Avian Flu Diary: India Ministry of Health: A Fatal Case of Nipah in Kozhikode district of Kerala

Credit CDC

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Although novel influenza and coronaviruses top our list of pandemic concerns there are lesser threats - like Monkeypox, Lassa Fever, and Nipah - that are regarded as having either epidemic, or potentially even pandemic, potential.

Among these, Nipah has the highest fatality rate and is often listed as a virus of concern.

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.
Three years ago, in the Johns Hopkins Clade X exercise, a genetically altered Nipah virus (spliced onto a parainfluenza backbone) was the cause of their fictional pandemic.
Also in 2018, 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.

Carried by fruit bats common to S.E. Asia, in 1998 Nipah sparked an outbreak in Malaysia, which spread first 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).

Since then, we've seen sporadic outbreaks in Bangladesh and India. Unlike COVID-19 - which appears to kill roughly 1% of those infected, human infection with the Nipah virus is fatal between 70% and 90% of the time.

In addition to bats and humans - other mammals have been infected in the wild (horses, pigs, and dogs) - and many others have been experimentally infected in the lab (including guinea pigs, hamsters, ferrets, squirrel monkeys, and African green monkeys).

In the 2013 paper The pandemic potential of Nipah virus by Stephen P. Luby, the author wrote (bolding mine):

Characteristics of Nipah virus that increase its risk of becoming a global pandemic include: humans are already susceptible; many strains are capable of limited person-to-person transmission; as an RNA virus, it has an exceptionally high rate of mutation: and that if a human-adapted strain were to infect communities in South Asia, high population densities and global interconnectedness would rapidly spread the infection.

While the Nipah outbreaks we've seen have only demonstrated limited human-to-human transmission, each outbreak provides the virus with additional opportunities to better adapt to humans, and potentially increase its threat.

Which is why, although rare, we pay attention to reports of outbreaks of Nipah. Today India's Ministry of Health and Family Welfare have issued the following press release on a fatal Nipah infection in a 12-year-old boy in Kerala.

A case of Nipah Virus detected in Kozhikode district of Kerala

Centre rushes team to Kerala to support State in Public Health Measures

Posted On: 05 SEP 2021 8:00AM by PIB Delhi

A case of Nipah virus has been detected in Kozhikode district of Kerala.

A suspected case of NIPAH, a 12 yr old boy who presented with features of encephalitis and myocarditis was reported on 3rd September, 2021 from Kozhikode district of Kerala.

The virus is spread by saliva of fruit bats. The boy was hospitalized and has passed away today morning.

The Central Government has rushed a team of NCDC to the State, which will be reaching today. The team will provide technical support to the State.

The following immediate public health measures have been advised by the Centre:

1. Active case search in the family, families, village and areas with similar topography (especially Malappuram).
2. Active contact tracing (for any contacts) during past 12 days.
3. Strict quarantine of the contacts and isolation of any suspects.
4. Collection and transportation of samples for lab testing.

It may be recalled that in 2018 also, there was a Nipah outbreak in Kozhikode and Malappuram districts of Kerala.
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MV

While most of the Nipah outbreaks over the past two decades have been centered in Bangladesh, in the summer of 2018 - in Nipah Transmission In Kerala Outbreak - we looked at the apparently robust household and nosocomial transmission of the Nipah virus in Kerala, Southern India.

Kerala State -Credit Wikipedia

While that outbreak was declared over on July 1st, 2018 after 19 infections were recorded. a fresh case was reported the following year in the same region (see India: MOH Confirms Nipah Case In Kerala), sparking renewed concerns.

Now, a little more than 2 years later, Kerala finds itself dealing with another case.

Two years ago, in PLoS NTDS: Prioritizing Surveillance of Nipah Virus in India, we looked at a study that found 7 species of bats in Kerala carrying Nipah, which makes further spillovers from bats to humans a genuine concern.

The past couple of decades have been an excellent time to be a Chiropterist, as the number of bat borne disease threats continue to mount. A few (non-Nipah) examples include: