With no vaccines available in the last two years, how has the Karnataka Health Department been fighting against KFD aka Monkey Fever?
KFD, also known as Monkey Fever, is a tick-borne viral disease.
The Kyasanur Forest Disease, also known as KFD, is back in Karnataka’s forests, especially in the Sagara region of Shivamogga, raising significant public health concerns. The first death of this year — of an 18-year-old girl — was reported on Monday, 8 January.
However, with no vaccines available in the last two years, the state Health Department has managed to keep the numbers low and they are hoping that with better surveillance and proactive measure, they will continue to keep it low.
“Of 2,911 people screened for KFD, two cases have tested positive in the district. Of this, one death was seen on Monday. The other person who had tested positive for KFD has recovered,” District Health Officer Dr Rajesh Suragihalli told South First.
In the Boppanamane village of Aralikoppa gram panchayat, located in Hosanagara taluk of Shivamogga district, an 18-year-old girl tragically succumbed to the illness. This marks the first death of the year in the area.
The girl, Ananya, on 27 December 2023, initially experienced chills and fever. She was first taken to McGann District Hospital for treatment, where she stayed for three days before being transferred to KMC Hospital in Manipal. Unfortunately, despite all medical efforts, she passed away.
Dr Suragihalli said that this village is, interestingly, a non-KFD area and it has been almost nine years since the disease was last seen in this area. A detailed travel history of the girl was taken and a death audit has been ordered.
“She had very low haemoglobin, as low as 3.2. She has probably travelled to KFD regions. Initially, she had a high fever with chills and was diagnosed with viral encephalitis. There was, unfortunately, a delay in the family coming for treatment and by the time our health officials visited her residence, she was extremely drowsy, due to her anaemic status, coupled with viral encephalitis,” Dr Suragihalli said, who added that the girl’s first KFD test came back negative.
He said that the girl was shifted to KMC Hospital for further treatment, with the expenses covered by the Health Department. Her blood samples taken for the second time tested positive for KFD. Unfortunately, on Monday morning, the girl succumbed to illness.
Meanwhile, to see if the cause of death was primarily KFD, a death audit is being conducted. Also, her sister who also has chills and fever, has been diagnosed with dengue and she has tested negative for KFD. However, she has been hosptialised and is under treatment.
KFD, also known as Monkey Fever, is a tick-borne viral disease. This zoonotic infection is transmitted to humans through the bite of an infected tick — Haemaphysalis spinigera — and can result in serious health complications.
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The disease was first identified in the Kyasanur forest area of Karnataka in the 1950s and has since remained endemic to the region, with occasional spikes in cases. The last significant peak was in 2019, with 23 deaths and 343 cases reported in Shivamogga alone.
Scientists have observed that the disease peaks every three years, often due to lapses in vaccination and immunity status among the population.
The spread of KFD has been primarily attributed to the man-animal interface, with villagers in forested areas being the most affected. The close contact of villagers with forest ecosystems, where they often venture for activities like collecting firewood or letting cattle graze, increases their exposure to infected ticks.
Over the years, the disease has expanded from its original epicentre in the Kyasanur forest range to nearby districts such as Sagara, Hosanagara, Chikkamagaluru, Karwar, and Mysuru. It has also reached neighbouring states like Goa, Maharashtra, and Tamil Nadu.
According to experts, the death of monkeys, often a precursor to human infections, prompts health officials to categorise areas as high, moderate, or low-risk for KFD.
“Every monkey death is being reported to us by the forest officials. We are leaving no stone unturned to check that area and screen all the people, residing around that area, for KFD,” said Dr Suragihalli.
He explained that if monkey deaths are noted, Health Department officials plunge into action — like sprinkling of Malathion powder in a 60-metre area and continued surveillance for early detection.
He said that the outbreaks are normally in summer as villagers visit nearby forest areas to collect firewood and dry leaves to save for the rainy season and also let cattle into forests for grazing. “With this, ticks enter the backyard of these villagers, resulting in KFD,” he said.
Usually, these ticks vanish with the rains around in the forest. So, with the onset of rains in May, the KFD infection lowers significantly.
While experts agree that vaccination is key in controlling KFD and health authorities would administer booster vaccines to villagers residing in KFD-prone areas annually, particularly between December and March, for the last two years, there have been no vaccines available.
The production of vaccines for the entire country used to happen in a laboratory in Bengaluru.
Confirming this, Dr Suragihalli said that it’s been two years since vaccines became unavailable and added that they are managing with prophylactic measures.
However, a vaccine is in the process of being made, confirmed Principal Secretary, Health and Family Welfare, Dr TK Anil Kumar to South First. He said that a Hyderabad-based company has agreed to manufacture the vaccines for KFD.
“The ICMR-National Institute of Virology (ICMR-NIV) has initiated the process of developing a vaccine, collaborating with the Indian Immunological Company in Hyderabad. They have been designated to receive the NIV virus strain for vaccine development,” Dr Kumar said.
He added that the groundwork for this project has already begun, with preliminary preparations carried out by NIV.
“By February, the virus strain is expected to be transferred to them. It is anticipated that the preclinical phase will take approximately one year. In principle, the initial steps have been set in motion and continuous communication is being maintained. The vaccine development is expected to progress over the course of a year,” he stated.
Though challenging, a proactive approach is being taken to combat Kyasanur Forest Disease (KFD) in the absence of vaccines over the last two years. The department has interestingly been able to keep the disease under control with the help of different prevention methods and stringent surveillance measures.
Explaining the measures in detail, Dr Suragihalli said that there is a constant need for surveillance to keep the disease under control. The aim of the department, he added, is to prevent mortalities from the disease.
“A spike was seen in 2019 and as it is expected that there will be a spike once every three years, we had expected a huge number in 2022. However, we saw only eight cases that year with zero mortality. Similarly, in 2023, there were only 14 reported cases and, again, no mortality. We have not reduced any testing sample size,” he explained.
Here is the list of safety measures taken by the Health Department in the absence of vaccines:
As part of the preventive strategy, all households in KFD-prone areas are supplied with DEPA oil, which stands for Diethyl Phenyl Acetamide, a synthetic repellent used as a personal protective measure against ticks and other arthropods.
“DEPA oil is applied to clothing and exposed skin to repel ticks and other insects. It works by interfering with the olfactory senses of these pests, making it difficult for them to detect and latch onto a host. This oil has been supplied to all households in KFD-prone areas,” Dr Suragihalli informed.
He said that the use of DEPA oil is a preventive measure and is part of an integrated approach to control KFD. However, he added, that this alone won’t help. “It is of utmost importance to spread awareness about the disease, prevention, and treatment,” said Dr Suragihalli.
Despite the lack of vaccines, the department has conducted extensive testing across affected areas. The rapid response teams are being promptly dispatched to the affected areas for early intervention.
D Randeep, Commissioner, Health and Family Welfare, told South First, “Our officials are ensuring that every household is visited and checked for fever. We have also informed the villagers to immediately report any fever cases and get admitted at the earliest. Surveillance measures, supplying of DEPA oil have been happening very well and we are hoping the numbers will be in control this year as well.”
Interestingly, the rapid response teams are now also looking into non-KFD areas where there is likelihood of travel to KFD areas, to ensure early detection. The recent death of the 18-year-old girl highlights the importance of early intervention and the need for constant vigilance in not just high-risk areas but surrounding areas too, Dr Suragihalli said.
The department is conducting ground-level workshops and awareness programmes, reaching out to communities from all levels. These programmes are crucial in educating the public about the disease, its prevention, and the importance of immediate medical attention in case of symptoms.
Another key strategy has been the promotion of personal hygiene practices, especially for those with travel history to affected areas.
Prophylactic measures, such as taking a bath after visiting high-risk areas, have been encouraged to reduce the risk of infection.
The Health Department is collaborating with other departments, including the forest and animal husbandry departments, to implement comprehensive strategies. This includes issuing travel advisories in forest areas and monitoring cattle health to prevent the spread of the disease.
“Any monkey deaths are asked to be reported. Also, tourists who come from other districts, cities, states have also been advised to watch out for symptoms and ensure they wear clothes covering their body. Travel advisories are being issued by the Forest Department, too. So a collaborative work is happening in the area,” Dr Suragihalli added.
The health officer emphasised that while morbidity may be associated with KFD, the department’s primary goal is to prevent mortality.
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