Nipah Virus outbreak in Kerala

The Nipah virus, a serious zoonotic infection, has once again made headlines in India, particularly in Kerala. With recent cases and a confirmed death, it’s crucial to stay informed about the virus, its symptoms, and the measures being taken to control its spread.

Recent Outbreak in Kerala

In July 2024, Kerala reported a new Nipah virus outbreak after a 14-year-old boy from Malappuram died from the infection. The boy’s condition deteriorated rapidly, and despite intensive medical care, including the use of monoclonal antibodies, he succumbed to the virus.

Following this tragic event, the state has been on high alert, with a total of 330 individuals, including health workers, under observation. Four people in the boy’s contact list have developed symptoms, with one in critical condition.

What is the Nipah Virus?

The Nipah virus is a highly infectious pathogen that primarily affects animals like bats and pigs, and can be transmitted to humans through direct contact with infected animals or contaminated food. It can also spread between people, making it a significant public health concern.

Nipah Virus Symptoms

The human infection presents as an encephalitic syndrome.

• Initial signs: Fever, headache, muscle aches, nausea, sore throat.
• Progression: Dizziness, drowsiness, neurological signs of encephalitis.
• Severe cases: Seizures, coma within 24-48 hours.
• Severity varies: Mild to severe illness, including brain swelling and possible death.
• In Pigs: The virus primarily affects the respiratory and nervous systems.
  • A common symptom in pigs is a chronic cough, often referred to as ‘barking pig syndrome‘.
  • Pigs may also show symptoms like shivering and seizures.
  • The disease spreads rapidly among pigs.

Treatment of Nipah Virus

• No specific treatment or vaccine currently available.
• Ribavirin (antiviral) might help reduce mortality in encephalitis cases.
• Treatment focuses on intensive supportive care and symptom management.

Nipah Virus in Kerala History

The first Nipah outbreak in Kerala occurred in 2018, catching health authorities off-guard. The virus claimed 17 lives out of 18 confirmed cases. It spread among humans before being identified, and the state had limited knowledge of how to handle it. Social distancing, contact tracing, and isolation became new concepts in Kerala’s society during this outbreak.

In June 2019, a Nipah case was reported in Ernakulam, marking the second outbreak in Kerala. The consecutive outbreaks prompted the health department to work on a systematic approach. Guidelines for Nipah virus infection control were issued, covering diagnosis, surveillance, treatment, and sample collection. A resource group of senior doctors held brainstorming meetings, and protocols were refined with the involvement of the World Health Organization (WHO).

In 2020, Kerala did not report any Nipah cases, but the 2019 protocol was updated and shared across the healthcare system. In 2021, a 12-year-old boy died from Nipah in Kozhikode amid the COVID-19 pandemic. The public’s familiarity with quarantining and isolation due to COVID-19 protocols facilitated Nipah control, with the virus being confined to a single case that year.

Over the years, the state improved its ability to detect Nipah. In 2018, confirmation came from labs outside the state. In 2019, Kerala set up its own testing facilities. In 2023, Nipah was detected in Kozhikode with rapid testing, and the state established virology labs and mobile testing units to speed up diagnosis.

In 2023, Nipah re-emerged in Kozhikode. The health department promptly responded by collecting fever data and conducting surveillance. Samples were tested locally, and results were confirmed by the National Institute of Virology in Pune. The state continues to manage the 2023 outbreak based on the guidelines established in 2021, building on its experience from previous outbreaks.

Government Response and Measures

In response to the outbreak, Kerala’s Health Department has implemented several measures to control the spread:

• Isolation and Quarantine: High-risk individuals are isolated, and a mobile lab from the National Institute of Virology (NIV) is deployed for testing.
• Lockdown: Certain areas in Malappuram have been placed under lockdown to prevent further transmission.
• Public Awareness: A route map of the victim’s movements has been published to encourage self-reporting among those who may have been exposed.

The Centre has also sent a “One Health” outbreak response team to assist in the investigation and control efforts, focusing on identifying additional cases and providing technical support.

Conclusion

The Nipah virus remains a serious public health challenge in India, especially in regions like Kerala. Staying informed, practicing good hygiene, and following public health guidelines are essential to protecting yourself and others from this dangerous virus.

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