NEW DELHI: The fresh outbreak of the deadly Nipah virus, which has killed one and infected a few others in Kerala might be a double whammy for the state reeling under Covid-19, but experts feel curbing Nipah should not be a massive problem.
Nipah’s high mortality — 68%, 100% and 91% in the three outbreaks in India so far — makes it fearsome, but the high lethality also curbs opportunities for the virus to spread, which means it is easier to douse a Nipah outbreak than a Covid-19 outbreak.
The Centre on Sunday rushed a team of the National Centre for Disease Control experts to Kerala after a 12-year old boy, diagnosed with Nipah in Kozikode, died.
A list of 100 persons who came in contact with him has been prepared and they are being monitored. At least two relatives are said to have developed symptoms.
Caused by a highly pathogenic virus, Nipah is understood to be carried by bats and is transmitted by spill-over to humans and livestock.
Globally, only about 650 cases have been reported since 1998, confined to a few countries and yet it is categorised as a highly serious disease due to high fatality rate of 40-100%.
Symptoms include fever, respiratory distress and swelling of the brain.
Rajalakshmi A, an infectious disease expert at the Kerala Institute of Medical Sciences, said that despite high death rate, the saving grace about the pathogen is it’s spread from human to human is limited, unlike SARS CoV 2.
The reproductive number values — rate at which one human infects others — are dramatically different for SARS-COV-2 and Nipah.
While SARS-COV-2 Wuhan strain had an R value of 2-3 and the Delta variant 5-6, this figure for Nipah is estimated to be 0.33 to 0.48.
“With an aggressive contact tracing and quick isolation of suspected cases, we will be able to manage the outbreak in about two weeks,” she said.
Rajan Payyappilly, a virologist with Kannur medical college, stressed that Nipah was not a “smart” virus.
“I would throw up the analogy of a man cutting the branch on which he is sitting to explain how Nipah behaves,” he said, adding that as the virus kills most people it infects, it runs out of hosts very soon if intimate contact between patient and others is stopped.
“So far in every outbreak, the virus has contained itself and it’s likely that the pattern will be repeated, although healthcare workers treating patients and suspects should be extra careful.”
Virologist Shahid Jameel said Nipah with an animal reservoir may never go away as they hide in these reservoirs.
“Testing and isolation are things to be done,” he stressed.
Expecting pattern to remain the same
Rajan Payyappilly, a virologist with Kannur medical college, said that so far in every Nipah outbreak, the virus has contained itself and it’s likely that the pattern will be repeated.
Centre recommends strengthening hospital, community-based surveillance in Kozhikode
Based on a report by a central team which was deputed in Kozhikode in Kerala in the wake of Nipah virus infection outbreak, the Centre has recommended strengthening both hospital and community-based surveillance in the district and undertaking an active search for cases in containment areas.
In a letter to Chief Secretary Dr V P Joy, Union Health Secretary Rajesh Bhushan on Monday stated that the nearby districts of Kannur, Malappurum and Wayanad need to be alerted and district authorities must identify primary and secondary contacts as well as prepare line listing of high risk and low risk contacts.
He also stated that all high risk contacts may be moved to identified facility quarantine and observed for symptoms.
The central team from the National Centre for Disease Control (NCDC) was deputed to Kozhikode on Sunday, in the wake of Nipah outbreak in that district.
The team has so far attended meetings with the minister for forests and wildlife as well as the Kerala health minister.
"The central team has carried out field investigations along with district surveillance officer and other officials. It has also visited the epicentre, the house of a 12-year-old male diseased child, has interacted with family members, neighbours, field health functionaries, ward members, local elected representatives, ANMs, ASHAS and has reviewed event-based surveillance in the community," Bhushan said in his letter.
He said presently, NIV, Alleppy is providing laboratory support but in accordance with the request of the state government, DG, ICMR has initiated action to establish point of care testing at VRDL, Kozhikode.
The Government Medical College, Kozhikode has been identified as the treatment centre, the letter said.
Adequate number of single-room isolation facilities and negative pressure ICUs maybe earmarked as stan by, a referral system be established along with carmarked ambulances and trained staff and adequate stock of Ribaverin (anti-viral) and PPEs need to be maintained at the district level, the secretary recommended.
The ICMR is exploring the feasibility of getting appropriate monoclonal antibodies for treatment purpose, Bhushan said.
The secretary further highlighted the need for setting up a 24x7 control room for daily reporting and sharing information with the media.
Coordination with the Animal Health and Wildlife Department and other field officers may be initiated to trap and collect samples from fruit bats for virological studies and other associated measures, Bhushan suggested.
"I once again reiterate the commitment of the Union Health and Family Welfare Ministry to extend all possible technical support to the state government in addressing the present problem in an effective manner," Bhushan said in his letter.
(With PTI Inputs)