Nipah outbreak: 10 die in Kerala, no treatment available; all we know so far

Kerala govt has made all necessary arrangements to stem the spread of panic due to the virus infection whose first outbreak was in Malaysia and has claimed as many as 300 lives since

The Nipah virus has so far claimed 10 lives in Kozhikode and Malappuram districts in north Kerala while the condition of two persons undergoing treatment for the viral disease is said to be critical, according to state Health Minister K K Shylaja.

The World Health Organization (WHO) had been informed about the outbreak of the virus in Kerala, she told reporters on Tuesday.

Two persons -- Rajan and Ashokan, who were undergoing treatment at Kozhikode and died this morning, had been confirmed to have contracted the virus, she said. A nursing assistant, Lini, who died yesterday had also contracted the virus. 

Of the 18 samples sent for testing, 12 have tested positive for the virus. Of those who tested positive, 10 have died.

Two deaths reported on May 20 from Malappuram -- Sindhu and Sijitha -- also tested positive for the Nipah virus. The two had come to Kozhikode Medical College Hospital for treatment and had been in touch with one of the infected persons who later died of the virus, the minister said.

No fresh case has been reported so far, she said, adding that Union Health minister J P Nadda, who is in Geneva, had called her and enquired about the situation in the state and has promised all help from the central government.

The Centre on Monday sent a multi-disciplinary National Centre for Disease Control (NCDC) team. A high level team from AIIMS also reached the state. 

In a series of tweets on Monday evening, Kerala Chief Minister Pinarayi Vijayan's office said the "government is closely monitoring the spread of the Nipah virus. Health department is doing everything possible to save the lives of the infected & prevent the advance of virus".

CM Vijayan further assured that the state's health minister and labour minister were camped at the affected district of Kozhikode to lead the relief efforts. Private hospitals had also been instructed to not deny treatment to anyone suffering from fever, Vijayan said.



Vijayan also informed of a state-wise alert to remain vigilant in order to check the spread of the virus-borne disease. "Though the virus has been reported only in Kozhikode, a statewide alert has been given to remain vigilant. A 24-hour control room has been opened to monitor the situation. CM has also requested all to follow the instructions of the health department to tackle this crisis," Vijayan's office said in a tweet.

Named after an area in Malaysia where the first outbreak of the viral fever was reported, Nipah is understood to have a mortality rate of 70 per cent. Here are a few important things to know about the virus, nipah virus symptoms in humans, its immediate outbreak in Kerala, and precautions:

The Nipah virus infection:

The World Health Organization (WHO) describes Nipah virus (NiV) infection as a "newly emerging zoonosis that causes severe disease in both animals and humans". The natural host of the virus, according to WHO, are fruit bats of the Pteropodidae family, Pteropus genus (fruit-eating species).

How does Nipah virus infection spread and what are the symptoms?

The transmission of the Nipah virus takes place through the following means:

• Direct contact with infected bats

• Direct contact with infected pigs

• Direct contact with other NiV-infected people

The infection with Nipah virus is associated with encephalitis (inflammation of the brain), says the Center for Disease Control and Prevention. The tell-tale signs of somebody having been infected by the Nipah virus are the following:

• An infected person shows symptoms of fever and headache in 3-14 days of exposure and an incubation period of five to 14 days

• Clinical signs are fever, headache, dizziness and vomiting, followed by drowsiness, disorientation and mental confusion

• More than 50 per cent of the patients face a reduced level of consciousness and prominent brain-stem dysfunction

• Some patients have a respiratory illness during the early part of their infections, and half of the patients with severe neurological signs also show pulmonary signs

The origin of the Nipah virus

• The Nipah virus was first identified in Malaysia's Kampung Sungai Nipah in 1998

• Pigs were understood to be the intermediate hosts during that outbreak

• Around 1.1 million pigs had to be culled to control the outbreak

• But a Nipah outbreak need not necessarily have an intermediate host

The earlier instances of Nipah outbreak in India

• In India, Nipah Virus affected the humans without any involvement of pigs

• The first outbreak was observed in Siliguri, West Bengal in 2001

• The second incident also emerged in West Bengal, in Nadia district in 2007

• Scientists found humans contracted the disease by drinking raw date palm sap tapped directly from trees

Nipah virus toll: The Nipah virus claimed over 300 lives across Malaysia, Singapore, Bangladesh and India between 1998 and 2008, according to WHO.

Global instances of Nipah outbreak

• Bangladesh recorded several Nipah outbreaks in humans almost every year from 2001 to 2013

• The virus has also been detected in Cambodia, Thailand, Indonesia, Madagascar in Southern Africa and Ghana in West Africa on fruit bats or bats seropositive to NiV antibodies, according to a 2013 ICMR-sponsored research paper.

The treatments of the Nipah virus

• According to WHO, there is no vaccine currently available for either humans or animals

• NiV-infected patients are currently limited to supportive care

• People have also been cautioned that they should not consume fruits that have fallen on to the ground

What doctors' say about the Nipah virus diagnosis

According to Dr Atul Gogia, senior consultant, Department of Medicine, Sir Ganga Ram Hospital Nipah is just another viral infection that affects the respiratory and central nervous systems with symptoms like drowsiness. "Like most other viral infections, Nipah also has no treatment and can only be managed through intensive supportive care," he says. The senior doctor does not rule out the possibility of an infected person travelling to other parts of the country and spreading the disease, but he affirms that at present there is no threat in other parts of the country.