Kerala State -Credit Wikipedia
#14,108
Yesterday's suspected Nipah case in Southern India - involving a 23 y.o. college student - has been confirmed by the MOH (see below), and there are multiple (so far, unconfirmed) media reports that at least 4 of his recent contacts - currently in isolation - have developed fevers.
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).The WHO Nipah Summary reads:
Key facts
- Nipah virus infection in humans causes a range of clinical presentations, from asymptomatic infection (subclinical) to acute respiratory infection and fatal encephalitis.
- The case fatality rate is estimated at 40% to 75%. This rate can vary by outbreak depending on local capabilities for epidemiological surveillance and clinical management.
- Nipah virus can be transmitted to humans from animals (such as bats or pigs), or contaminated foods and can also be transmitted directly from human-to-human.
- Fruit bats of the Pteropodidae family are the natural host of Nipah virus.
- There is no treatment or vaccine available for either people or animals. The primary treatment for humans is supportive care.
- The 2018 annual review of the WHO R&D Blueprint list of priority diseases indicates that there is an urgent need for accelerated research and development for the Nipah virus.
Ministry of Health and Family Welfare
Dr. Harsh Vardhan reviews the public health measures for Nipah Virus
Assures all support to Kerala Government to manage Nipah Virus
Posted On: 04 JUN 2019 10:54AM by PIB Delhi
Following confirmation of a suspect case of Nipah Virus Disease by National Institute of Virology (NIV) Pune, an urgent meeting was convened by the Union Minister of Health and Family Welfare, Dr. Harsh Vardhan at his residence at 8 am, here today.
The following officers were present at the meeting:
The Union Health Minister Dr. Harsh Vardhan spoke to the Health Minister of Kerala, Smt K. K. Shailaja, and discussed the current situation and assured all support from the Centre. He had also spoken to her yesterday.
- Ms. Preeti Sudan, Secretary (HFW)
- Dr. Balram Bhargava, Secretary (DHR)
- Shri Sanjeeva Kumar, Addl. Secretary (H)
- Dr. S. Venkatesh, DGHS
- Dr. Sujeet K Singh, Director, NCDC and
- Dr. Gangakhetkar, Scientist G and Head ECD, ICMR
The following actions have been taken:
The State has already initiated the following actions:
- A Central Team with six officers has been deployed and have reached for epidemiological investigation protocol, contact tracing for early detection of suspects, testing protocols for suspects and review of isolation facilities
- A Control room established and NCDC Strategic Health Operations Center (SHOC) activated. The phone number of control room is number 011-23978046.
- A team from National Institute of Virology, Pune (ICMR) with Monoclonal Antibodies is being sent to Ernakullam.
- A team from NIV for conducting/testing bats for Nipah virus is being dispatched today. The Union Health has spoken to DG Forest to extend all cooperation in this regard.
- Contact tracing and surveillance
- Standard capacity building for health functionaries, ambulance fleet drivers and others
- Infection control activities in hospitals. Dedicated trained teams to handle cases
- Rapid Response Teams at institutions
- Help desk at Medical College Ernakulam established.
- Dedicated trained doctors, nurses, paramedics at hospitals. Vigil activated in all districts.
- Awareness generation.
Perhaps the most detailed English language coverage can be found on NDTV (New Delhi TV), which provides a synopsis, and a video news report, at the following link:
Kerala Student, 23, Infected With Nipah, Confirms Government: 10 Points
It appears this student was symptomatic for several days before hospitalization, and may have gone several more days in the hospital before being placed into isolation. According to the above article:
Four more people, including two nurses, are down with fever and two of them had come in contact with the 23-year-old man. Over 80 people, among them 22 students, are under surveillance.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.
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 not believed to be `airborne' in the traditional sense - the Nipah virus is readily detected in the saliva and respiratory secretions of infected patients - and can probably be spread via large droplets propelled by violent coughing.Although outbreaks have thus far been limited in size, last summer, in IJID: Enhancing Preparation For Large Nipah Outbreaks Beyond Bangladesh, we looked at an open-access article that discussed the potential of the Nipah virus producing a large urban epidemic, similar to what we saw in West Africa with Ebola in 2014.
While this sort of outbreak is not expected with Nipah, prior to 2014, the same could have been (and was) said about Ebola.Viruses - due to their rapid and unpredictable mutability - have a long history of exceeding our expectations. And quite often, not in a good way.
