As the number of Nipah virus infection cases in Kerala’s Kozhikode district rose to six, the Indian Council of Medical Research (ICMR) Director General Dr Rajeev Bahl has warned that the mortality rate for such infections was significantly higher when compared to Covid-19 infections.
Meanwhile, educational institutions in the district have been ordered shut till 24 September in a bid to contain the virus outbreak.
The district administration has also issued directions against any kind of public gatherings, and places of worship in the containment zones have been closed.
“In Covid-19, the mortality rate typically remains at no more than 2-3 percent, whereas in Nipah virus infection cases, the mortality rate has varied significantly, ranging between 40 percent and 70 percent,” Bahl told reporters on Friday, 15 September.
He emphasised that all the current Nipah virus cases in Kerala had been in contact with a single index patient, and efforts were underway to contain the outbreak.
Bahl also outlined precautionary measures for preventing and containing the spread of the Nipah virus. He mentioned that there were some four to five measures, some of which overlap with those taken against Covid-19, including frequent handwashing and mask-wearing.
“In the case of Nipah, the most critical measure is avoiding contact with infected individuals, since the initial patient usually contracts it from an external source, and subsequent cases are often contacts of that patient,” noted Bahl.
“The next crucial precaution is to avoid exposure to body fluids and blood, and emphasis on biosafety, hospital safety, and isolation,” he added.
20 doses of monoclonal antibodies ordered
At present, there are no vaccines available for the Nipah virus. However, patients in the early stages of infection are administered doses of monoclonal antibodies.
The ICMR chief also said India had requested an additional 20 doses of monoclonal antibodies from abroad.
“In 2018, we received a supply of monoclonal antibody doses from Australia. Currently, these doses are accessible and sufficient for the treatment of only 10 patients. An additional 20 doses are currently being procured. It’s crucial to note that this medicine must be administered during the early stages of the infection for it to be effective,” he said.
According to him, no one so far has been administered the medicine in India, and it could only be given as compassionate-use medicine.
He said monoclonal antibodies had been given to 14 patients infected with the Nipah virus outside India, and all of them had survived.
“Only phase 1 trial to establish the safety of the medicine has been done outside. Efficacy trials have not been done. It can only given as compassionate-use medicine,” he said.
The decision to use the antibody, however, would have to be of the Kerala government, besides that of doctors and the families of patients, he noted.
On why Nipah virus cases keep surfacing in Kerala, Bahl said, “We do not know. In 2018, we found that the outbreak in Kerala was related to bats. We are not sure how the infection passed from bats to humans. The link couldn’t be established. We are trying to find out this time as well. It always happens in the rainy season.”
6th case on Friday
Kerala’s Kozhikode has registered six cases positive for the virus. The virus outbreak was confirmed on 12 September after two fever-related deaths were reported in the district.
Kerala Health Minister Veena George’s office on Friday said that a 39-year-old man had been confirmed with the Nipah virus after his samples turned positive. He was under observation in a hospital.
He had sought treatment at a private hospital where Nipah-positive patients were being treated for other ailments earlier, it said in a statement.
Of the three infected people under treatment, the condition of a nine-year-old child remains critical.
Meanwhile, in a relief to the state government, the 11 samples sent for testing returned negative results for the virus. A government source confirmed the negative results.
The samples of another 15 people on the high-risk contact list have also been sent for tests.
Karnataka issues travel advisory
The Karnataka Health Department has asked people to avoid unnecessary travel to Kerala’s Nipah affected areas and also issued several other insructions.
Leaving no stone unturned in its efforts to protect the public from the Nipah virus, the department is taking proactive measures to enhance surveillance in districts bordering Kerala, including Chamarajanagara, Mysuru, Kodagu, and Dakshina Kannada.
The advisory encompasses a range of actions to protect public health and prevent the transmission of the virus. Apart from the travel restriction, some of the key measures outlined in the advisory are:
Check Points and Fever Surveillance: Checkpoints have been established at entry points from Karnataka to Kerala, with a focus on intensifying fever surveillance in the bordering districts.
Public Awareness: Extensive dissemination of informational materials to educate the public about the Nipah virus, with the aim of preventing unnecessary panic.
Health Staff Training: Training for healthcare staff at all levels, including Primary Health Care Institutions (PHCIs), to ensure a robust response to potential cases.
Rapid Response Teams: Activation of District Rapid Response Teams (RRTs), inclusive of veterinary officers, to be prepared for swift action.
Quarantine Facilities: Identification of at least two beds in district hospitals for quarantining suspected cases, with a focus on negative pressure ICU units.
Medical Supplies: Ensuring an ample supply of essential drugs and oxygen in healthcare facilities. Maintaining an adequate stock of PPE, viral transport media (VTM), and other accessories for sample collection and transportation.
Private Healthcare Reporting: Mandatory reporting of suspected cases by private hospitals, nursing homes, and clinics to the District Health and Family Welfare Officer.
Sample Collection and Shipment: Immediate collection of clinical samples from suspected cases and arranging for their shipment to the NIV in Pune.
Districts bordering Kerala have been instructed to submit compliance reports within 24 hours, indicating the preventive measures taken.
On Thursday, the ICMR delivered the only available experimental treatment — monoclonal antibodies— to the state.
The antiviral is the only option available to the government to treat the infection, although its efficacy is yet to be clinically proven.
The m102.4 monoclonal antibody, an experimental therapeutic, was imported during the 2018 Nipah outbreak for the treatment of infected patients on compassionate grounds. It was not used back then as the outbreak had ended by the time it arrived.
The standard operating procedures and protocols for its use were prepared at the time with the ICMR’s support.
George said the stability of the antiviral was discussed with a Central expert committee. “Further steps or course of action will be decided by the expert committee,” she added, referring to consultations between the state and the Union Health Ministry.
Mobile lab for testing
Meanwhile, a mobile laboratory has been sent to ground zero in Kerala to enable the state to test samples. Earlier, the samples had to be sent to the National Institute of Virology in Pune.
The ICMR’s National Institute of Virology (NIV) in Pune sent its mobile BSL-3 (Biosafety Level-3) laboratory to Kozhikode to test samples for the virus in the district itself.
The ICMR’s mBSL-3 — the first Biosafety Level-3 containment mobile laboratory in South Asia — is expected to help with early testing and detection of the infection at the district level itself.
The mobile laboratory was set up in February 2022 to investigate newly emerging and reemerging viral infections that are highly infectious and potentially lethal for humans.
Additionally, a fully-equipped mobile virology testing laboratory of the Rajiv Gandhi Centre for Biotechnology (RGCB) was dispatched to the northern Kerala district to strengthen virus testing and detection.
George lauded the RGCB for stepping in to help with the containment efforts, and said more samples could now be tested.
RGCB Director Chandrabhas Narayana said the services of a group of six experts had been made available in the mobile unit, which could give results within six hours.