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How Kerala is tackling the second Nipah outbreak

Health officials in full protective gear at an isolation ward of Ernakulam Medical College in Kochi.

Health officials in full protective gear at an isolation ward of Ernakulam Medical College in Kochi.   | Photo Credit: Thulasi Kakkat

As the deadly Nipah virus resurfaces in Kerala, the State machinery has swung into action for swift containment of the brain damaging disease.

According to the World Health Organisation, Nipah virus is a newly emerging disease that can be transmitted from its reservoir (natural wildlife host), the flying foxes (fruit bats), to both animals and humans.

Symptoms range from asymptomatic infection, acute respiratory infection and encephalitis. Infected people initially develop influenza-like symptoms of fever, headache, vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis.

(This is a compilation of The Hindu's coverage of the Nipah outbreak. It will be updated as and when new information emerges.)

How Kerala is tackling the second Nipah outbreak

Two more tested negative for Nipah

Health officials in protective gear at an isolation ward of the Government Medical College, Ernakulam, on Thursday where suspected Nipah cases have been admitted. Thulasi Kakkat

Health officials in protective gear at an isolation ward of the Government Medical College, Ernakulam, on Thursday where suspected Nipah cases have been admitted. Thulasi Kakkat  

Further assuaging the anxiety of authorities and the general public, two more suspected cases were tested negative for Nipah thus clearing nine persons of infection ever since a youngster from North Paravur was confirmed to have infected with the virus on June 4.

At present, ten persons remain admitted to the isolation ward of the Ernakulam Government Medical College Hospital after three more persons were brought in with symptoms of Nipah late on Friday night. Out of these, all except one have been cleared. The result of one patient is being awaited.

One more addition to the isolation ward seems likely later in the day with efforts being underway for shifting a patient with symptoms suspected of Nipah from a private hospital in North Paravur. The condition of the youngster who was tested positive for Nipah, however, continues to remain stable.

Sanitisation drive underway

The core committee spearheading the anti-Nipah drive met to take stock of the situation at the district collectorate on Saturday morning. Education Minister C. Ravindranath presided. The meeting decided to continue to keep apace the drive with focus on prevention and treatment.

An expert team from the Pune-based National Institute of Virology (NIV) continues to camp at the Government Medical College Hospital and undertake examination of the lab and sanitisation drive.

A three member team from NIV comprising of Dr. Sudeep, Dr. Gokhale and Dr. Balasubramanyam visited Vadakkekkara in North Paravur to identify areas for the study of bats. The technical team formed for the study will start operating today. A team from the forest department led by Arun Zachariah will also participate in the endeavour.

Monitoring of private hospitals

Four teams have been deployed for the monitoring of private hospitals. The teams had so far visited 63 hospitals, including 18 on Friday alone.

The health department is keeping a close watch over 52 persons who had come in contact with the Nipah-inflicted patient and were subsequently classified as high-risk category. They were among the 318 persons traced to have contact with the affected youngster. Among them 260 have been classified as low-risk category.

Those who had come into contact with the bodily fluids of the affected patient or had been with him for not less than 12 hours were considered as high risk category. Meanwhile, the health department continues its efforts to trace the origin of the virus.

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How Kerala is tackling the second Nipah outbreak

One more case tests negative for Nipah

Health officials remove waste from an isolation ward of the Government Medical College in Ernakulam. Nipah, a rare and often deadly disease which is back in the news with a student in Kerala diagnosed with the infection, is a zoonotic virus transmitted from animals such as bats or pigs to humans, and can also spread through contaminated food and people-to-people contact.

Health officials remove waste from an isolation ward of the Government Medical College in Ernakulam. Nipah, a rare and often deadly disease which is back in the news with a student in Kerala diagnosed with the infection, is a zoonotic virus transmitted from animals such as bats or pigs to humans, and can also spread through contaminated food and people-to-people contact.   | Photo Credit: PTI

Areas in Ernakulam district with heavy density of bats to be marked

One more person currently being treated at the isolation ward of the Government Medical College Hospital, Ernakulam, has tested negative for the Nipah virus. Six suspected cases were tested negative earlier, Health Minister K.K. Shylaja said in New Delhi on Friday.

However, the seven persons admitted to the isolation ward will be monitored for the entire length of the incubation period of the virus.

Meanwhile, efforts to trace the source of Nipah virus continued four days after a youngster was tested positive for the virus. An expert team from the Pune-based National Institute of Virology has descended on the district to mark out places with high concentration of bats. The team comprises an entomologist and a field biologist. Besides, the Forest Department has identified three spots with heavy concentration of bats in Vadakkekkara, the area from where the youngster who tested positive for Nipah hails. An action plan has been drawn up for their trapping using nets from Saturday, a medical bulletin issued by District Collector K. Mohammed Y. Safirulla on Friday said.

Patient stable

The condition of the 23-year-old youngster continues to remain stable despite intermittent bouts of fever. He had food and spoke with his mother. A medical board was convened to discuss his treatment.

No fresh admissions for suspected Nipah have been reported in the district so far in the day.

The number of calls to the call centres set up in the wake of Nipah dropped on Friday with only 22 calls being received during the day. So far, 512 calls had been received since the confirmation of Nipah.

Misinformation

The Cyber Space Monitoring Team has intensified its action against those found guilty of engaged in spreading misinformation relating to Nipah. The team handed over eight such cases to the police. One such fake news was detected on Friday while the police have so far registered cases against two.

Though the situation remains under control, the Health Department will continue with its anti-Nipah preventive drive. Around 10,000 three-layered masks and 450 personal protection kits have been made available.

New isolation ward

A new isolation ward has been set up at the Government Medical College Hospital, Ernakulam. Specially trained teams have been deployed for manning the new isolation ward with 30 beds. The teams include 70 doctors, 102 paramedical staff and 30 attenders. A team has also been kept on stand-by. Arrangements have also been put in place for the scientific disposal of biomedical waste.

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How Kerala is tackling the second Nipah outbreak

52 high-risk contacts of Nipah patient under close examination

A health official in full protective gear at an isolation ward of Government Medical College in Ernakulam.

A health official in full protective gear at an isolation ward of Government Medical College in Ernakulam.   | Photo Credit: Thulasi Kakkat

318 persons had contact with the Nipah-afflicted patient

The Health Department is keeping a close watch over 52 persons who had come into contact with the Nipah-afflicted patient and were subsequently classified as high-risk category. They were among 318 persons traced to have contact with the affected youngster. Among them, 266 have been classified as low-risk category.

Those who had come into contact with the bodily fluids of the affected patient or had been with him for not less than 12 hours were considered as high risk category. The health machinery is working overtime to trace more persons, if any, who happened to be in contact with the patient. An expert team will conduct a field investigation at the places where the Nipah-afflicted patient has been to, including the hospital where he had initially received treatment.

Experts from the National Institute of Virology, All India Institute of Medical Sciences (AIIMS), National Institute of Mental Health and Neuro-Sciences (NIMHANS) and National Centre for Disease Control have conducted studies by visiting various places. Experts from AIIMS and NIMHANS visited the hospital and conducted the clinical study of the patient.A point-of-care lab for conducting Nipah-related tests has been set up at the microbiology lab of the Government Medical College, Ernakulam, with the help of experts from the National Institute of Virology.

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How Kerala is tackling the second Nipah outbreak

State to have 3 virology institutes soon

Doctors attending on patients at Ernakulam Medical College at Kalamassery. PTI

Doctors attending on patients at Ernakulam Medical College at Kalamassery. PTI   | Photo Credit: A S

Existing institute in Alappuzha also getting upgraded

In place of an almost non-functional virology institute in Alappuzha, the State will soon have three virology institutes, Health Minister K.K. Shylaja has said.

The State had approached the Union government last year during the Nipah outbreak for assistance to set up a virology institute in Kozhikode.

Administrative sanction for the project was obtained last month.

An amount of ₹3 crore has been sanctioned for the institute to come up under Indian Council of Medical Research, she said.

The Health Minister said that the existing virology institute in Alappuzha was getting upgraded with support from the National Virology Institute.

The State had sought support for this too. The kind of biological safety level required to set up such institutes required support from the Union government. “We cannot have virology institutes in every district,” she added. Besides, the State had also started an advanced virology institute in Thiruvananthapuram under the Science and Technology Department.

The infrastructure of the institute, being built with an advisory panel of scientists, was almost complete.

She said her visit to Delhi on Friday would include talks with the Union Health Minister with regard to more funds for setting up a good virology institute.

Contract tracing

Principal Secretary (Health) Rajan Khobragade said contact tracing done for the Nipah- infected person had resulted in identifying 316 persons who had come in direct or indirect contact with the person.

Of this, data had been collected for 255 and risk analysis had been done on 224. From this, 33 had been identified as high-risk group — those who had come into contact with the person’s body fluids or had been in the same room with the infected person for 12 hours. The rest 191 had been categorised as low-risk. Data on the rest would be completed soon, he said.

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How Kerala is tackling the second Nipah outbreak

Experts seek to identify epicentre of Nipah

Droppings of bats collected from Vadakkekara and Chittattukara areas of Kochi, pig and cattle farms inspected

Experts began collecting droppings of bats from the Vadakkekara and Chittattukara areas of Kochi on Thursday as part of the Nipah surveillance programme.

The places were chosen for sample collection as the disease was confirmed in a youth hailing from the region. The collection of droppings will continue on Friday too.

Besides the bat habitats in the region, experts from the National Institute of High Security Animal Diseases, Bhopal, and Southern Regional Disease Diagnostic Laboratory of the Institute of Animal Health and Veterinary Biologicals, Bengaluru, visited pig and cattle farms in the region on Thursday and collected blood samples of pigs, said K.M. Dileep, District Animal Husbandry Officer, Ernakulam.

Serum samples of bats would have to be collected at a later stage though it was not collected on Thursday. Round-the-year surveillance on bats may have to be put in place as the disease was reported successively for two years, he said.

Meanwhile, the delay in identifying the epicentre of the Nipah outbreak was hampering the specific surveillance plans on susceptible animal populations.

It is through epidemiological investigations that the epicentre of the outbreak is identified. Though experts in animal diseases have reached Kochi following the outbreak, they are currently focussing on general surveillance of pigs and bats, the two species that are likely to serve as the reservoir of the virus.

Currently, the attention is on general surveillance and not collection of samples since the epicentre of the disease is unknown, said a senior forest veterinarian. One cannot go out and randomly collect samples from any area as it may trigger panic among general public. Unless some specific information is available on the epicentre, it would be a futile exercise to collect samples, he said.

Calls at helpline

Meanwhile, people are calling up the 24x7 helpline (0484-2351264) opened by the department in Kochi seeking information on the disease. The callers were keen to know about the animals that were likely to be the reservoirs of the disease. Pigs and bats were the two animals that needed to be observed in this case, said Mr. Dileep.

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How Kerala is tackling the second Nipah outbreak

Nipah scare: Two under observation at MCH

No known contact with confirmed case

In the wake of the Statewide alert against Nipah, two youth, who reported at the Government Medical College Hospital (MCH), Thiruvananthapuram, on Thursday with fever, headache, and with a history of travel to Ernakulam in the past two weeks, are currently isolated and under observation at the hospital.

The youths, an 18-year-old and a 19-year-old, from Kadakkal and Kalliyoor respectively in Thiruvananthapuram district, had reported at the MCH with fever and headache.

Their symptoms are not suggestive of Nipah but as per the current State guidelines, any fever patient from or with a travel history to Ernakulam, Idukki, and Thrissur have to be isolated and kept under observation. Their throat swabs and other samples have been sent to the National Institute of Virology, Alappuzha unit. As per the current protocol, they will be under observation for the next 48 hours or till the lab results come.

“The youths are not even on the suspected list as they have had no known contact with the lone Nipah-confirmed case or the current persons on the Nipah-suspects list. Both had just travelled for a day to Ernakulam within the last two weeks. They were isolated as a precautionary measure and as a test of our preparedness in the OP clinics,” senior doctors said.

Both are doing well at present. Though one of them was initially reported to be a bit disoriented, doctors said the youth had just had a panic or anxiety attack because of Nipah scaremongering in media. An infectious disease expert said the panic was unwarranted and that they did not expect any more positive cases in the current Nipah episode in State.

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How Kerala is tackling the second Nipah outbreak

Health officials gear up for Nipah emergency

King George Hospital plans to open a special isolation ward on its premises.

The detection of seven cases of suspected Nipah infections in Kerala and its possible spread is causing concern among the general public.

Though there is no immediate threat to the city, the Health Department is gearing up to meet any exigency.

Travel across the country being made easy with improved air connectivity. There is, however, no cause for panic as the suspected patients were isolated and all precautions have been taken to check the spread of the disease, the officials said.

It may be recalled that 11 persons died in Kerala after they were affected by the Nipah virus in May, 2018. The health officials here do not want take any chances.

“We are planning to open an isolation ward after holding discussions with specialist doctors,” Dr. G. Arjuna, Superintendent of King George Hospital (KGH) said here on Thursday.

The symptoms of Nipah infection, like any other viral infection, are fever, headache, sore throat, vomiting and inflammation of the brain leading to disorientation or mental confusion.

The patients generally die but those who survive can have long-term complications such as birth defects in their children, he said.

Alert sounded

“We have received an alert on the guidelines to be taken to prevent the outbreak of the disease in the district. The Primary Health Centres (PHCs) in rural areas have been alerted as bats are found mostly in villages. There is an general isolation ward at the Infectious Diseases Hospital (IDH),” District Medical and Health Officer S. Tirupathi Rao told The Hindu.

A large number of bats used to hang from the branches of banyan trees in the Old Central Jail Complex, till a few years ago. Their number has dwindled over the years, following the axing of trees to pave the way for construction of the VUDA Central Park.

Vector-borne infection

Fruit bat (Indian Flying Fox) acts as a vector, and the virus is spread from the bat’s saliva, when it pecks at fruits. Large-scale deforestation and environmentally destructive practices are responsible for the spread of the virus, opine environmental activists.

“The Indian Flying Fox (Mega chiroptera) is large in size and feeds only on fruits while the insect bats (Micro chiroptera) are small in size and feed on insects and mosquitoes. Bats normally live away from human habitations,” says Murthy Kantimahanti, a conservation biologist at the Eastern Ghats Wildlife Society, Visakhapatnam.

Dr. Appa Rao, Head of the Pathology Department in KGH said that Nipah infection was first reported in Malaysia in 1999.

“Nipah virus spreads rapidly when compared to Japanese encephalitis. Nipah infection causes encephalitis and respiratory problems. In a majority of patients, it does not show any symptoms at all,” he said.

The incubation period of the virus ranges from four days to two months.

“We have kits to treat Japanese encephalitis and the Virology Lab of Andhra Medical College (AMC) is equipped to undertake surveillance of the diseases,” he said.

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How Kerala is tackling the second Nipah outbreak

Migrant labour camps found flouting hygiene norms

Pre-monsoon checks held at 30 camps; notices served on five

In an ongoing annual inspection drive, the Ernakulam District Labour Office conducted pre-monsoon checks at nearly 30 migrant labour camps across the district in the past week.

“Conducted in collaboration with the Health Department, efforts have been doubled in the wake of Nipah to take stock of hygiene in the camps,” said K. Sreelal, Regional Joint Labour Commissioner, Ernakulam.

According to informal estimates, there are over 1,000 migrant labour camps in the district.

Of the camps that were inspected in Kochi, Aluva, Angamaly, Perumbavoor, and Muvattupuzha, five were found to be in unhygienic condition and were issued notices, according to a Labour office source.

“Some camps lack proper toilets, waste disposal mechanisms, and adequate drinking water. During the monsoon, water leaking into dwellings and stagnant rainwater can cause health problems,” said an assistant labour officer.

“Notices have been issued to the contractor or owner of the construction site where the camp has been set up. They have been directed to address the issue in 40 days, following which another inspection will be conducted,” Mr. Sreelal said. If the owner or contractor fails to comply with the order, a stop memo will be issued to prevent further work on the site. “Of the estimated 6 lakh migrant labour population in the district, most live in overcrowded dwellings where chances of outbreak of infectious diseases are high,” said Benoy Peter, executive director, Centre for Migration and Inclusive Development (CMID).

Voice messages

“Considering language barriers and long working hours, migrant workers are excluded from health warnings or news about infections,” he said. CMID is circulating voice messages among migrant workers in Assamese, Bengali, Tamil, and Odia on Nipah, its symptoms and prevention.

Dr. Mathews Nambelil, District Programme Officer, National Health Mission (NHM), said, “On their routine visits to migrant labour camps, health inspectors have been directed to check for signs of high fever.”

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How Kerala is tackling the second Nipah outbreak

Nipah: six suspected patients in Kerala test negative

Preventive measures: Health-care workers at Government Medical College, Ernakulam, in protective gear.

Preventive measures: Health-care workers at Government Medical College, Ernakulam, in protective gear.   | Photo Credit: H. Vibhu

They will be moved from isolation ward only after observation: Health Minister

Samples of body fluids taken from six patients at the Government Medical College Hospital in Kochi that were sent to the National Virology Institute, Pune, have tested negative for Nipah.

 

However, the patients will be moved from the isolation ward of the hospital only after observation, said Minister for Health K.K. Shylaja here on Thursday.

Meanwhile, the 23-year old confirmed Nipah patient being treated at a private hospital is stable, she added.

Body fluid samples of the seventh suspected case of Nipah admitted to the hospital late on Wednesday have been sent to the virology institutes in Alappuzha and Pune for tests.

Of the seven people in the isolation ward, three are nurses who had provided care to the confirmed Nipah patient. One is his classmate while others are from Chalakudy, Parakadavu and Kothamamalam and are being treated in the medical college hospital. These cases apparently have had no contact with the confirmed case.

The Minister said that all those quarantined for being in direct or indirect contact with the confirmed case will continue in the isolation ward till the incubation period is over.

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How Kerala is tackling the second Nipah outbreak

Caught napping: on Nipah outbreak in Kerala

Kerala makes up for lost focus by acting quickly on the Nipah outbreak

A year after Kerala’s prompt action quickly brought the deadly Nipah virus infection outbreak under check in two districts (Kozhikode and Malappuram), the State has once again shown alacrity in dealing with a reported case. A 23-year-old student admitted to a private hospital in Ernakulam on May 30 tested positive for the virus on June 4. But even as the government was awaiting confirmation from the National Institute of Virology, Pune, steps had been taken to prevent the spread of the disease by tracing the contacts, setting up isolation wards and public engagement. Two health-care workers who had come into contact with the patient exhibited some symptoms and are being treated. While 311 people who had come in close contact with the student are kept in isolation to prevent the spread of the disease, the numbers might be more — the student had reportedly travelled to four districts (Ernakulam, Thrissur, Kollam, and Idukki) recently. Containing the spread of the Nipah virus is important as the mortality rate was 89% last year, according to a paper in the journal Emerging Infectious Diseases. The source of infection in the index case (student) remains unknown. However, transmission to 18 contacts last year and the two health-care workers this year has been only through the human-to-human route.

If Kerala was taken by surprise by the first outbreak last year, its recurrence strongly suggests that the virus is in circulation in fruit bats. After all, the virus isolated from four people and three fruit bats (Pteropus medius) last year from Kerala clearly indicated that the carrier of the Nipah virus which caused the outbreak was the fruit bat, according to the paper in Emerging Infectious Diseases. Analysing the evolutionary relationships, the study found 99.7-100% similarity between the virus in humans and bats. The confirmation of the source and the recurrence mean that Kerala must be alert to the possibility of frequent outbreaks. Even in the absence of hard evidence of the source of the virus till a few days ago, fruit bats were widely believed to be the likely candidates. That being so and considering the very high mortality rate when infected with the virus, it is shocking that Kerala had not undertaken continuous monitoring and surveillance for the virus in fruit bats. One reason for the failure could be the absence of a public health protection agency, which the government has been in the process of formulating for over five years, to track such infective agents before they strike. Not only should Kerala get this agency up and running soon, it should also equip the Institute of Advanced Virology in Thiruvananthapuram to undertake testing of dangerous pathogens. Known for high health indicators, Kerala cannot lag behind on the infectious diseases front.

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How Kerala is tackling the second Nipah outbreak

Nipah virus: condition of 5 in Kochi govt hospital isolation ward stable

Preventive measures: Health-care workers at Government Medical College, Ernakulam, in protective gear on Monday to meet any emergency in the wake of a person suspected to be infected with Nipah virus being admitted to a private hospital in Kochi.

Preventive measures: Health-care workers at Government Medical College, Ernakulam, in protective gear on Monday to meet any emergency in the wake of a person suspected to be infected with Nipah virus being admitted to a private hospital in Kochi.   | Photo Credit: H. Vibhu

A sixth person is set to join them; Chief Minister to visit Kochi on Thursday for a review meeting.

The condition of five persons, who were admitted to the isolation ward of the Government Medical College at Kalamassery in Kochi following the confirmation of Nipah infection in a 23-year-old youth from Paravur, continues to be stable.

A sixth person, also from Paravur and who was believed to have been in touch with the youth, was being transferred to the isolation ward with fever-like symptoms, said sources.

The infected person continues to make progress at a private hospital in the city. Samples collected from the five suspected cases have been sent to the Manipal Virology Institute and the National Institute of Virology in Pune.

Chief Minister Pinarayi Vijayan is expected to reach Kochi on Thursday for a review meeting of the situation. Health Minister K.K. Shylaja, who was in Kochi on Wednesday, reviewed the situation with experts at a meeting held at the medical college. It was decided not to postpone the reopening of schools as the situation was well under control.

Human monoclonal antibodies, considered to be effective in treating the zoonotic virus infection, have been brought to Kochi and they will be administered to those admitted to the isolation ward, subject to their polymerase chain reaction test results.

The authorities are keeping a close watch on 311 persons who are suspected to have come in contact with the index patient.

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How Kerala is tackling the second Nipah outbreak

Nipah virus: all you need to know

According to WHO, the Nipah virus infection is a newly emerging zoonosis, that is, a disease transmitted from animals to humans. The virus belongs to a new genus termed Henipavirus (subfamily Paramyxovirinae).

The symptoms of Nipah are similar to that of influenza: fever, muscle pain, and respiratory problems. Inflammation of the brain can also cause disorientation. Late onset of Encephalitis can also occur. Sometimes a person can have an asymptomatic infection, and be a carrier of Nipah and not show any symptoms.

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How Kerala is tackling the second Nipah outbreak

In Kerala, focus is now on encephalitis and meningitis to zero in on possible Nipah cases

The Health Department is reportedly keeping a close watch on encephalitis and meningitis cases in Kozhikode and Malappuram districts to zero in on possibility of Nipah infection in patients admitted to government and private hospitals.

Encephalitis, caused by a virus infection, is the inflammation of the brain, and meningitis, caused by bacterial infection, is the inflammation of the meninges or tissues that surround the brain or spinal cord. Symptoms of encephalitis include fever, headache, neck pain, drowsiness and nausea. Those with meningitis will have headache, fever, stiff neck, and nausea. Nipah-infected patients generally will show encephalitis symptoms along with disorientation, respiratory issues and a confused state of mind.

There is a possibility of Nipah cases getting passed off as encephalitis or meningitis. The department is learnt to be on alert to avoid this. Body fluid samples of suspected cases now will have to be sent for detailed lab tests.

The Kozhikode district administration on Tuesday directed all the government and private hospitals in the district to alert the District Medical Officer (DMO) about such cases. Patients should be transported to hospitals only by ambulance vehicles. It has been decided to train ambulance drivers to address emergency situations and ensure enough ambulance vehicles are available.

A special team of expert doctors drawn from medical colleges and other hospitals was formed in Malappuram in May itself when close to 80 cases of meningitis and encephalitis cases were reported from the district in around three months. There were a couple of deaths too. The Health Department had also prepared a treatment protocol. A surveillance team under the DMO will have to be alerted about any unusual fever cases.

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How Kerala is tackling the second Nipah outbreak

National virology institute at Alappuzha to be upgraded soon

The National Institute of Virology at Alappuzha, still struggling to find its functional reliability for testing various viral diseases, will be scaled up in the coming months according to Health Minister K. K. Shylaja.

Besides, the State had also started a virology institute in Thiruvananthapuram under the Science and Technology department and a virology institute under ICMR has also been set up in Kozhikode.

However, none of them have the capability to take up work to meet the State's needs.

Lack of a reliable virus testing laboratory is a blot as the State has been witnessing new diseases for a decade now.

In the wake of the Nipah outbreak in Kozhikode last year, the existence of the Alappuzha institute at its present stature had been questioned several times. While steps have been taken to improve the facilities at Alappuzha, they have not become full-fledged, said the Minister.

The institute is designed to be a bio-safety level 3 establishment but it is not yet equipped for the same. The administrative sanction for the work at Alappuzha virology institute was received only last month, she said.

The Health Ministry has moved to expedite the work, she added.

A bio-safety level is a set of bio-containment precautions required to isolate dangerous biological agents in an enclosed laboratory facility.

Four types or levels of laboratory are certified based on the organisms which are handled there. Only a lab certified as BSL 4 is allowed to handle extremely dangerous pathogens, such as Ebola. An institute with BSL 1 works with less risky organisms. BSL 3 or 4 is required to handle the Nipah virus.

Approvals for upgrading Kozhikode institute to a level three was only has also been received. While the Thiruvananthapuram institute will be developed as a level-three institute, it is not yet fully functional.

There is a need for a level three institute but not every district needs to have one. Building a level 3 or 4 requires certain parameters to be followed, said Ms. Shylaja.

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Nipah scaremongering: Kerala police book two conspiracy theorists

Taking precautions: Health officials at an isolation ward of Ernakulam Medical College Hospital on Tuesday.

Taking precautions: Health officials at an isolation ward of Ernakulam Medical College Hospital on Tuesday.   | Photo Credit: The Hindu

They claimed that the reappearance of the virus in the State was an “elaborate hoax” by pharmaceutical companies to ratchet up their product sales

The Kerala police have booked two suspected conspiracy theorists who claimed that the reappearance of the Nipah virus in the State was an “elaborate hoax” by pharmaceutical companies to ratchet up their product sales.

S. Surendran, District Police Chief, Kochi, told The Hindu that the falsehood spread by the accused had threatened public interest at a critical time.

They had also implied that the government was complicit in the “conspiracy” hatched by the private firms. They had attempted to erode the confidence of the public in the government’s attempt to contain the contagion, he said.

The Central Police, Kochi, has booked them on the charge of creating mischief and spreading falsehood in society.

Another senior official said that the police action in Kochi was part of a broader drive to combat false or harmful information regarding the viral outbreak.

 

It did not apply to credible opinions, criticism, satirical caricatures or mockery of the current situation.

The Kerala Police Cyberdome, the State law enforcement’s internet watchdog, had stepped up efforts to fact check online content related to Nipah.

It had flagged up a marked increase in misinformation and alarmist propaganda related to Nipah, prompting Chief Minister Pinarayi Vijayan to warn people on Tuesday against trusting canards spread through the internet.

Investigators had zeroed in on two proponents of naturopathy, who promoted magic cures and quack treatments.

One posted a video of himself eating a mango which he claimed was discarded by a fruit bat to dispel the scientific finding that the mammal could transmit the virus to humans.

The other argued against hospitalising persons suspected of Nipah infection and claimed he could treat the viral affliction without drugs and through dietary adjustments.

Both have an outsize presence on social media and their messaging to their large number of followers was particularly disconcerting to public health authorities.

Authorities had faced a similar predicament during an outbreak of rat fever in 2018 when a set of social media evangelists for alternative medicine urged the public to shun doxycycline, a prophylactic distributed by health authorities to contain the spread of leptospirosis.

In the past, some fringe elements posted scaremongering videos in an attempt to derail the government’s polio immunisation campaign on the false ground that it infringed on their religious beliefs.

Cyber investigators had also come across fearmongering social media posts, urging the public to shun Nipah caregivers, public spaces and not to send children to school.

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Nipah virus: Kerala health dept. to set up isolation wards in Pathanamthitta hospitals

Preventive measures: Health-care workers at Government Medical College, Ernakulam, in protective gear on Monday to meet any emergency in the wake of a person suspected to be infected with Nipah virus being admitted to a private hospital in Kochi.

Preventive measures: Health-care workers at Government Medical College, Ernakulam, in protective gear on Monday to meet any emergency in the wake of a person suspected to be infected with Nipah virus being admitted to a private hospital in Kochi.   | Photo Credit: H. Vibhu

Housewife dies of fever, H1N1 infection suspected

The Kerala Health Department has taken all preventive measures in Pathanamthitta district in the wake of of a repoirted Nipah case in the northern part of the State, according to District Medical Officer DMO A.L. Sheeja.

A 47-year old housewife from Mallappally who was undergoing treatment for fever at the Kottayam Government Medical College Hospital, died on Tuesday. There were reports of H1N1 infection causing her death.

Dr. Sheeja said the samples collected from the throat of the deceased had been sent to the Virology Laboratory in Manipal for investigation.

 

According to the DMO, directions have been issued to the authorities concerned for setting up isolation wards and cough corners at the government hospitals in Pathanamthitta, Thiruvalla, Kozhecherry, Adoor, Ranni, Konni, and Mallappally as well as two private hospitals in Thiruvalla on a warfooting.

Addressing a meeting of the heads of various hospitals in the district, Dr. Sheeja said separate out-patient facilities for fever patients should be set up at all hospitals in the district.

Meanwhile, as many as 215 persons sought treatment for fever at various government hospitals in the district on Tuesday, according to official sources.

 

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How Kerala is tackling the second Nipah outbreak

To plug spread of Nipah virus, Kerala takes steps to intensify surveillance

A security personnel stands guard in front of the Casualty Department in Government Medical College, where one suspected case of Nipah virus infection was admitted, in Ernakulam, on Tuesday.

A security personnel stands guard in front of the Casualty Department in Government Medical College, where one suspected case of Nipah virus infection was admitted, in Ernakulam, on Tuesday.   | Photo Credit: H. Vibhu

Team from various institutes under Union Health Ministry in State to tackle infection

 

The Kerala government has strengthened surveillance and preventive steps as the Nipah virus infection was confirmed in the 23-year old patient in a private hospital.

The patient will not be shifted from the present hospital as it may lead to the spread of the infection, said Health Minister K.K. Shylaja. The hospital was taking good care of the patient, she added.

Principal Secretary (Health) Rajan Gobragade, speaking at the media briefing along with the Minister, said that steps had been initiated to look into the deaths registered in the State during the three weeks. The surveillance was to pick up any unnoticed case that had symptoms similar to Nipah, he said. This was to plug the spread of the infection and to trace its origin, he added.

 

Ms. Shylaja said that the health team would place on home quarantine people who had been in contact with a person reported with the infection to contain further spread of the virus.

Usually, the incubation period for the disease was said to be 14 days and the worldwide practice was to keep the patient in quarantine for a longer period, she added. The expert team here would be taking a decision on these matters, said the Minister.

A six-member team from various institutes under the Union Health Ministry are here to provide expertise on tackling the Nipah infection.

Dr. Animesh Ray, Associate Professor, Internal Medicine, All-India Institute of Medical Sciences, Dr. B. Anup Kumar, virologist, National Institute of Virology, Alappuzha, Dr. Vikram V. Holla, Assistant Professor, Neurology, NIMHANS, Dr. Sanket Kulkarni, Deputy Director, National Centre for Disease Control, New Delhi, Dr. K. Regu, Joint Director, Entomologist, NCDC, Kozhikode, and Dr. Chdiesh Nagarajan, Assistant Director, Microbiology (Zoonosis), NCDC, Delhi, would be working with the Kochi and Kozhikode teams.

A similar team was active during the infection in Kozhikode last year and they had worked along with the Kozhikode team that controlled all preventive activities.

Training had been going on in various batches for doctors and other healthcare workers since the last two days as the Kozhikode medical team comes with the previous experience in checking the spread of the virus.

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How Kerala is tackling the second Nipah outbreak

23-year-old student infected with Nipah virus, confirms Kerala govt

A security personnel stands guard in front of the Casualty Department in Government Medical College, where one suspected case of Nipah virus infection was admitted, in Ernakulam, on Tuesday.

A security personnel stands guard in front of the Casualty Department in Government Medical College, where one suspected case of Nipah virus infection was admitted, in Ernakulam, on Tuesday.   | Photo Credit: H. Vibhu

Four others, suspected to have been infected with the Nipah virus, have been quarantined

Nearly a year after the outbreak in Kozhikode and Malappuram, the deadly Nipah has resurfaced in Kerala. It has been confirmed that a 23-year-old college student here is infected.

“The test results have come from the National Institute of Virology (NIV), Pune, and it is positive for Nipah. The health authorities have made elaborate arrangements and medicines are in stock,” Health Minister K.K. Shylaja said here on Tuesday.

The Minister said 311 people from various districts with whom the student had interacted in recent times were under observation.

Three persons who attended to the student initially and one who studied with him were suffering from fever and sore throat. They had been shifted to an isolation ward set up at the Kalamassery Medical College Hospital in Kochi for a detailed examination. Their health condition was satisfactory, authorities said.

The student, hailing from North Paravur in Ernakulam district, studies in a college at Thodupuzha in Idukki district. The student, who was suffering from fever, had gone to Thrissur district with a group of students to attend a training programme there.

Ms. Shylaja said the student, who is being treated at a private hospital here, was not on any support system such as ventilator. “Good care is being given to the patient. The patient sometimes become restless due to fever.... We expect a good result,” she said.

The Minister urged the people not to panic and instead take precautionary measures to prevent the spread of the disease. “We have confidence that we can face it. We faced it in Kozhikode last year and contained it,” she said.

“From now on, there will be a high alert and three samples (blood, urine, and throat) from every person who shows symptoms of Nipah will be taken and sent to the NIV, Alappuzha, Pune, and Manipal,” said Health Secretary Rajan Khorbagade. He said experts from the Indian Council of Medical Research were in constant touch with the health authorities here.

The Centre rushed a six-member team to Kerala on Tuesday. Union Health Minister Harsh Vardhan spoke to Ms. Shylaja to discuss the situation and assured her all support from the Centre.

The Health Ministry said the team, among them an epidemiologist, had been sent to the State for contact tracing for early detection of suspects and review isolation facilities.

A control room has been set up and the Strategic Health Operations Centre (SHOC) of the National Centre for Disease Control (NCDC) has been activated, the phone number for which is 011-23978046, a statement stated.

(With inputs from agencies)

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How Kerala is tackling the second Nipah outbreak

All you need to know about Nipah virus

Blood taken for test

Blood taken for test   | Photo Credit: M_SRINATH

Three people have died from the infection in Kerala so far

Last evening, the health department of Kerala confirmed the first Nipah virus infection in the State after testing the blood samples of two persons who died of viral fever in Kozhikode district. Private and government hospitals are on high alert to monitor the disease and its spread.

According to WHO, the Nipah virus infection is a newly emerging zoonosis, that is, a disease transmitted from animals to humans. The virus belongs to a new genus termed Henipavirus (subfamily Paramyxovirinae).

Which animals can spread the disease?

The natural host of the virus are fruit bats belonging to the family Pteropodidae. In 2004, humans were affected after eating the date palm contaminated by infected fruit bats. Pigs can also act as intermediate hosts.

When was it first reported?

It was first identified in 1998 at Kampung Sungai Nipah village, Malaysia. The virus is named after this village.

What are the symptoms in humans?

The symptoms of Nipah are similar to that of influenza: fever, muscle pain, and respiratory problems. Inflammation of the brain can also cause disorientation. Late onset of Encephalitis can also occur. Sometimes a person can have an asymptomatic infection, and be a carrier of Nipah and not show any symptoms.

How do doctors diagnose Nipah ?

    • Serology- blood tests to see the antibodies
    • Histopathology- microscopic study of tissues
    • PCR- Polymerase Chain Reaction technique to look for viral DNA
    • Virus isolation

Confirmatory tests include

    • Serum Neutralization Test
    • ELISA
    • RT-PCR

The Nipah virus is classified as a biosecurity level (BSL) 4 agent and the tests should be carried out in special labs to prevent its spread. The blood and body fluid samples of two persons who died in Kozhikode were studied at the special laboratory at National Virology Institute, Pune.

Are there any vaccines?

Currently, there are no vaccines for both humans and animals. Intensive supportive care is given to humans infected by Nipah virus.

According to WHO, ribavarin can reduce the symptoms of nausea, vomiting, and convulsions associated with the disease. Individuals infected need to be hospitalised and isolated. Special care should be taken to prevent human-to-human transmission. Surveillance systems should be established to detect the virus quickly and to initiate appropriate control measures.

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How Kerala is tackling the second Nipah outbreak

As Nipah fears resurface, Kerala to strengthen preventive measures

Test tube with blood sample for Nipah virus test.

Test tube with blood sample for Nipah virus test.   | Photo Credit: Getty Images/iStockphoto

The samples of a patient in Kochi have been sent to the National Institute of Virology (NIV) in Pune, and health authorities are awaiting the results.

In the wake of a suspected case of Nipah virus infection at a private hospital in Kochi, a high-level committee has decided to strengthen preventive measures, even as confirmation is awaited from the National Institute of Virology (NIV) in Pune.

The committee, comprising Health Secretary Rajan Kobargade, District Collector Mohammed Y. Safirulla, District Medical Officer N.K. Kuttappan, and other senior Health officials, met in Kochi after a private hospital reported on Sunday that a college student from North Paravur studying in Thodupuzha was admitted with an infection that could not be identified by them.

The samples of the patient have been sent to Pune and health authorities are awaiting the results.

A team from Kozhikode was arriving to oversee and train the Health officials in matters of technical management in case the infection gets confirmed, District Medical Officer N.K. Kuttappan told The Hindu.

A control room will be opened at the Collectorate for any information related to the Nipah virus. An isolation ward is being arranged at the Government Medical College, Ernakulam. Equipment and other facilities are being brought into the casualty ward.

Government closely monitoring situation: Pinarayi Vijayan

In a Facebook post, Kerala Chief Minister Pinarayi Vijayan said the government was closely monitoring the situation. Kerala’s health network was capable of handling any emergency, he said. He urged people to follow the Health department’s instructions.

“There is need to be cautious, but it is not a cause for panic,” he said. A series of measures had been ramped up to tackle the problem, he said; contact tracing, case isolation, quality care and community engagement were being done diligently. He asked people to be careful against spreading rumours through social media.

Kerala Health Minister K.K. Shylaja reiterated that the Health Department was capable of handling any situation — isolation wards and other facilities had been arranged at hospitals and medical colleges. People should stop spreading fake news about Nipah infection, she said, adding that a doctor should be consulted for aggravated cough and fever.

Last year, when a Nipah infection was detected in Kozhikode, the Health department took preventive steps to check its spread. Isolation wards were arranged in various hospitals and symptoms of the viral infection were watched closely, said the Minister.

The infection is usually spread from animal to animal, but in rare cases it spreads from animal to humans too. Bats and pigs are found to be the usual carriers.

The virus could spread through fruits bitten by carrier bats or when the excreta of such animals find their way into the foods consumed by humans. It can spread through close contact with infected persons, especially when precautions are not taken.

In case of infection, it takes five to 14 days for the symptoms to manifest. Common symptoms are fever, headache, giddiness and loss of consciousness.

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