The emergence of a PAM cluster in a single locality, according to health officials, is a rare occurrence, even on a global scale.
Published Aug 29, 2024 | 12:00 PM ⚊ Updated Aug 29, 2024 | 12:00 PM
Kavinkulam, Athiyanoor in Thiruvananthapuram where PAM cluster got formed. (Dileep V Kumar/ South First)
A shadow of fear has fallen in Athiyanoor, a quiet grama panchayath nestled in Kerala’s Thiruvananthapuram, as eight residents from the adjacent wards of Poothamkode and Maruthamkode of this panchayath have been struck by a rare and deadly brain infection—Primary Amoebic Meningoencephalitis (PAM), caused by the free-living amoeba Naegleria fowleri.
While one victim has tragically succumbed to the infection, the others are fighting for their lives at the Government Medical College Hospital in Thiruvananthapuram (GMCH).
With only four infected people recovering until now in Kerala, the brain-eating amoeba with a 97 percent mortality rate has become a main concern for people residing around water bodies.
The emergence of a PAM cluster in a single locality, according to health officials, is a rare occurrence, even on a global scale. This unusual situation has left health authorities baffled and searching for answers.
While the exact source of infection remains elusive, health officials suspect a nearby pond, Kavinkulam, may be involved. However, conclusive evidence linking the pond to the outbreak is yet to be established.
Naegleria fowleri is commonly found in warm freshwater environments, such as lakes, hot springs, and poorly maintained swimming pools.
The amoeba enters the body through the nose, and it then travels to the brain where it causes infection and inflammation.
Another way of entry could be through a ritual, where people rinse their nostrils and nasal passages using water, including tap water.
Once inside the nasal passage, Naegleria fowleri travels through the olfactory nerve to the brain, where it causes severe damage to the tissues. The infection typically progresses rapidly, leading to inflammation of the brain and the meninges.
The normally serene Kavinkulam pond, which lies between the wards of Poothamkode and Maruthamkode, has become the focal point of suspicion.
Flex sign at the Kavinkulam pond. (Dileep V Kumar/ South First)
Once a place where locals gathered to cool off in the summer heat, is now viewed with unease, its waters potentially harbouring the invisible killer that has ravaged the village.
Despite this, health officials have yet to find conclusive evidence linking Kavinkulam—or any other source—to the infection. The uncertainty has left the community on edge, their once-simple lives now overshadowed by an inexplicable threat.
The algae-filled pond, now shrouded in mystery, has been cordoned off with a cloth barrier erected on all sides.
A small flex sign stands prominently, warning onlookers and potential visitors: “Entry to this pond has been barred as the sample from this pond has been sent for testing, and a result is awaited.”
“We just don’t know where it’s coming from,” says one health official adding, “The fact that a cluster of PAM cases has emerged from such a small area is highly unusual, perhaps even unprecedented worldwide. We’re exploring all possibilities, but as of now, we’re still in the dark.”
At the same time, the community demands answers from the authorities.
“We need answers. We need to know how this happened, and we need to know how to protect ourselves,” said Pushpangathan, who lives near this pond and used to wash his clothes there.
The lack of clear information has fuelled a wave of rumours and speculation among the community. One particularly concerning suspicion suggests that the individuals who contracted the infection may have been involved in drug use.
According to this speculation, the infected might have mixed drugs with the water from the pond and then inhaled the mixture through their noses using the hollow stem of a papaya plant as a makeshift straw.
While the angle of drug use has been given by the health department, the affected families, however, have vehemently denied these accusations, expressing their deep frustration and anger over what they describe as baseless and damaging claims.
The families believe that such unfounded theories are being spread by certain individuals within the health department as a means to divert attention from their failures in identifying and addressing the real cause of the infection. They argue that instead of providing clarity and solutions, the authorities are resorting to creating fictitious narratives that only serve to stigmatize the victims and their families further.
Outraged by the defamation these rumours have caused, the families stated to South First that they are seriously considering taking legal action against those responsible for spreading these false claims, including officials from the health department and even the Health Minister.
A victim’s cousin Vijitha speaks with South First. (Dileep V Kumar/ South First)
They believe that such defamatory statements have not only added to their trauma but have also tarnished the reputation of their loved ones, who are already suffering from the impact of this mysterious and life-threatening illness.
Talking to South First, Vijitha, cousin of PS Akhil, who succumbed to PAM on 23 July, said, “How can the Health Minister make such a claim? Do they have any evidence to support this? To our knowledge, these individuals have no history of drug use. Making such statements without proof will only tarnish their reputations. If the Health Department is so certain, they should release the evidence. Otherwise, we will be compelled to take legal action.”
Sreekala, the mother of Sreekuttan, who is currently undergoing treatment for PAM at GMCH, voiced her frustration and disbelief at the recent remarks by the minister to South First.
Sreekala claimed, “The minister claims our children were infected due to drug use. If that’s true, how do you explain cases in three-year-olds and four-year-olds? Our children were hardworking manual labourers.”
“They earned a daily wage of ₹800 or ₹900, just enough to keep our families going. We have loans to repay, and every rupee counts. Given our circumstances, how can we accept the minister’s claim about drug use?”
The locals speaking with South First noted the health department’s failure to address the dire conditions, despite the pond being in close proximity to the Health and Wellness Centre Kannaravila.
Instead, they reportedly extended their drainage pipes directly into the pond. An Anganwadi is also operating next to the health centre.
Adding to their concerns, residents like Vijitha allege serious lapses in sample collection and surveillance.
Vijitha revealed that the first test—conducted using surface water—came back negative, only for discrepancies to later emerge due to improper sampling techniques.
Vijitha also claimed that upon the direction of officials, she collected the water from the pond and handed it over to them. A second test, taken 21 days after Akhil’s death, involved deep water samples, but the results remain undisclosed.
The Athiyanoor grama panchayath and health authorities are yet to receive these crucial test results.
Additionally, Vijitha and her family cast doubt on the health department’s surveillance claims.
“We learned through the media that 54 people who used this pond were under observation, but we haven’t been informed. They mentioned conducting a house survey, but health officials only visited us five days ago,” she shared, highlighting the communication gap and inadequate response to the unfolding crisis.
While the family members expressed satisfaction with the ongoing treatment and appreciated the government’s decision to offer it free of cost, they voiced concerns about the combination of five drugs, often referred to as “cocktail drugs,” being used to treat PAM. They said their worries intensified after a 19-year-old patient, Dhanush, had to undergo dialysis following the treatment.
“He had no prior health issues, yet now he’s on dialysis. We can’t help but wonder if it’s due to the cocktail drugs,” Sreekala shared her concern.
She further added, “We are grateful that these drugs have saved lives from PAM, and we’ve placed our faith in the treatment. However, we need to have a serious discussion about the potential long-term impacts on those who recover. We’re also uncertain when—or if—they’ll return to full health.”
The recent spike in Primary Amoebic Meningoencephalitis (PAM) cases in Kerala has raised significant concerns, especially given the rarity of this deadly brain infection.
The emergence of a cluster of cases has further intensified the situation, prompting the Indian Council of Medical Research (ICMR) to intervene.
Minister Veena George during the technical workshop on PAM (Sourced)
An ICMR team visited Thiruvananthapuram on Tuesday, 27 August, to participate in a technical workshop focused on PAM. At the same workshop, they have decided to roll out research activities on the brain infection.
According to Health Minister Veena George, the state will conduct research activities based on the One Health approach to address PAM, and this might be the first time that a government has undertaken research on PAM.
“The focus will be on why there is a spike in PAM cases in the state. That’s why the state decided to join hands with agencies like ICMR, Indian Institute of Science and others. The state will roll out an action plan on PAM. Also, a case-control study will be carried out with the help of ICMR and the National Institute of Epidemiology,” said Veena.
According to the health department, in 2024, 19 got infected and five succumbed to PAM, while four persons have recovered. The department stated that only 11 persons had recovered from PAM in the world.
Meanwhile, Kerala’s health department maintains that there is nothing unique about the state regarding PAM reporting.
They argue that Kerala’s robust surveillance mechanisms are the reason for the higher number of reported cases.
“Why Kerala? It’s because our surveillance systems are exceptionally strong. Other states are also seeing PAM cases, but they may go unreported or be handled by individual hospitals. In Kerala, the state government is actively involved in the detection and reporting of such cases. In short, we are proactively searching for them,” a health official stated to South First.
At the same time, the official also added that the Kavinkulam PAM adult cluster is an exemption and the reasons behind it are “something they don’t want to discuss right now.”
When South First, reached out to Dr Aravind R, Head of Infectious Diseases at the Government Medical College in Thiruvananthapuram, he said, “It should be assumed that any warm freshwater potentially contains the Naegleria fowleri amoeba. It is naturally occurring in the environment and cannot be eradicated. The key is to be vigilant. The state is planning to consider Western Australia as a model for managing PAM. The workshop will give a picture of this.”
It is learnt that the Department of Health, Government of Western Australia has implemented several strategies to manage the risk of Primary Amoebic Meningoencephalitis (PAM) caused by Naegleria fowleri. These strategies focus on water treatment, public health education, and surveillance including environmental investigations.
(Edited by Sumavarsha Kandula)
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