Nipah virus in Kerala kills 12-yr-old boy, infects 2 health workers: Symptoms, treatment

The deadly Nipah virus has rung its bell again in the southern state of Kerala after almost three years, killing a 12-year-old boy and infecting two health workers. The death is first such incident in the Covid-ravaged state after it wreaked havoc in parts of Kozhikode and Malappuram districts around 2018.

As Kerala reels under a daily increase of nearly 30,000 cases of COVID-19, the deadly Nipah virus has come as another thorn in its side, prompting the state to further increase the alertness of its health machinery to prevent an outbreak of a different infection.

Acting swiftly, the state and central governments rushed their teams to Kozhikode to assess the situation in the areas of Chathamangalam Panchayat.

What is Nipah virus, how does it spread?

As per World Health Organisation, Nipah (NiV) is a zoonotic virus (it is transmitted from animals to humans) and can also be transmitted through contaminated food or directly between people. In infected people, it causes a range of illnesses from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis. The virus can also cause severe disease in animals such as pigs, resulting in significant economic losses for farmers.

Although Nipah virus has caused only a few known outbreaks in Asia, it infects a wide range of animals and causes severe disease and death in people, making it a public health concern.

The first recognised Nipah outbreak in the world was reported among pig farmers in Malaysia in 1999.

The WHO also stated, "During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India in 2001, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission through providing care to infected patients.

Nipah virus symptoms, fatality rate:

The WHO states that human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis.

Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.

The incubation period (interval from infection to the onset of symptoms) is believed to range from 4 to 14 days. However, an incubation period as long as 45 days has been reported.

Most people who survive acute encephalitis make a full recovery, but long term neurologic conditions have been reported in survivors. Approximately 20% of patients are left with residual neurological consequences such as seizure disorder and personality changes. A small number of people who recover subsequently relapse or develop delayed onset 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.

As per US Centres for Disease Control and Prevention (CDC), infection with Nipah virus (NiV) can cause mild to severe disease, including swelling of the brain (encephalitis) and potentially death.

Symptoms may initially include one or several of the following:

-Fever

-Headache

-Cough

-Sore throat

-Difficulty breathing

-Vomiting

-Severe symptoms may follow, such as:

-Disorientation, drowsiness, or confusion

-Seizures

-Coma

-Brain swelling (encephalitis)

Infections that lead to symptoms and sometimes death much later after exposure (known as dormant or latent infections) have also been reported months and even years after exposure, CDC adds.

Nipah virus treatment:

"There are currently no drugs or vaccines specific for Nipah virus infection although WHO has identified Nipah as a priority disease for the WHO Research and Development Blueprint. Intensive supportive care is recommended to treat severe respiratory and neurologic complications," WHO states.

Prevention of Nipah virus:

-The WHO recommends, "If an outbreak is suspected, the animal premises should be quarantined immediately. Culling of infected animals—with close supervision of burial or incineration of carcasses—may be necessary to reduce the risk of transmission to people. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease."

-Routine and thorough cleaning and disinfection of pig farms with appropriate detergents may be effective in preventing infection.

As per CDC, In areas where Nipah virus (NiV) outbreaks have occurred (Bangladesh, Malaysia, India, and Singapore), people should:

-Practice handwashing regularly with soap and water

-Avoid contact with sick bats or pigs

-Avoid areas where bats are known to roost

-Avoid consumption of raw date palm sap

-Avoid consumption of fruits that may be contaminated by bats

-Avoid contact with the blood or body fluids of any person known to be infected with NiV

However, with the current cases detected, State Health Minister Veena George, who is camping in Kozhikode district said the situation was under control and there was no need for any panic. Meanwhile, a team from the National Centre for Disease Control (NCDC) reached the state to provide support as two others also displayed symptoms of the virus infection.

Two healthcare workers, who are among the 20 high-risk contacts of the deceased 12-year old boy, have been identified with symptoms of Nipah virus infection, George said here on Sunday, adding that, all the high-risk contacts will be shifted to the Kozhikode Medical College. "We have identified 188 contacts till now. The surveillance team have marked 20 of them as high-risk contacts. Two of these high-risk contacts have symptoms. Both are healthcare workers. One works with a private hospital, while the other is a staff member of Kozhikode Medical College hospital," she told reporters after chairing a high-level meeting to take stock of the situation.

The first Nipah virus disease outbreak in South India was reported from Kozhikode district in Kerala on May 19, 2018. There have been 17 deaths and 18 confirmed cases as of June 1, 2018. The outbreak was contained and declared over by June 10, 2018. 

Thereafter, in June 2019, a new case of Nipah was reported from Kochi and the sole patient was a 23-year old student, who later recovered. With this year's reporting of a case, it is the fifth time the virus has been detected in India and the third in Kerala.