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Nipah: Viral Fear

Nipah: Viral Fever
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How experience has taught Kerala to successfully manage a deadly virus

IT WAS IN May last year the Nipah virus first announced itself in Kerala, killing 17 in a week, a fatality rate of 91 per cent. Only two of those positive survived. But Kerala’s healthcare system contained the virus before it could gather force.

A resilient scourge, it has just hit the state again. Its index case this time is a 23-year-old college student admitted in a private hospital on May 30th with fever and symptoms of encephalitis. Blood samples sent to the National Institutes of Virology and Manipal Centre for Virus Research tested positive. Worryingly, he was in a training camp with 22 other students. Seven were admitted with symptoms of which six tested negative, said the state’s health minister. Contact tracing started on the very first day after the virus was suspected. So far, 145 of the 314 people on the contact list have been profiled.

Nipah transmits from animals to humans and from humans to humans but only by close contact, mostly through exposure to a coughing patient’s droplets. Precautions can make one safe even if in close contact with a carrier. The virus was discovered in Malaysia’s Sungai Nipah village during an outbreak in 1998 among pig farmers. By 2015, more than 600 cases of infections were reported across Bangladesh, Singapore, the Philippines and India. Nipah was listed among 10 priority diseases in the 2018 World Health Organization Research and Development Blueprint. The first recorded outbreak in India, killing 66, was in Siliguri, West Bengal, in 2001. Laboratory confirmation came only five years later.

The speed of its spread was in evidence last year in Kerala when on May 17th 28-year-old Mohammed Sabith was admitted to the taluk hospital in Kozhikode for encephalitis but soon developed unusual signs, including tachycardia and high blood pressure, prompting experts to suspect a virus unfamiliar to the state’s healthcare. His younger brother had died 12 days ago with similar symptoms. Three more in his family were then brought to the hospital and all succumbed. In a week, 17 people who were in direct contact with the index patient, including a nurse, died. Authorities acted promptly by isolating suspected cases, setting up quarantine wards and conducting contact tracing, infection control practices and risk communication. (As there is no treatment, prevention and medical care are the only options.) They kept 2,642 contacts of the index and secondary cases under surveillance. Reopening of schools and marriages and religious functions were postponed to prevent crowds from congregating and spreading the virus. Remains of those whom Nipah killed weren’t handed over to the families but buried adhering to WHO guidelines. People cooperated too. The epidemic started subsiding. No cases were reported after May 30th last year and the the state was declared free from Nipah on July 1st.

Sabith probably got the virus from fruit bats when he went into a well to clean it. Chances of infection are high during the bat’s breeding season. It also happens if they are disturbed because of climate change or habitat destruction. The Indian Council of Medical Research later confirmed fruit bats were the source of the outbreak.

Why did Nipah come to Kerala only? “We cannot say this virus is not there anywhere else in the country, the chances are very high. We have a robust healthcare system that traces the virus. People here are sufficiently educated for self-reporting. Authorities are also vigilant,” says Dr B Iqbal, former Vice Chancellor of Kerala University, neurology expert and a health activist.

The index patient this time is slowly recovering, whose family is not ostracised as happened with the index patient last year.

“There is no point in being scared. We have to be vigilant, listen to experts and ignore conspiracy theories,” says 21-year-old Ajanya Ajuz, one of the two Nipah survivors in Kerala.