In all, just six people tested positive for the virus in zoonotic disease-prone Kozhikode district. All have recovered.
Nipah viruses binding receptors on human cells. A 3D illustration. (iStock)
With all four people Nipah-infected people testing “double negative”, the latest outbreak of the virus — the fourth in Kerala since 2018 — appears to have been contained.
In all, just six people tested positive for the virus in zoonotic disease-prone Kozhikode district.
While two died, the other four have now been declared free of the disease — indicating a fatality rate of 33 percent compared to the 90+ percent seen in the past two outbreaks — in 2018 and 2021 — that involved fatalities. An outbreak in 2019 did not cause any deaths.
Also, in what is being claimed as a “world first” in terms of Nipah treatment, the nine-year-old boy who was on ventilator support has fully recovered.
Kerala Health Minister Veena George was understandably elated.
“Unlike before, this time was unique,” she said told reporters on Friday, 29 September, pointing to the fact that no one other than the contacts of the first patient — the index case — was infected. “It means, since Nipah was detected on 11 September, the Health Department ensured that no fresh case emerged.”
A resident of Maruthonkara in the district died of Nipah on 30 August and a native of Vatakara town also died of similar symptoms at a private hospital on 11 September.
The National Institute of Virology (NIV), Pune, confirmed both cases as Nipah the next day.
Kerala Chief Minister Pinarayi Vijayan has lauded the efforts of the health workers, the ministerial team including George, and other local associations for working together to fight the outbreak.
He declared that those who were diagnosed with the infection and were under treatment have been cured.
“We were able to develop an extensive system in place to fight the outbreak with the help of public health systems, local institutions, and communities, at the very early stages of the suspected Nipah outbreak,” Vijayan said in a Facebook post.
The chief minister said the experience Kerala gained after the outbreak in 2018 also came in handy in strengthening the precautionary steps taken by the government.
“Isolation and surveillance of all those who came in contact with the patients helped in reducing the severity of the outbreak,” he said, adding that it was a matter of pride that entire state stood together to fight an epidemic like Nipah.
The Kerala government has withdrawn containment in all zones and allied restrictions imposed in the northern district, as no new cases of Nipah virus have been reported here since 16 September.
However, the district authorities have advised people to continue to be vigilant against the viral infection, maintain social distancing, and ensure the use of masks and sanitisers.
In a Facebook post, Health Minister George credited effective and timely intervention of the state health system for bringing the Nipah fatality rate to 33 percent in its fourth outbreak.
The virus strain seen in Kerala was the Bangladesh variant, which generally has a high mortality rate, George noted. This variant can cause death among 70-90 percent of the infected people.
“However, we have lost the lives of two out of the total six affected persons in Kozhikode,” she noted, and credited the relatively early identification of patients and treatment using antiviral drugs as reasons for the low mortality rate.
Looking ahead, she said there was a need to further strengthen research activities so as to completely avoid loss of human life due to any Nipah outbreak in the future.
George said she had spoken via video call to the four persons who had been infected, adding that all of them had completely recovered from the disease.
The first two Nipah outbreaks in India were reported from West Bengal in 2001 and 2007.
The 2001 outbreak in Siliguri district bordering Bangladesh — where Nipah had been previously reported — was the most serious seen in India, with 45 deaths from a total of 66 confirmed patients, indicating a mortality rate of about 68 percent. The index patient in this case was never identified.
The second outbreak was reported in the Nadia district in 2007. In this instance, all five Nipah-positive patients died within days of the infection, indicating a 100 percent fatality rate.
In Kerala’s first outbreak in 2018, there were 19 infections recorded, with 17 fatalities, indicating a fatality rate of 90 percent. The index case was reported on 2 May from the sub-divisional hospital in Perambra in Kozhikode district.
In 2019, a 23-year-old student was detected on 4 June in Kochi. Over 300 people were put under observation, but no further cases were reported. The student later recovered.
In 2021, there was one just fatality, that of a 12-year-old boy of Pazhur village located of the Chathamangalam Gram panchayat in Kozhikode district in September. The outbreak was localised in the village.
Doctors South First has spoken to said people infected with Nipah can show symptoms similar to the Covid infection. Cough, sore throat, dizziness, drowsiness, muscle pain, tiredness, and swelling of the brain (encephalitis), which can cause headache, stiff neck, confusion, seizures, and sensitivity to light are some common symptoms.
A person might also fall unconscious, ultimately leading to death.
Similar to Covid, constant washing of hands, masking up and maintaining social distancing are the best way to ensure one does no contract the virus.
“People infected with Nipah will usually have a history of consumption of raw fruits, date syrups or may have come in contact with those with Nipah infection,” Dr Sanjay G, a physician from Bengaluru’s Shanti Hospital, said in an earlier interview.
“It is always best to avoid half-eaten fruits, or those fallen on the ground. Ensure fruits and vegetables are thoroughly cleaned before consuming,” he advised.
Doctors said that Nipah can be transmitted through contaminated food and also from human to human. Greater vigil and stricter adherence to safety norms are needed to contain Nipah.
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