A comparison and udpate on Nipah virus in Kerala
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Nipah comes with Covid - the Kerala update
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- The story: News emerged of a young boy infected with the Nipah virus dying in a private hospital in Kozhikode. He showed symptoms of encephalitis and myocarditis – inflammation of the brain and heart muscles respectively.
- Nipah returns: The re-emergence of the deadly Nipah virus in Kerala is a new risk when Kerala is struggling with the Covid-19 pandemic, contributing about 60% of all new cases in India. Previous outbreaks of Nipah were largely localised and contained quickly.
- Nipah virus update: The first outbreaks of the Nipah virus among humans was reported from Malaysia (1998) and Singapore (1999). Its name comes from the village in Malaysia where the person in whom the virus was first isolated died of the disease. Since first identified in 1998-99, there were multiple outbreaks of the Nipah virus, all in South and Southeast Asian nations. In Bangladesh, there have been at least 10 outbreaks since 2001. In India, West Bengal had seen an outbreak in 2001 and 2007, while Kerala had reported several cases in 2018.
- Details: It is a zoonotic virus, and is transmitted from animals to human beings.
- The transmission happens mainly through consumption of contaminated food. But human-to-human transmission is also considered possible.
- The animal host reservoir for this virus is known to be the fruit bat, commonly known as flying fox. Fruit bats are known to transmit this virus to other animals like pigs, and also dogs, cats, goats, horses and sheep.
- Humans get infected mainly through direct contact with these animals, or through consumption of food contaminated by saliva or urine of these infected animals.
- Person-to-person transmission is not fully established, but some outbreaks in Bangladesh, the Philippines and India suggested “that respiratory droplets of an infected person can transmit the virus”.
- Comparison with Covid-19: The Nipah virus spreads far more slowly than SARS-CoV-2, but its ability to kill is a big concern. During the first outbreak in Siliguri, 45 of the 66 people confirmed to have been infected died (mortality rate of 68%). In the next outbreak, in Nadia district of West Bengal, in 2007, all the five infected people died.
- During the most recent outbreak in Kerala in 2018, 17 of the 18 patients confirmed to have been infected died.
- In 2019, one case of Nipah virus infection was detected in Ernakulam, but prompt response restricted any further spread. The infected person survived.
- In the Malaysian outbreak in 1999, a total of 265 people had been found infected, of whom 105 had died.
- In comparison, the mortality rate of Covid-19 epidemic is expected to be around one per cent.
- Kerala's handling: In 2018, Kerala had no past experience of handling a disease with such a high fatality rate. The state followed the protocol for Ebola virus disease which had been reported mainly in sub-Saharan Africa. At one point in June 2018, around 3,000 people were under quarantine in Kozhikode and nearby Malappuram districts. All the persons who had direct or indirect contact with the suspected Nipah cases were thus put under observation. When the state reported Nipah again in 2019, the health department already had a protocol in place to handle the situation. In 2019, only one case was reported in Ernakulam district.
- Today, movement to and from the three infected wards have been banned. Police have put up barricades and checkpoints at all locations leading to the village of the victim.
- With Covid-19 protocols already in place, there is heightened awareness about transmission of viral diseases. The ongoing use of PPE kits, gloves and masks, especially by healthcare workers and hospital staff, is likely to offer reduced opportunity for the transmission of the Nipah virus.
- Should others worry: Since mostly all outbreaks of the Nipah virus have been localised and contained quickly, at least in comparison to the ongoing Covid-19 pandemic, there is little to worry. Sudies noted the reproductive number (R0) in the previous outbreaks of Nipah virus was about 0.48. The R-value is a measure of how quickly the virus spreads in the population. A value less than one means less than one person is being infected by an already infected person. The outbreak is expected to diminish relatively quickly. Nipah outbreaks have happened mainly in sparsely populated villages, so the potential of the virus to spread to many individuals has been low.
- EXAM QUESTIONS: (1) Compare and contrast the Covid-19 virus and the Nipah virus, in terms of transmissibility and mortality. (2) Why is the Covid-19 outbreak likely to be of help in trying to contain the Nipah outbreak? Explain.
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