Monday, May 21, 2018

Indian Government Responds To Reported Nipah Outbreak In Kerala


The Nipah virus - normally carried by fruit bats common to S.E. Asia - was only first identified 20 years ago after an outbreak in Malaysia, which spread from bat to pigs - and then from pigs to humans - eventually infecting at least 265 people, killing 105 (see Lessons from the Nipah virus outbreak in Malaysia).

Similar to Australia's Hendra virus - Nipah - because of its high mortality and (limited) human-to-human transmissibility - has garnered a reputation among researchers as having at least some pandemic or bio-terrorism potential.
  • In Steven Soderbergh's 2011 pandemic thriller `Contagion’, technical advisor Ian Lipkin - director of Columbia University’s Center for Infection and Immunity in New York - painstakingly created a fictional MEV-1 pandemic virus based on a mutated Nipah virus. 
  •  In 2015's Blue Ribbon Study Panel Report on Biodefense a bi-partisan panel described a fictional biological attack on Washington D.C.  using a genetically engineered Nipah virus as part of their presentation. 
  • Just last week, in the Johns Hopkins Clade X exercise, a genetically altered Nipah virus (spliced onto a parainfluenza backbone) was the cause of their fictional pandemic.  
  • And earlier this year, in WHO List Of Blueprint Priority Diseases, we saw Nipah and Henipaviral diseases listed among the 8 viral threats in need of urgent accelerated research and development.    
Overnight, India media (and now Western media) have been reporting on an outbreak of Nipah in Kozhikode, in India's southern Kerala state (see Crof's blog Kozhikode: 11 die of suspected Nipah virus infection; medical officials say no need to panic).

While the Indian media is known for its hyperbole, and the exact number of cases and/or deaths vary between accounts - other reports - such as the BBC's  Deadly Nipah virus claims victims in India at least confirm the main points of the story.

The only official statement I've found (the MOH website remains typically silent) has been the following brief press release from the Press Information bureau.
Ministry of Health and Family Welfare           21-May, 2018 13:51 IST
Shri J P Nadda assures all support to Kerala Government to manage Nipah Virus; Sends a multi-disciplinary Central team to investigate the outbreak

In view of the rising number of cases and reported deaths due to Nipah Virus in Kozhikode, Kerala, Shri J P Nadda, Union Minister of Health and Family Welfare has assured all support to the Kerala Government and has directed a multi-disciplinary Central team from National Centre for Disease Control to immediately visit the district, and assist the State and closely monitor the situation. The team will reach Kerala today.

“We are closely monitoring the situation. I have spoken to Shri Alphons and Smt K Shailaja, Health Minister, Kerala and assured them all support of the Central government. I have also dispatched a Central team to assist the State government and initiate required steps,” the Union Health Minister said in a statement from Geneva.

On the directions of the Health Minister, Smt. Preeti Sudan, Secretary (HFW) has also spoken to the Principal Health Secretary of Kerala and reviewed the situation.

The Central team includes Dr Sujeet K Singh, Director, National Centre for Disease Control, Dr S K Jain, Head Epidemiology, NCDC, Dr P Ravindran, Director, Emergency Medical Relief (EMR), Dr Naveen Gupta, Head Zoonosis, NCDC along with two clinicians and one expert from Ministry of Animal Husbandry.
Over the past decade nearly all of the reported Nipah outbreaks have come out of Bangladesh, often linked to date palm sap collection (see Bangladesh: Nipah Update).
Fruit bats of the Pteropodidae family have a preference for roosting in the tops of trees rather than caves, which allows them to contaminate date juice collection jars with their virus laden urine and feces
Once infected via a zoonotic exposure, humans can transmit the virus on to others, albeit not terribly efficiently (see EID Journal Person-to-Person Transmission of Nipah Virus in a Bangladeshi Community).

While outbreaks of Nipah have tended to be limited in size, we'll be following the events in Kozhikode (pop. 550,000) closely, as our knowledge of the virus is limited as well.

Stay tuned. 

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