What Kerala learnt from third outbreak of Nipah virus
The origin of the Nipah virus and its carrier are still unknown as was the case in the earlier two outbreaks -- 2018 in Kozhikode when 17 lives were lost and 2019 in Ernakulam when a youth was saved after long hospitalisation
Kerala health officials hit a blind alley in 2018 when Nipah virus first broke out in Kerala since there was no known treatment for the disease, but three years later they were better prepared when the zoonotic virus revisited for the third time. Though it claimed the life of a 12-year-old boy last Sunday, reports from ground zero suggest its threat is receding fast.
“We are really relieved that other than the index case, no other infection has been reported so far. We will strengthen our surveillance and speed up efforts to pinpoint the source of infection,” said state health minister Veena George, adding that the lessons from the 2018 outbreak helped the administration contain it quickly.
But the origin of the virus and its carrier are still unknown as was the case in the earlier two outbreaks-- 2018 in Kozhikode when 17 lives were lost and 2019 in Ernakulam when a youth was saved after long hospitalisation.
Experts say the state will have to formulate a proactive strategy to face the increasing threat of recurring zoonotic diseases and not wait for the outbreak to act. The state needs to strengthen its surveillance system backed by enough scientific studies, they say.
They point to the initial confusion to buttress their point. When the Nipah-infected boy was rushed to the government medical college hospital in Kozhikode on Aug 30, he was diverted to a private hospital without conducting any tests or diagnosis, merely on the pretext that there was no ventilator to spare.
As was the case during the 2018 outbreak of the virus, a private hospital, Malabar Institute of Medical Sciences, sent the boy’s samples to the National Institute of Virology in Pune for testing, which helped in the virus’ early detection. Now, state health minister Veena George has ordered a probe into alleged lapses on the part of the medical college hospital.
“Yes, we have learnt many lessons on the curative side, but are yet to learn enough surveillance lessons. The boy was in four different hospitals before he was admitted to the MIMS. In an epidemic, surveillance is the key, but we become alert only after the onset,” said Dr SS Lal, a public health expert who worked with the World Health Organization.
He said that while 70% of the health sector is in the hands of the private sector in the state, the government still keeps it in the dark and attempts to hijack all credits for political reasons.
Unlike 2018, when the virus was diagnosed after four deaths, this time the boy’s status as Nipah positive was confirmed hours before his death, allowing for quick contact tracing, route mapping and sealing of the area around his residence. “I was unconscious for more than 10 days and heard about Nipah for the first time in life when I was about to be discharged. We have a robust health system and committed workers. And this really helped contain the scourge this time,” said M Ajanya, a nurse, first Nipah patient to be cured in 2018.
After the first outbreak, many promises such as setting up of a high-end animal testing lab, virology institute, a scientific study on bats (chiropterology) and a treatment protocol for separate zoonotic diseases, were made. Experts say most of these were yet to be met.
“The most important is to find out how the boy got infected and whether it is the index case. Since zoonotic diseases recur frequently, we need an integrated team of experts from all fields to study it,” said Dr NM Arun, an internal medicine expert.
Experts add that though the fruit bats are considered to be the main carriers of Nipah virus, a clear link or interface between bats and human beings is yet to be established.
Experts said that Covid containment protocols such as masking, physical distancing and no overcrowding also helped the state blunt the impact of Nipah. “Covid-19 protocol and its prevention techniques came in handy for containing Nipah also.
Unlike earlier incidents, we have to identify the source of the virus to check its further outbreak,” said another public health expert Dr Padmanabha Shenoy. According to the World Health Organization (WHO) guidelines, at least 70% of Nipah infections can be fatal.
“Zoonotic diseases are here to stay. We need a permanent single window mechanism for early detection and warning to prevent outbreak of such diseases. More research is also needed in the area,” said Dr Prejit Nambiar, a teacher at the Kerala Veterinary and Animal Sciences University, who specialises in zoonoses and food safety. He said a close interaction is necessary between medical experts, veterinary professionals, environmental scientists and wildlife professionals to tackle this.