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Nipah virus leaves Kerala public health officials in state of disarray as casualty figure touches ten in 48 hours

Kerala's health sector has been dealt a severe blow after the National Institute of Virology in Pune confirmed on Sunday night that the suspected virus that had led to the death of three of a family in Kozhikode was indeed the dreaded Nipah virus.

With the casualty figure touching ten within the past 48 hours, the state’s public health department is in a state of shock and disarray. While the blood samples of four deceased had confirmed the virus, the rest were being tested at the institute in Pune at the time of filing of this report.

The state health department has also confirmed that at least 25 people with similar symptoms are under observation at various hospitals in Kozhikode district where the outbreak initially took place.

The entry of Nipah, or Henipavirus as it is known in medical parlance, in this part of the world has made things difficult for the medical community. Doctors do not have prior experience in this regard, and are struggling to contain the spread of the disease.

A high level team of doctors from the national capital has also been rushed by the Union health ministry to take stock of the situation in state’s northern districts.

 Nipah virus leaves Kerala public health officials in state of disarray as casualty figure touches ten in 48 hours

A meeting chaired by Kerala health minister KK Shailaja in progress at Kozhikode. Naveen Nair

At the time of filing this report, a high-level emergency meeting chaired by the state health minister was on at the Kozhikode Medical College Hospital. A medical alert has also been sounded across the state, with district collectors asked to be ready for any eventuality.

“The state has been put on a high alert after we got the confirmation. The central government has also been informed. We have also asked private hospitals to provide all help to patients. Their treatment cost will be borne by the state,’’ KK Shailaja, Minister for Health and Social Welfare told mediapersons in Kozhikode.

Recently, a family of three had died at a village in Chengaroth in Kozhikode district due to symptoms similar to encephalitis. Muhammed Salih and his brother Sabith, aged 26 and 23, and their maternal aunt Mariyam, aged 50, were the first victims of Nipah.

As doctors were unable to get answers about which virus led to the disease, their samples were rushed to Pune. From there, the much-feared confirmation came in on Sunday evening. But by then, two more deaths had been reported. At least one of them, Ismail, had come into contact with the deceased Sabith while in hospital.

But what has set alarm bells ringing for the authorities is the death of a nurse, Lini, who had attended on one of the victims in the government hospital. With consent from her family, Lini’s body was cremated by the state itself without being taken to her house, summing up the alarming situation.

“Even though we say there is no need to panic, we are still in a state of shock after Lini’s death. It only shows how unprepared we are in dealing with a situation like this,’’ said one doctor based in Kozhikode on the condition of anonymity.

The government has meanwhile rushed in more health officials to Perambra and adjoining areas. All hospitals in the area have been advised to quarantine patients who show similar symptoms.
“There is no need to panic as the outbreak is confined to a small area. But we have formed task force teams to ensure that the outbreak is contained at the earliest. The priority before the government now is to minimise deaths. We are doing all that is possible to ensure this,’’ added the health minister.

Fear of spread of virus

Although the state claims that the outbreak is limited to a small area in Kozhikode, developments in the adjoining district of Malappuram are not encouraging. Four deaths of people who showed similar symptoms have already been reported from Malappuram. Health workers suspect that the cause may be Nipah.

“The symptoms in Malappuram suggest that the cases were of encephalitis. However, whether the disease is actually Nipah can only be confirmed after we get the samples tested in Pune. At the moment, that is what we are doing. We are not taking any chances. All measures to contain the virus have been put in place here too,’’ said Dr Sakhina, District Medical Officer, Malappuram.

As ‘fruit bats’ found in large numbers all over rural Kerala are the natural hosts of this deadly virus, it becomes doubly challenging for health officials to contain it. These bats fly for at least 200 kilometers in search of food at night. This means that containing the virus in a densely populated state like Kerala becomes an even tougher task.

What makes the situation worse is that Nipah has an incubation period of four to 15 days which means that unless effective quarantine measures are put in place to ensure that people do not travel to affected areas, the number of cases could rise the coming days.

“Anyone can travel to Kozhikode and also travel from the town elsewhere at the moment. We will have to tackle the issue of quarantining, failing which this virus can spread in any direction in the state. It will then become absolutely impossible to contain it. The measures being taken at the moment are inadequate to contain the virus,’’ a senior doctor from Malappuram told Firstpost.

What is Nipah?

According to the World Health Organisation, Nipah Virus (NiV) Infection is “a newly emerging zoonosis that causes severe disease in both animals and humans.” In other words, it is a virus that spreads from animals to humans and then spreads among humans.

It normally affects human beings initially in the form of encephalitis. It is accompanied by fever, headache, cough, drowsiness and finally coma.

With no specific drugs to treat the disease apart from life-supporting medical care, many patients die within a few days. Alarmingly, Nipah has a mortality rate of close to 75 percent, making it one of the most dreaded diseases after Ebola.

The virus is found to be present in the urine, faeces and saliva of the fruit bats. It is believed that half-eaten fruits or faecal droppings of bats could be potential carries of the virus when they come in contact with human beings.

In the case of the family in Perambra, it is believed that one of the members of the family might have come in contact with a half-eaten fruit dropped by a bat in the courtyard of their house or consumed water from the well adjoining their house in which dead bats were found.

The disease could have then spread from one person to another in the household, leading to the death of three.

The virus was first found among pigs in Malaysia in 1998. At that time, about a million pigs had to be culled across farms after more than 100 people came in contact with the virus. Here also, fruit bats were believed to have spread the virus to the pigs.

Health officials clueless about Nipah's arrival in Kerala

What troubles health experts in Kerala is the lack of clarity on the manner in which the virus came to the state.

The only other reported case of Nipah in India was from Siliguri in West Bengal way back in January 2001. But Nipah has been common in many parts of Bangladesh where, from 2001 to 2011, the disease had been reported every year without fail.

Health officials in Kerala are clueless on how the virus could have traveled from Bangladesh or West Bengal to northern Kerala.

“At the moment, we are absolutely clueless about how the virus reached Kerala. Fruit bats are not migratory. The maximum they will fly is 300 miles. How did a virus earlier reported thousands of miles away come to northern Kerala? This can only be revealed through a minute study of all the circumstances,’’ Dr PS Jinesh from Info Clinic, a Facebook group of doctors that works to clear myths told Firstpost.

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Updated Date: May 21, 2018 15:26:29 IST

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