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Nipah outbreak confirmed in Kerala; what you need to know and how to fight it

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Following an outbreak which killed 17 people an year ago, Nipah is back in Kerala. This time, a 23-year-old student caught Nipa in Ernakulam district. The health minister has assured that adequate precautions are being taken to contain the Nipah virus this time and the general public need not panic. Four others, including two nurses who were in contact with the youth, have shown signs of heavy fever and one of them has been moved into isolation ward, the health minister said. The virus which spreads from human to human and has a mortality rate of 70% appeared in the state for the first time in 2018 and ended up claiming 17 lives. There is no vaccine to prevent it. The youth, a student from Idukki district, was hospitalized with high fever in Kochi 10 days ago, the health minister had told reporters on Monday.
“The public need not worry since none of the 86 people traced so far have showed any signs of the virus attack, yet the government is making all preparations in view of a chance outbreak,” the minister had said on Monday.

“The government is closely monitoring the current situation,”
chief minister Pinarayi Vijayan said in a Facebook post and urged everyone to follow the instructions of the Health department.

“No one needs to be afraid. Be alert. The Health department is all set to face any situation,” he said. The chief minister also asked people not to indulge in fake campaigns about the Nipah virus on social media.

Union Health Minister Harsh Vardhan assured all help to Kerala and said he is in touch with Kerala government on the issue. “The Centre will send monoclonal antibody (medicines) to Kerala. Everything that needs to be done in a scientific manner has been initiated.

The government has started a control room number 1077 where the public can get any information on Nipah or clear their doubts or raise concerns, she said .A team of six experts, including doctors from AIIMS, have arrived in Kochi, she added. Besides the patient, health officials in Kerala have identified 86 people who interacted with the student who are being observed for possible Nipah virus infection.

Meanwhile, a new study published by an international group of researchers in the New England Journal of Medicine revealed an elevated risk to caregivers, the role of respiratory secretions, and other new clues about the Nipah virus. It also throws light at what fuels transmission among humans and findings that could help control future outbreaks.

About Nipah

Nipah is a zoonotic virus i.e. it spreads from animals to humans. The Nipah virus is transmitted from flying foxes (fruit bats) to animals and humans. Generally it affects animals like pigs, dogs, horses, among others. If spread among humans, Nipah virus can cause serious illness which may result in death.The World Health Organisation says the Nipah virus infects a range of animals and causes severe disease and death in people which makes it a cause of concern for public health. Nipah virus can be transmitted through “contaminated food or directly between people”.

“In infected people, it causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis,” WHO says in its guidelines on Nipah virus. Nipah virus can spread among humans if they establish close contact with Nipah-infected people, bats or pigs. “Bat secretions laden with virus can infect people during fruit tree climbing, eating/handling contaminated fallen fruits or consuming raw date palm sap/juice or toddy,” says the National Centre for Disease Control in its guidelines on Nipah virus. The guidelines outline that besides animal-to-human transmission, Nipah virus can also transmit between humans. The human-to-human transmission occurs when a healthy person has close contact with an infected person at home or during treatment at hospitals. Another possible source of infection can be bodies of people who died due to Nipah virus. The National Centre for Disease Control (NCDC) advises that handling of such dead bodies should be done strictly in accordance with government advisory. “During this emotional moment traditional rituals and practices may need to be modified to prevent the exposure of family members to the disease,” NCDC said.

#Nipah outbreak confirmed in Kerala; what you need to know and how to fight it.#NipahVirus— Maktoob Media (@MaktoobMedia) June 4, 2019

The symptoms of Nipah virus infection

People infected with Nipah virus may suffer from brain fever; fever with persistent cough and difficulty in breathing, acute respiratory infection (mild or severe); influenza-like symptoms — fever, headache, muscle pain, vomiting, sore throat, dizziness, drowsiness and neurological signs indicating encephalitis. WHO says that in some cases people can also experience pneumonia and severe respiratory problems, including acute respiratory distress. “Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours,” it says in its guidelines on Nipah virus.

In order to minimise and avoid transmission of Nipah virus, one should wash hands with soap and water after contacting an infecting person or virus. People should avoid consuming raw date palm sap or toddy. Dead bodies of Nipah-infected people should be handled as per guidelines issued by health officials. Any laxity in this could worsen the situation. Consume fruits only after washing them properly. Do not eat half-eaten fruits lying on ground. These fruits could have been eaten by infected animals, especially flying fox which is the main transmitter of Nipah virus. Care should be taken while handling sick animals. Gloves and other protective clothing should be worn during slaughter and culling of infected animals and any contact with infected pigs should be avoided as far as possible.

According to the World health Organisation, currently there are no specific drugs or vaccines for Nipah virus. Taking cognisance of the seriousness of Nipah virus, the WHO has identified it as a “priority disease” for the WHO Research and Development Blueprint. WHO recommends that intensive supportive care should be provided to treat severe respiratory and neurologic complications borne out of Nipah infection. WHO says that the drug Ribavirin has shown to be effective against Nipah viruses in laboratory. However, “human investigations have been inconclusive and the clinical usefulness of Ribavirin remains uncertain”. Besides this most people who survive acute encephalitis make a full recovery. However, those who have survived the diseases have reported long-term neurologic conditions. “Approximately 20 per cent of patients are left with residual neurological consequences such as seizure disorder and personality changes. A small number of people, suffer a relapse or develop delayed onset encephalitis, after showing signs of recovery,” WHO says.

The first Nipah virus outbreak in Kerala was reported last year. A total of 17 people lost their life due to the infection while 18 others were also infected. The outbreak was largely concentrated in Kozikhode and Malappuram districts of Kerala.

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