With Truenat available locally, only samples that test positive for Nipah need to be sent to the main laboratories for reconfirmation.
Strengthening the hands of the Kerala health system that is fighting to contain the spread of the Nipah virus in Kozhikode district, the Indian Council for Medical Research (ICMR) has allowed the state to conduct Truenat tests, which uses portable, smart chip-based, battery-operated RT-PCR kits, in certain hospitals.
Kerala Health Minister Veena George said that the permission was accorded after the state strongly demanded it during its discussions with ICMR.
Only hospitals with level-2 biosafety facilities — where there are certain strict protocols in place to prevent contamination of samples — will be permitted to use Truenat test facilities.
With Truenat available locally, only samples that test positive for Nipah need to be sent to Thiruvananthapuram, Thonnakkal, or Kozhikode laboratories for reconfirmation.
This will help Kerala conduct tests faster, detect if there is an outbreak, and set preventive measures faster, she told reporters in Thiruvananthapuram.
George said that a Standard Operating Procedure (SOP) for the Truenat tests will be formulated soon.
Talking about the Nipah outbreak in Kozhikode, the health minister said that there have been no positive cases reported in the past four days and that the health condition of all patients under treatment remains stable.
“The condition of the nine-year-old boy, who was earlier on ventilator support, is improving clinically. He is responding, which is a positive sign,” the minister said.
She said that, so far, 323 samples were sent for testing and 317 of them have been negative.
“Only six cases were found positive. Persons from the contact list of the index patient have completed their 21 days of isolation for the incubation period and they have now been removed from isolation. At present, there are 994 persons under isolation,” George said.
Talking about the health monitoring mechanism at the ground level, the minister said that it was the health workers who passed on the information to the district surveillance officer about two people from the same family getting admitted to a hospital.
The details of the two patients were immediately collected from the private hospital where they were admitted and samples were sent for testing.
“We suggested running the influenza viral panel test for them and when that turned negative, we asked the samples to be tested for Nipah,” the minister said.
When the samples tested positive at Kozhikode Medical College, they were sent to National Institute of Virology for confirmation.
The minister said that all this was done within hours and that it helped the state health department put the prevention protocol in place. She said that identifying the index case quickly also helped them contain the spread.
Even the ICMR is unable to find the answer to the question of why Nipah is recurring only in Kozhikode. “ICMR studies said that many states, including Kerala, are prone to this infection,” George said.
She said that in order to find the reason, the Kerala Health Department would be conducting a zero-surveillance study in the area.
The study will be conducted by checking the presence of the Nipah antibody among the people who were in high-risk contact with the patients.
According to the findings of the ICMR, the virus that caused the infection in 2018 and in 2023 are almost identical and there is no mutation in the virus.
However, there are changes in the symptoms. In the case of the first patient who died in the present outbreak, the primary diagnosis was that of pneumonia. The nine-year-old boy was also first diagnosed with community-acquired pneumonia,” the minister said.
She said further discussions will be held with regard to finalising the diagnosis and testing protocols for Nipah.
“Patients with acute respiratory distress syndrome and encephalitis would also be checked for Nipah. This is a learning experience for us, as we do not know with what symptoms this infection manifests,” George said.
The patients who have tested negative and completed 21 days of isolation will be checked once again if they develop any symptoms in the next 21 days.
“Twenty one days is the incubation period. But we also give another 21 days as a shadow period to ensure nobody is left out,” George said.
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