sap contaminated with NiV and close physical contact with Nipah infected patients, especially by contact with body fluids.
• Diagnosis: Identification of Nipah virus RNA by PCR from respiratory secretions, urine, or cerebrospinal fluid and/or isolation of Nipah virus from respiratory secretions, urine or cerebrospinal fluid. In India, testing facility is available at National Institute of Virology (NIV), Pune.
• Clinical features: Fever, altered mental status, severe weakness, headache, respiratory distress, cough, vomiting, muscle pain, convulsion, diarrhea.
• Case–fatality rate: 40–75%; however, this rate can vary by outbreak and can be upto 100%.
• Treatment: Currently there is no known treatment or vaccine available for either people or animals. Ribavirin, an antiviral may have a role in reducing mortality among patients with encephalitis caused by Nipah virus disease. Intensive supportive care with treatment of symptoms is the main approach to managing the infection in people.

(Source: National Center for Disease Control, Ministry of Health & Family Welfare)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA