After Nipah jolt, the vigil and the unknown



Though the public health apparatus in Kerala reacted swiftly to the crisis, key challenges remain

The Nipah virus outbreak in Kerala has perhaps been one of the biggest health challenges the State has faced in recent times. The infection, which has previously been reported abroad in Malaysia and Bangladesh, and at home in West Bengal, has claimed 13 lives so far in the State. A few more patients are battling for life and over a dozen people are under observation at various government and private hospitals across Kerala.

The infection — described by the World Health Organisation (WHO) as a “public health risk” with the potential to develop into an epidemic — first came to the notice of two doctors attached to a private hospital in Kozhikode. One of their patients, admitted with fever in mid-May, had displayed unusual symptoms. The doctors later found that his brother had died a fortnight ago in similar circumstances.

The patient’s blood and body fluid samples were sent to a laboratory in Manipal in Karnataka for analysis as they suspected it to be a virus unheard of in Kerala. By the time the results came, the patient had died. One more member of the family died as well.

A couple of days later, and after confirmation by the National Institute of Virology, Pune, the Kerala government officially declared the cause of the deaths to be Nipah virus infection. As this happened, more people with symptoms of fever and neurological symptoms began to be admitted to hospitals.

Emerging disease

According to the WHO, the infection is a “newly emerging zoonosis that causes severe disease in both animals and humans”, and is on the WHO list of ‘Blueprint priority diseases’. The natural host of the virus are fruit bats of the Pteropodidae family, Pteropus genus.

The virus, the WHO says, was first identified during a disease outbreak in Kampung Sungai Nipah, Malaysia, in 1998. Initial symptoms are somewhat similar to influenza fever and muscle ache, say doctors. It can later affect the central nervous system, lead to respiratory issues, and ultimately end up in encephalitis. As a vaccine is not available, the only form of treatment possible is for fever and neurological symptoms.

The public health apparatus in Kerala responded swiftly to the crisis as the presence of the virus was confirmed in the second case. So far, the infection has not spread among the community and the Health Department is now preparing a “line list” of people who may stand a chance of developing infection. Ground-level health activists and revenue staff are on the alert to detect and isolate any suspected case and provide them treatment. Isolation wards have been set up at government hospitals in all districts.

After reviewing the measures, a multi-disciplinary Central team led by the National Centre for Disease Control (NCDC), New Delhi, has said that it is “not a major outbreak” and “only a local occurrence”. It has also fine-tuned the draft guidelines, case definitions, advisories for health-care workers, information to the public, and advisories for sample collection and transportation.

Another team from the Union Health Ministry has also said that the efforts taken so far to contain the disease have been fruitful. The WHO too has lauded the government’s activities.

The government had earlier issued an advisory restricting travel to four northern districts in the State — Kozhikode, Malappuram, Wayanad and Kannur. The advisory has since been modified and applies to only the first two districts. As laboratory results of more suspected cases are turning out to be negative, the Kerala government hopes that the situation will soon be under control, but it is still cautious.

Drug research

Research on developing a new drug to fight the virus is expected to begin soon at the Government Medical College, Thiruvananthapuram, in association with the Indian Council for Medical Research and global experts.

However, there are challenges. Efforts to trace the source of infection in the first case have not yielded results so far. It remains to be seen if there could be carriers other than fruit bats. This might also throw up the possibility of infection elsewhere. Finally, those under observation and treatment need proper care.

The battle is far from over.


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