Nipah Virus Outbreak: Death Toll Rises In India, Nepal is in high alert

As Brain-Damaging Disease Spreads in India, health officials in Nepal are in high alert to possible entry of the disease.

May 31, 2018, 11:30 p.m.

As Brain-Damaging Disease Spreads in India, health officials in Nepal are in high alert to possible entry of the disease. According to the Health Ministry Officials,  the ministry has already issued circular to the hospitals all over the country to make possible efforts to contain the disease.

 As the rare virus claims more lives in the Indian state of Kerala, concerns have been raised about the potential of Nipah to become a global health emergency.

 According to the global media reports, as health workers in India scramble to contain an ongoing outbreak of Nipah, a rare and deadly virus with no known cure, concerns have been raised about the disease’s potential to become the next global health emergency.

 “At least 13 people in the Indian state of Kerala have died from the Nipah virus in the recent outbreak. On Monday, The Hindu newspaper reported that a patient with Nipah-like symptoms was under observation in a hospital in Goa, a state in western India. If diagnosed with the disease, the patient — reportedly a 20-year-old man who’d traveled to Goa from Kerala — could be the first case of Nipah infection outside Kerala since the recent outbreak began earlier this month,” reports international media.

 The Nipah virus, which was first identified in 1999 after an outbreak in Malaysia and Singapore, is a disease thought to be transmitted by bats, pigs or other animals to humans. The virus, which has a mortality rate of up to 70 percent, can cause encephalitis, or inflammation of the brain, as well as severe respiratory symptoms, according to the World Health Organization. There is currently no cure or vaccine for Nipah, though research into a possible vaccine is reportedly underway.

 The current outbreak is believed to have originated with a family living in the coastal Kerala city of Kozhikode. India’s Ministry of Health and Family Welfare said last week that public health workers had found several bats in a water well that had been used by three family members who died after contracting the Nipah virus. The Times of India reported, however, that samples taken from the bats tested negative for the virus.

 Nipah Virus Antibody Arrives In India

 Nipah Virus:  Antibody to fight infection flown to India from Australia

Efforts are also underway to procure the cell line which Australia used to develop the antibody. Once ICMR gets the cell line, India can start manufacturing it.

 According to Indian media, the antibody to fight the Nipah Virus will reach India on Thursday night, Rajeev Sadanandan, Additional Chief Secretary, Health and Family Welfare, Government of Kerala, has confirmed to TNM. He added that the package from the University of Queensland will first reach Delhi, from where it will be brought to Kerala.

 The Human Monoclonal Antibody (M 102.4) is a non-patented drug, developed by Dr Christopher C Broder from Australia. The antibody is still referred by a number and not a name as clinical trials are yet to be completed. This is an antibody and not a vaccine, which can neutralise the effects of the Nipah Virus. It has been found to be effective in vitro (in cells or microorganisms placed in a test tube or culture dish). Reports say it has not been tested on humans so far but can be used on compassionate grounds.

 For the last few days, the Kerala State Health Department and Indian Council of Medical Research (ICMR) had been trying to procure it through the WHO.

 Efforts are also underway to procure the cell line which Australia had used to develop the antibody. Once the ICMR gets the cell line, India can start manufacturing the antibodies.

 With the arrival of the antibody, there is much hope for those who are under critical care due to the Nipah Virus.

 Regarding the current death toll and suspected cases, Kozhikode District Medical Officer Dr Jayasree told TNM, “Of the 17 confirmed cases of Nipah, so far 15 deaths have occurred. This number does not reflect Sadik’s death. Two confirmed cases have been under treatment. As of May 30, the suspected cases stands at 8.”

 Incubation period and disease transmission

 As of May 31, if there is no case of infection due to secondary transmission, then by June 5 it can be said that the danger is over, said Rajeev Sadanandan. But the whole scenario will change if a new infection case is reported anytime now.

 Experts say the mean incubation period of Nipah Virus is around 10 days. The mean falls within a range. The outer range is 18 days. The first incidence of infection took place around May 1. Other cases were noticed on May 17. So what can be assumed is that by 18,19 May, if all precautions had been taken, then by June 5, infected cases, if any, should come to light. But this does not apply if there are secondary or tertiary transmissions.

 Rajeev Sadanandan added, “If we don’t have a third wave of infection, then it can be said that the danger is over by June 5”

 Dr Arun Kumar, Head of the Manipal Centre for Virus Research (MCVR), said, “In case of Nipah, only when the patient becomes very sick, they will be transmitting the disease. The transmission is primarily through droplet transmission. It is in the later stages of the illness that the patients develop cough. That is a time, transmission can happen. Cough generates droplets and droplets can transmit only within a 1 meter distance.”

 He elaborated, “So the people who cared for the infected patients, they will definitely be within 1 meter and they have contracted the disease. This is against the people at home or when the patient was less sick. Which is why some of the family members or the people who were in close contact in the initial stage of the disease, have been spared from contracting the virus. That is why we don’t see clusters around these cases in the community.”

 He also highlighted that a link has been established, that every single confirmed case so far have had contact with the indexed patients in two different places viz at the Perambra Taluk Hospital and at the Kozhikode Medical College.

 To much relief, it was confirmed on Tuesday that the two children of nurse Lini Puthusshery do not have Nipah infection. Lini Puthusshery, a nurse from the EMS Memorial Cooperative hospital at Perambra who had attended to Sadik, succumbed to the infection and passed away on May 21. Since last few days, the children had been put under observation. Now with results out, the possibilities have been ruled out.

 Dr Arun stressed on vigilance and said, “The vigilance will continue. From the last reported case to 42 days we will keep up the vigilance. We don’t want to miss a single case. Because if we miss a single case, that will lead to another hospital outbreak. If suspected cases go for treatment at a place where the staff does not expect Nipah, then it can transmit there. We don’t want that to happen. Right now, no secondary transmission has happened. All are primary transmission.”






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