KOZHIKODE: Emphasising the agonising nature of Nipah outbreaks in the Malabar region, two individuals, once hailed for surviving the deadly infection, remain in a vegetative state, months after being declared virus-free. The cases have raised profound concern among families and healthcare professionals, revealing a terrifying, often unseen, aftermath of the battle with the virus: A brain that simply refuses to wake up.
These aren’t just statistics; they are lives suspended in a cruel limbo, highlighting the devastating and often unpredictable long-term neurological impact of Nipah. The region, still reeling from outbreaks in August 2023 and May 2025 across Kozhikode and Malappuram districts, now faces a new, agonising question: What does “survival” truly mean when the mind remains trapped?
Tito Joseph is a 25-year-old Malayali from Mardala in Mangaluru. For 19 agonising months, Tito has been confined to a hospital bed, a silent testament to Nipah’s insidious power. His brother, Shijo, voices the family’s despair. “We thought the worst was over when the virus test turned negative. My brother has not opened his eyes in over 19 months. We just want to know, will he ever wake up?”
Tito’s case is particularly perplexing. During his initial month of Nipah treatment, he endured the ordeal alone, showing no severe health concerns apart from fleeting high temperature. “Our family was relaxed,” Shijo recalls. “But the post-Nipah period completely changed our lives. We have been living in the hope of seeing him return to life.” According to doctors treating Tito, his condition is believed to be the first of its kind in the country for a Nipah survivor.
Adding to this sombre reality is the case of a 42-year-old woman, whose family, seeking privacy, has chosen to keep her identity hidden. She remained on ventilator support in the intensive care unit of EMS Memorial Hospital, Perinthalmanna, before being transferred to her residence.
Despite receiving two doses of monoclonal antibodies and other critical medicines as part of the state’s Nipah treatment protocol, her condition remains stable, with no signs of improvement or deterioration.
Nipah leaves a lasting impact on brain: Doctor
Both patients, after initially testing negative for the virus and being declared clinically stable, astonishingly showed neurological deterioration, slipping into a unresponsive, coma-like state. Medical teams have categorised their condition as a “persistent vegetative state”.
While the two no longer carry the active virus, the damage inflicted by Nipah’s assault on the brain and nervous system appears to be long-lasting and severe.
“The virus may trigger a post-infectious immune response or cause direct, irreversible damage to brain tissue,” explains Dr Priya Menon, a neurologist at a private hospital in Kozhikode.
“The swelling or haemorrhage in certain parts of the brain can lead to coma. In some cases, despite being ‘cured’ virologically, the brain does not recover.”
Dr Rajesh Raveendran, a prominent infectious disease expert, elaborates. “Nipah is not like most viruses. It not only causes respiratory failure and encephalitis but also leaves a lasting impact on the brain. In some survivors, delayed-onset or relapsing encephalitis can occur even months later.”
The emotional and financial toll on these families is immense. Their initial relief at a negative virus test has been replaced by a gnawing despair, as they witness their loved ones in an unresponsive state.
The state government, in collaboration with the World Health Organization (WHO), is reportedly working towards building a Nipah-specific recovery framework.
‘Vegetative state’
A 42-year-old woman from Valanchery in Malappuram tested positive for Nipah in May 2025
She turned negative after 2 weeks of hospital treatment
Currently, she is in a vegetative state, and takes treatment at a hospital in Perinthalmanna
Tito Joseph, a nurse, contracted the virus in August 2023 while caring for a Nipah patient at a hospital in Kozhikode
He tested negative in Sept 2023
After completing his quarantine in November, he started experiencing headaches and other discomfort
In December 2023, Tito developed encephalitis and went into coma stage. He has been hospitalised for the past 19 months
