Outbreak status:
Ministry of Health and Family Welfare, Government of India, reported six laboratory-confirmed male cases of Nipah virus, aged 9 to 45 years, including two deaths, from September 12th, to 15th, 2023 in Kozhikode district, Kerala. The source of transmission for the first case was not discovered and all the confirmed cases were infected by the first case. As of 27 September 2023, 1,288 confirmed contacts of the confirmed cases were traced, including high-risk contacts and healthcare workers. Since September 15th, no new cases have been detected. This is the sixth outbreak of Nipah virus in India since 2001.
About the disease:
Nipah virus (NiV) was first discovered in 1999 after an outbreak in Malaysia and Singapore. This outbreak resulted in approximately 300 human cases and more than 100 deaths. Since 1999, no outbreaks have been recorded in Malaysia and Singapore. Since then more cases have been investigated, mainly in Bangladesh and India.
Niv is a zoonotic virus from the family Paramyxoviridae. It is transmitted from animals to humans and can also be transmitted through contaminated foods or directly from person to person. The host animal for NiV is the fruit bat (genus Pteropus), also known as the flying fox. It is also transmitted to pigs.
Symptoms:
- Fever
- Headache
- Muscle pain
- Nausea and vomiting
- Sore throat
In advanced cases, severe respiratory symptoms and meningitis symptoms may appear, which may cause epileptic seizures, leading to coma in some cases.
Incubation period of the disease:
4 to 14 days
Public Health Response:
Central multidisciplinary teams have been established by the Ministry of Health and Family Welfare, the Health Research Department, as well as the Animal Husbandry Department to support the management of the endemic area in infection and disease containment measures. 19 core committees were established and tasked with various response measures including surveillance, sample testing, contact tracing, patient transportation, case management, logistics and supplies.
2. Surveillance and contact tracing:
District health authorities implemented active house-to-house surveillance in the declared containment zones. A total of 53,708 homes were surveyed as of September 27th, 2023. Restrictions on movement, social distancing and mandatory wearing of masks in public places are in place.
3. Laboratory tests:
Laboratory tests for suspected cases as well as environmental and animal samples were performed in the Regional Network Laboratory for Viral Research and Diagnostic Laboratories at the Government Medical College (GMC).
4.Preparedness of health facilities:
Emergency departments were equipped to deal with any suspected cases and respond to emergency situations. Isolation rooms and intensive care units (ICU) have been kept for suspected cases in preparation for treating those infected with the virus.
5.Logistics management:
Adequate stock of preventive and protective equipment, medicines and other necessary logistics services were provided by the state government.
6.Preventive plan for the burial of the deceased infected with the virus:
Arrangements have also been made for the transportation and management of dead bodies by the state government as per standard protocol and IPC precautions.
Animal Prevention Sector:
Samples of bats, animal droppings, and half-eaten fruit were collected on September 15th from the village where the first case lived, in a 300-acre (121-hectare) forest that is considered as home to several bat species. All samples were negative for the Nipah virus
WHO risk assessment:
The World Health Organization has classified Nipah virus infection as high risk. The death rate is 33.3%, with a high number of contacts and the absence of treatments and vaccines for the Nipah virus.
WHO recommendations:
In the absence of a vaccine or licensed treatment available for Nipah virus, the only way to reduce or prevent infection in people is to raise awareness of risk factors and educate people about measures they can take to reduce exposure to Nipah virus infection by the following steps:
- Reducing the risk of transmission of infection from animals to humans by intensifying epidemiological surveillance, health awareness, and following prevention measures.
- Reducing the risk of human-to-human transmission by washing hands constantly and avoiding contact with infected people or contacts. Health care workers shall follow standard precautions for infection prevention and control, in addition to precautions for exposure to infectious agents from patient droplets or laboratory samples, when working in rooms of patients with suspected or confirmed Nipah virus infection, and when handling/managing waste from Nipah virus patients.
- Infection prevention and control.