Nipah a warning sign of Kerala’s zoonotic threat
The fact that the reappearance of the Nipah virus and the death of an infected boy took Kerala’s health administration by surprise shows how the state had lowered its guard against the deadly contagion despite past experience. Though there has been only one confirmed case so far and as many as 68 samples have tested negative since then, it may be too early to relax considering the nature of the virus and the crucial delay in detecting the infection.
The third Nipah outbreak within four years needs to be treated as a warning signal. That Kozhikode Medical College Hospital, one of the top tertiary care hospitals in the state with a history of treating Nipah cases, failed to identify the symptoms in the boy is shocking. As the first case was reported, three ministers and top officials of the health department rushed to Kozhikode for crisis management. This reactionary approach, instead of having a foolproof disease monitoring and warning system, is a major handicap.
Kerala, a hotspot for infectious diseases, still lacks an active surveillance mechanism to identify an outbreak. Four decades ago, Kerala set up a cell for the prevention of epidemic and infectious disease by connecting major medical colleges. It helped the state control dengue, Japanese encephalitis and leptospirosis outbreaks. However, the focus waned over the years. It is time to revive the cell and put in place a monitoring system that works 24x7.
The state also needs to consider other factors that make it vulnerable to zoonotic diseases. Increased dependency on animal protein as part of the dietary requirement and widespread encroachment of natural habitats are exposing Kerala to a greater risk of animal-to-human pathogen transfer. The state needs to adopt the ‘One Health’ approach of the WHO, which recognises that human health is closely connected to the health of animals and the shared environment, thereby helping prevent, detect, contain, eliminate and respond to animal and public health risks. Formation of a zoonotic disease monitoring committee as advised by the National Centre for Disease Control would be another step in the right direction. Certainly, there will be similar outbreaks in the future, but being alert will help us deal with the situation better and prevent possible fatalities.