2018 Nipah virus outbreak in Kerala

The 2018 Kerala Nipah virus outbreak was an outbreak of the Nipah virus in the state of Kerala, India, traced to fruit bats in the area. The outbreak was localized in Kozhikode and Malappuram districts of Kerala^[1][2] and claimed 17 lives,^[3][4] including that of Mohammed Sadiq, the first suspected case.^[5] The outbreak was contained and declared over on June 10, 2018.^[5] This is the third outbreak reported in India, with previous ones having occurred in 2001 (45 deaths) and 2007 (5 deaths).^[6][7]

Timeline

The index case of the outbreak was reported at a sub-divisional hospital in Kozhikode district on May 2. This patient—Mohammed Sadiq—was later taken to the Government Medical College, Kozhikode for further treatment, where he later succumbed to the virus. Later, his brother Mohammed Salih was admitted to Baby Memorial Hospital, Kozhikode,^[8] with suspected viral encephalitis. A team of doctors here suspected Nipah, as the symptoms were similar to that of his brother who had passed away by then. The samples were tested at the Manipal Institute of Virology where it was confirmed as a case of Nipah; samples were also tested positive at National Institute of Virology, Pune.

Sadiq had passed the virus to 16 at Medical College Hospital; later two more were infected, increasing the total count of infected to 18. There were 10 deaths in the first week, including a health worker who was a caregiver for the initial patients before diagnosis.^[9] The outbreak began in Kozhikode district and later spread to the adjoining Malappuram district. Health advisories were issued for Northern Kerala as well as the adjoining districts of Karnataka, with two suspected cases detected in Mangalore on 23 May 2018.^[10]

Over 2,000 people in Kozhikode and Malappuram districts were quarantined and kept under observation during the period of the outbreak.^[11] To fight the outbreak, M 102.4—a human monoclonal antibody for which clinical trials are still going on—was imported from Australia.^[12] This was facilitated by renowned Nipah researcher Christopher Broder.^[13] The outbreak also lead to the revival of World Health Organization's Nipah Drug Trials Group, lead by Soumya Swaminathan.

After Sadiq, 16 of the affected patients succumbed to the disease and two patients recovered fully. The outbreak was officially declared over on 10 June 2018.^[5]

Virology and epidemiology

The presence of the Nipah virus in patients was confirmed from RT-PCR tests conducted at the Manipal Institute of Virology and the National Virology Institute, Pune.^[14]

Though the first set of samples did not detect the virus in bats,^[15] later tests proved that fruit bats in the area were the source of the virus.^[16]

Responses

On 23 May 2018, Kerala Health Department issued a travel advisory asking travelers to the Northern districts of Kerala to be extra cautious.^[17]

On 25 May 2018, the Ministry of Health and Prevention of the United Arab Emirates advised postponing unnecessary travel to Kerala and avoiding its fruits and vegetables until the situation was under control.^[18]

On 1 June 2018, Thamarassery diocese in northern Kerala urged churches to stop giving Communion on the tongue, to postpone religious classes, and to avoid weddings and family get-togethers and unnecessary travel until the virus spread was contained.^[19]

Recognition

Kerala's efforts in containing the outbreak under the leadership of Minister K. K. Shailaja and Additional Chief Secretary Rajeev Sadanandan^[13][20] were lauded by many, including the Kerala High Court^[21] and Robert Gallo of the Institute of Human Virology, Baltimore.^[22] It also earned Rajeev Sadanandan the moniker "Nipah Rajeev".^[23]

Kerala Government gave early increments to 61 people to reward them for their efforts in tackling this outbreak: 4 assistant professors, 19 staff nurses, 7 nursing assistants, 17 cleaning staff, 4 hospital attenders, 2 health inspectors, 4 security staff, 1 plumber, and 3 lab technicians. Twelve junior residents and two senior residents were also awarded gold medals of one sovereign each. The "Best Nurse in Public Service Award" was instituted in memory of Lini Puthussery, a nurse who contracted Nipah and died while treating the affected.

Kerala Government also lauded many others from the medical fraternity and administration for their contributions in tackling this outbreak.^[24]

References